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Health Promot Pract. 2018 Nov;19(6):925-934. doi: 10.1177/1524839917740119. Epub 2017 Nov 23.

Nudging Healthier Choices in a Hospital Cafeteria: Results From a Field Study.

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1 Independent Consultant, San Francisco, CA.
2 Northern Kentucky University, Highland Heights, KY, USA.
3 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
4 Boston University, Boston, MA, USA.


More than two thirds of adults and one third of children are overweight or obese in the United States. These trends have led to initiatives to provide information that supports informed choices. Traffic light labeling has been shown to increase consumer awareness and encourage healthy selections. This article contributes to the literature on healthy choices by comparing the additional contribution of a number of interventions used in combination with traffic light labeling. We conducted a 21-month field study in a workplace cafeteria. We analyzed cash register receipts, focusing on sales of beverages and chips. We found that the traffic light system was effective. The addition of caloric information to traffic light labeling had a positive effect on the purchase of healthy chips. However, other interventions appeared to produce more harm than good, essentially wiping out the benefits from traffic light labeling. These findings suggest that although it is possible to improve on traffic light labeling with selective interventions, caution is in order as some interventions may trigger compensatory behavior that results in the purchase of unhealthy items.


behavior change; health promotion; obesity


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