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Easy access to healthy foods ‘nudges’ clinicians to better diets

Low-cost changes in hospital canteens could lead to healthier staff

Adrian O'Dowd

Friday, 25 January 2019

Hospital canteens and food outlets can make low-cost changes to their layouts which could lead to NHS staff choosing to eat more healthily, suggests a new study* published in the online journal BMJ Open.

Researchers from Warwick Medical School at the University of Warwick found that increasing the proportion of healthy options, making them easier to reach and reducing portion size were effective.

Obesity has been associated with absenteeism, presenteeism, early retirement, injuries, discrimination and litigation.

The NHS employs around 1.4m staff and absence due to poor health is estimated to cost the health service £2.4bn a year. There have been policies in place to promote healthy diet and nutrition in NHS organisations since 2016.

The research team was commissioned by Public Health England to look at existing evidence from other studies on interventions to increase healthy purchasing and/or consumption of food and drink by NHS staff.

They analysed 18 studies, 13 of which had looked at the ways in which the environment can be changed to support healthy purchasing and consumption by healthcare staff, based in healthcare settings.

Their work follows previous research carried out at Warwick which demonstrated that moving location of fruit and vegetables to the front entrance of a shop, with no further advertising or messaging added to encourage customers, can lead to a 15% sales increase in those products.

The latest study built on this by examining whether the same effect could be used by the UK’s largest employer (the NHS), where it could have the largest impact on the national workforce.

The researchers started from the point of view that healthcare staff face many barriers to accessing healthy food, such as lack of time, unpredictable and demanding workloads, and inconvenient access to food.

‘Choice architecture’ involves changing the environment that staff are working in to promote healthy behaviour, often by ‘nudging’ them towards better options.

The researchers’ analysis found changes that reduce the effort required to select healthy options, or increasing the effort required to select unhealthy options, improved diets.

For example, one study put a healthy vegetable-based spread in easy to reach positions, while another arranged desserts so that fresh fruit salad was in the easiest access positions.

Increasing the availability of healthy options also drove healthier diets. When 75% of the snacks on offer in one hospital canteen were healthy and 25% were unhealthy, more healthy snacks were bought.

Offering smaller sizes of main meals and other products alongside their standard sizes was also shown to improve dietary behaviour.

Lead author Dr Oyinlola Oyebode from Warwick Medical School said: “The NHS is the largest employer in the UK and so supporting the NHS workforce to improve their health will have effects on a significant proportion of the UK population.

“Improving workforce health will improve the efficiency of the NHS by helping reducing staff absence and early retirement, for example. Health professionals also have an important role to play in health promotion to the general public and there is evidence that they can do this most successfully if they are supported to make healthy choices themselves.”


*Al-Khudairy L, Uthman O A, Walmsley R, et al. Choice architecture interventions to improve diet and/or dietary behaviour by Healthcare staff in high-income countries: a systematic review. DOI: 10.1136/bmjopen-2018-023687

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