CHOOSING WELL: From left, Sonnenberg, Levy, Thorndike and Barraclough in front of a “Choose Well, Eat Well" display in the Eat Street Café.
“CHOOSE WELL, EAT WELL,” a simple, inexpensive nutrition program launched at the MGH in 2010, has proven successful in encouraging healthier choices at the hospital’s largest cafeteria, the Eat Street Café. The program – developed and monitored by MGH physicians, dieticians and health policy experts – is based on a nutrition label color-coding system and the careful positioning of food and beverages in display cases. A report about the results of the program has been released online and will appear in the print edition of American Journal of Public Health in March.
“We found that labeling foods with a simple red, yellow and green color scheme to indicate their relative healthiness led patrons to purchase more healthy and fewer unhealthy items,” says Anne Thorndike, MD, MPH, of the MGH Division of General Medicine, who led the study. “We also found that moving items around to make the healthy items more convenient and visible led to further improvement in the nutritional quality of items purchased.”
The program was rolled out in two phases. In the first phase, which began in March 2010, color-coded labels were attached to all food items – green signifying the healthiest items, yellow indicating less healthy items, and red for those with little or no nutritional value. Signage encouraged customers to consume green items often, yellow items less often and to consider other choices for red items. For the second phase, which began in June 2010, displayed items were rearranged according to the principles of what is called choice architecture. Green items were displayed at eye level, while red or yellow items were placed below eye level. This phase focused on cold beverages, pre-made sandwiches and chips – items likely to be purchased by customers who have little time to spend and may be more influenced by convenience.
At the end of the six-month period, sales of green items had increased significantly, while sales of unhealthy red items decreased. During phase one, sales of all red items decreased 9.2 percent, with red beverage purchases dropping 16.5 percent. Green item sales increased 4.5 percent, with a 9.6 increase in green beverages. In phase two, red item sales dropped another 4.9 percent compared with phase one, with beverages dropping by 11.4 percent; and while sales of green items decreased 0.8 percent in phase two, sales of green beverages increased another 4 percent.
Thorndike says the “Choose Well, Eat Well” program is continuing. The colored labels will be expanded to all food service sites, and ongoing analysis is planned. Additional co-authors of the report – which was supported by the National Center for Research Resources and the National Heart, Lung and Blood Institute – are Lillian Sonnenberg, DSC, RD, LDN, and Susan Barraclough, MS, RD, LDN, MGH Nutrition and Food Services; Douglas Levy, PhD, Mongan Institute of Health Policy at MGH; and Jason Riis, PhD, Harvard Business School.
Read more articles from the 1/27/12 Hotline issue.