how to motivate people to eat more plant-based: …alpro foundation student symposium ‐leeds march...

Alpro Foundation student symposium ‐ Leeds March 15, 2017

1

How to motivate people to eat more plant-based:

Nudging adolescents towards plant-based food choices

Dr Hannah Ensaff

Contents

Background & study overview

Qualitative analysis – adolescents’ perspectives on plant-based foods

Intervention study – nudge strategies to shift adolescents’ food choice towards plant-based foods

Implications for policy & practice, and further research


2

Background – school nutrition & food choice

School children [8.6M; 4.6M Primary & 3.2M Secondary state schools England1]

Spend 190 days of the year in school

Childhood Obesity in England

Reception (4-5y) 9.3% obese »»»»»»» Year 6 (10-11y) 19.8% obese2

Secondary schools : 1/3 of all 11-15 year olds overweight (including obese)3

Boys – 14% overweight & 20% obese Girls – 17% overweight & 19% obese

Eating Habits

↓ children’s risk of health problems, both long & short term

establishing good eating habits that will be carried into adulthood

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school food is a way of addressing dietary disparities between children of different socio-economic backgrounds

Adolescents’ diet falls short of dietary recommendations

Excessive intakes of saturated fat and sugar, along with low fruit and vegetable consumption4

Poor food choice; fast or grab-and-go foods; low intake of plant-based foods

Mirrored in school canteens, where students commonly bypass freshly prepared nutrient rich meals5

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Adolescents’ diet & food choice

Background – cont’d


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An Overview of the Study

To investigate the attitudes and perceptions of young people towards plant-based diets, and to assess the impact of behavioural nudge tactics on students’ food choices

PHASE I: Qualitative element – plant-based foods Gain an understanding of adolescents’ perspectives of plant-based foods

PHASE II: Design, implementation & test of nudgesIntervention: small changes to the food choice architecture to ‘nudge’ students towards plant-based food choices

Evaluate the impact of the ‘nudges’

The Schools2 inner city secondary schools

Yorkshire

11- 18 year old students

Intervention school:

~ 1100 students

Free School Meal* 33% [National average 14.6%]

English Not as First Language 26% [National average 14.3%]

Control school: size, FSM, ENFL, same catering co.

*The Free School Meal programme is a national programme providing a free school meal for students of low income families


4

PHASE I: Qualitative element – plant-based foods

Semi-structured Focus Groups with 30 x Y10 students (age 14-15 y) at baseline & post intervention

How students choose what to eat / Relative importance of different parameters / Plant-based foods / Spectrum of diet

Focus group interviews incorporated several activities to encourage engagement and discussion

Audio recorded, transcribed and analysed

Grounded Theory Methodology

Categories & Concepts

Food choice parameters “you want to get something that actually tastes good” Food taste, appearance Personal food history, habits and familiarity Peers Convenience Price

Perceived drivers & benefits of plant-based foods – why ‘others’ choose plant based foods

Animal welfare, dislike of meat Health, variety, freshness

Barriers to plant-based food choice “it’s not the kind of food I eat” Food neophobia & fussiness Effort to prepare Perceptions of tastiness Confusion about health benefit Food identity


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Selected QuotesIt has to look good for you to want to buy it

. . . you want to get something that actually tastes good

I like to stick with foods that I know I like . . .

I'd give it a little try but I wouldn't eat it all . . . [only] taste it

Plant-based foods

Food choice parameters

I think you need like all your vitamins and minerals and all that . . . not just all vegetables

Probably wouldn't try it

unhealthy . . . ‘cause you have to have it [meat] in your diet

. . . it’s not the kind of food I eat

I think you need like meat and stuff for like protein and calcium . . . and stuff like that . . . not just vegetables and stuff

Incorporating food cues

ADOLESCENTS

Food choice parameters

Taste, Appearance,Food history,

Habits, FamiliarityPeers,

Convenience, Price

Perceived drivers & benefits of plant

based foods for ‘others’

Animal welfareDislike of meat

Health, Variety, Freshness

Addressing barriers

PLANT–BASED FOODS

Re-presentedPLANT–BASED FOODS

The Grounded Theory Model: Adolescents & plant-based foods


6

Implications for Policy & Practice

Familiarity & plant-based by stealth– focussing on foods rather than labelling

– focussing on taste and appearance

Health & freshness– some interest in healthy eating

– health attributes promoted [& reciprocal benefits]

Education to promote a deeper understanding– of plant-based diets and nutrition

– of environmental benefits of adopting a plant-based diet

Choice architecture

Food Choice Architecture how the environment influences our food choices

framing of food choices in terms of the relative availability and presentation of different food items

Nudge based on behavioural economics choice architecture is adjusted to encourage / discourage

certain behaviourExclusions: informing individuals; eliminating choice

School dining environment

small changes to the food choice architecture to ‘nudge’ students towards certain food choices

Impact – daily food choice largely automatic; influenced by environmental nudge strategies


7

3 week menu cycle

WEEK 3 MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

MAIN MEAL

Minced Lamb & Vegetable Pie With Baby Boiled Poatatoes.

Roast Turkey and Stuffing with Gravy Oven Roast and Creamy Mash

Beef Casserole & Dumplings With Savoury Wedges

Roast Pork with Apple Sauce And Creamy Mash

Savoury Mince & Yorkshire Pudding Baby Boiled Potatoes

Chicken Curry and Rice

Quorn Shepherd’s Pie

Salmon & Broccoli Bake or Homemade Salmon Fishcakes

Beef Lasagne

Fish in Crispy Batter with Parsley Sauce and Chipped Potatoes

VEGETARIAN Homemade Pizza

Corn & Leek Quiche

Cheese Pie

Pasta Bake

Vegetable Curry & Rice

VEGETABLES

Broccoli/Cauliflower Mixed Salads

Sweetcorn Mixed Salads

Sliced Carrots Mixed Salads

Spring Cabbage Mixed Salads

Mushy peas Mixed Salads

HOT DESSERTS

Apple & Lemon Roll & Custard

Orange Sponge & Chocolate Sauce

Flan Jeanette & Custard

Chocolate Sponge & Vanilla Sauce

Farmhouse Bake & Custard

ADDITIONAL DESSERTS

Fresh Fruit Mixed Fruit Bags Fresh Fruit Salad Fruit Yoghurt Angel Delight Fruit Flapjack

Fresh Fruit Mixed Fruit Bags Fresh Fruit Salad Fruit Yoghurt Fruit Jelly Fruit Muffins

Fresh Fruit Mixed Fruit Bags Fresh Fruit Salad Fruit Yoghurt Chocolate Dream Fruit Flapjack

Fresh Fruit Mixed Fruit Bags Fresh Fruit Salad Fruit Yoghurt Jelly Whip Fruit Muffins

Fresh Fruit Mixed Fruit Bags Fresh Fruit Salad Fruit Yoghurt Chocolate Velvet Fruit Flapjack

DRINKS Fruit Smoothies Aqua Juice Semi Skimmed Milk Fresh Fruit Juices Hot Drinks

Fruit Smoothies Aqua Juice Semi Skimmed Milk Fresh Fruit Juices Hot Drinks




HOT ‘Lite Bites’

Chicken Joes’s Variety Pizza Filled baked Potatoes Pasta King Baguettes *Homemade Beef Patties in bun

Chicken Joes’s Variety Pizza Filled baked Potatoes Pasta King Filled Baguettes *Chicken Breast Fillet in bun

Chicken Joes’s Variety Pizza Filled baked Potatoes Pasta King Filled Baguettes *Spicy Chicken Drumsticks

Chicken Joes’s Variety Pizza Filled baked Potatoes Pasta King Filled Baguettes *Homemade Beef Pattie in bun

Chicken Joes’s Variety Pizza Filled baked Potatoes Pasta King Filled Baguettes *Chicken Breast Fillet in bun.

COLD ‘Lite Bites’ & Salads

Tortilla Wraps/Pitta Assorted Sandwiches Speciality Sandwiches Filled Baguettes Mixed Salad Tubs Pasta Salads





Dish of the dayNutritionally valuable

Grab & Go items

Pizza

Pasta


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PHASE II: Design, implementation & test of nudges

Designated food items to be promoted – our plant-based foods

Menu cycles for the schools

Recipes from the catering company

Specificity of the codes used in the point of sale data

Diet with an emphasis on fruit, vegetables, pulses, grains & nuts and smaller amounts of animal products (meat, chicken, fish, dairy & eggs)

. . . and an emphasis on whole foods and a reduced amount of highly refined foods


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Foods selected:

Freshly prepared daily specials – vegetarian

Sandwiches containing salad

Whole fruit

Fruit pots


Nudge strategies:

Observation visits: mapping out the canteen, photographing food on offer (layout, presentation), canteen in action

Experience and analysis of focus groups

Review of previous studies

Initial list of potential strategies

Close consultation and discussion with catering staff, catering company and school leadership

Nudge strategies selected:Product placement & arrangement

Food presentation

Stickers, labels and posters


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Nudge strategies

Freshly prepared daily specials – vegetarian


Fruit pots

Whole fruit

Disposable pots/trays Stickers on packaging Pyramid display stand

Prefilled pots/trays End of shelf label Prominent position

Poster displayed in holder Window sticker in display unit

Increased numbers on display

Intervention did not involve any changes to the food on offer to students, and the changes were not publicised overtly to students

Intervention for 6 weeks in Summer term Baseline: 29 weeks Intervention: 6 weeks - students made choices within the adjusted

choice architecture Post-intervention: 3 weeks – choice architecture reinstated to its

baseline state for the remainder of the summer term

Whole fruit

Before


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Freshly prepared daily

specials – vegetarian


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Data analysis

Data for complete academic year and previous year

All food & drink choices throughout the day

>200 000 transactions

Date, time, product, price, FSM entitlement, year group

Data analysis:

Food choice patterns [between year and within year]

Selection of food items % of all items within relevant categories

Independent effect of the intervention on the uptake of

promoted food items


14

30830

436

9715 9476

Aqua Juice Large

Bacon Roll

Bacon Sandwiches

Bagels Filled

Baked Beans

Bear Yo

Yo

Brazil Break Deal

Brazil M

eal Deal

Capri Sun

Cheese

Cheese & Onion…

Cheese On Toast

Cheese Panini

Chick Tikka W

rap

Chicken W

ings

Chips

Classic Baugette

Classic Sandwich

Cookies

Cookies 45p

Crumpets

Deluxe Baguette

Deluxe Sandwiches

Digestive Biscuit

Dish Of Day M

eat

Dish Of Day Veg

Flat Bread

Toasty

Fruit Pot

Frozen Cow 1…

Frozen Cow 2…

Frozen Cow 3…

Fruit Cuplet

Fruit Pot & W

ater

Fruit Salad

Pots

Fruitina Slush

Grab Bag Deal

Half Cheese Bagel

Highland Spring

Hot Drinks

Hot Pudding

Ice Cream

Ice Lolly

Iced

Bun

Jacket Potatoes

Jelly Pots

Joes W

rap Deal

Large Boxed Salads

Lemon Cake

Love Joe's W

rap

2628

540

56816498

10087

8098

10422

4550 4533

Main M

eal &

Pudding/ Drink

Meal D

eal Jacket

Meal D

eal M

eat

Meal D

eal Promo

Meal D

eal V

eg

Meat Pan

ini

Meat Pizza

Milk

Mini M

ilk

Mousse Pot

Muller Yo

ghurt Pots

Noodles

Nutra Grain/Eleveses

Panini M

eal D

eal

Pasta & Sauce

Pasta M

eal D

eal

Pasta Pasta Saver

Pasta Pots

Petit Pain

Piece Of Fruit

Pizza Cheese & Tomato

Plain Cheese Toastie

Plain Pasta

Popcorn

Potato W

edges

Pretzels

Rapidz

Salad Portion

Sandwiches With Salad

Sauce Portions

Sausage Rolls

Savoury W

rap Over (V)

Shaker Salads

Slurp And Slush

Small Salad

Box

Soup & A Roll

Soup &sandwich Deal

The Juice

Tikka Slice

Toast

Toast & Jam

Toasted 1/2 Bagel

Toasted M

uffin

Toasted Teacake

Toastie

Tray Bakes

Tropicana

Tuna Mayo

Value Baguettes

Value Sandwich

Vegtables

Viva Milk

Wrap At Break

Wrap Deal

Wrap Filled

Yazoo

Yazoo Small

2,0%1,8%

Y0 1.2%

2,9%

4,2%Y1 3.7%

Baseline Intervention Post

Fruit

0.23%

0.56%vegetarian

daily specials 0.03%

0.06%

1.36%sandwiches containing

salad 0.87%


Overall Results [No. of items selected as a percentage of the relevant category]

0.5%

0.2%0.4%Y00.2%

1.6%

Y1 0.8%


Salads ***

all promoted food items baseline 1.4%; intervention 3.0%; post-intervention 2.2%

all FVS [fruit/veg/salad] food items baseline 1.5%; intervention 3.8%; post-intervention 2.6%


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Logistic Regression Analysis

Logistic regression models to see if various food items could be predicted [covariates of FSM entitlement, year group, price, day of week, time (baseline, intervention, post intervention)]

Independent effect of the intervention: controlling for everything else (FSM, price, day of the week, year group) students are 2.5 times more likely to choose a ‘nudged’ food during the intervention (relative to baseline)

Independent effect of the intervention: controlling for everything else (FSM, price, day of the week, year group) students are 3 times more likely to choose a FVS [Fruit/Veg/Salad] item during intervention (relative to baseline)

Post intervention

Changes we hadn’t made – unintended consequences

Catering Manager:We did burritos today. We did them 3 weeks ago. When I did them 3 weeks ago we sold out, and we sold 2 today [post intervention].

I had my reservations about whether it would work . . . And I think I’ve been pleasantly surprised that it has worked.


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Further work

Low starting point for plant-based foods

[daily average of 3 fruit pots & 6 pieces of fruit – compared to 236 cookies & traybakes]

Pilot study – larger trial recommended

Nudge strategies promoted designated foods; further nudges to demote other items

The different nudge strategies’ relative contributions to the effects observed

Spillover effect seen in salads

Acknowledgements

The Students & Staff at the control and intervention schools

The Catering Company – Catering Manager & team, Regional Manager

Services Facility Company & Biometrics companies

Leeds Beckett University – D Braybrook, S Coan, P Sahota, H Akter

University of Leeds – M Homer

Leeds City Council – H McLeod, H Smithies

Alpro Foundation

how to motivate people to eat more plant-based: …alpro foundation student symposium ‐leeds march...

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