Julie Brimblecombe1, Emma McMahon2, Megan Ferguson3, Khia De Silva4, Anna Peeters5, Edward Miles2, Thomas Wycherley6, Leia Minaker7, Luke Greenacre8, Anthony Gunther2, Emma Chappell4, Mark D Chatfield3, Catherine L Mah9. 1. Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia; Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia. Electronic address: julie.brimblecombe@monash.edu.au. 2. Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia. 3. Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. 4. Arnhem Land Progress Aboriginal Corporation, Darwin, NT, Australia. 5. Institute for Health Transformation, Deakin University, Geelong, VIC, Australia. 6. Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia; Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, SA, Australia. 7. School of Planning, University of Waterloo, Waterloo, ON, Canada. 8. Business School, Monash University, Melbourne, VIC, Australia. 9. Faculty of Health, Dalhousie University, Halifax, NS, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND: The effectiveness of healthy food promotion on food and beverage sales in real-world food retail settings has been shown in randomised trials. The effectiveness of restrictions on the promotion of unhealthy food is, however, less clear. We aimed to assess the effect of restricted unhealthy food promotion, specifically those items contributing most to free sugar sales, on food and beverage sales. METHODS: In this community-level pragmatic, partially randomised, parallel group trial, stores were randomly assigned by a statistician using a single sequence of random assignments to the intervention group, in which a co-designed strategy restricted merchandising of unhealthy food, or to a control group of usual retail practice. The trial was done in partnership with an organisation operating 25 stores in remote Australia. The primary analysis was based on difference in weekly sales with the strategy compared with no strategy in free sugar from all foods and beverages (g/total MJ; primary outcome), targeted food or beverages (weight and free sugars; g/total MJ), and gross profit (AU$) using mixed models. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001588280. FINDINGS:Between June 13 and Aug 15, 2018, 20 stores were recruited; ten stores were randomly assigned to the intervention group and ten stores to the control group. The trial was done between Sept 2 and Dec 2, 2018. The Healthy Stores 2020 strategy resulted in a reduction in sales of free sugar of 2·8% (95% CI -4·9 to -0·7). Targeted beverages were reduced by 8·4% (-12·3 to -4·3) and associated free sugar by 6·8% (-10·9 to -2·6), sugar-sweetened soft drinks by 13·2% (-18·5 to -7·6), and associated free sugar by 13·4% (-18·7 to -7·7). Reductions in sales of free sugar from confectionery of 7·5% (-14·3 to -0·2) and in weight sold (-4·6%, -11·1 to 2·3) resulted; however, the reduction in weight was not statistically significant. No differences in sales of table sugar and sweet biscuits were observed. Gross profit was not impacted adversely; a small increase resulted (5·3%, 0·3 to 10·5). INTERPRETATION: Restricted merchandising of unhealthy foods and beverages, while allowing for complementary merchandising of healthier foods and beverages in a real-world store setting and co-designed with retailers, can achieve both public health and business relevant gains. FUNDING: Australian National Health and Medical Research Council.
RCT Entities:
BACKGROUND: The effectiveness of healthy food promotion on food and beverage sales in real-world food retail settings has been shown in randomised trials. The effectiveness of restrictions on the promotion of unhealthy food is, however, less clear. We aimed to assess the effect of restricted unhealthy food promotion, specifically those items contributing most to free sugar sales, on food and beverage sales. METHODS: In this community-level pragmatic, partially randomised, parallel group trial, stores were randomly assigned by a statistician using a single sequence of random assignments to the intervention group, in which a co-designed strategy restricted merchandising of unhealthy food, or to a control group of usual retail practice. The trial was done in partnership with an organisation operating 25 stores in remote Australia. The primary analysis was based on difference in weekly sales with the strategy compared with no strategy in free sugar from all foods and beverages (g/total MJ; primary outcome), targeted food or beverages (weight and free sugars; g/total MJ), and gross profit (AU$) using mixed models. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001588280. FINDINGS: Between June 13 and Aug 15, 2018, 20 stores were recruited; ten stores were randomly assigned to the intervention group and ten stores to the control group. The trial was done between Sept 2 and Dec 2, 2018. The Healthy Stores 2020 strategy resulted in a reduction in sales of free sugar of 2·8% (95% CI -4·9 to -0·7). Targeted beverages were reduced by 8·4% (-12·3 to -4·3) and associated free sugar by 6·8% (-10·9 to -2·6), sugar-sweetened soft drinks by 13·2% (-18·5 to -7·6), and associated free sugar by 13·4% (-18·7 to -7·7). Reductions in sales of free sugar from confectionery of 7·5% (-14·3 to -0·2) and in weight sold (-4·6%, -11·1 to 2·3) resulted; however, the reduction in weight was not statistically significant. No differences in sales of table sugar and sweet biscuits were observed. Gross profit was not impacted adversely; a small increase resulted (5·3%, 0·3 to 10·5). INTERPRETATION: Restricted merchandising of unhealthy foods and beverages, while allowing for complementary merchandising of healthier foods and beverages in a real-world store setting and co-designed with retailers, can achieve both public health and business relevant gains. FUNDING: Australian National Health and Medical Research Council.
Authors: Lily Grigsby-Duffy; Sally Schultz; Liliana Orellana; Ella Robinson; Adrian J Cameron; Josephine Marshall; Kathryn Backholer; Gary Sacks Journal: Int J Environ Res Public Health Date: 2020-12-03 Impact factor: 3.390
Authors: Adyya Gupta; Laura Alston; Cindy Needham; Ella Robinson; Josephine Marshall; Tara Boelsen-Robinson; Miranda R Blake; Catherine E Huggins; Anna Peeters Journal: Nutrients Date: 2022-01-11 Impact factor: 5.717