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dc.contributor.authorReynolds, James P.
dc.contributor.authorVentsel, Minna
dc.contributor.authorKosīte, Daina
dc.contributor.authorRigby Dames, Brier
dc.contributor.authorBrocklebank, Laura
dc.contributor.authorMasterton, Sarah
dc.contributor.authorPechey, Emily
dc.contributor.authorPilling, Mark
dc.contributor.authorPechey, Rachel
dc.contributor.authorHollands, Gareth J.
dc.contributor.authorMarteau, Theresa M.
dc.date.accessioned2021-09-14T19:11:39Z
dc.date.available2021-09-14T19:11:39Z
dc.date.issued2021-09-14
dc.date.submitted2020-12-21
dc.identifier.issn1549-1277
dc.identifier.otherpmedicine-d-20-06163
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/328000
dc.description.abstractBackground: Overconsumption of energy from food is a major contributor to the high rates of overweight and obesity in many populations. There is growing evidence that interventions that target the food environment may be effective at reducing energy intake. The current study aimed to estimate the effect of decreasing the proportion of higher energy (kcal) foods, with and without reducing portion size, on energy purchased in worksite cafeterias. Methods and findings: This stepped-wedge randomised controlled trial (RCT) evaluated 2 interventions: (i) availability: replacing higher energy products with lower energy products; and (ii) size: reducing the portion size of higher energy products. A total of 19 cafeterias were randomised to the order in which they introduced the 2 interventions. Availability was implemented first and maintained. Size was added to the availability intervention. Intervention categories included main meals, sides, cold drinks, snacks, and desserts. The study setting was worksite cafeterias located in distribution centres for a major United Kingdom supermarket and lasted for 25 weeks (May to November 2019). These cafeterias were used by 20,327 employees, mainly (96%) in manual occupations. The primary outcome was total energy (kcal) purchased from intervention categories per day. The secondary outcomes were energy (kcal) purchased from nonintervention categories per day, total energy purchased per day, and revenue. Regression models showed an overall reduction in energy purchased from intervention categories of −4.8% (95% CI −7.0% to −2.7%), p < 0.001 during the availability intervention period and a reduction of −11.5% (95% CI −13.7% to −9.3%), p < 0.001 during the availability plus size intervention period, relative to the baseline. There was a reduction in energy purchased of −6.6% (95% CI −7.9% to −5.4%), p < 0.001 during the availability plus size period, relative to availability alone. Study limitations include using energy purchased as the primary outcome (and not energy consumed) and the availability only of transaction-level sales data per site (and not individual-level data). Conclusions: Decreasing the proportion of higher energy foods in cafeterias reduced the energy purchased. Decreasing portion sizes reduced this further. These interventions, particularly in combination, may be effective as part of broader strategies to reduce overconsumption of energy from food in out-of-home settings. Trial registration: ISRCTN registry ISRCTN87225572.
dc.languageen
dc.publisherPublic Library of Science
dc.subjectResearch Article
dc.subjectBiology and life sciences
dc.subjectMedicine and health sciences
dc.subjectResearch and analysis methods
dc.subjectSocial sciences
dc.titleImpact of decreasing the proportion of higher energy foods and reducing portion sizes on food purchased in worksite cafeterias: A stepped-wedge randomised controlled trial
dc.typeArticle
dc.date.updated2021-09-14T19:11:38Z
prism.issueIdentifier9
prism.publicationNamePLOS Medicine
prism.volume18
dc.identifier.doi10.17863/CAM.75451
dcterms.dateAccepted2021-07-27
rioxxterms.versionofrecord10.1371/journal.pmed.1003743
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
datacite.contributor.supervisoreditor: Popkin, Barry M.
dc.contributor.orcidReynolds, James P. [0000-0003-1536-1557]
dc.contributor.orcidVentsel, Minna [0000-0001-8308-9140]
dc.contributor.orcidRigby Dames, Brier [0000-0002-9859-2985]
dc.contributor.orcidPilling, Mark [0000-0002-7446-6597]
dc.contributor.orcidPechey, Rachel [0000-0002-6558-388X]
dc.contributor.orcidHollands, Gareth J. [0000-0002-0492-3924]
dc.identifier.eissn1549-1676
pubs.funder-project-idWellcome Trust (206853/Z/17/Z)
pubs.funder-project-idCancer Research UK (C4770/A29425)
pubs.funder-project-idWellcome Trust (106679/Z/14/Z)


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