Can Information Enhanced with Nudges Mitigate the Rise of Childhood Obesity in the Global South?

Pham Khanh Nam; Brandon J. Restrepo; Matthias Rieger; Natascha Wagner

doi:10.3368/jhr.0821-11827R2

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Figure 1
Schematic of Key Intervention Activities
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Figure 2
Timeline of Data Collection and Intervention Activities
Notes: Activities until November 2019 in the timeline were registered in the AEA trial registry. Planned dates of the study, intervention, and first follow-up survey deviated from actual dates due to unforeseen practical/logistical reasons. The trial registry status was changed to “completed” on September 27, 2020, after a first draft of the paper was completed. The italicized part or second follow-up survey was done after completion of the AEA-registered activities and analysis. We publicly registered this second follow-up and research hypothesis/questions on March 10, 2021 on aspredicted.org.

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Table 1

Baseline Balance

		Reg. Effect	N	Overall	Control	Treatment	p-Value	q-Value
				(1)	(2)	(3)	(4)	(5)
Panel A: Primary Outcomes, Families
(1)	BMI z-score	–	727	2.319	2.319	2.318	0.99	0.99
	Overweight or obese	–	727	0.945	0.948	0.942	0.74	0.99
	Obese	–	727	0.651	0.67	0.631	0.27	0.99
	Waist (cm)	–	725	72.867	72.781	72.953	0.75	0.99
	Body fat (%)	–	728	34.954	34.935	34.974	0.94	0.99
(2)	Snack choice (cookie = 1, fruit = 0)	–	726	0.638	0.632	0.644	0.74	0.74
(3)	Children are born to be fat (strongly disagree or disagree = 1, otherwise = 0)	+	679	0.633	0.628	0.639	0.78	0.99
	Vegetables needed each day (in g, log)	+	496	5.162	5.13	5.194	0.64	0.99
	Fruits needed each day (g, log)	+	498	4.978	4.953	5.004	0.67	0.99
	Calories needed each day (log)	–	362	6.321	6.32	6.323	0.99	0.99
(4)	Past 30 days, number of:
	Meals in “western-style” fast-food or pizza place	–	677	1.498	1.555	1.438	0.46	0.69
	Ready to eat food meals from grocery store	–	677	2.641	2.406	2.886	0.18	0.54
	Frozen meals/pizzas	–	674	0.849	0.858	0.839	0.92	0.92
	Past 7 days, number of days (days at home plus days outside excl. school):
	Consumed soft drinks	–	677	1.835	1.714	1.961	0.12	0.54
	Consumed fruit	+	677	3.984	3.971	3.997	0.91	0.92
	Consumed green vegetables	+	676	4.417	4.306	4.533	0.34	0.68
Panel B: Secondary Outcomes, Families
(1)	Perceived healthiness of child’s diet (excellent or very good = 1, otherwise = 0)	∼	680	0.296	0.294	0.297	0.92	0.92
(1)	Perceived healthiness of child’s current weight (healthy = 1, no = 0)	∼	680	0.791	0.761	0.823	0.05	0.10
(2)	Past 30 days, spending on (log):
	Sweet snacks	–	556	0.482	0.447	0.519	0.07	0.21
	Salty snacks	–	552	0.352	0.342	0.362	0.59	0.84
	Soft drinks	–	549	0.284	0.288	0.28	0.84	0.84
(3)	Past 7 days, number of:
	Hours TV, video games, other electronic devices	–	678	14.493	14.703	14.274	0.78	0.84
	Days physically active for a total of at least 20 minutes	+	679	2.389	2.294	2.488	0.24	0.72
	Days walking/biking for at least 10 minutes	+	674	2.223	2.239	2.205	0.84	0.84

Notes: Q-values by family of indicators as indicated by horizontal dividers. “Reg. Effect” means effect direction registered in AEA RCT Registry.

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Table 2

Anthropometrics and Snack Choice

	BMI z-Score	Overweight or Obese	Obese	Waist (cm)	Body Fat (%)	Average Effect (1–5)	Snack Choice (Cookie = 1, Fruit = 0)
	(1)	(2)	(3)	(4)	(5)	(6)	(7)
Panel A: Overall
Control mean	2.28	0.96	0.64	75.43	35.93		0.46
Treatment	–0.036	–0.030**	0.018	–0.613*	–0.832***	–0.073**	–0.049
Treatment	(0.027)	(0.015)	(0.025)	(0.327)	(0.278)	(0.033)	(0.036)
Q-value	0.22	0.10	0.47	0.10	0.02
N	675	675	675	676	678		677
Panel B: Boys
Control mean	2.50	0.98	0.74	77.07	35.85		0.53
Treatment	0.031	–0.011	0.047	–0.162	–0.200	0.003	–0.045
Treatment	(0.039)	(0.014)	(0.032)	(0.429)	(0.401)	(0.046)	(0.048)
q-value	0.71	0.71	0.71	0.71	0.71
N	390	390	390	392	393		392
Panel C: Girls
Control mean	1.95	0.92	0.50	73.01	36.04		0.37
Treatment	–0.126***	–0.058*	–0.034	–1.065**	–1.712***	–0.185***	–0.050
Treatment	(0.036)	(0.030)	(0.040)	(0.530)	(0.375)	(0.052)	(0.054)
q-value	0.00	0.07	0.41	0.07	0.00
N	285	285	285	284	285		285

Notes: *p < 0.1, **p < 0.05, ***p < 0.01. OLS estimates. Robust standard errors in brackets below estimates. All covariates, reduced sample. Q-values are calculated over Columns 1–5 as preregistered.

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Table 3

Diet

	Past 30 Days			Past 7 Days
	Meals in “Western-Style” Fast-Food or Pizza Place	Ready to Eat Food Meals from Grocery Store	Frozen Meals/Pizzas	Consumed Soft Drinks	Consumed Fruit	Consumed Green Vegetables	Average Effect (SD)
	(1)	(2)	(3)	(4)	(5)	(6)	(7)
Panel A: Overall
Control mean	1.29	3.13	0.68	1.73	4.05	4.83
Treatment	–0.143	–0.308	–0.212*	–0.343*	0.216	0.296	–0.098**
Treatment	(0.140)	(0.359)	(0.128)	(0.189)	(0.281)	(0.339)	(0.040)
q-value	0.44	0.44	0.30	0.30	0.44	0.44
N	621	612	605	394	354	338
Panel B: Boys
Control mean	1.29	3.20	0.63	1.74	3.99	4.89
Treatment	–0.260	–0.424	–0.021	–0.294	0.149	–0.085	–0.065
Treatment	(0.201)	(0.458)	(0.200)	(0.267)	(0.345)	(0.462)	(0.051)
q-value	0.71	0.71	0.92	0.71	0.92	0.92
N	356	353	349	228	205	190
Panel C: Girls
Control mean	1.30	3.02	0.77	1.72	4.12	4.74
Treatment	–0.012	–0.163	–0.462***	–0.409	0.218	0.571	–0.124**
Treatment	(0.205)	(0.591)	(0.160)	(0.276)	(0.491)	(0.514)	(0.062)
q-value	0.95	0.94	0.02	0.42	0.94	0.54
N	265	259	256	166	149	148

Notes: Effects in Columns 5 and 6 enter negatively into the average effect calculation. *p < 0.1, **p < 0.05, ***p < 0.01. OLS estimates. Robust standard errors in brackets below estimates. All covariates, reduced sample. Q-values are calculated over Columns 1–6 as preregistered.

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Table 4

Perceptions

	Perceived Healthiness of Child’s Diet (Excellent or Very Good = 1, Otherwise = 0)	Perceived Healthiness of Child’s Current Weight (Healthy = 1, No = 0)	Average Effect (SD)
	(1)	(2)	(3)
Panel A: Overall
Control mean	0.34	0.74
Treatment	–0.083**	–0.039	–0.132**
Treatment	(0.036)	(0.034)	(0.054)
q-value	0.04	0.24
N	634	637
Panel B: Boys
Control mean	0.34	0.75
Treatment	–0.090*	–0.028	–0.126*
Treatment	(0.047)	(0.045)	(0.072)
q-value	0.12	0.54
N	363	366
Panel C: Girls
Control mean	0.35	0.74
Treatment	–0.056	–0.059	–0.125
Treatment	(0.057)	(0.051)	(0.084)
q-value	0.33	0.33
N	271	271

Notes: *p < 0.1, **p < 0.05, ***p < 0.01. OLS estimates. Robust standard errors in brackets below estimates. All covariates, reduced sample. Q-values are calculated over Columns 1–2 as preregistered.

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Table 5

Anthropometrics (Longer Term, Second Follow-Up)

	BMI z-Score	Overweight or Obese	Obese	Waist (cm)	Body Fat (%)	Average Effect (SD)
	(1)	(2)	(3)	(4)	(5)	(6)
Panel A: Overall
Control mean	2.21	0.95	0.63	79.62	36.83
Treatment	0.034	0.004	0.044	–0.217	–0.175	0.020
Treatment	(0.038)	(0.018)	(0.038)	(0.495)	(0.418)	(0.047)
q-value	0.83	0.83	0.83	0.83	0.83
N	420	420	420	419	421
Panel B: Boys
Control mean	2.43	0.95	0.77	81.56	37.41
Treatment	0.099**	0.036	0.032	0.265	0.390	0.095
Treatment	(0.049)	(0.023)	(0.041)	(0.630)	(0.557)	(0.058)
q-value	0.23	0.30	0.61	0.68	0.61
N	240	240	240	240	241
Panel C: Girls
Control mean	1.87	0.96	0.41	76.53	35.91
Treatment	–0.105*	–0.064**	0.083	–1.229	–1.518**	–0.158**
Treatment	(0.056)	(0.028)	(0.066)	(0.812)	(0.638)	(0.073)
q-value	0.10	0.06	0.21	0.17	0.06
N	180	180	180	179	180

Notes: *p < 0.1, **p < 0.05, ***p < 0.01. OLS estimates. Robust standard errors in brackets below estimates. All covariates, reduced sample. q-values are calculated over Columns 1–5 as preregistered.