Behavioral Economics for Healthy Eating

(BeWell Trial)

Overseen By Anne N Thorndike, MD, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Massachusetts General Hospital

Disqualifiers: Non-English/Spanish speakers, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

3750 Participants Needed

Trial Summary

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Basic SWAP implementation, Behavioral economics-enhanced SWAP implementation for healthy eating?

Research shows that using behavioral economics strategies, like nudging and choice architecture, can effectively encourage healthier food choices. These strategies have been successful in increasing healthy food purchases and improving vegetable intake among different groups, suggesting they could be effective in promoting healthy eating habits. ^{1 2 3 4 5}

Is the Behavioral Economics for Healthy Eating treatment safe for humans?

The research articles do not provide specific safety data for the Behavioral Economics for Healthy Eating treatment, but they focus on using incentives and strategies to encourage healthier choices, which are generally considered safe approaches. ^{2 3 6 7 8}

How does the Behavioral economics-enhanced SWAP implementation treatment differ from other treatments for promoting healthy eating?

The Behavioral economics-enhanced SWAP implementation treatment is unique because it uses behavioral economics strategies to make healthier food choices easier and more appealing, unlike traditional methods that may rely solely on education or financial incentives. This approach changes the environment and context in which food choices are made, encouraging healthier decisions without requiring significant conscious effort from individuals. ^{1 9 10 11 12}

What is the purpose of this trial?

This is a cluster randomized controlled trial of 30 food pantries affiliated with the Greater Boston Food Bank to test the use of behavioral economics (BE) tools to encourage food pantries to implement the Supporting Wellness at Pantries (SWAP) program, with the goal of fostering accurate use of SWAP traffic light labels on pantry shelves and increasing the healthfulness of foods chosen by pantry clients. Primary outcomes will be assessed at 6 and 12 months to compare the implementation and effectiveness of the SWAP program in the intervention vs. control pantries.

Research Team

Anne N Thorndike, MD, MPH

Principal Investigator

Massachusetts General Hospital

Eligibility Criteria

This trial is for food pantries within an hour's drive of Boston that partner with the Greater Boston Food Bank, offer maximum client choice, and don't currently use traffic-light nutrition rankings. Clients participating in assessments must be adults who speak English or Spanish.

Inclusion Criteria

Food pantries enrolled in the study must be partner agencies of the Greater Boston Food Bank that are maximum client choice, located within approximately 1 hour driving time of Boston, and not actively using traffic-light nutrition ranking

Exclusion Criteria

Food pantries that are not affiliated with the Greater Boston Food Bank and are not maximum client choice

I use a food pantry and do not speak English or Spanish.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Implementation

Pantries implement the SWAP program using behavioral economics tools or basic strategies

12 months

Ongoing monitoring and support visits

Follow-up

Participants are monitored for the effectiveness of the SWAP program implementation

6 months

Adaptation and Extension

BE-enhanced SWAP strategy is adapted and offered to control group pantries

Post-12 months

Treatment Details

Interventions

• Basic SWAP implementation
• Behavioral economics-enhanced SWAP implementation

Trial Overview The study compares two ways to implement the SWAP program in food pantries: one enhanced by behavioral economics and a basic version. It aims to see if these methods help correctly apply SWAP's traffic light labels on foods and improve clients' healthy choices over 6 to 12 months.

Participant Groups

Group I: Behavioral economics-enhanced SWAP implementation strategy Experimental Treatment 1 Intervention

Pantries assigned to the intervention group will receive behavioral nudges for implementing the SWAP nutrition program. These include: 1) invoice labeling with the food labeled as red, yellow, or green; 2) receipt of the SWAP toolkit at no cost; 3) pantry learning communities; 4)incentives to purchase SWAP implementation materials (e.g., shelves); 5) food bank recognition for SWAP implementation.

Group II: Basic SWAP implementation strategy Active Control 1 Intervention

Pantries assigned to the control arm will receive email communication from the food bank dietitian providing them with information about SWAP, online links to SWAP implementation guides, and encouragement to purchase SWAP Toolkits on their own.

Who Is Running the Clinical Trial?

Massachusetts General Hospital

Lead Sponsor

Trials

3,066

Recruited

13,430,000+

Findings from Research

Financial incentives based on behavioral economics significantly increased the odds of health behavior change, with participants having nearly four times higher odds of changing their behavior compared to those in the control group (odds ratio of 3.96).

The effectiveness of these financial incentives did not vary significantly by demographic factors such as gender, age, or education, but showed that Black participants had higher odds of behavior change compared to White participants when using conditional payments, while higher-income individuals had lower odds of change with a specific incentive structure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis. Haff, N., Patel, MS., Lim, R., et al.[2022]

In a study of 35 randomized controlled trials, financial incentives (FIs) based on behavioral-economic principles, particularly deposit contracts, were found to be the most effective in promoting healthy diet, weight control, and physical activity, significantly increasing goal achievement compared to no incentives.

While both deposit and lottery-based incentives improved physical activity levels during the intervention, only the deposit incentive maintained its effectiveness in the follow-up period, suggesting that behavioral insights can enhance the long-term impact of financial incentives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of the Effectiveness of Behavioral Economic Incentive Programs for Goal Achievement on Healthy Diet, Weight Control and Physical Activity: A Systematic Review and Network Meta-analysis. Boonmanunt, S., Pattanaprateep, O., Ongphiphadhanakul, B., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Nudges and choice architecture to promote healthy food purchases in adults: A systematized review. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Testing the effectiveness of in-home behavioral economics strategies to increase vegetable intake, liking, and variety among children residing in households that receive food assistance. [2016]

4. England pubmed.ncbi.nlm.nih.gov

Improving the cost-effectiveness of obesity programs: three basic strategies for reducing the cost per pound. [2014]

5. United States pubmed.ncbi.nlm.nih.gov

A 2-phase labeling and choice architecture intervention to improve healthy food and beverage choices. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Use of Insurance Against a Small Loss as an Incentive Strategy. [2020]

7. England pubmed.ncbi.nlm.nih.gov

Make the healthy choice the easy choice: using behavioral economics to advance a culture of health. [2018]

8. England pubmed.ncbi.nlm.nih.gov

Effect of default menus on food selection and consumption in a college dining hall simulation study. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Healthier Choices in School Cafeterias: A Systematic Review of Cafeteria Interventions. [2019]

10. England pubmed.ncbi.nlm.nih.gov

Evaluation of the Effectiveness of Behavioral Economic Incentive Programs for Goal Achievement on Healthy Diet, Weight Control and Physical Activity: A Systematic Review and Network Meta-analysis. [2023]

11. Netherlands pubmed.ncbi.nlm.nih.gov

Behavioral Economics and the Supplemental Nutrition Assistance Program:: Making the Healthy Choice the Easy Choice. [2018]

12. England pubmed.ncbi.nlm.nih.gov

Nationwide expansion of a financial incentive program on fruit and vegetable purchases among Supplemental Nutrition Assistance Program participants: A cost-effectiveness analysis. [2016]