This episode of Market Tidbits was brought to you by daxue consulting. Allison Malmsten, daxue’s Media and Marketing Manager, talks about the results from a daxue survey of 747 Chinese consumers. Allison talks in detail about health perceptions in China, what the implications are for foreign brands looking to sell healthy food in China, how high is the level of food-related health awareness in China, and how does health awareness in China differs from the West.
Health awareness in China around certain nutrients like protein, sugar, and carbs
Allison Malmsten: For this episode of Market Tidbits, I am so excited to share daxue consulting’s survey results on health perceptions in China. Our goal was not just to find whether Chinese people are healthy, but rather to define what exactly they consider to be healthy. Because nowadays we live in a world with a wealth of information on the internet, some of it accurate, some of it not, and much of it conflicting.
There’s a myriad of ideas about what is healthy, so we wanted to define what exactly Chinese people believe is healthy. Our survey had over 700 respondents, 72% of them were from Tier 1 and Tier 2 cities. 84% of them were under 30 years old. So, while this group does not represent China’s population as a whole, it certainly does give us some insight on some of the trends, especially some of the high consumption consumers in higher tier cities.
Let’s dive into the results. One of the first questions we asked was, what is your perceived health level of the following nutrients? We asked about nutrients like protein, added sugar, fat, and trans-fats. Some of what we found really was not surprising. For example, most respondents consider products with high levels of protein to be prime examples of healthy food in China, which was expected. And most people also consider fiber to be healthy. However, what was surprising to us is that added sugar, something that is widely recognized as unhealthy in the west has a relatively neutral perception in China. And yes, in the survey we did specify added sugar, and not just sugar. So, products with high levels of added sugar are not necessarily considered to be examples of unhealthy food in China.
Also, fat and carbs are often pitted against each other as responsible for weight gain. Hence, low-fat diets were trending globally in the 90s, while low-carb diets are trending today. The survey shows that the Chinese have a more favorable view towards carbs than fat, which can signal to us that low-carb diets would be less popular in China. Trans-fats are recognized as a dietary hazard in the west as the body cannot burn them. However, around 35% of our survey respondents said that they believe trans-fats are either neutral or healthy. It is likely that many of the people had heard of trans-fats, but were unaware of how they impact the body. Around 14% of the respondents said that they were unfamiliar with trans-fats.
We also asked about omega-3. Omega-3 is something that becomes more recognized as a country is more familiar with nutrients or nutrient-related products like vitamins and supplements. Around 40% of the respondents were not familiar with omega-3. However, those that were familiar with omega-3 also had a relatively neutral view towards it. 30% said it was neutral and 24% it was moderately healthy. What this tells us is that there’s room to grow in the understanding of very specific nutrients like omega-3 and perhaps different types of vitamins.
Therefore, brands that are marketing types of healthy food products in China that are related to omega-3, should work on the education part of their marketing. So, their messages can show why it’s important to have omega-3 in your diet, how it impacts the body, and what exactly it is.
According to Chinese consumers, what are some examples of unhealthy and healthy food in China?
When it comes to what specific food Chinese respondents said was healthy, what surprised me was that only 62% of Chinese said that salads were healthy. However, 96% said that fruit is healthy and 80% said that nuts are healthy. This could be related to the TCM belief that foods are better eaten when they’re warm and/or cooked; but we will return to that topic later.
Given that salads are both raw and cold, this could have contributed to people believing that they are not as good for the body.
What else is interesting is that in a country with a high rate of lactose intolerance, milk was considered to be a healthy food in China by 92% of the people surveyed.
The nut milk market is undergoing tremendous growth; especially new healthy food products in China like oat milk. However, only 73% believe that nut milks are healthy, which is less than cow’s milk.
Also in the dairy category, 69% said that yogurt products are healthy.
When it comes to more convenient, healthy food in China, snacks like nuts are always the top choice. 80% of respondents said that nuts are healthy.
We also asked whether a variety of foods were unhealthy. The top five categories for unhealthy food in China were fried food, street food, cured meat, cookies, and granola bars. When it comes to snacking in China, the most reached for and healthiest choice is going to be foods like nuts. Granola bars are not considered to be healthy, perhaps because they’re a little bit more processed and have sugars in them.
Health perceptions in China and the importance assigned to each meal
One trend taking the globe by storm is intermittent fasting, which often requires skipping meals. We were curious to find out about Chinese perceptions on the importance of each meal. First, to see whether this trend is feasible in China. But secondly, to see if it were to become a trend in China, when would people be fasting? During breakfast, lunch, or during dinner?
In Chinese, there’s a saying “Eat breakfast like a king, lunch like a prince, and dinner like a pauper” (白天吃的像皇帝，夜晚吃得像贫民). So, it’s not surprising that nearly 64% of respondents said that breakfast is the most important meal for your health; while 30% said lunch was and only 4% said that dinner was. However, when asked which meal you eat the most often and in the highest quantity, over half of respondents said that they ate a big lunch the most often. Only 6% said that they ate breakfast the most often and in the highest quantity.
Also, when asked which meals you often miss due to being too busy, meaning involuntarily missing meals and not including fasting, 63% of respondents said breakfast. And a quarter of respondents said that they actually don’t ever miss meals. The least missed meal surprisingly was lunch despite the busy workdays in China. So, obviously, there’s not much correlation between the ideologies of what constitutes a healthy dietary regimen in China and the actual practice of maintaining a healthy diet. Breakfast is the most skipped meal. It is also eaten the least abundantly but most people believe it is the most important to your health. This presents opportunities for brands to fill in the gap and provide convenient and healthy breakfast food in China.
Modern Chinese beliefs towards Traditional Chinese Medicine and food and what influence TCM has on the diet of Chinese consumers
One of the core beliefs of many Chinese people is that food is medicine and medicine is food. Because traditional Chinese medicine is heavily influenced by food including the balance of hot and cold foods; and includes the use of different herbal remedies. We asked a lot about beliefs on traditional Chinese medicine to see if it’s just a tradition or if it’s still being practiced.
One of the common topics in TCM and food is the belief that hot food is healthier than cold food. Earlier we mentioned that salads are only considered healthy by around 60% of people; and what we found is that 36% believe that hot food is indeed healthier than cold food. However, around half of the respondents were neutral on this topic. 12% of respondents believe there’s not a correlation between the heat of the food and the health level.
On a similar note, we also asked if cooked food is healthier than raw food. One practice in China is that vegetables are often cooked very thoroughly and it’s not common to find raw vegetables in meals. This is very different from the health standards of the west, which is more likely to follow raw food diets. 65% believe that cooked food is indeed healthier than raw food while 28% were neutral on the topic.
As previously mentioned, one of the core beliefs of TCM is that yin is more cold, cool, and damp while yang is bright, hot, and sunny. A lot of Chinese believe that food also has yin and yang qualities. Although it’s often said as 上火 and 败火/去火. 上火 (shanghuo) is bringing heat to the body and 败火/去火 (baihuo/quhuo) is kind of removing heat. So, shanghuo is yang while baihuo/ quhuo is yin. 60% said that yin and yang is important in the diet, while 32% said it’s neutral. Lastly, we asked if they believe in traditional Chinese medicine and if it’s used in their daily life. Half said yes, almost 40% were neutral, and only 11% said no. So, it seems even among young city dwellers, TCM is still very important in the Chinese diet.
How COVID-19 impacted the daily routine and eating habits of Chinese consumers
We’ve seen a lot of research that shows that habits really changed during the Covid-19 pandemic. And we even saw sales for certain kinds of fresh foods rise. One thing that really set China apart during the pandemic was that Chinese people actually bought more fresh produce, while their western counterparts bought more processed food and snack food. Another interesting trend was that when it came to snacks, meal replacement products, and heartier snacks like beef jerky, or other meat snacks actually rose in sales.
So we asked about the impact of Covid-19 on eating habits, daily routine, and health awareness in China. However, what we found was not as significant as expected. Most reported no change in their habits but the food did report changes so when it comes to the daily routine. 70% of respondents said that they had no change. 20% even said that they had gotten less healthy when it comes to eating habits. Only 11% of respondents said that they got healthier, while 81% said that there was no change. As for health awareness in China, 43% said that they have higher health awareness now. However, 55% said that there was really no change, so the impact of Covid-19 was actually rather neutral.
Prevalence of the Keto diet and meal replacements in China
We decided to ask about two diets, meal replacement and the ketogenic diet. Meal replacement has been trending on Chinese social media like Xiaohongshu, especially since the coronavirus. Since meal replacement seems to be trending in China, we wanted to test to see if people have really heard of it, or if social media has made it seem like a bigger trend than it really is. It seems over 90% of our respondents have heard of meal replacement. However, of the ones who have heard of meal replacement, only 42% believe that it’s healthy. Surprisingly, 44% have actually tried it which is significantly high; but it seems out of those who have tried it or have heard of it, belief in the actual effectiveness of it is quite low. Only 13% believe it is or would be effective.
On the other hand, we also asked about the keto diet. The keto diet in China is not as well-known as it would be in the West. Essentially, the keto diet is a high-fat, low-carb diet. However, from our earlier research, we found that the Chinese perceive carbs to be healthier than fat which goes against the principles of this diet which is high fat, low carbs. The science behind this diet is that when somebody eats a very high-fat diet, their body will resort to burning fat instead of carbs, this is called ketosis. It’s really popular among those who desire to lose weight and it is often paired with intermittent fasting.
We wanted to see whether this is trending in China as well, but we found that less than half, or 46% of respondents had actually heard of the diet. Out of the 341 respondents that actually have heard of the keto diet, only 18% have ever tried it; and 41% said that they believe that it is or would be effective. Comparing the two diet trends, it’s certainly clear that meal replacement is more popular. Actually, out of those who have heard of the diets, the keto diet enjoyed a relatively positive perception with 41% believing that it is or would be effective, while only 13% believe that meal replacement is or would be effective.
How Chinese evaluate their own health, and complexes around body weight
Lastly, we also asked our respondents to evaluate their own health habits. To be clear, a self-evaluation does not indicate their actual health level. That would require going to a doctor, calculating their BMI, and seeing how they eat. Rather, it shows whether they want to improve, or it shows their desire to improve. We asked about the daily routine, eating habits, and health awareness in China.
It seems most people believe they have a high level of health awareness in China; but the confidence in their health awareness does not necessarily correlate to more confidence in their eating habits and daily routine. Most Chinese believe that their eating habits are relatively neutral. However, when it comes to their daily routine, around 38% believe that they have a poor daily routine.
According to a government report in 2020, more than half of Chinese people were overweight, as such, weight loss is increasingly a concern in China. When it comes to weight loss, we decided to look at each gender. Despite the fact that around half of the population is overweight, 75% of women believe that they need to lose weight. 70% of men say they need to lose weight, averaging out at about 73% of respondents. This tells us that weight loss is a very important driver in the health and wellness market in China. This market is also expected to grow as the rate of obesity also increases.
Takeaways for brands marketing in the health and wellness market in China
So, the final takeaways that brands should know about the wellness and health and wellness market in China are as follows.
Firstly, education is key. From the survey, we can see that many Chinese are not aware of certain nutrients (such as omega-3 fatty acids), or they might even have misunderstandings (such as seeing trans-fats as being healthy). Therefore, it is important for health brands to communicate to consumers why their products are healthy, what nutrients are in it, and what the nutrients’ purpose is. This can be done through live streaming, which is often used for demonstrations for healthy food products in China, and to educate consumers about the contents of the product.
Secondly, convenience is important for young, busy consumers. Most Chinese believe that breakfast is the most important meal, yet skip it due to being too busy. As a result, videos and blogs about easy-to-prepare meals are going viral. Brands can tap into this by making their healthy food products in China more convenient, or marketing them through videos, such as, how to cook quick meals with the products.
In addition to convenience, flavour was the top criteria when it comes to choosing both snacks and drinks. So, it’s important not to sacrifice flavour. What’s going to be key in the health and wellness market in China is integrating the product with TCM. Brands need to understand the influential role that TCM plays in health perceptions in China and how it impacts opinions on healthy food products in China. For example, raw vegetables are not perceived to be as healthy as cooked vegetables. It leaves little room for diets like the paleo-diet which is centered around raw vegetables. Food temperature is also pretty important to some Chinese. A product that is meant to be served hot like a soup may do better than something that’s meant to be served cold like a salad.
Also, it’s worth studying up on the common herbs used in TCM to understand their effects and how they’re commonly perceived among Chinese people. Many Chinese consumers prefer natural ingredients to processed food. Hence a lot of western snacks like granola bars are perceived to be very unhealthy; whereas in the west, they’re often marketed as a healthy food in China.
To summarize our survey results, we’re very optimistic about the increasing level of health awareness in China. A report by Boston Consulting Group estimates the health and wellness market in China is worth around 70 billion us dollars in 2020.
To learn more about our survey and health perceptions in China you can check out the results on our blog at health-perceptions.