ArticleThe international journal of behavioral nutrition and physical activity2025
Exploring nudging strategies for plant-based dietary choices in hospital patients: a quasi-experimental study.
Article in The international journal of behavioral nutrition and physical activity, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe global food system is responsible for climate change, biodiversity loss, and land-use changes. At the same time, the prevalence of diet-related, chronic diseases is increasing worldwide. A dietary shift to a plant-based diet could protect both planetary and individual health. Nudging can positively influence dietary choices. We investigated how different nudges influenced inpatients' choices of plant-based menus.
methodsA quasi-experimental study was conducted across three consecutive four-week phases at the University Hospital Essen, Germany. In the baseline phase, inpatients chose meals from a standard menu without any intervention. In a second phase, an order nudge was applied by listing the plant-based dish first on the menu. In the third phase, a combined nudge was applied, adding a verbal recommendation to the order nudge. Data from 6,575 inpatients (mean age: 57.3 ± 18.7; 50.6% female) covering 26,949 meal choices were analyzed using logistic regression and generalized linear modeling.
resultsIndependent of nudging, female sex and younger age predicted plant-based menu choices (p <. 001, respectively). Controlling for the effects of sex and age, patients were nearly twice as likely to choose the plant-based menu during both intervention phases compared to baseline (order nudge: OR = 1.95; 95% CI [1.55-2.45]; p <.001; combined nudge: OR = 1.95; 95% CI, [1.56-2.44]; p <.001). However, there was no significant difference in plant-based menu selection between the two nudges (OR = 1.00; 95% CI [0.80-1.25]; p =.992). Subgroup analyses further revealed that both women and men as well as middle-aged (36-64 years) and older adults (≥ 65 years), but not younger adults (18-35), were significantly more likely to select plant-based menus during the interventions compared to baseline. Among both sexes and across all age groups, no differences in plant-based meal selection were found between the order and the combined nudge (all p >.001).
conclusionCentrally implemented nudging is a simple and effective strategy that can increase patients' choice of plant-based menus, which in turn may promote patient health and contribute to positive environmental outcomes.
trial registrationDRKS00036763. Registered 29 April 2025.
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