Sproesser et al. BMC Public Health         (2019) 19:1606 
https://doi.org/10.1186/s12889-019-7844-4
DEBATE Open Access
Understanding traditional and modern
eating: the TEP10 framework
Gudrun Sproesser1* , Matthew B. Ruby2, Naomi Arbit3, Charity S. Akotia4, Marle dos Santos Alvarenga5,
Rachana Bhangaokar6, Isato Furumitsu7, Xiaomeng Hu8, Sumio Imada7, Gülbanu Kaptan9, Martha Kaufer-Horwitz10,
Usha Menon11, Claude Fischler12, Paul Rozin13, Harald T. Schupp1 and Britta Renner1
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.
Keywords: Traditional eating, Modern eating, Conceptual framework, Dietary change, Western diet
Background foods is available to people in almost all parts of the
We are currently in the midst of a major change in what Earth [5]. One result of all of this has been an increase
people eat and in the way they eat [1–4]. Some of these in life expectancy. In the USA, life expectancy increased
changes have been described as a nutrition transition, from 47 years in 1900 to 78 years in 2007, for example
which refers to a shift from diets high in complex carbo- [17]. Another advantage of the globalization and
hydrates and fiber towards more varied diets with a modernization of food and eating is that many of the
higher proportion of fats, saturated fats, and sugar [3, 5– distinctive, nutritious and delicious foods developed by
9]. The changes partially result from the globalization different cuisines, at different localities in the world are
and modernization of food and eating, for example, ac- now widely available. In a survey of people in 17 coun-
cess to new technologies, modern supermarkets, and tries spanning a wide range of developmental status,
food marketing [3, 10, 11]. Also, urbanization has sepa- 500–2000 individuals per country were asked ‘What is
rated a large part of the world’s population from the dir- your favorite food?’ [18]. We inspected the five most fre-
ect production of foods, which has produced changes in quently named foods within these 17 countries and cate-
eating behavior [12]. Furthermore, these changes have gorized these 85 foods into traditional within the
been accompanied by a general increase in wealth and respective country vs. imported from other countries.
food supply [13] as well as by a decrease in food insecur- The results showed that 24 of these foods can be consid-
ity [14]. Food safety has improved [15], costs for many ered traditional in the respective country (e.g., fufu in
foods have decreased [16], and a much wider variety of Ghana, feijoada in Brazil), 29 can be considered foods
that have been imported from other parts of the world
* Correspondence: gudrun.sproesser@uni-konstanz.de to the respective country (e.g., pizza and pasta in the
1Department of Psychology, University of Konstanz, Konstanz, Germany Netherlands), and the remaining 32 could not be
Full list of author information is available at the end of the article
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Sproesser et al. BMC Public Health         (2019) 19:1606 Page 2 of 14
classified in these two categories (e.g., vegetables in instance, foods labeled as sustainable or local are com-
Germany). mon in Western supermarkets today and there are head-
At the same time, however, increasing wealth has pro- lines such as “Europe’s food sector shows highest growth
moted eating away from home and obesity has increased. of sustainable product sales” [30]. Whether one con-
The latter will probably affect more people than food in- siders the massive changes in eating behavior a net posi-
security [19] at some point in the next few decades. tive or negative, there is no doubt that a shift from
Also, obesity already co-exists together with food inse- traditional to modern foods and eating has occurred and
curity [20, 21]. As a result of the forces described, there that this is a timely and increasingly important topic.
has been a shift from acute, infectious diseases to However, what exactly is traditional and modern eat-
chronic, degenerative diseases (the epidemiological revo- ing? Importantly, whereas changes in eating behavior are
lution, [22, 23]). All of these forces are at work around measurable, such as the intake of nutrients across time,
the world, with developed countries such as the United what is considered traditional and modern eating mostly
States, Germany, Japan and France much further along appears to be subject to a consensus agreement. Specif-
in this change or transition than developing countries, ically, how much increase in a specific eating behavior
such as India, Ghana and Brazil. With the increasing in- over time is necessary to define this eating behavior as
cidence of obesity and chronic diseases, the negative modern? What absolute level of a specific eating behav-
consequences of these changes, that is the shift from ior then and now is necessary to call it traditional or
traditional to modern eating, has become more salient in modern? Hence, we believe that it is subject to human
the scholarly literature [3, 6, 7]. Diets have become ho- evaluation whether something is considered traditional
mogenized and words like ‘Coca-Colonization’ have been or modern, and that this holds for both experts and lay
used to describe the changes [7], see also [24]. In people.
addition, advantages of traditional eating have been Moreover, what is considered traditional and modern
highlighted. For instance, it has been argued that trad- eating varies across time, society, and culture. For in-
itional regional food consumption is a step towards sus- stance, what is called modern in 2018 might be called
tainable rural development [25]. In addition, traditional in 2100. Similarly, a food (e.g. sushi) might be
Trichopoulou [25] stated that traditional foods are envir- perceived traditional in one country (e.g. Japan), but
onmentally friendly because they are often plant-based modern in another country (e.g., Germany). The latter
and integrated in the local biosystem, although there are example shows that, within a certain time, society, and
certainly also animal-source traditional foods [26]. culture, one might even talk about three categories when
The change from traditional to modern eating has also taking the perspective of foods: historically traditional,
been seen as a net negative by many in the general pub- imported traditional, and modern. For instance, sushi
lic and the media. In his New York Times bestseller might be considered ‘historically traditional’ in Japan,
“Food Rules” [27], Michael Pollan states “Regard nontra- ‘imported traditional’ in Germany, whereas a new type
ditional foods with skepticism” as one rule for eating of breakfast cereal might be considered ‘modern’ in both
wisely (p. 91). According to Pollan [27], “people who eat countries. However, the present article takes the per-
according to the rules of a traditional food culture are spective of people in a society or culture, for whom the
generally healthier than those of us eating a modern consumption of ‘imported traditional’ foods might be
Western diet of processed foods” (p. 89). There are some nevertheless a ‘modern’ behavior, rendering two categor-
signs of a return to traditional eating. Specifically, there ies, namely ‘traditional’ and ‘modern’ eating behavior.
seems to be a growing interest in sustainable food con- As far as it concerns these two categories, taking the
sumption, with some commonalities to traditional eat- perspective from 2018 and compiling international
ing: Low meat consumption, low food waste, and high views, the literature indicates that multiple definitions of
consumption1 of local foods were both labeled as sus- traditional and modern eating exist, rendering it com-
tainable (see Sustainable Development Goals [28]) and plex and multifaceted. For instance, an often-applied
traditional [3, 6, 8, 29]. This growing interest is under- definition of traditional and modern eating focuses on
lined by the terms sustainability, climate change, and en- what people eat. Specifically, in scientific articles, mod-
vironmental friendliness having joined the public ern diets have been defined by a high consumption of
discourse. Also, the interest in sustainable food has be- meat, sugar, oils, and fats [1, 3, 5, 6, 8–10, 31]. In con-
come a new source of income for the food industry. For trast, traditional diets have been defined by a high intake
of fiber and grains [3, 6, 8–10]. However, comparing to-
1Please note that with the term “high consumption” we refer to the day’s eating in many Western societies to how it was
overall intake across multiple eating occasions. Most often, this might 100 years ago, one finds that there are not only differ-
mean a frequent consumption of the respective food but might also
mean a high consumed amount in a single eating occasion in some ences in what people eat but also in how they eat, for ex-
cases. ample, whether people eat at home or in other places [3,
Sproesser et al. BMC Public Health         (2019) 19:1606 Page 3 of 14
4]. This ‘how’-dimension of traditional eating has re- traditional or modern eating. Instead, when authors of a
ceived considerably less research attention. Furthermore, manuscript mentioned something as part of traditional
a comprehensive compilation and systematization of or modern eating, that was sufficient to be included as a
these different facets has not yet been conducted and, facet of traditional and modern eating. A further inclu-
thus, research in this area is impeded. This article aims sion criterion was English, French, or German as the ar-
to fill in this gap by comprehensively compiling and sys- ticle’s language.
tematizing the different facets that are suggested to Second, to prevent bias due to most literature target-
underlie traditional and modern eating. Moreover, we ing Western countries [32], we included facets that re-
aim to present a comprehensive framework of traditional sulted from discussions within our group, whose
and modern eating across societies and cultures. members combine expertise from ten different countries.
Specifically, we included perspectives from the USA (PR,
MR, NA), Mexico (MK), Brazil (MA), France (CF),
Method: conceptualizations of traditional and Germany (GS, BR, HS), Ghana (CA), Turkey (GK), India
modern eating (RB, UM), China (XH), and Japan (SI, IF). Criteria for
A qualitative approach was chosen to meet the aims of approaching the members of our group were being an
the article. Specifically, facets were compiled from the academic and native of one of these countries, and well
previous literature and expert discussions. In an inclu- informed about eating in their native countries. Besides
sive approach, everything that was mentioned to be part that, some members of our group had already collabo-
of traditional or modern eating was compiled as a facet. rated in other cross-cultural food-related projects in the
A single mention of a behavior as part of traditional or past which prompted to approach them for the present
modern eating by one article or one expert was enough study. Our international group with interdisciplinary re-
for it to be listed as a facet in the present work. The only search experience draws on expertise in the psychology,
specification was that the facets had to be broad enough anthropology, and sociology of eating, as well as nutri-
to potentially apply to more than one country. Hence, tion and epidemiology.
single traditional dishes, like Schnitzel in Austria [26], Criteria for the selection of countries were diversity in
were not included as facets. terms of cuisines, obesity prevalence, income, and geog-
First, we compiled facets of traditional and modern raphy. The cuisines of these countries are characterized
eating through an extensive literature review in 2017 by distinct flavor principles. Specifically, the Mexican fla-
and 2018. The literature review targeted articles that vor principle is marked by tomatoes, onions, and chili
specified characteristics of traditional or modern eating. peppers; the Japanese by soy sauce, sugar, and rice wine
Something was extracted as a facet of traditional or vinegar; the German by sour cream, vinegar, dill, mus-
modern eating if the article explicitly used words like tard, and black pepper; the French by butter, cream,
‘traditional’ or ‘modern’ in relation to the facet. Further- wine, and boquet garni; the Chinese by soy sauce, rice
more, if an article stated that there was a pronounced in- wine, and ginger root; the Brazilian by chili peppers,
crease in the facet within the last century, this was dried shrimp, ginger root, and palm oil; the Indian by
extracted as a modern facet. For instance, Popkin & garam masala; the Ghanaian by tomatoes, onion, and
Gordon-Larsen [6] stated that “modern societies seem to chili peppers sautéed in palm oil; and the Turkish by hot
be converging on a diet high in saturated fats, sugar, and and intense spices [33, 34]. In addition, the US American
refined foods …” (p. S2). Hence, we extracted the facets cuisine constitutes a unique mixture of different ethnic
‘high consumption of saturated fats, sugar, and refined groups [35]. Moreover, obesity prevalence in these coun-
foods’ to characterize modern eating. The facets were tries differs and is displayed in Fig. 2. Specifically, obesity
extracted from the articles and saved together with the prevalence ranged from 3.4% in India to 36% in the USA
referencing article. The literature review was performed in 2014 [37]. Furthermore, six of the countries (India,
by one reviewer (GS) in major databases (e.g., Web of Ghana, China, Brazil, Mexico, Turkey) are considered
Science, PsycINFO, Google Scholar). Several combina- middle-income countries, whereas the remaining four
tions of the terms traditional, modern, food, eating, and countries are considered high-income countries (range
nutrition transition were used. Also, references of rele- in GDP/capita from $2016 in India to $62,641 in the
vant articles were screened and scientific books were USA [38]). In addition, the ten countries cover five dif-
reviewed. No limits were established regarding the year ferent continents (North America, South America, Af-
of publication. However, only articles published in peer- rica, Europe, and Asia) and different climates, namely
reviewed academic journals or scientific books were in- the equatorial climate (Ghana, Brazil, Mexico, India), the
cluded. Amongst these, any type of article or review was arid climate (USA, Mexico, India, China), the warm
included. Hence, we did not limit the literature review to temperature climate (Germany, France, USA, Mexico,
empirical findings showing that something is part of Brazil, Turkey, India, China, Japan), the snow climate
Sproesser et al. BMC Public Health         (2019) 19:1606 Page 4 of 14
(USA, Turkey, China, Japan) and the polar climate foods,2 plant-based foods, grains [5, 10], fruit [31], vege-
(China [39]). tables [3, 31], and fiber [6, 8, 10, 31]. In contrast, mod-
Discussions took place in formal meetings about ern diets are characterized by a high consumption of
what constitutes traditional and modern eating in the both energy-dense foods [1, 31] and diet drinks and
respective countries. Specifically, based on the litera- foods. Moreover, modern eating includes a high consump-
ture review a first list of facets was put together and tion of refined foods [3, 6, 8, 10], animal-source foods [3,
presented to nine of our group (below referred to as 6, 8], sugar and caloric sweeteners [1, 3, 5, 6, 8–10, 31],
‘experts’) in a first face-to-face meeting. GS facilitated artificial sweeteners, oils and fats (especially trans fats and
this meeting asking the experts about any missing saturated fats [1, 3, 5, 6, 8–10, 31]), and salt [1, 3].
facet in this list. Based on the experts’ feedback, the
first list was extended, resulting in a second list of Processing (subdimension 2)
facets. This list was subsequently sent to all experts A second subdimension is the manner of production as
via email for reviewing and adding any facet that was well as the level of processing of foods. Nine facets were
missing. If necessary, GS held an online face-to-face meet- subsumed in this subdimension. Specifically, traditional
ing with an expert to clarify specific points. The feedback diets are characterized by a high consumption of indus-
from all experts was incorporated into the facets list, trially unprocessed [9, 40] and fresh foods whereas mod-
resulting in a third list. This third list was finally reviewed ern diets are characterized by a high consumption of
in a second face-to-face meeting with all experts resulting industrially mass produced [29] and ultra-processed [1,
in a fourth and final list of facets. This final list includes a 8, 9] foods. In their NOVA classification, Monteiro et al.
compilation of 106 facets of traditional and modern eating [54] categorize foods into the four groups ‘Unprocessed
(see Table 1). or minimally processed foods’, ‘Processed culinary ingre-
Third, an iterative process based on the constant dients’, ‘Processed foods’, and ‘Ultra-processed foods’.
comparative method of qualitative data analysis was Ultra-processed foods “are not modified foods but for-
used to implement a grounded theoretical approach mulations made mostly or entirely from substances de-
[52]. Steps in the analytic process were (1) to classify rived from foods and additives” (p. 9 [54]). Examples of
a first set of the 106 facets into emergent categories, ultra-processed foods are subsumed in this subdimen-
(2) to compare the remaining facets with these cat- sion, such as a high consumption of convenience prod-
egories, and (3) to classify these facets into the exist- ucts [41], ultra-processed microwavable or frozen meals
ing categories and, if necessary, to revise these that were industrially produced, fast food [41], and soft
categories or to generate new ones. This process re- drinks [31] (please see [55] for an example how foods
sulted in the classification of the 106 facets into 12 are categorized in the four groups). Foods that are la-
subdimensions, six of which were further subsumed beled as organic were also discussed as part of modern
under the dimension ‘what people eat’, and six of eating with the emphasis on the label being modern, not
which were subsumed under the dimension ‘how necessarily the way of production.
people eat’ (see Fig. 1). As this research was part of a
larger project, the Traditional Eating Project: 10
countries (TEP10; funded by the German Research Preparation (subdimension 3)
Foundation, Grant SP 1610/2–1, granted to GS), the This subdimension refers to both who prepares the food
framework is called TEP10 framework. as well as where and how the food is prepared. Fourteen
facets were subsumed in this subdimension. For in-
stance, consumption of home-made food [41] that was
prepared by women is considered part of traditional eat-
Results ing. Regarding how the food is prepared, traditional
Dimension ‘what people eat’ foods require a long preparation time as well as are pre-
The first dimension represents what people eat and in- pared as one’s grandmother would have done [42]. In
cludes six subdimensions, namely Ingredients, Processing, contrast, modern eating is defined by the use of time-
Preparation, Temporal Origin, Spatial Origin, and Variety. saving food preparation equipment such as microwave
ovens, rice cookers, and bread machines [41], and by a
Ingredients (subdimension 1) lot of different ways to cook and heat up foods (e.g., fry-
A major aspect that differentiates traditional and mod- ing, boiling, steaming, grilling). Also, high consumption
ern eating is food ingredients. Fourteen facets were sub-
2
sumed in this subdimension. For instance, the literature Please note that the term ‘basic foods’ relates to a definition provided
by The Department of Health of the Australian Government [53]:
review and authors’ discussions revealed that traditional Basic foods provide the nutrients essential for life and growth. These
diets are characterized by a high consumption of basic foods are also known as ‘everyday foods’.
Sproesser et al. BMC Public Health         (2019) 19:1606 Page 5 of 14
Table 1 Facets of traditional and modern eating mentioned in previous research and in our group discussions as well as their
assignment to the 12 subdimensions and 2 dimensions
Facets Source (Reference; D = Group discussion) T/Ma
Dimension What People Eat
Subdimension Ingredients
High consumption of energy-dense foods Dubé et al. (2014) [31]; Monteiro et al. (2013) [1] M
D
Consuming diet drinks or foods D M
High consumption of refined foods Chopra et al. (2002) [10]; Popkin (2003) [8]; Popkin & Gordon-Larsen M
(2004) [6]; Popkin et al. (2012) [3]
High consumption of basic foods like wheat, corn, or rice D T
High consumption of animal-source foods Popkin (2003) [8]; Popkin & Gordon-Larsen (2004) [6]; Popkin et al. M
(2012) [3]
High consumption of plant-based foods D T
High consumption of grain Chopra et al. (2002) [10]; Drewnowski & Popkin (1997) [5] T
High consumption of fruit Dubé et al. (2014) [31] T
High consumption of vegetables Dubé et al. (2014) [31]; Popkin et al. (2012) [3] T
High consumption of fiber Chopra et al. (2002) [10]; Dubé et al. (2014) [31]; Popkin (2003) [8]; T
Popkin & Gordon-Larsen (2004) [6]
High consumption of sugar and caloric sweeteners Chopra et al. (2002) [10]; Drewnowski & Popkin (1997) [5]; Dubé et al. M
(2014) [31]; Monteiro et al. (2013) [1]; Popkin (2003) [8]; Popkin (2009)
[9]; Popkin & Gordon-Larsen (2004) [6]; Popkin et al. (2012) [3]
Consuming artificial sweeteners (e.g., in diet drinks, to sweeten D M
coffee or tea)
High consumption of oils and fats (especially trans fats and Chopra et al. (2002) [10]; Drewnowski & Popkin (1997) [5]; Dubé et al. M
saturated fats) (2014) [31]; Monteiro et al. (2013) [1]; Popkin (2003) [8]; Popkin (2009)
[9];
Popkin & Gordon-Larsen (2004) [6]; Popkin et al. (2012) [3]
D
High consumption of salt Monteiro et al. (2013) [1]; Popkin et al. (2012) [3] M
Subdimension Processing
High consumption of industrially unprocessed foods Monteiro et al. (2011) [40]; Popkin (2009) [9] T
High consumption of fresh foods D T
High consumption of industrially ultra-processed foods Monteiro et al. (2013) [1]; Popkin (2003) [8]; Popkin (2009) [9] M
D
Eating foods that are industrially mass-produced Trichopoulou et al. (2007) [29] M
High consumption of convenience products Jabs & Devine (2006) [41] M
Consumption of ultra-processed microwavable or frozen meals D M
that were industrially produced
Consumption of fast foods Jabs & Devine (2006) [41] M
Consumption of soft drinks Dubé et al. (2014) [31] M
Eating foods with organic label D M
Subdimension Preparation
High consumption of foods that require a long preparation/ D T
cooking time
Knowing how to cook D T
High consumption of foods that was cooked by a woman D T
High consumption of foods that has been prepared at home Jabs & Devine (2006) [41] T
D
Eating home-canned foods D T
Eating foods that have been prepared in grandmother’s way Vanhonacker et al. (2010) [42] T
Sproesser et al. BMC Public Health         (2019) 19:1606 Page 6 of 14
Table 1 Facets of traditional and modern eating mentioned in previous research and in our group discussions as well as their
assignment to the 12 subdimensions and 2 dimensions (Continued)
Facets Source (Reference; D = Group discussion) T/Ma
Flavoring most of the foods in a way that is typical for your D T
country/region
Consumption of foods that are seasoned at the table (e.g., with D T
salt, pepper)
High consumption of foods that were prepared using time- Jabs & Devine (2006) [41] M
saving preparation equipment such as microwave ovens, rice
cookers, and bread machines
Availability of a lot of different ways to cook/heat up foods D M
High consumption of fried foods Popkin (2009) [9] M
High consumption of grilled foods Popkin (2009) [9] M
High consumption of ready-prepared foods Jabs & Devine (2006) [41] M
Eating take-away or delivered meals Popkin (2009) [9] M
D
Subdimension Temporal Origin
High consumption of foods that have been eaten since the Trichopoulou et al. (2007) [29] T
second World War
High consumption of foods that were known already by D T
grandparents
High consumption of typical dishes D T
High consumption of foods from other countries’ cuisines D M
Eating pizza Pingali (2006) [43] M
D
High consumption of foods that are recently produced D M
Consuming genetically modified foods Lusk et al. (2005) [44] M
Subdimension Spatial Origin
High consumption of local food products Trichopoulou et al. (2007) [29] T
D
High consumption of seasonal foods D T
Consumption of global food products from mass production Trichopoulou et al. (2007) [29]; Popkin et al. (2012) [3] M
Food available everywhere D M
Buying most foods at markets or small family stores D T
High consumption of cheap food products from supermarkets; D M
especially cheap meat products
All foodstuffs are purchased (as opposed to grown or raised by D M
oneself)
Eating foods from vending machines D M
Subdimension Variety
Eating a diverse and varied diet Drewnowski & Popkin (1997) [5] M
Large number of food choices D M
Eating a large variety of different flavors D M
Eating a large variety of different types of fruits and vegetables D M
Eating a large variety within one type of fruit or vegetable D T
Dimension How People Eat
Subdimension Temporal Aspects
Taking time for eating D T
Eating an entire meal within 10 min or less D M
Regular/fixed mealtimes Fjellström (2004) [45] T
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Table 1 Facets of traditional and modern eating mentioned in previous research and in our group discussions as well as their
assignment to the 12 subdimensions and 2 dimensions (Continued)
Facets Source (Reference; D = Group discussion) T/Ma
Eating at the same time in a family D T
Eating at traditional mealtimes Mestdag (2005) [46] T
D
Consumption of main meals Fjellström (2004) [45] T
D
Snacking Mestdag (2005) [46]; Popkin (2009) [9]; Zizza et al. (2001) [47] M
D
Irregular/flexible mealtimes; skipping meals D M
Consumption of traditional dishes at celebrations/special D T
occasions (e.g., Sundays, festivals)
Subdimension Spatial Aspects
Eating at home Jabs & Devine (2006) [41]; Popkin (2003) [8]; Popkin et al. (2012) [3] T
D
Eating out of home Popkin (2009) [9] M
Eating in restaurants Jabs & Devine (2006) [41]; Story et al. (2008) [4] M
Eating in buffet restaurants D M
Eating on the run Jabs & Devine (2006) [41]; Mestdag (2005) [46] M
High consumption of foods to go D M
Eating while working D M
Subdimension Social Aspects
Eating together/ in company D T
Eating with family Jabs & Devine (2006) [41]; Mestdag (2005) [46] T
D
Eating with colleagues D M
Eating alone Fischler (2011) [48]; Kwon et al. (2018) [49] M
Highly constraining, homogeneous collective rules Fischler (1990) [50] T
Eating is guided by social norms (Heteronomy) Fischler (1990) [50] T
Eating the same foods as the others when eating at home D T
Individualistic D M
Men get preferential treatment over women at mealtimes D T
Eating while being served foods by others D T
Larger family events center on meals D T
Having conversations while eating D T
Subdimension Meals
Lunch or dinner as main meal of the day D T
Meals end with a sweet dessert D T
Foods that are eaten for breakfast differ largely from foods that D M
are eaten for other meals
Drinking soft drinks during the main meal (e.g., cola) D M
Consumption of larger portion sizes Benson (2009) [51] M
Subdimension Appreciation
Appreciation of foods D T
More food waste D M
Dissociation: not knowing where foods come from, and what is D M
in them
Table manners D T
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Table 1 Facets of traditional and modern eating mentioned in previous research and in our group discussions as well as their
assignment to the 12 subdimensions and 2 dimensions (Continued)
Facets Source (Reference; D = Group discussion) T/Ma
Eating in a way that shows respect for others at the table D T
Doing something else while eating Jabs & Devine (2006) [41] M
Using plastic utensils (e.g., plastic forks) D M
Subdimension Concerns
Major concern: availability and quantity of food Fischler (1990) [50] T
Concern about whether foods are spoiled D T
Major concern: quality of food Fischler (1990) [50] M
Intuitive eating D T
Analytical eating D M
Interest in nutrition and consumer education D M
Interest in food & health labels D M
Trouble deciding what to eat Fischler (1990) [50] M
Concerns about eating too much D M
Note. a T refers to when a facet was mentioned as part of traditional eating by the respective reference(s) or in the group discussions; M refers to when a facet
was mentioned as part of modern eating respectively
of fried and grilled foods can be considered modern [9] modern times, foods are mostly bought in supermarkets,
as well as a high consumption of ready-prepared food in convenience stores, or from vending machines.
[41] or take-away/delivered meals [9].
Variety (subdimension 6)
Temporal origin (subdimension 4) Within this subdimension, modern eating is character-
The fourth subdimension that we identified includes facets ized by a large choice of available foods. Five facets were
that refer to the length of time that a food has been part of subsumed in this subdimension. One example facet is a
the diet in any particular region. Seven facets were diverse and varied diet [5]. This variety may be especially
subsumed in this subdimension. For instance, foods that pronounced regarding the availability of different flavors.
are typical for the region or foods present for a long time Also, eating a variety of different types of fruits and veg-
(e.g., before the Second World War, as suggested by etables was discussed to be part of modern eating (e.g.,
Trichopoulou and colleagues [29]) are considered as trad- apples, bananas, grapes), being able to eat them year-
itional. Our discussions revealed that a high consumption round via imports from countries with different climate.
of foods that were already known by people’s grandparents Notwithstanding, diversity within one type of fruit or
is another facet in this subdimension. Weichselbaum, vegetable may be part of traditional eating (e.g., eating
Benelam, and Soares Costa [26] published a synthesis different kinds of local apples).
report listing such traditional foods across Europe. For
instance, Wiener Schnitzel is considered a traditional food in Dimension ‘how people eat’
Austria, Pumpernickel bread in Germany, Cured Greenland The second dimension represents how people eat and
shark in Iceland, and Kebab with yogurt in Turkey [26]. includes the six subdimensions: Temporal Aspects, Spatial
Aspects, Social Aspects, Meals, Appreciation, and Concerns.
Spatial origin (subdimension 5)
This subdimension has to do with where the consumed Temporal aspects (subdimension 1)
foods come from. Eight facets were subsumed in this The first subdimension that we identified includes dur-
subdimension. For instance, traditional eating is defined ation of eating and when people eat. Nine facets were
as a seasonally restricted and local food consumption subsumed in this subdimension. Specifically, it was dis-
[29]. In contrast, modern eating is characterized by con- cussed that, traditionally, people take time3 to eat. In
sumption of foods that are imported from all over the addition, Fjellström [45] and Mestdag [46] stated that,
world [3, 29], and are therefore available for consump- traditionally, people eat main meals at regular and
tion throughout the year. Moreover, authors’ discussions
revealed that, traditionally, foods were primarily bought 3Please note that ‘taking time to eat’ and other terms within this
at farmers’ markets or grown by oneself whereas in manuscript are subjective and subject to interpretation.
Sproesser et al. BMC Public Health         (2019) 19:1606 Page 9 of 14
Fig. 1 The TEP10 framework of traditional and modern eating, displaying dimensions, subdimensions, and examples of facets of traditional (‘T’)
and modern (‘M’) eating
traditional mealtimes. Moreover, our group’s discussions mentions that traditionally, eating is guided by social
revealed that, in many countries, it is traditional for all norms and highly constraining, homogeneous collective
family members to eat together at the same time. Also, rules. As a result, everybody eats the same food within a
traditional dishes are often consumed on special occa- meal at home. One of these rules, which is present in
sions (e.g., Sundays, festivities). In contrast, modern eat- many countries, is that, traditionally, men get preferen-
ing has been discussed to be characterized by a shorter tial treatment over women at mealtimes. For instance,
eating duration, by eating irregularly, and by skipping men eat while women serve food in India, Ghana, and
meals. Moreover, Zizza et al. [47] consider snacking be- Mexico. In comparison, modern eating is more individu-
tween meals as part of modern eating. alistic and egalitarian, and based on individual prefer-
ences rather than on social norms [50].
Spatial aspects (subdimension 2)
This subdimension focusses on where people eat. Seven
facets were subsumed in this subdimension. For in- Meals (subdimension 4)
stance, traditional eating is characterized by eating at Another subdimension that we identified was the signifi-
home [3, 8, 41]. In contrast, eating in restaurants is cance and content of meals, such that some meals con-
modern [4, 41], especially in buffet restaurants. More- sistently feature particular content, and some meals
over, eating on the run is categorized as part of modern during the day are considered more important and sub-
eating in the USA [41]. Also, eating food ‘to-go’ (i.e., stantial than others. Five facets were subsumed in this
take-away food) as well as eating while working was clas- subdimension. For instance, which meal is considered
sified as modern. the main meal of the day is a discriminant feature be-
tween traditional and modern eating. For example, trad-
Social aspects (subdimension 3) itionally, the main meal is lunch in Germany, whereas in
A third subdimension is with whom people eat, and the modern times the main meal is dinner.4 Regarding the
extent to which social norms are present and followed. content of meals, traditionally, Western main meals end
Twelve facets were subsumed in this subdimension. Spe- with a sweet dessert. In contrast, drinking soft drinks
cifically, eating together, especially with the family, is during the main meal was considered to be modern, as
part of traditional eating [41, 46]. Also, meals are trad- well as consuming special foods for breakfast that differ
itionally central opportunities for conversations in many largely from the foods eaten at other meals.
countries and are at the center of larger family events. In
contrast, in modern times, people more often eat by 4Please note that this largely varies by country. For instance, in the
themselves [48]. As another social aspect, Fischler [50] USA the main meal is traditionally dinner.
Sproesser et al. BMC Public Health         (2019) 19:1606 Page 10 of 14
Appreciation (subdimension 5) at special occasions. Also, it is possible that a combin-
This subdimension targets the extent to which respect is ation of some modern and some traditional facets has
shown for the food consumed, as well as for other health effects. For instance, eating a wide variety of dif-
people at the table. Seven facets were subsumed in this ferent types of fruits and vegetables (modern) as part of
subdimension. Specifically, authors’ discussions revealed a family dinner at home (traditional) might have a health
that traditional eating is characterized by the appreci- effect. The presented framework enables both the differ-
ation of food and adhering to table manners, that is to entiated examination as well as the investigation of the
eat according to socially accepted conventions. In con- joint impact and interplay of different facets on health
trast, modern eating is marked by wasting food (e.g., outcomes.
throwing away the rest of a meal instead of eating it The potential of a joint examination of multiple facets
later), using plastic utensils, and not knowing where the of traditional and modern is displayed in Fig. 2. Specific-
food comes from or what is in it. Also, doing something ally, for ten selected countries, the co-occurrence of
else while eating is part of modern eating (e.g., watching ‘modern vs. traditional ingredient’5 consumption and
screens [41]). obesity prevalence is displayed in Fig. 2. The ‘modern vs.
traditional ingredient consumption’ that is displayed on
Concerns (subdimension 6) the left Y-Axis of Fig. 2 is calculated with data from the
The sixth subdimension deals with concerns about eat- Food and Agriculture Organization of the United Na-
ing. Nine facets were subsumed in this subdimension. tions [36]. Specifically, we computed the percentage of
For instance, traditional eating is characterized by con- consumed energy that comes from ‘modern ingredients’
cerns about the availability of food, whereas, in modern divided by the percentage of energy that comes from
times, concerns center on the quality of food [50]. Also, ‘traditional ingredients’. As a high consumption of ce-
traditionally, people eat in an intuitive way, whereas reals, vegetables, and fruits was reported to be part of
modern eating is often marked by an analytical ap- traditional eating [3, 10, 31], these were regarded as
proach. Specifically, people pay attention to nutritional ‘traditional ingredients’. Similarly, a high consumption of
aspects and food labels. Scrinis [56] has labeled this sugar/sweeteners, meat/offal, and vegetable oils/animal
focus on nutrients as ‘nutritionism’. In the light of the fats was reported to be part of modern eating [1, 6, 8, 9];
variety and abundance of the modern food environment, therefore these were regarded as ‘modern ingredients’.
people are concerned both about what to eat [50] and With values higher than 1, people in the USA, Germany,
about eating too much. and France derive more energy from ‘modern’ than from
‘traditional’ ingredients, whereas the opposite is true for
Discussion Brazil, Mexico, Japan, Turkey, China, India, and Ghana
The TEP10 framework summarizes a comprehensive with values below 1. As can be seen, across these ten
compilation and systematization of the different facets countries, the co-occurrence of modern vs. traditional
that are suggested to underlie traditional and modern ingredients consumption is related to obesity prevalence
eating. It shows that traditional and modern eating is (r = .68). It is, however, important to note that such a re-
characterized not only by what people eat, but also by lationship with obesity prevalence might be absent or
how they eat. Twelve subdimensions and 106 facets were even reversed for other subdimensions or facets of trad-
suggested to underlie traditional and modern eating. itional and modern eating.
Therefore, the current study provides a broad overview As for the relationship between traditional eating and
of what constitutes the concept of traditional and mod- health outcomes, the TEP10 framework shows that there
ern eating. are two further issues that need to be considered. First,
Importantly, the present framework shows that trad- this relationship needs to be investigated in relation to
itional and modern eating is complex and multifaceted. society, culture, and time. An example why this is im-
It is not only defined by one facet, such as eating trad- portant lies in ‘imported traditional’ foods which were
itional dishes, but by the co-occurrence of multiple considered to be part of modern eating in the adopting
facets at the same time, such as eating traditional dishes society or culture. However, these imported foods prob-
on Sundays together with the family. This co-occurrence ably have similar nutritional qualities to those from trad-
might be the critical factor in finding evidence for the itional cuisines. Hence, given that the consumption of
relationship between traditional and modern eating and sushi can be considered traditional in Japan but modern
health. Specifically, certain facets might need to come
5
together to have an effect on health outcomes. For in- Please note that the expression ‘modern vs. traditional ingredients’ is
stance, foods with traditional temporal origin, such as used for simplification. However, while some ingredients and foods are
objectively modern (they did not exist in the past), what is specifically
Wiener Schnitzel in Austria [26], might need to be eaten modern in many cases is not the food itself but how much and how
according to traditional temporal aspects, such as only often it is consumed.
Sproesser et al. BMC Public Health         (2019) 19:1606 Page 11 of 14
Fig. 2 Bars represent the quotient of percentage of energy derived through ‘modern vs. traditional ingredients’ with data from the FAO [36].
Points depict the prevalence of obesity in 2014 (i.e. BMI≥ 30 kg/m2) [37]. Note. Cereals, starchy roots, pulses, vegetables and fruits were
considered to be ‘traditional ingredients’ whereas sugar/sweeteners, meat/offal, and vegetable oils/animal fats were considered to be
‘modern ingredients’
in Germany, the ingested nutrients of a German ‘modern mass-production has been classified as modern [29].
eater’ who eats a lot of sushi are comparable to a Japa- This shows again that generic statements about the rela-
nese ‘traditional eater’ who does so. This demonstrates tionship between traditional eating and health outcomes
that general statements about the relationship between are difficult to support. Rather, statements about the re-
traditional eating and health are rarely tenable but need lationship between certain facets of traditional eating or
to be related to society, culture, and time. their co-occurrence and health are possible.
Second, the TEP10 framework shows that a simple di- The multidimensionality of traditional and modern
chotomy between traditional and modern eating is an eating also underlines its conceptual distinction from
oversimplification, even within a certain time, society, or sustainable and healthy eating. Specifically, although low
culture. Specifically, a person might score high on trad- meat consumption, low food waste, and high consump-
itional eating regarding one facet or subdimension but tion of local foods seems to be part of both sustainable
high on modern eating regarding another facet or subdi- (see Sustainable Development Goals [28]) and traditional
mension. For instance, an Italian who consumes a lot of eating [3, 6, 8, 29], traditional eating was defined by
frozen mass-produced pizza would score high on trad- many other facets. In a similar vein, a high intake of
itional eating with regard to the Temporal Origin subdi- fruits, vegetables, unprocessed and fresh foods as well as
mension, as pizza has been labeled traditional in Italy a low intake of fat, sugar, and salt seems to be both part
[57]. However, he or she would score high on modern of traditional [1, 3, 5, 6, 8–10, 31, 40] and healthy eating
eating with regard to the Processing subdimension as [58]. However, traditional eating goes beyond the
Sproesser et al. BMC Public Health         (2019) 19:1606 Page 12 of 14
consumption of these foods and also includes how future research needs to add quantitative evidence
people eat. whether the facets are part of traditional and modern
As far as it concerns healthy eating, the TEP10 eating; for instance, by surveying people about the ‘tradi-
framework shows a new perspective on modern eat- tionality’ or ‘modernity’ of facets.
ing. Specifically, a frequently mentioned characteristic
of modern eating is that there is a focus on nutrients Conclusion
(‘nutritionism’, [56]) and concerns about the healthi- The TEP10 framework is a step towards a comprehen-
ness of foods coexist with a high consumption of sive understanding of the concept of traditional and
‘modern’ ingredients that are considered to be un- modern eating. Specifically, traditional and modern eat-
healthy, such as sugar. Specifically, Rozin et al. [59] ing is not only characterized by what people eat but also
showed that US-Americans scored highest on con- by how they eat, a dimension that has been neglected in
cerns about the healthiness of foods as compared to past research. The present article sheds new light on the
Belgians, French, and Japanese. At the same time, US- overall phenomenon of traditional and modern eating,
Americans also score highest on the intake of ‘mod- underlining its multidimensionality. Also, it shows that
ern’ ingredients such as meat, sugar, oils, and fats, as reducing traditional and modern eating to single dimen-
compared to the other three countries [36]. This sions, subdimensions, or facets constitutes an oversim-
paradox appears to be a central characteristic of mod- plification of the overall phenomenon. Future research
ern eating. Therefore, we included concerns in the might benefit from considering the multidimensionality
framework of traditional and modern eating, although and interplay of multiple facets of traditional and mod-
one could argue that concerns do not qualify as ern eating. This might provide new insights into the
‘eating’. transition from traditional towards modern eating, its
The TEP10 framework allows a comprehensive and consequences and underlying factors, moving forward
in depth investigation of traditional and modern eat- research on this timely and important topic.
ing in future research. Next to the investigation of
consequences (e.g., for health), it also enables examin- Abbreviations
ation of the drivers of the transition from traditional BMI: Body Mass Index; D: Group discussion; FAO: Food and Agriculture
Organization of the United Nations; M: Modern; T: Traditional;
towards modern eating. For instance, motives for why TEP10: Traditional Eating Project: 10 countries
people eat what they eat [60–62] or what meaning
food has for individuals [63] might be factors under- Acknowledgements
lying the different facets of traditional and modern We would like to thank Dr. Xuan Gao, Tianjiao Yu, Anne Kaufmann and
Desiree Katzenberger for their valuable support.
eating. The TEP10 framework offers both to compre-
hensively investigate traditional and modern eating as Authors’ contributions
well as to focus on single facets, while acknowledging GS, MR, NA, CA, MA, RB, IF, XH, SI, GK, MK, UM, CF, PR, HS, and BR have made
the multidimensionality of the overall phenomenon. substantial contributions to the conception of this work. GS performed the
literature review and drafted the framework with substantial contributions
Furthermore, the TEP10 framework enables re- from MR, NA, CA, MA, RB, IF, XH, SI, GK, MK, UM, CF, PR, HS, and BR. GS
searchers to uncover similarities and differences in drafted the paper. MR, NA, CA, MA, RB, IF, XH, SI, GK, MK, UM, CF, PR, HS, and
the concept of traditional and modern eating across BR provided critical revisions. GS, MR, NA, CA, MA, RB, IF, XH, SI, GK, MK, UM,
CF, PR, HS, and BR gave their final approval of the version to be published
the world. In the case of Japan, we have already in- and agreed to be accountable for all aspects of the work in ensuring that
vestigated whether the presented multidimensionality questions related to the accuracy or integrity of any part of the work are
of traditional and modern eating is valid [64]. Specif- appropriately investigated and resolved. All authors read and approved the
final manuscript.
ically, we asked 340 adults from Japan to rate the
‘traditionality’ of 46 facets. The results showed that, Funding
in accordance with the TEP10 framework, traditional This work was supported by the German Research Foundation within the
and modern eating is also multidimensional in Japan. project “Why people eat in a traditional or modern way: A cross-country
study” (Grant SP 1610/2–1, granted to GS) and by the JSPS KAKENHI Grant
More precisely, both dimensions what and how (Grant Number JP16KT0097, granted to SI and IF). Additional funding came
people eat are part of traditional and modern eating from the Federal Ministry of Education and Research, Germany (BMBF; Project
in Japan as well as ten subdimensions of the TEP10 SmartAct; Grant 01EL1420A, granted to BR & HS). The funding sources had
no involvement in study design; in the collection, analysis and interpretation
framework [64]. of data; in the writing of the report; or in the decision to submit the article
There are some limitations and avenues for future re- for publication.
search that need to be addressed. The presented compil-
ation of facets constitutes a first step and is certainly a Availability of data and materials
Not applicable.
developing process with additional facets to be poten-
tially included in the future, for example from countries Ethics approval and consent to participate
that were not represented in this manuscript. Also, Not applicable.
Sproesser et al. BMC Public Health         (2019) 19:1606 Page 13 of 14
Consent for publication years 1900–2007. 2018. https://www.cdc.gov/nchs/data/hus/2010/022.pdf .
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Author details sectional data to identify and quantify the relative importance of factors
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