Purpose: We reviewed, analysed and compared methods for integrating sustainability in food-based dietary guidelines (FBDG) worldwide, aiming to support a more widespread systematic and methodologically sound consideration of sustainability in future FBDGs. Special attention was paid on how synergies and trade-offs between human health and environmental sustainability were addressed in FBDGs and communicated towards guideline users.

Methods: We included official FBDGs provided in the online repository by the Food and Agriculture Organization (FAO). Only material in English or German that was readily available over the FAO website was included. We searched for aspects of environmental sustainability in FBDGs with pre-defined keywords. We identified keywords through a full analysis of 12% of all FBDGs and an analysis of FBDGs of which we already knew they had sustainability incorporated due to previous reviews. Identified sections were analyzed using the software tool MAXQDA.

Results: Of 94 FBDGs in the FAO repository, 32 were available fully or in part in English or German in a machine-readable format and were included in our analysis. Of these, 24 incorporated aspects of environmental sustainability. Most operationalized were interdependencies and synergies between human health and environmental sustainability (11 countries). According to these guidelines, synergies may emerge from consuming less meat (four countries), and by shifting towards more plant-based foods (nine countries), as well as an energy balanced diet (five countries). More controversially, some guidelines also posited that synergies may accrue from decreasing animal foods in general (five countries), as well as sugar (two countries) and processed foods (five countries). Sustainability also was addressed within several food groups. Aspects were incorporated into guidelines as part of the introduction, in form of single statements, as a recurring theme, or within a specific chapter on sustainability.

Conclusions: Of 32 analysed countries, 75% (n=24) have incorporated sustainability in their FBDGs. One initial step for future FBDGs could be a stronger emphasis on synergies between health and sustainability.

 

Purpose: Supermarkets are a major source of food for families, and women remain primarily responsible for food shopping. The factors women perceive to influence their food shopping choices are poorly understood. This study examined women’s perceptions of these factors, particularly in relation to store layout, and the ways that supermarkets could support healthier choices.

Methods: In this qualitative cross-sectional study, semi-structured telephone interviews were conducted with 20 women customers aged 18-45 years, recruited from six supermarkets across England. Participants were asked to describe factors in-store that prompted their food selections. The actions supermarkets, governments and customers can take to support healthier food shopping choices were explored. Thematic analysis was conducted using QSR NVIVO software 11. Four researchers were involved in developing the initial coding framework, double-coding six interview transcripts and refining the coding framework.

Results: Participants had a median age of 39.5 years (IQR: 35.1, 42.3), median weekly grocery spend of £70 (IQR: 50, 88), and 44% had left school aged 16 years. Six key themes were identified: 1) Physical Environment, 2) Value for Money, 3) Influence of Family, 4) Physiological/Psychological State, 5) Level of Awareness of Food Decisions and 6) Responsibility for healthy eating. Women reported that achieving value for money, feeling hungry, tired, or stressed, and meeting family members’ food preferences influenced their food shopping choices. Many participants described how they made unintended food selections as a result of prominent placement of unhealthy products, even if they adopted more conscious approaches to food shopping (i.e., written or mental lists). Participants described healthy eating as a personal responsibility but some stated that governments and supermarkets could be more supportive to help customers make healthier food shopping choices.

Conclusions: This study highlighted how the in-store environment can prompt unhealthy food choices. The responsibility for healthy food choices is seen to belong to individuals but the supermarket environment is not designed to facilitate this. Creating healthier supermarket environments could reduce the burden of personal responsibility for healthy eating, by making healthier choices easier. Future research could explore the interplay of personal, societal and commercial responsibility for food choices and health status.

Purpose: The COVID-19 pandemic disrupted usual routines, including families’ food acquisition and consumption patterns. This pandemic could have lasting effects on consumer behaviour and implications on future strategies to improve population diet. The aim of this study was to gain in-depth understanding of families lived experiences by i) examining the impact of the COVID-19 pandemic disruption on the food purchasing and eating behaviours of young women, and ii) identifying the insights these experiences bring to designing future healthy eating interventions.

Methods: A cross-sectional sample of 34 customers of a UK discount supermarket chain completed semi-structured telephone interviews. Women were asked questions to understand their lived experiences of food shopping, cooking and eating during the COVID-19 pandemic lockdown. Interviews were transcribed verbatim and analysed thematically.

Results: Participants’ median age was 35 years and 56% were in paid employment. Findings show that participants overwhelmingly displayed emotional responses to COVID-19 pandemic disruptions of their food purchasing and dietary behaviours. Anxiety was common, with many feeling anxious about not acquiring enough or preferred foods for their families; contracting COVID-19 while food shopping; or needing to balance food costs, meal/snack variety and health. Frustration was also widespread, particularly about those who stockpiled; the poor availability of products which caused challenging situations at family mealtimes; shoppers who did not respect social distancing rules; and queues/one-way systems that made food shopping longer or less successful. These negative emotions were balanced against feelings of empathy, altruism and pleasure. Many participants were understanding of government and supermarket restrictions, or took the risk of shopping in-store to leave delivery slots for vulnerable customers or to help neighbours. Several women enjoyed leaving the house/family to go food shopping but missed being able to browse for meal ideas; others liked having more family meals and time to cook healthier dishes together.                 

Conclusions: Strategies to improve food purchasing and diet may be enhanced if positive emotions, like pleasure in families cooking and eating together, are targeted. As communicating the necessity for COVID-19 rules increased public acceptance, a similar approach could be adopted for policies to improve supermarket environments that may disrupt shoppers’ routines.

Purpose: Little is known around the geographic context in which unhealthy snacking behaviours occur. To investigate i)how often Dutch adults consume unhealthy snacks, ii)at what types of locations they obtain these snacks, and iii) whether there are sociodemographic differences in the frequency and location of snack food consumption.

Methods: Cross-sectional survey with 1784 Dutch adults. Participants reported the frequency of consumption of 10 snack foods (e.g. cookies, fried snacks) and the type of location they obtained them (e.g. supermarkets, snack bars) along with age, sex, number of children in the household, income, education and occupation. Logistic regression analyses identified sociodemographic differences in i) high frequency of snack consumption and ii) the top three most used locations.

Findings: Mean age was 43 years (64% women), 40% had children and 45% were highly educated. Sweets, chocolate, cookies, crisps/salty snacks, and nuts were consumed most frequently (at least weekly), followed by pizza and fried snacks (at least monthly). Pies/cake, ice cream and sausage rolls were consumed yearly. The three most often reported locations for obtaining snacks were “supermarket during regular shopping”, “supermarket during unplanned visit” and “at family/friends’ homes”. Less often reported were train stations, sports clubs, workplaces, bakeries, snack bars, gas stations, specialty stores and bars/restaurants. There were notable sociodemographic differences in the frequency and location of snack food consumption. Compared to males, females were less likely to report high consumption of pizza (OR:0.51, 95%CI:0.35;0.73), fried snacks (OR:0.62, 95%CI:0.48;0.80) and sausage rolls (OR:0.26, 95%CI:0.16;0.42), but more likely to report high consumption of chocolate (OR:1.36, 95%CI:1.10;1.68). Regular supermarket visits were especially important locations for purchasing snacks for households with children, who were consistently more likely to purchase all types of snacks from the supermarket than households without children; e.g., OR for purchasing sweets from the supermarket=1.58 (95%CI:1.28;1.96), OR for purchasing chocolate from the supermarket=1.43 (95%CI:1.13;1.79).

Conclusions: People with different sociodemographic characteristics use the food environment in different ways. However, the supermarket was consistently used by all subgroups to obtain all types of snacks, whether on a regular grocery shopping, an unplanned shop, or by family and friends.

Purpose: Research on the relation between the food environment and dietary behaviours is inconsistent. This inconsistency may be due to a discrepancy between assumed exposure (e.g., measured proximity or density of food retailers) and actual exposure (use of food retailers). We aimed to investigate the mediating role of use of fast-food outlets, regular, and discount supermarkets in the association between distance from home to food retailers and snack consumption.

Methods: Cross-sectional survey among Dutch adults (mean age 42.5y, 64% women). Total snack consumption was calculated by summing the frequency of consumption of 10 snack foods (e.g. chocolate, cookies, fried snacks). Participants reported on whether or not they used selected food retailers within 10-minutes walking from home. Objectively measured distances to each food retailer were calculated within 800 metres (equalling a 10-minute walk) around the home. Complete case (N=1589), multiple regression analyses with bootstrapped confidence intervals were used to estimate the mediating role of use of food retailers.

Findings: Distances from home to either fast-food outlets, discount and regular supermarkets were not associated to snack consumption. We observed no significant mediating effect of use of food retailers in the analysed associations. Nonetheless, we found that to every 100 metres further away from the respective food retailer, participants had 8% lower odds of using a fast-food outlet (odds ratio(OR)=0.92, 95% confidence interval(CI)=0.87;0.97); 14% lower odds of using a regular supermarket (OR=0.86, 95%CI=0.81;0.90) and 11% lower odds of using a discount supermarket (OR=0.89, 95%CI=0.87;0.90). The use of fast-food outlets (β=4.09, 95%CI=2.71;5.48) and regular supermarkets (β=1.88, 95%CI=0.24;3.52), were, in turn, associated with higher snack consumption.  

Conclusions: Distances to fast-food outlets, regular and discount supermarkets were not associated with snack consumption, neither considering the total effect or via the use of food retailers. However, we found that distance was a predictor of use of food retailers, and that the use of fast-food outlets and regular supermarkets was associated with higher snack consumption. 

Purpose: As health educators and leaders, universities can and should demonstrate good health promotion practice to the wider community. Previous research shows that healthy food retail interventions also need to consider commercial sustainability and should take a holistic approach to consumer experience. However, there are very few long-term evaluations of multi-component university healthy food retail interventions. The aim of this study was to determine the health behavior and commercial outcomes of a healthy vending policy implemented as one part of a holistic university food policy.

Methods: A quasi-experimental design evaluated a multi-component policy implemented across four university campuses in Victoria, Australia in April 2018. Beverages were classified based on their nutritional content using a voluntary state government traffic light framework as 'red' ('limit'), 'amber' ('choose carefully'), or 'green' ('best choices'). Policies included (i) display ≤20% ‘red’ beverages and ≥50% ‘green’ beverages; (ii) machine traffic light labelling; (iii) health-promoting machine branding; (iv) review of machine placement; and (v) recycled bottle packaging. Monthly electronic sales data were collected from 51 beverage vending machines from January 2016 (27 months pre-policy) to December 2019 (21 months post-policy). Interrupted time series analysis of sales data compared ‘red’, ‘amber’, and ‘green’ beverage volume sales, and revenue post-policy to predicted sales.

Results:  By the 21st month post-policy implementation, there was a 112.5% [95%CI: 23.5, +201.6] increase in total beverage volume sold and a 100.4% [+33.1, +167.6] increase in revenue. There was no change in ‘red’ beverage volume sold, but increases in ‘green’ (+119.7% [+33.9, +205.5]) and ‘amber’ (+209.1% [+5.7, +412.5]) volume sold.

Conclusions: This study is the longest follow-up of a beverage vending intervention to date. The sustained health behavior and commercial impacts of this multi-component policy at 21 months suggest that such vending interventions can be effective and sustainable in the medium- to long-term. While it is difficult to say to what extent the holistic approach contributed to the success of this real-world policy, it does provide a promising model to promote healthy food retail in vending and other contexts.