Nudging towards sustainable dining: Exploring menu nudges to promote vegetarian meal choices in restaurants

Food choice behavior plays a large role in achieving sustainability goals. Meat in particular has a negative environmental impact as compared with plant-based food - and is more frequently chosen in restaurant contexts. To increase plant-based meal choices in restaurants, we tested three nudges for menus that are likely to be implemented by restaurant owners: a hedonic label (e.g., artisanal vegetable burger), a chef's recommendation (specifying the vegetarian option as the chef's favorite), and a salience nudge (a box around the vegetarian option). In an online experiment, we showed participants (n = 513) in four conditions (no nudge, hedonic label, chef's recommendation, and salience nudge) five menus with four meal options each, one of which was vegetarian. We asked participants to choose a meal and subsequently to rate these meals on how tasty and indulgent they were (taste and indulgence attributions). We then revealed which nudge was used to the participants and asked how participants received it. Results show that the hedonic label and chef's recommendation nudge (but not the salience nudge) both increase vegetarian meal choices. The hedonic label increased participants' attributions of indulgence of the meal, but not of tastiness. This finding fits with restaurants' gastronomic, pleasure-seeking context and shapes future directions of labeling interventions, namely that indulgence attributions can be increased in vegetarian foods. Furthermore, the nudges were generally well accepted and participants' intention to return to the (virtual) restaurant was high. Finally, customers expected the hedonic label nudge to be more effective in promoting vegetarian food choices than the other two nudges, partially corresponding with our findings of actual effectiveness.

Real-world nudging, pricing, and mobile physical activity coaching was insufficient to improve lifestyle behaviours and cardiometabolic health: the Supreme Nudge parallel cluster-randomised controlled supermarket trial

BACKGROUND

Context-specific interventions may contribute to sustained behaviour change and improved health outcomes. We evaluated the real-world effects of supermarket nudging and pricing strategies and mobile physical activity coaching on diet quality, food-purchasing behaviour, walking behaviour, and cardiometabolic risk markers.

METHODS

This parallel cluster-randomised controlled trial included supermarkets in socially disadvantaged neighbourhoods across the Netherlands with regular shoppers aged 30-80 years. Supermarkets were randomised to receive co-created nudging and pricing strategies promoting healthier purchasing (N = 6) or not (N = 6). Nudges targeted 9% of supermarket products and pricing strategies 3%. Subsequently, participants were individually randomised to a control (step counter app) or intervention arm (step counter and mobile coaching app) to promote walking. The primary outcome was the average change in diet quality (low (0) to high (150)) over all follow-up time points measured with a validated 40-item food frequency questionnaire at baseline and 3, 6, and 12 months. Secondary outcomes included healthier food purchasing (loyalty card-derived), daily step count (step counter app), cardiometabolic risk markers (lipid profile and HbA1c via finger prick, and waist circumference via measuring tape), and supermarket customer satisfaction (questionnaire-based: very unsatisfied (1) to very satisfied (7)), evaluated using linear mixed-models. Healthy supermarket sales (an exploratory outcome) were analysed via controlled interrupted time series analyses.

RESULTS

Of 361 participants (162 intervention, 199 control), 73% were female, the average age was 58 (SD 11) years, and 42% were highly educated. Compared to the control arm, the intervention arm showed no statistically significant average changes over time in diet quality (β - 1.1 (95% CI - 3.8 to 1.7)), percentage healthy purchasing (β 0.7 ( - 2.7 to 4.0)), step count (β - 124.0 (- 723.1 to 475.1), or any of the cardiometabolic risk markers. Participants in the intervention arm scored 0.3 points (0.1 to 0.5) higher on customer satisfaction on average over time. Supermarket-level sales were unaffected (β - 0.0 (- 0.0 to 0.0)).

CONCLUSIONS

Co-created nudging and pricing strategies that predominantly targeted healthy products via nudges were unable to increase healthier food purchases and intake nor improve cardiometabolic health. The mobile coaching intervention did not affect step count. Governmental policy measures are needed to ensure more impactful supermarket modifications that promote healthier purchases.

TRIAL REGISTRATION

Dutch Trial Register ID NL7064, 30 May 2018, https://www.onderzoekmetmensen.nl/en/trial/20990.

Mental models of the protein shift: Exploring consumers' perceptions of the transition

The protein transition is one of today's major societal challenges to mitigate climate change. To support lasting consumer engagement, it has been suggested to look into consumers' understanding of the protein transition to identify barriers that go beyond the practical issues of changing one's diet. The current study explored consumers' mental models of how the transition unfolds to examine which factors consumers perceive as important drivers of the transition. With a fixed set of factors and actors identified with a questionnaire, Dutch consumers (N = 214) mapped their mental models. The content and structure of the mental models were analyzed with a focus on how consumers perceive their own role. Animal well-being and environmental concerns were most often included as important drivers. The findings showed a lack of consensus about which actor(s) drive the transition (i.e., none of the actors were included by a majority of the participants). This diffusion of responsibility may be a barrier for consumers to act. Moreover, the relative simplicity of the observed mental models suggests that consumers do not yet employ systems thinking. A systems thinking mindset may help consumers understand how the system behind the transition works and how their individual contributions matter. Two avenues to encourage consumer engagement were identified: 1) emphasizing the responsibility of different actors and what consumers can contribute, and 2) encouraging a systems thinking mindset.

Personal values, motives, and healthy and sustainable food choices: Examining differences between home meals and restaurant meals

People are increasingly eating out in restaurants, where meals tend to be higher in calories, less nutritious, and contain more meat. In this paper, we argue that differences in the motivational processes underlying people's food choices could help to explain why food choices made in restaurants are typically unhealthier and less sustainable than at home. Using online survey data from 301 Dutch participants, we compared the influence of stable personal values and transient food choice motives on the healthiness and sustainability of meals chosen in a hypothetical choice task, which was geared to the home and restaurant consumption contexts. As expected, participants opted for unhealthy and meat-based meals more often in the restaurant than the home context. Conservation values related negatively and self-transcendence values positively to choosing sustainable meals both in the home and in the restaurant context, although the relation with self-transcendence values was significantly weaker in the restaurant context. Also, taste and social eating were considered more important for choosing restaurant meals, while health was a more important motive for food choices at home. Finally, model comparisons revealed that motives were better predictors of healthy meal choices in both contexts, while the influence of values and motives on sustainable meal choices was more similar. In conclusion, the results from the present study enhance our understanding of differences between choosing home and restaurant meals by providing an account of the values and motives associated with the healthiness and sustainability of home and restaurant meal choices.

Understanding public support for COVID-19 pandemic mitigation measures over time: Does it wear out?

Background

COVID-19 mitigation measures intend to protect public health, but their adverse psychological, social, and economic effects weaken public support. Less favorable trade-offs may especially weaken support for more restrictive measures. Support for mitigation measures may also differ between population subgroups who experience different benefits and costs, and decrease over time, a phenomenon termed "pandemic fatigue."

Methods

We examined self-reported support for COVID-19 mitigation measures in the Netherlands over 12 consecutives waves of data collection between April 2020 and May 2021 in an open population cohort study. Participants were recruited through community panels of the 25 regional public health services, and through links to the online surveys advertised on social media. The 54,010 unique participants in the cohort study on average participated in 4 waves of data collection. Most participants were female (65%), middle-aged [57% (40-69 years)], highly educated (57%), not living alone (84%), residing in an urban area (60%), and born in the Netherlands (95%).

Results

COVID-19 mitigation measures implemented in the Netherlands remained generally well-supported over time [all scores >3 on 5-point scale ranging 1 (low)-5 (high)]. During the whole period studied, support was highest for personal hygiene measures, quarantine and wearing face masks, high but somewhat lower for not shaking hands, testing and self-isolation, and restricting social contacts, and lowest for limiting visitors at home, and not traveling abroad. Women and higher educated people were more supportive of some mitigation measures than men and lower educated people. Older people were more supportive of more restrictive measures than younger people, and support for more socially restrictive measures decreased most over time in higher educated people or in younger people.

Conclusions

This study found no support for pandemic fatigue in terms of a gradual decline in support for all mitigation measures in the first year of the pandemic. Rather, findings suggest that support for mitigation measures reflects a balancing of benefits and cost, which may change over time, and differ between measures and population subgroups.

Make it a habit: how habit strength, goal importance and self-control predict hand washing behaviour over time during the COVID-19 pandemic

OBJECTIVE

Hand washing has been at the core of recommendations and guidelines that aim to curb infectious diseases in general, and COVID-19 in particular. As hand washing comes down to an individual's behaviour, we aimed to study how individual psychological variables influence hand washing over time during the COVID-19 pandemic.

DESIGN

Over the course of 20 weeks, participants answered questions about their hand washing behaviour, goal importance, habit strength and self-control. Participants from an experimental and a control condition completed a baseline and final measurement, and the experimental condition was invited to bi-weekly measurements through reminders.

MAIN OUTCOME MEASURE

Hand washing behaviour over the past 14 days was assessed by self-report at baseline and final measurement, and additionally repeatedly over the course of 20 weeks in the experimental condition.

RESULTS

Hand washing behaviour decreased over time, but this decrease was buffered by habit strength and goal importance. The decrease was smaller in the experimental condition that received reminders every 2 weeks.

CONCLUSION

Sending personal reminders on hand washing behaviour contributes to hand washing behaviour. Moreover, taking habit strength and goal importance, and to a lesser extent self-control into account is important when designing interventions to promote hand washing behaviour.

How do people understand the spread of COVID-19 infections? Mapping mental models of factors contributing to the pandemic

OBJECTIVE

To describe the mental models people hold about the COVID-19 pandemic, with a focus on how they understand the factors that drive the spread of COVID-19 and what kind of beliefs are associated with these models.

DESIGN

In a series of three studies (total N = 461), we asked participants to identify factors that are relevant for COVID-19 proliferation (Study 1a), rate the importance of factors (Study 1 b), and create a mental model of how these factors relate to virus spread by employing a validated tool for mental model elicitation (Study 2). Main outcome measures: inclusion and centrality of factors in mental models of COVID-19 infection spread.

RESULTS

Mitigation measures issued by government, adherence to measures, and virus characteristics were most strongly represented in participants' mental models. Participants who perceived measures as appropriate or who experienced more control and more worry over the spread of the virus created more complex models compared to participants who were less satisfied with measures or who felt lower control and less worry.

CONCLUSION

These findings suggest that people are able to create sensible mental models of virus transmission but may appreciate transparent communication to comprehend the bigger picture behind the governmental mitigation strategy.

Can we have a second helping? A preregistered direct replication study on the neurobiological mechanisms underlying self-control

Self‐control is of vital importance for human wellbeing. Hare et al. (2009) were among the first to provide empirical evidence on the neural correlates of self‐control. This seminal study profoundly impacted theory and empirical work across multiple fields. To solidify the empirical evidence supporting self‐control theory, we conducted a preregistered replication of this work. Further, we tested the robustness of the findings across analytic strategies. Participants underwent functional magnetic resonance imaging while rating 50 food items on healthiness and tastiness and making choices about food consumption. We closely replicated the original analysis pipeline and supplemented it with additional exploratory analyses to follow‐up on unexpected findings and to test the sensitivity of results to key analytical choices. Our replication data provide support for the notion that decisions are associated with a value signal in ventromedial prefrontal cortex (vmPFC), which integrates relevant choice attributes to inform a final decision. We found that vmPFC activity was correlated with goal values regardless of the amount of self‐control and it correlated with both taste and health in self‐controllers but only taste in non‐self‐controllers. We did not find strong support for the hypothesized role of left dorsolateral prefrontal cortex (dlPFC) in self‐control. The absence of statistically significant group differences in dlPFC activity during successful self‐control in our sample contrasts with the notion that dlPFC involvement is required in order to effectively integrate longer‐term goals into subjective value judgments. Exploratory analyses highlight the sensitivity of results (in terms of effect size) to the analytical strategy, for instance, concerning the approach to region‐of‐interest analysis.

Discussing overweight in dogs during a regular consultation in general practice in the Netherlands

In previous studies, it has been demonstrated that, similar to general practitioners, veterinarians find it difficult to discuss overweight in dogs. This study aimed to provide insight in the barriers and motivators for veterinarians to discuss overweight in dogs and to compare the results with findings from human medicine. Sub‐hypotheses were postulated based on existing literature to investigate if lack of time, fear of offending clients, or lack of skills were potential barriers, and if feeling responsible and feeling compassion were potential motivators for veterinarians to discuss overweight in dogs. To this end, an online survey (n = 59) was conducted. Furthermore, 15 small animal clinicians working in general practice were interviewed by semi‐structured face‐to‐face interviews. Results from the online survey indicated that veterinarians find it sometimes difficult to discuss overweight in dogs. Veterinarians who responded to the online survey did not experience strong barriers but did make use of motivators (e.g. feeling responsible and feeling compassion) when discussing overweight in dogs. Interestingly, results from the semi‐structured face‐to‐face interviews showed that the responding veterinarians did experience strong barriers, as well as motivators, when discussing overweight in dogs with their clients. The most prominent barrier was customer dissatisfaction, whereas lack of time and lack of skills were also experienced. The most prominent motivator was feeling responsible for animal health and preventive veterinary medicine. These findings were strikingly similar to previous research on discussing childhood overweight by general practitioners. To improve treatment and prevention of overweight in dogs, veterinarians need more communication skills and should be more aware of the motivators that drive their self‐motivation. Improving awareness on overweight and its comorbidities should be a One Health issue.

Evaluating the Potential Benefit of a Combined Weight Loss Program in Dogs and Their Owners

Introduction: Little has been published on the psychological bond between the owner and the pet, and how this might influence shared habits that could lead to overweight and obesity. Another factor that could improve the effectiveness of a weight loss plan, is that the owner would see the dog as a weight loss partner and therefore this could increase the motivation to follow the assigned diet and exercise guidelines.

Objective: The aim of this research was to evaluate the potential mutual effects of weight loss programs for both dogs and dog owners.

Methods: Two studies were conducted: In the human-centered trial, 60 dog owners were enrolled, who signed up to receive dietary and exercise recommendations to lose weight themselves during an 8 week period, from which 29 were randomly assigned to also get recommendations for their dog. For the dog-centered trial, we selected 13 dog owners that wanted their dog to lose weight during a 6 week period, from which 7 were randomly assigned to also get recommendations for themselves. The average weight loss over the time period was recorded. A questionnaire was used to evaluate diet and exercise habits, as well as information about the relationship between the dog and owner.

Results: The average human weight loss was 2.6% in the owner+dog group (n = 29) and 2.3% in the owner only group (n = 31; p > 0.05). Forty percent (24/60) of the dogs in the human-centered trial were overweight. The overweight dogs in the owner+dog group (n = 12/29) lost 3.7% of their body weight, compared to 1.2% in the overweight dogs from the owner only group (n = 12/31; p > 0.05). In the dog-centered trial, the 7 dogs in the dog+owner group lost 8.0% of their body weight, vs. 8.3% in the six dogs in the dog only group (p > 0.05). The owners in the dog+owner group lost 2.5% of their body weight, compared to 0.5% in the dog only group (p > 0.05). In both trials owners' perceived responsibility for both their own and their dogs' weight significantly increased. In addition, habit strength regarding unhealthy feeding and exercise behaviors in relation to the dogs decreased, and self-efficacy in relation to providing the dog with healthy food and exercise increased.

Conclusion: Active weight loss in either dog owner or dog, seemed to lead to passive weight loss in the other, especially when some tools or guidelines were provided. These findings support mutual benefits of weight loss programs for dogs and dog owners, and support future weight loss programs to be a One Health approach.

Beyond Discrete Choices - Investigating the Effectiveness of a Proximity Nudge With Multiple Alternative Options

Nudges are defined as small adjustments in the choice architecture that stimulate desirable behavior. Nudging techniques can be used as a promising policy tool, but research has hardly systematically taken into account the complexity of the situation in which nudges have been implemented. In the current studies, we investigated the effectiveness of a proximity nudge on food choice in a realistic situation with multiple options in the immediate surroundings of the target option. In two studies, we presented participants from a community sample with an assortment of either three or nine different types of chocolate. For half of the participants, the target chocolate was placed most proximally on a table. Across two studies, we demonstrated that the proximity nudge was effective in stimulating the choice for a specific piece of chocolate in a simple and more complex situation. Results were further qualified by Bayesian analyses, which revealed most support for the hypothesis that the proximity effect existed in both the conditions with three and nine options, regardless of the number of options in the choice set. Results imply that the proximity effect can remain robust in realistic situations that include multiple options in the immediate environment to choose from.

When in Doubt, Follow the Crowd? Responsiveness to Social Proof Nudges in the Absence of Clear Preferences

Nudges have gained popularity as a behavioral change tool that aims to facilitate the selection of the sensible choice option by altering the way choice options are presented. Although nudges are designed to facilitate these choices without interfering with people’s prior preferences, both the relation between individuals’ prior preferences and nudge effectiveness, as well as the notion that nudges ‘facilitate’ decision-making have received little empirical scrutiny. Two studies examine the hypothesis that a social proof nudge is particularly effective when people have no clear prior preference, either because people are indifferent (in a color-categorization task; Study 1, N = 255) or because people experience a choice conflict (making shopping decisions about meat products; Study 2, N = 97). Both studies employed a social proof nudge to steer participants’ choices. The potential facilitating effect of the nudge was tested using a mouse-tracker paradigm that implicitly assessed experienced uncertainty during decision-making. Results showed that the nudge was effective in steering participants’ decisions; the facilitation effect (i.e., reduced uncertainty regarding the decision) was only observed for conflicting preferences, but not under indifference. A better understanding of when and how nudges can influence individuals’ behavior may help in deciding whether nudges are an appropriate policy tool for changing particular undesirable behavior.

The (bitter) sweet taste of nudge effectiveness: The role of habits in a portion size nudge, a proof of concept study

Seemingly insignificant daily practices, such as sugar usage in tea, can have a great accumulated impact on societal issues, such as obesity. That is why these behaviours are often the target of nudge interventions. However, when these behaviours are performed frequently they may turn into habits that are difficult to change. The aim of the current study was to investigate whether a portion size nudge has the potential to work in accordance with (instead of against) existing habits. Specifically, it was tested whether a portion size nudge would be more effective in reducing the amount of sugar added to tea, when people have a strong habit of adding a fixed amount of teaspoons of sugar to a cup of tea. The study (N = 123) had a mixed factorial design with teaspoon size (reduced size vs. control) as a within-subject factor, and habit disruption context condition (hot tea vs. cold tea) as a between-subjects factor. A paired t-test indicated that this nudge reduced sugar intake on average by 27% within subjects. When the context allowed for automatic enactment of the habit, the effectiveness of this nudge was moderated by habit strength. Surprisingly, the nudge effect was actually less pronounced when people had a strong habit. Implications for effective nudge interventions are discussed.

Discussing overweight in children during a regular consultation in general practice: a qualitative study

Background

Overweight in children is a rising problem leading to serious consequences later in life. The Dutch guideline ‘Obesity’ for general practitioners recommends discussing obesity in children regardless of the reason of consultation and provides diagnostic and therapeutic tools. However, limited literature indicates that general practitioners experience barriers to discuss this topic. The aim of this study was to determine current perceived barriers of general practitioners in discussing overweight during a regular consultation in children aged 4 to 12 years and to what extent they discuss the topic. Furthermore, we attempt to get more insight in the specific needs and ideas for improvement among GPs.

Methods

A semi-structured in-depth interview study was conducted. Dutch general practitioners with a broad range of demographic characteristics were invited to participate. The transcripts were analysed using a modified version of the constant comparative method. Using this method, we identified perceived barriers of general practitioners.

Results

Ten general practitioners were included in the study. Four major themes were identified in the interviews: absence of physical or mental complaints related to overweight, internal barriers of the general practitioners, the child’s family background and logistics. Major barriers appeared to be a low consultation rate of these children, the sensitivity of the topic (e.g. fear for children’s or parents’ reactions and/or disturbance of the relation, influence on the self-esteem of the child, resistance in the parents), the absence of a long-standing relation between general practitioner and child or parent, the background of the child and lack of time or prioritizing.

Conclusion

Dutch general practitioners indicate to experience barriers and need tools for how to discuss children’s overweight during regular consultations within the limited time available. The low consultation rate among children aged 4 to 12 years due to lack of physical complaints is mentioned as a new and important barrier. Therefore, the prior focus might be raising awareness among parents concerning overweight in children aged 4 to 12 years and, thereby, stressing the potential supporting role of primary care professionals in tackling the overweight of their child.

How highlighted utensils influence consumption in a dark setting

OBJECTIVE

Previous research has shown that people consume less food in the dark compared to normal vision conditions. While this effect is commonly attributed to increased attention to internal cues, it could also be caused by increased difficulty to maneuver in a dark setting. This study investigated this potential alternative explanation.

DESIGN

A 2 (dark versus normal vision setting) × 2 (highlighted versus non-highlighted utensils) between-subjects design was employed.

MAIN OUTCOME MEASURES

Perceived difficulty of maneuvering and consumption of yoghurt were assessed as main outcome measures.

RESULTS

Participants consumed marginally less in dark compared to normal vision conditions, and experienced higher difficulty of maneuvering. Importantly, both effects were qualified by a significant interaction with highlighting, which increased consumption and reduced perceived difficulty compared to no highlights. Difficulty of maneuvering did not mediate the interactive effect of vision and highlighting on consumption.

CONCLUSION

Difficulty to maneuver should be considered when investigating eating behaviour under dark conditions. In line with an embodied cognition account, results also reveal the necessity of visual information for interaction with objects in the environment and imply that detail-deprived object information may be sufficient for activation of the motor system.

Improving cardiometabolic health through nudging dietary behaviours and physical activity in low SES adults: design of the Supreme Nudge project

Background

Initiating and maintaining a healthy lifestyle -including healthy eating and sufficient physical activity- is key for cardiometabolic health. A health-promoting environment can facilitate a healthy lifestyle, and may be especially helpful to reach individuals with a lower socio-economic status (SES). In the Supreme Nudge project, we will study the effects of pricing and nudging strategies in the supermarket – one of the most important point-of-choice settings for food choices – and of a context-specific mobile physical activity promotion app. This paper describes the stepwise and theory-based design of Supreme Nudge, which aims to develop, implement and evaluate environmental changes for a sustained impact on lifestyle behaviours and cardiometabolic health in low SES adults.

Methods

Supreme Nudge uses a multi-disciplinary and mixed methods approach, integrating participatory action research, qualitative interviews, experimental pilot studies, and a randomized controlled trial in a real-life (supermarket) setting. First, we will identify the needs, characteristics and preferences of the target group as well as of the participating supermarket chain. Second, we will conduct a series of pilot studies to test novel, promising and feasible intervention components. Third, a final selection of intervention components will be implemented in a full-scale randomised controlled supermarket trial. Approximately 1000 low SES adults will be recruited across 8–12 supermarkets and randomised at supermarket level to receive 1) no intervention (control); 2) environmental nudges such as food product placement or promotion; 3) nudges and a tailored physical activity app that provides time- and context specific feedback; 4) pricing interventions, nudges, and the physical activity app. The effects on dietary behaviours and physical activity will be evaluated at 3, 6 and 12 months, and on cardiometabolic health at 6 and 12 months. Finally, we will evaluate the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of the intervention, and we will use insights from System Innovation and Transition Management theories to define the best strategies for implementation and upscaling beyond the study period.

Discussion

The Supreme Nudge project is likely to generate thorough evidence relevant for policy and practice on the effects of a mixed method and multi-disciplinary intervention targeting dietary behaviours and physical activity.

Trial registration

The real-life trial has been registered on 30 May 2018, NTR7302.

Hungry for an intervention? Adolescents' ratings of acceptability of eating-related intervention strategies

Background

Effective interventions promoting healthier eating behavior among adolescents are urgently needed. One factor that has been shown to impact effectiveness is whether the target population accepts the intervention. While previous research has assessed adults’ acceptance of eating-related interventions, research on the opinion of adolescents is lacking. The current study addressed this gap in the literature.

Methods

Two thousand seven hundred sixty four adolescents (aged 10–17 years) from four European countries answered questions about individual characteristics (socio-demographics, anthropometrics, and average daily intake of healthy and unhealthy foods) and the acceptability of ten eating-related intervention strategies. These strategies varied in type (either promoting healthy eating or discouraging unhealthy eating), level of intrusiveness, setting (home, school, broader out-of-home environment), and change agent (parents, teacher, policy makers).

Results

Based on adolescents’ acceptability ratings, strategies could be clustered into two categories, those promoting healthy eating and those discouraging unhealthy eating, with acceptability rated significantly higher for the former. Acceptability of intervention strategies was rated moderate on average, but higher among girls, younger, overweight and immigrant adolescents, and those reporting healthier eating. Polish and Portuguese adolescents were overall more accepting of strategies than UK and Dutch adolescents.

Conclusions

Adolescents preferred intervention strategies that promote healthy eating over strategies that discourage unhealthy eating. Level of intrusiveness affected acceptability ratings for the latter type of strategies only. Various individual and behavioral characteristics were associated with acceptability. These findings provide practical guidance for the selection of acceptable intervention strategies to improve adolescents’ eating behavior.

The role of pre-treatment proactive coping skills in successful weight management

OBJECTIVES

Proactive coping encompasses future-oriented self-regulatory skills that help people prepare for future difficulties before they occur, such as planning and monitoring. The aim of the present study was to examine the interplay between pre-treatment proactive coping skills and expected difficulties during weight loss in determining successful weight management.

METHOD

Obese and overweight Dutch adults (N=119) who enrolled in a weight management intervention reported their level of proactive coping skills and expected difficulties at the start of intervention. Two months later, weight loss was assessed via self-report.

RESULTS

The results show that the detrimental effects of a low level of proactive coping skills were compensated by the expectation that many difficulties would accompany the weight loss attempt. Also, pre-treatment proactive coping skills did not predict weight loss success above and beyond self-efficacy and socio-demographic factors (e.g., gender).

CONCLUSION

It is concluded that future-oriented self-regulatory skills and beliefs about impending difficulties at the start of intervention may have predictive value for subsequent success in weight management.

Personality moderates the links of social identity with work motivation and job searching

Work motivation is critical for successful school-to-work transitions, but little is known about its determinants among labor market entrants. Applying a social identity framework, we examined whether work motivation and job searching are social-contextually determined. We expected that some job seekers are more sensitive to contextual influence, depending on their personality. Mediation analyses on 591 Dutch vocational training students indicate that the perception of more positive work norms in someone's social context was related to higher levels of intrinsic motivation, which in turn predicted higher preparatory job search behavior and job search intentions. Multi-group analysis shows that perceived work norms more strongly predict work motivation among overcontrollers compared to resilients and undercontrollers. In conclusion, work motivation and job searching appear contextually determined: especially among those sensitive to contextual influence, people seem to work when they believe that is what people like them do.

Activation in inhibitory brain regions during food choice correlates with temptation strength and self-regulatory success in weight-concerned women

Food choices constitute a classic self-control dilemma involving the trade-off between immediate eating enjoyment and the long term goal of being slim and healthy, especially for weight-concerned women. For them, decision-making concerning high (HE) and low energy (LE) snacks differs when it comes to the need for self-control. In line, our first study aim was to investigate which brain regions are activated during food choices during HE compared to LE energy snacks in weight-concerned women. Since it is particularly difficult to resist HE snacks when they are very tasty, our second aim was to investigate in which brain regions choice-related activation varies with the food's tastiness. Our third aim was to assess in which brain regions choice-related activation varies with individual differences in self-regulatory success. To this end, 20 weight-concerned women indicated for 100 HE or LE snacks whether they wanted to eat them or not, while their brains were scanned using fMRI. HE snacks were refused more often than equally-liked LE snacks. HE snack choice elicited stronger activation in reward-related brain regions [medial to middle orbitofrontal cortex (OFC), caudate]. Highly tasty HE snacks were more difficult to resist and, accordingly, activation in inhibitory areas (inferior frontal gyrus, lateral OFC) was negatively associated with tastiness. More successful self-controllers showed increased activation in the supplementary motor area during HE food choices. In sum, the results suggest that HE snacks constitute a higher reward for weight-concerned women compared to (equally-liked) LE snacks, and that activation during food choice in brain regions involved in response inhibition varied with tastiness and individual differences in self-regulatory success. These findings advance our understanding of the neural correlates of food choice and point to new avenues for investigating explanations for self-regulatory failure.

It's my party and I eat if I want to. Reasons for unhealthy snacking

Investigating the reasons that people give for unhealthy snacking behavior is important for developing effective health interventions. Little research, however, has identified reasons that apply to a large audience and most studies do not integrate multiple factors, precluding any conclusions regarding their relative importance. The present study explored reasons for unhealthy snacking among a representative community sample. Participants (N = 1544) filled out the newly developed Reasons to Snack inventory assessing an elaborate range of motives at baseline and 1-month follow-up. Exploratory and replication factor analyses identified six categories: opportunity induced eating, coping with negative emotions, enjoying a special occasion, rewarding oneself, social pressure, and gaining energy. The highest mean scores were obtained for enjoying a special occasion and opportunity induced eating. Regression analyses with participant characteristics as independent variables and each category of reasons as dependent variables showed differences for age. For all reasons except to enjoy a special occasion, younger people reported a higher score. Women indicated a higher score than men on coping with negative emotions, enjoying a special occasion and gaining energy. People who diet to a stronger extent reported a higher score for snacking because of social pressure, to reward oneself and to cope with negative emotions, with the latter also being related to a higher BMI. Finally, a higher education was associated with enjoying a special occasion. Future health interventions could allocate more attention to diminishing unhealthy snacking with regard to the six identified categories, specifically focusing on enjoying a special occasion and opportunity induced eating.

Bedtime procrastination: A self-regulation perspective on sleep insufficiency in the general population

Getting insufficient sleep has serious consequences in terms of mental and physical health. The current study is the first to approach insufficient sleep from a self-regulation perspective by investigating the phenomenon of bedtime procrastination: going to bed later than intended, without having external reasons for doing so. Data from a representative sample of Dutch adults (N = 2431) revealed that a large proportion of the general population experiences getting insufficient sleep and regularly goes to bed later than they would like to. Most importantly, a relationship between self-regulation and experienced insufficient sleep was found, which was mediated by bedtime procrastination.

Sweet lies: neural, visual, and behavioral measures reveal a lack of self-control conflict during food choice in weight-concerned women

Despite their intentions, weight-concerned individuals generally fail to control their eating behavior. However, it is unknown whether this failure is due to a lack of effortful self-control, or to not experiencing an internal conflict between weight goals and food temptations. The present study used fMRI, eye tracking and reaction times to assess the degree of conflict experienced by weight-concerned women during food choices that posed either a self-control dilemma (i.e., requiring a choice between healthy and palatable foods), or not. Contrary to the common assumption in self-control theory that food choices posing a self-control dilemma evoke internal conflict, we found that choices requiring self-control induced no conflict, as demonstrated by lower reaction times, fixation durations, number of gaze switches between snacks, and lower activation of the anterior cingulate cortex. Our results suggest that self-control failure might be due to a lack of experienced conflict, rather than to failing to act upon the perception of such conflict. This implies that effectiveness of weight maintenance interventions might be improved if they also focus on increasing the ability to detect a self-control dilemma, in addition to the current focus on increasing self-regulatory capacity.

How norms work: self-identification, attitude, and self-efficacy mediate the relation between descriptive social norms and vegetable intake

BACKGROUND

The current studies aim to show that descriptive social norms influence vegetable intake and to investigate three potentially underlying processes (self-identification, attitude, and self-efficacy).

METHODS

In two studies, descriptive social norms regarding vegetable intake were manipulated (majority vs. minority norm). Study 1 investigated both the relation between baseline vegetable intake and self-identification, attitude, and self-efficacy, as well as the effect of the norm manipulation on vegetable intake over a one-week period. Study 2 investigated potential mediation of the effect of the manipulation on vegetable intake intentions through self-identification, attitude, and self-efficacy.

RESULTS

Study 1 showed that the proposed mediators were related to a baseline measure of vegetable intake. Moreover, in participants identifying strongly with the norm referent group, majority norms led to higher vegetable consumption than minority norms. Study 2 showed that the direct effect of the social norm manipulation on vegetable intake intentions was partly mediated by self-identification, attitude, and self-efficacy.

CONCLUSIONS

These studies shed first light on processes underlying the effect of descriptive social norms on health behavior. A norm describing the behavior of a salient social group leads people to identify more with, have more positive attitudes toward, and feel more self-efficacious regarding that behavior.

Coping under pressure: employing emotion regulation strategies to enhance performance under pressure

Performing under high pressure is an emotional experience. Hence, the use of emotion regulation strategies may prove to be highly effective in preventing choking under pressure. Using a golf putting task, we investigated the role of arousal on declined sport performance under pressure (pilot study) and the effectiveness of emotion regulation strategies in alleviating choking under pressure (main study). The pilot study showed that pressure resulted in decreased performance and this effect was partially mediated by increased arousal. The main study, a field study, showed that whereas the choking effect was observed in the control condition, reappraisal and, particularly, distraction were effective emotion regulation strategies in helping people to cope instead of choke under pressure. These findings suggest that interventions that aim to prevent choking under pressure could benefit from including emotion regulation strategies.

Influence of negative affect on choice behavior in individuals with binge eating pathology

Research suggests that individuals with binge eating pathology (e.g., bulimia nervosa (BN) and binge eating disorders (BED)) have decision making impairments and particularly act impulsively in response to negative affect. The aim of this study was to examine the influence of negative affect on choice behavior in women with BN and BED. Ninety women (59 with BN or BED and 31 healthy controls) watched a sad or control film fragment and were subsequently asked to complete a choice behavior task (as measured by a variation of the Bechara Gambling Task (BGT)). Results showed that negative affect influenced choice behavior differently in healthy controls and in women with BN and BED after punishment (but not after reward). In the context of increased negative affect, punishment was associated with more disadvantageous choice behavior in both BN and BED women but not in healthy controls, while the effect was the exact opposite in both groups after a decrease in negative affect. Levels of sadness were not found to influence choice behavior after reward in either groups. These findings suggest that emotional states may have a direct impact on choice behavior of individuals with binge eating pathology and are not only related to pathological behavior itself.

Allured or alarmed: counteractive control responses to food temptations in the brain

Typically, it is believed that palatable, high caloric foods signal reward and trigger indulgent responses. However, Counteractive Control Theory suggests that, to the extent that people are concerned about their weight, a confrontation with palatable foods should also trigger 'alarm bell responses' which promote successful self-control. Our study is the first to investigate such counteractive control processes in the brain employing functional magnetic resonance imaging (fMRI) in a sample of successful self-regulators. Indeed, besides the traditional finding that foods elicit heightened attention as witnessed by greater activation of primary visual cortex, we found that viewing palatable foods elicited brain activation in areas associated with self-regulation. Crucially, brain activation in self-regulation areas was related to diet importance. Thus, our results are the first to show that food cues not only evoke hedonic brain responses; in successful self-regulators they also trigger alarm bell responses, which may reflect the neural processes underlying successful self-control.

Don't tell me what I should do, but what others do: the influence of descriptive and injunctive peer norms on fruit consumption in adolescents

OBJECTIVES

While healthy eating patterns are of high importance in adolescence, most adolescents portray quite unhealthy eating behaviour. One reason for this may be that social norms among peers tend to be unsupportive of healthy eating. The current study investigates whether communicating health-promoting descriptive and injunctive norms influences adolescents' intended and actual fruit consumption.

DESIGN

The study employed an experimental prospective design.

METHODS

A norm message manipulation (descriptive vs. injunctive vs. no-norm control) was administered to high school students, after which fruit intake intention (N = 96) was assessed. At follow-up, actual fruit intake over 2 days (N = 80) was recorded.

RESULTS

Adolescents receiving the descriptive norm did not report higher fruit intake intentions than the control group, but did consume (borderline, p = .057) significantly more fruit in the following 2 days (2.3 portions per day) than the control condition (1.7 portion per day). Adolescents receiving the injunctive norm reported lower fruit intake intentions than the other two groups, but actual fruit consumption (1.5 portions per day) was similar to that of the control group.

CONCLUSIONS

Health-promoting injunctive norms not only had no positive effects on fruit intake but actually caused a decrease in fruit intake intentions, indicating that injunctive norms may be vulnerable to reactance. A health-promoting descriptive norm was found to positively affect fruit intake in adolescents. No effect on fruit intake intention was found. Results show that simple single-sentence norm messages hold the potential to substantially influence health behaviour.

Access to excess: how do adolescents deal with unhealthy foods in their environment?

PURPOSE

Easy access to unhealthy foods is believed to contribute to the current overweight epidemic. It remains unclear, however, how access to unhealthy foods is related to self-regulation of food intake. This study tests the hypothesis that using self-regulation strategies buffers the negative influences of easy access to unhealthy foods.

METHODS

Cross-sectional survey data from 2764 adolescents aged 10-17 years from four European countries (The Netherlands, UK, Poland and Portugal) about use of self-regulation strategies, access to unhealthy foods and intake of unhealthy foods (sweet and salty snacks and sugar-sweetened beverages) were used.

RESULTS

Both access to unhealthy foods and use of self-regulation strategies were independently, but in opposing directions, related to intake of unhealthy foods. Easy access to unhealthy food products was associated with higher consumption, but this effect could be attenuated by use of self-regulation strategies to facilitate healthy eating even when the food environment tempts one to do otherwise.

CONCLUSIONS

Health promotion policy and programs should not only address the food environment but could also teach young people better strategies to deal with it.

Double trouble: restrained eaters do not eat less and feel worse

OBJECTIVE

While high levels of dietary restraint do not appear to reflect actual caloric restraint, it has been found to be a risk factor for a wide array of maladaptive eating patterns. These findings raise the question what, if not caloric restriction, dietary restraint entails. We propose that the very finding that restrained eaters do not eat less than they intend to do can provide an answer. Based on this disparity between the intention to restrain oneself and actual behaviour, we therefore hypothesised that high levels of restraint are associated with eating-related guilt.

METHOD

Three studies (N = 148) using unobtrusive measures of food intake; different restraint scales; and different measures of guilt tested whether restraint is related to eating-related guilt.

RESULTS

Results indicated that restraint was not associated with food intake, but instead was associated with increased levels of guilt after eating. Guilt was explicitly related to food intake. Moreover, the observed guilt could not be attributed to a general increase in negative affect.

CONCLUSION

The results of these studies suggest that restraint is not an indicator of actual restricted food intake, but rather a reflection concerns about food and eating manifested in eating-related guilt.

Body esteem and eating disorder symptomatology: the mediating role of appearance-motivated exercise in a non-clinical adult female sample

OBJECTIVES

Low body esteem poses a risk for the development of eating disorder symptomatology. Appearance-motivated exercise, as opposed to health-motivated exercise, has been associated with both low body esteem and eating disorder symptomatology. The aim of this study was to investigate the mediating role of appearance-motivated exercise in the link between body esteem and eating disorder symptomatology.

METHOD

Female fitness club members (N=81) reported their body esteem, eating disorder symptomatology and exercise motives.

RESULTS

Appearance-motivated exercise partially mediated the link between low body esteem and eating disorder symptomatology. In contrast, health-motivated exercise was unrelated to both body esteem and eating disorder symptomatology.

CONCLUSION

Results indicate that the motives underlying exercise in response to low body esteem have differential consequences for the potential development of eating disorders, signifying the clinical relevance of considering motives behind exercise.

A double burden: emotional eating and lack of cognitive reappraisal in eating disordered women

OBJECTIVE

To examine the influence of emotional eating and lack of cognitive reappraisal on eating pathology in women with binge-purge and restricting type eating disorders.

METHOD

Women with a diagnosis of anorexia or bulimia nervosa according to the DSM-IV-tr (n = 50) and non-clinical women without eating disorders (n = 52) were asked about emotional eating tendencies, adaptive emotion regulation strategies (cognitive reappraisal) and eating pathology symptoms.

RESULTS

In binge-purging women, emotional eating with limited use of cognitive reappraisal predicted level of eating pathology but not in the restricting and non-clinical women.

DISCUSSION

Emotional eating tendencies in combination with a low tendency to use cognitive reappraisal may influence the severity of eating pathology in individuals with binge-purge behaviours. Evidently, patients with these characteristics require a therapy that addresses adaptive emotion regulation skills.

Taking stock of self-control: a meta-analysis of how trait self-control relates to a wide range of behaviors

Given assertions of the theoretical, empirical, and practical importance of self-control, this meta-analytic study sought to review evidence concerning the relationship between dispositional self-control and behavior. The authors provide a brief overview over prominent theories of self-control, identifying implicit assumptions surrounding the effects of self-control that warrant empirical testing. They report the results of a meta-analysis of 102 studies (total N = 32,648) investigating the behavioral effects of self-control using the Self-Control Scale, the Barratt Impulsiveness Scale, and the Low Self-Control Scale. A small to medium positive effect of self-control on behavior was found for the three scales. Only the Self-Control Scale allowed for a fine-grained analysis of conceptual moderators of the self-control behavior relation. Specifically, self-control (measured by the Self-Control Scale) related similarly to the performance of desired behaviors and the inhibition of undesired behaviors, but its effects varied dramatically across life domains (e.g., achievement, adjustment). In addition, the associations between self-control and behavior were significantly stronger for automatic (as compared to controlled) behavior and for imagined (as compared to actual) behavior.

Decision-making impairments in women with binge eating disorder in comparison with obese and normal weight women

OBJECTIVE

The purpose of the current study was to examine decision making in female patients with binge eating disorder (BED) in comparison with obese and normal weight women.

METHOD

In the study, 20 patients with BED, 21 obese women without BED and 34 healthy women participated. Decision making was assessed using the Iowa Gambling Task (IGT). Several questionnaires were administered measuring binge eating severity, sensitivity for punishment and reward, and self-control.

RESULTS

The findings indicated that the BED and obese group performed poorly on the IGT. Participants who have BED and are obese did not improve their choice behaviour over time, whereas participants with normal weight showed a learning effect. An association between IGT performance and binge eating severity was found.

CONCLUSION

This study demonstrates that patients with BED display decision-making deficits on the IGT comparable with other forms of disordered eating. Future research should focus on unravelling the processes underlying the deficits.

Planning What Not to Eat: Ironic Effects of Implementation Intentions Negating Unhealthy Habits

The present studies tested the effectiveness of implementation intentions with an “if [situation], then not [habitual response]” structure. Based on ironic process theory and the literature on the processing of negations, it was expected that these “negation implementation intentions” would, ironically, strengthen the habit (situation—response association) one aims to break. In line with the hypotheses, forming negation implementation intentions resulted in cognitive ironic rebound effects as well as behavioral ironic rebound effects compared to an intention only condition or a replacement implementation intention. Additionally, it was found that negation implementation intentions are most likely to result in ironic rebound effects when the habit to be negated is strong. Although implementation intentions are generally highly effective in facilitating behavior change even when this involves breaking unwanted habits, the present research suggests that they are ineffective when they have a negating structure.

Self-control, diet concerns and eater prototypes influence fatty foods consumption of adolescents in three countries

As adolescent overweight has become a widespread problem in the developed world, it is timely to understand commonalities underlying dietary practices across countries. This study examines whether consumption of fruits and vegetables and fatty foods among adolescents in different countries is related to the same individual difference and social influence factors-in particular, adolescents' self-control, diet concerns and perceptions of typical (un)healthy eating peers (prototypes). We included 511 normal weight and overweight adolescents (14-19 years) from the United States, the Netherlands and Hungary, who completed a survey during class hours. After controlling for country and demographics, an additional 8% of the variance in the consumption of fatty foods was explained by self-control, diet concerns and prototypes of unhealthy eaters. Only 3% of fruit and vegetable consumption was explained by these factors, and only the association with self-control was significant. This study demonstrates that the same individual difference and social influence factors may influence adolescents' dietary practices in different countries. In addition to highlighting country differences in dietary practices and the prevalence of overweight, exploring common factors that may shape dietary practices across countries is important for future research. These commonalities may advance conceptual understanding and inform prevention across developed countries.

Cool and independent or foolish and undisciplined? Adolescents' prototypes of (un)healthy eaters and their association with eating behaviour

PURPOSE

The Prototype/Willingness model states that adolescents' willingness to engage in health-related behaviours is determined by the favourability of prototypes of persons engaging in this behaviour. The objective of the present study is to systematically investigate the content and evaluation of adolescents' prototypes of (un)healthy eaters and examine their associations with eating behaviour.

METHODS

Four studies (including a pilot study) were conducted that addressed the salience (N=79), the characteristics (N=287), and the evaluation (N=167) of eater prototypes, and their association with eating behaviour (N=97), respectively.

RESULTS

These studies revealed that (1) adolescents hold salient and distinct images of typical (un)healthy eaters; (2) the healthy eater prototype mostly consists of positive traits whereas the unhealthy eater prototype reflects mostly negative traits; (3) eater-specific prototypes are distinct from generic risk prototypes and unrelated to age, bodyweight, and social desirability; and (4) unhealthy eater prototypes are significantly associated with unhealthy eating behaviour.

CONCLUSION

Adolescents hold relatively unfavourable social images of unhealthy eaters and relatively favourable images of healthy eaters. Only unhealthy eater prototypes are associated with actual food consumption, suggesting that addressing unhealthy eater prototypes may be an important and novel ingredient of interventions aimed at changing adolescents' unhealthy eating habits.

Finding the critical cue: implementation intentions to change one's diet work best when tailored to personally relevant reasons for unhealthy eating

Implementation intentions promote acting on one's good intentions. But does specifying where and when to act also suffice when goals involve complex change that requires not merely initiating a behavior but rather substituting a habit with a new response? In a pilot study and two experiments, the authors investigated the efficacy of implementation intentions to replace unhealthy snacks with healthy snacks by linking different types of cues for unhealthy snacking (if-part) to healthy snacking (then-part). The pilot study identified cues for unhealthy snacking, differentiating between situational (where/when) and motivational (why) cues. Studies 1 and 2 tested the efficacy of implementation intentions that specified either situational or motivational cues in altering snacking habits. Results showed that implementation intentions specifying motivational cues decreased unhealthy snack consumption whereas the classic specification of where and when did not. Extending previous research, for complex behavior change "why" seems more important than "where and when."