The use of private regulatory measures to create healthy food retail environments: a scoping review.

OBJECTIVE: 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. DESIGN: 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. SETTING: Food retail. PARTICIPANTS: Food retail settings using private regulatory measures to create healthier food retail environments. RESULTS: 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). CONCLUSIONS: 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.

Exploring the prospective acceptability of a healthy food incentive program from the perspective of people with type 2 diabetes and experiences of household food insecurity in Alberta, Canada.

OBJECTIVE: FoodRx is a 12-month healthy food prescription incentive program for people with type 2 diabetes (T2DM) and experiences of household food insecurity. In this study, we aimed to explore potential users' prospective acceptability (acceptability prior to program use) of the design and delivery of the FoodRx incentive and identify factors influencing prospective acceptability. DESIGN: We used a qualitative descriptive approach and purposive sampling to recruit individuals who were interested or uninterested in using the FoodRx incentive. Semi-structured interviews were guided by the theoretical framework of acceptability, and corresponding interview transcripts were analysed using differential qualitative analysis guided by the socioecological model. SETTING: Individuals living in Alberta, Canada. PARTICIPANTS: In total, fifteen adults with T2DM and experiences of household food insecurity. RESULTS: People who were interested in using the FoodRx incentive (n 10) perceived it to be more acceptable than those who were uninterested (n 5). We identified four themes that captured factors that influenced users' prospective acceptability: (i) participants' confidence, views and beliefs of FoodRx design and delivery and its future use (intrapersonal), (ii) the shopping routines and roles of individuals in participants' social networks (interpersonal), (iii) access to and experience with food retail outlets (community), and (iv) income and food access support to cope with the cost of living (policy). CONCLUSION: Future healthy food prescription programs should consider how factors at all levels of the socioecological model influence program acceptability and use these data to inform program design and delivery.

Adolescents' experiences with the food selection at the sports arena in the area of Oslo, Norway: a focus group study.

OBJECTIVE: To investigate adolescents' experiences with the food selection at the sport arena. DESIGN: Four focus group interviews were conducted with 4-6 participants each. Interviews were recorded and transcribed verbatim. The transcripts were coded in NVivo and the analysis was guided by thematic analysis. SETTING: Adolescents from handball and football clubs in Oslo and Viken, Norway, participated in the study. PARTICIPANTS: A total of nine boys (11-14 years old) and ten girls (11-14 years old) participated in the study. RESULTS: We identified four main themes: interest for healthy food; experiences with the food selection at the sports arena; factors influencing participants' food choices at the sports arena and expectations related to a healthy food selection at the sports arena. Adolescents across the focus groups experienced the food selection at the sports arena as unhealthy. Price, marketing and availability of unhealthy food were important factors that influenced their food choices at the sports arena. The trainer appeared to motivate the participants to eat healthy. CONCLUSIONS: Participants wished for a healthier food selection at the sports arena. Cost of food emerged as a factor that influenced their food choices. Our study also indicates that marketing of unhealthy food and beverages should be restricted, to influence adolescence food choice towards healthier alternatives.

Food and beverage selection in children's sports arenas in Norway: a cross-sectional study.

OBJECTIVE: To assess the selection of foods and beverages in children's sports arenas in Norway. DESIGN: 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. SETTING: Children's sports clubs in Norway. PARTICIPANTS: Representatives from 301 children's sports clubs in Norway answered the questionnaire between September and November 2021. RESULTS: 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. CONCLUSIONS: 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.

Associations between food intake and psychosomatic symptoms in 16-year-old adolescents.

AIMS: An increase in psychosomatic symptoms among adolescents has recently been reported. Few studies have examined the relation between food intake and psychosomatic symptoms. The aim was to study the association between food intake and overall psychosomatic burden and separate psychosomatic symptoms. METHODS: In this cross-sectional study, we used data from 6248 girls and 7153 boys in south-east Sweden who turned 16 years of age during the academic years 2009/2010 to 2015/2016 and responded to a health questionnaire at the school health services. The association between overall healthy food intake and a low psychosomatic burden was calculated as odds ratios (95% confidence interval) and stratified for other lifestyle habits and gender. RESULTS: Sixty-nine per cent of the boys and 35% of the girls had a low psychosomatic burden. There was a positive association between an overall healthy food intake and a low psychosomatic burden (P<0.0001), regardless of other lifestyle habits and gender. An overall healthy food intake was also positively associated with a lower frequency of the separate psychosomatic symptoms of concentration difficulties, sleep difficulties, a poor appetite or dizziness (P<0.0001). CONCLUSIONS: A healthy food intake seems to be associated with a low psychosomatic burden among adolescents. Further knowledge is needed to explore whether an improved food intake can reduce psychosomatic symptoms and enhance mental health.

The impact of healthy nutrition education based on traffic light labels on food selection, preference, and consumption in patients with acute coronary syndrome: a randomized clinical trial.

BACKGROUND: Acute Coronary Syndrome is the most common heart disease and the most significant cause of death and disability-adjusted life years worldwide. Teaching a healthy eating style is one preventive measure to prevent the disease's recurrence. This study aimed to determine the effect of healthy nutrition education with the help of traffic light labels on food selection, preference, and consumption in patients with acute coronary syndrome. METHODS: This randomized, single-blinded clinical trial was conducted with 139 participants (66 in the intervention group and 73 in the control group) from January 2021 to August 2021 in Shaheed Rajaie Hospital, Tehran, Iran. The control group received standard training. The intervention group, besides this, received additional bedside training with an educational poster on traffic light labels from the research team during their final hospitalization days. Data were collected using a researcher-made questionnaire on food selection, preference, and consumption. RESULTS: The Brunner-Munzel test showed no significant difference between the two groups in terms of selection (P = 0.127), preference (P = 0.852), and food consumption (P = 0.846) in the baseline, while after the intervention, there were significant differences in selection (P > 0.001), preference (P > 0.001), and consumption (p < 0.004). Comparing the difference between the two groups in the difference between the before and after scores for selection (p < 0.001), preference (p < 0.001), and food consumption (p = 0.011) with the Brunner-Munzel test indicated a significant difference in all outcome variables. CONCLUSIONS: Teaching healthy eating styles with the help of traffic light labels affected food selection, preference, and consumption and led to healthier diets in these patients. CLINICAL TRIAL REGISTRATION NUMBER: Clinical trial registration: It was prospectively registered in the Iran Clinical Trials Registration Center on this date 30/10/2020 (IRCT20200927048857N1).

Beyond individual responsibility towards healthy food choices: A qualitative study among Pakistani women in Hong Kong.

While biomedical understandings of food and diet coupled with discourses on individual responsibility towards healthy food choices are nowadays prominent, other social and cultural meanings attached to food and diet are largely devalued. The limits of such a reductionist approach are more evident when related to the experiences of migrant and ethnic populations, whose alternative knowledge(s) and practices about food and health are especially neglected. A multicultural city with a public healthcare system inherited from the British colonial times and largely shaped by biomedical ideas of health, Hong Kong offers a lens into the limits of such a reductionist approach. Due to their vulnerability in the context of Hong Kong as shaped by intersecting social identities, 72 women from Pakistan were recruited to be our community partners in a community-based participatory action research project to investigate their health needs and concerns. 12 focus group discussions were conducted, exploring their experiences of "healthy" food and overweight especially related to their encounters with the Hong Kong public healthcare system, as these issues emerged as key health concerns within the community. Four major themes emerged: unmet expectations of care, health is beyond the individual, constraints to a healthy diet in the context of migration, and beyond health: food as care for diasporic women. This study highlights the limit of a reductionist approach to healthy food as merely based on nutrition and individual responsibility. It stresses the need of a counter-discourse in the field of public health, emphasizing not only alternative cultural ideas of health and food, but also enlarging the field of health in biomedical terms to embrace "care" and acknowledging the structural constraints shaping migrant and ethnic population's vulnerability in making "healthy" food choices.

Impact of food swap recommendations on dietary choices in an online supermarket: A randomized controlled trial.

One novel strategy to shift food choices in digital shopping environments is to automatically recommend healthier alternatives when an unhealthy choice is made. However, this raises the question which alternative products to recommend. This study assesses 1) whether healthier food swap recommendations are effective, even though the unhealthy choice was made in the presence of visible FOP nutrition labels, and 2) how the similarity of the alternatives influences the acceptance of food swap recommendations. Based on a pre-test, similarity of the recommendation was operationalized in terms of animal-based versus plant-based options. A randomized controlled trial (healthy food swap recommendation conditions: none, similar animal-based, dissimilar plant-based, or mixed animal- and plant-based) with 428 Dutch participants was conducted in a simulated online supermarket. Additional healthier food swap recommendations improved the nutritional quality of the final basket compared to only providing Nutri-Score nutrition labels (-1.7 mean FSA score, p < .001, medium Cohen's d = -0.48). Compared to the dissimilar condition, acceptance of an alternative was more likely in the mixed (odds-ratio = 2.78, p = .015) and in the similar condition (odds-ratio = 2.24, p = .048), but the nutritional quality of the final basket did not differ between treatment conditions. Individuals in treatment conditions who did not receive any recommendation (i.e. only made healthy choices) had higher Nutri-Score familiarity and general health interest than individuals who received recommendations. This suggests that for individuals with higher knowledge and motivation FOP nutrition labels were sufficient, whereas for individuals with lower knowledge and motivation additional food swap recommendations can improve dietary choices. Food swap recommendations may act as meaningful reminders by disrupting the automatic choice process and triggering individuals to rethink their (unhealthy) choice.

Hydroxylated Tetramethoxyflavone Affects Intestinal Cell Permeability and Inhibits Cytochrome P450 Enzymes.

Tetramethoxyflavones (TMFs) found in the Citrus genus have garnered considerable interest from food scientists and the health food industry because of their promising biological properties. Nonetheless, there are currently limited data available regarding the effectiveness and bioavailability of "hydroxylated TMFs", which are flavones known for their potential in disease prevention through dietary means. This study aims to provide insights into the chemical and biological properties of hydroxylated TMF and evaluates its effects on intestinal cell permeability and cytochrome P450 (CYP) inhibition. Liquid chromatography-mass spectrometry (LC-MS) and microsomes analyze the TMFs and hydroxylated TMFs, elucidating cell penetration and metabolic inhibition potential. 3H7-TMF shows the fastest (1-h) transport efficiency in intestinal cells. The Caco-2 cell model exhibits significant transport and absorption efficiency. Dissolved hydroxyl-TMF with hydrophilicity possibly permeates the gut. 3H7-TMF has higher transport efficiency (46%) 3H6-TMF (39%). IC50 values of TMFs (78-TMF, 57-TMF, 3H7-TMF, 3H6-TMF) against CYP enzymes (CYP1A2, CYP2D6, CYP2C9, CYP2C19, CYP3A4) range from 0.15 to 108 µM, indicating potent inhibition. Hydroxyl groups enhance TMF hydrophilicity and membrane permeability. TMFs display varied inhibitory effects due to hydroxyl and methoxy hindrance. This study underscores the strong CYP inhibitory capabilities in these TMFs, implying potential food-drug interactions if used in medicines or supplements. These findings can also help with food nutrition improvement and pharma food developments through innovative approaches for Citrus waste valorization.

Natural alternatives for processed meat: Legislation, markets, consumers, opportunities and challenges.

Consumers' interest in food with less and/or free from synthetic additives has increased considerably in recent years. In this context, researchers and industries have concentrated efforts on developing alternatives to these compounds. Replacing synthetic additives in meat products is a challenge, given their importance for sensory characteristics and food safety. Complementary technologies combined with the replacement and/or reduction of synthetic additives (hurdle technologies) has been studied focusing on the protection and extension of the shelf life of meat products. This review reports alternatives for replacing and/or reducing the use of synthetic additives in meat derivatives, aiming at the development of more natural and simpler meat products, familiar to consumers and considered clean labels.

Technology and functional insights into the nicotinamide mononucleotide for human health.

Nicotinamide mononucleotide (NMN), a naturally occurring biologically active nucleotide, mainly functions via mediating the biosynthesis of NAD+. In recent years, its excellent pharmacological activities including anti-aging, treating neurodegenerative diseases, and protecting the heart have attracted increasing attention from scholars and entrepreneurs for production of a wide range of formulations, including functional food ingredients, health care products, active pharmaceuticals, and pharmaceutical intermediates. Presently, the synthesis methods of NMN mainly include two categories: chemical synthesis and biosynthesis. With the development of biocatalyst engineering and synthetic biology strategies, bio-preparation has proven to be efficient, economical, and sustainable methods. This review summarizes the chemical synthesis and biosynthetic pathways of NMN and provides an in-depth investigation on the mining and modification of enzyme resources during NMN biosynthesis, as well as the screening of hosts and optimization of chassis cells via metabolic engineering, which provide effective strategies for efficient production of NMN. In addition, an overview of the significant physiological functions and activities of NMN is elaborated. Finally, future research on technical approaches to further enhance NMN synthesis and strengthen clinical studies of NMN are prospected, which would lay the foundation for further promoting the application of NMN in nutrition, healthy food, and medicine in the future. KEY POINTS: • NMN supplementation effectively increases the level of NAD+. • The chemical and biological synthesis of NMN are comprehensively reviewed. • The impact of NMN on the treatment of various diseases is summarized.

A food bank program to help food pantries improve healthy food choices: mixed methods evaluation of The Greater Boston Food Bank's Healthy Pantry Program.

BACKGROUND: The Greater Boston Food Bank's (GBFB) Healthy Pantry Program (HPP) is an online training that teaches food pantry staff to implement behavioral nudges (e.g., traffic-light nutrition labels, choice architecture) to promote healthier client choices. This study assessed if HPP was associated with healthier food bank orders by food pantries and identified implementation facilitators and barriers. METHODS: This mixed methods study collected quantitative data from a matched cohort of 10 HPP food pantries and 99 matched control food pantries in eastern Massachusetts that allow clients to choose their own food, and qualitative data from structured individual interviews with 8 HPP pantry staff. A difference-in-differences analysis compared changes in percentage of pantries' food bank orders (by weight) of foods labeled green/yellow (healthier choices) and fresh produce from baseline to 6 and 10 months between HPP and control pantries. Interviews were coded for implementation facilitators and barriers. RESULTS: Before starting HPP, green-yellow ordering was 92.0% (SD 4.9) in control and 87.4% (SD 5.4) in HPP pantries. Participation in HPP was not associated with changes in green-yellow or fresh produce ordering at 6 or 10 months. HPP implementation facilitators included HPP training being accessible (sub-themes: customizable, motivating) and compatible with client-choice values. Barriers included resource limitations (sub-themes: staff shortage, limited space) and concerns about stigmatizing client food choices with use of labels for unhealthy foods. CONCLUSIONS: An online program to help pantries promote healthier client choices was not associated with changes in how much healthy food pantries ordered from the food bank, suggesting it did not substantially change client choices. Implementation challenges and high baseline healthy ordering may have influenced HPP's effectiveness.

Co-creation of health-enabling initiatives in food retail: academic perspectives.

INTRODUCTION: Co-creation of healthy food retail comprises the systematic collaboration between retailers, academics and other stakeholders to improve the healthiness of food retail environments. Research into the co-creation of healthy food retail is in its early stages. Knowledge of the roles and motivations of stakeholders in intervention design, implementation and evaluation can inform successful co-creation initiatives. This study presents academic experiences of stakeholder roles and motivations in the co-creation of healthy food retail environments. METHODS: Purposive sampling of academics with research experience in the co-creation of healthy food retail initiatives. Semi-structured interviews conducted between October and December 2021 gathered participants' experiences of multi-stakeholder collaborative research. Thematic analysis identified enablers, barriers, motivations, lessons and considerations for future co-creation of healthy food retail. RESULTS: Nine interviewees provided diverse views and applications of co-creation research in food retail environments. Ten themes were grouped into three overarching areas: (i) identification of stakeholders required for changes to healthier food retail; (ii) motivations and interactions, which included the intrinsic desire to build healthier communities along with recognition of their work; and (iii) barriers and enablers included adequate resourcing, effective and trusting working relationships and open communications. CONCLUSION: This study provides insights that could help future co-creation in healthy food retail environments. Trusting and respectful relationships and reciprocal acknowledgement between stakeholders are key practices in the co-creation process. These constructs should be considered in developing and testing a model that helps to systematically co-create healthy food retail initiatives that ensure all parties meet their needs while also delivering research outcomes.

The palm or the plate? An assessment of dietary guideline promotion, awareness, and preferences among Saudis: cross-sectional survey.

BACKGROUND: Dietary Guidelines for Saudis are offered and promoted in two forms: the Healthy Food Palm and the Saudi Healthy Plate. However, public awareness, recognition, and engagement with these guidelines is not well studied. Understanding the factors behind dietary guideline promotion, awareness, recognition, and use may lead to greater optimization of and engagement with the guidelines. This study aims to assess recognition of and public engagement with the My Palm and My Plate dietary guidelines as well as dietary guideline awareness, perceptions, and preferences among Saudis. METHODS: To compare awareness, knowledge, and usability between the Healthy Food Palm and the Saudi Healthy Plate dietary guidelines, a cross-sectional survey-based study was conducted among Saudi adult males and females above 18 (n = 674) between October 2021 and January 2022. Participants were split into groups based on age and gender. T-test and χ2 tests were used to determine differences between groups for continuous and categorical variables, respectively. RESULTS: Most participants were unaware of the Healthy Food Palm and the Saudi Healthy Plate guidelines, with only 11.1% and 30.3% able to recognize guideline-associated visual illustrations, respectively. However, nearly half of the participants correctly identified the number of food groups in the Healthy Food Palm and Saudi Healthy Plate. As well, more than half of the sample preferred the Saudi Healthy Plate, while one-quarter of the sample preferred neither guideline. In terms of future public health promotion, participants identified that "convenience and availability" (29.6%) and "my own health" (28.6%) were the most influential dietary choice factors with "social media campaigns" (2.4%) and the involvement of "an influencer" (3.1%) being the least influential dietary choice factors. CONCLUSIONS: Implementation of and public awareness of dietary guidelines is less than optimal, and opportunities exist for greater information dissemination and public engagement. Measurement and ongoing evaluation of public dietary guideline awareness and use and a more in-depth understanding of dietary choice influences and behaviors are important considerations for dietary guideline development and promotion.

The combined effect of front-of-package labels and influencer recommendations on food choice decisions.

Many governments have adopted front-of-pack nutrition labels (FOP labels) that give advice about how healthy a product is. An increasing number of digital food influencers are also informing consumers about the nutritional quality of products and promoting healthy consumption. In this context, the current study analyzes how both sources of information come together to affect purchase intention. Drawing on congruence theory, we propose that the influencer's recommendation reinforces the effect of the FOP label when there is congruence between the two; however, consumers clearly prefer to follow the recommendation of the influencer over the FOP label when the information sources are non-congruent. We develop a between-subjects experimental design in which the level of congruence between the two information sources is manipulated. The effect of the influencer on purchase intention is mediated by the credibility of the FOP label. A second study confirms the superiority of the influencer effect observed in the first study.

Trends in functional food development with three-dimensional (3D) food printing technology: prospects for value-added traditionally processed food products.

One of the recent, innovative, and digital food revolutions gradually gaining acceptance is three-dimensional food printing (3DFP), an additive technique used to develop products, with the possibility of obtaining foods with complex geometries. Recent interest in this technology has opened the possibilities of complementing existing processes with 3DFP for better value addition. Fermentation and malting are age-long traditional food processes known to improve food value, functionality, and beneficial health constituents. Several studies have demonstrated the applicability of 3D printing to manufacture varieties of food constructs, especially cereal-based, from root and tubers, fruit and vegetables as well as milk and milk products, with potential for much more value-added products. This review discusses the extrusion-based 3D printing of foods and the major factors affecting the process development of successful edible 3D structures. Though some novel food products have emanated from 3DFP, considering the beneficial effects of traditional food processes, particularly fermentation and malting in food, concerted efforts should also be directed toward developing 3D products using substrates from these conventional techniques. Such experimental findings will significantly promote the availability of minimally processed, affordable, and convenient meals customized in complex geometric structures with enhanced functional and nutritional values.

Evaluation and prioritization of actions on food environments to address the double burden of malnutrition in Senegal: perspectives from a national expert panel.

OBJECTIVE: To evaluate the extent of implementation of public policies aimed at creating healthy eating environments in Senegal compared to international best practice and identity priority actions to address the double burden of malnutrition. DESIGN: The Healthy Food Environment Policy Index (Food-EPI) was used by a local expert panel to assess the level of implementation of 43 good practice policy and infrastructure support indicators against international best practices using a Likert scale and identify priority actions to address the double burden of malnutrition in Senegal. SETTING: Senegal, West Africa. PARTICIPANTS: A national group of independent experts from academia, civil society, non-governmental organizations and United Nations bodies (n =15) and a group of government experts from various ministries (n =16) participated in the study. RESULTS: Implementation of most indicators aimed at creating healthy eating environments were rated as "low" compared to best practice (31 on 43, or 72%). The Gwet AC2 inter-rater reliability was good at 0.75 (CI 0.70 - 0.80). In a prioritization workshop, experts identified forty-five actions, prioritizing ten as relatively most feasible and important and relatively most effective to reduce the double burden of malnutrition in Senegal (example: Develop and implement regional school menus based on local products (expand to 14 regions) and measure the extent of the promotion of unhealthy foods to children). CONCLUSIONS: Significant efforts remain to be made by Senegal to improve food environments. This project allowed to establish an agenda of priority actions for the government to transform food environments in Senegal to tackle the double burden of malnutrition.

Benchmarking for accountability on obesity prevention: evaluation of the Healthy Food Environment Policy Index (Food-EPI) in Australia (2016-2020).

OBJECTIVE: Despite broad agreement on the need for comprehensive policy action to improve the healthiness of food environments, implementation of recommended policies has been slow and fragmented. Benchmarking is increasingly being used to strengthen accountability for action. However, there have been few evaluations of benchmarking and accountability initiatives to understand their contribution to policy change. This study aimed to evaluate the impact of the Healthy Food Environment Policy Index (Food-EPI) Australia initiative (2016-2020) that assessed Australian governments on their progress in implementing recommended policies for improving food environments. DESIGN: A convergent mixed methods approach was employed incorporating data from online surveys (conducted in 2017 and 2020) and in-depth semi-structured interviews (conducted in 2020). Data were analysed against a pre-defined logic model. SETTING: Australia. PARTICIPANTS: Interviews: twenty stakeholders (sixteen government, four non-government). Online surveys: fifty-three non-government stakeholders (52 % response rate) in 2017; thirty-four non-government stakeholders (36 % response rate) in 2020. RESULTS: The Food-EPI process involved extensive engagement with government officials and the broader public health community across Australia. Food-EPI Australia was found to support policy processes, including as a tool to increase knowledge of good practice, as a process for collaboration and as an authoritative reference to support policy decisions and advocacy strategies. CONCLUSIONS: Key stakeholders involved in the Food-EPI Australia process viewed it as a valuable initiative that should be repeated to maximise its value as an accountability mechanism. The highly collaborative nature of the initiative was seen as a key strength that could inform design of other benchmarking processes.

An assessment of implementation gaps and priority recommendations on food environment policies: the Healthy Food Environment Policy Index in Japan.

OBJECTIVE: The current study aimed to evaluate policies and actions for food environments by the Japanese Government using the Healthy Food Environment Policy Index (Food-EPI). DESIGN: Public health experts rated the extent of implementation of food environment-related Policy and the Infrastructure-support components, compared with international best practices. Subsequently, the experts proposed and prioritised future actions to address implementation gaps in an online workshop. SETTING: Japan. PARTICIPANTS: A total of sixty-six experts rated policy implementation by the Japanese Government and twenty-three participated in the workshop on future actions. RESULTS: The implementations of regulations on unhealthy foods and non-alcoholic beverages were rated low in the domains of Food composition, Food labelling and Food promotion, Food prices and Food retail in the Policy component. The implementations of several domains in the Infrastructure-support component were, overall, rated at a higher level, specifically for monitoring and intelligence systems. Based on the rating, reducing health inequalities by supporting people, both economically and physically, was the highest priority for future actions in both components. CONCLUSIONS: The current study found that Japan has a robust system for long-term monitoring of population health but lacks regulations on unhealthy foods and non-alcoholic beverages compared with international best practices. The current study confirmed the importance of continuous accumulation of evidence through national monitoring systems. Developing comprehensive regulations to restrict food marketing, sales and accessibility of unhealthy foods and non-alcoholic beverages is needed to improve the health of food environments in Japan.

Supplemental Nutrition Assistance Program (SNAP)-authorized retailers received a low score using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool.

BACKGROUND: The Supplemental Nutrition Assistance Program (SNAP) supports Americans with lower income to purchase dietary products at authorized retailers. This research aimed to evaluate SNAP-authorized retailers' public commitments in support of nutrition security and to examine differences between traditional grocers and nontraditional (e.g., convenience, drug, dollar) SNAP-authorized retailers' public commitments. METHODS: Prominent United States (U.S.) SNAP-authorized retailers nationally and in two U.S. states (California and Virginia) were identified based on number of store locations (n = 61). Public information available in grey literature were reviewed and scored using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool. SNAP-authorized retailers were classified as traditional (e.g., grocery) or nontraditional (e.g., non-grocery) retailers. Total BIA-Obesity from 0 to 615, representing low to optimal support) and category scores were calculated for corporate strategy, relationships with external organizations, product formulation, nutrition labeling, product and brand promotion, and product accessibility. Descriptive statistics were used to describe BIA-Obesity scores overall and by category. Mann-Whitney U was used to test for potential differences in median BIA-Obesity total scores between traditional and nontraditional SNAP-authorized retailers (a priori, p < 0.05). RESULTS: Average total BIA-Obesity scores for SNAP-authorized retailers ranged from 0 to 112 (16.5 ± 23.3). Total BIA-Obesity scores for traditional SNAP-authorized retailers (32.7 ± 33.6; median 25) were higher than nontraditional SNAP-authorized retailer scores (11.2 ± 16; median 5) (p = 0.008). For BIA-Obesity categories, average scores were highest for the category relationships with external organizations (8.3 ± 10.3) and lowest for promotion practices (0.6 ± 2.1). CONCLUSIONS: Results of this research underscore a dearth of available evidence and substantial opportunity for improvement regarding SNAP-authorized retailer strategies to support nutrition security among Americans with lower income.