Nutritional nudges at restaurants: Establishments´ adoption and perceptions by consumers

Poor dietary habits have a direct impact on disease burden and mortality. It is known that consumers' environment influences dietary habits. Despite this, countries including Colombia have scarce scholarly research about food environments and how the population reacts to them. As behavioral settings, restaurants are part of the environment influencing dietary intake. In the case of Colombia, in 2018, 42% of the population ate out at least four times per month.1 Even during the pandemic, ordering food from restaurants offered convenience and a solution for cooking fatigue.2 In 2021, Colombian restaurant sales increased at a higher rate than in 2019 and 2020.3,4 Since frequent food consumption away from home is associated with greater daily energy intake 5 and statistics show that these dietary practices represent a health risk 6, the increase in restaurant food consumption could result in negative health consequences for the Colombian population. While several studies describe the disadvantageous conditions for healthy choices at restaurants, 7–9 few studies have addressed how to change them.10,11 Furthermore, limited research has evaluated which aspects of a healthy environment are valued the greatest by the consumer. Since most research in this field is conducted in developed economies like the United States, United Kingdom, or Australia, research in other countries where restaurant patronage is increasing, like Colombia, is needed to understand what initiatives should be adopted to create healthier restaurant food environments for consumers. Different sectors of society are interested in healthy eating promotion in restaurants. These sectors include but are not limited to governments, consumers, and restauranteurs. For example, governments should ensure that food environments are as healthy as possible to enhance citizens' health and welfare.12 Consumer interest in a healthy diet is rising 13–15. Individuals with a "health" mindset regularly make healthy choices (or what they think are healthy ones) and look for places that meet that need.16,17 These consumers are often referred to as "health-concerned" or "health-conscious." 18–20 In the U.S, this market segment has prompted a growing trend of health-focused restaurants (National Restaurant Association, 2019b). In this manuscript, restaurants that offer healthy items and use marketing communications to emphasize them are called health-focused restaurants. Contrary, other establishments do not aim attention at healthy items, referred to as other-focused restaurants. The literature reports that restaurants can improve their image and increase loyalty and consumers' value perception through healthy eating promotions. 21–23 Despite the interest, little is known regarding how restaurants may adopt effective strategies to promote healthier choices. Experts in behavioral economics have suggested using "nudges" as a strategy to improve consumer decision-making.24 A nudge is a factor that may modify the conditions under which people make decisions to "push" them toward desirable behaviors.24 Initiatives that persuade people toward better food choices without their complete awareness can be characterized as nutritional nudges. Recommendations to implement various nutritional nudges in restaurants have become more popular recently. Guidelines such as using visual cues, improving the menu profile, and healthy default options are examples of nutritional nudges.25 Most studies in healthy eating promotion at restaurants have focused on testing specific nutritional nudges and their effect on intake. However, what is less clear is how restaurants might implement those strategies. Consequently, there is a need to better understand the types of restaurants that implement healthy eating initiatives and which initiatives they implement. A better comprehension could bring positive results for government, consumers, and restauranteurs. This descriptive study focuses on the following research question: Which nutritional nudges suggested by the literature are perceived as important by restaurants and consumers? With that purpose in mind, the adoption of nutritional nudges by the restaurant industry and the importance perceived by consumers will be examined. Additionally, consumers' health concern level will be analyzed to understand variances in consumers' perceived importance of nudges per type of consumer. Restaurants' nutritional nudges adoption will be a proxy variable for their relevance to the industry. Important nudges may change according to the market segment and context. For this reason, health-focused and other focused restaurants will be studied in two different countries: Colombia and the United States. These two contexts were selected as case studies. U.S was chosen as a comparison country where nutritional nudges have been more extensively studied and dining out behavior is higher. Colombia represents a country with a developing economy, scarce scholarly research about food environments and restaurant consumer behaviors. In this way, a second question will be addressed: Does nutritional nudges' importance differ across the type of consumer, restaurants' market segments, and countries? From a practical perspective, identifying what restaurants are doing for healthy eating promotion and how consumers perceive these initiatives can play a crucial role in creating healthier food environments. Results may be used as guidance by the restaurant industry interested in healthy eating as a business concept. Some restauranteurs are responding to the health-concern consumers' demand with "better for you" offerings. This research may point out if there is a difference in health-focused to other focused restaurants in terms of their nutritional nudges' adoption. Information that may be valuable to analyze competitors and differential offerings. In the same way, recognizing which nutritional nudges customers prioritize may help shape restaurants' offerings. Research on restaurants could impact not only health conditions associated with food consumption but also the economy. In the case of Colombia, without considering other types of restaurants, full-service restaurants employ more than 700,000 employees and generate around $4700 million USD in sales per year.26 Restaurants are considered an attractive entrepreneurial opportunity in Colombia.27 In 2018, the hospitality and foodservice sector increased by 1841 establishments in less than one year.28 Therefore, this entrepreneurial restaurant sector plays a significant role in the Colombian economy. If restauranteurs could better address social concerns related to consumer food choices, it is possible that their business would be rewarded and the economy as well. This research will provide insights for policymakers. Involving restaurants in healthy initiatives align with the Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2030 developed by the World Health Organization29 which includes an objective to create health-promoting environments. Comparing restaurants in two different countries may provide insights into additional healthy eating strategies that may be adopted. In fact, it can provide justification to the industry to employ a wider breadth of initiatives and how consumers value those initiatives. In Colombia, the Public Health Plan 2012-2021 prioritized interventions in environments to improve population health and wellbeing.30 Restaurants are key behavioral settings for food consumption. Findings from this study will show how the Colombian food environments contrast to other country contexts. Comparing restaurants in Colombia and U.S will provide valuable insights regarding the applicability of nutritional nudges that have been tested mainly in developed economies. It is relevant to know if that research is transferable to other country contexts with different characteristics, like Colombia. This study will show if the frameworks and guidelines generated in developed countries, like U.S, about nutritional nudges may be a useful frame of reference to formulate guidelines for other types of countries like Colombia. From a scholarly perspective, the present research will examine the adoption of different types of nutritional nudges in restaurants with a distinct focus. Future research may go deeper into those nudges less adopted by the industry and their potential drawbacks. Recognizing how much the establishments are using the recommendations reported in the literature or if they are adopting other strategies may contribute to conceptualizing what a healthy restaurant is. Furthermore, this research will contribute to a deeper understanding of health concerns as a consumer trait. Recently, literature in hospitality management has addressed the health-concerned restaurant consumer profile, but much is still unknown.17,21 Our proposed study will differentiate what is important for consumers who seek healthy options when eating out and ascertain what is relevant for those with low-health concern. Findings may show that health concern plays a moderating role in the perceived importance of initiatives presented in the consumer nutritional environment.