Study shows increasing ‘healthy competition’ between menu options nudges patients towards greener, lower-fat hospital food choices

(Press-News.org) New research has shown hospital patients could reduce the carbon footprint and saturated fat content of their selected meals by up to almost a third – if the weekly menu featuring the same dishes is cleverly reorganised.

The study, led by the University of Bristol, features in a special issue of the journal Philosophical Transactions of the Royal Society B, which sets out innovative ways to help make the UK’s food healthier, fairer, and more sustainable.

The researchers developed a cunning way to redesign weekly set menus so healthier, greener dishes weren’t competing so much with typically more popular, less healthy options, boosting the likelihood of them being picked more often in hospitals across the UK.

Their cunning theory was already proven to work with students, having been tested in a university canteen, and this study indicates patients and the planet also stand to reap rewards from a reshuffled menu.

Study lead author Dr Annika Flynn, Senior Research Associate at the University of Bristol, said: “Rather than penalising healthy options, like lentil curry, by putting them alongside really popular choices, like meaty lasagne, we simply switched around their place on a weekly menu to give them a better chance of being selected.

“Creating healthier competition between dishes resulted in great benefits both in terms of significantly reducing patients’ carbon footprint and their saturated fat intake.”

The study modelled the strategic dish swap technique using weekly menus from 12 NHS hospitals across the UK. For each hospital menu, 50 people from that hospital catchment area reported their preference for 15 dishes offered on the weekly menu. Using data from their preferences, the researchers reorganised the weekly menu to create an optimised menu.

Dr Flynn explained: “The key thing is that the optimised menu features the same 15 dishes as the original, just reorganised on different days to boost uptake of the more sustainable, healthier options.”

Results indicated that in 11 of the 12 hospitals, the menu reorganisation approach worked. Overall, the optimised menus were predicted to reduce carbon footprint between 9.1% and 29.3% and reduce saturated fat intake among patients between 5.0% and 26.5%.

Dr Flynn said: “The findings are really exciting because they show the menu swapping method could work in different settings and on a large scale. Hospital food often gets criticised and of course, especially when you’re unwell it’s important to have a range of options. If in that process patients can be steered towards making healthier choices, which are also more sustainable from an environmental perspective, without even noticing it’s a huge win-win.”

The researchers developed and tested their hypothesis as part of a project called SNEAK (Sustainable Nutrition, Environment, and Agriculture, without Consumer Knowledge), supported by the UK Research and Innovation (UKRI) Transforming UK Food Systems (TUKFS), which aims to improve people’s health in environmentally-sustainable ways.

Some 42% of UK workers report using a canteen, and millions of children and young people are served meals daily at schools and universities, so there is strong potential for the menu manipulation method to make positive health and environmental inroads  in various settings.

Study co-author Jeff Brunstrom, Professor of Experimental Psychology at the University of Bristol and NIHR Bristol Biomedical Research Centre, said: “People don’t like change, so implementing successful behavioural change interventions can be challenging and costly. This modelling study shows our low-cost ‘sneaky’ technique presents an enticing opportunity to make people’s diets greener and healthier without them even realising it.”

The promising findings are among a raft of pioneering measures and related policy recommendations to feature in the journal special issue, called ‘Transforming terrestrial food systems for human and planetary health.’

Professor Guy Poppy, Pro Vice-Chancellor for Research and Innovation at the University of Bristol and Director of TUKFS, edited the special issue.

Prof Poppy said: “Food is at the heart of our health, our environment, and our economy.

“It’s great to see Bristol researchers at the forefront of innovative solutions, which could help support healthier, more sustainable food choices for people of all ages in a wide range of public procurement contexts, including schools, hospitals and care homes.

“These different settings form a big proportion of all the food we eat, so effective changes like the dish swap formula could make a tangible, affordable difference at population-level, fuelling better, greener diets for all.”

The research was funded by UKRI TUKFS and is also supported by the National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (Bristol BRC).

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