Barriers and facilitators to implementation of healthy food and drink policies in public sector workplaces: a systematic literature review.

CONTEXT: Many countries and institutions have adopted policies to promote healthier food and drink availability in various settings, including public sector workplaces. OBJECTIVE: The objective of this review was to systematically synthesize evidence on barriers and facilitators to implementation of and compliance with healthy food and drink policies aimed at the general adult population in public sector workplaces. DATA SOURCES: Nine scientific databases, 9 grey literature sources, and government websites in key English-speaking countries along with reference lists. DATA EXTRACTION: All identified records (N = 8559) were assessed for eligibility. Studies reporting on barriers and facilitators were included irrespective of study design and methods used but were excluded if they were published before 2000 or in a non-English language. DATA ANALYSIS: Forty-one studies were eligible for inclusion, mainly from Australia, the United States, and Canada. The most common workplace settings were healthcare facilities, sports and recreation centers, and government agencies. Interviews and surveys were the predominant methods of data collection. Methodological aspects were assessed with the Critical Appraisal Skills Program Qualitative Studies Checklist. Generally, there was poor reporting of data collection and analysis methods. Thematic synthesis identified 4 themes: (1) a ratified policy as the foundation of a successful implementation plan; (2) food providers' acceptance of implementation is rooted in positive stakeholder relationships, recognizing opportunities, and taking ownership; (3) creating customer demand for healthier options may relieve tension between policy objectives and business goals; and (4) food supply may limit the ability of food providers to implement the policy. CONCLUSIONS: Findings suggest that although vendors encounter challenges, there are also factors that support healthy food and drink policy implementation in public sector workplaces. Understanding barriers and facilitators to successful policy implementation will significantly benefit stakeholders interested or engaging in healthy food and drink policy development and implementation. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42021246340.

The prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in a representative sample of New Zealand adults.

OBJECTIVE: This study aimed to estimate the prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in New Zealand adults. We also examined socio-demographic and lifestyle correlates of these dietary patterns. DESIGN: The New Zealand Health Survey is a representative rolling cross-sectional survey of New Zealanders; data from the 2018/19 and 2019/20 waves were used for this analysis. Participants were asked if they completely excluded red meat, poultry, fish/shellfish, eggs or dairy products from their diet. SETTING: New Zealand. PARTICIPANTS: Adults, aged ≥ 15 years (n 23 292). RESULTS: The prevalence of red-meat excluders (2·89 %), pescatarians (1·40 %), vegetarians (2·04 %) and vegans (0·74 %) was low. After adjustment for socio-demographic and lifestyle factors, women (OR = 1·54, 95 % CI: 1·22, 1·95), Asian people (OR = 2·56, 95 % CI: 1·96, 4·45), people with tertiary education (OR = 1·71, 95 % CI: 1·18, 2·48) and physically active people (OR = 1·36, 95 % CI: 1·04, 1·76) were more likely to be vegetarian/vegan. Those aged ≥ 75 years (OR = 0·28, 95 % CI: 0·14, 0·53) and current smokers (OR = 0·42, 95 % CI: 0·23, 0·76) were less likely to be vegetarian/vegan. Similar associations were seen between socio-demographic and lifestyle factors and the odds of being a red-meat excluder/pescatarian. CONCLUSIONS: Approximately 93 % of New Zealand adults eat red meat and a very small number exclude all animal products from their diets. The Eating and Activity Guidelines for New Zealand adults recommend a plant-based diet with moderate amounts of animal-source foods. A comprehensive national nutrition survey would provide detailed information on the amount of red meat and other animal-source foods that the New Zealand population currently consumes.

Meat-Free Mondays in Hospital Cafés in Aotearoa, New Zealand.

Current human meat consumption levels contribute to environmental degradation and are a risk factor for non-communicable diseases. Globally, meat-reduction policy interventions are limited. Meat-Free Mondays (MFMs) is a global campaign to reduce meat consumption to improve planetary and human health. We conducted a mixed methods evaluation of MFMs at three District Health Boards (DHBs) (one not considering a MFM policy, one that had trialled MFMs and one implementing MFMs) to investigate attitudes towards MFMs and barriers and enablers to implementation. An online staff survey and eleven semi-structured interviews with food service managers, café managers and sustainability managers were conducted. Of the 194 survey participants, 51% were actively cutting back on meat, mainly for health, environmental concerns and enjoyment of plant-based dishes, and 59% were positive towards MFMs. Qualitative analysis using a general inductive approach identified four themes: (1) 'Change and choice' (impact on personal choice), (2) 'Getting it right' (product and price, food quality, health, customer retention and sales), (3) 'Human and planetary health' (hospitals as leaders in healthy, sustainable diets), (4) 'Implementation success' (communication and education). Recommendations for implementation of MFMs included seeking feedback from other DHBs, wide consultation with food service staff, cultural and dietitian food service support and providing evidence of the success of MFMs and alternatives to MFMs.

Tools and resources used to support implementation of workplace healthy food and drink policies: A scoping review of grey literature.

AIMS: This study aimed to identify and evaluate tools and resources used to support the implementation of workplace healthy food and drink policies, primarily in Australia and New Zealand. METHODS: A scoping grey literature review included searches of government agencies and non-governmental organisations' websites in six English-speaking countries, public health nutrition intervention databases and Google search engine queries. Paper-based and digital tools were included if they were written in English, referred to within a policy or on a policy's website, and primarily targeting supply-side stakeholders. Tools were evaluated on two domains: 'Features' (summarised descriptively) and 'Usability and Quality' (with inter-rater reliability scores calculated using an intraclass correlation coefficient). RESULTS: Twenty paper-based tools were identified relating to Australian (n = 14) and New Zealand (n = 6) policies, and a further six digital tools were identified from Australia (n = 3) and Canada (n = 3). Target audiences included workplace managers, food providers and suppliers. The paper-based tools focused on general implementation guidance. In contrast, digital tools tended to support specific elements of policy implementation. 'Usability and Quality' scores ranged from 2.9 to 4.5 (out of 5.0) for paper-based tools, and 3.9 to 4.2 for digital tools, with a moderate agreement between reviewer scores (intraclass correlation coefficient 0.523, p = 0.010). CONCLUSIONS: A range of tools have been developed to support the implementation of workplace healthy food and drink policies. Understanding the strengths and limitations of current tools will assist in developing improved aids to support policy implementation.

Nutrient content and cost of canned and dried legumes and plant-based meat analogues available in New Zealand supermarkets.

AIMS: Plant-based eating patterns are recommended for human and planetary health. Plant-based protein sources in supermarkets include traditional options and plant-based meat analogues. This cross-sectional survey examined the nutritional content, healthiness, cost and labelling of these products. METHODS: Nutrient content and claims on canned legumes (plain [N = 64] and flavoured [N = 25]), canned baked beans (N = 23), dried legumes (N = 21), tofu (plain [N = 8] and flavoured [N = 5]), falafels (N = 14), meat analogues (meat-free burgers [N = 11], meat-free sausages [N = 10] and 'other' meat-free products [N = 20]) were obtained from a database of packaged foods in New Zealand. Mean (SD) energy, protein, total fat, saturated fat, sodium and dietary fibre content (per 100 g) was calculated for each category. Healthiness was assessed using an estimated Health Star Rating (Rating ≥3.5 considered 'healthy'). Product data were linked with household purchasing data from the 2019 Nielsen IQ® consumer panel to calculate mean purchase price/100 g/category. The number and type of nutrition claims were compared across categories. RESULTS: The highest mean protein content was 'other' meat-free products (14.8 ± 6.9 g/100 g). Meat-free sausages had the highest sodium and saturated fat content (643 ± 148 mg/100 g, 3.7 ± 4.5 g/100 g). Overall, few meat analogues (N = 5, 12%) scored an estimated Health Star Rating ≥3.5. Dried legumes were the cheapest plant protein (mean ± SD) purchase price = NZ $0.30 ± 0.16/100 g), compared with 'other' meat-free products (purchase price = NZ $2.57 ± 0.88/100 g). The most common nutrition claims on meat analogues were about protein content. Dietary fibre claims were the most common on canned and dried legumes. CONCLUSION: Meat analogues offer convenience, however, may be less healthy and more expensive than traditional plant-based proteins. This study assists dietitians in providing accurate consumer messaging about healthy plant-based proteins.

The utilisation of legal instruments by United Nations actors to restrict the exposure of children to unhealthy food and beverage marketing: a qualitative content analysis of UN instruments.

INTRODUCTION: United Nations (UN) agencies are influential global health actors that can introduce legal instruments to call on Member States to act on pressing issues. This paper examines the deployment and strength of global health law instruments used by UN actors to call on Member States to restrict the exposure of children to unhealthy food and beverage marketing. METHODS: Global health law instruments were identified from a review of four UN agencies that have a mandate over children's exposure to marketing of unhealthy food and beverage products namely: the World Health Organization (WHO); the Food and Agriculture Organization (FAO); the United Nations General Assembly (UNGA) and the UN Office of the High Commissioner for Human Rights (OHCHR). Data on marketing restrictions were extracted and coded and descriptive qualitative content analysis was used to assess the strength of the instruments. RESULTS: A wide range of instruments have been used by the four agencies: seven by the WHO; two by the FAO; three by the UNGA; and eight by the UN human rights infrastructure. The UN human rights instruments used strong, consistent language and called for government regulations to be enacted in a directive manner. In contrast, the language calling for action by the WHO, FAO and UNGA was weaker, inconsistent, did not get stronger over time and varied according to the type of instrument used. CONCLUSION: This study suggests that a child rights-based approach to restricting unhealthy food and beverage marketing to children would be supported by strong human rights legal instruments and would allow for more directive recommendations to Member States than is currently provided by WHO, FAO and UNGA. Strengthening the directives in the instruments to clarify Member States' obligations using both WHO and child rights mandates would increase the utility of global health law and UN actors' influence.

Product promotional strategies in supermarkets and their effects on sales: A case study of breakfast cereals and drinks in New Zealand.

AIMS: To examine the frequency of promotions on breakfast cereals and drinks in a major New Zealand supermarket chain, determine the healthiness of promoted versus non-promoted products, and quantify the effects of promotions on sales. METHODS: Weekly data on product promotions and sales were collected in six Auckland supermarkets for 198 breakfast products over 12 weeks. The healthiness of products was determined using the Health Star Rating system, and the effect of promotions on sales was estimated using linear mixed models. RESULTS: On average, 47% of breakfast products in a given week were promoted using on-shelf tickets, 12% in weekly mailers, and 9% via promotional displays. The healthiness of promoted and non-promoted breakfast products was comparable. In relation to weekly sales of non-promoted products, all three promotional strategies had substantial (2 to 2.5 times higher sales) and statistically significant (P < 0.001) effects on product sales. CONCLUSION: Promotions are frequently used and effective at increasing sales. Marketing strategies focusing solely on promoting healthier products could be an important nudging strategy to improve the healthiness of supermarket food purchases.

Unhealthy food and beverage marketing to children on digital platforms in Aotearoa, New Zealand.

BACKGROUND: Children's exposure to unhealthy food and beverage marketing has a direct impact on their dietary preference for, and consumption of, unhealthy food and drinks. Most children spend time online, yet marketing restrictions for this medium have had slow uptake globally. A voluntary Children's and Young People's Advertising (CYPA) Code was implemented in Aotearoa, New Zealand (NZ) in 2017. This study explores the Code's limitations in protecting children from harmful food and beverage marketing practices on digital platforms accessible to children. METHODS: A cross-sectional content analysis of company websites (n = 64), Facebook pages (n = 32), and YouTube channels (n = 15) of the most popular food and beverage brands was conducted between 2019 and 2021 in NZ. Brands were selected based on market share, web traffic analysis and consumer engagement (Facebook page 'Likes' and YouTube page views). Analysis focused on volume and type of food posts/videos, level of consumer interaction, nutritional quality of foods pictured (based on two different nutrient profile models), and use of specific persuasive marketing techniques. RESULTS: Eighty-one percent of websites (n = 52) featured marketing of unhealthy food and beverages. Thirty-five percent of websites featuring unhealthy food and beverages used promotional strategies positioning their products as 'for kids'; a further 13% used 'family-oriented' messaging. Several websites featuring unhealthy products also had designated sections for children, 'advergaming,' or direct messaging to children. Eighty-five percent of all food and drink company Facebook posts and YouTube videos were classified as unhealthy. Twenty-eight percent of Facebook posts for unhealthy products featured persuasive promotional strategies, and 39% premium offers. Nearly 30% of YouTube videos for unhealthy food and beverages featured promotional strategies, and 13% premium offers. Ten percent of Facebook posts and 13% of YouTube videos of unhealthy food and beverages used marketing techniques specifically targeting children and young people. CONCLUSIONS: The voluntary CYPA Code has been in effect since 2017, but the inherent limitations and loopholes in the Code mean companies continue to market unhealthy food and beverages in ways that appeal to children even if they have committed to the Code. Comprehensive and mandatory regulation would help protect children from exposure to harmful marketing.

2021 Assessment of New Zealand district health boards' institutional healthy food and drink policies: the HealthY Policy Evaluation (HYPE) study.

AIM: To assess adoption of the voluntary National Healthy Food and Drink Policy (NHFDP) and the alignment of individual institutional healthy food and drink policies with the NHFDP. METHOD: All 20 district health boards (DHBs) and two national government agencies participated. Policies of those organisations that had not fully adopted the NHFDP were assessed across three domains: nutrition standards; promotion of a healthy food and beverages environment; and policy communication, implementation and evaluation. Three weighted domain scores out of 10, and a total score out of 30 were calculated. RESULTS: Nine of the 22 organisations reported adopting the NHFDP in full. Of the remaining 13, six referred to the NHFDP when developing their institutional policy and three were working toward full adoption of the NHFDP. Mean scores (SD) were 8.7 (1.0), 6.1 (2.6) and 3.8 (2.2) for the three domains, and 18.6 (4.8) in total. Most individual institutional policies were not as comprehensive as the NHFDP. However, some contained stricter/additional clauses that would be useful to incorporate into the NHFDP. CONCLUSION: Since a similar policy analysis in 2018, most DHBs have adopted the NHFDP and/or strengthened their own nutrition policies. Regional inconsistency remains and a uniform mandatory NHFDP should be implemented that incorporates improvements identified in individual institutional policies.

Designing legislative responses to restrict children's exposure to unhealthy food and non-alcoholic beverage marketing: a case study analysis of Chile, Canada and the United Kingdom.

INTRODUCTION: Introducing legislation that restricts companies from exposing children to marketing of unhealthy food and beverage products is both politically and technically difficult. To advance the literature on the technical design of food marketing legislation, and to support governments around the world with legislative development, we aimed to describe the legislative approach from three governments. METHODS: A multiple case study methodology was adopted to describe how three governments approached designing comprehensive food marketing legislation (Chile, Canada and the United Kingdom). A conceptual framework outlining best practice design principles guided our methodological approach to examine how each country designed the technical aspects of their regulatory response, including the regulatory form adopted, the substantive content of the laws, and the implementation and governance mechanisms used. Data from documentary evidence and 15 semi-structured key informant interviews were collected and synthesised using a directed content analysis. RESULTS: All three countries varied in their legislative design and were therefore considered of variable strength regarding the legislative elements used to protect children from unhealthy food marketing. When compared against the conceptual framework, some elements of best practice design were present, particularly relating to the governance of legislative design and implementation, but the scope of each law (or proposed laws) had limitations. These included: the exclusion of brand marketing; not protecting children up to age 18; focusing solely on child-directed marketing instead of all marketing that children are likely to be exposed to; and not allocating sufficient resources to effectively monitor and enforce the laws. The United Kingdom's approach to legislation is the most comprehensive and more likely to meet its regulatory objectives. CONCLUSIONS: Our synthesis and analysis of the technical elements of food marketing laws can support governments around the world as they develop their own food marketing restrictions. An analysis of the three approaches illustrates an evolution in the design of food marketing laws over time, as well as the design strengths offered by a legislative approach. Opportunities remain for strengthening legislative responses to protect children from unhealthy food marketing practices.

Perspective: Food Environment Research Priorities for Africa-Lessons from the Africa Food Environment Research Network.

Over the last 2 decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization, and development. These changes have altered African food environments and, subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transition have contributed to Africa's complex burden of malnutrition-obesity and other diet-related noncommunicable diseases (DR-NCDs)-along with persistent food insecurity and undernutrition. Available evidence links unhealthy or obesogenic food environments (including those that market and offer energy-dense, nutrient-poor foods and beverages) with suboptimal diets and associated adverse health outcomes. Elsewhere, governments have responded with policies to improve food environments. However, in Africa, the necessary research and policy action have received insufficient attention. Contextual evidence to motivate, enable, and create supportive food environments in Africa for better population health is urgently needed. In November 2020, the Measurement, Evaluation, Accountability, and Leadership Support for Noncommunicable Diseases Prevention Project (MEALS4NCDs) convened the first Africa Food Environment Research Network Meeting (FERN2020). This 3-d virtual meeting brought researchers from around the world to deliberate on future directions and research priorities related to improving food environments and nutrition across the African continent. The stakeholders shared experiences, best practices, challenges, and opportunities for improving the healthfulness of food environments and related policies in low- and middle-income countries. In this article, we summarize the proceedings and research priorities identified in the meeting to advance the food environment research agenda in Africa, and thus contribute to the promotion of healthier food environments to prevent DR-NCDs, and other forms of malnutrition.

Implementing healthy food environment policies in New Zealand: nine years of inaction.

BACKGROUND: The INFORMAS [International Network for Food and Obesity/Non-communicable Diseases (NCDs) Research, Monitoring and Action Support] Healthy Food Environment Policy Index (Food-EPI) was developed to evaluate the degree of implementation of widely recommended food environment policies by national governments against international best practice, and has been applied in New Zealand in 2014, 2017 and 2020. This paper outlines the 2020 Food-EPI process and compares policy implementation and recommendations with the 2014 and 2017 Food-EPI. METHODS: In March-April 2020, a national panel of over 50 public health experts participated in Food-EPI. Experts rated the extent of implementation of 47 "good practice" policy and infrastructure support indicators compared to international best practice, using an extensive evidence document verified by government officials. Experts then proposed and prioritized concrete actions needed to address the critical implementation gaps identified. Progress on policy implementation and recommendations made over the three Food-EPIs was compared. RESULTS: In 2020, 60% of the indicators were rated as having "low" or "very little, if any" implementation compared to international benchmarks: less progress than 2017 (47%) and similar to 2014 (61%). Of the nine priority actions proposed in 2014, there was only noticeable action on one (Health Star Ratings). The majority of actions were therefore proposed again in 2017 and 2020. In 2020 the proposed actions were broader, reflecting the need for multisectoral action to improve the food environment, and the need for a mandatory approach in all policy areas. CONCLUSIONS: There has been little to no progress in the past three terms of government (9 years) on the implementation of policies and infrastructure support for healthy food environments, with implementation overall regressing between 2017 and 2020. The proposed actions in 2020 have reflected a growing movement to locate nutrition within the wider context of planetary health and with recognition of the social determinants of health and nutrition, resulting in recommendations that will require the involvement of many government entities to overcome the existing policy inertia. The increase in food insecurity due to COVID-19 lockdowns may provide the impetus to stimulate action on food polices.

Impact of a voluntary industry code for advertising food to children and young people: an analysis of New Zealand television data.

OBJECTIVE: To evaluate the impact of the 2017 update to the voluntary Advertising Standards Authority (ASA) code for advertising food on children and young people's exposure to unhealthy food advertisements on New Zealand television. DESIGN: Audience ratings data were analysed for New Zealand children and young people's television viewing for eight random days prior to (June to August 2015) and following (October to December 2018) the code update, from 06.00 to midnight (864 h). Food advertisements were coded using three nutrient profiling models. The number of children and young people watching television each year was compared. SETTING: Three free-to-air New Zealand television channels. PARTICIPANTS: New Zealand children aged 5-18 years. RESULTS: Television viewer numbers decreased over the 3 years (P < 0·0001). The mean rate of unhealthy food advertising on weekdays was 10·4 advertisements/h (2015) and 9·5 advertisements/h (2018). Corresponding rates for weekend days were 8·1 and 7·3 advertisements/h, respectively. The percentage of food advertisements which were for unhealthy foods remained high (63·7 % on weekdays and 65·9 % on weekends) in 2018. The ASA definition of children's 'peak viewing time' (when 25 % of the audience are children) did not correspond to any broadcast times across weekdays and weekend days. CONCLUSIONS: Between 2015 and 2018, children and young people's television exposure to unhealthy food advertising decreased. However, almost two-thirds of all food advertisements were still unhealthy, and the updated ASA code excluded the times when the greatest number of children was watching television. Consequently, government regulation and regular monitoring should reflect the evolving food marketing environment.

Energy, Sodium, Sugar and Saturated Fat Content of New Zealand Fast-Food Products and Meal Combos in 2020.

This study aimed to benchmark the healthiness of the New Zealand (NZ) fast-food supply in 2020. There are currently no actions or policies in NZ regarding the composition, serving size and labeling of fast food. Data on serving size and nutrient content of products was collected from company websites and in-store visits to 27 fast-food chains. For each fast-food category and type of combo meal, medians and interquartile ranges were calculated for serving size and energy, sodium, total sugar, and saturated fat per serving. Nutrient contents/serving were benchmarked against the United Kingdom (UK) soft drinks levy sugar thresholds and targets for salt for away from home foods, the NZ daily intake guidelines for energy, sodium, and saturated fat, and the World Health Organization (WHO) recommendation for free sugars. Analyses were conducted for the 30.3% (n = 1772) of products with available nutrition information and for 176 meal combos. Most (n = 67; 91.8%) sugar-sweetened drinks would qualify for a UK soft drink industry levy and 47% (n = 1072) of products exceeded the relevant UK sodium target. Half of the meal combos provided at least 50.3% of the daily energy requirements and at least 88.6% of the maximum recommended intake of sodium. Fast-food products and combo meals in NZ contribute far more energy and negative nutrients to recommended daily intake targets than is optimal for good health. The NZ Government should set reformulation targets and serving size guidance to reduce the potential impact of fast- food consumption on the health of New Zealanders.

Comparison of Healthiness, Labelling, and Price between Private and Branded Label Packaged Foods in New Zealand (2015-2019).

We aimed to compare New Zealand private label (PL) and branded label (BL) packaged food products in relation to their current (2019) healthiness (sodium and sugar contents, and estimated Health Star Rating (HSR) score), display of the voluntary HSR nutrition label on the package, and price. Healthiness and HSR display of products were also explored over time (2015 to 2019). Data were obtained from Nutritrack, a brand-specific food composition database. Means and proportions were compared using Student t-tests and Pearson chi-square tests, respectively. Changes over time were assessed using linear regression and chi-square tests for trends (Mantel-Haenzel tests). Altogether, 4266 PL and 19,318 BL products across 21 food categories were included. Overall, PL products in 2019 had a significantly lower mean sodium content and price, a higher proportion of products with estimated HSR ≥ 3.5/5 (48.9% vs. 38.5%) and were more likely to display the HSR on the pack compared with BL products (92.4% vs. 17.2%, respectively). However, for most food categories, no significant difference was found in mean sodium or sugar content between PL and BL products. In the period 2015-2019, there were no consistent changes in estimated HSR score, sodium or sugar contents of PL or BL products, but there was an increase in the proportion of both PL and BL products displaying HSR labels. In most food categories, there were PL options available which were similar in nutritional composition, more likely to be labelled with the HSR, and lower in cost than their branded counterparts.

Cost and greenhouse gas emissions of current, healthy, flexitarian and vegan diets in Aotearoa (New Zealand).

OBJECTIVE: To compare the costs and climate impact (greenhouse gas emissions) associated with current and healthy diets and two healthy and environmentally friendly dietary patterns: flexitarian and vegan. DESIGN: Modelling study. SETTING: Aotearoa (New Zealand). MAIN OUTCOME MEASURES: The distribution of the cost and climate impact (kgCO2e/kg of food per fortnight) of 2 weekly current, healthy, vegan and flexitarian household diets was modelled using a list of commonly consumed foods, a set of quantity/serves constraints for each, and constraints for food group and nutrient intakes based on dietary guidelines (Eating and Activity Guidelines for healthy diets and EAT-Lancet reference diet for vegan and flexitarian diets) or nutrition survey data (current diets). RESULTS: The iterative creation of 210-237 household dietary intakes for each dietary scenario was achieved using computer software adapted for the purpose (DIETCOST). There were stepwise differences between diet scenarios (p<0.001) with the current diet having the lowest mean cost in New Zealand Dollars (NZ$584 (95% CI NZ$580 to NZ$588)) per fortnight for a family of four) but highest mean climate impact (597 kgCO2e (95% CI 590 to 604 kgCO2e)), followed by the healthy diet (NZ$637 (95% CI NZ$632 to NZ$642), 452 kgCO2e (95% CI 446 to 458 kgCO2e)), the flexitarian diet (NZ$728 (95% CI NZ$723 to NZ$734), 263 kgCO2e (95% CI 261 to 265 kgCO2e)) and the vegan diet, which had the highest mean cost and lowest mean climate impact (NZ$789, (95% CI NZ$784 to NZ$794), 203 kgCO2e (95% CI 201 to 204 kgCO2e)). There was a negative relationship between cost and climate impact across diets and a positive relationship within diets. CONCLUSIONS: Moving from current diets towards sustainable healthy diets (SHDs) will reduce climate impact but generally at a higher cost to households. The results reflect trade-offs, with the larger constraints placed on diets, the greater cost and factors such as nutritional adequacy, variety, cost and low-emissions foods being considered. Further monitoring and policies are needed to support population transitions that are country specific from current diets to SHD.

Measuring cost and affordability of current vs. healthy diets in Argentina: an application of linear programming and the INFORMAS protocol.

BACKGROUND: Food cost and affordability is one of the main barriers to improve the nutritional quality of diets of the population. However, in Argentina, where over 60% of adults and 40% of children and adolescents are overweight or obese, little is known about the difference in cost and affordability of healthier diets compared to ordinary, less healthy ones. METHODS: We implemented the "optimal approach" proposed by the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS). We modelled the current diet and two types of healthy diets, one equal in energy with the current diet and one 6.3% lower in energy by linear programming. Cost estimations were performed by collecting food product prices and running a Monte Carlo simulation (10,000 iterations) to obtain a range of costs for each model diet. Affordability was measured as the percentage contribution of diet cost vs. average household income in average, poor and extremely poor households and by income deciles. RESULTS: On average, households must spend 32% more money on food to ensure equal energy intake from a healthy diet than from a current model diet. When the energy intake target was reduced by 6.3%, the difference in cost was 22%. There are no reasonably likely situations in which any of these healthy diets could cost less or the same than the current unhealthier one. Over 50% of households would be unable to afford the modelled healthy diets, while 40% could not afford the current diet. CONCLUSIONS: Differential cost and affordability of healthy vs. unhealthy diets are germane to the design of effective public policies to reduce obesity and NCDs in Argentina. It is necessary to implement urgent measures to transform the obesogenic environment, making healthier products more affordable, available and desirable, and discouraging consumption of nutrient-poor, energy-rich foods.

The Timing, Nature and Extent of Social Media Marketing by Unhealthy Food and Drinks Brands During the COVID-19 Pandemic in New Zealand.

Background: Concerns have been raised that health and societal causes surrounding the COVID-19 pandemic were misappropriated by companies to promote their unhealthy products to vulnerable populations during a time of increased stress and hardship (i.e., COVID-washing). Social media is a common medium for unhealthy foods and beverage marketing due to lack of regulation and low levels of monitoring. Purpose: This study aimed to investigate the timing, nature and extent of COVID-washing on public social media accounts by New Zealand's major food and drink brands in the initial stage of the pandemic after the first case was detected in New Zealand and when stay-at-home lockdown restrictions (Level 4 and 3 Alert levels) were in place. Methods: A content analysis of social media posts from February to May 2020 by the twenty largest confectionery, snacks, non-alcoholic beverages, and quick-service restaurant (fast-food) brands was undertaken. COVID-19 related posts were identified and classified to investigate the timing, themes and engagement with social media marketing campaigns, flagging those that may breach New Zealand's Advertising Standards. Results: 14 of 20 unhealthy food and drink brands referenced COVID-19 in posts during the 4-month period, peaking during nationwide lockdown restrictions. Over a quarter of all posts by the 14 brands (n = 372, 27.2%) were COVID-19 themed. Fast-food brands were most likely to use COVID-19 themed posts (n = 251/550 posts, 46%). Fast-food brands also had the highest number of posts overall during the pandemic and the highest engagement. The most commonly-used theme, present in 36% of all social media posts referring to COVID-19, was to draw on feelings of community support during this challenging time. Suggesting brand-related isolation activities was also common (23%), and the message that "consumption helps with coping" (22%). Six posts were found to potentially breach one of New Zealand's advertising standards codes by promoting excessive consumption or targeting children. Conclusion: COVID-washing was used by unhealthy food and drinks brands to increase brand loyalty and encourage consumption. The current Advertising Standards system is ineffective and must be replaced with a government-led approach to effectively regulate social media advertising to protect all New Zealanders, particularly in times of crisis.

Which companies dominate the packaged food supply of New Zealand and how healthy are their products?

Improvement of national food supplies are an opportunity to improve a country's health. Our aim was to identify the major food companies manufacturing packaged foods and non-alcoholic beverages available in New Zealand supermarkets in 2018; to assess the healthiness of products using (1) the Health Star Rating (HSR) system, (2) Australian Dietary Guidelines classification (core/discretionary), and (3) by level of processing; to compare the healthiness of products displaying and not displaying the HSR and; to assess potential for food reformulation within selected food sub-categories. Information on packaged foods was obtained from the Nutritrack supermarket database. Companies that manufactured each food and brand were identified using company websites and the New Zealand companies register. In total, 13,506 packaged products were mapped to 1,767 brands and 1,214 companies. Based on market share of products available for sale (Euromonitor data), there were 22 dominating companies producing 31% of products and 17% of brands. Fifty-nine percent of products were classified as unhealthy (HSR <3.5/5 stars), 53% as discretionary, and 69% as ultra-processed. Products displaying the HSR on the package had a higher mean HSR ±SD than if the HSR was not displayed (3.2±1.3 versus 2.5±1.4, p = 0.000). Efforts to improve the healthiness of products should be directed to the 22 food companies dominating this market share, particularly in the core foods groups which are currently less likely to meet Heart Foundation reformulation targets (bread, breakfast cereals, cheese, canned baked beans, yoghurt). The New Zealand supermarket packaged food supply included in the Nutritrack database is dominated by a small number of companies and is mostly unhealthy. Government leadership is required to improve the healthiness of the packaged food supply and provide adequate information to consumers. This includes interventions setting reformulation targets for core food groups, setting population nutrient intake targets and mandating that the HSR is displayed on all products.