Visual Cues and Optimal Defaults in Fast-Food Combo Meals Benefit Health-Concerned Consumers—A Randomized Scenario-Based Experiment

Background: The use of low-calorie menu items as optimal defaults and visual cues may nudge consumers to healthier choices at restaurants. However, little is known regarding their effects on emotions and behavioral intentions, particularly among people with different levels of health concern. Objective: Evaluate optimal defaults and visual cues’ effect on anticipated pleasure and order intention depending upon consumers’ health concern level. Design: Between-subjects randomized scenario-based experiment. Participants/setting: In all, 636 US adults recruited through an online crowdsourcing platform in July 2020. Intervention: Participants saw 1 of 6 menu boards in a fast-food drive-through simulation. Half the menu boards included meal photos with (1) menu items to be arranged as a combo by choice (ie, create-your-own combo); (2) traditional combos that included high-calorie default items; or (3) optimal combos that included low-calorie default items. The remaining 3 boards were identical without photos. Main outcome measures: Anticipated pleasure, order intention, and health concern were evaluated with 7-point Likert scales. Analysis: Statistical tests included multiple regression, Kruskal-Wallis, χ², and analysis of variance. Education and sex were tested as potential confounders. Results: Optimal combos negatively affected anticipated pleasure (P = .003) and order intention (P < .001) compared with choice combos. Order intention reduction was the same for traditional and optimal combos (P = .128). The presence of photos changed order intention for optimal combos but varied by consumer's health concern level. When health concern was lower, photos decreased the likelihood of ordering the optimal combos (B = −3.06, P = .001), but when health concern was higher, photos enhanced ordering intention compared with the choice group (B = 0.60, P = .001). The photos did not affect anticipated pleasure for any level of health concern. Conclusions: The adverse effect of optimal defaults and how visual cues may reduce their negative effect should be considered in menu design.