The Effect of Price Reduction on Salad Bar Purchases at a Corporate Cafeteria.” An excellent peek at the kind of steps that employers ought to take to improve eating habits in their work forces: subsidize the purchase of healthy foods. In this CDC study, reducing the price of salads drove up consumption by 300%.  If this was a stock, we would all rush out to buy it.

Influencing behavior through both choice architecture and pricing differentials challenges many employers, however. There is a fear factor in play (“some of my people will be unhappy”), as well as financial issues, because the corporate managers responsible for food services often have their compensation linked to the division’s profitability.  You make a lot more money selling soda than you do selling romaine.  The same perverse financial conundrum appears when corporate food service companies run cafeterias.  The on-site chef and managers typically operate on a tightly managed budget that leaves them little flexibility to seek out and provide healthier options.

A chef employed by one of the largest corporate food service providers in the country told me last year that he could not substitute higher protein Greek yogurt for the sugar-soaked, low-protein yogurt in his breakfast bar. When I asked why, he told me that Greek yogurt was not on his ordering guide, and he was not allowed to buy it from a local club warehouse and bring it in.  In this same company, beverage coolers were stuffed to overflowing with sugar-sweetened drinks, all of which were front and center (and cheap), while waters and low-fat milk were shunted to the side coolers.  In another scenario, health system leaders I met with last year all raised their hands when I asked if they had wellness programs and kept them up when I asked if they also sold sugar-sweetened beverages in their cafeterias at highly profitable prices.  The irony was completely lost on them.  They had to be walked through the inconsistency of telling their employees to take (worthless) HRAs and biometrics, but then facilitating access to $0.69 22 oz fountain sodas.

The connection between environment and individual choices is lost on many corporate leaders. Differential pricing, product positioning, and using eating environments as educational settings are essential tools for helping employees start the process of thinking differently about their dietary choices.  Environmental and population change is hard, and it will take years to see benefits.  But, employers looking for an answer to a persistent medical care spending conundrum would be wise to start looking at their environments and the messages that they are sending employees, either overtly or subtly.  If candy bowls abound in your office and every celebration is a festival of cakes and cookies (because as an HR VP once told me “these foods make our people feel good”), you are not only courting long-term health problems, you are completely missing the opportunity to inculcate a different set of health values in your people.

Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness.  An iconoclast to the core, he is the author of the Khanna On Health Blog, where this post originally appeared.

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13 Responses for “The Salad Bar That Turned Around a Fortune 500 Company …”

  1. The simplest ideas are sometimes the hardest to sell, particularly inside large enterprise. The thinking is that if it didn’t take a $2M Accenture engagement to build the initiative, it’s not valid. This one could save them millions – in lives and in dollars.

    GREAT post.

  2. Our foods are overloaded with sugars, salt, tran fats, etc. and the only way to eat healthy these days is learning how to cook our own meals with healthy ingredients and low on fat, sugar, carbs. Just like in those old good times, when every meal was made from scratch…

  3. maithri says:

    “Environmental and population change is hard, and it will take years to see benefits.”

    No kidding.

    Just look at all of the specials on mass consumption you might find at a Dunkin Doughnuts or Krispy Kreme-great with coffee, perfect for the workplace.

    Might be tough to replace, say, a birthday cake at an employee birthday party…celebratory sweets are sort of entrenched within our culture.

    Whether this is true or not, many would argue that the rarity of a birthday, company milestone, etc., might just not be the same without a little sugar/dietary excess.

    • Sandra_Raup says:

      High sugar treats used to be occasional, as the name implies, and in small amounts. Now it is often routine and in larger servings. I wonder if we “boomers” rebelled against our parents’ generation discipline when we grew up and passed that on to the next generation. I’m probably showing my age, but I think learning from a young age how to deny yourself is a good thing.

  4. Vic, wonderful post that gets to the root question: does the U.S. believe in public health and the health of The Commons? Is this the job of the private sector, where larger companies are putting more $ toward wellness in 2013 but smaller companies are doing back-of-napkin calculations on whether to pay-or-play with health insurance coverage in 2014? It’s time for a transparent, nationwide, all-stakeholder conversation on this issue. And as an aside, Greek yogurt is a fast-growing dairy segment among paying consumers, even as it’s higher-priced. So there’s a willing public listening to the food=health message.

  5. Paul says:

    Substituted veggies with dip for the usual afternoon sweets at a Continuous Improvement all-day meeting yesterday. They were all gone by the time I got to the table!

  6. Vik Khanna says:

    Great comments, all, and thanks for your kind words about the post. Clearly, there are no easy answers, and there is a complex push-pull interaction that goes on between individuals and their environments. However, I was struck by Sandra_Raup’s note, which concludes with a reference to personal discipline. It is increasingly a lost art in our culture. Start with your family and build from there. If you have a pantry loaded with junk, then lectures about making good choices will fall on the deaf ears of children who will be all too happy to fill up on chips and cookies. It is the same situation in the workplace wellness environment; an employer that facilitates poor choices, while simultaneously exhorting employees to be efficient medical consumers is, well, trying to let them have their cake and eat it, too. Doesn’t work at home and won’t work at work.

  7. Greg Juhn says:

    There are a lot of simple but powerful steps that employers can take to reinforce healthier decisions, and this is a great example. Without these infrastructure changes, you can’t build the “culture of health” that companies seek. The wellness industry is evolving away from many of the old-school methods and adopting behavioral economics. Simple things like pricing and placement of healthy foods can make a big difference, without taking away employee choice or forcing health food on employees who don’t want it.

  8. Sarah says:

    Interesting topic.

    I read recently that its now become harder and more expensive to insure employees who are overweight and obese. Even companies who are relocating look for states with lower levels of obesity. I suspect that companies will encourage their employees to eat more healthy as it will save them money. Although the motivation is purely financial at least its a step in the right direction.

  9. Mitch Collins says:

    I do some work for a very large company that has a standard plain vanilla wellness program. I visit one of their locations and the vending machines offer:
    -Soda
    -Chips, cookies, candy
    -Highly processed “sandwiches”, all with salt, preservatives, unhealthy fats

    But they care about their employee’s health! The sign in the break room says so!

  10. fran melmed says:

    Great post. I have been shocked when I’m sitting in a client’s lobby, waiting to be picked up to go discuss their health and wellness strategy, and i see employees walk by with 30+ oz soda cups they picked up from their cafeteria.

    It’s critical for employers to look at the environment they design and foster, whether for better eating, better movement, or better emotional health.

    The only additional comment I wanted to make was about individual discipline. I think we’re only now starting to understand how hard it is to maintain individual discipline and how much individual discipline does not matter. When I say it does not matter, let me be clear about why I say that. When foods are designed to tweak our brains and to avoid our feelings of satiety, when policies drive what’s affordable and what’s not, when other policies are lacking about what’s marketed and to whom, individual discipline is dealing with a tsunami it’s going to be hard-pressed to withstand.

    fran

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