Background
Preventing obesity requires maintenance of healthy eating behaviors over time. Food
labels and strategies that increase visibility and convenience of healthy foods (choice
architecture) promote healthier choices, but long-term effectiveness is unknown.
Purpose
Assess effectiveness of traffic-light labeling and choice architecture cafeteria intervention
over 24 months.
Design
Longitudinal pre–post cohort follow-up study between December 2009 and February 2012.
Data were analyzed in 2012.
Setting/participants
Large hospital cafeteria with a mean of 6511 transactions daily. Cafeteria sales were
analyzed for (1) all cafeteria customers and (2) a longitudinal cohort of 2285 hospital
employees who used the cafeteria regularly.
Intervention
After a 3-month baseline period, cafeteria items were labeled green (healthy); yellow
(less healthy); or red (unhealthy) and rearranged to make healthy items more accessible.
Main outcome measures
Proportion of cafeteria sales that were green or red during each 3-month period from
baseline to 24 months. Changes in 12- and 24-month sales were compared to baseline
for all transactions and transactions by the employee cohort.
Results
The proportion of sales of red items decreased from 24% at baseline to 20% at 24 months
(p<0.001), and green sales increased from 41% to 46% (p<0.001). Red beverages decreased from 26% of beverage sales at baseline to 17% at
24 months (p<0.001); green beverages increased from 52% to 60% (p<0.001). Similar patterns were observed for the cohort of employees, with the largest
change for red beverages (23%–14%, p<0.001).
Conclusions
A traffic-light and choice architecture cafeteria intervention resulted in sustained
healthier choices over 2 years, suggesting that food environment interventions can
promote long-term changes in population eating behaviors.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- (Body Mass Index). National, regional, and global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants.Lancet. 2011; 377: 557-567
- Health and economic burden of the projected obesity trends in the USA and the UK.Lancet. 2011; 378: 815-825
- The global obesity pandemic: shaped by global drivers and local environments.Lancet. 2011; 378: 804-814
- Changing the future of obesity: Science, policy, and action.Lancet. 2011; 378: 838-847
- Consumers may not use or understand calorie labeling in restaurants.J Am Diet Assoc. 2006; 106: 917-920
- Consumer estimation of recommended and actual calories at fast food restaurants.Obesity (Silver Spring). 2011; 19: 1971-1978
- Changing human behavior to prevent disease: the importance of targeting automatic processes.Science. 2012; 337: 1492-1495
- Mindless eating and healthy heuristics for the irrational.Am Econ Rev Papers Proc. 2009; 99: 165-169
- Nudge to nobesity, I: Minor changes in accessibility decrease food intake.Judg Dec Making. 2011; 6: 323-332
- Nudge to nobesity, II: Menu positions influence food orders.Judgment and Decision Making. 2011; 6: 333-342
- Inviting consumers to downsize fast-food portions significantly reduces calorie consumption.Health Aff (Millwood). 2012; 31: 399-407
- Patient understanding of food labels: the role of literacy and numeracy.Am J Prev Med. 2006; 31: 391-398
- A 2-phase labeling and choice architecture intervention to improve healthy food and beverage choices.Am J Public Health. 2012; 102: 527-533
- Food choices of minority and low-income employees: a cafeteria intervention.Am J Prev Med. 2012; 43: 240-248
- Impact of different food label formats on healthiness evaluation and food choice of consumers: a randomized-controlled study.BMC Public Health. 2009; 9: 184
- Consumer testing of the acceptability and effectiveness of front-of-pack food labelling systems for the Australian grocery market.Health Promot Int. 2009; 24: 120-129
- Evaluating the impact of menu labeling on food choices and intake.Am J Public Health. 2010; 100: 312-318
- The science of front-of-package food labels.Public Health Nutr. 2013; 16: 430-439
- Strategies for promoting healthier food choices.Am Econ Rev Papers Proc. 2009; 99: 159-164
- Choice architecture as a means to change eating behaviour in self-service settings: a systematic review.Obes Rev. 2013; 14: 187-196
- “Traffic-light” nutrition labelling and “junk-food” tax: a modelled comparison of cost-effectiveness for obesity prevention.Int J Obes (Lond). 2011; 35: 1001-1009
United States Department of Agriculture. Dietary guidelines for Americans. www.mypyramid.gov/guidelines/index.html. Updated 2005.
- Public health action amid scientific uncertainty: the case of restaurant calorie labeling regulations.JAMA. 2009; 302: 434-435
- Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices: a review of the literature.Int J Behav Nutr Phys Act. 2008; 5: 51
- Purchasing behavior and calorie information at fast-food chains in New York City, 2007.Am J Public Health. 2008; 98: 1457-1459
- Evaluation of a voluntary menu-labeling program in full-service restaurants.Am J Public Health. 2010; 100: 1035-1039
- Calorie labeling and food choices: a first look at the effects on low-income people in New York City.Health Aff (Millwood). 2009; 28: w1110-w1121
- Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: cross sectional customer surveys.BMJ. 2011; 343: 4464
- Mandatory menu labeling in one fast-food chain in King County, Washington.Am J Prev Med. 2011; 40: 122-127
- Facts up front versus traffic light food labels: a randomized controlled trial.Am J Prev Med. 2012; 43: 134-141
- The public health and economic benefits of taxing sugar-sweetened beverages.N Engl J Med. 2009; 361: 1599-1605
- Increasing consumption of sugar-sweetened beverages among U.S. adults: 1988–1994 to 1999–2004.Am J Clin Nutr. 2009; 89: 372-381
- Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk.Circulation. 2010; 121: 1356-1364
- Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis.Diabetes Care. 2010; 33: 2477-2483
- Reduction in consumption of sugar-sweetened beverages is associated with weight loss: the PREMIER trial.Am J Clin Nutr. 2009; 89: 1299-1306
Cardello H, Wolfson J, Yufera-Leitch M, Warren L, Spitz M. Better-for-you foods: an opportunity to improve public health and increase food industry profits. Hudson Institute: Washington DC, March 2013; www.hudson.org/files/publications/better_for_you_combinedFINAL.pdf
Article Info
Identification
Copyright
© 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
