A rapid review of the acceptability and impact of approaches to reduce the salt, fat and sugar content of people’s diets on consumers and industry

Background

Various approaches have been tried or proposed across the world to reduce population intake of fat, salt and sugar. These include initiatives that directly target food producers or retailers, consumers, or both. This report summarises the findings of 49 systematic reviews identified through a search of published literature, reporting on the acceptability and efficacy of population-scale initiatives to reduce fat, salt and sugar consumption.

Results

Public attitudes and acceptability

• Attitudes and acceptability on population-level approaches to reducing the consumption of high fat, salt and sugar (HFSS) foods are not widely studied.
• Public support for taxes is typically low, but can be increased when:
  • The revenue raised is ring-fenced for health-supporting activities
  • Fiscal approaches are believed to be effective
  • There is trust that governments will spend the revenue as is publicised
• Reformulation of products to reduce their fat, salt or sugar content is more acceptable when introduced gradually and alongside a rationale as to the subsequent health benefits.
• Acceptability of reformulated foods rests mainly on perceptions of taste and sensory experience, relative to expectations. How easily this sensory experience, and therefore acceptability, can be maintained through reformulation varies across different food groups and products.
• Acceptability of advertising restrictions is not well researched beyond children. There is largely public support of this approach for children.

Effectiveness on influencing purchasing and consumption

• Nutrient taxes are likely to be effective in changing intake and improving health when at a high enough level, and particularly when combined with subsidies for healthy foods.
• Combined fiscal approaches are not regressive and can reduce health inequalities.
• Reformulation can reduce the intake of unhealthy food and improve health. More research is needed to explore whether and how best to alert consumers to reformulation to avoid compensation effects.
• Nutritional Fact Panel labels may be useful to influence the choices of people already motivated to improve their health. However, some claims (primarily low-fat) can lead to the unintended consequence of increasing consumption, through consumer interpretation of the product being ‘good for me’ or providing permission to consume more.
• Advertising restrictions on foods high in fat, salt and sugar to children are cost-effective when regulations are mandatory, but not when self-regulated by industry. Reducing the impact of the advertising of HFSS food targeted at children on their parents, as the purchasers of children’s food, is also important but this is not well studied.

Influences on and from the food industry

• Nutrient taxes, and labelling requirements can influence the food industry to change product formulation and food preparation/content, moving towards healthier content and portion sizes.
• Pricing interventions that raise the cost of unhealthy food and lower the cost of healthy food can lead to changes in stocking and product placement by retailers and increase the sales of healthy food options.
• Targeting taxes, reformulation or labelling on individual nutrients or products can result in unintended/compensatory effects in different parts of the food industry. Engagement with industrial partners may help to predict, understand and avoid this.
• Industry opposition and lobbying has been a significant barrier to the introduction of healthy food policies, and a reason for their repeal, in many countries.