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Cardiovascular DiseaseNCT02808910

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

A study testing Nudged to eat less added salt and more other seasonings, Nudged to avoid foods high in salt content, and to choose foods low in salt content and Nudged to eat more vegetables in people with Cardiovascular Disease and Obesity, run by LHL Helse at 1 site in Norway.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

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. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Cardiovascular Disease, Obesity
What is being tested?
Nudged to eat less added salt and more other seasonings, Nudged to avoid foods high in salt content, and to choose foods low in salt content and Nudged to eat more vegetables
Could I receive a placebo?
No, everyone receives an active treatment
How many people
144 participants
Where
1 siteNorway
Study dates
Apr 2016to 1 Apr 2018
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 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

Who cannot join

  • None

Trial locations and contacts

1 site in 1 country.

Norway1 site

  • LHL-klinikkene Feiring

    Feiring, 2093

Other trials in Norway

About this study

Official title: Nudging: How Small Changes in the Cafeteria of the Feiring Heart Clinic Can Result in a Healthier Food Choice.

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.

Read the detailed description

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.

Being tested
Nudged to eat less added salt and more other seasonings, Nudged to avoid foods high in salt content, and to choose foods low in salt content, Nudged to eat more vegetables, Nudged to eat smaller portions, Nudged to eat less calorie-dense food
Keywords
behavior, food intake, salt, vegetables, portion size, weight loss, habits
Medical subject headings
Cardiovascular Diseases, Obesity, Behavior, Weight Loss, Habits

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Nudged to eat less added salt and more other seasoningsBehavioural

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

  • Nudged to eat more vegetablesBehavioural

  • Nudged to eat smaller portionsBehavioural

  • Nudged to eat less calorie-dense foodBehavioural

Study groups in NCT02808910
Study groupRoleWhat they receive
Salt nudgeExperimentalThe 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.
Receives: Behavioral: Nudged to eat less added salt and more other seasonings; Behavioral: Nudged to avoid foods high in salt content, and to choose foods low in salt content
Vegetable nudgeExperimentalThe 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.
Receives: Behavioral: Nudged to eat more vegetables
Portion size nudgeExperimentalThe 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.
Receives: Behavioral: Nudged to eat smaller portions; Behavioral: Nudged to eat less calorie-dense food
Combined nudgeExperimentalAll three nudges are combined in this intervention.
Receives: Behavioral: Nudged to eat less added salt and more other seasonings; Behavioral: Nudged to avoid foods high in salt content, and to choose foods low in salt content; Behavioral: Nudged to eat more vegetables; Behavioral: Nudged to eat smaller portions; Behavioral: Nudged to eat less calorie-dense food
Control groupsNo interventionNo 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.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in BMI from start of intervention to end of intervention

    BMI is measured, and change in BMI between day 0 and day 28 is used.

    Measured: Measured at baseline at day 0 of intervention and at completion of intervention at day 28 of intervention)

  2. Change in dietary habits 1

    Habits are compared with habits as listed before the start of the 4 week intervention period. Done through an online survey.

    Measured: 6 weeks after the 4 week intervention period

  3. Change in dietary habits 2

    Habits are compared with habits as listed before the start of the 4 week intervention period. Done through an online survey.

    Measured: 6 months after the 4 week intervention period

Secondary outcomes (8)

  1. Dietary choices in cafeteria 1.1

    Participants make photos of their meal including drinks, and register any condiments or seasoning added

    Measured: Tuesday lunch meal during the first week of the intervention

  2. Dietary choices in cafeteria 1.2

    Participants make photos of their meal including drinks, and register any condiments or seasoning added

    Measured: Thursday lunch meal during the first week of the intervention

  3. Dietary choices in cafeteria 2.1

    Participants make photos of their meal including drinks, and register any condiments or seasoning added

    Measured: Tuesday lunch meal during the second week of the intervention

  4. Dietary choices in cafeteria 2.2

    Participants make photos of their meal including drinks, and register any condiments or seasoning added

    Measured: Thursday lunch meal during the second week of the intervention

  5. Dietary choices in cafeteria 3.1

    Participants make photos of their meal including drinks, and register any condiments or seasoning added

    Measured: Tuesday lunch meal during the third week of the intervention

  6. Dietary choices in cafeteria 3.2

    Participants make photos of their meal including drinks, and register any condiments or seasoning added

    Measured: Thursday lunch meal during the third week of the intervention

  7. Dietary choices in cafeteria 4.1

    Participants make photos of their meal including drinks, and register any condiments or seasoning added

    Measured: Tuesday lunch meal during the fourth week of the intervention

  8. Dietary choices in cafeteria 4.2

    Participants make photos of their meal including drinks, and register any condiments or seasoning added

    Measured: Thursday lunch meal during the fourth week of the intervention

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Jun 2016 (estimated)
  2. Study startApr 2016
  3. Primary completion20 May 2017
  4. Study completion1 Apr 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Non-randomised
Intervention model
Single group
Masking
Single blind
Who is masked
Participant
Enrolment
144 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02808910
Sponsor's protocol ID
2016/231300
Other IDs
2016
Status last verified
Aug 2019
First submitted
3 May 2016
Last updated
15 Aug 2019
Results posted
No
Data monitoring committee
No
Individual data sharing
No

Publications

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

  • 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.

    PubMed 19954563

  • 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.

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

  • 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.

    PubMed 23231863

Questions about this trial

What is this clinical trial studying?

A study testing Nudged to eat less added salt and more other seasonings, Nudged to avoid foods high in salt content, and to choose foods low in salt content and Nudged to eat more vegetables in people with Cardiovascular Disease and Obesity, run by LHL Helse at 1 site in Norway.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 15 Aug 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Norway. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in BMI from start of intervention to end of intervention (time frame: Measured at baseline at day 0 of intervention and at completion of intervention at day 28 of intervention)). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02808910, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Aug 2019.

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