Applying Behavioral Nudges in a Dietary Comparator for Surgical Trials: Developing the MediDiet

Introduction: The Mediterranean diet is being studied as an alternative to surgery for common gastrointestinal conditions. However, dietary change can be challenging. "Nudges" - behavioral science strategies seeking to influence cognitive processes to promote good behaviors - may help. We conducted a pilot study evaluating the acceptability of the MediDiet, a behaviorally designed dietary intervention incorporating nudges and recommendations based on the Mediterranean Diet. Methods: We conducted a three-phase pilot study involving parallel randomized surveys of U.S. adults. After completing a validated questionnaire assessing dietary consistency with a Mediterranean diet, participants were randomized to feedback containing no nudge versus nudge: peer comparison; peer comparison + positive affect induction; or default. Participants then rated their positive and negative emotions, motivation for dietary change, and interest in recipes. Responses were analyzed using baseline covariate-adjusted regression. Results: Among 1,709 participants, 56% were men, 73% were White, and the mean age was 38. In response to dietary feedback, participants reported low negative emotions, high positive emotions, moderate motivation for dietary change and high interest in recipes. Nudges did not affect the extent of negative (p=0.104) or positive (p=0.34) emotions, motivation (p=0.139), or interest (p=0.86). In exploratory analyses, those with moderate and high consistency with the Mediterranean diet, with or without nudges, reported lower negative affect, greater positive affect, greater motivation, and greater interest in recipes, than the minimally consistent, no nudge group. Conclusion: Delivering dietary feedback based on the Mediterranean diet using behavioral nudges was acceptable among U.S. adults, rousing positive reactions without triggering negative ones. As early evidence, this pilot study provides the basis for testing nudge-based dietary guidance among individuals with symptomatic gallstones, diverticulitis, and other gastrointestinal diseases.

Web-Based Personalized Nutrition System for Delivering Dietary Feedback Based on Behavior Change Techniques: Development and Pilot Study among Dietitians

Given the complex and varied nature of individual characteristics influencing dietary behaviors, personalized dietary advice may be more effective than generalized “one-size-fits-all” advice. In this paper, we describe a web-based personalized nutrition system for improving the quality of overall diet in the general adult population. The development process included identification of appropriate behavior change techniques, modification of dietary assessment method (Meal-based Diet History Questionnaire; MDHQ), selection of dietary components, and a personalized dietary feedback tool. A pilot study was conducted online among 255 dietitians. Each completed the MDHQ, received his/her own dietary feedback report, and evaluated the relevance of the report based on 12 questions using a 5-point Likert scale from “totally disagree” (score 1) to “totally agree” (score 5). The mean value of overall acceptability score of dietary feedback report was 4.2. The acceptability score was, on average, higher in plausible energy reporters (compared with implausible energy reporters), participants who printed out the report (compared with those who did not), and those spending ≥ 20 min to read the report (compared with those spending < 20 min). This is the first attempt to develop a web-based personalized nutrition system in Japan, where dietitians were broadly supportive of the dietary feedback report.

Image-Based Dietary Assessment and Tailored Feedback Using Mobile Technology: Mediating Behavior Change in Young Adults

Assessing the implementation of nutrition interventions is important to identify characteristics and dietary patterns of individuals who benefit most. The aim was to report on young adults’ experiences of receiving dietary feedback text messaging intervention. Diet was captured using an image-based 4-day mobile food recordTM application (mFRTM) and assessed to formulate two tailored feedback text messages on fruit and vegetables and energy-dense nutrient-poor (EDNP) foods and beverages. At 6-months 143 participants completed a second mFRTM and a questionnaire evaluating the dietary feedback. Participants who agreed the text messages made them think about how much vegetables they ate were more likely to increase their intake by at least half a serve than those who disagreed [odds ratio (OR) = 4.28, 95% Confidence Interval (CI): 1.76 to 10.39]. Those who agreed the text messages made them think about how much EDNP foods they ate, were twice as likely to decrease their intake by over half a serve (OR = 2.39, 95%CI: 1.12 to 5.25) than those who disagreed. Undertaking detailed dietary assessment ensured the tailored feedback was constructive and relevant. Personal contemplation about vegetable and EDNP food intake appears to be a mediator of dietary change in young adults.