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Using Nudges to Promote Healthy Food Choices in the School Dining Room: A Systematic Review of Previous Investigations.

BACKGROUND
There is a growing interest in low-cost interventions that modify obesogenic environments and encourage positive behavior change. We conducted a systematic review of studies that used behavioral nudges to promote a healthy school cafeteria environment.


METHODS
A literature search was conducted using 5 databases; of 381 papers noted, we included 25 and assessed them using the Quality Assessment Tool for Quantitative Studies.


RESULTS
Most studies used relatively small, convenience samples and data collection methods that could not be described as robust, necessitating cautious interpretation of their results. A range of behavioral nudges were employed. Seventeen studies reported positive effects on children's selection and 11 studies reported improvements in their consumption of target foods, effected by changing the order of serving; increasing the convenience, attractiveness, and normativeness of selecting healthy options; increasing the variety available; and attractive target food labeling.


CONCLUSIONS
Overall, this review identified the requirement for well-designed and well-controlled investigations into the effects of changing the choice architecture in school cafeterias, assessing short-, medium-, and long-term changes in individual children's consumption, utilizing validated measures, and conducted across a variety of settings, including dining rooms of schools outside the United States.