Implementing Food Environment Policies at Scale: What Helps? What Hinders? A Systematic Review of Barriers and Enablers

Abstract

Background: Policies that support healthier food environments, including healthy retail food availability and promotion, are an important strategy for obesity prevention. The aim of this systematic review was to examine the evidence for barriers and enablers to successful implementation of healthy food and drink policies, delivered at scale. Methods: MEDLINE, SCOPUS and INFORMIT were searched to May 2019 for peer-reviewed studies. Google and Google Scholar were searched for grey literature. Studies of any design relating to a healthy food and drink policy delivered at scale (≥10 sites) in non-commercial food settings, for specific retail outlets (e.g., vending machines, cafes, cafeterias, school canteens), and that reported on implementation barriers and/or enablers were included. Studies in commercial food retail environments (e.g., supermarkets) were excluded. Studies were appraised for quality and key information was extracted and summarised. Extracted information on barriers and enablers was further grouped into overarching themes relating to perceptions of the policy itself, organisational and contextual factors influencing policy implementation, stakeholder responses to the implemented policy and perceived policy impacts. Results: Of 19 studies, 16 related to policies implemented in schools, two in hospital/health facilities and one in a sport/recreation setting. Most studies were conducted in North America or Australia, and policy implementation occurred mainly at state/regional or federal levels. The most commonly cited barriers across overarching themes and intervention settings were: lack of stakeholder engagement or prioritisation of the policy (11 studies); resistance to change from school stakeholders or customers (8 studies); and concern over profitability, revenue and/or commercial viability (8 studies). Few studies reported on mitigation of barriers. Enablers most commonly raised were: stakeholder engagement, whole-school approach and/or prioritisation of the policy (9 studies); policy level or higher-level support in the form of information, guidance and/or training (5 studies); and leadership, school/policy champion, management commitment and/or organisational capacity (4 studies). Conclusions: Key considerations for policy implementation ranged from building stakeholder support, prioritising policy implementation within organisations, to implementing strategies that address financial concerns and implementation barriers.

School Food Environment in Urban Zambia: A Qualitative Analysis of Drivers of Adolescent Food Choices and Their Policy Implications

“…The growing double burden of malnutrition is an emerging public health concern in Zambia. Early evidence shows that Zambia is undergoing a nutrition transition with a shift from the traditional Zambian diet of nshima (a thick porridge made from maize meal) (which is consumed with a variety of protein and/or vegetable relish) to more processed fast foods [ 26 ]. Consequently, nearly a quarter of the adult population are overweight or obese [ 27 ] while 35% of children under five years are stunted [ 28 ].…”

Factors That “Nudge People towards the Healthier” Snacks—A Qualitative Study with Student, Faculty, and Staff Leaders and Decision Makers

“…While organizational structure has been found to be a barrier in other research [ 6 , 43 , 44 ], the complicated dynamics of the state university system have not been mentioned in this detail prior to the current study. So too, the loss of revenue has been found to be a barrier to implementing and designing policies to improve food environments in prior research [ 6 , 7 , 43 , 44 ]. Other universities have utilized pilot studies to identify the foods that consumers will purchase to offset this concern, while others have incorporated substantial marketing campaigns to do so [ 39 , 40 , 41 ].…”

“…For many years, obesity interventions focused primarily on the individual, and they did not serve to successfully curb the trends [ 3 ]. The new research suggests that there is a myriad of influences, contributors, and circumstances that create the epidemic of overweight and obesity and high adiposity which many countries are currently experiencing [ 4 , 5 , 6 , 7 ].…”

Disparities in Recommendations for Colorectal Cancer Screening Among Average-Risk Individuals: An Ecobiosocial Approach

“… 1–3 CRC also increasingly becomes a public health concern in countries with a middle to high human development index (HDI) following the adoption of a westernized lifestyle as the consequence of economic growth. 4 , 5 …”