Can changing the position of online menu items increase selection of fruit and vegetable snacks? A cluster randomized trial within an online canteen ordering system in Australian primary schools

Abstract

Background Manipulating the position of food items within the physical food environment has consistently been found to influence item selection. However, the extent to which this strategy is effective in an online food environment is unknown. Objective This study investigated whether an intervention to position fruit and vegetable snack items as the first and last menu items in an online school canteen ordering system increased the selection of those items. It was hypothesized that at follow-up, a higher proportion of online lunch orders in intervention schools would contain the target items (fruit and vegetable snacks) in comparison to control schools. Design Six primary schools in New South Wales, Australia, were recruited to a clustered randomized controlled trial conducted over an 8-wk period. Intervention schools received a redesigned menu where the target items were positioned first and last on the online menu. Control schools received no change to their online menu. Results During the baseline period 1938 students (1203 intervention, 735 control) placed at least one online lunch order and were included in the study, with 16,109 orders placed throughout the study. There was no significant difference between groups over time in the proportion of orders that contained a “Fruit and Veggie Snack” item (OR = 1.136 [95% CI: 0.791, 1.632] P = 0.490). Conclusions Evidence from this large trial with robust study design and objectively collected data suggests that positioning fruit and vegetable snack items first and last within an online canteen menu does not increase the selection of these items. Further research is warranted to confirm this finding with other target menu items (e.g., treats) and across other purchasing contexts and online food ordering platforms. This trial was registered at the Australian New Zealand Clinical Trials Registry, http://www.anzctr.org.au/ as ACTRN12616001520426.

Prominent positioning and food swaps are effective interventions to reduce the saturated fat content of the shopping basket in an experimental online supermarket: a randomized controlled trial

“…fruit and vegetable snacks) on the proportion of orders in an online school canteen ordering system. The discrepancy with our findings might be because that intervention was trying to make more prominent a category of food which people were not necessarily trying to buy, whereas we were trying to make certain foods more prominent within a specific category from which participants had been instructed to select an item [23].…”

Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis

“…(2) 14 interventions (13 RCTs and 1 non-RCT) aimed to increase healthy food offerings on menus [37][38][39][40][41][42][43][44][45][46][47][48]62,72]; and (3) 16 interventions (14 RCTs and 2 non-RCTs) aimed to increase the population's healthy food purchases [25][26][27][28][29]40,45,46,56,60,61,65,66,[69][70][71] (Table 2).…”

“…The included interventions were set in 12 different countries. Most of them were performed in the United States (n = 20) [26][27][28]37,38,40,48,51,52,55,56,60,61,63,[65][66][67][68][69][70] and Australia (n = 11) [25,39,41,43,[45][46][47]58,59,62,71], while the other studies were conducted in Lebanon [29], Brazil [44], Denmark [50], Malaysia [42], Scotland [53], Belgium [49], Mexico [72], Ecuador [54], Ireland [64], and the UK [57].…”

“…The included studies took place in different settings. Twenty-four RCT and 5 non-RCT studies were applied in school settings, specifically in primary and secondary schools [25,27,29,38,41,42,44,[46][47][48][49][53][54][55]57,60,63,65,66,68,69,71] or in a childcare service center [39,43,58,59,62,67,72]. Then, 8 RCTs were conducted in community settings, including 1 intervention in sporting clubs [45]; 2 interventions in restaurants [26] and/or food stores [40]; 4 interventions in after-school programs in churches, communities and schools [37,51,52,70]; and 1 intervention in recreation centers, including corner stores, wholesalers and carry-out restaurants [56].…”

“…Among the 16 interventions targeting food purchase outcomes [25][26][27][28][29]40,45,46,56,60,61,65,66,[69][70][71], (a) 13 presented results on food and beverage items purchased in restaurants and food service establishments by customers [26][27][28][29]40,45,56,60,61,65,66,69,71], (b) 1 intervention [46] presented results on healthy purchases in terms of food nutrient content, and (c) 2 interventions presented results on both food items and nutrient content [25,70] (Table S2).…”