Evaluation of the introduction of a healthy food and drink policy in 13 community recreation centres on the healthiness and nutrient content of customer purchases and business outcomes: An observational study

Abstract

Introduction This observational study assessed the introduction of a comprehensive healthy food and drink policy across 13 community organisation managed aquatic and recreation centres in Victoria, Australia, and the associated changes on business outcomes, and the healthiness of purchases. The policy, based on state government guidelines, mandated that food and drink availability be based on healthiness classification: ’red’ (limit) <10%, and ‘green’ (best choice) >50%, and the remainder ‘amber’ (choose carefully). Methods Six years of monthly sales data were split into three periods, prior to (1/01/2013–31/12/2014), during (1/01/2015–31/12/2016) and post (1/1/2017–31/12/2018), policy implementation. Using point-of-sale data, food and drink nutrient content, and state guidelines, items were classified as ‘red’/‘amber’/‘green’. Linear models with Newey West standard errors were fitted to compare the mean value of outcomes between post- to pre-policy implementation periods, for each outcome and centre; and were pooled using random effect meta-analyses. Results Comparing post- to pre-policy implementation periods, total food sales did not change (mean percentage difference: -3.2% (95% confidence interval (CI) -21% to 14%), though total drink sales declined -27% (CI -37% to -17%). The mean percentage of ‘red’ foods sold declined by -15% (CI -22% to -7.7%), ‘amber’ food sales increased 11% (CI 5.5% to 16%). ‘Green’ food sales did not change (3.3%, CI -1.4% to 8.0%). The mean percentage of ‘red’ drinks sold declined -37% (CI -43% to -31%), ‘amber’ and ‘green’ drink sales increased by 8.8% (CI 3.6% to 14%) and 28% (CI 23% to 33%), respectively. The energy density and sugar content (percentage of total weight/volume) of both food and drinks decreased. Conclusions This study has shown that the implementation of a policy to improve the health of retail food environments can result in a shift towards healthier purchases. Sales revenue from foods did not decline, though revenue from drinks did, indicating future research needs to explore mitigation of this.

The use of private regulatory measures to create healthy food retail environments: a scoping review

“…Four articles (57,75,76) reported on United Kingdom (UK) voluntary supermarket checkout food policies, and three articles (59,77,78) reported on the United States (US) National Restaurant Association's Kids LiveWell program in the regional restaurant chain, Silver Diner. The remaining twenty-three articles reported on initiatives used in hospital and health service food retail outlets (n 6) (12,43,52,58,68,79) , vending machines (n 4) (14,44,65,70) , fast food outlets (n 3) (47,80,81) , supermarkets (n 3) (15,39,54) , independently owned food retail outlets (n 2) (42,45) , remote and regional community stores (n 2) (46,53) , universities (n 2) (52,66) and sports and aquatic centres (n 1) (60) . Table 1 provides a summary of the characteristics of the included studies.…”

“…Mueller, 2017 (59) Silver Diner Full Service Restaurant Not described Not described Not described Voluntary Naughton, 2023 (60) Policy implementation was supported by a health promotion officer based at YMCA head office, with each centre responsible for implementing the policy into their own food retail outlet.…”

“…Of the twenty-six initiatives, ten were implemented in the USA (45,47,51,52,58,65,66,70,78,81) , seven in Australia (12,43,44,46,53,60,79) , five in the UK (42,54,68,76,80) , two in Canada (13,56,62) , one in Germany (14) and one in South Africa (39) . Sixteen (62 %) initiatives were voluntary (13,14,39,42,45,47,53,58,60,64,66,75,(78)(79)(80)(81) , six (23 %) mandatory (46,51,52,65,68,70) , two (7•5 %) used both voluntary and mandatory approaches (12,…”

“…As noted in Table 1, of the twenty-six initiatives described, fourteen initiatives operated within one of the domains (14,39,47,50,(52)(53)(54)(57)(58)(59)66,68,70,80,81) and twelve operated across multiple domains (12,(42)(43)(44)(45)47,54,60,62,65,78,79) . Thirteen operated in the domain of point of purchase information; (12,(42)(43)(44)(45)47,60,61,65,(67)(68)(69)78) sixteen took the form of food quality standards; (12,14,33,(42)(43)(44)47,52,…”

“…Of the twenty-six initiatives, thirteen used one mechanism and thirteen used multiple mechanisms. Within the initiatives described: twenty-four targeted altering food availability or accessibility, (12)(13)(14)39,(41)(42)(43)(44)46,47,(51)(52)(53)(54)(55)(56)58,60,61,66,(68)(69)(70) nine targeted altering consumer preference or choice (12,14,41,45,53,65,(67)(68)(69) and ten targeted altering food formulation (12,14,(41)(42)(43)47,52,56,60,66) .…”