بازاریابی جدید برای کشاندن مشتریان رستوران به سمت محیط غذایی سالم برای کاهش چاقی A novel marketing mix and choice architecture framework to nudge restaurant customers toward healthy food environments to reduce obesity in the United States

Introduction The restaurant industry in the United States (U.S.) and globally is highly competitive, dynamic and profitable. The National Restaurant Association projected U.S. sales to exceed $780 billion in 2016 (1) (Table 1). The top 20 U.S.-headquartered quick-service (QSR), fast-casual (FCR) and full-service restaurant (FSR) chains generated over $155 billion dollars between 2015 and 2016 (2). Several U.S.-headquartered chains (i.e. McDonald’s, Subway, Yum! Brands, Burger King and Domino’s Pizza) operate franchise businesses in 70 to 100 countries worldwide (3–7). Table 1 provides definitions of commonly used terms to describe the restaurant sector. Recent marketing research suggests that nearly two-thirds of Americans visit fast food restaurants (hereafter called QSRs) and 40% visit FCRs every week (8). Yet half of Americans struggle to find healthy options at restaurants (9). An international study of adults across 10 countries found that less than 20% were satisfied with healthy restaurant menu options (10). Extensive evidence reveals that people’s consumption of food and beverage products sold by or purchased at FSRs and limited-service restaurants (LSRs), which include QSRs and FCRs, are high in fat, sugar and sodium (HFSS), which is associated with poor diet quality and increased risk of obesity and diet-related non-communicable diseases (NCDs) (11–19). In 2014, more than two-thirds (70.7%) of American adults were overweight or obese (20), and 32.4% of American children and adolescents, ages 2–19 years, were overweight or obese (21). Nearly 2.7 billion adults will be overweight or obese worldwide by 2025 (22). Reducing the frequency and amount of HFSS restaurant offerings may help to reduce obesity and NCD risks, especially among children and adolescents (23). Restaurant owners and managers currently use marketing mix principles (i.e. product, place, price and promotion) to build corporate brand awareness and loyalty among individuals who purchase and consume products that generate revenue to maximize company profits (24,25). Wansink (26) has emphasized the importance of restaurants using marketing principles to make healthy food and beverage choices more convenient (to see, order, pick up and consume); attractive (via name, appearance, price and expectations); and normal (to order, purchase, serve and eat) to promote healthy dietary goals among individuals and populations. However, restaurant owners do not comprehensively combine marketing mix principles with choice architecture strategies, which include interventions that design choices in different ways to influence people’s decision-making and behaviours in micro-environments.