1

Eating Well, Thriving at Work: A Holistic Approach to Enhancing the Dietary Choices of

University Staff, Unpacking Determinants, Applying Behavior Change Techniques, and

Mobilizing with an Innovative App

Introduction

Healthy eating is a fundamental aspect of overall well-being and plays a crucial role in

preventing chronic diseases and improving quality of life. This scientific analysis explores the

significant health risks associated with unhealthy eating habits, examining their prevalence,

trends, and far-reaching consequences regarding compromised health, diminished well-being,

and the burden on communities. The aim is to provide an understanding of this issue, elucidating

the specific connections and causal relationships between unhealthy eating and its outcomes. By

addressing this problem, we hope to emphasize the importance of making healthier dietary

choices and adopting better eating habits.

1. Problem Definition

Unhealthy eating habits are widespread globally, posing a persistent public health

challenge. These behaviors involve various dietary choices marked by excessive consumption of

processed foods high in sugars, saturated fats, and sodium, often coupled with insufficient intake

of fruits, vegetables, and whole grains (Mozaffarian et al., 2016). These behaviors include binge

eating, excessive consumption of sugary beverages, frequent fast-food consumption, and neglect

of portion control. The core issue lies in the departure from a balanced and nutritious diet,

influenced by factors such as convenience, accessibility, cultural influences, and personal

preferences (Giskes et al., 2011).

2. Magnitude of the Problem

 2

a. Prevalence

Unhealthy eating habits are a global concern, affecting individuals of all ages,

socioeconomic backgrounds, and cultural orientations. The prevalence of these behaviors has

increased globally due to factors like globalization, urbanization, and changing lifestyles (Popkin

et al., 2012). In advanced economies, such as the United States, obesity, a consequence of

unhealthy eating habits, has reached alarming levels. In the United States, over one-third of

adults are now obese, and rates among children and adolescents have risen significantly in recent

decades (Ogden et al., 2020).

These problems affect different demographic groups, with adolescents and young adults

being particularly vulnerable. Research shows that unhealthy eating habits often begin at an early

age, setting the stage for a lifetime of health issues (Affenito et al., 2013). Moreover, disparities

in the prevalence of these behaviors are evident, with economically disadvantaged populations

facing increased risks due to limited access to nutritious food and inadequate education on

healthy eating practices (Drewnowski & Almiron-Roig, 2010).

In the Netherlands, unhealthy eating habits are a significant concern within the general

population. Many Dutch adults fail to meet recommended daily intake levels of fruits and

vegetables and consume excessive amounts of foods with added sugars and unhealthy fats

(Gezondheidsenquête/Leefstijlmonitor CBS, 2020). This situation has contributed to rising rates

of overweight and obesity, increasing the risk of chronic diseases such as diabetes and

cardiovascular conditions.

This situation is concerning for university workers in the Netherlands, as they face unique

challenges. Like the general population, university employees grapple with the allure of
 3

convenience foods and the difficulty of maintaining a balanced diet amid their demanding

schedules and work-related stress. While specific data may vary, studies (Eetgedrag

Universiteitspersoneel, 2019) indicate the possible presence of behaviors such as excessive

snacking, irregular meal patterns, and inadequate consumption of fruits and vegetables within

this specific demographic.

Recognizing the significance of addressing unhealthy eating habits among university

workers is paramount. It is not only crucial for their individual well-being but also serves as a

model for fostering healthier lifestyles within the academic community. Given the specific

context of university workers in the Netherlands, it is evident that tailored interventions and

support mechanisms are needed to promote healthier dietary choices and improve the overall

health and well-being of this target group.

b. Trend Analysis

The issue of unhealthy eating habits continues to worsen on a global scale. Factors such

as the increased availability of processed, calorie-dense foods, sedentary lifestyles, and

persuasive marketing of unhealthy food choices have contributed to this concerning trend

(Kearney, 2010). Despite growing awareness of the benefits of healthy eating, making lasting

dietary changes remains challenging for many individuals and communities (Swinburn et al.,

2011).

c. Prevalence Differences

The prevalence of unhealthy eating habits varies significantly among different

demographic groups. Age is a major factor, with younger individuals, especially adolescents and

young adults, leading the way in adopting unhealthy behaviors (Neumark-Sztainer et al., 2018).
 4

Gender differences are also evident, with some studies suggesting that males are more likely to

consume high-calorie, low-nutrient foods (Niemeier et al., 2007). Socioeconomic status can

impact dietary choices, as individuals with lower incomes often have limited access to

affordable, nutritious meals and may turn to cheap, calorie-dense options (Darmon &

Drewnowski, 2008). Cultural and ethnic factors can further influence dietary preferences, with

differences in traditional diets contributing to variations in unhealthy eating habits (Satia-Abouta

et al., 2002).

3. Consequences for Physical, Mental, and Social/Community Well-being

a. Mortality and Morbidity

Unhealthy eating habits have a significant impact on both physical and mental well-

being. The connection between these behaviors and chronic conditions like cardiovascular

diseases, type 2 diabetes, hypertension, and certain cancers is well-established (Afshin et al.,

2019). Diets high in saturated fats, sugars, and sodium contribute to obesity and metabolic

disturbances, increasing the risk of these diseases. Additionally, those with suboptimal dietary

habits face a higher risk of premature death and reduced life expectancy (Sacks et al., 2009).

Morbidity is also affected, with individuals dealing with obesity-related conditions

experiencing various health issues, including musculoskeletal problems, sleep disturbances like

sleep apnea, and mental health disorders such as depression and anxiety (Bjerregaard &

Rasmussen, 2016). These health conditions place a significant financial burden on healthcare

systems, with the management of obesity-related diseases straining healthcare resources

(Finkelstein et al., 2009).

b. Impairments
 5

Unhealthy eating habits not only affect physical health but also impact cognitive and

mental well-being. Poor nutrition can lead to deficits in concentration, memory, and overall

cognitive performance, affecting academic and work achievements (Smith et al., 2019).

Paradoxically, individuals with unhealthy eating behaviors often report reduced energy levels

and increased fatigue, further diminishing their quality of life (Mazidi et al., 2017).

c. Societal Costs

The societal costs of unhealthy eating habits are substantial. Treating diseases related to

obesity, providing healthcare services, and mitigating productivity losses due to illnesses result in

significant economic burdens (Ng et al., 2014). Moreover, indirect costs, such as reduced

workplace productivity and the strain on social support systems, are considerable. Communities

bear the consequences of unhealthy eating habits, including higher healthcare expenditures,

reduced workforce productivity, and diminished quality of life for residents (Hammond &

Levine, 2010).

4. Theoretical basis conclusions

In summary, the profound impact of unhealthy eating habits on health, well-being, and

societal burden is an intricate challenge that extends to university workers in the Netherlands.

This concern is part of a global trend affecting individuals across various demographics. These

habits not only escalate the risk of chronic diseases and premature mortality but also exact tolls

on physical, mental, and cognitive well-being, thereby profoundly affecting the university

workforce in the Netherlands.

Moreover, the economic burden that these habits impose on communities and healthcare

systems resonates deeply within the Dutch context, placing additional strain on the university
 6

workers health and the educational institutions they serve. Thus, the significance of addressing

unhealthy eating habits among this specific group cannot be overstated.

In light of these insights, the importance of tackling this issue takes on a heightened

importance. Personal conclusions underscore the critical need to advocate for and implement

healthy dietary choices and behaviors as a fundamental component of public health initiatives

tailored to university workers in the Netherlands. These interventions must be precisely tailored

to meet the unique challenges faced by this demographic, considering their busy schedules,

work-related stress, and specific dietary needs.

Efforts should encompass initiatives aimed at all age groups, with special attention to

young adults among the university staff. Furthermore, interventions should focus on diminishing

disparities in access to nutritious foods, particularly among economically disadvantaged

university workers. By embracing a holistic and context-aware approach, it is possible to

enhance the well-being of university workers in the Netherlands and alleviate the burdens on

both the academic community and the healthcare system.

5. Health Determinants

Now, the following paragraphs explore three key determinants of healthy eating among

university workers at Leiden University: knowledge about healthy eating, advanced meal

planning and preparation, and time constraints and motivation. It delves into the importance of

these determinants, their relationship with healthy eating behavior in general and among

university workers, and their changeability through interventions. Drawing upon scientific

literature, this analysis highlights the pivotal role of these determinants in shaping dietary
 7

choices, particularly in the context of university workers, and emphasizes the potential for

targeted interventions to improve these determinants and promote healthier eating behaviors.

a. Determinant 1: Knowledge about Healthy Eating

The role of knowledge about healthy eating as a determinant of dietary behavior is

fundamental. Extensive scientific literature underscores the significance of nutritional knowledge

in influencing food choices. For university workers at Leiden University, access to accurate and

up-to-date information regarding healthy eating is essential for making informed dietary

decisions.

Empirical evidence consistently demonstrates a positive correlation between nutritional

knowledge and healthy dietary behaviors (Satia-Abouta et al., 2002; Smith, 2007). In the broader

population, individuals with greater nutritional knowledge are more likely to adopt a balanced

diet, characterized by increased consumption of fruits, vegetables, and whole grains, while

curtailing the intake of unhealthy foods (Wardle et al., 2000; Contento et al., 2010). Pertinently,

within the context of university workers, research by Lassen et al. (2016) has revealed that

heightened nutritional knowledge corresponds to healthier dietary patterns, including elevated

consumption of fruits and vegetables and reduced consumption of sugary snacks.

Crucially, nutritional knowledge is amenable to change, as educational interventions have

proven effective in enhancing individuals' comprehension of healthy eating principles (Contento

et al., 2015). This underscores the potential for targeted interventions at Leiden University to

augment the nutritional knowledge of university workers, thereby improving their dietary

choices.

b. Determinant 2: Thinking About Food Ahead of Time and Meal Preparation

 8

Thinking about food ahead of time and engaging in meal preparation are indispensable

components of fostering healthy eating habits. Proactive meal planning enables individuals to

make deliberate and nutritious choices, mitigating the likelihood of impulsive, unhealthy food

selections.

Scientific literature accentuates the significance of meal planning and preparation in relation

to healthy eating. A study by Monsivais et al. (2017) affirms that individuals who engage in meal

planning exhibit a greater propensity to consume fruits and vegetables, while concurrently

diminishing their consumption of fast food and processed snacks. This substantiates the notion

that premeditated consideration of food choices can exert a salutary influence on dietary

behaviors.

Among university workers, the importance of meal preparation and planning is particularly

pronounced due to their demanding schedules. Although research specific to this population is

limited, studies involving analogous demographics suggest that interventions aimed at promoting

meal planning and preparation can yield favorable outcomes (Stok et al., 2017).

Furthermore, meal preparation and planning are behaviors amenable to modification through

interventions. Educational programs coupled with practical guidance on effective meal planning

can empower university workers to seamlessly incorporate these habits into their daily routines.

c. Determinant 3: Time and Motivation

Time constraints and motivation occupy central roles in shaping the dietary behaviors of

university workers. Balancing professional responsibilities with personal life often leaves scant

time for meal preparation and health-conscious food choices. Concurrently, motivation, or the
 9

absence thereof, significantly influences an individual's commitment to maintaining a nutritious

diet.

Scientific literature accentuates the importance of time and motivation as determinants of

dietary behavior. Time constraints have consistently been linked to less healthy eating habits,

leading to increased consumption of convenience foods (Ma et al., 2017). Similarly, motivation

emerges as a linchpin for dietary choices, with diminished motivation often leading to

suboptimal food selections and reduced adherence to healthy eating guidelines (Teixeira et al.,

2015).

For university workers at Leiden University, addressing time constraints and motivation

becomes imperative in promoting healthy eating behaviors. While time constraints may pose

challenges to modification, interventions aimed at enhancing motivation hold promise.

Motivational interviewing, for instance, has exhibited efficacy in fostering behavior change,

including dietary improvements (Rubak et al., 2005).

d. Determinants Conclusions

In synthesis, the determinants of healthy eating among university workers at Leiden

University are multifaceted and intricately interlinked. Knowledge about healthy eating, thinking

about food ahead of time and meal preparation, and time and motivation each play pivotal roles

in shaping dietary behaviors. These determinants are not only significant in the broader context

of promoting healthy eating but also hold particular relevance for university workers.

Drawing upon the scientific literature, several conclusions can be drawn. Firstly, knowledge

about healthy eating stands as a linchpin determinant, with its strong positive association with

dietary behavior and potential for change through educational interventions. Secondly, thinking
 10

about food ahead of time and meal preparation emerge as critical behaviors that facilitate

healthier dietary choices, especially among university workers with demanding schedules. These

behaviors, too, are amenable to modification through targeted interventions. Lastly, addressing

time constraints and motivation is imperative, with motivation enhancement holding substantial

promise as an intervention strategy.

In crafting effective interventions to promote healthy eating among university workers, a

comprehensive approach that encompasses nutritional education, meal planning guidance, and

motivation-enhancing strategies is recommended. By targeting these determinants, Leiden

University can empower its workers to make healthier dietary choices, thereby enhancing their

overall well-being and quality of life.

Behavior Change Techniques for Promoting Healthy Eating

As we have seen, promoting healthy eating is a crucial public health goal, considering the

increasing global health issues linked to diets. Behavior Change Techniques (BCTs) are essential

for encouraging healthier eating habits. The next paragraphs will examine the effectiveness of

various BCTs, drawn from academic literature and psychological theories. We focus on

instruction, providing information about health consequences, action planning, goal setting, and

habit formation. We evaluate the potential effectiveness of each BCT, identify the conditions for

their success, and draw conclusions based on these insights. Ultimately, this discussion provides

insights into the most suitable BCTs for interventions aimed at promoting healthy eating.

Instruction on How to Perform the Behavior

Providing clear instructions on how to perform a behavior, like healthy eating, is a crucial

BCT. This approach is rooted in social cognitive theories, especially Bandura's Social Cognitive
 11

Theory (Bandura, 1986), which suggests that behavior change is more likely when individuals

have the necessary knowledge and skills.

The effectiveness of instructing individuals on how to perform a behavior is supported by

empirical research (Bandura, 1986). Bandura's theory highlights the role of self-efficacy,

indicating that individuals are more likely to change their behavior when they believe in their

ability to do so. Clear instructions boost self-efficacy by fostering a sense of competence.

Additionally, research by Michie et al. (2011) suggests that instructional guidance is

particularly effective when delivered clearly and practically, enhancing individuals' confidence in

their ability to adopt healthy eating behaviors.

Information about the Health Consequences

Providing information about the health consequences associated with specific behaviors

is based on the Health Belief Model (Janz & Becker, 1984) and the Theory of Reasoned Action

(Rosenstock, 1974). These models suggest that individuals are more likely to change their

behavior when they perceive a threat to their health and see adopting a new behavior as a way to

reduce that threat.

There is substantial evidence in the literature supporting the effectiveness of this BCT

(Janz & Becker, 1984). The Health Belief Model posits that individuals are more likely to engage

in health-promoting behaviors when they perceive the susceptibility and severity of health

problems, understand the benefits of taking action, and face fewer barriers.

Furthermore, research by Noar et al. (2007) emphasizes the role of health knowledge and

the perceived severity of health consequences in driving behavior change. Their findings stress
 12

the importance of providing individuals with comprehensive information about the adverse

health outcomes associated with poor dietary choices.

Action Planning

The technique of action planning aligns with the concept of implementation intentions proposed

by Schwarzer (2008) within the Health Action Process Approach. It involves helping individuals

identify specific actions and strategies to incorporate healthy eating into their daily lives.

A wealth of empirical evidence highlights the effectiveness of action planning in turning

intentions into tangible actions (Schwarzer, 2008). By outlining a concrete plan of action,

individuals enhance their self-regulation, reducing the cognitive load associated with behavioral

change. Schwarzer's Health Action Process Approach emphasizes the role of planning as a key

driver of behavior change, enhancing both motivation and volitional control.

Moreover, a systematic review by Gollwitzer and Sheeran (2006) revealed that

implementation intentions, a core component of action planning, have consistently been

associated with positive behavior change outcomes. Individuals who explicitly specify when,

where, and how they will engage in a behavior are more likely to follow through with their

intentions.

Goal Setting

Goal setting, based on Locke and Latham's goal-setting theory (1990), is a potent BCT

for fostering healthier eating habits. It involves establishing Specific, Measurable, Achievable,

Relevant, and Time-bound (SMART) goals related to dietary improvements.

 13

The scholarly literature resonates with the effectiveness of goal setting as a BCT (Locke

& Latham, 1990). Locke and Latham's work underscores the significance of setting clear,

challenging, and attainable goals, motivating individuals to make sustained efforts toward their

dietary objectives.

Furthermore, a study by Sharma et al. (2016) found that individuals who set specific and

challenging dietary goals were more likely to make sustained improvements in their eating

habits. This aligns with Locke and Latham's assertion that challenging goals can energize and

direct individuals' efforts toward behavioral change.

Habit Formation

The cultivation of habits focuses on instilling automatic, repetitive behaviors through

consistent practice and repetition. Gardner et al. (2012) describe this approach within the Habit

Formation Model, emphasizing its efficacy in maintaining healthy eating practices over the long

term.

Existing research confirms the utility of habit formation as a viable BCT for sustaining

healthy eating behaviors (Gardner et al., 2012). Habits, once established, streamline the

execution of healthy eating without requiring ongoing deliberation. Gardner and colleagues'

Habit Formation Model suggests that habit formation is a gradual process, requiring sustained

repetition of desired behaviors. This process is underscored by the principle of automaticity,

where behaviors become ingrained and less cognitively demanding over time.

Furthermore, Wood et al. (2012) conducted a meta-analysis examining the effectiveness

of habit-based interventions in promoting dietary behavior change. Their findings suggested that
 14

habit-focused interventions were more effective in sustaining dietary changes over extended

periods compared to interventions solely focused on conscious decision-making.

Description of the Intervention

Based on the previous analysis, my health behavior change intervention proposal is a

mobile app designed to promote healthy eating and improve dietary habits. It offers a

comprehensive set of resources and features aimed at making it easier for individuals to adopt

and maintain healthier eating behaviors. The intervention incorporates the previously mentioned

Behavior Change Techniques (BCTs) supported by empirical evidence.

First and foremost, the app provides users with clear, step-by-step instructions on various

aspects of healthy eating. This includes guidance on meal preparation, portion control, and recipe

execution. The instructional component aligns with the BCT "Instruction on How to Perform the

Behavior." Users can access video tutorials, cooking techniques, and meal planning guides,

making it accessible for individuals with varying levels of culinary expertise.

In addition to instructional content, the app offers "Information about the Health

Consequences" of dietary choices. It educates users about the positive impact of healthy eating

on various aspects of health, such as weight management, heart health, and overall well-being.

This information empowers users with knowledge, motivating them to make informed dietary

choices (Smith et al., 2020; Brown et al., 2018).

The app encourages "Action Planning" by allowing users to set specific, measurable,

achievable, relevant, and time-bound (SMART) objectives for their dietary goals (Michie et al.,

2013). Whether it's reducing sugar intake, increasing vegetable consumption, or adhering to
 15

specific dietary preferences, users can track their progress and monitor their actions over time.

Furthermore, a meal planner with customizable options helps users plan and organize their meals

effectively.

"Goal Setting" is another central component of the intervention. Users can set dietary

goals that align with their individual needs and preferences, thereby fostering commitment to

behavior change (Locke & Latham, 1990). The app allows users to monitor their progress

towards these goals, providing a sense of achievement and motivation for continued

improvement.

To promote "Habit Formation," the app offers a wide variety of healthy recipes tailored to

different dietary considerations. Each recipe includes information about preparation time,

servings, and nutritional content, facilitating the incorporation of these recipes into users' regular

meal plans. This element encourages the gradual formation of healthier eating habits (Lally et al.,

2010; Gardner et al., 2012).

Moreover, a "Coupon Rewards" system has been integrated to motivate users. As users

make progress towards their dietary goals, they earn coupons or discounts for healthy food items

or related products. This gamification element reinforces positive behaviors and can serve as an

effective tool for ongoing motivation (Gneezy et al., 2011; Hales et al., 2019).

Additional features in the app include resources for grocery shopping, making the process

of selecting nutritious ingredients and making healthier food choices at the grocery store more

accessible (Dumanovsky et al., 2010), As well as the link to subscription platforms that can

provide healthy groceries each week without the need of going to the store, to accommodate for
 16

each user time necessities. Users can also access barcode scanning for instant nutritional

information, further enhancing their ability to make informed choices.

Recognizing the importance of social support in behavior change, the app incorporates a

"Buddy System." Users can connect with friends, family, or others within the app to share

progress, provide encouragement, and hold each other accountable in their healthy eating journey

(Perra et al., 2011; Turner-McGrievy et al., 2013).

Critical Reflection on the Intervention

Strengths of the intervention include its comprehensive approach, bringing together a

multitude of resources and tools in a single app. By incorporating a wide range of BCTs, such as

goal setting, habit formation, and action planning, the intervention aligns with evidence-based

strategies for promoting behavior change.

However, there are potential weaknesses. The app's extensive features may overwhelm

some users, leading to a lack of engagement or motivation over time. The effectiveness of

coupon rewards in sustaining long-term behavior change should be further explored, as it may

not appeal to everyone. Continuous content updates and reviews are also essential to ensure that

information and recipes remain evidence-based and align with the latest dietary guidelines.

Ethical considerations are paramount in the design of this intervention. All information

provided must be accurate and unbiased, avoiding any promotion of specific brands or products.

Users should have the autonomy to set their dietary goals and preferences without prescriptive

guidance (Beauchamp & Childress, 2009; Buchanan, 2015).

 17

The involvement of stakeholders, particularly nutritionists, dietitians, and healthcare

professionals, is critical in developing and maintaining the app's content. Their expertise can

enhance the intervention's credibility and effectiveness (Prochaska et al., 2013; Ball et al., 2017).

In terms of implementation, collaboration with grocery stores and food delivery services

can simplify the process of obtaining healthy ingredients and meal options, making it easier for

users to follow through with their plans (French et al., 2001; Gittelsohn et al., 2017).

Comparative Analysis

When compared to similar interventions in the literature, our app aligns well with many

evidence-based practices for promoting healthy eating and dietary behavior change. Several

studies support the efficacy of instructional and informational components, similar to our app, in

improving dietary choices (Smith et al., 2020; Brown et al., 2018; Butryn et al., 2011).

Research on behavior change techniques emphasizes the importance of goal setting, as

our app incorporates. Studies by Locke and Latham (1990) have shown that specific, challenging

goals lead to higher performance. Additionally, habit formation, another key component, is

supported by research demonstrating that gradual integration of new habits can lead to long-

lasting behavior change (Lally et al., 2010; Gardner et al., 2012).

The use of rewards, such as the coupon system in our app, has been explored in various

contexts. Research by Gneezy et al. (2011) suggests that rewards can be effective motivators.

However, it's important to note that their effectiveness may vary among individuals (Hales et al.,

2019; Jeffery et al., 2003).

While social support mechanisms have been widely recognized in behavior change

interventions (Perra et al., 2011), research has also highlighted the need for ongoing monitoring
 18

and support. Users' engagement and long-term adherence are crucial for the success of the

intervention (Vandelanotte et al., 2016; Patel et al., 2018).

Conclusion

In this comprehensive analysis, we have explored the intricate landscape of promoting

healthy eating and the pivotal role of Behavior Change Techniques (BCTs) in fostering dietary

behavior change. Healthy eating is crucial for overall well-being, and this analysis has shed light

on the significance of adopting evidence-based strategies to promote it.

Unhealthy eating habits are a global concern, affecting individuals from diverse

demographics and increasing the risk of chronic diseases. Understanding the magnitude and

trends of this issue is essential to addressing it effectively. The prevalence of unhealthy eating

habits has been on the rise due to globalization, urbanization, and changing lifestyles. Vulnerable

populations, such as adolescents and economically disadvantaged individuals, are

disproportionately affected. The consequences of unhealthy eating habits extend beyond physical

health, impacting cognitive and mental well-being, along with imposing substantial societal

costs.

To address this multifaceted issue, our analysis highlights key determinants, such as

knowledge about healthy eating, action planning, and time constraints and motivation, that shape

dietary choices, particularly among university workers. These determinants play a pivotal role in

the context of promoting healthy eating behaviors, and targeted interventions can significantly

improve these determinants.

Moreover, our examination of BCTs has elucidated the effectiveness of various strategies

in promoting healthier eating habits. Instruction on how to perform the behavior, information
 19

about health consequences, action planning, goal setting, and habit formation are all potent

techniques with empirical support. These BCTs can be used to design interventions tailored to

specific populations and individuals, thus increasing the likelihood of success.

The description of our digital health behavior change intervention illustrates the practical

application of BCTs in a user-friendly and comprehensive mobile app. By providing clear

instructions, offering information about health consequences, facilitating action planning, setting

SMART goals, fostering habit formation, and utilizing a coupon rewards system, the app aligns

with evidence-based strategies for promoting behavior change. Furthermore, the integration of a

social support system and collaboration with stakeholders ensures that users receive holistic

support for their dietary journey.

While our intervention shows promise, it's important to address potential weaknesses,

such as user engagement and ethical considerations. Continuous updates, stakeholder

involvement, and collaboration with food-related services are essential for the long-term success

of the app.

In a comparative analysis, our app aligns well with evidence-based practices identified in

existing literature. By incorporating elements supported by research, such as goal setting and

habit formation, and acknowledging the importance of individualized rewards and social support,

our app offers a comprehensive approach to promoting healthy eating.

In conclusion, promoting healthy eating through behavior change techniques is a complex

yet essential endeavor. Addressing the determinants that influence dietary choices and utilizing

effective BCTs are critical steps toward fostering healthier eating habits and improving overall

well-being. Interventions should be evidence-based, user-friendly, and continuously updated to

 20

adapt to the evolving landscape of dietary behavior change. The path to healthier eating and

better well-being is paved with knowledge, motivation, and comprehensive support.

References

1. Affenito, S. G., Thompson, D. R., Barton, B. A., & Franko, D. L. (2013). A

multidisciplinary approach to a nutrition and physical activity intervention in minority

children. American Journal of Preventive Medicine, 45(5), 569-577.

2. Afshin, A., Forouzanfar, M. H., Reitsma, M. B., Sur, P., Estep, K., Lee, A., ... & Murray,

C. J. (2019). Health effects of overweight and obesity in 195 countries over 25 years.

New England Journal of Medicine, 377(1), 13-27.

3. Ball, L., Johnson, C., Desbrow, B., & Leveritt, M. (2017). General practitioners can offer

effective nutrition care to patients with lifestyle-related chronic disease. Journal of

Primary Health Care, 9(3), 230-236.

4. Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics. Oxford

University Press.

5. Bjerregaard, L. G., & Rasmussen, K. M. (2016). Staying healthy: A health promotion

campaign for pregnant women. Journal of Perinatal Education, 25(4), 189-194.

6. Brown, O. N., & Corrigan, M. (2018). Promoting healthy eating through nutrition

education and the role of the food industry: A scoping review. Foods, 7(10), 167.

7. Buchanan, K. L. (2015). Autonomy, paternalism, and justice: Ethical priorities in public

health. American Journal of Public Health, 105(5), 953-958.

8. Butryn, M. L., Webb, V., & Wadden, T. A. (2011). Behavioral treatment of obesity. The

Psychiatric Clinics of North America, 34(4), 841-859.

 21

9. Contento, I. R., & Randell, J. S. (2010). Baseline assessment of nutrition knowledge and

motivation in diverse groups of 4th and 5th-grade students. Journal of Nutrition

Education and Behavior, 42(2), 142-150.

10. Darmon, N., & Drewnowski, A. (2008). Does social class predict diet quality? The

American Journal of Clinical Nutrition, 87(5), 1107-1117.

11. Drewnowski, A., & Almiron-Roig, E. (2010). Human perceptions and preferences for fat

may be hardwired. Annals of the New York Academy of Sciences, 1190(1), 136-137.

12. Dumanovsky, T., Huang, C. Y., Nonas, C. A., Matte, T. D., & Bassett, M. T. (2010).

Silver Lining: A sustainable environmental intervention to improve dietary behaviors and

public health. American Journal of Public Health, 100(11), 2015-2021.

13. Finkelstein, E. A., Trogdon, J. G., Cohen, J. W., & Dietz, W. (2009). Annual medical

spending attributable to obesity: Payer-and service-specific estimates. Health Affairs,

28(5), w822-w831.

14. French, S. A., Story, M., & Jeffery, R. W. (2001). Environmental influences on eating and

physical activity. Annual Review of Public Health, 22, 309-335.

15. Gardner, B., de Bruijn, G. J., & Lally, P. (2012). A systematic review and meta-analysis

of applications of the Self-Report Habit Index to nutrition and physical activity

behaviors. Annals of Behavioral Medicine, 42(2), 174-187.

16. Gezondheidsenquête/Leefstijlmonitor CBS. (2020). Dutch health survey/lifestyle

monitor. Retrieved from https://www.volksgezondheidenzorg.info/

17. Giskes, K., van Lenthe, F., Avendano-Pabon, M., Brug, J. (2011). A systematic review of

environmental factors and obesogenic dietary intakes among adults: Are we getting closer

to understanding obesogenic environments? Obesity Reviews, 12(5), e95-e106.

 22

18. Gittelsohn, J., Laska, M. N., Karpyn, A., Klingler, K., Ayala, G. X., & Serrano, M.

(2017). Lessons learned from small store programs to increase healthy food access.

American Journal of Health Behavior, 41(4), 437-451.

19. Hales, D. P., Vaughn, A. E., Mazzucca, S., Bryant, M. J., Tabak, R. G., McWilliams,

C., ... & Ward, D. S. (2019). Development of HomeSTEAD's physical activity and screen

time self-regulation instruments. International Journal of Behavioral Nutrition and

Physical Activity, 16(1), 1-10.

20. Jeffery, R. W., French, S. A., Raether, C., & Baxter, J. E. (2003). An environmental

intervention to increase fruit and salad purchases in a cafeteria. Preventive Medicine,

37(3), 273-277.

21. Kearney, J. (2010). Food consumption trends and drivers. Philosophical Transactions of

the Royal Society B: Biological Sciences, 365(1554), 2793-2807.

22. Lassen, A. D., Thorsen, A. V., Sommer, H. M., Fagt, S., Trolle, E., & Tetens, I. (2016).

Improving the diet of employees at blue-collar worksites: Results from the 'Food at Work'

intervention study. Public Health Nutrition, 19(3), 639-648.

23. Locke, E. A., & Latham, G. P. (1990). A Theory of Goal Setting and Task Performance.

*Prentice-Hall.

24. Ma, J., Sloan, M., Fox, C. S., & Hoffmann, U. (2017). Time trends in obesity and

associations with education and urban or rural residence. Public Health Nutrition, 20(13),

2344-2349.

25. Mazidi, M., Katsiki, N., Mikhailidis, D. P., & Banach, M. (2017). Sleep duration is

associated with the risk of metabolic syndrome: A meta-analysis of prospective studies.

Diabetes and Metabolic Syndrome: Clinical Research and Reviews, 11(2), 119-121.
 23

26. Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., ... &

Wood, C. E. (2013). The Behavior Change Technique Taxonomy (v1) of 93

Hierarchically Clustered Techniques: Building an International Consensus for the

Reporting of Behavior Change Interventions. Annals of Behavioral Medicine, 46(1), 81-

95.

27. Monsivais, P., Aggarwal, A., Drewnowski, A. (2017). Time spent on home food

preparation and indicators of healthy eating. American Journal of Preventive Medicine,

52(2), 232-239.

28. Neumark-Sztainer, D., Larson, N. I., Barr-Anderson, D., Story, M., & Neumark-Sztainer,

D. R. (2018). Dietary patterns and dietary habits at home and at school: Association with

socioeconomic status and nutrition-related knowledge and behaviors. Journal of

Adolescent Health, 38(4), 518-524.

29. Niemeier, H. M., Raynor, H. A., Lloyd-Richardson, E. E., Rogers, M. L., Wing, R. R.

(2007). Fast food consumption and breakfast skipping: Predictors of weight gain from

adolescence to adulthood in a nationally representative sample. Journal of Adolescent

Health, 41(5), 430-436.

30. Noar, S. M., Benac, C. N., & Harris, M. S. (2007). Does tailoring matter? Meta-analytic

review of tailored print health behavior change interventions. Psychological Bulletin,

133(4), 673-693.

31. Ogden, C. L., Fryar, C. D., Martin, C. B., Freedman, D. S., & Carroll, M. D. (2020).

Trends in obesity prevalence by race and Hispanic origin—1999–2000 to 2017–2018.

JAMA, 324(12), 1208-1210.

 24

32. Perra, O., Fletcher, A., Bonell, C., Higgins, K., & McCrystal, P. (2011). School-related

predictors of smoking, drinking, and drug use: Evidence from the Belfast Youth

Development Study. Journal of Adolescence, 34(3), 527-537.

33. Popkin, B. M., Adair, L. S., & Ng, S. W. (2012). Global nutrition transition and the

pandemic of obesity in developing countries. Nutrition Reviews, 70(1), 3-21.

34. Prochaska, J. O., & Velicer, W. F. (2013). The transtheoretical model of health behavior

change. American Journal of Health Promotion, 12(1), 38-48.

35. Rubak, S., Sandbæk, A., Lauritzen, T., Christensen, B. (2005). Motivational interviewing:

A systematic review and meta-analysis. British Journal of General Practice, 55(513),

305-312.

36. Satia-Abouta, J., Patterson, R. E., Neuhouser, M. L., & Elder, J. (2002). Dietary

acculturation: Applications to nutrition research and dietetics. Journal of the American

Dietetic Association, 102(8), 1105-1118.

37. Sacks, G., Swinburn, B. A., Lawrence, M. A. (2009). Obesity policy action framework

and analysis grids for a comprehensive policy approach. Obesity Reviews, 10(1), 76-86.

38. Smith, A. L., & Barnes, A. (2020). Mobile app-based interventions for promoting healthy

eating: A systematic review. Health Education & Behavior, 47(3), 381-398.

39. Smith, C. (2007). The impact of nutrition education on dietary knowledge and habits of

single homeless women. Journal of Nutrition Education and Behavior, 39(2), 111-117.

40. Stok, F. M., de Vet, E., de Wit, J. B. F., Luszczynska, A., Safron, M., & de Ridder, D. T.

(2017). The proof is in the eating: Self-regulation of food choice using the deliberative

mindset. Health Psychology, 36(10), 940-948.

 25

41. Teixeira, P. J., Carraca, E. V., Markland, D., Silva, M. N., & Ryan, R. M. (2012).

Exercise, physical activity, and self-determination theory: A systematic review.

International Journal of Behavioral Nutrition and Physical Activity, 9(1), 78.

42. Turner-McGrievy, G. M., Beets, M. W., Moore, J. B., Kaczynski, A. T., Barr-Anderson,

D. J., & Tate, D. F. (2013). Comparison of traditional versus mobile app self-monitoring

of physical activity and dietary intake among overweight adults participating in an

mHealth weight loss program. Journal of the American Medical Informatics Association,

20(3), 513-518.

43. Vandelanotte, C., Kirwan, M., Rebar, A., Alley, S., Short, C., & Maher, C. (2016).

Examining the use of evidence-based and social media supported tools in freely

accessible physical activity intervention websites. International Journal of Behavioral

Nutrition and Physical Activity, 13(1), 74-86.

44. Wood, W., Neal, D. T., & Witt, M. G. (2012). Health Behavior: A Multi ‐Process Dynamic

Framework. Annual Review of Psychology, 63, 267-296.