Developing public health policies for the out of home food sector to improve diet and reduce obesity

在英国，超过四分之一的成年人现在患有肥胖症，仅与肥胖症相关的疾病每年就花费经济270亿英镑。肥胖症的流行是由于经济和社会变化导致了“肥胖”的食物环境。造成肥胖的食物环境的一个关键方面是户外食品(OOHF)部门，它被定义为从家庭外购买食物以立即消费的零售部门，包括外卖或家庭递送餐馆食物(例如，OOHF网点包括咖啡店、咖啡馆、食堂、餐馆和快餐店)。随着时间的推移，这个国家的饮食已经变得更加依赖OOHF。然而，这种向更多地依赖OOHF来源的转变现在是一个重大问题，因为目前OOHF部门销售的食品往往卡路里含量高，饮食质量低，这导致OOHF部门导致人口水平的体重增加和肥胖。由于OOHF部门在国民饮食中的作用越来越大，针对OOHF部门的公共卫生政策已被确定为减少饮食相关疾病的关键，英国政府现已将OOHF部门确定为肥胖政策行动领域。为可在OOHF部门实施的广泛的新公共卫生政策建立证据基础现在是研究重点。在这个项目中，我们将使用跨学科的方法来产生基于证据的公共卫生政策建议，这些建议可以在OOHF部门实施，以改善饮食和减少肥胖。为了确定哪些政策将是最有效的，我们首先需要了解OOHF部门对国家饮食的确切贡献。在工作包1中，我们将进行同类最具全国代表性的在线调查，并收集新的数据，使我们能够第一次量化不同的OOHF直销食品来源对国家饮食的能量摄入和整体营养质量的贡献。在工作包2中，我们将使用虚拟和现实世界消费者行为研究方法相结合的方法来检查OOHF部门实施的一系列政策如何影响消费者行为。我们将研究财政政策(例如税收)、结构性政策(例如改变现有产品)和以信息为基础的政策(例如改进菜单标签)的影响，以揭示哪些政策对饮食有最大的积极影响及其原因。然后，工作包3将利用工作包1和2产生的证据进行流行病学和经济模拟。我们将量化不同的OOHF部门政策对人口健康(例如，减少肥胖率和每年挽救的生命)和经济的长期影响。在整个项目中，我们将审查哪些政策可能有利于所有人口的健康，并确定哪些政策有可能减少基于健康的社会不平等。例如，在工作包1中，我们将检查OOHF来源在饮食中的作用是否根据社会经济地位(SES)和人口概况而有所不同，在工作包2中，我们将招募不同的参与者样本，以测试测试的政策是否有利于SES较低和较高的人的饮食。工作包3建模将考虑到基于社会经济地位的基线在饮食和健康方面的差异，以及任何基于社会经济地位的OOHF使用模式和基于SES的政策的有效性，以确定哪些OOHF政策将是公平的(惠及所有人)或有可能缩小健康不平等(例如，特别有利于低社会经济地位群体)。在项目期间，负责肥胖政策行动的非学术合作伙伴和一个由国际公共卫生专家组成的指导小组将向我们提供建议。这种方法将使我们的研究在英国和全球产生的学术贡献和长期影响最大化。

In the UK, more than one quarter of adults now have obesity and obesity-related disease alone costs the economy £27billion per year. The obesity epidemic emerged due to economic and societal changes that resulted in an 'obesogenic' food environment. A key aspect of the 'obesogenic' food environment is the out of home food (OOHF) sector, which is defined as the retail sector in which food is purchased from outside of the home for immediate consumption, including takeaway or home delivered restaurant food (e.g. OOHF outlets include coffee shops, cafes, canteens, restaurants and fast-food outlets). Over time the nation's diet has become more dependent on the OOHF. However, this shift towards an increased reliance on OOHF sources is now a significant problem because at present food products sold by the OOHF sector tend to be high in calories and low in dietary quality, which has resulted in the OOHF sector contributing to population level weight gain and obesity. Because of the growing role that the OOHF sector has on nation's diets, public health policies that target the OOHF sector have been identified as being key to reducing diet-related disease and UK government have now identified the OOHF sector as an area of obesity policy action. Generating an evidence base for an extensive range of new public health policies that can be implemented in the OOHF sector is now research priority. In this project we will use a cross-disciplinary approach to generate evidence based public health policy recommendations that can be implemented in the OOHF sector to improve diet and reduce obesity. To identify which policies will be most effective, we first need to understand the exact contribution that the OOHF sector has on the nation's diet. In Work Package 1 we will conduct the largest nationally representative online survey of its kind and collect new data that will allow us to quantify for the first time the contribution that different OOHF outlet food sources have on the energy intake and overall nutritional quality of the nation's diet. In Work Package 2, we will use a combination of virtual and real-world consumer behaviour study methods to examine how a range of policies implemented in the OOHF sector affect consumer behaviour. We will study the effects of fiscal (e.g. taxation), structural (e.g. altering products available) and information-based (e.g. improved menu labelling) policies to uncover which policies have the largest positive effect on diet and why. Work Package 3 will then draw on the evidence generated from Work Package 1 and 2 to conduct epidemiological and economic modelling. We will quantify the long-term impacts that different OOHF sector policies would have on population health (e.g. reduction to obesity prevalence and lives saved per year) and the economy. Throughout the project we will examine which policies are likely to benefit the health of all of the population and identify policies that have potential to reduce health-based social inequalities. For example, in Work Package 1 we will examine whether the role of OOHF sources on the diet differs based on socioeconomic status (SES) and demographic profile and in Work Package 2 we will recruit diverse participant samples in order to test whether tested policies benefit the diet of people from both lower and higher SES. Work Package 3 modelling will account for SES-based baselines differences in diet and health, as well as any SES patterning of OOHF usage and SES-based effectiveness of policies to identify which OOHF policies will be equitable (benefit all) or have potential to narrow health inequalities (e.g. particularly beneficial for low SES groups). During the project we will be advised by non-academic partners responsible for obesity policy action and a steering group of international public health experts. This approach will maximise the academic contribution and long-term impact that our research will have in the UK and globally.