Changing the assortment of available food and drink for leaner, greener diets

Marteau, Theresa; Hollands, Gareth J; Pechey, Rachel; Reynolds, James P.; Jebb, Susan

doi:10.1136/bmj-2021-069848

Cited by 15 publications

(20 citation statements)

References 51 publications

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“…Patterning observed in some studies has been consistent with potential differential impact of availability interventions by SEP, suggesting those with higher SEP may be more likely to respond to increased healthier food availability, but with insufficient power to test effects [ 2 , 16 ]. Establishing the mechanisms that might underlie the impact of availability may help establish how best to implement this promising intervention [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Explaining the effect on food selection of altering availability: two experimental studies on the role of relative preferences

2022

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Background Increasing the availability of healthier or plant-based foods increases their selection. The current studies aimed to examine the extent to which relative preferences account for food selections following availability interventions. In particular, (a) whether increasing the availability of lower-energy options increases the likelihood that individuals’ highest-ranked option is lower-energy, and (b) the extent to which selections reflect individuals’ highest-ranked option from the available range. Methods UK adults (Study 1: n = 1976; Study 2: n = 1078) took part in within-subjects online studies. In both studies, the order of preference between food options was established by participants choosing the option that they would prefer “to eat right now” from every possible pairing within a pool of eight options. Then, participants were shown either predominantly higher-energy options (three higher- and one lower-energy) or predominantly lower-energy options (vice versa), presented in a random order. Results When predominantly lower-energy options were presented, the odds of the highest-ranked option being a lower-energy option increased ten-fold (Study 1: odds ratio: 10.1; 95%CI: 8.9,11.4; Study 2: odds ratio: 10.4; 95%CI: 7.4,14.7), compared to when predominantly higher-energy options were available. In both studies, around 90% of selections reflected the highest-ranked option in the range offered in the studied availability conditions (range 88–92%). Conclusions These studies suggest that increased availability of lower-energy options increases the likelihood of an individual’s highest-ranked option being lower-energy, and that the highest-ranked option has the greatest likelihood of selection. As such, preferences may be a key contributor to the effects of altering availability on food selections. Trial registration ISRCTN (http://www.isrctn.com/ISRCTN27598623; 3/12/19 [Study 1]; http://www.isrctn.com/ISRCTN61010183; 20/4/20 [Study 2]).

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Section: Introductionmentioning

confidence: 99%

Explaining the effect on food selection of altering availability: two experimental studies on the role of relative preferences

2022

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“…The promise of so-called 'availability' interventions that change proportions of unhealthy (relative to more healthy) products, is highlighted by an emerging evidence base in relation to food 5 . A Cochrane systematic review found that reducing the proportion of available food products of a certain type (e.g., unhealthy snacks) resulted in markedly reduced selection of those foods 7 , although the included evidence was limited in both quality and quantity.…”

Section: Introductionmentioning

confidence: 99%

“…More recent field trials also suggest that decreasing the proportion of higher energy or meat-based foods reduces their consumption [8][9][10][11] . In terms of alcohol products, there is an absence of evidence, with no eligible studies identified in the aforementioned Cochrane review 7 or in a recent search update 5 . In what is, to our knowledge, the only previous study that has examined the potential of such an intervention applied to alcohol, the proportion of participants selecting an alcoholic drink decreased from 74% when one-quarter of the available drinks were non-alcoholic, to 51% when three-quarters were non-alcoholic 12 .…”

Section: Introductionmentioning

confidence: 99%

Impact on alcohol selection and online purchasing of changing the proportion of available non-alcoholic versus alcoholic drinks: A randomised controlled trial

Clarke

Blackwell

Ferrar

et al. 2022

Preprint

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Background Increasing the availability of non-alcoholic options is a promising population-level intervention to reduce alcohol consumption, currently unassessed in naturalistic settings. This study in an online retail setting aimed to estimate the impact of increasing the proportion of non-alcoholic (relative to alcoholic) drinks, on selection and actual purchasing of alcohol. Methods Adults (n=737) who regularly purchased alcohol online were randomly assigned to one of three groups: Higher Proportion of non-alcoholic drinks available (75%); Same Proportion (50%); Lower Proportion (25%). Participants selected drinks in a simulated online supermarket, before purchasing them in an actual online supermarket. The primary outcome was the number of alcohol units selected (with intention to purchase); secondary outcomes included purchasing. Findings 607 participants completed the study and were included in the primary analysis. The Higher Proportion group selected 10.0 fewer alcohol units than the Lower Proportion group (-32%; 95%CI -42%,-22%) and 7.1 fewer units compared to the Same Proportion group (-25%; 95%CI -36%,-13%), based on model results in those selecting any drinks containing alcohol (559/607). There was no evidence of a difference between the Same Proportion and Lower Proportion groups (2.9 fewer units, -9%; 95%CI -22%,5%). For all other outcomes, alcohol selection and purchasing were consistently lowest in the Higher Proportion group. Interpretation This study provides evidence that substantially increasing the proportion of non-alcoholic drinks - from 25% to 50% or 75% - meaningfully reduces alcohol selection and purchasing. Further studies are warranted to assess whether these effects are realised in a range of real-world settings.

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“…Availability interventions involve altering the number of instances of a product within the physical micro-environment. These interventions represent a paradigmatic example of micro-environmental interventions that have shown promising evidence of effectiveness [ 10 , 11 ]. The mechanism by which these interventions operate is not fully known.…”

Section: Introductionmentioning

confidence: 99%

Is altering the availability of healthier vs. less-healthy options effective across socioeconomic groups? A mega-analysis

Pechey

Hollands

Reynolds

et al. 2022

Int J Behav Nutr Phys Act

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Background Availability interventions have been hypothesised to make limited demands on conscious processes and, as a result, to be less likely to generate health inequalities than cognitively-oriented interventions. Here we synthesise existing evidence to examine whether the impact of altering the availability of healthier vs. less-healthy options differs by socioeconomic position. Methods Individual-level data (21,360 observations from 7,375 participants) from six studies (conducted online (n = 4) and in laboratories (n = 2)) were pooled for mega-analysis. Multilevel logistic regressions analysed the impact of altering the availability of healthier options on selection of a healthier (rather than a less-healthy) option by socioeconomic position, assessed by (a) education and (b) income. Results Participants had over threefold higher odds of selecting a healthier option when the available range was predominantly healthier compared to selections when the range offered was predominantly less-healthy (odds ratio (OR): 3.8; 95%CIs: 3.5, 4.1). Less educated participants were less likely to select healthier options in each availability condition (ORs: 0.75–0.85; all p < 0.005), but there was no evidence of differences in healthier option selection by income. Compared to selections when the range offered was predominantly less-healthy, when predominantly healthier options were available there was a 31% increase in selecting healthier options for the most educated group vs 27% for the least educated. This modest degree of increased responsiveness in the most educated group appeared only to occur when healthier options were predominant. There was no evidence of any differential response to the intervention by income. Conclusion Increasing the proportion of healthier options available increases the selection of healthier options across socioeconomic positions. Availability interventions may have a slightly larger beneficial effect on those with the highest levels of education in settings when healthier options predominate.

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Changing the assortment of available food and drink for leaner, greener diets

Abstract: Theresa Marteau and colleagues discuss the potential of “availability interventions” to improve diets and reduce inequalities

Cited by 15 publications

References 51 publications

Explaining the effect on food selection of altering availability: two experimental studies on the role of relative preferences

Explaining the effect on food selection of altering availability: two experimental studies on the role of relative preferences

Impact on alcohol selection and online purchasing of changing the proportion of available non-alcoholic versus alcoholic drinks: A randomised controlled trial

Is altering the availability of healthier vs. less-healthy options effective across socioeconomic groups? A mega-analysis

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