Effect of physical activity calorie equivalent (PACE) labels on food purchased in worksite cafeterias
| ISRCTN | ISRCTN31315776 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN31315776 |
- Submission date
- 22/03/2021
- Registration date
- 30/03/2021
- Last edited
- 10/04/2024
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Nutritional, Metabolic, Endocrine
Plain English summary of protocol
Background and study aims
The number of people who are overweight or obese has been increasing in the UK, which contributes to high rates of type 2 diabetes, heart disease and numerous cancers. As up to 20% of calories are purchased at work, this is a good venue to create a healthier food environment and help people improve their diets. One approach to reducing excess energy intake has been to add calorie labels on food and drinks to inform people about the amount of energy (referred to below as calories) in each product. An alternative to only providing calorie labels is to convert calorie information into the physical activity needed to expend the energy in that product. These labels, known as Physical Activity Calorie Equivalent (PACE) labels, typically include an image to highlight the type of physical activity – usually walking – together with information on how much of this activity is required. This study aims to test the impact of a PACE label intervention on the number of calories that are purchased in worksite cafeterias.
Who can participate?
Worksite cafeterias
What does the study involve?
The intervention involves displaying PACE labels on or near (i.e. along shelf edging, on tent cards placed next to products, or on menus) foods belonging to selected categories, including main meals, sides, sandwiches, desserts, bakery, savoury, confectionery, and cold drinks. The PACE label will depict an image of a figure walking, together with the number of minutes of walking required to expend the calories contained within the product. The calorie content of the product will also be displayed on the PACE label.
To test if the PACE label intervention is effective, 10 worksite cafeterias will receive the intervention after a baseline period in which the worksite cafeterias are operating as usual. After the intervention has been implemented, the researchers aim to detect whether it resulted in fewer calories being purchased across the 10 sites. These results will help us determine if PACE labels might help people reduce the number of calories that they consume in the workplace.
What are the possible benefits and risks of participating?
There are no foreseeable risks in taking part. Similarly, there are no specific benefits of taking part.
Where is the study run from?
University of Cambridge (UK)
When is the study starting and how long is it expected to run for?
April 2020 to June 2021
Who is funding the study?
Wellcome Trust (UK)
Who is the main contact?
Dr James Reynolds
jpr63@medschl.cam.ac.uk
Contact information
Scientific
Institute of Public Health
Forvie Site
Robinson way
Cambridge
CB2 0SR
United Kingdom
| Phone | +44 (0)1223 762569 |
|---|---|
| jpr63@medschl.cam.ac.uk |
Study information
| Study design | Multicentre randomized stepped-wedge cluster design |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Stepped-wedge cluster randomized design |
| Study setting(s) | Other |
| Study type | Prevention |
| Participant information sheet | Not available in web format, please use contact details to request a participant information sheet |
| Scientific title | Effect of physical activity calorie equivalent (PACE) labels on energy purchased in cafeterias: a stepped-wedge randomized controlled trial |
| Study objectives | PACE labels reduce energy purchased relative to no labels. |
| Ethics approval(s) | Approved 08/12/2020, Cambridge Psychology Research Ethics Committee based at the University of Cambridge (School of the Biological Sciences, 17 Mill Lane, Cambridge, CB2 1RX, UK; +44 (0)1223 766876; Cheryl.Torbett@admin.cam.ac.uk), ref: PRE.2020.105 |
| Health condition(s) or problem(s) studied | Excess energy intake in working-age adults |
| Intervention | A stepped-wedge design (Campbell & Walters, 2014) will be used, with each of the sites randomly allocated to the time at which they implement the PACE label intervention. Weeks 1 to 4 will comprise the minimum baseline period during which time data will be recorded without any intervention. This will be followed by a period of 8 weeks during which the interventions will be introduced – in an order determined by randomisation - and maintained until the end of the trial period. The PACE label intervention will be introduced in week 5 at the first two sites. After this, two sites per week will introduce the intervention. The interventions will be maintained until the end of week 12 when data collection ends across all sites. This means baseline and intervention periods last between 4 and 8 weeks. PACE labels contain information on the energy content (kcal) of a product and information on the amount of physical activity required to expend this amount of energy. The physical activity equivalent in the current study will be expressed in terms of minutes of walking required to expend the energy (kcal) contained within the product by the average-sized adult. An image of a figure walking and the energy (kcal) content of the product will also be displayed with this information. The labels will be displayed in up to four places: 1. Attached on the product itself where this is appropriate (e.g., a muffin made on-site wrapped in plastic). This will not be possible in certain cases where there is not a place to attach it or the product is branded (e.g., a hot meal, a can of coke, a packet of crisps). 2. Along shelf edging at the point of choice 3. On tent cards placed next to products 4. On menus (printed or electronic via email or screens) Intervention categories are defined as the target food and drink categories and products within those that receive the labels. This will depend on discussions with cafeteria managers and catering companies but will likely include the following: main meals (the meat or vegetarian principal element of a meal), sides (carbohydrate-rich portions, e.g. chips), sandwiches (including sandwiches, paninis, wraps, bread rolls), desserts (hot desserts, e.g. crumbles; dessert pots, e.g. yoghurt, cheesecake, mousse, jelly, granola; and sliced cake), bakery (e.g. freshly made cakes, muffins, cookies; pre-packed croissants and flapjacks), savoury snacks (e.g. crisps), confectionery (e.g. chocolate bars, sweets), and cold drinks (including soft drinks, e.g. can of coke, bottle of water). Items that are unlikely to receive the interventions are those which are not sold through the till system (such as products in vending machines) and those for which energy content is not available. |
| Intervention type | Behavioural |
| Primary outcome measure | Total energy (kcal) purchased from intervention categories per day after controlling for the total transactions. Total energy purchased is calculated from the total number of sales for all items within the intervention categories and the total number of calories for each of these items. Sales data are recorded using electronic tills every day of operation during the trial (i.e., until the end of week 12). Transactions are defined as the number of unique payments to purchase products in the cafeteria, whereas sales are defined as the total number of individual products that are sold in the cafeteria. |
| Secondary outcome measures | 1. Total energy (kcal) purchased per day from i. non-intervention food and drink categories, and ii. all food and drink products. Total energy purchased is calculated from the total number of sales and the total number of calories for each of these items. These data will be collected using the electronic tills for every day of operation for all cafeterias during the length of the trial (i.e., until the end of week 12) 2. Total revenue from each cafeteria. This is calculated from the number of all items sold in the cafeterias and the price of each of these items. These data will be collected using the electronic tills for every day of operation for all cafeterias during the length of the trial (i.e., until the end of week 12) |
| Overall study start date | 01/04/2020 |
| Completion date | 29/06/2021 |
Eligibility
| Participant type(s) | Other |
|---|---|
| Age group | All |
| Sex | Both |
| Target number of participants | 10 worksites. Participant-level data are not being collected. |
| Key inclusion criteria | The researchers are not using individual-level data but are using anonymous transaction-level data for each cafeteria. This means that data from any people using the worksite cafeterias will be included. Consent for participation is obtained at the site level. The inclusion criteria for the worksite cafeterias are: 1. The cafeteria must cater to a workforce greater than 500 2. Having electronic point of sale (EPOS) tills that record sales data 3. Being able to provide kcal information for all food and drink being sold 4. An absence of existing calorie labels (not including nutritional information on branded packaging) |
| Key exclusion criteria | Worksites not meeting the inclusion criteria |
| Date of first enrolment | 04/04/2021 |
| Date of final enrolment | 05/04/2021 |
Locations
Countries of recruitment
- England
- United Kingdom
Study participating centre
Robinson Way
Cambridge
CB2 0SR
United Kingdom
Sponsor information
University/education
Trinity Lane
Cambridge
CB2 1TN
England
United Kingdom
| Phone | +44 (0)1223 769291 |
|---|---|
| researchgovernance@medschl.cam.ac.uk | |
| Website | https://www.cam.ac.uk |
"ROR" |
https://ror.org/013meh722 |
Funders
Funder type
Research organisation
Private sector organisation / Trusts, charities, foundations (both public and private)
- Alternative name(s)
- Wellcome, WT
- Location
- United Kingdom
Results and Publications
| Intention to publish date | 01/06/2022 |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Not expected to be made available |
| Publication and dissemination plan | The full protocol and statistical analysis plan will be uploaded to the Open Science Framework. The results of this research will be written up and submitted to a peer-reviewed, open-access journal and may be presented at professional research conferences. The researchers will also prepare a lay summary. It is possible that the Company involved will wish to make the information available to their customers in a simplified format. |
| IPD sharing plan | The data will not be made freely available as this is proprietary data provided in confidence from a business. The data will be stored on secure servers by the research team. |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Results article | Primary data | 08/11/2022 | 09/11/2022 | Yes | No |
| Protocol (other) | 10/04/2024 | No | No |
Editorial Notes
10/04/2024: Link to protocol file added.
09/11/2022: Publication reference added.
30/03/2021: The participant information sheet has been uploaded.
24/03/2021: Trial's existence confirmed by Cambridge Psychology Research Ethics Committee.
