Impact of a smarter lunchroom intervention on food selection and consumption among adolescents and young adults with intellectual and developmental disabilities in a residential school setting

Schools are captive environments for public health interventions to improve dietary intake. Principles of behavioral economics and social psychology guide recent efforts to nudge students toward better food choices in school cafeteria environments. This study assessed whether a Smarter Lunchroom intervention adapted for students with I/DD, aged 9 to 22, would increase the selection and consumption of fruits, vegetables, and whole grains; and reduce the selection and consumption of refined grains. The 3-month intervention took place at a residential school between February and June 2012. We employed a quasi-experimental, pre-post design comparing 5 matched days of dietary data. Selection, consumption, and plate waste of foods at lunch were assessed using digital photography. From baseline to follow-up, the daily selection of whole grains increased by 27% from 1.62 to 2.06 servings (absolute mean difference 0.44 servings, p=0.005), and refined grains decreased by 40% from 0.82 to 0.49 servings (absolute mean difference 0.33 servings, p=0.005). The daily consumption of fruits increased by 46% from 0.39 to 0.57 servings (absolute mean difference 0.18 servings, p=0.008), whole grains increased by 27% from 1.44 to 1.83 servings (absolute mean difference 0.38 servings, p=0.008), and refined grains decreased by 46% from 0.68 to 0.37 servings (absolute mean difference 0.31 servings, p=0.004). Fruit (p=0.04) and vegetable (p=0.03) plate waste decreased. This Smarter Lunchroom intervention improved food choices and dietary intake of students with I/DD while decreasing fruit and vegetable plate waste. Nudge approaches offer promise for improving the food selection and consumption habits of youth with I/DD.