To measure the effects of health-related food taxes on the environmental impact of consumer food purchases in a virtual supermarket.

This is a secondary analysis of data from a randomised controlled trial in which participants were randomly assigned to a control condition with regular food prices (n 152), an experimental condition with a sugar-sweetened beverage (SSB) tax (n 131) or an experimental condition with a nutrient profiling tax based on Nutri-Score (n 112). Participants were instructed to undertake their typical weekly grocery shopping for their households. Primary outcome measures were three environmental impact indicators: greenhouse gas (GHG) emissions, land use and blue water use per household per week. Data were analysed using linear regression analyses.

Three-dimensional virtual supermarket.

Dutch adults (≥ 18 years) who were responsible for grocery shopping in their household (n 395).

GHG emissions (–7·6 kg CO2-eq; 95 % CI –12·7, –2·5) and land use (–3·9 m2/year; 95 % CI –7·7, –0·2) were lower for the food purchases of participants in the nutrient profiling tax condition than for those in the control condition. Blue water use was not affected by the nutrient profiling tax. Moreover, the SSB tax had no significant effect on any of the environmental impact indicators.

A nutrient profiling tax based on Nutri-Score reduced the environmental impact of consumer food purchases. An SSB tax did not affect the environmental impact in this study.

To investigate whether financial constraint and perceived stress modify the effects of food-related taxes on the healthiness of food purchases.

Moderation analyses were conducted with data from a trial where participants were randomly exposed to: a control condition with regular food prices, an sugar-sweetened beverage (SSB) tax condition with a two-tiered levy on the sugar content in SSB (5–8 g/100 ml: €0·21 per l and ≥8 g/100 ml: €0·28 per l) or a nutrient profiling tax condition where products with Nutri-Score D or E were taxed at a 20 percent level. Outcome measures were overall healthiness of food purchases (%), energy content (kcal) and SSB purchases (litres). Effect modification was analysed by adding interaction terms between conditions and self-reported financial constraint or perceived stress in regression models. Outcomes for each combination of condition and level of effect modifier were visualised.

Virtual supermarket.

Dutch adults (n 386).

Financial constraint or perceived stress did not significantly modify the effects of food-related taxes on the outcomes. Descriptive analyses suggest that in the control condition, the overall healthiness of food purchases was lowest, and SSB purchases were highest among those with moderate/high levels of financial constraint. Compared with the control condition, in a nutrient profiling tax condition, the overall healthiness of food purchases was higher and SSB purchases were lower, especially among those with moderate/high levels of financial constraint. Such patterns were not observed for perceived stress.

Further studies with larger samples are recommended to assess whether food-related taxes differentially affect food purchases of subgroups.

To investigate the effects of a sugar-sweetened beverage (SSB) tax and a nutrient profiling tax on consumer food purchases in a virtual supermarket.

A randomised controlled trial was conducted with a control condition with regular food prices (n 152), an SSB tax condition (n 130) and a nutrient profiling tax condition based on Nutri-Score (n 112). Participants completed a weekly grocery shop for their household. Primary outcome measures were SSB purchases (ordinal variable) and the overall healthiness of the total shopping basket (proportion of total unit food items classified as healthy). The secondary outcome measure was the energy (kcal) content of the total shopping basket. Data were analysed using regression analyses.

Three-dimensional virtual supermarket.

Dutch adults aged ≥18 years are being responsible for grocery shopping in their household (n 394).

The SSB tax (OR = 1·62, (95 % CI 1·03, 2·54)) and the nutrient profiling tax (OR = 1·88, (95 %CI 1·17, 3·02)) increased the likelihood of being in a lower-level category of SSB purchases. The overall healthiness of the total shopping basket was higher (+2·7 percent point, (95 % CI 0·1, 5·3)), and the energy content was lower (−3301 kcal, (95 % CI −6425, −177)) for participants in the nutrient profiling tax condition than for those in the control condition. The SSB tax did not affect the overall healthiness and energy content of the total shopping basket (P > 0·05).

A nutrient profiling tax targeting a wide range of foods and beverages with a low nutritional quality seems to have larger beneficial effects on consumer food purchases than taxation of SSB alone.

To investigate the level of public acceptability of a sugar-sweetened beverage (SSB) tax and its associated factors.

Participants completed an online self-administered questionnaire. Acceptability of an SSB tax was measured on a seven-point Likert scale (strongly disagree to strongly agree). Associations between acceptability and sociodemographic factors, weight status, SSB consumption and beliefs about effectiveness (e.g., ‘An SSB tax would reduce people’s SSB consumption’), appropriateness, socioeconomic and economic benefit, implementation and trust were assessed using multivariable linear regression analyses.

The Netherlands.

Dutch adults aged ≥18 years representative of the Dutch population for age, sex, education level and location (n 500).

Of the participants, 40 % supported and 43 % opposed an SSB tax in general. Moreover, 42 % supported (43 % opposed) an SSB tax as a strategy to reduce overweight, and 55 % supported (32 % opposed) an SSB tax if revenue is used for health initiatives. Participants with a low education level (B = –0·82, 95 % CI –1·31, –0·32), overweight (B = –0·49, 95 % CI –0·89, –0·09), moderate or high SSB consumption (B = –0·86, 95 % CI –1·30, –0·43 and B = –1·01, 95 % CI –1·47, –0·56, respectively) and households with adolescents (B = –0·57, 95 % CI –1·09, –0·05) reported a lower acceptability of an SSB tax than their counterparts. Beliefs about effectiveness, appropriateness, socioeconomic and economic benefit, implementation and trust were associated with acceptability (P < 0·001).

Public acceptability of an SSB tax tends to be higher if revenue is used for health initiatives. The factors associated with acceptability should be taken into consideration.

To examine the availability of packaged food products in New Zealand supermarkets by level of industrial processing, nutrient profiling score (NPSC), price (energy, unit and serving costs) and brand variety.

Secondary analysis of cross-sectional survey data on packaged supermarket food and non-alcoholic beverages. Products were classified according to level of industrial processing (minimally, culinary and ultra-processed) and their NPSC.

Packaged foods available in four major supermarkets in Auckland, New Zealand.

Packaged supermarket food products for the years 2011 and 2013.

The majority (84 % in 2011 and 83 % in 2013) of packaged foods were classified as ultra-processed. A significant positive association was found between the level of industrial processing and NPSC, i.e. ultra-processed foods had a worse nutrient profile (NPSC=11·63) than culinary processed foods (NPSC=7·95), which in turn had a worse nutrient profile than minimally processed foods (NPSC=3·27), P<0·001. No clear associations were observed between the three price measures and level of processing. The study observed many variations of virtually the same product. The ten largest food manufacturers produced 35 % of all packaged foods available.

In New Zealand supermarkets, ultra-processed foods comprise the largest proportion of packaged foods and are less healthy than less processed foods. The lack of significant price difference between ultra- and less processed foods suggests ultra-processed foods might provide time-poor consumers with more value for money. These findings highlight the need to improve the supermarket food supply by reducing numbers of ultra-processed foods and by reformulating products to improve their nutritional profile.

To assess the mean package size and manufacturer-recommended serving size of sweet beverages available in four high-income countries: Australia, Canada, the Netherlands and New Zealand.

Cross-sectional surveys.

The two largest supermarket chains of each country in 2012/2013.

Individual pack size (IPS) drinks (n 891) and bulk pack size (BPS) drinks (n 1904).

For all IPS drinks, the mean package size was larger than the mean serving size (mean (sd)=412 (157) ml and 359 (159) ml, respectively). The mean (sd) package size of IPS drinks was significantly different for all countries (range: Australia=370 (149) ml to New Zealand=484 (191) ml; P<0·01). The mean (sd) package size of Dutch BPS drinks (1313 (323) ml) was significantly smaller compared with the other countries (New Zealand=1481 (595) ml, Australia=1542 (595) ml, Canada=1550 (434) ml; P<0·01). The mean (sd) serving size of BPS drinks was significantly different across all countries (range: Netherlands=216 (30) ml to Canada=248 (31) ml; P<0·00). New Zealand had the largest package and serving sizes of the countries assessed. In all countries, a large number of different serving sizes were used to provide information on the amount appropriate to consume in one sitting.

At this point there is substantial inconsistency in package sizes and manufacturer-recommended serving sizes of sweet beverages within and between four high-income countries, especially for IPS drinks. As consumers do factor serving size into their judgements of healthiness of a product, serving size regulations, preferably set by governments and global health organisations, would provide consistency and assist individuals in making healthier food choices.

The aim of the present study was to gain insight into (i) processed snack-food availability, (ii) processed snack-food salience and (iii) the size of dinnerware among households with overweight gatekeepers. Moreover, associations between gatekeepers’ characteristics and in-home observations were determined.

A cross-sectional observation of home food environments was conducted as part of a baseline measurement of a larger study.

Home food environments of overweight and obese gatekeepers in the Netherlands.

Household gatekeepers (n 278). Mean household size of the gatekeepers was 3·0 (sd 1·3) persons. Mean age of the gatekeepers was 45·7 (sd 9·2) years, 34·9 % were overweight and 65·1 % were obese. Of the gatekeepers, 20·9 % had a low level of education and 42·7 % had a high level of education.

In 70 % of the households, eight or more packages of processed snack foods were present. In 54 % of the households, processed snack foods were stored close to non-processed food items and in 78 % of households close to non-food items. In 33 % of the households, processed snack foods were visible in the kitchen and in 15 % of the households processed snack foods were visible in the living room. Of the dinnerware items, 14 % (plates), 57 % (glasses), 78 % (dessert bowls), 67 % (soup bowls) and 58 % (mugs) were larger than the reference norms of the Netherlands Nutrition Centre Foundation. Older gatekeepers used significantly smaller dinnerware than younger gatekeepers.

Environmental factors endorsing overconsumption are commonly present in the home environments of overweight people and could lead to unplanned eating or passive overconsumption.

Nutritional interventions to decrease energy intake, aimed at portion sizes and front-of-package labelling, are effective only if people do not compensate for their reduced energy intake. Since several observational studies indicate that these interventions could prompt compensation behaviour, it is important to assess underlying beliefs. Therefore, the purpose of the two studies reported here was to develop a Diet-related Compensatory Health Beliefs Scale (Diet-CHBS).

Cross-sectional surveys were conducted for the scale development. Study 1 provided data on the factor analysis and convergent validity, while Study 2 assessed the Diet-CHBS’ test–retest reliability.

VU University Amsterdam (Study 1) and twenty-five worksite cafeterias in the Netherlands (Study 2).

Study 1 was conducted among 179 students and their parents; Study 2 was conducted among 119 worksite cafeteria visitors.

The results of Study 1 showed that the scale consisted of the hypothesized factors of compensation beliefs with regard to portion sizes (α = 0·73), front-of-package health logos (α = 0·77) and exercise (α = 0·75). The scale's overall Cronbach's α was 0·82. The Diet-CHBS had a Pearson correlation of 0·32 with a general health compensatory beliefs scale, signifying satisfactory convergent validity. Study 2 showed that the intra-class correlation coefficient between T1 and T2 was 0·69, indicating adequate test–retest reliability.

The Diet-CHBS is a valid and reliable instrument for assessing diet-related compensatory health beliefs in response to nutritional interventions. It is important to take such beliefs into account in further intervention studies aimed at preventing overweight and obesity.

To study differences in the role of price and value in food choice between low-income and higher-income consumers and to study the perception of consumers about pricing strategies that are of relevance during grocery shopping.

A cross-sectional study was conducted using structured, written questionnaires. Food choice motives as well as price perceptions and opinion on pricing strategies were measured.

The study was carried out in point-of-purchase settings, i.e. supermarkets, fast-food restaurants and sports canteens.

Adults (n 159) visiting a point-of-purchase setting were included.

Price is an important factor in food choice, especially for low-income consumers. Low-income consumers were significantly more conscious of value and price than higher-income consumers. The most attractive strategies, according to the consumers, were discounting healthy food more often and applying a lower VAT (Value Added Tax) rate on healthy food. Low-income consumers differ in their preferences for pricing strategies.

Since price is more important for low-income consumers we recommend mainly focusing on their preferences and needs.

To assess the prevalence of normal weight, overweight and obesity among 10–18-year-old Czech Republic adolescents and to assess the association between energy balance-related behaviours and overweight/obesity.

Cross-sectional data from ‘The 6th Nation-wide Anthropological Survey of Children and Adolescents 2001 Czech Republic’ have been used.

Height and weight were objectively measured. Data on adolescents’ behaviours were assessed with self-reported questionnaires. Background variables were assessed by means of a parental questionnaire. Multi-level logistic regression analyses were conducted to assess behavioural risk factors of being overweight/obese.

Data on 31 228 adolescents aged 10–18 years were included in the present study.

The highest prevalence of being overweight or obese was found among boys and younger adolescents. Boys were more physically active, watched more television (TV) and used the computer more often than did girls. Being on a diet and skipping meals were positively associated with being overweight/obese, independent of gender. In boys (10–14 years old), inverse associations with being overweight/obese were found when being more physically active. Monitoring weight showed inverse relations with being overweight/obese in 15–18-year-old girls. Watching TV more than 7 h a week was positively associated with being overweight/obese in 15–18-year-old girls, and was found to be negatively associated in boys of the same age group.

These behaviours should be targeted when preventing overweight and obesity among Czech Republic adolescents. Studies using better measures of energy balance-related behaviours are needed.

Insight into the role of energy balance-related behaviours (EBRB) is of great importance when it comes to prevention of weight gain and design of interventions tailored to target these behaviours.

First, the present study examines the longitudinal association of four EBRB in Norwegian adolescents. Second, it aims to examine whether clusters of EBRB are cross-sectionally associated with being overweight.

The present study is part of the ‘Fruits and Vegetables Make the Marks’ project. The study sample consists of twenty control schools in two Norwegian counties.

Survey questionnaires were completed by 884 pupils with an average age at baseline, September 2001, of 11·8 years. In the follow-up surveys in May 2002 and May 2005, a total of 809 and 724 adolescents participated, respectively. Four EBRB were measured: habitual fruit and vegetable intake, snacking and soda consumption, television and computer use and physical activity.

Results of the associations between EBRB were similar for boys and girls. The odds, ranging from 1·14 to 12·06, were mostly significant. One out of four clusters, the unhealthy cluster, was significantly and cross-sectionally associated with overweight and obesity.

Longitudinal associations of EBRB show that it is important to start early with interventions that aim to prevent unhealthy behaviours becoming habitual. These behaviours should be targeted at the same time as they tend to co-occur. More research, preferably longitudinal and more objective, is needed to investigate associations between health behaviours and body weight among adolescents.

A front-of-pack nutrition logo on products with relatively favourable product compositions might help consumers to make more healthful choices. Studies investigating actual nutrition label use in point-of-purchase settings are scarce. The present study investigates the use of the ‘Choices’ nutrition logo in Dutch supermarkets.

Adults were asked to complete a validated questionnaire about motivation for food choice and their purchased products were scored for the Choices logo after they had done their shopping.

Nine supermarkets in The Netherlands.

A total of 404 respondents participated.

Of the respondents, 62 % reported familiarity with the logo. The motivations for food choice that were positively associated with actually purchasing products with the logo were attention to ‘weight control’ and ‘product information’. The food choice motive ‘hedonism’ was negatively associated with purchasing products with the logo.

This is the first study to investigate actual use of the Choices logo. In order to stimulate consumers to purchase more products with a favourable product composition, extra attention should be paid to hedonistic aspects such as the tastefulness and the image of healthy products.

To examine the association between energy density and energy costs in single food items and composed diets, and to explore differences in energy density and energy cost between income levels.

A cross-sectional study using data from two Dutch cohort studies and recent national food prices. Food prices were retrieved from two market leader supermarkets. Data on dietary intake were measured using a computerized face-to-face interview (cohort 1) and 24 h recalls (cohort 2).

The Netherlands.

A sample of 373 young adults from the Amsterdam Growth and Health Longitudinal Study (AGHLS, measured in 2000) and a sample of 200 community-dwelling elderly from the Longitudinal Ageing Study Amsterdam (LASA, measured in 2007).

We found significant inverse associations between energy density and energy costs in single food items (r = −0·436, P < 0·01) and composed diets (AGHLS men r = −0·505, women r = −0·413, P < 0·001; LASA men r = −0·559, women r = −0·562, P < 0·001). Furthermore, we found that people stratified into higher energy density quartiles consumed significantly more energy per day, less fruits and vegetables, and had significantly lower diet costs. Explorative analyses on income did not reveal significant differences regarding energy density, costs, or fruit and vegetable intake.

In the Netherlands also, energy density was inversely related with energy costs, implying that healthier diets cost more. However, we could not find differences in energy density or costs between income levels. Future research, using precise food expenditures, is of main importance in studying the economics of obesity and in the aim of making the healthier choice easier.

Larger food portion sizes lead to increased energy intake levels and might contribute to the current obesity epidemic. Only a very limited number of studies are available on the actual development of food portion sizes during past decades. The present study aims to reveal trends in portion sizes of some high-energy-dense food products during recent decades in The Netherlands.

The data were collected from manufacturers and from information found in professional journals, marketing and advertising materials, and on manufacturers’ websites.

A number of trends in food portion sizes were observed. Larger sizes have been added to the portion size portfolio. The portion sizes of a number of products have also increased since their introduction, although this did not apply to all the products included. Finally, multi-packs have been introduced and the number of products within a multi-pack has also increased.

A trend towards larger portion sizes was observed, which is relevant to the public health debate regarding the prevention of overweight and obesity. It is recommended that developments in food portion sizes continue to be monitored over the coming years, and the effects of the newly introduced portion sizes on food intake be studied.