Healthy Nudges in the School Lunch Line

In an online commentary in JAMA Pediatrics, Mitesh Patel and Kevin Volpp comment on a new school-based randomized trial that tested whether increased food palatability, combined with choice architecture, improved the diet of elementary and middle school children.

The intervention had two phases: first, schools were randomized to a control or to receive a chef’s visit twice a week for seven months. After three months, schools were again randomized to a “choice architecture” intervention that included preferential placement of fruits, vegetables, and milk, and promotional signage and packaging. The result after seven months? Healthier food choices and consumption increased with both chefs and choice architecture, as well as chefs alone. Choice architecture alone had smaller improvements in food selection and no change in consumption.

Patel and Volpp apply their insights from behavioral economics to understand the results and to suggest enhanced strategies.

First, they note that kids behave rationally in consuming better-tasting food at higher rates. Although this might seem obvious, making food taste better is often overlooked in “nudging” students toward healthier food choices.

Second, default options “change the path of least resistance” and heavily influence food choices, much as defaults matter in retirement savings, flu shots, or organ transplantation. Patel and Volpp note that in this study, defaults in the self-service food line were leveraged by changing the healthier option’s location to the front of the line, and could be leveraged even further by manipulating portion sizes or provided less healthy alternatives only upon request.

Third, they note framing nutritional information and providing small incentives might increase the impact of promotional signs and packaging alone.  Novel framing strategies such as color-coded “traffic lights” and incentives as small as $0.25 have shown promise.

The commentary, and the study that prompted it, are worth reading.

Reblogged from LDI Health Policy$ense. Original post can be found here.