Author(s): Thorndike AN, Riis J, Sonnenberg LM, Levy DE
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Abstract 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. © 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.
This article was published in Am J Prev Med
and referenced in Journal of Health Education Research & Development