Supermarket top-up of Healthy Start vouchers increases fruit and vegetable purchases in low-income households.

Stark, widening health and income inequalities in the United Kingdom underpin the need for increased support for low-income families to access affordable and nutritious foods. Using anonymised supermarket loyalty card transaction records, this study aimed to assess how an additional Healthy Start voucher (HSV) top-up of £2, redeemable only against fruit and vegetables (FVs), was associated with FV purchases among at-risk households. Transaction and redemption records from 150 loyalty card-holding households, living in northern England, who had engaged with the top-up scheme, were analysed to assess the potential overall population impact. Using a pre-post study design, 133 of these households' records from 2021 were compared with equivalent time periods in 2019 and 2020. Records were linked to product, customer and store data, permitting comparisons using Wilcoxon matched-pairs sign-ranked tests and relationships assessed with Spearman's Rho. These analyses demonstrated that 0.9 more portions of FV per day per household were purchased during the scheme compared to the 2019 baseline (p = 0.0017). The percentage of FV weight within total baskets also increased by 1.6 percentage points (p = 0.0242), although the proportional spend on FV did not change. During the scheme period, FV purchased was higher by 0.4 percentage points (p = 0.0012) and 1.6 percentage points (p = 0.0062) according to spend and weight, respectively, in top-up redeeming baskets compared to non-top-up redeeming baskets with at least one FV item and was associated with 5.5 more HSV 'Suggested' FV portions (p < 0.0001). The median weight of FV purchased increased from 41.83 kg in 2019 to 54.14 kg in 2021 (p = 0.0017). However, top-up vouchers were only redeemed on 9.1% of occasions where FV were purchased. In summary, this study provides novel data showing that safeguarding funds exclusively for FV can help to increase access to FV in low-income households. These results yield important insights to inform public policy aimed at levelling up health inequalities.

Encouraging healthier grocery purchases online: A randomised controlled trial and lessons learned.

Online supermarket platforms present an opportunity for encouraging healthier consumer purchases. A parallel, double-blind randomised controlled trial tested whether promoting healthier products (e.g. lower fat and lower calorie) on the Sainsbury's online supermarket platform would increase purchases of those products. Participants were Nectar loyalty membership scheme cardholders who shopped online with Sainsbury's between 20th September and 10th October 2017. Intervention arm customers saw advertisement banners and recipe ingredient lists containing healthier versions of the products presented in control arm banners and ingredient lists. The primary outcome measure was purchases of healthier products. Additional outcome measures were banner clicks, purchases of standard products, overall purchases and energy (kcal) purchased. Sample sizes were small due to customers navigating the website differently than expected. The intervention encouraged purchases of some promoted healthier products (spaghetti [B = 2.10, p < 0.001], spaghetti sauce [B = 2.06, p < 0.001], spaghetti cheese [B = 2.45, p = 0.001], sour cream [B = 2.52, p < 0.001], fajita wraps [B = 2.10, p < 0.001], fajita cheese [B = 1.19, p < 0.001], bakery aisle products (B = 3.05, p = 0.003) and cola aisle products [B = 0.97, p < 0.002]) but not others (spaghetti mince, or products in the yogurt and ice cream aisles). There was little evidence of effects on banner clicks and energy purchased. Small sample sizes may affect the robustness of these findings. We discuss the benefits of collaborating to share expertise and implement a trial in a live commercial environment, alongside key learnings for future collaborative research in similar contexts.

Impact of Breakfast Skipping and Breakfast Choice on the Nutrient Intake and Body Mass Index of Australian Children.

Recent data on breakfast consumption among Australian children are limited. This study examined the impact of breakfast skipping and breakfast type (cereal or non-cereal) on nutrient intakes, likelihood of meeting nutrient targets and anthropometric measures. A secondary analysis of two 24-h recall data from the 2007 Australian National Children's Nutrition and Physical Activity Survey was conducted (2-16 years; n = 4487) to identify (a) breakfast skippers and (b) breakfast consumers, with breakfast consumers further sub-divided into (i) non-cereal and (ii) cereal consumers. Only 4% skipped breakfast and 59% of skippers were 14-16 years. Breakfast consumers had significantly higher intakes of calcium and folate, and significantly lower intakes of total fat than breakfast skippers. Cereal consumers were more likely to meet targets and consume significantly higher fibre, calcium, iron, had significantly higher intakes of folate, total sugars and carbohydrate, and significantly lower intakes of total fat and sodium than non-cereal consumers. The prevalence of overweight was lower among breakfast consumers compared to skippers, and among cereal consumers compared to-cereal consumers (p < 0.001), while no significant differences were observed for mean body mass index (BMI), BMI z-score, waist circumference and physical activity level across the categories. Breakfast and particularly breakfast cereal consumption contributes important nutrients to children's diets.

The nurse's role in promoting weight loss and encouraging healthier lifestyles.

The increasing incidence of obesity in the UK has prompted a range of initiatives to raise awareness of the problem. In view of the well-known links between obesity and chronic disease, the focus is now on addressing the issue as part of patient care by advising adults and children on weight management and changes in diet and exercise.