A default option for health : improving nutrition with the financial and geographic constraints of food insecurity

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Abstract
Food insecurity, the limited availability of nutritionally adequate food, is associated with increased risk for obesity and associated health problems. There is a crucial need for sustainable interventions that improve diet-related health in individuals with food insecurity. In behavioral economics, the default option is the option a consumer obtains if they do not make an active choice. The current study aims to improve the nutritional quality of groceries purchased online by individuals with food insecurity with the use of a prefilled online grocery shopping cart (i.e., a default option). Over the course of five weeks, food pantry users (n = 38) purchased approximately $48.50 worth of groceries using a local store’s online website. The first time participants purchased groceries online (T0: baseline) they were instructed to keep in mind nutrition, cost, and taste. For the subsequent four shopping timepoints (T1-T4), participants were randomized to receive nutrition education or a prefilled online grocery shopping cart that met their nutritional needs based on sex and age. From baseline to T1, participants in the Default condition had an immediate, significant increase in Healthy Eating Index (HEI) scores (i.e., a measure of diet quality) and a significant decrease in total calories and energy density of foods purchased. Overall, these differences were maintained throughout the treatment period (T1-T4). In the Default condition, initial improvement in HEI scores was maintained throughout the treatment period. Calories and energy density of foods purchased significantly increased in the Default condition throughout the intervention, but these values were always lower (i.e., indicating healthier grocery purchases) compared with the Nutrition Education condition. In the Nutrition Education condition, initial levels of HEI scores, calories, and energy density, indicating significantly less healthy grocery purchases, were maintained (i.e., no significant increase or decrease) from the beginning to end of treatment. These results provide preliminary evidence that the use of a default option while online grocery shopping can improve food purchasing behavior in individuals with food insecurity and significant budgetary constraints. Implementation of this intervention via online platforms may specifically benefit those living in food deserts with limited access to healthy options.

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