Study finds dieters may overestimate the healthiness of their eating habits

In a small study, most adults seeking to lose weight overestimated the healthiness of their diet, according to preliminary research to be presented at the American Heart Association’s Scientific Sessions 2022. The meeting, held in person in Chicago and virtually, Nov. 5-7, 2022, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

“We found that while people generally know that fruits and vegetables are healthy, there may be a disconnect between what researchers and health care professionals consider to be a healthy and balanced diet compared to what the public thinks is a healthy and balanced diet,” said study author Jessica Cheng, Ph.D., a postdoctoral research fellow in epidemiology at the Harvard T. H. Chan School of Public Health and in general internal medicine at Massachusetts General Hospital, both in Boston. This research was conducted while Dr. Cheng was a predoctoral fellow/Ph.D. candidate in the department of epidemiology at the University of Pittsburgh School of Public Health.

Nearly half of adults in the U.S. try to lose weight each year, according to the Centers for Disease Control and Prevention, with a majority attempting to eat more fruits, vegetables and salads. Healthy eating is essential for heart and general health, and longevity. Dietary guidance from the American Heart Association issued in 2021 advises adults to eat a variety of fruits and vegetables; opt for whole grains rather than refined grains; choose healthy protein sources; substitute nonfat and low-fat dairy products for full-fat versions; choose lean cuts of meat (for those who eat meat); use liquid plant oils instead of tropical oils and animal fats; choose minimally processed over ultra-processed foods; minimize foods and beverages with added sugar; choose foods with little or no added salt; and limit or avoid alcohol.

Researchers evaluated the diets of 116 adults aged 35-58 years old in the greater Pittsburgh, PA, area who were trying to lose weight. Study participants met one-on-one with a dietitian to discuss their nutrition and then tracked everything they ate and drank every day for one year on the Fitbit app. They also weighed themselves daily and wore a Fitbit device to track their physical activity.

Researchers calculated a Healthy Eating Index (HEI) score at the beginning and end of the study based on the types of foods that participants reported eating. Participants were asked to complete a 24-hour food recall for two days at each time point. The HEI is a measure for assessing how closely a dietary pattern aligns with the U.S. government’s Dietary Guidelines for Americans. A score of 0 to 100 is possible, with a higher score indicating a healthier diet. The score is based on the frequency of eating various dietary components such fruits, vegetables, whole and refined grains, meat and seafood, sodium, fats and sugars.

Participants self-scored their beginning and ending diet quality to determine their perceived scores. Their scores were also on a 0-100 scale based on the components of the HEI. The self-assessment of their beginning diet was a “look back” as they scored both their starting and ending diets at the end of the study. The difference in their starting and ending score was their perceived diet change. A difference of 6 points or less between the researchers’ HEI score and the participant’s perceived score was considered “good agreement.”

At the end of the study, about 1 in 4 participants’ scores had good agreement between their perceived diet score and the researcher-assessed score. The remaining 3 out of 4 participants’ scores had poor agreement, and most reported a perceived score that was higher than the HEI score assigned by researchers. The average perceived score was 67.6, and the average HEI score was 56.4.

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