Diet and Health Inequalities (DIO Food)

The cost-of-living crisis, with increasing food and energy costs, will produce more diet and health inequalities for those from the most vulnerable groups, particularly children and those from socially deprived areas. In September 2022, 40% of British consumers reported that they were worried about being able to afford to purchase food in the next month, a characteristic of food insecurity. Inequalities in diet contribute to overall inequalities in health, as those with unhealthy diets tend to have lower life expectancy, and higher risk of obesity, heart disease, type 2 diabetes, and certain cancers. With healthier foods becoming unaffordable to those on low -income, the health inequality gap is expected to widen, unless significant changes in food systems are made. We need evidence-based solutions to support the National Food Strategy approach to, 'deliver safe, healthy, affordable food, regardless of where people live or how much they earn'.

In September 2022, 25% of households with children were reported as being food insecure. This is a staggering 2.5-fold increase in the number of households experiencing food insecurity since January 2021. For families on low income, the poorest fifth of the UK population needs to spend 47% of their disposable income to consume a healthy diet according to the Eatwell Guide, in contrast to 11% needed by the richest fifth in the UK. The supermarket food environment has an important role to play in the mediation of better food purchasing for consumers. Dietary habits have a key role to influence health, and targeting those that already face diet inequalities is a key component to tackle health inequalities.

One key challenge facing people with low income is the ability to afford a healthy, balanced diet. The current UK economic climate has led to a cost-of-living and energy crisis that has caused a significant reduction in people's 'real' disposable incomes. This cost-of-living crisis is disproportionately affecting poorer households and is likely to be amplifying existing dietary inequalities and challenges, such as food insecurity (FI) which is defined as 'the state of being without reliable access to a sufficient quantity of affordable, nutritious food'. Indeed, FI is typically experienced by families on lower incomes. Paradoxically, research indicates those experiencing FI are also more likely to be living with obesity. Nutritionally poor, often ultra-processed, energy-dense foods are notoriously cheaper and more readily available, making the purchase of healthy, nutritious food challenging. Individuals living with FI need specific, tailored interventions, which the current UK food system does not provide. As research shows, structural changes in the food system are needed, as behavioural interventions appear to have little impact on tackling food insecurity among low-income families.

This new work expands the existing FIO Food scope of living with obesity to connect with vulnerable citizens who are facing diet and health inequalities. As the cost-of-living crisis is a dynamic process, we need approaches to timely respond to the emerging 'crisis', using the most recent data.

Open Science Framework - pre-prints and study protocols

• Hunter, E., Douglas, F., & Johnstone, A. (2023, October 3). Diet and Health Inequalities (DIO) Food Project: Feeding intentions and practices of parents and carers of infants (0-6 months) living on a low income in the UK. https://doi.org/10.17605/OSF.IO/834HU
• Jenneson, V., Pontin, F., Ennis, E., Fildes, A., & Morris, M. (2024, April 16). Protocol: Using retail sales data to evaluate impacts of the High Fat, Sugar and Salt (HFSS)product placement restrictions legislation in England. https://doi.org/10.17605/OSF.IO/KTSZA
• Fildes, A., Kininmonth, A. R., Ennis, E., Jenneson, V., & Morris, M. (2024, June 10). Protocol: A mixed methods evaluation of Retailer and Customer responses to the implementation of the High Fat, Sugar and Salt (HFSS) product placement restrictions legislation in England. https://doi.org/10.17605/OSF.IO/KTSZA
• Jenneson, V., Pontin, F., Ennis, E., Fildes, A., & Morris, M. (2024) Has HFSS legislation led to healthier food and beverage sales? The DIO-Food protocol - using supermarket sales data for policy evaluation. IJPDS, 9(4). https://doi.org/10.23889/ijpds.v9i4.2426

Early Years - UK Infant Food Insecurity

Lead: Prof. Flora Douglas

This WP will apply a qualitative research approach to address a policy data gap associated with maternal and infant food insecurity experience in the UK. Nutrition during pregnancy and early years directly impacts long-term health. There is growing recognition of the importance of epigenetic pathways in relation to in utero/early life stress exposures and metabolic disease and obesity. This study targets early years for improving diet, including obesity prevention, and is consistent with the overall aims and underpinning rational of the FIO Food study. Much has been done to track household and later childhood food insecurity experience, and to secure the Right to Food for children in Scotland and the UK through policy development. But there is policy gap related to maternal and infant food insecurity in the UK. In the context of the current cost of living crisis, there is a desperate need to identify key priorities and policy actions concerning the impact of household food insecurity experience at this crucial early life stage.

Our key objective is to capture parents' and carers' perceptions of the relationship between the current food system and other influences impacting infant feeding practice, associated with the current cost of living crisis. The last maternal and infant survey on maternal nutrition and infant feeding in Scotland was in 2017 and this work builds on capturing current behaviours, choices and experiences of pregnant and lactating women. Our impact will be to produce research briefing to feed into at least one knowledge exchange event with key stakeholders from food industry, social and health policy and practice, and third sector domains.

Research protocol: https://osf.io/834hu

Review of HSFS policy on retail purchase patterns

Lead: Prof. Michelle Morris

In October 2022, legislation came into effect in England that restricts promotion of products High Fat, Sugar or Salt (HFSS) by in-store and online location. Eighteen months on from the legislation's implementation, a team of researchers led by Professor Michelle Morris, and supported by IGD (Institute of Grocery Distribution), will be evaluating the impact of this legislation.

The team are working with ASDA, Morrisons, Sainsbury's and Tesco, who collectively represent 65%* of supermarket sales, to understand the impact of the HFSS legislation restricting location placement of HFSS products.

The analysis, conducted by researchers at the University of Leeds, will answer the following research questions:

(1) What happened to HFSS product sales after introduction of the policy?

(2) What happened to the retail product portfolios after introduction of the policy?

(3) Were impacts of the HFSS legislation equitable across different sociodemographic groups across the country?

(4) Has the HFSS legislation led to healthier overall purchasing using Eatwell guide as a metric?

These questions will be answered using store level sales data, supplemented by contextual information collected in interviews and surveys with the retailers and customers.

The sales data provided by the retailers will be for stores selected across deciles of our Priority Places for Food Index (developed in collaboration with Which? in 2022) to allow us to investigate whether the legislation has impacted different communities equally. The researchers will analyse the impacts of the implementation from a health and sustainability perspective, using the Eatwell Guide . The team will also use innovative data products created by Dr Fran Pontin (Eatwell algorithm) and Dr Victoria Jenneson (Nutrient Profile Model Calculator ) in their analysis, providing insight that cannot be found elsewhere.

Link to study protocol: https://osf.io/ktsza/

*Kantar Worldpanel Grocery Market Share as of 17/04/24

Knowledge mobilisation

Lead: Prof. Alex Johnstone

Measuring impact is one of the key evaluation metrics in the TUKFS-SPF projects network. Different target audiences warrant different measures of impact, and we increasingly face the need to find creative ways to share our outputs with the project's stakeholders. Research communication is defined as, the process of interpreting or translating complex research findings into a language, format and context that non-experts can understand. It goes significantly beyond the mere dissemination of research results. Effective and innovative research communication is a complex and skilled activity addressing a range of audience groups as well as a vital element in ensuring that research makes a difference. This is why we will work with a Research Impact Officer (RIO) to maximise the potential of the DIO Food Study.

The RIO will undertake science communication and impact activities with the Project Team, to improve communication with stakeholders to target the reduction of health inequalities and meet regularly with the project's patient and public involvement (PPI) advocate groups to articulate their own needs so that communication is driven by demand rather than from the top down. The quality of science is not the sole factor that influences decision-making, even if robust evidence is produced - there is a need to make research outputs more accessible.