Low-cost changes in hospital canteens could 'nudge' customers to healthier diets

Making healthy food easier to access in hospital canteens and food outlets, as well as increasing healthy options and reducing portion sizes, are the most effective ways of encouraging healthcare staff to improve their diets according to a new study from the University of Warwick.

Using 'nudge theory', which has been shown to encourage healthy eating in other settings, these low-cost changes could have a significant effect on improving the health of the workforce of the NHS, the largest employer in the UK.

The study, conducted by researchers at Warwick Medical School, is published in BMJ Open today. It examines ways in which the environment can be changed to support healthy purchasing and consumption by healthcare staff and analyses the results of 13 studies into the use of choice architecture in healthcare settings.

It follows previous research that demonstrated that moving location of fruit and vegetables to the front entrance of a shop, with no further advertising or messaging added to encourage customers, can lead to a 15% sales increase in those products. This latest study builds on this by examining whether the same effect could be used by the UK's largest employer, where it could have the largest impact on the national workforce.

Healthcare staff face many barriers to accessing healthy food, such as lack of time, unpredictable and demanding workloads, and inconvenient access to food. Choice architecture involves changing the environment that staff are working in to promote healthy behaviour, often by 'nudging' them towards better options.

The researchers found changes that reducing the effort required to select healthy options, or increasing the effort required to select unhealthy options, improved diets. For example, one study put a healthy vegetable based spread in easy to reach positions, while another arranged desserts so that fresh fruit salad was in the easiest access positions.

Increasing the availability of healthy options also drove healthier diets, for example when 75% of the snacks on offer in one hospital canteen were healthy and 25% were unhealthy, more healthy snacks were bought. Offering smaller sizes of main meals and other products alongside their standard sizes was also shown to improve dietary behaviour.

Obesity has been associated with absenteeism, presenteeism, early retirement, injuries, discrimination and litigation.

The NHS employs around 1.4 million staff while absence due to poor health is estimated to cost it £2.4 billion a year. There have been policies in place to promote healthy diet and nutrition in NHS organisations since 2016.

Lead author Dr. Oyinlola Oyebode from Warwick Medical School said: "The NHS is the largest employer in the UK and so supporting the NHS workforce to improve their health will have effects on a significant proportion of the UK population. Improving workforce health will improve the efficiency of the NHS by helping reducing staff absence and early retirement, for example.

"Health professionals also have an important role to play in health promotion to the general public and there is evidence that they can do this most successfully if they are supported to make healthy choices themselves."