Changing Physical Environments

Our work on changing physical environments:

Here at the BHRU, we study ways in which we can alter the characteristics of the physical environments around us (or choice architecture) to shape our behaviour in a healthier direction.

Why is this important?

These kinds of interventions share some common features suggesting untapped potential for changing population health behaviour:

  • They can influence many people at once because they involve changing environments that many people are exposed to.
  • They do not typically rely on educational or persuasive messages that need to be thought about and so can influence people who do not have the time or inclination to engage with such messages.

Click on the images below to find out more about the work we have been doing in this area:

Key studies:

  • Should we change the number of less healthy food options available rather than the number of healthier options?

    Cues in our environments shape our behaviour, but little research has addressed whether healthier food cues have a similar impact to less healthy food cues. This online study examined the impact on food selection of the number of (i) healthier and (ii) less healthy snack foods available. UK adults (n=1,509) chose the food they would most like to eat from: (a) two healthier and two less healthy foods, (b) six healthier and two less healthy foods, or (c) two healthier and six less healthy foods. Compared to being offered two healthier and two less healthy options, the odds of choosing a healthier option were twice as high with four additional healthier options, while the odds of choosing a less healthy option were four times higher with four additional less healthy options. This suggests that less healthy food cues can have a larger effect than healthier ones. Consequently, removing less healthy as opposed to adding healthier food options could have greater impact on encouraging healthier selections.

    Availability of healthier vs. less healthy food and food choice: an online experiment. Pechey, R., & Marteau, T. M. BMC Public Health

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  • Can the shape of a glass impact on how fast we drink?

    Previous studies suggest that glassware design may influence drinking behaviour, however it remains unclear whether these effects are limited to alcohol, and what the underlying mechanisms are. This study investigated the effect of glass shape on total drinking time for a soft drink, using inward-sloped, straight-sided, and outward-sloped tumblers. We explored two sets of underlying mechanisms: micro-drinking behaviours (e.g. sip size), and perceptual effects (e.g. volume judgments).

    Drinking was ~20% faster from outward-sloped glasses than straight-sided ones. This extends previous research, suggesting glass shape may influence drinking speed for a soft drink. Though glass shape influences ability to judge volume (perceptual effects), we found no evidence that this related to drinking speed. Changes in the micro-structure of drinking (e.g. sip size) may be important in driving the effect of glass shape on drinking speed, and future studies, powered to test these mechanisms, are warranted.

    Impact of glass shape on time taken to drink a soft drink: A laboratory-based experiment. Langfield T, Pechey R, Pilling M, Marteau TM. PLOS ONE, 2018.
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  • What is the potential impact of calorie labelling in worksite cafeterias? A pilot study

    Reducing excess consumption of food and drink is core to tackling the high prevalence of overweight and obesity in the UK and elsewhere. Here we provide the results of a pilot trial estimating the potential impact of calorie labelling on energy purchased across six worksite cafeterias.

    Post-intervention feedback amongst cafeteria patrons and worksite managers and caterers suggested high levels of acceptability. Several barriers to intervention implementation were identified. The predicted effect of labelling to reduce energy purchased was only evident at one out of six sites studied. Before progressing to a full trial, we propose that the calorie labelling intervention needs to be optimised, and a number of operational issues resolved.

    Impact of calorie labelling in worksite cafeterias: a stepped wedge randomised controlled pilot trial. Vasiljevic M, Cartwright E, Pilling M, Lee M-M, Bignardi G, Pechey R, Hollands GJ, Jebb SA, Marteau TM, 2018

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  • What is the potential impact of reducing portion sizes in worksite cafeterias?

    Reducing the portion sizes of foods available in restaurants and cafeterias is one promising approach to reducing energy intake, but there is little evidence of its impact from randomised studies in field settings. In this paper, we provide the results of a pilot trial estimating the potential impact of reducing portion sizes of targeted foods in worksite cafeterias. Feedback after the intervention suggested it was broadly acceptable to customers and cafeteria staff. Each of the six cafeterias showed a reduction in daily energy purchased from intervention categories, but the overall reduction across all sites of 8.9% was not statistically significant. The results of this trial suggest that reducing portion sizes could be effective in reducing energy purchased from targeted food categories, but also that future studies will need to address factors that prevented optimal implementation, including site dropout and only reducing portion sizes of a limited range of products.


    Impact of reducing portion sizes in worksite cafeterias: a stepped wedge randomised controlled pilot trial. Hollands GJ, Cartwright E, Pilling M, Pechey R, Vasiljevic M, Jebb SA, Marteau TM, 2018

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  • The TIPPME intervention typology for changing environments to change behaviour

    Reflecting interest in concepts of ‘nudging’ and ‘choice architecture’, there is increasing research and policy attention on altering aspects of the small-scale physical environment, such as portion sizes or product positioning, to change health-related behaviour. In a new paper, published in Nature Human Behaviour, we introduce a new framework we have developed: the Typology of Interventions in Proximal Physical Micro-Environments (TIPPME).

    This provides a way to classify and describe an important class of interventions to change selection, purchase and consumption of food, alcohol and tobacco. This has the potential to benefit both researchers and policymakers through facilitating both the synthesis of cumulative evidence about the effects of interventions (including clearer reporting), and the identification and discussion of a broader range of interventions to be developed and evaluated.

    The TIPPME intervention typology for changing environments to change behaviour. Hollands GJ, Bignardi G, Johnston M, Kelly MP, Ogilvie D, Petticrew M, Prestwich A, Shemilt I, Sutton S, Marteau TM

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  • Understanding interventions that change behaviour outside of conscious awareness

    In a paper published in Health Psychology Review, we have proposed a framework for describing or categorising interventions to change behaviour by the degree to which their effects may be considered non-conscious. This is important because unhealthy behaviours often occur directly in response to environmental cues outside of conscious awareness, meaning that interventions that target non-conscious rather than conscious processes may have significant potential to shape healthier behaviours and improve health. However, examining this key premise requires a practicable conceptual framework that can be used to better describe and assess these interventions. This paper builds on a previous analysis by the same authors highlighting the importance of targeting automatic processes to change behaviour, published in Science in 2012.

    Non-conscious processes in changing health-related behaviour: a conceptual analysis and framework. Hollands, Marteau, & Fletcher.

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  • Can portion, package and tableware size increase consumption?

    shutterstock_41447758.jpgOur systematic review has produced the most conclusive evidence to date that people consistently consume more food and drink when offered larger-sized portions, packages or tableware than when offered smaller-sized versions.

    The size of this effect, based on combining data from 61 randomised controlled trials (6,711 participants), suggests that if sustained reductions in exposure to large sizes could be achieved across the whole diet, this could reduce average daily energy consumed from food by up to 16% (279 kcals) among UK adults.


    Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Hollands, Shemilt, Marteau, Jebb, Lewis, Wei, Higgins & Ogilvie. 2015.

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    • To view Cochrane UK coverage of this Cochrane review in the ‘Evidently Cochrane’ blog (from 15/09), click here.
    • To join the Twitter conversation about this Cochrane review, follow: @BHRUCambridge and #PortionSize
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  • What are the ways we can change the physical environments around us to change behaviour?

    PrintWe conducted a large-scale systematic scoping review of evidence for the effects on diet, physical activity, alcohol and tobacco use of a wide range of physical environment (choice architecture) interventions, in settings such as restaurants, shops and workplaces. We were then able to map the existing evidence and identify important gaps in what we know to inform future research.

    Altering micro-environments to change population health behaviour: towards an evidence base for choice architecture interventions. Hollands, Shemilt, Marteau, Jebb, Kelly, Nakamura, Suhrcke & Ogilvie. 2013.

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  • Do supermarket end-of-aisle displays affect sales of drinks?

    white wine in bottles in wine shopEnd-of-aisle displays are often used by supermarkets to promote sales. We found from our study that:

    • Putting drinks on end-of-aisle displays increases sales of both alcoholic and non-alcoholic drinks. For alcohol, this sales increase was similar to 4–9% decrease in price.
    • Limiting the use of aisle ends for alcohol and other less healthy products could be an effective way of increasing the healthiness of our weekly shopping.


    Sales impact of displaying alcoholic and non-alcoholic beverages in end-of-aisle locations: An observational study. Nakamura, Pechey, Suhrcke, Jebb & Marteau, 2014.

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Publications related to physical environment interventions (choice architecture):