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

TLDR

The study evaluated whether a two‑phase labeling and choice‑architecture intervention could raise sales of healthy foods and beverages in a large hospital cafeteria. Phase 1 applied color‑coded labels (red = unhealthy, yellow = less healthy, green = healthy), and Phase 2 added choice‑architecture changes that increased the visibility and convenience of selected green items, with sales tracked over successive 3‑month periods. The intervention lowered sales of red items and raised sales of green items—particularly beverages—while the choice‑architecture phase further boosted green item and bottled water sales, showing that labeling alone improves healthy choices and that adding choice architecture amplifies the effect.

Abstract

We assessed whether a 2-phase labeling and choice architecture intervention would increase sales of healthy food and beverages in a large hospital cafeteria.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 that increased the 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.At baseline (977,793 items, including 199,513 beverages), 24.9% of sales were red and 42.2% were green. Sales of red items decreased in both phases (P < .001), and green items increased in phase 1 (P < .001). The largest changes occurred among beverages. Red beverages decreased 16.5% during phase 1 (P < .001) and further decreased 11.4% in phase 2 (P < .001). Green beverages increased 9.6% in phase 1 (P < .001) and further increased 4.0% in phase 2 (P < .001). Bottled water increased 25.8% during phase 2 (P < .001) but did not increase at 2 on-site comparison cafeterias (P < .001).A color-coded labeling intervention improved sales of healthy items and was enhanced by a choice architecture intervention.