A 2-Phase Labeling and Choice Architecture Intervention to Improve Healthy Food and Beverage Choices

Abstract

Objectives We assessed whether a 2-phase labeling and choice architecture intervention would increase sales of healthy food and beverages in a large hospital cafeteria. Methods Phase 1 was a 3-month color-coded labeling intervention (red = unhealthy, yellow = less healthy, green = healthy). Phase 2 added a 3-month choice architecture intervention that increased the visibility and convenience of some green items. We compared relative changes in 3-month sales from baseline to phase 1 and from phase 1 to phase 2. Results At baseline (977 793 items, including 199 513 beverages), 24.9% of sales were red and 42.2% were green. Sales of red items decreased in both phases (P < .001), and green items increased in phase 1 (P < .001). The largest changes occurred among beverages. Red beverages decreased 16.5% during phase 1 (P < .001) and further decreased 11.4% in phase 2 (P < .001). Green beverages increased 9.6% in phase 1 (P < .001) and further increased 4.0% in phase 2 (P < .001). Bottled water increased 25.8% during phase 2 (P < .001) but did not increase at 2 on-site comparison cafeterias (P < .001). Conclusions A color-coded labeling intervention improved sales of healthy items and was enhanced by a choice architecture intervention. (Am J Public Health. 2012;102:527–533. doi:10.2105/AJPH.2011.300391)

Problem restructuring for better decision making in recurring decision situations

“…The goal of restructuring is to lead a decision maker to a sequence of choices that more closely align with the optimal strategy. This approach parallels recent developments in psychology and behavioral economics [85,3,76,11,86] that restructure a decision problem rather than attempting to change a person's decision making strategy directly. For instance, this work has proposed removing options to allow people to focus on an appropriate set of choices and characteristics of those choices, which would suggest, for instance, that a used car buyer is likely reach a better decision more quickly if presented with a smaller set of possible cars and only the most important characteristics of those cars.…”

“…Other research attributes people's difficulty in decision-making to the conflict between a "reflective system" and an "automatic system" [85,17]. As described in the body of this paper, other research has investigated the usefulness of restructuring for decisions simpliciter [3,76,85,11,86]. Research in economics on search theory has focused largely on theoretical aspects of the optimal search strategy, with a smaller body of work showing the extent to which people's strategies diverge from the theoretical optimal one [33,58].…”

Behavioral Economics and the Psychology of Fruit and Vegetable Consumption

“…This is why manufacturers pay so much money in slotting fees at supermarkets. Thorndike et al (2012) increased sales of bottled water in a hospital cafeteria 30% by simply placing bottles of water in baskets beside each food station in the cafeteria. These additional displays did not involve refrigeration, so it may not work for juice, but it certainly could work for easy to grab fruits such as apples or bananas.…”

“…Thorndike et al (2012) used a traffic light system in a large hospital cafeteria, which led to significant changes in product choice, although they do not specifically report changes in fruits and vegetables. Many grocery chains are introducing in-house or third party labeling schemes such as Guiding Stars developed by Hannaford, Healthy Ideas developed by Stop & Shop/Giant, and NuVal developed by David Katz of Yale and used at several chains nationwide.…”

“…In these schemes, fruits and vegetables are generally at the top of the scale, but the impact on consumer purchases has not yet been systematically studied. The traffic light system used by Thorndike et al (2012) is somewhat unique in that it actually directs customers away from unhealthy choices. Many marketers are reluctant to do this, but it may be the most effective way to influence behavior.…”