Developing public health policies for the out of home food sector to improve diet and reduce obesity

In the UK, more than one quarter of adults now have obesity and obesity-related disease alone costs the economy £27billion per year. The obesity epidemic emerged due to economic and societal changes that resulted in an 'obesogenic' food environment. A key aspect of the 'obesogenic' food environment is the out of home food (OOHF) sector, which is defined as the retail sector in which food is purchased from outside of the home for immediate consumption, including takeaway or home delivered restaurant food (e.g. OOHF outlets include coffee shops, cafes, canteens, restaurants and fast-food outlets). Over time the nation's diet has become more dependent on the OOHF. However, this shift towards an increased reliance on OOHF sources is now a significant problem because at present food products sold by the OOHF sector tend to be high in calories and low in dietary quality, which has resulted in the OOHF sector contributing to population level weight gain and obesity.

Because of the growing role that the OOHF sector has on nation's diets, public health policies that target the OOHF sector have been identified as being key to reducing diet-related disease and UK government have now identified the OOHF sector as an area of obesity policy action. Generating an evidence base for an extensive range of new public health policies that can be implemented in the OOHF sector is now research priority. In this project we will use a cross-disciplinary approach to generate evidence based public health policy recommendations that can be implemented in the OOHF sector to improve diet and reduce obesity. To identify which policies will be most effective, we first need to understand the exact contribution that the OOHF sector has on the nation's diet. In Work Package 1 we will conduct the largest nationally representative online survey of its kind and collect new data that will allow us to quantify for the first time the contribution that different OOHF outlet food sources have on the energy intake and overall nutritional quality of the nation's diet. In Work Package 2, we will use a combination of virtual and real-world consumer behaviour study methods to examine how a range of policies implemented in the OOHF sector affect consumer behaviour. We will study the effects of fiscal (e.g. taxation), structural (e.g. altering products available) and information-based (e.g. improved menu labelling) policies to uncover which policies have the largest positive effect on diet and why. Work Package 3 will then draw on the evidence generated from Work Package 1 and 2 to conduct epidemiological and economic modelling. We will quantify the long-term impacts that different OOHF sector policies would have on population health (e.g. reduction to obesity prevalence and lives saved per year) and the economy.

Throughout the project we will examine which policies are likely to benefit the health of all of the population and identify policies that have potential to reduce health-based social inequalities. For example, in Work Package 1 we will examine whether the role of OOHF sources on the diet differs based on socioeconomic status (SES) and demographic profile and in Work Package 2 we will recruit diverse participant samples in order to test whether tested policies benefit the diet of people from both lower and higher SES. Work Package 3 modelling will account for SES-based baselines differences in diet and health, as well as any SES patterning of OOHF usage and SES-based effectiveness of policies to identify which OOHF policies will be equitable (benefit all) or have potential to narrow health inequalities (e.g. particularly beneficial for low SES groups). During the project we will be advised by non-academic partners responsible for obesity policy action and a steering group of international public health experts. This approach will maximise the academic contribution and long-term impact that our research will have in the UK and globally.