Exploring Strategies to Promote a Healthier Food Environment

Abstract

Excess weight, which affects over 70% of the population in the United States, has been associated with a plethora of chronic diseases, including diabetes, cardiovascular disease, some cancers, and mortality. As posited by the ecological model of behavior change, our environment shapes the way we behave, so to change behavior requires changing the ecology in which we live. Therefore, the three papers that make up this dissertation explores various strategies to promote a healthier food environment.

In paper 1, we asked how beverages with child-directed marketing compare to beverages without such marketing with respect to front-of-package claims and nutrient profile. We found that sugary fruit drinks with child-directed marketing were more likely to show front-of-package micronutrient claims (OR=2.1, 95% CI=1.5, 3.1) and contained more vitamin C (18.5% daily value, 95% CI=1.6, 35.5) than fruit drinks without child-directed marketing. These results suggest that beverages companies may be fortifying their sugary beverages with vitamin C in order to market their beverages with micronutrient claims. We put forth a series of recommendations to change the marketing landscape.

In paper 2, we examine whether beverage taxes influence beverage prices and consumer behavior by studying the impact of the Philadelphia beverage tax in one of the largest longitudinal studies of beverage taxes to date. Our results showed that the average price of taxed beverages in Philadelphia increased by 1.6 cents-per-ounce (95% CI: 1.1, 2.0; 28.7% increase; 107% pass-through) compared to Baltimore in the year after the beverage tax. This change in price led to loyalty cardholders in Philadelphia purchasing 6.8 ounces (95% CI: -7.3, -6.2) fewer of taxed beverages per transaction compared to Baltimore post-tax. Both the price and volume of nontaxed beverages in Philadelphia compared to Baltimore did not significantly differ after the beverage tax was implemented. This study provides strong evidence at the individual-level that beverage taxes can alter consumer behavior.

In paper 3, we studied whether nudges on restaurant menus can influence which portion sizes diners select in an online randomized controlled experiment. We found that regardless of pricing scheme, participants were more likely to select a reduced portion entrée if we named the smaller portion “Standard” or “Just Right” compared to leaving it blank. We show evidence of an effective low-cost strategy to promote selection of lower-calorie smaller portions when dining out. Restaurants can potentially benefit from such a menu change by not only reducing food waste, but also expanding their customer base to include those who seek healthier alternatives when dining out.

Together, these papers make the argument that there are many tools we can use to change our environment. Although no single action can solve the issue of excess weight, better beverage packaging regulations, beverage taxes in more cities, and menu changes in chain restaurants can help ensure that people are making healthy choices at every stage of life.