Nutrition is a mandatory action that is among the key factors in sustaining life for all living things. According to the definition of the Turkish Public Health Institution¹, nutrition; is an important behavior that must be followed to stay healthy, improve our health status and get the food and liquids (water etc.) our body needs on time and in the required amount to live a quality life. Today, not being able to eat healthy, along with the lack of a physical exercise routine, are considered two main problems of public health². Eating and drinking habits have changed significantly. There are many reasons for this situation, from global changes to changes in daily life and global negativities^3,4,5,6,7,8. Individuals have turned to processed and ultra-processed products with low nutritional values and high energy and calorie values. These products include ultra-processed bread, French fries, ready-made/frozen pizza, packaged salty snacks and biscuits, packaged ready meals, margarine, spreads and sauces, confectionery and pastries, buns and cakes, etc⁹. There have also been significant increases in the rate of eating out of home (mainly fast food)¹⁰.

Changes in eating habits will inevitably have negative effects on public health. More than two billion people worldwide are overweight or obese. 11% of the general world population, consisting of mothers and babies, is malnourished¹¹. This negativity has attracted the attention of researchers and many studies have been conducted on healthy eating behavior. Researchers have examined the unhealthy eating behaviors of individuals and societies and tried to reveal the reasons^12,13,14,15. While some authors put forward unconsciousness as the reason¹⁶, others focused on the education factor as a solution^17,18,19. However, studies are showing that the profession performed in daily life has an effect on healthy eating behaviour^20,21,22.

Academic studies show that healthy eating habits are directly proportional to the education received. This study aims to test whether healthy eating habits are a behavioral pattern that can only be acquired through education. For this purpose, it compares healthcare professionals who receive health training and food and beverage industry employees. It focuses on whether people’s occupations have an impact on their ability to acquire healthy eating habits. In addition, the indirect effect of dietitians who provide professional services on healthy nutrition to people in the process of gaining healthy eating habits is tested. This study challenges the ongoing and cult education phenomenon in the literature by revealing other variables that affect healthy eating habits, which are commonly associated with formal education. Primary data were collected to achieve the objectives of the study. Confirmatory factor analysis was performed. A T-test was used for pairwise comparisons. The empirical results to be obtained will enable the subject addressed in separate studies to be seen practically in a single study. In addition, the study results are important in understanding the driving motivational factors of food and beverage industry employees regarding healthy eating.

Adequate and balanced nutrition

There are nutritional styles specific to each society and are affected by the geographical conditions, the society’s economy and socio-cultural situations^23,24,25. As a result of these situations, the importance of local dishes specific to that region has begun to increase²⁶. One of the most basic needs of the individual is nutrition²⁷. If it is met in the best way, nutrition appears as a confidence-building factor in the implementation of the person’s other needs²⁸.

Nutrition; It is the intake of nutrients necessary for sustaining life, maintaining health and growth²⁹. For an individual to be healthy, energy and nutrients must be consumed in a well-balanced manner³⁰. It has been shown that when any of these nutrients are not taken or taken insufficiently, health deteriorates and growth and development slow down or stop³¹. It is the intake and use of the necessary nutrients in the body in the appropriate amount and in the most economical way, without losing or deteriorating their nutritional value, to carry out body functions and maintain growth and development in the best way, thanks to healthy nourishment³². An individual’s nutritional needs vary depending on age, gender, genetic structure, physical activity status and existing diseases. The amount of nutrients and the amount of energy increase compared to normal during adolescence³³.

An individual should be fed adequately and balanced to live a physically and psychologically healthy life in every period of life^34,35. The basic conditions of healthy nutrition are listed as consuming sufficient amounts of food³⁶, being diverse, having a balanced diet³⁷, having high subjective quality³⁸, being physically active³⁹ and having high hygiene conditions⁴⁰. With adequate and healthy nutrition, which is seen as the basis of a healthy life, it is aimed for people to be healthy throughout their lives, to improve their health and to live a quality life. By improving the individual’s environmental conditions, it is possible to prevent nutritional problems that disrupt the standard of living and diseases that can be caused by unhealthy nutrition, such as cardiovascular diseases, hypertension, diabetes, iron-iodine-protein deficiencies, rickets, dental caries and ultimately obesity. In addition, by making it easier to access and consume healthy foods, nutrition education should be given to the whole society and awareness should be raised⁴¹.

Gaining adequate and balanced nutritional habits ensures that individuals in the geriatric age group are healthy. Therefore, society should be made aware by giving seminars and training on adequate and balanced nutrition⁴². Demirci⁴³ stated that the benefits of healthy nutrition for the human body are the subject of many scientific studies. Well-balanced nutrition nutrition appears as an important condition that enables individuals to maintain their health, increases body resistance against diseases, improves physical and psychological health, gives energy and increases their success. It is one of the most important conditions for a healthy and successful life. If a person has a balanced and adequate diet, they will have an active life and a healthy appearance. All body structures such as vision, skin structure, muscle strength and hair are active and healthy. Their height is proportional to their body weight and they always have a vigorous and sporty appearance. At the same time, they are individuals who have developed mentally and psychologically⁴⁴.

For adequate and balanced nutrition; Milk and dairy products, proteins such as meat, eggs and legumes, vegetables and fruits, and grain group products should be consumed in sufficient quantities at every meal. Food diversity should be ensured during nutrition and the same products should not be consumed for a long time. When starting the day, you should have breakfast and not skip meals. Salt and sugar production should not be taken more than necessary. Among grain products, care should be taken to consume whole grain products. Water consumption should be at least 2.5 L per day⁴⁵. An individual’s lifestyle is an important factor in the emergence of problems such as chronic kidney diseases, heart diseases and respiratory diseases^46,47. Many chronic diseases will be prevented with a balanced and healthy diet, however, nutrition-related lifestyle variables that increase risk factors should be learned and implemented by the general population. It is possible to protect and sustain the health of the individual with a correct eating habit^{48,49,50,51,52}.

While healthy nutrition has many benefits for people, unbalanced nutrition also has its harms. These will be detailed in the next section.

Disadvantages of inadequate and unbalanced nutrition

Tayar and Korkmaz⁵³ stated that it is necessary to have an adequate and balanced diet because if the individual is malnourished, it will cause problems in growth and development and the body’s inability to perform its functions properly. Inadequate and unbalanced nutrition can cause problems in the growth, development and routine functions of the individual. Since their bodies are less resistant to microbes, these people become more susceptible to illnesses and disease processes last longer than normal. Any food consumed in inadequate amounts can cause deterioration in body health. However, unhealthy nutrition can also negatively affect people’s mental functions such as their desire to work, planning and generating new ideas. If malnutrition is severe, it can lead to more serious health problems⁵⁴.

With globalization, individuals’ intense working hours lead to changes in their food preferences and eating habits. Fast food has become preferred due to the need to eat quickly to save time. Obesity disease seems to be widespread in the world due to irregular and unhealthy nutrition. Obesity; It is the presence of more fat in the body than it should be. Risk factors for obesity; are age, gender, environmental factors, economic status, education level, lack of physical activity, nutritional habits, and genetic and psychological factors. Individuals generally continue the eating habits they acquired during childhood and adolescence into old age. The prevalence of obesity has been increasing since childhood. Those who are obese during childhood and adolescence have a higher risk of becoming obese in adulthood compared to those who are thin during this period⁵⁵.

Unbalanced and unhealthy eating habits pave the way for many diseases such as cardiovascular diseases, diabetes and hypertension, as well as obesity. To be protected from such diseases and to live a healthy life, attention should be paid to nutrition and health should be maintained from childhood⁵⁶. Maguire and Monsivais⁵⁷ children, pregnant women, people with difficult working conditions and unemployed adults are the groups most affected by malnutrition.

Some situations also hurt a balanced diet. Some of these are as follows⁵⁸;

• Lack of adequate education on nutrition.

• Insufficient use of health institutions.

• Having a physical environment with poor conditions.

• Ignorance about food hygiene and food safety.

• Unconscious nutrition.

• The relationship between the production and consumption of food.

• Imbalances.

• Lack of sufficient food due to reasons such as famine, war, and natural disaster.

• Financial inadequacies in Purchasing.

• Inability to break away from traditions.

• Rapid population growth.

Factors affecting nutritional habits

Health behavior; is all the behaviors related to the protection and development of the individual’s health⁵⁹. The role of health professionals in achieving healthy lifestyle behaviours is very important. For this reason, the training healthcare professionals receive on this subject and their ability to apply it is of great importance. The healthcare worker must first apply the training he receives to his own life and set an example for society^60,61. Nutritional habits are an issue that is emphasized all over the world because they affect the individual physically and psychologically. Situations such as the number of meals, the content and quantity of meals, purchasing food, preparing and cooking meals, as well as whether the person eats fast or slow, the time it takes to chew the food, psychological state, whether the food is hot or cold, are important during nutrition. However, education, income, customs and traditions, climate, environment and living space affect eating habits. For such reasons, it is very difficult to change a person’s eating habits⁶².

Hacıhasanoğlu et al.⁶³ stated that the individual acquires his/her eating habits in the family environment, and then he takes his final form with the influence of the training received and the environment. Nutrition does not mean that an individual unconsciously eats the foods he wants or eats to satisfy his hunger. According to the definition of the World Health Organization (WHO), nutrition; refers to individuals being in a state of complete physical, mental and social well-being. Individuals need to have an adequate and balanced diet to increase their living standards and to consciously consume the foods the body needs in appropriate amounts and at the right time for a healthy life⁵⁴. Behaviors that affect an individual’s healthy nutrition; Factors such as gender, age, economic status, marital status and education level come to the fore. Increasing nutrition awareness is one of the primary requirements for societies to achieve the targeted quality of life. For this purpose, societies should act by placing healthy nutrition at the centre of their lifestyle⁶⁴. Many factors affect individuals’ food preferences and eating habits. These factors are divided into two groups: (a) individual and (b) external factors (environmental). When studies focusing on individuals’ food and beverage choices are reviewed, it is possible to list external factors as follows: information, social environment and physical environment⁶⁵, food environment⁶⁶, global epidemics and pandemics⁶⁷, social, economic and cultural influences⁶⁸, media⁶⁹, parental lifestyle⁷⁰ etc. Individual factors can be listed as follows; Stress⁷¹, personal-state and food-internal factors⁶⁵, personal values, beliefs and habits⁷², physiological and individual characteristics⁵⁶ etc. (see Table 1). All these factors directly or indirectly affect the nutritional level.

In order to help individuals gain balanced eating habits, it is important to determine the factors that cause unbalanced eating. The subject discussed in this paper will help determine these factors. It is anticipated that empirical findings will shed light on the literature.

This study aims to comparatively analyze the healthy eating habits of health and food and beverage sector employees. In this context, a survey was conducted with health and food and beverage sector employees in Gaziantep Province. The “Attitude Scale Towards Healthy Nutrition (ASHN)”, which was tested for validity and reliability by Tekkurşun Demir and Cicioğlu⁴³ and consists of four dimensions and 21 5-point Likert-type items, was delivered online to potential participants. Participants were included in the study using a random sampling method. Of the 446 returned surveys, 21 were eliminated because they affected the reliability coefficient and normal distribution. Analyzes were made on the remaining 425 survey data. While 202 of the participants are healthcare sector employees (HSE), 223 are food and beverage sector employees (FBSE). The necessary ethics committee permission for the application part of the research was received from Hasan Kalyoncu University Scientific Research and Publication Ethics Board on 20.06.2023. The data collection process was meticulously executed in full compliance with pertinent guidelines and regulations.

Academic ethical principles were observed in all methodologies used in this study. In addition, relevant guidelines and guidelines from pioneering studies were followed and implemented throughout the entire methodology. During the data collection phase of the study, no identity information was requested from any participant that would identify. This was only done to ensure the protection of their personal data. Individuals aged 18 and over participated in the study. Informed consent was obtained from participants at the beginning of the online survey form. Potential participants, who were informed about the research in writing, were faced with the option of “I have read and understood. I agree or disagree to participate in this survey with my consent.” For participants who consented, the survey questions became visible and the answering process began. For potential participants who did not consent, the online answering process was terminated with the warning “Thank you for your time. Your survey process has ended.” Even if participants started the survey, they had the chance to go back and leave the survey at any stage. Even if they completed the survey and submitted their answers, they had the authority to go back and correct them or delete them completely diagnose or expose them.

Data collection was carried out between 26.06.2023 and 16.07.2023. After this date, the system is closed to accepting surveys. S17, S18, S19, S20 and S21, among the negative items in the ASHN, were reverse-coded before analysis. After the items were subjected to validity and reliability analysis, skewness and kurtosis values ​​were checked. After proving the normal distribution (homogeneity) of the data, structural accuracy for the factor structures was tested. At this stage, discriminant (AVE) and convergent (CR) validity were tested. In the last stage, parametric mean comparisons (t-test and F-test) were made for the two groups of samples considered and the analysis process was terminated.

Demographic profile of participants

The data regarding the participants in the research sample were separated through frequency analysis and presented in Table 2. Participants were allowed to choose more than one option in the question “source of nutrition information”. In this context, it was determined that HSE made 317 markings and FBSE made 410 markings. The relevant questions were separated according to their frequencies and percentages through multiple-answer analysis based on the total number of markings. The results showed that participants in both sample groups made more than one mark (115 healthcare sector employees and 187 food and beverage sector employees).

When the demographic data of the participants is examined, it is seen that the total number of participants is close to each other. It is seen that the proportion of women is high in HSEs and the proportion of men is high in FBSEs. While participants with undergraduate and graduate education constitute more than half of the total participants in HSEs, participants with primary and high school education constitute half of the total participants in FBSEs. It is seen that the education level of HSEs is higher than that of FBSEs. The lack of formal education required to work in the health sector is seen as the main reason for this situation. Certificates received from non-formal education institutions may be sufficient to work in FBS. While the monthly income level in HSEs is concentrated in the range of 18,001–23,000 TL, in FBSEs the concentration is in the range of 11,500 − 18,000 TL. The rate of HSEs receiving healthy nutrition education (46.5%) is higher than FBSEs (25.6%). FBSEs were more likely to receive dietitian support in the last year (34.1%), to have followed a diet program before or to be currently following it (41.3%), and to have gone to the internal medicine outpatient clinic for weight problems in the last year (18.8%). Their rates are higher than those of HSEs. While almost all HSEs (93.1%) sometimes or always pay attention to their daily diet, this rate is 74.9% for HSEs. Social media is among the sources where participants get nutrition information. It is important for both groups. While health personnel and family are the priority for FBSEs, newspapers, magazines, TV programs and health personnel are other important sources of information for FBSEs.

Validity, reliability and comparison analysis

The scale used within the scope of the study was primarily subjected to reliability analysis. During the analysis, it was determined that items coded I1 and I15 negatively affected the reliability level. Therefore, both items were removed from the analysis. The reliability level of the remaining 19 items was obtained as α = 0.779. This value shows that the data obtained has a good level of reliability⁶⁴. Before proceeding with advanced analysis in the study, it was tested through the normality test whether the items for which the scale was created were distributed homogeneously or not, to decide on the type of analysis. After checking the skewness and kurtosis values, it was seen that all values were between − 1.5 and + 1.5. Thus, it was decided that the data obtained was normally distributed^73,74 and parametric tests were preferred in data analysis.

The structural validity of the scale used in data collection was tested with confirmatory factor analysis (CFA). 4 dimensions of the scale were analyzed through AMOS24. For the Nutritional Knowledge (NK) dimension tested, α = 0.891; α = 0.708 for Emotion Towards Nutrition (EN); It was obtained as α = 0.742 for Positive Nutrition Habits (PSNH) and α = 0.726 for Poor Nutrition Habits (PONH). In structural validations, the average variance extracted (AVE) is a measure of the ratio of the amount of variance captured by a construct to the amount of variance due to measurement error. The model-based reliability coefficient used to assess the reliability of a scale score in confirmatory structural studies is Composite reliability (CR). This coefficient is based on the assumption of unidimensional measurement scales and independent measurement errors⁷⁵. AVE ≥ 0.50 for all sizes; It was observed that the assumption of AVE < CR ≥ 0.70 was met. Thus, it was decided that all factor structures provided combination and discriminant validity⁷⁶. All factor loadings exceeded the 0.60 threshold. Fit indices for the resulting confirmatory model were GFI ≥ 0.90; CFI ≥ 0.90; RMSEA ≤ 0.08; CMIN/DF was obtained as ≤ 0.05. These coefficients proved that the dimensions in the factor analysis model were structurally confirmed (see Table 3).

The factorial averages of both groups in the sample were compared via t-test. According to the arithmetic statistics obtained, it was seen that the NK level was above the average in both groups and there was no statistically significant difference between them (t = 0.689; p > 0.05). A significant difference was detected between the participants’ EN levels depending on the sector they work in. The result obtained showed that the EN level of FBSEs (x̄=3.26) was farther from indecision than that of HSEs (x̄=2.98) (t = 0.038; p > 0.05). FBSEs are relatively more conscious about PSNH (x̄=3.81) than HSEs (x̄=3.53). However, the PONH level of FBSEs (x̄=1.62) is lower than that of HSEs (x̄=2.19). The findings regarding the effects of external factors of the study on nutritional habits are summarized in Fig. 1.

Summary model of research result.

Full size image

This study determines the factors affecting healthy nutrition. For this purpose, data obtained from healthcare sector employees and food and beverage sector employees were compared. The results showed that the healthy nutrition levels of both groups were almost equal. We expected that the constant cooking of food and beverage industry workers would desensitize them to nutrition. However, food and beverage industry workers were resistant to maintaining a healthy diet. There is no significant difference between the knowledge levels of both groups. However, food and beverage industry employees were more optimistic about emotions towards nutrition, positive nutrition habits and poor nutrition habits. In addition, the healthy nutrition level of healthcare workers who received professional support was not affected. Dietitian support was an important factor for food and beverage industry employees. This proved that dietitian support is important in gaining healthy eating habits in individuals who have not received formal education.

In this study, two groups with formal and informal knowledge about nutrition were compared. In addition, demographic questions were diversified to make in-depth interpretations of the results obtained. The analyses performed in the study primarily showed that the scale used was validated. The demographic results are fully consistent with the two groups selected for the sample. Namely, in Turkey, as in the international arena, it is mandatory to receive formal education to work in the health sector. Except for support personnel (security, cleaning, etc.), people who complete a certain formal education curriculum and graduate from the program are employed in health-related business lines (doctor, nurse, technician, civil servant, etc.) in the health sector. Although formal education is available in the food and beverage industry, this is not mandatory for employment in the sector. People who have no formal education but have experience can be employed in this sector⁷⁷. Studies confirm this information. In his study to determine the nutrition knowledge levels of chefs, Çekal⁷⁸ concluded that more than half of the participating cooks had primary and secondary school education, while the majority of them did not receive formal vocational training. When the collected data are examined, it is seen that the high level of education of HSEs and the fact that FBSEs are predominantly at high school and below the level of education supports this claim, which is similar to the literature.

The level of knowledge about nutrition in both groups is close to each other. When the emotional dimension towards nutrition is considered, it can be stated that HSEs are relatively more conscious. The answers given by both groups to the dimension consisting of expressions regarding satisfaction with the consumption of chocolate, fast food, delicatessen products, fried foods and sherbet desserts are at the level of indecision. However, HSEs are relatively dissatisfied with consuming such foods. The fact that FBSEs are on the production side and constantly produce the products in question may cause the harms of such products to be ignored after a while and there will be no harm in consuming them. The desensitization of individuals to some stimuli they are exposed to in daily life⁷⁹ and the fact that the movements they constantly repeat are accepted/normalized after a certain rate of repetition, even if they are unethical⁸⁰, form the basis for explaining the obtained result.

Regarding negative eating habits, both groups are far from indecisive and have a positive average. However, FBSEs are in a more moderate position on this issue. The same situation is seen with unhealthy eating habits. Participating groups are free from unhealthy eating habits. FBSEs have a clearer distance stance than HSEs. When detailed analysis is made for both cases, it is seen that the rate of FBSEs paying attention to nutrition in daily life is higher than that of HSEs. However, the number of participating FBSEs who received support from a dietitian in the last year or who are currently on a diet program and who visited the internal medicine outpatient clinic due to weight problems in the last year is higher than the number of HSEs. This clearly shows that professional support has a significant impact on the acquisition of healthy eating habits and the continuation of the established order^81,82. It is known that individuals are encouraged to eat healthy by three types of motivation sources. These include; early information leading to the routine formation of healthier eating habits, provision of practical sessions to increase knowledge and support and referral to services from health professionals⁸³. Thus, it can be clearly established that FBSEs who receive support from health professionals are more sensitive about healthy nutrition.

In our study, we concluded that our sample group that received health education was conscious about healthy nutrition and that the education they received encouraged this. Considering the samples of studies conducted on a similar subject, it is seen that receiving nutrition education is important in acquiring healthy nutrition behaviour. Özenoğlu et al.¹⁹, in their study conducted with undergraduate students of medical faculty, nutrition dietetics, midwifery and nursing departments, concluded that the department in which they are educated affects eating habits. Onurlubaş et al.⁸⁴ revealed that individuals who received healthy nutrition education from the formal education curriculum through participation in events such as conferences and panels believed that they ate healthy in daily life. Individuals who received healthy nutrition education stated that they could not eat healthily in daily life. In their study conducted with a group of physical education undergraduate students, Poplawska et al.⁸⁵ revealed that senior students ate healthier than first-year students and were selective about food and beverages. Grabia et al.⁸⁶ provided healthy nutrition education to young athletes in adolescence through individual and group training. The results of the study revealed that the training provided encouraged healthy eating behaviour in both groups, although at different levels.

When the results obtained in the study are evaluated in general in the light of this information, it can be stated that having received formal health education or working professionally in the food and beverage business catalyzes healthy eating behaviour. In addition, it has been observed that individuals who receive professional support on nutrition, even if they have not received formal health or nutrition education, can develop positive behaviour regarding healthy nutrition.

The most important limitation of this paper is the sample. The study compared only healthcare professionals and food & beverage industry employees. It is important for future studies to include different occupational groups in the sample for the generalizability of the results. Three exogenous factors were used for the purpose of the study. These are (a) being an expert in food and drink, (b) having received formal education in health, and (c) receiving professional support (dietician support) in nutrition. Increasing the number of variables or conducting analyses with different variables will contribute deeply to the healthy nutrition literature. However, this study focused on comparing data obtained from professionals from different occupational groups. The effect of external variables on healthy nutrition was not tested structurally and through regression equations. It is thought that making an evaluation based on the structural model will make the results of future studies interesting. In addition, using socio-demographic parameters such as personality traits, work tempo, and daily working hours in comparison will contribute to filling the existing literature gap.