Nudge to nobesity I: Minor changes in accessibility decrease food intake

2011

Very small but cumulated decreases in food intake may be sufficient to have significant effects, even erasing obesity over a period of years" (Rozin et al., 2011). In two studies, one a lab study and the other a real-world study, we examine the effect of manipulating the position of different foods on a restaurant menu. Items placed at the beginning or the end of the list of their category options were up to twice as popular as when they were placed in the center of the list. Given this effect, placing healthier menu items at the top or bottom of item lists and less healthy ones in their center (e.g., sugared drinks vs. calorie-free drinks) should result in some increase in favor of healthier food choices.

Objective: Each day, tens of millions of restaurant goers, conference attendees, college students, military personnel, and school children serve themselves at buffets – many being all-you-can-eat buffets. Knowing how the food order at a buffet triggers what a person selects could be useful in guiding diners to make healthier selections. Method: The breakfast food selections of 124 health conference attendees were tallied at two separate seven-item buffet lines (which included cheesy eggs, potatoes, bacon, cinnamon rolls, low-fat granola, low-fat yogurt, and fruit). The food order between the two lines was reversed (least healthy to most healthy, and vise-versa). Participants were randomly assigned to choose their meal from one line or the other, and researchers recorded what participants selected. Results: With buffet foods, the first ones seen are the ones most selected. Over 75% of diners selected the first food they saw, and the first three foods a person encountered in the buffet comprised 66% of all the foods they took. Serving the less healthy foods first led diners to take 31% more total food items (p,0.001). Indeed, diners in this line more frequently chose less healthy foods in combinations, such as cheesy eggs and bacon (r = 0.47; p,0.001) or cheesy eggs and fried potatoes (r = 0.37; p,0.001). This co-selection of healthier foods was less common. Conclusions: Three words summarize these results: First foods most. What ends up on a buffet diner's plate is dramatically determined by the presentation order of food. Rearranging food order from healthiest to least healthy can nudge unknowing or even resistant diners toward a healthier meal, helping make them slim by design. Health-conscious diners, can proactively start at the healthier end of the line, and this same basic principle of ''first foods most'' may be relevant in other contexts – such as when serving or passing food at family dinners.

In an effort to bolster employee satisfaction, many employers provide free snacks at the office. Unfortunately , keeping employees happy can conflict with the goal of keeping them healthy, since increased snacking at work can contribute to overeating and obesity. Building on the growing body of research in choice architecture, we tested one factor that might influence snack consumption without impacting satisfaction: the relative distance between snacks and beverages. In a large field study at Google, we measured snack consumption when snacks were closer to or farther from beverages. We found that employees who used the beverage station closer to the snack station were more likely to take a snacke the likelihood of snacking increased from 12% to 23% for men and from 13% to 17% for women when the beverage station closest to the snack station was used. These results imply that employers and even families could reduce snack consumption easily, cheaply, and without backlash, by increasing the relative distance between beverages and snacks.

Foods

Recent studies show that visual exposure to different portion sizes can lead to portion alterations in subsequent meals, suggesting that manipulations of tableware sizes may also modify portion size perception and downstream eating behaviour. The present study aims to address this novel question by testing 61 male participants (20–40 years; 19.7–41.5 kg·m−2) over three breakfast sessions in a controlled laboratory. In each session, the participant was served a pre-determined breakfast portion in either medium (control; CT), small (SC), or large (LC) jars. Participants were asked to rate post-meal satiety, and then recorded food intake for the rest of the day using Food Records. Our results indicated significant changes in post-meal satiety following the SC or LC condition, compared to CT (SC: 55.3 ± 10.8, LC: 31.0 ± 8.4, CT: 42.1 ± 9.6, F(2, 108) = 25.22, p < 0.001). SC led to a reduction in post-breakfast energy intake (F(2, 108) = 61.28, p < 0.001), but was counteracted by a...

International Journal of Behavioral Nutrition and Physical Activity, 2018

Background: Reducing the portion sizes of foods available in restaurants and cafeterias is one promising approach to reducing energy intake, but there is little evidence of its impact from randomised studies in field settings. This study aims to i. examine the feasibility and acceptability, and ii. estimate the impact on energy purchased, of reducing portion sizes in worksite cafeterias. Methods: Nine worksites in England were recruited to reduce by at least 10% the portion sizes of foods available in their cafeterias from targeted categories (main meals, sides, desserts, cakes). In a stepped wedge randomised controlled pilot trial, each site was randomised to a date of implementation, staggered fortnightly, following a baseline period of four weeks. Impact on energy purchased was analysed using generalised linear mixed modelling. We also assessed feasibility, acceptability, and fidelity of intervention implementation. Results: Data from six of the nine randomised sites were analysed, with three sites excluded for not providing sufficient data and/or not implementing the intervention. The extent to which the intervention was implemented varied by site, with between 6 and 49% of products altered within targeted categories. Feedback following the intervention suggested it was broadly acceptable to customers and cafeteria staff. For the primary outcome of daily energy (kcal) purchased from intervention categories, there was no statistically significant change when data from all six sites were pooled: percentage change − 8.9% (95% CI:-16.7, − 0.4; p = 0.081). Each of these six sites showed reductions in energy purchased, ranging from − 15.6 to − 0.3%, which were borderline statistically significant at two sites (respective percentage changes (95% CIs): − 15.6% (− 26.7, − 2.8); − 14.0% (− 25.0, − 1.2)). Secondary outcome data are suggestive of a compensatory increase in energy purchased from food categories not targeted by the intervention, with no overall effect observed on energy purchased across all categories. Conclusions: The results of this pilot trial suggest that reducing portion sizes could be effective in reducing energy purchased and consumed from targeted food categories, and merits investigation in a larger trial. Future studies will need to address factors that prevented optimal implementation including site dropout and application across a limited range of products. Trial Registration: (ISRCTN52923504). Registered on 20th September 2016.

International Journal of Behavioral Nutrition and Physical Activity

Background: There is considerable uncertainty regarding the impact of tableware size on food consumption. Most existing studies have used small and unrepresentative samples and have not followed recommended procedures for randomised controlled trials, leading to increased risk of bias. In the first pre-registered study to date, we examined the impact on consumption of using larger versus smaller plates for self-served food. We also assessed impact on the underlying meal micro-structure, such as number of servings and eating rate, which has not previously been studied. Methods: The setting was a purpose-built naturalistic eating behaviour laboratory. A general population sample of 134 adult participants (aged 18-61 years) was randomly allocated to one of two groups varying in the size of plate used for self-serving lunch: large or small. The primary outcome was amount of food energy (kcal) consumed during a meal. Additionally, we assessed impact on meal micro-structure, and examined potential modifying effects of executive function, socioeconomic position, and sensitivity to perceptual cues. Results: There was no clear evidence of a difference in consumption between the two groups: Cohen's d = 0.07 (95% CI [− 0.27, 0.41]), with participants in the large plate group consuming on average 19.2 (95% CI [− 76.5, 115.0]) more calories (3%) compared to the small plate group (large: mean (SD) = 644.1 (265.0) kcal, versus small: 624.9 (292.3) kcal). The difference between the groups was not modified by individual characteristics. There was no evidence of impact on meal micro-structure, with the exception of more food being left on the plate when larger plates were used. Conclusions: This study suggests that previous meta-analyses of a low-quality body of evidence may have considerably overestimated the effects of plate size on consumption. However, the possibility of a clinically significant effectin either directioncannot be excluded. Well-conducted trials of tableware size in real-world field settings are now needed to determine whether changing the size of tableware has potential to contribute to efforts to reduce consumption at population-level.

International Journal of Behavioral Nutrition and Physical Activity, 2020

Background Smaller portions may help to reduce energy intake. However, there may be a limit to the magnitude of the portion size reduction that can be made before consumers respond by increasing intake of other food immediately or at later meals. We tested the theoretical prediction that reductions to portion size would result in a significant reduction to daily energy intake when the resulting portion was visually perceived as ‘normal’ in size, but that a reduction resulting in a ‘smaller than normal’ portion size would cause immediate or later additional eating. Methods Over three 5-day periods, daily energy intake was measured in a controlled laboratory study using a randomized crossover design (N = 30). The served portion size of the main meal component of lunch and dinner was manipulated in three conditions: ‘large-normal’ (747 kcal), ‘small-normal’ (543 kcal), and ‘smaller than normal’ (339 kcal). Perceived ‘normality’ of portion sizes was determined by two pilot studies. Ad l...

2008

International Journal of Obesity, 2006

Objective and purpose: Although there is increasing interest in how environmental factors influence food intake, there are mixed results and misunderstandings of how proximity and visibility influence consumption volume and contribute to obesity. The objective of this paper is to examine two questions: first, how does the proximity and salience of a food influence consumption volume? Second, are proximate foods consumed more frequently because they are proximate, or are they consumed more frequently because people lose track of how much they eat? Research methods and procedures: The 4-week study involved the chocolate candy consumption of 40 adult secretaries. The study utilized a 2 Â 2 within-subject design where candy proximity was crossed with visibility. Proximity was manipulated by placing the chocolates on the desk of the participant or 2 m from the desk. Visibility was manipulated by placing the chocolates in covered bowls that were either clear or opaque. Chocolates were replenished each evening, and placement conditions were rotated every Monday. Daily consumption was noted and follow-up questionnaires were distributed and analyzed. Results: There were main effects for both proximity and visibility. People ate an average of 2.2 more candies each day when they were visible, and 1.8 candies more when they were proximately placed on their desk vs 2 m away. It is important to note, however, that there was a significant tendency for participants to consistently underestimate their daily consumption of proximately placed candies (À0.9) and overestimate their daily consumption of less proximately placed candies ( þ 0.5). Discussion: These results show that the proximity and visibility of a food can consistently increase an adult's consumption of it. In addition, these results suggest that people may be biased to overestimate the consumption of foods that are less proximate, and to underestimate those that are more proximate. Knowing about these deviation tendencies is important for those attempting effectively monitor their consumption of fat and sugar.

2015

Childhood obesity is on the rise in the United States, putting many of the nation’s children at an increased risk of developing serious health conditions. One way this crisis is being addressed is through efforts such as those made by the National School Lunch Program to improve children’s dietary quality by increasing the amount of fruits and vegetables provided in school meals. However, offering students more fruits and vegetables does not guarantee that they will consume more fruits and vegetables, and some critics believe these new regulations will simply lead to more meal waste without increasing students’ fruit and vegetable consumption. This study applies behavioral economics-based principles to a school cafeteria setting to test the effectiveness of subtle “nudges” that encourage fruit and vegetable consumption on increasing students’ selection and overall intake of fruits and vegetables using a pre-post quasi-experimental design. To test this, plate waste was recorded from ...

2013

Copyright © 2013 Linda Thunström, Jonas Nordström. This is an open access article distributed under the Creative Commons Attri-bution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We use a field experiment in a lunch restaurant to analyze how meal attributes and a “nudge ” impact healthy labeled meal consumption. The nudge consists of increasing the salience of healthy labeled meals by placing them at the top of the menu. We find that certain meal attributes (e.g. poultry and red meat) greatly increase both sales and the market share of the healthy labeled meal. We conclude that a careful design of the healthy food supply may be efficient in en-couraging healthier meal choices, e.g. supplying healthy labeled versions of popular conventional meals. We find no impact on healthy labeled meal sales from the nudge.

Nutrition journal, 2018

One of the driving factors of dietary overconsumption throughout the last decennia is the increase of food portion sizes. Larger portions induce higher daily energy intake, so reducing portion size may reduce intake of excess calories. However, real-life studies about the effects of portion size reduction are lacking. Therefore, this study examined the effect of a French fries portion size reduction on French fries consumption, French fries plate waste, satiety and caloric intake during the subsequent afternoon among university students and employees in a Belgian on-campus restaurant setting. Moreover, this study evaluated consumers' perception about the portion size reduction. The study took place over a two-time (i.e. baseline and intervention week) 4-day period (Tuesday-Friday) in the on-campus restaurant where ±1200 meals are served every day. French fries' portions were reduced by 20% by replacing the usual porcelain bowl served during the baseline week (±200 g) with sm...

2012

Previous research shows that taste is one of the most important factors in determining food choices, and that food choices may be affected by ”nudging”. We analyze how taste, as determined by meal attributes, and nudging affects consumption of a healthy labeled meal. Our analysis is based on a field experiment in a lunch restaurant and our results imply that sales of the healthy labelled meal, and its market share, is greatly impacted by its taste. Nudging, as in order of display on the menu, does not impact sales of the healthy labelled meal in our experiment. We conclude that supplying tasty healthy meals may be key to significantly impact healthy eating, superior to other policy measures aimed at encouraging healthier food choices, such as information, nudging and food tax reforms.

Can visual plate-related dietary guidance systems-such as the MyPlate guideline or the Half-Plate Rule-help people eat better when dining at home or in restaurants? To help explore this, 104 young adults completed a food diary study after having been randomly assigned to follow either 1) USDA MyPlate guidelines, 2) the Half-Plate Rule, or 3) no guidelines (control condition). Both of the visual dietary guidance systems were considered easy to understand, to follow, and left people with fewer questions about what to eat (all p<.01). Moreover, people who rated a system "easy to follow" indicated they had consumed less (meat (r = .268), but this was uncorrelated with fruit and vegetable intake (r =.092) and carbohydrate intake (r = .069). There are three key conclusions to these and other findings: First, the simplest guidance system may be more effective than no system. Second, even the most perfect dietary guidance system will not change behavior if the foods are not available or it is not followed. Third, guidance systems could over-increase the consumption of any food they specifically mention.

Obesity Research, 2005

WANSINK, BRIAN, JAMES E. PAINTER, AND JILL NORTH. Bottomless bowls: why visual cues of portion size may influence intake. Obes Res. 2005;13:93-100. Objective: Using self-refilling soup bowls, this study examined whether visual cues related to portion size can influence intake volume without altering either estimated intake or satiation. Research Methods and Procedures: Fifty-four participants (BMI, 17.3 to 36.0 kg/m 2 ; 18 to 46 years of age) were recruited to participate in a study involving soup. The experiment was a between-subject design with two visibility levels: 1) an accurate visual cue of a food portion (normal bowl) vs. 2) a biased visual cue (self-refilling bowl). The soup apparatus was housed in a modified restaurant-style table in which two of four bowls slowly and imperceptibly refilled as their contents were consumed. Outcomes included intake volume, intake estimation, consumption monitoring, and satiety. Results: Participants who were unknowingly eating from self-refilling bowls ate more soup [14.7 Ϯ 8.4 vs. 8.5 Ϯ 6.1 oz; F(1,52) ϭ 8.99; p Ͻ 0.01] than those eating from normal soup bowls. However, despite consuming 73% more, they did not believe they had consumed more, nor did they perceive themselves as more sated than those eating from normal bowls. This was unaffected by BMI. Discussion: These findings are consistent with the notion that the amount of food on a plate or bowl increases intake because it influences consumption norms and expectations and it lessens one's reliance on self-monitoring. It seems that people use their eyes to count calories and not their stomachs. The importance of having salient, accurate visual cues can play an important role in the prevention of unintentional overeating.