Table 2

Characteristics of included studies

StudyParticipants/worksiteInterventionsOutcomes
Dorresteijn et al 25 Canteen, medical centre.
University Medical Centre with >11 000 employees, >1000 hospital beds and >2000 customers visiting the hospital restaurant each day.
Inclusion/exclusion: N/A (data not collected from individuals).
(1) Point-of-decision prompts on hospital elevator doors promoting stair use. In the hospital restaurant: (2) point of- purchase prompts promoting reduced-salt soup.
(3) Point-of-purchase prompts promoting lean croissants.
(4) Reversal of the accessibility and availability of diet margarine and butter.
Comparator: No comparator.
Number and ratio of purchased normal-salt soup, reduced-salt soup, croissants, lean croissants purchased, diet margarine and butter.
Geaney et al 67 Canteen, hospital.
Participants were representative sample of 100 adults aged 18–64 years working in two public sector hospitals (50 staff from each hospital).
Inclusion: Being an employee and consuming at least one main meal in the hospital staff canteen daily.
Exclusion: None reported.
Restricting food high in salt, fat and sugar. Modifying menus to make healthier options available. Replacing purchasing orders for high salt products (eg, bacon) with low salt alternatives (eg, turkey). Salt removed in all cooking places and tables but available in small sachets at service. Nutrition information on salt reduction and a healthy diet displayed. No sauces or accompaniments added without customer’s consent. Staff encouraged to consume extra salad and vegetable options at no extra charge. Cooking oil use limited. All desserts fruit based.
Comparator: Canteen at another hospital with no intervention.
Macronutrients (g/day): total sugars, sucrose, fructose, total fat, saturated fat, protein, carbohydrates, salt. Micronutrients (mg/day): K, Ca, Fe, vitamin B6, vitamin B12, vitamin C, vitamin D.
Lassen et al 26 Canteen, hospital.
The canteen was seeking Keyhole certification in Denmark. Participants were canteen customers approached at random after purchasing lunch.
Inclusion: Purchasing lunch in the canteen.
Exclusion: Not reported.
Introduction of the Keyhole symbol on freshly prepared food in the canteen. The Keyhole symbol is used in the Nordic countries as a sign of a healthy choice (meeting certain criteria).
Comparator: No intervention.
Energy per meal consumed (kJ), energy density of meal (kJ/100 g), fat content (E%), fruit and vegetables (g/100 g), salt (g/100 g), refined sugars (g/100 g), wholegrain (g/100 g).
Lowe et al 34 Canteens, hospitals.
Inclusion: Reporting eating lunch in the hospital cafeteria at least two times each week, on average, being between 21 and 65 years of age and being a hospital or university employee.
Exclusion: Having a current diagnosis of a chronic disease or condition known to affect appetite or bodyweight, taking medication known to affect appetite or bodyweight, being pregnant or planning to become pregnant within the next 24 months, being enrolled or having plans to label within the next 24 months in an organised weight management programme, and/or having plans to terminate hospital employment within the next 12 months.
When the intervention period began, participants in both groups were exposed to environmental change (EC): reductions in the energy density (ED) of some foods offered in the cafeteria and introduction of nutritional labels for all foods sold in the cafeterias.
Participants in the EC-Plus condition received two additional intervention components: training in reducing the ED of their diet and discounts on low-ED foods purchased in the cafeteria.
Comparator: Environmental change only.
Fruit (servings/day), vegetables (servings/day), bread products (servings/day), dairy products (servings/day), fats and sweets (servings/day), meats (servings/day);
Purchased kcal (kcal): purchased calories from fat (%); purchased calories from protein (%); purchased calories from carbohydrate (%).
MacDonald et al 38 Aboriginal Community controlled health organisations.
Inclusion/exclusion: Not reported.
A tailored ‘Healthy Catering Toolkits’ to local caterers at each site and included order forms classified according to the ‘traffic light guide’ to ensure healthy catering choices were easy ordering choices for staff. They also distributed ‘traffic light guide’ posters and information sheets, a nutrition policy template and a wallet-sized card for interpreting food labels.
Comparator: No comparator.
Proportion of purchased foods in category ‘foods to limit’ (%).
Meyers27 Canteen, hospital.
A hospital cafeteria that served hospital staff, students and hospital visitors.
Inclusion/exclusion: Not reported.
Desserts were arrayed in columns four deep along the cafeteria counter. On control days research assistants arrayed desserts in columns of four, high-calorie desserts alternating with low-calorie desserts, permitting equal access to each dessert. High-calorie desserts were placed in the two front positions with low-calorie desserts in the read (less accessible) positions on days 3 and 5. On days 2 and 4 this order was reversed.
Comparator: No comparator.
Dessert purchases.
Milich28 Canteen, hospital.
Inclusion: Being a female employee (identifiable by an ID badge and/or uniform) and having a food tray.
Exclusion: Being a patient or visitor, being visibly pregnant or being an employee who had brought food from home or only bought part of her meal in the cafeteria.
Calorie signs were posted for foods in the cafeteria.
The intervention consisted of 1 week of price increase, followed by 1 week of price increase and calorie presentation.
Comparator: No comparator.
Calories bought (kcal), money spent ($).
Racette et al 35 Worksites, medical centre.
Inclusion: All employees >18 years of age were eligible, including those who smoked, had pre-existing disease (eg, hypertension, diabetes) or used medications.
Exclusion: Not reported.
The intervention comprised a constellation of nutrition components, physical activity components, and incentives designed to promote healthy dietary and physical activity behaviours, with the goals of promoting weight control and reducing risk factors for cardiovascular disease.
Specific intervention components included weekly healthy snack cart, monthly lunchtime seminars, monthly newsletters, walking maps, participation cards and participation rewards. Each week a registered dietitian/exercise specialist was available at the worksite to provide support.
Comparator: Health assessments only.
Fruit and vegetable intake (servings/day).
Sato et al 29 Cafeteria, medical centre.
Customers of the medical centre cafeteria aged 18 years and older. Roughly 70% of the customers at Kaiser Permanente San Francisco Medical Center are Kaiser employees; the rest are visitors or patients in the hospital. The cafeteria serves roughly 100 customers per day.
Inclusion/exclusion: N/A (receipts collected anonymously).
A ‘Healthy Pick’ option meeting various criteria was made available every day. The meals available were labelled with information featuring calories, fat and sodium.
Comparator: No comparator.
Number of Healthy Picks purchased, number of main meals purchased.
Sorensen et al 36 39–41 Community health centres.
Inclusion: Being a permanent employee and working at least 15 hours a week.
Exclusion: Not reported.
The core intervention included periodic exposure to national 5-a-Day campaigns and a general nutrition presentation. In the additional worksite intervention, educational activities and changes were made to the worksite environment including labelling and adding fruit and vegetables to vending machines.
Comparator: Core intervention only.
Fruit and vegetable intake (servings/day).
Stites et al 37 Canteen, hospital.
Inclusion: Having a body mass index of at least 25.0 kg/m2, eating at least three lunches/week in the hospital cafeteria, being willing to allow researchers to collect data about their lunch purchases, and having access to a computer at work.
Exclusion: Having a diagnosis of unstable hypertension, dyslipidaemia or coronary artery disease whose medical therapy had changed in the past three months, having plans to terminate hospital employment within 4 months following study enrolment, or being pregnant.
During the Full Intervention phase participants received mindful eating training, were encouraged to pre-order their lunches, and were given vouchers to use on lunch purchases. Following this there was a Partial Intervention phase, where participants were encouraged to preorder their lunches but did not receive vouchers. The preordering system listed the food available daily in the cafeteria, along with nutritional information. Employees had to order at least 45 min ahead of scheduled pick up time.
Comparator: Wait list control.
Kcal per lunch purchased (kcal), fat grams per lunch purchased (g).
Thorndike et al 30 32 33 Canteen, hospital.
Hospital employees have the option of paying for cafeteria purchases by direct payroll deduction using a ‘platinum plate’ card.
Inclusion: Using ‘platinum plate’ and making a purchase in the cafeteria at least three times during each 3-month period from baseline to the end of follow-up.
Exclusion: Not reported.
A traffic light food labelling system was introduced, along with signage explaining it. Three months later further changes were introduced, including rearranging items in the beverage and sandwich refrigerators to put all the green items at eye level; placing baskets of bottled water throughout the cafeteria; and providing pre-packaged salads next to the pizza counter.
Comparator: No comparator.
Of items bought: % red, % green (red labels and green labels as denoting unhealthy and healthy choices respectively).
Of beverages bought: % red,
% green.
Van Kleef31 Canteen, hospital.
Inclusion/exclusion: N/A.
Four successive weeks were randomly assigned to four experimental conditions:
Intervention 1: 25% of products healthy, these located at top shelves.
Intervention 2: 25% of products healthy, these located at bottom shelves.
Intervention 3: 75% of products healthy, these located at bottom shelves.
Intervention 4: 75% of products healthy, these located top at shelves.
Comparator: No comparator.
Number of healthy snacks sold, number of unhealthy snacks sold.
Beresford et al 46 28 worksites (six health service organisations).
Inclusion: (for worksites) Having a food-serving cafeteria and having between 250 and 2000 employees.
Exclusion: N/A.
The intervention was tailored to worksites. Elements included a kick-off event, the 5-a-Day message being posted on boards in each worksite, more fruit and vegetables becoming part of the menus and the provision of a self-help manual for every employee.
Comparator: No intervention.
Fruit and vegetable intake (servings/day).
Holdsworth43 44 Six worksites (two healthcare).
Inclusion/exclusion: Not reported.
The Heartbeat Award scheme increases opportunities for behaviour change by providing customers with information, reminders and reinforcement to guide them towards healthier choices.
Comparator: No intervention.
Daily intake of biscuits and cakes, sweet puddings, confectionery, sugary drinks, processed meat, hard cheese, crisps, low-fat cheese, fried food, beans and pulses, fruit, vegetables, chicken and fish, starchy foods, red meat, low calorie drinks. All reported (1) no change/negative change and (2) positive change.
Kwak et al 48 59 12 worksites (two hospitals).
Inclusion: Employees with body mass index>18 kg/m2 and not under any medical restrictions.
Exclusion: Not reported.
There was an individual and an environmental component to the intervention. Interventions included changes in the assortment of food products in the cafeteria, workshops, an information wall containing information on the balance between food intake and physical activity, posters or prompts stimulating stair use, and ways to form lunch-walking and cycling groups.Intake of fibre-rich bread, low-fibre bread, fibre-rich main meal, low-energy-dense toppings, high-energy-dense toppings, low-energy-dense main meal, high-energy-dense main meal, low-energy-dense snacks, high-energy-dense snacks, low-energy-dense drinks, high-energy-dense drinks (all in servings/day).
Sorensen et al 47 49 16 worksites (at least one intervention and one control site specialising in ‘healthcare’).
Inclusion: (for worksites) Having 200–2000 employees, having a cafeteria with a kitchen, having an annual turnover rate of <25%, having <25% of employees working rotating shifts, part time or off site and being stable as a company, defined as having no plans for geographic relocation or major lay-offs in the next 2 years.
Exclusion: Not reported.
Worksites received a 15-month intervention with various elements. These included direct education programmes, such as classes offered in all intervention worksites and optional activities tailored to individual worksites, and environmental programmes which targeted cafeterias both to increase the availability of low-fat, high-fibre foods and to provide supportive nutrition education by labelling those food options.
Comparator: No intervention.
Total dietary fat (% kcal), total dietary fibre (g).
Vermeer et al 42 45 25 worksites (15 hospitals).
Inclusion: (for worksites) Selling on average 30 meals/day, offering a reducible meal at least twice per week, being willing to be randomly allocated to a study condition, following the study protocol and providing their daily sales figures of hot meals and fried snacks.
Exclusion: Not reported.
Intervention 1: A smaller portion (ie, about two-thirds of the size of the existing portion) was offered in addition to the existing portion and proportional pricing was employed (ie, the price was 65% of the existing size).
Intervention 2: A smaller portion was added to the assortment and value size pricing (ie, a lower price per unit for large portions than for small portions) was employed (ie, the price was 80% of the existing size).
Comparator: No intervention.
Number of large meals sold, number of small meals sold, number of fried snacks sold.
  • N/A, not applicable.