Improving healthy food & beverage choices through choice architecture

In my previous blog post, I discussed a study by Thorndike et al that looked at how both labeling healthy and unhealthy food choices with colour codes affected the purchase of healthy foods and beverages (1). The previous post focused on the “traffic light” labeling program, which created a new feedback loop that simplified the complexity of making healthy decision. Today I’ll look at the second phase of their experiment – choice architecture. Strategies that alter our environment to “nudge” people towards a desired choice can also serve to reduce the complexity of decision making. The results presented by Thorndike et al provide evidence to suggest that the simple rearrangement of the location of healthy food choices within a cafeteria can contribute to an increase consumer purchases of these options (1).

Choice architecture refers to how our environment is designed to influence the choices we make. In the study by Thorndike et al, healthy items (those with a green coded label) were placed at eye level in coolers throughout the cafeteria. Additionally, bottled water was placed in displays in new locations – all with the goal of increasing visibility. Is it simply enough to make a healthy choice more visible to get people to choose it? The study found that yes, at least for beverages, placing healthy choices more prominently throughout the cafeteria led to an increase in sales of those items. Bottled water sales increased 25.8% during the second phase of the study.

According to Richard Thaler (2), there are three basic principles of choice architecture. First, establish desirable defaults. Defaults refer to the the path of least resistance. Next expect errors; or design with the acknowledgement that humans make mistakes. And third, give feedback.

How can we leverage these principles to effectively nudge people towards healthier behaviours? Some interventions, such as studied by Thorndike et al have begun by modifying the defaults. The Smarter Lunchrooms Movement is another initiative with similar goals in schools across the US. Reducing the size of bowls in the lunch room, an example of changing the default, led to students serving smaller portions of cereal at breakfast. Similarly, putting chocolate milk behind the plain milk increases the difficulty of getting chocolate milk and led to an increase in the amount of plain milk sold over chocolate milk. Moving baskets of fresh fruit next to the cashiers in school cafeteria also led to an increase in their sales(3).

Can the concepts of nudges be taken beyond the school lunch room? In an upcoming post I’ll take a look at the UK Behavioural Insights Teams and the opposing views on its potential for success.

References:

1. Thorndike, A., Sonnenberg, L., Riis, J., Barraclough, S., & Levy, D. (2012). A 2-Phase Labeling and Choice Architecture Intervention to Improve Healthy Food and Beverage Choices American Journal of Public Health DOI: 10.2105/AJPH.2011.300391

2. Thaler, R. and C. Sunstein. (2008) Nudge: Improving Decisions about Health, Wealth and Happiness. Yale University Press. New Haven and London.

3.  Just, D.R. and B. Wansink (2009) Smarter Lunchrooms: Using Behavioral Economics to Improve Meal Selection. Choices 24(3)

Related readings:

• Behavioural Economics – a way to fight Big Food from Verdant Nation
• Google’s Impressive Healthy Food Program from Marion Nestle on Food Politics
• Opting In versus Opting Out by Richard Thaler

Friday Feedback Favourites

Each Friday (OK, today’s Saturday… I’m a little behind these days!), I share a collection of stories, research, or other news and notes related to the role of feedback in complex systems that catch my attention during the previous week. Most of these I share on twitter when I first read about them; if you have a twitter account, feel free to follow me. If you’re not on twitter, I hope that you enjoy this selection of my favourites; links are provided so you can explore each one fully.

Here are this week’s favourites:

• Ever suffered writer’s block? There’s a number of nifty tools to help keep you motivated and on track to meet your writing deadlines, including one called Write or Die. If you’re prone to procrastinate, this might be for you – allowing you to set a goal (number of words to write), time limit and penalty (ranging from changing screen colour, an alarm sounding, or deleting the text you’ve just written!). Me, I prefer the idea of Written? Kitten! where typing rewards you with a picture of a cute kitten, how’s that for dangling a carrot? (Hat tip to @TravisSaunders for the link to whizbang’s post on writing tools from #scio12)
• BJ Fogg of STandford University has developed a new model to help understand behaviour change. The basic premise of the model is that three elements, motivation, ability and trigger, must occur simultaneously in order to elicit a behaviour. His research at the Persuasive Technology Lab includes projects focussed on exploring ways for computing systems to assist in changing human behavior.

Image snow day! from cory schmitz on flickr

Leveraging feedback to improve healthy food & beverage choices

Energy-dense foods purchased outside the home are an important contributor to the obesity epidemic facing our society. Can public health interventions that target the point of purchase help support individuals making healthy choices? A recent paper by Thorndike et al published in the American Journal of Public Health explores the effects of one such intervention (1).

In a large hospital cafeteria, researchers implemented a two stage experiment. In the first stage, they introduced nutrition labels that were colour coded red, yellow or green to help consumers identify the healthfulness of foods and beverages. In the second stage, the locations of foods and beverages were changed in order to increase the visibility of the healthy food and beverage choices (colour coded green).

Implementation of the colour coded labels (Phase 1) led to a significant decrease in sales of all red items from baseline measurements with sales of beverages in this category decreasing the most. At the same time, sales of green items increased, again with the greatest increase seen for beverages. Changing the visibility of green items in Phase 2 led to a further decrease in the sales of red items. However, only green beverages saw an additional increase in sales due to the rearranged product placement in the cafeteria.

As I’ve blogged about previously, feedback is important to consider in promoting behaviour change. The first phase of this study is an example of creating a new feedback loop to support individuals in making healthy behaviour changes. Menu labeling at the point of purchase is not a new idea though. Policies requiring restaurants to display calories for all menu items are popular public health interventions. However, research examining the success of these interventions in changing food choices has shown mixed results (2). Reading and interpeting nutrition labels is confusing and complex, requiring the consumer to understand kilocalories, serving sizes, and energy requirements. Additionally, the caloric value of a food or beverage is not the only determinant of its healthfulness.

The simplified colour coding used in the study by Thorndike reduces the complexity associated with identifying healthy food and beverage choices and was not determined by caloric value alone. The intervention’s success suggests that similar programs may be able to further improve the effectiveness of other menu labeling policies. However, an important challenge to this simplified approach of colour-coding healthful and less healthful foods will be reaching a consensus on the criteria by which foods and beverages are categorized.

I’ll explore choice architecture, and the effects of changing where healthy foods and beverages were positioned in an upcoming post.

References

1. Thorndike, A., Sonnenberg, L., Riis, J., Barraclough, S., & Levy, D. (2012). A 2-Phase Labeling and Choice Architecture Intervention to Improve Healthy Food and Beverage Choices American Journal of Public Health DOI: 10.2105/AJPH.2011.300391

2. Robert Wood Johnson Foundation. (2009) Menu Labeling: Does Providing Nutrition Information at the Point of Purchase Affect Consumer Behavior? A Research Synthesis, June 2009. http://www.rwjf.org/files/research/20090630hermenulabeling.pdf

Hat tip to Carrie Matteson for suggesting the article.

For additional information, please also see:

• powerpoint presentation by the authors available in pdf format 
• legal and policy resources on menu labeling from the CDC

 

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Friday Feedback Favourites

Each Friday, I share a collection of stories, research, or other news and notes related to the role of feedback in complex systems that catch my attention during the previous week. Most of these I share on twitter when I first read about them; if you have a twitter account, feel free to follow me. If you’re not on twitter, I hope that you enjoy this selection of my favourites; links are provided so you can explore each one fully.

Here are this week’s favourites:

• In Discover Magazine, David Eagleman discusses the automatic processes our unconscious mind takes care of: “Your Brain Knows a Lot More Than You Realize“.
• This very cool project in Vancouver is a community business, looking for the community’s input in how they develop. Through a series of polls, the public will vote on what is created at “This Space“, 243 Union Street in Vancouver’s Chinatown/Strathcona neighbourhood. The winning vote from the second poll, “What type of local service do you think belongs at 243 Union Street?” was a local products grocery store. This Space is now looking for a “fresh food expert“.
• Ginger.io (a spin-off company from the MIT Media Lab) recently won a $100,000 award in the Data Design Diabetes challenge for the final development of an app that uses sensor data from your mobile phone to predict individual behaviour changes – read more about it here from Fast Company.