'Traffic light' food labels, positioning of healthy items produce lasting choice changes

January 7, 2014

The use of color-coded "traffic light" food labels and changes in the way popular items are displayed appear to have produced a long-term increase in the choice of more healthful food items among customers in a large hospital cafeteria. A Massachusetts General Hospital (MGH) team reports in the American Journal of Preventive Medicine that the previously reported changes in the proportions of more and less healthy foods purchased in the months after their program began have persisted up to two years after the labeling intervention was introduced.

"Our current results show that the significant changes in the purchase patterns of both hospital employees and all customers resulting from the labels and the choice architecture program did not fade away as cafeteria patrons became used to them," says Anne Thorndike, MD, MPH, of the MGH Division of General Medicine, who led the study. "This is good evidence that these changes in persist over time."

Initiated in March of 2010, the program was developed by the research team – including leaders of the MGH Food and Nutrition Service – to deliver information about in a simplified way that did not require reading and understanding detailed . The first phase involved the application of "traffic light" labels – green for the healthiest items, such as fruits, vegetables and lean sources of protein; yellow for less healthy items, and red for those with little or no nutritional value – to all items in the main hospital cafeteria. Several weeks before the labels were introduced, cafeteria cash registers began to identify and record each purchased item as red, yellow or green.

The second "choice architecture" phase, started three months after the labels were introduced, focused on cold beverages, pre-made sandwiches and chips – all of which were rearranged to display more healthful items where they were most likely to be selected. For example, bottled water, diet beverages and low-fat dairy products were positioned at eye level, while beverages with yellow or red labels were placed at lower levels.

As the team reported in the March 2012 American Journal of Public Health, at the end of the initial six-month study period, the program led to significant increases in the purchases of "green" items and reduced purchases of "red" items, with the largest changes in beverage purchases. A subsequent study in the September 2012 American Journal of Preventive Medicine, focused on employees enrolled in a program in which their meals could be paid by payroll deduction, revealed similar changes in purchase patterns across all racial and ethnic groups as well as job types.

The current study analyzed purchase patterns for the 24 months following the program's implementation and found that the changes present at the end of the first year were virtually unchanged at the end of the second. Overall, purchases of "green" items had increased 12 percent, compared with the pre-intervention period, and "red" item purchases dropped 20 percent. Purchases of "red" beverages – primarily sugar-sweetened beverages – dropped 39 percent, while "green" beverage purchases increased 10 percent. The changes remained similar for all types of employees, and overall cafeteria sales during the two-year period were stable.

"These findings are the most important of our research thus far because they show a food labeling and product placement intervention can promote healthy choices that persist over the long term, with no evidence of 'label fatigue,' " says Thorndike, an assistant professor of Medicine at Harvard Medical School. "The next steps will be to develop even more effective ways to promote healthy choices through the food service environment and translate these strategies to other worksite, institutional or retail settings."

Explore further: 'Traffic-light' labeling increases attention to nutritional quality of food choices

Related Stories

'Traffic-light' labeling increases attention to nutritional quality of food choices

October 17, 2013
A simple, color-coded system for labeling food items in a hospital cafeteria appears to have increased customer's attention to the healthiness of their food choices, along with encouraging purchases of the most healthy items. ...

Color-coding, rearranging food products improves healthy choices in hospital cafeteria

January 19, 2012
A simple program involving color-coded food labeling and adjusting the way food items are positioned in display cases was successful in encouraging more healthful food choices in a large hospital cafeteria. The report from ...

Color-coded labels improve healthy food choices in employees from all backgrounds

August 7, 2012
A program designed to encourage more healthful food choices through simple color-coded labels and the positioning of items in display cases was equally successful across all categories of employees at a large hospital cafeteria. ...

Taxing unhealthy food spurs people to buy less

June 19, 2013
Labeling foods and beverages as less-healthy and taxing them motivates people to make healthier choices, finds a recent study in the American Journal of Preventive Medicine. When faced with a 30 percent tax on less healthy ...

Consumers order a less unhealthy meal when the menu has nutritional labeling

November 18, 2013
An evaluation team led by the Drexel University School of Public Health has published a new study demonstrating that customers of full-service restaurants use nutritional labeling on menus to make healthier food choices.

Green food labels make nutrition-poor food seem healthy

March 12, 2013
Green calorie labels may lead people to see nutrition-poor foods in a healthier light.

Recommended for you

High-fat diet in pregnancy can cause mental health problems in offspring

July 21, 2017
A high-fat diet not only creates health problems for expectant mothers, but new research in an animal model suggests it alters the development of the brain and endocrine system of their offspring and has a long-term impact ...

To combat teen smoking, health experts recommend R ratings for movies that depict tobacco use

July 21, 2017
Public health experts have an unusual suggestion for reducing teen smoking: Give just about any movie that depicts tobacco use an automatic R rating.

Opioids and obesity, not 'despair deaths,' raising mortality rates for white Americans

July 20, 2017
Drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014, with the bulk of that spike occurring since the mid-1990s when addictive prescription opioids became broadly available, according ...

Aging Americans enjoy longer life, better health when avoiding three risky behaviors

July 20, 2017
We've heard it before from our doctors and other health experts: Keep your weight down, don't smoke and cut back on the alcohol if you want to live longer.

Parents have critical role in preventing teen drinking

July 20, 2017
Fewer teenagers are drinking alcohol but more needs to be done to curb the drinking habits of Australian school students, based on the findings of the latest study by Adelaide researchers.

Fresh fish oil lowers diabetes risk in rat offspring

July 19, 2017
Fresh fish oil given to overweight pregnant rats prevented their offspring from developing a major diabetes risk factor, Auckland researchers have found.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.