Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this randomized controlled trial, listing food and restaurant options in order of ascending energy content reduced the energy content of participants’ meal choices compared to the control.

2. Furthermore, repositioning food and restaurant options based on energy content reduced the final price of participants’ choices.

Evidence Rating Level: 1 (Excellent)

Consuming meals at restaurants or through delivery take-outs has been associated with higher energy consumption and body mass index (BMI), which can have adverse long-term health effects. The way in which food options are presented may impact food selection and purchasing choices. However, the impact of changing the presentation of food choices on consumption has yet to be thoroughly tested. Therefore, the present study aimed to investigate whether repositioning food or restaurant options in a food delivery platform based on energy affects the energy content of meal choices.

The study included 9,003 adult participants from the UK. Participants were included if they were 18 or older and used food delivery platforms. Participants who failed attention checks or had hypothetical orders containing more than 4,000 or fewer than 150 kcals were excluded. Participants were asked to make choices on a simulated food delivery platform that included 21 restaurants and 570 food or drink items. Participants were randomized into either a control condition that listed food and restaurant choices randomly or one of four intervention groups: 1) food options displayed in ascending order of energy, 2) restaurant options displayed in ascending order of average energy content per main meal, 3) intervention 1 and 2 combined, and 4) restaurants positioned as in intervention 2, but food positioned based on kcal/price, with low-calorie, high-price foods listed at the top. The primary outcome was the average energy content and price of participants’ meal choices in each group.

The results demonstrated that all four interventions led to a decrease in the energy content of the participants’ meal choices compared to the control. Repositioning both food items and restaurants based on energy led to the greatest energy reduction, while repositioning only food choices led to the least reduction in energy. Furthermore, all interventions except repositioning by kcal/price led to a reduced basket price. The study was limited by its simulated nature, which may have impacted participants’ choices, as they were not actually receiving the food they selected. Nonetheless, the results suggested that thoughtful repositioning of food options could be a wide-scale intervention to promote healthier food choices.

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