Objective-We surveyed customers in a hospital cafeteria in Boston, Massachusetts before and after implementation of traffic light food labeling to determine the effect of labels on customers' awareness and purchase of healthy foods.Methods-Cafeteria items were identified as red (unhealthy), yellow (less healthy), or green (healthy). Customers were interviewed before (N = 166) and after (N = 223) labeling was implemented. Each respondent was linked to cash register data to determine the proportion of red, yellow, and green items purchased. Data were collected from February-April 2010. We compared responses to survey questions and mean proportion of red, yellow, and green items per transaction between customers interviewed during baseline and customers interviewed during the intervention. Survey response rate was 60%.Results-Comparing responses during labeling intervention to baseline, more respondents identified health/ nutrition as an important factor in their purchase (61% vs. 46%, p = 0.004) and reported looking at nutrition information (33% vs. 15%, p < 0.001). Respondents who noticed labels during the intervention and reported that labels influenced their purchases were more likely to purchase healthier items than respondents who did not notice labels (p < 0.001 for both).

Background/Aims: Behavioral nudges in the food environment increase healthy choices, but it is unknown if they improve diet and health. The ChooseWell 365 study will determine if an automated, personalized worksite intervention to nudge healthier choices improves overall diet and cardiometabolic health. Design: Randomized controlled trial of 602 hospital employees who regularly use on-site cafeterias and pay with an employee ID. Intervention: The intervention combines an environmental strategy (traffic-light labeling) with objective feedback and personalized nudges (health/lifestyle tips, social norms, incentives) to promote healthy food choices. The ChooseWell 365 software platform automatically generates personalized emails and letters that integrate employees’ weight goals with health, lifestyle, and cafeteria purchasing data. Over one year, the intervention group receives two weekly emails. One provides a log of daily purchases; the second provides personalized health/lifestyle tips. The intervention group receives monthly mailed letters with social norm comparisons and financial incentives for healthier purchases. The one-year intervention will be completed in February 2019; all follow-up will be completed March 2020. Outcomes: Weight, cardiometabolic risk factors, and dietary intake at one and two-year followup. Other outcomes include worksite food purchases by study participants and other non-participant employees who are socially connected (inferred from purchasing data) to participants. Conclusions: ChooseWell 365 tests a novel strategy to deliver a scalable worksite prevention program that is integrated into the workday. The intervention is personalized but automated and therefore does not require costlier individual counseling. In the future, this program could be applied broadly in other worksite settings.

Key Points Question Is a workplace program to promote healthy food choices using traffic light labels and choice architecture (product placement) changes associated with sustained reduction in calories purchased by employees? Findings This cohort study of 5695 hospital employees who used the workplace cafeteria found that implementation of a traffic light–labeling and choice architecture program was associated with a 6.2% decrease in calories per transaction over 2 years, including a 23.0% decrease in calories from the least healthy foods. Meaning Workplace point-of-purchase programs to promote healthy food choices could help improve dietary intake and prevent weight gain in employee populations.