Vices and vegetables: a systematic review and series of meta-analyses examining the relationships among compensatory health beliefs with health-related intentions and behaviors.

backgroundCompensatory health beliefs (CHBs), the belief that a healthy behavior can offset the effects of a health-compromising one, have been theorized to both justify unhealthy behaviors and motivate health-promoting ones. However, findings in the literature are inconsistent.

methodsThese meta-analyses synthesized 252 effect sizes from 59 independent samples using robust variance estimation to examine the relationships between CHBs and four outcomes: intentions and engagement in compensatory health behaviors and intentions and engagement in health-compromising behaviors.

resultsApproximately 13,760 individuals were represented across these analyses (ages 12-79; women ∼66.1%; college-based = 69.8%). CHBs were significantly associated with greater intentions to engage in compensatory health behaviors (r = 0.21) and with greater engagement in health-compromising behaviors (r = 0.18), but were not reliably associated with compensatory health behaviors or intentions to engage in health-compromising behaviors. Heterogeneity was substantial across all models, but only one significant moderator emerged: CHBs were more strongly associated with compensatory intentions in studies examining diet compared to physical activity. Funnel plot symmetry and stability across values of ρ supported the robustness of findings.

conclusionsThese results highlight the potential for CHBs to undermine health behavior change efforts, particularly when intentions to engage in healthy behaviors are not carried out. Future work should explore state-level CHBs and real-time decision-making to clarify how and when these beliefs influence behavior.