Geographic reach and nutritional quality of foods available from mobile online food delivery service applications: novel opportunities for retail food environment surveillance

Use of online food delivery services among adults in five countries from the International Food Policy Study 2018-2021

Aim

Online food delivery services (OFDS) are popular for purchasing meals prepared outside home, increasing access to energy-dense and nutrient-poor foods. This adversely impacts dietary choices and health outcomes. Our study examined trends in OFDS use in Australia, Canada, Mexico, the United Kingdom (UK), and the United States (US) from 2018 to 2021.

Methods

Repeated annual cross-sectional data was sourced from the International Food Policy Study for five countries among adults over 18 years (N = 83,337). Weighted estimates for trends in i) the proportion of the respondent's purchasing meals per week using OFDS, and ii) average number (and standard deviation (SD)) of meals purchased per week using OFDS were assessed. Logistic regression models were fitted.

Findings

OFDS use increased among adults between 2018-2021 (Australia: 17 % of respondents purchased at least one meal in the last 7 days using OFDS in 2018 to 25 % in 2021, Canada: 12 % to 19 %, Mexico: 28 % to 38 %, UK: 19 % to 28 %, and US: 17 % to 21 %). Average number of meals purchased per week outside home remained consistent for all countries over time (e.g., in Australia, 2.70 (SD 0.06) meals in 2018 and 2.63 (SD 0.06) in 2021). However, average number of meals purchased using OFDS nearly doubled between 2018 and 2021 (e.g., in Australia, 0.45 (SD 0.03) meals in 2018 to 0.81 (SD 0.04) in 2021).

Conclusion

OFDS use is increasing and are substituting the conventional forms of purchasing meals outside home. Nutritional quality of foods sold, marketing practices and purchasing patterns on OFDS deserve further attention.

"We know what we should be eating, but we don't always do that." How and why people eat the way they do: a qualitative study with rural australians

BACKGROUND

There is evidence that most people are aware of the importance of healthy eating and have a broad understanding regarding types of food that enhance or detract from health. However, greater health literacy does not always result in healthier eating. Andreasen's Social Marketing Model and Community-Based Social Marketing both posit that, in order to change health behaviours, it is crucial to understand reasons for current behaviours and perceived barriers and benefits to improved behaviours. Limited research has been conducted, however, that explores these issues with general populations. This study aimed to help address this gap in the evidence using a qualitative methodology.

METHODS

Three group discussions were conducted with a total of 23 participants: (1) young women aged 18-24 with no children; (2) women aged 35-45 with primary school aged children; and (3) men aged 35-50 living with a partner and with pre- or primary school aged children. The discussions took place in a regional centre of Victoria, Australia. Transcriptions were thematically analysed using an inductive descriptive approach and with reference to a recent integrated framework of food choice that identified five key interrelated determinants: food- internal factors; food- external factors; personal-state factors; cognitive factors; and sociocultural factors.

RESULTS

We found that food choice was complex, with all five determinants evident from the discussions. However, the "Social environment" sub-category of "Food-external factors", which included family, work, and social structures, and expectations (or perceived expectations) of family members, colleagues, friends, and others, was particularly prominent. Knowledge that one should practice healthy eating, which falls under the "Cognitive factor" category, while seen as an aspiration by most participants, was often viewed as unrealistic, trumped by the need and/or desire for convenience, a combination of Food-external factor: Social environment and Personal-state factor: Psychological components.

CONCLUSIONS

We found that decisions regarding what, when, and how much to eat are seen as heavily influenced by factors outside the control of the individual. It appears, therefore, that a key to improving people's eating behaviours is to make it easy to eat more healthfully, or at least not much harder than eating poorly.

Adolescents' use of online food delivery applications and perceptions of healthy food options and food safety: a cross-sectional study in the United Arab Emirates

Introduction

This cross-sectional study aimed to assess Online food delivery applications (OFDA) usage trends among adolescent users in the United Arab Emirates (UAE), focusing on their perceptions of healthy food options and food safety (n = 532).

Methods

Sociodemographic information, frequency of OFDA use, factors affecting food choices, and perceptions of healthy food and food safety were investigated. A total perception score was calculated for each participant.

Results

Most participants used OFDAs weekly (65.4%), favoring fast food (85.7%). Factors like appearance and price drove food choices (65.0%), while taste and cost hindered healthy food orders (29.7 and 28.2%). Younger and frequent users had lower scores for perceiving healthy food, while seeking healthy options was associated with higher scores (p < 0.05). Females and those seeking healthy food showed higher food safety scores (p < 0.05).

Discussion

The study suggests tailored interventions to promote healthier choices and improve food safety perceptions among adolescents using OFDAs in the UAE.

Benchmarking online food delivery applications against menu labelling laws: a cross-sectional observational analysis

OBJECTIVE

It is unknown how well menu labelling schemes that enforce the display of kilojoule (kJ) labelling at point-of-sale have been implemented on online food delivery (OFD) services in Australia. This study aimed to examine the prevalence of kJ labelling on the online menus of large food outlets with more than twenty locations in the state or fifty locations nationally. A secondary aim was to evaluate the nutritional quality of menu items on OFD from mid-sized outlets that have fewer locations than what is specified in the current scheme.

DESIGN

Cross-sectional analysis. Prevalence of kJ labelling by large food outlets on OFD from August to September 2022 was examined. Proportion of discretionary ('junk food') items on menus from mid-sized outlets was assessed.

SETTING

Forty-three unique large food outlets on company (e.g. MyMacca's) and third party OFD (Uber Eats, Menulog, Deliveroo) within Sydney, Australia. Ninety-two mid-sized food outlets were analysed.

PARTICIPANTS

N/A.

RESULTS

On company OFD apps, 35 % (7/23) had complete kJ labelling for each menu item. In comparison, only 4·8 % (2/42), 5·3 % (2/38) and 3·6 % (1/28) of large outlets on Uber Eats, Menulog and Deliveroo had complete kJ labelling at all locations, respectively. Over three-quarters, 76·3 % (345/452) of menu items from mid-sized outlets were classified as discretionary.

CONCLUSIONS

Kilojoule labelling was absent or incomplete on a high proportion of online menus. Mid-sized outlets have abundant discretionary choices and yet escape criteria for mandatory menu labelling laws. Our findings show the need to further monitor the implementation of nutrition policies on OFD.

Characteristics of food establishments registered with a meal delivery app in Latin America

Numerous studies have characterised the establishments registered with meal delivery apps (MDA) in several countries. However, little evidence is available regarding these platforms in Latin America (LA). The purpose of this study is to characterise food establishments registered with an MDA in nine LA cities. The establishments (n 3339) were characterised by the following keyword groups: 'Typical cuisine', 'Meat and fish', 'Snacks', 'Breakfast', 'Desserts' and 'Healthy'. In addition, we identified the marketing strategies present in the establishments' advertisements: photos, discounts and free delivery. Mexico City had the highest number of establishments registered with MDA (773), followed by Bogotá (655), Buenos Aires (567) and São Paulo (454). There is a direct relationship between the number of inhabitants of the cities and the number of the registered establishments. 'Snacks' was the keyword group most used by establishments in five of the nine cities. Establishments in two cities were most often characterised by the terms 'Typical cuisine' (Mexico City and Santiago de Chile) and 'Meats and fish' (Quito and San Jose). Photos were present in the advertisements of at least 84·0 % of the establishments. In addition, at least 40 % of establishments in Montevideo, Bogotá, São Paulo, Lima and Santiago de Chile offered discounts. Free delivery was present in at least 50 % of establishments in Quito, San Jose, Mexico City, Santiago de Chile and Lima. Photos were also the most common marketing strategy used by the establishments classified in all groups of keywords, while free delivery and discounts differed among them.

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.

Availability of calorie information on online food delivery service platforms among major chain restaurants in Canadian provinces with different calorie labelling policies

OBJECTIVE

This study aimed to characterize the availability of calorie labelling on major online food delivery (OFD) platforms for the largest restaurant brands in Canada to examine differences in provinces with and those without mandatory calorie labelling regulations.

METHODS

Data were collected for the 13 largest restaurant brands with locations in Ontario (with mandatory menu labelling) and Alberta and Quebec (with no mandatory menu labelling) from the web applications of the three largest OFD platforms in Canada. Data were sampled from three selected restaurant locations within each province (n = 117 locations across all provinces) on each platform. Univariate logistic regression models were used to test differences in the presence and amount of calorie labelling and other nutritional information across provinces and platforms.

RESULTS

The analytical sample included 48,857 food and beverage items (n = 16,011 in Alberta, n = 16,683 in Ontario, and n = 16,163 in Quebec). Items were more likely to have menu labelling in Ontario (68.7%) than in Alberta (44.4%, OR = 2.75, 95% CI 2.63-2.88) or Quebec (39.1%, OR = 3.42, 95% CI 3.27-3.58). In Ontario, 53.8% of restaurant brands had calorie labelling for  > 90% of items, compared to 23.0% in Quebec and 15.4% in Alberta. The presence of calorie labelling also differed across platforms.

CONCLUSION

Nutrition information from OFD services differed across provinces with and those without mandatory calorie labelling. Chain restaurants on OFD service platforms were more likely to provide calorie information in Ontario, where calorie labelling is mandatory, compared to elsewhere where no such policy exists. In all provinces, calorie labelling was inconsistently implemented across OFD service platforms.

Socioeconomic distribution of food outlet availability through online food delivery services in seven European countries: A cross-sectional study

This area-level cross-sectional study examined online food outlet availability through the most popular online food delivery service platforms (OFDS) across seven European countries, and explored how this online food outlet availability was socioeconomically distributed. Data collection of online food outlet availability was automated in England, Italy, Luxembourg, the Netherlands, Portugal, Spain and Switzerland. We used a geographic information system to join online food outlet availability to socio-demographic information. Median number of food outlets delivering through OFDS was highest in England and lowest in Italy, Portugal and Spain. We also found that high-income areas have the greatest online food outlet availability in most countries. In England, areas with a middle income had the least online food outlets available and no income data was available for Switzerland. Further work is needed to understand drivers of disparities in online food outlet availability, as well as possible implications for public health.

The Effects of Ontario Menu Labelling Regulations on Nutritional Quality of Chain Restaurant Menu Items-Cross-Sectional Examination

Restaurant foods are associated with excessive energy intake and poor nutritional quality. In 2017, the Healthy Menu Choices Act mandated food service establishments with ≥20 outlets in Ontario to display the energy content on menus. To examine the potential impact of menu labelling, nutrition information for 18,760 menu items were collected from 88 regulated and 53 unregulated restaurants. Descriptive statistics were calculated for serving size, energy, saturated fat, sodium and total sugars. Quantile regression was used to determine the differences between regulated and unregulated restaurants. The energy content of menu items from regulated restaurants (median (95% CI): 320 kcal (310, 320)) was significantly lower than those from unregulated restaurants (470 kcal (460, 486), p < 0.001). Saturated fat, sodium and total sugars were significantly lower in regulated restaurants (4 g (4, 4), 480 mg (470, 490) and 7 g (6, 7), respectively) than in unregulated restaurants (6 g (6, 6), 830 mg (797, 862) and 8 g (8, 9), respectively, p < 0.001). This study showed that menu items from regulated restaurants had smaller serving size, lower levels of energy and nutrients of public health concern compared to those from the unregulated restaurants, suggesting potential downstream beneficial effects of menu labelling in lowering caloric content and nutrients of public health concern in foods.

The inexorable rise of automated food deliveries and potential anticipatory policy actions

OBJECTIVE

Food deliveries to consumers using autonomous vehicles are forecast to become commonplace in Australia and globally. The aims of this study were to (i) explore the anticipated nature of AV food delivery services in Australia and (ii) identify available policy options to optimise positive outcomes and minimise any negative consequences for health and well-being.

METHODS

In total, 36 interviews were conducted with 40 expert stakeholders across a range of relevant sectors including transport, urban planning, health and telecommunications. Interviewees discussed the ways in which automated food deliveries are likely to be implemented and the potential implications for lifestyles and health.

RESULTS

The interviewees expected automated food deliveries to constitute an extension of current trends towards online food ordering and rapid home deliveries, with potential adverse implications for diet quality at the population level.

CONCLUSIONS

Effective regulation of automated food and beverage delivery services will be needed to anticipate and address this emerging phenomenon.

IMPLICATIONS FOR PUBLIC HEALTH

There is the opportunity to optimise the public health outcomes associated with automated food deliveries while minimising potential negative consequences through proactive anticipatory action. Delays could result in undesirable and irreversible changes to the food environment.

Examination of sleep in relation to dietary and lifestyle behaviors during Ramadan: A multi-national study using structural equation modeling among 24,500 adults amid COVID-19

Background

Of around 2 billion Muslims worldwide, approximately 1.5 billion observe Ramadan fasting (RF) month. Those that observe RF have diverse cultural, ethnic, social, and economic backgrounds and are distributed over a wide geographical area. Sleep is known to be significantly altered during the month of Ramadan, which has a profound impact on human health. Moreover, sleep is closely connected to dietary and lifestyle behaviors.

Methods

This cross-sectional study collected data using a structured, self-administered electronic questionnaire that was translated into 13 languages and disseminated to Muslim populations across 27 countries. The questionnaire assessed dietary and lifestyle factors as independent variables, and three sleep parameters (quality, duration, and disturbance) as dependent variables. We performed structural equation modeling (SEM) to examine how dietary and lifestyle factors affected these sleep parameters.

Results

In total, 24,541 adults were enrolled in this study. SEM analysis revealed that during RF, optimum sleep duration (7-9 h) was significantly associated with sufficient physical activity (PA) and consuming plant-based proteins. In addition, smoking was significantly associated with greater sleep disturbance and lower sleep quality. Participants that consumed vegetables, fruits, dates, and plant-based proteins reported better sleep quality. Infrequent consumption of delivered food and infrequent screen time were also associated with better sleep quality. Conflicting results were found regarding the impact of dining at home versus dining out on the three sleep parameters.

Conclusion

Increasing the intake of fruits, vegetables, and plant-based proteins are important factors that could help improve healthy sleep for those observing RF. In addition, regular PA and avoiding smoking may contribute to improving sleep during RF.

Nutritional Content of Popular Menu Items from Online Food Delivery Applications in Bangkok, Thailand: Are They Healthy?

The rise in online food delivery (OFD) applications has increased access to a myriad of ready-to-eat options, which may lead to unhealthier food choices. Our objective was to assess the nutritional profile of popular menu items available through OFD applications in Bangkok, Thailand. We selected the top 40 popular menu items from three of the most commonly used OFD applications in 2021. Each menu item was collected from the top 15 restaurants in Bangkok for a total of 600 items. Nutritional contents were analysed by a professional food laboratory in Bangkok. Descriptive statistics were employed to describe the nutritional content of each menu item, including energy, fat, sodium, and sugar content. We also compared nutritional content to the World Health Organization's recommended daily intake values. The majority of menu items were considered unhealthy, with 23 of the 25 ready-to-eat menu items containing more than the recommended sodium intake for adults. Eighty percent of all sweets contained approximately 1.5 times more sugar than the daily recommendation. Displaying nutrition facts in the OFD applications for menu items and providing consumers with filters for healthier options are required to reduce overconsumption and improve consumer food choice.

Online on-demand delivery services of food and alcohol: A scoping review of public health impacts

The increase in availability of online on-demand food and alcohol delivery services has changed the way unhealthy commodities are accessed and understood. We conducted a systematic scoping review of academic and grey literature to map the current knowledge of public health and regulatory/policy outcomes arising from on-demand food and alcohol delivery (defined as delivery within 2 h). We systematically searched three electronic databases and completed supplementary forward citation searches and Google Scholar searches. In total, we screened 761 records (de-duplicated) and synthesised findings from 40 studies by commodity types (on-demand food or alcohol) and outcome focus (outlet, consumer, environmental, labour). Outlet-focused outcomes were most common (n = 16 studies), followed by consumer (n = 11), environmental (n = 7), and labour-focused (n = 6) outcomes. Despite geographical and methodological diversity of studies, results indicate that on-demand delivery services market unhealthy and discretionary foods, with disadvantaged communities having reduced access to healthy commodities. Services that deliver alcohol on-demand can also subvert current alcohol access restrictions, particularly through poor age verification processes. Underpinning these public health impacts is the multi-layered nature of on-demand services and context of the COVID-19 pandemic, which creates ongoing complications as to how populations access food and alcohol. Changing access to unhealthy commodities is an emerging issue in public health. Our scoping review considers priority areas for future research to better inform policy decisions. Current regulation of food and alcohol may not appropriately cover emerging on-demand technologies, necessitating a review of policy.

Establishing the Relative Accuracy of Using City Directories as Proxies to Define and Reconstruct Historical Alcohol Environments

OBJECTIVE

Research on alcohol environments has established that poorer and minoritized communities are frequently overburdened by off-premise outlets (e.g., liquor stores). These outlets have more associated harms, including increased alcohol consumption and crime rates. Little, if any, research has shown how these socio-spatial disparities in exposure have grown or shifted over time, and no studies have established a method for re-creating historical alcohol environments.

METHOD

Our results suggest that in our study city of Flint, MI, disparities in the alcohol environment have narrowed since 1950. Although liquor stores are still more likely to be located in poorer and more heavily African American neighborhoods, the pattern has become insignificant over time. Furthermore, the number of alcohol outlets per capita has declined. Thus, although the city remains more overburdened with alcohol outlets than its suburbs, the disparity has shrunk.

CONCLUSIONS

This work has implications for those working in alcohol prevention and policy, as well as in urban planning. Practitioners and researchers can use this method to model alcohol availability over time in their own communities, which helps better inform the discussion on disparities experienced in poor and minoritized neighborhoods.

Nutritional quality and consumer health perception of online delivery food in the context of China

Background

Today, the popularization of mobile internet technology has enabled the public’s need for food convenience and diversity arising from modern fast-paced lifestyles to be met at a relatively low cost. The digital age of the restaurant industry has arrived. Online food delivery (OFD) is rapidly developing globally. However, the public’s awareness of the nutritional quality of food through OFD and their knowledge of dietary nutrition remain to be investigated.

Methods

In the context of China, this study attempts to evaluate the nutritional quality of best-selling OFD set meals (i.e., meal combos) based on the current official Chinese dietary guidelines 2022. It accomplishes this by collecting data on popular OFD restaurants among consumers in 115 Chinese universities from the restaurants’ delivery addresses. Moreover, 20,430 valid questionnaires were collected online from undergraduates, graduate students, and other young groups aged 18–30 throughout China for descriptive analysis to investigate consumers’ perceptions of the nutritional quality of food through OFD and its health impact.

Results

The results of the nutritional quality evaluation of the OFD set meals ranged widely from 15 to 85, with a mean of 36.57 out of a possible maximum score of 100; and 89.56% scored less than 50. The nutritional quality of OFD foods was thus generally low. The nutritional quality of foods was negatively correlated with their popularity among consumers.

Conclusions

Young OFD consumers generally paid low attention to dietary nutrition knowledge and seldom paid attention to nutritional quality when choosing OFD foods while the nutritional quality of OFD foods was generally low. Respondents subjectively reported that long-term consumption of OFD food caused weight gain, increased blood lipids, and gastrointestinal discomfort. They thought that the reason might be excessive oil, salt, and sugar in the food, while ignoring the balance between different types of food.

Refining the Nutrition Environment Measures Survey (NEMS) for Healthy Community Stores: Adaptations to Capture Alternative Food Retailers and Align with Dietary Guidelines

Inadequate consumption of healthy food is an ongoing public health issue in the United States. Food availability measures of supply versus consumption of healthy foods are disconnected in many studies. There is a need for an objective assessment of the food environment in order to assess how the food supply aligns with the Healthy Eating Index (HEI). Data were collected as part of the Healthy Community Stores Case Study Project, including a refined Nutrition Environment Measures Survey for Healthy Community Stores (NEMS-HCS) and an updated Healthy Food Availability Index that aligns with the Healthy Eating Index (HFAHEI). This paper will focus on the NEMS-HCS development process, findings, and HFAHEI application. All food items were more likely to be found at grocery stores rather than corner stores. Food pricing was often above the Consumer Price Index averages for six food items. The NEMS-HCS assessment better aligned with the HEI because it included a wider variety of meats, frozen fruits and vegetables, and an increased selection of whole grains. HFAHEI scoring was inclusive of non-traditional and alternative community stores with a health focus, making it suitable for use at the local level, especially in neighborhoods where supermarkets and large chain stores are less common.

Retail food environment in a Brazilian metropolis over the course of a decade: evidence of restricted availability of healthy foods

OBJECTIVE

To evaluate changes in the retail food environment profile in a Brazilian metropolis over a 10-year period.

DESIGN

An ecological study was conducted in the city of Belo Horizonte, Minas Gerais, Brazil. The addresses of formal food establishments were geocoded and classified according to their sold-food profile. Density changes were analysed according to neighbourhood, population size, income level and geospatial distribution.

SETTING

Totally, 468 neighbourhoods in the city of Belo Horizonte, Minas Gerais, Brazil.

PARTICIPANTS

Totally, 83 752 formal food establishments registered for operation in any one or more of those years: 2008, 2011, 2015 and 2018.

RESULTS

There was an increase in unhealthy establishments (154 %), followed by mixed (51 %) and healthy establishments (32 %), during the period evaluated, in addition to an increase in density according to income categories. There was a higher proportion of unhealthy establishments in relation to healthy establishments, indicating worsening of the community food environment over time.

CONCLUSIONS

Over the course of 10 years, changes in the neighbourhood's food environment were unfavourable for adequate access to healthy foods in lower-income neighbourhoods. The findings reinforce the need for interventions aimed at increasing the availability of businesses that offer healthy food in the city.

Investigating experiences of frequent online food delivery service use: a qualitative study in UK adults

BACKGROUND

Food prepared out-of-home is typically energy-dense and nutrient-poor. This food can be purchased from multiple types of retailer, including restaurants and takeaway food outlets. Using online food delivery services to purchase food prepared out-of-home is increasing in popularity. This may lead to more frequent unhealthy food consumption, which is positively associated with poor diet and living with obesity. Understanding possible reasons for using online food delivery services might contribute to the development of future public health interventions, if deemed necessary. This knowledge would be best obtained by engaging with individuals who use online food delivery services as part of established routines. Therefore, we aimed to investigate customer experiences of using online food delivery services to understand their reasons for using them, including any advantages and drawbacks.

METHODS AND RESULTS

In 2020, we conducted telephone interviews with 22 adults living in the UK who had used online food delivery services on at least a monthly basis over the previous year. Through codebook thematic analysis, we generated five themes: 'The importance of takeaway food', 'Less effort for more convenience', 'Saving money and reallocating time', 'Online food delivery service normalisation' and 'Maintained home food practices'. Two concepts were overarching throughout: 'Place. Time. Situation.' and 'Perceived advantages outweigh recognised drawbacks'. After considering each of the accessible food purchasing options within the context of their location and the time of day, participants typically selected online food delivery services. Participants reported that they did not use online food delivery services to purchase healthy food. Participants considered online food delivery service use to be a normal practice that involves little effort due to optimised purchasing processes. As a result, these services were seen to offer convenient access to food aligned with sociocultural expectations. Participants reported that this convenience was often an advantage but could be a drawback. Although participants were price-sensitive, they were willing to pay delivery fees for the opportunity to complete tasks whilst waiting for delivery. Furthermore, participants valued price-promotions and concluded that receiving them justified their online food delivery service use. Despite takeaway food consumption, participants considered home cooking to be irreplaceable.

CONCLUSIONS

Future public health interventions might seek to increase the healthiness of food available online whilst maintaining sociocultural values. Extending restrictions adopted in other food environments to online food delivery services could also be explored.

Understanding the Online Environment for the Delivery of Food, Alcohol and Tobacco: An Exploratory Analysis of 'Dark Kitchens' and Rapid Grocery Delivery Services

Online spaces are increasingly important in the sale of food, alcohol and tobacco. This analysis focuses on two developments in online food delivery: delivery-only 'dark kitchens' and rapid grocery delivery services (RGDS), with the aim to understand and assess the availability of health harming and health promoting products through these services. Data was collected for one metropolitan local authority in London, UK, using publicly available online sources. Being explorative in nature, the analysis includes descriptive statistics and qualitative assessment. Three dark kitchens (renting kitchens to 116 food businesses), three grocery delivery apps, and 76 grocery businesses available through online delivery platforms were identified. Most businesses renting dark kitchen space were 'virtual restaurants' (52%) selling fast food (47%) or dessert (21%) through online delivery platforms. RGDS sold a variety of items, with a focus on pre-packaged foods high in fat, salt and sugar, alcoholic beverages and tobacco. These items were also most likely to be promoted through offers and promotional language. Fruits and vegetables were less commonly available and mainly on grocery delivery apps. Online delivery services increase the temporal and geographic availability and promotion of many unhealthy products. Research expanding on the geographic area of interest is needed.

Perspective: Are Online Food Delivery Services Emerging as Another Obstacle to Achieving the 2030 United Nations Sustainable Development Goals?

Online food delivery usage has soared during the 2019 novel coronavirus (COVID-19) pandemic which has seen increased demand for home-delivery during government mandated stay-at-home periods. Resulting implications from COVID-19 may threaten decades of development gains. It is becoming increasingly more important for the global community to progress toward sustainable development and improve the wellbeing of people, economies, societies, and the planet. In this perspective article, we discuss how the rising use of these platform-to-consumer delivery operations may impede advances toward the United Nations 2030 Sustainable Development Goals (SDGs). Specifically, online food delivery services may disrupt SDGs that address good health and wellbeing, responsible consumption and production, climate action and decent work and economic growth. To mitigate potential negative impacts of these meal delivery apps, we have proposed a research and policy agenda that is aligned with entry points within a systems approach identified by the World Health Organization. Food industry reforms, synergised public health messaging and continuous monitoring of the growing impact of online food delivery should be considered for further investigation by researchers, food industry, governments, and policy makers.

Food promoted on an online food delivery platform in a Brazilian metropolis during the COVID-19 pandemic: a longitudinal analysis

OBJECTIVE

To analyse food advertised on an online food delivery (OFD) platform during 16 weeks of the COVID-19 pandemic in Brazil.

DESIGN

Longitudinal study. We randomly selected foods advertised on the OFD app's home page, classifying the food items into water; natural juices and smoothies; vegetables; fruits; traditional meals and pasta; ultra-processed beverages; ice cream and candies, and salty packaged snacks; sandwiches; savoury snacks; and pizza. We also registered the marketing strategies used to promote the food items, such as photos, discounts, 'combo deals', and messages on healthiness, value for the money, tastiness, and pleasure.

SETTING

Belo Horizonte, Minas Gerais, Brazil.

PARTICIPANTS

1,593 food items.

RESULTS

In general, the OFD platform most commonly promoted traditional meals and pasta, ultra-processed beverages, and sandwiches-these food groups were offered 20-25% of the time during the 16 weeks. There were no promotions for water during the whole period, and the least common promotions were those for natural juices and smoothies, vegetables, and fruits (<5%). The most common food promotion strategies were photos (>80%) and discounts (>95%), while approximately 30% of the offers featured combo deals. Messages on tastiness, pleasure, and value for the money varied from 15% to 40%.

CONCLUSION

Although the OFD platform offered traditional meals and pasta, most of the foods and beverages advertised were unhealthy and promoted with persuasive strategies. This finding highlights a growing public health concern: an increase in unhealthy eating patterns during the pandemic.

Losses, Gains, and Changes to the Food Environment in a Rural Kentucky County during the COVID-19 Pandemic

The COVID-19 pandemic has caused alterations to be made in the way many people access, prepare, and consume food. Rural communities are particularly impacted due to pre-existing structural vulnerabilities, i.e., poverty, lack of infrastructure, and limited fresh food options. This study aimed to characterize experiences of one rural Appalachian community's changes to the food environment during the pandemic. In April 2021, six focus groups were conducted with residents of Laurel County, Kentucky. Using grounded theory, we identified losses, gains, and overall changes to the community food environment since the onset of COVID-19. Seventeen Laurel Countians (17 female; ages 30-74) participated in the six focus groups. Three main themes emerged regarding food environment changes-(1) modifications of community food and nutrition resources, (2) expansion and utilization of online food ordering, and (3) implications of the home food environment. Rural communities faced considerable challenges during the COVID-19 pandemic, in part, due to gaps in existing infrastructure and loss of pre-existing resources. This study illustrates the complexity of changes occurring during COVID-19. Using the preliminary data obtained, we can better understand pre-existing issues in Laurel County and suggestions for future programming to address the inequitable access and response during public health emergencies and beyond.