Presentation Abstract

Session: 05-Public Health Nutrition
Thursday, Mar 24, 2011, 8:45 AM -10:00 AM
Presentation: 016 - A Choice Architecture Intervention Improved Healthy Food and Beverage Choices in a Large Hospital Cafeteria
Location: Atrium Ballroom A
Pres. Time: Thursday, Mar 24, 2011, 9:30 AM - 9:45 AM
Category: +NPAM - Lifestyle Interventions/Behavioral Factors
Keywords: Public health; Nutrition; Interventions
Author(s): Anne N. Thorndike, Douglas Levy, Lillian Sonnenberg, Susan Barraclough, Massachusetts General Hosp, Boston, MA; Jason Riis, Harvard Business Sch, Boston, MA
Abstract: Background: Menu labeling is a public health strategy for reducing obesity, but behavioral economics suggests that people do not make rational choices based on information. We hypothesized that an intervention to alter the “choice architecture” of a cafeteria would increase healthy choices after introducing an informational-based labeling intervention.
Methods: We conducted a 2 phase intervention in Massachusetts General Hospital’s main cafeteria that has a daily average of 6430 visitors with 17,040 items sold. After collecting baseline sales data for 3 months, we implemented a red (unhealthy), yellow (less healthy), green (healthy) labeling intervention based on USDA guidelines for total calories, saturated fat, fruits, vegetables, whole grains, and lean protein. After 3 months, we implemented a choice architecture intervention to alter visibility and convenience of some red and green items (i.e. non-sugared beverages at eye level). Sales data were collected through cafeteria registers. We calculated sales of red and green items for all non-holiday weekdays and compared the relative change in proportion of sales during each 3-month period: baseline, RYG (labeling only), and CA (labeling + choice architecture).
Results: During baseline, 23.6% of total cafeteria sales were red and 34.2% were green. Sales of red items decreased 7.3% during RYG (p<.001) and further decreased 4.8% during CA (p<.001). Sales of green items increased 3.2% during RYG (p<.001) but decreased 1.3% during CA (p<.001). During baseline, 26.0% of total sales were beverages; 4438 beverages were sold per day. Changes in proportion of sales of beverages are shown in the table.

Conclusion: An intervention to alter the visibility and convenience of healthy and unhealthy items in a cafeteria increased the effectiveness of a labeling intervention to improve healthy food and beverage choices. Point-of-purchase interventions to alter choice architecture can improve the effectiveness of interventions that provide information alone.
Disclosures:   A.N. Thorndike: B. Research Grant; Significant; Dr. Thorndike is supported by the grant 1K23 HL93221-01 A1 from the NIH. D. Levy: B. Research Grant; Significant; Dr. Levy was supported by the pilot grant from Harvard Catalyst/The Harvard Clinical and Translational Science Center (NIH Grant #1 UL1 RR 025758-02). L. Sonnenberg: None. S. Barraclough: None. J. Riis: None.