Feedback on cafeteria purchases helps employees make healthier food choices

Automated emails and letters that provide personalized feedback related to cafeteria purchases at work may help employees make healthier food choices. That's the conclusion of a new study that was led by investigators at Massachusetts General Hospital (MGH) and is published in JAMA Network Open.

As many adults spend half (and sometimes more) of their waking hours working, the workplace provides a unique opportunity to promote health with programs that target obesity, unhealthy diets, and other risk factors for chronic diseases and premature death.

Building on findings from previous studies, researchers designed the ChooseWell 365 clinical trial to test a 12-month automated, personalized behavioral intervention to prevent weight gain and improve diet in hospital employees. For the trial, 602 MGH employees who regularly used the hospital's cafeterias were randomized to an intervention group or a control group. For one year, participants in the intervention group received two emails per week that included feedback on their previous cafeteria purchases and offered personalized health and lifestyle tips. They also received one letter per month with comparisons of their purchases with those of their peers, as well as financial incentives for healthier purchases. Control participants received one letter per month with general healthy lifestyle information.

"This novel workplace strategy was completely automated and did not require that people take time away from work to participate, making it ideal for busy hospital employees," explains lead author Anne N. Thorndike, MD, MPH, an investigator in the Division of General Internal Medicine at MGH and an associate professor of Medicine at Harvard Medical School.

Participants in the intervention group increased their healthy cafeteria food purchases to a greater extent than participants in the control group. They also purchased fewer calories per day. These differences were observed during the one-year intervention as well as during a year of additional assessments. There were no differences between the groups in terms of weight change at 12 or 24 months, however.

"Few if any prior workplace studies have been able to make sustained changes in dietary choices of employees," says Thorndike. "This study provides evidence that food purchasing data can be leveraged for delivering health promotion interventions at scale."