Availability of healthier vs. less healthy food and food choice: an online experiment

Background: Our environments shape our behaviour, but little research has addressed whether healthier cues have a similar impact to less healthy ones. This online study examined the impact on food choices of the number of (i) healthier and (ii) less healthy snack foods available, and possible moderation by cognitive load and socioeconomic status. Methods: UK adults (n = 1509) were randomly allocated to one of six groups (two cognitive load x three availability conditions). Participants memorised a 7-digit number (7777777: low cognitive load; 8529713: high cognitive load). While remembering this number, participants chose the food they would most like to eat from: (a) two healthier and two less healthy foods, (b) six healthier and two less healthy foods, or (c) two healthier and six less healthy foods. Results: Compared to being offered two healthier and two less healthy options, the odds of choosing a healthier option were twice as high (Odds Ratio (OR): 2.0, 95% CI: 1.6, 2.6) with four additional healthier options, while the odds of choosing a less healthy option were four times higher (OR: 4.3, 95% CI: 3.1, 6.0) with four additional less healthy options. There were no significant main effects or interactions with cognitive load or socioeconomic status. Conclusions: This study provides a novel test of the impact of healthier vs. less healthy food cues on food choice, suggesting that less healthy food cues have a larger effect than healthier ones. Consequently, removing less healthy as opposed to adding healthier food options could have greater impact on healthier choices. Studies are now needed in which choices are made between physically-present foods.