Efficacy of supermarket and web-based interventions for improving dietary quality: a randomized, controlled trial

Abstract

Dietary interventions may best be delivered at supermarkets, which offer convenience, accessibility, full food inventories and, increasingly, in-store registered dietitians, online shopping and delivery services. In collaboration with a large retail supermarket chain, we conducted a multisite supermarket and web-based intervention targeting nutrition trial (no. NCT03895580), randomizing participants (n = 247 (139 women and 108 men)) 2:2:1 to two levels of dietary education (Strategy 1 and Strategy 2) or an enhanced control group that included educational components beyond the routine standard of care. Both Strategies 1 and 2 included individualized, in-person, dietitian-led, purchasing data-guided interventions. Strategy 2 also included online tools for shopping, home delivery, selection of healthier purchases, meal planning and healthy recipes. The primary endpoint was change in dietary approaches to stop hypertension (DASH) score (a measure of adherence to the DASH diet) from baseline to 3 months. The primary endpoint was met because, at 3 months, the DASH score increased by 4.7 more for the combined Strategy 1 and Strategy 2 groups than for the control group (95% confidence interval (CI) (0.9, 8.5), P = 0.02). In a prespecified hierarchical test, at 3 months, DASH score increased by 3.8 more for the Strategy 2 group than for the Strategy 1 group (95% CI (0.8, 6.)9, P = 0.01). This trial demonstrates the efficacy of data-guided, supermarket-based, dietary interventions and modern online shopping tools in improving dietary quality in a free-living, community-based population. The trial also demonstrates the opportunity for academic investigators to collaborate with retailers to design and rigorously test comprehensive healthcare interventions.

Fixing America’s eating habits with effective stakeholder collaborations

“…The cost of this is huge -influencing every aspect of the lives of affected individuals, their families and society. However, despite a tremendous amount of effort devoted to improving diet quality in the USA 3 , the eating patterns of most US adults have not changed much over the past 20 years 4,5 . So, what fresh strategies are needed to improve the diet quality of Americans?…”

“…So, what fresh strategies are needed to improve the diet quality of Americans? A report by Steen et al 3 in this issue of Nature Medicine sheds light on one promising approach, whereby dietary intervention delivered in supermarkets improved the quality of shoppers' diets.…”

“…Steen et al 3 report a promising and innovative approach to combat challenges in improving diet quality, involving collaboration among researchers, food retailers and the customers. They report the results of a randomized dietary intervention trial (SuperWIN, NCT03895580) conducted at supermarkets.…”

“…However, the lack of sustained, long-term success up to now should not discourage us from delivering interventions at food retailers. Steen et al 3 reported high participant engagement, which suggests that improving and refining the communication approach may be a key to producing long-term success. Using shopping data to guide interventions -including online tools and other strategies -also has the potential to improve intervention efficacy 7 .…”

“…The trial reported by Steen et al 3 demonstrates an effective intervention utilizing the food environment in supermarkets, data-guided dietitian consultation and online tools in a free-living, community-based population. It also demonstrates successful collaboration between academic researchers and food retailers in communicating healthy eating information to participants, and it is crucial that such collaborations continue in order to improve and refine approaches to communicating healthy eating information.…”