Research Article: Supermarket policies on less-healthy food at checkouts: Natural experimental evaluation using interrupted time series analyses of purchases

Date Published: December 18, 2018

Publisher: Public Library of Science

Author(s): Katrine T. Ejlerskov, Stephen J. Sharp, Martine Stead, Ashley J. Adamson, Martin White, Jean Adams, Barry M. Popkin

Abstract: BackgroundIn response to public concerns and campaigns, some United Kingdom supermarkets have implemented policies to reduce less-healthy food at checkouts. We explored the effects of these policies on purchases of less-healthy foods commonly displayed at checkouts.Methods and findingsWe used a natural experimental design and two data sources providing complementary and unique information. We analysed data on purchases of small packages of common, less-healthy, checkout foods (sugary confectionary, chocolate, and potato crisps) from 2013 to 2017 from nine UK supermarkets (Aldi, Asda, Co-op, Lidl, M&S, Morrisons, Sainsbury’s, Tesco, and Waitrose). Six supermarkets implemented a checkout food policy between 2013 and 2017 and were considered intervention stores; the remainder were comparators.Firstly, we studied the longitudinal association between implementation of checkout policies and purchases taken home. We used data from a large (n ≈ 30,000) household purchase panel of food brought home to conduct controlled interrupted time series analyses of purchases of less-healthy common checkout foods from 12 months before to 12 months after implementation. We conducted separate analyses for each intervention supermarket, using others as comparators. We synthesised results across supermarkets using random effects meta-analyses. Implementation of a checkout food policy was associated with an immediate reduction in four-weekly purchases of common checkout foods of 157,000 (72,700–242,800) packages per percentage market share—equivalent to a 17.3% reduction. This decrease was sustained at 1 year with 185,100 (121,700–248,500) fewer packages purchased per 4 weeks per percentage market share—equivalent to a 15.5% reduction. The immediate, but not sustained, effect was robust to sensitivity analysis.Secondly, we studied the cross-sectional association between checkout food policies and purchases eaten without being taken home. We used data from a smaller (n ≈ 7,500) individual purchase panel of food bought and eaten ‘on the go’. We conducted cross-sectional analyses comparing purchases of common checkout foods in 2016–2017 from supermarkets with and without checkout food policies. There were 76.4% (95% confidence interval 48.6%–89.1%) fewer annual purchases of less-healthy common checkout foods from supermarkets with versus without checkout food policies.The main limitations of the study are that we do not know where in the store purchases were selected and cannot determine the effect of changes in purchases on consumption. Other interventions may also have been responsible for the results seen.ConclusionsThere is a potential impact of checkout food polices on purchases. Voluntary supermarket-led activities may have public health benefits.

Partial Text: In most industrialised countries, large supermarket chains have captured the majority of the grocery market [1]. Although retailers are clearly responsive to consumer demand, they also play a major role in shaping food preferences and purchasing behaviour [1–3].

This is the first study we are aware of to evaluate the impact of voluntary supermarket-led checkout food policies on purchases. It contributes to the small but growing literature on industry-led activities to promote healthier diets [29–33]. We conducted a pragmatic natural experimental evaluation of the introduction of checkout food policies in six of nine large UK supermarket chains, using two different but complementary data sources. In a longitudinal analysis of purchases brought into the home, we found that implementation of a checkout food policy was associated with a significant immediate reduction in purchases of single-serve or small packages of sugary confectionery, chocolate, and crisps of 17.3%. One year post implementation, the weighted average percentage change was 15.5% lower than what would have been expected if a checkout food policy had not been implemented. The immediate, but not sustained, effect was robust in the sensitivity analysis. In the cross-sectional analysis of purchases consumed ‘on the go’ in 2016 and 2017, we found 75.3%–79.5% fewer purchases of common checkout foods from supermarkets with versus without checkout food policies, supporting a longer-term effect of supermarket checkout food policies, especially for purchases eaten without being brought home. The cross-sectional analysis showed no difference between supermarkets with clear and consistent versus vague or inconsistent checkout food policies. We were not able to robustly formally test any difference by policy category in the longitudinal analyses.



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