There is a need for dietary shifts to make the transformation towards diets that are healthier and more environmentally sustainable. In the past 50 years, we have seen a shift towards unhealthy diets high in calories, and heavily processed and animal source foods. Transitions to unhealthy diets are increasing the burden of obesity and diet-related non-communicable diseases and are contributing to environmental degradation. Dietary guidelines are an important behaviour change policy tool to guide consumers in terms of the foods and diets they should be eating. However, healthy diets alone do not produce substantial reductions in greenhouse gas emissions. Therefore, dietary guidelines need to include recommendations for environmental sustainability.
A few countries have started to produce dietary recommendations for health and environmental impacts. In addition, dietary guidelines in most countries fail to take account of reasons behind peoples’ food choices, such as habits, preferences, affordability, circumstance, culture, and social norms. Another issue with the implementation of nutrient-based dietary guidelines is that people eat foods, not nutrients. Foods contain multiple nutrients that cannot be readily swapped for one another. Therefore, more food-based interventions are necessary for effective behaviour change strategies towards more healthy and sustainable dietary patterns.
Evidence on existing interventions
Food purchasing is a key determinant of food consumption, and interventions targeting the nutritional and environmental quality of food prior to or during shopping presents a clear opportunity for effective behaviour change. Individual-level interventions previously identified as effective behaviour change techniques include tailored dietary advice, information, self-monitoring, and personalised feedback. Interventions implemented in grocery stores, particularly those that manipulate price, suggest that swaps, and perhaps manipulating item availability, have an impact on purchasing and could play a role in public health strategies to improve health. Using swaps to promote health would be a scalable and low-cost intervention, but currently there is limited evidence on its effectiveness. The success of offering swaps depends on consumers accepting the suggested swaps, but most studies thus far did not explore why swap acceptance rates could be low. Acceptance could be low due to how swaps were framed, perceived to restrict freedom and personal autonomy, and perceived to be less palatable. Also, many consumers put lower importance on health messages and higher importance on taste and price. Indeed, product costs have been a particularly crucial factor for those on lower incomes, and lower price can encourage choices of healthier products more effectively than health status labels.
The development of behaviour change interventions requires an understanding of facilitators and barriers for consumers to make food choices that are healthier and more environmentally sustainable, but also economically affordable. Currently we know relatively little about how individuals interact with their food environment and apply their perceived knowledge of healthy and sustainable diets. Several factors including socio-economic, life-stage, demographic, and geographic background, can drive individual decisions and behaviours when selecting foods and drinks, indicating that behaviour change interventions require a more in-depth understanding of drivers of individual food choice, on a more granular level.