Behavioral Design Strategies Improve Healthy Food Sales in a Military Cafeteria

Abstract

Purpose

This study examined the use of behavioral design strategies to improve healthier food sales.

Design

A quasi-experimental, one-group, repeated measures design examined changes in food sales following behavioral design adjustments.

Setting

United States military base hospital dining facility.

Subjects

U.S. military service members, retirees, and civilian employees.

Intervention

Behavioral design changes included placement, layout, messaging, default healthy bundling, a stoplight rating system, strategic positioning of healthy items on menu boards, and an increase in healthier snacks.

Measures

Food sales were assessed by point-of-sales data.

Analysis

T-tests examined total sales of each food adjusted weekly between baseline and intervention and intervention and post-intervention. 16 food items targeted by the intervention were examined. Weekly food sales were calculated for the 18-week baseline, 18-week intervention, and 9-week post-intervention. Further, analysis estimated negative binomial models for food item sales.

Results

The hospital dining facility served 600 to 900 meals per day. Weekly foods sales decreased during the intervention for desserts, cooked starches, hummus, and yogurt (P < 0.01). Sales increased during the intervention for fruit cups, cooked vegetables, vegetable and turkey burgers, grilled chicken, packaged salads, French fries, hamburgers, and hot dogs (P < 0.02).

Conclusion

This study demonstrates that a mixture of behavioral design strategies can be operationalized with reasonable fidelity and can lead to increases in the sales of some healthy foods in military worksites.