1
|
Li Z, Fang Y, Zhang N, Zhu W, Chang S, Zhou S, Zhang M, Ma G. Evaluating Childhood Overweight- and Obesity-Related Food Marketing Policies in China Using the Food-Environment Policy Index (Food-EPI). Nutrients 2024; 16:482. [PMID: 38398807 PMCID: PMC10893324 DOI: 10.3390/nu16040482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE Addressing the increasing global health issue of childhood obesity, exacerbated by pervasive food marketing, this study critically evaluated China's food marketing policies in comparison with international best practices, aiming to uncover policy content and implementation gaps and inform policy enhancement strategies. METHOD Three key indicators were utilized from the Healthy Food-Environment Policy Index (Food-EPI)'s food promotion domain. A panel of experts (n = 13) from academic institutions, China Centers for Disease Control and Prevention, and the food industry assessed the Chinese government's policy scores and implementation levels concerning food marketing. Benchmarked against international best practices using the Food-EPI process, this evaluation encompassed context analysis, data collection, evidence-based policy action, government validation, policy rating, scoring, and results translation for government and stakeholders. The three chosen indicators specifically addressed childhood overweight- and obesity-related food marketing in broadcast media (Indicator 1), non-broadcast media (Indicator 2), and child gathering settings (Indicator 3). RESULTS Specifically, Indicator 1, the Single Food Marketing Indicator Score was measured at 2.31 ± 0.38, with an accompanying Food Marketing Policy Implementation Percentage of 46.2%, and Low Implementation Level. For non-broadcast mediums (Indicator 2), these metrics were gauged at 1.77 ± 0.27, 35.4%, and Low Implementation Level, respectively. In child gathering settings (Indicator 3), for efforts curbing unhealthy food promotion, a score of 2.77 ± 0.27, an implementation percentage of 55.4%, and Medium Implementation Level was obtained. Cumulatively, the overarching efficacy of food marketing policy enforcement was determined to be suboptimal, with the consolidated figures being Total Food Marketing Score as 2.28 ± 0.97, Total Food Marketing Policy Implementation Percentage as 45.6%, and Total Food Marketing Policy Implementation Level as Low. CONCLUSION Like many countries, China's food marketing policies and implementation have room for improvement when compared to international best practices. Recommendations include emphasizing nutritional legislation, fostering stakeholder collaboration, bolstering public health campaigns, and leveraging technology for stringent enforcement.
Collapse
Affiliation(s)
- Zhenhui Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Z.L.); (Y.F.); (N.Z.); (W.Z.); (S.Z.)
| | - Yujie Fang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Z.L.); (Y.F.); (N.Z.); (W.Z.); (S.Z.)
| | - Na Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Z.L.); (Y.F.); (N.Z.); (W.Z.); (S.Z.)
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Wenli Zhu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Z.L.); (Y.F.); (N.Z.); (W.Z.); (S.Z.)
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Suying Chang
- Child Health Development Section, United Nations International Children’s Emergency Fund (UNICEF) Office for China, 12 Sanlitun Lu, Chaoyang District, Beijing 100600, China;
| | - Shuyi Zhou
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Z.L.); (Y.F.); (N.Z.); (W.Z.); (S.Z.)
| | - Man Zhang
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
- School of Nursing, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; (Z.L.); (Y.F.); (N.Z.); (W.Z.); (S.Z.)
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| |
Collapse
|
2
|
Rossi CE, Pinho MGM, Corrêa EN, de Abreu ÂH, Rech CR, Ferreira JRDC, de Vasconcelos FDAG. Neighborhood Availability and Use of Food, Physical Activity, and Social Services Facilities in Relation to Overweight and Obesity in Children and Adolescents. Food Nutr Bull 2023; 44:12-26. [PMID: 36601667 DOI: 10.1177/03795721221146215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the association of a combined measure of availability and use of facilities from the food environment and overweight (including obesity) among schoolchildren, while taking into account the physical activity and social-assistance environments. METHODS Cross-sectional study with a probabilistic sample of schoolchildren aged 7 to 14 years living in a southern Brazilian city (n = 2026). Multilevel analyses were performed with overweight as outcome and the food environment as main exposure. Models were adjusted for the physical activity and social-assistance environments, as well as individual and other residential neighborhood characteristics. RESULTS Greater availability of restaurants around the home was associated with higher odds of overweight (odds ratio [OR] = 1.40; 95% CI = 1.06-1.85). Stronger associations were found for schoolchildren reporting to use restaurants (OR = 1.48; 95% CI = 1.15-1.90). This association remained significant after adjusting for the presence of other food retailers. Schoolchildren who had social-assistance facilities around their homes, but reported not to use them, showed consistently higher odds of being overweight (OR = 1.34; 95% CI = 1.01-1.78) as compared to schoolchildren who had these facilities near home and used them. The physical activity environment was not associated with the outcome. CONCLUSIONS Availability and use of the food and social-assistance environments were significantly associated with overweight (including obesity) among the schoolchildren. Future research should consider the use of environmental facilities in combination to their geographical availability. Our results highlight the need for policies that limit the access to obesogenic food outlets by children and adolescents.
Collapse
Affiliation(s)
| | - Maria Gabriela M Pinho
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands.,Upstream Team, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Elizabeth Nappi Corrêa
- Universidade Federal de Santa Catarina. Rua Engenheiro Agronômico Andrei Cristian Ferreira, s/n-Centro de Ciências da Saúde, Trindade, Florianópolis-Santa Catarina, Brazil
| | - Ângelo Horta de Abreu
- Gis Especialist. Imagem-Enterprise for Geographic Intelligence Solutions. Belo Horizonte-Minas Gerais, Brazil
| | - Cassiano Ricardo Rech
- Programa de Pós-Graduação em Educação Física (PPGEF), Campus Universitário Trindade, Florianópolis-Santa Catarina, Brazil
| | | | - Francisco de Assis Guedes de Vasconcelos
- Universidade Federal de Santa Catarina. Rua Engenheiro Agronômico Andrei Cristian Ferreira, s/n-Centro de Ciências da Saúde, Trindade, Florianópolis-Santa Catarina, Brazil
| |
Collapse
|
3
|
Benchmarking public policies to create healthy food environments compared to best practice: the Healthy Food Environment Policy Index in Guatemala. Arch Public Health 2022; 80:174. [PMID: 35854354 PMCID: PMC9295498 DOI: 10.1186/s13690-022-00928-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Benchmarking the implementation of healthy food environment public policies against international best practices may accelerate the government response to prevent obesity and non-communicable diseases (NCDs) in the countries. The aim of the study was to determine the extent of food environment policy implementation in Guatemala and to identify and prioritize actions for the government to accelerate their implementation. Methods The INFORMAS Healthy Food Environment Policy Index (Food-EPI from the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support) was used. Evidence of implementation for 50 good practice indicators within the seven food policies and six infrastructure support domains was compiled, and subsequently validated by Guatemalan government officials. A national civil society expert panel on public health and nutrition performed an online assessment of the implementation of healthy food environment policies against best international practices. The level of agreement among evaluators was measured using the Gwet second order agreement coefficient (AC2). The expert panel recommended actions for each indicator during on-site workshops and those actions were prioritized by importance and achievability. Results The expert panel rated implementation at zero for 26% of the indicators, very low for 28% of indicators, low for 42%, and medium for 4% of indicators (none were rated high). Indicators at medium implementation were related to the use of evidence for developing policies and ingredient list/nutrition information panels on packaged foods. Seventy-seven actions were recommended prioritizing the top 10 for immediate action. The Gwet AC2 was 0.73 (95% CI 0.67–0.80), indicating a good concordance among experts. Conclusions In the Food-EPI of Guatemala, almost all indicators of good practice had a low or less level of implementation. The expert panel proposed 12 priority actions to accelerate policy implementation to tackle obesity and NCDs in the country. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00928-w.
Collapse
|
4
|
Mialon M, Bertscher A, Bero L, Vandevijvere S. Proposed methods for evaluating efforts made by governments to prevent and mitigate corporate influence and conflicts of interest in public health policy. HRB Open Res 2022; 5:41. [PMID: 37496747 PMCID: PMC10366553 DOI: 10.12688/hrbopenres.13553.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 07/28/2023] Open
Abstract
Background: There is evidence that corporations try to delay, weaken, and avoid the adoption of measures that would protect and improve population health. This is particularly true and problematic for health harming industries, such as those producing ultra-processed foods, alcohol, and cigarettes. Financial conflicts of interest (COI) are also problematic in policy-making because they may compromise decision-makers' loyalty and independent judgment. Public opinion is in favor of preventing and mitigating that influence from corporations and COI on public health policy. A scoping review recently identified twenty-three mechanisms that could be adopted with that purpose and which principally cover: i) transparency and disclosure; ii) identification, monitoring, and education; iii) management; iv) prohibition of interactions with the industry and/or COI. There is, however, limited knowledge on the adoption of such mechanisms by governments. We therefore propose new methods for evaluating that progress at the country level. Methods and expected results: The proposed evaluation comprises five steps: 1) Gathering information about the national context; 2) Gathering evidence on the implementation of mechanisms by national governments; 3) Verification of step 2 by government officials and policy experts and local public health experts; 4) Identification and prioritization of actions in a workshop; 5) Supporting the translation of findings into policy actions. Conclusions: The evaluation of progress made by governments in their implementation of mechanisms for preventing and mitigating the influence of corporations and COI in public health policy could help countries systematize their efforts, benchmark their progress internationally, and give perspective on particular weaknesses, approaches, and investment gaps needed for change. We will implement and validate our methods in Ireland, as a first case-study.
Collapse
Affiliation(s)
- Mélissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, D02 H308, Ireland
| | - Adam Bertscher
- Tobacco Control Research Group, Department of Health, University of Bath, Bath, BA2 7AY, UK
| | - Lisa Bero
- Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, 80045, USA
| | | |
Collapse
|
5
|
An assessment of implementation gaps and priority recommendations on food environment policies: the Healthy Food Environment Policy Index in Japan. Public Health Nutr 2022; 25:1720-1732. [PMID: 34924082 PMCID: PMC9991651 DOI: 10.1017/s1368980021004900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current study aimed to evaluate policies and actions for food environments by the Japanese Government using the Healthy Food Environment Policy Index (Food-EPI). DESIGN Public health experts rated the extent of implementation of food environment-related Policy and the Infrastructure-support components, compared with international best practices. Subsequently, the experts proposed and prioritised future actions to address implementation gaps in an online workshop. SETTING Japan. PARTICIPANTS A total of sixty-six experts rated policy implementation by the Japanese Government and twenty-three participated in the workshop on future actions. RESULTS The implementations of regulations on unhealthy foods and non-alcoholic beverages were rated low in the domains of Food composition, Food labelling and Food promotion, Food prices and Food retail in the Policy component. The implementations of several domains in the Infrastructure-support component were, overall, rated at a higher level, specifically for monitoring and intelligence systems. Based on the rating, reducing health inequalities by supporting people, both economically and physically, was the highest priority for future actions in both components. CONCLUSIONS The current study found that Japan has a robust system for long-term monitoring of population health but lacks regulations on unhealthy foods and non-alcoholic beverages compared with international best practices. The current study confirmed the importance of continuous accumulation of evidence through national monitoring systems. Developing comprehensive regulations to restrict food marketing, sales and accessibility of unhealthy foods and non-alcoholic beverages is needed to improve the health of food environments in Japan.
Collapse
|
6
|
Mialon M, Bertscher A, Bero L, Vandevijvere S. Methods for evaluating efforts made by governments to prevent and mitigate corporate influence and conflicts of interest in public health policy. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13553.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: There is evidence that corporations try to delay, weaken, and avoid the adoption of measures that would protect and improve population health. This is particularly true and problematic for health harming industries, such as those producing ultra-processed foods, alcohol, and cigarettes. Financial conflicts of interest (COI) are also problematic in policy-making because they may compromise decision-makers’ loyalty and independent judgment. Public opinion is in favor of preventing and mitigating that influence from corporations and COI on public health policy. A scoping review recently identified twenty-three mechanisms that could be adopted with that purpose and which principally cover: i) transparency and disclosure; ii) identification, monitoring, and education; iii) management; iv) prohibition. There is, however, limited knowledge on the adoption of such mechanisms by governments. We therefore propose new methods for evaluating that progress at the country level. Methods and expected results: The proposed evaluation comprises five steps: 1) Gathering information about the national context; 2) Gathering evidence on the implementation of mechanisms by national governments; 3) Verification of step 2 by government officials and policy experts and local public health experts; 4) Identification and prioritization of actions in a workshop; 5) Supporting the translation of findings into policy actions. Conclusions: The evaluation of progress made by governments in their implementation of mechanisms for preventing and mitigating the influence of corporations and COI in public health policy could help countries systematize their efforts, benchmark their progress internationally, and give perspective on particular weaknesses, approaches, and investment gaps needed for change. We will implement and validate our methods in Ireland, as a first case-study.
Collapse
|
7
|
Mackay S, Gerritsen S, Sing F, Vandevijvere S, Swinburn B. Implementing healthy food environment policies in New Zealand: nine years of inaction. Health Res Policy Syst 2022; 20:8. [PMID: 35033119 PMCID: PMC8760574 DOI: 10.1186/s12961-021-00809-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/16/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The INFORMAS [International Network for Food and Obesity/Non-communicable Diseases (NCDs) Research, Monitoring and Action Support] Healthy Food Environment Policy Index (Food-EPI) was developed to evaluate the degree of implementation of widely recommended food environment policies by national governments against international best practice, and has been applied in New Zealand in 2014, 2017 and 2020. This paper outlines the 2020 Food-EPI process and compares policy implementation and recommendations with the 2014 and 2017 Food-EPI. METHODS In March-April 2020, a national panel of over 50 public health experts participated in Food-EPI. Experts rated the extent of implementation of 47 "good practice" policy and infrastructure support indicators compared to international best practice, using an extensive evidence document verified by government officials. Experts then proposed and prioritized concrete actions needed to address the critical implementation gaps identified. Progress on policy implementation and recommendations made over the three Food-EPIs was compared. RESULTS In 2020, 60% of the indicators were rated as having "low" or "very little, if any" implementation compared to international benchmarks: less progress than 2017 (47%) and similar to 2014 (61%). Of the nine priority actions proposed in 2014, there was only noticeable action on one (Health Star Ratings). The majority of actions were therefore proposed again in 2017 and 2020. In 2020 the proposed actions were broader, reflecting the need for multisectoral action to improve the food environment, and the need for a mandatory approach in all policy areas. CONCLUSIONS There has been little to no progress in the past three terms of government (9 years) on the implementation of policies and infrastructure support for healthy food environments, with implementation overall regressing between 2017 and 2020. The proposed actions in 2020 have reflected a growing movement to locate nutrition within the wider context of planetary health and with recognition of the social determinants of health and nutrition, resulting in recommendations that will require the involvement of many government entities to overcome the existing policy inertia. The increase in food insecurity due to COVID-19 lockdowns may provide the impetus to stimulate action on food polices.
Collapse
Affiliation(s)
- Sally Mackay
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, 1023, New Zealand.
| | - Sarah Gerritsen
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, 1023, New Zealand
- Centre for Longitudinal Research He Ara Ki Mua, School of Population Health, University of Auckland, Auckland, 1743, New Zealand
| | - Fiona Sing
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, 1023, New Zealand
| | - Stefanie Vandevijvere
- Sciensano (Scientific Institute of Public Health), Epidemiology and Public Health, J.Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Boyd Swinburn
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, 1023, New Zealand
| |
Collapse
|
8
|
McLoughlin GM, Allen P, Walsh-Bailey C, Brownson RC. A systematic review of school health policy measurement tools: implementation determinants and outcomes. Implement Sci Commun 2021; 2:67. [PMID: 34174969 PMCID: PMC8235584 DOI: 10.1186/s43058-021-00169-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/08/2021] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Governments in some countries or states/provinces mandate school-based policies intended to improve the health and well-being of primary and secondary students and in some cases the health of school staff. Examples include mandating a minimum time spent per week in programmed physical activity, mandating provision of healthy foods and limiting fat content of school meals, and banning tobacco products or use on school campuses. Although school health researchers have studied whether schools, districts, or states/provinces are meeting requirements, it is unclear to what extent implementation processes and determinants are assessed. The purposes of the present systematic review of quantitative measures of school policy implementation were to (1) identify quantitative school health policy measurement tools developed to measure implementation at the school, district, or state/provincial levels; (2) describe the policy implementation outcomes and determinants assessed and identify the trends in measurement; and (3) assess pragmatic and psychometric properties of identified implementation measures to understand their quality and suitability for broader application. METHODS Peer-reviewed journal articles published 1995-2020 were included if they (1) had multiple-item quantitative measures of school policy implementation and (2) addressed overall wellness, tobacco, physical activity, nutrition, obesity prevention, or mental health/bullying/social-emotional learning. The final sample comprised 86 measurement tools from 67 peer-review articles. We extracted study characteristics, such as psychometric and pragmatic measure properties, from included articles based on three frameworks: (1) Implementation Outcomes Framework, (2) Consolidated Framework for Implementation Research, and (3) Policy Implementation Determinants Framework. RESULTS Most implementation tools were developed to measure overall wellness policies which combined multiple policy topics (n = 35, 40%) and were in survey form (n = 75, 87%). Fidelity was the most frequently prevalent implementation outcome (n = 70, 81%), followed by adoption (n = 32, 81%). The implementation determinants most assessed were readiness for implementation, including resources (n = 43, 50%), leadership (n = 42, 49%), and policy communication (n = 41, 48%). Overall, measures were low-cost and had easy readability. However, lengthy tools and lack of reported validity/reliability data indicate low transferability. CONCLUSIONS Implementation science can contribute to more complete and rigorous assessment of school health policy implementation processes, which can improve implementation strategies and ultimately the intended health benefits. Several high-quality measures of implementation determinants and implementation outcomes can be applied to school health policy implementation assessment. Dissemination and implementation science researchers can also benefit from measurement experiences of school health researchers.
Collapse
Affiliation(s)
- Gabriella M McLoughlin
- Implementation Science Center for Cancer Control (WU-ISC3) and Prevention Research Center, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
- Division of Public Health Sciences (Department of Surgery), Washington University School of Medicine, Washington University in St. Louis, St. Louis, 63110, USA.
| | - Peg Allen
- Implementation Science Center for Cancer Control (WU-ISC3) and Prevention Research Center, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Callie Walsh-Bailey
- Implementation Science Center for Cancer Control (WU-ISC3) and Prevention Research Center, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ross C Brownson
- Implementation Science Center for Cancer Control (WU-ISC3) and Prevention Research Center, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
- Division of Public Health Sciences (Department of Surgery), Washington University School of Medicine, Washington University in St. Louis, St. Louis, 63110, USA
| |
Collapse
|
9
|
Ngqangashe Y, Goldman S, Schram A, Friel S. A narrative review of regulatory governance factors that shape food and nutrition policies. Nutr Rev 2021; 80:200-214. [PMID: 34015107 DOI: 10.1093/nutrit/nuab023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/14/2021] [Accepted: 03/03/2021] [Indexed: 01/23/2023] Open
Abstract
Food composition, marketing restrictions, nutrition labeling, and taxation policies are recommended for preventing diet-related noncommunicable diseases. In view of the increasing but variable adoption of food policies globally, this narrative review examines the actors, regulatory frameworks, and institutional contexts that shape the development, design, and implementation of these policies. We found a diverse range of actors using various strategies, including advocacy, framing, and evidence generation to influence policy agendas. We identified diverse regulatory designs used in the formulation and implementation of the policies: command and control state regulation for taxes and menu labels, quasi-regulation for sodium reformulation, and co-regulation and industry self-regulation for food marketing policies. Quasi-regulation and industry self-regulation are critiqued for their voluntary nature, lack of independence from the industry, and absence of (or poor) monitoring and enforcement systems. The policy instrument design and implementation best practices highlighted in this review include clear policy goals and rigorous standards that are adequately monitored and enforced. Future research should examine how these combinations of regulatory governance factors influence policy outcomes.
Collapse
Affiliation(s)
- Yandisa Ngqangashe
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sharni Goldman
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ashley Schram
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sharon Friel
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
10
|
Tay Z, Whitton C, van Dam RM, Chia KS, Swinburn B, Vandevijvere S, Rebello SA. Identifying implementation gaps and priorities for the Singapore government to improve food environment policies: perspectives from a local expert panel. Public Health Nutr 2020; 24:1-8. [PMID: 33046170 DOI: 10.1017/s1368980020003468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Singapore, an urbanised, developed nation, with a high reliance on food importation and a high prevalence of eating out is facing rising rates of obesity and diabetes. The objective of the current study was to characterise and evaluate the Singapore government's policies to improve the food environment and to identify and prioritise concrete actions. DESIGN The Healthy Food Environment Policy Index tool and process were used. An expert panel rated the Singapore government's implementation of forty-seven indicators compared with international best practice in 2018. Indicators were prioritised, and specific recommendations were proposed by panel. SETTING Singapore. PARTICIPANTS Twenty experts primarily from academia. RESULTS As compared with international benchmarks, the level of implementation of most indicators (thirty-three indicators, 70 %) by the Singapore government was evaluated as being at least moderate. Highly rated indicators included those related to provision of healthier meals at school, supporting the use of healthier ingredients by food vendors and governmental leadership. More policy indicators (6, 26 %) as compared with infrastructure support indicators (2, 8 %) received a 'very little or no implementation' rating. After rating, the experts prioritised eleven indicators and proposed thirty-one actions informed by several considerations including those of effectiveness, political acceptability, feasibility and unique characteristics of food retail in Singapore. CONCLUSIONS Supported by documented evidence, an independent expert panel identified areas of strengths and provided specific recommendations to meaningfully improve the Singapore food environment to facilitate healthier eating. Fundamental recommendations including improving nutrition profiling and strengthening monitoring systems have the potential to positively influence environments across policy domains.
Collapse
Affiliation(s)
- Zoey Tay
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, 12 Science Drive 2, MD1 Tahir Foundation Building, 10-01V, 117549, 65-65168557, 65-67791489, Singapore
| | - Clare Whitton
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, 12 Science Drive 2, MD1 Tahir Foundation Building, 10-01V, 117549, 65-65168557, 65-67791489, Singapore
- School of Public Health, Curtin University, Perth, Australia
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, 12 Science Drive 2, MD1 Tahir Foundation Building, 10-01V, 117549, 65-65168557, 65-67791489, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, 12 Science Drive 2, MD1 Tahir Foundation Building, 10-01V, 117549, 65-65168557, 65-67791489, Singapore
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Victoria Street West, Auckland, New Zealand
| | - Stefanie Vandevijvere
- Department of Epidemiology and Public Health, Sciensano (Scientific Institute of Public Health), Brussels, Belgium
| | - Salome A Rebello
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, 12 Science Drive 2, MD1 Tahir Foundation Building, 10-01V, 117549, 65-65168557, 65-67791489, Singapore
| |
Collapse
|
11
|
Santana MO, Guimarães JS, Leite FHM, Mais LA, Horta PM, Bortoletto Martins AP, Claro RM. Analysing persuasive marketing of ultra-processed foods on Brazilian television. Int J Public Health 2020; 65:1067-1077. [DOI: 10.1007/s00038-020-01456-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/16/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022] Open
|
12
|
Blasco-Blasco M, Puig-García M, Piay N, Lumbreras B, Hernández-Aguado I, Parker LA. Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review. PLoS One 2020; 15:e0237542. [PMID: 32886663 PMCID: PMC7473520 DOI: 10.1371/journal.pone.0237542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Given that most evidence-based recommendations for managing type 2 diabetes mellitus (T2DM) are generated in high-income settings, significant challenges for their implementation exist in Latin America and the Caribbean region (LAC), where the rates of T2DM and related mortality are increasing. The aim of this study is to identify the facilitators and barriers to successful management of T2DM in LAC, from the perspectives of patients, their families or caregivers, healthcare professionals, and/or other stakeholders. METHODS We conducted a systematic review in MEDLINE, Web of Science, SciELO, and LILACS. We included studies of disease management, prevention of complications and risk factor management. We qualitatively synthesized the verbatim text referring to barriers and/or facilitators of diabetes management according to the Theoretical Domain Framework and described their relative frequencies. FINDINGS We included 60 studies from 1,595 records identified. 54 studies (90%) identified factors related to the environmental context and resources, highlighting the importance of questions related to health care access or lack of resources in the health system, and the environmental context and living conditions of the patients. Issues related to "social influences" (40 studies) and "social/professional role and identity" (37 studies) were also frequently addressed, indicating the negative impact of lack of support from family and friends and clinicians' paternalistic attitude. 25 studies identified patients beliefs as important barriers, identifying issues such as a lack of patients' trust in the effectiveness of the medication and/or the doctor's advice, or preferences for alternative therapies. CONCLUSIONS Successful diabetes management in LAC is highly dependent on factors that are beyond the control of the individual patients. Successful disease control will require emphasis on public policies to reinforce health care access and resources, the promotion of a patient-centred care approach, and health promoting infrastructures at environmental level.
Collapse
Affiliation(s)
- Mar Blasco-Blasco
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Marta Puig-García
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Nora Piay
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Blanca Lumbreras
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lucy Anne Parker
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
13
|
Jürkenbeck K, Zühlsdorf A, Spiller A. Nutrition Policy and Individual Struggle to Eat Healthily: The Question of Public Support. Nutrients 2020; 12:E516. [PMID: 32085503 PMCID: PMC7071418 DOI: 10.3390/nu12020516] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 01/30/2023] Open
Abstract
The evidence for the effectiveness of nutrition policy interventions is growing. For the implementation of such interventions, social acceptability is crucial. Therefore, this study provides insight into public support for nutrition policy measures such as labelling and taxation. Further it analyses the level of acceptance in a quantitative segmentation approach. A new element to our approach is the comparison of different policy instruments, focusing on the interaction between policy acceptance and the perceived individual struggle to eat healthily. The survey was conducted in November 2017 and a total of 1035 German consumers are included in the data. The results indicate that the majority of German citizens accept nutrition policy interventions. Based on a cluster analysis, five different target groups according to the general acceptance of policy interventions and their own struggle to eat healthily are derived. The five-cluster solution reveals that both consumers who tend to eat a healthy diet as well as those who have problems with their diet support nutritional interventions. This shows that the perceived own struggle to eat healthily does not predict whether consumers accept nutrition policy interventions.
Collapse
Affiliation(s)
- Kristin Jürkenbeck
- Department of Agricultural Economics and Rural Development, Marketing of Food and Agricultural Products, University of Goettingen, 37073 Göttingen, Germany; (A.Z.); (A.S.)
| | | | | |
Collapse
|
14
|
Vandevijvere S, Mackay S, D'Souza E, Swinburn B. The first INFORMAS national food environments and policies survey in New Zealand: A blueprint country profile for measuring progress on creating healthy food environments. Obes Rev 2019; 20 Suppl 2:141-160. [PMID: 31483561 DOI: 10.1111/obr.12850] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/13/2019] [Accepted: 02/26/2019] [Indexed: 12/30/2022]
Abstract
The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support aims to benchmark national food environments. This study proposes a blueprint country profile to measure progress on creating healthy food environments, based on the results of the first, comprehensive survey in New Zealand (NZ). We assessed the implementation of national food environment policies and food industry commitments to improve population nutrition and the strength and comprehensiveness of public sector settings' nutrition policies. The healthiness of the packaged food supply, including health-related labelling, was evaluated. Food environments were measured in 833 schools, 204 supermarkets, 1500 takeaway outlets, 28 hospitals, 70 sport centres, and around all NZ schools. Food swamps, defined as areas with high relative density of unhealthy food outlets, were identified, and food marketing to children on television, websites, social media and packages, in magazines, and in and around schools was measured. The cost differential between healthy and current household diets was calculated for different population groups. NZ's food environment profile is largely unhealthy, and there are inequalities in access to healthy food environments. It is anticipated that the proposed country profile can help other countries tackle unhealthy food environments through increasing accountability of governments and the industry.
Collapse
Affiliation(s)
- Stefanie Vandevijvere
- School of Population Health, Department of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Sally Mackay
- School of Population Health, Department of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Erica D'Souza
- School of Population Health, Department of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Boyd Swinburn
- School of Population Health, Department of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
15
|
Nieto C, Rodríguez E, Sánchez-Bazán K, Tolentino-Mayo L, Carriedo-Lutzenkirchen A, Vandevijvere S, Barquera S. The INFORMAS healthy food environment policy index (Food-EPI) in Mexico: An assessment of implementation gaps and priority recommendations. Obes Rev 2019; 20 Suppl 2:67-77. [PMID: 30618143 DOI: 10.1111/obr.12814] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/09/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022]
Abstract
Mexico is one of the countries with the highest prevalence of obesity and recently declared a national epidemic of diabetes. Healthy food environments have the potential to improve the diet of the population and decrease the burden of disease. The aim of the study was to assess the efforts of the Mexican Government towards creating healthier food environments using the Healthy Food Environment Policy Index (Food-EPI). The tool was developed by the International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support (INFORMAS). Then, it was adapted to the Latin-American context and assessed the components of policy and infrastructure support. Actors from academia, civil society, government, and food industry assessed the level of implementation of food policies compared with international best practices. Actors were classified as (1) independents from academia and civil society (n = 36), (2) government (n = 28), and (3) industry (n = 6). The indicators with the highest percentage of implementation were those related to monitoring and intelligence. Those related to food retail were rated lowest. When stratified by type of actor, the government officials rated several indicators at a higher percentage of implementation compared with independent actors. None of the indicators were rated at high implementation. Government officials and independent actors agreed upon nine priority actions to improve the food environment in Mexico. These actions have the potential to improve government commitment and advocacy efforts to create healthier food environments.
Collapse
Affiliation(s)
- Claudia Nieto
- Centro de Investigación en Nutrición y Salud, Instituto Nacional De Salud Pública, Cuernavaca, Morelos, Mexico
| | - Estefania Rodríguez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional De Salud Pública, Cuernavaca, Morelos, Mexico
| | - Karina Sánchez-Bazán
- Centro de Investigación en Nutrición y Salud, Instituto Nacional De Salud Pública, Cuernavaca, Morelos, Mexico
| | - Lizbeth Tolentino-Mayo
- Centro de Investigación en Nutrición y Salud, Instituto Nacional De Salud Pública, Cuernavaca, Morelos, Mexico
| | - Angela Carriedo-Lutzenkirchen
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional De Salud Pública, Cuernavaca, Morelos, Mexico
| |
Collapse
|
16
|
Vandevijvere S, Barquera S, Caceres G, Corvalan C, Karupaiah T, Kroker-Lobos MF, L'Abbé M, Ng SH, Phulkerd S, Ramirez-Zea M, Rebello SA, Reyes M, Sacks G, Sánchez Nóchez CM, Sanchez K, Sanders D, Spires M, Swart R, Tangcharoensathien V, Tay Z, Taylor A, Tolentino-Mayo L, Van Dam R, Vanderlee L, Watson F, Whitton C, Swinburn B. An 11-country study to benchmark the implementation of recommended nutrition policies by national governments using the Healthy Food Environment Policy Index, 2015-2018. Obes Rev 2019; 20 Suppl 2:57-66. [PMID: 30609260 DOI: 10.1111/obr.12819] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/28/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022]
Abstract
The Healthy Food Environment Policy Index (Food-EPI) aims to assess the extent of implementation of recommended food environment policies by governments compared with international best practices and prioritize actions to fill implementation gaps. The Food-EPI was applied in 11 countries across six regions (2015-2018). National public health nutrition panels (n = 11-101 experts) rated the extent of implementation of 47 policy and infrastructure support good practice indicators by their government(s) against best practices, using an evidence document verified by government officials. Experts identified and prioritized actions to address implementation gaps. The proportion of indicators at "very low if any," "low," "medium," and "high" implementation, overall Food-EPI scores, and priority action areas were compared across countries. Inter-rater reliability was good (GwetAC2 = 0.6-0.8). Chile had the highest proportion of policies (13%) rated at "high" implementation, while Guatemala had the highest proportion of policies (83%) rated at "very low if any" implementation. The overall Food-EPI score was "medium" for Australia, England, Chile, and Singapore, while "very low if any" for Guatemala. Policy areas most frequently prioritized included taxes on unhealthy foods, restricting unhealthy food promotion and front-of-pack labelling. The Food-EPI was found to be a robust tool and process to benchmark governments' progress to create healthy food environments.
Collapse
Affiliation(s)
| | - Simon Barquera
- Instituto Nacional de Salud Publica (INSP), Cuernavaca, Mexico
| | - Gabriela Caceres
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Santiago, Chile
| | - Camila Corvalan
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Santiago, Chile
| | - Tilakavati Karupaiah
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Kuala Lumpur, Malaysia.,Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Mary L'Abbé
- Faculty of Medicine, Department of Nutritional Sciences, The University of Toronto, Toronto, Canada
| | - See Hoe Ng
- School of Health and Society, The University of Wollongong, NSW, Australia
| | - Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
| | - Manuel Ramirez-Zea
- Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala
| | - Salome A Rebello
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Marcela Reyes
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Santiago, Chile
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Deakin University, Melbourne, Australia
| | | | - Karina Sanchez
- Instituto Nacional de Salud Publica (INSP), Cuernavaca, Mexico
| | - David Sanders
- Faculty of Community and Health, The University of the Western Cape, Bellville, South Africa
| | - Mark Spires
- Faculty of Community and Health, The University of the Western Cape, Bellville, South Africa
| | - Rina Swart
- Faculty of Community and Health, The University of the Western Cape, Bellville, South Africa
| | | | - Zoey Tay
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | | | - Rob Van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Lana Vanderlee
- Faculty of Medicine, Department of Nutritional Sciences, The University of Toronto, Toronto, Canada
| | | | - Clare Whitton
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Boyd Swinburn
- School of Population Health, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
17
|
Jones AC, Kirkpatrick SI, Hammond D. Beverage consumption and energy intake among Canadians: analyses of 2004 and 2015 national dietary intake data. Nutr J 2019; 18:60. [PMID: 31627756 PMCID: PMC6800499 DOI: 10.1186/s12937-019-0488-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/28/2019] [Indexed: 01/09/2023] Open
Abstract
Background Among adults and children consuming Western diets, beverages are significant sources of free sugars, saturated fats, excess calories, and alcohol, with relevance to chronic disease risk. The impact of recent healthy eating policies and beverage market evolutions on population-level consumption patterns in Canada is unknown. The current study examined trends in intake of a range of beverage types among a nationally-representative sample of Canadians, with stratification by socio-demographic characteristics. Methods The 2004 (n = 34,775) and 2015 (n = 20,176) nutrition-focused cycles of the Canadian Community Health Surveys are cross-sectional surveys representative of the population of the 10 Canadian provinces. Based on a single multiple-pass 24-h dietary recall for each participant, fluids consumed as beverages were grouped into seven categories. Using linear regression, reported intake (volume, ml and energy, kcal) of each category was characterized over time and in relation to sex, age, ethnicity, income, body mass index (BMI), and province of residence. Results In 2015, Canadians reported consuming an average of 1806 ml (275 kcal) fluids as beverages per day, including: plain water 867 ml (0 kcal); other unsweetened beverages, e.g. coffee, 364 ml (6 kcal); sugar-sweetened beverages (SSBs) 204 ml (99 kcal); plain milk 132 ml (64 kcal); alcoholic drinks 120 ml (71 kcal); 100% juice 74 ml (34 kcal); and diet or low calorie beverages 44 ml (2 kcal). Differential consumption was observed across socio-demographic groups, with high consumption of sugary drinks (i.e., SSBs and 100% juice) and alcohol across groups. From 2004 to 2015, the reported volumes of beverages consumed decreased by 10% (energy: − 24%). With adjustment for socio-demographic characteristics, there were significant changes (p < 0.001) over time in intake of: 100% juice − 40% (− 38%); plain milk − 37% (− 35%); SSBs − 26% (− 20%); diet or low calorie beverages (− 46%); and other unsweetened beverages − 11% (− 42%). The volume of plain water consumed increased by 10% (p < 0.0001). Intake of alcoholic (volume and energy) and diet or light beverages did not change significantly. Conclusions Lower intake of beverages was reported by Canadians in 2015 versus 2004, with a shift towards plain water. Consumption of sugary drinks decreased, but these beverages continue to contribute substantially to Canadians' overall energy intake. The findings underscore the need for policies to further reduce the consumption of sugary and alcoholic beverages, as well as calories from beverages.
Collapse
Affiliation(s)
- Amanda C Jones
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington, Newtown, 6242, New Zealand.
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada
| |
Collapse
|
18
|
Kasture A, Vandevijvere S, Robinson E, Sacks G, Swinburn B. Benchmarking the commitments related to population nutrition and obesity prevention of major food companies in New Zealand. Int J Public Health 2019; 64:1147-1157. [PMID: 31230118 DOI: 10.1007/s00038-019-01272-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/29/2019] [Accepted: 06/15/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To benchmark comprehensiveness, specificity and transparency of the nutrition-related commitments of major food companies in New Zealand. METHODS We applied the Business Impact Assessment on Obesity and Population Level Nutrition (BIA-Obesity). The largest 25 New Zealand companies in each of the packaged food (n = 15), non-alcoholic beverage (n = 2), supermarket (n = 2) and quick-service restaurant (n = 6) sectors were selected. Publicly available information on commitments was collected through an online search. Representatives from each company were asked to review and/or supplement the information collected. Commitments were then assessed, and recommendations made at the company and sector levels. RESULTS Overall scores ranged from 0 to 75% across all companies with a median score of 38%. The best-performing domain was 'corporate nutrition strategy' (median score = 55%), and the worst-performing domain was 'product accessibility' (median score = 0%). Twelve out of 25 companies fully engaged with the process. CONCLUSIONS The comprehensiveness, specificity and transparency of company commitments varied but were low overall. In the absence of strong industry commitments, government regulations, such as restrictions on unhealthy food marketing, are urgently needed. Future assessments should incorporate performance measures.
Collapse
Affiliation(s)
- Apurva Kasture
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | | | | | | | - Boyd Swinburn
- School of Population Health, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
19
|
Jones A, Thow AM, Ni Mhurchu C, Sacks G, Neal B. The performance and potential of the Australasian Health Star Rating system: a four‐year review using the RE‐AIM framework. Aust N Z J Public Health 2019; 43:355-365. [DOI: 10.1111/1753-6405.12908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Alexandra Jones
- George Institute for Global HealthUNSW Sydney New South Wales
- Charles Perkins CentreThe University of Sydney New South Wales
| | - Anne Marie Thow
- Menzies Centre for Health PolicyThe University of Sydney New South Wales
| | - Cliona Ni Mhurchu
- George Institute for Global HealthUNSW Sydney New South Wales
- National Institute for Health InnovationUniversity of Auckland New Zealand
| | - Gary Sacks
- School of Health and Social DevelopmentDeakin University Melbourne Victoria
| | - Bruce Neal
- George Institute for Global HealthUNSW Sydney New South Wales
- Department of Epidemiology and Biostatistics, School of Public HealthFaculty of Medicine, Imperial College London London United Kingdom
| |
Collapse
|
20
|
Allman-Farinelli M, Ijaz K, Tran H, Pallotta H, Ramos S, Liu J, Wellard-Cole L, Calvo RA. A Virtual Reality Food Court to Study Meal Choices in Youth: Design and Assessment of Usability. JMIR Form Res 2019; 3:e12456. [PMID: 30684440 PMCID: PMC6682284 DOI: 10.2196/12456] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/12/2018] [Accepted: 12/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background Regular consumption of take-out and fast foods with sugary drinks is associated with poor quality diets and higher prevalence of obesity. Among the settings where such food is consumed is the food court typically found in shopping malls prominent in many countries. Objective The objective of this research was to develop a virtual reality food court that could be used to test food environmental interventions, such as taxation, and ultimately to facilitate the selection of healthier food choices. Methods Fourteen food courts in Sydney, Australia were selected to include those in the city center and suburbs of high and low socioeconomic status. Researchers visited the courts to collect information on number and type of food outlets, all menu items for sale, cost of foods and beverages and sales promotions. This information was used to assemble 14 food outlets typically found in food courts, and representative menus were compiled. The UNITY gaming platform was used to design a virtual reality food court that could be used with HTC VIVE goggles. Participants navigated the virtual reality food court using the head-mounted display, keyboard, and mouse and selected a lunch meal, including food and beverage. A validated questionnaire on presence within the virtual reality food court and system usability was completed at the end of the session. The constructs for presence included a sense of control, sensory fidelity, realism, distraction, and involvement. Questions were rated on a scale from 1 (worst) through 7 (best) for each of 28 questions giving a maximum total score of 196. The systems usability scale (SUS) that gives a final score out of 100 was also assessed. Results One hundred and sixty-two participants with a mean age of 22.5 (SD 3.1) years completed the survey. The mean score for total presence was 144 (SE 1.4) consisting of control: 62.1 (SE 0.8), realism: 17.5 (SE 0.2), involvement: 9.6 (SE 0.2), sensory fidelity: 34.9 (SE 0.4), and distraction: 24.0 (SE 0.3). The mean SUS was 69 (SE 1.1). Conclusions Virtual reality shows promise as a tool to study food choice for test interventions to inform practice and policy.
Collapse
Affiliation(s)
- Margaret Allman-Farinelli
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, University of Sydney, Australia
| | - Kiran Ijaz
- School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| | - Helen Tran
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, University of Sydney, Australia
| | - Hermes Pallotta
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, University of Sydney, Australia
| | - Sidney Ramos
- School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| | - Junya Liu
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, University of Sydney, Australia
| | - Lyndal Wellard-Cole
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, University of Sydney, Australia
| | - Rafael A Calvo
- School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| |
Collapse
|