Student food choices in a university cafeteria in Saudi Arabia : an empirical investigation.

Background: One of the major health, social and economic problems in the Kingdom of Saudi Arabia is the rising prevalence of overweight and obesity amongst young people and the implications this has for the future burden of chronic diseases, such as type 2 diabetes. Nearly 10% of the Saudi population are now diagnosed with diabetes at a cost to the nation in 2010 estimated at $0.9 billion. Aim: To investigate factors influencing choice of healthy food items by students in a university cafeteria in Saudi Arabia. Theoretical framework: Psychological theories of how individual factors affect behaviours and concepts from the emerging field of behavioural economics underpinned the studies. Methods: Three empirical studies involving students at the University of Ha’il, central Saudi Arabia: 1. Questionnaire gathering background information about students’ health-related behaviours and knowledge of behavioural risk factors for type 2 diabetes, 2. Investigation of student purchasing patterns and intentions through a) a questionnaire probing willingness-to-buy fruit (a healthier option) if available in the campus cafeteria, b) a controlled experiment manipulating menu choices, 3. Analysis of actual purchasing decisions when fruit was introduced to the campus cafeteria. Impacts of price variation and health messages were explored in Studies II and III. Results: 1. Students report poor health-related behaviours (dietary and physical activity); knowledge of the link between lifestyle and type 2 diabetes is patchy. 2a. Over 50% of cafeteria users said they would buy fruit if available. 2b. Choice of healthy items was responsive to price manipulation. 3. When fruit was available, it was purchased by less than 10%. Health messages had no effect on healthy item choices. Conclusions: Pricing strategies may be effective to stimulate healthier choices. Additional health education targeting individual psychological determinants of behaviour change may also be required