The impact of interventions to promote healthier ready‐to‐eat meals (to eat in, to take away or to be delivered) sold by specific food outlets open to the general public: a systematic review

Abstract

SummaryIntroductionReady‐to‐eat meals sold by food outlets that are accessible to the general public are an important target for public health intervention. We conducted a systematic review to assess the impact of such interventions.MethodsStudies of any design and duration that included any consumer‐level or food‐outlet‐level before‐and‐after data were included.ResultsThirty studies describing 34 interventions were categorized by type and coded against the Nuffield intervention ladder: restrict choice = trans fat law (n = 1), changing pre‐packed children's meal content (n = 1) and food outlet award schemes (n = 2); guide choice = price increases for unhealthier choices (n = 1), incentive (contingent reward) (n = 1) and price decreases for healthier choices (n = 2); enable choice = signposting (highlighting healthier/unhealthier options) (n = 10) and telemarketing (offering support for the provision of healthier options to businesses via telephone) (n = 2); and provide information = calorie labelling law (n = 12), voluntary nutrient labelling (n = 1) and personalized receipts (n = 1). Most interventions were aimed at adults in US fast food chains and assessed customer‐level outcomes. More ‘intrusive’ interventions that restricted or guided choice generally showed a positive impact on food‐outlet‐level and customer‐level outcomes. However, interventions that simply provided information or enabled choice had a negligible impact.ConclusionInterventions to promote healthier ready‐to‐eat meals sold by food outlets should restrict choice or guide choice through incentives/disincentives. Public health policies and practice that simply involve providing information are unlikely to be effective.

Why do the public support or oppose obesity prevention regulations? Results from a South Australian population survey

“…These findings reflect a popular belief that information provision is an effective mechanism for motivating healthy behaviours . Such perceptions are discordant with evidence that shows education to be largely ineffective in changing population dietary patterns, and that more restrictive interventions addressing socio‐environmental influences offer the greatest likelihood of impact . In particular, front‐of‐pack nutrition labelling has been found to have limited discernible impact on the healthiness of food purchases .…”

“…25 Such perceptions are discordant with evidence that shows education to be largely ineffective in changing population dietary patterns, and that more restrictive interventions addressing socio-environmental influences offer the greatest likelihood of impact. 26,27 In particular, front-of-pack nutrition labelling has been found to have limited discernible impact on the healthiness of food purchases. 26,28,29 However, those in the most disadvantaged socio-economic group-a key target population for obesity prevention policies and programs 30 -were more likely than those in any other group to report wanting to use nutrition labels themselves.…”

“…26,27 In particular, front-of-pack nutrition labelling has been found to have limited discernible impact on the healthiness of food purchases. 26,28,29 However, those in the most disadvantaged socio-economic group-a key target population for obesity prevention policies and programs 30 -were more likely than those in any other group to report wanting to use nutrition labels themselves.…”

Behavioural Insights and (Un)healthy Dietary Choices: a Review of Current Evidence

“…Some of these reviews focus on specific settings such as schools (Nørnberg et al 2015), universities (Roy et al 2015), and self-service settings (Skov et al 2013); others cover workplace interventions (Allan et al 2017) or children in their home environment (Lycett et al 2017). Other reviews focus on specific ways food is presented, such as type of tableware (e.g., Holden et al 2016), or have not focused on choice but rather included relevant literature while reviewing a wider set of interventions to foster healthier choices (e.g., Hillier-Brown et al 2017;Kahn-Marshall and Gallant 2012).…”

Healthy Public Policy Options to Promote Physical Activity for Chronic Disease Prevention: Understanding Canadian Policy Influencer and General Public Preferences

“…12 It may be the case that survey participants in our study were supportive of policies that "enabled choice" because they interpreted these types of interventions as enhancing rather than limiting individual autonomy. Despite these known challenges of using the Nuffield interventional ladder, we opted for this framework as it has been widely applied, 11,[26][27][28] which allowed us to further interpret our study results within the broader literature.…”