Vices and vegetables: a systematic review and series of meta-analyses examining the relationships among compensatory health beliefs with health-related intentions and behaviors.

Abstract

Background: Compensatory health beliefs (CHBs), the belief that a healthy behavior can offset the effects of a health-compromising one, have been theorized to both justify unhealthy behaviors and motivate health-promoting ones. However, findings in the literature are inconsistent.

Methods: These meta-analyses synthesized 252 effect sizes from 59 independent samples using robust variance estimation to examine the relationships between CHBs and four outcomes: intentions and engagement in compensatory health behaviors and intentions and engagement in health-compromising behaviors.

Results: Approximately 13,760 individuals were represented across these analyses (ages 12-79; women ∼66.1%; college-based = 69.8%). CHBs were significantly associated with greater intentions to engage in compensatory health behaviors (r = 0.21) and with greater engagement in health-compromising behaviors (r = 0.18), but were not reliably associated with compensatory health behaviors or intentions to engage in health-compromising behaviors. Heterogeneity was substantial across all models, but only one significant moderator emerged: CHBs were more strongly associated with compensatory intentions in studies examining diet compared to physical activity. Funnel plot symmetry and stability across values of ρ supported the robustness of findings.

Conclusions: These results highlight the potential for CHBs to undermine health behavior change efforts, particularly when intentions to engage in healthy behaviors are not carried out. Future work should explore state-level CHBs and real-time decision-making to clarify how and when these beliefs influence behavior.