‘Today is the last day I’m eating sweets’
‘I will include salad every day in my meals now’
‘I am joining the gym tomorrow morning’
When was the last time you said this, or the last time you heard someone say it?
Despite good-intentioned efforts and weeks and weeks of motivation, the majority of people are unable to alter their meal preferences for a healthier lifestyle or even lose weight. With a ton of weight-control books and diet programs available, health-related diseases like obesity, diabetes, hypertension, and cardiovascular problems still prevail. Traditionally, a major problem in India has been malnutrition and poverty-related hunger; however, in the last decade or so, obesity and overnutrition have assumed importance, especially in high socio-economic groups residing in urban areas.
Thus, it becomes important to examine how to encourage healthy eating habits (among urban Indians in particular). Understanding food choice is of significant interest to public health policymakers, food retailers, caterers, as well as food and nutrition researchers. Solutions like: taxes on sugary drinks, developing standardized measures of overnutrition, increasing active travel to work, more advertising etc have been suggested. Of these, very few focus on behavior change using the framework of choice architecture, perhaps on account of the constantly changing eating habits of millennial citizens.
Choice architecture, or nudging, makes use of changes in the decision-making environment to encourage healthy eating, without affecting the autonomy of the individual and without restricting their choice. Similarly, behavioural interventions can opt to prime individuals to provide subtle cues that could unconsciously prompt healthy eating behaviour. Though nudges are better at changing the structure of food consumption (e.g., eating more vegetables), primes may be more effective at altering the quantity of food consumption. In their field experiment at a grocery store, Papies et al. (2014) showcased how health priming brought about a drastic reduction in the purchase of high-calorie snacks among overweight and obese consumers. Overweight and obese participants who received a flyer that contained health and diet-related words purchased 75% fewer unhealthy snacks as compared to those who received the same flyer that did not use health and diet-related words.
Meta-analyses (studies that compile results from other studies in an effort to synthesize knowledge) reiterate the finding that the manipulation of food product orders can influence food choices. Thorndike et al. (2012) conducted a two-phase labelling and choice architecture intervention, where the first phase used a 3-month colour coding intervention (red = unhealthy, yellow = less healthy, green = healthy) and Phase 2 used another 3-month intervention, which increased the visibility of green items. Upon comparing results, it was found that the sales of red items decreased in both phases and the sales of green items increased in Phase 1. Similarly, Ensaff et al. (2015) designed an intervention in a secondary school by changing the position, labelling and arrangement of select food items to see its impact on students’ plant-based food choices. These included freshly prepared vegetarian daily specials, sandwiches containing salad, fruit plate, and whole fruit. Based on nearly 200,000 transactions by students, it was found that selection of the targeted food choice during the intervention (3%) and post-intervention (2.2%) time period significantly increased, compared to the baseline (1.4%).
Taking into account the past literature, we suggest some potential interventions to nudge people to make healthier choices.
Position of food:
In the Indian context, items rich in nutrients and protein may be classified as healthy food, as are those dense in vegetables and fruits. For example, common foods such as high-on-protein pulses (e.g. dal) will be categorised as healthy food, as well as fruit platters. Unhealthy food could be carbohydrate-rich foods such as rice and bread. Upon positioning healthy food as more accessible than unhealthy food, say for instance, in a cafeteria or corporate food lounge, the effects of the nudge can be measured when people make their selection.
Word search puzzles:
Subtle external changes can also alter food choice behaviour. A word search of health-related terms such as ‘healthy’, ‘nutritious’, ‘strong’, ‘exercise’, ‘fitness’ can be provided in each food tray mat, at a café or restaurant, to prime people to consume more nutritious food.
Food labels and nutrition:
Food labels on packaged food items indicate the ingredients used and the calories they contain, which often go unnoticed. Reminding consumers to check these food labels at the back along with the expiry date can help people make a better and more informed choice before making purchases.
Even at the public policy level, promoting health and building knowledge around healthier eating habits has remained a challenge yet to be solved. Policymakers try to do so by changing health-related knowledge, attitudes and/or structural barriers. While public information campaigns have been successful in raising awareness of unhealthy eating, they have failed to translate that message into action. Another intervention to be looked at from the individual level, is how to control the size of serving food. Front-of-package label (FoPL) designs, which are clear and impactful, also play an important role in increasing awareness and shifting food-eating norms. In conclusion, combined intervention efforts at both individual and societal efforts is an effective way to help people make healthier choices.