The BSFS demonstrated substantial validity and reliability, although difficulties arose around clinical decision points (Types 2, 3, 5, 6) that warrant investigation in larger clinical populations. Potential for improving validity and reliability through modifications to the BSFS or training in its use should be explored.

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Objectives. To examine the prevalence and magnitude of price promotions in a major Australian supermarket and how they differ between core (healthy) and discretionary (less healthy) food categories. Methods. Weekly online price data (regular retail price, discount price, and promotion type) on 1579 foods were collected for 1 year (April 2017 to April 2018) from the largest Australian supermarket chain. Products audited were classified according to Australian Dietary Guidelines definitions of core and discretionary foods and according to their Health Star Rating (a government-endorsed nutrient profiling scheme). Results. On average, 15.1% (95% confidence interval [CI] = 14.7%, 15.3%) of core foods and 28.8% (95% CI = 28.6%, 29.0%) of discretionary foods were price promoted during a given week. Average discounts were −15.4% (95% CI = −16.4, −14.4) for core products and −25.9% (95% CI = −26.8, −25.1) for discretionary products. The percentage of products on price promotion and the size of the discount were larger for products with a lower Health Star Rating (P < .05). Conclusions. Price promotions were more prevalent and greater in magnitude for discretionary foods than for core foods. Policies to reduce the prevalence and magnitude of price promotions on discretionary foods could improve the healthiness of food purchased from supermarkets.

Sugar-sweetened beverage taxation: an update on the year that was 2017 It has now been four years since the implementation of the Mexican sugar-sweetened beverage (SSB) tax at the beginning of 2014the first substantial, nationwide tax on SSB for health-related reasons. The enactment of this SSB tax, its robust evaluation and positive effects on reducing SSB purchases set a path for increasing global action in the years to follow. The implementation of SSB taxes as part of wider efforts to address obesity and diet-related chronic diseases was recognized to be at a tipping point in 2016 (1). Unlike other recommended obesity prevention policies, such as restrictions on unhealthy food marketing to children, SSB taxes are fast becoming a norm in the USA and elsewhere around the globe, and the scientific evidence base is increasing and strengthening. Contradicting the view that SSB taxes are a progressive or left-wing preference, a recent study found that most SSB taxes are implemented by conservative or right-wing governments (2). A recent review (3) on key policy lessons from health taxes does, however, highlight the importance of being clear about the primary goal of the tax as health taxes remain vulnerable to hostile lobbying. Earmarking health taxes for health spending was clearly found to increase both public and political support for their implementation. Here we provide an updated timeline of action (below and Fig. 1) and highlight evidence and lessons for the year that was 2017. Notable action Much of the SSB tax action in 2017 was concentrated in the USA, with the implementation of SSB taxes in six cities following city council or public vote (all approved in 2016 with the exception of Seattle, Washington, which was approved in June 2017). In the Middle East the highest SSB taxes to date were implemented in Saudi Arabia and United Arab Emirates. Other countries and jurisdictions that joined the SSB tax crusade included Portugal, Brunei and the Catalonian region of Spain. This year also saw Estonia and Thailand pass legislation on SSB taxes, with taxation due to be mandated in the coming years. Meanwhile, the UK and Ireland are preparing for a 2018 implementation of a two-tiered levy on the sugar content in SSB. Below we summarize each of these actions. For specific design elements of each tax (magnitude, type of tax and targeted products), see Fig. 1. Actions in the USA After defeating a relentless $US 9 million campaign by the American Beverage Association opposing the SSB tax proposal in 2016 (4) , Philadelphia adopted the SSB tax legislation in January 2017. The tax was introduced with the explicit goal of financing universal pre-kindergarten, for which broad support existed, and deliberately not framed as a health intervention, to avoid contentious debates about the role of government in changing individual behaviour (5). The Mayor of Philadelphia announced that as of June 2017, the tax had funded 2000 preschool childhood education placements and provided 4500 neighbourhood public-school students and the...

Large changes to food retail settings are required to improve population diet.However, limited research has comprehensively considered the business implications of healthy food retail strategies for food retailers. We performed a systematic scoping review to identify types of business outcomes that have been reported in healthy food retail strategy evaluations. Peer-reviewed and grey literature were searched.We identified qualitative or quantitative real-world food or beverage retail strategies designed to improve the healthiness of the consumer nutrition environment (eg, changes to the "marketing mix" of product, price, promotion, and/or placement).Eligible studies reported store-or chain-level outcomes for measures of commercial viability, retailer perspectives, customer perspectives, and/or community outcomes. 11 682 titles and abstracts were screened with 107 studies included for review from 15 countries. Overall item sales, revenue, store patronage, and customer level of satisfaction with strategy were the most frequently examined outcomes. There was a large heterogeneity in outcome measures reported and in favourability for retailers of outcomes across studies. We recommend more consistent reporting of business outcomes and increased development and use of validated and reliable measurement tools. This may help generate more robust research evidence to aid retailers and policymakers to select feasible and sustainable healthy food retail strategies to benefit population health within and across countries.

Objective: Price promotions are used to influence purchases and represent an important target for obesity prevention policy. However, no long-term contemporary data on the extent and frequency of supermarket price promotions exists. We aimed to evaluate the frequency, magnitude and weekly variation of beverage price promotions available online at two major Australian supermarket chains over 50 weeks. Methods:Beverages were categorised into four policy-relevant categories (sugar-sweetened beverages, artificially-sweetened beverages, flavoured milk and 100% juice, milk and water). The proportional contribution of each category to the total number of price proportions, the proportion of price promotions within the available product category, the mean discount, and weekly variation in price promotions were calculated.Results: For Coles and Woolworths respectively, 26% and 30% of all beverages were price promoted in any given week. Sugar-sweetened beverages made up the greatest proportion of all price promotions (Coles: 46%, Woolworths: 49%). Within each product category, the proportion of sugar-sweetened and artificially-sweetened beverages that were price promoted was similar, higher than the other categories and reasonably constant over time. Diet drinks and sugar-sweetened soft drinks were most heavily discounted (by 29-40%). Conclusions:Beverage price promotions are used extensively in Australian supermarkets, undermining efforts to promote healthy population diets. Implications for public health:Policies restricting price promotions on sugar-sweetened beverages are likely to be an important part of strategies to reduce obesity and improve population nutrition.

A 20% sugar-sweetened beverage price increase was associated with a reduction in their purchases and an increase in purchases of healthier alternatives. Community retail settings present a bottom-up approach to improving consumer beverage choices.