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Inadequate consumption of dairy products without appropriate dietary substitution may have deleterious health consequences. Social research reveals the factors that may impede compliance with dietary recommendations. This is particularly important given the recent introduction of functional dairy products. One of the challenges for public health professionals is to demonstrate the efficacy of nutrition education in improving attitudes toward nutrient rich foods. The aim of this study was to explore the salient beliefs of adult weight loss trial participants regarding both traditional and functional dairy products and to compare these with a control group not exposed to nutrition education.
Non-trial participants perceived dairy foods as weight inducing and were sceptical of functional dairy products. A lack of time/ability to decipher dairy food labels was also discussed by these individuals. In contrast trial participants discussed several health benefits related to dairy foods, practised label reading and were confident in their ability to incorporate dairy foods into their diet. Normative beliefs expressed were similar for both groups indicating that these were more static and less amenable to change through nutrition education than control and behavioural beliefs.
Nutrition education provided as a result of weight loss trial participation influenced behavioural and control beliefs relating to dairy products. This study provides a proof of concept indication that nutrition education may improve attitudes towards dairy products and may thus be an important target for public health campaigns seeking to increase intake of this food group.
Dairy products represent an important core food group within many Western diets. Items such as milk, cheese and yoghurt provide an important source of protein and are the greatest contributor of calcium to the Australian diet . Dairy food intake has also been associated with a decreased risk of developing osteoporosis , and the metabolic syndrome . Current public health recommendations suggest that Australian adults consume a minimum of two to three serves of dairy products per day for optimal health . However, up to four serves of dairy foods per day may be recommended for particular population groups to ensure optimal calcium intake of a minimum of 1000 mg/day according to Australian Nutrient Reference Values . In a large longitudinal study of Australian women aged 50-55 years, only 32% were found to be consuming a minimum of two serves of yoghurt, milk or cheese per day . The latest available National Nutrition Survey indicates that Australian adults on average are not meeting recommended dietary intakes for calcium , potentially increasing the risk of developing osteoporosis in these individuals .
Social research enables exposure of the factors that may impede compliance with dietary recommendations. Within this research paradigm, the technique of focus groups provides a means for generating hypotheses relating to consumer behaviour . For example, research on dairy product consumption in elderly and young women in New Zealand found that a fear of weight gain, perceptions of adverse health effects and inappropriate medical advice were important barriers to increasing consumption . Whether this is also the case in the current Australian context is not known. It is an area worthwhile pursuing, particularly with the introduction of functional dairy products. Whilst a universally agreed upon definition of functional foods is lacking, in general functional foods may include those that have been formulated to provide additional health benefits beyond the provision of nutrients . Functional dairy foods may include calcium enriched or plant sterol and omega 3 fortified products. These products also represent a key area of growth for the national dairy industry.
One of the challenges for public health professionals is to demonstrate the efficacy of nutrition education in improving attitudes toward nutrient rich foods. In particular, there is a lack of evidence evaluating the role that nutrition education may have on shaping attitudes towards dairy foods. It is important to evaluate these attitudes in Australian adults, as this group have reported inadequate calcium  and dairy product intake . In this study we explore the uptake of nutritional advice to participants in a weight loss trial where the dietary guidance was based on the Australian Guide to Healthy Eating  in which dairy foods were a key component. A comparative group of similar non trial participants from the same study population was recruited identify differences of opinion which could be attributed to trial participation and exposure to nutrition education. We hypothesized that trial participants would express more positive attitudes and beliefs towards traditional dairy foods and new functional dairy products in comparison to non trial participants.
Overall non-trial participants reported that they believed that calcium and bone health were the key health benefits attributable to the consumption of dairy foods, with few other health benefits identified.
This perception mirrors previous focus group outcomes reported by Hagy et al , whereby women attributed the health benefits of dairy foods to their calcium content and potential for osteoporosis prevention, and failed to identify other nutrients such as protein or specific vitamins and minerals present within dairy products. In contrast, the trial participants identified health benefits attributable to dairy products beyond bone health. Dairy foods were seen as a significant source of protein, vitamins and minerals. This may reflect the extent of nutrition education received by this group.
Overall trial participants did not report perceiving dairy products to be weight inducing, with one participant discussing literature which indicated that dairy products may assist with weight loss. Most trial participants did not feel that the fat from full cream dairy products was cause for concern, discussing negligible differences between the fat content of full cream dairy products and their reduced fat counterparts. Another participant expressed the belief that reduced fat dairy products were high in sodium; however this view was not shared by the group. Persistent belief of fallacies surrounding dairy products, despite intensive nutrition education illustrates the difficult and challenging nature of communicating nutrition concepts related to food.
Discussions relating to functional dairy products by non trial participants indicated that most were highly resistant to these products. A high degree of scepticism with regards to their efficacy in producing beneficial health effects and the removal of the product from its natural state were cited as key factors which would impede consumption of these items for this group. The perception that dairy products have deviated significantly from their natural state over the years was also shared by trial participants, with a preference for 'natural' products shared by the group. However, trial participants expressed a more open attitude to consuming functional dairy products such as calcium enriched milk and dairy products containing plant sterols than non trial participants. This observation may reflect the exposure to what would be termed functional products by many participants throughout the clinical trial. Despite being more open to functional products than non trial participants, some degree of scepticism of their efficacy was also expressed by trial participants and a preference for food sources from which to derive additional health benefits naturally was discussed. Preferences for food products with minimal processing have been reported throughout the literature . The perceived healthfulness of food products is an important factor influencing their acceptance by consumers and a food's health value is hypothesised to decrease in proportion with processing technologies it may have undergone . Thus despite an overall improvement in attitude towards functional foods evident within the trial participants, preferences for natural food products with minimal processing was overriding.
Perceived behavioural control has been reported in the literature to be most predictive of intention to consume dairy products and correlated significantly (r = .48, P < .001) with dairy product consumption in a sample of older adults . Similarly, Park & Ureda  reported that pregnant women's perceived level of control was related to eventual milk consumption. Thus improvements in perceived efficacy regarding one's ability to consume dairy products or functional dairy foods may be the most important aspect of the TPB in terms of generating the desired behaviour. Overall trial participants discussed considerably less control barriers that may restrict dairy food consumption in comparison to non trial participants, indicating that nutrition education may have improved the beliefs surrounding dairy foods that are most likely to facilitate an increase in their eventual consumption.
The normative influence of general practitioners in terms of identifying particular dairy products, such as cheese, as weight inducing or cholesterol raising was identified by both groups. Older women reported that physicians were the strongest normative influence regarding dairy foods with many avoiding particular items solely as a result of advice received from their doctor . General practitioners are a key source of nutrition information for many individuals , thus any advice given should reflect the current body of evidence to limit unnecessary avoidance of key food groups. As expected, trial participants discussed that dietitians encouraged dairy product consumption or appropriate alternatives for individuals not willing to consume dairy foods.
In relation to functional dairy products, both groups reported feeling highly sceptical of the food industry and unlikely to purchase functional dairy foods based on advertising messages or their own initiative. Generally however, non trial participants would try these items if recommended by health professionals, whilst trial participants were sceptical of health practitioners recommending functional foods and wanted independent scientific research regarding the efficacy of these products to make their own judgements. Previous consumer research regarding perceptions of functional dairy products indicates that physicians and health professionals were regarded as being the most credible source of information regarding functional dairy foods . Trial participants desire to seek independent scientific research may reflect their exposure to evidence based nutrition education that has fostered confidence in their ability to decipher nutrition messages autonomously. Alternatively, this contrast may reflect personality differences between the groups. The willingness of the trial group to volunteer for this study following completion of an intensive twelve month clinical trial suggests that these individuals were highly motivated with a desire to learn healthier eating practices. 2b1af7f3a8