The cost-of-living crisis is feeding the paradox of obesity and food insecurities in the UK

Investigating the mediating role of physical activity within the association between food insecurity and BMI

Food insecurity is linked with obesity and while the mechanisms behind this association are complex, lower levels of leisure-time physical activity in those with food insecurity may contribute to this. Individual-level factors (such as concerns of performing physical activity) may partly determine levels of physical activity within individuals with food insecurity, as such individuals may seek to minimise their levels of physical activity in order to preserve energy. Using the Food Insecurity Physical Activity Concerns Scale (FIPACS) (used to measure concerns of performing leisure-time physical activity, focusing on factors specific to food insecurity), the current study investigated whether the association between household food insecurity and body mass index (BMI) is explained by a mediation pathway of FIPACS scores and leisure-time physical activity. We also investigated whether the association between food insecurity and FIPACS scores is moderated by nutrition knowledge. Participants (N = 329, food insecure = 55) completed an online survey consisting of the FIPACS, the International Physical Activity Questionnaire long-form (IPAQ), the Diet, Disease, and Weight management sub-section of the General Nutrition Knowledge Questionnaire, a measure of diet quality, and self-reported BMI. Findings revealed that FIPACS scores and leisure-time physical activity did not mediate the association between food insecurity and BMI (b < 0.01, SE = 0.01). Additionally, nutrition knowledge did not moderate the association between food insecurity and FIPACS scores (b = -0.09, SE = 0.08). Findings suggest that concerns of performing physical activity in the context of food insecurity are unrelated to leisure-time physical activity, and that these two factors do not explain the association between food insecurity and BMI. Future research should investigate other factors in the link between food insecurity, physical activity, and BMI.

Diet and health inequalities: Connecting with vulnerable groups to address food insecurity-the DIO food project

The current cost-of-living crisis is disproportionately affecting families experiencing poverty and is likely to be amplifying existing dietary inequalities and challenges, such as food insecurity (FI). Government policies designed to address diet inequality in the UK have historically had minimal impact on population diet and health and may have even widened existing inequalities. Therefore, the effect of nutrition policies on those experiencing FI in the context of the current cost-of-living crisis needs to be better understood. The aim of the Diet and Health Inequalities (DIO Food) project is to work with early years, people living on a low income and retailers to generate opportune evidence-based research and commentary that will inform diet-related health inequalities policy and practice. DIO Food is related to the existing Food Insecurity in people living with Obesity (FIO Food) project, which consists of four interlinked work packages (WPs1-4). DIO Food consists of three interlinked work packages (WPs5-7), which enhance the scope of FIO Food, and are described in this article. WP5 addresses a paucity of research on maternal and infant food insecurity in the UK, by applying a qualitative research approach to capture parents' and carers' perceptions of the relationship between the food system and other influences impacting infant feeding practice, associated with the cost-of-living crisis. WP6 will conduct the first-ever cross-retailer independent evaluation of England's high fat, sugar and salt (HFSS) product placement legislation. Researchers will analyse store-level supermarket sales data provided by large UK retailers to produce sector-level insights into whether HFSS legislation reduced HFSS purchasing, improved the healthiness of retailer product portfolios, and was equitable across areas with different characteristics. WP7 will support WP5 and 6, by strengthening engagement with key stakeholders, including at-risk consumers and representatives of major supermarkets, and effectively translating research outcomes and stakeholder perspectives for policy and industry decision-makers.

Heating or eating? The framing of food and fuel poverty in UK news media

Amidst the cost-of-living crisis the UK news has been increasingly reporting of individuals "choosing between heating and eating," suggesting overlapping food and fuel poverty (FFP). The media plays a powerful role in establishing narratives, shaping political debates, and even influencing what societies regard as an "issue" or a "public health issue." Relying on framing theory, this media analysis seeks to better understand how FFP have been constructed relationally in the UK news and how surrounding public health messaging has been employed. Using the NexisLexis database, we searched for UK news articles about intersecting FFP published between January 2010 and April 2022. After double screening, relevant data were extracted from 185 articles and data fragments were coded and analysed. FFP-focused news largely gained momentum in late 2021 into 2022. Two frame categories - descriptive and prescriptive - of FFP were identified. Descriptive frames explained the experience of FFP as a: trade-off between goods (71% of articles), mutual cutback of goods (28%), or just poverty (income/monetary poverty) (1%). Prescriptive frames assigned blame or responsibility to: government (59% of articles), food/fuel industry (13%), community or charity organisations (12%), or individuals (3%). Relatively few (29%) articles linked FFP with health consequences, and none framed it as a health issue. The prominence of the trade-off frame in the UK news suggests that FFP is a crucial topic for the UK public that requires joint attention. Despite the prominence of the government responsibility framing, the frame lacks accompanying prescriptions of consistent, specific, targeted solutions. A public health frame in the UK news may address this gap by outlining potential evidence-based solutions and increasing capacity by appointing responsible actors to help prevent and address this issue.

Connected Food: First Steps for an Ambitious National Food Strategy

Background: The global food system faces growing pressure from population growth, climate change, wealth inequity, geo-political instability, and damage to the ecosystems on which our food supply depends. Fragmentation of the priorities and needs of food system stakeholders-citizens, food producers, food industries, governments-compounds the problem, with competing or misaligned interests increasing the risk of failure to adequately meet the needs of those that form, and are served, by the food system. Growing consensus on the need for transformative system level change to address the problems facing the food system is yet to be significantly reflected in strategic action. Methods: The national food strategy of the UK is offered as an exemplar to discuss the need to promote more coherent and ambitious visions of transformative change that acknowledge the complexity of the food system as a whole. We draw upon cross-sectoral experience to distil the needs, priorities, and key food system tensions that must be acknowledged to promote transformative systems change that equitably delivers healthy sustainable diets, contributes to a resilient global food system, and protects the environment. Results: Greater coherence, ambition, and consideration of the food system as a whole are needed if a UK national food strategy is to contribute to significant transformative change. Conclusions: To promote this, we advocate for (1) a food system digital twin to model and test potential food system interventions or legislation; (2) a citizens' forum to inform and co-develop a cohesive national food strategy; and (3) increased cohesion and integration of food system governance within government to drive a coherent, ambitious national food strategy.

Tackling diet inequalities in the UK food system: is food insecurity driving the obesity epidemic? (The FIO Food project)

By 2050 the number of adults living with obesity in the UK will rise with approximately one in four in the adult population. This rising trend is not equitable, with higher prevalence in socially disadvantaged groups. There is an apparent paradox of not being able to provide food for the family to eat, a feature of food insecurity and living with obesity. With the current cost-of-living crisis, there is a challenge to afford both food and fuel bills. Environmentally sustainable and healthy diets are proposed to improve public health and reduce the impact of the food system on the environment, while also improving diet quality. However, healthier foods tend to be nearly three times more expensive than unhealthy foods, and this provides a challenge for citizens on low incomes. In this review, we explore some of the evidence for solutions in the retail food environment to support the UK food system to be safe, nutritious, environmentally friendly and fair for all. We highlight the value of co-production in research, to give value and power to the lived experience to address these inequalities. Our multidisciplinary research approach within the FIO Food research grant will generate new insights into modifiable and potentially impactful changes to the UK food system, specifically for the retail food sector. We believe that the co-creation, design and delivery of research with those living with obesity and food insecurity will help to transform the UK food system for health and the environment in this vulnerable group.

The association between COVID-19 related income loss and diet quality: The mediating role of distress

The COVID-19 lockdowns saw many individuals lose income, experience distress and increase intake of foods that would typically be considered less 'healthy' (more processed and less fresh produce). Establishing whether there are direct and indirect links between these variables would be of benefit in preparing for similar future events but also has implications for the current global financial climate, where many are experiencing relative decreases in income. Adults in two locations (UK and Australia) (N = 917) completed online questionnaires to explore the impact of the first COVID-19 lockdown on their change in income, emotional wellbeing (depression, anxiety, stress, loneliness), resilience and diet quality. A structural equation model revealed that income loss was indirectly associated with diet quality via distress. As such, the greater the loss of income experienced, the more distress reported; distress was then directly associated with a less nutritious diet. This pattern of results existed when data from both countries were combined but also when they were modelled individually. Our findings indicate that where individuals experience a sudden reduction of income there are likely to be negative consequences for both mental and physical health. It is plausible that these findings would extend to other circumstances in which sudden loss of income may be experienced such as reductions in state social care, rising inflation and interest rates and sudden increases to the general cost of living.

Nutrients or processing? An analysis of food and drink items from the UK National Diet and Nutrition Survey based on nutrient content, the NOVA classification and front of package traffic light labelling

UK front of package labelling (FOPL) informs consumers on the nutrient content of food. However, FOPL does not consider food processing, and with the UK government being urged to act on ultra-processed food (UPF), whether UPF should be added to FOPL is unclear. This study compared food and drink in the UK National Diet and Nutrition Survey (NDNS) Intake24 database based on FOPL, nutrient content and NOVA classification, to understand whether UPF are covered by dietary recommendations for foods high in fat, salt and sugar. NDNS items were coded into minimally processed food (MPF), processed culinary ingredients, processed food and UPF according to the NOVA classification and FOPL traffic lights. UPF contained greater energy, fat, saturated fat (SF), total sugar (TS) and salt than MPF. UPF had a greater odds of containing red FOPL and an unhealthier overall FOPL score (OR:4·59 (95 % CI: 3·79, 5·57); OR:7·0 (95 % CI: 6·1, 8·2), respectively) and lower odds of containing green FOPL (OR:0·05 (95 % CI: 0·03, 0·10)), compared with MPFs. For items with no red FOPL, UPF still contained greater energy, fat, SF, TS and salt than MPF. However, several UPF have healthier FOPL scores. UPF had an unhealthier nutritional profile and FOPL score than MPF. For items with no red FOPL, UPF still had an unhealthier profile than MPF, with a higher energy density. Importantly, not all UPF were unhealthy according to FOPL. These results indicate partial overlap between FOPL, nutrient content and NOVA classification of UK food and drink products, with implications for UK food and drink labelling.