(1) Background: The influence of food culture on eating behavior and obesity risk is poorly understood. (2) Methods: In this qualitative study, 25 adults in France with or without overweight/obesity participated in semi-structured interviews (n = 10) or focus groups (n = 15) to examine attitudes to food consumption and external pressures that influence eating behavior and weight management. Results were compared to an equivalent study conducted in the United States, thereby contrasting two countries with markedly different rates of obesity. Emerging key themes in the French data were identified through coding using a reflexive approach. (3) Results: The main themes identified were: (1) influence of commensality, social interactions, and pleasure from eating on eating behavior, (2) having a balanced and holistic approach to nutrition, (3) the role of environmental concerns in food consumption, (4) relationship with “natural” products (idealized) and food processing (demonized), (5) perceptions of weight status and management. Stress and difficulties in hunger cue discernment were viewed as important obstacles to weight management in both countries. External pressures were described as a major factor that explicitly influences food consumption in the U.S., while there was an implicit influence of external pressures through eating-related social interactions in France. In France, products considered “natural” where idealized and juxtaposed against processed and “industrial” products, whereas this was not a salient aspect in the U.S. (4) Conclusions: This first comparative qualitative study assessing aspects of food culture and eating behaviors across countries identifies both common and divergent attitudes to food and eating behavior. Further studies are needed to inform the development of effective behavioral interventions to address obesity in different populations.

Environmental factors such as food availability and variety can function as cues for overeating in individuals susceptible to overweight or obesity, but relatively little is known about other types of environmental factors that may also be important. This qualitative study compared and contrasted categories of internal and external cues through focus groups and key informant interviews with 24 adults (26 to 77 years old) in the United States who had a body mass index within the healthy range (21.6 ± 2.5 kg/m2) or had overweight or obesity (29.1 ± 3.6 kg/m2). Five domains of external factors influencing food intake were identified: (a) Environmental cues including food availability and variety; (b) normative expectations for dietary intake; (c) food palatability; (d) overt social pressures to overeat; and (e) perceived social expectations around eating. All external domains were noted by participants with overweight or obesity to be challenging, and solutions to avoid overeating were lacking; however, overt social pressures and perceived social expectations appeared to be especially problematic. By explicitly defining different domains of external factors that challenge healthy weight regulation, this study identifies specific targets to address in interventions for healthy weight management.

Objectives Cultural factors influence obesity risk, but this relationship has not been systematically studied due to the lack of a validated survey instrument. The objective of this project was to develop a prototype questionnaire to assess the relationship between body mass index (BMI) and sociocultural factors. Methods Interviews and focus groups were conducted in the US (N = 24) and France (N = 25). Recordings were transcribed and analyzed (NVivo), and results informed the new questionnaire. The questionnaire was administered in two pilots using Amazon Mechanical Turk (pilot 1: N = 25 adults in France and 25 in US; pilot 2: N = 120 US adults). Demographic information was also collected. Questions were grouped by theme and scores were created from response averages within each theme. The scores were analyzed in relation to BMI, age and country (ANOVA, Spearman correlation). The scores included cultural insularity (high score = greater role of cultural identity in food choices), external eating pressures (high score = stronger perceived and overt pressures), food insecurity (high score = greater food insecurity), childhood intake control (high score = stricter parental control of eating during childhood), and nutrition knowledge (high score = better discernment of healthy vs. unhealthy foods). Results In France, the cultural insularity score was higher than in the US (P = 0.01) and was correlated with BMI (r = 0.5, P = 0.03). The childhood intake control score was also inversely associated with BMI in France (r = −0.5, P = 0.03). In the US, BMI was positively associated with the external eating pressures (pilot 2: r = 0.2, P = 0.03) and nutrition knowledge (pilot 2: r = 0.2, P = 0.04) scores, and was inversely associated with the food insecurity score (pilot 2: r = −0.24, P = 0.008). In both countries, age was associated with the childhood intake control score (France: r = 0.5, P = 0.03, and US pilot 1: r = 0.4, P = 0.03, pilot 2: r = 0.4, P < .0001). Conclusions This approach and prototype questionnaire identified novel cultural factors associated with high BMI in France and the US. Additional research is needed to validate the prototype and identify core cultural factors associated with risk of obesity in different cultures. Funding Sources USDA agreement #8050–51,000-105–01S; Danone Research; Institute of Cardiometabolism and Nutrition.