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To investigate the effects of a sugar-sweetened beverage (SSB) tax and a nutrient profiling tax on consumer food purchases in a virtual supermarket.
A randomised controlled trial was conducted with a control condition with regular food prices (n 152), an SSB tax condition (n 130) and a nutrient profiling tax condition based on Nutri-Score (n 112). Participants completed a weekly grocery shop for their household. Primary outcome measures were SSB purchases (ordinal variable) and the overall healthiness of the total shopping basket (proportion of total unit food items classified as healthy). The secondary outcome measure was the energy (kcal) content of the total shopping basket. Data were analysed using regression analyses.
Three-dimensional virtual supermarket.
Dutch adults aged ≥18 years are being responsible for grocery shopping in their household (n 394).
The SSB tax (OR = 1·62, (95 % CI 1·03, 2·54)) and the nutrient profiling tax (OR = 1·88, (95 %CI 1·17, 3·02)) increased the likelihood of being in a lower-level category of SSB purchases. The overall healthiness of the total shopping basket was higher (+2·7 percent point, (95 % CI 0·1, 5·3)), and the energy content was lower (−3301 kcal, (95 % CI −6425, −177)) for participants in the nutrient profiling tax condition than for those in the control condition. The SSB tax did not affect the overall healthiness and energy content of the total shopping basket (P > 0·05).
A nutrient profiling tax targeting a wide range of foods and beverages with a low nutritional quality seems to have larger beneficial effects on consumer food purchases than taxation of SSB alone.
The purpose of this article is to describe a series of recent studies from the authors and many of their colleagues aimed at improving the food environments of adolescents in the Netherlands and thereby improving their food choices. These studies are performed in the wider context of national and local strategies for the prevention of overweight and obesity in the Netherlands. Interventions were developed with local stakeholders and carried out in schools, supermarkets and low-income neighbourhoods. We conclude that current national policies in the Netherlands are largely ineffective in reducing the prevalence of overweight and obesity. Local integrated programmes in the Netherlands, however, seem to result in a reduction of overweight, especially in low-income neighbourhoods. It is impossible to say which elements of such an integrated approach are effective elements on their own. We found very little evidence for the effectiveness of separate interventions aimed at small changes in the food environment. This suggests that such interventions are only effective in combination with each other and in a wider systems approach. Future studies are needed to further develop the practical methodology of implementation and evaluation of systems science in combination with participatory action research.
The aim of the current study was to establish whether the neighbourhood food environment, characterised by the healthiness of food outlets, the diversity of food outlets and fast-food outlet density within a 500 m or 1000 m street network buffer around the home address, contributed to ethnic differences in diet quality.
Cross-sectional cohort study.
Amsterdam, the Netherlands.
Data on adult participants of Dutch, South-Asian Surinamese, African Surinamese, Turkish and Moroccan descent (n total 4728) in the HELIUS study were analysed.
The neighbourhood food environment of ethnic minority groups living in Amsterdam is less supportive of a healthy diet and of less diversity than that of participants of Dutch origin. For example, participants of Turkish, Moroccan and South-Asian Surinamese descent reside in a neighbourhood with a significantly higher fast-food outlet density (≤1000 m) than participants of Dutch descent. However, we found no evidence that neighbourhood food environment characteristics directly contributed to ethnic differences in diet quality.
Although ethnic minority groups lived in less healthy food environments than participants of ethnic Dutch origin, this did not contribute to ethnic differences in diet quality. Future research should investigate other direct or indirect consequences of residing in less supportive food environments and gain a better understanding of how different ethnic groups make use of their neighbourhood food environment.
To investigate to what extent promotions in Dutch supermarket sales flyers contribute to a healthy diet and whether there are differences between supermarket types.
A cross-sectional study investigating promotions on foods and beverages (n 7825) in supermarket sales flyers from thirteen Dutch supermarket chains (8-week period), including ten traditional, two discount and one organic supermarket chain(s). Promoted products were categorised by food group (e.g. bread), contribution to a healthy diet (yes/no), degree of processing (e.g. ultra-processed), promotion type (temporary reduction in price, volume-based promotions or advertised only) and percentage discount of price promotions. Differences between supermarket chains in the degree of healthiness and processing of products and the types of price promotions were investigated.
In total, 70·7 % of all promoted products in supermarket sales flyers did not contribute to a healthy diet and 56·6 % was ultra-processed. The average discount on less healthy products (28·7 %) was similar to that of healthy products (28·9 %). Less healthy products were more frequently promoted via volume-based promotions than healthy products (37·6 % v. 25·4 %, P < 0·001). Discount supermarket chains promoted less healthy (80·3 %) and ultra-processed (65·1 %) products more often than traditional supermarket chains (69·6 % and 56·6 %, respectively).
The majority of promoted products via supermarket sales flyers do not contribute to a healthy diet. As promotions are an important determinant of food purchasing decisions, supermarkets do not support healthy choices. Future studies should identify barriers that withhold supermarket chains from promoting more healthy foods in supermarket sales flyers.
To explore differences in proportion of food budget and total food expenditure by dwelling type.
A cross-sectional study using data from the Australian Bureau of Statistics 2015–2016 Household Expenditure Survey. Food expenditure was examined on multiple categories: fresh fruits, fresh vegetables, pre-prepared meals, meals in restaurants, hotels and clubs, and fast food and takeaway meals, using two-part models and zero-one inflated beta regression models. Dwelling types were categorised as separate house, semi-detached house, low-rise apartment and high-rise apartment.
Seven thousand three hundred and fifty-eight households from greater capital city areas.
Households living in high-rise apartments were estimated to allocate a greater proportion of their food budget to meals in restaurants, hotels and clubs, and to spend more (actual dollars) on that category, compared with other dwelling types. No substantial differences were estimated in the proportion of food budget allocated to the other food categories across dwelling types.
The dwelling type households live in may play a role in their food budget. Households living in a high-rise apartment may potentially spend more on meals in restaurants, hotels and clubs than those living in other dwelling types. Given the growth in urban population and the changes in living arrangements, findings point to the critical need for a better understanding of the influence of dwelling types on food expenditure and call for research investigating the relationship between the two.
For all IPS drinks, the mean package size was larger than the mean serving size (mean (sd)=412 (157) ml and 359 (159) ml, respectively). The mean (sd) package size of IPS drinks was significantly different for all countries (range: Australia=370 (149) ml to New Zealand=484 (191) ml; P<0·01). The mean (sd) package size of Dutch BPS drinks (1313 (323) ml) was significantly smaller compared with the other countries (New Zealand=1481 (595) ml, Australia=1542 (595) ml, Canada=1550 (434) ml; P<0·01). The mean (sd) serving size of BPS drinks was significantly different across all countries (range: Netherlands=216 (30) ml to Canada=248 (31) ml; P<0·00). New Zealand had the largest package and serving sizes of the countries assessed. In all countries, a large number of different serving sizes were used to provide information on the amount appropriate to consume in one sitting.
At this point there is substantial inconsistency in package sizes and manufacturer-recommended serving sizes of sweet beverages within and between four high-income countries, especially for IPS drinks. As consumers do factor serving size into their judgements of healthiness of a product, serving size regulations, preferably set by governments and global health organisations, would provide consistency and assist individuals in making healthier food choices.
The aim of the present study was to gain insight into (i) processed snack-food availability, (ii) processed snack-food salience and (iii) the size of dinnerware among households with overweight gatekeepers. Moreover, associations between gatekeepers’ characteristics and in-home observations were determined.
A cross-sectional observation of home food environments was conducted as part of a baseline measurement of a larger study.
Home food environments of overweight and obese gatekeepers in the Netherlands.
Household gatekeepers (n 278). Mean household size of the gatekeepers was 3·0 (sd 1·3) persons. Mean age of the gatekeepers was 45·7 (sd 9·2) years, 34·9 % were overweight and 65·1 % were obese. Of the gatekeepers, 20·9 % had a low level of education and 42·7 % had a high level of education.
In 70 % of the households, eight or more packages of processed snack foods were present. In 54 % of the households, processed snack foods were stored close to non-processed food items and in 78 % of households close to non-food items. In 33 % of the households, processed snack foods were visible in the kitchen and in 15 % of the households processed snack foods were visible in the living room. Of the dinnerware items, 14 % (plates), 57 % (glasses), 78 % (dessert bowls), 67 % (soup bowls) and 58 % (mugs) were larger than the reference norms of the Netherlands Nutrition Centre Foundation. Older gatekeepers used significantly smaller dinnerware than younger gatekeepers.
Environmental factors endorsing overconsumption are commonly present in the home environments of overweight people and could lead to unplanned eating or passive overconsumption.
Nutritional interventions to decrease energy intake, aimed at portion sizes and front-of-package labelling, are effective only if people do not compensate for their reduced energy intake. Since several observational studies indicate that these interventions could prompt compensation behaviour, it is important to assess underlying beliefs. Therefore, the purpose of the two studies reported here was to develop a Diet-related Compensatory Health Beliefs Scale (Diet-CHBS).
Cross-sectional surveys were conducted for the scale development. Study 1 provided data on the factor analysis and convergent validity, while Study 2 assessed the Diet-CHBS’ test–retest reliability.
VU University Amsterdam (Study 1) and twenty-five worksite cafeterias in the Netherlands (Study 2).
Study 1 was conducted among 179 students and their parents; Study 2 was conducted among 119 worksite cafeteria visitors.
The results of Study 1 showed that the scale consisted of the hypothesized factors of compensation beliefs with regard to portion sizes (α = 0·73), front-of-package health logos (α = 0·77) and exercise (α = 0·75). The scale's overall Cronbach's α was 0·82. The Diet-CHBS had a Pearson correlation of 0·32 with a general health compensatory beliefs scale, signifying satisfactory convergent validity. Study 2 showed that the intra-class correlation coefficient between T1 and T2 was 0·69, indicating adequate test–retest reliability.
The Diet-CHBS is a valid and reliable instrument for assessing diet-related compensatory health beliefs in response to nutritional interventions. It is important to take such beliefs into account in further intervention studies aimed at preventing overweight and obesity.
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