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

Objectives. We assessed whether a 2-phase labeling and choice architecture intervention would increase 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 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. Results. 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). Conclusions. A color-coded labeling intervention improved sales of healthy items and was enhanced by a choice architecture intervention. (Am J Public Health. 2012;102:527-533. doi:10.2105/AJPH.2011.300391)