Impact of behavioral design strategies on patrons’ food choices in a US Army hospital cafeteria

Authors: Nadine Nugent*, Division of Nutrition, Physical Activity and Obesity (DNPAO), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Stephen Onufrak, Division of Nutrition, Physical Activity and Obesity (DNPAO), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Seung Hee Lee-Kwan, Division of Nutrition, Physical Activity and Obesity (DNPAO), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Diane Harris, Division of Nutrition, Physical Activity and Obesity (DNPAO), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention
Topics: Behavioral Geography, Environment, Quantitative Methods
Keywords: Behavioral Design, Military populations, food service, obesity
Session Type: Paper
Day: 4/4/2019
Start / End Time: 9:55 AM / 11:35 AM
Room: 8229, Park Tower Suites, Marriott, Lobby Level
Presentation File: No File Uploaded


Introduction: Over 60% of active-duty military personnel are overweight or have obesity. Environmental changes to promote consumption of healthier foods and beverages among military personnel is one approach to address this problem. This study determined the effect of implementing behavioral design (BD) strategies on food purchases in a US Army hospital cafeteria. Methods: BD strategies were implemented for 18 weeks (6 menu cycles) from August–December 2017 and post intervention data collections were late December-February 2018 (3 cycles). These included a daily ‘performance’ plate, menu board adaptations, salad bar reconfiguration, healthy grab and go items, color-coded labeling, addition of healthy side vegetables to the grill station, and provision of fruit baskets by the registers. Sales (adjusted for total cafeteria sales volume) of selected healthier and less healthy foods were compared before, during, and after the intervention period. Results: Compared to the pre-intervention period (6 cycles), adjusted sales during the intervention increased 12% for healthy entrees, 8% for hot vegetables, 9% for whole fruit, 92% for fruit cups, and 135% for prepackaged salads while sales decreased 23% for desserts. However, sales during the intervention increased 45% for French fries. Improvements in sales of healthy entrees and whole fruit did not persist after the intervention period but did persist for other foods such as hot vegetables and salads. Discussion: Findings suggest that BD changes may increase some healthier food choices among military personnel in cafeterias. However, adjunct strategies may be required to reduce unhealthier food choices and sustain healthier choices over time.

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