Article | American Journal of Public Health | March 2012

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

by Anne Thorndike, Lilian Sonnenberg, Jason Riis, Susan Barraclough and Douglas E. Levy

Abstract

Objectives: We assessed whether a 2-phase labeling and choice architecture intervention increased 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 which increased 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 (N=977,793 items, including 199,513 beverages), 24.9% of sales were red and 42.2% green. Sales of red items decreased in both phases (p<0.001), and green items increased in Phase 1 (p<0.001). Largest changes occurred among beverages. Red beverages decreased 16.5% during Phase 1 (p<0.001) and further decreased 11.4% in Phase 2 (p<0.001). Green beverages increased 9.6% in Phase 1 (p<0.001) and further increased 4.0% in Phase 2 (p<0.001). Bottled water increased 25.8% during Phase 2 (p<0.001) but did not increase at two on-site comparison cafeterias (p<0.001). Conclusions: A color-coded labeling intervention improved sales of healthy items and was enhanced by a choice architecture intervention.

Keywords: Health; Sales; Change; Food and Beverage Industry;

Citation:

Thorndike, Anne, Lilian Sonnenberg, Jason Riis, Susan Barraclough, and Douglas E. Levy. "A 2-phase Labeling and Choice Architecture Intervention to Improve Healthy Food and Beverage Choices." American Journal of Public Health 102, no. 3 (March 2012): 527–533.