Lessons from Smart Cart 2.0: Considerations for integrating purchasing data into healthy eating interventions with AI approaches

The increasing prevalence of chronic diseases related to suboptimal diet quality in the US and worldwide contributes to burgeoning healthcare costs and excess death and disability. Changing dietary intake is essential but difficult because dietary behaviors stem from interconnected biological, psychological, environmental, and social factors that are rarely comprehensively addressed in interventions. Emerging digital technologies present a paradox in food environments: some facilitate healthier eating while other practices, like targeted marketing and price manipulation, exploit behavioral vulnerabilities and promote poor dietary habits. Smart Cart 2.0 – a personalized digital healthy eating intervention using artificial intelligence (AI) and machine learning (ML) to detect patterns and influence dietary choices – offers critical lessons for health technology design. This perspective contends that improving digital dietary behavior interventions hinges on responsible implementation: fully leveraging technology’s promise while establishing safeguards against premature adoption. With appropriate guardrails, digital technologies provide tremendous opportunity to improve the delivery, personalization, and scalability of healthy eating interventions.