Behavioral Design Strategies Improve Healthy Food Sales in a Military Cafeteria.

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.