App-etizing Solutions: How Food Delivery Apps Revolutionise Healthier Eating

Three randomised trials presented at this year's European Congress on Obesity (ECO) in Dublin, Ireland (17-20 May) suggest that simple initiatives to help individuals choose lower-calorie options when ordering meals in delivery apps could help combat the obesity pandemic.

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Revamping Food Delivery Apps: How Simple Interventions Slash Calories by 2-15%

The study, which used a simulated food delivery app, discovered that interventions that prominently displayed lower-calorie foods and restaurants, pre-selected smaller portions by default, and displayed calorie labels all significantly reduced the total calorie content of takeaways by 2-15% when compared to a control app. Dr. Filippo Bianchi of the Nesta innovation foundation and the Behavioural Insights Team in London conducted the study with colleagues from the University of Oxford.

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Simple App Interventions to Combat Excess Calories and Tackle Obesity

“Our findings suggest that simple interventions could help people select lower-calorie options on delivery apps without the need to remove less healthy options,” says Dr Bianchi. “This doesn’t mean that we always have to swap pizza for a green salad - even initiatives that make it easy to make small changes to what we eat could help to slowly reduce obesity if delivered at scale.”

Delivery apps like Uber Eats, JustEat, and Deliveroo are used by around 25 million adults in the United Kingdom, a 55% rise since 2015. Takeaways can be a fantastic treat, but they contain far more excess calories than home-cooked meals and are associated with an increased risk of gaining too much weight.

Previous investigations of major UK restaurant chains discovered that just 9% of dishes contained less than 600 kcals per meal, and over half (47%) of meals contained at least 1,000 kcals or more—equivalent to roughly half of an adult's daily-recommended energy intake (1^✔ ✔Trusted Source
(Over)eating out at major UK restaurant chains: observational study of energy content of main meals

Go to source). Takeaway and delivery meal consumption have also been associated with higher energy intake and a higher body mass index (BMI) (2).

“Delivery apps could reach millions of people and help us select healthier food options, and yet there is very little research looking at what works to promote healthier and more nutritious options in these settings,” says Dr Bianchi.

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Slimming Down Menus in Food Delivery Apps: Unveiling the Impact

To learn more, researchers created a simulated food delivery app and performed three randomised controlled trials with 23,783 persons (aged 18 or older who used meal delivery apps) to compare 14 interventions promoting the selection of lower-calorie items to control.

Participants in each session were instructed to select a dinner for themselves, just as they would in real life. The total quantity of calories in the basket at checkout was the primary outcome. The findings were adjusted to account for potentially confounding variables such as BMI, age, gender, and income.

Default Portion Interventions Slash Calorie Intake in Food Delivery Orders

Three interventions promoting the choice of reduced portion sizes via defaults were studied in the first trial. In total, 6,000 participants were randomly assigned to one of three groups (1^✔ ✔Trusted Source
(Over)eating out at major UK restaurant chains: observational study of energy content of main meals

Go to source): control (no intervention) (2^✔ ✔Trusted Source
Consumption of takeaway and delivery meals is associated with increased BMI and percent fat among UK Biobank participants

Go to source); default plus normalisation (using the term regular instead of small); or default and normalisation plus availability (the addition of an extra 'extra small' portion size option).

The control group ordered a meal with an average of 1,411 kcals—56-70% of an adult's recommended daily calorie intake in a single takeaway meal. When compared to the control group, all three interventions reduced calorie purchases by an average of 5.5% (78 kcals per order; default) to 12.5% (177 kcals per order; combined intervention).

Strategic Repositioning Puts Healthier Options at the Top of the Menu

The second trial examined four interventions that repositioned meals and restaurants to emphasize lower-calorie options.

Overall, 9,003 adults were randomly assigned to a control group (restaurants and foods were listed randomly) or to one of the following interventions (1^✔ ✔Trusted Source
(Over)eating out at major UK restaurant chains: observational study of energy content of main meals

Go to source): lower-calorie food options listed at the top of menus (2^✔ ✔Trusted Source
Consumption of takeaway and delivery meals is associated with increased BMI and percent fat among UK Biobank participants

Go to source); restaurant options with lower-calorie main meals at the top of the restaurant selection page; interventions 1 and 2 combined; or interventions 1 and 2 combined, but food and restaurant options repositioned so lower calorie and higher price options were at the top. This most recent program was intended to promote healthier options while not negatively impacting restaurant businesses.

The control delivery app participants ordered a meal with an average of 1,382 kcals—55-69% of an adult's recommended daily calorie intake.

All interventions significantly lowered the total calorie content of orders when compared to the control app, but relocating both food and restaurants to offer lower calorie options at the top was the most successful, resulting in an average of 15% (209 kcals) reduction per order.

Importantly, the combined intervention, which also considered food costs, lowered the calorie content of orders by an average of 8% (117 kcals) while increasing the basket price, keeping compliant with businesses' economic aims.

Food Delivery App Strategies to Slash Calories and Enhance User Experience

The final research examined the impact of seven different calorie label styles on the choice of lower-calorie products in 8,780 adults. Some labels simply stated the number of calories in various selections, while others tried more creative techniques to safeguard persons who may be triggered by calorie information. Two labels, for example, allowed users to interact with a toggle that allowed them to hide or expose the calorie information on the simulated app.

Compared to the control app (which did not include calorie information), five of the seven labels considerably lowered the calorie content of orders, ranging from an average of 2% (33 kcals/order reduction) to 8% (110 kcals/order reduction for calorie labels combined with a filter that allows individuals to display or hide the labels).

The same authors' Think-aloud study, which was published concurrently at ECO, investigated how to improve the effectiveness and acceptability of calorie labeling in food delivery apps in collaboration with 20 adult delivery app users in the UK.

The key recommendations include: providing a filter that allows users to turn on and off calorie labels; communicating recommended energy intake per meal (i.e., 600 kcal) rather than per day (i.e., 2,000 kcal); and avoiding framing calorie label messaging or formatting as judgmental (e.g., red fonts).

“These studies provide encouraging proof-of-concept evidence that small tweaks in delivery apps could help many people to identify and select healthier foods. Testing similar initiatives with real restaurants and delivery apps will be important to assess the long-term impact of these interventions in the real world. Further research should also explore the best way to balance desired health impacts while minimising effects on businesses and cost-of-living concerns for consumers,” says Dr Bianchi.

References:

1. (Over)eating out at major UK restaurant chains: observational study of energy content of main meals - (https://www.bmj.com/content/363/bmj.k4982)
2. Consumption of takeaway and delivery meals is associated with increased BMI and percent fat among UK Biobank participants - (https://pubmed.ncbi.nlm.nih.gov/35681260/)

Source-Medindia