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ObjectivesSales of ultraprocessed foods (UPFs) and beverages are rising in low-income and middle-income countries. Such foods are often linked with weight gain, obesity, type 2 diabetes and hypertension—diseases that are on the rise in India. This paper analysed patterns in purchases of processed and UPF by urban Indian households.SettingPanel data from Kantar —Worldpanel Division, India for 2013 and 2016.Participants58 878 urban Indian households.MethodsWe used K-mean partition clustering and multivariate regression to analyse patterns in processed food (PF) and UPF purchase for urban India.ResultsThree-quarters of urban Indian households purchased over ten PF groups. Mean per person annual PF purchase was 150 kg. UPF purchase was low at 6.4 kg in 2016 but had grown by 6% since 2013. Cluster analysis identified three patterns of consumption, characterised by low (54% of the households in 2016), medium (36%) and high (10%) PF purchase quantities. High cluster households purchased over three times as much PFs and UPF as the low cluster households. Notably, salt purchases were persistently high across clusters in both years (>3.3 kg), while sweet snack and ready-to-eat food purchases grew consistently in all clusters between 2013 and 2016. A positive and significant association was found between household purchases of UPF and their socioeconomic status as well as ownership of durables, such as refrigerator, colour television and washing machine (all p<0.001). Spatial characteristics including size of town (p<0.05) in which the household is located were also positively associated with the purchase of UPF.ConclusionResults suggest the need for tailored regional and city level interventions to curb the low but growing purchase of UPF. New data on obesity and rise of non-communicable diseases, the results are concerning given the links between lifestyle changes and the speed of urbanisation in Indian cities.

ObjectivesThe UK Soft Drinks Industry Levy (SDIL), implemented in 2018, has been successful in reducing the sugar content and purchasing of soft drinks, with limited financial impact on industry. Understanding the views of food and drink industry professionals involved in reacting to the SDIL is important for policymaking. However, their perceptions of the challenges of implementation and strategic responses are unknown. The aim of this study, therefore, was to explore how senior food and drink industry professionals viewed the SDIL.DesignWe undertook a qualitative descriptive study using elite interviews. Data were analysed using Braun and Clarke’s thematic analysis, taking an inductive exploratory and descriptive approach not informed by prior theory or frameworks.Setting and participantsInterviews were conducted via telephone with 14 senior professionals working in the food and drink industry.ResultsFive main themes were identified: (1) a level playing field…for some; industry accepted the SDIL as an attempt to create a level playing field but due to the exclusion of milk-based drinks, this was viewed as inadequate, (2) complex to implement, but no lasting negative effects; the SDIL was complex, expensive and time consuming to implement, with industry responses dependent on leadership buy-in, (3) why us?—the SDIL unfairly targets the drinks industry; soft drinks are an unfair target when other categories also contain high sugar, (4) the consumer is king; consumers were a key focus of the industry response to this policy and (5) the future of the SDIL; there appeared to be a wider ripple effect, which primed industry to prepare for future regulation in support of health and environmental sustainability.ConclusionsInsights from senior food and drink industry professionals illustrate how sugar-sweetened beverage taxes might be successfully implemented and improve understanding of industry responses to taxes and other food and drink policies.Trial registration number ISRCTN18042742.

Restricting the advertisement of products with high fat, salt, and sugar (HFSS) content has been recommended as a policy tool to improve diet and tackle obesity, but the impact on HFSS purchasing is unknown. This study aimed to evaluate the impact of HFSS advertising restrictions, implemented across the London (UK) transport network in February 2019, on HFSS purchases. Over 5 million take-home food and drink purchases were recorded by 1,970 households (London [intervention], n = 977; North of England [control], n = 993) randomly selected from the Kantar Fast Moving Consumer Goods panel. The intervention and control samples were similar in household characteristics but had small differences in main food shopper sex, socioeconomic position, and body mass index. Using a controlled interrupted time series design, we estimated average weekly household purchases of energy and nutrients from HFSS products in the post-intervention period (44 weeks) compared to a counterfactual constructed from the control and pre-intervention (36 weeks) series. Energy purchased from HFSS products was 6.7% (1,001.0 kcal, 95% CI 456.0 to 1,546.0) lower among intervention households compared to the counterfactual. Relative reductions in purchases of fat (57.9 g, 95% CI 22.1 to 93.7), saturated fat (26.4 g, 95% CI 12.4 to 40.4), and sugar (80.7 g, 95% CI 41.4 to 120.1) from HFSS products were also observed. Energy from chocolate and confectionery purchases was 19.4% (317.9 kcal, 95% CI 200.0 to 435.8) lower among intervention households than for the counterfactual, with corresponding relative reductions in fat (13.1 g, 95% CI 7.5 to 18.8), saturated fat (8.7 g, 95% CI 5.7 to 11.7), sugar (41.4 g, 95% CI 27.4 to 55.4), and salt (0.2 g, 95% CI 0.1 to 0.2) purchased from chocolate and confectionery. Relative reductions are in the context of secular increases in HFSS purchases in both the intervention and control areas, so the policy was associated with attenuated growth of HFSS purchases rather than absolute reduction in HFSS purchases. Study limitations include the lack of out-of-home purchases in our analyses and not being able to assess the sustainability of observed changes beyond 44 weeks. This study finds an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy, sugar, and fat purchased from HFSS products. These findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products.

BackgroundFrequent consumption of out-of-home (OOH) foods, including takeaways, is linked to higher energy intake and poorer diet quality. In April 2022, calorie labelling was mandated in England for large OOH businesses to support healthier choices. This paper aimed to explore knowledge and use of calorie labelling when ordering takeaway food online and other factors influencing food choices, overall and by sociodemographic characteristics.MethodsA cross-sectional survey of 1040 takeaway consumers in England from an OOH purchase panel assessed knowledge and awareness of calorie labelling legislation, self-reported impact on online takeaway choices, and key drivers of takeaway consumption. Data were analysed using descriptive statistics, logistic regressions and thematic analysis.ResultsOver 27% of respondents ordered takeaways once or more per week. Respondents aged 35 years and older were less likely (OR 0.28–0.52, p<0.05), while those with obesity were more likely (OR 2.01, p<0.001) to report frequent takeaway purchases. Women were more knowledgeable about the recommended energy meal content than men (OR 2.06, p<0.001), yet only 15% of respondents knew the guideline amount. Awareness of calorie labelling regulations was 63% overall, but was less likely in middle socioeconomic groups (OR 0.56–0.63, p<0.05). During past online orders, 23% noticed calorie labels; of these, 26% reduced food calories ordered, and 10% reduced drink calories ordered. Taste and price were key drivers of takeaway choices, while health and sustainability were less influential. Strong support emerged for healthier menu options and traffic light labelling to help improve the healthiness of takeaway orders.ConclusionGiven the limited reported impact, calorie labels may only benefit a minority. As meal healthiness was ranked as a relatively less important driver for takeaway choices, further policies are required to complement calorie labelling in promoting healthier food environments.

BackgroundLittle is known about who uses online food delivery services and how use of these services is associated with social inequalities in food purchasing and diet-related health. This study explored associations between social position and use of online takeaway food and grocery delivery services, and its association with weight status.MethodsData were obtained from households in a consumer research panel living in London and the north of England (n=1521) in February 2019. Use of online grocery delivery services was determined via recorded purchases, and takeaway food delivery app use via survey responses. Social position was approximated through occupation-based social grade and household income. We used logistic regression to estimate the association between social position and use of online delivery services, and the relationship between online delivery service use and weight status.ResultsOverall, 13.2% of respondents used takeaway food delivery apps over a 7-day period and 15.6% of households used online grocery delivery services over a 4-week period. High-income households were more likely to use online grocery delivery services than low-income households (OR 2.01, 95% CI 1.22 to 3.34). In contrast, households with lower social grade were more likely to use takeaway food delivery apps compared with households in the highest grade (OR 2.31, 95% CI 1.38 to 3.87). While takeaway food delivery app use was positively associated with living with obesity (relative risk ratio 1.84, 95% CI 1.20 to 2.82), use of online grocery delivery services was not.DiscussionFindings indicate that use of online food delivery services is patterned by markers of social position and weight status, which may lead to dietary inequalities. The potential impact of increased and differential usage of online delivery services on diet and dietary inequalities warrants further research.

Online grocery delivery services (OGDSs) are a popular way of acquiring food. However, it is unclear whether OGDS use is associated with the healthiness of purchases and whether there are sociodemographic differences in OGDS use. If so, the increased prevalence of OGDS use may have implications for population diet, and differential OGDS use could contribute to diet inequalities. This study aimed to examine whether OGDS use varies by sociodemographic characteristics and is associated with the amount and types of groceries purchased. Item-level take-home food and drink purchase data (n=3,233,920 items) from households in London and the North of England were available from the 2019 UK Kantar fast-moving consumer goods panel (N=1911). Purchases were categorized as being bought online or in-store. We used logistic regression to estimate the likelihood of an above-median frequency of OGDS use by sociodemographic characteristics. We used Poisson regression to estimate the differences in energy and nutrients purchased by households that had above- and below-median OGDS use and the proportion of energy purchased from products high in fat, salt, and sugar (HFSS) online versus in-store among households that used both shopping methods (n=665). In total, 668 (35%) households used OGDSs at least once in 2019. Of the households that used OGDSs, the median use was 5 occasions in 2019. Households were more likely to have above-median use in London versus in the North of England (odds ratio 1.29, 95% CI 1.01-1.65) and if they had a higher annual household income (odds ratio 1.56, 95% CI 1.02-2.38 for ≥£50,000 [US $64,000] vs <£20,000 [$25,600]). Households with above-median OGDS use had a higher weekly mean purchase of energy by 1461 (95% CI 1448-1474) kcal per person compared with households with below-median OGDS use. For households that used a combination of in-store and online shopping, HFSS products made up a lower proportion (-10.1%, 95% CI -12% to -8.1%) of energy purchased online compared to in-store. Differences in grocery purchases between households with above- and below-median OGDS use could have positive or negative consequences. The extra energy purchased among households with above-median OGDS use could lead to overconsumption or food waste, which has negative consequences for population and environmental health. Alternatively, this extra energy may be replacing out-of-home purchasing, which tends to be less healthy, and may be beneficial for the population diet. Households made fewer HFSS purchases when shopping online compared to in-store, which may be due to differences in the shopping environment or experience, such as fewer promotions and advertisements when shopping online or not having to transport and carry purchases home. As higher-income households used OGDS more frequently, the implications of this sociodemographic pattern on dietary inequalities must be explored.

Little is known about consumer response to food safety recalls in low- and middle- income countries. Using an event-study framework, this paper examines the immediate and long-term changes in noodle purchases after the nationwide removal of Maggi instant noodles from the market in India in 2015. We show that this recall had a negative impact on the purchases of Maggi noodles among urban households for at least two years. This provides evidence of the huge costs of recalls on food producers that can be leveraged by policymakers to promote food safety. We also find strong evidence for a positive spillover effect to non-Maggi noodles that is more persistent among households with more regular purchasing habits of Maggi noodles. This indicates that consumers with more persistent habits of buying a recalled product are less likely to stigmatize alike food products under different brands. Our results are robust to alternative assumptions of pre-trends in purchases and placebo tests.

BackgroundOnline grocery delivery services (OGDS) provided a way to reduce physical contact with others during the COVID-19 pandemic. However, OGDS may not have been equally available to all households and may have exacerbated health inequalities. Pre-pandemic, OGDS use was more prevalent among higher-income households and was associated with some healthier purchasing behaviours. This study aimed to explore whether there were differences in the sociodemographic patterning of OGDS use and online grocery purchases, before and during the pandemic.MethodsItem-level take-home food and drink purchase data were obtained from the UK Kantar Fast Moving Consumer Goods Panel. Households were randomly sampled if residing in London and the North of England (n=1,245). Purchases from the early stages of the pandemic [23/03/2020–14/06/2020] (n=636,762), during the UK’s strictest lockdown period, were compared to the same period in 2019 [25/03/2019–16/06/2019] (n=562,573). Purchases were categorised as being bought online or in-store based on store type information. We categorised households as using OGDS: 1) in 2019 and 2020 (existing user), 2) in 2020 but not in 2019 (new adopter), 3) in 2019 but not in 2020 or 4) not in 2019 or 2020 (non-user). We used logistic regression to estimate the likelihood of being in each OGDS use category (yes/no) by sociodemographic characteristics. T-tests were used to test differences in monthly household purchases, overall and by food group. All analyses were conducted in Stata SE 16.ResultsHouseholds with an annual income of ≥£40,000 were more likely to be existing users (OR 2.18, 95% CI 1.20 to 3.94 for £40,000-£50,000 vs <£20,000). Households with shoppers aged ≥65 years vs 18–34 years were more likely to be new adopters (OR 2.30, 95% CI 1.10 to 4.80). New adopters had the greatest reduction in mean monthly in-store shopping, -2.7 occasions (95% C -3.3 to -2.1) [-33.8%]. Among existing users, mean monthly online purchases increased by 16,891 kcal (95% CI 8,171 to 25,610) [+27.9%], but the mean proportion of energy that was from fruit and vegetables decreased, -1.7% (95% CI -2.9 to -0.5) [-21.3%].DiscussionHigher rates of adoption among the oldest age group may reflect greater caution due to higher risk of severe illness from COVID-19 with age. Reductions in fruit and vegetable purchases relative to other food categories could have negative health implications. However, it was not possible to discern whether this was a consumer-led change in purchasing behaviour or due to product shortages.

Restricting the advertisement of products with high fat, salt, and sugar (HFSS) content has been recommended as a policy tool to improve diet and tackle obesity, but the impact on HFSS purchasing is unknown. This study aimed to evaluate the impact of HFSS advertising restrictions, implemented across the London (UK) transport network in February 2019, on HFSS purchases. Over 5 million take-home food and drink purchases were recorded by 1,970 households (London [intervention], n = 977; North of England [control], n = 993) randomly selected from the Kantar Fast Moving Consumer Goods panel. The intervention and control samples were similar in household characteristics but had small differences in main food shopper sex, socioeconomic position, and body mass index. Using a controlled interrupted time series design, we estimated average weekly household purchases of energy and nutrients from HFSS products in the post-intervention period (44 weeks) compared to a counterfactual constructed from the control and pre-intervention (36 weeks) series. Energy purchased from HFSS products was 6.7% (1,001.0 kcal, 95% CI 456.0 to 1,546.0) lower among intervention households compared to the counterfactual. Relative reductions in purchases of fat (57.9 g, 95% CI 22.1 to 93.7), saturated fat (26.4 g, 95% CI 12.4 to 40.4), and sugar (80.7 g, 95% CI 41.4 to 120.1) from HFSS products were also observed. Energy from chocolate and confectionery purchases was 19.4% (317.9 kcal, 95% CI 200.0 to 435.8) lower among intervention households than for the counterfactual, with corresponding relative reductions in fat (13.1 g, 95% CI 7.5 to 18.8), saturated fat (8.7 g, 95% CI 5.7 to 11.7), sugar (41.4 g, 95% CI 27.4 to 55.4), and salt (0.2 g, 95% CI 0.1 to 0.2) purchased from chocolate and confectionery. Relative reductions are in the context of secular increases in HFSS purchases in both the intervention and control areas, so the policy was associated with attenuated growth of HFSS purchases rather than absolute reduction in HFSS purchases. Study limitations include the lack of out-of-home purchases in our analyses and not being able to assess the sustainability of observed changes beyond 44 weeks. This study finds an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy, sugar, and fat purchased from HFSS products. These findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products.

BackgroundOnline grocery delivery services (OGDS) are becoming increasingly popular. The impact of OGDS on population diet and inequalities in food purchases is under-studied. This study examined how use of OGDS varies by sociodemographic characteristics and is associated with the amount and types of grocery purchased.MethodsFood and drink purchase data were available from households (n=1911) in the 2019 UK Kantar Fast Moving Consumer Goods Panel. Households were randomly sampled if residing in London and the North of England. Purchases were categorised as being bought online or in-store based on store type information. We used logistic regression to estimate the likelihood of above median frequency of OGDS use by sociodemographic characteristics. We then used Poisson regression to estimate (i) differences in overall energy purchased by households with above and below median OGDS use and (ii) the proportion of energy purchased from 35 food groups online versus in-store among households that used both shopping methods (n=665). All analyses were conducted in Stata SE 16.ResultsMedian use was five occasions in 2019 for households that used OGDS (n=668). Higher-income households were more likely to have above median use (OR 1.56, 95% CI 1.02 to 2.38 for ≥£50,000 versus <£20,000). Households with above, versus below, median OGDS use purchased a mean of 1,460.8 kcal (95% CI 1,447.7 to 1,473.8) more energy per person per week. Households that used both in-store and online shopping methods tended to have healthier purchases online. Online versus in-store purchases had a larger proportion of energy from vegetables (1.0%, 95% CI 0.2 to 1.8), healthy non-milk-based drinks (1.6%, 95% CI 0.7 to 2.4) and alcohol (1.2%, 95% CI 0.4 to 2.1), and a smaller proportion of energy from puddings and biscuits (-3.3%, 95% CI -4.1 to -2.5), and chocolate and confectionery (-1.5%, 95% CI -2.2 to -0.7).ConclusionAlthough online purchases were healthier, households with above median OGDS use had greater total energy purchases. This may lead to increases in over-consumption or waste. Further, OGDS may intensify existing socioeconomic inequality in food purchasing because of differential OGDS use across socioeconomic groups. Thus, the online food environment may have positive and negative consequences for population diet. Study limitations include reliance on self-reported data, as households may have forgotten to report some purchases, and the lack of information on intra-household distribution of purchases.