Using Nudges to Promote Healthy Food Choices in the School Dining Room: A Systematic Review of Previous Investigations

Abstract

There is a growing interest in low-cost interventions that modify obesogenic environments to encourage positive behaviour change. We have conducted a systematic review of the studies that used behavioural nudges to promote a healthy school cafeteria environment. A focused literature search was conducted using five databases; out of 381 papers, 25 were included in the present review and assessed using the Quality Assessment Tool for Quantitative Studies.Most studies used relatively small, convenience samples and data collection methods that could not be described as robust, necessitating cautious interpretation of their results. A range of behavioural nudges were employed. Seventeen studies reported positive effects on children's selection and 11 studies reported improvements in their consumption of target foods, effected by changing the order of serving; increasing the convenience, attractiveness, and normativeness of selecting healthy options; increasing the variety available; and attractive target food labelling.Overall, this review identified the requirement for well-designed and well-controlled investigations into the effects of changing the choice architecture in school cafeterias, assessing short-, medium-, and long-term changes in individual children's consumption, utilising validated measures, and conducted across a variety of settings, including dining rooms of schools outside the US.

A nudge in the right direction: the role of food choice architecture in changing populations' diets

“…Research has been conducted in laboratories (59,98,99) as well as online (33,71,72) . Critically, there is also a growing body of work conducted in real-world food settings (100) such as schools (101,102) , university cafeterias (103,104) , workplace (105) and healthcare sites (106) . To date, populations have included children and adolescents (101,102,107,108) , young adults at university (109) , adults (110) and older adults (74) .…”

“…Critically, there is also a growing body of work conducted in real-world food settings (100) such as schools (101,102) , university cafeterias (103,104) , workplace (105) and healthcare sites (106) . To date, populations have included children and adolescents (101,102,107,108) , young adults at university (109) , adults (110) and older adults (74) . Similar effects in adults and children have been reported (100) and a systematic review (108) examining children's dietary behaviour and nudge interventions found positive results in thirty-three of the forty studies.…”

“…Numerous systematic reviews (66,96,101,102,(105)(106)(107)(108)117,118) and several meta-analyses (60,61,100,110,112) have examined the evidence on choice architecture interventions for changing food choice. There are strong indications that nudge strategies hold promise (60,66,101,108,110,119) , and there is a growing consensus on their merits and potential to shift populations' diets. However, inconsistent findings are evident (107,118) and the quality of studies has been emphasised as critical in making further progress in the field.…”

The Impact of a Gradual Healthier Assortment among Vocational Schools Participating in a School Canteen Programme: Evidence from Sales and Student Survey Data

“…These nudges aimed to make healthier choices more convenient, attractive and acceptable, such as changing the order of serving vegetables or prompting children to take fruit. Results of most studies showed an increase in the selection or consumption of target foods [10].…”

Business outcomes of healthy food service initiatives in schools: A systematic review

“…10 A previous review of health outcomes of choice architecture interventions in mainly US schools found that 17/25 included studies reported increased selection of target healthier options, including 11 studies reporting increased consumption of target foods. 11 Despite this, the lower cost and higher profit margins for less healthy foods, 12 and poor access to supply of healthier, affordable alternatives 13 remain drivers for schools to continue to provide and promote less healthy foods.…”