If Office Cafeterias Comply with U.S. Nutrition Standards, It Could Save Millions in Health Care Spending

New research from the Friedman School of Nutrition at Tufts and the Harvard T.H. Chan School of Public Health suggests that government and private sector cafeterias that comply with basic nutritional guidelines provided by the U.S. government for cafeterias can improve the health of the employees who eat lunch there—and save hundreds of millions in health care dollars, as well.

The voluntary Federal Food Service Guidelines (FFSG), released in 2011, call for more fruits, vegetables, and whole grains, and less processed meat, sodium, and sugar-sweetened beverages, in cafeteria offerings. Cafeterias are also recommended to provide nutrition education and use choice architecture in the layout of their offerings to nudge consumers to make healthier food choices. However, these guidelines have generally not been implemented in most government or private sector cafeterias.

The new research, published in the Journal of Public Health Policy, concluded that over a lifetime, $212 million in health care costs can be saved among 15 million government employees eating in cafeterias following FFSG standards. Savings come mainly from reductions in the costs of treating major diet-related diseases such as heart disease and diabetes. 

The intervention was also estimated to produce lifetime reductions in heart attacks (107/million employees); strokes (30/million); diabetes (134/million) ischemic heart disease deaths (56/million); and stroke deaths (8/million) among U.S. government workers. 

If the FFSG were implemented in private sector cafeterias, the research estimated an additional lifetime savings of $540 million in health care costs among the 39 million private sector employees eating in cafeterias.

“With diet-related diseases like diabetes and obesity as common and as costly as they are, we need to be using all the tools at our disposal to improve health and reduce health care spending,” says Dariush Mozaffarian, dean of the Friedman School of Nutrition Science and Policy at Tufts and one of the study’s co-authors. “This research suggests that implementing the voluntary Federal Food Service Guidelines across U.S. cafeterias would save lives, while creating costs savings far larger than the cost of implementing the guidelines themselves. These gains are seen even though most Americans eat a relatively small number of meals from their workplace cafeterias. Overall, this is a win for the government or private employers, the employees, and society.”

Co-authors of the study include first author Shafika Abrahams-Gessel and senior author Thomas Gaziano, both Brigham and Women's Hospital researchers; and at Tufts, senior author and Adjunct Professor Renata Micha, Professor Parke Wilde, Associate Professor Fang Fang Zhang, and Junxiu Liu, a former postdoctoral fellow at the Friedman School; Mengyuan Ruan, a research analyst at Tufts University School of Medicine; and researchers from the National Institutes of Health and Myongji University.

About 1 in 4 employed adults in the U.S. consume food and beverages obtained at their workplace during the week, averaging about two meals per week. To reach their cost-saving conclusions, the researchers used a validated modeling system to examine dietary intake data collected through surveys administered through the NHANES program, a national research project that for decades has surveyed a representative sample of about 5,000 people in 15 different counties across the U.S. each year. Each participant is carefully chosen for demographics that are representative of approximately 65,000 others in the country like them.  Through a sophisticated, validated microsimulation model, the researchers took the survey data provided by NHANES participants to make accurate predictions about much larger populations.

For this study, the scientists used the NHANES data collected from full-time local, state, and federal employees aged 35-65 working at least 35 hours per week between 2009-2016.  The researchers also examined a second population of private sector workers, using similar methods.

“The City of New York has recently instituted new mandatory nutrition standards for all foods purchased by the city, which will improve the quality of over 200 million meals served per year,” said Mozaffarian.  “This highlights the timeliness of our new research, which suggests meaningful benefits if other cities, states, and private employers implemented similar guidelines.”