Friday, August 17, 2012

Program improves food choices


CHOOSE WELL: Before, at left, sugar-sweetened soft drinks and juices were mixed together with diet beverages and low-fat items. Now, at right, healthier beverages are placed at or above eye level, while less healthy items are placed below.

MGH Nutrition and Food Services launched the “Choose Well, Eat Well” program in 2010 to encourage more healthful food choices by MGH employees, patients and visitors patronizing the Eat Street Café and other food service sites. A study published earlier this year confirmed that purchases of more healthful items increased after the program’s introduction, and now an Aug. 7 study in the American Journal of Preventive Medicine (AJPM) reports that the program’s success includes employees from all socioeconomic statuses and racial and ethnic groups.

“These findings are important because obesity is much more common among Americans who are black or Latino and among those of low socioeconomic status,” says Douglas Levy, PhD, of the Mongan Institute for Health Policy at MGH, lead author of the report. “Improving food choices in these groups may help reduce their obesity levels and improve population health.”

“Choose Well, Eat Well” was implemented in two phases. In March 2010, color-coded labels were attached to all items in Eat Street Café – green signifying the healthiest items, such as fruits, vegetables and lean meats; yellow indicating less healthy items; and red for those items with more negative than positive nutritional characteristics. The second “choice architecture” phase, which began in June 2010, focused on cold beverages, pre-made sandwiches and chips – items likely to be purchased by customers influenced by convenience. Green items were displayed at eye level while yellow or red items were placed below eye level (see photo). Additional baskets containing bottled water were placed near hot food stations.

The current study analyzed data reflecting purchases by more than 4,600 MGH employees enrolled in the Platinum Plate program, which allows purchases through payroll deduction. Although no information that could identify a particular employee was available to the research team, based on human resources data, employees were categorized by race or ethnicity and socioeconomic status associated with job type and education level.

Before the start of the program, black and Latino employees and those with jobs associated with lower levels of education and lower incomes purchased more red items and fewer green items than did white employees and those with jobs associated with higher education levels and higher incomes. By September 2010, all categories of employees had reduced their purchase of red items and were purchasing more green items compared to baseline. A focused analysis of
beverage purchases found that all groups were purchasing a greater number of healthful beverages. “Because these measures are both simple and inexpensive to implement, they could easily be tried in a variety of food sales environments – such as cafeterias, convenience stories and even vending machines,” says Levy.

The “Choose Well, Eat Well” program has been extended to all food service sites. Additional co-authors of the AJPM report are Lillian Sonnenberg, DSC, RD, LDN, and Susan Barraclough, MS, RD, LDN, MGH Nutrition and Food Services; Anne Thorndike, MD, MPH, MGH division of General Medicine; and Jason Riis, PhD, Harvard Business School. 

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