Evidence-informed policy actions to increase healthy eating

January 1, 2019

Learn how local, provincial and territorial governments can increase healthy eating by implementing evidence-informed policies

Inside this healthy eating policy pack

• Background evidence: healthy eating and cancer
• Evidence-informed policy actions to increase healthy eating
• Key statistics: healthy eating in Canada
• Public and policymakers’ perceptions of healthy eating in Canada
• Economic evidence to support healthy eating policy
• Indicators to measure progress on healthy eating policy

What are evidence-informed healthy eating policy actions for local, provincial, and territorial governments?

Evidence-informed policy interventions exist at the local, provincial and territorial levels to promote and support healthy eating as summarized in the section below. Along with current healthy eating policy actions, evidence-based opportunities for further policy action are noted, from key sources, including but not limited to: Food-EPI Canada ¹ and Alberta’s Nutrition Report Card on Food Environments for Children and Youth.²

To understand the extent to which evidence-informed healthy eating policy actions across Canada have been adopted at the local, provincial and territorial levels, policies were analyzed from within the Prevention Policies Directory.  A level of adoption in Canada (low, medium or high) was assigned to each evidence-informed policy action to help illustrate areas of strength and weakness across the country:

• LOW = no or very few jurisdictions have adopted evidence-informed policy action, and/or the breadth of the policy action is limited in scope
• MEDIUM = some, but not all jurisdictions have adopted evidence-informed policy action, and/or the breadth of the policy action is incomplete
• HIGH = most jurisdictions have adopted comprehensive evidence-informed policy action

Click on each policy action for details on what evidence-informed healthy eating policies have been adopted by local and provincial territorial governments.

Quick links to policy actions

1. Food labelling
2. Food provision
3. Food prices
4. Food promotion
5. Food retail
6. Food composition

1. Food labelling ¹

Definition: Regulatory system implemented by the government for consumer-oriented labelling on food packaging and menu boards in restaurants to enable consumers to easily make informed food choices and prevent misleading claims.

Evidence supporting food labelling includes:

• Reviews indicate industry self-regulation of labelling of unhealthy food result in restrictions that are vague and have small measurable effects.^3,4
• Nutritional labelling is effective when accompanied by simple explanation of how to interpret information presented.⁵
• Reviews indicate use of simple icons, checklists, logos of influential organizations at point-of-purchase may support dietary changes when combined with environmental changes.^6,7,8
• Labelling requirements can influence manufacturers’ practices, such as fostering reformulation of foods.⁸

Labelling caloric content of restaurant menu items may help reduce average caloric content purchase per meal (e.g., by 7.8%) ⁹

2. Food provision ¹

Definition: Government ensures that there are healthy food service policies implemented in government-funded settings to ensure that food provision encourages healthy food choices, and the government actively encourages and supports private companies to implement similar policies.

Evidence supporting food provision includes:

• School-based approaches, including school-based gardening, are effective in improving diet and physical activity.⁸
• School-based policies in Europe to control vending machines, provision of free fruit, and regulation of nutritional content of school meals show a positive effect on behavior in short-term.¹⁰
• Banning SSBs from vending machines and replacing them with healthier options resulted in a reduction in consumption of unhealthy foods by students and an increase in meeting recommendations for fruit, vegetables and milk.¹¹
• Workplace interventions to improve diet and physical activity (e.g., modifications to workplace environment, changing food served in cafeteria/vending machines) resulted in weight loss.¹²

3. Food prices ¹

Definition: Food pricing policies are aligned with health outcomes by helping to make healthy eating choices easier, cheaper choices.

Evidence supporting food prices includes:

• Several reviews and studies indicate that taxing unhealthy foods result in a reduction in consumption of unhealthy foods.¹³
• Taxing sugar-sweetened beverages (SSBs) is more effective on a per-calorie than per-ounce basis.¹⁴
• A tax on producers targeting sweeteners directly leads to less of a loss on consumer surplus.¹⁵
• Larger the tax increase, greater response in curbing consumption, with most studies suggesting a tax over 20% which when applied to SSBs is estimated to reduce obesity by 3.5% in the US.^{16,8,17,18,19,20}
• Specific taxes (e.g., fixed value based on quantity, size or weight) are more effective than ad valorem taxes (e.g., proportional to price).²⁰
• Some studies suggest subsidies for healthy foods tend to be more effective in promoting healthy eating than use of taxes.¹³
• Monetary incentives (discounts, coupons, vouchers, loans) have been shown to be effective in increasing purchase of healthier food options in stores or supermarkets.²¹
• Direct-to-consumer price discounts were consistently effective in increasing the purchase and consumption of healthier promoted foods in larger food venues (e.g., supermarkets, restaurants and cafeterias).²²
• A 10% decrease in price (subsidy) increased consumption of fruits and vegetables by 12%, whereas a 10% increase in price (tax) decreased consumption of unhealthy foods by 6%.²³
• A 10% subsidy for healthy foods resulted in a 12% increase in consumption of healthy foods, including an average 14% increase in consumption of fruit and vegetables, resulting in a small but significant reduction in BMI.¹⁶
• Fruit and vegetable stamps were found to reduce disparities between low-income consumers and higher-income consumers.²⁴
• Combining pricing policies with information interventions such as mass media campaigns or changes to labelling are most effective.²⁵
• Pricing policies may reinforce consumer education by drawing awareness to which products are being taxed or subsidized, or reinforce appropriate portion sizes.^23,24

4. Food promotion ¹

Definition: There is comprehensive policy implemented by the government to reduce the impact (exposure and power) of promotion of unhealthy foods across all media, particularly to children (<16 years).

Evidence supporting food promotion includes:

• Over the long-term, bans on advertising fast food and junk food to children may be effective.¹³
• Strong relationships exist between marketing practices and changes in food preference.²⁶
• Quebec’s marketing to children rules have resulted in 7.1% to 9.3% decrease in the probability of purchasing fast food, translating to a drop in 11M to 22M fast food meals purchased.¹⁰
• Increases in television advertising for certain foods and beverages increased children’s tendency to consume those items.²⁷ For example, a 100% increase in advertising for carbonated soft drinks was correlated with 6.5% increase in children’s consumption of those drinks, and a 1.3% increase in consumption in response to fast food advertising

5. Food retail ¹

Definition: Government has the power to implement policies and programs to support the availability of healthy foods and limit the availability of unhealthy foods in communities (outlet density and locations) and in-store (product placement).

Evidence supporting food retail includes:

• Working with food-service outlets to increase availability of healthy foods (incentives or educational materials) resulted in small improvements in healthier option.⁷
• Use of agricultural subsidies to create infrastructure, production, transportation, and marketing of healthier foods may have a significant long-term impact on improving availability of healthy foods.⁸
• Presence of farmers’ markets that include vouchers for community members led to increased consumption of fruit and vegetables.⁸
• Encouraging community gardening may be effective in improving diet and healthy eating.⁸
• Availability of outlets that offer healthy choices will improve diet of surrounding communities, and will potentially lead to reduction in body weight and BMI.⁸

6. Food composition ¹

Definition: Government systems implemented that ensure that processed foods and out-of-home meals minimize the energy density and nutrients of concern (sodium, saturated fat, trans fat, added sugar).

Evidence supporting food composition includes:

• changing content of pre-packaged children’s meals reduced overall quantity of calories purchased, increased purchases of non-fat chocolate milk, and resulted in a slight decrease in purchase of carbonated soft drinks ⁷
• mandatory sodium reduction regulation in Denmark resulted in an average decrease from 9.5g per capita per day in 2001 to 8.6g per day in 200 ¹⁰
• a trans fat ban in take-away foods resulted in reduction in consumption of trans fats, but an increase in consumption of saturated fats ⁷

References

¹  Vanderlee L, Goorang S, Karbasy K, Schermel A, L’Abbe M. Creating healthier food environments in Canada: Current policies and priority actions – Summary report. Toronto; University of Toronto, 2017. Available at: http://labbelab.utoronto.ca/food-epi-canada-2017/

² Alberta Policy Coalition for Chronic Disease Prevention (APCCP). (2018). Alberta’s Nutrition Report Card on Healthy Food Environments for Children and Youth. Retrieved from: http://abpolicycoalitionforprevention.ca/evidence/albertas-nutrition-report-card/

³ Galbraith-Emami S, Lobstein T. The impact of initiatives to limit the advertising of food and beverage products to children: A systematic review. Obesity Reviews 2013; 14(12): 960-974.

⁴ Ronit K, Jensen JD. Obesity and industry self-regulation of food and beverage marketing: A literature review. European Journal of Clinical Nutrition 2014; 68(7): 753-759

⁵ National Institute for Agricultural Research. Summary of public and private actions to change eating behaviour. Paris: National Institute for Agricultural Research; 2010.

⁶ Chandon P, Wansink B. Does food marketing need to make us fat? A review and solutions. Nutrition Reviews 2012; 70(10): 571-593.

⁷ Hillier-Brown FC, Summerbell CD, Moore HJ, et al. 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. Obesity Reviews 2017; 18(2): 227-246.

⁸ Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: A scientific statement from the American Heart Association. Circulation 2012; 126(12): 1514-1563.

⁹ Crockett RA, King SE, Marteau TM, et al. Nutritional labelling for healthier food or non-alcoholic drink purchasing and consumption. Cochrane Database of Systematic Reviews 2018; 2: Cd009315.

¹⁰ Capacci S, Mazzocchi M, Shankar B, et al. Policies to promote healthy eating in Europe: A structured review of policies and their effectiveness. Nutrition Reviews 2012; 70(3): 188-200

¹¹ Mayne SL, Auchincloss AH, Michael YL. Impact of policy and built environment changes on obesity-related outcomes: A systematic review of naturally occurring experiments. Obesity Reviews 2015; 16(5): 362-375.

¹² Anderson LM, Quinn TA, Glanz K, et al. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: A systematic review. American Journal of Preventive Medicine 2009; 37(4): 340-357.

¹³ Waddell K, Wilson MG, Panchal P, Mattison CA. Rapid synthesis: Identifying effective and cost-effective population-level approaches to promote healthy eating. Hamilton: McMaster Health Forum, 29 March 2018.

¹⁴ Miao Z, Beghin JC, Jensen HH. Taxing sweets: Sweetener input tax or final consumption tax? Contemporary Economic Policy 2012; 30(3): 344-361.

¹⁵ Zhen C, Brissette IF, Ruff RR. By ounce or by calorie: The differential effects of altenative sugar sweetened beverage tax strategies. American Journal of Agricultural Economics 2014; 96(4): 1070-1083.

¹⁶ Afshin A, Penalvo JL, Del Gobbo L, et al. The prospective impact of food pricing on improving dietary consumption: A systematic review and meta-analysis. Plos One 2017; 12(3): e0172277

¹⁷ Mytton OT, Clarke D, Rayner M. Taxing unhealthy food and drinks to improve health. BMJ: British Medical Journal 2012; 344: e2931.

¹⁸ 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. Obesity Reviews 2013; 14(2): 110-128

¹⁹ Thow AM, Jan S, Leeder S, Swinburn B. The effect of fiscal policy on diet, obesity and chronic disease: A systematic review. Bulletin of the World Health Organization 2010; 88(8): 609-614

²⁰ Wright A, Smith KE, Hellowell M. Policy lessons from health taxes: A systematic review of empirical studies. BMC Public Health 2017; 17(1): 583.

²¹ Liberato S, Bailie R, Brimblecombe J (2014). Nutrition interventions at point-of-sale to encourage healthier food purchasing: a systematic review. BMC Public Health 14:919.

²² Budd N, Cuccia A, Jeffries J, Prasad D, Frick K, Powell L, Katz F, Gittelsohn J. (2015). B’More healthy: retail rewards – design of a multi-level communications and pricing intervention to improve the food environment in Baltimore City. BMC Public Health. 15:283.

²³ Thow A, Downs S, & Jan S. (2014). A systematic review of the effectiveness of food taxes and subsidies to improve diets: Understanding the recent evidence. Nutrition Reviews, 72(9), 551-565.

²⁴ Dallongeville J, Dauchet L, de Mouzon O, Requillart V, Soler LG. Increasing fruit and vegetable consumption: A cost-effectiveness analysis of public policies. European Journal of Public Health 2011; 21(1): 69-73.

²⁵ National Institute for Agricultural Research. Summary of public and private actions to change eating behaviour. Paris: National Institute for Agricultural Research; 2010.

²⁶ Cairns G, Angus K, Hastings G, Caraher M. Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary. Appetite 2013; 62: 209-15.

²⁷ Andreyeva T, Kelly IR, Harris JL. Exposure to food advertising on television: Associations with children’s fast food and soft drink consumption and obesity. Economics & Human Biology 2011; 9(3): 221-233.