A systematic review of school meal nudge interventions to improve youth food behaviors

Abstract

Background: School meal programs have a large reach and thus are ideal environments in which to implement interventions targeting improved youth eating behaviors and reduced food waste. This systematic review summarizes the evidence on the effectiveness of school meal nudge interventions on influencing children's eating and waste behaviors. Methods: Inclusion criteria required studies have participants in primary or secondary school (grades K-12) with interventions that occurred during school lunch or breakfast in the cafeteria and included at least one of the following outcomes: selection, consumption, waste, or school meal participation. Analyses of intervention outcomes were restricted to studies of strong and moderate quality. Results: Twenty-nine studies were included in the quality assessment. Included interventions fell into three categories: 1) placement/convenience, 2) marketing/promotion, or 3) variety/portions. The 20 strong and moderate quality studies included in outcome analyses generally used strong data collection methods and study designs, but were limited by an overall lack of intervention fidelity checks. Multi-component interventions often did not use methods that allowed for separate analyses of outcomes for different intervention components. Conclusions: School meal nudge interventions were positively associated with food selection, and had an inconsistent relationship with food consumption. There were few studies evaluating the impact of nudge interventions on meal participation or food waste. The limited evidence available links nudges to improved meal participation, as well as undesirable increases in food waste. Future research in this area should use methods that incorporate implementation metrics, attend to systems factors, and allow the outcomes of individual intervention components to be isolated.

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.…”

Examining Nutrition and Food Waste Trade-offs Using an Obesity Prevention Context

“…interventions 57 are also frequently implemented in school nutrition programs to improve dietary behaviors and reduce food waste. 58 Yet, there are few peer-reviewed studies that evaluate the impact of these interventions on waste, and the limited available evidence suggests that behavioral economics interventions are associated with no change in or increased levels of waste. 58 For example, researchers increased the portion size of the fruits and vegetables during school lunch by 50% in an effort to improve fruit and vegetable consumption.…”

“…58 Yet, there are few peer-reviewed studies that evaluate the impact of these interventions on waste, and the limited available evidence suggests that behavioral economics interventions are associated with no change in or increased levels of waste. 58 For example, researchers increased the portion size of the fruits and vegetables during school lunch by 50% in an effort to improve fruit and vegetable consumption. Although consumption increased for the items that were served in larger portions, there were also increases in fruit and vegetable waste.…”