Preferred Healthy Food Nudges, Food Store Environments, and Customer Dietary Practices in 2 Low-Income Southern Communities.

OBJECTIVE: To examine how food store environments can promote healthful eating, including (1) preferences for a variety of behavioral economics strategies to promote healthful food purchases, and (2) the cross-sectional association between the primary food store where participants reported shopping, dietary behaviors, and body mass index. METHODS: Intercept survey participants (n = 342) from 2 midsized eastern North Carolina communities completed questionnaires regarding preferred behavioral economics strategies, the primary food store at which they shopped, and consumption of fruits, vegetables, and sugary beverages. RESULTS: Frequently selected behavioral economic strategies included: (1) a token and reward system for fruit and vegetable purchases; and (2) price discounts on healthful foods and beverages. There was a significant association between the primary food store and consumption of fruits and vegetables (P = .005) and sugary beverages (P = .02). CONCLUSIONS AND IMPLICATIONS: Future studies should examine associations between elements of the in-store food environment, purchases, and consumption.

Diet Quality of Items Advertised in Supermarket Sales Circulars Compared to Diets of the US Population, as Assessed by the Healthy Eating Index-2010.

BACKGROUND: Supermarkets use sales circulars to highlight specific foods, usually at reduced prices. Resulting purchases help form the set of available foods within households from which individuals and families make choices about what to eat. OBJECTIVE: The purposes of this study were to determine how closely foods featured in weekly supermarket sales circulars conform to dietary guidance and how diet quality compares with that of the US population's intakes. DESIGN: Food and beverage items (n=9,149) in 52 weekly sales circulars from a small Midwestern grocery chain in 2009 were coded to obtain food group and nutrient and energy content. Healthy Eating Index-2010 (HEI-2010) total and component scores were calculated using algorithms developed by the National Cancer Institute. HEI-2010 scores for the US population aged 2+ years were estimated using data from the 2009-2010 National Health and Nutrition Examination Survey. HEI-2010 scores of circulars and population intakes were compared using Student's t tests. RESULTS: Mean total (42.8 of 100) HEI-2010 scores of circulars were lower than that of the US population (55.4; P<0.001). Among individual components, Total Protein Foods was the only one for which 100% of the maximum score was met by both circulars and the population. The scores were also similar between the circulars and population for Whole Grains (22%; P=0.81) and Seafood and Plant Proteins (70% to 74%; P=0.33). Circular scores were lower than those of the population for Total and Whole Fruits, Total Vegetables and Greens and Beans, Dairy, Sodium, and Empty Calories (P<0.001); they were higher only for Fatty Acids (P=0.006) and Refined Grains (P<0.001). CONCLUSIONS: HEI-2010 total scores for these sales circulars were even lower than US population scores, which have been shown repeatedly to reflect low diet quality. Supermarkets could support improvements in consumer diets by weekly featuring foods that are more in concordance with food and nutrient recommendations.

Shopper marketing nutrition interventions: Social norms on grocery carts increase produce spending without increasing shopper budgets.

OBJECTIVES: We assessed the efficacy of an easy-to-implement shopper marketing nutrition intervention in a pilot and two additional studies to increase produce demand without decreasing store profitability or increasing shopper budgets. METHODS: We created grocery cart placards that detailed the number of produce items purchased (i.e., descriptive norm) at particular stores (i.e., provincial norm). The effect of these placards on produce spending was assessed across 971,706 individual person grocery store transactions aggregated by day. The pilot study designated a baseline period (in both control and intervention store) followed by installation of grocery cart placards (in the intervention store) for two weeks. The pilot study was conducted in Texas in 2012. In two additional stores, we designated baseline periods followed by 28 days of the same grocery cart placard intervention as in the pilot. Additional interventions were conducted in New Mexico in 2013. RESULTS: The pilot study resulted in a significant difference between average produce spending per day per person across treatment periods (i.e., intervention versus same time period in control) (16%) and the difference between average produce spending per day per person across stores in the control periods (4%); Furthermore, the same intervention in two additional stores resulted in significant produce spending increases of 12.4% and 7.5% per day per person respectively. In all stores, total spending did not change. CONCLUSIONS: Descriptive and provincial social norm messages (i.e., on grocery cart placards) may be an overlooked tool to increase produce demand without decreasing store profitability and increasing shopper budgets.

Foods advertised in US weekly supermarket sales circulars over one year: a content analysis.

BACKGROUND: The nutritional content of Americans' shopping carts is suboptimal despite federal dietary guidance, in this case, the MyPlate consumer icon which displays desired proportions of vegetables, fruits, dairy, grains and protein foods for consumption. Consumers mention print advertising-such as weekly sales circulars-frequently as influencing their grocery shopping decisions. METHODS: To examine and describe the relative proportions of advertised foods aggregated into the MyPlate food grouping system, a content analysis of 9 209 foods advertised in 52 weekly supermarket newspaper sales inserts in 2009 from a local grocery chain was conducted in a Midwestern community. RESULTS: Overall, the protein foods group was most often represented in sales circulars (25% of total items), followed by grains (18%); dairy (10%); vegetables (8%) and fruits (7%). Less than 3% of sales advertisements were for dark green and red & orange vegetables. Over twice as much whole fruit versus 100% fruit juice was advertised (70% vs. 30%, respectively; P < 0.001). Significantly fewer protein foods and more grains than expected were advertised in the fall, and slightly more dark green vegetables were advertised in winter and spring than in summer and fall (P = 0.05). CONCLUSIONS: The average American diet, including underconsumption of fruits and vegetables but overconsumption of protein foods, was reflected in the relative frequency of food groups advertised in weekly sales circulars. Modifying sales circulars to represent healthier food groups may preserve retail profits (considering these groups' higher profit margin) while promoting adherence to federal dietary guidance.

Shopper marketing nutrition interventions.

Grocery stores represent a context in which a majority of people's food purchases occur. Considering the nutrition quality of the population's food intake has dramatically decreased, understanding how to improve food choice in the grocery store is paramount to healthier living. In this work, we detail the type of financial resources from which shoppers could draw (i.e., personal income and benefits from government food assistance programs to low income populations) and explain how these financial resources are allocated in the grocery store (i.e., planned, unplanned, error). Subsequently, we identify a conceptual framework for shopper marketing nutrition interventions that targets unplanned fruit and vegetable purchases (i.e., slack, or willingness to spend minus list items). Targeting slack for fresh fruit and vegetable purchases allows retailers to benefit economically (i.e., fruit and vegetables are higher margin) and allows shoppers to improve their nutrition without increasing their budgets (i.e., budget neutrality). We also provide preliminary evidence of what in-store marketing of fresh fruits and vegetables could entail by modifying grocery carts and grocery floors to provide information of what is common, normal, or appropriate fruit and vegetable purchases. In each example, fresh fruit and vegetable purchases increased and evidence suggested shopper budget neutrality. To provide context for these results, we detail measurement tools that can be used to measure shopper behaviors, purchases, and consumption patterns. Finally, we address theoretical, practical, and policy implications of shopper marketing nutrition interventions.

Larger bowl size increases the amount of cereal children request, consume, and waste.

OBJECTIVE: To examine whether larger bowls bias children toward requesting more food from the adults who serve them. STUDY DESIGN: Study 1 was a between-subject design involving 69 preschool-age children who were randomized to receive either a small (8 oz) or large (16 oz) cereal bowl and were asked to tell researchers how much cereal they wanted for a morning snack. Study 2 was a within-subject design involving 18 school-age children at a summer camp who were given a small (8 oz) cereal bowl on one day and a large (16 oz) cereal bowl on another day and asked by a cafeteria server how much cereal and milk they wanted for breakfast. Hidden scales measured how much cereal and milk were served, consumed, and wasted. Body mass index was calculated at the end of the study. RESULTS: In study 1, the young children requested almost twice as much cereal to eat when presented with the larger bowl compared with the smaller bowl. In study 2, the older children consumed 52% more and wasted 26% more when served in the larger bowl. CONCLUSION: A step toward potentially reducing overeating and waste would be for parents and adult caregivers to use smaller bowls for serving food to children.

Mindless eating challenge: retention, weight outcomes, and barriers for changes in a public web-based healthy eating and weight loss program.

BACKGROUND: Most dietary programs fail to produce lasting outcomes because participants soon return to their old habits. Small behavioral and environmental changes based on simple heuristics may have the best chance to lead to sustainable habit changes over time. OBJECTIVE: To evaluate participant retention, weight outcomes, and barriers for changes in a publicly available web-based healthy eating and weight loss program. METHODS: The National Mindless Eating Challenge (NMEC) was a publicly available, online healthy eating and weight loss program with ongoing recruitment of participants. This volunteer sample consisted of 2053 participants (mean age 39.8 years, 89% female, 90% white/Caucasian, BMI mean 28.14). Participants completed an initial profiling survey and were assigned three targeted habit change suggestions (tips). After each month, participants were asked to complete a follow-up survey and then receive new suggestions for the subsequent month. RESULTS: In terms of overall attrition, 75% (1549/2053) of participants who completed the intake survey never returned to follow up. Overall mean weight loss among returning participants was 0.4% of initial weight (P=.019). Participants who stayed in the program at least three calendar months and completed at least two follow-up surveys (38%, 189/504) lost on average 1.8 lbs (1.0%) of their initial weight over the course of the program (P=.009). Furthermore, participants who reported consistent adherence (25+ days/month) to the suggested changes reported an average monthly weight loss of 2.0 lbs (P<.001). Weight loss was less for those who discontinued after 1-2 months or who did not adhere to the suggested changes. Participants who reported having lost weight reported higher monthly adherence to suggestions (mean 14.9 days, SD 7.92) than participants who maintained (mean 12.4 days, SD 7.63) or gained weight (mean 12.0 days, SD 7.50; F=14.17, P<.001). Common reported barriers for changes included personally unsuitable or inapplicable suggestions, forgetting or being too busy to implement changes, unusual circumstances, and emotional eating. CONCLUSIONS: Because the bulk of the free and commercially available online diet and nutritional tools conduct no evaluation research, it is difficult to determine which aspects of a program are successful and what are reasonable expectations of results. The results of this study suggest that online interventions based on small changes have the potential to gradually lead to clinically significant weight loss, but high attrition from publically available or "free" programs still remains a challenge. Adherence to and effectiveness of small habit changes may be improved through further tailoring to individual circumstances and psychological needs.

Attractive names sustain increased vegetable intake in schools.

OBJECTIVE: This study will determine if the selective use of attractive names can be a sustainable, scalable means to increase the selection of vegetables in school lunchrooms. METHODS: Study 1 paired an attractive name with carrots in five elementary schools (n=147) and measured selection and consumption over a week compared to controls. Study 2 tracked food sales of vegetables in two elementary schools (n=1017) that were systematically attractively named or not named over a two-month period. Both studies were conducted in New York in 2011. RESULTS: Study 1 found that elementary students ate twice the percentage of their carrots if attractively named as "X-ray Vision Carrots," than if un-named or generically named as the "Food of the Day." Study 2 found that elementary school students were 16% more likely to persistently choose more hot vegetable dishes (p<0.001) when they were given fun or attractive names. DISCUSSION: Attractive names effectively and persistently increased healthy food consumption in elementary schools. The scalability of this is underscored by the success of Study 2, which was implemented and executed for negligible cost by a high school student volunteer.

Exploring how calorie information and taxes on high-calorie foods influence lunch decisions.

BACKGROUND: The potential combined effects of public policy tools-such as calorie information and taxes on highly caloric foods-on purchasing behavior are rarely studied. Furthermore, these tools are rarely studied in the context of individual differences (eg, dietary restraint), which may play a key role in their effectiveness. OBJECTIVE: The current study tests the combined effects of providing calorie information and increased taxes on the total number of calories purchased for lunch. Furthermore, these public policy tools were investigated in the context of high- and low-restrained eaters. DESIGN: University students (n = 178) had to choose lunch from a menu 3 different times. The prices for the high-calorie foods on the menu increased each time (125% and 150% of base price). In addition, there were 3 between-subject factors: budget (high compared with low), calorie-information (calorie information compared with no calorie information), and dietary restraint. RESULTS: Elasticity analyses show a tax × calorie information interaction. A price increase for the high-calorie foods reduced the percentage of calories chosen for lunch but only in the absence of calorie information. CONCLUSIONS: A tax of ≥25% on high-calorie foods may decrease the demand for calories and could be a good policy measure to decrease the prevalence of obesity. However, calorie information seems to interfere with the effect of a tax on high-calorie foods.

The 100-calorie semi-solution: sub-packaging most reduces intake among the heaviest.

This study addresses two questions about sub-packaging: (i) Do 100-calorie packages reduce the calorie intake of overweight individuals differently than normal-weight individuals? (ii) Do they enable individuals to accurately track intake? Thirty-seven undergraduates were randomly given either four 100-calorie packages of crackers or one 400-calorie package of crackers to eat while watching television. The average participant ate 25.2% (75.1 calories) less when given four 100-calorie packages of crackers than when given one 400-calorie package (P = 0.006). In addition, much of this influence was driven by overweight participants whose intake decreased by 54.1%. However, all of the participants underestimated their consumption by 60% or more, indicating that sub-packaging does not appear to increase one's accuracy in estimating how much is consumed. Smaller sized sub-packaging most greatly benefits those who are overweight, yet it does so without making people more aware of how much they have eaten.

Just thinking about exercise makes me serve more food. Physical activity and calorie compensation.

Based on the findings demonstrating compensation between mental effort and subsequent food consumption, this article focuses on the compensatory mechanism between thinking about physical activity and food intake. Results from a field experiment indicate that simply reading about physical activity leads participants to compensate by serving themselves more snacks. The amount of snacks served was mediated by biased calorie estimation. Additionally, we also manipulated the way physical activity was perceived (as tiring exercise or as a fun activity). Although results suggest extra consumption when exercise is perceived as tiring, differences were not statistically significant.

When snacks become meals: How hunger and environmental cues bias food intake.

BACKGROUND: While environmental and situational cues influence food intake, it is not always clear how they do so. We examine whether participants consume more when an eating occasion is associated with meal cues than with snack cues. We expect their perception of the type of eating occasion to mediate the amount of food they eat. In addition, we expect the effect of those cues on food intake to be strongest among those who are hungry. METHODS: One-hundred and twenty-two undergraduates (75 men, 47 women; mean BMI = 22.8, SD = 3.38) were randomly assigned to two experimental conditions in which they were offered foods such as quesadillas and chicken wings in an environment that was associated with either meal cues (ceramic plates, glasses, silverware, and cloth napkins at a table), or snack cues (paper plates and napkins, plastic cups, and no utensils). After participants finished eating, they were asked to complete a questionnaire that assessed their hunger, satiety, perception of the foods, and included demographic and anthropometric questions. In addition, participants' total food intake was recorded. RESULTS: Participants who were in the presence of meal-related cues ate 27.9% more calories than those surrounded with snack cues (416 versus 532 calories). The amount participants ate was partially mediated by whether they perceived the eating occasion to be a meal or a snack. In addition, the effect of the environmental cues on intake was most pronounced among participants who were hungry. CONCLUSIONS: The present study demonstrated that environmental and situational cues associated with an eating occasion could influence overall food intake. People were more likely to eat foods when they were associated with meal cues. Importantly, the present study reveals that the effect of these cues is uniquely intertwined with cognition and motivation. First, people were more likely to eat ambiguous foods when they perceived them as a meal rather than a snack. Second, the effect of the environmental cues on intake was only observed among those who were hungry.

"Is this a meal or snack?" Situational cues that drive perceptions.

What determines whether a person perceives an eating occasion as a meal or snack? The answer may influence what and how much they eat on that occasion and over the remainder of the day. A survey of 122 participants indicated that they used food cues (such as the food quality, portion size, perceived healthfulness, and preparation time) as well as environmental cues (such as the presence of friends and family, whether one is seated, and the quality of napkins and plates) to determine if they were eating a meal rather than a snack. Implications for dieters and for health professionals are provided.