NIH-Funded $4 Million Study Will Test Whether Prefilled Online Grocery Carts Improve Family Diets

A University at Buffalo research team is launching a study to determine whether preloading online grocery carts with healthy ingredients can improve the diets of families with young children at risk for obesity. The effort is funded by a $4 million grant from the National Institute for Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, and it is designed to test a new family-based approach to early obesity prevention that aims to make the healthy choice the feasible, appealing and easy choice. Stephanie Anzman-Frasca, PhD, associate professor of pediatrics in the Jacobs School of Medicine and Biomedical Sciences at UB and director of its Child Health and Behavior Lab, is the principal investigator.

The research question centers on a concept known as “optimal defaults.” The idea is that when a healthy option is set up as the starting point, while people retain the freedom to change it, healthier decisions become more automatic and require less effort. Anzman-Frasca’s lab is interested in identifying and scaling effective ways of modifying modern food environments to make choosing nutritious foods more feasible, appealing and more automatic. Research supports the idea that repeated exposures to nutritious foods can support children in developing healthy food preferences and dietary patterns over time, but the modern food environment does not necessarily make it easy for families to provide those exposures.

The new study builds directly on a 4-week pilot study the UB team conducted with Instacart involving families that had 2-to-5-year-old children at risk for obesity. In that pilot, families were provided with healthy recipes, and some of the families had their online grocery carts preloaded with the ingredients to make those recipes. The findings showed that purchases were significantly more nutritious in the prefilled cart group compared to a group that received only the recipes. Families paid for their grocery purchases as usual and were free to alter their carts as they liked, and most participants in the prefilled cart group accepted at least some of the recipe ingredients placed into their carts.

“Leveraging optimal defaults – in this case making healthy choices more automatic by prefilling online grocery carts with healthy ingredients while still giving families the autonomy to opt out – shows a lot of promise,” Anzman-Frasca says. “The fact that this optimal defaults intervention worked for families with young children was exciting, given that we know children in this age group can be hesitant to try new foods.” Anzman-Frasca and her team at UB have also conducted pioneering work demonstrating the optimal defaults concept with adults, and the pilot findings suggested that healthier choices can be supported by making them easier and more automatic.

The new project is the first time optimal defaults will be studied on a large scale with families’ online grocery shopping. Approximately 200 families will be recruited, all of whom will receive healthy recipes that meet nutritional criteria from the Traffic Light Diet, an evidence-based diet developed at UB for family-based obesity prevention and treatment. Half the families will also receive online grocery carts prefilled with the necessary ingredients to make those recipes. Provision of recipes and prefilled carts will continue for six months during the study, with follow-up assessments on the nutritional quality of groceries purchased at six and 12 months.

Because dietary restrictions and food preferences vary from household to household, the researchers have been working on an expanded recipe bank that will allow the provided recipes to be tailored to families’ food preferences. “We focused on identifying and adapting recipes that are simple, affordable, nutritious and customizable to address factors like time constraints, food costs and pickiness, which can make healthy eating challenging for families in today’s food environment,” says project coordinator Jack McGowan. Both the healthy recipes and the prefilled carts are designed to be low in cost, adhering to budgetary guidance from the U.S. Department of Agriculture’s Thrifty Food Plan.

The study will measure more than grocery purchases. “In addition to assessing grocery purchases, our new study includes measures of parent and child dietary intake and weight outcomes, allowing us to test whether targeting grocery purchases impacts these health metrics over time,” Anzman-Frasca explains. Because children are still growing, and because families are being recruited whose children are at risk for obesity but not necessarily presenting with obesity now, child weight loss is not an outcome the team will evaluate. Instead, height and weight will be monitored over time to observe healthy, age-appropriate growth.

To evaluate what children and families are consuming, the researchers will use the Healthy Eating Index, or HEI, a dietary rating system that encourages greater consumption of food groups like fruits, vegetables, whole grains and protein, and lower consumption of refined grains, sodium and added sugar. “A diet that adheres to this rating system is associated with many health benefits besides healthy weight,” Anzman-Frasca continues, “and exposing children to foods encouraged by the HEI can also support healthier dietary patterns as they grow, given evidence that repeated exposure to nutritious foods like vegetables can support vegetable acceptance and intake over time.”

An interesting result of the pilot study was that grocery spending went down in both groups even though this was not a goal of the study. The researchers will examine how much families spend throughout the new study, adding an economic dimension to the evaluation of the intervention. If the large-scale trial confirms the pilot findings, the results could inform how online grocery platforms are designed to support family nutrition, since prefilling carts leaves families with the autonomy to opt out while making nutritious ingredients the automatic starting point.

Recruitment of families for the new study began this month and is ongoing. The team includes Leonard H. Epstein, PhD, SUNY Distinguished Professor in the Department of Pediatrics at the Jacobs School, who developed the Traffic Light Diet, as co-investigator, along with Lucia A. Leone, PhD, associate professor in the Department of Community Health and Health Behavior, and Gregory Wilding, PhD, professor in the Department of Biostatistics, both in the UB School of Public Health and Health Professions. Corby Martin, PhD, of Pennington Biomedical Research Center and Mackenzie Ferrante, PhD, of Rutgers University, are also co-investigators. The Independent Health Foundation is a community collaborator on the project, contributing nutritional expertise and recipe ideas from their Healthy Options at Home program, and the University at Buffalo Civic Engagement Research Fund supported recipe bank development for this project. More information is available on the lab’s Facebook page: www.facebook.com/ubhablab.

Subject of Research: A randomized study testing whether preloading online grocery carts with healthy recipe ingredients improves the diets of families with young children at risk for obesity.

Article Title: Could online grocery shopping help families eat healthier? NIH funds a $4 million study at UB to find out

Article References: Could online grocery shopping help families eat healthier? NIH funds a $4 million study at UB to find out. Original publication (Bibliographic details unavailable.)

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Keywords: obesity prevention, online grocery shopping, optimal defaults, child nutrition, Healthy Eating Index, Traffic Light Diet, University at Buffalo, NIH funding, Instacart pilot study, family dietary habits, prefilled grocery carts, pediatric health