Total Lunchroom Makeovers: How Principles of Asymmetric Paternalism can Address New School Lunchroom Guidelines

Background: Recently, new regulations were announced that affect what foods schools can offer and what foods students must take as part of a school lunch program meal. Despite well-intended policies, these new mandates do not guarantee that students will actually eat healthier lunches. In this study, we evaluate the impact that a combination of low-cost and no-cost environmental changes, based in principles of asymmetric paternalism, have on what students take and eat during lunch. Methods: In two different cafeterias we introduced several environmental changes, which we refer to as the total lunchroom makeover. Before and after the changes were implemented, trained field researchers collected fruit, vegetable, and starchy side consumption data for each student who purchased a school lunch program meal. Probit regression techniques were used to examine the differences in the likelihood of selecting and consuming fruits, vegetables, and starchy sides before and after the makeover. Results: Total lunchroom makeover changes increased the likelihood that students selected fruit by 13.4% and vegetables by 23.0%. In terms of consumption, after the total lunchroom makeover students were 17.9% more likely to eat fruit and 24.5% more likely to eat vegetables. The intervention had no impact on selection or consumption of starchy sides. Conclusions: This study provides strong evidence that simple, low-cost and no-cost environmental changes can nudge students to take and eat healthier lunches. Even though students still had the liberty to select the items they wished, these cues led them to make healthier choices.