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

There is a growing interest in low-cost interventions that modify obesogenic environments to encourage positive behaviour change. We have conducted a systematic review of the studies that used behavioural nudges to promote a healthy school cafeteria environment. A focused literature search was conducted using five databases; out of 381 papers, 25 were included in the present review and assessed using the Quality Assessment Tool for Quantitative Studies.
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 behavioural 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 labelling.
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, utilising validated measures, and conducted across a variety of settings, including dining rooms of schools outside the US.