Suggestions for Nudging Children toward Healthier Food Choices

Noting that "almost one-third of children in the United States are overweight or obese, a level that has not improved over the past decade," the editorial authors outline three strategies for using behavioral economics (which recognizes that individuals behave irrationally when making decisions, but often in predictable manners) and choice architecture (which applies insights from behavioral economics to real-life scenarios) to change behaviors related to food choice. The editorial, co-written by Mitesh S. Patel, MD, MBA, MS, assistant professor, and Kevin G. Volpp, MD, PhD, professor, both of Medicine and Health Care Management at Penn, accompanies an article on a study using a clinical trial to test interventions to change students' food choices at school.

"The results of this study highlight that the design of food choices can significantly influence behavior," said Patel. "Lessons from this intervention in school cafeterias could be applied more broadly in settings that impact both children and adults."

First, school leaders and dieticians should recognize the fact that children (and adults) are behaving rationally when they choose foods that taste better. Accepting this reality, the authors point to efforts to make school-based meals more palatable -- but still healthy -- through collaborations with professional chefs, such as First Lady Michelle Obama's Chefs Move to Schools program. They note research findings showing that chef involvement increases the consumption of healthier foods by children.

Next, default (or "opt out") options should be used to steer children to healthier food choices and portion sizes. For example, in a cafeteria self-service food line, placing fruit and vegetables at the front of the line when plates are relatively empty was found to increase consumption of these foods. (It is a marketing truism that placing certain "guilty pleasure" items near the cashier increases impulse buying, but this usually involves cases of immediate gratification, such as candy, and less so foods that lead to longer-term health benefits.)

Third, making food information more appealingly and health benefits more understandable to children may lead to healthier food choices. The authors suggest that "nutritional value might better be displayed using a color-coded scheme that is easily relatable, such as that of a traffic light," to help children easily choose which foods to eat and which to avoid. The authors also cite previous research indicating that rewards of as little as 25 cents per day have led to a doubling in consumption of fruits and vegetables, even after the intervention period ended.

"Lessons from behavioral economics could be used to develop interventions that help build better eating habits," said Volpp. "Default options, information framing and incentives are a few areas that show promise and should continue to be evaluated in future studies." The Penn-authored JAMA Pediatrics editorial is in reference to "Effects of choice architecture and chef-enhanced meals on the selection and consumption of healthier school foods: a randomized clinical trial" by Cohen et al, also published in the current issue of JAMA Pediatrics.