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.
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