Understanding traditional and modern eating: the TEP10 framework
Gudrun Sproesser, Matthew B. Ruby, Naomi Arbit, Charity S. Akotia, Marle dos Santos Alvarenga, Rachana Bhangaokar, Isato Furumitsu, Xiaomeng Hu, Sumio Imada, Gülbanu Kaptan, Martha Kaufer-Horwitz, Usha Menon, Claude Fischler, Paul Rozin, Harald T. Schupp & Britta Renner
BMC Public Health volume 19, Article number: 1606 (2019) Cite this article

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Abstract
Across the world, there has been a movement from traditional to modern eating, including a movement of traditional eating patterns from their origin culture to new cultures, and the emergence of new foods and eating behaviors. This trend toward modern eating is of particular significance because traditional eating has been related to positive health outcomes and sustainability. Yet, there is no consensus on what constitutes traditional and modern eating. The present study provides a comprehensive compilation of the various facets that seem to make up traditional and modern eating. Specifically, 106 facets were mentioned in the previous literature and expert discussions, combining international and interdisciplinary perspectives. The present study provides a framework (the TEP10 framework) systematizing these 106 facets into two major dimensions, what and how people eat, and 12 subdimensions. Hence, focusing only on single facets of traditional and modern eating is an oversimplification of this complex phenomenon. Instead, the multidimensionality and interplay between different facets should be considered to gain a comprehensive understanding of the trends, consequences, and underlying factors of traditional and modern eating.

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Background
We are currently in the midst of a major change in what people eat and in the way they eat [1,2,3,4]. Some of these changes have been described as a nutrition transition, which refers to a shift from diets high in complex carbohydrates and fiber towards more varied diets with a higher proportion of fats, saturated fats, and sugar [3, 5,6,7,8,9]. The changes partially result from the globalization and modernization of food and eating, for example, access to new technologies, modern supermarkets, and food marketing [3, 10, 11]. Also, urbanization has separated a large part of the world’s population from the direct production of foods, which has produced changes in eating behavior [12]. Furthermore, these changes have been accompanied by a general increase in wealth and food supply [13] as well as by a decrease in food insecurity [14]. Food safety has improved [15], costs for many foods have decreased [16], and a much wider variety of foods is available to people in almost all parts of the Earth [5]. One result of all of this has been an increase in life expectancy. In the USA, life expectancy increased from 47 years in 1900 to 78 years in 2007, for example [17]. Another advantage of the globalization and modernization of food and eating is that many of the distinctive, nutritious and delicious foods developed by different cuisines, at different localities in the world are now widely available. In a survey of people in 17 countries spanning a wide range of developmental status, 500–2000 individuals per country were asked ‘What is your favorite food?’ [18]. We inspected the five most frequently named foods within these 17 countries and categorized these 85 foods into traditional within the respective country vs. imported from other countries. The results showed that 24 of these foods can be considered traditional in the respective country (e.g., fufu in Ghana, feijoada in Brazil), 29 can be considered foods that have been imported from other parts of the world to the respective country (e.g., pizza and pasta in the Netherlands), and the remaining 32 could not be classified in these two categories (e.g., vegetables in Germany).

At the same time, however, increasing wealth has promoted eating away from home and obesity has increased. The latter will probably affect more people than food insecurity [19] at some point in the next few decades. Also, obesity already co-exists together with food insecurity [20, 21]. As a result of the forces described, there has been a shift from acute, infectious diseases to chronic, degenerative diseases (the epidemiological revolution, [22, 23]). All of these forces are at work around the world, with developed countries such as the United States, Germany, Japan and France much further along in this change or transition than developing countries, such as India, Ghana and Brazil. With the increasing incidence of obesity and chronic diseases, the negative consequences of these changes, that is the shift from traditional to modern eating, has become more salient in the scholarly literature [3, 6, 7]. Diets have become homogenized and words like ‘Coca-Colonization’ have been used to describe the changes [7], see also [24]. In addition, advantages of traditional eating have been highlighted. For instance, it has been argued that traditional regional food consumption is a step towards sustainable rural development [25]. In addition, Trichopoulou [25] stated that traditional foods are environmentally friendly because they are often plant-based and integrated in the local biosystem, although there are certainly also animal-source traditional foods [26].

The change from traditional to modern eating has also been seen as a net negative by many in the general public and the media. In his New York Times bestseller “Food Rules” [27], Michael Pollan states “Regard nontraditional foods with skepticism” as one rule for eating wisely (p. 91). According to Pollan [27], “people who eat according to the rules of a traditional food culture are generally healthier than those of us eating a modern Western diet of processed foods” (p. 89). There are some signs of a return to traditional eating. Specifically, there seems to be a growing interest in sustainable food consumption, with some commonalities to traditional eating: Low meat consumption, low food waste, and high consumptionFootnote1 of local foods were both labeled as sustainable (see Sustainable Development Goals [28]) and traditional [3, 6, 8, 29]. This growing interest is underlined by the terms sustainability, climate change, and environmental friendliness having joined the public discourse. Also, the interest in sustainable food has become a new source of income for the food industry. For instance, foods labeled as sustainable or local are common in Western supermarkets today and there are headlines such as “Europe’s food sector shows highest growth of sustainable product sales” [30]. Whether one considers the massive changes in eating behavior a net positive or negative, there is no doubt that a shift from traditional to modern foods and eating has occurred and that this is a timely and increasingly important topic.

However, what exactly is traditional and modern eating? Importantly, whereas changes in eating behavior are measurable, such as the intake of nutrients across time, what is considered traditional and modern eating mostly appears to be subject to a consensus agreement. Specifically, how much increase in a specific eating behavior over time is necessary to define this eating behavior as modern? What absolute level of a specific eating behavior then and now is necessary to call it traditional or modern? Hence, we believe that it is subject to human evaluation whether something is considered traditional or modern, and that this holds for both experts and lay people.