The effect of healthier menu item price reductions in the out-of-home food sector on energy purchased and consumed: a restaurant-based pilot experiment.

backgroundFrequent out-of-home food sector (OOHFS) use is associated with poor dietary intake and obesity. There are limited real-world studies on pricing interventions to encourage healthy eating in the OOHFS. We performed a pilot study to collect preliminary trial data on the potential impact of a price reduction intervention on healthier menu items on purchasing and consumption of kilocalories (kcal) in a full-serviced restaurant among people from both lower and higher socioeconomic position (SEP).

methodsThe main trial design was a pre vs. post price reduction comparison (within-subjects), where participants (adults aged ≥ 18 years) received a control menu with standard pricing at visit 1 and a menu with price manipulations (30% reduction for healthy items) at visit 2. A sub-study was conducted with a comparison sample to estimate potential pre-post changes to outcome variables in the absence of a pricing intervention. Linear mixed models assessed pre-post changes in kcal purchased and kcal consumed.

resultsIn total, 114 participants were recruited; 92 were randomised to the main study and 22 to the comparison sub-study. Of those participating in the main study, 78 completed and 14 were lost to follow-up. There were no participants lost to follow-up in the comparison study. Of the completers, 46 participants were considered higher SEP (i.e. bachelor's degree or higher) and 32 participants were lower SEP (i.e. some college or associate degree or lower). Kcal purchased and consumed decreased from visit 1 to visit 2; however, this reduction was only statistically significant for total kcal consumed (regression coefficient: -98.0 (95% CI -181.9, -14.2), p = 0.02). There were no notable intervention effect differences between higher and lower SEP participants, but we were under-powered to formally test for SEP differences. In the comparison study, kcal purchased and consumed was also lower at visit 2 compared to visit 1, although this should be interpreted with caution due to the small sample size.

conclusionA price reduction intervention on lower energy menu items is potentially effective in encouraging healthier eating in a restaurant setting. Larger studies with inclusion of a control group (e.g., randomised controlled trials) are now needed to confirm intervention effects and whether they are equitable across different socioeconomic groups.