Baltimore, Maryland - A pilot program designed to encourage mom and pop carryout shops in Baltimore to promote and sell healthier menu items not only improved eating habits, but also increased the stores’ gross revenue by an average 25 percent, new Johns Hopkins Bloomberg School of Public Health research found.

A key finding, published in the July/August issue of the American Journal of Health Promotion, is that not only were healthier options expanded in low-income, African-American neighborhoods, but that storeowners actually made money selling these foods — which the researchers say should make it easier to convince more carryouts to alter their menus.

“We can now tell carryout owners that it can be profitable to offer a wider variety of healthy foods in their stores,” says the study’s senior author Joel Gittelsohn, PhD, a professor in the Bloomberg School’s Department of International Health and a member of its Center for Human Nutrition and Global Obesity Prevention Center. “So it is not only good for the health of people living in their community, it’s also good for the bottom line.”

Americans consume more than one-third of their total calories away from home. A large proportion of these foods are purchased at fast-food restaurants and carryouts, and low-income people spend a larger proportion of their food dollars on these foods than high-income people. In many Baltimore neighborhoods where fresh food — and even fast food — is scarce, these small carryouts are a main source of meals for residents. Previous research suggests residents of Southwest Baltimore spent $280 a month at supermarkets and $153 at carryouts.

For their three-phase pilot program, beginning in February 2011, the researchers worked with eight carryouts in Baltimore: four were guided to make changes, while the other four were not. Seven of the eight provided enough data to be included in the analysis.

First, the researchers helped redesign the carryout menus, creating professional-looking laminated boards with large photos of the healthier options and a green leaf logo indicating healthy choices. They used the word “fresh” instead of “healthy” so as not to repel people who see healthy as a word with negative connotations of tastelessness.

Phase two included the introduction and promotion of healthy side dishes already on the menu (say, collard greens) and the introduction of new healthy sides (say, salads, yogurt or fruit) and beverages into the store. To assure storeowners that they wouldn’t take a financial loss if the items didn’t sell, initial stocks of the new items were provided free of charge to participating stores by the researchers

In the third phase, the researchers worked with carryout owners to add new healthy entrees (for example, grilled chicken instead of fried) to the menus and promoted healthy combo meals that were offered at a discount. They performed successful taste tests in the stores to promote new items.

Carryouts also started selling entrée salads after the side salads they promoted became popular. The entrée salads were assembled in stores using the ingredients they already had on hand for sandwiches, such as lettuce, tomatoes, cucumbers, onions, cheese and cold cuts, says study author Seung Hee Lee-Kwan, who earned her PhD at the Bloomberg School in 2013 and now works for the Centers for Disease Control and Prevention.

The researchers analyzed receipts covering 186,654 unit sales over the course of the study period in stores that made changes and those that did not. Increases in revenue at the participating stores began as early as the menu redesign phase and were sustained for the duration of the eight-month study, the researchers say. Once healthy sides and beverages were promoted more heavily in the store, revenue from these healthy items increased by 62 percent. The increased revenue was the result of selling a greater number of healthy items than before.

“When we found these promising results, we were excited because programs like these can potentially improve diets and reduce the risk of obesity and other diet-related chronic diseases,” Lee-Kwan says.

The city of Baltimore has already shown interest in the findings. Modified versions of the program are being used in the city’s six indoor public markets, and in carryouts near 15 city recreation centers.

“Environmental Intervention in Carryout Restaurants Increases Sales of Healthy Menu Items in a Low-Income Urban Setting” was written by Seung Hee Lee-Kwan, PhD; Sara N. Bleich, PhD; Hyunju Kim, BA; Elizabeth Colantuoni, PhD; Joel Gittelsohn, PhD.

The research was supported by the Center for a Livable Future and the Baltimore Diabetes Research and Training Center.