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7 Effective Ways to Achieve Healthier, Clean Eating

Researchers have identified eating nudges—ways to approach foods and meal planning—that will guide you to lowering your calorie intake while maintaining the pleasure.

With Romain Cadario, PhD, and Caroline Apovian, MD

The intention is there—be it today, next week, soon, or in the new year—you can be ready to reset your diet to meet your health goals. You may find yourself saying no thanks to fried foods, passing up fast food, and skipping the hidden calories in those sugary beverages.

Sure, the resolve is there. You know that the extra pounds increase your risk of chronic diseases such as heart disease, diabetes and obesity but then you slip. Then, you feel guilty or frustrated or both. And, you know your doctor will say something at your next visit.   

Leave fruit out on the counter, you when your hungry it's in easy reach.Healthy food nudges are simple ways to set you up for successful eating. Putting fresh fruit on the counter means you'll grab it, rather than searching the pantry for a more unhealthy snack. Photo: 123rf

Healthy Eating Nudges Offer Easy Ways to Cut Calories

It’s fine to know that eating healthy, or as many say these day: eating clean, will help you avoid those dreaded diseases, so now what?!

Researchers are suggesting a switch in thinking—don't hassle yourself to make better choices, try supportive nudges.

Traditionally, public health experts have relied on nutrition education or economic incentives, such as taxing sodas or offering to pay for pounds lost, to persuade us all to eat better. However, the concept of relying on gentle nudges makes much more sense.

Two researchers, Romain Cadario, PhD, a visiting assistant professor at Boston University who did the research while at the IESEG School of Management in Paris, and Pierre Chandon, a researcher at INSEAD in Fontainebleau, France, recently conducted an ambitious review of the literature.1

They identified 96 previously published diet studies, drilling down and analyzing the results, using a technique known as a meta-analysis. The selected studies looked at various strategies that worked to inspire healthier eating and achieve weight loss.1

What this research team found may convert rid you of guilt and turn you into an effective self-nudger of your own health habits.

First, the definition of an eating nudge is something that alters your food choice without outlawing any foods or giving you a financial incentive.  So, fruit, for example, that is stored at eye level in the refrigerator is a nudge because it is the first item you see when you open the fridge where as an all-out  ban on cookies is not a nudge.2

Researchers Identify 3 Types of Effective Food Nudges 

First, the research duo classified the nudges into three groups:

  • Cognitive—such as nutrition labelling
  • Affective—such as appealing to the pleasure of food
  • Behavioral—such as using a luncheon plate instead of “dinner” plate

Next, Dr. Cadario says,1 they separated out the nudges according to the aims, finding 7 different types:

  1. Nutrition labeling. Relying on information on the Food Facts panel is considered a cognitive nudge, because by knowing the calorie count, the carb grams, the amount of fiber, sugar, or sodium, you make a choice about eating the food to meet your dietary needs.
  2. Food graphics. This goes a step beyond the food package label, such as when grocery stores provide color codes for food products, perhaps using a green sticker to guide frequent (healthy) choices, yellow stickers to suggest occasional food choices, and red for foods best avoided.  
  3. Visibility bonuses. This is another cognitive nudge—using the concept of out of sight is out of mind—has you putting the foods you want to eat more frequently at eye level in your pantry and in the fridge, and storing foods that are best limited to the very bottom and top shelves.
  4. Food inspirations. A strategy to generate interest and promote pleasure in your food choices. For example, you might not think about adding beets to your salad but if you see a package labeled as ''dynamite beets," it may capture your attention, so you’ll give them a try.
  5. Personalized exchanges. This affective nudge involves a written or verbal message sent by text, email, or voice mail reminder that sends a personalized reminder to eat a leafy green today, or to try the attached recipe for grilled salmon and veggies for an easy summer meal. In the market, you might see: "All the makings of a salad, right here" that draws you to the produce section.   
  6. Convenience boosts. This behavioral strategy might include signs pointing you in the market to a healthy line of ''grab and go" foods or to pre-sliced portions.
  7. Size adjustments. Another behavioral strategy that you might find very effective is, for example, using a salad-size bowl for watermelon and a 3-sectioned plate for dinner so the vegetables fill the large spot, and the meat and potatoes or pasta are served into the smaller sections.

Why Consider Incorporating Food Nudges to Your Daily Routine?

The researchers used complicated calculations to figure out which strategies were best. From the point of view of reducing calories, the behavioral approaches, such as downsizing the plate size, won out, proving to be the most effective and best utilized of all the nudges presented.

Dr. Cadario offers examples of each type of Food Nudge, as a way of helping you to appreciate the value of these concepts in your own daily experience:

Behavioral nudges reduced daily calories by 209 kcal, which added up to a reduction in overall energy intake by 12%. The researchers calculated what that might mean in terms of teaspoons of sugar eaten daily, too. With a behavioral nudge, individuals reduced the amount of sugar used by more than 13 teaspoons of sugar a day.1

Affective nudges (dynamite beets and "Have a salad!") proved to be the next most effective method in terms of reducing food intake—decreasing calories by 129 kcal a day, which amounted to reduction in energy intake of 7.5% and decreased the amount of sugar consumed by about 8 teaspoons daily.

Cognitive nudges (putting the bread in the bottom drawer and the carrots on the middle shelf in the fridge), which achieved a drop in calories by 64 kcal, a reduction in energy intake by 3.7%, and a drop in sugar by 4 teaspoons a day.

But whatever form of nudge was examined, the nudges were all aimed at increasing healthy eating, says Dr. Cadario. Interestingly, efforts focused on reducing unhealthy eating habits achieved a 30% increase in results as compared to messages and nudges aimed at increasing healthy eating behaviors.1

The studies that were carried out in cafeterias and restaurants to test encouraging nudges had stronger positive effects than those done at grocery stores and supermarkets.1 The researchers aren't sure why, but suggested that it could be that food choices in restaurants and cafeterias are eaten immediately so the nudges are acted upon on-the-spot, while any nudges presented while shopping for food has more competing messages, and so many other choices.

Tailor Food Nudges to Fit You and Your Family

Caroline Apovian, MD, FACE, FACN, director of the Center for Nutrition and Weight Management at Boston Medical Center, and professor of medicine at Boston University School of medicine in Massachusetts, reviewed this study for EndocrineWeb, and says she uses the nudge approach with her patients already..

She says she has found the behavioral nudges to work best with many more of her patients. If you don't want to eat chocolate cake, don't tempt yourself, she says. "Do not bring the chocolate cake into the house," she says, “because if it is in the refrigerator, chances are excellent that you will eat it. And when you go out, if there’s talk of ordering dessert, suggest one that everyone likes and ask for four forks. That way you can enjoy a few bites, feel satisfied, and leave feeling satisfied.”

Her other suggestion for an effective diet nudge: "Make your house safe for you to eat healthy in," she says. Think ''default," she tells her patients. In other words: "Make sure salad fixings and fresh fruit is in the fridge so you can have it when you are looking for a quick meal or a midday snack." And if you always have some fruit, say tangerines or cherries, in a bowl on the counter, it will act as a positive nudge to grab some fruit, if you find yourself hungry between meals, or even as you set out to cook dinner.   

Although the researchers cite differences in the effectiveness between the three approaches (ie, cognitive, affective, and behavioral) and the calorie reduction achieved, Dr. Apovian says, “on average, the nudges translated to savings of 124 calories a day, or 8 fewer teaspoons of sugar, for nearly everyone who incorporates some of these changes into their meal planning.”

Rethinking the Way You Define Your Dieting Success

Healthier eating should be viewed on a continuum, meaning it’s a process meant to reflect the long-term. Some experts suggest defining whether you are successful or not by looking beyond the number on the weight scale and comparing yourself to an ''ideal'' weight.3

Instead, measure your success by your sense of your quality of life, your self-esteem, and daily energy level, as these are all important signs of improved overall health—and thinking not about some ideal weight but your best  body weight means establishing a goal that is reachable and can be maintained.3 Any healthy eating nudges that support your efforts to attain your diet goal, are worthy of your attention.

Best Nudge: Consider Pleasure First and Foremost 

Dr. Cadario says, you might try another approach to maintaining a positive eating strategy based not on the study data but taking a suggestion from his cultural experience: "If you want to eat healthy, it sould come with some pleasure in it," he says. "If you are only eating for health, you are sacrificing the joy of eating and you will not say the course for very long."

The French, he says, know how to focus on getting pleasure from their meals but Americans, he says, seem to forget this important ingredient. Just being surrounded by friends and family can make the meal enjoyable so the focus on the food becomes less important.

Combining his opinion with his study results, he tells EndocrineWeb, "If at home, you may want to nudge yourself to plan meals around vegetables, serve smaller portion sizes, and to cook in advance, by preparing dinner the night before [so it is ready to heat and eat]. Most importantly, be sure you are eating what you like just not too much."

Neither Dr. Cadario nor Dr. Apovian have any relevant financial disclosures.

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