Restricting promotions on food and drink high in fat, sugar or salt

This would need to be staggered. Option 1 and 2 within a 2 year period and incrementally move towards option 3 and option 4. The key target of option 3 is important to support the aim of reducing childhood obesity.

Discretionary foods are not included in the Eatwell Guide as they are not required for a healthy balanced diet. Despite this, the intake of these foods is still too high in Scotland. In 2016, approximately 40% of all take home food and drinks were bought through price promotions of which discretionary foods accounted for around 50% and healthier categories, 30%. Over the last 4-5 years, these figures have not improved much. In 2019/20, Foods Standard Scotland (FSS) found that food and drinks purchased on a price promotion were likely to be skewed towards less healthy categories compared to non-discretionary foods, 36.9% and 24.7%, respectively.

The Scottish Health Survey (2020) found the most commonly consumed discretionary foods amongst adults were cakes (33% twice a week or more), sweets or chocolates (29% once a day or more) and ice cream (29% once a week or more). In addition to this, in 2019 only one in five adults and one in seven children met the recommendation for consumption of fruit and vegetables. This is suggestive of encouraging supermarkets and retailers to include healthier alternatives in price promotions.

In 2020, FSS carried out “The Food in Scotland Consumer Tracking Survey Wave 10” which found 58% would support the restriction in marketing or promotions of some unhealthy foods and drinks. When asked “would you support restricting the marketing/promotion of some unhealthy food/drink inside shops/supermarkets or online?” 68% agreed with the statement “it worries me that unhealthy foods seem to be on price promotion more often than healthy ones” and 50% agreed that promotional offers on foods high in fat, sugar and salt should be banned.

The public’s view on Interests, Needs and Concerns around Food in Scotland Report (2022) revealed that 58% of consumers thought supermarkets encouraged consumers to buy unhealthy food. It was also reported that 1 in 4 felt heavily processed foods were often the only option available to them and 55% people in Scotland felt it was easy to eat multiple portions of fruit and vegetables per day.

Similarly, The UK’s Public Interests, Needs and Concerns around Food Report found 54% felt marketing and promotions in supermarkets encouraged them to choose unhealthy options; and qualitative research reported a generalised feeling of frustration that promotions often focused on more processed products. Those individuals who largely bought products through offers or multi-buys wished that the products were healthier.

Although there is work to be done regarding price promotions, there are various supermarkets who have already taken action to encourage tasting and buying fruits and vegetables. For example, in the last few years Aldi have released a weekly “Super-6” which are 6, usually seasonal, fruits and or vegetables at a temporary price reduction. As well as this, Tesco provides fresh fruit for children for in store shopping with parents or carers.

Sainsbury's found that by reducing the price of a variety of fruit and vegetables to 60p in stores across the country between 2019 and 2021, portions of promoted fruit and vegetables sold, increased by 78%. In general, exotic and higher value fruits were purchased more however this was not consistent across the time frame. This study emphasises the importance of using incentives, placement and signposting in delivering short-term positive changes. The long-term changes are not yet known, however a report is due this year to investigate whether consumers continued to eat a greater number of fruits and vegetables a year after the trial ended. It is worth noting that Sainsbury’s, typically, is known as a “high-end” supermarket and therefore is not necessarily representative of Glasgow’s’ target population living in SIMD 1 and 2.

To conclude, the evidence presented above strongly favours the restriction of price promotions for foods listed in category 4 due to the high consumption of discretionary and HFSS foods in Scotland. The proposal also aligns with the Good Food Nation Bill and other national and local level actions to improve diet and support the population to be a healthy weight. NHS GGC Board recognise the excellent work done by various supermarkets thus far, however now is the time to implement mandatory price promotion restrictions and help the Scottish population to make healthier choices.

There is limited evidence detailing the use of Nutrient Profile Modelling (NPM) in Scotland, however the evidence presented below is in support of NPM.

Pinho-Gomes et al, 2021 investigated the extent to which the 2005/2018 NPM were consistent with the Eatwell Guide messages when assessing the healthiness of 3028 UK diets through an observational study. The findings showed The Eatwell Guide and both versions of the Nutrient Profiling Model were in agreement with significant results; 2005 versions, P<0.0001 and 2018 version using the NPM cut off score of 4 – P<0.0001.

Although the NPM could be a very successful tool, Bandy et al, (2021) found that when comparing the UK’s top 10 food and beverage companies using NPM, there had been little change in the profiling scores between 2015 and 2018. The study recommended further policy action is required to encourage companies to make further product changes to support healthier diets for the population. The UK’s voluntary reformulation policies which set targets to reduce calories, sugar and salt has not appeared to show any significant changes to nutritional quality of food so a mandatory policy should be considered.

The main caveat for the NPM is that it doesn’t take portion sizes into consideration so an item like mayonnaise which is high in fat but typically consumed in smaller quantities would be rated less healthy than various pizzas for example, which are usually consumed in larger quantities. Another example is nuts or nut butters which are encouraged as part of a balanced diet but can be high in salt and “healthier” fats (OHA, 2021). Additionally, the NPM was originally developed in 2004-2005 by the Food Standards Agency (FSA) and has not been updated since despite a UK Government consultation in 2018 which received a low number of responses and little support from companies who did, relating to the sugar threshold of products. The Scottish Government are proposing to use this 2004-2005 version of the NPM until the new model is published, however there are concerns that this will not reflect the ever changing food environment and evidence which has emerged over the last ten to fifteen years.

To summarise, the NPM could be a useful guide for manufacturers to scrutinise their products and to identify lower FSS products that would remain exempt however, the model should be subject to regular review to ensure manufacturers are adhering to the guidelines and products are aligned within the correct groups. In addition to this, sufficient training will be necessary for businesses to avoid system errors. Smaller businesses may also require more support when using the model.

Although it is advantageous for the environment to reduce food packaging, which works in tandem with Scotland’s sustainability policy, bakeries, hot deli counters and fast food outlets, to name a few, all provide non-pre-packed products which are often HFSS foods. If these were to be excluded, this would provide a loop hole for manufacturers to avoid packaging any of these products and therefore would still be available to the public without going through the NPM. There is concern that this would drive the supermarkets and other outlets to move away from pre-packed thus allowing companies to promote HFSS foods. The policy should be enforced as widely as possible to ensure consistency across Scotland and fairness for all businesses.

There are few studies investigating the impact of “extra free” and “meal deal” options however the general consensus is that consumers who buy more on promotions are 13% more likely to be overweight or obese, purchase more HFSS foods, and in greater volumes (Cancer research, 2019).

Meal deals that contain items high in FSS should be included in the multi-buy restrictions. Crawford et al (2017) found that children in secondary schools around Glasgow often pick unhealthier items when buying a meal deal at lunch time. It was also noted that few of the retail outlets offering meal deals or promotions included fruit or vegetables/healthy components in the price. It should be highlighted that this study only provides a snapshot of school lunch time behaviour on one day in 2017 however is suggestive that some options within meal deals should be excluded from price promotions.

Contrary to this, not all meal deal options are HFSS, for example, a meal deal containing a chicken club wholemeal sandwich, a pot of fruit and a low fat yoghurt would equate to a balanced lunch. Perhaps a consideration should be made for items which score high in the NPM to be excluded or charged more for within a meal deal and all other healthier items like fruit, low fat/sugar yoghurts etc are exempt. By increasing the price of the items which score high with NPM, individuals may have no choice but to choose the cheaper items.

Both types of price promotions should be included within the restrictions however with the cost of living/energy and food costs, there would need to be adequate promotion and availability of healthier alternatives and suitable deals on these.

It is widely known that regular consumption of Sugar Sweetened Beverages (SSB) exacerbates the risk of developing non-communicable diseases like tooth decay, Type 2 Diabetes, High blood pressure and Obesity. Therefore the Scottish population should be reducing intake of SSB’s and other foods high in sugar and suitable alternatives should be included within the offer of unlimited refills.

According to FSS, between 2016 and 2018, soft drinks contributed to around 20% of total free sugar consumption in Scotland. However only 4% of this contribution was from eating out of the home, highlighting household consumption of SSB’s is higher at home (FSS, 2021)

Unlimited refills may encourage individuals to drink more than they usually would in order to get their money’s worth, however there is limited evidence to support this claim and the evidence provided in the Scottish Governments Consultation, paragraph 89 is outdated to 2011. In addition to this, there is a relatively small group of restaurants which offer free refills, most of which are chains like Nandos and Pizza Hut etc so it would perhaps be more realistic to suggest that SSB’s are not included in unlimited refills but to still include drinks with no added sugar. It would also be advantageous for restaurants and similar to offer water as standard practise to encourage consumers to drink water alongside their soft drinks or to reduce the number of soft drinks ordered.

There is limited evidence about the category suggested below and there may be other options however all you can eat buffets and similar is suggested to be included the restrictions for unlimited amounts. Buffet style restaurants may encourage overeating due to the consumer refilling several plates to receive the “most for their money”. Additionally, if buffet style meals were included in the unlimited amounts restrictions, there may be a positive outcome of reduced food waste as consumers would have less plates and be less likely to refill with new foods to try.

There is limited evidence available for purchasing data in Scotland however the graphs below from FSS "Monitoring retail purchase and price promotions in Scotland (2014-18) report", show that TPR’s have remained the most common form of price promotion in Scotland and accounted for around 23% of all calories purchased in 2018. In addition, HFSS foods are most likely to be bought when on a TPR, as shown by Figure 19.

On the other hand, the evidence provided within the Consultation, in paragraph 77, has been taken from the FSS Situation Report which was done during the height of the Covid-19 pandemic. During this time, many were furloughed, resulting in a reduced household income. According to the Food in Scotland Consumer Tracker Wave 10 Results 24% of adults had a reduced income during Covid-19, and 3% sought help from emergency supports, so it comes as no surprise that people were making use of TPR and other promotions.

With this in mind, it is clear that TPR’s account for a large percentage of calories bought in supermarkets especially for HFSS items. However, it would be beneficial for TPR’s to remain in supermarkets for store cupboard essentials and fresh, tinned or frozen fruits and vegetables to encourage consumers choosing healthier items.

Upselling/upsizing in fast food or takeaways or retailers (cinema)
In 2019, FSS launched a “No to Upsizing” campaign to urge the Scottish population to be aware of the extra calories that accumulate through upsizing meal sizes or adding sides, starters or desserts. Therefore by including upselling or upsizing in the price promotion restrictions, the public will not be encouraged to add more calories to their choices.

In general, many out of home retailers and fast food outlets offer upsizing for a specific cost. In the Food in Scotland Consumer Tracker Wave 10 Results, 33% of respondents (1,015 Scottish adults), said it was hard to say no to upsizing or upselling offers when ordering a takeaway/delivery. Sample size

The Royal Society for Public Health and Slimming World published a report "Size Matters" in 2017 which detailed the responses of 2,055 UK adults regarding their views on upselling. Two thirds of the population had experienced upselling at least once in a typical week with the most common settings being restaurants, fast food outlets, supermarkets and coffee shops (72%, 64%, 60% and 59%, respectively). When asked to detail individual experiences, 34% had bought a larger than intended coffee and 32% had orders a larger meal after being encouraged by a member of staff. Although this report is slightly outdated, it highlights the dangerous impact of upselling.


Supermarket or retail memberships
Some supermarkets have clubcard or loyalty schemes where certain items are temporarily reduced in conjunction with the use of a card for a limited time. Many of these items are discretionary foods and are not required for a balanced diet. On the other hand, supermarkets could offer more fruit and vegetables as part of their “Clubcard prices” to encourage those on a lower income to buy. This would also help to meet the Scottish Dietary Target of eating more fruits and vegetables and less food and drink high in fat, sugar and salt.

Free samples of new food and drinks
Outlets which offer free samples of HFSS products should be included in this policy and consideration should be made to offering free samples of healthier alternatives.

Targeted foods in all of the locations mentioned above should be included in the proposed restrictions to improve the consumer shopping environment and help encourage healthier options, ultimately reducing the impact of a previous obesogenic environment. High visibility of healthier foods if included within price promotions would be encouraged and welcomed.

In the Food in Scotland Consumer Tracker Wave 10 Results 67% agreed (1,015 Scottish adults) that placing high fat, sugar and salt foods near checkouts mean people buy more than they otherwise would.

In agreement with the comments within consultation that careful consideration is needed in terms of how these locations are defined and loop holes businesses could find to get around this.

Images of HFSS foods, often indicating price promotions should be included in the restrictions. Seasonal items like Easter eggs, Halloween confectionary and Christmas advent calendars are usually advertised on windows, car park displays and on entry to supermarkets. These images may encourage the consumer to buy a product they otherwise wouldn’t have, or buy more than required, had they not seen the promotion.

Another improvement that would be highly recommended would be to move healthier options at the “ready to eat/take away” section in supermarkets towards eye level. In supermarkets it is often the case that unhealthier items are placed where the consumer can clearly see them and fruit or yoghurts for example are higher or lower than strict eye level.

Lastly, some supermarkets often have randomly placed HFSS items amongst fresh fruit or vegetables on stands with promotional offers attached and at the entrances or exits. The placement of these items should only be within the designated area of the supermarket for example bakery products within the bakery aisle and so on.

As a general rule the HFSS targeted foods should be restricted on all of the above to discourage the consumer from impulsively adding to their basket unless the consumer is actively seeking out these items. If the consumer does not see these items on screen, they may be less likely to add to their shopping. It is often the case that HFSS foods are advertised first on the “offers” pages so perhaps supermarkets could consider putting healthier items further up or more visible to consumers.

Favourite product page- professional opinion that we do not have the knowledge to comment on this particular aspect.

The Obesity Health Alliance (OHA, 2020) undertook a study investigating how retailers encourage consumers to purchase HFSS products online through multi-buy promotions. The survey is only representative of one day searching online and included Tesco, Sainsbury’s, Asda, Morrison’s and Ocado. Asda had just under a quarter of all confectionary as part of a multi-buy option, Ocado had just under 15% and both Tesco and Morrison’s had 11%. The study found that supermarkets that used multi-buys in confectionary, put these offers at the top of the page for first viewing and typically, once an item has been purchased once or shown interest in it is likely for the product to be shown in the “Recommended for you” section. Although this study only shows the offers available on one day across 5 supermarkets, it represents a huge number of products on price promotions and highlights the importance of restricting these offers online.

Similar restrictions could be proposed for online delivery/takeaways where consumers order food online for deliveries. The home page of many takeaway sites and popular franchises immediately showcase any promotions available to consumers.

Since the Covid-19 Pandemic there has been a marked increase in food purchases and retailers delivering to home locations. In 2020, takeaways grew to a market value of £1.1 billion, a 31% increase since 2019 and the delivery market also gained 1.2 million new customers, which was an increase of 54% from 2019 (FSS COVID-19_Situation_Report). Additionally, 66% of consumers (1,015 Scottish adults) report finding it difficult to eat healthily when ordering a take away and 60% agree there are not enough healthy choices when ordering a takeaway or delivery (Food in Scotland Consumer Tracker Wave 10 Results).

Pop-ups should also be restricted online.

The consultation is very comprehensive however alcohol price promotions could perhaps be considered since many of these products are high in sugar and calories.

As a general rule, the policy should be enforced as widely as possible to ensure consistency across Scotland and fairness for all businesses. Smaller businesses should also have supported lead in times to ensure effective transition and an amended version of the policy however, large companies with small chain outlets should not be exempt from the policy e.g. convenience stores.

Discussion is needed on how to make equal and “level playing field” across the different types of premises, e.g. considering sizes of businesses, ability to adhere to guidance, therefore not unfairly discriminating against smaller businesses.
Agree that smaller business need to have an amended version of the policy.

Places such as schools, leisure/sports/community/after school venues that sell food should be considered as these may be venues that children/families visit more regularly.

Large work places like hospitals which have vending machines and outlets that are targeting school aged children should be included within the scope of this policy e.g. vans and small local shops/venues.

This is not our area of expertise however this could be revisited in the future, as a phase 2 of the policy to ascertain, after monitoring, what impact the restrictions of price promotions are having on pubic outlets. For example Wholesalers are not widely accessible by the public, however there are “wholesalers” that are accessed by the public so there should be consideration given to the definition of the “wholesalers” and if the business is more targeting the public, then the policy should be amended to include these outlets.

On the basis that specialist businesses like chocolatiers and sweet shops usually have smaller premises with fewer locations to promote items, it would be difficult to include in location restrictions. It could also be argued that the general public are less likely to spend time in specialist shops compared to larger supermarkets for weekly shops.

The types of price promotions used in these “specialist business” should be considered.

This is not our area of expertise however consideration is needed so not to penalise smaller businesses and to prevent “loop holes” which mean businesses can avoid some restrictions and continue to promote/not restrict HFSS products.
Smaller branches of larger business should not be exempt from the policy.

As this is not our area of expertise, we cannot provide further comments.

As this is not our area of expertise, we cannot provide further comments.

The consultation is very comprehensive and no other exemptions come to mind.

As this is not our area of expertise, we cannot provide further comments. Further information on what this entails for local authorities would be required to answer this question.

It is the opinion that if adequate support, time and funding is provided, local authorities could be best placed to enforce the policy as they have a better understanding of the demographics, population and premises which provide food within the local area.

Further information for what the local authorities would be responsible for/ required to implement is required. It would be expected that extra funding, resources and training for staff etc would be beneficial however it is difficult to comment on what extent these would be needed/feasible at this time.

This is not our area of expertise so cannot provide further comments.

The demand and resources available in relation to enforcement may be impacted with several businesses recovering from the pandemic and struggling with the rising costs of living/running businesses, especially independent smaller convenience stores.
If promotion of some foods are restricted, better alternatives need to be included in promotions and this policy would not necessarily result in this outcome.. Healthy promotions need to be cost appropriate for individuals and families considering the rising cost of living.
This policy should be aligned with other health promotion activities that complement the promotion of healthy lifestyle choices. It should be noted that dietary changes take a long time to become embedded into socially normal eating habits.
Whilst enforcement is not an area where we can offer particular expertise, it is recognised that timing for the implementation of this policy is sensitive. Current cost of living crises is having a huge impact on all sectors of society, affecting their ability to feed themselves and their families. At this point in time, multi-buys, promotional offers, temporary price reductions and loyalty rewards all present ways for citizens to get value for their constrained budgets and policy that seeks to restrict the availability of particular types of foods, may have the unintended consequence of creating greater food insecurity and this needs very careful consideration.
Currently for some families, any calories are better than no calories.

As this is not our area of expertise, we cannot provide further comments however whilst legislation accompanying this policy may ensure compliance, it will have cost and capacity implications for any agency charged with regulation.

Age:
• Possible positive impact on children’s eating habits through the reduction of price promotions on high sugar yoghurts, cereals and snacks.
• Older individuals who have developed preferences over the course of life may be negatively impacted with ready meals or HFSS foods changing recipe or increasing in price.
• Teenagers, eating outwith the school environment, may be encouraged to eat healthier meal deals etc. if the unhealthy options are increased in price or excluded from price promotions.
• The adult population may be positively impacted through choosing healthier options when eating out of the home environment for example if the cost of healthier options become more accessible.

Throughout this response, evidence has been provided emphasising the high consumption of discretionary and HFSS foods in Scotland over the life span.

Sex: As this is not our area of expertise, we cannot provide further comments.

Religion/race: Possible negative impact on ethnic minorities with smaller retail businesses which are prevailing in many Glasgow communities.

Sexual orientation: As this is not our area of expertise, we cannot provide further comments

Disability: Possible negative impact on those children or adults with selective eating habits, for example, children with Autism Spectrum Disorder.

Pregnancy and maternity: As this is not our area of expertise, we cannot provide further comments

Gender reassignment: As this is not our area of expertise, we cannot provide further comments

Marriage/civil partnership: As this is not our area of expertise, we cannot provide further comments

Families that were previously reliant on price promotions may have less affordable choices. The graph below from FSS shows those living in SIMD1 buy more calories on promotion from confectionery and regular soft drinks compared to the least deprived SIMD5.

With the cost of living crisis, some families will rely on price promotions for things such as cooking sauces, pasta, and noodles with added flavours etc. It has been proposed that these foods should be included in the restrictions however this could be detrimental to some families. Through the NPM, manufacturers will be encouraged to reformulate products like the above mentioned due to high salt or sugar content, meaning those products could remain within price promotions and still provide a cheaper alternative for those with socio-economic disadvantage.

The timing of the implementation of this policy should be considered in context of the cost of living rises. The most deprived of the population spend a greater percentage of their income on food therefore the policy needs to consider the impact on our most deprived population. Implementation of the policy in isolation will not change food preferences and shopping habits and may not result in improved nutritional intake. It must be supported by other policies to improve food habits. The policy should also be accompanied by access to healthy foods and access to activities that are in-expensive.

Positive
• Healthier options hopefully become cheaper due to the nutrient profiling scoring system.
• Food manufacturers may consider reformulating products to ensure they can continue to offer price promotions through the nutrient profiling model.
Negative
• Those with lack of cooking skills and knowledge may struggle using healthier ingredients to cook from scratch if store cupboard essentials like sauces are removed from price promotions.
• Children or adults with Autism Spectrum Disorder who have severe selective eating might struggle to afford alternative options if foods that were previously affordable through price promotions are removed.
• The acceptability of reduced price promotions amongst the Scottish population and new foods included in specific promotions.

There is a requirement to ensure restrictions don’t exclude a large range of foods popular with particular population groups in comparison to others. Also the policy should ensure that a wide and diverse range of foods which are lower FSS alternatives are visible/promoted.

There are a significant percentage of people who are at risk of malnutrition, many of these people are under the care of a health professional. Such people are advised on increasing their protein and calories intake. This policy may significantly impact on this patient group and consideration needs to be given how this risk can be off set e.g. social system that allocates them a 10% of their food bills. It is estimated that approx. 3 million people in the UK are at risk of malnutrition. Many of these people will not be under the care of a health professional, so this should be considered when implementing the policy to ensure needs are met.

As this is not our area of expertise, we cannot provide further comments.

Alcohol has a significant contribution in terms of calories and obesity and this has not been included within this policy.

It is recognised that this policy alone is insufficient to change the Scottish palate and eating habits of the Scottish population however is a great step in trying to encourage the purchase of healthier options.

It was also felt that the format of this respondent information form was hard to edit, especially if additional writing space is required or images are inserted. Furthermore, some of the language used was hard to understand and a few question were not worded well.