A Master of Science thesis in the School of Exercise Science, Physical and Health Education

Abstract:

Chronic diseases, including obesity are a global epidemic with significant long term mental and physical health complications, as well as societal costs from loss of productivity and health care expenditures. The causes of chronic disease and obesity are multifaceted and are linked to the complexity of eating behaviour, which develops over many years and is a product of our food environment as well as our social influences. First-year undergraduate students living in residence and on meal plans have lower vegetable intake than is recommended for optimal health and disease and obesity prevention. They also gain on average 2-3 kg in their first year due to factors like stress, increased autonomy in food choices and the food environment they face. With more than 2 million Canadian young adults attending post-secondary institutions and the importance of diet to overall health and wellness, building healthy eating habits and preventing weight gain during this life transition is an important public health priority. Nudges or choice architecture interventions aim to encourage public health goals without removing choice for participants. Nudging seems to have a stronger effect in deterring the choice of unhealthy foods over motivating the choice of healthy foods. Conversely, pricing strategies where healthy foods are subsidized appear effective. Many intervention studies have been conducted in cafeterias with young adults but there was a need for studies that compared the impact of nudge interventions against economic strategies on the purchase of vegetables. This study occurred in the main cafeteria serving undergraduate students on meal plans at the University of Victoria (n=1700). A longitudinal, quasi-experimental, single case ABACA research design was conducted and salad bar sales data was tracked. After a baseline period (A), an economic incentive was provided in the form of a loyalty card (B), this was then withdrawn for a second baseline period (A), followed by a cognitive and affect nudge implemented in the form of tent cards and sandwich boards with reasons to eat more vegetables conveyed with eye-catching, colourful graphics and messaging (C) and finally a third baseline measure (A) after withdrawal of the cognitive nudge. The results showed that small economic incentives and nudges were not enough to have an impact on salad bar sales and that they declined throughout the term with too much overlapping data to establish an intervention effect. Larger economic incentives, behaviour or placement nudges and a focus on deterring unhealthy foods may have had an effect but these intervention options were not deemed feasible by food service management in this context. It may also be that there need to be more extensive changes to an individual’s microsystem and that these need to be supported by other changes in the microsystem and further changes at the level of the meso, macrosystem or exosystem through university-level intervention in food service operations or government policy or regulation.

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