MedicalResearch.com Interview with:
Anne Thorndike, MD, MPH
Massachusetts General Hospital
General Internal Medicine Division
Boston, MA 02114
MedicalResearch.com: What is the background for this study?
Response: Nearly one-third of the 150 million US adults who are employed are obese. Employees frequently eat meals acquired at work, and workplace food is often high in calories. Effective strategies for reducing non-nutritive energy intake during the workday could help address the rising prevalence of obesity.
Simplified labeling, such as traffic-light labels, provide understandable information about the relative healthfulness of food and can be placed on menu boards, shelf labels, and individual packages to help employees make healthier choices. Choice architecture (e.g., product placement) interventions make it easier and more convenient for employees to choose a healthy item. It is unknown if labeling interventions are associated with sustained reductions in calorie intake, or if there are only temporary effects after which most people revert to higher-calorie choices.
A previous study demonstrated that a hospital cafeteria traffic-light labeling and choice architecture program resulted in a higher proportion of healthy green-labeled purchases and lower proportion of unhealthy red-labeled purchases over two years. The current study analyzed calories purchased by a longitudinal cohort of 5,695 hospital employees who used the cafeteria regularly. The study examined changes in calories purchased over time and hypothesized the effect of the change in calorie intake on employees’ weight.
MedicalResearch.com: What are the main findings?
Response: During the 3-month baseline period before the traffic light labeling and choice architecture, employees’ cafeteria purchases had an average of 565 calories per transaction. One year after the program started, this had decreased by 19 calories per transaction, and at two years, this had decreased by 35 calories per transaction, a 6.2% reduction relative to baseline. The largest reduction occurred for the unhealthy red-labeled items, decreasing 42 calories per transaction at two years from 183 calories at baseline, a 23% relative reduction. The healthiest green-labeled items increased 6 calories per transaction from 152 calories, a 4.0% relative increase from baseline.
Among 453 frequent purchasers who had 36 or more transactions every quarter over two years, the total number of calories purchased during baseline was 41,784, and this decreased an average of 4,275 calories per quarter over two years. Assuming these employees had no compensatory changes in diet or physical activity, this equated to a reduction of 47 calories per day and estimated a 2.0 kg weight loss over 3 years.
MedicalResearch.com: What should readers take away from your report?
Response: This is the first study to evaluate longitudinal objective food purchasing data to demonstrate that a simple food labeling and choice architecture intervention was associated with sustained reductions in the calories of food purchased. Results of this study suggest that employees who used the workplace cafeteria most frequently could have lost weight or, more conservatively, avoided weight gain over 3 years. These findings support broader implementation of healthy eating interventions in other large workplaces, particularly hospitals and healthcare settings, to address the unprecedented levels of obesity and obesity-related chronic diseases in the US and worldwide.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The next step in this research is to measure changes in health outcomes of employees who are exposed to workplace healthy eating programs to determine if changes in dietary intake at work lead to changes in cardiometabolic risk factors, such as blood pressure, cholesterol, and hemoglobin A1c. It is also important to test the effectiveness of these interventions in other non-healthcare and more rural workplace settings.
This research was funded in part by the NIH R01 grant HL125486.
Thorndike AN, Gelsomin ED, McCurley JL, Levy DE. Calories Purchased by Hospital Employees After Implementation of a Cafeteria Traffic Light–Labeling and Choice Architecture Program. JAMA Netw Open. Published online July 10, 20192(7):e196789. doi:10.1001/jamanetworkopen.2019.6789
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