Brian Wansink, Ph.D. Food and Brand Lab Cornell University

1. Smarter LunchroomsThat Guide Students to Healthier Choices Brian Wansink, Ph.D. Food and Brand Lab Cornell University School Nutrition Association – 37th LAC March 2, 2009

2. Special Thanks to Three Incredible Colleagues David Just Collin Payne Jennifer Noble

3. I’ll finish with helping you think of a small plan you can start today. Smarter LunchroomsThat Guide Students to Healthier Choices I’ll start with a overview of compensation behavior . . . and its key implications for school lunches I’ll show new 2 studies that show how changes can be made to lunchrooms that guide or nudge students into eating healthier (without compensating later)

4. What’s Compensation Behavior?

5. What’s Compensation Behavior? or Why do some people gain weight when they go on diets?

6. What Do People Do When They Go on Diets? The Target Behavior 1) They start exercising 2) They start eating low-fat or healthy foods The Compensating Behavior

7. What Do People Do When They Go on Diets? The Target Behavior 1) They start exercising 2) They start eating low-fat or healthy foods The Compensating Behavior 1) They eat more than they burn – “I deserve it” 2) They overeat the foods and they reward themselves later – “I deserve it”

8. We Often See Compensating Behavior with Children What We “Pressure” • “Clean Your Plate” • “Go to your room” • “I want you to stop ‘hanging out’ with Spike” What We “Get” • . • . • .

9. We Often See Compensating Behavior with Children What We “Pressure” • “Clean Your Plate” • “Go to your room” • “I want you to stop ‘hanging out’ with Spike” What We “Get” • The next day…poured more snacks (APedMedicine 2008) • More “unacceptable” behaviors • . . .

10. If We Were to Tell Students What to Eat (or not eat) at School, What Compensating Behavior Might We Get?

11. Different Compensating Behaviors. . . You can’t eat double chocolate chunk peanut butter cookies at lunch.

12. Different Compensating Behaviors. . . I’m going to have 3 cookies when I get home You can’t eat double chocolate chunk peanut butter cookies at lunch. I can’t wait until snack time. I’m going start bringing my own lunch with whatever I want I’m going to McCookie King for lunch.

13. How Do We Prevent the Compensating Behavior of Students • Nudge them or guide them into making good decisions, without them realizing it. • Change the Lunchroom and we can change their behavior • We can say “No cookies,” or • We can nudge them into getting an apple • “Stealth Health” (Wansink 2006)

14. A Example: Problem • Bottle-neck in lunch lines at cash register • Lots of unhealthy food around • Kids impulse buy unhealthy food

15. A Example: Problem • Bottle-neck in lunch lines at cash register • Lots of unhealthy food around • Kids impulse buy unhealthy food Solution 1: • Move snacks • Disad: Lost revenue; won’t do it Solution 2: • Replace unhealthy with healthy • Result: Better & = revenue

16. Part II. Two Studies on Designing Smarter Lunchrooms

17. School Lunches and Behavior • School lunches offer substantial control of • Content and portions • Prices • Eating environment • Food environment • Choice mechanism • Payment and parental control • High Schools • Flexibility in choice • Prepayment accounts (restrictions are possible) and cash payment options • Debate has focused primarily on content

18. What to Do? Take “Bad” foods off the Menu • What’s bad mean? • Lower participation? • Higher food costs? • Disempowering? Guide or ”Nudge” Better Decisions • Are there environmental adaptations we could make to help kids make smarter decisions? • Empowering • Higher participation • Less subjective

19. How Do You Determine What Lunchroom Changes Might Work? • Observe 100s of high school lunch periods • Identify empirical anomalies • Screen anomalies (theory x intervention relevance) • Observational audit (power & moderators) • One anomaly . . . • Students who pay with cash buy more healthy foods and less unhealthy foods

20. Does Cash Make You Eat Better? • Observed & coded 207 cash meal and 212 debit meal purchasers • Milk/water vs. punch/juice/pop • Extra fruit/vegetable vs. dessert

21. Does Cash Make You Eat Better? • Observed & coded 207 cash meal and 212 debit meal purchasers • Milk/water vs. punch/juice/pop • Extra fruit/vegetable vs. dessert • Findings: • Cash buyers bought made more positive and fewer negative food choices • Why? • Self-selection? • Debt deferral? • Invisible money & invisible consequences

22. Lunch Payment Study • We used the Trillium dining facility at Cornell • Serves thousands of students a day • Used familiar foods; purchased at cost • 155 (55% male) 18-19 year olds • Cafeteria: recruited on-site + credit • $10 + $10 toward food • Cash, debit, restricted debit

23. Entrees Bacon Cheese Burger $ 5 . 0 0 Chicken Breast $ 5 . 0 0 Turkey Sandwich $4.50 Chicken Fingers (3 pc.) $4.00 Sides Salad $2. 0 0 Baked Potato Chips $1.00 Macaroni and Cheese $2. 5 0 French Fries $1.50 Dessert Brownie $ 1 . 5 0 Peaches $1.0 0 D r inks Skim Milk $1.00 Soda $1.00 Water $1.50 Suppose you had to choose

24. Results

25. Restricted Debit Cards Alter Spending Behavior More on healthy. Less on unhealthy. ---------------------- Same overall.

26. Calorie Intake Differs Widely Across Payment Conditions More healthy calories. Less unhealthy calories. ---------------------- Fewer overall calories.

27. Food-by-Food DifferencesStudents with Restricted Debit Cards purchase more of (some of the) healthier foods and less of (some of the) less healthy foods than those using either cash or debit

28. Asking Students to Pay Cash for Items like Desserts, Fries, and Soft Drinks • Decreased how much of these items they bought • Increased how much milk, water, and fruit they bought Conclusion: Making students pay cash for the “indulgences” still gives them the freedom to do so, and doesn’t seem to lead to compensating behavior (because they had a choice)

29. Study 2: Making Vegetables Cool Thanks to the Robert Wood Johnson Foundation (Healthy Eating Research grants)

30. Eating habits in the home don’t end at breakfast…or in childhood • And healthy food doesn’t exactly top a child’s Top 10 List of favorite food. • But what if it did? • Subtle environmental interventions • Changing the name of peas to Power Peas • Children in 1st or 2nd grade took 60% more • It overcame (-) associations with a simple yet “power”ful manipulation

31. Which is Tastier? Traditional Red Beans and Rice Creamy Macaroni and Cheese Flash-frozen-fresh Garden State Green beans • Beans and Rice • Macaroni and Cheese • Green beans

32. Taking it to the next level • Introducing favorable icons with healthy foods • Induce healthy food choice • Invoke positive thoughts • Stickers (also low cost and effective) Color Cookies are now a “sometime food” Toy Cartoon Character

33. Descriptive Words and Healthy Eating (3) Tomato/Carrot Lunch Study • Effects of label “X-ray vision carrot” on post treatment • Data points: M, Tu, Th, F • Kids were exposed to: Food of the Day (FoD) AND/OR X-ray vision carrots (Xray) conditions on Tue and Thu (M-baseline, F-post treatment). • Thus, some kids were exposed to FoD twice, some kids Xray twice, and some kids both FoD and Xray (randomized). • Kids were asked to take and eat carrots (DV: # of carrots taken and eaten)

34. Descriptive Words:Carrot Results • Related-sample t test comparing participants exposed to FoD twice with those exposed to Xray twice on carrots taken on post treatment compared to baseline, t(49) = -1.78, p = .08

35. General Findings • Significant influences of environmental factors (e.g., package size and label) on eating. • These findings can be used to increase the intake of healthy foods (e.g., cereals and fruit).

36. Subtle environmental interventions in creative menu naming Low-cost Low involvement Simple yet powerful—important to find ways to decrease obesity rates Can make changes without burdening the school food budget Immediately adopt and tailor to your situation

37. Does This Work in the Long-Term? This is not a positive reinforcement/intervention scenario (no room cleaning reward) These often fail It enhances, or makes more salient, foods to convey a + meaning What was the 2nd favorite kid’s food in 1928?

38. PART 3: NEXT STEPS

39. Possible Next Steps . . . 1. Share your own Smarter Lunchroom ideas at www.SmarterLunchrooms.org 2. Consider . . . HS: Cash payments for “indulgences” Elementary: Ask a new staffer to play the Name Game 3. Become a research partner (or media partner) 4. Pilot a new program with us 5. Be a model “Lunchroom of the Future” (Criteria: New facility, HS, media-friendly, wide menu, not high income)

40. Thank YouPossible Next Steps . . . 1. Share your own Smarter Lunchroom ideas at www.SmarterLunchrooms.org 2. Consider . . . HS: Cash payments for “indulgences” Elementary: Ask a new staffer to play the Name Game 3. Become a research partner (or media partner) 4. Pilot a new program with us 5. Be a model “Lunchroom of the Future” (Criteria: New facility, HS, media-friendly, wide menu, not high income)

41. Lunchroom of the Future • New Middle School in ______ • Designing a Lunchroom of the Future • Objective: • Start from the bottom up • Provide a vivid profile of what a Healthy Choice Lunchroom will look like • Launch in Fall 2010

42. Next Steps • Suggestions about studies • Synergy ideas with other USDA centers • Food and Nutrition Services • Other areas? • Implementation ideas • Dissemination issues

43. Thank you

44. More Info… www.MindlessEating.org www.SmallPlateMovement.org www.foodpsychology.cornell.edu Education Resources: Lesson plans, in-class exercises, posters, cartoons Science Fair Grants (K-12 + 4-H): Book royalty proceeds