Abstract
Unhealthy population diets contribute to the burden of non-communicable diseases. Policies targeting food environments (FE policies) may improve population diets. This review of systematic reviews aims to summarise recent evidence of the effectiveness of FE policies in improving diets. We searched PubMed for systematic reviews published from January 2010 onwards. Eligible FE policies included: nutrition and food labelling, provision of foods in public institutions or specific settings, price, marketing, nutrition quality and portion size, and availability of foods in retail and food service establishments. A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) instrument was used to assess review quality. Reviews of critically low quality were excluded. Results were narratively reported in text and tables. The search identified 1102 records after removing duplicates. Following screening and quality assessment we included 12 systematic reviews. Two reviews focused on nutrition and food labelling, two on provision of foods in school settings, four on price, none on marketing policies, three on nutrition quality and portion size and one on the availability of foods in retail and food service establishments. Pricing policies (tax/subsidy) appear effective in altering intake and purchase of targeted foods and beverages. FE policies targeting the availability of foods in retail and food establishments, food provision in school settings, product reformulation and the size of portions/packages or items of tableware also appear effective. Overall, policies targeting food environments appear effective in improving population diets. However, there is a need for further high-quality evidence.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Gakidou E, Afshin A, Abajobir AA, Abate KH, Abbafati C, Abbas KM, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1345–422.
Afshin A, Sur PJ, Fay KA, Cornaby L, Ferrara G, Salama JS, et al. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393:1958–72.
Hyseni L, Atkinson M, Bromley H, Orton L, Lloyd-Williams F, McGill R, et al. The effects of policy actions to improve population dietary patterns and prevent diet-related non-communicable diseases: Scoping review. Eur J Clin Nutr. 2017;71:694–711.
Rose G, Khaw KT, Marmot M. Rose’s strategy of preventive medicine. Oxford: Oxford University Press; 2009. https://doi.org/10.1093/acprof:oso/9780192630971.001.0001.
Mozaffarian D, Afshin A, Benowitz NL, Bittner V, Daniels SR, Franch HA, et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American heart association. Circulation. 2012;126:1514–63.
Hyseni L, Elliot-Green A, Lloyd-Williams F, Kypridemos C, O’Flaherty M, McGill R, et al. Systematic review of dietary salt reduction policies: evidence for an effectiveness hierarchy? PLoS ONE. 2017;12:e0177535.
Mozaffarian D, Angell SY, Lang T, Rivera JA. Role of government policy in nutrition—barriers to and opportunities for healthier eating. BMJ. 2018;361. https://doi.org/10.1136/bmj.k2426.
Mozaffarian D, Rosenberg I, Uauy R. History of modern nutrition science-implications for current research, dietary guidelines, and food policy. BMJ. 2018;361. https://doi.org/10.1136/bmj.k2392.
Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, et al. The global obesity pandemic: Shaped by global drivers and local environments. Lancet. 2011;378:804–14.
James P, Seward MW, James O’Malley A, Subramanian SV, Block JP. Changes in the food environment over time: examining 40 years of data in the Framingham Heart Study. Int J Behav Nutr Phys Act. 2017;14:84.
Gorski MT, Roberto CA. Public health policies to encourage healthy eating habits: Recent perspectives. J Healthc Leadersh. 2015;7:81–90.
World Health Organization. European Food and Nutrition Action Plan 2015–2020. Copenhagen, Denmark; 2015.
Swinburn B, Vandevijvere S, Kraak V, Sacks G, Snowdon W, Hawkes C, et al. Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed government healthy food environment policy index. Obes Rev. 2013;14:24–37.
Djojosoeparto SK, Kamphuis CBM, Vandevijvere S, Harrington JM and Poelman MP on behalf of the JPI-HDHL Policy Evaluation Network. The Healthy Food Environment Policy Index (Food-EPI): European Union. An assessment of EU-level policies influencing food environments and priority actions to create healthy food environments in the EU. Utrecht, Utrecht University, The Netherlands; 2021.
Afshin A, Penalvo J, Del Gobbo L, Kashaf M, Micha R, Morrish K, et al. CVD prevention through policy: a review of mass media, food/menu labeling, taxation/subsidies, built environment, school procurement, worksite wellness, and marketing standards to improve diet. Curr Cardiol Rep. 2015;17. https://doi.org/10.1007/s11886-015-0658-9.
Wolrd Health Organization. Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Geneva: World Health Organization, Geneva PP; 2017.
Hawkes C, Jewell J, Allen K. A food policy package for healthy diets and the prevention of obesity and diet-related non-communicable diseases: the NOURISHING framework. Obes Rev. 2013;14:159–68.
Hyseni L, Bromley H, Kypridemos C, O’Flaherty M, Lloyd-Williams F, Guzman-Castillo M, et al. Systematic review of dietary trans-fat reduction interventions. Bull World Heal Organ. 2017;95:821–30g.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372. https://doi.org/10.1136/bmj.n71.
Chandler J, Cumpston M, Thomas J, Higgins JPT, Deeks JJCM. Chapter I: Introduction. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handb. Syst. Rev. Interv. version 6.2 (updated Febr. 2021). 2021.
World Bank Country and Lending Groups—World Bank Data Help Desk. 2021. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Accessed 12 Dec 2020.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5:210.
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358. https://doi.org/10.1136/bmj.j4008.
Hollands GJ, Shemilt I, Marteau TM, Jebb SA, Lewis HB, Wei Y, et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database Syst Rev. 2015;9:CD011045.
Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev. 2019. https://doi.org/10.1002/14651858.CD012573.pub3.
Crockett RA, King SE, Marteau TM, Prevost AT, Bignardi G, Roberts NW, et al. Nutritional labelling for healthier food or non-alcoholic drink purchasing and consumption. Cochrane Database Syst Rev. 2018;2:Cd009315.
Swartz JJ, Braxton D, Viera AJ. Calorie menu labeling on quick-service restaurant menus: an updated systematic review of the literature. Int J Behav Nutr Phys Act. 2011;8:135.
Hendry VL, Almíron-Roig E, Monsivais P, Jebb SA, Neelon SE, Griffin SJ, et al. Impact of regulatory interventions to reduce intake of artificial trans-fatty acids: a systematic review. Am J Public Heal. 2015;105:e32–42.
Afshin A, Peñalvo JL, Del Gobbo L, Silva J, Michaelson M, O’Flaherty M, et al. The prospective impact of food pricing on improving dietary consumption: a systematic review and meta-analysis. PLoS ONE. 2017;12:e0172277.
Redondo M, Hernández-Aguado I, Lumbreras B. The impact of the tax on sweetened beverages: a systematic review. Am J Clin Nutr. 2018;108:548–63.
Delgado-Noguera M, Tort S, Martínez-Zapata MJ, Bonfill X. Primary school interventions to promote fruit and vegetable consumption: a systematic review and meta-analysis. Prev Med. 2011;53:3–9.
Hashem KM, He FJ, MacGregor GA. Effects of product reformulation on sugar intake and health-a systematic review and meta-analysis. Nutr Rev. 2019;77:181–96.
An R. Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments. Public Heal Nutr. 2012;16:1215–28.
Backholer K, Sarink D, Beauchamp A, Keating C, Loh V, Ball K, et al. The impact of a tax on sugar-sweetened beverages according to socio-economic position: a systematic review of the evidence. Public Heal Nutr. 2016;19:3070–84.
Micha R, Karageorgou D, Bakogianni I, Trichia E, Whitsel LP, Story M, et al. Effectiveness of school food environment policies on children’s dietary behaviors: a systematic review and meta-analysis. PLoS ONE. 2018;13:e0194555.
Chaloupka FJ, Powell LM, Warner KE. The use of excise taxes to reduce tobacco, alcohol, sugar beverage consumption. Annu Rev Public Heal. 2019;40:187–201.
Gittelsohn J, Trude ACB, Kim H. Pricing strategies to encourage availability, purchase, and consumption of healthy foods and beverages: a systematic review. Prev Chronic Dis. 2017;14:E107.
Powell LM, Chriqui JF, Khan T, Wada R, Chaloupka FJ. Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes. Obes Rev. 2013;14:110–28.
Kirkpatrick SI, Raffoul A, Maynard M, Lee KM, Stapleton J. Gaps in the evidence on population interventions to reduce consumption of sugars: a review of reviews. Nutrients 2018;10. https://doi.org/10.3390/nu10081036.
Cornelsen L, Green R, Turner R, Dangour AD, Shankar B, Mazzocchi M, et al. What happens to patterns of food consumption when food prices change? Evidence from a systematic review and meta-analysis of food price elasticities globally. Heal Econ. 2015;24:1548–59.
Andreyeva T, Long MW, Brownell KD. The impact of food prices on consumption: A systematic review of research on the price elasticity of demand for food. Am J Public Health. 2010;100:216–22.
Escobar MA, Veerman JL, Tollman SM, Bertram MY, Hofman KJ. Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis. BMC Public Health. 2013;13:1072.
Epstein LH, Jankowiak N, Nederkoorn C, Raynor HA, French SA, Finkelstein E. Experimental research on the relation between food price changes and food-purchasing patterns: a targeted review. Am J Clin Nutr. 2012;95:789–809.
Boyland EJ, Nolan S, Kelly B, Tudur-Smith C, Jones A, Halford JC, et al. Advertising as a cue to consume: a systematic review and meta-analysis of the effects of acute exposure to unhealthy food and nonalcoholic beverage advertising on intake in children and adults. Am J Clin Nutr. 2016;103:519–33.
Cairns G, Angus K, Hastings G. The extent, nature and effects of food promotion to children: a review of the evidence to December 2008. World Health. 2009;173.
Sadeghirad B, Duhaney T, Motaghipisheh S, Campbell NRC, Johnston BC. Influence of unhealthy food and beverage marketing on children’s dietary intake and preference: a systematic review and meta-analysis of randomized trials. Obes Rev. 2016;17:945–59. https://doi.org/10.1111/obr.12445.
Smith R, Kelly B, Yeatman H, Boyland E Food marketing influences children’s attitudes, preferences and consumption: a systematic critical review. Nutrients. 2019;11. https://doi.org/10.3390/nu11040875.
Appel LJ, Frohlich ED, Hall JE, Pearson TA, Sacco RL, Seals DR, et al. The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association. Circulation. 2011;123:1138–43.
Croker H, Packer J, Russell S, Stansfield C, Viner RM. Front of pack nutritional labelling schemes: a systematic review and meta-analysis of recent evidence relating to objectively measured consumption and purchasing. J Hum Nutr Diet. 2020;33:518–37.
Center for Disease Control and Prevention. Adult Obesity Facts | Overweight & Obesity | CDC. 2021. https://www.cdc.gov/obesity/data/adult.html. Accessed 20 Jan 2021.
Front of pack nutritional labelling schemes: a systematic review and meta-analysis of recent evidence relating to objectively measured consumption and purchasing. 33:518–37.
Acknowledgements
The authors would like to thank Nanna Louise Riis, Kirsten Bjørnsbo, Kamille Almer Bernsdorf Torp, Signe Damsbo Birch and Tine Buch-Andersen for providing helpful comments on a previous version of this paper.
Author information
Authors and Affiliations
Contributions
KLH was responsible for designing the review, writing the review article, conducting the search, pre-liminary and full-text screening, quality assessment, data extraction and narrative synthesis, interpretation of results, creating tables and figures, and updating references list. SG was responsible for writing the review article, for full-text screening, quality assessment, data extraction and narrative synthesis, and interpretation of results. CUE was responsible for designing the review, conducting the search, full-text screening, quality assessment, data extraction and provided feedback on the paper. UT and TJ were responsible for designing the review and provided feedback on the paper. All authors read and approved the final paper.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hansen, K.L., Golubovic, S., Eriksen, C.U. et al. Effectiveness of food environment policies in improving population diets: a review of systematic reviews. Eur J Clin Nutr 76, 637–646 (2022). https://doi.org/10.1038/s41430-021-01008-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41430-021-01008-y
This article is cited by
-
How an agreement with restriction of unhealthy food marketing and sodium taxation influenced high fat, salt or sugar (HFSS) food consumption
BMC Public Health (2024)
-
An examination of public support for 35 nutrition interventions across seven countries
European Journal of Clinical Nutrition (2023)