The use of food swaps to encourage healthier online food choices: a randomized controlled trial

Online retail nudges to help parents with lower-income choose healthy beverages for their children: A randomized clinical trial

BACKGROUND

Nudges offer a promising tool to reduce sugary drink intake among children who are most at risk for diet-related disease.

OBJECTIVE

To examine the impact of online store nudges on purchases of sugary drinks for children in lower-income households.

METHODS

Caregivers with lower-income were recruited to an online shopping experiment and instructed to spend $10-$30 on three beverages for their child aged 1-5 years. Participants were randomized to navigate an online supermarket in its standard version (n = 1106) or a version with nudges (n = 1135), including a product placement nudge (i.e. placing healthy beverages in prominent positions) and a swap nudge (i.e. offering a swap of water, plain milk and/or 100% fruit juice upon selection of sugary drinks).

RESULTS

On average, participants purchased 1887 (SD = 2113) and 620 (SD = 1528) calories from sugary drinks per basket in the control and experimental conditions, respectively. Model-based results indicate that those in the experimental condition purchased 1267 (95% CI: 1419, 1114) fewer calories from sugary drinks, and fewer grams of total sugar (β = -253.5 g (95% CI: -286.3, -220.6)) and added sugar (β = -287.8 g (95% CI: -323.1, -252.5)) purchased from sugary drinks.

CONCLUSION

Nudges may be an effective, acceptable, scalable strategy for leading caregivers in lower-income households to purchase fewer sugary drinks for their children.

Impact of food swap recommendations on dietary choices in an online supermarket: A randomized controlled trial

One novel strategy to shift food choices in digital shopping environments is to automatically recommend healthier alternatives when an unhealthy choice is made. However, this raises the question which alternative products to recommend. This study assesses 1) whether healthier food swap recommendations are effective, even though the unhealthy choice was made in the presence of visible FOP nutrition labels, and 2) how the similarity of the alternatives influences the acceptance of food swap recommendations. Based on a pre-test, similarity of the recommendation was operationalized in terms of animal-based versus plant-based options. A randomized controlled trial (healthy food swap recommendation conditions: none, similar animal-based, dissimilar plant-based, or mixed animal- and plant-based) with 428 Dutch participants was conducted in a simulated online supermarket. Additional healthier food swap recommendations improved the nutritional quality of the final basket compared to only providing Nutri-Score nutrition labels (-1.7 mean FSA score, p < .001, medium Cohen's d = -0.48). Compared to the dissimilar condition, acceptance of an alternative was more likely in the mixed (odds-ratio = 2.78, p = .015) and in the similar condition (odds-ratio = 2.24, p = .048), but the nutritional quality of the final basket did not differ between treatment conditions. Individuals in treatment conditions who did not receive any recommendation (i.e. only made healthy choices) had higher Nutri-Score familiarity and general health interest than individuals who received recommendations. This suggests that for individuals with higher knowledge and motivation FOP nutrition labels were sufficient, whereas for individuals with lower knowledge and motivation additional food swap recommendations can improve dietary choices. Food swap recommendations may act as meaningful reminders by disrupting the automatic choice process and triggering individuals to rethink their (unhealthy) choice.

Simple dietary substitutions can reduce carbon footprints and improve dietary quality across diverse segments of the US population

Changing what foods we eat could reduce environmental harms and improve human health, but sweeping dietary change is challenging. We used dietary intake data from a nationally representative sample of 7,753 US children and adults to identify simple, actionable dietary substitutions from higher- to lower-carbon foods (for example, substituting chicken for beef in mixed dishes such as burritos, but making no other changes to the diet). We simulated the potential impact of these substitutions on dietary carbon emissions and dietary quality. If all consumers who ate the high-carbon foods instead consumed a lower-carbon substitute, the total dietary carbon footprint in the United States would be reduced by more than 35%. Moreover, if adopted, these substitutions would improve consumers' overall dietary quality by 4-10%, with benefits projected for all age, gender, and racial and ethnic groups. These results suggest that a 'small changes' approach could be a valuable starting point for addressing diet's impact on climate and health.

The impact of calorie labelling and proportional pricing on out of home food orders: a randomised controlled trial study using a virtual food and drink delivery app

BACKGROUND

Mandatory calorie labelling in the out-of-home food sector was introduced in England in 2022, and menu pricing strategies that ensure cost is equivalent to portion size (proportional pricing) have been proposed as a policy to reduce obesity. Food delivery app-based platforms now contribute significantly to diet, and evidence suggests that those at a socioeconomic disadvantage may have greater exposure to unhealthy options on these platforms. However, public health policies to improve nutritional quality of food ordered from food delivery apps has received limited examination.

OBJECTIVE

This experimental study assessed the impact of calorie labelling and proportional pricing on item and meal size selection, calories ordered, and money spent when selecting food and drinks from three outlet types on a virtual delivery app.

METHODS

UK adult participants (N = 1126, 49% female), stratified by gender and education level completed an online study where they ordered items from three branded food and beverage outlets (coffee shop, sandwich outlet, fast food outlet) using a virtual delivery app. Participants were presented food and beverage options with vs. without calorie labels and with value (larger portions are proportionally cheaper) vs. proportional pricing.

RESULTS

Calorie labelling did not influence portion size selection for any outlets, but significantly reduced calories ordered from the coffee shop (-18.95kcals, 95% CI -33.07 to -4.84) and fast food outlet (-54.19kcals, 95% CI -86.04 to -22.33). Proportional pricing reduced the likelihood of choosing a larger beverage from the coffee shop (OR = 0.58, 95% CI 0.45 to 0.75), but was associated with increased calories ordered from the fast food outlet (51.25kcals, 95% CI 19.59 to 82.90). No consistent interactions were observed with participant characteristics, suggesting that effects of calorie labelling and pricing on outcomes were similar across sociodemographic groups.

CONCLUSIONS

Calorie labelling on food delivery platforms may effectively reduce calories ordered. Proportional pricing may be useful in prompting consumers to select smaller portion sizes, although further research in real-world settings will now be valuable.

Exploring the role of decision support systems in promoting healthier and more sustainable online food shopping: A card sorting study

This study aims to identify opportunities and barriers in developing and implementing Food Shopping Support Systems (FSSS) for healthier and more sustainable choices, given the growing consumer demand and persistent societal problems related to food. The study examined the social and technical value of FSSS in an early development stage through one-on-one expert interviews (n = 20) and consumer focus groups (4 groups, n = 19). Experts were employed in the fields of behavioral sciences, digital marketing, decision aids, software development, persuasive technologies, and public health and sustainability. Consumer participants were used to shopping online. Through a card sorting task followed by semi-structured interview questions, responses were elicited. Participants were presented with 17 cards in 5 rounds, each addressing a different topic related to decision support. Results show that support is perceived useful, particularly when suggestions are personalized, transparent, and justified (using labelling or informative text). Opportunities for uptake were presenting suggestions early in the shopping trip in a visible but non-disruptive manner, allowing autonomy to choose the type of guidance (e.g., show sustainable but not healthier suggestions) and to (not) provide personal data, and educating consumers. Negative attitudes were associated with support being disruptive or steering, being of low credibility, and unclarity about what is healthy or sustainable. Consumer participants expressed concerns about too generic suggestions in relation to health and lack of knowledge about labelling. They emphasized that excessive support and required effort, such as repeatedly providing data, can be burdensome. Experts also worried about limited consumer interest and not having the required data to provide support. Results from this study reveal the potential for successful digital interventions to encourage healthier and more sustainable choices and what this means for further development.

Planning engagement with web resources to improve diet quality and break up sedentary time for home-working employees: A mixed methods study

As home working becomes more common, employers may struggle to provide health promotion interventions that can successfully bridge the gap between employees' intentions to engage in healthier behaviors and actual action. Based on past evidence that action planning can successfully encourage the adoption of healthier behaviors, this mixed-methods study of a web-based self-help intervention incorporated a randomized planning trial that included quantitative measures of engagement and follow-up qualitative interviews with a subsample of participants. Participants either (a) selected a movement plan for incorporating a series of 2-min exercise videos into their work week to break up sedentary time and a balanced meal plan with recipe cards for a week's lunches and dinners or (b) received access to these resources without a plan. Selecting a movement plan was more effective at increasing engagement with the web resources compared to the no-plan condition. In the follow-up interviews, participants indicated that the plan helped to remind participants to engage with the resources and made it simpler for them to follow the guidance for exercises and meals. Ease of use and being able to fit exercises and meals around work tasks were key factors that facilitated uptake of the resources, while lack of time and worries about how colleagues would perceive them taking breaks to use the resources were barriers to uptake. Participants' self-efficacy was associated with general resource use but not plan adherence. Overall, including plans with online self-help resources could enhance their uptake. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Little Bird Told Me… Nutri-Score Panoramas from a Flight over Europe, Connecting Science and Society

Within the Farm to Fork Strategy, the European Commission ask for a unified Front Of Pack nutritional label for food to be used at the European level. The scientific debate identified the Nutri-Score (NS) as the most promising candidate, but within the political discussion, some Member States brought to attention several issues related to its introduction. This misalignment led to a postponement of the final decision. With the aim to shed some light on the current stances and contribute to the forthcoming debate, the objective of the present work is to understand to what extent scientific research addresses the issues raised by the general public. We applied a structural topic model to tweets from four European countries (France, Germany, Italy, Spain) and to abstracts of scientific papers, all dealing with the NS topic. Different aspects of the NS debate are discussed in different countries, but scientific research, while addressing some of them (e.g., the comparison between NS and other labels), disregards others (e.g., relations between NS and traditional products). It is advisable, therefore, to widen the scope of NS research to properly address the concerns of European society and to provide policymakers with robust evidence to support their decisions.

Nutri-Score: Its Benefits and Limitations in Children's Feeding

Reducing the burden of noncommunicable diseases (NCDs) is one of the top priorities of public health policies worldwide. One of the recognized means of achieving this objective is to improve the diet quality. The Nutri-Score (N-S) is a [five-color-A, B, C, D, E letters] front-of-pack labeling logo intended to help consumers quickly identify the healthier prepackaged foods within a food category. Available studies have shown that the N-S is an efficient tool to achieve this aim in terms of consumers' awareness, perception, understanding, and purchasing and that its use may help to reduce the prevalence of NCDs. The N-S is currently implemented on a voluntary basis in 7 European countries and a discussion is underway within the European Commission to achieve a harmonized mandatory label. However, no study on the putative impact of the N-S on children's dietary patterns and health is available. The N-S is not applicable to infants' and young children's formulas and to specific baby foods, the compositions of which are already laid down in European Union regulations. The N-S does not replace age-appropriate dietary guidelines. As children consume an increasing number of adult type and processed foods, the relevance of the N-S for children should be evaluated considering the children's high specific requirements, especially in younger children. This is especially necessary for fitting fat and iron requirements, whereas protein-rich foods should be better framed. Moreover, efforts should be made to inform on how to use the N-S and in education on healthy diets.

Testing the impact of overt and covert ordering interventions on sustainable consumption choices: A randomised controlled trial

Food products have significant impacts on the environment over their life cycle. We investigated whether displaying products in ascending order of carbon footprint in an online supermarket environment can shift consumer choices towards more sustainable options. We examined whether the effect of the ordering intervention differs when the ordering is overt (information about the ordering is explicit), compared to when it is covert (participants not told about the ordering). We conducted a three-arm parallel-group randomised trial using 1842 online participants from England, Wales, and Northern Ireland. Participants shopped for a meal, choosing one product from each of six product categories in a simulated online supermarket. Six products were listed vertically on each product-category page. Products were randomly ordered for the control arm but ordered by carbon footprint in the covert and overt ordering arms. In the overt ordering arm, a statement was displayed at the top of each product page about the ordering of products. The primary outcome was whether one of the three most sustainable products was chosen in each product category. There was no effect of the covert ordering on the probability of choosing more sustainable products compared with the control arm (OR = 0.97, 95% CI 0.88-1.07, p = 0.533). Furthermore, we did not find evidence that the effects of the covert ordering and overt ordering differed (p = 0.594). Within the control condition, products in different positions were chosen with similar frequencies, suggesting that product positioning does not have an impact on choices. This may explain why re-ordering products had no effect. In the overt condition, only 19.5% of people correctly answered that the products were ordered according to sustainability in a follow-up question, suggesting that they didn't notice the statement. Results suggest that choices for grocery products might be too ingrained to be changed by subtle rearrangements of choice architecture like the ordering interventions, and highlight the difficulty of conveying information effectively to consumers in the online grocery shopping environment.

A Systematic Review of Marketing Practices Used in Online Grocery Shopping: Implications for WIC Online Ordering

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) plans to allow participants to redeem their food package benefits online, i.e., online ordering. As grocery shopping online has become more common, companies have developed strategies to market food products to customers using online (or mobile) grocery shopping platforms. There is a significant knowledge gap in how these strategies may influence WIC participants who choose to shop for WIC foods online. This review examines the relevant literature to (1) identify food marketing strategies used in online grocery shopping platforms, (2) understand how these strategies influence consumer behavior and consumer diet, and (3) consider the implications for WIC participants. A total of 1862 references were identified from a systematic database search, of which 83 were included for full-text screening and 18 were included for data extraction and evidence synthesis. The included studies provide policymakers and other stakeholders involved in developing WIC online order processes with valuable information about the factors that shape healthy food choices in the online food retail environment. Findings indicate that some marketing interventions, such as nutrition labeling and food swaps, may encourage healthier food choices in the online environment and could potentially be tailored to reinforce WIC messaging about a healthy diet.

Intervention strategies to promote healthy and sustainable food choices among parents with lower and higher socioeconomic status

BACKGROUND

A global shift towards more healthy and sustainable diets is necessary for the prevention of obesity and chronic diseases, as well as for the growing pressure on our ecosystems. Given that parents are important actors in affecting dietary behaviors of their children, developing intervention strategies targeting families and their practices is promising to reach positive behavior change among children. Also, it is important to tailor these interventions to the needs of parents with different socioeconomic statuses (SES), given that health inequalities continue to grow. This study aims to investigate perspectives of lower and higher SES parents on the usability and acceptability of various innovative intervention strategies.

METHODS

Fourteen focus groups and four individual interviews (n = 78, n_lowerSES = 17; n_higherSES = 61) were conducted in Belgium. A semi-structured interview guide was used to facilitate the discussions. The interviews were recorded, transcribed, and analyzed via thematic content analysis using NVivo.

RESULTS

To encourage healthy and sustainable food choices, interventions via online food shopping platforms and nudging strategies in grocery stores were mostly cited by higher SES parents, but these were less applicable for lower SES parents as they buy less online and mainly consider the price of products. Mobile applications that provide inspiration for healthy and sustainable recipes and easily accessible shopping lists received moderate support among lower and higher SES parents. Furthermore, both lower and higher SES parents showed interest in meal boxes delivered at home, but lower SES parents have not yet tried such meal boxes because of their higher prices. Still, both groups of SES parents mentioned many advantages of these meal boxes, such as the convenience and time-saving component, as well as the cooking inspiration aspect.

CONCLUSION

Our study reveals the preferences of lower and higher SES parents for practical intervention strategies, providing insight in what features these strategies should have to be acceptable and useful. Hence, the findings can inform the development of a tailored family-based intervention strategy to improve parental food choices in favor of increased health and sustainability.