Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis

Abstract

Out-of-home eating is increasing, but evidence about its healthiness is limited. The present systematic review and meta-analysis aimed to elucidate the effectiveness of full-service restaurant and canteen-based interventions in increasing the dietary intake, food availability, and food purchase of healthy meals. Studies from 2000–2020 were searched in Medline, Scopus, and Cochrane Library using the PRISMA checklist. A total of 35 randomized controlled trials (RCTs) and 6 non-RCTs were included in the systematic review and analyzed by outcome, intervention strategies, and settings (school, community, workplace). The meta-analysis included 16 RCTs (excluding non-RCTs for higher quality). For dietary intake, the included RCTs increased healthy foods (+0.20 servings/day; 0.12 to 0.29; p < 0.001) and decreased fat intake (−9.90 g/day; −12.61 to −7.19; p < 0.001), favoring the intervention group. For food availability, intervention schools reduced the risk of offering unhealthy menu items by 47% (RR 0.53; 0.34 to 0.85; p = 0.008). For food purchases, a systematic review showed that interventions could be partially effective in improving healthy foods. Lastly, restaurant- and canteen-based interventions improved the dietary intake of healthy foods, reduced fat intake, and increased the availability of healthy menus, mainly in schools. Higher-quality RCTs are needed to strengthen the results. Moreover, from our results, intervention strategy recommendations are provided.

Nutritional Composition and Environmental Impact of Meals Selected in Workplace Canteens before and after an Intervention Promoting the Adherence to the Mediterranean Diet

“…It is worth noting that the actual salt intake derived from the canteen dishes could be even higher due to the discretionary salt possibly added by canteen users at the table. This observation confirms previous considerations on the need to simultaneously develop consumer-based and establishment-based strategies [ 31 ] addressed to the different figures acting in the food services, ranging from the canteen staff to the final consumers, to maximise beneficial outcomes.…”

“…As practical implications of the present study, tailored training sessions dedicated to cooks can be suggested to improve the nutritional quality of dishes, as already reported in the same setting by Vitale and colleagues (2017). Furthermore, it is worth noting that, to effectively improve the dietary intake in workplace canteens, even if further evidence is needed, a multitude of actions should be applied, ranging from the application of consumer-based strategies to the modification of the meal offering to enhancing the proposal of healthier options while limiting the counterparts [ 31 ].…”

Eating contexts determine the efficacy of nutrient warning labels to promote healthy food choices

“…Our data suggest that prompting a healthy context before or during food purchase could increase the efficacy of NWL to drive healthier food choices and have a larger impact on calorie intake compared to typical behavior and to situations of unrestrained eating where health considerations are minimized (i.e., dining out, buying food for pleasure). Most interventions at food retailers or restaurants have focused 10.3389/fnut.2022.1026623 on improving the healthiness the food available and increasing the visibility of healthier options (65,66). Still, interventions that prompted a healthy context in cafeteria settings led to increased dietary quality (67,68), which might increase further if NWL are included in the intervention.…”

Effects of nutritional intervention strategies in the primary prevention of overweight and obesity in school settings: systematic review and network meta-analysis

“…That environments where children and adolescents spend time offer good opportunities to promote healting eating habits, has been confirmed in a metaanalysis 133 that synthesised data on intervention strategies to promote healthy meals in restaurants and canteens. The most prominent improvements for intake of healthy food groups were found in studies in children.…”

“…The most prominent improvements for intake of healthy food groups were found in studies in children. 133 The school environment is therefore a suitable setting for implementing these strategies. Also, the availability of healthy items in school canteens is associated with an increased willingness of children and adolescents to buy these food groups.…”