Why Choosing Healthy Foods is Hard, and How to Help: Presenting the 4Ps Framework for Behavior Change

The association of impulsivity with effects of the ChooseWell 365 workplace nudge intervention on diet and weight

Impulsivity is associated with unhealthy food choices. Nudge interventions in the food environment may be particularly helpful for individuals with high impulsivity. To examine if trait, choice, and action impulsivity were associated with the effectiveness of a workplace-based nudge intervention to improve diet and weight. This was a planned secondary analysis of 487 participants of ChooseWell 365, a randomized controlled trial that tested a 12-month nudge intervention to improve cafeteria purchases among hospital employees. Trait impulsivity was measured with the Barratt Impulsiveness Scale. Choice and action impulsivity were assessed with delay discounting and response inhibition tasks, respectively. Tertiles were generated for each measure. Multivariable regression models examined the association of impulsivity with cafeteria purchases [Healthy Purchasing Score (HPS)] over 12 months, dietary intake [Healthy Eating Index-2015 (HEI) score], and body mass index (BMI) measured at 12 months. Interaction terms tested differences in intervention effect by level of impulsivity. Participants with higher trait (p = .02) and choice (p < .001) impulsivity had lower baseline HPS than those with lower impulsivity. Employees of all impulsivity levels increased healthy eating, but higher trait impulsivity was associated with smaller increase in HPS over 12 months (p = .03). In the highest action impulsivity tertile, 12-month BMI increased less for intervention vs. control participants (0.3 vs. 0.5 kg/m2; p-interaction = .04). There were no interaction effects for trait or choice impulsivity. A workplace nudge intervention improved food choices among employees of all impulsivity levels and attenuated weight gain in those with higher action impulsivity.

Behavioural change box? Applying the COM-B model to understand behavioural triggers that support consumption of fruits and vegetable among subscribers of a fruit and vegetable box scheme

OBJECTIVE

To understand the key mechanisms that support healthy dietary habits promoted by fruit and vegetable (F&V) box schemes, testing relevant behaviour change triggers identified under the COM-B model in an evaluation research study of a Portuguese F&V box scheme (PROVE).

DESIGN

Correlation study with a post-test-only non-equivalent group design based on survey data. The mechanisms underpinning the differences between subscribers and non-subscribers are operationalised as mediation effects. Data availability, theoretical relevance and empirical validation supported the selection and testing of four potential mediators for the effects of subscribing to the box scheme on F&V consumption. These estimations derive from the coefficients of a structural equation model combined with the product coefficient approach and Sobel test.

SETTING

The study is part of a wider evaluation study on the impact of the PROVE box scheme on sustainability, health and equity.

PARTICIPANTS

A sample of PROVE box subscribers (n 294) was compared with a matched subsample of non-subscribers (n 571) in a nationally representative survey.

RESULTS

Subscribing to the PROVE box correlates with an increased probability of eating at least five portions of F&V, irrespective of differences in age, education and perceived economic difficulties. Diet quality perceptions, and more robustly, the strength of meal habits and household availability were identified as relevant mediators.

CONCLUSIONS

The subscription to an F&V box scheme is connected with proximal context that enables the consumption of F&V by ensuring more readily available F&V and better situational conditions associated with healthier meal habits.

Five Shapes of Cognitive Dissonance - Using Objective Hermeneutics to Understand the Meat Paradox

Objective Hermeneutics is a qualitative method that focuses on few sequences of texts, which helps understand single cases. It is used to explore how consumers cope with the contradiction between their enjoyment for meat and their empathy for animals without using frameworks drafted by social scientists. Five cases are analysed, which range from strong references towards the societal norm of meat eating to a feeling of uncertainty in the face of the animals' death. None of the cases, however, sees the necessity to find a rationale for their own meat consumption. The study concludes by raising the question about the persistence of a societal consensus for meat consumption.

Early Adolescents' Food Selection After Evaluating the Healthiness of Remote Peers' Food Choices

This study investigates whether asking early adolescents to evaluate the food choices of remote peers improves their own food selection. Participants were students from fifth (N = 219, M_age  = 9.30 years) and sixth grades (N = 248, M_age  = 10.28 years) of varying nationalities living in the United Arab Emirates (race and ethnicity were not collected). Students saw peers' healthy or unhealthy food choices before picking their own food. In some conditions, students also critically evaluated the healthiness of the peers' choices. Evaluation of peer choices led to healthier decisions (d = .53) to the point that it offsets the negative impact of observing unhealthy peer choices. This effect is larger for sixth graders compared to fifth graders.

Women's perceptions of factors influencing their food shopping choices and how supermarkets can support them to make healthier choices

OBJECTIVES

To examine women's perceptions of factors that influence their food shopping choices, particularly in relation to store layout, and their views on ways that supermarkets could support healthier choices.

DESIGN

This qualitative cross-sectional study used semi-structured telephone interviews to ask participants the reasons for their choice of supermarket and factors in-store that prompted their food selections. The actions supermarkets, governments and customers could take to encourage healthier food choices were explored with women. Thematic analysis was conducted to identify key themes.

SETTING

Six supermarkets across England.

PARTICIPANTS

Twenty women customers aged 18-45 years.

RESULTS

Participants had a median age of 39.5 years (IQR: 35.1, 42.3), a median weekly grocery spend of £70 (IQR: 50, 88), and 44% had left school aged 16 years. Women reported that achieving value for money, feeling hungry, tired, or stressed, and meeting family members' food preferences influenced their food shopping choices. The physical environment was important, including product quality and variety, plus ease of accessing the store or products in-store. Many participants described how they made unintended food selections as a result of prominent placement of unhealthy products in supermarkets, even if they adopted more conscious approaches to food shopping (i.e. written or mental lists). Participants described healthy eating as a personal responsibility, but some stated that governments and supermarkets could be more supportive.

CONCLUSIONS

This study highlighted that in-store environments can undermine intentions to purchase and consume healthy foods. Creating healthier supermarket environments could reduce the burden of personal responsibility for healthy eating, by making healthier choices easier. Future research could explore the interplay of personal, societal and commercial responsibility for food choices and health status.

Certification Labels in Shaping Perception of Food Quality—Insights from Polish and Belgian Urban Consumers

Food quality is considered to be one of the most important determinants of food choice. Given the variety of food products and the overflow of information in the market, certification labels are intended to encourage consumers to select healthier and more sustainable product options. This study focuses on how urban consumers from Poland and Belgium perceive food quality and whether certification labels shape their views on it. Research material was collected using quantitative (Paper and Pencil Interviews (PAPI)) and qualitative (focus groups (FGs)) methods. The survey was conducted among people visiting sustainable food fairs, on a sample of 701 adults in the cities of Warsaw, Brussels and Ghent. This study confirms that consumers are interested in food quality when choosing food, but their perception varies depending on the place of residence and other socio-demographic characteristics (age, income, education, household structure). Certificates were important for consumers if their message clearly signals exceptional quality and is consistent with awareness of sustainability challenges. Consumers from Belgium (a country with a long-established market economy) reveal deeper knowledge and a more favourable approach to certification labels than Poles. The role of labelling in shaping consumers’ perceptions of food quality depends on their awareness, experience and understanding of sustainability issues. This, in turn, is determined by the cultural environment of consumers, which in the case of our study was the country of residence.

COVID-19 Drives Consumer Behaviour and Agro-Food Markets towards Healthier and More Sustainable Patterns

This study examines the extant state of research into our understanding of the impact of the coronavirus pandemic in its early stages on food-purchasing behaviour. As such, it includes a summary and categorisation of the findings, extending to consumption preferences worldwide. After the indiscriminate stockpiling of food, which was witnessed in many countries following the implementation of the lockdown, the impact of COVID-19 (COronaVIrus Disease-2019) on consumer habits has inversely varied in function of personal attitudes, individual and household experiences, and characteristics. Specific contexts, and the financial, economic, and logistic nature of these contexts, have also been found to be of relevance in examining the research relating to the coronavirus pandemic and food-purchasing behaviour. Concurrent with the pandemic, some worldwide trends have emerged—home cooking has been rediscovered, leading to an increase in the demand for staple foodstuffs, and purchases from small, local retailers and online food shopping have been accorded preferential treatment. Despite price volatility and concern about future household incomes, a significant proportion of consumers have shifted to buying healthier, more sustainable food. Moreover, food wastage has seen a notable decrease in volume. Such an occasion should be strategically exploited by manufacturers and retailers in satisfying this consumer demand. Finally, the COVID-19 crisis would seem to offer an unparalleled opportunity to re-engineer the agro-food market by driving the transition toward more sustainable supply and production patterns. Thus, stronger and more equitable partnerships between farmers, manufacturers, retailers, and citizens may be in the process of being forged.

Lifestyle Intervention Enabled by Mobile Technology on Weight Loss in Patients With Nonalcoholic Fatty Liver Disease: Randomized Controlled Trial

Background

The prevalence of nonalcoholic fatty liver disease (NAFLD) reaches up to 30% in the Asian adult population, with a higher prevalence in obese patients. Weight reduction is typically recommended for patients at high risk or diagnosed with NAFLD, but is a challenge to achieve.

Objective

We aimed to evaluate the effect of a lifestyle intervention with a mobile app on weight loss in NAFLD patients.

Methods

This prospective randomized controlled trial included 108 adults with NAFLD confirmed by steatosis on ultrasound and a body mass index ≥23 kg/m² who were recruited from a fatty liver outpatient clinic. The patients were randomly allocated to either a control group (n=53) receiving standard care, consisting of dietary and lifestyle advice by a trained nurse, or an intervention group (n=55) utilizing the Nutritionist Buddy (nBuddy) mobile app in addition to receiving dietary and lifestyle advice by a dietitian. Body weight, alanine aminotransferase (ALT), aspartate aminotransferase (AST), waist circumference, and blood pressure were measured at baseline, and then at 3 and 6 months. Intention-to-treat and per-protocol analyses were used for statistical comparisons.

Results

The intervention group had a 5-fold higher likelihood (relative risk 5.2, P=.003, 95% CI 1.8-15.4) of achieving ≥5% weight loss compared to the control group at 6 months. The intervention group also showed greater reductions in weight (mean 3.2, SD 4.1 kg vs mean 0.5, SD 2.9 kg; P<.001), waist circumference (mean 2.9, SD 5.0 cm vs mean –0.7, SD 4.4 cm; P<.001), systolic blood pressure (mean 12.4, SD 14.8 mmHg vs mean 2.4, SD 12.4 mmHg; P=.003), diastolic blood pressure (mean 6.8, SD 8.9 mmHg vs mean –0.9, SD 10.0 mmHg; P=.001), ALT (mean 33.5, SD 40.4 IU/L vs mean 11.5, SD 35.2 IU/L; P=.004), and AST (mean 17.4, SD 27.5 U/L vs mean 7.4, SD 17.6 IU/L, P=.03) at 6 months.

Conclusions

Lifestyle intervention enabled by a mobile app can be effective in improving anthropometric indices and liver enzymes in patients with NAFLD. This treatment modality has the potential to be extended to a larger population scale.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12617001001381; https://tinyurl.com/w9xnfmp

Traffic-light labels and financial incentives to reduce sugar-sweetened beverage purchases by low-income Latino families: a randomized controlled trial

OBJECTIVE

The objective of the present study was to test the effectiveness of financial incentives and traffic-light labels to reduce purchases of sugar-sweetened beverages in a community supermarket.

DESIGN

In this randomized controlled trial, after a 2-month baseline period (February-March 2014), in-store traffic-light labels were posted to indicate healthy (green), less healthy (yellow) or unhealthy (red) beverages. During the subsequent five months (April-August 2014), participants in the intervention arm were eligible to earn a $US 25 in-store gift card each month they refrained from purchasing red-labelled beverages.

SETTING

Urban supermarket in Chelsea, MA, USA, a low-income Latino community.

SUBJECTS

Participants were customers of this supermarket who had at least one child living at home. A total of 148 customers (n 77 in the intervention group and n 71 in the control group) were included in the final analyses.

RESULTS

Outcomes were monthly in-store purchases tracked using a store loyalty card and self-reported consumption of red-labelled beverages. Compared with control participants, the proportion of intervention participants who purchased any red-labelled beverages decreased by 9 % more per month (P=0·002). More intervention than control participants reduced their consumption of red-labelled beverages (-23 % v. -2 % for consuming ≥1 red beverage/week, P=0·01).

CONCLUSIONS

Overall, financial incentives paired with in-store traffic-light labels modestly reduced purchase and consumption of sugar-sweetened beverages by customers of a community supermarket.

The climatic impact of food consumption in a representative sample of Irish adults and implications for food and nutrition policy

Objective

To evaluate the greenhouse gas emissions (GHGE) associated with the diet of Irish adults.

Design

GHGE were estimated by applying conversion factors to habitual food consumption data taken from the National Adult Nutrition Survey, which was representative of the population. Descriptive analyses were undertaken for GHGE for the total population, as well as accounting for energy misreporting and across categories of sociodemographic and socio-economic factors and tertiles of emissions.

Setting

Republic of Ireland.

Subjects

Adults aged 18–87 years (n1500).

Results

The GHGE derived from daily dietary intakes was estimated as 6·5 kg of CO2equivalents (CO2eq) per person. Males, younger consumers, those with secondary education and student employment status were associated with significantly higher GHGE. Red meat was the highest contributor to GHGE with 1646 g CO2eq arising from a mean intake of 47 g/d. Dairy and starchy staples were the next largest dietary GHGE sources, with mean daily emissions of 732 g CO2eq and 647 g CO2eq, respectively. The lowest emissions were associated with consumption of vegetables, fruits and legumes/pulses/nuts.

Conclusions

Based on profiling using actual food consumption data, it is evident that one single measure is not sufficient and a range of evidence-based mitigation measures with potential to lower emissions throughout the food chain should be considered. The research contributes towards an improved understanding of the climatic impact of the dietary intakes of Irish adults and can serve to inform a sustainability framework to guide action in food and nutrition policy development.

Features in Grocery Stores that Motivate Shoppers to Buy Healthier Foods, ConsumerStyles 2014

We examined nine features in grocery stores shoppers reported motivated them to purchase more healthful foods in the past month. Features were compiled from common supermarket practices for each of the 4 Ps of marketing: pricing, placement, promotion, and product. We examined percentages of the features overall and by shopping frequency using Chi square tests from a 2014 cross sectional web-based health attitudes and behaviors survey, ConsumerStyles. The survey was fielded from June to July in 2014. Participants were part of a market research consumer panel that were randomly recruited by probability-based sampling using address-based sampling methods to achieve a sample representative of the U.S.

POPULATION

Data from 4242 adults ages 18 and older were analyzed. About 44 % of respondents indicated at least one feature motivated them to purchase more healthful foods. Top choices included in-store coupons or specials (20.1 %), availability of convenient, ready-to-eat more healthful foods (18.8 %), product labels or advertising on packages (15.2 %), and labels or signs on shelves that highlighted more healthful options (14.6 %). Frequent shoppers reported being motivated to purchase more healthful foods by in-store tastings/recipe demonstrations and coupons/specials more often than infrequent shoppers. Enhancing the visibility and appeal of more healthful food items in grocery stores may help improve dietary choices in some populations but additional research is needed to identify the most effective strategies for interventions.