Food and nutrition information: a study of sources,
uses, and understanding
Reports the results of a survey
which was conducted of 400
self-selecting UK subjects to
assess understanding of
nutritional terms and con-
cepts. Analyses the results
with respect to demographic
criteria and finds good overall
understanding, but there are
some surprising misconcep-
tions and a lack of under-
standing of recently intro-
duced concepts. States that
comprehension was clearly
related to familiarity with the
terminology employed. Nutri-
tional myths and misconcep-
tions were not widely held,
although there were some
discrepancies between expert
and lay understanding (e.g.
cholesterol popularly per-
ceived as a type of saturated
fat, and evening primrose oil
as a vitamin). Despite some
deficiencies in understanding,
claims use of food label infor-
mation in making purchasing
decisions was extensive.
Examines sources of back-
ground knowledge of food and
nutrition, and of current fads
and scare stories, and pre-
sents the results. Studies of
nutritional understanding are
seen as part of the wider
domain of the public under-
standing of science.
The author wishes to thank
The Boots Company plc and
the University of Brighton
for help with this study, and
in particular Janet Illing and
David Horner from those
respective organizations.
British Food Journal
99/2 [1997] 43–49
© MCB University Press
[ISSN 0007-070X]
Robert Abbott
Information Services Manager, Boots Healthcare International, Nottingham, UK
Introduction
The trend towards healthier eating in recent
years has increased consumer demand for
more detailed, accurate and accessible infor-
mation, principally on food package labels,
and covering nutritional content, ingredients
and claims, as well as aspects relating to food
safety, such as expiry dates, storage and cook-
ing instructions[1]. Many surveys have found
that consumers say they want and would use
nutrition information[2], and it may also be
that many personal decisions about diet
would be helped by some understanding of the
underlying science[3]. The public need help in
distinguishing accurate nutrition informa-
tion from that which is false or misleading.
However, an awareness of healthy eating prac-
tices is no guarantee of their adoption.
Nutritional understanding would seem to
fall within the wider scope of the public
understanding of science, although as yet it
has scarcely been investigated by the practi-
tioners of that discipline. Precursors go back
a long way, but awareness of public under-
standing of science as an issue really began
in the UK in 1985 with the Royal Society
report produced by Sir Walter Bodmer[3],
with a popular version the following year[4].
This report aimed to show why it was impor-
tant that all sections of the public should have
some understanding of science, and to stimu-
late action by scientists and others to
improve this understanding. A basic thesis of
the report was that better public understand-
ing of science can be a major element in pro-
moting national prosperity, in raising the
quality of public and private decision-mak-
ing, and in enriching the life of the individ-
ual. The public are exposed to all sorts of
scientific issues which they need to under-
stand, in order to reach the right decisions.
One of these issues is the choice of diet.
Durant et al.[5] comment that much scien-
tific knowledge is remote from and irrelevant
to everyday life, and this is true for scientists
and non-scientists alike. Nutrition, as an
everyday necessity, is an obvious exception.
Knowledge of nutritional science and its
correct understanding and adoption in prac-
tice can positively enhance wellbeing and
possibly extend one’s lifespan, whereas igno-
rance or rejection of it can be detrimental to
health. In this respect it differs from most
other applications of scientific knowledge.
The present study was undertaken as an
exploration of an aspect of public understand-
ing and information usage and transfer. It
attempted to look at different types and
extents of understanding, for example the
effects of “expert” versus “lay” understand-
ing, and understanding of traditional subject
matter as opposed to that which is novel or
currently the focus of media attention. Spe-
cific objectives of the present study were to
collect data to provide evidence of the under-
standing of some basic nutritional principles
and food components (balanced diet, vita-
mins and minerals, terms frequently appear-
ing on food labels), the sources of nutritional
information most frequently used, common
misconceptions and myths, and use and pre-
ferred design of food labels.
Methodology
A 40-item questionnaire was designed,
piloted and revised. The first block of 15 ques-
tions was designed to produce evidence of
understanding of a balanced diet, the sources
and properties of vitamins and minerals,
awareness of supposed nutritional or medical
properties for which label claims cannot be
made, awareness of other controversial or
popular beliefs, and understanding of some
basic nutritional terms.
Each of these questions contained five state-
ments, and respondents were asked to tick
any or all of the statements which they
believed to be true. As with all the multiple
choice questions in the survey, the position of
correct answers within each question was
randomized. Some of the questions were
worded with different levels of difficulty in
the terminology employed, in some cases
deliberately placing together ideas which
might be confused easily. Some questions also
sought evidence of differences in “expert”
versus “non-expert” understanding, and
“traditional” versus “fashionable” knowl-
edge. A further batch of eight questions
offered three statements each, only one of
which was correct. This section included
[ 43 ]
Robert Abbott questions on the understanding of terms and Table I
Food and nutrition symbols appearing on food labels, and basic Demographic characteristics of the sample
information: a study of knowledge about major nutrient types. population
sources, uses, and
Four questions were concerned specifically
understanding Number %
with food labels. These included preferred
British Food Journal
requirements for food label design, and read- Age range
99/2 [1997] 43–49
ing habits and usage of food label informa- Under 20 13 3.25
tion. Two further questions asked respon- 20-29 103 25.75
dents for the most likely sources where they 30-39 87 21.75
encountered news stories about the supposed 40-49 69 17.25
benefits or dangers of particular foods or 50-59 41 10.25
food components, and the most important over 59 86 21.50
sources of background knowledge of food and Sex
nutrition. Demographic data was also Female 288 72.00
recorded. Male 111 27.75
The questionnaire was advertised in the Relevant professional expertise
internal newsletter (circulation approxi- Yes 60 15.00
mately 58,000) of The Boots Company PLC, a No 337 84.25
major UK health care manufacturing and
Education
retailing company, and was sent to respon-
No qualifications 94 23.50
dents on request, with all returned question- ‘O’-level or equivalent 306 76.50
naires being submitted to a prize draw. Many ‘A’-level or equivalent 186 46.50
occupations are represented within the com- Degree or equivalent 116 29.00
pany, and entry in the survey was extended to
Responsible for regular
other family members and retired employees.
household shopping
There is virtually complete geographical
Yes 297 74.25
coverage of the UK through the company’s
No 101 25.25
retail outlets, with a major concentration of
employees in the East Midlands. However, Responsible for shopping
because the sample was self-selecting, and for special dietary needs
connected with a single organization, it may Yes 110 27.50
not be representative of the general popula- No 288 72.00
tion. This must be borne in mind when evalu-
ating the results. The questionnaire was
balanced diet, but only 76 per cent thought
circulated during August 1994.
that fats were essential.
• Very high levels of respondents knew that
children (97.0 per cent), the elderly (96.8%
Results
per cent) and expectant mothers (97.8 per
Demographic characteristics cent) should eat a balanced diet, but lower
A total of 401 completed questionnaires was numbers knew that vegetarians (89 per
returned, the first 400 of which were included cent) and athletes (88 per cent) should also
in the analysis of results. The demographic eat a balanced diet.
characteristics of the sample population are • Improved health was seen as a benefit of a
shown in Table I. There was a clear majority balanced diet by nearly 99 per cent of the
of female respondents (72 per cent), probably
respondents, but this figure fell to 75.5 per
reflecting the staff composition of the retail
cent when expressed as “optimal benefits
stores (82 per cent female). Of the respon-
from nutrients”, and 27.8 per cent saw “los-
dents, 15 per cent were judged, from details of
ing weight” as a benefit of a balanced diet.
their occupation, to be likely to possess poten-
• Of the sample, 94 per cent knew that vita-
tially relevant expertise.
mins and minerals can be obtained ideally
Questions on understanding of nutritional from a balanced diet, although 10.3 per cent
terms and concepts ticked multi-vitamin and multi-mineral
The full results are too extensive to present supplements as the ideal source.
here, but the most significant points to • The definition of a diet as “what you eat”
emerge were as follows: was agreed to by nearly 82 per cent of the
• Very high levels of respondents knew that sample, although 38 per cent regarded it as
proteins (97.3 per cent), vitamins (97.8 per a way of eating so as to lose weight, and 13.3
cent), carbohydrates (90.3 per cent) and per cent thought that a diet must be pre-
minerals (91.8 per cent) are essential in a scribed by a doctor or dietitian.

[ 44 ]
Robert Abbott • There were good levels of knowledge about
Food and nutrition the meaning of RDA (87.5 per cent correct
information: a study of answers), calorie (71.8 per cent), ascorbic
sources, uses, and acid (75.8 per cent) and E numbers (65.5 per
understanding
cent), although 28.5 per cent of the sample
British Food Journal regarded E numbers as food additives often
99/2 [1997] 43–49
causing allergy and other reactions.
• Knowledge about antioxidants was less
certain, with recognition of good examples
of antioxidants being 46.5 per cent for beta-
carotene, 40.3 per cent for vitamin C, 41.5
per cent for vitamin E and 28.0 per cent for
selenium. It was thought by 37.5 per cent of
the sample that antioxidants may protect
against cancer, against the effects of ageing
by 22.5 per cent, against heart disease by
43.5 per cent and against free radicals by
43.3 per cent.
• More people (86.8 per cent) recognized that
vitamin C could protect against the com-
mon cold than against scurvy (83.3 per
cent), with 25.8 per cent agreeing with the
statement that it could protect against can-
cer, and 48.3 per cent agreeing that high
doses can be beneficial to health.
• Over 56 per cent of respondents knew that
folic acid may protect against spina bifida,
but only 26.8 per cent recognized this con-
cept when expressed as “neural tube
defects”. The traditional role of folic acid to
protect against anaemia was recognized by
37 per cent, while 12 per cent thought incor-
rectly that it helped to protect against rick-
ets and 11 per cent likewise against eczema.
There were effects of gender here: the
answer “spina bifida” was given by 62 per
cent of females but only 43.6 per cent of
males, yet for “neural tube defects” the
figures were very similar, namely 26.4 per
cent of females and 27.9 per cent of males.
• Of the respondents, 98 per cent knew that
calcium is essential for health, but far fewer
respondents knew that zinc (63.5 per cent)
and selenium (43.8 per cent) are also essen-
tial, while aluminium and lead were
thought to be essential by 8.5 per cent and
5.0 per cent respectively.
• That too much vitamin A can be harmful
was known by 56.5 per cent of the sample.
• Evening primrose oil was regarded as being
a vitamin by 22.5 per cent.
• Very few people believed the myth about
eating fish being “good for the brain” (10
per cent for improved memory and 4 per
cent when expressed as “makes you more
intelligent”)
• Of the sample, 12 per cent thought that table
salt was a good source of potassium as
opposed to 88 per cent who knew the correct
answer, sodium; over 10 per cent thought
that sugar is a kind of hydrocarbon, com-
pared with 84.5 per cent who knew the cor-
rect answer, carbohydrate, and 4.3 per cent
who thought that it was a kind of mineral.
• Vitamin B6 was known by 72.5 per cent of
the sample to help reduce the symptoms of
pre-menstrual tension, but the figure
dropped to 50.5 per cent if the initials PMS
were used, while 12.5 per cent thought that
it might help reduce the symptoms of heart
disease. Again, there was a marked effect of
gender, with 81.6 per cent of females but
only 49.6 per cent of males ticking the
answer relating to pre-menstrual tension.
For “PMS” the figures were slightly closer:
55.9 per cent of females and 36 per cent of
males.
• Cholesterol was thought to be a type of
saturated fat by 70.5 per cent, and as being
invariably harmful by 65.3 per cent,
although 45.0 per cent knew that it is made
by the body and 17.3 per cent that it is essen-
tial to health.
• Almost a third of the recipients thought that
“mg” means a millionth of a gram; over 8 per
cent thought that “%” means approximately.
Questions relating to food labels
Responses to these questions are presented in
Tables II and III
Table II
Preferences for food labelling
Preference for food labels to: %
Give more detailed information 55.5
Use simpler words 44.8
Use more symbols or pictures 23.5
Have less information given as numbers 35.3
Remain as they are 14.5
Table III
Use of food label information
Question %
Does nutrition information on food labels affect your
decision whether or not to make a purchase?
Often 32.5
Sometimes 49.5
Rarely 17.5
Do you look at broad nutrition claims on food labels
(e.g. low fat, low sodium, high in fibre)?
Often 43.5
Sometimes 40.8
Rarely 15.5
Do you read the detailed information on food labels (e.g.
lists of ingredients, nutritional composition)?
Often 46.5
Sometimes 39.3
Rarely 13.8
[ 45 ]
Robert Abbott behaviour and the implications of the study
Food and nutrition Questions on sources of nutritional are then discussed.
information: a study of information
sources, uses, and
understanding In a question asking for the most likely Consumer knowledge of food and nutrition
sources of information on new claims con- Overall there was a good understanding of
British Food Journal
99/2 [1997] 43–49 cerning nutritional benefits or dangers, most the concepts of balanced diet and what might
popular first choice was television (43.5 per be called “traditional” knowledge of vitamins
cent), followed by newspapers (21.5 per cent) and minerals. More recent or controversial
and then by magazines (12.5 per cent). The ideas showed less consistent results (knowl-
results are summarized in Table IV. edge of antioxidants in particular was lim-
ited) and there were some surprising misun-
derstandings of commonplace terms and
Table IV symbols. The prevalence of nutritional
Sources of information about benefits or dan- myths, such as that fish makes you brainy or
gers of foods or food ingredients that E numbers imply undesirable food addi-
Source of information % tives, was small.
There were interesting effects of recently
TV 43.5
fashionable ideas, particularly concerning
Radio 8.3
Friends/work colleagues 3.0 folic acid and birth defects, and ascorbic acid
Relatives 1.8 and the common cold or cancer, which
Magazines 12.3 showed that these recent concerns were bet-
Newspapers 21.5 ter known than the traditional roles of these
Health club, gym, etc. 0.5 vitamins, with respect to anaemia and scurvy
Doctor 2.0 respectively. There were effects of difficulty of
Pharmacist 0.8 terminology, for example concerning the
In-store information 1.5 supposed effects of vitamin B6 on pre-men-
strual tension and folic acid in the prevention
of birth defects. A recent US study[6] found
Another question similarly asked for back- that 71 per cent of women aged 15-44 in Geor-
ground sources of basic knowledge of food and gia did not know that folic acid can prevent
nutrition. The results are presented in Table some birth defects. Knowledge of this issue
V. Most popular first choice was school (23 per correlated strongly with education and social
cent), followed by parents (nearly 14 per cent), class. In the present study the figure was a
TV and food labels (both 11 per cent). similar 73.2 per cent when the concept was
expressed as “neural tube defects” but only
43.2 per cent when expressed as “spina
Table V bifida”. Other recent studies have found vari-
Sources of basic knowledge of food and nutrition able results.
Source of basic knowledge % “Technical” wording fazed some people,
particularly that referring to antioxidants,
School 23.0
and with confusion between the terms carbo-
College/university, etc. 11.0
hydrate and hydrocarbon. Surprisingly high
TV 7.8
Radio 1.0 numbers of people did not know the meaning
Parents 13.8 of mg or of the percentage sign, which has
Other relatives 2.3 implications beyond nutrition.
Work 5.8 Two particular points to note were that 22.5
Magazines 8.5 per cent of the sample regarded evening prim-
Newspapers 3.5 rose oil as a vitamin, perhaps because of
Books 8.3 where it is often placed in pharmacies, and
Food labels 11.0 high levels of the sample population thought
In-store information 1.5 of cholesterol as being a type of saturated fat
which is invariably harmful. This indicates
the prevalence among the general population
of inter-subjectively held ideas which differ
Discussion from those held by the “expert” scientific
The results are discussed under the three community.
main headings of consumer knowledge of Overall, though, the results were encourag-
food and nutrition, food labelling and sources ing, compared with many previous studies
of nutrition information. The factors neces- which have shown that many consumers have
sary for bringing about a change in consumer a poor understanding of the functions or

[ 46 ]
Robert Abbott effects of nutrients, or hold nutritional mis-
Food and nutrition conceptions[7-9].
information: a study of
sources, uses, and Food labelling studies
understanding
Major studies of nutritional labelling conduc-
British Food Journal ted in the UK include the 1990 Consumers’
99/2 [1997] 43–49
Association report on the use of nutrition
labels[10] which showed that consumers were
confused by the information on food labels ; a
study by the British Market Research
Bureau[11] which looked at different label
designs; a Ministry of Agriculture, Fisheries
and Food (MAFF) study in 1990[1] which
recorded that 46 per cent of a sample popula-
tion said they took a great deal or quite a lot
of notice of the information on food labels ;
and a series of studies conducted by the Co-
operative Wholesale Society[12,13]. Similar
studies have been conducted in the USA[2,14]
and elsewhere.
The results of the present study show that
more than half the sample population wanted
more detail on food labels, with less than 15
per cent satisfied with them as they are. The
use of simpler terminology was widely
favoured, with less numerical content, but
surprisingly little enthusiasm for increased
use of graphical presentation. More than 80
per cent of the sample claimed that the infor-
mation on food labels “often” or “sometimes”
affected their purchasing decision, much
higher than in the Consumers’ Association
study[10], for example. This could possibly be
related to the work environment of the
respondents. Females, the better educated,
and those with professional expertise, and
those with special dietary concerns claimed
to make relatively greater use of food label
information. These findings are in general
agreement with, for example, the MAFF
study[1], and the Leatherhead Food Research
Association study[15].
Sources of nutritional information
The literature on nutrition education, like
that on labelling, is extensive and somewhat
contradictory. It was particularly noticeable
in the present study how a basic level of edu-
cation, up to “O”-level or GCSE or equivalent,
provided a good foundation for nutrition
knowledge, confirming the remarks of, for
example, Jacoby et al.[2] on the necessity for
relevant prior education for the effective
interpretation and use of information. How-
ever, the findings in the present study are
only partially in agreement with those of
Jacoby et al., who found that most consumers
neither understood nor used nutrition infor-
mation when deciding on food purchases.
This may be a reflection of the sample compo-
sition. Education is only one of many factors
determining food choice; other factors
include income, ethnicity, behavioural and
lifestyle factors, physiological factors, social
pressures and norms, and attitudes to diet
and health[16].
The media is potentially a valuable educa-
tive resource, for people of all ages, although
their impact is notoriously difficult to evalu-
ate because of the problem of separating their
influence from other factors[17]. The general
level of formal nutrition education, even for
groups such as medical students, is widely
regarded as inadequate[18], whereas much
information is gleaned from product adver-
tisements, information which may, however,
be mutually contradictory, incomplete, and
biased. Developing a balanced view is often
difficult. Nutrition education is especially
problematical where it has to overcome pre-
existing misconceptions, since as Dwyer et
al.[19] observe, the holders of such views will
tend to believe that they already possess the
correct information. Issues of literacy and
readability are also of crucial relevance.
The findings on sources of nutrition infor-
mation in the present study are broadly simi-
lar to those of the Office of Health Economics
study[20]. This survey of 1200 people asked for
sources of health information used, their
relative value, and how effective health infor-
mation was in altering behaviour and
lifestyles. The three key sources of informa-
tion were found to be television, newspapers
and magazines, and the general practitioner,
with some differences noted as to age and
gender, and with a general comment that
women are generally better informed about
health matters than are men.
One interesting area in need of further
investigation is how information about sup-
posed activities of food components, which
cannot be claimed formally on the label – for
instance, vitamin C for prophylaxis against
cancer, or vitamin B6 for minimizing the
effects of pre-menstrual syndrome – is
obtained, interpreted and translated into
purchasing practice.
Factors necessary for changing consumer
behaviour
The Health of the Nation report[21] of 1992
identified risk factor targets within the area
of diet and nutrition, to be met by the year
2005. These targets related to the reduction of
total and saturated fat in the diet, obesity and
alcohol intake. Many similar initiatives from
around the world could be cited. In order to
achieve such goals it is mandatory that con-
sumers receive clear and unconfusing mes-
sages which are in line with the best scien-
tific evidence[22], and that they act upon this
information.
[ 47 ]
Robert Abbott As the links between nutrition and disease
Food and nutrition become unravelled, the public will be exposed
information: a study of to more news stories – both true and false[23] –
sources, uses, and pertaining to this issue, and will need to be
understanding
more aware of the characteristics of truly
British Food Journal scientific experiments, and to be able to detect
99/2 [1997] 43–49
bogus claims. Changing behaviour involves
imparting correct information, ensuring that
it is understood, and bringing about changes
in attitude and motivation. There are prob-
lems at all stages of this process.
Motivation is crucial, and without it, nutri-
tion knowledge has minimal impact. Translat-
ing nutrition information into appropriate
food consumption patterns is difficult even
for well informed and motivated
consumers[24]. Guthrie[22] states that the fear
of the consequences of wrong nutrition can be
more motivating than mere nutritional
knowledge. In order for enduring learning,
attitude modification and behavioural change
to occur, information about nutrition must be
attended to, understood and integrated into
existing conceptual frameworks[25], that is, it
has to become structured knowledge. Knowl-
edge in itself, however, is not a sufficient insti-
gator of change[25-27], but it is a necessary
ingredient if one is to understand health mes-
sages, to accept their relevance to one’s own
life and to change one’s own lifestyle. This
was illustrated, for example, in the 1992
National Dairy Council survey[28] which
found that, while 95 per cent of the 2,000 sub-
jects interviewed recognized the importance
of a healthy diet, 63 per cent did not worry or
care about what they ate. Similarly, although
82 per cent of that sample knew of the link
between unhealthy diet and heart disease,
most refused to change their eating habits,
and many people were worried that healthier
eating would be too expensive. The survey
suggested that people are so confused by con-
flicting advice on healthy diets that they have
developed bad eating habits and there was a
general lack of detailed understanding of
some aspects of food and nutrition. This was
not the overall finding of the present study.
Implications of the study findings
This study should be seen in the wider context
of nutrition education, the transfer of infor-
mation from the public domain to the individ-
ual mind, and the public understanding of
science. Rather than placing too much empha-
sis on individual responses, it may be more
appropriate to consider what the study shows
in principle and how more specific studies
could be devised. This was a relatively small-
scale survey of a self-selecting sample and,
while its results are indicative of trends, they
should not be regarded as necessarily repre-
sentative of the population as a whole.
[ 48 ]
The results show that, despite good overall
understanding, there are many items of fact
across different ranges of subject matter
which are not well understood, and there are
effects resulting from variations in style of
terminology and presentation. It is not obvi-
ous where problems will occur. Areas of
weakness are sometimes within subject areas
that are complex and unfamiliar, sometimes
they reflect the difficulty in comprehending
the terminology employed, and sometimes
there is no obvious explanation. Though the
questions in this survey were all designed to
elicit specific effects, they were essentially
arbitrary. In a practical sense, what is needed
now is a similar, but more tightly structured,
study of terminology proposed for a real food-
labelling initiative. The study demonstrates
that, though it is not possible to predict, intu-
itively or reliably, those aspects of informa-
tion transfer which will cause difficulty or
misunderstanding, it is possible to identify
those aspects retrospectively and to proceed
from there. In order to transfer bodies of
information successfully it is desirable to
pilot them in detail, with no prior assump-
tions, on a sample representative of the
intended target population.
Particular aspects of nutritional under-
standing which were sought in this study and
which merit more detailed investigation are:
• the effects of difficulty of terminology;
• academic or theoretical knowledge of nutri-
ents versus practical knowledge of foods
and their nutritional benefits;
• traditional versus currently fashionable
knowledge;
• popular myths;
• superficial awareness versus rigorous
understanding;
• expert versus lay knowledge;
• knowledge of activities for which medical
claims cannot be made.
Cognitive profiling could be undertaken as a
way to predict likely areas of difficulty and
confusion, so that educational or promotional
campaigns could be targeted and designed for
greater accuracy of effect. This approach
might be expected to reveal differences
between populations – in terms of their demo-
graphic composition – which would reflect
the knowledge these populations had been
exposed to at various times and according to
their needs, interests and concerns. It is sug-
gested that detailed profiling of populations is
undertaken to establish more exactly what
these areas of ignorance or misunderstand-
ing are, and in what types of population they
are most prevalent. Any educational cam-
paigns, either formally as in schools, or via
the mass media or through food labelling,
Robert Abbott should take into consideration the findings of
Food and nutrition such profiling studies and be designed for
information: a study of optimal information transfer.
sources, uses, and
understanding
British Food Journal Conclusions
99/2 [1997] 43–49
It is desirable that nutrition education should
be brought into the orbit of the public under-
standing of science so that benefit can be
derived from the cross-fertilization between
the two disciplines and their mutually rele-
vant literature. Given the importance of
nutrition to the wellbeing of everyone, and
the dangers inherent in rejecting or misun-
derstanding valuable findings in nutrition
research, it would appear that studies of the
public understanding of nutrition must, in
the long term, provide a rational basis for
improving the reliable and accurate transfer
of nutrition information from the scientific
community to the community at large. Once
this is achieved, the education and motiva-
tion necessary for the adoption of good nutri-
tional practice stand a chance of being suc-
cessful; without it, nutritional practice will
always remain sub-optimal.
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