Date of this Version
American Journal of Preventive Medicine
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.
Originally published in the American Journal of Preventive Medicine © 2014 Elsevier
This is a pre-publication version. The final version is available at http://dx.doi.org/10.1016/j.amepre.2013.10.002
Thorndike, A. N., Riis, J., Sonnenberg, L. M., & Levy, D. E. (2014). Traffic-Light Labels and Choice Architecture: Promoting Healthy Food Choices. American Journal of Preventive Medicine, 46 (2), 143-149. http://dx.doi.org/10.1016/j.amepre.2013.10.002
Date Posted: 15 June 2018
This document has been peer reviewed.