By Vik Khanna
“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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