title: A 2-phase labeling and choice architecture intervention to improve healthy food and beverage choices.
abstract: OBJECTIVE
  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.
authors.affiliation: General Medicine Unit, Massachusetts General Hospital, Boston, MA 02114, USA. athorndike@partners.org
authors.forename: Anne N
authors.initials: AN
authors.lastname: Thorndike
authors.forename: Lillian
authors.initials: L
authors.lastname: Sonnenberg
authors.forename: Jason
authors.initials: J
authors.lastname: Riis
authors.forename: Susan
authors.initials: S
authors.lastname: Barraclough
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Levy
mesh_terms: D001628:Beverages; D001900:Boston; D002755:Choice Behavior; D003116:Color; D005502:Food; D005521:Food Service, Hospital; D006769:Hospitals, General; D006801:Humans; D008297:Male; D011356:Product Labeling