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Swinburn B, Sacks G, Vandevijvere S, Kumanyika S, Lobstein T, Neal B, Barquera S, Friel S, Hawkes C, Kelly B, L'abbé M, Lee A, Ma J, Macmullan J, Mohan S, Monteiro C, Rayner M, Sanders D, Snowdon W, Walker C. INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support): overview and key principles. Obes Rev 2013; 14 Suppl 1:1-12. [PMID: 24074206 DOI: 10.1111/obr.12087] [Citation(s) in RCA: 391] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Non-communicable diseases (NCDs) dominate disease burdens globally and poor nutrition increasingly contributes to this global burden. Comprehensive monitoring of food environments, and evaluation of the impact of public and private sector policies on food environments is needed to strengthen accountability systems to reduce NCDs. The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) is a global network of public-interest organizations and researchers that aims to monitor, benchmark and support public and private sector actions to create healthy food environments and reduce obesity, NCDs and their related inequalities. The INFORMAS framework includes two 'process' modules, that monitor the policies and actions of the public and private sectors, seven 'impact' modules that monitor the key characteristics of food environments and three 'outcome' modules that monitor dietary quality, risk factors and NCD morbidity and mortality. Monitoring frameworks and indicators have been developed for 10 modules to provide consistency, but allowing for stepwise approaches ('minimal', 'expanded', 'optimal') to data collection and analysis. INFORMAS data will enable benchmarking of food environments between countries, and monitoring of progress over time within countries. Through monitoring and benchmarking, INFORMAS will strengthen the accountability systems needed to help reduce the burden of obesity, NCDs and their related inequalities.
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Swinburn B, Vandevijvere S, Kraak V, Sacks G, Snowdon W, Hawkes C, Barquera S, Friel S, Kelly B, Kumanyika S, L'Abbé M, Lee A, Lobstein T, Ma J, Macmullan J, Mohan S, Monteiro C, Neal B, Rayner M, Sanders D, Walker C. Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed Government Healthy Food Environment Policy Index. Obes Rev 2013; 14 Suppl 1:24-37. [PMID: 24074208 DOI: 10.1111/obr.12073] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Government action is essential to increase the healthiness of food environments and reduce obesity, diet-related non-communicable diseases (NCDs), and their related inequalities. This paper proposes a monitoring framework to assess government policies and actions for creating healthy food environments. Recommendations from relevant authoritative organizations and expert advisory groups for reducing obesity and NCDs were examined, and pertinent components were incorporated into a comprehensive framework for monitoring government policies and actions. A Government Healthy Food Environment Policy Index (Food-EPI) was developed, which comprises a 'policy' component with seven domains on specific aspects of food environments, and an 'infrastructure support' component with seven domains to strengthen systems to prevent obesity and NCDs. These were revised through a week-long consultation process with international experts. Examples of good practice statements are proposed within each domain, and these will evolve into benchmarks established by governments at the forefront of creating and implementing food policies for good health. A rating process is proposed to assess a government's level of policy implementation towards good practice. The Food-EPI will be pre-tested and piloted in countries of varying size and income levels. The benchmarking of government policy implementation has the potential to catalyse greater action to reduce obesity and NCDs.
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Review |
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175 |
3
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Ni Mhurchu C, Vandevijvere S, Waterlander W, Thornton LE, Kelly B, Cameron AJ, Snowdon W, Swinburn B. Monitoring the availability of healthy and unhealthy foods and non-alcoholic beverages in community and consumer retail food environments globally. Obes Rev 2013; 14 Suppl 1:108-19. [PMID: 24074215 DOI: 10.1111/obr.12080] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Retail food environments are increasingly considered influential in determining dietary behaviours and health outcomes. We reviewed the available evidence on associations between community (type, availability and accessibility of food outlets) and consumer (product availability, prices, promotions and nutritional quality within stores) food environments and dietary outcomes in order to develop an evidence-based framework for monitoring the availability of healthy and unhealthy foods and non-alcoholic beverages in retail food environments. Current evidence is suggestive of an association between community and consumer food environments and dietary outcomes; however, substantial heterogeneity in study designs, methods and measurement tools makes it difficult to draw firm conclusions. The use of standardized tools to monitor local food environments within and across countries may help to validate this relationship. We propose a step-wise framework to monitor and benchmark community and consumer retail food environments that can be used to assess density of healthy and unhealthy food outlets; measure proximity of healthy and unhealthy food outlets to homes/schools; evaluate availability of healthy and unhealthy foods in-store; compare food environments over time and between regions and countries; evaluate compliance with local policies, guidelines or voluntary codes of practice; and determine the impact of changes to retail food environments on health outcomes, such as obesity.
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135 |
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Kelly B, Vandevijvere S, Ng S, Adams J, Allemandi L, Bahena‐Espina L, Barquera S, Boyland E, Calleja P, Carmona‐Garcés IC, Castronuovo L, Cauchi D, Correa T, Corvalán C, Cosenza‐Quintana EL, Fernández‐Escobar C, González‐Zapata LI, Halford J, Jaichuen N, Jensen ML, Karupaiah T, Kaur A, Kroker‐Lobos MF, Mchiza Z, Miklavec K, Parker W, Potvin Kent M, Pravst I, Ramírez‐Zea M, Reiff S, Reyes M, Royo‐Bordonada MÁ, Rueangsom P, Scarborough P, Tiscornia MV, Tolentino‐Mayo L, Wate J, White M, Zamora‐Corrales I, Zeng L, Swinburn B. Global benchmarking of children's exposure to television advertising of unhealthy foods and beverages across 22 countries. Obes Rev 2019; 20 Suppl 2:116-128. [PMID: 30977265 PMCID: PMC6988129 DOI: 10.1111/obr.12840] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/13/2019] [Accepted: 01/17/2019] [Indexed: 12/23/2022]
Abstract
Restricting children's exposures to marketing of unhealthy foods and beverages is a global obesity prevention priority. Monitoring marketing exposures supports informed policymaking. This study presents a global overview of children's television advertising exposure to healthy and unhealthy products. Twenty-two countries contributed data, captured between 2008 and 2017. Advertisements were coded for the nature of foods and beverages, using the 2015 World Health Organization (WHO) Europe Nutrient Profile Model (should be permitted/not-permitted to be advertised). Peak viewing times were defined as the top five hour timeslots for children. On average, there were four times more advertisements for foods/beverages that should not be permitted than for permitted foods/beverages. The frequency of food/beverages advertisements that should not be permitted per hour was higher during peak viewing times compared with other times (P < 0.001). During peak viewing times, food and beverage advertisements that should not be permitted were higher in countries with industry self-regulatory programmes for responsible advertising compared with countries with no policies. Globally, children are exposed to a large volume of television advertisements for unhealthy foods and beverages, despite the implementation of food industry programmes. Governments should enact regulation to protect children from television advertising of unhealthy products that undermine their health.
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Comparative Study |
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122 |
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Friel S, Hattersley L, Snowdon W, Thow AM, Lobstein T, Sanders D, Barquera S, Mohan S, Hawkes C, Kelly B, Kumanyika S, L'Abbe M, Lee A, Ma J, Macmullan J, Monteiro C, Neal B, Rayner M, Sacks G, Swinburn B, Vandevijvere S, Walker C. Monitoring the impacts of trade agreements on food environments. Obes Rev 2013; 14 Suppl 1:120-34. [PMID: 24074216 DOI: 10.1111/obr.12081] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The liberalization of international trade and foreign direct investment through multilateral, regional and bilateral agreements has had profound implications for the structure and nature of food systems, and therefore, for the availability, nutritional quality, accessibility, price and promotion of foods in different locations. Public health attention has only relatively recently turned to the links between trade and investment agreements, diets and health, and there is currently no systematic monitoring of this area. This paper reviews the available evidence on the links between trade agreements, food environments and diets from an obesity and non-communicable disease (NCD) perspective. Based on the key issues identified through the review, the paper outlines an approach for monitoring the potential impact of trade agreements on food environments and obesity/NCD risks. The proposed monitoring approach encompasses a set of guiding principles, recommended procedures for data collection and analysis, and quantifiable 'minimal', 'expanded' and 'optimal' measurement indicators to be tailored to national priorities, capacity and resources. Formal risk assessment processes of existing and evolving trade and investment agreements, which focus on their impacts on food environments will help inform the development of healthy trade policy, strengthen domestic nutrition and health policy space and ultimately protect population nutrition.
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Review |
12 |
80 |
6
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Lee AJ, Kane S, Ramsey R, Good E, Dick M. Testing the price and affordability of healthy and current (unhealthy) diets and the potential impacts of policy change in Australia. BMC Public Health 2016; 16:315. [PMID: 27067642 PMCID: PMC4828857 DOI: 10.1186/s12889-016-2996-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/01/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Price and affordability of foods are important determinants of health. Targeted food pricing policies may help improve population diets. However, methods producing comparable data to inform relevant policy decisions are lacking in Australia and globally. The objective was to develop and pilot standardised methods to assess the price, relative price and affordability of healthy (recommended) and current (unhealthy) diets and test impacts of a potential policy change. METHODS Methods followed the optimal approach proposed by INFORMAS using recent Australian dietary intake data and guidelines. Draft healthy and current (unhealthy) diet baskets were developed for five household structures. Food prices were collected in stores in a high and low SES location in Brisbane, Australia. Diet prices were calculated and compared with household incomes, and with potential changes to the Australian Taxation System. Wilcoxen-signed rank tests were used to compare differences in price. RESULTS The draft tools and protocols were deemed acceptable at household level, but methods could be refined. All households spend more on current (unhealthy) diets than required to purchase healthy (recommended) diets, with the majority (53-64 %) of the food budget being spent on 'discretionary' choices, including take-away foods and alcohol. A healthy diet presently costs between 20-31 % of disposable income of low income households, but would become unaffordable for these families under proposed changes to expand the GST to apply to all foods in Australia. CONCLUSIONS Results confirmed that diet pricing methods providing meaningful, comparable data to inform potential fiscal and health policy actions can be developed, but draft tools should be refined. Results suggest that healthy diets can be more affordable than current (unhealthy) diets in Australia, but other factors may be as important as price in determining food choices.
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Research Support, Non-U.S. Gov't |
9 |
79 |
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Kelly B, King L, Baur L, Rayner M, Lobstein T, Monteiro C, Macmullan J, Mohan S, Barquera S, Friel S, Hawkes C, Kumanyika S, L'Abbé M, Lee A, Ma J, Neal B, Sacks G, Sanders D, Snowdon W, Swinburn B, Vandevijvere S, Walker C. Monitoring food and non-alcoholic beverage promotions to children. Obes Rev 2013; 14 Suppl 1:59-69. [PMID: 24074211 DOI: 10.1111/obr.12076] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Food and non-alcoholic beverage marketing is recognized as an important factor influencing food choices related to non-communicable diseases. The monitoring of populations' exposure to food and non-alcoholic beverage promotions, and the content of these promotions, is necessary to generate evidence to understand the extent of the problem, and to determine appropriate and effective policy responses. A review of studies measuring the nature and extent of exposure to food promotions was conducted to identify approaches to monitoring food promotions via dominant media platforms. A step-wise approach, comprising 'minimal', 'expanded' and 'optimal' monitoring activities, was designed. This approach can be used to assess the frequency and level of exposure of population groups (especially children) to food promotions, the persuasive power of techniques used in promotional communications (power of promotions) and the nutritional composition of promoted food products. Detailed procedures for data sampling, data collection and data analysis for a range of media types are presented, as well as quantifiable measurement indicators for assessing exposure to and power of food and non-alcoholic beverage promotions. The proposed framework supports the development of a consistent system for monitoring food and non-alcoholic beverage promotions for comparison between countries and over time.
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Review |
12 |
73 |
8
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Rayner M, Wood A, Lawrence M, Mhurchu CN, Albert J, Barquera S, Friel S, Hawkes C, Kelly B, Kumanyika S, L'abbé M, Lee A, Lobstein T, Ma J, Macmullan J, Mohan S, Monteiro C, Neal B, Sacks G, Sanders D, Snowdon W, Swinburn B, Vandevijvere S, Walker C. Monitoring the health-related labelling of foods and non-alcoholic beverages in retail settings. Obes Rev 2013; 14 Suppl 1:70-81. [PMID: 24074212 DOI: 10.1111/obr.12077] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Food labelling on food packaging has the potential to have both positive and negative effects on diets. Monitoring different aspects of food labelling would help to identify priority policy options to help people make healthier food choices. A taxonomy of the elements of health-related food labelling is proposed. A systematic review of studies that assessed the nature and extent of health-related food labelling has been conducted to identify approaches to monitoring food labelling. A step-wise approach has been developed for independently assessing the nature and extent of health-related food labelling in different countries and over time. Procedures for sampling the food supply, and collecting and analysing data are proposed, as well as quantifiable measurement indicators and benchmarks for health-related food labelling.
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Review |
12 |
70 |
9
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Neal B, Sacks G, Swinburn B, Vandevijvere S, Dunford E, Snowdon W, Webster J, Barquera S, Friel S, Hawkes C, Kelly B, Kumanyika S, L'Abbé M, Lee A, Lobstein T, Ma J, Macmullan J, Mohan S, Monteiro C, Rayner M, Sanders D, Walker C. Monitoring the levels of important nutrients in the food supply. Obes Rev 2013; 14 Suppl 1:49-58. [PMID: 24074210 DOI: 10.1111/obr.12075] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A food supply that delivers energy-dense products with high levels of salt, saturated fats and trans fats, in large portion sizes, is a major cause of non-communicable diseases (NCDs). The highly processed foods produced by large food corporations are primary drivers of increases in consumption of these adverse nutrients. The objective of this paper is to present an approach to monitoring food composition that can both document the extent of the problem and underpin novel actions to address it. The monitoring approach seeks to systematically collect information on high-level contextual factors influencing food composition and assess the energy density, salt, saturated fat, trans fats and portion sizes of highly processed foods for sale in retail outlets (with a focus on supermarkets and quick-service restaurants). Regular surveys of food composition are proposed across geographies and over time using a pragmatic, standardized methodology. Surveys have already been undertaken in several high- and middle-income countries, and the trends have been valuable in informing policy approaches. The purpose of collecting data is not to exhaustively document the composition of all foods in the food supply in each country, but rather to provide information to support governments, industry and communities to develop and enact strategies to curb food-related NCDs.
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Review |
12 |
63 |
10
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Vandevijvere S, Monteiro C, Krebs-Smith SM, Lee A, Swinburn B, Kelly B, Neal B, Snowdon W, Sacks G. Monitoring and benchmarking population diet quality globally: a step-wise approach. Obes Rev 2013; 14 Suppl 1:135-49. [PMID: 24074217 DOI: 10.1111/obr.12082] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support) aims to monitor and benchmark the healthiness of food environments globally. In order to assess the impact of food environments on population diets, it is necessary to monitor population diet quality between countries and over time. This paper reviews existing data sources suitable for monitoring population diet quality, and assesses their strengths and limitations. A step-wise framework is then proposed for monitoring population diet quality. Food balance sheets (FBaS), household budget and expenditure surveys (HBES) and food intake surveys are all suitable methods for assessing population diet quality. In the proposed 'minimal' approach, national trends of food and energy availability can be explored using FBaS. In the 'expanded' and 'optimal' approaches, the dietary share of ultra-processed products is measured as an indicator of energy-dense, nutrient-poor diets using HBES and food intake surveys, respectively. In addition, it is proposed that pre-defined diet quality indices are used to score diets, and some of those have been designed for application within all three monitoring approaches. However, in order to enhance the value of global efforts to monitor diet quality, data collection methods and diet quality indicators need further development work.
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Review |
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63 |
11
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Sacks G, Swinburn B, Kraak V, Downs S, Walker C, Barquera S, Friel S, Hawkes C, Kelly B, Kumanyika S, L'Abbé M, Lee A, Lobstein T, Ma J, Macmullan J, Mohan S, Monteiro C, Neal B, Rayner M, Sanders D, Snowdon W, Vandevijvere S. A proposed approach to monitor private-sector policies and practices related to food environments, obesity and non-communicable disease prevention. Obes Rev 2013; 14 Suppl 1:38-48. [PMID: 24074209 DOI: 10.1111/obr.12074] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Private-sector organizations play a critical role in shaping the food environments of individuals and populations. However, there is currently very limited independent monitoring of private-sector actions related to food environments. This paper reviews previous efforts to monitor the private sector in this area, and outlines a proposed approach to monitor private-sector policies and practices related to food environments, and their influence on obesity and non-communicable disease (NCD) prevention. A step-wise approach to data collection is recommended, in which the first ('minimal') step is the collation of publicly available food and nutrition-related policies of selected private-sector organizations. The second ('expanded') step assesses the nutritional composition of each organization's products, their promotions to children, their labelling practices, and the accessibility, availability and affordability of their products. The third ('optimal') step includes data on other commercial activities that may influence food environments, such as political lobbying and corporate philanthropy. The proposed approach will be further developed and piloted in countries of varying size and income levels. There is potential for this approach to enable national and international benchmarking of private-sector policies and practices, and to inform efforts to hold the private sector to account for their role in obesity and NCD prevention.
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Review |
12 |
62 |
12
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Kanter R, Reyes M, Vandevijvere S, Swinburn B, Corvalán C. Anticipatory effects of the implementation of the Chilean Law of Food Labeling and Advertising on food and beverage product reformulation. Obes Rev 2019; 20 Suppl 2:129-140. [PMID: 31245920 DOI: 10.1111/obr.12870] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/20/2019] [Accepted: 03/29/2019] [Indexed: 12/15/2022]
Abstract
This study evaluated the anticipated food and beverage product reformulation by industry before the Chilean Law of Food Labeling and Advertising (Law 20.606) was implemented in June 2016 requiring a front-of-package (FOP) warning label for products high in sodium, total sugars, saturated fats, and/or total energy. Fieldworkers photographed a purposive sample of packaged food and beverage products in February 2015 (n = 5421) and February 2016 (n = 5479) from six different supermarkets in Santiago, Chile. The same products collected in both years (n = 2086) from 17 food and beverage categories with added critical nutrients (nutrients of concern: sodium, total sugars, and saturated fats) were included in this longitudinal study. The average change in energy and critical nutrient content was estimated by category. The number of warning labels potentially avoided because of reformulation was determined. Between February 2015 and February 2016, no category experienced reductions >5% average change in energy or critical nutrient content; and some increased in critical nutrient content. Few products (<2%) would have avoided at least one warning label with reformulation. In a diverse sample of food and beverage products, there was minimal reformulation by industry in anticipation of the implementation of the 2016 Chilean Law of Food Labeling and Advertising.
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53 |
13
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Kanter R, Reyes M, Corvalán C. Photographic Methods for Measuring Packaged Food and Beverage Products in Supermarkets. Curr Dev Nutr 2017; 1:e001016. [PMID: 29955678 PMCID: PMC5998779 DOI: 10.3945/cdn.117.001016] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/16/2017] [Accepted: 09/12/2017] [Indexed: 12/12/2022] Open
Abstract
Background: The global obesity pandemic and rates of nutrition-related noncommunicable diseases (NCDs) have increased worldwide, especially in the Latin American and Caribbean region. In an attempt to control this obesity epidemic, the Chilean government has established a comprehensive set of regulatory actions, including beverage taxation, warning labels on foods, and marketing restrictions to children. To improve the effectiveness of actions to prevent obesity, a better understanding of the food environment is needed. Objective: We developed and standardized photographic methods to assess and monitor packaged food and beverage products in supermarkets. Methods: A standardized protocol and food categorization system was used to guide photo collection and data management of photos taken between February and April 2015 in 11 supermarkets, consisting of 5 different supermarket chains, from high- (n = 6) and lower-middle (n = 5)-income neighborhoods in Santiago, Chile. Photos (n = ∼50,000) from nearly 10,000 unique food products from high- and lower-middle-income neighborhoods were used for this study. Results: We developed standardized methods to use photographs to assess and monitor the food environment. A food categorization scheme is essential to guiding the data collection process. Substantial time and human resources are required to assess packaged food and beverage products in supermarkets. Because the number of photos per food product is variable, the organization of the photographs according to the food categorization system, before data entry, is imperative for easy access during data entry and analysis. We identified the information necessary for a photographic registry, which, with the food categorization system, is critical to create unique identifiers that are linked to each food product and its photos. Conclusions: To adequately monitor food environments, standardized methods for food photo collection and management are essential. The information collected on food package photos to monitor food environments is important for guiding and evaluating actions in the context of the ongoing obesity and NCD epidemics.
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research-article |
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51 |
14
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L'Abbé M, Schermel A, Minaker L, Kelly B, Lee A, Vandevijvere S, Twohig P, Barquera S, Friel S, Hawkes C, Kumanyika S, Lobstein T, Ma J, Macmullan J, Mohan S, Monteiro C, Neal B, Rayner M, Sacks G, Sanders D, Snowdon W, Swinburn B, Walker C. Monitoring foods and beverages provided and sold in public sector settings. Obes Rev 2013; 14 Suppl 1:96-107. [PMID: 24074214 DOI: 10.1111/obr.12079] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper outlines a step-wise framework for monitoring foods and beverages provided or sold in publicly funded institutions. The focus is on foods in schools, but the framework can also be applied to foods provided or sold in other publicly funded institutions. Data collection and evaluation within this monitoring framework will consist of two components. In component I, information on existing food or nutrition policies and/or programmes within settings would be compiled. Currently, nutrition standards and voluntary guidelines associated with such policies/programmes vary widely globally. This paper, which provides a comprehensive review of such standards and guidelines, will facilitate institutional learnings for those jurisdictions that have not yet established them or are undergoing review of existing ones. In component II, the quality of foods provided or sold in public sector settings is evaluated relative to existing national or sub-national nutrition standards or voluntary guidelines. Where there are no (or only poor) standards or guidelines available, the nutritional quality of foods can be evaluated relative to standards of a similar jurisdiction or other appropriate standards. Measurement indicators are proposed (within 'minimal', 'expanded' and 'optimal' approaches) that can be used to monitor progress over time in meeting policy objectives, and facilitate comparisons between countries.
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Review |
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38 |
15
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Measuring the Healthiness of the Packaged Food Supply in Australia. Nutrients 2018; 10:nu10060702. [PMID: 29857517 PMCID: PMC6024847 DOI: 10.3390/nu10060702] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/26/2018] [Accepted: 05/29/2018] [Indexed: 02/08/2023] Open
Abstract
The increasing availability of packaged foods plays a key role in nutritional transition. This study examined the healthiness of the Australian packaged food supply using a range of different metrics; 40,664 packaged products from The George Institute's FoodSwitch database were included. Median and interquartile range (IQR) were determined for each measure of nutrient composition; mean and standard deviation (SD) for the measure based upon Health Star Rating (HSR); and proportions (%) for the measures based upon products with a higher HSR, classification of foods as either core or discretionary, extent of processing and proportions of foods that met reformulation targets for sodium, saturated fat and total sugars. Overall median (IQR) values were 1093 (1256) kJ/100 g for energy, 1.7 (6.3) g/100 g for saturated fat, 5.3 (21.4) g/100 g for total sugars, 163 (423) g/100 g for sodium and 50 (100) g or mL for serving size. Overall mean (SD) HSR was 2.8 (1.4), proportion with HSR < 3.5 was 61.8%, proportion of foods defined as discretionary was 53.0% and proportion of foods defined as highly processed was 60.5%. There were sodium targets set for 21,382/40,664 (53%) foods and achieved for 14,126/40,664 (35%). Corresponding figures for saturated fat were 328/40,664 (0.8%) and 130/40,664 (0.3%). Nutrient profiling, dietary guidelines and the extent of food processing provided comparable assessments of the nutritional quality of Australia's packaged food supply. Individual measures of nutrient composition did not, but may be of value for identifying specific foods of concern.
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Journal Article |
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32 |
16
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Lee AJ, Kane S, Lewis M, Good E, Pollard CM, Landrigan TJ, Dick M. Healthy diets ASAP - Australian Standardised Affordability and Pricing methods protocol. Nutr J 2018; 17:88. [PMID: 30261887 PMCID: PMC6161417 DOI: 10.1186/s12937-018-0396-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper describes the rationale, development and final protocol of the Healthy Diets Australian Standardised Affordability and Pricing (ASAP) method which aims to assess, compare and monitor the price, price differential and affordability of healthy (recommended) and current (unhealthy) diets in Australia. The protocol is consistent with the International Network for Food and Obesity / non-communicable Diseases Research, Monitoring and Action Support's (INFORMAS) optimal approach to monitor food price and affordability globally. METHODS The Healthy Diets ASAP protocol was developed based on literature review, drafting, piloting and revising, with key stakeholder consultation at all stages, including at a national forum. DISCUSSION The protocol was developed in five parts. Firstly, for the healthy (recommended) and current (unhealthy) diet pricing tools; secondly for calculation of median and low-income household incomes; thirdly for store location and sampling; fourthly for price data collection, and; finally for analysis and reporting. The Healthy Diets ASAP protocol constitutes a standardised approach to assess diet price and affordability to inform development of nutrition policy actions to reduce rates of diet-related chronic disease in Australia. It demonstrates application of the INFORMAS optimum food price and affordability methods at country level. Its wide application would enhance monitoring and utility of dietary price and affordability data from a health perspective in Australia. The protocol could be adapted in other countries to monitor the price, price differential and affordability of current and healthy diets.
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Research Support, Non-U.S. Gov't |
7 |
32 |
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Lee A, Patay D, Herron LM, Parnell Harrison E, Lewis M. Affordability of current, and healthy, more equitable, sustainable diets by area of socioeconomic disadvantage and remoteness in Queensland: insights into food choice. Int J Equity Health 2021; 20:153. [PMID: 34193163 PMCID: PMC8243618 DOI: 10.1186/s12939-021-01481-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/25/2021] [Indexed: 12/20/2022] Open
Abstract
Background Poor diet is the leading preventable risk factor contributing to the burden of disease globally and in Australia, and is inequitably distributed. As the price of healthy foods is a perceived barrier to improved diets, evidence on the cost and affordability of current (unhealthy) and recommended (healthy, more equitable and sustainable) diets is required to support policy action. Methods This study applied the Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods protocol to measure the cost, cost differential and affordability of current and recommended diets for a reference household in Queensland, Australia. Food prices were collected in 18 randomly selected locations stratified by area of socioeconomic disadvantage and remoteness. Diet affordability was calculated for three income categories. Results Surprisingly, recommended diets would cost 20% less than the current diet in Queensland as a whole. Households spent around 60% of their food budget on discretionary choices (that is, those not required for health that are high in saturated fat, added sugar, salt and/or alcohol). Queensland families would need to spend around 23% of their income on recommended diets. However, recommended diets would not be affordable in low socioeconomic or very remote areas, costing 30 and 35% of median household income respectively. The government supplements due to the SARS-CoV-2 pandemic would improve affordability of recommended diets by 29%. Conclusions Study findings highlight that while price is one factor affecting consumer food choice, other drivers such as taste, convenience, advertising and availability are important. Nevertheless, the study found that recommended diets would be unaffordable in very remote areas, and that low-income families are likely experiencing food stress, irrespective of where they live in Queensland. Policy actions, such as increasing to 20% the current 10% tax differential between basic healthy, and unhealthy foods in Australia, and supplementing incomes of vulnerable households, especially in remote areas, are recommended to help improve diet equity and sustainability, and health and wellbeing for all. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01481-8.
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Research Support, Non-U.S. Gov't |
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Lee AJ, Kane S, Herron LM, Matsuyama M, Lewis M. A tale of two cities: the cost, price-differential and affordability of current and healthy diets in Sydney and Canberra, Australia. Int J Behav Nutr Phys Act 2020; 17:80. [PMID: 32571334 PMCID: PMC7309977 DOI: 10.1186/s12966-020-00981-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/08/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The perception that healthy foods are more expensive than unhealthy foods has been reported widely to be a key barrier to healthy eating. However, assessment of the relative cost of healthy and unhealthy foods and diets is fraught methodologically. Standardised approaches to produce reliable data on the cost of total diets and different dietary patterns, rather than selected foods, are lacking globally to inform policy and practice. METHODS This paper reports the first application, in randomly selected statistical areas stratified by socio-economic status in two Australian cities, of the Healthy Diets Australian Standardized Affordability and Pricing (ASAP) method protocols: diet pricing tools based on national nutrition survey data and dietary guidelines; store sampling and location; determination of household incomes; food price data collection; and analysis and reporting. The methods were developed by the International Network on Food and Obesity/NCD Research, Monitoring and Action Support (INFORMAS) as a prototype of an optimum approach to assess, compare and monitor the cost and affordability of diets across different geographical and socio-economic settings and times. RESULTS Under current tax policy in Australia, healthy diets would be 15-17% less expensive than current (unhealthy) diets in all locations assessed. Nevertheless, healthy diets are likely to be unaffordable for low income households, costing more than 30% of disposable income in both cities surveyed. Households spent around 58% of their food budget on unhealthy food and drinks. Food costs were on average 4% higher in Canberra than Sydney, and tended to be higher in high socioeconomic locations. CONCLUSIONS Health and fiscal policy actions to increase affordability of healthy diets for low income households are required urgently. Also, there is a need to counter perceptions that current, unhealthy diets must be less expensive than healthy diets. The Healthy Diets ASAP methods could be adapted to assess the cost and affordability of healthy and unhealthy diets elsewhere.
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Lee A, Lewis M. Testing the Price of Healthy and Current Diets in Remote Aboriginal Communities to Improve Food Security: Development of the Aboriginal and Torres Strait Islander Healthy Diets ASAP (Australian Standardised Affordability and Pricing) Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2912. [PMID: 30572646 PMCID: PMC6313302 DOI: 10.3390/ijerph15122912] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/06/2018] [Accepted: 12/18/2018] [Indexed: 11/29/2022]
Abstract
Aboriginal and Torres Strait Islander peoples suffer higher rates of food insecurity and diet-related disease than other Australians. However, assessment of food insecurity in specific population groups is sub-optimal, as in many developed countries. This study tailors the Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods protocol to be more relevant to Indigenous groups in assessing one important component of food security. The resultant Aboriginal and Torres Strait Islander Healthy Diets ASAP methods were used to assess the price, price differential, and affordability of healthy (recommended) and current (unhealthy) diets in five remote Aboriginal communities. The results show that the tailored approach is more sensitive than the original protocol in revealing the high degree of food insecurity in these communities, where the current diet costs nearly 50% of disposable household income compared to the international benchmark of 30%. Sixty-two percent of the current food budget appears to be spent on discretionary foods and drinks. Aided by community store pricing policies, healthy (recommended) diets are around 20% more affordable than current diets in these communities, but at 38.7% of disposable household income still unaffordable for most households. Further studies in urban communities, and on other socioeconomic, political and commercial determinants of food security in Aboriginal and Torres Strait Islander communities appear warranted. The development of the tailored method provides an example of how national tools can be adapted to better inform policy actions to improve food security and help reduce rates of diet-related chronic disease more equitably in developed countries.
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Healthy Diets in Rural Victoria-Cheaper than Unhealthy Alternatives, Yet Unaffordable. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112469. [PMID: 30400654 PMCID: PMC6266685 DOI: 10.3390/ijerph15112469] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 01/22/2023]
Abstract
Rural communities experience higher rates of obesity and reduced food security compared with urban communities. The perception that healthy foods are expensive contributes to poor dietary choices. Providing an accessible, available, affordable healthy food supply is an equitable way to improve the nutritional quality of the diet for a community, however, local food supply data are rarely available for small rural towns. This study used the Healthy Diets ASAP tool to assess price, price differential and affordability of recommended (healthy) and current diets in a rural Local Government Area (LGA) (pop ≈ 7000; 10 towns) in Victoria, Australia. All retail food outlets were surveyed (n = 40). The four most populous towns had supermarkets; remaining towns had one general store each. Seven towns had café/take-away outlets, and all towns had at least one hotel/pub. For all towns the current unhealthy diet was more expensive than the recommended healthy diet, with 59.5% of the current food budget spent on discretionary items. Affordability of the healthy diet accounted for 30⁻32% of disposable income. This study confirms that while a healthy diet is less expensive than the current unhealthier diet, affordability is a challenge for rural communities. Food security is reduced further with restricted geographical access, a limited healthy food supply, and higher food prices.
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Research Support, Non-U.S. Gov't |
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Kanter R, Reyes M, Swinburn B, Vandevijvere S, Corvalán C. The Food Supply Prior to the Implementation of the Chilean Law of Food Labeling and Advertising. Nutrients 2018; 11:nu11010052. [PMID: 30597842 PMCID: PMC6356190 DOI: 10.3390/nu11010052] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 01/06/2023] Open
Abstract
This study aimed to evaluate the composition of the food supply ahead of the implementation of the Chilean Law of Food Labeling and Advertising (Law 20.606) in June 2016. The INFORMAS (International Network for Food and Obesity/Non-communicable Diseases (NCDs) Research, Monitoring and Action Support) framework for monitoring the composition of the food supply was used. The Law’s initial (2016) and final (2019) limits were used to evaluate if foods would receive a “High in” warning for Calories, Sodium, Sugars and/or Saturated Fats (initial/final, solids: >350/275 kcal; >800/400 mg; >22.5/10 g; >6/4 g; liquids: >100/70 kcal; >100/100 mg; >6/5 g; >3/3 g respectively). Foods were excluded if they required reconstitution, had missing information or if total labeled energy was estimated as incorrect (n = 942). In February 2015 and 2016, fieldworkers photographed a purposeful sample of packaged food and beverage products (n = 5421 and n = 5479) from 6 different supermarkets in Santiago, Chile. Seven percent of foods had no added critical nutrients (n = 720). Two-thirds of products had critical nutrients exceeding at least one initial limit indicative of a “high in” warning. Under the final phase limits, only 17% of foods would have zero warning labels. By 2019, 10 of the 17 food and beverage categories studied are predicted to have less than half of their products without a high in sodium warning label. While 8 of the 17 categories studied are predicted to have less than half their products without a high in total sugars or a high in total calories warning label, respectively; while even fewer food and beverage categories are predicted to be without a high in saturated fat warning label. Most products will have to be reformulated to avoid at least one front-of-package warning label.
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Journal Article |
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Mackay S, Buch T, Vandevijvere S, Goodwin R, Korohina E, Funaki-Tahifote M, Lee A, Swinburn B. Cost and Affordability of Diets Modelled on Current Eating Patterns and on Dietary Guidelines, for New Zealand Total Population, Māori and Pacific Households. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061255. [PMID: 29899249 PMCID: PMC6025104 DOI: 10.3390/ijerph15061255] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/06/2018] [Accepted: 06/12/2018] [Indexed: 11/17/2022]
Abstract
The affordability of diets modelled on the current (less healthy) diet compared to a healthy diet based on Dietary Guidelines was calculated for population groups in New Zealand. Diets using common foods were developed for a household of four for the total population, Māori and Pacific groups. Māori and Pacific nutrition expert panels ensured the diets were appropriate. Each current (less healthy) diet was based on eating patterns identified from national nutrition surveys. Food prices were collected from retail outlets. Only the current diets contained alcohol, takeaways and discretionary foods. The modelled healthy diet was cheaper than the current diet for the total population (3.5% difference) and Pacific households (4.5% difference) and similar in cost for Māori households (0.57% difference). When the diets were equivalent in energy, the healthy diet was more expensive than the current diet for all population groups (by 8.5% to 15.6%). For households on the minimum wage, the diets required 27% to 34% of household income, and if receiving income support, required 41–52% of household income. Expert panels were invaluable in guiding the process for specific populations. Both the modelled healthy and current diets are unaffordable for some households as a considerable portion of income was required to purchase either diet. Policies are required to improve food security by lowering the cost of healthy food or improving household income.
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Research Support, Non-U.S. Gov't |
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Brinsden H, Lobstein T, Landon J, Kraak V, Sacks G, Kumanyika S, Swinburn B, Barquera S, Friel S, Hawkes C, Kelly B, L'abbé M, Lee A, Ma J, Macmullen J, Mohan S, Monteiro C, Neal B, Rayner M, Sanders D, Snowdon W, Vandevijvere S, Walker C. Monitoring policy and actions on food environments: rationale and outline of the INFORMAS policy engagement and communication strategies. Obes Rev 2013; 14 Suppl 1:13-23. [PMID: 24074207 DOI: 10.1111/obr.12072] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) proposes to collect performance indicators on food policies, actions and environments related to obesity and non-communicable diseases. This paper reviews existing communications strategies used for performance indicators and proposes the approach to be taken for INFORMAS. Twenty-seven scoring and rating tools were identified in various fields of public health including alcohol, tobacco, physical activity, infant feeding and food environments. These were compared based on the types of indicators used and how they were quantified, scoring methods, presentation and the communication and reporting strategies used. There are several implications of these analyses for INFORMAS: the ratings/benchmarking approach is very commonly used, presumably because it is an effective way to communicate progress and stimulate action, although this has not been formally evaluated; the tools used must be trustworthy, pragmatic and policy-relevant; multiple channels of communication will be needed; communications need to be tailored and targeted to decision-makers; data and methods should be freely accessible. The proposed communications strategy for INFORMAS has been built around these lessons to ensure that INFORMAS's outputs have the greatest chance of being used to improve food environments.
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Review |
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Vandevijvere S, Mackay S, Swinburn B. Measuring and stimulating progress on implementing widely recommended food environment policies: the New Zealand case study. Health Res Policy Syst 2018; 16:3. [PMID: 29370804 PMCID: PMC5785861 DOI: 10.1186/s12961-018-0278-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/09/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Monitoring the degree of implementation of widely recommended food environment policies by national governments is an important part of stimulating progress towards better population nutritional health. METHODS The Healthy Food Environment Policy Index (Food-EPI) was applied for the second time in New Zealand in 2017 (initially applied in 2014) to measure progress on implementation of widely recommended food environment policies. A national panel of 71 independent (n = 48) and government (n = 23) public health experts rated the extent of implementation of 47 policy and infrastructure support good practice indicators by the Government against international best practice, using an extensive evidence document verified by government officials. Experts proposed and prioritised concrete actions needed to address the critical implementation gaps identified. RESULTS Inter-rater reliability was good (Gwet's AC2 > 0.8). Approximately half (47%) of the indicators were rated as having 'low' or 'very little, if any' implementation compared to international benchmarks, a decrease since 2014 (60%). A lower proportion of infrastructure support (29%) compared to policy (70%) indicators were rated as having 'low' or 'very little, if any' implementation. The experts recommended 53 actions, prioritising nine for immediate implementation; three of those prioritised actions were the same as in 2014. The vast majority of experts agreed that the Food-EPI is likely to contribute to beneficial policy change and increased their knowledge about food environments and policies. CONCLUSION The Food-EPI has the potential to increase accountability of governments to implement widely recommended food environment policies and reduce the burden of obesity and diet-related diseases.
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Journal Article |
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Vandevijvere S, Mackenzie T, Mhurchu CN. Indicators of the relative availability of healthy versus unhealthy foods in supermarkets: a validation study. Int J Behav Nutr Phys Act 2017; 14:53. [PMID: 28441947 PMCID: PMC5405544 DOI: 10.1186/s12966-017-0512-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/12/2017] [Indexed: 11/24/2022] Open
Abstract
Background In-store availability of healthy and unhealthy foods may influence consumer purchases. Methods used to measure food availability, however, vary widely. A simple, valid, and reliable indicator to collect comparable data on in-store food availability is needed. Methods Cumulative linear shelf length of and variety within 22 healthy and 28 unhealthy food groups, determined based on a comparison of three nutrient profiling systems, were measured in 15 New Zealand supermarkets. Inter-rater reliability was tested in one supermarket by a second researcher. The construct validity of five simple indicators of relative availability of healthy versus unhealthy foods was assessed against this ‘gold standard’. Results Cumulative linear shelf length was a more sensitive and feasible measure of food availability than variety. Four out of five shelf length ratio indicators were significantly associated with the gold standard (ρ = 0.70–0.75). Based on a non-significant difference from the ‘gold standard’ (d = 0.053 ± 0.040) and feasibility, the ratio of cumulative linear shelf length of fresh and frozen fruits and vegetables versus soft and energy drinks, crisps and snacks, sweet biscuits and confectionery performed best for use in New Zealand supermarkets. Conclusions Four out of the five shelf length ratio indicators of the relative availability of healthy versus unhealthy foods in-store tested could be used for future research and monitoring, but additional validation studies in other settings and countries are recommended. Consistent use of those shelf length ratio indicators could enhance comparability of supermarket food availability between studies, and help inform policies to create healthy consumer food retail environments. Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0512-0) contains supplementary material, which is available to authorized users.
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Validation Study |
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