Obesity has now overtaken smoking as the biggest cause of preventable death in England and Scotland, according to recent research. Nesta and the Behavioural Insights Team (BIT) set out below why we think making changes to the way we shop for food online could help us to live healthier lives. We also suggest actions that retailers, researchers and policy makers can take to help people make healthier online food choices.
In April 2020, one month after the UK entered its first national lockdown, online grocery sales doubled and takeaway deliveries saw a 21% rise compared with the previous year. While online grocery sales have fallen slightly from their lockdown peak, they remain high: over a four week period in July and August 2021, 20% of UK households in the UK ordered online deliveries from supermarkets. It’s not just supermarkets that offer online grocery shopping. Since the pandemic, several rapid grocery delivery services such as Weezy, Gorillas and Getir, provide cheap groceries delivered in under 20 minutes in several large cities.
Though the total amount of food purchased through online takeaways platforms is expected to be smaller than that purchased from online supermarkets, they are likely to be an important source of calories in people's diets. A 2021 survey found that 67% of adults had used JustEat, the most popular delivery platform, in the previous year. Research shows that while there are exceptions, the majority of takeaway meals exceed dietary energy, fat, sugar and salt recommendations and that exposure to takeaways is associated with higher obesity prevalence. Furthermore, the higher density of takeaways in areas of greater deprivation suggests that consumption of takeaway fast-food may contribute to health inequalities.
Retailers can have a positive impact on consumers' food choices, helping to reduce the prevalence of obesity. Research suggests that shopping online may reduce impulse purchases. In one US study, consumers spent less on sweets and desserts when shopping online, compared to shopping in-store. This may be due to reduced exposure to till point or end of aisle promotions, or because online food sites present users with a shopping list based on previous purchases, limiting the opportunity for browsing and impulse purchases. Other researchers have suggested that online shopping might be more conducive to healthy shopping by allowing customers to filter by nutrition-related attributes, such as those low in salt or sugar.
Evidence that people buy fewer unhealthy products online is based on observational evidence rather than randomised controlled trials. It is therefore not clear if it was the online shopping experience itself that led to healthier food choices. For example, it may be that people who are more likely to shop online, who tend to be younger and wealthier, are more likely to make healthier food choices regardless of where they shop.
Online shopping can be more convenient for people with physical access issues, but evidence suggests that the young and wealthy are currently the biggest users. One survey found that wealthy UK consumers are ten times more likely to order groceries online compared to lower-income groups and data suggests that people aged 25 - 54 are more than twice as likely to shop online than those over 55. This suggests that, though online food services have the potential to help more people access healthy food, steps need to be taken to make sure everyone can benefit from them. Not doing so risks exacerbating existing disparities in obesity prevalence; adults in the most deprived areas of the UK are in excess of 50% more likely to be obese than those in the least affluent areas.
One potential way to help lower-income families access online shopping services is to open up current welfare assistance schemes to online shopping. The Supplemental Nutrition Assistance Program (SNAP), a US based initiative that provides those with low incomes with monthly food benefits, allows participants to buy groceries online — uptake varied greatly between participating states. In an average month in 2020, 2% of SNAP recipients in Vermont and up to 17% in Kentucky used SNAP online. Similar schemes in the UK, like the Government's' Healthy Start voucher scheme, cannot be used online.
There are many changes that online retailers, including large supermarkets and smaller retailers, takeaways and other food delivery outlets, could make to encourage customers to make healthier choices. These changes focus on removing cues that push people towards purchasing unhealthy foods and on adding nudges towards healthier options.
Labels: research conducted in online environments indicates that attaching nutrition labels to products can reduce the calorie count of a weekly shop by up to 6%. However, not all labels are equal. Evidence indicates that our understanding of labels is best when they are simple. The Nutriscore label, which shows a single colour health rating per product, is the most effective. The flexibility of the online shopping environment offers potential to explore the timing and placement of different labelling interventions. For example, websites could show individual product labels while consumers are browsing, or they could provide real time feedback about what proportion of their overall basket is made up of red, amber, or green foods.
Positioning and defaults: changing the environment so that the default option is the healthy one may be more effective than providing information about nutrition and asking the consumer to make an active choice. In a simulated online supermarket experiment, prioritising foods low in saturated fat reduced the total calories purchased. The effect of this nudge was not impacted by a range of demographics, including income and BMI. Furthermore, a pilot conducted by BIT and Nesta using a simulated online takeaway platform found that when products are available in multiple sizes (small, medium and large) making the small size the default resulted in participants choosing it more often.
Swaps: a way to nudge consumers towards healthier shopping baskets is to suggest food swaps when they select products where healthier alternatives exist. In one trial run on an Australian supermarket’s online shopping service, offering healthy swaps prior to online checkout reduced the proportion of foods high in saturated fat that consumers purchased. The effect of this intervention was higher among individuals with higher body mass index and people over 40.
Access to retailers’ data and robust evaluation can help to increase our understanding of the impact of online interventions that aim to encourage healthier eating. Nesta is keen to work in collaboration with retailers to analyse their data and test the impact of interventions in real-life shopping contexts, rather than relying on experiments using simulated shopping platforms. Research would also be advanced by the open sharing of data by retailers so that researchers could explore:
Online food environments present opportunities to help improve the nation’s health, which government could play a leading role in shaping. For example, developing evidence-based guidelines for online food retailers on best-practice, for example in the ordering of search results. Policymakers might also explore the feasibility of implementing consistent, simple and accessible ratings for retailers, just as the Food Standards Agency does with hygiene ratings, showing which retailers promote healthy products. In addition to tipping the balance of competitive pressure in favour of healthier providers, this may serve to incentivise retailers to make adjustments to meet the threshold of the better ratings.
Online food delivery platforms, whether for groceries or takeaways, represent just some of the complex web of environmental and personal factors that come together to drive our food choices. However, the rapid rise in their popularity, coupled with the relative ease with which potentially impactful changes to the way food choices are presented can be made and tested, provides an opportunity for retailers, researchers and policy makers to make it easier for consumers to make healthier food choices.
We are interested in working with policymakers and retailers of all sizes to explore ways of making online services better for customers' health and for business. If you have any thoughts or questions, or would like to work with us, please get in touch with Jonathan Bone.