reduce the availability and promotion of foods high in sugar and fat.
Behavioral economics approaches can complement
in workplace vending machines could shift consumers toward healthier items while not completely removing the possibility of purchasing unhealthy items.
Nudging interventions promote the healthy behaviors that consumers want for themselves yet still allow them to make choices for themselves (Thaler and Sunstein, 2003).
Moreover, the use of implementation intentions, which are defined as predetermined, goal-directed responses to situations that typically provoke unhealthy behaviors (Gollwitzer and Sheeran, 2006), is another alternative to regulation. Although implementation intentions are not entirely effective in changing habits, research has demonstrated that linking certain situations to desired responses can prove effective in working toward behavior change when consumers have specific goals (Gollwitzer and Sheeran, 2006; Orbell and Sheeran, 2000; Sheeran and Orbell, 1999). For example, a group of researchers asked participants to form an implementation intention as an alternative to an unhealthy habit (e.g., eating fruit instead of chips while watching TV) in a situation where they would normally perform an unhealthy behavior. Results showed that responses to implementation intention cues were strengthened while responses to habitual cues were weakened, showing that participants were more capable of thinking of the healthy behaviors (Adriaanse et al., 2011).
Ways for the food industry to use convenience to improve health
Convenience is an important factor for most Americans when making decisions, particularly when choosing foods and beverages (Glanz et al., 1998; Chou et al., 2004; Cutler et al., 2003; Rozin, 2005). Free soda refills are a useful example of how convenience affects behavior. Specifically, the convenience of free refills allows customers to skip the line and have more of the beverage to quench their thirst without having to pay additional money.
Similarly, one study demonstrated that when students were required to use a separate checkout lane to purchase potato chips as an accompaniment to their meal, they were less likely to make the purchase (Meiselman et al., 1994).
The same idea applies to full-service restaurants and fast-food outlets with drive-thru windows where customers often do not have to wait a long time before receiving their food and can quickly continue on to their next destination. In fact, Chou, Grossman, and Saffer (2004) conclude that convenience based on location of these fast-food and full-service restaurants serves as the primary predictor of local obesity trends. Food companies could
harness the appeal of convenience through a number of creative methods, including faster checkout lines for ordering healthy items at fast-food venues, placing drive-through produce windows at grocery stores and pharmacies where food is sold, or showcasing more healthy options at the checkout area in supermarkets to replace the candy items often found in checkout aisles.
Leveraging default options to promote health in restaurants and grocery stores
Research has demonstrated that consumers tend to stick with default options when making menu elections, regardless of how the alternative options are presented to them (Kahneman, 2003). The food and beverage industry can easily partake in encouraging the healthy eating behavior of their patrons by offering healthy options as the default choice for menu items. Thus, the typical unhealthy items that are offered as the default would serve as alternative options that would be available to the consumer upon request. One study found an increase in purchases of healthy foods and a decrease in purchases of unhealthy foods when only healthy items were shown in a cafeteria convenience line (Hanks, 2012). Other studies have also demonstrated that consumers will be more inclined to choose healthier food items when they are more accessible (van Kleef et al., 2012). This ultimately resulted in a decrease in potato chip sales. By manipulating environments to encourage healthy eating behaviors, consumers are more inclined to make healthier food choices.
Larger portion sizes have become increasingly prominent in both restaurant and fast-food meals (Nielsen and Popkin, 2003), as well as in items available for purchase in grocery stores and supermarkets (Wansink, 2006), and portion size has been noted as a contributor of overeating amongst Americans (Rolls, 2003). Such portion sizes can induce consumers to purchase their foods more often while providing more caloric and food
“bang” for their buck. They can often also charge more for such larger portions and such that their marginal costs are small (for example, on things like sugary beverages) this can increase profits. Applying the idea of mass defaults to decrease the portion size for all customers would ultimately work toward having consumers eat less at a time. Wansink, Painter, and North (2005) report that the portion size consumers are given may imply what is
perceived as normal. Thus, if consumers were provided with smaller portions, they would be more inclined to see this as normal and consume less. This could ultimately reduce overconsumption.
Using food cues to promote healthy dietary choices
Television commercials, billboards, product placement in movies, and food placed strategically in checkout lines are all external cues that prompt individuals to consume food. Consumers’ internal cues (e.g., feelings of satiety) can be overwhelmed by these external cues. One study found that participants who rely on internal cues (e.g., fullness) consumed significantly more calories when they were primed with food cues compared to those who did not receive a food cue (Liu et al., 2014). Research has suggested that the visceral nature of food makes it all the more challenging for a person to refrain from eating or purchasing it upon being faced with food cues.
Companies like McDonald’s have already shifted some of their marketing techniques to promote fruit instead of French fries in children’s meals, suggesting healthy cues can feasibly replace at least some of the unhealthy cues in fast-food venues.
Additionally, the food and beverage industry can implement name and product description changes to their items in order to enhance the preference for healthier food items. As noted in previous literature, researchers have seen stronger preferences for healthier products develop upon describing the items with adjectives such as “succulent” or “homemade” to make them more attractive (Wansink et al., 2005). For example, The Healthy Lunchroom Initiative saw an increase of up to 26% in fruit consumption when the fruit was described with more appealing language (Wansink, 2006). Furthering this idea, the industry must be cautious when settling on descriptions and names for products so that they do not encourage overconsumption. One study found that dieters perceived a salad to be extremely healthy based on the language used, thus ate more of it (Irmak et al., 2011). One notable example of industry capitalizing on the healthfulness of meals involves McDonald’s inclusion of fruit in its Happy Meals. Though fries are still served with the fruit, McDonald’s promotes the message that they have sold billions of pieces of fruit in Happy Meals since 2014. Their promotion of salads also represents a marketing shift, though the majority of ads and
menus still promote energy-dense, nutrient-poor foods.
Food policy implications associated with behavioral economics approaches
A number of regulatory and voluntary pledges (e.g., non-enforceable corporate commitments to improve marketing standards or healthfulness of menu items) have been implemented in restaurants, school cafeterias, and workplace settings to encourage healthier behaviors. For a thorough discussion of policy recommendations regarding schools and children as compared to suggestions for restaurants and adults, refer to the work of Liu and colleagues (2014). Their policy recommendations account for the complex nuances that allow schools and child-relevant settings to be amenable to food policy changes because children do not have the same choice sets as adults and are embedded in a system that is intended to place at least some value on children’s health, whereas restaurant settings (which serve many adult consumers) are more likely to oppose regulatory enforcements that limit freedom of choice and may be more amenable to voluntary changes or incentive-based programs. Specifically, Liu and colleagues (2014) describe how public schools have more flexibility when implementing policies because they are public institutions that are ideal for public policy experiments; society is more willing to regulate the behavior of children (as compared to adults); and government can maintain a higher degree of control over school food environments. School environments may also be ideal places to implement restrictions on child-targeted food marketing, and society may view restrictions in this arena as more palatable than broad-sweeping restrictions on marketing.
In contrast to school environments, Liu and colleagues (2014) point out that regulating restaurants is considerably more challenging for a variety of reasons. Public schools participate in free and reduced school lunch programs and must be responsive to federal regulations. Adult consumers are much more resistant to policies that they perceive as restrictions on freedom and choices, making restaurants less likely to implement changes seen in some school environments. Liu and colleagues propose that government policies could provide performance-based incentives or penalties for serving high proportions of healthy or unhealthy foods. One option could be to provide
various levels of tax reduction incentives that correspond to various healthfulness standards (e.g., certain percentages of food and beverage items meet healthy nutrition standards in both nutrient content and portion size).
Liu and colleagues (2014) also propose penalties for selling high proportions of unhealthy foods, similar to gas emission penalties. Other options for promoting healthier consumption at restaurants include heavily promoting healthy foods or inviting consumers to downsize their portion.
Other sectors that may be suitable outlets for behavioral change interventions are venues associated with health-related activities (e.g., hospitals or health insurance agencies) or those that supply some foods and beverages to their large workforce (e.g., large corporate firms). Hospital systems and health insurance companies are inherently tied to health, and hospitals in particular face a critical need to consider the health and nutritional wellness of their patients and employees. Indeed, a healthcare system in Portland, Oregon recently decided to prohibit the sale of soda (Hallman, 2015), and other hospitals have closed fast-food restaurants because of the “inconsistent message” to patients about health (Gordon, 2012). While hospitals may experience unique opportunities to shift their food environments, they may set an ideal example for other venues with looser associations to health (e.g., sports arenas), and help build momentum toward improving food options. Furthermore, some companies already supply employees with access to free beverages or meal vouchers when employees stay late. These types of companies may be especially eager to implement behavioral change interventions (e.g., restructured cafeterias) that will improve or maintain the health of their workforce, thus contributing to their overall productivity.
Conclusion
We reviewed traditional and behavioral economics principles that hold promise as dietary intake improvement efforts, especially in the realm of policy change. Though some policies based on traditional economic principles are linked with decreased consumption of unhealthy products (Colchero et al., 2016; Rayner and Lang, 2011; Bassett et al., 2008; Bollinger et al., 2011; Burton et al., 2006; Chu et al., 2009; Pulos and Leng, 2010;
Roberto et al., 2010; Variyam and Cawley, 2006), these approaches often
assume consumers behave rationally and act according to their best interests.
Calorie labeling on menus, SSB taxes, and even mandatory changes to school lunch programs are some examples of traditional policies that typically face intense opposition from the food industry and many consumers because of the perception that some of these policies promote excessive government intervention and restrict freedom of choice. However, as described by Liu and colleagues (2014), interventions that target children or take place in schools are much more palatable and feasible than policies that restrict choices among adults.
Behavioral economics principles consider that consumers often behave in irrational ways, even when perfect information is presented. Consumers’ own biases, visceral factors, preferences for immediate gratification, current norms (e.g., mass defaults and personalized defaults in the environment), and a variety of other factors affect the decisions consumers make about food and beverage consumption and physical activity. As suggested by other researchers, behavioral economics approaches (e.g., offering healthy default options for menu items, behavioral nudge intentions toward healthier alternatives to enhance healthy behaviors, changing the ordering of menus as opposed to just offering menu labels) should be used to supplement current and future obesity intervention policies (Liu et al., 2014; Loewenstein and Ubel, 2011). It is critical that policymakers continue to pursue policies rooted in traditional economic policies (e.g., SSB taxes) because these policies may be more effective at reducing consumption (Colchero et al., 2016; Rayner and Lang, 2012).
Future research should examine ways to combine traditional economic approaches (e.g., price incentives) with behavioral nudges or cues that encourage the development of healthy dietary habits. For example, one study demonstrated that taxing unhealthy foods might be more effective if a label explains that the product is being taxed because it is unhealthy (Shah et al., 2013). One critical area of study involves examining how behavioral economics principles affect low-income consumers or individuals with limited literacy. Finally, existing food assistance programs that already involve significant government oversight (e.g., the Supplemental Nutrition Assistance Program; local government food procurement policies) may be ideal settings to test behavioral economics principles described in this chapter.
Taken together, these concepts from traditional and behavioral economics
research can be leveraged to form smarter policies that make it easy and convenient for consumers to engage in healthy behaviors. A number of current obesity prevention and intervention policies are implemented without rigorous empirical testing, which is critical for ensuring the identification of proven, effective programs that can be replicated. Furthermore, the implementation of untested interventions may inadvertently suggest that all environmental approaches to improve dietary intake are ineffective.
Behavioral economics principles have the potential to provide helpful supplements to obesity prevention efforts, but policy proposals should be closely tied with empirical research examining the impact of the policy on consumer behavior.
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