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Force-fed
Doesthefoodsystemconstricthealthychoicesfortypical
Britishfamilies?
Methods
Introduction:Ourtypicalfamily
Our‘typical’familyisamiddle-incomehouseholdwithchildrenlivinginEngland.Middle-income
householdsaredefinedasthosewithanequivalisedhouseholdincomethatfallswithinthe3rd
quintileforequivalisedhouseholdincomeintheFamilyResourcesSurveyfortherelevantyear
(DepartmentforWorkandPensions,2013).Equivalisationtakesintoaccountvariationsinthesize
andcompositionofhouseholds,reflectingthefactthatafamilyofseveralpeopleneedsahigher
incomethanasingleindividualsotheycanenjoyacomparablestandardofliving1.In2013,
householdsinthethirdquintilehadanequivalisedgrosshouseholdincomeofbetween£24,388and
£34,268.Forafamilycomposedoftwoadultsandtwochildren,onechildunder14yearsofageand
onechildaged14yearsorover,thisequatestoagrosshouseholdincomeofbetween£37,000and
£52,000.
Althoughwemostlyreportresultsformiddle-incomehouseholds,estimatesforthetotalpopulation
havebeenusedwhereincomedatahasnotbeenavailable.Wherepossible,anydemographic
differences(e.g.byincomeorregion)havealsobeennoted.
Chapter1:dietaryintakes
Datasourceandpopulation
UKNationalDietandNutritionSurveyRollingProgramme(2008–2012)
DatafromtheUKNationalDietandNutritionSurvey(NDNS)RollingProgramme(Waves1–4
(2008/2009to2011/2012)wasusedtoexaminedietaryintakesforeachofourfamilymembers
(NatCenSocialResearch,etal.,2015a).TheNDNSisarollingprogrammethataimstoprovide
comprehensive,cross-sectionalinformationonthedietaryhabitsandnutritionalstatusof
individualsagedone-and-a-halfyearsandolderlivinginprivatehouseholdsintheUK.Amultistage
probabilitysamplingdesignisusedtocollectarandomsampleofprimarysamplingunits(PSUs).
WithinthesePSUs,privateaddressesarerandomlyselectedforinclusion.Uptooneadultandone
childperhouseholdarerandomlyselectedtotakepartinthesurvey.
Interviewerscollectinformationonsocio-demographics,andshopping,cookingandeatinghabits,
andparticipantsalsocompleteafour-dayfooddiary.Forchildrenaged11yearsandyounger,
parentsorcarerscompletethefour-dayfooddiary.Aspartofthesurvey,anursetakes
anthropometricandbloodpressuremeasurements,andcollectsbloodsamplesforlaboratory
analyses.Bloodsampleanalysestestfornutritional,routinemetabolicandcardiovascularoutcomes.
MoreinformationontheNDNSmethodologycanbefoundelsewhere(Bates,etal.,2014).
TheNDNSalsoincludesresultsfromaseriesof24-hoururinarysodiumsurveysconductedon
representativesamplesoftheUK.Saltintakecanbemeasuredusingurinarysodiumexcretion,
1
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/432843/hbai-low-incomehow-is-it-measured-infographic.pdf
2
whichreflectsanindividual’ssodiumintake.Moreinformationontheurinarysodiumsurveyscanbe
foundelsewhere(Sadler,etal.,2011).
Nutritionaloutcomes
1.ProportionoffamilymembersmeetingUKdietandnutritionrecommendations
TheproportionoffamilymemberswithmeandailyintakesmeetingUKdietaryreferencevalues
(DRVs)forspecificmacronutrientsandfoodgroupsoutlinedinTables1–2wereobtained.
Adequacyofmicronutrientintakeswasdeterminedbycalculatingtheproportionoffamilymembers
withintakesbelowlowerreferencenutrientintakes(LRNIs)forkeymicronutrients(seetables5.14
and5.32inNationalDietandNutritionSurvey:ResultsfromYears1–4(combined)oftheRolling
Programme(2008/2009–2011/2012)formicronutrientLRNIsandRNIs(Bates,etal.,2014).Thedata
arenotshownbutarereferredtointhenarrativereport.
Table1:Dietaryreferencevaluesforkeymacronutrients
Macronutrient
Recommendation
Totalfat
Populationaveragenomorethan35%offoodenergyfor
individualsaged5yearsandabove.
Saturatedfattyacids
Populationaveragenomorethan11%offoodenergyfor
individualsaged5yearsandabove.
Transfattyacids
Populationaveragenomorethan2%offoodenergy.
2
Freesugars Populationaveragenomorethan5%ofdailyenergyfromfoodand
drinkforallages.
3
AOACfibre Populationaverageofatleast30g/dayforadults;15g/dayfor
childrenaged2–5years;20g/dayforchildrenaged5–11years;
25g/dayforchildrenaged11–16years;and30g/dayforadolescents
aged16–18years.
Salt
Maximumintakeof6g/dayforindividualsaged11yearsandabove;
5g/dayforchildrenaged7–10years;3g/dayforchildrenaged4–6
years.
2
Freesugars’includesallmonosaccharidesanddisaccharidesaddedtofoodsbythemanufacturer,cookor
consumer,plussugarsnaturallypresentinhoney,syrupsandunsweetenedfruitjuices.TheNDNSdoesnot
containaderivedvariableforfreesugars,onlynon-milkextrinsicsugars(NMES).NMESincludesstewed,
cannedanddriedfruitwhereasthefreesugarsclassificationdoesnot.Therefore,NMESareusedbutmay
resultinaslightoverestimateoffreesugarintake.
3
LatestrecommendationsforfibreareforAOACfibre.TheNDNSonlycontainsestimatesforNon-Starch
Polysaccharides(Englystmethod)sothesevalueswereadjustedby1.33asper
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/404094/ERG_eatwell_mode
lling_update_paper_final.pdf
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Table2:UKrecommendationsforconsumptionoffruitandvegetables,redandprocessedmeat,and
oilyfish
Foodgroup
Recommendation
Fruitandvegetables
Atleastfiveportionsperdayforchildrenaged11yearsand
above.Oneportionisapproximatelyequivalenttoaservingof
80g.
Redandprocessedmeat
Nomorethan70g/dayforadults.
(Includesbeef,lamb,pork,
sausages,burgersandkebabs,
offal,processedredmeatand
redmeat)
Oilyfish
Atleastoneportionperweekforadultsandchildren(140g).
(Includesanchovies,carp,trout,
mackerel,herring,jackfish,
pilchards,freshandcanned
salmon,sardines,sprats,
swordfish,freshtunaand
whitebait)
2.Dietarysaltintakes
Estimatesfordailydietaryconsumptionofsaltforeachfamilymemberandtheproportionof
individualsconsumingmorethantheUKrecommendationsfordietarysaltintake(Table3)were
calculatedfromthe24-hoururinarysodiumexcretiondatausingtheequation:17.1mmolofsodium
excreted=1gofsaltconsumed.Thisassumesthatthedietaryintakeofsodiumisequaltothe
urinaryoutput,andthatallsodiuminthedietcomesfromsalt.Resultsforestimateddailysalt
intakesarebasedon24-hoururinecollectionsthatwereclassifiedascomplete.
Table3:UKrecommendationsfordietarysaltintake
Agegroup
Recommendedmaximumsaltintake
4–6years
3g/day
7–10years
11–18years
19–64years
5g/day
6g/day
6g/day
Urinecollectionsforadultsaged19to64yearswereclassifiedas‘complete’or
‘incomplete/unreliable’byeitheroftwocriteria:‘completebyPABA’,wheretheparticipanthas
reportedtakingthreePABAtabletsandtheamountofPABArecoveredintheurinecollectionis
consistentwithcompleteness;or‘completebyclaim’,whereparticipantsreporttakingfewerthan
threePABAtabletsandreportedcollectionofallurinepassedduring23to25hours,jointlyreferred
toas‘standardcriteria’.Forparticipantsaged11to65yearsandover,onlyresultsofurine
collectionsclassifiedascompletebythesecriteriaareincludedinthenarrativereport.Childrenaged
fourto10yearsaremorelikelytohavedifficultyswallowingtabletsthanolderparticipants,so
compliancewiththePABAprotocolislikelytobepoorerinthisagegroup,particularlyatthe
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youngerendoftheagerange.Therefore,forchildrenagedfourto10years,wealsousedan
alternativechildcriterionwherecollectionswereregardedas‘complete’whentheywereclaimedto
includeallurinepassedfor23to25hoursfromthestarttimeirrespectiveofPABAexcretion.
3.Proportionofenergyintakefrom‘lesshealthy’and‘morehealthy’foods.
NutrientProfiling(NP)GuidancefromtheDepartmentofHealthwasusedtoinvestigatethe
proportionofenergyobtainedfrom‘healthy’foodsbasedonanutrientprofilemodeldevelopedby
theFoodStandardsAgencyin2004/2005(DepartmentofHealth,2011).Themodelusesascoring
systemwherebypointsareallocatedbasedonthenutrientcontentper100gofafoodordrink.‘A’
pointsareawardedforspecificnutrients(energy,saturatedfat,totalsugarandsodium);and‘C’
pointsareawardeddependingonthecontentoffruit,vegetablesandnutsinthefoodordrink.The
finalnutrientscoreisderivedbysubtractingthescorefor‘C’nutrientsfromthescorefor‘A’
nutrients.
Anyfooditemisconsidered‘lesshealthy’iftheoverallNPscoreis4ormoreandadrinkitemis
considered‘lesshealthy’iftheoverallNPscoreis5ormore.Usingthismodel,aNPscorewas
calculatedforeachfood/drinkentryintheNDNSdatasetinordertoclassifyitas‘morehealthy’or
‘lesshealthy’.Themeanproportionofdailyenergyconsumptionfrommorehealthy/lesshealthy
foodswasthencalculatedforeachfamilymember.
4.Proportionofenergyintake‘ultra-processed’foods
WeusedtheNOVAclassificationforprocessedandultra-processedfoodstoclassifyfoodentriesin
theNDNSdatasetbasedonthedegreeofprocessing(Monteiro,etal.,2015).Theclassificationcan
beusedtogroupfoodentriesintothreemaingroupsandsub-groups(Table4).Group1contains
unprocessedfoodsthatareconsumedwithoutfurtherprocessingandpreparation,withthe
exceptionofwashing,cuttingandsqueezing.Thesecondgroupcontainsprocessedculinary
ingredients,includingplantoils,animalfats,andsugarsorsyrups.Group3containsprocessedfoods,
furtherdividedintoprocessedfoodproductsandultra-processedfoods.Aftereachfoodentryinthe
NDNSwasclassifiedintooneoftheNOVAgroups,wedeterminedtheproportionofeachofour
familymember’sdailyenergyintakethatcamefromfoodsthatwereinGroup3(processedand
ultra-processedfoods).Wereportthefindingsforultra-processedfoodsonly.
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Table4:NOVAClassification
Foodgroupsanddefinition
Examples
1.Unprocessedandminimallyprocessedfoods
Unprocessedfoodsareofplantorigin(leaves,stems,roots,
tubers,fruits,nuts,seeds)oranimalorigin(meat,other
flesh,tissueandorgans,eggs,milk),shortlyafterharvesting,
gathering,slaughterorhusbanding.Minimallyprocessed
foodsareunprocessedfoodsalteredinwaysthatdonotadd
orintroduceanysubstance,butmayinvolvesubtracting
partsofthefoodinwaysthatdonotsignificantlyaffectits
use.Minimalprocessesincludecleaning,scrubbingand
washing;winnowing,hulling,peeling,grinding,grating,
squeezingandflaking;skinning,boning,carving,portioning,
scalingandfilleting;drying,skimmingandfatreduction;
pasteurisationandsterilising;chilling,refrigeratingand
freezing;sealingandbottling(assuch);simplewrapping,and
vacuumandgaspacking.Malting,whichaddswater,isa
minimalprocess,asisfermenting,whichaddsliving
organisms,whenitdoesnotgeneratealcohol.
2.Processedculinaryingredients
Processedculinaryingredientsarefoodproductsextracted
andpurifiedbyindustryfromconstituentsoffoods,orelse
obtainedfromnature,suchassalt.Specificprocesses
includepressing,millingandpulverising.Stabilisingor
purifyingagentsandotheradditivesmayalsobeused.
3.Ready-to-consumeproducts
3.1.Processedfoodproducts
Thesearemanufacturedbyaddingsubstancessuchasoil,
sugarorsalttowholefoods,tomakethemdurableand
morepalatableandattractive.
Theyaredirectlyderivedfromfoodsandrecognisableas
versionsoftheoriginalfoods.Theyaregenerallyproduced
tobeconsumedaspartofmealsordishes,ormaybeused,
togetherwithultra-processedproducts,toreplacefoodbasedfreshlyprepareddishesandmeals.Processesinclude
canningandbottlingusingoils,sugarsorsyrups,orsalt;and
methodsofpreservationsuchassalting,salt-pickling,
smokingandcuring.
3.2.Ultra-processedproducts
Theseareformulatedmostlyorentirelyfromsubstances
derivedfromfoods,andtypicallycontainlittleornowhole
foods.Theyaredurable,convenient,accessible,highlyor
ultra-palatable,oftenhabit-forming.Theyaretypicallynot
recognisableasversionsoffoods,althoughtheymayimitate
theappearance,shapeandsensoryqualitiesoffoods.Many
ingredientsarenotavailableinretailoutlets.Some
ingredientsaredirectlyderivedfromfoods,suchasoils,fats,
flours,starchesandsugar.Othersareobtainedbyfurther
processingoffoodconstituents.Numerically,themajorityof
theingredientsarepreservatives;stabilisers,emulsifiers,
solvents,bindersandbulkers;sweeteners,sensory
enhancers,coloursandflavours;andprocessingaidsand
otheradditives.Bulkmaycomefromaddedairorwater.
Micronutrientsmayfortifytheproducts.Mostultraprocessedproductsaredesignedtobeconsumedby
themselvesorincombinationassnacks.Theydisplacefoodbased,freshlyprepareddishesandmeals.Processesinclude
hydrogenation,hydrolysis;extruding,mouldingand
reshaping;andpre-processingbyfryingorbaking.
Fresh,chilled,frozenandvacuum-packed
vegetablesandfruits;grains(cereals),includingall
typesofrice;fresh,frozenanddriedbeansand
otherlegumes(pulses),rootsandtubers;fungi;
driedfruitsandfreshlypreparedorpasteurised
non-reconstitutedfruitjuices;unsaltednutsand
seeds;fresh,dried,chilledandfrozenmeat,
poultry,fishandseafood;dried,fresh,pasteurised
full-fat,low-fatandskimmedmilk,andfermented
milksuchasplainyoghurt;eggs;teas,coffeeand
herbalinfusions;tap,filtered,springandmineral
water.
Plantoils;animalfats;sugarsandsyrups;starches
andflours;uncooked‘raw’pastasmadefromflour
andwater,salt.
3.1.Processedfoodproducts
Cannedorbottledvegetablesandlegumes(pulses)
preservedinbrine;peeledorslicedfruits
preservedinsyrup;tinnedwholeorpiecesoffish
preservedinoil;saltednuts;un-reconstituted
processedmeatandfishsuchasham,baconand
smokedfish;cheese.
3.2.Ultra-processedproducts
Chips(crisps),manytypesofsweet,fattyorsalty
snackproducts;ice-cream,chocolates,candies
(confectionery);Frenchfries(chips),burgersand
hotdogs;poultryandfish‘nuggets’or‘sticks’
(‘fingers’);breads,bunsandcookies(biscuits);
breakfastcereals;pastries,cakesandcakemixes;
‘energy’bars;preserves(jams),margarines;
desserts;canned,bottled,dehydrated,packaged
soupsandnoodles;sauces;meat;yeastextracts;
soft,carbonated,colaand‘energy’drinks;sugared,
sweetenedmilkdrinks,condensedmilkand
sweetenedincluding‘fruit’yoghurts;fruitandfruit
‘nectar’drinks;instantcoffee,cocoadrinks;noalcoholwineandbeer;pre-preparedmeat,fish,
vegetable,cheese,pizzaandpastadishes;infant
formulas,follow-onmilksandotherbabyproducts;
‘health’and‘slimming’productssuchaspowdered
orfortifiedmealanddishsubstitutes.
(Adaptedfrom:FoodClassificationSystemsBasedonFoodProcessing:SignificanceandImplicationsforPoliciesandActions:A
SystematicLiteratureReviewandAssessment.CurrObesRep.2014,3:256)
6
Analyses
TheNDNSdatasetwasobtainedfromtheUKdataservice(UKDataService,2015).Statisticalanalysis
wasconductedinStata(versionSE14.0;StataCorporation).Weightsandthe‘svy’surveycommand
wereusedwhenconductinganalysestoallowforthecomplexsampledesign.Nutritionintake
estimatesarisingfromNDNSdataarereportedformaleandfemaleadults(aged19to64years)and
children(agedone-and-a-halftothreefourto10yearsand11to18years)livinginmiddle-income
householdsinEngland(n=511).AllanalysesusingNDNSdatawereconductedusingdatafromall
foursurveyyears(2008–2012)4.
Chapter1:healthconsequences
Datasourcesandpopulation
HealthSurveyforEngland2013
Dataonhealthoutcomesforeachfamilymemberwereobtainedfromthe2013cross-sectionofthe
HealthSurveyforEngland(HSE),anannualsurveyofanationallyrepresentativesampleofthe
generalpopulationlivinginhouseholdsinEngland(NatCenSocialResearch,etal.,2015b).TheHSE
utilisesamultistagestratifiedprobabilitysamplingdesignwithpostcodesectorsastheprimary
samplingunitandthePostcodeAddressFileasthesamplingframeforhouseholds.Interviewersvisit
participantstocollectdataondemographicandsocioeconomicindicators,informationonhealth
andhealth-relatedbehaviours,andtakeheightandweightmeasurements.Withconsent,nurses
visittotakeadditionalmeasurements,collectbiologicalsamplesandrecordinformationon
medicationuse.DetailedinformationontheHSEmethodsandresultscanbefoundelsewhere
Children’sDentalHealthSurvey2013
The2013Children’sDentalHealth(CDH)Surveyisaseriesofnationalchildren’sdentalhealth
surveysthathavebeencarriedoutevery10yearssince1973(Health&SocialCareInformation
Centre,2013).TheCDHsurvey2013usedaclustered,stratified,multistagedesigntorandomly
selectarepresentativesampleofchildrenagedfive,eight,12and15yearsattendingstateand
independentschoolsacrossEngland,WalesandNorthernIreland.Thesampleincludedacademies
andfreeschoolsinEngland,butexcludedspecialschools.
DatawascollectedthroughadentalexaminationcarriedoutbyNHSqualifieddentistsandnurses,a
self-completionquestionnairecompletedby12-and15-year-olds,andaparentalself-completion
questionnaire.Thesurveyprovidesinformationonclinicalindicatorsoforalhealth,reported
perceptionsoforalhealth,andbehavioursanddentalserviceusagepatternscapturedfromthe
parentalandpupilquestionnaires.Atotalof13,628childrenweresampled.Dentalexaminations
werecarriedouton9,866children.Responseratesvariedbyagecohort:70%infive-year-olds;65%
ineight-year-olds,83%in12-year-oldsand74%in15-year-olds.Theresponseratefortheselfcompletionquestionnairechildrenaged12and15yearswhoagreedtoadentalexaminationwas
99.6%.Theoverallresponseratefortheparentalquestionnairewas43%.Furtherinformationonthe
4
AllyearsoftheNDNSrollingprogrammewereusedtoincreasesamplesize.
7
CDHsurveydesignandresultscanbefoundelsewhere(Health&SocialCareInformationCentre,
ChildDentalHealthSurvey2013,England,WalesandNorthernIreland,2013).
Healthoutcomes
Overweight/obesity
TheHealthSurveyforEngland(2013)containsinformationonanthropometricmeasurements:the
interviewertookheightandweight,andthenursetookwaistmeasurements.Thisdatawasusedto
determineratesforoverweightandobesityforadultsandchildrenlivinginmiddle-income
householdsinEngland5.
Diabetes
TheHSE2013collectedinformationonself-reporteddoctor-diagnoseddiabetes.Objectiveblood
measurementsofhighbloodsugarlevelsforadultsaged16yearsandoverarealsotaken.TheHSE
interviewmakesnodistinctionbetweenType1andType2diabetesbecauseofchangingpatternsof
thedisease.Inpreviousyears,itwasassumedthatparticipantswhoreportedhavingdoctordiagnoseddiabetesbeforetheageof35andwhowerehavinginsulintherapyatthetimeofthe
surveyhadType1diabetes,andallotherparticipantswithdoctor-diagnoseddiabeteswere
classifiedashavingType2diabetes.Asincreasingnumbersofpeoplearenowbeingdiagnosedwith
Type2diabetesbelowtheageof35,andsomeadultswithType2diabetesarenowprescribed
insulintherapy,thesedistinctionsarenolongerreliable.Theestimatespresentedinthereport
thereforedonotdistinguishbetweenType1andType2diabetes.
Dentalhealth
TheChildren’sDentalHealthSurvey2013wasusedtoidentifydentalcariesinchildrenagedfive,
eight,12and15yearslivinginEngland.Obviousdecayexperienceisthetraditionalmeasureusedin
dentalepidemiologysurveysseekingtoestablishthenumberof‘cavities’tobe‘filled’.
Analyses
TheHSEdatasetwasobtainedfromtheUKDataService(UKDataService,2015).Statisticalanalysis
wasconductedinStata(versionSE14.0;StataCorporation).Weightsandthe‘svy’surveycommand
wereusedwhenconductinganalysestoallowforthecomplexsample.Estimatesforadult
overweight/obesityanddiabetesoutcomeswereage-standardisedtoallowcomparisonsbetween
groupsafteradjustingfortheeffectsofanydifferencesintheiragedistributions.Allage
standardisationhasbeenundertakenseparatelywithineachsex,expressingmaledatatotheoverall
malepopulationandfemaledatatotheoverallfemalepopulation.TheHSEdatasetcontainsa
variablefornethouseholdequivalisedincome.Thiswasusedtoidentifyhouseholdswithan
equivalisedhouseholdincomewithinthe3rdquintileintheFamilyResourcesSurveyfor2013.Health
outcomeestimatesusingHSEdataarereportedformaleandfemaleadults(aged19to64years)
andchildren(agedfourto10and11to18years)livinginmiddle-incomehouseholdsinEngland
(n=1455).
5
Dataforadultswasage-standardisedtoallowcomparisonsbetweengroupsafteradjustingfortheeffectsof
anydifferencesintheiragedistributions.Allagestandardisationwasundertakenseparatelywithineachsex,
expressingmaledatatotheoverallmalepopulationandfemaledatatotheoverallfemalepopulation.
8
EstimatesfordentalcariesinchildrenweretakendirectlyfromtheChildren’sDentalHealthSurvey
2013reporttablesforEngland.ItwasnotpossibletoobtaindatafromtheChildren’sDentalHealth
Survey2013stratifiedbyincomelevel.Therefore,estimatesprovidedinthereportareforall
childrenlivinginEngland.
Chapter2:Foodeatenandthrownaway
Datasourcesandpopulation
LivingCostsandFoodSurvey(2013)
TheLivingCostsandFoodSurvey(LCF),previouslyknownastheExpenditureandFoodSurvey,isa
nationalcross-sectionalsurveyofprivatehouseholdsconductedintheUnitedKingdom(ONS,etal.,
2015)
TheLCFemploysamulti-stagestratifiedrandomsamplewithclustering.Addressesaredrawnfrom
thePostcodeAddressFile(PAF).TheLCFcollectsinformationonpurchasingatthehouseholdand
individuallevel.Eachindividualaged16andoverinthehouseholdvisitedisaskedtokeepadiary
recordofdailyexpenditurefortwoweeks.Informationaboutregularexpenditure,suchasrentand
mortgagepayments,isobtainedfromahouseholdinterviewalongwithretrospectiveinformation
oncertainlarge,infrequentexpenditures,suchasthoseonvehicles.MoreinformationabouttheLCF
canbefoundelsewhere(Bulman,etal.,2013).
Horizonsdata(2013/2015)
Horizonsisasourceoffoodserviceinsights,dataandtrendsfortheUK,Europeanandglobal
foodservicemarkets(Horizons,2015).Horizonsproduceareport,‘EatingOut-Look’,fromsurvey
researchconductedintheeating-outmarket.EatingOut-Lookisapanelsurveyrunquarterly,twice
withconsumersandtwicewithoperators(Horizons,2015).Thesurveycollectsinformationon
eating-outbehaviourfromrepresentativesamplesof2,000consumersand300operators,including
frequencyofeatingout,wherepeopleeatoutandwhoeatsoutthemost,amongothers.Boththe
consumerandoperatorsurveyareconductedonline.
KantarWorldpanel(2013)
Dataonhouseholdretailfoodanddrinkpurchasingfor52weeksending26May2013wasobtained
fromKantarWorldpanel(Kantar,2015).KantarWorldpanelconductsconsumerpanelresearchin
theUK.Purchasingdataiscollectedbyacontinuouslyreportingpanelof30,000demographically
representativeBritishhouseholds.Panellistsareaskedtorecorddetailsofallfoodanddrink
purchasedforhouseholdconsumption,includingvolumesboughtandpricespaid.Thesampling
frameforKantar’ssurveywasGreatBritain(n=32,545).Moreinformationaboutthedatacanbe
viewedelsewhere(Kantar,2015).
SchoolLunchTake-upSurvey(2013/2014)
TheSchoolLunchTake-upSurvey,commissionedbytheDepartmentforEducation,wasconducted
inthe2013/2014financialyear(DepartmentforEducation,2015).Thesurveyisasourceof
9
independentdataonschoollunchtake-up,schoollunchprices,typesofcateringprovisionand
school’sperceptionsofschoollunchtake-up.Althoughthesampleframewasallprimary,specialand
secondaryschoolsinEngland,thereportcontainsfindingsfromonlyprimaryandspecialschoolsdue
tosecondaryschools’lowresponserate.Schoolswerestratifiedbyschoolphase,typeofschool,size
andtheproportionofpupilseligibleforschoolmeals.Schoolscompletedthesurveyeitherviaan
onlineExcelspreadsheetorbytelephone.Theoverallresponserateforthesurveywas19%ofthe
sample.Theresponseratevariedbyschooltype,i.e.primary,specialorsecondary.
HouseholdFoodandDrinkWasteintheUK(2012)
WRAP(Waste&ResourcesActionProgramme)isaregisteredcharitythatworkstohelpbusinesses,
individualsandcommunitiesintheUKtoreducewaste,increasesustainabilityanduseresources
moreefficiently(WRAP,2016).WRAPconductedresearchintothequantityandtypesoffoodand
drinkwastegeneratedbyUKhouseholdsin2012(WRAP,2013).Theestimateswerederivedfroma
combinationofthreemaindatasources:
1. Datafromwasteauditscommissionedbylocalauthoritiesanddatasubmittedto
WasteDataFlow,aweb-basedsystemformunicipalwastedatareportingbyUKlocal
authorities(WasteDataFlow,2016).
2. Datacollectedfrom1800consentinghouseholdsin2013ontheweightandtypesoffood
anddrinkwasted.
3. Diaryrecordsofwastefromalldisposalroutesfromthehomein2012.
MoreinformationabouttheHouseholdFoodandDrinkWasteintheUKreportcanbefound
elsewhere(WRAP,2013).
Expenditureandwasteoutcomes
Wheredowebuyourfoodandhowmuchdowespend?
TheLivingCostsandFoodSurvey(LCF)2013wasusedtolookathousehold-levelexpenditureon
foodanddrinkpurchasedforhouseholdconsumption,aswellasfoodconsumedoutsideofthe
home.Dataontotalspendingonretailfoodanddrink,householdshoppingfrequency,spendper
householdandspendpertripwasobtainedfromKantar.Kantaralsoprovideddataonthegrocery
marketshareofmajorretailersandprovidedalistofthetop80productcategoriesintermsof
annualspending.Thetop20itemsinthislistaccountedfor50%oftotalannualconsumerspending
onretailfoodanddrinkpurchasedforhouseholdconsumption.AsKantardatawasforallUK
households,expendituredatausedinthemainnarrativewasobtainedfromtheLCFdatarather
thanKantardatatoallowafocusonmiddle-incomehouseholdswithchildren.
Eatingatschool
Estimatesforschoollunchuptakeinprimaryandspecialschoolsanddifferencesinuptakebetween
freeandpaidluncheswereobtainedfromtheSchoolLunchTake-upSurvey2013/2014.
Eatingout
Horizon’sEating-OutlooksurveyprovidedinformationonhowoftenconsumersintheUKeat
outsideofthehome.Eatingoutexpenditureestimatesprovidedinthenarrativereportwere
obtainedfromtheLCF2013survey.TheLCFsurveyrecordedexpenditureondifferentitemsdefined
aseither‘household’or‘eatingout’expenditure,wherebyhouseholdexpenditurecoversallfood
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anddrinkboughtforconsumptionathomeandeatingoutcoversfoodthatneverentersthe
household.Eatingoutexpenditureincludesexpenditureonitemssuchasrestaurantmeals,school
mealsandsnacks,andmealsboughtandeatenatwork.
AccordingtoHorizon’sdata,McDonaldsUKwastheQuickServiceRestaurantwiththebiggest
marketsharein2013sowelookedinmoredetailattheirmenuandthepricesfordifferentfoods.
Informationonthenutritionalcompositionofmenuitems,includingtheamountoffat,saturated
fat,salt,sugarandenergyper100goftheproduct,wasobtainedfromtheMcDonaldswebsite
(McDonalds,2015).
TheWorldHealthOrganizationRegionalOfficeforEuropeNutrientProfilingModelwasusedto
identifywhethereachfoodanddrinkitemonthemenuwouldberestrictedfrommarketingto
children(WHORegionalOfficeforEurope,2015).Foodanddrinkitemswereclassifiedintooneof
thecategorieslistedinthemodel.Oncetheappropriatecategorywasidentified,thenutritional
contentofthefoodproductwascrosscheckedagainstthethresholdsofthemodel.Ifoneormoreof
thenutrientswereabovethesetthreshold,theitemwasnotpermittedtobemarketedtochildren.
Forsomeitems,addedsugarsandnon-sugarsweetenerswerenotpermittedinanyamounts.
Nutritionalinformationonthesewasnotavailableonthenutritioninformationsectionofthe
website,howevertheingredientslistforeachproductwascheckedtolookforitemsthatwould
containorbeclassifiedasaddedsugarsornon-sugarsweeteners.PricesforMcDonald’smenuitems
wereobtainedfromahighstreetstore.
TheWRAPHouseholdFoodandDrinkWasteintheUKreportlistsestimatesforavoidablehousehold
foodanddrinkwastefromUKhouseholdsforanumberoffooditems.Estimatesarepresentedas
weightoftotalavoidablewaste(tonnes)andintermsofthecostofavoidablewaste(£millionper
year).Avoidablewasteisaclassificationusedinthereportrelatingtofoodanddrinkthrownaway
thatwas,atsomepointpriortodisposal,edible,e.g.milk,lettuce,fruitjuice,meat(e.g.Unavoidable
wastewouldincludemeatbones,eggshellsetc.).
TheWRAPestimatesforcostofavoidablewasteforparticularfooditemswerematchedasbest
possiblewiththetop20productsintheKantarlistofproductcategoriesrankedintermsof
consumerspendingonretailfoodanddrink.Foreachproductinthislist,wecalculatedthecostof
avoidablewasteasaproportionoftotalannualspendingusingtheKantarfiguresforannual
spendingoneachproduct.
Analyses
TheLCFdatasetwasobtainedfromtheUKDataService(UKDataService,2015).Statisticalanalysis
wasconductedinStata(versionSE14.0;StataCorporation).Theunitofanalysesforexpenditure
datausingtheLCFsurveywasthehousehold.TheLCFassignsweightstocasestocorrectforunit
non-responseinthesurveysample.ExpenditureestimatesusingdatafromtheLCFsurveyare
presentedformiddle-incomehouseholdsinEngland(n=192).
TheLCFdatasetcontainsavariablefornethouseholdequivalisedincome.Thiswasusedtoidentify
middle-incomehouseholdswithanequivalisedhouseholdincomewithinthe3rdquintileforthe
FamilyResourcesSurveyfor2013.Thesamplewasalsolimitedtothesehouseholdswithoneor
morechildren(n=~192households).
11
Chapter3:Driversoffoodchoice:labellingandformulationsdata
Kantarprovidedalistofthetop80productcategoriesintermsofconsumerspending,themarket
shareofeachitem,andthebrandleaderandbranddetail(e.g.Warbutonscrumpets)foreachofthe
80products.
TheKantardatawasusedtodetermine4fourcommonlyconsumedprocessedproducts(bread,
breakfastcereals,readymealsandyoghurts)inwhichhealthyproductsshouldbereadilyavailable.
Eachproductinthelistoftop80itemswasrandomlyassignedaretailerbasedontheretailer
marketshare.Foreachprocessedproductcategory,asampleofallavailableuniqueproducts
availableintheretailer’sonlinegrocerystorewastaken(onedayonlyin2015).Foreachsample,
informationwascollectedon:thenumberofavailableproducts;thetypesoffront-of-packlabelling
usedandthelevelsofnutrientsreported(e.g.green,orange,redlabels);theproportionofproducts
onpromotion;andtheproportionofproductswithhealthornutrientclaims.
Theremainingdatainchapter3isdrawnfromsecondarysources,referringwherepossibleto
systematicreviews.
Chapter4:Thefoodsystemdriversoffoodprice
Chapter4ofthereportisintendedtoillustratethewaysinwhichthepolicyenvironmentimpactson
thepriceofitemsinourtypicalfamily’sdiet.Werandomlyassignedsupermarketstoallitemsinthe
shoppingbasketbasedweightedbysupermarketmarketshare(seeabove).Wethenchosethe
brandleaderoffourfoodcategorieswhichappearedinthetop20itemsoftheshoppingbasketto
illustratedifferentproblemareasofthediet:vegetables(whitepotatoes,ownlabel,randomly
assignedtoTesco),freshbeef(leanmince,ownlabel,randomlyassignedtoAsda),freshpoultry
(wholechicken,ownlabel,randomlyassignedtoAsda)andyoghurt(Müllercorner).Vegetables
werechosenbecauseourtypicalfamilyeatstoolittlefruitandvegetablesandfibre.Meatwas
chosenbecausemembersofourtypicalfamilyeattoomuchredandprocessedmeat,andbecause
meathasasignificantenvironmental-footprint.Yoghurtswerechosenbecausetheyillustratea
productforwhichhealthyoptionsareavailableaswellasprocessed,highsugaroptions.Wethen
usedkeyinformantinterviewstotracethefoodbacktothefarm.Thiswaspossibleforthemeat
andpotatoesbutnotfortheyoghurtforwhichMüllerwasnotwillingtoprovidetheinformation
needed.Weusedkeyinformantinterviews,policyanalysis(below)andgovernmentdatato
examinethepoliciesaffectingprice.
Fortheanalysisoftheyoghurt,intheabsenceofinformationfromMüllerwehadtodeducethe
amountofsugarandmilkintheyoghurtfromthecaloriesandcalciumlevelsintheproduct,using
whererelevantMcCanceandWiddowsonasareference.AveragepricedataonMüllercrunch
yoghurtsandNaturalyoghurtcamefromasnapshotanalysisofpricesinallfourmajorsupermarkets
onthelastweekdayinJuneandNovember2015.Promotionswerecapturedinthispricedata
whichwassourcedfromMysupermarket.com.Naturalyoghurtpriceanalysisincludedalltypesof
naturalyoghurtbutthepriceperkcaldatawasbasedonwholenaturalyoghurt.
12
Policyanalysis
Thepoliciesthathaveaninfluenceonthefoodsystemaresummarisedthroughoutthedocument.
TheywereextractedfromanEvidenceSummarypreparedbytheFoodFoundationintheinitial
stagesofpreparingaFoodEnvironmentPolicyIndex(Food-EPI)fortheUnitedKingdom(UK).The
methodsforFoodEPIhavebeendevelopedbytheInternationalNetworkforFoodandObesity/
NCDsResearch,MonitoringandActionSupport(INFORMAS)andpilotedinNewZealand.Thegoalof
theFood-EPIistoidentifyandprioritiseactionsneededtoaddresscriticalgapsingovernment
policiesandinfrastructuresupport.Thefirststepintheprocessistoreviewevidenceandpolicy
documentsthatrelatetothefoodenvironment,andtocompileanEvidenceSummary.TheFood-EPI
hasbeenfullycompletedinNewZealandandisbeingundertakeninseveralothercountries,
includingThailand,MexicoandSouthAfrica.
Food-EPImethodsaredescribedindetailbySwinburnetal.inTheLancet(2015),Vandevijvere,S
andSwinburn,B.intheBritishMedicalJournal(2014)andSwinburnetal.ObesityReviews(2013).
TheEvidenceSummaryfortheUKFood-EPIwasbasedonareviewofgovernmentlegislation,plans
andpolicies,parliamentarycommitteereports,expertadvisorygroupreportsandmajor
authoritativeevidence-basedreportspertainingtofoodenvironments.6Thesewerederivedfroman
internetsearchoforganisationdatabasesandgreyliterature.Atotalof211resourceswerecitedin
thedraftEvidenceSummarydocumentby5November2015.
ThepoliciessetoutinthisdocumentcovertheUK,whichismadeupoffourcountries:England,
Wales,ScotlandandNorthernIreland.Devolutiontookplacein1999whenpowersweretransferred
fromtheUKParliamentinWestminstertotheScottishParliament,theNationalAssemblyforWales,
andtheNorthernIrelandAssembly.EnglandistheonlycountryoftheUKthatdoesnothavea
devolvedParliamentorAssembly,andtheWestminsterParliamentdecidesonEnglishaffairs.Asa
resultofdevolution,policiesincertainareas–includinghealth,agriculture,education,the
environment,andlocalgovernment–isdeterminedbythedevolvedpowers.TheUKisamemberof
theEuropeanUnion(EU),soallfournationsaresubjecttoEUlegislation.Specificlegislationand
policiesthatapplydifferentlyinEngland,Scotland,WalesorNorthernIrelandarenoted.
6
Foodenvironmentisdefinedasthecollectivephysical,economic,policyandsocioculturalsurroundings,
opportunitiesandconditionsthatinfluencepeople’sfoodandbeveragechoices,andnutritionalstatus.
13
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