Paths to Healthier Eating: Perceptions and Interventions for Success

Abstract

Next article FreeInterventions for Healthier EatingPaths to Healthier Eating: Perceptions and Interventions for SuccessPierre Chandon, Kelly L. Haws, and Peggy J. LiuPierre Chandon, Kelly L. Haws, and Peggy J. LiuPDFPDF PLUSFull TextSupplemental Material Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreHealthy eating is highly relevant to multiple stakeholders, from consumers to marketers to policy makers. Every consumer makes food decisions daily; food is a $2.5 trillion industry worldwide (Fortune Business Insights 2022), and promoting healthier eating is a major public policy issue given rising obesity rates in most countries. Interest in understanding, more generally, the role of food decision making in consumers' lives has increased in conjunction with these societal trends.We believe that consumer research has an important role to play in understanding and shaping food decision making to produce positive outcomes for as many constituents as possible, because of its unique ability to straddle the line between consumer welfare and implications for the producers and marketers of food products. This special issue of JACR seeks to add new insights to our understanding of interventions to increase healthy eating by (1) reflecting on what healthy eating means through the lens of consumers' perceptions of what they should do to eat healthy, (2) increasing our understanding of the methods used to test healthy eating interventions, and (3) examining whether and when various healthy eating interventions are actually effective at leading to healthier eating.Understanding what healthy eating means to consumers is important as consumers use their own interpretations of "healthy" when making daily decisions about food consumption (Ronteltap et al. 2012). Accordingly, we begin with a discussion of how healthy eating is understood, expressed, and operationalized, introducing a framework of key paths to healthy eating and presenting insights from a survey of consumers. We then consider the evidence about which interventions actually work (or do not work) at leading to healthier eating. We present key findings from the special issue articles, which are organized into four main sets (Table 1 contains a summary). We close with a discussion of the challenges that food researchers often face when testing interventions for healthy eating and possibilities for addressing those challenges.Table 1. Overview of Articles in this Special Issue on Interventions for Healthier EatingAuthorsTitleType of paperInterventionsData sourceHealthiness outcomesHowe, Ubel, and FitzsimonsOpen Science Online Grocery: A Tool for Studying Choice Context and Food ChoiceMethod/conceptualCustomizable labels, product positionMock online grocery storeCustomizable at the product or basket levelHaws et al.Examining Eating: Bridging the Gap between "Lab Eating" and "Free-Living Eating"Method/conceptualWho, what, where, when, why, and how factorsNoneMultiple; emphasis on expanding outcomesSilverman et al.Harder Than You Think: Misconceptions about Logging Food with Photos versus TextMethod/conceptualLogging consumption as text vs. PhotosField experiment with app company and university labPersistence of food loggingNielsen et al.Consumption Variety in Food RecommendationTest of cognitive interventionProduct recommendations algorithmSimulation using consumption data from weight loss appVariety of entire diet; links to changes in body weightAllard and PuntoniMisunderstood Menu Metrics: Side-Length Food Sizing Leads to Quantity Underestimation and OvereatingTest of cognitive interventionDisplay of food size informationOnline and university labConsumption quantity perception and preferencesOh, van der Lans, and MukhopadhyayChoice Architecture Effects on Indulgent Consumption: Evidence from Combinations of Nudges at an Ice-Cream StoreTest of cognitive interventionNutrition labeling and product grouping and positionField experiment with ice cream storeConsumption quantity and nutritional qualityMalan et al.Increasing the Selection of Low-Carbon-Footprint Entrées through the Addition of New Menu Items and a Social Marketing Campaign in University DiningTest of cognitive interventionCarbon footprint labeling and environmental social messagesField experiment with university cafeteriaSales by food typePoquet et al.Effect of a Pleasure-Oriented Intervention Conducted at Home on the Energy Intake of Midafternoon Snacks Consumed by ChildrenTest of affective interventionSensory, psychosocial, and interpersonal pleasure family training kitField study with familiesSnack consumption quantity and nutritional qualityCeylan, Aydınoğlu, and MorwitzEmbarrassed by Calories: Joint Effect of Calorie Posting and Social ContextTest of affective interventionCalorie posting in individual or social contextField experiment with restaurant and online labConsumption quantityGai, Tuk, and SweldensLight or Regular, Now or Later: The Impact of Advance Ordering and Restrained Eating on Choices and Consumption of Light and Regular Vice FoodTest of behavioral interventionAdvance orderingUniversity labSnack consumption quantity and nutritional qualityMonnier et al.Baking Your Own Cookies: Does Food Self-Production Increase Consumption?Test of behavioral interventionCooking your own foodUniversity labDaily cookie consumptionView Table ImageWhat Does Healthy Eating Mean for Consumers?A Framework of Three Main Paths to Healthy EatingWe introduce a three-pronged framework to structure our understanding of consumers' perceptions about what healthy eating means. As illustrated in figure 1, these three main paths consist of (1) the type(s) of food that we eat ("type"), (2) the quantity of foods that we eat ("quantity"), and (3) the overall balance in the variety of foods that we eat ("balance"). These three paths are grounded in key themes from prior research on the meaning of healthy eating.Figure 1. Three paths to healthy eating. This is a nonexhaustive set of potential paths and subpaths to healthy eating. There may be additional paths and subpaths that consumers may take, and consumers may take any combination of paths.View Large ImageDownload PowerPointRegarding the type path, particular food groups (such as whole grains, fruits, and vegetables) seem to be widely accepted by consumers as "healthy," whereas others (e.g., red meat, candy) tend to be considered "unhealthy" (Willett and Stampfer 2013). Relatedly, specific nutrients, such as fat, sugar, salt, and protein, are critical to determining food healthiness perceptions (Croll, Neumark-Sztainer, and Story 2001; Paquette 2005). The four type subpaths were adapted from the naturalness-valence framework (André, Chandon, and Haws 2019; Chandon and Cadario 2022), which distinguishes four ways that foods claim to be healthy, depending on whether the focus is on the presence of good (vs. the absence of bad) and the preservation of nature (vs. nutritional improvements).Regarding the quantity path, portion sizes have been implicated as a major contributor to the obesity epidemic (Young and Nestle 2002); quantity also plays a 1:1 role alongside caloric density in increasing calories, which some consumers aim to control (Woolley and Liu 2021). Although prior research shows that consumers often neglect quantity in their healthiness assessments relative to type, when quantity is made salient to them, they do recognize that it affects health, and this influences their calorie perceptions and food choices (Chernev and Gal 2010; Liu et al. 2019). The four quantity subpaths were developed from a general notion of different portion sizes of healthy and unhealthy foods and different frequencies of consumption of healthy and unhealthy foods, drawing on the concept of vice-virtue bundles (Liu et al. 2015; Haws and Liu 2016) and research on the frequency of eating different foods (Sussman, Paley, and Alter 2021).Finally, the balance path is captured by research on the importance of variety as a critical aspect of a healthy diet (Raynor and Epstein 2001; Haws et al. 2017). An optimal diet, from pleasure as well as from health standpoints, requires a balanced variety across food groups. This is underscored in the many scientific and popular eating guides that emphasize the importance of eating across multiple food groups (e.g., MyPlate, Food Pyramid), as well as balancing proportions across food groups. The two balance subpaths were adapted from research on different time-frame levels of variety (Haws et al. 2017).Altogether, while acknowledging that these three paths are not exhaustive of all possible paths, we suggest that they do comprise three main paths well-grounded in prior research. Using this framework, we conducted a survey to provide a snapshot of how American consumers think about healthy eating in 2022.Healthy Eating Survey FindingsOur key survey objectives were to understand (1) how "health" compared to other eating motivations such as taste, (2) what consumers perceive "healthy eating" to mean, and (3) their perception of the importance of the three paths and of their subpaths for healthier eating.Our respondents consisted of 499 US-based participants recruited from Prolific Academic in 2022 (Mage=38.78 years; 59.3% female, 37.9% male, and 2.8% other; median income=$50,000−$59,999; race: 74.9% White, 9.6% Black, 6.8% Asian, 8.7% other; MBMI=27.17). The survey, data, and syntax are posted at https://researchbox.org/765 and the key measures are also included in an appendix.First, we assessed the importance of various considerations when making eating decisions, inspired by a large-scale survey (N=2,967) conducted by Glanz et al. (1998), which asked respondents how important taste, nutrition, cost, convenience, and weight control are when purchasing food and eating out. To this list, we added "health" along with six other possible motivations—"social bonding," "hunger," "getting energy," "habit," "time constraints," and "religious or cultural issues" (see also Renner et al.'s [2012] Eating Motivation Survey for a larger list of eating motivations). For each of these 12 considerations (presented in random order), respondents were asked, "How important is each of the following to you when you are making eating decisions?" (1 = not at all important, 7 = very important).The results are presented with the considerations listed in order of importance in figure 2. Our results replicated those of Glanz et al. (1998), indicating that the relative importance of these five eating goals have not changed in 25 years: Taste is still (and by a wide margin) the most important consideration, followed by cost, and then by nutrition and convenience (rated as equally important), with weight control being the last of the five goals, with a much lower rating. Among the additional goals that we studied, hunger was second only to taste, and ahead of cost, and health was rated similarly as nutrition. Getting energy was rated between convenience and time constraints. Time constraints and habit were rated similarly as weight control, near the scale midpoint, whereas social bonding and religious and cultural factors were both significantly below the midpoint and were therefore rated as relatively unimportant by most respondents.Figure 2. Importance of different considerations for eating decisions. The gray bars denote the five considerations already measured in Glanz et al. (1998). Error bars denote standard errors.View Large ImageDownload PowerPointSecond, we captured participants' open-ended responses in terms of what healthy eating means to them and why healthy eating matters (i.e., what are the outcomes of healthy eating). The top part of figure 3 contains a word cloud on responses to what healthy eating means to them. The most popular theme focused on specific food types, defined either as food groups (e.g., vegetables, fruit, grain) or basic nutrients (e.g., sugar, protein, fat), while themes of quantity (e.g., portion control, moderation) and balance (e.g., balanced diet, balanced meal) were also evident. The open-ended responses therefore support the three-pronged paths to healthier eating. The bottom part of figure 3 contains a word cloud on responses to why healthy eating matters, showing more consensus across consumers on the themes of energy, healthy body, weight, and disease.Figure 3. Word clouds for "what healthy eating means" (top) and "why it matters" (bottom). For the word cloud for "what healthy eating means" (top), the dark blue words denote the "type (what to eat)" theme, the medium-toned blue words denote the "quantity (how much to eat)" theme, and the light blue words denote the "balance" theme.View Large ImageDownload PowerPointThird, we captured participants' beliefs in terms of what healthy eating means to them through a structured approach, mapping onto our framework's three different paths to healthy eating (fig. 1). First, we asked participants to allocate 100 points across the three main paths to healthy eating—type, quantity, and balance—which we defined for them as (1) What you eat (Type): This refers to the types of foods that you try to include in your diet, based on the nature of the food itself; (2) How much you eat of the foods you eat (Quantity): This refers to the portion sizes for each meal or snack of the various foods that you eat and how often you eat the various foods you eat; and (3) Balance: This involves balancing the various types of food you eat over time.Although consumers saw importance in all three paths, the Type path was the top rated (M=40.9%, SD=15.8), with both Quantity (M=30.8%, SD=13.2) and Balance (M=28.3%, SD=15.2) being viewed as similarly important. These results support the contention that food types dominate consumers' perceptions of the importance of paths to healthier eating (e.g., Liu et al. 2019), while recognizing that quantity and balance are also critical.Finally, we delved into a more detailed examination of the three main factors, by asking participants to indicate the importance of each of the 10 subpaths to healthy eating, as captured in figure 1. All 10 subpaths were listed in random order, and participants indicated "how important you think each is to healthy eating" (1 = not at all important, 7 = very important).Figure 4 summarizes the findings, with the subpaths listed in order of importance. The top-rated subpath was a food type one, focused on eating foods with positive attributes. The next two were quantity subpaths capturing the frequency of eating behaviors (rather than the portion sizes consumed), highlighting consumers' recognition that healthy eating occurs over time, not in single sittings. Two subpaths, "eating foods that are organic or wholesome" and "eating larger portions of healthier foods" received markedly lower ratings than the other subpaths but were still rated above the midpoint of 4. Interestingly, although type was rated as a more important path to healthy eating than quantity and balance, it includes not just the most important subpath ("eating foods higher in positive attributes") but also the second least-important subpath ("eating foods that are organic or wholesome"). This suggests that a path's overall importance may be determined by its most important subpath. It also underscores the benefits of examining the specific subpaths to healthy eating.Figure 4. Perceived importance of subpaths to healthy eating. The dark blue bars denote "type (what to eat)" paths, the medium-tone blue bars denote "quantity (how much to eat)" paths, and the light gray bars denote "balance" paths to healthy eating. Error bars denote standard errors.View Large ImageDownload PowerPointNew Evidence on Healthy Eating InterventionsTable 1 summarizes the articles in this special issue, organized into four main sets (methodological/conceptual, cognitive interventions, affective interventions, behavioral interventions) and indicates the data source(s), intervention(s) tested, and healthiness outcome(s) examined in each article. Given our findings on what healthy eating means to consumers, we were pleased to note that the articles tackled "healthy eating" in different ways that matter to consumers (Table 1's last column). Next, we summarize key insights from the four main sets of articles, which employed a wide range of different methodologies. The interventions can be categorized using the Cadario and Chandon (2020) framework as cognitive (provision of nutrition, environmental, or size information), affective (emphasis on the sensory or hedonic benefits of food), or behavioral interventions (attempt to directly influence behavior without necessarily changing what consumers think or what they want [e.g., advance ordering or cooking]).Methodological/Conceptual InsightsOur first set of articles approaches the topic of healthier eating interventions from a methodological or conceptual perspective, focusing on tools or frameworks to guide researchers. First, Howe, Ubel, and Fitzsimons (2022) introduce an open-source online grocery store tool that researchers can use to test a wide range of interventions using a highly realistic online shopping experience. The timing of the introduction of this tool is notable given that the COVID-19 pandemic has accelerated the acceptance of online grocery shopping (Verdon 2022). We see great potential for testing both existing and new interventions, and combinations of interventions, using this flexible and user-friendly resource. Furthermore, this resource allows for operationalizing healthy eating across all three paths, as it has the potential to examine food type, food quantities, and the balance of foods purchased.Second, Haws et al. (2022) consider the ways in which "lab eating" can differ from the ways people actually eat, which they call "free-living eating." They offer a framework across key factors, including the who, what, where, when, why, and how of eating, while recommending ways to close the gap between lab eating and free-living eating when testing interventions. They show that striking a crucial balance between isolating psychological mechanisms through lab eating studies and testing interventions in realistic situations through free-living eating studies is crucial to prompting lasting behavioral change. Their framework also prompts greater recognition of different healthy eating paths that shift beyond consumers making choices between two foods in the lab (one prototypically healthy and one prototypically unhealthy) toward accounting for the important role of quantity (including frequency over time) and balance in free-living eating.The article with a methodological focus the in toward and of a based tool that consumers can use to their own consumption et al. 2022). Logging consumption is a tool and making this and more is Interestingly, et al. (2022) show although consumers to their eating believe that consumption using be they actually their consumption when they use a although is important, the tool that healthier eating (e.g., through food types, quantity, and balance over articles in this issue cognitive interventions for healthier eating. consumers have the foods and over a of time, can be tested, and interventions using such data with an for capturing free-living eating, to the that the food has been and et al. 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