Wednesday, September 21, 2022

Designing food environment to improve behavior

Breaking a bad habit takes a lot of willpower. The environment - family, significant others, friends, coworkers, classmates, neighbors, personal physician, religiosity/spirituality, media - can provide support or serve as a barrier to changing behavior.  

The eating environment is central to one's health since it can influence not only individual's weight—for good or for bad, but also put them at risk for the development of many diseases and conditions, such as arthritis, diabetes, and heart disease. 

Recent review analyzed 357 studies focused on the digital and physical food environments. The dimensions studied were (1) Food availability, (2)
Food prices; (3) Vendor and product properties (in terms of nutritional composition, overall quality, level of processing, etc., (4) Marketing and regulation; (5) Food accessibility (referring to individual access in terms of physical distance to shops, time, modes of transportation and daily mobility); (6) Affordability; (7) Convenience and, finally, (8) Desirability. 

Most studies focused on this topic, followed by research on vendors and their marketing strategies (especially unhealthy food marketing to children), although cumulatively there was more emphasis on external than on personal domain.

One systematic review (Rounsefell et al, 2020) indicated that digital food environment was, indeed, influencing eating patterns - for example, when peers or celebrities posted idealized images). Food-related posts on social media also influenced satiety, by amplifying feelings of hunger and neglect of satiety clues. Digitalization has the potential to increase food availability and may even provide less expensive options to specific products but is still adding a new cost to buying food, in the form of delivery fees. 

Public health interventions achieve medium-sized influences on food behavior in children and almost negligible in adolescents. Mobile apps might be effective, but the most effective behavior change technique is yet to be found. Goal setting, problem solving, periodic goal/outcome reviews and feedback, self-monitoring of behavior, social support, information about health consequences, and behavior practice/rehearsal could all be effective to some extent. But the use of smartphone weight loss apps is still not sufficient to produce clinically meaningful health outcomes.

Behavioral interventions encourage people to act, but the actions are controlled by the individual. ~25% of individuals are influenced by existing wearable and mobile app solutions, but 75% need something better. Personalized combination of interventions, individual psychology and activity environment along with a better integration of human element are needed for designing successful digital interventions to improve health-related behavior. 


Vargas‐Garcia EJ, Evans CE, Prestwich A, Sykes‐Muskett BJ, Hooson J, Cade JE. Interventions to reduce consumption of sugar‐sweetened beverages or increase water intake: evidence from a systematic review and meta‐analysis. Obesity Reviews. 2017 Nov;18(11):1350-63.

Rounsefell K, Gibson S, McLean S, Blair M, Molenaar A, Brennan L, Truby H, McCaffrey TA. Social media, body image and food choices in healthy young adults: A mixed methods systematic review. Nutrition & Dietetics. 2020 Feb;77(1):19-40.

Al Zuhaibi K, McCullough F, Salter AM. Effectiveness of health and fitness smartphone applications to improve dietary habits and physical activity in Omani adults. Proceedings of the Nutrition Society. 2017;76(OCE2).

Chew HSJ, Koh WL, Ng JSHY, Tan KK Sustainability of Weight Loss Through Smartphone Apps: Systematic Review and Meta-analysis on Anthropometric, Metabolic, and Dietary Outcomes J Med Internet Res 2022;24(9):e40141 doi: 10.2196/40141 PMID: 36129739

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