Interventions using behavioural insights to influence children's diet‐related outcomes: A systematic review

Abstract

The global prevalence of children with overweight and obesity continues to rise. Obesity in childhood has dire long-term consequences on health, social and economic outcomes. Promising interventions using behavioural insights to address obesity in childhood have emerged. This systematic review examines the effectiveness and health equity implications of interventions using behavioural insights to improve children's diet-related outcomes. The search strategy included searches on six electronic databases, reference lists of previous systematic reviews and backward searching of all included studies. One-hundred and eight papers describing 137 interventions were included. Interventions using behavioural insights were effective at modifying children's diet-related outcomes in 74% of all included interventions. The most promising approaches involved using incentives, changing defaults and modifying the physical environment. Information provision alone was the least effective approach. Health equity implications were rarely analysed or discussed. There was limited evidence of the sustainability of interventions-both in relation to their overall effectiveness and cost-effectiveness. The limited evidence on health equity, long-term effectiveness and the cost-effectiveness of these interventions limit what can be inferred for policymakers. This review synthesises the use of behavioural insights to improve children's diet-related outcomes, which can be used to inform future interventions.

Long-Term Effectiveness of a Multi-Strategy Choice Architecture Intervention in Increasing Healthy Food Choices of High-School Students From Online Canteens (Click & Crunch High Schools): Cluster Randomized Controlled Trial

“…In the primary school setting (aged 5-12 years), the same Click & Crunch intervention was found to be effective at improving healthy food purchases by primary school students at 18 months (+3.8% “everyday” and –2.6% “less healthy” items purchased) [ 29 ]. Such findings demonstrate the potential merit of the Click & Crunch intervention on improving the nutritional quality of both primary and high school student online lunch purchases over both the short and longer term and challenge the previously held notion that choice architecture interventions may attenuate over time due to their “novelty effect” or “label fatigue” experienced by end users [ 10 ].…”

“…This is the first study to assess the long-term effectiveness of an intervention embedded within an online lunch ordering system for high school students and is one of few studies to assess the long-term effectiveness of food choice architecture interventions more broadly [ 10 , 23 , 24 ]. The Click & Crunch High Schools cluster RCT found that intervention students, relative to control, ordered significantly more healthy “everyday” items and significantly fewer “less healthy” items from baseline to 15-month follow-up.…”

“…Furthermore, the greater length of time that students were exposed to the intervention may have increased the likelihood of habitual patterns in the purchasing of more healthy foods. The sustained intervention effectiveness may also be attributable to the precommitment involved with “preordering,” which may prevent impulse purchasing of “less healthy” foods due to hunger-based cues [ 10 ].…”

“…Interventions that incorporate choice architecture strategies (eg, provision of information, changing default options, and using incentives) [ 10 ] are effective in improving adolescent diet-related outcomes. A recent systematic review found that out of 137 included choice architecture interventions that aimed to modify child or adolescent diet-related outcomes, 74% were effective [ 10 ].…”

“…Interventions that incorporate choice architecture strategies (eg, provision of information, changing default options, and using incentives) [ 10 ] are effective in improving adolescent diet-related outcomes. A recent systematic review found that out of 137 included choice architecture interventions that aimed to modify child or adolescent diet-related outcomes, 74% were effective [ 10 ]. Despite this, of the 137 studies, only 9 were conducted in high schools and while 6 of the 9 studies (67%) were shown to be effective, all of the interventions were short in duration (average 10 weeks) and none assessed long-term effectiveness [ 11 ].…”