A Small Nudge for Better Health Through Reduced Salt Intake, Increased Vegetable Intake, and Smaller Portion Size

NCT ID: NCT02808910

Last Updated: 2019-08-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

144 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-04-30

Study Completion Date

2018-04-01

Brief Summary

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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

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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.

Conditions

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Cardiovascular Disease Obesity

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Participants

Study Groups

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Salt nudge

The following changes will be made in the cafeteria: Salt will be placed in a corner of the buffet, rather than on each dining table. Other spices, without sodium, will be provided on the table. A sign will be placed on the table that nudges participants to try the other spices. Food in the buffet that is high in salt will be labeled with a negative-appearing symbol, and food in the buffet that is low in salt will be labeled with a positive symbol.

Group Type EXPERIMENTAL

Nudged to eat less added salt and more other seasonings

Intervention Type BEHAVIORAL

Nudged to avoid foods high in salt content, and to choose foods low in salt content

Intervention Type BEHAVIORAL

Vegetable nudge

The following changes will be made in the cafeteria: Names of the vegetable dishes in the buffet will be made more attractive. Signs will be placed with reminders to eat more vegetables. Signs will be placed with a visual indication of the percentage of a meal that should consist of vegetables.

Group Type EXPERIMENTAL

Nudged to eat more vegetables

Intervention Type BEHAVIORAL

Portion size nudge

The following changes will be made in the cafeteria: Smaller plates will replace the regular plates. Verbal and visual nudges to reduce portion size will be given. Utensils for self-serving calorie-dense foods in the buffet will be smaller than normal.

Group Type EXPERIMENTAL

Nudged to eat smaller portions

Intervention Type BEHAVIORAL

Nudged to eat less calorie-dense food

Intervention Type BEHAVIORAL

Combined nudge

All three nudges are combined in this intervention.

Group Type EXPERIMENTAL

Nudged to eat less added salt and more other seasonings

Intervention Type BEHAVIORAL

Nudged to avoid foods high in salt content, and to choose foods low in salt content

Intervention Type BEHAVIORAL

Nudged to eat more vegetables

Intervention Type BEHAVIORAL

Nudged to eat smaller portions

Intervention Type BEHAVIORAL

Nudged to eat less calorie-dense food

Intervention Type BEHAVIORAL

Control groups

No changes are made to the cafeteria, compared to the pre-study situation. One control group participates after each of the nudges to control for effects of time of the year.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Nudged to eat less added salt and more other seasonings

Intervention Type BEHAVIORAL

Nudged to avoid foods high in salt content, and to choose foods low in salt content

Intervention Type BEHAVIORAL

Nudged to eat more vegetables

Intervention Type BEHAVIORAL

Nudged to eat smaller portions

Intervention Type BEHAVIORAL

Nudged to eat less calorie-dense food

Intervention Type BEHAVIORAL

Eligibility Criteria

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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
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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NIBIO - Norwegian Institute of Bioeconomy Research

OTHER

Sponsor Role collaborator

Norwegian University of Life Sciences

OTHER

Sponsor Role collaborator

Animalia

UNKNOWN

Sponsor Role collaborator

LHL Helse

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Laila Dufseth

Role: PRINCIPAL_INVESTIGATOR

LHL Helse

Locations

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LHL-klinikkene Feiring

Feiring, , Norway

Site Status

Countries

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Norway

References

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Wansink, B. & Sobal, J. Mindless eating: The 200 daily food decisions we overlook. Environment and Behavior. 2007, 39(1):106-123. 2007

Reference Type BACKGROUND

Rolls BJ. Plenary Lecture 1: Dietary strategies for the prevention and treatment of obesity. Proc Nutr Soc. 2010 Feb;69(1):70-9. doi: 10.1017/S0029665109991674. Epub 2009 Dec 3.

Reference Type BACKGROUND
PMID: 19954563 (View on PubMed)

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.

Reference Type BACKGROUND

Just, D.R. & Wansink, B. Smarter Lunchrooms: Using Behavioral Economics to Improve Meal Selection. Chocies Magazine. 2009, 24(3).

Reference Type BACKGROUND

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.

Reference Type BACKGROUND
PMID: 23231863 (View on PubMed)

Other Identifiers

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2016/231300

Identifier Type: -

Identifier Source: org_study_id

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