Effectiveness of food environment policies in improving population diets: a review of systematic reviews | European Journal of Clinical Nutrition – Nature.com

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European Journal of Clinical Nutrition (2021)
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Unhealthy population diets contribute to the burden of non-communicable diseases. Policies targeting food environments (FE policies) may improve population diets. This review of systematic reviews aims to summarise recent evidence of the effectiveness of FE policies in improving diets. We searched PubMed for systematic reviews published from January 2010 onwards. Eligible FE policies included: nutrition and food labelling, provision of foods in public institutions or specific settings, price, marketing, nutrition quality and portion size, and availability of foods in retail and food service establishments. A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) instrument was used to assess review quality. Reviews of critically low quality were excluded. Results were narratively reported in text and tables. The search identified 1102 records after removing duplicates. Following screening and quality assessment we included 12 systematic reviews. Two reviews focused on nutrition and food labelling, two on provision of foods in school settings, four on price, none on marketing policies, three on nutrition quality and portion size and one on the availability of foods in retail and food service establishments. Pricing policies (tax/subsidy) appear effective in altering intake and purchase of targeted foods and beverages. FE policies targeting the availability of foods in retail and food establishments, food provision in school settings, product reformulation and the size of portions/packages or items of tableware also appear effective. Overall, policies targeting food environments appear effective in improving population diets. However, there is a need for further high-quality evidence.
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Gakidou E, Afshin A, Abajobir AA, Abate KH, Abbafati C, Abbas KM, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1345–422.
Article  Google Scholar 
Afshin A, Sur PJ, Fay KA, Cornaby L, Ferrara G, Salama JS, et al. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393:1958–72.
Article  Google Scholar 
Hyseni L, Atkinson M, Bromley H, Orton L, Lloyd-Williams F, McGill R, et al. The effects of policy actions to improve population dietary patterns and prevent diet-related non-communicable diseases: Scoping review. Eur J Clin Nutr. 2017;71:694–711.
CAS  Article  Google Scholar 
Rose G, Khaw KT, Marmot M. Rose’s strategy of preventive medicine. Oxford: Oxford University Press; 2009. https://doi.org/10.1093/acprof:oso/9780192630971.001.0001.
Mozaffarian D, Afshin A, Benowitz NL, Bittner V, Daniels SR, Franch HA, et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American heart association. Circulation. 2012;126:1514–63.
Article  Google Scholar 
Hyseni L, Elliot-Green A, Lloyd-Williams F, Kypridemos C, O’Flaherty M, McGill R, et al. Systematic review of dietary salt reduction policies: evidence for an effectiveness hierarchy? PLoS ONE. 2017;12:e0177535.
Article  Google Scholar 
Mozaffarian D, Angell SY, Lang T, Rivera JA. Role of government policy in nutrition—barriers to and opportunities for healthier eating. BMJ. 2018;361. https://doi.org/10.1136/bmj.k2426.
Mozaffarian D, Rosenberg I, Uauy R. History of modern nutrition science-implications for current research, dietary guidelines, and food policy. BMJ. 2018;361. https://doi.org/10.1136/bmj.k2392.
Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, et al. The global obesity pandemic: Shaped by global drivers and local environments. Lancet. 2011;378:804–14.
Article  Google Scholar 
James P, Seward MW, James O’Malley A, Subramanian SV, Block JP. Changes in the food environment over time: examining 40 years of data in the Framingham Heart Study. Int J Behav Nutr Phys Act. 2017;14:84.
Article  Google Scholar 
Gorski MT, Roberto CA. Public health policies to encourage healthy eating habits: Recent perspectives. J Healthc Leadersh. 2015;7:81–90.
PubMed  PubMed Central  Google Scholar 
World Health Organization. European Food and Nutrition Action Plan 2015–2020. Copenhagen, Denmark; 2015.
Swinburn B, Vandevijvere S, Kraak V, Sacks G, Snowdon W, Hawkes C, et al. 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;14:24–37.
Article  Google Scholar 
Djojosoeparto SK, Kamphuis CBM, Vandevijvere S, Harrington JM and Poelman MP on behalf of the JPI-HDHL Policy Evaluation Network. The Healthy Food Environment Policy Index (Food-EPI): European Union. An assessment of EU-level policies influencing food environments and priority actions to create healthy food environments in the EU. Utrecht, Utrecht University, The Netherlands; 2021.
Afshin A, Penalvo J, Del Gobbo L, Kashaf M, Micha R, Morrish K, et al. CVD prevention through policy: a review of mass media, food/menu labeling, taxation/subsidies, built environment, school procurement, worksite wellness, and marketing standards to improve diet. Curr Cardiol Rep. 2015;17. https://doi.org/10.1007/s11886-015-0658-9.
Wolrd Health Organization. Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Geneva: World Health Organization, Geneva PP; 2017.
Hawkes C, Jewell J, Allen K. A food policy package for healthy diets and the prevention of obesity and diet-related non-communicable diseases: the NOURISHING framework. Obes Rev. 2013;14:159–68.
Article  Google Scholar 
Hyseni L, Bromley H, Kypridemos C, O’Flaherty M, Lloyd-Williams F, Guzman-Castillo M, et al. Systematic review of dietary trans-fat reduction interventions. Bull World Heal Organ. 2017;95:821–30g.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372. https://doi.org/10.1136/bmj.n71.
Chandler J, Cumpston M, Thomas J, Higgins JPT, Deeks JJCM. Chapter I: Introduction. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handb. Syst. Rev. Interv. version 6.2 (updated Febr. 2021). 2021.
World Bank Country and Lending Groups—World Bank Data Help Desk. 2021. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Accessed 12 Dec 2020.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5:210.
Article  Google Scholar 
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358. https://doi.org/10.1136/bmj.j4008.
Hollands GJ, Shemilt I, Marteau TM, Jebb SA, Lewis HB, Wei Y, et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database Syst Rev. 2015;9:CD011045.
Google Scholar 
Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev. 2019. https://doi.org/10.1002/14651858.CD012573.pub3.
Crockett RA, King SE, Marteau TM, Prevost AT, Bignardi G, Roberts NW, et al. Nutritional labelling for healthier food or non-alcoholic drink purchasing and consumption. Cochrane Database Syst Rev. 2018;2:Cd009315.
PubMed  Google Scholar 
Swartz JJ, Braxton D, Viera AJ. Calorie menu labeling on quick-service restaurant menus: an updated systematic review of the literature. Int J Behav Nutr Phys Act. 2011;8:135.
Article  Google Scholar 
Hendry VL, Almíron-Roig E, Monsivais P, Jebb SA, Neelon SE, Griffin SJ, et al. Impact of regulatory interventions to reduce intake of artificial trans-fatty acids: a systematic review. Am J Public Heal. 2015;105:e32–42.
Article  Google Scholar 
Afshin A, Peñalvo JL, Del Gobbo L, Silva J, Michaelson M, O’Flaherty M, et al. The prospective impact of food pricing on improving dietary consumption: a systematic review and meta-analysis. PLoS ONE. 2017;12:e0172277.
Article  Google Scholar 
Redondo M, Hernández-Aguado I, Lumbreras B. The impact of the tax on sweetened beverages: a systematic review. Am J Clin Nutr. 2018;108:548–63.
Article  Google Scholar 
Delgado-Noguera M, Tort S, Martínez-Zapata MJ, Bonfill X. Primary school interventions to promote fruit and vegetable consumption: a systematic review and meta-analysis. Prev Med. 2011;53:3–9.
Article  Google Scholar 
Hashem KM, He FJ, MacGregor GA. Effects of product reformulation on sugar intake and health-a systematic review and meta-analysis. Nutr Rev. 2019;77:181–96.
Article  Google Scholar 
An R. Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments. Public Heal Nutr. 2012;16:1215–28.
Article  Google Scholar 
Backholer K, Sarink D, Beauchamp A, Keating C, Loh V, Ball K, et al. The impact of a tax on sugar-sweetened beverages according to socio-economic position: a systematic review of the evidence. Public Heal Nutr. 2016;19:3070–84.
Article  Google Scholar 
Micha R, Karageorgou D, Bakogianni I, Trichia E, Whitsel LP, Story M, et al. Effectiveness of school food environment policies on children’s dietary behaviors: a systematic review and meta-analysis. PLoS ONE. 2018;13:e0194555.
Article  Google Scholar 
Chaloupka FJ, Powell LM, Warner KE. The use of excise taxes to reduce tobacco, alcohol, sugar beverage consumption. Annu Rev Public Heal. 2019;40:187–201.
Article  Google Scholar 
Gittelsohn J, Trude ACB, Kim H. Pricing strategies to encourage availability, purchase, and consumption of healthy foods and beverages: a systematic review. Prev Chronic Dis. 2017;14:E107.
Article  Google Scholar 
Powell LM, Chriqui JF, Khan T, Wada R, Chaloupka FJ. Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes. Obes Rev. 2013;14:110–28.
CAS  Article  Google Scholar 
Kirkpatrick SI, Raffoul A, Maynard M, Lee KM, Stapleton J. Gaps in the evidence on population interventions to reduce consumption of sugars: a review of reviews. Nutrients 2018;10. https://doi.org/10.3390/nu10081036.
Cornelsen L, Green R, Turner R, Dangour AD, Shankar B, Mazzocchi M, et al. What happens to patterns of food consumption when food prices change? Evidence from a systematic review and meta-analysis of food price elasticities globally. Heal Econ. 2015;24:1548–59.
Article  Google Scholar 
Andreyeva T, Long MW, Brownell KD. The impact of food prices on consumption: A systematic review of research on the price elasticity of demand for food. Am J Public Health. 2010;100:216–22.
Article  Google Scholar 
Escobar MA, Veerman JL, Tollman SM, Bertram MY, Hofman KJ. Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis. BMC Public Health. 2013;13:1072.
Article  Google Scholar 
Epstein LH, Jankowiak N, Nederkoorn C, Raynor HA, French SA, Finkelstein E. Experimental research on the relation between food price changes and food-purchasing patterns: a targeted review. Am J Clin Nutr. 2012;95:789–809.
CAS  Article  Google Scholar 
Boyland EJ, Nolan S, Kelly B, Tudur-Smith C, Jones A, Halford JC, et al. Advertising as a cue to consume: a systematic review and meta-analysis of the effects of acute exposure to unhealthy food and nonalcoholic beverage advertising on intake in children and adults. Am J Clin Nutr. 2016;103:519–33.
CAS  Article  Google Scholar 
Cairns G, Angus K, Hastings G. The extent, nature and effects of food promotion to children: a review of the evidence to December 2008. World Health. 2009;173.
Sadeghirad B, Duhaney T, Motaghipisheh S, Campbell NRC, Johnston BC. Influence of unhealthy food and beverage marketing on children’s dietary intake and preference: a systematic review and meta-analysis of randomized trials. Obes Rev. 2016;17:945–59. https://doi.org/10.1111/obr.12445.
CAS  Article  Google Scholar 
Smith R, Kelly B, Yeatman H, Boyland E Food marketing influences children’s attitudes, preferences and consumption: a systematic critical review. Nutrients. 2019;11. https://doi.org/10.3390/nu11040875.
Appel LJ, Frohlich ED, Hall JE, Pearson TA, Sacco RL, Seals DR, et al. The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association. Circulation. 2011;123:1138–43.
Article  Google Scholar 
Croker H, Packer J, Russell S, Stansfield C, Viner RM. Front of pack nutritional labelling schemes: a systematic review and meta-analysis of recent evidence relating to objectively measured consumption and purchasing. J Hum Nutr Diet. 2020;33:518–37.
CAS  Article  Google Scholar 
Center for Disease Control and Prevention. Adult Obesity Facts | Overweight & Obesity | CDC. 2021. https://www.cdc.gov/obesity/data/adult.html. Accessed 20 Jan 2021.
Front of pack nutritional labelling schemes: a systematic review and meta-analysis of recent evidence relating to objectively measured consumption and purchasing. 33:518–37.
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The authors would like to thank Nanna Louise Riis, Kirsten Bjørnsbo, Kamille Almer Bernsdorf Torp, Signe Damsbo Birch and Tine Buch-Andersen for providing helpful comments on a previous version of this paper.
Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
Katrine Lindberg Hansen, Sanja Golubovic, Christian Ulrich Eriksen, Torben Jørgensen & Ulla Toft
Department of Public Health, Faculty of Medicine and Health Sciences, University of Copenhagen, Copenhagen, Denmark
Torben Jørgensen & Ulla Toft
The Faculty of Medicine, Aalborg University, Aalborg, Denmark
Torben Jørgensen
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KLH was responsible for designing the review, writing the review article, conducting the search, pre-liminary and full-text screening, quality assessment, data extraction and narrative synthesis, interpretation of results, creating tables and figures, and updating references list. SG was responsible for writing the review article, for full-text screening, quality assessment, data extraction and narrative synthesis, and interpretation of results. CUE was responsible for designing the review, conducting the search, full-text screening, quality assessment, data extraction and provided feedback on the paper. UT and TJ were responsible for designing the review and provided feedback on the paper. All authors read and approved the final paper.
Correspondence to Ulla Toft.
The authors declare no competing interests.
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Hansen, K.L., Golubovic, S., Eriksen, C.U. et al. Effectiveness of food environment policies in improving population diets: a review of systematic reviews. Eur J Clin Nutr (2021). https://doi.org/10.1038/s41430-021-01008-y
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Received: 23 April 2021
Revised: 11 August 2021
Accepted: 03 September 2021
Published: 20 September 2021
DOI: https://doi.org/10.1038/s41430-021-01008-y
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