Removing seasonal confectionery from prominent store locations and purchasing behaviour within a major UK supermarket: Evaluation of a nonrandomised controlled intervention study

Background: The proportion of energy from free sugars and saturated fat currently exceeds the UK-recommended intake across all age groups. Recognising the limits of reformulation programmes, the government in England has announced their intention to introduce legislation to restrict the promotion of foods high in free sugars, salt, and saturated fats in prominent store locations. Here, we evaluated a grocery store intervention to remove seasonal confectionery from prominent locations within a major UK supermarket. Methods and findings: A nonrandomised controlled intervention study with interrupted time series (ITS) analysis was used. Data were analysed from 34 intervention stores located in 2 London boroughs and 151 matched control stores located elsewhere in the UK owned by the same retailer. Stores were matched based on store size and overall sales during the previous year. Between 15 February 2019 and 3 April 2019 (before Easter), stores removed free-standing promotional display units of seasonal confectionery from prominent areas, although these products were available for purchase elsewhere in the store. Store-level weekly sales (units, weight (g), and value (£)) of seasonal chocolate confectionery products were used in primary analyses, with data from 1 January 2018 to 24 November 2019. Secondary outcomes included total energy, fat, saturated fat, and sugars from all in-store purchases. Multivariable hierarchical models were used to investigate pre/post differences in weekly sales of confectionery in intervention versus control stores. ITS analyses were used to evaluate differences in level and trends after intervention implementation. Over a preintervention baseline period (15 February 2018 to 3 April 2018), there were no significant differences in sales (units, weight, and value) of all chocolate confectionery between intervention versus control stores. After intervention implementation, there was an attenuation in the seasonal increase of confectionery sales (units) in intervention stores compared to control (+5% versus +18%; P < 0.001), with similar effects on weight (g) (+12% versus +31%; P < 0.001) and value (£) (−3% versus +10%; P < 0.001). ITS analyses generally showed statistically significant differences in the level at the point of intervention (P ranges 0.010 to 0.067) but also in the trend afterwards (P ranges 0.024 to 0.053), indicating that the initial difference between intervention and control stores reduced over time. There was a significant difference in level change in total energy sold, adjusted for the total weight of food and drink (kcal/g, P = 0.002), and total fat (fat/g) (P = 0.023), but no significant changes in saturated fat or sugars from total sales in ITS models. There was no evidence that the main results varied across store deprivation index. The limitations of this study include the lack of randomisation, residual confounding from unmeasured variables, absolute differences in trends and sales between intervention versus control stores, and no independent measures of intervention fidelity. Conclusions: Removal of chocolate confectionery from prominent locations was associated with reduced purchases of these products, of sufficient magnitude to observe a reduction in the energy content of total food purchases. These results from a “real-world” intervention provide promising evidence that the proposed legislation in England to restrict promotions of less healthy items in prominent locations may help reduce overconsumption. Trial registration: https://osf.io/br96f/

Comparison of Three Dietary Assessment Methods to Estimate Meat Intake as Part of a Meat Reduction Intervention among Adults in the UK

Food diaries are used to estimate meat intake at an individual level but it is unclear whether simpler methods would provide similar results. This study assessed the agreement between 7 day food diaries in which composite dishes were disaggregated to assess meat content (reference method), and two simpler methods: (1) frequency meal counts from 7 day food diaries; and (2) 7 day dietary recalls, each using standard estimated portion sizes. We compared data from a randomized controlled trial testing a meat reduction intervention. We used Bland-Altman plots to assess the level of agreement between methods at baseline and linear mixed-effects models to compare estimates of intervention effectiveness. At baseline, participants consumed 132 g/d (±75) of total meat; frequency meal counts and dietary recalls underestimated this by an average of 30 and 34 g/day, respectively. This was partially explained by an underestimation of the assumed portion size. The two simpler methods also underestimated the effect of the intervention, relative to control, though the significant effect of the intervention was unchanged. Simpler methods underestimated absolute meat intake but may be suitable for use in studies to measure the change in meat intake in individuals over time

Effect of increasing the price of sugar-sweetened beverages on alcoholic beverage purchases: an economic analysis of sales data.

BACKGROUND: Taxing soft-drinks may reduce their purchase, but assessing the impact on health demands wider consideration on alternative beverage choices. Effects on alcoholic drinks are of particular concern, as many contain similar or greater amounts of sugar than soft-drinks and have additional health harms. Changes in consumption of alcoholic drinks may reinforce or negate the intended effect of price changes for soft-drinks. METHODS: A partial demand model, adapted from the Almost Ideal Demand System, was applied to Kantar Worldpanel data from 31 919 households from January 2012 to December 2013, covering drink purchases for home consumption, providing ~6 million purchases aggregated into 11 groups, including three levels of soft-drink, three of other non-alcoholic drinks and five of alcoholic drinks. RESULTS: An increase in the price of high-sugar drinks leads to an increase in the purchase of lager, an increase in the price of medium-sugar drinks reduces purchases of alcoholic drinks, while an increase in the price of diet/low-sugar drinks increases purchases of beer, cider and wines. Overall, the effects of price rises are greatest in the low-income group. CONCLUSION: Increasing the price of soft-drinks may change purchase patterns for alcohol. Increasing the price of medium-sugar drinks has the potential to have a multiplier-effect beneficial to health through reducing alcohol purchases, with the converse for increases in the price of diet-drinks. Although the reasons for such associations cannot be explained from this analysis, requiring further study, the design of fiscal interventions should now consider these wider potential outcomes.Funding - This study was funded by the UK Department of Health Policy Research Programme (107/0001-Policy Research Unit in Behaviour and Health). LC is funded by an MRC fellowship grant MR/L012324/1. The views expressed in this article are those of the authors and not necessarily those of the UK Department of Health. The UK Department of Health had no role in the writing of the manuscript but approved the decision to submit the manuscript for publication

Downsizing: policy options to reduce portion sizes to help tackle obesity.

The worldwide prevalence of obesity and overweight has risen substantially over the past three decades with no country yet achieving a reduction.1 International and national ambitions to “end childhood obesity”2 and “reduce non-communicable diseases by 25% by 2025”3 are unmatched by policiesthat could realise them. The causes of obesity are complex but overconsumption of food and sugary drinksis a critical proximal determinant, driven in part by large portion sizes. The importance of developing interventions and policies to reduce the size, availability, and appeal of large portionsis underscored by the compelling evidence that people eat and drink more from larger portions

Effectiveness of an Online Programme to Tackle Individual’s Meat Intake through SElf-regulation (OPTIMISE):A randomised controlled trial

Purpose A reduction in meat intake is recommended to meet health and environmental sustainability goals. This study aimed to evaluate the effectiveness of an online self-regulation intervention to reduce meat consumption. Methods One hundred and fifty one adult meat eaters were randomised 1:1 to a multi-component self-regulation intervention or an information-only control. The study lasted 9 weeks (1-week self-monitoring; 4-week active intervention; and 4-week maintenance phase). The intervention included goal-setting, self-monitoring, action-planning, and health and environmental feedback. Meat intake was estimated through daily questionnaires in weeks 1, 5 and 9. The primary outcome was change in meat consumption from baseline to five weeks. Secondary outcomes included change from baseline to nine weeks and change in red and processed meat intake. We used linear regression models to assess the effectiveness of all the above outcomes. Results Across the whole sample, meat intake was 226 g/day at baseline, 118 g/day at five weeks, and 114 g/day at nine weeks. At five weeks, the intervention led to a 40 g/day (95%CI − 11.6,− 67.5, P = 0.006) reduction in meat intake, including a 35 g/day (95%CI − 7.7, − 61.7, P = 0.012) reduction in red and processed meat, relative to control. There were no significant differences in meat reduction after the four-week maintenance phase (− 12 g/day intervention vs control, 95% CI 19.1, − 43.4, P = 0.443). Participants said the intervention was informative and eye-opening. Conclusion The intervention was popular among participants and helped achieve initial reductions in meat intake, but the longer-term reductions did not exceed control. Trial registration ClinicalTrials.gov NCT04961216, 14th July 2021, retrospectively registered

Evaluation of OPTIMISE (Online Programme to Tackle Individual’s Meat Intake Through Self-regulation): Cohort Study

BACKGROUND: There is an urgent need to reduce society’s meat consumption to help mitigate climate change and reduce noncommunicable diseases. OBJECTIVE: This study aimed to investigate changes in meat intake after participation in an online, multicomponent, self-regulation intervention. METHODS: We conducted a pre-post observational study among adult meat eaters in the United Kingdom who signed up to a website offering support based on self-regulation theory to reduce meat consumption. The program lasted 9 weeks (including a 1-week baseline phase, a 4-week active intervention phase, and a 4-week maintenance phase), comprising self-monitoring, goal setting, action planning, and health and environmental feedback. Meat intake was estimated during weeks 1, 5, and 9 using a 7-day meat frequency questionnaire. We analyzed the change in mean daily meat intake from baseline to week 5 and week 9 among those reporting data using a hierarchical linear mixed model. We assessed changes in attitudes toward meat consumption by questionnaire and considered the acceptability and feasibility of the intervention. RESULTS: The baseline cohort consisted of 289 participants, of whom 77 were analyzed at week 5 (26.6% of the baseline sample) and 55 at week 9 (71.4% of the week 5 sample). We observed large reductions in meat intake at 5 and 9 weeks: –57 (95% CI –70 to –43) g/day (P<.001) and –49 (95% CI –64 to –34) g/day (P<.001), respectively. Participants’ meat-free self-efficacy increased, meat-eating identities moved toward reduced-meat and non–meat-eating identities, and perceptions of meat consumption as the social norm reduced. Participants who completed the study reported high engagement and satisfaction with the intervention. CONCLUSIONS: Among people motivated to engage, this online self-regulation program may lead to large reductions in meat intake for more than 2 months, with promising signs of a change in meat-eating identity toward more plant-based diets. This digital behavior change intervention could be offered to complement population-level interventions to support reduction of meat consumption