Nudging healthier food and beverage choices through salience and priming. Evidence from a systematic review

• Author-identified nudging interventions influencing dietary choices were reviewed.
• Only 13 articles comprising 26 studies testing ‘priming’ and ‘salience’ nudges were identified.
• Most studies were low levels of evidence and received poor or average quality ratings.
• ‘Priming’ and ‘salience’ nudges have mixed efficacy for influencing healthier choices.
• A combination of ‘priming’ and ‘salience’ nudges influences healthier choices.

High rates of overweight, obesity and chronic disease are partly attributable to an increased prevalence of poor dietary choices, which are in part due to the modern environment being conducive to the development of habitual unhealthy food and beverage choices. Nudging aims to influence habitual behaviors by altering the presentation of options to consumers. This systematic literature review investigated nudging interventions, as attributed by the original authors, and their effectiveness for influencing healthier choices. Eight bibliographic databases from the disciplines of psychology, business and health were searched. Included studies were available in the English language and as full-text peer reviewed publication. Studies used nudging or choice architecture interventions that influenced adult food and beverage choices. The number of papers reporting nudging interventions (as attributed by the authors) was low, with only thirteen articles included in the review (comprising 26 primary studies). All studies fall into ‘salience’ and ‘priming’ – type nudging interventions, which were tested across different adult populations and settings – including laboratories, canteens, cafeterias and restaurants. According to the NHMRC levels of evidence (NHMRC, 2007) only two interventions were of a high level of evidence, and the majority of articles received average or poor quality ratings, as per the Scottish Intercollegiate Guidelines. Combined ‘salience’ and ‘priming’ nudges showed consistent positive influence on healthier food and beverage choices. This review had limited ability to determine effectiveness of nudging due to various populations and settings tested and the use and reporting of incomparable outcome measures. This is the first review to synthesize nudging interventions, finding minimal uptake of nudging in the academic literature, and mixed effectiveness of nudging for influencing healthier food and beverage choices. This review is registered with PROSPERO – CRD42013005056.