Milk and milk products were identified once again by the Dietary Guidelines for Americans as a food group under-consumed by adults, particularly older females (USDA and HHS, 2010). Calcium, vitamin D, and potassium, all nutrients found abundantly in fluid milk, remain as nutrients of public health concern. Specifically, fewer than 10% of women older than age 51 are consuming the recommended amount of calcium per day (Bailey, 2010). Because milk and milk products provide a “package” of nutrients (calcium, vitamin D, protein, etc.) that are beneficial to bone and cardiovascular health, it is essential that older adults, especially women, meet the recommended daily intake.
Traditional nutrition education outreach efforts often encourage or persuade women to increase fluid milk intake using only knowledge-based outreach (e.g., “milk is good for your bones”). Yet fluid milk consumption continues to be less than adequate in women ages 50 and older, who are drinking only an average of 1/2 cup per day (USDA, ARS, 2010). While mean intake of fluid milk in older adults has not changed over time, the proportion of adults ages 50 years and older who drink fluid milk has significantly decreased (USDA, ARS, 2010).
Various reasons—such as a dislike for the taste of milk, self-perceived lactose intolerance, and unconcern for meeting calcium needs—are cited for why adult women are not consuming the recommended amount of milk products each day (Chapman et al., 1995). When attempting to change dietary behaviors, researchers have noted that addressing an individual’s attitude and belief systems is important, particularly in regard to milk consumption (Brewer et al., 1999; Gulliver and Horwath, 2001). Hence, a greater understanding and respect for the attitudes, barriers, and beliefs as they relate to milk and milk consumption is needed before behavior change will ensue.
Recent research by Mobley et al. (2011) revealed that gastrointestinal disturbances were reported as the primary barrier to adequate milk consumption in low-income older women. Female focus group participants, ages 60 years and older, repeatedly cited real or perceived symptoms of lactose intolerance as a deterrent to consuming milk. One participant noted, “If I know that I am going to be out in public, I won’t drink it [milk] because it will make you gassy.” While lactose intolerance affects some adults, self-diagnosis tends to overestimate prevalence and may cause individuals to eliminate milk and its vital nutrients from their diet (Suchy et al., 2010). A recent evidence report on lactose intolerance and health indicates that true lactose-intolerant individuals may still able to consume up to 12 g of lactose per day (or 1 cup of milk) (Wilt et al., 2010). With this in mind, strategies to educate or persuade individuals with real or perceived lactose intolerance on how to consume milk products are warranted.
Taste remains the No. 1 driver for food choices (Glanz et al., 1998; IFIC 2010), but it is not the primary barrier to fluid milk consumption in older women. Attitudes toward the taste of milk and milk products are mostly positive among older women (Mobley et al., 2011). However, older women are opposed to consuming or being advised to drink lower-fat milk. Nonfat milk was often described as “chalk water,” “blue water,” or “watered-down milk.” A focus group participant noted, “I don’t want 2% or skim or whatever you are saying. It all looks like chalk water.” Unless women were directed by a physician to consume lower-fat milk (“I am the type of person that anything the doctor tells me that is going to help me, I am willing to try.”), they were not willing to switch from drinking whole or reduced-fat milk and would opt not to drink milk rather than make the switch.
Considering other avenues beyond traditional informational health campaigns for adults, specifically older women, is crucial to ensure behavior change. Older females already know that milk products are important to health, especially bone health (Mobley et al., 2010; Mobley et al., 2011). Communicating how to consume adequate milk and milk products while minimizing symptoms of lactose maldigestion appears to be a key factor in changing consumption habits among older women. Various tips on how to gradually increase the amount of fluid milk consumed if symptoms of lactose intolerance are present (i.e., drinking small amounts of milk with food and eating yogurt) exist, yet results of communication intervention efforts remain to be seen.
Amy R. Mobley, Ph.D., R.D.,
Assistant Professor, Dept. of Foods and Nutrition, Purdue University,
West Lafayette, Ind.
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