SPECIAL ARTICLE

Behavioral Economics and the Supplemental Nutrition

Assistance Program:
Making the Healthy Choice the Easy Choice
Alice S. Ammerman, DrPH,1,2 Terry Hartman, MPH, MS, CCRC,3 Molly M. DeMarco, PhD1,2

The Supplemental Nutrition Assistance Program (SNAP) serves as an important nutritional safety net
program for many Americans. Given its aim to use traditional economic levers to provide access to
food, the SNAP program includes minimal nutritional requirements and restrictions. As food choices
are influenced by more than just economic constraints, behavioral economics may offer insights and
tools for altering food purchases for SNAP users. This manuscript outlines behavioral economics
strategies that have potential to encourage healthier food choices within the SNAP program.
Am J Prev Med 2017;52(2S2):S145–S150. & 2016 American Journal of Preventive Medicine. Published by
Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

INTRODUCTION conditions simultaneously.8 The problem is now more

commonly one of not “knowing where the next meal is

T
he Supplemental Nutrition Assistance Program
(SNAP) in various iterations has provided critical
support to food-insecure individuals for more
than 75 years. It has served as an important food safety
net program, as evidenced by participation rates increas-
ing substantially after the 2008 economic downturn.1
A recent White House report showed that SNAP has
played an essential role in lifting families out of poverty
and hunger.2 However, the impact on diet quality has been
more modest, and it is evident that SNAP participants, like
most Americans, have substantial room for improvement
in the dietary factors most associated with chronic disease
risk.3,4 The SNAP program is designed around traditional
economic levers, such as income supplementation, but this
alone does not appear adequate to promote healthy
choices. Behavioral economics offers a collection of
theories and strategies5,6 that, when implemented, can
change the environment to “make the healthy choice the
easy choice” by nudging individuals toward healthier food
selection in retail and other food choice situations.
Since the first iteration of SNAP (formerly Food
Stamps) was implemented in 1939, nutrition-related
health challenges have changed markedly. The program
was initially designed to address protein/calorie insuffi-
ciency and also had a role in reducing agricultural
surpluses.7 The U.S. now faces a food insecurity–obesity
paradox, where many individuals suffer from both
coming from” or lack of access to affordable, healthy
food, rather than calorie deficits. Low-income individuals
are likely able to obtain enough calories but these calories
may come from cheap foods that are calorie dense and
nutritionally poor. Therefore, nutrition and health pro-
fessionals now increasingly use the term food insecurity,
an economic concept, rather than the biological notion of
“hunger.”9 Though national survey data show that SNAP
participants value nutrition, their time and financial
constraints complicate the task of making healthy food
choices.10 To address this issue, the U.S. Department of
Agriculture (USDA) has developed the Thrifty Food
From the 1Department of Nutrition, Gillings School of Global Public
Health, University of North Carolina at Chapel Hill, Chapel Hill, North
Carolina; 2Center for Health Promotion and Disease Prevention (CDC
Prevention Research Center), University of North Carolina at Chapel Hill,
Chapel Hill, North Carolina; and 3Sanford School of Public Policy, Duke-
UNC USDA Center for Behavioral Economics and Healthy Food Choice
Research, Duke University, Durham, North Carolina
Address correspondence to: Alice S. Ammerman, DrPH, Center for
Health Promotion and Disease Prevention; Department of Nutrition,
Gillings School of Global Public Health and School of Medicine, University
of North Carolina at Chapel Hill, Chapel Hill NC 27599. E-mail:
alice_ammerman@unc.edu.
This article is part of a supplement issue titled The Supplemental
Nutrition Assistance Program's Role in Addressing Nutrition-Related
Health Issues.
0749-3797/$36.00
http://dx.doi.org/10.1016/j.amepre.2016.08.017

& 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. Am J Prev Med 2017;52(2S2):S145–S150 S145
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
S146 Ammerman et al / Am J Prev Med 2017;52(2S2):S145–S150
Plan, which promotes affordable recommendations to
follow the Dietary Guidelines for Americans predicated on
the fact that people are primarily cooking at home.11,12
Though potentially lacking adequate refrigeration, meal
preparation facilities, or transportation, some SNAP and
other low-income families may have to rely heavily on
non-perishable processed calorie-dense foods to help
stretch SNAP benefits to the end of the month.10,13
The SNAP program provides the potential for many
families to purchase healthier food. Other USDA nutrition
assistance programs such as the Special Supplemental
Nutrition Program for Women, Infants, and Children
(WIC) are restricted to “healthier” foods consistent with
the Dietary Guidelines for Americans. However, SNAP has
very few restrictions on the type of foods that can be
purchased, giving the consumer more flexibility and free-
dom of choice. With flexibility comes the potential to make
either healthy or less healthy choices. The SNAP-Ed
(education) program, also funded by the USDA, represents
the most far-reaching nutrition education program avail-
able for low-income consumers. SNAP-Ed is funded at a
level of more than $400 million annually and seeks to reach
95 million Americans with incomes below 185% of the
Federal Poverty Level.14 It is designed to help low-income
individuals, including those on SNAP, make healthful food
and physical activity choices. The SNAP-Ed Toolkit15
includes a list of SNAP-Ed interventions that have been
reviewed and deemed evidence based for broader dissemi-
nation. In 2010, the SNAP-Ed program added obesity
prevention, along with nutrition education, to its mandate
and embraced changes to the policies, systems, and
environments that facilitate better food choices by low-
income consumers. Behavioral economic theory is being
incorporated into interventions in traditional (supermar-
kets and convenience stores) and non-traditional (farmers’
markets and food co-ops) retail environments to nudge
consumers toward healthier food choices.16–18 These inter-
ventions can be used to nudge SNAP recipients and other
low-income consumers through the SNAP-Ed program.
Behavioral economics has been popularized by books
such as Nudge5 and Switch.19 The subtitle to Nudge is
“Improving Decisions About Health, Wealth, and Happi-
ness,” whereas for Switch it is “How to Change Things
When Change Is Hard.” Together, these phrases capture
the challenges faced by SNAP recipients, who have limited
resources and time, making healthy food choices that
much harder. Behavioral “nudges” are a key component of
behavioral economics. As defined by the authors of Nudge,
Thaler and Sunstein,5 “A nudge is any aspect of the choice
architecture that alters behavior in a predictable way
without forbidding any options or significantly changing
their economic incentives.” Behavioral nudges and food
psychology in combination with more-traditional
economic levers such as price, income supports, and
information are creating opportunities to foster healthier
food intake among SNAP recipients.
In a review for the Economic Research Service of
USDA, Just and colleagues20 addressed the question
“Could behavioral economics help improve diet quality
for nutrition assistance program participants?” In recog-
nizing that food choices are determined by factors beyond
traditional economic forces, Just suggests that behavioral
economics can “illuminate a broad array of strategies to
influence consumers’ food choices.” In doing so, beha-
vioral economics expands the list of possible strategies for
improving the diet quality and health of participants in
USDA nutrition assistance programs such as SNAP.
BEHAVIORAL ECONOMICS AND HEALTH
PSYCHOLOGY TRIGGERS
Behavioral economics triggers that can lead to either
healthy or unhealthy food choices can help to identify
potential areas for nudging SNAP recipients toward
healthier choices. Many of these approaches overlap or
work best in coordination.
Choice Architecture
Choice architecture refers to an approach to influencing
consumer decision making through the design of environ-
ments in which choices are made. Consumers often describe
“willpower” as the missing factor that prevents them from
making and maintaining healthy dietary change. This
construct relates to the ability to resist temptation and make
the behavioral decisions and actions required to stick to a
plan for improved nutrition. However, the current food
environment creates temptations and messages encouraging
less healthy food choices; willpower is easily overwhelmed.
Choice architecture can be used to create environments
where healthy choices are more obvious and easier to make,
requiring much less in the way of self-control or willpower.
An example of how choice architecture can be used with the
SNAP population is through product placement within the
retail setting. Healthier food items can be placed on end
caps, at eye level, or near the checkout aisles. Another
approach to choice architecture involves default options—
pre-set courses of action that transpire without any decision
making required of the consumer. One default option may
be to couple the new provision of the recent farm bill that
allows the purchase and delivery of foods to homebound
elderly or disabled SNAP participants with limiting the
selections of food available for purchase to healthier items.21
Cues
Cues are important environmental triggers that can
either tempt one into making bad decisions or remind
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 Ammerman et al / Am J Prev Med 2017;52(2S2):S145–S150
the consumer that they are trying to make healthy
changes. Cues and environmental triggers are used
extensively in the Smarter Lunchroom intervention
developed and tested at the USDA-funded Cornell
Center for Behavioral Economics in Child Nutrition.22
Those implementing Smarter Lunchrooms place fresh
fruit in an appealing, well-lit bowl. They might also place
chocolate milk behind the healthier dairy options so it is
less visible and harder to reach. Potential cues for SNAP
participants may include placing healthy, economical
food items in prominent locations, including checkout,
improving lighting at displays of healthier options, or
creating visually appealing displays within grocery retail
outlets frequented by SNAP shoppers to promote their
sale. Although there is evidence that these cues work in
the short run, it is less clear whether they continue to
nudge behavior change after the novelty has worn off.
Present Bias/Hyperbolic Discounting
Present bias/hyperbolic discounting refers to the ten-
dency for people to choose a smaller/sooner reward over
a larger/later reward, and thus greater emphasis on the
present and on pleasurable inputs, at the expense of
considering future implications such as adverse health
outcomes associated with poor dietary choices. Although
not unique relative to other shoppers, this is an under-
standable problem facing a low-income SNAP shopper
with a young child or two riding in his shopping cart.
Pleasing an irritable child can easily trump choosing the
healthiest options. To combat the desire to choose a
smaller/sooner reward and save SNAP funds for other
purchases, grocery outlets could provide healthy snacks
to children as they are shopping with their parents. In
fact, recently some supermarket retailers have begun
offering a complementary piece of fresh fruit to children
while shopping with an adult. Not only does this send a
message that the retailer cares about customer well-being
(by offering a healthy option as opposed to the frequently
offered free cookies), it may be an effective business
strategy to increase customer purchases of that fruit
if the child decides he or she likes it, thus serving as a
behavioral cue as well.
Cognitive Overload
Cognitive overload can impair decision making owing to
the complexity or volume of information, such as reading
and interpreting food labels or determining the unit cost
of a product. This can be a significant problem in a
typical grocery store that stocks up to 42,000 different
items. Creative approaches have shown promise in retail
establishments, using simple cues such as arrows on the
floor pointing toward the produce section or grocery
basket signs encouraging greater selection of fresh
February 2017
S147
23
produce. Other strategies include bundling of healthier
food options such as salad ingredients or vegetable stir
fry. Bundling is often used by retailers to increase sales or
move perishable products. This could mean a win–win
between SNAP customers and grocers because bundling
of produce in set dollar amounts can facilitate purchase
by SNAP customers needing to stay within their SNAP
allotment. Budgeting is easier when the cost of a set
amount of produce is known versus finding out when
weighed at the time of checkout.
Salience
Salience pertains to the availability of necessary informa-
tion at the point of decision. For example, WIC partici-
pants often find it difficult to identify WIC-approved
foods when not clearly labeled. “Shelf talkers” and
grouping healthier options on aisle end caps use beha-
vioral economics strategies to put healthier options in
front of customers and make their purchase easier. End
caps change frequently to market different products as
they depend on the salience of change to get the
consumer’s attention. Most studies of end caps and
healthier food choices are based on short-term trials.
More research is needed to determine the willingness of
retailers to maintain healthier end caps and whether
nudges toward healthy choices have a persistent impact
over time. The aforementioned bundling example may be
another way to use salience to nudge SNAP customers
toward healthy choices because the necessary informa-
tion (exact produce price) is provided.
Pre-commitment
Pre-commitment involves making choices or partial
decisions prior to entering a more tempting environ-
ment, at a time when one can be more thoughtful about
the challenges of “present bias.” A simple example is
using a shopping list and sticking to it. Pre-commitment
also offers a number of interesting opportunities within
the SNAP program. As mentioned above, the most recent
farm bill permits food ordering and delivery programs to
become authorized SNAP retailers if they meet SNAP
requirements and serve elderly and disabled SNAP
recipients who are unable to come to a retail location
to shop for food.21 Placing an order from home while not
tempted by the many options in a grocery store and
perhaps using SNAP-Ed tools that nudge toward heal-
thier choices may lead to better diet quality. In another
development, SNAP recipients are now able to use their
benefits to pay for “shares” in a Community Supported
Agriculture program. Members generally buy a “share”
in a local farm at the beginning of the season and then
receive a box of seasonal fresh produce each week.
Non-profit and for-profit farmers’ markets and direct
S148 Ammerman et al / Am J Prev Med 2017;52(2S2):S145–S150
marketing farmers that operate a Community Supported
Agriculture model can accept payment up to 14 days in
advance of delivering the food to the SNAP customer or
making the food available for pickup. This is a form of
pre-commitment, as those SNAP funds are “committed”
to fresh farm produce and thus not available to purchase
less healthy items from traditional retailers.
Loss/Risk Aversion
Loss/risk aversion refers to people’s tendency to strongly
prefer avoiding immediate losses over acquiring longer-
term gains. A recent study suggests that low-income
primary caregivers choose to minimize the cost of
uneaten and thus wasted foods by choosing to purchase
more calorie-dense, processed foods they know their
children will eat. Higher-income caregivers, who have the
resources to withstand the cost of uneaten food, are more
likely to repeatedly introduce healthier food items that
their children might reject at first but learn to like over
time.24 It is easy to see how the loss/risk aversion among
lower-resource caregivers like SNAP recipients could
impact their children’s taste acquisition and longer-
term eating habits.24 This suggests the need for new food
introduction and taste testing in schools and other
settings where the cost associated with early refusals is
not absorbed by the consumer. Strategies to make it easy
to let parents know when children try and like a healthy
food while at school or in child care could also increase
the SNAP caregiver’s willingness to try serving the food
at home. The aforementioned idea of a healthy snack
provided to a child while shopping with the parent is
another way to address risk aversion among SNAP
recipients as their child gets to try a new food item with
no monetary risk to the parent.
BEHAVIORAL ECONOMICS AND SNAP
POLICY
There are a number of ways in which SNAP Policy at the
national or state level can build on or facilitate behavioral
economics approaches to further enhance healthy food
choices.25
More-Frequent SNAP Benefit Issuances
Some SNAP advocates have proposed the idea to break the
food stamp cycle of receiving all benefits at the beginning
of the month and running out by the end of the month by
spreading out benefits issuance over the month and
avoiding lean times at the end of the month. Because
SNAP participants are more likely to use the majority of
their benefits when they first receive them instead of
budgeting to last throughout the month,26 twice-monthly
versus monthly payments could be useful to facilitate the
purchase of perishable products, such as fruits and
vegetables, throughout the month. This is a change that
could be made at the state level and has already been
implemented in Michigan.27 However, even with spread-
ing of benefits over time, without a healthier food
environment, nutrition education, or behavioral nudges,
the result could still be poor food choices. As described
above, the SNAP-Ed program has identified evidence-
based interventions in a toolkit for SNAP-Ed providers
that could address this concern (toolkit),15 through
educating consumers on stretching the food dollar or
using SNAP to purchase and preserve seasonal bulk (and
thus less expensive) produce from farmers markets or
farm stands through canning or freezing. More research is
needed to understand whether more-frequent food SNAP
benefit issuance would result in better food choices.
Subsidizing Healthy Foods
Studies have shown that subsidizing the purchase of
healthy foods can raise the consumption of these items.
The 2008 Farm Bill authorized $20 million for pilot
projects to determine if incentives provided to SNAP
recipients at the point of sale increase the purchase of
fruits, vegetables, or other healthful foods. This effort was
referred to as the Healthy Incentives Pilot (HIP). Under
HIP, SNAP participants received an incentive of 30 cents
for every SNAP dollar spent on targeted fruits and
vegetables credited back to their SNAP Electronic Benefit
Transfer card. The incentive could then be spent on any
SNAP-eligible foods and beverages. Study results show
that HIP participants consumed 26% more targeted fruits
and vegetables than non-HIP participants—about 0.25
cup more per day—and purchased a greater variety
of fruits and vegetables.28 The Agriculture Act of 2014
(P.L. 113-79) authorized USDA to provide grant funds to
eligible organizations to design and implement point of
purchase incentive projects to increase fruit and vege-
table purchases among SNAP participants. USDA is
funding a number of projects through this Food Inse-
curity Nutrition Incentive Grant Program29 and is
conducting an independent evaluation. This cost offset
assistance is a more direct economic lever to purchasing
more fruits and vegetables.
Retailers’ Food Stocking Requirements
As required by the 2014 Farm Bill, USDA has proposed a
rule designed to provide SNAP participants increased
access to healthy foods by requiring stores that accept
SNAP to stock a wider array of food choices. The
stocking provisions in the proposed rule would require
SNAP-authorized retail establishments to offer seven
varieties of qualifying foods in four staple food groups
for sale on a continuous basis, along with perishable
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 Ammerman et al / Am J Prev Med 2017;52(2S2):S145–S150
foods in at least three of the four staple food groups. The
staple foods groups are dairy products; breads and
cereals; meats, poultry, and fish; and fruits and vegeta-
bles. A focus of the proposed rule is to increase healthier
food access in areas where consumers might depend on
smaller grocery, convenience, and gas-mart retailers for
an increasing volume of their food purchases in the
absence of more-traditional and larger food retailers.
Research regarding current stocking practices of non-
traditional retailers suggests that implementing these
rules may be challenging for smaller retailers. Assisting
retailers to implement the new SNAP stocking require-
ments, including nudges to encourage purchases of the
newly stocked items, represents a behavioral economics
approach to adapting to new SNAP regulations.30 Nud-
ging consumers toward purchases of fresh or frozen
fruits and vegetables when they are not accustomed to
buying these foods in a small convenience store has the
potential to help retailers with stocking requirement
implementation.
Pre-order and Home Delivery
As described above under pre-commitment strategies,
new SNAP rules will allow consumers to order foods for
delivery or to prepay with SNAP in certain situations.
More work is needed to study the impact of these rule
changes, but there is significant potential to overcome
access barriers as well as create behavioral nudges toward
healthier choices. In addition, such flexibility can help
reduce the stigma associated with program participation.
Food Restrictions
Limiting foods allowed on the SNAP program could be
described as a default option approach in behavioral
economics. As described above, the WIC program uses
this approach by providing food benefits but prescribing
the specific foods that can be purchased. There is
currently much debate about the strategy of restricting
the type of foods that can be purchased on SNAP. Most
often mentioned is removing sugar-sweetened beverages
(SSBs) from eligible SNAP foods, given mounting
evidence that SSBs are strongly associated with obesity
and diabetes. Those opposing this idea have held that it is
a paternalistic approach and that the primary benefit of
SNAP is as an income supplement. Proponents, on the
other hand, believe that the SSBs contribute only
negatively to a healthy diet and that SNAP participants
are often targeted by beverage advertising. Several articles
in this journal supplement address the pros and cons of
restricting SSBs on SNAP benefits.
Behavioral economics strategies and psychology could
be useful in helping “win over” consumers to a policy that
would remove SSBs from SNAP benefits. The food
February 2017
S149
industry has used the strategy of pre-commitment to
support consumer desire for self-control or willpower.
Almost half of Americans worry about their weight “all” or
“some of the time.” Fear of overconsumption of highly
palatable foods has resulted in a substantial market for
100-calorie packs of snack foods. By purchasing these
limited portion size packages, consumers are pre-
committing that they will eat only what is in the package
they purchased, as opposed to trying to limit their intake
from a standard package of cookies. Although it is always
possible to eat a second or third 100-calorie packet, the
packs are perceived as an aid to weight control efforts for
which consumers are willing to pay more. Interestingly,
consumers revolted when the same strategy was proposed
in New York City regarding SSB portion size, with
consumers seeing it as an affront to free choice. Of course
in this case, food companies were not benefiting from the
sale of a smaller portion size. The Leung article31 in this
issue presents an interesting opportunity in that it adds to
the evidence that a majority of SNAP consumers approve
of restricting SSB access on the program, particularly when
paired with a healthy food incentive (SNAPþ). Taking a
page from the food industry 100-calorie snack package
playbook, perhaps such a strategy could be “sold” to SNAP
participants as a way to assist them with healthier choices
for their family using behavioral economic strategies,
incentivizing healthier choices, and removing the need
for SSB self-control, thus making the healthy choice easier.
DISCUSSION AND CONCLUSIONS
The SNAP program serves as an important federal food
safety net for many in the U.S. Given its aim to use
traditional economic levers to improve access to food, the
SNAP program includes minimal food restrictions. Food
choice, however, is influenced by more than just eco-
nomics. Consumers make complicated decisions about
how to spend their food dollars every day. The behavioral
economics strategies discussed here may offer useful tools
to encourage healthier food choices within the SNAP
program. This manuscript outlines behavioral economics
strategies that have the potential to encourage healthier
food choices by SNAP participants. However, more
research is needed in this promising area to determine
the impact and inform future policy directions.
ACKNOWLEDGMENTS
Publication of this article was supported by the Physicians
Committee for Responsible Medicine. The findings and conclu-
sions in this article are those of the authors and do not
necessarily represent the official position of the Physicians
Committee for Responsible Medicine.
S150 Ammerman et al / Am J Prev Med 2017;52(2S2):S145–S150
Funding for this study is provided by the Duke-UNC USDA
Center for Behavioral Economics and Healthy Food Choice
Research, which is funded by grant 59-5000-4-0062 from the
U.S. Department of Agriculture. The authors express their
sincerest gratitude to Dr. Joanne Guthrie, Dr. Anita Singh, and
Barbara Murphy from the U.S. Department of Agriculture for
their thoughtful review and comments in the development of
this manuscript.
The views expressed in our research are those of the
investigators and cannot be attributed to the U.S. Department
of Agriculture, its Economic Research Service, or its Food and
Nutrition Service.
No financial disclosures were reported by the authors of
this paper.
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