This systematic review investigates the characteristics, effectiveness and acceptability of interventions to encourage healthier eating in small, independent restaurants and takeaways.

We searched five databases (CENTRAL, MEDLINE, Embase, CINAHL and Science Citation Index and Social Science Citation Index) in June 2022. Eligible studies had to measure changes in sales, availability, nutritional quality, portion sizes or dietary intake of interventions targeting customer behaviour or restaurant environments. We evaluated study quality using the Mixed Methods Appraisal Tool. Results are synthesised narratively, and interventions’ impact on personal autonomy is assessed using the Nuffield intervention ladder.

Small, independent or local restaurants or hot food takeaway outlets, with no restrictions by year or country.

Anyone selling or purchasing food in intervention settings (e.g. restaurant staff/owners, customers).

We screened 4624 records and included 12 studies describing 13 interventions in 351 businesses. Most studies were of poor quality. Customer-level intervention components mostly operated on the lower rungs of the Nuffield ladder, and most had limited positive effects on increasing demand, measured as sales or orders of healthy options. Whilst rare, most interventions measuring business outcomes operated on higher ladder rungs and showed small positive results. There was insufficient evidence to investigate differences in impact by intervention intrusiveness. Acceptability was greater for interventions that were low-effort, inexpensive and perceived as not negatively impacting on customer satisfaction.

Despite some evidence of small positive effects of healthy eating interventions on healthier purchases or restaurant/hot food takeaway practices, a weak evidence base hinders robust inference.

The creation of a healthy food environment is highly dependent on the policies that governments choose to implement. The objective of this study is to compare the level of implementation of current public policies aimed at creating healthy food environments in Burkina Faso with international good practice indicators.

This evaluation was carried out using the Food-EPI tool. The tool has two components (policy and infrastructure support), thirteen domains and fifty-six good practice indicators adapted to the Burkina Faso context.

Burkina Faso.

Expert evaluators divided into two groups: the group of independent experts from universities, NGO and civil society and the group of experts from various government sectors.

Among the fifty-six indicators, it was assessed the level of implementation as ‘high’ for six indicators, ‘medium’ for twenty-four indicators, ‘low’ for twenty-two indicators and ‘very low’ for four indicators. High implementation level indicators include strong and visible political support, targets on exclusive breastfeeding and complementary feeding, strong and visible political support for actions to combat all forms of malnutrition, monitoring of exclusive breastfeeding and complementary feeding indicators, monitoring of promotion and growth surveillance programmes and coordination mechanism (national, state and local government). The indicators on menu labelling, reducing taxes on healthy foods, increasing taxes on unhealthy foods and dietary guidelines are the indicators with a ‘very low’ level of implementation in Burkina Faso.

The general results showed that there is a clear need for further improvements in policy and infrastructure support to promote healthy food environments.

To quantify and compare concurrent within-person trends in lifestyle risks, nutrition status and drivers of food choice among urban migrants in Central Asia.

We collected panel data on household structure, drivers of food choice, nutrition knowledge and diverse measures of nutrition status and lifestyle risk from urban migrants at 0, 3, 6 and 9 months using harmonised methodology in two cities. Trends were analysed using mixed-effects models and qualitatively compared within and between cities.

Ulaanbaatar, Mongolia, and Almaty, Kazakhstan.

200 adults (22–55 years) who migrated to these cities within the past 2 years.

Adjusting for age and sex, each month since migration was positively associated with fasting TAG in Almaty (0·55 mg/dl; 95 % CI: 0·13, 0·94) and BMI (0·04 kg/m2; 95 % CI: 0·01, 0·07), body fat (0·14 %; 95 % CI: 0·01, 0·26) and fasting glucose (0·04 mmol/l; 95 % CI: 0·02, 0·05) and lipids in Ulaanbaatar (P < 0·05). In Almaty, nutrition knowledge (measured using an objective 20-point scale) declined despite improvements in diet quality (measured by Prime Diet Quality Score). The influence of food availability, price and taste on food choice increased in Almaty (P < 0·05). Upon multivariable adjustment, nutrition knowledge was positively associated with diet quality in Almaty and adherence to ‘acculturated’ diet patterns in both cities (P < 0·05). Different trends in smoking, sleep quality and generalised anxiety were observed between cities.

Findings indicate heterogeneous shifts in nutrition, lifestyles and drivers of food choice among urban migrants in Central Asia and provide an evidence base for focused research and advocacy to promote healthy diets and enable nutrition-sensitive food environments.

Over recent decades, the commercial ultra-processed food industry has grown, making snacks high in energy, added sugar, saturated fat and sodium affordable and accessible to consumers. Dietary patterns high in ultra-processed snacks are concerning as this can result in negative health outcomes. This study aims to provide insight into available snack products in South African supermarkets, and the marketing thereof, which can be used to support policy development aimed at improving the healthfulness of the food supply and consumption patterns.

This was an observational cross-sectional, mixed-method study.

Secondary data from six major supermarket chains (eight stores) in three different suburbs in Cape Town, South Africa was analysed to evaluate the nutritional composition of snack products (n 3837). The same eight supermarkets were revisited to obtain information on marketing via an observational checklist. Qualitative interviews were also conducted with store managers.

Majority (89 %) of the products assessed either contained non-sugar sweeteners or were high in sugar, saturated fat or sodium. These snack items that are high in nutrients of concern to limit were available at checkout areas in all stores and were found in high-traffic areas, and several in-store promotional strategies such as branded displays, special offers and combo-deals were commonly found.

The current South African supermarket environment encourages consumers to purchase unhealthy snacks. Most snacks assessed in this study cannot be recommended for regular consumption due to the nutritional composition being high in nutrients linked to poor health outcomes. There is a need for regulation of the in-store marketing of unhealthy snacks in South Africa. Retail settings are potential intervention points for limiting exposure to these unhealthy products.

In this paper, we examined whether there are inequalities in access to food retail (by type and healthiness) across local government areas (LGA) in Greater Melbourne and by LGA grouped based on their distance from the central business district and Growth Area designation. We also examined whether these inequalities persisted over time.

This is a secondary analysis of a repeated cross-sectional census of food outlets collected at four time points (2008, 2012, 2014 and 2016) across 31 LGA. Using Geographical Information Systems, we present a spatial analysis of food retail environments in Melbourne, Australia, at these four times over eight years.

Greater Melbourne, Australia.

31 LGA in Greater Melbourne.

Findings show significant inequalities in access to healthy food retail persisting over time at the LGA level. Residents in lower density urban growth areas had the least access to healthy food retail. Unhealthy food retail was comparatively more accessible, with a temporal trend indicating increased accessibility over time in urban growth areas only.

Accessibility to food outlets, particularly healthy food outlets and supermarkets, in Greater Melbourne is not equal. To identify and address health inequalities associated with rapid urban growth, further understanding of how people interact with the food environment needs to be explored.

This review aimed to (i) synthesise evidence of the impact of publicly procured school meals programmes on nutritional outcomes of children/adolescents (5–18 years) in sub-Saharan Africa and (ii) identify challenges and facilitators to implementing effective school meals programmes.

Mixed-methods systematic review (n 7 databases). Nutritional outcomes assessed were anthropometrics (underweight, stunting, wasting, overweight/obesity), micronutrient deficiencies, food consumed and food environment. Qualitative findings were coded using a nine-step school food system framework: production of food, wholesale and trading, transportation and storage, processing and distribution, food preparation, distribution to students, student stakeholders, community involvement and infrastructure support.

Sub-Saharan Africa.

Children/adolescents (5–18 years), parents, school personnel and government officials.

Thirty-three studies (twenty-six qualitative, seven quantitative) from nine sub-Saharan African countries were included. Six studies found a positive impact of publicly procured school meals programmes on nutritional outcomes (wasting (n 1), stunting (n 3), underweight (n 1), vitamin A intake (n 1) and dietary diversity (n 1)). Fifty-three implementation challenges were identified, particularly during food preparation (e.g. training, payment), distribution to students (e.g. meal quantity/quality/diversity, utensils) and infrastructure support (e.g. funding, monitoring, coordination). Implementation facilitators were identified (n 37) across processing and distribution (e.g. programme coordination), student stakeholders (e.g. food preferences, reduced stigma) and community involvement (e.g. engagement, positive perceptions). Included policy recommendations targeted wholesale and trading, food preparation, student stakeholders and infrastructure support in nine, fifteen and twenty-five studies, respectively.

As many challenges remain, strengthening implementation (and therefore the nutritional impact) of school meals programmes in sub-Saharan Africa requires bold commitment and improved coordination at multiple levels of governance.

Evaluate the 5-year changes in the consumers’ food environment in the area of a health promotion service in Brazilian primary health care. Our hypothesis is that the consumers’ food environment in the areas with primary healthcare services has changes that may favour healthy eating habits over time.

Longitudinal study.

The territory around the primary healthcare services in Belo Horizonte, Minas Gerais, Brazil.

All food stores and open-air food markets that sell fruits and vegetables around the primary healthcare services in 2013 (n 272) and in 2018 (n 265).

Fruit diversity increased by 13·4 % (P < 0·001) and vegetables variety and quality by 16·1 % (P = 0·003) and 12·5 % (P < 0·001), respectively. Corn snacks showed an increase in availability (13·5 %; P = 0·002). The increase in advertising was observed for fruits and vegetables (34·6 %; P < 0·001) and ultra-processed foods (47·6 %; P < 0·001). Supermarkets showed an increase in the Healthy Food Store Index (three points; P < 0·001), while fruits and vegetables stores showed a decrease of one point in the index (P < 0·001).

The unequal changes in the consumers’ food environment according to the food stores types demonstrate the importance of food supply policies that promote a healthy environment and favour the maintenance of traditional healthy food retailers.

Healthy food retail programmes (HFRP) in the USA generally aim to increase healthy foods access to improve diet quality and health, yet the impact is mixed. These programmes primarily target adults, even though adolescents frequently and independently visit stores to purchase snacks. This study’s aims are to explore successes and challenges of implementing HFRP (Aim 1) and examine how HFRP can be tailored to adolescents (Aim 2).

One-time, virtual, semi-structured interviews with individuals who were involved in a HFRP, followed by a socio-demographic characteristics survey. Interviews were designed based on the RE-AIM framework and the Hexagon Tool and analysed using Braun and Clark’s (2006) thematic analysis approach. Descriptive statistics were used to summarise participants’ socio-demographic characteristics.

New York City (NYC).

Adults (18 years or older) who have designed, implemented and/or evaluated an HFRP in NYC and speak/understand English (n 21).

Aim 1: For successes, strategies to build relationships with the community were most discussed. Regarding challenges, securing reliable funding was the hardest to overcome. Suggested solutions included designing profitable HFRP, targeting shortcomings in food distribution systems and increasing consumer demand. Aim 2: Most participants had not considered adolescents in previous HFRP but suggested involving youth in developing HFRP to encourage youth-driven solutions and promote youth advocacy.

Future HFRP should focus on activities that help store owners purchase affordable healthy foods from distributors, which translates to affordability for customers. Federal and local policies can assist by funding complementary programmes. Additionally, adolescents should be considered in these efforts.

We aimed to understand what influences parents’ purchasing behaviours when shopping for groceries online and potential ways to improve the healthiness of online grocery platforms.

We conducted semi-structured interviews, guided by the Marketing Mix framework. Reflexive thematic analysis was used to analyse data.

Online interviews were conducted with primary grocery shoppers.

Parents (n 14) or caregivers (n 2) using online grocery platforms at least every 2 weeks.

Most participants perceived purchasing healthy food when shopping for groceries online to be more challenging compared to in physical stores. They expressed concerns about the prominence of online marketing for unhealthy food. Participants from lower socio-economic backgrounds often depended on online supermarket catalogues to find price promotions, but healthy options at discounted prices were limited. Across socio-economic groups, fresh items like meat and fruit were preferred to be purchased instore due to concerns about online food quality.

Participants believed online grocery platforms should make healthy foods more affordable and supported regulations on supermarket retailers to promote healthy options and limit unhealthy food promotion online.

Participants had varied experiences with online grocery shopping, with both positive and negative aspects. Efforts to improve population diets need to include mechanisms to create health-enabling online grocery retail platforms. Government interventions to restrict marketing of unhealthy foods and promote marketing of healthy options on these platforms warrant investigation.

To characterise the food environment of Dutch small and medium-sized enterprises (SMEs), encompassing physical, sociocultural, economic and policy features and to explore variations within SMEs according to company characteristics (number of employees, location of work and presence of worksite cafeteria).

Online cross-sectional survey study of a representative Dutch SME sample by a panel agency.

Dutch SMEs.

Three hundred and fifteen employees of Dutch SMEs responsible for food and drink in their company.

Most SMEs did not have a worksite cafeteria, no provision of fruits or vegetables, and did not offer discounts on food or drinks. The food environment of these SMEs varied significantly based on company characteristics. For example, SMEs with a worksite cafeteria were significantly more likely to have fruits (OR = 8·76, 95 % CI (4·50, 17·06)), vegetables (OR = 10·29, 95 % CI (5·49, 19·31)) and company food policies (OR = 5·04, 95 % CI (2·08, 12·20)) than SMEs without. Additionally, SMEs with ≥ 50 employees were more likely to have fruits (OR = 2·39, 95 % CI (1·42, 4·03)), vegetables (OR = 1·89, 95 % CI (1·04, 3·46)) and company food policies (OR = 2·82, 95 % CI (1·09, 7·29) than SMEs with < 50 employees. Moreover, having a worksite cafeteria (B = 0·23, 95 % CI (0·08, 0·38)) and employees working mostly on-site (B = 0·14, 95 % CI (0·01, 0·28)) were associated with stronger social norms of healthy and sustainable eating at work compared to SMEs without a worksite cafeteria and working mostly off-site.

In SMEs, an overall comprehensive picture of the food environment points to its limited active encouragement of healthy food choices, particularly so in small SMEs without a worksite cafeteria. Company characteristics strongly influence SME food environments and should be considered when developing interventions improving SME workplace food environments.

To assess the selection of foods and beverages in children’s sports arenas in Norway.

A cross-sectional study design with a digital questionnaire was used. Descriptive statistics were used to present the results. Moreover, Pearson’s χ2 tests examined the factors that could aid in distinguishing clubs with healthy or unhealthy consumables.

Children’s sports clubs in Norway.

Representatives from 301 children’s sports clubs in Norway answered the questionnaire between September and November 2021.

In total, 89·4% of the participating sports clubs (n 301) offered soda drinks with sugar. Most of the sports clubs (88 %) reported to offer batter-based cakes such as pancakes and waffles and 63·8 % offered cakes. Furthermore, 47·5% sold hot dishes with processed meat, such as hamburgers and hot dogs. More than 80% of the sports clubs offered sweets and snacks, while 44·5% did not offer fruits, vegetables and/or berries. Notably, the important factors that distinguished sports clubs with healthier food selections from those with unhealthier selections were the presence of guidelines for the food offered and purchase agreements with food suppliers.

Educational, governmental guidelines for the promotion of healthy eating and establishing agreements with suppliers of healthier foods could help to overcome barriers to unhealthy food selection.

It is unknown how well menu labelling schemes that enforce the display of kilojoule (kJ) labelling at point-of-sale have been implemented on online food delivery (OFD) services in Australia. This study aimed to examine the prevalence of kJ labelling on the online menus of large food outlets with more than twenty locations in the state or fifty locations nationally. A secondary aim was to evaluate the nutritional quality of menu items on OFD from mid-sized outlets that have fewer locations than what is specified in the current scheme.

Cross-sectional analysis. Prevalence of kJ labelling by large food outlets on OFD from August to September 2022 was examined. Proportion of discretionary (‘junk food’) items on menus from mid-sized outlets was assessed.

Forty-three unique large food outlets on company (e.g. MyMacca’s) and third party OFD (Uber Eats, Menulog, Deliveroo) within Sydney, Australia. Ninety-two mid-sized food outlets were analysed.

N/A.

On company OFD apps, 35 % (7/23) had complete kJ labelling for each menu item. In comparison, only 4·8 % (2/42), 5·3 % (2/38) and 3·6 % (1/28) of large outlets on Uber Eats, Menulog and Deliveroo had complete kJ labelling at all locations, respectively. Over three-quarters, 76·3 % (345/452) of menu items from mid-sized outlets were classified as discretionary.

Kilojoule labelling was absent or incomplete on a high proportion of online menus. Mid-sized outlets have abundant discretionary choices and yet escape criteria for mandatory menu labelling laws. Our findings show the need to further monitor the implementation of nutrition policies on OFD.

Different forms of public and private regulation have been used to improve the healthiness of food retail environments. The aim of this scoping review was to systematically examine the types of private regulatory measures used to create healthy food retail environments, the reporting of the processes of implementation, monitoring, review and enforcement and the barriers to and enablers of these.

Scoping review using the Johanna Briggs Institute guidelines. Ovid MEDLINE, PsycINFO, Embase, CINAHL Plus, Business Source Complete and Scopus databases were searched in October 2020 and again in September 2023 using terms for ‘food retail’, ‘regulation’ and ‘nutrition’. Regulatory measure type was described by domain and mechanism. Deductive thematic analysis was used to identify reported barriers and enablers to effective regulatory governance processes using a public health law framework.

Food retail.

Food retail settings using private regulatory measures to create healthier food retail environments.

In total, 17 694 articles were screened and thirty-five included for review from six countries, with all articles published since 2011. Articles reporting on twenty-six unique private regulatory measures cited a mix of voluntary (n 16), mandatory (n 6) measures, both (n 2) or did not disclose (n 2). Articles frequently reported on implementation (34/35), with less reporting on the other regulatory governance processes of monitoring (15/35), review (6/35) and enforcement (2/35).

We recommend more attention be paid to reporting on the monitoring, review and enforcement processes used in private regulation to promote further progress in improving the healthiness of food retail environments.