How do you get the croquette out of the canteen?

What measures can businesses take in these ‘closed settings’? And how do you ensure that an intervention really has an impact? Researchers on the Implementation of nutrition interventions in intramural care institutions and out-of-home settings project examined existing research, and now plan to conduct practical experiments.

A ‘closed setting’ is an environment in which consumers have a limited choice of food and drink. The choices available are determined by the organisation or setting. “Caterers and hospital restaurants always offer a limited number of menu options,” project leader Marieke Meeusen explains. “Given that limited choice, our key research question is how to enable people in these closed settings to still eat healthy and sustainable food.”

Interventions that work for both consumers and staff

A group of researchers carried out an international literature review covering a variety of closed settings. They approached it from two angles. “First of all, we wanted to identify the measures that work for consumers, as well as those that don’t,” senior researcher Machiel Reinders says. “Then there’s the question of whether a particular intervention also works for the staff, meaning the people who prepare and serve the food. A good intervention might still end up failing if it’s unworkable for staff. It might be too difficult, too expensive, or too time consuming.”

Changing portion sizes or food placement

The report focuses on three kinds of settings – restaurants/cafes, workplaces, and healthcare facilities – and on different kinds of interventions. One such intervention is simply to provide information to consumers about healthy eating. “That's a voluntary approach,” Reinders says. “You're not changing anything, but you hope that the information changes consumer behaviour.”

Another approach is to change the choices available to consumers. Such an approach could include changing portion sizes or changing the placement of products on the shelf or in the store. These can be considered as more substantial interventions in the food environment.

“You can also go even further and prohibit certain unhealthy products,” Reinders says. “This could including banning sales of sweets. We didn’t find any examples of that in our research, possibly because interventions like that are very difficult to implement in practice.”

Placing fruit by the cashier

Interventions in the food environment appear to be most effective. Positive reinforcement through ‘nudging’ interventions can encourage people to make better choices. “This means consumers still have choice, but placing fruit next to the cashier ensures that the easiest choice is also the healthiest one,” Reinders says.

Pricing interventions are also effective. Making certain products cheaper or more expensive will influence the choices that consumers make. But the effectiveness of price stimuli is short-lived, according to Reinders. “It’s also often less appealing to sellers, because it can be economically unviable.”

Lack of time or capacity

The role of staff in canteens and restaurants is also important. The literature review therefore looked at barriers and supports. What helps staff, and what hinders them? “Barriers can include a lack of time, capacity, and support and communication from management,” Reinders says.

“Staff don’t always know what their role is or what the purpose of an intervention is. It’s then perceived as adding to the workload.” Meeusen adds, “staff might have a fixed amount of time to prepare a sandwich, and adding a salad garnish takes up more time. If everything is scheduled down to the minute, they’ll end up short on time.”

No top-down impositions

For staff to support an intervention, it’s important that they feel the intervention matters and that the changes they are implementing are making a difference to the health or satisfaction of their customers. “Many people who work in catering have few qualifications or have had limited work experience,” Meeusen says. “They might perceive this as a criticism of the way they have done things up to now. If you want staff to support the intervention, it needs to be fully and carefully explained rather than imposed from above.”

Support is essential to success

That’s why you always need to consider what would be the most appropriate intervention. “If you present a top-10 of effective interventions to a company, staff might point out that numbers 1 to 3 absolutely won’t work,” says Meeusen. “But number 7 might be appropriate and gain support. If that support isn’t there, it won’t work. That’s why research into the best intervention also involves co-creation, with consultation and interviews.”