1. Mollohan, Elise MSN, RN, CNE

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To the Editor,


Thank you for the opportunity to respond to Oluwatosin Dada's thoughtful discussion of my concept analysis of dietary culture.1 Considering the significant impact of cardiovascular disease on global health, it is of critical importance that nurses and other health care providers engage in scholarly discourse and discovery aimed at promoting heart-healthy dietary change. I appreciate Dada's support for the methodology used in my analysis and for elaborating on selected key points from my work. In critique, Dada asserts that an analysis of dietary behavior would be more useful than dietary culture, favoring dietary behavior as a "broader concept." I value this opportunity to discuss further the importance of examining the multiple, complex factors that influence diet on a deeper level, rather than from a broad perspective.


Dada's primary criticism hinges on the premise of dietary behavior as a more valuable concept to nursing science and practice, citing the "narrow scope" of dietary culture. However, the author does not present a definition of dietary behavior or scientific evidence in support of this claim. Identifying the potential usefulness of defining one concept does not negate the value of defining and understanding other interrelated concepts, particularly within a phenomenon as complex as diet. Defining dietary culture provides a means to delineate it from other concepts while providing a deeper understanding of its internal structure.2


A recent publication by Marijn Stok et al3 provides support for the conceptual differences between dietary behavior and dietary culture. The authors analyzed dietary behavior because of the "fuzzy" nature of the concept and the lack of a consistent definition across disciplines.3 Dietary behavior is defined in terms of 3 categories, including food choice, eating behavior, and dietary intake/nutrition.3 Within the 3 main categories are 34 terms that provide a taxonomy for the concept. While minor connections to social context and culture are evident within some definitions of the taxonomy terms, culture is not explicitly represented.3 Dietary pattern was identified within the taxonomy and is defined in terms of cultural connections, such as Mediterranean, Western, and Prudent.3 This association supports patterned group eating behaviors as a defining attribute of dietary culture, as identified in the concept analysis.1 Also, the association demonstrates the interrelated nature of dietary behavior and dietary culture, underscoring the importance of differentiating the concepts. The concept analysis of dietary behavior and my analysis of dietary culture are complementary, working together to build a more well-formulated understanding of diet in relation to health.


Another critical point raised by Dada is that a dietary behavior analysis would more clearly delineate the complexities of interpersonal and external factors that impact diet. However, dietary behavior conceptually emphasizes the individual aspects of diet.3 Dada asserts that dietary behavior in the United States is heavily influenced by neoliberalism. Individual responsibility and inequality as a consequence of choice are central tenets of neoliberalism.4 Within the lens of neoliberalism, poverty, lack of education, poor diet, and other factors associated with poor health status can be blamed on the individual.4,5 Thus, I would argue that neoliberal philosophy presents a distraction from the reality of external influences on diet, promoting the perception of individual choice based on free will. The concept analysis of dietary culture acknowledges the external influences on individual dietary behaviors in the United States, as discussed within the context of compatibilism.1


Dada further suggests that dietary behavior may better explain the complexities of cultural shifts in dietary pattern, alluding to the westernization of South Asian or West African dietary habits. On the contrary, the evolution of dietary culture is a primary example of why there is a need to understand the concept more clearly. Factors associated with cultural shift are discussed in the background of the original article and can be linked to the antecedents identified on pages E6-E7.1 Availability, economic, resources, and practicality are particularly relevant in this regard. The antecedents of dietary culture are evident in a discussion of trends and determinants of the westernization of Asian diets.6 Pingali6 identified economic growth and associated urbanization as factors that lead to increased access to and affordability of convenience and processed foods. In addition, lifestyle changes have increased the demand for convenience foods and processed foods, which connects with practicality as an antecedent of dietary culture.1,6 Exploring dietary culture in depth provides a framework for understanding the complexity of the cultural impact on diet.


Dada and I agree on the importance of this topic to nursing science and practice. We are also in agreement that dietary culture alone cannot fully explain the complexity of diet. There is a need to explore a variety of concepts that relate to diet in further depth to gain a full understanding of the phenomenon. Thus, the specific nature of analyzing dietary culture does not negate its significance to building nursing knowledge. Rather, it provides an in-depth understanding of culture as one key factor that impacts individual dietary behaviors. Researchers commonly explore diet within a broad scope, emphasizing the individual. I contend that continuing to explore diet primarily from a broad lens fails to acknowledge its complexity. Nurse scientists need to build in-depth knowledge and understanding of the multiple factors that contribute to diet to identify strategies and interventions that will accomplish meaningful change to promote improved cardiovascular health.


-Elise Mollohan, MSN, RN, CNE


PhD in Nursing Candidate


The University of Akron


Akron, Ohio


Professional Instructor


Ashland University


Ashland, Ohio




1. Mollohan EA. Dietary culture: a concept analysis. ANS Adv Nurs Sci. 2018;41(4):E1-E12. [Context Link]


2. Walker L, Avant K. Strategies for Theory Construction in Nursing. Upper Saddle River, NJ: Pearson/Prentice Hall; 2011. [Context Link]


3. Marijn Stok F, Renner B, Allan J, et al Dietary behavior: an interdisciplinary conceptual analysis and taxonomy. Front Psychol. 2018;9:1689. [Context Link]


4. Ayo N. Understanding health promotion in a neoliberal climate and the making of health conscious citizens. Crit Public Health. 2012;22(1):99-105. [Context Link]


5. Hartmann C. Postneoliberal public health care reforms: neoliberalism, social medicine, and persistent health inequalities in Latin America. Am J Public Health. 2016;106(12):2145-2151. [Context Link]


6. Pingali P. Westernization of Asian diets and the transformation of food systems: implications for research and policy. Food Policy. 2007;32(3):281-298. [Context Link]