Women Consumers’ Views on Legislation to Restrict Prominent Placement and Multibuy Promotions of High Fat, Sugar, and Salt Products in England: A Qualitative Perspective

Document Type : Original Article

Authors

1 Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK

2 National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

3 School of Geography and Environmental Science, University of Southampton, Southampton, UK

4 NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Southampton, UK

5 Centre for Food Policy, City, University of London, London, UK

Abstract

Background 
As part of the childhood obesity strategy, the UK Government has introduced regulations to restrict the ways high fat salt and sugar (HFSS) products can be promoted in retail settings from October 2022. This study explored (i) consumers’ views on the likely impact of the UK legislation restricting the placement and promotion of HFSS products on their shopping behaviours and (ii) consumers’ beliefs about who is responsible for healthy eating.

Methods 
Using a cross-sectional study design, qualitative semi-structured telephone interviews were conducted with a purposive sample of women who shopped at a discount supermarket. Thematic analysis was employed to identify key themes.

Results 
Participants’ (n = 34) had a median age of 35 years and over half were in paid employment. Five themes were identified: (1) The legislation is acceptable, but people can still (and should be able to) buy HFSS items; (2) The legislation is likely to have more impact on shoppers who do not plan their shopping; (3) Affordability of healthy food is just as, or more, important than the legislation; (4) It’s up to the individual to eat healthily; and (5) Government and retailers can better support consumers to make healthy choices.

Conclusion 
Most participants were optimistic about the incoming regulations and believed that it would support consumers to make healthier food choices. Many raised concerns, however, that the high price of healthy foods and continued availability of unhealthy foods within the stores could undermine the legislation’s benefits. Coupling the legislation with interventions to promote and reduce the costs of healthier products would go some way to ensure its success. Raising awareness about marketing strategies that play into consumer concerns for cost and autonomy could further increase acceptance of the policy.

Keywords


  1. Henry Dimbleby. The National Food Strategy: An Independant Review for Government, Part 1. https://www.nationalfoodstrategy.org/part-one/. Published 2020. Accessed July 7, 2022.
  2. NHS Digital. National Child Measurement Programme, England 2020/21 School Year. https://digital.nhs.uk/data-and-information/publications/statistical/national-child-measurement-programme/2020-21-school-year.
  3. World Health Organization. Chapter 2, WHO European Regional Obesity Report. Regional Office for Europe; 2022.
  4. Marmot M. Social justice, human rights and health equity. J Public Health (Oxf). 2021;43(3):e423-e424. doi:1093/pubmed/fdaa010
  5. Roberto CA, Swinburn B, Hawkes C, et al. Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. Lancet. 2015;385(9985):2400-2409. doi:1016/s0140-6736(14)61744-x
  6. Department of Health and Social Care. Tackling Obesity: Empowering Adults and Children to Live Healthier Lives. Department of Health and Social Care; 2020.
  7. Department of Health and Social Care. The Nutrient Profiling Model. Department of Health and Social Care; 2011.
  8. UK. PM backs public’s right to choose with delay to BOGOF restrictions. https://www.gov.uk/government/news/pm-backs-publics-right-to-choose-with-delay-to-bogof-restrictions.  Published June 17, 2023.
  9. Department of Health and Social Care. Childhood Obesity: A Plan for Action, Chapter 2. Department of Health and Social Care; 2018.
  10. Bennett R, Zorbas C, Huse O, et al. Prevalence of healthy and unhealthy food and beverage price promotions and their potential influence on shopper purchasing behaviour: a systematic review of the literature. Obes Rev. 2020;21(1):e12948. doi:1111/obr.12948
  11. Obesity Health Alliance. Out of Place: The Extent of Unhealthy Foods in Prime Locations in Supermarkets. 2018. http://obesityhealthalliance.org.uk/wpcontent/uploads/2018/11/Out-of-Place-Obesity-Health-Alliance-2.pdf.
  12. Shaw SC, Ntani G, Baird J, Vogel CA. A systematic review of the influences of food store product placement on dietary-related outcomes. Nutr Rev. 2020;78(12):1030-1045. doi:1093/nutrit/nuaa024
  13. Hartmann-Boyce J, Bianchi F, Piernas C, et al. Grocery store interventions to change food purchasing behaviors: a systematic review of randomized controlled trials. Am J Clin Nutr. 2018;107(6):1004-1016. doi:1093/ajcn/nqy045
  14. Black C, Ntani G, Inskip H, et al. Measuring the healthfulness of food retail stores: variations by store type and neighbourhood deprivation. Int J Behav Nutr Phys Act. 2014;11:69. doi:1186/1479-5868-11-69
  15. Vogel C, Abbott G, Ntani G, et al. Examination of how food environment and psychological factors interact in their relationship with dietary behaviours: test of a cross-sectional model. Int J Behav Nutr Phys Act. 2019;16(1):12. doi:1186/s12966-019-0772-y
  16. Adams J, Mytton O, White M, Monsivais P. Why are some population interventions for diet and obesity more equitable and effective than others? The role of individual agency. PLoS Med. 2016;13(4):e1001990. doi:1371/journal.pmed.1001990
  17. Vogel C, Ntani G, Inskip H, et al. Education and the relationship between supermarket environment and diet. Am J Prev Med. 2016;51(2):e27-e34. doi:1016/j.amepre.2016.02.030
  18. Black C, Moon G, Baird J. Dietary inequalities: what is the evidence for the effect of the neighbourhood food environment? Health Place. 2014;27:229-242. doi:1016/j.healthplace.2013.09.015
  19. Dhuria P, Lawrence W, Crozier S, Cooper C, Baird J, Vogel C. Women's perceptions of factors influencing their food shopping choices and how supermarkets can support them to make healthier choices. BMC Public Health. 2021;21(1):1070. doi:1186/s12889-021-11112-0
  20. Vogel C, Crozier S, Dhuria P, et al. Protocol of a natural experiment to evaluate a supermarket intervention to improve food purchasing and dietary behaviours of women (WRAPPED study) in England: a prospective matched controlled cluster design. BMJ Open. 2020;10(2):e036758. doi:1136/bmjopen-2020-036758
  21. Ministry of Housing, Communities & Local Government (MHCLG). English Indices of Deprivation 2019. London: MHCLG; 2019.
  22. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-357. doi:1093/intqhc/mzm042
  23. Azizi Fard N, De Francisci Morales G, Mejova Y, Schifanella R. On the interplay between educational attainment and nutrition: a spatially-aware perspective. EPJ Data Sci. 2021;10(1):18. doi:1140/epjds/s13688-021-00273-y
  24. Ross CE, Wu CL. The links between education and health. Am Sociol Rev. 1995;60(5):719-745. doi:2307/2096319
  25. DeJonckheere M, Vaughn LM. Semistructured interviewing in primary care research: a balance of relationship and rigour. Fam Med Community Health. 2019;7(2):e000057. doi:1136/fmch-2018-000057
  26. Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11(4):589-597. doi:1080/2159676x.2019.1628806
  27. Gillison F, Grey E, Griffin T. Parents' perceptions and responses to the UK soft drinks industry levy. J Nutr Educ Behav. 2020;52(6):626-631. doi:1016/j.jneb.2019.11.005
  28. Kwon J, Cameron AJ, Hammond D, et al. A multi-country survey of public support for food policies to promote healthy diets: findings from the International Food Policy Study. BMC Public Health. 2019;19(1):1205. doi:1186/s12889-019-7483-9
  29. Gómez-Donoso C, Sacks G, Vanderlee L, et al. Public support for healthy supermarket initiatives focused on product placement: a multi-country cross-sectional analysis of the 2018 International Food Policy Study. Int J Behav Nutr Phys Act. 2021;18(1):78. doi:1186/s12966-021-01149-0
  30. Ducrot P, Méjean C, Aroumougame V, et al. Meal planning is associated with food variety, diet quality and body weight status in a large sample of French adults. Int J Behav Nutr Phys Act. 2017;14(1):12. doi:1186/s12966-017-0461-7
  31. Dubowitz T, Cohen DA, Huang CY, Beckman RA, Collins RL. Using a grocery list is associated with a healthier diet and lower BMI among very high-risk adults. J Nutr Educ Behav. 2015;47(3):259-264. doi:1016/j.jneb.2015.01.005
  32. Monroe J. You Don't Batch Cook When You're Suicidal. Cooking on a Bootstrap blog. https://cookingonabootstrap.com/2020/07/30/the-price-of-potatoes-and-the-value-of-compassion/#:~:text=Whenever%20food%20poverty%2C%20obesity%2C%20or,which%20way%20into%20the%20light. Published July 30,
  33. Harris J, de Steenhuijsen Piters B, McMullin S, Bajwa B, de Jager I, Brouwer ID. Fruits and vegetables for healthy diets: priorities for food system research and action. In: von Braun J, Afsana K, Fresco LO, Hassan MHA, eds. Science and Innovations for Food Systems Transformation. Cham: Springer International Publishing; 2023:87-104. doi:1007/978-3-031-15703-5_6
  34. Monsivais P, Aggarwal A, Drewnowski A. Time spent on home food preparation and indicators of healthy eating. Am J Prev Med. 2014;47(6):796-802. doi:1016/j.amepre.2014.07.033
  35. Henry Dimbleby. The National Food Strategy: An Independant Review, The Plan. https://www.nationalfoodstrategy.org/. Published 2021. Accessed July 1, 2022.
  36. Pancrazi R, van Rens T, Vukotić M. How distorted food prices discourage a healthy diet. Sci Adv. 2022;8(13):eabi8807. doi:1126/sciadv.abi8807
  37. Piernas C, Harmer G, Jebb SA. Testing availability, positioning, promotions, and signage of healthier food options and purchasing behaviour within major UK supermarkets: evaluation of 6 nonrandomised controlled intervention studies. PLoS Med. 2022;19(3):e1003952. doi:1371/journal.pmed.1003952
  38. Vogel C, Crozier S, Penn-Newman D, et al. Altering product placement to create a healthier layout in supermarkets: outcomes on store sales, customer purchasing, and diet in a prospective matched controlled cluster study. PLoS Med. 2021;18(9):e1003729. doi:1371/journal.pmed.1003729
  39. World Emergency COVID19 Pandemic Ethics (WeCope) Committee. Statement on Autonomy and Responsibility within a public health emergency. WeCope; 2020.
  40. Kriznik NM, Kinmonth AL, Ling T, Kelly MP. Moving beyond individual choice in policies to reduce health inequalities: the integration of dynamic with individual explanations. J Public Health (Oxf). 2018;40(4):764-775. doi:1093/pubmed/fdy045
  41. Griffin N, Phillips SM, Hillier-Brown F, et al. A critique of the English national policy from a social determinants of health perspective using a realist and problem representation approach: the 'Childhood Obesity: a plan for action' (2016, 2018, 2019). BMC Public Health. 2021;21(1):2284. doi:1186/s12889-021-12364-6
  42. Department for Environment, Food & Rural Affairs. Government Food Strategy. Department for Environment, Food & Rural Affairs; 2022.
  43. Savona N, Thompson C, Smith D, Cummins S. Proportional responsibility versus individual responsibility for healthy eating: a complex systems analysis. Lancet. 2017;390 Suppl 3:S80. doi:1016/s0140-6736(17)33015-5
  44. Dieterle JM. Agency and autonomy in food choice: can we really vote with our forks? J Agric Environ Ethics. 2022;35(1):5. doi:1007/s10806-022-09878-3
  45. Buse K, Tanaka S, Hawkes S. Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure. Global Health. 2017;13(1):34. doi:1186/s12992-017-0255-3
  46. https://www.sustainweb.org/what-we-do/. Accessed July 25, 2022.
  47. Bryan CJ, Yeager DS, Hinojosa CP. A values-alignment intervention protects adolescents from the effects of food marketing. Nat Hum Behav. 2019;3(6):596-603. doi:1038/s41562-019-0586-6
  48. Bite Back 2030. The Video the Fast Food Industry Don't Want You to See. https://www.biteback2030.com/news/watch-video-fast-food-industry-dont-want-you-see. Published January 2020. Accessed July 13, 2022.
  49. Food Standards Agency. The 2014 Food and You Survey. London: Food Standards Agency; 2014.

Articles in Press, Corrected Proof
Available Online from 19 August 2023
  • Receive Date: 05 August 2022
  • Revise Date: 19 May 2023
  • Accept Date: 15 August 2023
  • First Publish Date: 19 August 2023