Nudges and Choice Architecture to Promote Healthy Food Purchases in Adults: A Systematized Review

Objective: Consistent with behavioral economic models that emphasize the context-dependance of behavioral choice, choice architecture strategies change the environmental context to promote or nudge healthier choices including the healthfulness of food purchases that may help reduce disease and premature death. This review summarizes research that investigated nudging interventions to promote healthful food purchase choices among adults. Method: A comprehensive systematized search strategy identified research published since 2009 that investigated the role of nudges and choice architecture interventions on adult food purchasing decisions with behavioral outcomes. Study data were extracted and summarized regarding nudge characteristics, design features, study quality, and food purchasing outcomes. Results: The search identified 1,129 articles, 33 of which met inclusion criteria. Twelve studies were rated as high quality, 21 as neutral, and none as low quality. Some evidence of effectiveness was found for priming nudges that manipulated physical, verbal, or sensational cues to promote healthy choices (8 of 11 studies); salience and affect nudges that used novel or personally relevant cues to direct attention to healthy choices (3/3); messenger nudges that presented information on socially normative food choices (2/2), and default nudges that made healthy options the preset choice (1/2). In studies that combined nudge types, combining priming and salience and affect nudges was at least partially effective in 5 of 5 studies. Conclusions: Nudge applications in food purchasing settings, particularly priming, offers a promising public health strategy to encourage healthier food choices among adults. More research is needed to determine optimal nudge combinations and contexts. Public Health Significance Statement Food purchasing is a key link between the food environment and eating behavior across multiple eating occasions and contexts and for multiple individuals within a household and is thus an important target to promote healthy eating, reduce obesity, and prevent chronic disease. This systematized review of research on the use of nudges and choice architecture to promote healthy food purchases among adults suggests that nudging can be an effective approach to promote healthier food choices. However, more research is needed to determine optimal combinations of nudges that can be implemented in adult food purchasing contexts to promote healthier consumer choices.