Assessing the determinants of food choices among adolescents in India: A rainbow model using the socio-ecological framework

In India, the rising risk of overweight and obesity among adolescents is a significant public health concern, primarily associated with their frequent consumption of nutrient-poor snacks, sugar-sweetened beverages, and fast foods. Identifying the determinants of their food choices is crucial for developing effective nutrition promotion strategies. This study aimed to identify the determinants of food choices among adolescents in two metro cities in North and South India using a cross-sectional, mixed-methods approach. The study involved adolescents (n = 869) studying in 8th and 9th grades from randomly selected government and private schools, utilizing a pre-tested questionnaire and virtual food preference flip cards (quantitative phase), along with in-depth interviews with adolescents, teachers, and parents (n = 11) (qualitative phase). A four-level socio-ecological model was adopted to categorize the determinants associated with adolescent's food choices. The findings revealed that taste (51%) was the primary determinant driving adolescents to choose outside foods, followed by peer influence (31%) and trendy foods (27%). In-depth interviews further highlighted the impact of social media, parental influence, celebrity endorsements, popular food trends, and marketing incentives such as toys and coupons on adolescents' food choices. The study provides a springboard for future research into the development of a nutrition-friendly choice architecture to encourage adolescents to make healthy food choices. Public health policy should utilize these determinants to transform the existing food environment of adolescents.