Healthy or Unhealthy on Sale? A cross-sectional study on the proportion of healthy and unhealthy foods promoted through flyer advertising by supermarkets in the Netherlands

The Difference between PC-Based and Immersive Virtual Reality Food Purchase Environments on Useability, Presence, and Physiological Responses

Computer simulations used to study food purchasing behavior can be separated into low immersion virtual environments (LIVE), which use personal computers and standard monitors to display a scene, and high immersion virtual environments (HIVE) which use virtual reality technology such as head-mounted displays to display a scene. These methods may differ in their ability to create feelings of presence or cybersickness that would influence the usefulness of these approaches. In this present study, thirty-one adults experienced a virtual supermarket or fast-food restaurant using a LIVE system or a HIVE system. Feelings of presence and cybersickness were measured using questionnaires or physiological responses (heart rate and electrodermal activity). The participants were also asked to rate their ability to complete the set task. The results of this study indicate that participants reported a higher sense of presence in the HIVE scenes as compared to the LIVE scenes (p < 0.05). The participant's heart rate and electrodermal activity were significantly higher in the HIVE scene treatment when compared to the LIVE scene (p < 0.05). There was no difference in the participant's ability to complete tasks in the different scenes. In addition, feelings of cybersickness were not different between the HIVE and LIVE scenes.

In-Store Marketing and Supermarket Purchases: Associations Overall and by Transaction SNAP Status

INTRODUCTION

In-store placement promotions are used widely in supermarkets, but their effects on customer purchases remain largely unknown. This study examined associations of supermarket placement promotions with customer purchases overall and by Supplemental Nutrition Assistance Program (SNAP) benefit use.

METHODS

Data on in-store promotions (e.g., endcaps, checkout displays) and transactions (n=274,118,338) were obtained from a New England supermarket chain with 179 stores from 2016 to 2017. Product-level analyses examined multivariable-adjusted changes in products' sales when they were promoted (versus not) across all transactions and stratified by whether the transaction was paid for with SNAP benefits. Food group-level analyses examined the extent to which a 20% increase from the mean number of weekly promotions for a food group (e.g., increasing the number of candy promotions from 17.0 to 20.4) was associated with total food group sales. Analyses were conducted in 2022.

RESULTS

Across stores, the mean (SD) number of promotions per week was highest for sweet/salty snacks (126.3 [22.6]), baked goods (67.5 [18.4]), and sugar-sweetened beverages (48.6 [13.8]) and lowest for beans (5.0 [2.6]) and fruits (6.6 [3.3]). Product sales were between 16% (low-calorie drinks) and 136% (candy) higher when promoted versus not promoted. In 14 of 15 food groups, associations were stronger among transactions made with SNAP benefits than among those not made with SNAP benefits. The number of in-store promotions was generally not associated with total food group sales.

CONCLUSIONS

In-store promotions, which were mostly for unhealthy foods, were associated with large product sales increases, particularly among SNAP purchasers. Policies limiting unhealthy in-store promotions and incentivizing healthy promotions should be explored.

Time-Varying Food Retail and Incident Disease in the Cardiovascular Health Study

INTRODUCTION

Natural experiments can strengthen evidence linking neighborhood food retail presence to dietary intake patterns and cardiometabolic health outcomes, yet sample size and follow-up duration are typically not extensive. To complement natural experiment evidence, longitudinal data were used to estimate the impacts of neighborhood food retail presence on incident disease.

METHODS

The Cardiovascular Health Study recruited adults aged 65+ years in 1989-1993. Analyses conducted in 2021-2022 included those in good baseline health, with addresses updated annually through the year of death (restricted to 91% who died during >2 decades of cohort follow-up). Baseline and annually updated presence of 2 combined food retail categories (supermarkets/produce markets and convenience/snack focused) was characterized using establishment-level data for 1-km and 5-km Euclidean buffers. Cox proportional hazards models estimated associations with time to each incident outcome (cardiovascular disease, diabetes), adjusting for individual and area-based confounders.

RESULTS

Among 2,939 participants, 36% with baseline supermarket/produce market presence within 1 km had excess incident cardiovascular disease (hazard ratio=1.12; 95% CI=1.01, 1.24); the association was attenuated and no longer statistically significant after adjustment for sociodemographic characteristics. Adjusted associations were robustly null for time-varying supermarket/produce market or convenience/fast food retail presence across analyses with outcomes of cardiovascular disease or diabetes incidence.

CONCLUSIONS

Food environment changes continue to be studied to provide an evidence base for policy decisions, and null findings in this longitudinal analysis add literature that casts doubt on the sufficiency of strategies targeting food retail presence alone of an elderly cohort for curtailing incident events of clinical importance.

Supermarket promotions in Western Sweden are incompatible with Nordic dietary recommendations and differ by area-level socioeconomic index

BACKGROUND

Large supermarket chains produce weekly advertisements to promote foods and influence consumer purchases. The broad consumer reach of these ads presents an opportunity to promote foods that align with dietary recommendations. Thus, the aim of this study was to investigate the health quality of supermarkets' weekly food promotions in a large region of Sweden with attention to more and less advantaged socioeconomic index areas.

METHODS

Analysis of weekly advertisements from 122 individual stores, representing seven chains, was carried out in a large region of Sweden from 2-29 March in 2020. Food promotions were divided into categories according to the Nordic Nutrition Recommendations and World Health Organization Regional Office for Europe's nutrient profile model, and defined as 'most healthy', 'healthy', 'unhealthy' and 'most unhealthy'. A mean socioeconomic index was used to classify each store location to determine whether proportions of the 'most unhealthy' foods differed between more advantaged and more disadvantaged socioeconomic index areas.

RESULTS

In total, 29,958 food items were analyzed. Two-thirds of promotions belonged to the food groups considered 'most unhealthy' and 'unhealthy'. In the 'most unhealthy' food group 'sugar-rich beverages and foods' constituted approximately 23.0% of the promotions. Food promotions had 25% increased odds to be from the 'most unhealthy' group (odds ratio 1.25, confidence interval 1.17, 1.33) in more disadvantaged socioeconomic index areas. This association could be explained by the supermarket chain the stores belonged to.

CONCLUSIONS

Our findings indicate that Swedish supermarkets promote a large proportion of unhealthy foods as classified by the Nordic Nutrition Recommendations. We also observe that certain national supermarket chains tend to locate their stores in more disadvantaged areas and promote a greater proportion of unhealthy foods in their weekly advertisements compared to the more advantaged areas. There is an urgent need for supermarkets to shift promotions toward healthier food items.

The association of unhealthy and healthy food store accessibility with obesity prevalence among adults in the Netherlands: A spatial analysis

Introduction

Obesity prevalence has almost tripled in Europe since 1980, and the obesogenic (food) environment is hypothesised to be one of the main drivers. Still, empirical evidence is rare for Europe.

Objective

This ecological study explores spatial patterns of obesity prevalence of adults (aged 19+) in the Netherlands in 2016. It studies, in particular, its global associations with (un)healthy food store accessibility while assessing local differences and evaluating the importance of the immediate versus the wider food surroundings.

Methods

In our ecological study, we used small-area estimated obesity prevalence (adults, aged 19+) from 2836 neighbourhoods (six-digit postal codes, wijken) and combined this with measures from Statistics Netherlands on accessibility to (unhealthy) fast food and (healthy) fresh food. Spatial lag of X (SLX) models were estimated for the entire Netherlands to explore global associations. Separate models for urban, suburban, and rural neighbourhoods and a geographically weighted regression (GWR) were estimated to explore and visualise local variations in the associations. Total associations from the SLX models were then decomposed to yield contributions of the immediate and wider food surroundings.

Results

Regional clusters of high obesity were observed in selected areas in the north-east, the south-west, and south-east. Limited accessibility to unhealthy food was globally associated with lower obesity prevalence, whereas better accessibility to fresh food stores and supermarkets was not. The association regarding worse accessibility to unhealthy food was strongest for urban neighbourhoods, especially for the Randstad region. In urban settings, also better accessibility to fresh food stores proved relevant. The wider food surrounding proved more important than the immediate food surrounding, throughout.

Discussion

Public policies addressing obesity might be more effective when reducing the presence of unhealthy food rather than expanding healthy food supply. Moreover, they should focus on urban regions and high obesity clusters, thereby considering wider food surroundings.

Where do Dutch adults obtain their snack foods? Cross-sectional exploration of individuals' interactions with the food environment

We investigated frequency of consumption and location of obtaining snack foods and sociodemographic differences therein. Data: cross-sectional survey data (N = 1784 Dutch adults 18-65 years) on the frequency of consumption of 10 snack foods and where they obtained them. Adjusted logistic regression analyses revealed notable differences in the frequency of snack food consumption between younger and older adults and between those with low vs. high socioeconomic position (SEP). The location of obtaining snack foods also differed between sociodemographic groups with supermarkets forming an important point-of-purchase for snack foods, especially for those with low SEP and with children in their household.

Sixty Percent of Foods Advertised in Grocery Store Flyers are Not In-line with Canada's Food Guide

Purpose: To evaluate foods advertised in discount and premium grocery flyers for their alignment with Canada's 2007 Food Guide (CFG) and assess if alignment differed by food category, season, page location, and price.Methods: Weekly flyers (n = 192) were collected from discount and premium grocery chains from each of 4 seasons. Health Canada's Surveillance Tool was used to assess food items as in-line or not in-line with CFG.Results: Of 35 576 food items, 39.7% were in-line with CFG. There were no differences in proportions of foods not in-line in discount versus premium flyers (60.9% and 60.0%, respectively). Other Foods and Meat & Alternatives were advertised most (28.0% and 26.3%, respectively; P < 0.001). Milk & Alternatives were the least advertised food group (10.3%). Vegetables & Fruit (19.6%), Grains (21.6%), Milk & Alternatives (20.6%), and Meat & Alternatives (20.2%) were promoted least in Fall (P < 0.001). A higher proportion of foods advertised on middle pages were not in-line (61.0%) compared with front (56.6%) and back (58.8%) pages (P < 0.001). Not in-line foods were more expensive ($3.49, IQR = $2.82) than in-line foods ($3.28, IQR = $2.81; P < 0.001).Conclusions: While there was no difference in healthfulness of foods advertised in discount versus premium flyers, grocers advertised more foods not in-line with CFG. Government policies to improve the food environment should consider grocery flyers.

Does the prevalence of promotions on foods and beverages vary by product healthiness? A population-based study of household food and drink purchases in New Zealand

OBJECTIVE

To assess the prevalence of promotions on foods and non-alcoholic drinks purchased by New Zealand households and to determine if they vary according to healthiness of products.

DESIGN

We undertook a cross-sectional analysis of Nielsen New Zealand Homescan® 2018/19 panel data. We conducted multivariate analyses to examine the variability in quantities of healthy v. unhealthy food and beverage products purchased on promotion. Promotion was self-reported by the panellist. Healthiness of products was measured by the Health Star Rating (HSR) system. We also carried out a subgroup analysis for beverages according to the threshold of < 5 g v. ≥ 5 g sugar per 100 ml content of products.

SETTING

The Nielsen New Zealand Homescan® data were linked with two New Zealand Food Composition Databases (Nutritrack and the FOODfiles).

PARTICIPANTS

Food and beverage purchases data by 1800 panel households were used.

RESULTS

Overall, 46 % (1 803 601/3 940 458) of all purchases made were on promotion. Compared with purchases of food and beverage products with HSR < 3·5 (unhealthy), food and beverage products with HSR ≥ 3·5 (healthy) were significantly less likely to be on promotion (OR = 0·78, 95 % CI 0·77, 0·79). The subgroup analysis for beverages shows that products with < 5 g sugar per 100 ml were significantly less likely to be on promotion than those with ≥ 5 g sugar per 100 ml (OR = 0·77, 95 % CI 0·75, 0·79).

CONCLUSIONS

Policies to improve healthy food retailing should focus on increasing the promotion of healthier food and drink options in stores and supermarkets.

Healthy Eating Index-2015 Scores Vary by Types of Food Outlets in the United States

Diet quality in the United States is improving over time but remains poor. Food outlets influence diet quality and represent the environments in which individuals make choices about food purchases and intake. The objective of this study was to use the Healthy Eating Index-2015 (HEI-2015) to evaluate the quality of foods consumed from the four major outlets where food is obtained—stores, full-service restaurants, quick-services restaurants, and schools—and to assess changes over time. This cross-sectional study used 24 h dietary recall data from eight cycles (2003–2004 to 2017–2018) of the National Health and Nutrition Examination Survey (NHANES). Linear trend estimation was used to test for changes in HEI scores over time, and balanced repeated replicate weighted linear regression was used to test for differences in total and component scores between types of food outlets. Overall, Americans are not consuming a mix of foods from any major category of food outlet that aligns with dietary guidelines. The total score for schools (65/100 points) and stores (62/100 points) was significantly higher than full-service (51/100 points) and quick-service (39/100 points) restaurants (p < 0.0001). HEI scores significantly improved over time for schools (p < 0.001), including an increase in whole grains from less than 1 point in 2003–2004 to 7 out of 10 points in 2017–2018. In 2017–2018, schools received the maximum score for total fruits, whole fruits, and dairy. Continued research on strategies for improving the quality of foods consumed from restaurants and stores is warranted.

Content of Brazilian supermarket circulars do not reflect national dietary guidelines

Previous research on foods advertised in supermarket circulars revealed that advertisement for foods at promotional prices influence food choices and shopping behaviour, but no paper reporting the Latin American context was identified. Furthermore, most studies only assessed the products advertised on the front pages and not in the entire circulars. This paper quantifies and categorizes, according to level of processing, the foods advertised in circulars from four Brazilian supermarket chains in order to assess their compatibility with the national dietary guidelines issued by the Ministry of Health. Printed and online circulars were collected between June and July 2016. Foods items advertised were identified and classified into one of four categories using the NOVA classification as unprocessed or minimally processed, processed culinary ingredient, processed or ultra-processed. Sixteen documents were analysed, and 1786 food items identified, where 23% were categorized as unprocessed or minimally processed, and 63% as ultra-processed foods. While the mean proportion of ultra-processed and unprocessed or minimally processed foods advertised on circular covers was similar (p = 0.49), the mean proportion of ultra-processed foods advertised in the entire circular was significantly higher than unprocessed or minimally processed foods (p < 0.001). Brazilian supermarket circulars are stimulating the acquisition of ultra-processed foods, which does not encourage food choices to be in line with what is recommended by the Dietary Guidelines for the Brazilian Population.

How healthy and processed are foods and drinks promoted in supermarket sales flyers? A cross-sectional study in the Netherlands

OBJECTIVE

To investigate to what extent promotions in Dutch supermarket sales flyers contribute to a healthy diet and whether there are differences between supermarket types.

DESIGN

A cross-sectional study investigating promotions on foods and beverages (n 7825) in supermarket sales flyers from thirteen Dutch supermarket chains (8-week period), including ten traditional, two discount and one organic supermarket chain(s). Promoted products were categorised by food group (e.g. bread), contribution to a healthy diet (yes/no), degree of processing (e.g. ultra-processed), promotion type (temporary reduction in price, volume-based promotions or advertised only) and percentage discount of price promotions. Differences between supermarket chains in the degree of healthiness and processing of products and the types of price promotions were investigated.

RESULTS

In total, 70·7 % of all promoted products in supermarket sales flyers did not contribute to a healthy diet and 56·6 % was ultra-processed. The average discount on less healthy products (28·7 %) was similar to that of healthy products (28·9 %). Less healthy products were more frequently promoted via volume-based promotions than healthy products (37·6 % v. 25·4 %, P < 0·001). Discount supermarket chains promoted less healthy (80·3 %) and ultra-processed (65·1 %) products more often than traditional supermarket chains (69·6 % and 56·6 %, respectively).

CONCLUSIONS

The majority of promoted products via supermarket sales flyers do not contribute to a healthy diet. As promotions are an important determinant of food purchasing decisions, supermarkets do not support healthy choices. Future studies should identify barriers that withhold supermarket chains from promoting more healthy foods in supermarket sales flyers.

The nature of food promotions over one year in circulars from leading Belgian supermarket chains

Background

To examine the proportion of healthier and less healthy food promotions in circulars of major Belgian supermarket chains.

Methods

Food promotions were collected from all circulars over 1 year from the five largest Belgian supermarket chains. Foods promoted were classified according to the World Health Organization Europe nutrient profile model categories and the level and purpose of processing as per the NOVA classification. In addition, promotional characters (i.e. cartoons, licensed characters, celebrities) and premium offers within the promotions were analysed.

Results

In total, 15,271 food promotions were analyzed. The most frequently promoted foods in circulars were processed meat, poultry and fish (11.8%); fresh and frozen fruit, vegetables and legumes (9.5%); soft drinks and sweetened beverages (9.0%); fresh and frozen meat, poultry, fish and eggs (8.6%); cakes, sweet biscuits and pastries (8.1%); ready-made and convenience foods (8.0%); chocolate and sugar confectionery; energy bars and sweet toppings (7.7%) and cheeses (5.7%). About 52.2% of food promotions across all circulars were for ultra-processed foods, with considerable variation across chains (42.9–61.6%).

Promotional characters and premium offers were found within 5.3 and 19.5% of promotions respectively. For all chains, circular covers were healthier compared to entire circulars, with a lower proportion of ultra-processed foods and a higher proportion of fresh fruit and vegetables promoted.

Conclusions

Food promotions in circulars were most frequently for ultra-processed foods, with considerable variation across chains. Circular covers were healthier than entire circulars. Policies to reduce less healthy food promotions could contribute to improving the healthiness of supermarket food purchases.

Are price discounts on sugar-sweetened beverages (SSB) linked to household SSB purchases? - a cross-sectional study in a large US household and retail scanner database

Background

Price promotions on sugar-sweetened beverages (SSBs) are commonly used by retailers to provide economic incentives for purchasing. Surprisingly, there is a lack of high-quality articles that examine the frequency and magnitude of sugary beverage discounting and consumer responses to discounts. The objective of this study is to quantify the association between exposure to price discounts and SSB purchases.

Methods

This cross-sectional study linked 2016 SSB consumption data from a U.S. household consumer panel (analytic sample N = 11,299 households) and weekly prices at stores where they shopped. We derived percent of the time SSBs were discounted (annual promotion frequency) and the amount of the discount (annual promotion magnitude) and assessed their association with household annual per capita SSB purchase ounces. Linear regression models adjusted for household size, income per capita, age, education, presence of children, race, occupation, region, and urbanicity. We also evaluated whether the association between promotion and purchase varied by socioeconomic status and race subgroups. Data were analyzed in 2019–2020.

Results

On average, households were exposed to SSBs price promotions 44% of the time. A 10-percentage point increase in annual SSB promotion frequency was associated with 13.7% increase in annual per capita purchasing (P < 0.0001), and a 1-percentage point increase in annual SSB promotion magnitude was associated with 15.3% increase in annual per capita purchasing (P < 0.0001). These associations did no vary significantly across socioeconomic status and race subgroups (Interaction P > 0.2).

Conclusions

More frequent and deeper price promotion was associated with higher annual per capita SSB purchases. Restricting SSB price promotions may be effective at reducing SSB consumption.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00673-w.

Food marketing in supermarket circulars in Brazil: An obstacle to healthy eating

The study aims to characterize the foods advertised in supermarket circulars in Belo Horizonte, Brazil, as well as to analyze the price and discounts applied to the products. Supermarket circulars were obtained from five supermarket chains during 2018. Foods were classified according to the NOVA classification system and the Pan-American Health Organization (PAHO) nutritional profile model. Advertised prices, with and without discount, were recorded. Ultra-processed foods responded for 66.9% of ads, followed by fresh or minimally processed foods with 19.9%, processed foods with 9.5%, and processed culinary ingredients with 3.7%. Only 3.5% of the products did not exceed any critical nutrients of the PAHO model. Processed foods had a higher cost (R$3.27/100 g) in relation to other food categories. Products excessive in trans-fat and sodium were statistically significant cheaper when compared to those that did not present inadequacy of these nutrients. The reverse was verified for foods excessive in saturated fat, in total fat and in added sugars. Processed culinary ingredients were more frequent on sale (27.7%), while processed foods were the least advertised with discount (15.9%). Products that were adequate in saturated fat, trans fat, total fat and added sugar were statistically significant more announced with discount. Processed culinary ingredients presented the lowest percentage of discount (13.5%). The study confirms the position of supermarket circulars in Brazil as an obstacle to healthy eating, due to the higher incidence of processed and ultra-processed food advertisements, although no greater financial stimulus was noted for these products.

Caracterização das barreiras e facilitadores para alimentação adequada e saudável no ambiente alimentar do consumidor

Resumo: O objetivo deste trabalho é explorar potenciais barreiras e facilitadores para alimentação saudável no ambiente alimentar do consumidor e analisar a associação com diferentes tipos de estabelecimentos comerciais tendo como referencial teórico o Guia Alimentar para a População Brasileira. Estudo transversal realizado no Município de Jundiaí, São Paulo, Brasil, com auditoria do ambiente alimentar do consumidor realizada em 650 comércios varejistas. Foram identificados barreiras e facilitadores das escolhas alimentares saudáveis no ambiente interno dos comércios. Análise fatorial foi utilizada para estimar fatores que caracterizassem o ambiente segundo barreiras e facilitadores. Regressão linear foi utilizada para avaliar a associação entre os fatores e as diferentes categorias de estabelecimentos. A maioria dos estabelecimentos tinham venda prioritária de ultraprocessados. Do total de comércios estudados, 75,9% disponibilizavam bebidas açucaradas; 37% arroz, feijão e 30% frutas e hortaliças. O primeiro fator caracterizou-se pela presença tanto de barreiras quanto de facilitadores (fator misto), o segundo fator caracterizou-se por mais facilitadores e o terceiro por maior presença de barreiras no ambiente do consumidor. Supermercados foram associados positivamente com os três fatores (valor de p < 0,001). Os sacolões/hortifrutis públicos e privados, os mercados de bairro tiveram associação positiva com o fator mais facilitadores (valor de p < 0,001). Os mercados e padarias se associaram positivamente ao fator mais barreiras (valor de p < 0,001). Os padrões que caracterizam barreiras e facilitadores para alimentação saudável diferem de forma significativa segundo tipos de comércios.

The Healthiness of Food and Beverages on Price Promotion at Promotional Displays: A Cross-Sectional Audit of Australian Supermarkets

Supermarket environments can strongly influence purchasing decisions. Price promotions are recognised as a particularly persuasive tactic, but the healthiness of price promotions in prominent in-store locations is understudied. This study compared the prevalence and magnitude of price promotions on healthy and unhealthy food and beverages (foods) displayed at prominent in-store locations within Australian supermarkets, including analyses by supermarket group and area-level socio-economic position. A cross-sectional in-store audit of price promotions on foods at key display areas was undertaken in 104 randomly selected stores from major Australian supermarket groups (Woolworths, Coles, Aldi and independents) in Victoria, Australia. Of the display space dedicated to foods with price promotions, three of the four supermarket groups had a greater proportion of display space devoted to unhealthy (compared to healthy) foods at each promotional location measured (end of aisles: 66%; island bins: 53%; checkouts: 88%). Aldi offered very few price promotions. Few measures varied by area-level socio-economic position. This study demonstrated that price promotions at prominent in-store locations in Australian supermarkets favoured unhealthy foods. Marketing of this nature is likely to encourage the purchase of unhealthy foods, highlighting the need for retailers and policy-makers to consider addressing in-store pricing and placement strategies to encourage healthier food environments.

Influence of Food and Beverage Companies on Retailer Marketing Strategies and Consumer Behavior

The retail food environment plays an important role in shaping dietary habits that contribute to obesity and other chronic diseases. Food and beverage manufacturers use trade promotion-incentives paid to retailers-to influence how products are placed, priced, and promoted in stores. This review aims to: (1) catalogue trade promotion practices that manufacturers use to influence retailer marketing strategies, and (2) describe how these retailer marketing strategies affect consumer purchasing behavior and attitudes. Researchers searched five databases, Academic Search Ultimate, Business Source Ultimate, PsycINFO, PubMed, and Web of Science, to identify literature from industry and academic sources published in English through November 2019. Twenty articles describing manufacturer trade promotion practices were synthesized and provided insight into four types of trade promotion practices: category management, slotting allowances, price discounts, and cooperative advertising. Fifty-four articles describing the impact of retailer marketing on consumers were synthesized and graded for quality of evidence. While comparison across studies is challenging, findings suggest that retailer marketing strategies, such as price promotions and prominent placement, lead to increased sales. Results can guide efforts by policymakers, public health practitioners, and food retailers to design retail environments that improve healthy eating while maintaining retailer financial interests. Additional research should measure the impact of retailer marketing strategies on consumer diet quality and retailer outcomes (e.g., return-on-investment).

Supermarket Circulars Promoting the Sales of 'Healthy' Foods: Analysis Based on Degree of Processing

The health and wellness food sector grew 98% from 2009 to 2014 in Brazil, the world's fourth-biggest market. The trend has reached supermarket circulars, which recently started to feature whole sections advertising health and wellness-enhancing foods. This study identified food items advertised in circulars' specific sections of two Brazilian supermarket chains (one regional, one national) during a 10-week period. Foods were classified according to degree of food processing and presence/type of claims on their front-of-pack (FoP) labels. Comparison between groups of Unprocessed/Minimally Processed foods vs. Ultra-processed foods and presence/type of claims employed Pearson chi-square test. From the 434 alleged health and wellness-enhancing foods advertised, around half (51.4%) were classified as Ultra-processed. Presence of reduced and increased nutrient-content claims was significantly higher in labels of Ultra-processed foods. Most frequent claims addressed sugar and fibre content. Brazilian supermarket circulars were found to be promoting the sale of Ultra-processed foods in their health and wellness sections, leading to a situation that can mislead the consumer and bring negative health outcomes.

A systematic review, and meta-analysis, examining the prevalence of price promotions on foods and whether they are more likely to be found on less-healthy foods

Objective:

There are concerns that price promotions encourage unhealthy dietary choices. This review aims to answer the following research questions (RQ1) what is the prevalence of price promotions on foods in high-income settings, and (RQ2) are price promotions more likely to be found on unhealthy foods?

Design:

Systematic review of articles published in English, in peer-review journals, after 1 January 2000.

Setting:

Included studies measured the prevalence of price promotions (i.e. percentage of foods carrying a price promotion out of the total number of foods available to purchase) in retail settings, in upper-mid to high-income countries.

Participants:

‘Price promotion’ was defined as a consumer-facing temporary price reduction or discount available to all customers. The control group/comparator was the equivalent products without promotions. The primary outcome for this review was the prevalence of price promotions, and the secondary outcome was the difference between the proportions of price promotions on healthy and unhealthy foods.

Results:

Nine studies (239 344 observations) were included for the meta-analysis for RQ1, the prevalence of price promotions ranged from 6 % (95 % CI 2 %, 15 %) for energy-dense nutrient-poor foods to 15 % (95 % CI 9 %, 25 %) for cereals, grains, breads and other starchy carbohydrates. However, the I-squared statistic was 99 % suggesting a very high level of heterogeneity. Four studies were included for the analysis of RQ2, of which two supported the hypothesis that price promotions were more likely to be found on unhealthy foods.

Conclusions:

The prevalence of price promotions is very context specific, and any proposed regulations should be supported by studies conducted within the proposed setting(s).

Prevalence of healthy and unhealthy food and beverage price promotions and their potential influence on shopper purchasing behaviour: A systematic review of the literature

Policies to restrict unhealthy food and beverage price promotions have been recommended, as part of a broader strategy to reduce obesity, but little evidence underpins such recommendations. We aimed to synthesize the literature on the prevalence of healthy and unhealthy food and beverage price promotions and their potential influence on purchasing behaviour. Eight scientific databases (covering health, business, and marketing) and grey literature were systematically searched using search terms related to "food and beverage price promotions" up until July 2019. Articles were included if they examined prevalence of, and/or consumer response to, food and non-alcoholic beverage price promotions, from a nutritional perspective. Of the 16 included studies, eight examined the prevalence of price promotions and eight examined the potential influence of price promotions on purchasing behaviour. Seven of the "prevalence" studies found that price promotions were more common for unhealthy foods and beverages. Seven "influence" studies found a greater proportion of price-promoted purchases were for unhealthy compared with healthy products. Policies that reduce the prevalence and/or influence of price promotions on unhealthy foods and beverages may shift consumer purchasing away from unhealthy foods and beverages. Empirical studies are required to better understand how consumers and industry may respond to such policies.

Price Promotions by Food Category and Product Healthiness in an Australian Supermarket Chain, 2017-2018

Objectives. To examine the prevalence and magnitude of price promotions in a major Australian supermarket and how they differ between core (healthy) and discretionary (less healthy) food categories.Methods. Weekly online price data (regular retail price, discount price, and promotion type) on 1579 foods were collected for 1 year (April 2017 to April 2018) from the largest Australian supermarket chain. Products audited were classified according to Australian Dietary Guidelines definitions of core and discretionary foods and according to their Health Star Rating (a government-endorsed nutrient profiling scheme).Results. On average, 15.1% (95% confidence interval [CI] = 14.7%, 15.3%) of core foods and 28.8% (95% CI = 28.6%, 29.0%) of discretionary foods were price promoted during a given week. Average discounts were -15.4% (95% CI = -16.4, -14.4) for core products and -25.9% (95% CI = -26.8, -25.1) for discretionary products. The percentage of products on price promotion and the size of the discount were larger for products with a lower Health Star Rating (P < .05).Conclusions. Price promotions were more prevalent and greater in magnitude for discretionary foods than for core foods. Policies to reduce the prevalence and magnitude of price promotions on discretionary foods could improve the healthiness of food purchased from supermarkets.

'Obesogenic' School Food Environments? An Urban Case Study in The Netherlands

(1) Background: This study aimed to explore and define socio-economic (SES) differences in urban school food environments in The Netherlands. (2) Methods: Retail food outlets, ready-to-eat products, in-store food promotions and food advertisements in public space were determined within 400 m walking distance of all secondary schools in the 4th largest city of The Netherlands. Fisher’s exact tests were conducted. (3) Results: In total, 115 retail outlets sold ready-to-eat food and drink products during school hours. Fast food outlets were more often in the vicinity of schools in lower SES (28.6%) than in higher SES areas (11.5%). In general, unhealthy options (e.g., fried snacks, sugar-sweetened beverages (SSB)) were more often for sale, in-store promoted or advertised in comparison with healthy options (e.g., fruit, vegetables, bottled water). Sport/energy drinks were more often for sale, and fried snacks/fries, hamburgers/kebab and SSB were more often promoted or advertised in lower SES areas than in higher SES-areas. (4) Conclusion: In general, unhealthy food options were more often presented than the healthy options, but only a few SES differences were observed. The results, however, imply that efforts in all school areas are needed to make the healthy option the default option during school time.

Food consumed outside the home in Brazil according to places of purchase

OBJECTIVE

This study aims to describe the places of purchase of food consumed outside the home, characterize consumers according to the places of consumption, and identify the food purchased by place of consumption in Brazil.

METHODS

We have used data from the Pesquisa de Orçamento Familiar (Household Budget Survey) of 2008-2009 with a sample of 152,895 subjects over 10 years of age. The purchase of food outside the home was collected from the records of all expenditures made in seven days. The places of purchase were grouped according to their characteristics: supermarket, bakery, street food, restaurant, snack bar, fruit shop, and other places. The types of food were grouped into nine categories, considering the nutritional aspects and the marketing characteristics of the item. We have estimated the frequency of purchase in the seven groups of places in Brazil and according to gender and type of food purchased per place. We have calculated the average age, income and years of education, as well as the per capita expenditure according to places of purchase of food consumed outside the home.

RESULTS

The purchase of food outside the home was reported by 41.2% of the subjects, being it greater among men than women (44% versus 38.5%). Adults had a higher frequency (46%) than teenagers (37.7%) and older adults (24.2%). The highest frequency of places of purchase were snack bar (16.9%) and restaurant (16.4%), while the fruit shop (1.2%) presented the lowest frequency. Sweets, snack chips and soft drinks were the most purchased items in most places. Average expenditure was higher for restaurant (R$33.20) and lower for fruit shop (R$4.10) and street food (R$5.00).

CONCLUSIONS

The highest percentage of food consumed outside the home comes from snack bars and restaurants, pointing to important places for the development of public policies focused on promoting healthy eating.

OBJETIVO

Descrever os locais de aquisição dos alimentos consumidos fora do lar, caracterizar os consumidores de acordo com os locais de consumo e identificar os alimentos adquiridos por local de consumo no Brasil.

MÉTODOS

Utilizaram-se dados da Pesquisa de Orçamento Familiar 2008-2009 em uma amostra de 152.895 indivíduos acima de 10 anos. A aquisição de alimentos para consumo fora do lar foi coletada por registros de todos os gastos realizados no período de sete dias. Os locais de aquisição de alimentos foram agrupados de acordo com suas características: supermercado, padaria, comida de rua, restaurante, lanchonete, frutaria e outros. Os tipos de alimentos adquiridos foram alocados em nove categorias de alimentos, considerando os aspectos nutricionais e as características de comercialização do item. Estimou-se a frequência de aquisição de alimentos nos sete grupos de locais no Brasil e por sexo e o tipo de alimento adquirido por local. Calculou-se a média de idade, de renda e de anos de escolaridade, bem como da despesa per capita segundo locais de aquisição de alimentos consumidos fora do lar.

RESULTADOS

A aquisição de alimentos fora do lar foi reportada por 41,2% dos indivíduos, sendo maior entre os homens do que nas mulheres (44% versus 38,5%). Os adultos apresentaram maior frequência de aquisição (46%) do que os adolescentes (37,7%) e os idosos (24,2%). Os locais com maiores frequências de consumo de alimentos fora do lar foram lanchonete (16,9%) e restaurante (16,4%), enquanto frutaria (1,2%) apresentou a menor frequência. Doces, salgadinhos e refrigerante foram os alimentos mais adquiridos na maioria dos locais. Os gastos médios com alimentos foram maiores para restaurante (R$33,20) e menores para frutaria (R$4,10) e comida de rua (R$5,00).

CONCLUSÕES

O maior percentual de consumo de alimentos fora do lar é proveniente de lanchonete e restaurante, apontando importantes locais para o desenvolvimento de políticas públicas com foco na promoção da alimentação saudável.

Supermarkets and unhealthy food marketing: An international comparison of the content of supermarket catalogues/circulars

BACKGROUND

Supermarket marketing activities have a major influence on consumer food purchases. This study aimed to assess and compare the contents of supermarket marketing circulars from a range of countries worldwide from an obesity prevention perspective.

METHODS

The contents of supermarket circulars from major supermarket chains in 12 non-random countries were collected and analysed over an eight week period from July to September 2014 (n=89 circulars with 12,563 food products). Circulars were largely English language and from countries representing most continents. Food products in 25 sub-categories were categorised as discretionary or non-discretionary (core) food or drinks based on the Australian Guide to Healthy Eating. The total number of products in each subcategory in the whole circular, and on front covers only, was calculated.

RESULTS

Circulars from most countries advertised a high proportion of discretionary foods. The only exceptions were circulars from the Philippines (no discretionary foods) and India (11% discretionary food). Circulars from six countries advertised more discretionary foods than core foods. Front covers tended to include a much greater proportion of healthy products than the circulars overall.

CONCLUSIONS

Supermarket circulars in most of the countries examined include a high percentage of discretionary foods, and therefore promote unhealthy eating behaviours that contribute to the global obesity epidemic. A clear opportunity exists for supermarket circulars to promote rather than undermine healthy eating behaviours of populations. Governments need to ensure that supermarket marketing is included as part of broader efforts to restrict unhealthy food marketing.