Improving food environments and tackling obesity: A realist systematic review of the policy success of regulatory interventions targeting population nutrition

Abstract

BackgroundThis systematic review (PROSPERO: CRD42015025276) employs a realist approach to investigate the effect of “real-world” policies targeting different aspects of the food environment that shape individual and collective nutrition.ObjectivesWe were interested in assessing intermediate outcomes along the assumed causal pathway to “policy success”, in addition to the final outcome of changed consumption patterns.Data sourcesWe performed a search of 16 databases through October 2015, with no initial restriction by language.Study eligibility criteriaWe included all publications that reported the effect of statutory provisions aimed at reducing the consumption of energy-dense foods and beverages in the general population. We allowed all methodological approaches that contained some measure of comparison, including studies of implementation progress.Study appraisal and synthesis methodsWe reviewed included studies using the appraisal tools for pre-post and observational studies developed by the National Heart, Lung, and Blood Institute. Given the considerable heterogeneity in interventions assessed, study designs employed, and outcome measures reported, we opted for a narrative synthesis of results.Results and implicationsResults drawn from 36 peer-reviewed articles and grey literature reports demonstrated that isolated regulatory interventions can improve intermediate outcomes, but fail to affect consumption at clinically significant levels. The included literature covered six different types of interventions, with 19 studies reporting on calorie posting on chain restaurant menus. The large majority of the identified interventions were conducted in the US. Early results from recent taxation measures were published after the review cut-off date but these suggested more favorable effects on consumption levels. Nevertheless, the evidence assessed in this review suggests that current policies are generally falling short of anticipated health impacts.

Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems

“…Local authorities need powers to apply zoning regulations in low-income areas to restrict unhealthy food outlets. 373 Contracts and procurement policies can be used to promote healthy diets from sustainable food systems in workplaces, schools and venues where public meals are provided, but these policies need persistence and continued political leadership for success. Multiple indicators of both human and environmental health discussed in this report need to be applied.…”

Nutrition Policy and Individual Struggle to Eat Healthily: The Question of Public Support

“…These interventions can range from providing information to instruments with a greater level of intervention, e.g., taxes on unhealthy foods, bans of advertisement targeted at children (for a detailed explanation of the different policy instruments see Table 1). Over the past few years, the debate on such policy instruments has gained international importance, as a result of increased efforts of the World Health Organization (WHO) [8][9][10]. For example, some European countries have introduced health-related ("fat") taxes.…”

“…For example, the tax on saturated fatty acids in Denmark was abolished again in January 2012, after a change of government. However, the importance of a suitable policy mix for a healthy diet is increasingly recognised in the literature [9,[13][14][15].…”

Impact of Dining Hall Structural Changes on Food Choices: A Pre-Post Observational Study

“…This demonstrates that the food service industry can play a positive role in the prevention of obesity and chronic disease, by introducing valued healthy alternatives via structural environmental changes, but without any concurrent information provision. Few studies report employing strategies of a structural nature to improve consumers' food choices [20,21,23,34]. Examinations of food service initiatives and policy interventions demonstrate that individually-focussed change efforts such as awareness raising dominate [20,35].…”