Taking Nudge Digital Food Choice at Work Dr Fiona Geaney
Workplace 1 2 3 4 Diet-related disease burden endangering our population health & sustainability of our healthcare systems Priority environment longer working hours & dependent on workplace meals Tolerant of complex interventions access to large homogenous populations Limited evidence effectiveness of workplace dietary interventions * Based on global aggregate 2015 Health Assessment Results
Story So Far 2013 Systematic Review 2015 Sub-study: Cross-sectional Study 2011 Observational Study 2013 Food Choice at Work Study Protocol 2016 Food Choice at Work Trial Limited evidence (n=6 studies) Cross-sectional comparison study in 2 hospitals 828 employees aged 18-64 years Small increases in daily Cluster fruit & controlled vegetable trial consumption for 9 months (n=100 employees) Higher nutrition knowledge is associated with Recommended guidelines 4 large manufacturing workplaces in Cork Employees fat, saturated fat, sugar and salt better diet quality and lower blood pressure Workplace culture specific 850 employees intakes were lower in the workplace that Inter-relationships between these variables are Collaborative approach Data collected at individual level, the primary received the initiative complex Measure short/long-term unit of impact analysis was at the workplace level Objective measures for diet, health status and cost
Food Choice at Work Interventions Cluster-controlled trial in 4 large multinational manufacturing workplaces in Ireland Control Education Environment Combined
Time to Define it: Choice Architecture Interventions Interventions that involve altering the properties or placement of objects or stimuli within microenvironments with the intention of changing health-related behaviour. Such interventions are implemented within the same micro-environment as that in which the target behaviour is performed, typically require minimal conscious engagement, can in principle influence the behaviour of many people simultaneously, and are not targeted or tailored to specific individuals. Hollands et al., 2013
Typology of Choice Architecture Interventions Intervention Class Intervention Type Education Environment Combined Alter both properties and placement of objects or stimuli FUNCTIONAL DESIGN Modified Menus (DASH Omniheart Compliant) Salad bar Replaced serving utensils LABELLING Calorie + traffic light menu labelling at point of choice (digital menu boards, menu boards/cards) PRESENTATION Improve presentation of food: colour, display SIZING Reduced portion sizes, products and serving utensils AVAILABILITY Increased availability of healthier meals (DASH OmniHeart) + food products in restaurant, fridges, coffee docks, vending machines Hollands et al., 2013 PROIMITY Placed fruit by cash registers (Removed confectionary) Removed salt from tables Strategic positioning of healthier products PRIMING Jugs of water on tables PROMPTING Educational key messages via intranet/table talkers
MRC Framework For Developing and Evaluating Complex Interventions
Cluster Controlled Trial Control Education Environment Combined Baseline Data Collection - Demographics - Health status: BMI, WC, BP - Nutrition knowledge - Process evaluation - Dietary intakes - Cost-effectiveness evaluation Implementation of Interventions: 9 Month Period Follow-up 3-4 months - Dietary Intakes - Health Status Follow-up 7-9 months (repeat baseline)
Recruitment of Workplaces Industrial Development Authority website: list of manufacturing workplaces in Cork (n=107) Workplaces were systematically screened for eligibility: phone On site face to face meetings were organised with potential companies (n=20) to discuss feasibility + support for the study Proof of concept study: 4 most suitable workplaces - purposively selected + allocated Inclusion criteria - Manufacturing multi-national workplace - Employ >250 employees - Daily workplace canteen for employees - Commit to complex intervention for duration of the study
Recruitment of Employees Inclusion criteria -Any permanent, full-time employee -Consumes at least one main meal at the workplace canteen every day Exclusion criteria - Non-permanent, part-time employees - Travel regularly for work - Does not purchase + consume a main meal from work daily - Medically advised not to participate in the study - Involved in an on-going diet programme external to work (e.g. weight watchers)
Trial Profile 850 recruited Baseline n=850 (18-64 years) Control 111 employees Education 226 employees Environment 113 employees Combined 400 employees Follow-up at 3-4 months n=678 (80%) 84 participated 160 participated 96 participated 338 participated Follow-up at 7-9 months n=541 (64%) 70 participated 113 participated 74 participated 284 participated
Demographics of Study Sample Majority of participants (i.e. employees): male (76%), aged 30-44 years (64%) married/cohabiting (73%) non-managers (76%) usually worked during day (65%) were overweight/obese (70%) tertiary level education (80%)
Changes within Workplaces from Baseline to 7-9 Months
Mean Differences in Dietary Intakes at 7-9 Months: Interventions vs. Control Variable Workplace Mean differences 95% CI p-value Total energy intake (-326.1, Education -133.6 (kcal/day) 58.9) 0.173 Environment +121.1 (-86.9, 329.0) 0.253 Combined -70.6 (-250.2, 109.0) 0.440 Total fat (g/day) Education -9.9 (-20.4, 0.6) 0.066 Environment -0.1 (-11.5, 11.2) 0.986 Combined -7.7 (-17.6, 2.0) 0.120 Saturated fat (g/day) Education -4.8 (-9.2, -0.4) 0.034 Environment -2.7 (-7.5, 2.0) 0.261 Combined -5.2 (-9.4, -1.1) 0.013 Total sugars (g/day) Education +7.2 (-6.9, 21.3) 0.318 Environment +16.4 (1.2, 31.6) 0.035 Combined +3.5 (-9.6, 16.6) 0.601 Salt (g/day) Education -0.8 (-1.9, 0.3) 0.144 Environment -0.4 (-1.6, 0.7) 0.459 Combined -1.3 (-2.3, -0.3) 0.010
Mean Differences in Health Status + Nutrition Knowledge at 7-9 months: Interventions vs. Control Variable Workplace Mean differences 95% CI p-value BMI (kg/m²) Education -0.8 (-2.1, 0.4) 0.196 Environment +0.3 (-1.1, 1.6) 0.711 Combined -1.2 (-2.4, -0.1) 0.047 Midway WC (cm) Education -1.2 (1.8, 0.5) 0.480 Environment +0.5 (-3.2, 4.2) 0.796 Combined -1.0 (-4.3, 2.2) 0.530 BP: Systolic Education -3.7 (-7.8, 0.4) 0.080 Environment +1.3 (-3.1, 5.8) 0.558 Combined -2.4 (-6.7, 1.4) 0.218 BP: Diastolic Education -1.3 (-4.1, 1.4) 0.331 Nutrition knowledge score Environment +2.0 (-0.9, 5.0) 0.176 Combined +0.6 (-1.9, 3.2) 0.633 Education +1.6 (-2.7, 5.9) 0.462 Environment -5.2 (-9.9, -0.6) 0.026 Combined +4.2 (0.3, 8.2) 0.034
Story So Far 2016 Process Evaluation 2016 Sub-study: Cross-sectional Study 2016 Cost Analysis of Food Choice at Work Interventions 2017 Cost-effectiveness of FCW intervention: perspective of healthcare providers and employers Interviews (n=27) Health were conducted and lifestyle at factors influence workplace Total costs for 500 employees Single-study per workplace economic evaluation with 1-year follow-up baseline + 7 9 months absenteeism follow-up Average annual cost per 517 employee: participants combined intervention: Workplace managers, 540 employees caterers, 62, nutrition education: Primary 57, environmental outcome: health-related modification: quality 7 of life participating employees, Employees FCW who teamare centrally obese, who and consume control: 0. a Secondary outcome: reduction in absenteeism (measured in Contextual factors poor such quality as workplace diet and who have low levels Nutrition of PA education cost monetary more than amounts). the environmental structures and cultures were more need to likely be to be absent from work modification and for strategies Environmental modification yielded the highest additional QALYs ( 101.37/QALY) and annual net benefit for employers considered (e.g. working longer duration. hours) ( 56.56/employee)
Focused Efforts To Invest In Employee Health Top 3 health risks for employees: 1 Unhealthy eating risk factor for coronary heart disease, stroke, diabetes and some types of cancers 2 3 Inactivity primary cause of most chronic diseases High stress working long hours and excessive travelling can lead to heart disease, high blood pressure, diabetes, depression, anxiety disorder and other illnesses * Based on global aggregate 2015 Health Assessment Results
How We Deliver Food Impact Nutrition analysis of all menus & food products Menu Modifications for Healthier & Sustainable Menus Portion Size Guidance Healthy Food Swaps Strategic Positioning of Healthy Alternatives Traffic Light, Calorie + Allergen Coding Food Impact Monitoring Employee Health Impact Express Health Blitz Monthly Nutrition Education (Key Messages, Interactive Session) Health + Nutrition Clinics Employee Health Impact Monitoring Workplace Culture Integration Integrates with Existing Employee Health and Wellbeing Platforms Integrates with Existing Foodservice provider Food Choice at Work Software Platform & Employee App Designated FCW leader + Tailored approach + Consistent monitoring + Annually updated
Don t Focus on the Tech, Focus on Changing Employees Dietary Behaviour Intervention Type Face to Face Tech FUNCTIONAL DESIGN Menu Modifications for Healthier & Sustainable Menus Salad bar Replaced serving utensils LABELLING Calorie, traffic light + allergen menu labelling at point of choice (digital menu boards, menu boards/cards) PRESENTATION Improve presentation of food: colour, display SIZING Reduced portion sizes, products and serving utensils AVAILABILITY Increased availability of healthier meals (DASH OmniHeart) + food products in restaurant, fridges, coffee docks, vending machines PROIMITY Placed fruit by cash registers (Removed confectionary) Removed salt from tables Strategic positioning of healthier products PRIMING Jugs of water/water dispensers PROMPTING Educational key messages via intranet/table talkers/clinics/employee app Hollands et al., 2013
Our Client & Caterer Dashboard Clients and caterers are initially asked for specific demographics so the system can be tailored accordingly. The dashboard displays a real-time, visual representation of the status of key metrics.
Our Recipe Analysis Process All recipes, food products & food supplier information are imported into the FCW platform Nutrition analysis is completed via the platform The FCW nutritionist recommends modifications to improve/enhance the nutritional content of the recipe (DASH OmniHeart Compliance) These changes are submitted to the caterer for approval
Our Recipe Analysis Process Users can switch between original, coded and modified versions The recipe displays allergen, dietary and nutrition information, as well as traffic lights for key ingredients
Our Recipe Information Ingredients & cost per ingredient Detailed review history between FCW team & caterer for each meal
Menu Labelling Displays - Your Way! Powered from FCW web platform. Achieved using digital menu boards, signage adjacent to the food and employee app. Digital Menu Boards Customised Menus Boards Customised Menu Cards
Our Mobile App Healthy on Top! User can filter meals by preferred restaurant, date, meal type, special diets, allergens and sort by calories, lights User will be able to rate their meals, access FCW activities (book into clinics) Calories and traffic lights per meal are displayed Click on each meal for detailed nutritional information
Our Operations Process PHASE 1 PHASE 2 PHASE 3 PHASE 4 System Set-up Implementation Maintenance Evaluation Audit of eating environments Awareness campaign Baseline health check clinics Menu and food product analysis (DASH) /Web platform Catering training FCW launch campaign Nutrition education Implement structural/ menu/product changes Menu and product calorie/traffic light displays Deploy Employee App Monthly nutrition education elements Maintain menu analysis/calorie/ traffic light displays Monthly logistic meetings Monthly observational visits Health check clinics Month 7: 1st impact report (1-6 months) Month 12: 2nd impact report (7-12 months) Month 1 * Actual timeline dependant on size of workplace Month 1-2 Month 1-7 Month 1-12
Partnership for Win-Win-Win CATERER EMPLOYEE WORKPLACE STAKEHOLDER Gains access to: White label web platform to plan healthier menus Detailed daily information calories/allergens/traffic lights Better understanding of employees dietary patterns and eating behaviours Food consumption monitoring Gains access to: Supportive healthy eating environment FCW Nutritionist FCW Clinics Monthly Nutrition Information Employee App (at work & home) Gains access to dashboard to monitor: ROI and the FCW impact on employee health, food consumption trends, absenteeism, productivity in real-time Employee engagement with FCW activities
Our Solution in Action at Microsoft Fewer harmful items Average employee reduced daily intake fewer calories less salt less saturated fat fewer total sugars Happy client Contract extended. Now rolling out to Microsoft in the UK 130kcal 0.6g 3.4g 3.5g Sustainable weight loss People on track to their preferred weight 3.8cm 6 lbs 9% 4% average reduction in waistline average weight loss lower overweight levels lower obesity levels Life saving Employees are reducing their risk of developing type 2 diabetes, hypertension & stroke
Food Choice at Work represents a powerful commitment from us, the employer, to support the health of our employees. This programme is creating a supportive healthy eating environment for all employees here in Microsoft and ensures that the healthy choice is always the convenient choice. We have access to an outstanding Food Choice at Work leader on site, who adapts the programme to the culture and climate in Microsoft. We are delighted to be a pioneering company of this programme. Brian O Donovan SENIOR GLOBAL LEARNING & DEVELOPMENT MANAGER, MICROSOFT 29
Time to Raise the Bar! 1 2 3 Viable model effective & feasible to implement in all public and private workplaces High quality research continuously informed by objective, high quality research. Need to know more! Long-term large scale trial (most effective interventions scale to increase reach) Collaboration of key stakeholders researchers, employees, workplace managers and caterers 4 Measure impact using key metrics for workplaces & population health * Based on global aggregate 2015 Health Assessment Results
Our Team Dr Fiona Geaney CEO, Founder Professor Ivan Perry Co-Founder Frank Beechinor Chairperson Peter Sedman Director of Technology Dr Claire Kehoe Product Lead Dr Sarah Fitzgerald Research Lead Clare Kelly Operations Lead Dave Collins CFO Anne Parle Food Choice at Work Leader Louise Welland Food Choice at Work Leader Mavis Mtshede Food Choice at Work Intern
Thank you for your time! f.geaney@foodchoiceatwork.com @foodchoice_work www.foodchoiceatwork.com