Clinical trial NCT02808910: A Small Nudge for Better Health Through Reduced Salt Intake, Increased Vegetable Intake, and Smaller Portion Size
Official title: Nudging: How Small Changes in the Cafeteria of the Feiring Heart Clinic Can Result in a Healthier Food Choice.
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Cardiovascular Disease
Obesity
Keywords: behavior
food intake
salt
vegetables
portion size
weight loss
habits
Lead sponsor: LHL Helse
Sponsor class: OTHER
Collaborators: name: NIBIO - Norwegian Institute of Bioeconomy Research
name: Norwegian University of Life Sciences
name: Animalia
First posted: 2016-06-22
Enrollment: 144
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SINGLE_GROUP
Primary purpose: SUPPORTIVE_CARE

Brief summary: This study will investigate whether small changes (nudges) made in a cafeteria, where participants eat for 4 weeks, can improve their food behavior and health during the 4 weeks, and 6 weeks and 6 months after their stay. Half the participants will be exposed to one of four types of nudges (focused on reducing salt intake, increasing vegetable intake, reducing portion size, and a combination of these nudges), and half of the participants will eat in the cafeteria as it is currently, without modifications.

Detailed description: A healthy diet is an important pillar for public health and for the prevention of several lifestyle diseases (e.g. obesity, cardiovascular diseases). However, diet choices are often not conscious choices. While it may help to make individuals more aware of healthy options for example through education or nutrition labels, it remains difficult for many to eat healthy. The food environment in which choices are made has an impact on the choice. Smart design of the food environment may help individuals to make a healthier choice, by nudging them towards the healthier alternative, while not limiting the availability of the less healthy choice.

This study tests how these 'nudges' can affect food behavior and health of participants in a 4-week rehabilitation course at Feiring Heart clinic. Nudges will be implemented in the cafeteria at the clinic.

Three types of nudges will be tested:

* Salt nudge: aims to reduce salt (sodium) intake. Salt will be less easily available in the cafeteria, and other spices (without sodium) will be made easily available. Food in the buffet that is either very high or very low in salt will be labeled.
* Vegetable nudge: aims to increase vegetable intake. Names of the vegetable dishes in the buffet will be made more attractive, signs will be placed with reminders to eat more vegetables, and with visual indications of the percentage of vegetables that should be part of a meal.
* Portion size nudge: aims to decrease portion size. Smaller plates will be provided, and utensils for self-serving calorie-dense foods in the buffet will be smaller than normal.
* One period will also combine all the nudges described above.

Outcomes include measures of food intake during the 4-week rehabilitation course, and whether food habits 6 weeks and 6 months after the 4-week course have changed, compared to before the course. BMI will be monitored during the 4-week period and self-assessed in the 6 months after. Physical activity habits will be considered during the entire experimental period, and satisfaction with the cafeteria food and service will be monitored throughout to assess whether the nudges impact customer satisfaction.

Results are expected to be transferable to other heart clinics, and cafeterias in other institutions.

Eligibility criteria: Inclusion Criteria:

* Participants should be part of the 4 week rehabilitation course at the Feiring heart clinic
* Participants should be willing and able to complete the necessary registration of food choices, and the relevant questionnaires

Exclusion Criteria:

* None

Primary outcomes:
measure: Change in BMI from start of intervention to end of intervention
timeFrame: Measured at baseline at day 0 of intervention and at completion of intervention at day 28 of intervention)
measure: Change in dietary habits 1
timeFrame: 6 weeks after the 4 week intervention period
measure: Change in dietary habits 2
timeFrame: 6 months after the 4 week intervention period
Secondary outcomes:
measure: Dietary choices in cafeteria 1.1
timeFrame: Tuesday lunch meal during the first week of the intervention
measure: Dietary choices in cafeteria 1.2
timeFrame: Thursday lunch meal during the first week of the intervention
measure: Dietary choices in cafeteria 2.1
timeFrame: Tuesday lunch meal during the second week of the intervention
measure: Dietary choices in cafeteria 2.2
timeFrame: Thursday lunch meal during the second week of the intervention
measure: Dietary choices in cafeteria 3.1
timeFrame: Tuesday lunch meal during the third week of the intervention
measure: Dietary choices in cafeteria 3.2
timeFrame: Thursday lunch meal during the third week of the intervention
measure: Dietary choices in cafeteria 4.1
timeFrame: Tuesday lunch meal during the fourth week of the intervention
measure: Dietary choices in cafeteria 4.2
timeFrame: Thursday lunch meal during the fourth week of the intervention
Other outcomes:
measure: Customer satisfaction of the cafeteria through a survey
timeFrame: Once per week during the intervention, on day 3, 11, 18 and 25 of the intervention
Locations:
city: Feiring
country: Norway
facility: LHL-klinikkene Feiring
Study officials:
affiliation: LHL Helse
name: Laila Dufseth
role: PRINCIPAL_INVESTIGATOR
References:
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citation: Rozin, P., Scott, S., Dingley, M., Urbanek, J.K., Jiang, H., Kaltenbach, M. Nudge to nobesity I: Minor changes in accessibility decrease food intake. Judgment and Decision Making, 2011, 6:323-332.
citation: Just, D.R. & Wansink, B. Smarter Lunchrooms: Using Behavioral Economics to Improve Meal Selection. Chocies Magazine. 2009, 24(3).
citation: van Kleef E, Otten K, van Trijp HC. Healthy snacks at the checkout counter: a lab and field study on the impact of shelf arrangement and assortment structure on consumer choices. BMC Public Health. 2012 Dec 12;12:1072. doi: 10.1186/1471-2458-12-1072.