Skip to main content Accessibility help

What is the public appetite for healthy eating policies? Evidence from a cross-European survey

  • Mario Mazzocchi (a1), Silvia Cagnone (a2), Tino Bech-Larsen (a3), Barbara Niedźwiedzka (a4), Anna Saba (a5), Bhavani Shankar (a6), Wim Verbeke (a7) and W Bruce Traill (a8)...

World Health Organization estimates that obesity accounts for 2–8% of health care costs in different parts of Europe, and highlights a key role for national policymaking in curbing the epidemic. A variety of healthy-eating policy instruments are available, ranging from more paternalistic policies to those less intrusive. Our aim is to measure and explain the level of public support for different types of healthy eating policy in Europe, based on data from a probabilistic sample of 3003 respondents in five European countries. We find that the main drivers of policy support are attitudinal factors, especially attribution of obesity to excessive availability of unhealthy foods, while socio-demographic characteristics and political preferences have little explanatory power. A high level of support for healthy eating policy does not translate into acceptance of higher taxes to fund them, however.

Corresponding author
*Correspondence to: Mario Mazzocchi, Associate Professor, Department of Statistical Sciences, University of Bologna, Bologna, Italy, Via Belle Arti 41, 40124 Bologna, Italy. Email:
Hide All
Anderson, J. C. and Gerbing, D. W. (1988), ‘Structural equation modeling in practice – a review and recommended 2-step approach’, Psychological Bulletin, 103(3): 411423.
Barry, C. L., Brescoll, V. L., Brownell, K. D., et al. (2009), ‘Obesity metaphors: how beliefs about the causes of obesity affect support for public policy’, Milbank Quarterly, 87(1): 747.
Barry, C. L., Niederdeppe, J. and Gollust, S. E. (2013), ‘Taxes on sugar-sweetened beverages results from a 2011 National Public Opinion Survey’, American Journal of Preventive Medicine, 44(2): 158163.
Beaglehole, R., Bonita, R., Horton, R., et al. (2011), ‘Priority actions for the non-communicable disease crisis’, Lancet, 377(9775): 14381447.
Bos, C., Van der Lans, I., Van Rijnsoever, F. and Van Trijp, H. (2013), ‘Understanding consumer acceptance of intervention strategies for healthy food choices: a qualitative study’, BMC Public Health, 13(1): 1073.
Botelho, A. and Pinto, L. C. (2002), ‘Hypothetical, real, and predicted real willingness to pay in open-ended surveys: experimental results’, Applied Economics Letters, 9(15): 993996.
Brambila-Macias, J., Shankar, B., Capacci, S., Mazzocchi, M., Perez-Cueto, F. J. A., Verbeke, W. and Trail, W. B. (2011), ‘Policy interventions to promote healthy eating: a review of what works, what does not, and what is promising’, Food and Nutrition Bulletin, 32(4): 365375.
Briggs, A. D. M., Mytton, O., Kehlbacher, A., et al. (2013), ‘Overall and income specific effect on prevalence of overweight and obesity of 20% sugar sweetened drink tax in UK: econometric and comparative risk assessment modelling study’, British Medical Journal, 347: f689.
Brownell, K. D. (2005), ‘The chronicling of obesity: growing awareness of its social, economic, and political contexts’, Journal of Health Politics Policy and Law, 30(5): 955964.
Brownell, K. D. and Frieden, T. R. (2009), ‘Ounces of prevention – the public policy case for taxes on sugared beverages’, New England Journal of Medicine, 360(18): 18051808.
Camacho, C. J., Higgins, E. T. and Luger, L. (2003), ‘Moral value transfer from regulatory fit: what feels right is right and what feels wrong is wrong’, Journal of Personality and Social Psychology, 84(3): 498510.
Capacci, S., Mazzocchi, M., Shankar, B., et al. (2012), ‘Policies to promote healthy eating in Europe: a structured review of policies and their effectiveness’, Nutrition Reviews, 70(3): 188200.
Caraher, M. and Cowburn, G. (2005), ‘Taxing food: implications for public health nutrition’, Public Health Nutrition, 8(8): 12421249.
Cattaneo, A., Monasta, L., Stamatakis, E., et al. (2010), ‘Overweight and obesity in infants and pre-school children in the European Union: a review of existing data’, Obesity Reviews, 11(5): 389398.
Cawley, J. (2006), ‘Markets and childhood obesity policy’, Future of Children, 16(1): 6988.
Cawley, J. (2008), ‘Contingent valuation analysis of willingness to pay to reduce childhood obesity’, Economics & Human Biology, 6(2): 281292.
Cecchini, M., Sassi, F., Lauer, J. A., Lee, Y. Y., Guajardo-Barron, V. and Chisholm, D. (2010), ‘Chronic diseases: chronic diseases and development 3 tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness’, Lancet, 376(9754): 17751784.
Chouinard, H. H., Davis, D. E., LaFrance, J. T. and Perloff, J. M. (2007), ‘Fat taxes: big money for small change’, Forum for Health Economics & Policy, 10(2): 2.
Crockett, S. J. and Kennedy, E. (2002), ‘Food industry’s role in national nutrition policy: working for the common good’, Journal of the American Dietetic Association, 102(4): 478479.
Diepeveen, S., Ling, T., Suhrcke, M., Roland, M. and Marteau, T. M. (2013), ‘Public acceptability of government intervention to change health-related behaviours: a systematic review and narrative synthesis’, BMC Public Health, 13: 756.
Drewnowski, A. and Specter, S. E. (2004), ‘Poverty and obesity: the role of energy density and energy costs’, American Journal of Clinical Nutrition, 79(1): 616.
Drewnowski, A. and Darmon, N. (2005), ‘Food choices and diet costs: an economic analysis’, Journal of Nutrition, 135(4): 900904.
Emm, L. G., Gillison, F. B. and Juszczyk, D. (2013), ‘Support for obesity-related policy and its association with motivation for weight control’, Psychology Public Policy and Law, 19(3): 321330.
Evans, W. D., Finkelstein, E. A., Kamerow, D. B. and Renaud, J. M. (2005), ‘Public perceptions of childhood obesity’, American Journal of Preventive Medicine, 28(1): 2632.
Fletcher, J. M., Frisvold, D. E. and Tefft, N. (2010), ‘The effects of soft drink taxes on child and adolescent consumption and weight outcomes’, Journal of Public Economics, 94(11–12): 967974.
Gortmaker, S. L., Swinbum, B. A., Levy, D., Carter, R., Mabry, P. L., Finegood, D. T., Huang, T., Marsh, T. and Moodie, M. L. (2011), ‘Obesity 4 changing the future of obesity: science, policy, and action’, Lancet, 378(9793): 838847.
Gray, B. H. (2009), ‘In this issue’, Milbank Quarterly, 87(1): 15.
Grier, S. and Bryant, C. A. (2005), ‘Social marketing in public health’, Annual Review of Public Health, 26: 319339.
Grunert, K. G. and Wills, J. M. (2007), ‘A review of European research on consumer response to nutrition information on food labels’, Journal of Public Health, 15(5): 385399.
Hardus, P. M., van Vuuren, C. L., Crawford, D. and Worsley, A. (2003), ‘Public perceptions of the causes and prevention of obesity among primary school children’, International Journal of Obesity, 27(12): 14651471.
Harvard School of Public Health. (2003), Obesity as a public health issue: a look at solutions, [10 August 2014].
Higgins, E. T., Friedman, R. S., Harlow, R. E., Idson, L. C., Ayduk, O. N. and Taylor, A. (2001), ‘Achievement orientations from subjective histories of success: promotion pride vs prevention pride’, European Journal of Social Psychology, 31(1): 323.
Hilbert, A., Rief, W. and Braehler, E. (2007), ‘What determines public support of obesity prevention?’, Journal of Epidemiology and Community Health, 61(7): 585590.
Iacobucci, D. (2010), ‘Structural equations modeling: fit Indices, sample size, and advanced topics’, Journal of Consumer Psychology, 20(1): 9098.
Jacobson, M. F. and Brownell, K. D. (2000), ‘Small taxes on soft drinks and snack foods to promote health’, American Journal of Public Health, 90(6): 854857.
Jensen, J. D. and Smed, S. (2013), ‘The Danish tax on saturated fat – short run effects on consumption, substitution patterns and consumer prices of fats’, Food Policy, 42: 1831.
Jöreskog, K. G. and Moustaki, I. (2006), Factor analysis of ordinal variables with full information maximum likelihood, SSI Scientific Software International, [10 August 2014].
Jöreskog, K. G., Sörbom, D., Du Toit, S. and Du Toit, M. (2001), LISREL 8: New Statistical Features, Lincolnwood, IL: Scientific Software International.
Jost, J. T., Glaser, J., Kruglanski, A. W. and Sulloway, F. J. (2003), ‘Political conservatism as motivated social cognition’, Psychological Bulletin, 129(3): 339375.
Kersh, R. (2009), ‘The politics of obesity: a current assessment and look ahead’, Milbank Quarterly, 87(1): 295316.
Kim, D. and Kawachi, I. (2006), ‘Food taxation and pricing strategies to “thin out” the obesity epidemic’, American Journal of Preventive Medicine, 30(5): 430437.
Lang, T. and Rayner, G. (2007), ‘Overcoming policy cacophony on obesity: an ecological public health framework for policymakers’, Obesity Reviews, 8: 165181.
Lang, T. and Rayner, G. (2010), ‘Corporate responsibility in public health’, British Medical Journal, 341: 110111. (2012), Code général des impôts, Article 1613 ter: contribution perçue sur les boissons et préparations liquides pour boissons destinées à la consommation humaine, [10 August 2014].
Leicester, A. and Windmeijer, F. (2004), ‘The ‘fat tax’: economic incentives to reduce obesity’, IFS Briefing Notes, 49: 19pp.
Ludwig, D. S. and Nestle, M. (2008), ‘Can the food industry play a constructive role in the obesity epidemic?’, Journal of the American Medical Association, 300(15): 18081811.
Mazzocchi, M., Brasili, C. and Sandri, E. (2008), ‘Trends in dietary patterns and compliance with World Health Organization recommendations: a cross-country analysis’, Public Health Nutrition, 11(5): 535540.
Mazzocchi, M., Traill, B. and Shogren, J. F. (2009), Fat Economics: Nutrition, Health, and Economic Policy, New York: Oxford University Press.
McColl, K. (2009), ‘“Fat taxes” and the financial crisis’, Lancet, 373(9666): 797798.
Millstone, E. and Lobstein, T. (2007), ‘The PorGrow project: overall cross-national results, comparisons and implications’, Obesity Reviews, 8: 2936.
Morain, S. and Mello, M. M. (2013), ‘Survey finds public support for legal interventions directed at health behavior to fight noncommunicable disease’, Health Affairs, 32(3): 486496.
Mytton, O., Gray, A., Rayner, M. and Rutter, H. (2007), ‘Could targeted food taxes improve health?Journal of Epidemiology and Community Health, 61(8): 689694.
Mytton, O., Clarke, D. and Rayner, M. (2012), ‘Taxing unhealthy food and drinks to improve health’, British Medical Journal, 344: e2931.
Nnoaham, K. E., Sacks, G., Rayner, M., Mytton, O. and Gray, A. (2009), ‘Modelling income group differences in the health and economic impacts of targeted food taxes and subsidies’, International Journal of Epidemiology, 38(5): 13241333.
Nordstrom, J. and Thunstrom, L. (2009), ‘The impact of tax reforms designed to encourage healthier grain consumption’, Journal of Health Economics, 28(3): 622634.
Oliver, J. E. and Lee, T. (2005), ‘Public opinion and the politics of obesity in America’, Journal of Health Politics Policy and Law, 30(5): 923954.
Parkinson, B. and Goodall, S. (2011), ‘Considering consumer choice in the economic evaluation of mandatory health programmes: a review’, Health Policy, 101(3): 236244.
Pickett, K. E., Kelly, S., Brunner, E., Lobstein, T. and Wilkinson, R. G. (2005), ‘Wider income gaps, wider waistbands? An ecological study of obesity and income inequality’, Journal of Epidemiology and Community Health, 59(8): 670674.
Powell, L. M. and Chaloupka, F. J. (2009), ‘Food prices and obesity: evidence and policy implications for taxes and subsidies’, Milbank Quarterly, 87(1): 229257.
Sikorski, C., Luppa, M., Schomerus, G., Werner, P., Konig, H. H. and Riedel-Heller, S. G. (2012), ‘Public attitudes towards prevention of obesity’, PLoS One, 7(6).
Smed, S. (2012), ‘Financial penalties on foods: the fat tax in Denmark’, Nutrition Bulletin, 37(2): 142147.
Stirling, A., Lobstein, T. and Millstone, E. (2007), ‘Methodology for obtaining stakeholder assessments of obesity policy options in the PorGrow project’, Obesity Reviews, 8: 1727.
Story, M. (1999), ‘School-based approaches for preventing and treating obesity’, International Journal of Obesity, 23: S43S51.
Suggs, L. S. and McIntyre, C. (2011), ‘European Union public opinion on policy measures to address childhood overweight and obesity’, Journal of Public Health Policy, 32(1): 91103.
Tiffin, R. and Arnoult, M. (2011), ‘The public health impacts of a fat tax’, European Journal of Clinical Nutrition, 65(4): 427433.
Variyam, J. N. (2008), ‘Do nutrition labels improve dietary outcomes?Health Economics, 17(6): 695708.
Veerman, J. L., Van Beeck, E. F., Barendregt, J. J. and Mackenbach, J. P. (2009), ‘By how much would limiting TV food advertising reduce childhood obesity?European Journal of Public Health, 19(4): 365369.
Wilde, P. (2009), ‘Self-regulation and the response to concerns about food and beverage marketing to children in the United States’, Nutrition Reviews, 67(3): 155166.
Wilkinson, R. G. and Pickett, K. E. (2006), ‘Income inequality and population health: a review and explanation of the evidence’, Social Science & Medicine, 62(7): 17681784.
World Health Organization. (2000), ‘Obesity: preventing and managing the global epidemic’, WHO Technical Report Series, Report number 894, 252pp.
Zhen, C., Finkelstein, E. A., Nonnemaker, J. M., Karns, S. A. and Todd, J. E. (2014), ‘Predicting the effects of sugar-sweetened beverage taxes on food and beverage demand in a large demand system’, American Journal of Agricultural Economics, 96(1): 125.
Zywicki, T. J., Holt, D. and Ohlhausen, M. K. (2004), ‘Obesity and advertising policy’, George Mason Law Review, 12(4): 9791011.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed