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. 2020 Jun 19;17(1):77.
doi: 10.1186/s12966-020-00983-y.

A systematic review of school meal nudge interventions to improve youth food behaviors

Jessica Jarick Metcalfe  1 , Brenna Ellison  2 , Nader Hamdi  1 , Rachel Richardson  2 , Melissa Pflugh Prescott  3
Affiliations

A systematic review of school meal nudge interventions to improve youth food behaviors

Jessica Jarick Metcalfe et al. Int J Behav Nutr Phys Act. .

Abstract

Background: School meal programs have a large reach and thus are ideal environments in which to implement interventions targeting improved youth eating behaviors and reduced food waste. This systematic review summarizes the evidence on the effectiveness of school meal nudge interventions on influencing children's eating and waste behaviors.

Methods: Inclusion criteria required studies have participants in primary or secondary school (grades K-12) with interventions that occurred during school lunch or breakfast in the cafeteria and included at least one of the following outcomes: selection, consumption, waste, or school meal participation. Analyses of intervention outcomes were restricted to studies of strong and moderate quality.

Results: Twenty-nine studies were included in the quality assessment. Included interventions fell into three categories: 1) placement/convenience, 2) marketing/promotion, or 3) variety/portions. The 20 strong and moderate quality studies included in outcome analyses generally used strong data collection methods and study designs, but were limited by an overall lack of intervention fidelity checks. Multi-component interventions often did not use methods that allowed for separate analyses of outcomes for different intervention components.

Conclusions: School meal nudge interventions were positively associated with food selection, and had an inconsistent relationship with food consumption. There were few studies evaluating the impact of nudge interventions on meal participation or food waste. The limited evidence available links nudges to improved meal participation, as well as undesirable increases in food waste. Future research in this area should use methods that incorporate implementation metrics, attend to systems factors, and allow the outcomes of individual intervention components to be isolated.

Keywords: Behavioral economics; Food waste; Nudge; School meals.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Outcomes from included school meal nudge studies (n = 20) listed by school meal component. Note. Positive (green), mixed (yellow), null (grey), and negative (red) outcomes are displayed for each meal component category (vegetables, fruits, entrée, milk, and water). One study [45] (not displayed in this figure) also measured participation in school meals. Only three studies were ranked as high quality [35, 45, 50]. All others were of moderate quality. Outcomes for studies in the following categories 1) placement or convenience, 2) marketing or promotion, 3) variety or portions, and 4) multi-component studies appear in Supplemental Figure 1
Fig. 3
Fig. 3
Methodological considerations and recommendations for designing future behavioral nudge interventions in school cafeterias
See this image and copyright information in PMC

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