Obesity continues to be a major public health concern, and children who are overweight by age 5 are at increased risk for future obesity, highlighting the importance of early efforts to promote healthy eating and growth. The goal of this project is to test a new family-based approach to early childhood obesity prevention, specifically using pre-filled, online grocery shopping carts to make it easier for parents to select healthy foods like fruits and vegetables. This study will be the first to test whether such default shopping carts can help promote the purchasing and consumption of healthier foods, as well as healthier diets and weight outcomes, among parents with obesity and their 2-to-5-year-old children, offering the potential for a meaningful impact on the health of young children and their families.
Obesity is a diet-related disease that continues to be a major public health concern. Children who are overweight by age 5 are at increased risk for future obesity, highlighting the importance of early efforts to promote healthy diets. Modifying home food availability can impact the diets of children and their families, and online grocery shopping offers untapped potential as a way to modify the family food environment. The objective of this grant is to test a new family-based approach to early obesity prevention, specifically using optimal defaults to promote healthier online grocery shopping. Making "optimal" choices easier by making them the default option has strong scientific support, but this strategy has not been implemented in the context of online grocery shopping on a large scale. The study team's preliminary research demonstrated the potential of pre-filling online grocery shopping carts with nutritious foods: this default grocery cart strategy had significant, positive effects on the nutritional quality of grocery purchases in two pilot studies. The proposed study will expand upon this preliminary research, recruiting 192 parents with obesity who use online grocery shopping and have a 2-to-5-year-old child. Families will be randomly assigned to a default grocery cart intervention or control group. Both groups will be provided with 4 main meal recipes and 4 lunch and/or snack recipes each week of a 6-month intervention period, with recipes corresponding to the Traffic Light Diet, an evidence-based diet for family-based obesity prevention and treatment. Corresponding nutritional guidance will be provided, with a goal to increase low energy-dense, high nutrient-dense foods and decrease the energy density of the diet. In addition, the defaults group's online grocery carts will be pre-filled with items that correspond to the provided recipes each week. Participants can alter these carts as they like. Assessments will occur via grocery receipt forms, phone interviews, remote food photography, height/weight measurements, and online surveys. Hypotheses corresponding to primary and secondary aims are: It is hypothesized that the defaults group will have household grocery purchases that are better-aligned with dietary goals (e.g., more fruits and vegetables, higher nutritional quality, fewer calories) (Aim 1), and that participating parents and 2-to-5-year-old children will have healthier dietary intake (e.g., more fruits and vegetables, higher nutritional quality, fewer calories) than controls (Aim 2) following the 6-month intervention. These aims are designed to leverage a simple but powerful behavioral principle, optimal defaults, to make purchasing of healthier foods easier among families with young children during a period of the life span in which dietary preferences and future weight trajectories are being established. In the long-term, this research offers the potential for a scalable, sustainable approach to facilitate healthier dietary intake among a broad population of individuals and families at risk for diet-related diseases.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
384
Packet of healthy recipes provided each week of a 6-month intervention, with nutrition education and healthy eating tips included.
Participants' online grocery carts are pre-filled with the ingredients from the main meal recipes featured in provided recipe packets that week. Participants can change these carts as they like.
Nutritional quality of household grocery purchases
Nutritional quality of household grocery purchases will be coded in accordance with the Healthy Eating Index and will include all groceries purchased that time point (online or in-person, etc.). Grocery purchases are scored in 13 categories from the Healthy Eating Index, with quintiles used to operationalize lower versus higher purchasing of these categories (ex. fruits, vegetables, whole grains), with a resulting possible nutritional quality range of 13-65. Two weeks of data collection occur per time point, and values are averaged to represent the average weekly nutritional quality of grocery purchases at that time point. Analyses will compare the nutritional quality of grocery purchases between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, in the context of marginal models adjusting for baseline nutritional quality, stratification factors, and household size.
Time frame: 6 months
Energy content of household grocery purchases
Energy content will be operationalized across all household grocery purchases in kcal. Two weeks of data collection occur per time point, and values are averaged to represent the average weekly energy content of grocery purchases at that time point. Analyses will compare the energy content of grocery purchases between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, in the context of marginal models adjusting for baseline energy content, stratification factors, and household size.
Time frame: 6 months
Fruits purchased
The number of different types of fruits purchased will be operationalized across all household grocery purchases. Two weeks of data collection occur per time point, and values are averaged to represent average number of fruits purchased. Analyses will compare fruits purchased between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, adjusting for baseline fruit purchasing, stratification factors, and household size.
Time frame: 6 months
Vegetables purchased
The number of different types of vegetables purchased will be operationalized across all household grocery purchases. Two weeks of data collection occur per time point, and values are averaged to represent average number of vegetables purchased. Analyses will compare vegetables purchased between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, adjusting for baseline vegetable purchasing, stratification factors, and household size.
Time frame: 6 months
High energy dense foods purchased
The number of different types of high energy dense foods purchased will be operationalized across all household grocery purchases. Two weeks of data collection occur per time point, and values are averaged to represent average number of high energy dense foods purchased. Analyses will compare high energy dense foods purchased between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, adjusting for baseline high energy dense food purchasing, stratification factors, and household size. High energy dense foods are coded based on cut-offs from the Traffic Light Diet (e.g., sugar \>25% of calories/serving).
Time frame: 6 months
Nutritional quality of child intake
Nutritional quality of children's intake is measured using remote food photography during 3 evening meals per time point. Trained raters analyze images of foods before and after the meal and quantify food intake. Nutritional quality of the foods consumed will be calculated in accordance with the Healthy Eating Index and aggregated across the 3 days of evening meal data collection. Analyses will compare nutritional quality of evening meal intake between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, adjusting for baseline nutritional quality of intake and stratification factors.
Time frame: 6 months
Nutritional quality of parent intake
Nutritional quality of parent's intake is measured using remote food photography during 3 evening meals per time point. Trained raters analyze images of foods before and after the meal and quantify food intake. Nutritional quality of the foods consumed will be calculated in accordance with the Healthy Eating Index and aggregated across the 3 days of evening meal data collection. Analyses will compare nutritional quality of evening meal intake between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, adjusting for baseline nutritional quality of intake and stratification factors.
Time frame: 6 months
Energy content of child intake
Energy content of children's intake is measured using remote food photography during 3 evening meals per time point. Trained raters analyze images of foods before and after the meal and quantify food intake. Energy consumed at the meal is aggregated across the 3 days of evening meal data collection. Analyses will compare energy consumed at the evening meal between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, adjusting for baseline energy content of intake and stratification factors. Energy consumed is in kcal.
Time frame: 6 months
Energy content of parent intake
Energy content of parent's intake is measured using remote food photography during 3 evening meals per time point. Trained raters analyze images of foods before and after the meal and quantify food intake. Energy consumed at the meal is aggregated across the 3 days of evening meal data collection. Analyses will compare energy consumed at the evening meal between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, adjusting for baseline energy content of intake and stratification factors. Energy consumed is in kcal.
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Time frame: 6 months
Child fruit intake
Child fruit intake is measured using remote food photography during 3 evening meals per time point. Trained raters analyze images of foods before and after the meal and quantify food intake. Number of different fruits consumed at the meal is aggregated across the 3 days of evening meal data collection. Analyses will compare fruit intake between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, adjusting for baseline fruit intake and stratification factors.
Time frame: 6 months
Parent fruit intake
Parent fruit intake is measured using remote food photography during 3 evening meals per time point. Trained raters analyze images of foods before and after the meal and quantify food intake. Number of different fruits consumed at the meal is aggregated across the 3 days of evening meal data collection. Analyses will compare fruit intake between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, adjusting for baseline fruit intake and stratification factors.
Time frame: 6 months
Child vegetable intake
Child vegetable intake is measured using remote food photography during 3 evening meals per time point. Trained raters analyze images of foods before and after the meal and quantify food intake. Number of different vegetables consumed at the meal is aggregated across the 3 days of evening meal data collection. Analyses will compare vegetable intake between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, adjusting for baseline vegetable intake and stratification factors.
Time frame: 6 months
Parent vegetable intake
Parent vegetable intake is measured using remote food photography during 3 evening meals per time point. Trained raters analyze images of foods before and after the meal and quantify food intake. Number of different vegetables consumed at the meal is aggregated across the 3 days of evening meal data collection. Analyses will compare vegetable intake between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, adjusting for baseline vegetable intake and stratification factors.
Time frame: 6 months
Child energy density of intake
Child energy density of intake is measured using remote food photography during 3 evening meals per time point. Trained raters analyze images of foods before and after the meal and quantify food intake. Energy density is calculated as kcal consumed relative to volume consumed (g) and aggregated across the 3 days of evening meal data collection for daily energy density of intake. Analyses will compare energy density of intake between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, adjusting for baseline energy density of intake and stratification factors.
Time frame: 6 months
Parent energy density of intake
Parent energy density of intake is measured using remote food photography during 3 evening meals per time point. Trained raters analyze images of foods before and after the meal and quantify food intake. Energy density is calculated as kcal consumed relative to volume consumed (g) and aggregated across the 3 days of evening meal data collection for daily energy density of intake. Analyses will compare energy density of intake between groups at the primary outcome time point of 6 months, immediately after the conclusion of the intervention, adjusting for baseline energy density of intake and stratification factors.
Time frame: 6 months