Anne N. Thorndike|Jason Riis|Lillian Sonnenberg|Douglas E. Levy
Traffic-Light Labels and Choice Architecture
Massachusetts General Hospital|Food and Nutrition Service|Massachusetts General Hospital
background preventing obesity requires maintenance healthy eating behaviors time food labels strategies increase visibility convenience healthy foods choice architecture promote healthier choices longterm effectiveness unknown purpose assess effectiveness trafficlight labeling choice architecture cafeteria intervention 24 months design longitudinal prepost cohort followup study december 2009 february 2012 data analyzed 2012 settingparticipants large hospital cafeteria mean 6511 transactions daily cafeteria sales analyzed 1 cafeteria customers 2 longitudinal cohort 2285 hospital employees used cafeteria regularly intervention 3month baseline period cafeteria items labeled green healthy yellow less healthy red unhealthy rearranged make healthy items accessible main outcome measures proportion cafeteria sales green red 3month period baseline 24 months changes 12 24month sales compared baseline transactions transactions employee cohort results proportion sales red items decreased 24 baseline 20 24 months p0001 green sales increased 41 46 p0001 red beverages decreased 26 beverage sales baseline 17 24 months p0001 green beverages increased 52 60 p0001 similar patterns observed cohort employees largest change red beverages 2314 p0001 conclusions trafficlight choice architecture cafeteria intervention resulted sustained healthier choices 2 years suggesting food environment interventions promote longterm changes population eating behaviors preventing obesity requires maintenance healthy eating behaviors time food labels strategies increase visibility convenience healthy foods choice architecture promote healthier choices longterm effectiveness unknown assess effectiveness trafficlight labeling choice architecture cafeteria intervention 24 months longitudinal prepost cohort followup study december 2009 february 2012 data analyzed 2012 large hospital cafeteria mean 6511 transactions daily cafeteria sales analyzed 1 cafeteria customers 2 longitudinal cohort 2285 hospital employees used cafeteria regularly 3month baseline period cafeteria items labeled green healthy yellow less healthy red unhealthy rearranged make healthy items accessible proportion cafeteria sales green red 3month period baseline 24 months changes 12 24month sales compared baseline transactions transactions employee cohort proportion sales red items decreased 24 baseline 20 24 months p0001 green sales increased 41 46 p0001 red beverages decreased 26 beverage sales baseline 17 24 months p0001 green beverages increased 52 60 p0001 similar patterns observed cohort employees largest change red beverages 2314 p0001 trafficlight choice architecture cafeteria intervention resulted sustained healthier choices 2 years suggesting food environment interventions promote longterm changes population eating behaviors