How to improve food choices through vending machines: The importance of healthy food availability and consumers' awareness

Vending machines (VMs) have been pointed out as an obesogenic factor contributing to increase the availability of unhealthy foods throughout the day. They usually offer nutrient-poor and energy-dense products, while healthy options are scarce or even absent. This study was carried out between April 2014 and December 2015 at the University of Parma (North Italy) to increase purchases of healthy foods in VMs through the enhancement of healthy product availability and the promotion of healthier food options through nutrition communication. Choices were retrospectively measured by comparing the amount of sales for 24 weeks at baseline and after improving the nutritional quality of products, with or without additional nutrition communication. Purchase of healthy foods increased after improving the nutritional quality of the available products. Product replacement was successful in increasing healthy product sales, while decreasing unhealthy choices. Differently, the addition of a point-of-sales nutrition information service only discouraged choices of less favourable foods without impacting notably on consumer behaviour. Iconographic labels in VMs were able to change only partially consumers' choices, reducing the purchase of less recommendable products but not substantially enhancing healthier choices. Overall, this study yielded useful information for the implementation of nutrition interventions through VMs, addressing food choices and promoting healthy dietary patterns without limitation of consumers' freedom. This kind of environmental interventions could lead to improvements in body weight management and consequent health outcomes.