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Rural Health Information Hub

Rural Restaurant Healthy Options Program

  • Need: Obesity is a widespread epidemic in the United States, especially in rural areas. Due to small profit margins and fear of losing customers, small owner-operated rural restaurants hesitate to make health-conscious changes to their menus.
  • Intervention: The Healthy Options Program offered an economical and low-maintenance program for owner-operated restaurants in Iowa to increase awareness of already existing healthy menu options and substitutions.
  • Results: Restaurants received positive feedback and experienced no financial loss. Customers noticed and appreciated the healthy option reminders, and ordering behavior improved.


Effective (About evidence-level criteria)


To raise awareness of obesity and encourage healthier lifestyle choices, the University of Iowa Prevention Research Center for Rural Health implemented a Healthy Options Program in small owner-operated rural restaurants in Iowa. This low-maintenance program provided an easy and cost-effective way of increasing awareness of already existing healthy menu options through table signs and posters. The feedback received was positive, as customers appreciated the display of healthy alternatives.

Services offered

Participating restaurants allowed table signs to be placed and optional window signs to be displayed. A press release template was available for local newspapers.


Based on a follow-up survey given to customers at various points throughout the implemented program:

  • Customers appreciated the reminders to eat healthy.
  • The table signs remained noticed 70% of the time.
  • Customers' ordering behavior was influenced 34% of the time.
  • Customers reported that their ordering behavior changes often included smaller portion sizes, healthier salad dressing and main course choices, and the addition of a side salad.
  • Those who were attempting to lose weight were more likely to utilize the signs when deciding what to order.

Interviews with restaurant owners and wait staff showed that the program and study measures did not disturb or negatively impact the restaurant's atmosphere or business.

The CDC lists the Rural Restaurant Healthy Options Program as a Prevention Research Center Tool Showing Evidence of Effectiveness.

For more detailed program results:

Nothwehr, F., Haines, H., Chrisman, M., & Schultz, U. (2014). Statewide Dissemination of a Rural, Non-Chain Restaurant Intervention: Adoption, Implementation and Maintenance. Health Education Research, 29(3), 433-441.

Nothwehr, F.K., Snetselaar, L., Dawson, J., & Schultz, U. (2013). Promoting Healthy Choices in Non-Chain Restaurants: Effects of a Simple Cue to Customers. Health Promotion Practice, 14(1), 132-138.

Nothwehr, F., Snetselaar, L., Dawson, J.D., Hradek, C., & Sepulveda, M. (2010). Healthy Option Preferences of Rural Restaurant Customers. Health Promotion Practice, 11(6), 828-836.


Some restaurant owners were not interested in joining the program, believing that they had no healthy options available or that their customers would not like it. However, study results showed that customers appreciated the program even if they did not make healthy choices at that time.


Due to the standardization of chain restaurants and federal law requirements for larger chains to post nutritional information, this program is catered toward and will get a warmer response from owner-operated, non-chain restaurants.

For more information, please read Tips for Enrolling Participants in the Healthy Options Program. Options for where to purchase the table sign holders and laminated posters are listed as well.

Contact Information

Heidi Haines, MS, Center Coordinator
University of Iowa Prevention Research Center for Rural Health
Healthy Options Program

Food security and nutrition
Wellness, health promotion, and disease prevention

States served

Date added
September 5, 2014

Date updated or reviewed
September 8, 2022

Suggested citation: Rural Health Information Hub, 2022. Rural Restaurant Healthy Options Program [online]. Rural Health Information Hub. Available at: [Accessed 31 May 2023]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.