nutrients Article Cultural Inﬂuences on the Regulation of Energy Intake and Obesity: A Qualitative Study Comparing Food Customs and Attitudes to Eating in Adults from France and the United States Maria Carlota Dao 1, * ,† , Sophie Thiron 2 , Ellen Messer 3 , Camille Sergeant 4 , Anne Sévigné 1 , Camille Huart 1 , Melinda Rossi 1 , Ilyssa Silverman 1 , Kylie Sakaida 1 , Pierre Bel Lassen 4,5 , Charlotte Sarrat 6 , Laura Arciniegas 2 , Sai Krupa Das 1 , Nicolas Gausserès 6 , Karine Clément 4,5 and Susan B. Roberts 1   Citation: Dao, M.C.; Thiron, S.; Messer, E.; Sergeant, C.; Sévigné, A.; Huart, C.; Rossi, M.; Silverman, I.; Sakaida, K.; Bel Lassen, P.; Sarrat, C.; et al. Cultural Inﬂuences on the Regulation of Energy Intake and Obesity: A Qualitative Study Comparing Food Customs and Attitudes to Eating in Adults from France and the United States. Nutrients 2021, 13, 63. https:// dx.doi.org/10.3390/nu13010063 Received: 27 November 2020 Accepted: 23 December 2020 Published: 28 December 2020 Publisher’s Note: MDPI stays neu- tral with regard to jurisdictional claims in published maps and institutional afﬁliations. Copyright: © 2020 by the authors. Li- censee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/ licenses/by/4.0/). 1 Energy Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA; anne.sevigne@etudiants.purpan.fr (A.S.); camille.huart1@gmail.com (C.H.); melinda.rossi.42@gmail.com (M.R.); isilverman415@gmail.com (I.S.); kyliesakaida@gmail.com (K.S.); Sai.Das@tufts.edu (S.K.D.); Susan.Roberts@tufts.edu (S.B.R.) 2 Laboratoire CERTOP, UMR CNRS 5044, Université Toulouse 2 Jean Jaurès, 31058 Toulouse, France; sophie.thiron@wanadoo.fr (S.T.); arciniegas.l.a@gmail.com (L.A.) 3 Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA; Ellen.Messer@tufts.edu 4 Assistance Publique Hôpitaux de Paris, Nutrition Department, CRNH Ile-de-France, Pitié-Salpêtrière Hospital, 83 boulevard de l’Hôpital, 75013 Paris, France; camille.sboy@yahoo.fr (C.S.); pierrebellassen@gmail.com (P.B.L.); karine.clement2@gmail.com (K.C.) 5 INSERM, Nutrition & Obesity—Systemic Approaches Research Group (NutriOmics), Sorbonne Université, 83 boulevard de l’Hôpital, 75013 Paris, France 6 Danone Research, 128 Avenue de la Vauve, CEDEX, 91767 Palaiseau, France; Charlotte.SARRAT@danone.com (C.S.); Nicolas.GAUSSERES@danone.com (N.G.) * Correspondence: carlota.dao@unh.edu † Current afﬁliation: Department of Agriculture, Nutrition, and Food Systems, University of New Hampshire, 129 Main Street, Durham, NH 03824, USA. Abstract: (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. Keywords: food culture; obesity; weight management; eating behavior Nutrients 2021, 13, 63. https://dx.doi.org/10.3390/nu13010063 https://www.mdpi.com/journal/nutrients