What is the effectiveness of obesity related interventions at retail grocery stores and supermarkets? -a systematic review.

BACKGROUND: The Prevalence of obesity and overweight has been increasing in many countries. Many factors have been identified as contributing to obesity including the food environment, especially the access, availability and affordability of healthy foods in grocery stores and supermarkets. Several interventions have been carried out in retail grocery/supermarket settings as part of an effort to understand and influence consumption of healthful foods. The review's key outcome variable is sale/purchase of healthy foods as a result of the interventions. This systematic review sheds light on the effectiveness of food store interventions intended to promote the consumption of healthy foods and the methodological quality of studies reporting them. METHODS: Systematic literature search spanning from 2003 to 2015 (inclusive both years), and confined to papers in the English language was conducted. Studies fulfilling search criteria were identified and critically appraised. Studies included in this review report health interventions at physical food stores including supermarkets and corner stores, and with outcome variable of adopting healthier food purchasing/consumption behavior. The methodological quality of all included articles has been determined using a validated 16-item quality assessment tool (QATSDD). RESULTS: The literature search identified 1580 publications, of which 42 met the inclusion criteria. Most interventions used a combination of information (e.g. awareness raising through food labeling, promotions, campaigns, etc.) and increasing availability of healthy foods such as fruits and vegetables. Few used price interventions. The average quality score for all papers is 65.0%, or an overall medium methodological quality. Apart from few studies, most studies reported that store interventions were effective in promoting purchase of healthy foods. CONCLUSION: Given the diverse study settings and despite the challenges of methodological quality for some papers, we find efficacy of in-store healthy food interventions in terms of increased purchase of healthy foods. Researchers need to take risk of bias and methodological quality into account when designing future studies that should guide policy makers. Interventions which combine price, information and easy access to and availability of healthy foods with interactive and engaging nutrition information, if carefully designed can help customers of food stores to buy and consume more healthy foods.

The health benefits of selective taxation as an economic instrument in relation to IHD and nutrition-related cancers.

OBJECTIVE: The present study aimed to estimate the health benefits of selective taxation of healthy and unhealthy food commodities in relation to CVD and nutrition-related cancers. DESIGN: The potential health effects of a selective taxation scenario were estimated as changes in the burden of disease, measured by disability-adjusted life years, from health outcomes affected by the changes in food intake. The change in burden of a disease was calculated as the change in incidence of the disease due to a modified exposure level, using the potential impact fraction. Estimates of relative risk for the associations between various foods and relevant diseases were found through a literature search and used in the calculation of potential impact fractions. SETTING: The study was based in Denmark, estimating the health effects of a Danish selective taxation scenario. SUBJECTS: The potential health effects of selective taxation were modelled for the adult Danish population. RESULTS: Halving the rate of value-added tax on fruit and vegetables and increasing the tax on fats would result in moderate reductions in the burden of disease from IHD, ischaemic stroke, and colorectal, lung and breast cancer (0·4­2·4 % change). The largest effect could be obtained through increased intake of fruit and vegetables (0·9­2·4 %). CONCLUSIONS: Applying selective taxation to healthy and unhealthy foods can moderately reduce the burden of disease in the Danish population.

Design of the OPUS School Meal Study: a randomised controlled trial assessing the impact of serving school meals based on the New Nordic Diet.

INTRODUCTION: Danish children consume too much sugar and not enough whole grain, fish, fruit, and vegetables. The Nordic region is rich in such foods with a strong health-promoting potential. We lack randomised controlled trials that investigate the developmental and health impact of serving school meals based on Nordic foods. AIM: This paper describes the rationale, design, study population, and potential implications of the Optimal well-being, development and health for Danish children through a healthy New Nordic Diet (OPUS) School Meal Study. METHODS: In a cluster-randomised cross-over design, 1021 children from 3rd and 4th grades (8-11 years old) at nine Danish municipal schools were invited to participate. Classes were assigned to two 3-month periods with free school meals based on the New Nordic Diet (NND) or their usual packed lunch (control). Dietary intake, nutrient status, physical activity, cardiorespiratory fitness, sleep, growth, body composition, early metabolic and cardiovascular risk markers, illness, absence from school, wellbeing, cognitive function, social and cultural features, food acceptance, waste, and cost were assessed. RESULTS: In total, 834 children (82% of those invited) participated. Although their parents were slightly better educated than the background population, children from various socioeconomic backgrounds were included. The proportion of overweight and obese children (14%) resembled that of earlier examinations of Danish school children. Drop out was 8.3%. CONCLUSIONS: A high inclusion rate and low drop out rate was achieved. This study will be the first to determine whether school meals based on the NND improve children's diet, health, growth, cognitive performance, and early disease risk markers.

Cost-effectiveness of Salmonella reduction in Danish abattoirs.

The objective of this paper is to compare the cost-effectiveness of four decontamination technologies at the pork abattoirs. The four technologies investigated are hot water, steam ultrasound, steam vacuum and lactic acid. In the analysis, the prevalence of Salmonella and the effects of the decontaminating technologies are stochastic with known distributions and they are expected to be implemented without distortion of the existing processing system. Cost data are collected from the Danish Meat Research Institute, suppliers of decontamination technology, abattoirs using the technology as well as the literature. The risk data are based on Danish surveillance data, research projects investigating the effects of different decontamination measures and the literature. Implemented on a full scale in abattoirs, the results suggest that the technologies might reduce Salmonella from the present level of 2.2% to between 0.18 and 0.89%. Among the technologies investigated, steam ultrasound showed to be the most cost-effective method followed by hot water decontamination.

Cost-effective design of economic instruments in nutrition policy.

This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively. The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10-30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn.

Environmental sub models for a macroeconomic model: agricultural contribution to climate change and acidification in Denmark.

Integrated modelling of the interaction between environmental pressure and economic development is a useful tool to evaluate environmental consequences of policy initiatives. However, the usefulness of such models is often restricted by the fact that these models only include a limited set of environmental impacts, which are often energy-related emissions. In order to evaluate the development in the overall environmental pressure correctly, these model systems must be extended. In this article an integrated macroeconomic model system of the Danish economy with environmental modules of energy related emissions is extended to include the agricultural contribution to climate change and acidification. Next to the energy sector, the agricultural sector is the most important contributor to these environmental themes and subsequently the extended model complex calculates more than 99% of the contribution to both climate change and acidification. Environmental sub-models are developed for agriculture-related emissions of CH(4), N(2)O and NH(3). Agricultural emission sources related to the production specific activity variables are mapped and emission dependent parameters are identified in order to calculate emission coefficients. The emission coefficients are linked to the economic activity variables of the Danish agricultural production. The model system is demonstrated by projections of agriculture-related emissions in Denmark under two alternative sets of assumptions: a baseline projection of the general economic development and a policy scenario for changes in the husbandry sector within the agricultural sector.