Put the money where the mouth is: The feasibility and effectiveness of food pricing strategies to stimulate healthy eating

Seidell, J.C. [Promotor]Schuit, A.J. [Promotor]Steenhuis, I.H.M. [Copromotor

Real‑world nudging, pricing, and mobile physical activity coaching was insufficient to improve lifestyle behaviours and cardiometabolic health: the Supreme Nudge parallel cluster‑randomised controlled supermarket trial

Background Context-specific interventions may contribute to sustained behaviour change and improved health outcomes. We evaluated the real-world effects of supermarket nudging and pricing strategies and mobile physical activity coaching on diet quality, food-purchasing behaviour, walking behaviour, and cardiometabolic risk markers.Methods This parallel cluster-randomised controlled trial included supermarkets in socially disadvantaged neighbourhoods across the Netherlands with regular shoppers aged 30–80 years. Supermarkets were randomised to receive co-created nudging and pricing strategies promoting healthier purchasing (N = 6) or not (N = 6). Nudges targeted 9% of supermarket products and pricing strategies 3%. Subsequently, participants were individually randomised to a control (step counter app) or intervention arm (step counter and mobile coaching app) to promote walking. The primary outcome was the average change in diet quality (low (0) to high (150)) over all follow-up time points measured with a validated 40-item food frequency questionnaire at baseline and 3, 6, and 12 months. Secondary outcomes included healthier food purchasing (loyalty card-derived), daily step count (step counter app), cardiometabolic risk markers (lipid profile and HbA1c via finger prick, and waist circumference via measuring tape), and supermarket customer satisfaction (questionnaire-based: very unsatisfied (1) to very satisfied (7)), evaluated using linear mixed-models. Healthy supermarket sales (an exploratory outcome) were analysed via controlled interrupted time series analyses.Results Of 361 participants (162 intervention, 199 control), 73% were female, the average age was 58 (SD 11) years, and 42% were highly educated. Compared to the control arm, the intervention arm showed no statistically significant average changes over time in diet quality (β − 1.1 (95% CI − 3.8 to 1.7)), percentage healthy purchasing (β 0.7 ( − 2.7 to 4.0)), step count (β − 124.0 (− 723.1 to 475.1), or any of the cardiometabolic risk markers. Participants in the intervention arm scored 0.3 points (0.1 to 0.5) higher on customer satisfaction on average over time. Supermarket-level sales were unaffected (β − 0.0 (− 0.0 to 0.0)).Conclusions Co-created nudging and pricing strategies that predominantly targeted healthy products via nudges were unable to increase healthier food purchases and intake nor improve cardiometabolic health. The mobile coaching intervention did not affect step count. Governmental policy measures are needed to ensure more impactful supermarket modifications that promote healthier purchases

Reducing cardiometabolic risk in adults with a low socioeconomic position: protocol of the Supreme Nudge parallel cluster-randomised controlled supermarket trial

This erratum describes changes made in our previously published study protocol [1], as the occurrence of the COVID-19 pandemic has led to insurmountable challenges in feasibility to maintain the original design. The planned start of participant recruitment for the trial coincided with the first COVID-19 lockdown in the Netherlands starting March 16 2020. As a result, the start of the study was postponed by 11 months. The continued/renewed lockdown hampered face-to-face contact and thus some planned physical measurements. These circumstances required adaptation to remote data collection methods, revision of recruitment goals and of the primary study outcomes, and inclusion of additional study sites to secure adequate participant inclusion rates. Therefore, below we present the revised methodology of the Supreme Nudge parallel cluster-randomised controlled supermarket trial. All changes made to the original protocol were reviewed and approved by the Medical Ethics Review Committee of VU University Medical Center (reference number: 2019.334) prior to implementation

A system dynamics and participatory action research approach to promote healthy living and a healthy weight among 10–14-year-old adolescents in Amsterdam: The LIKE programme

This paper describes the design of the LIKE programme, which aims to tackle the complex problem of childhood overweight and obesity in 10–14-year-old adolescents using a systems dynamics and participatory approach. The LIKE programme focuses on the transition period from 10-years-old to teenager and was implemented in collaboration with the Amsterdam Healthy Weight Programme (AHWP) in Amsterdam-East, the Netherlands. The aim is to develop, implement and evaluate an integrated action programme at the levels of family, school, neighbourhood, health care and city. Following the principles of Participatory Action Research (PAR), we worked with our population and societal stakeholders as co-creators. Applying a system lens, we first obtained a dynamic picture of the pre-existing systems that shape adolescents’ behaviour relating to diet, physical activity, sleep an

Are diets healthier when they contain branded foods?

Purpose - Market trend data show a growing popularity of discount food stores and of cheaper food products as opposed to more expensive leading brands (LB). Unexpectedly little is known about how these economic food choices affect diet quality and/or health. The purpose of this paper is to examine differences in nutrient content and cost of daily food intake data modeled to contain food exclusively from either LB, generic brands (GB) or discount brands (DB). Design/methodology/approach - This study analyzed nutrition information of 430 food products that were selected based on dietary intake data from a sub-sample of the Amsterdam Growth and Health Longitudinal Study. Data were collected in Dutch supermarkets, where information was copied from back-of-pack nutrition tables. Findings - Results showed that there were no statistically significant differences between the LB, GB or DB daily intake models in energy (kJ), protein, carbohydrates, total fat, saturated fatty acids, fiber or added sugar contents. However, there were significant differences in sodium content where LB had significant less sodium compared to GB and DB. Also, there were significant price differences: LB vs GBþh2.75/day; LB vs DBþh7.17/day; GB vs DBþh4.42/day. Originality/value - To the knowledge, this is the first study analyzing differences in nutrient content and price of leading, generic and discount food brand formats on a diet level. The analysis revealed that there is little reason to suggest that dietary nutrient quality is negatively affected by an increased consumption of DB products. Indeed, the substantial price difference between leading and DB suggests that discount products provide a reasonable alternative to LB

Effects of a price increase on purchases of sugar sweetened beverages. Results from a randomized controlled trial.

Sugar sweetened beverage (SSB) taxes are receiving increased political interest. However, there have been no experimental studies of the effects of price increases on SSBs or the effects on close substitutes such as diet drinks, alcohol or sugary snacks. Therefore, the aim of this study was to examine the effects of a price increase on SSBs on beverage and snack purchases using a randomized controlled design within a three-dimensional web-based supermarket. The trial contained two conditions: experimental condition with a 19% tax on SSBs (to reflect an increase in Dutch value added tax from 6% to 19%); and a control condition with regular prices. N = 102 participants were randomized and purchased groceries on a single occasion at a three-dimensional Virtual Supermarket. Data were analysed using independent t-tests and regression analysis. Results showed that participants in the price increase condition purchased significantly less SSBs than the control group (B = -90; 95% CI = -1.70 to -10 L per household per week). There were no significant effects on purchases in other beverage or snack food categories. This means that the higher VAT rate was effective in reducing SSB purchases and had no negative side-effects. © 2014

Consumer food choices: The role of price and pricing strategies.

AbstractObjectiveTo study differences in the role of price and value in food choice between low-income and higher-income consumers and to study the perception of consumers about pricing strategies that are of relevance during grocery shopping.DesignA cross-sectional study was conducted using structured, written questionnaires. Food choice motives as well as price perceptions and opinion on pricing strategies were measured.SettingThe study was carried out in point-of-purchase settings, i.e. supermarkets, fast-food restaurants and sports canteens.SubjectsAdults (n 159) visiting a point-of-purchase setting were included.ResultsPrice is an important factor in food choice, especially for low-income consumers. Low-income consumers were significantly more conscious of value and price than higher-income consumers. The most attractive strategies, according to the consumers, were discounting healthy food more often and applying a lower VAT (Value Added Tax) rate on healthy food. Low-income consumers differ in their preferences for pricing strategies.ConclusionsSince price is more important for low-income consumers we recommend mainly focusing on their preferences and needs.</jats:sec