A low-cost Behavioural Nudge and choice architecture intervention targeting school lunches increases children’s consumption of fruit: a cluster randomised trial

Abstract

Background Research has consistently indicated that most children do not consume sufficient fruit and vegetables to provide them with a healthy, balanced diet. This study set out to trial a simple, low-cost behavioural nudge intervention to encourage children to select and consume more fruit and vegetables with their lunchtime meal in a primary school cafeteria. Methods Four primary schools were randomly allocated to either the control or the intervention condition and baseline data were collected over two days in each school. Following this, changes were made to the choice architecture of the school cafeterias in the intervention schools and maintained over a three-week period. The intervention included improved positioning and serving of fruit, accompanied by attractive labelling of both fruit and vegetables on offer. Next, data were collected over two days in each school, with menus matched in each instance between baseline and follow-up. We employed a validated and sensitive photographic method to estimate individual children’s ( N = 176) consumption of vegetables, fruit, vitamin C, fibre, total sugars, and their overall calorie intake. Results Significant increases were recorded in the intervention schools for children’s consumption of fruit, vitamin C, and fibre. No significant changes were observed in the control condition. The increases in fruit consumption were recorded in a large proportion of individual children, irrespective of their baseline consumption levels. No changes in vegetable consumption were observed in either condition. Conclusions These results are the first to show that modest improvements to the choice architecture of school catering, and inclusion of behavioural nudges, can significantly increase fruit consumption, rather than just selection, in primary-age children. This has implications for the development of national and international strategies to promote healthy eating in schools. Trial registration AsPredicted: 3943 05/02/2017. URL: https://aspredicted.org/see_one.php?a_id=3943

Measuring lunchtime consumption in school cafeterias: a validation study of the use of digital photography

“…We obtained a high agreement with the weighed measures and good inter-rater reliability using total consumption and food category scores, derived from the weight estimates of individual food items. These data can be used to calculate the energy content of children’s meals and their micro- and macronutrient composition, using published nutrition tables and school meal recipes, to provide more detailed measures of consumption and its changes over time, for example in studies that seek to evaluate the effects of various school-based interventions ( 32 ) .…”

Dark Nudges and Sludge in Big Alcohol: Behavioral Economics, Cognitive Biases, and Alcohol Industry Corporate Social Responsibility

“…Nudges typically take the form of changes to the choice architecture , which involves designing the context in which people make choices, to influence decision‐making and make certain choices easier 8,16 . Examples include changes to the physical environment, such as putting fruit at eye level in a cafeteria to prompt purchase and presenting information in different ways to influence decisions 16‐18 …”

Interventions to increase the consumption of water among children: A systematic review and meta‐analysis

“…So far, research has mainly focused on the association between child‐related factors and water consumption and especially environmental factors have been understudied . Environmental interventions such as choice architecture interventions may be a promising approach to promote healthy dietary behaviors . Which specific parental and environmental factors need to be targeted in order to improve water consumption among children and which specific components of interventions are most effective in doing so need to be studied in more detail.…”