Leveraging the happy meal effect: Substituting food with modest nonfood incentives decreases portion size choice

The Moderating Power of Impulsivity: A Systematic Literature Review Examining the Theory of Planned Behavior

The theory of planned behavior (TPB) states that behavioral intention is the best predictor of actual behavior change. However, intention explains only a portion of the variance in behavior. Of specific interest is the question of which moderating or mediating variables can be leveraged to aid health promotion interventions utilizing the tenets of behavioral economics (delay discounting and commitment contracts) in the intention–behavior pathway. Impulsivity has been postulated to fill this role and may be applied to multiple behaviors. We aim to determine if impulsivity moderates the association between intention and actual behavior in the TPB, to discover what other variables may moderate or mediate this association, and to apply the findings to future studies in the field of behavioral economics. To this end, a systematic review was conducted using the PubMed, PsychINFO, and Embase online databases. Eligible studies in peer-reviewed journals published prior to November 2021 were selected. Thirty-three studies were included in the final review, examining physical activity, diet, preventive health, mental health, addiction, and medication adherence behaviors. Three main concepts emerged: (1) impulsivity moderates the association between intention and behavior change; (2) self-efficacy moderates the association between intention and behavior change; and (3) planning and self-efficacy contribute to moderated mediation. This review demonstrates a gap in the literature regarding the application of the TPB to the intention–behavior pathway for health behaviors. Future studies in behavioral economics may leverage the variables of impulsivity, self-efficacy, and planning to predict follow-through in this area and to develop targeted change initiatives.

The impact of interventions to promote healthier ready-to-eat meals (to eat in, to take away or to be delivered) sold by specific food outlets open to the general public: a systematic review

INTRODUCTION

Ready-to-eat meals sold by food outlets that are accessible to the general public are an important target for public health intervention. We conducted a systematic review to assess the impact of such interventions.

METHODS

Studies of any design and duration that included any consumer-level or food-outlet-level before-and-after data were included.

RESULTS

Thirty studies describing 34 interventions were categorized by type and coded against the Nuffield intervention ladder: restrict choice = trans fat law (n = 1), changing pre-packed children's meal content (n = 1) and food outlet award schemes (n = 2); guide choice = price increases for unhealthier choices (n = 1), incentive (contingent reward) (n = 1) and price decreases for healthier choices (n = 2); enable choice = signposting (highlighting healthier/unhealthier options) (n = 10) and telemarketing (offering support for the provision of healthier options to businesses via telephone) (n = 2); and provide information = calorie labelling law (n = 12), voluntary nutrient labelling (n = 1) and personalized receipts (n = 1). Most interventions were aimed at adults in US fast food chains and assessed customer-level outcomes. More 'intrusive' interventions that restricted or guided choice generally showed a positive impact on food-outlet-level and customer-level outcomes. However, interventions that simply provided information or enabled choice had a negligible impact.

CONCLUSION

Interventions to promote healthier ready-to-eat meals sold by food outlets should restrict choice or guide choice through incentives/disincentives. Public health policies and practice that simply involve providing information are unlikely to be effective.

Can a Toy Encourage Lower Calorie Meal Bundle Selection in Children? A Field Experiment on the Reinforcing Effects of Toys on Food Choice

The goal of this research was to test whether including an inexpensive nonfood item (toy) with a smaller-sized meal bundle (420 calories), but not with the regular-sized meal bundle version (580 calories), would incentivize children to choose the smaller-sized meal bundle, even among children with overweight and obesity. Logistic regression was used to evaluate the effect in a between-subjects field experiment of a toy on smaller-sized meal choice (here, a binary choice between a smaller-sized or regular-sized meal bundles). A random sample of 109 elementary school children from two schools in the Tucson, Arizona metropolitan area (55 females; Mage = 8.53 years, SDage = 2.14; MBMI = 18.30, SDBMI = 4.42) participated. Children's height and weight were measured and body-mass-index (BMI) was calculated, adjusting for age and sex. In our sample, 21 children were considered to be either overweight or obese. Logistic regression was used to evaluate the effect of a toy on smaller-sized meal choice. Results revealed that the inclusion of a toy with a smaller-sized meal, but not with the regular-sized version, predicted smaller-sized meal choice (P < .001), suggesting that children can be incentivized to choose less food when such is paired with a toy. BMI neither moderated nor nullified the effect of toy on smaller-sized meal choice (P = .125), suggesting that children with overweight and obesity can also be incentivized to choose less. This article is the first to suggest that fast-food restaurant chains may well utilize toys to motivate children to choose smaller-sized meal bundles. Our findings may be relevant for consumers, health advocates, policy makers, and marketers who would benefit from a strategy that presents healthier, but still desirable, meal bundle options.