Researchers call for digital personalized nutrition services to combat health inequality

11 Jul 2023 --- Researchers from the American Society for Nutrition have proposed to extend current personalized nutrition (PN) by creating adaptive, personalized nutrition advice systems (APNASs) customized to individual needs in real-life environments.

The research proposal, published in Advances in Nutrition, comes in light of the current situation in which most PN approaches use information such as gene variants to give advice. However, studies only show small to negligible effects on the effectiveness of personalized dietary recommendations. 

Scholars are becoming more critical of PN because it focuses on socially privileged groups rather than the general population, which leads to further health inequality. 

The researchers have proposed PN systems that look beyond biomedical targets. The most prominent concept relates to genetic differences based on single nucleotide polymorphisms (SNPs) or genetic risk scores associated with disease risks.

Renewed PN framework presented
Within the proposed revamped framework, the researchers suggest extending the goals to include individual goal preferences. For example, personalization processes of behavior change could be provided in situ, taking the personal situation and resources into account.

A participatory dialogue between individuals and experts has been identified as key to a new, healthier structure involving (actual or virtual) dieticians, nutritionists and advisors to help set nutrition goals. Digital nutrition that incorporates monitoring, advice and support has also been spotlighted. 

“We present this vision of a novel PN framework along with scenarios and arguments that describe its potential to efficiently address individual and population needs and target groups that would benefit most from its implementation,” the researchers state.

Core reasoning for propositionBehavior change techniques combined with digital ecosystems have been proposed as practical strategies to take PN forward.
If adapted to be more inclusive of a multi-faceted society, PN could solve many nutrition dilemmas because eating behavior ranges from physiological, psychological, economic and social.

For example, studies in Brazil, Germany, India and the US consistently yield a fixed set of motives that show that various food cultures have similar “basic functions of eating.” Empirical studies show that “social dining” is one such factor and has real-life benefits on nutritional status, well-being and social cohesion.

The “just-say-it” approach, from the field of risk communication, is one that the researchers purport is failing. The educated assumption is that providing detailed and frequent information about individual health indicators will lead to sustained behavior change and better health. 

However, the better-than-average phenomenon is another problematic concept in which people typically hold positive views of their eating motives and behaviors compared with peers of the same age and gender. 

In addition, providing personalized health advice may tap into the Barnum effect, which describes a psychological phenomenon where individuals demonstrate high levels of acceptance of descriptions of personal characteristics supposedly personalized to them. In contrast, these characteristics are generic and equally apply to a broad range of people.

Personalized generic communication is an age-old practice in marketing or health communication. “Consequently, personalized advice can induce a mental mindset with an array of expectancies, orienting people toward psychological, physiological and behavioral responses in line with such expectations, which, in turn, create changes in a self-fulfilling manner,” the researchers state.The researchers pinpointed participatory dialogue between individuals and experts as a critical factor in the proposed renewed field of PN. 

Are BCTs the next frontier?
The study proposes using behavior change techniques (BCTs) combined with digital ecosystems for targeted dynamic and adaptive intervention systems that support in-time and in situ decision-making about food consumption and preparation. 

According to the experts, parameters such as physical activity or social interactions and the provision of pleasure, overall happiness and well-being should be considered.

The proposed comprehensive approach requires constant interaction between multiple advisors or advice systems, which may be avatars or (user-defined) chatbots. This approach can target any social group, retailer, health insurance organization or public body.

On this note, researchers in the Netherlands developed DietBot, which provides fully automated and personalized dietary advice. Based on consumers’ receipts and food intake, the digital platform creates nutrition plans customized to users’ health status, dietary habits and preferences. 

The project is run by the Division of Human Nutrition & Health and Wageningen Food & Biobased Research from Wageningen University & Research (WUR).

By Inga de Jong