The University of Cincinnati, UC Health, Cincinnati Children’s and Kroger have partnered to help study how to make healthcare more accessible to consumers in a first-of-its-kind clinical trial designed to improve health outcomes through retail-based dietary interventions.
The Supermarket and Web-based Intervention Targeting Nutrition (SuperWIN) study is a partnership years in the making to improve the quality of food purchases. Results of the study showed improved adherence to the Dietary Approaches to Stop Hypertension, or DASH, diet. The SuperWIN trial is the latest evidence supporting how retailers, like Kroger, serve as an important healthcare destination by leveraging food and nutrition education to support the health and wellbeing of shoppers.
The study population was 247 UC Health Primary Care patients with at least one cardiovascular risk factor: obesity, hypertension and/or hypercholesterolemia. After meeting with a UC Heath primary care physician, patients completed a medical nutrition therapy visit with a Kroger Health dietitian. Patients who screened as eligible to participate in the study were then randomized into one of the three study arms.
“SuperWIN is probably the most scientifically rigorous study of a comprehensive healthcare intervention ever conducted with the retail industry,” says Dylan Steen, MD, of the Division of Cardiovascular Health and Disease at the UC College of Medicine and a UC Health cardiologist. “Grocery purchasing data is progressively being linked to nutrition information and thus could be used by dietitians, nurses, pharmacists, and physicians to provide the best, individualized guidance to patients.”
“Kroger Health is proud of our partnership with the University of Cincinnati and the SuperWIN trial,” says Bridget Wojciak, Director of Nutrition, Kroger Health. “We are striving every day to elevate the grocery store as a destination for preventive healthcare. Our Food as Medicine strategy is a dedicated, educated, and personalized approach to eating and enjoying food to prevent illness before it starts, and this study has shown that our strategy works.”
The study participants were provided a new Kroger loyalty card and randomized into three separate groups- control, Strategy 1, and Strategy 2. All three groups started with a medical nutrition therapy visit delivered by a Kroger Health dietitian at each participant’s preferred Kroger shopping location. The control group received no further education. In the Strategy 1 and Strategy 2 groups, participants received six additional in-store, personalized food product-directed education visits delivered by a Kroger Health dietitian. At the beginning of every Strategy 1 and Strategy 2 visit, the dietitian reviewed with their participant updated purchasing reports provided by the study in order to guide the visit.
“The participants were taught to shop better, right in the aisles of their home stores, based off each individual’s unique tastes and needs,” says Steen.
In addition, participants in the Strategy 2 group were introduced in a stepwise fashion to new technologies to support healthier purchases. These included Kroger.com for online shopping, home grocery delivery by The Grocery Runners, OptUP for simplifying making healthier purchases, and Yummly for healthier recipes and meal planning.
“Retail dietitians have expertise in showing customers the best food products to manage different diseases like diabetes and cardiovascular disease,” says Sarah Couch, PhD, of the Department of Rehabilitation, Exercise and Nutrition Science in the UC College of Allied Health Sciences, who designed the dietary portion of SuperWIN.
“The DASH diet has been well researched and shown to help lower blood pressure and modify lipids and to help with weight loss if it's calorically controlled in adults,” she says. “We know it works but getting people to change their diet to comply and keep following this dietary pattern long term has really been a challenge nationally.”
“Patients with cardiovascular risk linked to dietary choices face enormous challenges,” says Bernard Lenchitz, MD, professor in the UC College of Medicine Department of Internal Medicine, and vice president of the UC Health Primary Care Network. “This landmark study clearly demonstrates that retail-based interventions augment traditional office-based primary care.”
The results of the study showed on average, participants in both Strategies 1 and 2 who engaged with a Kroger Health dietitian for in-aisle education and shopping practice had a greater increase in their adherence to a DASH diet than the control group. Participants who were also introduced and trained on new technologies, Strategy 2, had an even greater increase in adherence to the DASH diet than those who did not receive this training.
Online shopping, grocery delivery and the use of nutrition and healthcare applications are rapidly rising globally. Steen says there are many reasons why these tools could improve the healthfulness of food purchases.
“SuperWIN provides evidence of the efficacy of incorporating online training and tools to improve dietary quality,” he says. “Scientific organizations have been calling for research to determine whether these technologies can help us address some of the major public health barriers around improving nutrition, both in high and low-income communities. For some patients with physical limitations preventing travel to a grocery store, these services will likely make it easier for them to follow the very specific dietary recommendations that are essential to managing their chronic conditions and improving their quality of life.”
Cincinnati Children’s oversaw the data management, statistical analysis, and interpretation of study results through faculty and staff in the Division of Biostatistics and Epidemiology. This included overall study design, database builds, data cleaning, interactive web-based reports for participants to review purchases and food intake, and modeling to test primary and secondary hypotheses. The Bionutrition core of the Schubert Research Clinic conducted dietary intake interviews with participants prior to the study and again after three and six months. Data collected from those interviews were used to estimate participants’ usual food and nutrition intake and, ultimately, determine whether or how these measures changed by the end of the study.
Couch says she’s confident that the SuperWIN results can make a true impact on the nation’s health because it is all about educating consumers and providing them with the necessary skills to make healthy food choices.
“Shoppers need to know how to select healthful products by learning how to read labels and what to look for when comparing products,” she said. “They need to understand how to plan their meals because meal planning is so essential to helping people stick to a plan. Also, once they get the food home, they need to know how to prepare that food to be most healthful. All the elements of food literacy were woven into the intervention design and that relates to giving people the knowledge and skills about the food they eat to enable them to comply with a healthy dietary pattern like DASH.”
Steen says the results of SuperWIN have laid the foundation for new era of research between independent academic researchers and retailers.
“Dietary interventions could be studied across larger populations. Telenutrition visits could be added to in-person visits. There are many possibilities,” he says. “It is important to note that dietary education visits could be combined with retail-based pharmacy visits. These interventions, individually or together, could be tailored to almost any chronic disease.”
“A transition to value-based care is urgently needed’” says Steen. “Retail-based interventions, like those studied in SuperWIN, can be integrated into clinical care provided by primary care clinicians and specialists to support this transition. We already know that consumers want high-quality healthcare with greater convenience, access, and lower costs. If you ask yourself how we, as a society, are going to extend the reach of healthcare beyond hospitals and traditional medical settings, it becomes readily apparent that this is the most promising path forward.”