Recent trends in energy and nutrient content of take-home food and beverage purchases in Great Britain: an analysis of 225 million food and beverage purchases over 6 years

Meat and dairy consumption in Scottish adults: insights from a national survey

BACKGROUND

Reducing meat and dairy consumption has been advocated for environmental benefits. This study aimed to better understand meat and dairy consumption in a population with high intakes.

METHODS

Dietary data were obtained from up to two online 24-h dietary recalls of adults (≥16 years) in the 2021 Scottish Health Survey, a nationally representative, repeated cross-sectional survey. The contribution of food groups to meat and dairy intake and the nutritional contributions of meat and milk products to intake of 28 nutrients were examined. Weighted mean (95% confidence interval [CI]) daily intakes were reported per capita, overall, and by demographic subgroups (age, gender and Scottish Index of Multiple Deprivation).

RESULTS

Mean daily intakes of total meat and dairy were 80.4 g (95% CI 77.1-83.7) and 238.6 g (95% CI 228.9-248.3) per capita, respectively. Chicken dishes, beef dishes and sandwiches were the primary contributors to meat intake, together accounting for 56.1% of meat consumed. Liquid milk accounted for 63.4% of the dairy consumed. Meat products were an important source of selenium and zinc (accounting for 26% and 25% of intake, respectively), whereas milk products were an important source of calcium (34%), iodine (38%) and vitamin A (25%).

CONCLUSIONS

Although meat and dairy consumption in Scotland is high, a number of food groups contributed to meat intake, providing several opportunities to target for a reduction in line with climate change ambitions. However, careful attention is required for replacements to ensure Scottish diets are nutritionally adequate.

Associations between the neighbourhood food environment and food and drink purchasing in England during lockdown: A repeated cross-sectional analysis

INTRODUCTION

Evidence for the effect of neighbourhood food environment (NFE) exposures on diet in the UK is mixed, potentially due to exposure misclassification. This study used the first national COVID-19 lockdown in England as an opportunity to isolate the independent effects of the NFE exposure on food and drink purchasing, and assessed whether these varied by region.

METHODS

Transaction-level purchasing data for food and drink items for at-home (1,221 households) and out-of-home consumption (171 individuals) were available from the GB Kantar Fast Moving Consumer Goods Panel for London and the North of England. The study period included 23rd March to 10th May 2020 ('lockdown'), and the same period in 2019 for comparison. NFE exposures included food outlet density and proximity, and NFE composition within a 1 km network buffer around the home. Associations were estimated for both years separately, adjusted for individual and household characteristics, population density and area deprivation. Interaction terms between region and exposures were explored.

RESULTS

There were no consistent patterns of association between NFE exposures and food and drink purchasing in either time period. In 2019, there was some evidence for a 1.4% decrease in energy purchased from ultra-processed foods for each additional 500 m in the distance to the nearest OOH outlet (IR 0.986, 95% CI 0.977 to 0.995, p = 0.020). In 2020, there was some evidence for a 1.8% reduction in total take-home energy for each additional chain supermarket per km2 in the neighbourhood (IR 0.982, 95% CI 0.969, 0.995, p = 0.045). Region-specific effects were observed in 2019 only.

DISCUSSION

Findings suggest that the differences in exposure to the NFE may not explain differences in the patterns or healthiness of grocery purchasing. Observed pre-pandemic region-specific effects allude to the importance of geographical context when designing research and policy. Future research may assess associations for those who relied on their NFE during lockdown.

Association Between Household Online Grocery Delivery Service Use and Food and Drink Purchase Behavior in England: Cross-Sectional Analysis

BACKGROUND

Online grocery delivery services (OGDSs) are a popular way of acquiring food. However, it is unclear whether OGDS use is associated with the healthiness of purchases and whether there are sociodemographic differences in OGDS use. If so, the increased prevalence of OGDS use may have implications for population diet, and differential OGDS use could contribute to diet inequalities.

OBJECTIVE

This study aimed to examine whether OGDS use varies by sociodemographic characteristics and is associated with the amount and types of groceries purchased.

METHODS

Item-level take-home food and drink purchase data (n=3,233,920 items) from households in London and the North of England were available from the 2019 UK Kantar fast-moving consumer goods panel (N=1911). Purchases were categorized as being bought online or in-store. We used logistic regression to estimate the likelihood of an above-median frequency of OGDS use by sociodemographic characteristics. We used Poisson regression to estimate the differences in energy and nutrients purchased by households that had above- and below-median OGDS use and the proportion of energy purchased from products high in fat, salt, and sugar (HFSS) online versus in-store among households that used both shopping methods (n=665).

RESULTS

In total, 668 (35%) households used OGDSs at least once in 2019. Of the households that used OGDSs, the median use was 5 occasions in 2019. Households were more likely to have above-median use in London versus in the North of England (odds ratio 1.29, 95% CI 1.01-1.65) and if they had a higher annual household income (odds ratio 1.56, 95% CI 1.02-2.38 for ≥£50,000 [US $64,000] vs <£20,000 [$25,600]). Households with above-median OGDS use had a higher weekly mean purchase of energy by 1461 (95% CI 1448-1474) kcal per person compared with households with below-median OGDS use. For households that used a combination of in-store and online shopping, HFSS products made up a lower proportion (-10.1%, 95% CI -12% to -8.1%) of energy purchased online compared to in-store.

CONCLUSIONS

Differences in grocery purchases between households with above- and below-median OGDS use could have positive or negative consequences. The extra energy purchased among households with above-median OGDS use could lead to overconsumption or food waste, which has negative consequences for population and environmental health. Alternatively, this extra energy may be replacing out-of-home purchasing, which tends to be less healthy, and may be beneficial for the population diet. Households made fewer HFSS purchases when shopping online compared to in-store, which may be due to differences in the shopping environment or experience, such as fewer promotions and advertisements when shopping online or not having to transport and carry purchases home. As higher-income households used OGDS more frequently, the implications of this sociodemographic pattern on dietary inequalities must be explored.

Tackling (Childhood) Obesity through a Voluntary Food Reformulation Policy: A Repeated Cross-Sectional Study Investigating Nutritional Changes in the Out-of-Home Sector

The Childhood Obesity Plan aimed to reduce sugar and energy in foods through a voluntary sugar-reduction programme. Our primary objective was to determine whether this implementation strategy had been successful, focusing on the out-of-home sector. We used a repeated cross-sectional design to evaluate nutritional changes in desserts served by leading chain restaurants. We extracted nutrition information from online menus in autumn/winter 2020, for comparison with baseline (2017) and interim (2018) values extracted from third-party datasets. We assessed compliance with the 20% sugar-reduction target and category-specific energy targets by product category and for pooled desserts. Overall, sugar/portion and energy/portion decreased by 11% and 4%, respectively. Policy targets were achieved in one of five categories (ice-cream: -38% sugar, p < 0.001; -30% energy, p < 0.001). Secondary outcomes were analysed for subgroups with the necessary data. Few chains significantly reduced sugar and/or energy across their dessert range. Energy/portion was positively associated with portion weight and sugar/portion but not with sugar/100 g. More than half of adults' desserts contained excessive sugar and/or saturated fat compared with dietary guidelines. Children's desserts less frequently exceeded guidelines. These results demonstrate that voluntary measures can drive substantial change when technical, commercial, and operational barriers can be overcome.

Trends in Loss-Adjusted Availability of Added Sugars and Energy Contribution from Macronutrients and Major Food Groups in Canada and the United States

A clear understanding of changes in the consumption of sugars and other sugars-containing foods has become essential for dietary recommendations and nutrition policy considerations. This study aimed to estimate the consumption trends of added sugars, energy, macronutrients, and food categories using food supply data.

Annual food availability data were obtained from Statistics Canada "Food Available in Canada" database and compared to the equivalent data from Canadian Community Health Survey 2004/2015 and USDA "Food Availability (Per Capita) Data System".

There was a 17% decline in the loss-adjusted per capita consumption of added sugars (%energy) in Canada over the past two decades, largely attributed to reduced intakes of refined sugar and sugars from soft drinks. Added sugars consumption was generally 30% less than that in the US. There was also a consistent decline in total energy intake and %energy from carbohydrates, accompanied by increased %energy derived from fats particularly during the most recent 10 years.

The observed trends in added sugars availability are similar to findings from the Canadian Community Health Surveys, demonstrating the potential application of annual loss-adjusted food availability data in monitoring trends in food and macronutrient intakes over time to complement dietary survey data in informing public policy development.

Associations between the food environment and food and drink purchasing using large-scale commercial purchasing data: a cross-sectional study

BACKGROUND

Evidence for an association between the local food environment, diet and diet-related disease is mixed, particularly in the UK. One reason may be the use of more distal outcomes such as weight status and cardiovascular disease, rather than more proximal outcomes such as food purchasing. This study explores associations between food environment exposures and food and drink purchasing for at-home and out-of-home (OOH) consumption.

METHODS

We used item-level food and drink purchase data for London and the North of England, UK, drawn from the 2019 Kantar Fast Moving Consumer Goods panel to assess associations between food environment exposures and household-level take-home grocery (n=2,118) and individual-level out-of-home (n=447) food and drink purchasing. Density, proximity and relative composition measures were created for both supermarkets and OOH outlets (restaurants and takeaways) using a 1 km network buffer around the population-weighted centroid of households' home postcode districts. Associations between food environment exposure measures and frequency of take-home food and drink purchasing, total take-home calories, calories from fruits and vegetables, high fat, salt and sugar products, and ultra-processed foods (UPF), volume of take-home alcoholic beverages, and frequency of OOH purchasing were modelled using negative binomial regression adjusted for area deprivation, population density, and individual and household socio-economic characteristics.

RESULTS

There was some evidence for an inverse association between distance to OOH food outlets and calories purchased from ultra-processed foods (UPF), with a 500 m increase in distance to the nearest OOH outlet associated with a 1.1% reduction in calories from UPF (IR=0.989, 95%CI 0.982-0.997, p=0.040). There was some evidence for region-specific effects relating to purchased volumes of alcohol. However, there was no evidence for an overall association between food environment exposures and take-home and OOH food and drink purchasing.

CONCLUSIONS

Despite some evidence for exposure to OOH outlets and UPF purchases, this study finds limited evidence for the impact of the food environment on household food and drink purchasing. Nonetheless, region-specific effects regarding alcohol purchasing indicate the importance of geographical context for research and policy.

The impact of price promotions on sales of unhealthy food and drink products in British retail stores

We study the health impact of food and beverage price promotion strategies-multi-buy offers and price discounts, typically biased toward unhealthy product categories-in British consumer retail. We are the first to employ econometric models from the marketing literature to analyze the impact of price promotions with a focus on population health. Our dynamic, reduced form demand model incorporates endogenous inventory (stock piling), consumption rates imputed from repeat purchases and allows for unobserved household heterogeneity. We find that removing price discounts is more effective for reducing purchase volume compared to removing multi-buy offers for 10 out of 12 food and drink groups, particularly those products for which price reduction is more common than multibuy. We find that price promotions induce consumption-and waste -through behavioral effects, associated with increased household inventory (stockpiling).

Combined carbon and health taxes outperform single-purpose information or fiscal measures in designing sustainable food policies

The food system is a major source of both environmental and health challenges. Yet, the extent to which policy-induced changes in the patterns of food demand address these challenges remains poorly understood. Using a survey-based, randomized controlled experiment with 5,912 respondents from the United Kingdom, we evaluate the potential effect of carbon and/or health taxes, information and combined tax and information strategies on food purchase patterns and the resulting impact on greenhouse gas emissions and dietary health. Our results show that while information on the carbon and/or health characteristics of food is relevant, the imposition of taxes exerts the most substantial effects on food purchasing decisions. Furthermore, while carbon or health taxes are best at separately targeting emissions or dietary health challenges, respectively, a combined carbon and health tax policy maximizes benefits in terms of both environmental and health outcomes. We show that such a combined policy could contribute to around one third of the reductions in residual emissions required to achieve the United Kingdom's 2050 net-zero commitments, while discouraging the purchase of especially unhealthy snacks, sugary drinks and alcohol and increasing the purchase of fruit and vegetables.

Changes in household food and drink purchases following restrictions on the advertisement of high fat, salt, and sugar products across the Transport for London network: A controlled interrupted time series analysis

BACKGROUND

Restricting the advertisement of products with high fat, salt, and sugar (HFSS) content has been recommended as a policy tool to improve diet and tackle obesity, but the impact on HFSS purchasing is unknown. This study aimed to evaluate the impact of HFSS advertising restrictions, implemented across the London (UK) transport network in February 2019, on HFSS purchases.

METHODS AND FINDINGS

Over 5 million take-home food and drink purchases were recorded by 1,970 households (London [intervention], n = 977; North of England [control], n = 993) randomly selected from the Kantar Fast Moving Consumer Goods panel. The intervention and control samples were similar in household characteristics but had small differences in main food shopper sex, socioeconomic position, and body mass index. Using a controlled interrupted time series design, we estimated average weekly household purchases of energy and nutrients from HFSS products in the post-intervention period (44 weeks) compared to a counterfactual constructed from the control and pre-intervention (36 weeks) series. Energy purchased from HFSS products was 6.7% (1,001.0 kcal, 95% CI 456.0 to 1,546.0) lower among intervention households compared to the counterfactual. Relative reductions in purchases of fat (57.9 g, 95% CI 22.1 to 93.7), saturated fat (26.4 g, 95% CI 12.4 to 40.4), and sugar (80.7 g, 95% CI 41.4 to 120.1) from HFSS products were also observed. Energy from chocolate and confectionery purchases was 19.4% (317.9 kcal, 95% CI 200.0 to 435.8) lower among intervention households than for the counterfactual, with corresponding relative reductions in fat (13.1 g, 95% CI 7.5 to 18.8), saturated fat (8.7 g, 95% CI 5.7 to 11.7), sugar (41.4 g, 95% CI 27.4 to 55.4), and salt (0.2 g, 95% CI 0.1 to 0.2) purchased from chocolate and confectionery. Relative reductions are in the context of secular increases in HFSS purchases in both the intervention and control areas, so the policy was associated with attenuated growth of HFSS purchases rather than absolute reduction in HFSS purchases. Study limitations include the lack of out-of-home purchases in our analyses and not being able to assess the sustainability of observed changes beyond 44 weeks.

CONCLUSIONS

This study finds an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy, sugar, and fat purchased from HFSS products. These findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products.

Escaping the Red Queen: Health as a corporate food marketing strategy

Public health advocates highlight the role of corporate actors and food marketing in shaping diets and health. This study analyses insider-oriented communications in food industry magazines in the UK to analyse actions and narratives related to health and nutrition, providing insights into relatively overlooked areas of marketing strategy including inter-firm dynamics. From a sample of four specialized food industry magazines covering the main industry segments we identified 319 articles (published 2007-2018) mentioning health or nutrition together with industry actions affecting the food environment. We identified health-related actions and analysed underlying strategies through content and thematic analyses. Health and nutrition have a rapidly growing role in food marketing strategy. Content analysis revealed a focus on ultra-processed foods, as well as product and nutrient-specific trends including increased health-based marketing of snacks and "protein rich" products. Health-related actions predominantly relied on consumer agency rather than invoking structural food environment changes. Thematic analysis identified proactive and defensive marketing strategies. Proactive approaches included large investments in health-related promotion of ultra-processed foods which are made highly visible to competitors, and the reliance on a "credence goods" differentiation strategies. Defensive strategies included a 'Red Queen' effect, whereby firms take health-related actions to keep up with competitors. These competitive strategies can create challenges, as well as some opportunities, for public health promotion. Challenges can include undermining efforts to support product comparison and healthier choice, and limiting firms' engagement in specific health improving actions. Systematic analysis of health-oriented marketing strategies could support more effective public health intervention.

Sociodemographic differences in self-reported exposure to high fat, salt and sugar food and drink advertising: a cross-sectional analysis of 2019 UK panel data

OBJECTIVES

To explore sociodemographic differences in exposure to advertising for foods and drinks high in fat, salt and sugar (HFSS) and whether exposure is associated with body mass index (BMI).

DESIGN

Cross-sectional survey.

SETTING

UK.

PARTICIPANTS

1552 adults recruited to the Kantar Fast Moving Consumer Goods panel for London and the North of England.

OUTCOME MEASURES

Self-reported advertising exposure stratified by product/service advertised (processed HFSS foods; sugary drinks; sugary cereals; sweet snacks; fast food or digital food delivery services) and advertising setting (traditional; digital; recreational; functional or transport); BMI and sociodemographic characteristics.

RESULTS

Overall, 84.7% of participants reported exposure to HFSS advertising in the past 7 days. Participants in the middle (vs high) socioeconomic group had higher odds of overall self-reported exposure (OR 1.48; 95% CI 1.06 to 2.07). Participants in the low (vs high) socioeconomic group had higher odds of reporting exposure to advertising for three of five product categories (ORs ranging from 1.41 to 1.67), advertising for digital food delivery services (OR 1.47; 95% CI 1.05 to 2.05), traditional advertising (OR 1.44; 95% CI 1.00 to 2.08) and digital advertising (OR 1.50; 95% CI 1.06 to 2.14). Younger adults (18-34 years vs ≥65 years) had higher odds of reporting exposure to advertising for digital food delivery services (OR 2.08; 95% CI 1.20 to 3.59), digital advertising (OR 3.93; 95% CI 2.18 to 7.08) and advertising across transport networks (OR 1.96; 95% CI 1.11 to 3.48). Exposure to advertising for digital food delivery services (OR 1.40; 95% CI 1.05 to 1.88), digital advertising (OR 1.80; 95% CI 1.33 to 2.44) and advertising in recreational environments (OR 1.46; 95% CI 1.02 to 2.09) was associated with increased odds of obesity.

CONCLUSIONS

Exposure to less healthy product advertising was prevalent, with adults in lower socioeconomic groups and younger adults more likely to report exposure. Broader restrictions may be needed to reduce sociodemographic differences in exposure to less healthy product advertising.

Have socio-economic inequalities in sugar purchasing widened? A longitudinal analysis of food and beverage consumer data from British households, 2014-2017

OBJECTIVE

To examine socio-economic inequalities in decreases in household sugar purchasing in Great Britain (GB).

DESIGN

Longitudinal, population-based study.

SETTING

Data were obtained from the GB Kantar Fast-Moving Consumer Goods (FMCG) panel (2014-2017), a nationally representative panel study of food and beverages bought and brought into the home. We estimated changes in daily sugar purchases by occupational social grade from twenty-three food groups, using generalised estimating equations (household-level clustering).

PARTICIPANTS

British households who regularly reported food and beverages to the GB Kantar FMCG (n 28 033).

RESULTS

We found that lower social grades obtained a lower proportion of sugar from healthier foods and a greater proportion of sugar from less healthy foods and beverages. In 2014, differences in daily sugar purchased between the lowest and the highest social grades were 3·9 g/capita/d (95 % CI 2·9, 4·8) for table sugar, 2·4 g (95 % CI 1·8, 3·1) for sugar-sweetened beverages, 2·2 g (95 % CI 1·5, 2·8) for chocolate and confectionery and 1·0 g (95 % CI 0·7, 1·3) for biscuits. Conversely, the lowest social grade purchased less sugar from fruits (2·1 g (95 % CI 1·5, 2·8)) and vegetables (0·7 g (95 % CI 0·5, 0·8)) than the highest social grade. We found little evidence of change in social grade differences between 2014 and 2017. These results suggest that recent overall declines in sugar purchases are largely equally distributed across socio-economic groups.

CONCLUSIONS

This suggests that recent population-level policy activity to reduce sugar consumption in GB does not appear to exacerbate or reduce existing socio-economic inequalities in sugar purchasing. Low agency, population-level policies may be the best solution to improving population diet without increasing inequalities.

Patterns of beverage purchases amongst British households: A latent class analysis

BACKGROUND

Beverages, especially sugar-sweetened beverages (SSBs), have been increasingly subject to policies aimed at reducing their consumption as part of measures to tackle obesity. However, precision targeting of policies is difficult as information on what types of consumers they might affect, and to what degree, is missing. We fill this gap by creating a typology of beverage consumers in Great Britain (GB) based on observed beverage purchasing behaviour to determine what distinct types of beverage consumers exist, and what their socio-demographic (household) characteristics, dietary behaviours, and weight status are.

METHODS AND FINDINGS

We used cross-sectional latent class analysis to characterise patterns of beverage purchases. We used data from the 2016 GB Kantar Fast-Moving Consumer Goods (FMCG) panel, a large representative household purchase panel of food and beverages brought home, and restricted our analyses to consumers who purchase beverages regularly (i.e., >52 l per household member annually) (n = 8,675). Six categories of beverages were used to classify households into latent classes: SSBs; diet beverages; fruit juices and milk-based beverages; beer and cider; wine; and bottled water. Multinomial logistic regression and linear regression were used to relate class membership to household characteristics, self-reported weight status, and other dietary behaviours, derived from GB Kantar FMCG. Seven latent classes were identified, characterised primarily by higher purchases of 1 or 2 categories of beverages: 'SSB' (18% of the sample; median SSB volume = 49.4 l/household member/year; median diet beverage volume = 38.0 l), 'Diet' (16%; median diet beverage volume = 94.4 l), 'Fruit & Milk' (6%; median fruit juice/milk-based beverage volume = 30.0 l), 'Beer & Cider' (7%; median beer and cider volume = 36.3 l; median diet beverage volume = 55.6 l), 'Wine' (18%; median wine volume = 25.5 l; median diet beverage volume = 34.3 l), 'Water' (4%; median water volume = 46.9 l), and 'Diverse' (30%; diversity of purchases, including median SSB volume = 22.4 l). Income was positively associated with being classified in the Diverse class, whereas low social grade was more likely for households in the classes SSB, Diet, and Beer & Cider. Obesity (BMI > 30 kg/m2) was more prevalent in the class Diet (41.2%, 95% CI 37.7%-44.7%) despite households obtaining little energy from beverages in that class (17.9 kcal/household member/day, 95% CI 16.2-19.7). Overweight/obesity (BMI > 25 kg/m2) was above average in the class SSB (66.8%, 95% CI 63.7%-69.9%). When looking at all groceries, households from the class SSB had higher total energy purchases (1,943.6 kcal/household member/day, 95% CI 1,901.7-1,985.6), a smaller proportion of energy from fruits and vegetables (6.0%, 95% CI 5.8%-6.3%), and a greater proportion of energy from less healthy food and beverages (54.6%, 95% CI 54.0%-55.1%) than other classes. A greater proportion of energy from sweet snacks was observed for households in the classes SSB (18.5%, 95% CI 18.1%-19.0%) and Diet (18.8%, 95% CI 18.3%-19.3%). The main limitation of our analyses, in common with other studies, is that our data do not include information on food and beverage purchases that are consumed outside the home.

CONCLUSIONS

Amongst households that regularly purchase beverages, those that mainly purchased high volumes of SSBs or diet beverages were at greater risk of obesity and tended to purchase less healthy foods, including a high proportion of energy from sweet snacks. These households might additionally benefit from policies targeting unhealthy foods, such as sweet snacks, as a way of reducing excess energy intake.