Rand Rr4379

Food consumption
in the UK
Trends, attitudes and drivers
Camilla d’Angelo, Emily Ryen Gloinson, Alizon Draper, Susan Guthrie
For more information on this publication, visit www.rand.org/t/RR4379
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iii
Preface
What we eat has big implications for our Food, Environment and Rural Affairs (Defra)
health, our society and the environment. and was delivered by RAND Europe.
Understanding these trends, what drives
RAND Europe is a not-for-profit research
them and how we can change consumption
organisation that aims to improve policy and
practices through interventions is crucial to
decision making in the public interest, through
inform policy. This report provides a review of
research and analysis. RAND Europe’s clients
consumer attitudes and practices to food in the
include European governments, institutions,
UK in support of the work of the Department
non-governmental organisations and firms
for Environment, Food and Rural Affairs (Defra)
with a need for rigorous, independent,
on food production and consumption. The
multidisciplinary analysis.
review presents evidence on: (1) the main
trends related to consumer food practices For more information about RAND Europe or
and attitudes; (2) the drivers of consumption this document, please contact:
(e.g. the role of information or food system Dr Susan Guthrie (Associate Director)
actors); (3) interventions that can influence RAND Europe
food consumption practices; and (4) personal Westbrook Centre, Milton Road,
differences between groups, or ‘food publics’, Cambridge CB4 1YG
across the trends, drivers and interventions. United Kingdom
The report provides a summary of the existing Tel. +44 (1223) 353 2579
evidence and gaps in the evidence. The study Email: [email protected]
was commissioned by the Department for
v
Summary
Introduction and objectives of the The study approach consisted of a rapid

evidence assessment (REA). REAs are similar
study
to systematic reviews, in taking a robust and
What we eat has big implications for our health, replicable approach to searching and reviewing
our society and the environment. Understanding the literature. However, the scope and coverage
these trends, what drives them and how we of literature is restricted using a range of
can change consumption practices through criteria that can be adjusted in response to the
interventions is crucial to inform policy. The aim volume of literature identified, enabling them to
of this study is to provide an overview of the be conducted within a more limited timeframe.
existing evidence in four main areas: The focus of this study was on identification
of existing evidence and evidence gaps within
• The trends related to consumer food
high-quality, primarily academic literature from
practices and attitudes, and to the changing
the last ten years. The methods and approach
food environment (e.g. out-of-home sector1,
for this study are summarised in detail in
online retail models) in the UK.
Annex A.
• The drivers of consumption (e.g. the role of
information or food system actors).
Consumption trends – which
• Interventions that can influence food foods are people consuming,
consumption practices.
where and how?
• The differences between groups, or ‘food
What people consume still falls short of dietary
publics’, across the trends, drivers and
guidelines. While diets are slowly changing,
interventions (i.e. segmentation).
people are generally not meeting the standards
This report provides evidence around these recommended for a healthy diet in the UK or
questions and identifies areas of uncertainty internationally (Figure 1). The UK population
where more evidence is required and, based continues to consume too much saturated fat
on this, suggests a number of priority areas for and not enough fruit, vegetables and fibre.
action and further research.
1 The ‘out-of-home’ sector has been defined as any outlet that provides food or drink that has been prepared and is
ready for immediate consumption (Department of Health and Social Care, 2018). This includes restaurants, cafes,
takeaways and any online businesses that sell food for takeaway or home delivery.
vi Food consumption in the UK
Figure 1 Food consumption trends in the UK in relation to dietary guidelines
No change/reduction Reduction Reduction Reduction

in fruit and vegetable in red meat in sugar in salt
consumption consumption consumption consumption
Source: RAND Europe analysis. Downward facing arrow indicates a reduction. Bidirectional arrow indicates no
change. Colour of arrows indicates relationship with existing dietary guidelines: red indicates the change is against
the desired direction; amber indicates there has been no change; and green indicates a change in the desired
direction. These trends are based on analysis over the last ten years.
There are socio-demographic differences The out-of-home food environment is

in the consumption of a healthy diet. Low increasingly common. There has been an
socio-economic status (in terms of education increase in the consumption of food outside
level, work status and income) is the single the home. The importance of the out-of-home
most consistent risk factor for an unhealthy environment is facilitated by digital technology
diet. There are also various other factors and the expansion of online food delivery
that influence consumption, such as age and platforms, particularly new players such as
gender; however, the evidence for these is less Deliveroo and Uber Eats. This trend, which is
strong or mixed, and studies are not always predicted to increase, has negative implications
adequately controlled. Despite these socio- for the consumption of a healthy diet since
demographic differences, diets remain on food outside the home tends to be less healthy.
average unhealthy across all groups.
Some individuals care about the origin,
The channels through which consumers sustainability and ethical production standards
purchase food are diversifying. The physical of their food. Some individuals are increasingly
food environment is becoming increasingly socially conscious, particularly in terms of
diverse and fragmented, particularly in terms the ethical, environmental and social impacts
of the channels through which individuals of their food choices. There has been an
purchase food. Individuals are increasingly increase in the sales of ethical and sustainable
shopping for food online and using food produce, such as Fairtrade and RSPCA
delivery services (e.g. vegetable boxes, Hello Assured products. However, total sales are low,
Fresh and Amazon Fresh). Although total use representing only 11 per cent of all household
of online channels currently remains low, this is food purchases. Some consumers also
a trend that is predicted to increase. increasingly care about the provenance of their
vii
food and production methods, but this mainly conducting research on food preferences and
relates to certain food groups (e.g. meat) and drivers of food practices is the ‘value-action
the evidence is unclear. However, it is likely that gap’, whereby individuals do not necessarily act
most consumers are unaware of the social in line with their stated beliefs. Box 1 provides
and environmental consequences of their a summary of the trends in food consumption
consumption and how this impacts on wider and attitudes reviewed in the literature.
issues. Moreover, a common challenge when
Box 1 Summary of UK trends in food consumption and attitudes to food reviewed in the literature
Trend 1: What people consume still falls short of dietary guidelines

• UK consumers are generally not meeting the standards recommended for a healthy diet.
• There have been reductions in salt, sugar, and red and processed meat consumption but
consumption of fruit, vegetables and fibre has shown little or no change.
Trend 2: The channels through which consumers purchase food are diversifying
• Although UK consumers continue to buy food from large supermarkets, other forms of
retailer, including mini supermarkets, have increased in popularity.
• The online grocery market is increasingly important, leading to an increase in supermarket
home delivery and other forms of home delivery (e.g. vegetable boxes, Hello Fresh and
Amazon Fresh).
Trend 3: The out-of-home food environment is increasingly common

• There has been significant growth in the consumption of food outside of the home, and the
proportion of individuals eating out on a regular basis is predicted to increase in the UK.
• The importance of the out-of-home environment is facilitated by digital technology and the
expansion of online food delivery platforms, particularly new players such as Deliveroo and
Uber Eats.
Trend 4: Some individuals care about the origin, sustainability and ethical production
standards of their food
• There has been an increase in the sales of ethical and sustainable products over the last
ten years, and an increase in the consumption of plant-based meals.
• Some consumers are concerned about food provenance and safety, although this may
depend on the food group, particularly meat.
• However, many consumers demonstrate a value-action gap, in that while they state
sustainable and ethical preferences, this often only translates into action if other needs
are satisfied (e.g. price, availability and perceived quality), and many consumers remain
unaware of social and environmental consequences of their consumption practices. The
most important barrier to purchasing sustainable and ethical food cited in the literature is
cost, with other barriers including perceived quality and habit.
viii Food consumption in the UK
Drivers of consumption – what ways that are neither fully understood nor fully
predictable. Figure 2 provides an overview
influences food consumption
of the strength of evidence regarding the
practices? influence of these drivers.
A myriad of diverse and interconnected drivers Cost and perceived value for money are
shape and influence the food decisions and significant drivers of consumption and often
practices of consumers. These interact in trump other drivers and consumer values.
Figure 2 Overview of the strength of evidence on different drivers of trends and patterns in
consumer practices and preferences and their coverage in the literature
High-
quality and
consistent
COST AVAILABILITY & MARKETING &
evidence CONVENIENCE ADVERTISING
High-quality
but mixed
FOOD SYSTEM WHERE & HOW FOOD FOOD
evidence ACTORS WE BUY FOOD SAFETY INFORMATION
COUNTRY OF FOOD SUPPLY-SIDE DRIVERS OF

ORIGIN QUALITY TECH
CONSUMPTION
Depends on and interacts
Moderate with personal level
evidence differences such as
ONLINE income, gender, age,
PURCHASES education, habit and time.
Source: RAND Europe analysis. There is high-quality and consistent evidence that the factors at the top of the
triangle are important drivers of consumption. The factors in the middle have high-quality sources with mixed
evidence regarding the relative importance of the factor in driving consumption practices. The factors at the bottom
of the triangle have moderate evidence illustrating the relative importance of the factor but are either not widely
covered in the academic literature or lack high-quality sources.
ix
Cost impacts on the healthiness, ethics and and the placement and availability of food,
sustainability of food choices, with consumers but also influence consumers through
less likely to pay for these types of foods if the education/information campaigns, labelling
price is perceived to be too high. However, the and price promotions. Big transnational food
impact of cost is also modulated by factors corporations can have a negative influence on
such as income, education level and gender. diets through driving the demand for processed
food and the fast-food market. National and
Availability and convenience influence the
local government, together with civil society
scope for consumers to make choices in a
organisations, also actively shape the food
given food environment. Individuals are more
environment through the implementation of
likely to be healthy in different environments
policies. There are many other food system
(e.g. at work, school or the supermarket) if
actors, including media, family, friends and
healthy options are made available. Individuals
schools. Although the literature cites a variety
are also likely to be healthy or socially
of food system actors as being important
responsible due to convenience, for example
in influencing the food environment and
through the delivery of organic vegetable
consumption practices, there is no evidence on
boxes. Conversely, the presence of relatively
their relative importance.
cheaper and unhealthy food also influences the
extent to which they are consumed and hence Clear and simple information can influence
the quality of peoples’ diets. consumers’ purchasing behaviour; however,
this depends on the type and format of the
Marketing has a significant effect on
information, and also on socio-demographic
consumer choices, in particular increasing the
differences. Consumers have varying levels
consumption of unhealthy food, especially in
of trust in different sources and channels.
children and young people. Emerging evidence
Packaging information is more likely to be used
suggests that social media is increasingly
by individuals with a higher socio-economic
influencing younger segments of the population.
background. Consumers may also place higher
The built and micro food environments are value on information about nutritional quality
likely to influence what we eat but there is rather than information on social responsibility
contrasting evidence about the specific nature of products.
of the impact. Home, school and university
Food safety is a concern for some consumers
are thought to be associated with healthier
when choosing food, with the type and
food choices compared with fast-food
level of concern shaped by products and
restaurants and convenience stores; however,
environments. Consumers are particularly
the evidence is mixed. The placement of food
concerned about food safety when choosing
in supermarkets likely influences consumers’
meat products and when in the out-of-home
food choices. Food environments are also
food environment compared with food
socially and culturally embedded, and so
prepared at home.
necessarily interact with other drivers such as
social relationships and social identity. Other important drivers include provenance of
food, perceived food quality, food production
Food system actors have a strong influence
technologies and technology in general, but the
in shaping and constraining the food choices
evidence around their importance and impact on
made by consumers (Figure 3). The food
consumption is less clear. Locally or nationally
industry, including manufacturers and
sourced products are often associated with
retailers, determine the content of products
perceived higher quality. Some consumers are
x Food consumption in the UK
Figure 3 Overview of the food systems actors that the literature cites as important in shaping
consumption practices in the UK
Friends Family Supermarkets
Fast-food
takeaways
Social media
CONSUMER
UK food Restaurants
Traditional media MEDIA
processing
industry
Cafe
UK food
UK FOOD retailing
industry Mobile vendors
INDUSTRY
Non-governmental
organisations Transnational Corner shops
food
OTHER corporations
Civil society IMPORTANT Convenience
organisations ACTORS stores
FOOD
AUTHORITIES
Schools Market stalls
Online food
National government Local councils delivery schemes
Source: RAND Europe analysis.
concerned about food production technologies, in food consumption and how these interact
but this depends on the technology and with the wider food environment.
does not always influence choice. Generally,
Socio-demographic differences are an
increasing digitalisation is likely to influence
important predictor of consumption in both
consumer practices, with evidence that
adults and children. Low socio-economic
consumers are increasingly purchasing food
status (in terms of education level, work status
online, although the impact of digitalisation on
and income) is the single most consistent risk
consumption is currently unclear.
factor for not consuming a healthy diet. Other
important factors include age and gender.
Individual and social differences Food decisions are rarely rational in the sense
– how do different people make of being fully conscious and reflective, and
decisions about food? instead are driven by largely unconscious
mechanisms, such as cultural and social norms,
The UK population is not homogeneous
heuristics, habit and emotions. This implies
and there are multiple ‘food publics’ with
that simple interventions aiming to provide
different experiences, beliefs and attitudes,
information to consumers are likely to have
which should be taken into account when
limited effectiveness as they rely on active and
understanding consumption patterns as well
rational decision making that is not necessarily
as policies to change them. Figure 4 provides
characteristic of many consumption decisions.
an overview of individual and social differences
xi
Figure 4 Overview of the drivers of individual and social differences in food consumption
ent and wider d

environm rivers
Food
One off
Trends
events
Relative
Heuristics income
Beliefs and Emotional

Education values response Age
Cooking
skills and
Time
Habits knowledge
Taste
Preferences Cultural
Deprivation and social
norms
Social Economic
shocks shocks
Mental
health
Source: RAND Europe analysis. The inner circle illustrates the values, beliefs, preferences and emotions of
consumers related to food that drive consumption practices. The second circle illustrates the individual and
social differences that drive consumption practices. The outer circle illustrates that the inner and second circle is
influenced by and interacts with the food environment and other drivers.
Beliefs and values, such as health, individuals believe and what they consume in
environmental and animal welfare concerns, practice. While certain individuals increasingly
can inform consumption but there is still a state sustainable and ethical preferences, this
significant value-action gap between what often only translates into actual practices if
xii Food consumption in the UK
other needs are satisfied (e.g. price, availability that affect knowledge and information
and quality). This gap also arises because can help to raise awareness about healthy,
individuals feel a lack of agency with regard sustainable and ethical diets but they do not
to certain issues in a food system dominated necessarily translate into behaviour change.
by large, powerful food actors. Wider socio- In general, more targeted, accessible and
economic changes can also contribute to understandable information is most effective
this gap – for example, during economic at changing consumption, be it through mass
crises some consumers are likely to shift their media campaigns or food labels. For example,
consumption towards less socially responsible, nutritional front-of-pack labels can improve the
cheaper products. consumption of healthier food, and traffic light
approaches (that provide information in a clear
Reflecting on the range of personal differences,
and interpretive format) appear to be the most
segmentation approaches can be useful
effective. Food labelling in restaurants can
to analyse differences in consumption
also reduce the number of calories consumed.
patterns; however, these are typically
However, evidence also suggests that use of
specific to a particular study context, the
labels may be restricted to certain groups with
specific variables included in the analysis
a higher income and education level, and thus
or driven by commercial motivations, and
may serve to widen health inequalities.
are not necessarily generalisable across the
population or able to predict behaviour. While Food environment: This covers
understanding this diversity can be useful to interventions that change the food
inform thinking and communication strategies, environment, from small changes
use of segmentation in policy design and to the layout and prominence of
implementation has limitations. food, to the types of food available in places
people spend a lot of time, like at work and in
Interventions – how can school. There is increasing evidence to suggest
that the ability of individuals to make healthy
policymakers influence food choices is limited by the availability of food
consumption decisions? through the built and micro environments.
Interventions can help to change food There have been limited attempts to develop
consumption so that it is more healthy, ethical interventions that attempt to change the
and sustainable. For the purpose of this food environment or address ‘food deserts’2
study, interventions were grouped into three by changing the density or prevalence of
overarching categories. Table 1 provides a food outlets and availability of healthy foods.
summary of interventions and evidence of their Interventions to address the micro environment
effectiveness. through ‘nudges’ – changing the placement of
food in supermarkets or portion sizes – may
Knowledge and information: This be effective in certain contexts (e.g. schools
covers interventions that affect and supermarkets). However, in general, good-
the knowledge and information quality academic studies around the effects
available to people about food, from of environmental interventions in ‘real-world’
advertising to labelling. Overall, interventions settings are lacking.
2 While there is no formal definition, ‘food deserts’ can be defined as areas with a low density of supermarkets selling
good-quality fresh produce and nutritious food (The University of Sheffield, 2018).
xiii
Price and ingredients: This There is a continuum across these possible

spans interventions that change policy approaches reflecting the extent to
the ingredients of foods that which the different approaches emphasise
are available or the prices of personal choice and freedoms, and also the
those foods, making it easier and more potential challenges in implementation.
economical to make better choices. There is
Studies and evaluations of most interventions
evidence to suggest that changing the cost
typically do not investigate the long-term
and content of food through taxes, subsidies
outcomes and often focus on intermediate
and reformulation programmes is effective
outcomes (e.g. changes in views or awareness
at changing consumption. There is evidence
rather than actions). This limits the ability to
that subsidies may have a bigger impact than
determine whether interventions are effective
taxes. However, the change in price needs to
at producing sustained changes in practices.
be significant to have an effect and currently
More comprehensive and longitudinal studies
there is limited understanding of possible
and evaluations to look at active changes in
substitution effects.3 This is partly due to a
consumption could help to build the evidence
limitation of studies investigating these types
base to support more informed interventions.
of policies, which are often based on modelling
rather than real-world data.
3 Substitution is an important issue that is not fully understood. Taxes/price increases can lead to substitution at two
levels: consumers may buy different (ideally healthier but potentially also unhealthy or cheaper) foods, and producers
may replace a particular target product with other unhealthy content (for example, reducing sugar but increasing fat).
xiv Food consumption in the UK xv
Table 1 Summary of interventions to change food consumption and evidence of their effectiveness
Intervention Effectiveness Strength of evidence Comments and caveats Key sources
Jepson et al., 2010; Muzaffar et al., 2018; Rekhy &

School education Moderate–high Moderate–high Interactive/experiential learning is most effective
McConchie, 2014; Dudley et al., 2015
Online approaches are likely less effective than phone/

Education in healthcare setting Moderate Moderate–high Jepson et al., 2010; Kelly et al., 2016; Harris et al., 2011
in person
and information
Limitations to campaign design (e.g. TV only, not

Knowledge
Mass media campaigns Low–moderate Low–moderate online) – better designed campaigns might be more Afshin et al., 2015; Kite et al., 2018; Wakefield et al., 2010
effective
Traffic light approaches are more effective than just Afshin et al., 2015; Campos, Doxey, & Hammond, 2011;
Labelling in supermarkets Low–moderate Moderate but mixed
information provision Cecchini & Warin, 2016; Shangguan Siyi et al., 2015
Labelling in restaurants/fast- (Littlewood et al., 2016; Magnusson, 2010; Wright &

Low Moderate but mixed More studies needed in real-world settings
food settings Bragge, 2018; Long et al., 2015; Sinclair et al., 2014
Limitations in both evaluation and policy design limit Afshin et al., 2015; Chambers et al., 2015; Galbraith-Emami
Advertising regulation Unclear but likely moderate Low
our knowledge of effectiveness & Lobstein, 2013; Mills et al., 2013
Mandatory approaches most effective; combining Coyle et al., 2009; Evans et al., 2012; Afshin et al., 2015;
Food provision in schools Moderate–high Moderate–high
with education approaches also effective Niebylski et al., 2014
Main effect is on fruit and vegetable intake, more Afshin et al., 2015; Geaney et al., 2013; Gudzune et
Worksite well-being Low Moderate–high limited evidence on other outcomes; significant al., 2013; Jepson et al., 2010; Niebylski et al., 2014;
Food environment
variability in intervention design limits generalisability Schliemann & Woodside, 2019
Bucher et al., 2016; Cadario & Chandon, 2019; Hartmann-

Micro environment – placement, Effectiveness likely depends on context; acceptability
Low–moderate Low–moderate but mixed Boyce et al., 2018; Hollands et al., 2015; Houghtaling et al.,
portion size of ‘nudges’ to public also a concern
2019
Food provision in other public

Unclear Low Very little evidence identified Niebylski et al., 2014
settings
No evidence of policy implementation and evaluation Afshin et al., 2015; Beaulac et al., 2009; Cobb et al., 2015;
Built food environment Unclear but likely moderate Low
identified Fleischhacker et al., 2011
Afshin et al., 2017; Eyles et al., 2012; Hartmann-Boyce et

content of food
Taxes, subsidies and price al., 2018; Ng et al., 2012; Niebylski et al., 2014; Thow et al.,
Low–moderate Moderate Understanding of substitution effects limited
Cost and
changes 2010; Andreyeva et al., 2010; Niebylski et al., 2015; Smith

et al., 2018; Wright et al., 2017
Substitution effects unclear; can be driven by other Federici et al., 2019; Grieger et al., 2017; Hashem et al.,
Reformulation of food Moderate Moderate
changes (price changes, labelling requirements) 2019
Source: RAND Europe analysis. All target participants are adults (19 years old and above) and children (up to 18 years old), except for interventions in schools that target children only. Depth of shading of the rows provides an indication of the most promising (darker) and
least promising (lighter) interventions based on the current evidence. ‘Effectiveness’ is defined as the ability to achieve the desired behaviour changes, i.e. to reduce food consumption or otherwise change dietary behaviours and/or increase awareness or knowledge related
to healthy/sustainable food consumption.
xvi Food consumption in the UK
Reflections – what does the understood. Digitalisation is diversifying the

channels through which individuals purchase
evidence say about food
food, with supermarket and other home delivery
consumption in the UK, and what services in particular (e.g. vegetable boxes,
should policymakers do next? Hello Fresh and Amazon Fresh) increasing in
There are a number of observations on food popularity. The out-of-home sector, partly driven
consumption in the UK arising from the by digitalisation, is also increasingly significant,
evidence in the literature. with impacts on what individuals consume.
However, there is currently a lack of clear
A minority of individuals are more sustainable academic evidence around how online shopping
and ethical in their consumption but, overall, and home delivery affects consumption
UK consumption still falls well short of practices and consumer diets.
nutritional guidelines. Although there have
been reduction in the consumption of salt, The food environment, in terms of
sugar and red meat within the last ten years, availability, marketing and advertising, has
there has been little change in the consumption a significant influence on consumption.
of fruit, vegetables and fibre, with high Individuals are often aware of the need
consumption of processed foods. Although for a healthy diet but they are constrained
survey evidence indicates an increase in the by the current food environment. There is
purchase of sustainable and ethical produce, increasing evidence that access to unhealthy
such as Fairtrade and RSPCA Assured products, food through the built food environment (e.g.
this likely represents a small minority of the fast-food restaurants, convenience stores) is
population. Moreover, a common challenge associated with obesity. There is increasing
when conducting research on food preferences research into ‘food deserts’ suggesting that
and drivers of food consumption is the value- they have a significant negative influence on
action gap – whereby individuals do not consumption. The micro environment (e.g.
necessarily act in line with their stated beliefs. through food placement and portion sizes)
also has an influence on consumption. Within
There are predictable socio-economic this environment is also the influence of
differences in the consumption of a marketing and advertising by manufacturers
healthy diet but the impact of wider socio- and retailers, which has a significant effect
demographic differences is less clear. Socio- on food purchases, particularly driving the
economic status (e.g. income and education consumption of unhealthy food in children
level) is the single most important predictor of and young people.
the consumption of a healthy diet. Other socio-
demographic factors such as age and gender Food decisions are rarely purely rational and
influence consumption too, although the knowledge-led, and instead are driven by a
evidence around these is less clear. However, myriad of interacting cultural, societal and
all groups continue to consume an unhealthy personal factors that lead to different ‘food
diet. Table 2 summarises the availability of publics’ with different values and practices.
evidence in the literature on socio-demographic Food decisions are rarely rational and instead
differences in food consumption practices. are driven by cultural and social norms but also
unconscious mechanisms, such as heuristics,
The food environment is becoming habit and emotions. Policy responses need to
increasingly diverse and fragmented but the take these personal factors into account.
impact of this on consumption is not well
xvii
Table 2 Availability (volume) of evidence in the literature on socio-demographic differences in food

consumption practices and response to interventions
Availability
Quality of of
Factor Evidence base Key sources
evidence academic
evidence
Barrett et al., 2017;

Lower incomes, economic Barton et al., 2015;
deprivation and lower levels Cribb et al., 2011; de
Widely
of education are associated High Ridder et al., 2017;
covered
with a poorer diet and being Defra, 2017; Pechey
overweight/obese & Monsivais, 2016;
Wrieden et al., 2013
Balcombe et al.,
Women tend to have slightly 2010; Christoph
greater consumption of Some et al., 2016; Defra,
Moderate
healthier foods and pay more evidence 2017; Micha et
Diet
for healthy foods al., 2015; Rekhy &
McConchie, 2014
Older individuals tend to

Appleton et al.,
consume healthier foods
Low– Some 2017; Lam &
overall, although it is not clear
moderate evidence Adams, 2017; Micha
whether this a true age effect
et al., 2015
or a cohort effect
Trends
The out-of-home food
environment (including
for example restaurants,
takeaway and fast-food Adams et al., 2015;
places) is increasingly Some Nielsen, Siega-Riz, &
Moderate
a major part of the diet evidence Popkin, 2002; Tyrrell
of younger adults and et al., 2017
Out of home
adolescents compared to
older adults, whose preferred
location is home
Latvala et al.,
Individuals with health and 2012; Su et al.,
Some
environmental concerns tend Low 2019; WRAP, 2015;
evidence
to be female and younger YouGov: Eating
Better, 2019
Beliefs and Ethically certified food is

values more commonly purchased Not widely
Low Mintel, 2019a
by older consumers (aged 55 covered
or more)
xviii Food consumption in the UK
Availability
Quality of of
evidence academic
evidence
Costs shape what people High Widely Appleton, 2016;

can afford to eat; those in covered Barton et al.,
low-income groups often 2015; Darmon &
have less expensive food Drewnowski, 2015;
expenditure practices, de Ridder et al.,
consume less healthy food 2017; Griffith et al.,
and less fruits and vegetables 2015; Hawkesworth
et al., 2017; Levin,
Price 2014; Levin et al.,
2012; Thomas et al.,
2019; Townshend
& Lake, 2017;
Drivers Whybrow et al., 2018
There is strong evidence High Widely Boyland et al., 2018;

that advertising negatively covered Buchanan et al.,
influences the food 2018; Cairns et al.,
preferences and choices of 2009; Chambers et
children and young people al., 2015; Griffith et
al., 2015; Happer
Marketing and & Wellesley, 2019;
advertising Kamar et al., 2016;
MacGregor &
Bicquelet, 2016
Time and convenience (i.e. Moderate Some Appleton, 2016;

food perceived to be ‘quick’ and evidence Howse et al., 2018;
Individual/ ‘easy’ to cook) are important Jilcott Pitts et al.,
social drivers of consumption 2018
differences Time and choices, particularly for lower-
convenience income individuals who often
lack time
Information campaigns also High Widely Chandon, 2013;

rely on personal agency covered Christoph et al.,
in changing practices, 2016; Friel et al.,
and evidence consistently 2015; Garnett et al.,
Interventions indicates that they tend 2015; McGill et al.,
to have greater impact in 2015
individuals with higher socio-
economic status and thus
possibly widen inequalities
Knowledge Use of food labelling High Widely Campos et al., 2011

and information is particularly covered
information high among individuals with
health conditions and special
dietary requirements and
notably lower among children,
adolescents, older adults
and people in lower socio-
economic groups
xix
Availability
Quality of of
evidence academic
evidence
Labels in restaurants and Low– Not widely Sinclair et al., 2014

fast-food settings may moderate covered
only have effects in certain
population subgroups, with
some evidence that women
may use menu labels
whereas men do not
Price changes through taxes Moderate Some Barrett et al., 2017;

or subsidies are regressive evidence Jensen et al., 2011;
and disproportionately have McGill et al., 2015;
more impact on those with Thow et al., 2010
lower incomes because they
spend a larger proportion
of their income on food and
because they tend to buy
relatively cheaper foods; even
Cost and
where taxes are regressive,
content
those on lower incomes may
still benefit proportionately
more from subsidies on fruit
and vegetables if they buy
them
Source: RAND Europe analysis. This table is a summary of the evidence on socio-demographic differences in food
consumption cited in the literature reviewed. It serves to highlight the differences and nuances in behaviour and
practices related to food. It is not intended as a segmentation and cannot be used to draw predictable conclusions
about consumption behaviour.
Future priorities for policy and practices, and the interventions to change these,
research and illustrates both the quality and availability
of the evidence for each factor. Building on this,
The literature reviewed highlights significant Box 2 summarises a number of key evidence
gaps in the evidence base. Some factors have gaps in the existing literature regarding trends,
high-quality evidence but are not extensively drivers and interventions. Based on these key
written about in the academic literature. Other evidence gaps, there are a number of priority
factors have low- or moderate-quality evidence areas that policymakers could consider, which
in the academic literature. Table 3 provides a are presented below and summarised in Box 3.
summary overview of areas explored in the
literature on food consumption behaviours and
xx Food consumption in the UK xxi
Table 3 Availability (volume) of evidence in the literature on food consumption practices and behaviours and interventions
Relevant to chapter
Individual/social
Quality of Availability of
Interventions
Factor Evidence base
differences
evidence academic evidence
Drivers
Trends
Demographic variables Analyses do often not control for the interaction of these with other factors High Strong 
Trends
Ethical and environmental Unclear whether these concerns influence consumption

High Strong  
concerns A value-action gap persists
Online purchases The role of increased online and out-of-home purchasing is not well understood Moderate Not widely covered  
Built and micro food environment Growing but mixed evidence base on the impact of the built environment on consumption High Not widely covered  
Drivers, individual/social differences
Food actors High-quality but not extensive evidence on the relative importance of different actors High Not widely covered 
Strong evidence on the type of information that is provided to food consumers, but a lack of academic
Food information High Some evidence 
evidence exploring the type of information that can change food practices
Consumers state the importance of the provenance of food when choosing certain food products
Country of origin Moderate Not widely covered  
(particularly meat) but there is not a lot of evidence
Food quality There is moderate evidence that perceived food quality is an important driver for consumer choice Moderate Some evidence 
Online purchases The role of the changing digital landscape and its influence on food consumption is not widely covered Moderate Not widely covered  
Segmentation Often specific to a particular context and not always generalisable across a population Moderate Not widely covered 
Limited evidence that consumers consider technologies in food production processes when making food- Not widely covered
Supply-side technologies Low–moderate 
related decisions
Evidence is still limited regarding whether it can influence behaviour change
Mass media campaigns Limitations to campaign design (e.g. TV only, not online); better designed campaigns might be more Moderate Not widely covered  
effective
Food labelling Evidence on the effect of food labelling in fast-food settings, supermarkets and restaurants is mixed Low-moderate Some evidence  
Can impact consumption but the evidence is limited

Advertising regulation Low–moderate Some evidence  
Limitations in both evaluation and policy design limit our knowledge of effectiveness
Interventions
Food provision and procurement Little research on the effects

Mixed Not widely covered  
in other public settings Very little evidence identified
Changes in the micro environment Mixed evidence and effectiveness of these interventions depends on context Low Not widely covered  
Built food environment Policy actions to address the built food environment have not been widely implemented or evaluated Low Not widely covered  
Reformulation of food Substitution effects unclear; can be driven by other changes (price changes, labelling requirements) Moderate Not widely covered  
Taxes and subsidies Understanding of substitution effects limited Moderate High  

xxii Food consumption in the UK
Box 2 Summary of key evidence gaps in the existing literature
Trends
• The effect of demographic variables on consumption is not well understood as analyses
are often not adequately controlled for the interaction of these variables with other factors
(e.g. correlation between age and wealth).
• Research indicates some differences in consumer practices when shopping online
compared to offline, but the overall effects of the changing food environment on
consumption, such as increased online and out-of-home purchasing, is not well
understood. For example, patterns and frequency of use of different types of outlet are not
clear, and the ways in which food options are presented affect consumption in an online
setting are not well established.
• The extent to which ethical and environmental concerns influence consumption is unclear
beyond information on purchasing data on specific food types (e.g. Fairtrade). Similarly,
though some consumers increasingly care about the provenance of their food and
production methods, the relative importance of these considerations and their influence on
consumption are unknown.
• A value-action gap persists and there is some evidence on why this might be the case;
however, there is very little evidence on how and when that gap can be closed.
Drivers
• The role of digital technology, both in terms of a route to purchase food, and as a source of
information and a vehicle for advertising, is not well understood and is likely to continue to
increase in importance. More evidence is needed on how new technologies and new and
existing platforms (e.g. social media) impact on consumption.
• Although there is a growing evidence base on the influence of the built and micro
environment on consumption, there are still important gaps that require further
investigation, such as the impact of socio-demographic differences in access to fast-food
outlets and the impact of planning policies on consumption.
• Although the literature cites a variety of food system actors as being important in
influencing the food environment and consumption practices, there is no evidence on their
relative importance.
Social differences
• Some of the evidence around social differences in consumption comes from cross-
sectional data, which means it is unclear whether interventions could effectively address
those differences by changing those personal factors or circumstances. More longitudinal
data would be helpful to better understand whether interventions can be effective in
changing consumption.
xxiii
Box 2 Summary of key evidence gaps in the existing literature (continued)
Interventions
• Many evaluations of the effectiveness of interventions are limited to short-term or
intermediate outcomes, which limits their usefulness. Examples include evaluation of
healthy eating campaigns, which often look at changes in attitudes or knowledge rather
than consumption; and evaluations of workplace well-being initiatives, which often have a
poor evaluation design, small sample sizes and only short-term follow-up. More long-term
evaluations looking at ultimate intended outcomes are needed. More generally, the quality
of evaluations could be improved.
• Interventions aiming to change information availability, either through healthy eating
campaigns or restriction of advertising, often focus on traditional media and do not target
new media. This may limit their effectiveness and makes it difficult to establish whether
these types of interventions could work if they were more comprehensive.
• Most evidence on interventions is focused on health outcomes rather than other types of
consumption behaviours (e.g. more sustainable or ethical consumption).
• There is some suggestion that studies in real-world settings may show different effects
on consumption than in experimental settings, typically with smaller effects seen in a real-
world context. More real-world data is therefore needed. Examples here include provision
of calorie information in food outlets and changes in food pricing.
• There is very limited evidence on the effect of changes in the food available in settings
such as hospitals or food delivered at home to low-income, older people. Given that
changes in provision in schools and, to a lesser extent, workplace settings have an effect
on consumption, this merits further investigation.
• There is very limited evidence on the impact of policies aiming to regulate or change the
environment in terms of density or prevalence of fast-food outlets or to address food
deserts. There is a strong association between obesity and access to unhealthy food,
for example through a high concentration of unhealthy fast-food outlets. However, many
studies are cross-sectional so the direction of causality is unclear, and the correlation
may be mediated by socio-economic status and educational attainment. This needs to be
better understood to support effective policy development. There are also no examples of
evaluations or reported implementation of policy interventions addressing the built food
environment in the academic literature, which is an important gap.
xxiv Food consumption in the UK
A ‘whole systems’ approach could help to ensure adequate information is available and
change food consumption appropriate policy responses are in place to
reflect our changing food environment.
Overall, the evidence indicates that a
combination of approaches across the policy
Gather real-world evidence around
spectrum is needed to promote a healthy,
subsidies, taxes and reformulation
ethical and sustainable diet rather than focusing
programmes to better understand
on any one measure alone. A balance is needed
potential substitution effects
between ‘soft’ measures (e.g. knowledge
and information provision) that promote Although there is emerging evidence that
individual-level change and ‘hard’ measures that changing the cost and content of food
encourage collective change (e.g. changes to through taxes, subsidies and reformulation
the food environment and cost and content of programmes is effective at changing practices,
food). Knowledge and information can serve to there are potential substitution effects that are
raise awareness, but individuals are limited in not well understood. Studies based on real-
their capacity to change their consumption by world data could help to provide more accurate
the availability of food in the food environment evidence around this.
and are also influenced by powerful drivers such
as cost and habit, which ultimately serve as Collect evidence on longer-term
significant barriers to healthy, sustainable and outcomes and more longitudinal data
ethical diets. It is particularly challenging to identify concrete
evidence on the longer-term outcomes
Invest in evaluations of the effectiveness of interventions and to understand what
of interventions that target the wider (and factors can result in changes in consumption
changing) food environment practices. Most evaluations of interventions
There is increasing evidence that individuals only include short-term follow-up and many
are limited to exercise healthy choices by often look at intermediate rather than final
the availability of food in their environment, outcomes. Assessments of the drivers of
and access to unhealthy food has been consumption are often cross-sectional,
associated with obesity. However, to date limiting the scope to look at whether changes
there are few interventions that have explicitly in personal circumstance, knowledge,
targeted the wider (built and micro) food experience and other wider factors can drive
environment to address the availability of changes in consumption over time. Improving
unhealthy food. Good-quality studies based in the evidence base through more long-term
a real-world setting are also required to help follow-up and increased longitudinal data
design effective interventions in this space. would not just help us to understand whether
Both policy and research as yet does not well existing interventions are working or what the
reflect changing modes of consumption and trends are. It would also enable us better to
information sources, particularly in relation to design policies that are effective at changing
online and out of home. For example, most consumption. Evidence gaps in longer-term
media campaigns are conducted through outcomes should not prevent the creation of
television, with limited use of new, online much needed interventions to address food
media, and evidence on purchase of food consumption, but all new policies should have
through online routes is currently limited. long-term evaluation built in.
Both policy and research needs to progress to
xxv
Box 3 Summary of possible priority areas for further consideration by policymakers
Priority area 1: A ‘whole systems’ approach is needed to change food consumption

• A combination of coordinated and complementary approaches across the spectrum of
policy categories is likely to be most effective at changing consumer diets to ensure they
are sustainable, affordable and healthy.
• Combining individual-level policies (e.g. information and knowledge provision) with
collective, population-level approaches (e.g. focusing on the food environment, and cost and
content of food) could help to promote sustainable, affordable and healthier food choices.
Priority area 2: Invest in evaluations of the effectiveness of interventions that target the
wider (and changing) food environment
• Although individuals are often aware that eating a healthy diet and being physically active
is necessary, many are constrained and influenced by their food environment (i.e. the
availability of food, marketing, advertising, food placement and portion sizes).
• More evaluations of interventions, supported by good-quality real-world data, are needed
that target the built and micro food environment (including online and out of home) to
address the availability of unhealthy food.
Priority area 3: Gather real-world evidence around subsidies, taxes and reformulation
programmes to better understand the potential substitution effects
• Understanding of the overall effectiveness of prices, subsidies and reformulation of foods is
limited by a lack of understanding of possible substitution effects.
• It would be important to conduct more real-world evaluations and studies to better
understand the impacts of these policies.
Priority area 4: Collect evidence on longer-term outcomes and more longitudinal data
• Most evaluations of interventions only include short-term follow-up and many often look at
intermediate rather than final outcomes.
• Collecting longitudinal data and evidence on the longer-term outcomes of interventions
would help to better understand what factors can result in changes in consumption
practices. This should form an ongoing activity alongside implementing interventions to
address food consumption.
xxvii
Table of contents
Preface iii
Summary v
Figures xxviii
Tables xxix
Boxes xxx
Abbreviations xxxi
Glossary of food certifications used in this report xxxii
Acknowledgements xxxiii
1. Why food consumption matters 1
2. Consumption trends – what foods are people consuming, where and how? 7
3. Drivers of consumption – what influences food consumption practices? 15
4. Individual and social differences – how do different people
make decisions about food? 27
5. Interventions – how can policymakers influence food consumption decisions? 35
6. Reflections – what does the evidence say about food consumption
in the UK, and what should policymakers do next? 53
References 69
Annex A. Approach and methodology 91
xxviii Food consumption in the UK
Figures
Figure 1 Food consumption trends in the UK in relation to dietary guidelines vi

Figure 2 Overview of the strength of evidence on different drivers of trends and
patterns in consumer practices and preferences and their coverage
in the literature viii
Figure 3 Overview of the food systems actors that the literature cites as important in
shaping consumption practices in the UK x
Figure 4 Overview of the drivers of individual and social differences in food consumption xi
Figure 5 Overview of the food system 3
Figure 6 Food consumption trends in the UK in relation to dietary guidelines 9
Figure 7 Overview of the strength of the evidence on the different drivers of trends
and patterns in consumer practices and preferences and their coverage
in the literature 16
Figure 8 Overview of the food systems actors that the literature cites as important
in shaping consumption practices in the UK 21
Figure 9 Overall differences in trust in sources of food information in the
EU in 2010 and 2019 22
Figure 10 Overview of the drivers of individual and social differences that influence
food consumption 28
Figure 11 Conceptual framework illustrating the drivers of food consumption
and their interaction 65
Figure 12 Flow diagram summarising number of studies identified and excluded
at different stages in the review process 100
xxix
Tables
Table 1 Summary of interventions to change food consumption and evidence

of their effectiveness xv
Table 2 Availability (volume) of evidence in the literature on socio-demographic
differences in food consumption practices and response to interventions xvii
Table 3 Availability (volume) of evidence in the literature on food consumption
practices and behaviours and interventions xxi
Table 4 Summary of interventions to change food consumption and evidence of
their effectiveness 37
Table 5 Availability (volume) of evidence in the literature on socio-demographic
differences in food consumption practices and response to interventions. 54
Table 6 Availability (volume) of evidence in the literature on food consumption
practices and interventions 61
Table 7 Stakeholder organisations consulted during the inception phase 93
Table 8 Expert advisory group 93
Table 9 Search strings for the rapid evidence assessment 94
Table 10 Inclusion and exclusion criteria for the literature review 95
Table 11 Criteria for quality review of studies 97
Table 12 Summary of study types and methodologies 101
xxx Food consumption in the UK
Boxes
Box 1 Summary of UK trends in food consumption and attitudes

to food reviewed in the literature vii
Box 2 Summary of key evidence gaps in the existing literature xxii
Box 3 Summary of possible priority areas for further consideration by policymakers xxv
Box 4 Summary of UK trends in food consumption and attitudes
to food reviewed in the literature 8
Box 5 Examples of segmentation approaches found in the literature 34
Box 6 Examples of front-of-pack food labelling interventions used in the UK
and their effectiveness 40
Box 7 Summary of key evidence gaps in the existing literature 62
Box 8 Summary of possible priority areas for further consideration by policymakers 67
xxxi
Abbreviations
Defra Department for Environment, Food and Rural Affairs
EU European Union
NGO Non-governmental organisation
REA Rapid evidence assessment
RSPCA Royal Society for the Prevention of Cruelty to Animals
SDIL Soft Drinks Industry Levy
UK United Kingdom
WHO World Health Organisation

xxxii Food consumption in the UK
Glossary of food certifications used in this report
Carbon Footprint: Certification scheme Red Tractor: Food assurance scheme operated
launched by the Carbon Trust in 2007. Carbon by Assured Food Standards, an independent
labels inform consumers about the carbon organisation, launched in 2000. The label
footprint of a product. recognises UK food and drink that has been
produced to a high-quality across the food
Fairtrade: Label established by Fairtrade
chain and as such is traceable.
International in 1997. The label operates as
a certification scheme for assuring ethical RSPCA Assured: Farm assurance scheme
trading standards for farmers and producers in introduced by the Royal Society for the
developing countries. Prevention of Cruelty to Animals in 1994. The
scheme assures a certain standard of animal
Marine Stewardship Council: Sustainable
welfare through traceability across the whole
seafood eco-label established by the World
supply chain.
Wildlife Fund and Unilever in 1996, and
operating as a not-for-profit since 1999. The
label operates as a certification scheme for
sustainable fisheries and to help promote
sustainable fishing to maintain seafood stocks.
Rainforest Alliance: Certification scheme
operated by the Rainforest Alliance and the
Sustainable Agricultural Network. The label
assures that products meet certain sustainable
production standards.
xxxiii
Acknowledgements
We would like to thank the project team at Alizon Draper, Dr Ariane Kehlbacher, Professor
Defra for their advice and support, and for Monique Raats, Dr Lada Timotijevic and Dr
engaging constructively and collaboratively Bernadette Egan for their advice and guidance
with us over the course of the project. In throughout the project. Finally, we would like to
particular, we would like to thank Nina Sal, thank our quality assurance reviewer at RAND
Molly O’Connor and Kieron Stanley. We are Europe, Dr Advait Deshpande, for his critical
also very grateful to our expert advisors Dr review and valuable comments on this report.
1
1 Why food consumption matters
The health and environmental of life (Public Health England, 2017). Ill health
as a result of being overweight obese is also
impacts of our food choices
expensive. Between 2014 and 2015, the NHS
Obesity4 is a global pandemic influenced by the spent an estimated £6.1 billion on weight-
food environment5 and individual choices (FAO, related ill health; more than is spent annually on
2018; Meldrum et al., 2017; WHO, 2004). Global the police, fire service and the judicial system
obesity rates have more than tripled since 1975 combined (Public Health England, 2017).
and levels of obesity in the UK are amongst Poor diet puts people at risk of poor health,
the worst in Europe (OECD, 2017). In the UK, but these risks are not equally distributed
29 per cent of adults are obese, and by age across populations, with low income groups at
11 so are 20 per cent of children (NHS Digital, greatest risk of having a low-quality diet and the
2019). This is a ‘blatantly visible – yet most accompanying health problems (Gakidou et al.,
neglected’ public health challenge (WHO, 2004) 2017).
and nutritionally poor and unhealthy diets are
Consumption practices also have an impact on
one of the main factors that make individuals
the environment. Food production, transport
overweight (Public Health England, 2017).
and packaging can contribute to greenhouse
Being overweight6 or obese, along with poor diet gas emissions, biodiversity loss and plastic
and nutrition, puts people at risk of ill health and and food waste. Food systems contribute
premature death (NHS Digital, 2019) through between 10–29 per cent of global greenhouse
conditions such as diabetes, cardiovascular gas emissions (Defra & Government Statistical
disease, cancer, musculoskeletal, liver and Service, 2019; Garnett et al., 2015) through
dental disease (WHO, 2004). In the UK alone, agriculture, preproduction and post-production
obesity-related illness is responsible for more food processes (Vermeulen et al., 2012).
than 30,000 deaths per year and on average Consumption practices also significantly
deprives an individual of an extra nine years affect deforestation, which is the main cause
4 Obesity is defined as having a body mass index greater than or equal to 30 (Public Health England, 2017).
5 This report follows the definition of food environments put forward by the Food and Agricultural Organisation of the
United Nations as the environments that constitute the food that is available to people’s everyday lives and the safety,
price, convenience, labelling and promotion, and nutritional quality of these foods. It encompasses both the physical
and social contexts within which food consumption occurs (FAO, 2016).
6 Being overweight is defined as having a body mass index greater than or equal to 25 (Public Health England, 2017).
2 Food consumption in the UK
of biodiversity loss worldwide (Vermeulen et al., 2015), although this is complex to predict as
al., 2012). In addition, consumption practices UK produce may be exported to other countries
create substantial food and plastic waste, instead. However, the exact amount by which
which has adverse effects on human health, meat consumption should be reduced and the
the environment and the economy (van food products that should replace meat remains
Otterdijk & Meybeck, 2011). Food waste is contentious (Willett et al., 2019). In 2011, the
costly and according to one estimate produces Scientific Advisory Committee on Nutrition
£20 billion in losses in the UK annually7, recommended that adults who have red meat
contributes to approximately 25 million intakes of more than 90 g per day should
tonnes of greenhouse gas emissions (WRAP, consider decreasing to 70 g per day (SACN,
2019) and decreases the supply of nutritious 2011). The UK government’s Eatwell Guide8
foods available to those in need (European recommends eating less red and processed
Commission, 2016). Plastic waste introduces meat and suggests that pulses are good
chemicals in the natural environment, alternatives to meat (Public Health England,
destroys natural habitats as plastic is non- 2018). An analysis by the Carbon Trust reported
biodegradable and leaves behind compounds that a diet in line with the Eatwell Guide would
that are dangerous to human health and have a 32 per cent lower environmental impact
wildlife (Ilyas et al., 2018; Institute for European (in terms of greenhouse gas emissions, water
Environmental Policy et al., 2018). It should be and land use) than the current average UK diet
noted that there is likely a trade-off between (Carbon Trust, 2016). A number of differences
food waste and removal of plastic packaging, contribute to the reduction, such as increasing
with evidence suggesting that plastic reduction potatoes, fish, wholemeal and white bread,
could increase food waste and use of other vegetables and fruit while reducing amounts
types of packaging may contain materials that of dairy, meat, rice, pasta, pizza and sweet
are more energy intensive or worse for the foods. The EAT-Lancet diet9 launched in January
environment (WRAP, 2019). Therefore, more 2019 calls for a reduction of about 50 per cent
research regarding the circular economy is in the global consumption of foods such as red
required to understand these trade-offs. meat (Willett et al., 2019). However, the World
Health Organisation (WHO) has withdrawn its
However, a change of diet could improve the
support for the EAT-Lancet diet, questioning its
adverse environmental consequences of the
scientific basis and feasibility (Torjesen, 2019).
food system. Dietary changes, particularly by
This was recently rebutted from the EAT-Lancet
reducing the consumption of meat and animal
Commission that claimed that rather than
products, can lead to a substantial reduction
advocating for ‘centralised control of dietary
of greenhouse gas emissions (Hallström et
choices’, they put forth the latest science and
al., 2015). A reduction in meat consumption
a definition of sustainable food production that
could also reduce the demand for land and
fits local and heterogeneous food diets and
thereby counter biodiversity loss (Hallström et
cultures worldwide (Rockström & Willett, 2019).
7 Food waste arising within UK households, hospitality and food service, food manufacture, retail and wholesale
sectors.
8 The Eatwell Guide is a policy tool developed by Public Health England used to define government recommendations
on eating healthily and achieving a balanced diet (Public Health England, 2016).
9 The EAT-Lancet diet was developed by the EAT-Lancet Commission on Food, Planet, Health and consists of a set of
global recommendations for a sustainable and healthy diet (Willett et al., 2019).
3
Figure 5 Overview of the food system

Sunlight
Biodiversity Know-how
Seed Labour
Water Chemicals Money
Nutrients Food
Biodiversity Food
wholesale
Land use Food

Agriculture companies
Climate Land & soil Famers
change BIOLOGICAL Ground water ECONOMIC Markets & CSA
SYSTEM SYSTEM
Pollution Grocery store
SUPPLY
Animal Restaurants
welfare
Transport
Farming Food
Trash Waste Commercial literacy Waste
Consumer
Food
Lobbying
Money
Government
& policy
DEMAND
HEALTH POLITICAL
SYSTEM SYSTEM
SOCIAL
Wellness Regulations
SYSTEM
Care Taxes
Social network
Prevention Subsidies
Media/Advertising
Food safety Ownership
Access
Food security Trade
Education
Food culture
Civic
engagement
Source: Adapted from the Nourish Food System Map, www.nourishlife.org. Copyright WorldLink, all rights reserved.
Our food system is changing and factors affect people’s diet, spanning behaviour,
the food environment, genetics and culture, as
so are we
well as the wider food system10 (Public Health
Tackling the adverse consequences of England, 2017). While obesity is in part the result
unhealthy diets is a complex challenge. Different of individual choices, the food environments
10 In this report, the ‘food system’ refers to the different processes and infrastructure needed in feeding a population.
It includes the stages that food travels, from production and processing through to packaging, consumption and
disposal and also the different actors involved in that process.
and cultures in which people operate make 2018). In addition, the availability of food is also
it increasingly difficult to make healthy and increasing with growing global supply chains
sustainable food choices. Many actors, and technological progress (Dablanc et al., 2017;
including the government and the food industry, FAO, 2018). Upcoming opportunities and events
contribute to the food environment, and they such as new technologies (e.g. novel foods,
all have a role to play in promoting healthy automation), changing consumer practices
and sustainable diets by making healthy food (e.g. sustainable and ethical concerns), political
choices easier to access and more appealing and other factors (e.g. the UK’s exit from the
(WHO, 2020). Figure 5 illustrates the complex European Union, antimicrobial resistance) also
and interconnected elements of the food system provide potential opportunities and challenges,
as well as the network of different groups with a with uncertain implications for UK food
stake in the food system. consumption patterns (Elta Smith et al., 2019).
Food is big business. The agri-food sector Some individuals are changing too, as
contributed £121 billion (9.4 per cent) to UK many have different attitudes to food and a
national gross value added in 2018 (Defra, range of values that guide food choices. For
2019). However, the food industry landscape in example, there is a growing concern about the
the UK is changing. For example, consumers environment among young people and some
are increasingly buying online and eating out individuals are increasingly eating less meat
of home (Dablanc et al., 2017; Nguyen et al., (YouGov: Eating Better, 2019). These different
5
attitudes and values are a result of an ageing 4. What are the differences between groups,
population (Allen et al., 2017; Dean et al., 2009), or ‘food publics’ (Darnton, 2016), across
migration, urbanisation and rising income levels the trends, drivers and interventions (i.e.
(FAO, 2018; Ruben et al., 2019). In addition, segmentation)?
wider trends in lifestyle, living conditions (i.e. the
This report provides a summary of the
number of people who live alone) and the rise of
existing evidence and evidence-gaps on these
alternative work arrangements also contribute
questions, with a focus on high-quality,12
to the different attitudes of individuals towards
primarily academic literature. The study
food and their consumption practices (Hanna &
approach consisted of a rapid evidence
Collins, n.d.; Ruben et al., 2019).
assessment (REA). The review included
high-quality academic studies from 2010
Food matters and we need to to 2019 restricted to the UK or the UK with
understand it comparator countries. In terms of scope,
the review considered studies addressing
What we eat can have big implications for trends in consumer attitudes and practices
our health, our society and the environment. in relation to food consumption; drivers of
Understanding current trends, what drives those practices; differences by consumer
them, and how we can change consumption groupings/segmentation; and policies/
practices through interventions is crucial interventions to change food consumption
to inform policy. The aim of this report is to and their effectiveness. The following studies
provide a review of consumer attitudes and were outside of the scope of the review:
practices towards food in the UK in support studies addressing the impact of food, diet or
of Defra’s work on food production and consumption patterns on health and health-
consumption. This work focuses on providing related behaviours (exclusion does not include
evidence on four main questions: health as a driver of consumption); and studies
1. What are the trends related to consumer addressing the relationship between socio-
food practices and attitudes and to the economic factors and health. The report was
changing food environment (e.g. out-of- completed before the Covid-19 pandemic,
home sector, online retail models) in the UK? and so the impacts of the pandemic on food
consumption trends, drivers and attitudes
2. What are the drivers of consumption11 (e.g.
are outside of the scope of this study. The
the role of information or food system
methods and approach for this study are
actors)?
summarised in detail in Annex A.
3. Which interventions can influence food
consumption practices?
11 There are many definitions of consumption. In this report, ‘consumption’ refers primarily to decisions made by
individuals about what foods to buy and eat, but also includes planning, preparation and intake of food (Sobal &
Bisogni, 2009). The exception to this definition is children, and particularly young children, who have less agency.
While many studies rely on consumption as a proxy for intake, some studies do unpick the relationship between
purchasing and intake and these have been described.
12 The overall assessment of the strength of the evidence that is presented in the findings is qualitative, taking into
account both the quality of individual studies, the number of studies reinforcing the point and, particularly, the
existence (or otherwise) of prior systematic review evidence suggesting confidence in a particular finding. These
factors have been combined together to give an overall assessment of the status of the existing evidence across
different areas. Please see Annex A for more detail on the quality assessment process and criteria.
7
2 Consumption trends – what foods are

people consuming, where and how?
Analysis of trends over the last ten years that the UK population continues to consume
(2010–2019) indicates that although the foods too much salt, sugar, and saturated fat, and not
people consume still fall short of nutritional enough fruit, vegetables, and fibre (Defra, 2017;
guidelines, attitudes and values are shifting Kamar et al., 2016; PHE & FSA, 2019), with
and the channels through which individuals most people eating less than ‘5 a day’.13 Trends
and households purchase food are diversifying. from various national surveys show no change
Notable trends observed include the increasing (PHE & FSA, 2019) or even reductions in fruit
consumption of ethical and sustainable and vegetable consumption, with purchases
foods, the increasing use of digital technology falling by 5.2 per cent between 2008 and 2015
to facilitate food purchasing, and, recently, (Defra, 2017; NHS Digital, 2018). Evidence
the widening of inequalities and increase in from the National Diet and Nutrition survey
levels of food poverty. Box 4 below provides a indicates that there is some reduction in the
summary of the trends in food consumption consumption of red and processed meat, from
and attitudes reviewed in the literature. 75 per cent of respondents in 2012 to 55 per
cent in 2018 (FSA, 2019b; PHE & FSA, 2019).
What people consume still falls There is some evidence, both in terms of
household purchases and consumption data,
short of dietary guidelines to suggest that sugar consumption is falling
Healthy diets typically include greater (by 7.3 per cent between 2012 and 2015)
consumption of fruit, vegetables and whole (Defra, 2017; PHE & FSA, 2019), including sugar
grains, and reduced consumption of sugar, sweetened beverages (PHE & FSA, 2019),
salt, processed foods and red meat (Defra, but levels of consumption of both remain
2017; WHO, 2004; Public Health England, high (Defra, 2017; Ng et al., 2012; PHE & FSA,
2018). While UK national nutrition surveys 2019). Some evidence also indicates that
indicate some positive changes to diets, salt consumption has fallen in the UK, falling
people are generally not meeting the standards 2.4 per cent between 2012 and 2015 (Defra,
recommended for a healthy diet in the UK or 2017), but remains above recommended levels
internationally (de Ridder et al., 2017; Micha et (Caraher & Hughes, 2019; Defra, 2017; PHE &
al., 2015). There is strong evidence to suggest FSA, 2019). Consumption of processed foods
13 The 5 A Day campaign is a health awareness campaign launched by the UK government in 2003 to get people to eat
at least five portions of a variety of fruit and vegetables a day (Policy Navigator, 2003).
Box 4 Summary of UK trends in food consumption and attitudes to food reviewed in the literature
Trend 1: What people consume still falls short of dietary guidelines

• UK consumers are generally not meeting the standards recommended for a healthy diet.
• There have been reductions in salt, sugar and red and processed meat consumption but
consumption of fruit, vegetables and fibre has shown little or no change.
Trend 2: The channels through which consumers purchase food are diversifying
• Although UK consumers continue to buy food from large supermarkets, other forms of
retailer, including mini supermarkets, have increased in popularity.
• The online grocery market is increasingly important, leading to an increase in supermarket
home delivery and other forms of home delivery (e.g. vegetable boxes, Hello Fresh and
Amazon Fresh).
Trend 3: The out-of-home food environment is increasingly common

• There has been significant growth in the consumption of food outside of the home and the
proportion of individuals eating out on a regular basis is predicted to increase in the UK.
• The importance of the out-of-home environment is facilitated by digital technology and the
expansion of online food delivery platforms, particularly new players such as Deliveroo and
Uber Eats.
Trend 4: Some individuals care about the origin, sustainability and ethical production
standards of their food
• There has been an increase in the sales of ethical and sustainable products over the last 10
years and an increase in the consumption of plant-based meals.
• Some consumers are concerned about food provenance and safety, although this may
depend on the food group, particularly meat.
• However, many consumers demonstrate a value-action gap, in that while they state
sustainable and ethical preferences, this often only translates into action if other needs
are satisfied (e.g. price, availability and perceived quality), and many consumers remain
unaware of social and environmental consequences of their consumption practices. The
most important barrier to purchasing sustainable and ethical food cited in the literature is
cost, with other barriers including perceived quality and habit.
9
Figure 6 Food consumption trends in the UK in relation to dietary guidelines
No change/reduction Reduction Reduction Reduction

in fruit and vegetable in red meat in sugar in salt
consumption consumption consumption consumption
Source: RAND Europe analysis. Downward facing arrow indicates a reduction. Bidirectional arrow indicates no
change. Colour of arrows indicates relationship with existing dietary guidelines: red indicates the change is against
the desired direction; amber indicates there has been no change; and green indicates a change in the desired
direction. These trends are based on analysis over the last ten years.
remains high, with analysis of National Diet food from large supermarkets (FSA, 2019b).
and Nutrition Survey data indicating that more One study found that older people may prefer
than half of all calories consumed on average luxury supermarkets (e.g. Marks & Spencer
across the UK population come from ultra- and Waitrose), though this may also be linked
processed foods (Rauber et al., 2018).14 Figure to income levels (Omar et al., 2014). However,
6 provides an overview of food consumption in recent years, survey evidence indicates
trends in the UK. that other forms of retailer have increased
in popularity, including mini supermarkets,
Together, these findings suggest that, overall,
supermarket home delivery and other forms
actions so far to encourage healthier eating
of home delivery (e.g. vegetable boxes, Hello
have been of limited or mixed effectiveness
Fresh and Amazon Fresh), although use
on aggregate, indicating further action may be
still remains low (FSA, 2019b). These newer
needed.
channels reflect the increasing importance of
the online grocery shopping market, which is
The channels through which projected to increase its market share from
consumers purchase food are 18.6 per cent to 23.4 per cent by 2024 (IGD,
diversifying 2019b).
Self-reported survey evidence shows that the Although there has been an increase in online
majority of UK consumers continue to buy sales in the UK, including in grocery shopping
14 Recent definitions of ‘ultra-processed’ food define it as foods typically modified by chemical processes, which are
then assembled into ready-to-eat food products using additives (e.g. flavours, colours, emulsifiers). Foods include
savoury snacks, reconstituted meat products, pre-prepared frozen dishes and soft drinks (Carlos A. Monteiro et al.,
2019). However, the term ‘ultra-processed’ is not defined consistently in the literature and is open to interpretation,
which can be a potential confounding factor in assessing the strength of the evidence.
(Mintel, 2018), ‘bricks and mortar’ store sales the behavioural economics literature about
currently continue to surpass online sales the impact of the food micro environment
(ONS, 2018b). In addition, recent evidence (e.g. the architecture of a supermarket) on
suggests that the number of UK customers food purchases (Bucher et al., 2016; Cadario &
shopping online dropped between 2015 and Chandon, 2019; Hartmann-Boyce et al., 2018;
2018 (Mintel, 2018); however, this may be an Hollands et al., 2015; Houghtaling et al., 2019).
effect of having reached saturation – an initial However, this is likely to apply very differently,
fast start with many early adopters, followed if at all, in an online context. In contrast, the
by slower growth in line with populations who surfeit of information in the online context,
are more used to this approach. There is some particularly through social media, is likely to
evidence to suggest that online sales also vary considerably influence the dynamics of healthy
by age, with younger consumers more likely food purchasing and communication of food
to shop online, compared to older shoppers information (Garcia et al., 2019).
who are less likely to shop for groceries online
(Mintel, 2018). Despite the recent slowdown The out-of-home food
in growth, digital food shopping is predicted
to increase, with food and grocery shopping
environment is increasingly
likely to be more automated in the next five common
to ten years (IGD, 2019). Research indicates Overall, the consumption of food and
some differences in consumer practices beverages from outside the home has
when shopping online compared to offline, undergone considerable growth over the last
particularly around the purchase of fresh decade, due to changes in consumer practices
produce, although the evidence is mixed. While and greater flexibility in personal budgets
some evidence suggests that consumers may (Jean Adams, Tyrrell, et al., 2012; FSA, 2019b).
be less likely to buy fresh produce online due One study found that in the UK, 27 per cent of
to concern about quality and freshness (Hand adults and 19 per cent of children consumed
et al., 2009), recent analysis of one Morrisons meals outside the home once per week or
data set (of real online grocery transactions via more and 21 percent of adults and children
Morrisons Google Analytics account) suggests ate takeaway meals at home once per week
that contrary to some findings, consumers or more (J. Adams et al., 2015). There is
spent more on fresh produce when shopping some evidence to suggest that attitudes have
online than offline (Munson et al., 2017). The also changed in the last 20 years, with eating
Morrisons dataset also investigated price out becoming more informal and no longer
sensitivity (e.g. propensity to engage with reserved for special occasions (Paddock et
offers), but found that online consumers al., 2017). The increase in out-of-home food
were not more price sensitive than offline consumption is also driven by the rise of digital
consumers (Munson et al., 2017). technology and expansion of online food
There is a need to build more evidence on delivery platforms, particularly new players
what policies are needed to encourage healthy such as Deliveroo and Uber Eats, and the
eating in the online setting. In an offline expansion of delivery-only or ‘dark’ kitchens15
setting, there is considerable evidence from (Edelman, 2019; Hirschberg et al., 2016).
15 Delivery only commercial kitchens with no physical customer-facing premises.

11
There is some evidence to suggest that health outcomes (e.g. biomarkers of greater
patterns of eating out may vary by age and cardiometabolic risk) (Lachat et al., 2012). This
socio-economic status. Whereas the out-of- trend suggests that policies should consider
home food environment (including for example the challenges presented by the out-of-home
restaurants, takeaway and fast-food places) sector, which is fragmented compared with the
is increasingly a major part of the diet of traditional food retail market and does not have
younger adults and adolescents (Adams et the same requirements around mandatory
al., 2015; Nielsen, Siega-Riz, & Popkin, 2002; nutrition labelling for example (Caraher &
Tyrrell et al., 2017), home appears to be the Hughes, 2019).
most important location of food consumption
for older adults, who are less likely to go to Some individuals care about the
restaurants, fast-food outlets or pubs (Omar
et al., 2014; Thompson et al., 2018; Ziauddeen
origin, sustainability and ethical
et al., 2018). Some evidence indicates that production standards of their food
children from lower income households are There is increasing awareness about
more likely to eat takeaway meals at home or the negative environmental impact of
purchase food from outside school (Adams et food production systems, with moves to
al., 2015; Wills, Danesi, Kapetanaki, & Hamilton, develop more sustainable dietary guidelines
2019). In contrast, the evidence in adults is (Apostolidis & McLeay, 2016; Lang & Mason,
mixed (J. Adams et al., 2015), with some 2018). For example, the UK government’s
evidence that adults with lower income tend to Eatwell Guide,16 published in 2016, has
consume more takeaway meals eaten at home taken some steps towards incorporating
(ONS, 2018b), compared to those with higher sustainability with wording to guide people
income who tend to spend more on restaurant to make more sustainable choices and an
and café meals (ONS, 2018a). The literature evaluation of the sustainability of the Eatwell
reviewed does not provide evidence around Guide carried out after its development. Also,
patterns or frequency of eating out by type of plant-based foods are given more prominence,
out of home food outlet in children or adults. which are more healthy and more sustainable.
The proportion of individuals eating out on a (Atherton & Head, 2016).
regular basis is predicted to increase in the There is considerable evidence showing an
UK (Caraher & Hughes, 2019). Food from increase in ethical, sustainable and healthy
outside the home tends to be less healthy and food purchases by consumers (Defra, 2010;
associated with a higher energy content than FSA, 2019b, 2019a; WRAP, 2015). Survey
food prepared in the home (i.e. containing data shows that sales of ‘socially responsible’
high quantities of fat, sugar and salt) (Goffe et produce17 have increased year on year since
al., 2017; Jaworowska et al., 2014; Lachat et 2007, despite the economic downturn, and in
al., 2012; Robinson et al., 2018) and has been 2017 represented 11 per cent of all household
associated with weight gain and other negative food sales (Defra, 2019; Price et al., 2016).
16 The Eatwell Guide is a policy tool developed by Public Health England used to define government recommendations
on eating healthily and achieving a balanced diet (Public Health England, 2016).
17 This includes for example: Fairtrade, organic, free range (eggs and poultry), vegetarian meat alternatives, sustainable
fish, RSPCA Assured foods and Rainforest Alliance. RSPCA Assured is a food labelling scheme that assures a certain
standard of animal welfare.
However, research from Mintel, a market al., 2016). There is also some evidence that
research organisation, suggests that over the some consumers prefer less processing and
last five years, sales of ethical food and drink18 are cautious around novel food technologies
have increased by 43 per cent from £5.7 billion for food processing, particularly around meat
in 2013 to £8.2 billion in 2018 (Mintel, 2019a). production, having a negative perception
The consumption of plant-based meals in of the production and processing of beef
particular is on the rise, and consumption has products (W. Verbeke et al., 2010). Consumers’
grown by 37 per cent in the last four years acceptance of novel food technologies such
(Kantar, 2019). There has been a particular as nanotechnologies varies greatly depending
increase in ‘flexitarian’ or semi-vegetarian on their awareness but also general attitude
diets (George, 2019; Mintel, 2019b), which towards new technologies, with some
according to one survey make up just over 9 evidence suggesting that consumers may
per cent of the UK population (George 2019). have greater acceptance for applications that
There is some evidence on socio-demographic are not ingested such as smart packaging
characteristics suggesting that environmentally (Santeramo et al., 2018). Some consumers are
sustainable consumers tend to be female and also concerned about food safety specifically
younger (Latvala et al., 2012; Su et al., 2019; when it comes to meat consumption, although
WRAP, 2015; YouGov: Eating Better, 2019), this may also be linked to meat-related food
whereas the consumption of ethically-certified scares, which are often short term and related
food is driven by older consumers (aged 55 or to political events (Font-i-Furnols & Guerrero,
more) (Mintel, 2019a). 2014). For example, events such as the bovine
spongiform encephalopathy crisis in the UK
There is also some evidence for in the 1990s and more recently the debate on
chlorinated chicken following the UK’s exit from
changes to various other consumer the European Union, can serve to highlight food
values (such as food provenance production in the public debate for a few years
and safety), although this may (Food Safety News, 2019; Murray, 2018).
depend on the food group. However, consumers typically demonstrate
In general, some consumers would like more a ‘value-action gap’,19 in that while certain
locally produced food (e.g. British food) (FSA, individuals increasingly state sustainable and
2019a), with one survey showing that 59 ethical preferences, this often only translates
per cent of shoppers agree that they try to into actual practices if other needs are satisfied
buy British food whenever they can (Defra, (e.g. price, availability and quality) (Apostolidis
2019). Some consumers may also prefer & McLeay, 2016; Bondy & Talwar, 2011; IGD,
shorter supply chains, although the evidence 2019a; W. Verbeke et al., 2010). For example,
around this is less clear and may be linked to a study of 3,000 UK households found that
one-off events such as the 2013 horsemeat although a range of issues (such as animal
scandal, which served to highlight the length welfare, ethical production and sustainability)
and complexity of food chains (J. Barnett et were rated as important by a high percentage
of households, the percentage claiming to
18 This includes for example: organic, Fairtrade, Rainforest Alliance and Marine Stewardship Council certified products.
19 The ‘value-action gap’ refers to gaps seen between stated consumer values and preferences and consumption
practices (Carrigan, 2017; Hassan et al., 2016).
13
actively seek these products was much lower awareness of how personal food choices (e.g.
across all three categories (Defra, 2011). The meat consumption) impact on wider issues
concept of a value-action gap – where stated (e.g. climate change), leading to resistance to
preferences do not necessarily translate into the idea of behavioural change (e.g. reducing
actions in practice – is a common challenge in personal meat consumption) (Happer &
conducting research on food preferences and Wellesley, 2019; Macdiarmid, Douglas, &
drivers of food practices (Garnett et al., 2015). Campbell, 2016). Even where individuals are
In many contexts, people will state that certain aware, there may be differences in their ability
values (e.g. animal welfare, sustainability) to act on their beliefs and values. For example,
are important or matter to them when asked we note that ethically certified food is more
(for example in a survey setting), but the commonly purchased by older consumers
extent to whether these preferences show in (aged 55 or more) (Mintel, 2019a). This may
consumption practices in real-world settings is reflect the values of this group, relative to the
often much more limited (BARR, 2006; Padel & wider population, or it may be that there is a
Foster, 2005; Vermeir & Verbeke, 2006). perception of greater quality, or simply that
they are better able to act on those values
A number of factors have been found to
due to factors such as wealth or availability of
contribute to the value-action gap. In particular,
time (Regan et al., 2018; Toti & Moulins, 2016).
price has been identified as a key barrier to
Some individuals may feel a lack of agency
ethical and sustainable food purchases (Defra,
with regard to issues such as sustainability and
2011; Mintel, 2019a) and in one study ‘price
animal welfare in a food system dominated by
conscious’ consumers made up the largest
large powerful companies (Howse et al., 2018).
segment in the market (Apostolidis & McLeay,
2016). The recession was found to decrease Based on these findings, it is likely that a
purchasing of Fairtrade products in ‘occasional’ combination of approaches may be effective
consumers compared to ‘active’ consumers, to encourage ethical and sustainable
with the former being more driven by product food consumption. The rise in ‘flexitarian’
characteristics such as price and quality (Bondy consumers suggests there could be scope
& Talwar, 2011). Perceived quality is another for policymakers to develop interventions
factor, with evidence from a choice experiment to encourage meat reduction. For example,
study showing that consumers expressed very information campaigns could be used to
low preferences for meat substitutes, partly due increase awareness and encourage the
to lower perceived quality, although the same reduction of meat consumption in those
consumers valued attributes such as being groups of consumers who currently lack
produced in the UK and having a low carbon awareness. Although these policies are
footprint (Apostolidis & McLeay, 2016). Habit unlikely to change practices on their own,
was also found to be a barrier in one study, with they could encourage consumers to accept
respondents in one survey stating that they did future, more substantive interventions
not choose sustainable and ethical food out of such as economic measures. There is also
habit (Defra, 2011). scope for policymakers to target the value-
action gap by making it easier for socially
In addition, not all consumers are equally aware
conscious consumers to purchase ethical and
of social and environmental consequences
sustainable food.
of their consumption. There can be a lack of
15
3 Drivers of consumption – what

influences food consumption practices?
The underlying drivers of trends and patterns in Howse et al., 2018; Lee et al., 2018; Stephens
consumer food practices and preferences are et al., 2018; Vinther et al., 2016). Consumer
complex. A range of diverse and interconnected choices are driven by the perceived affordability
factors shape and influence the actions and of certain food products (Appleton et al.,
decisions that individuals take within particular 2017), price (Akaichi et al., 2016; Apostolidis
food environments as well as the wider food & McLeay, 2019; Edwards et al., 2010; Font
system. By considering the influence of social i Furnols et al., 2011; Ghvanidze et al., 2017;
practices, cost, availability and access to Howse et al., 2018; Revoredo-Giha et al., 2018;
information and marketing, as well as the role Stephens et al., 2018) and perceived value for
of industry and government and the importance money (Blow et al., 2019; Bondy & Talwar, 2011;
of food quality and safety, it is possible to Griffith et al., 2015).
understand the diverse and complex system in
Costs shape what people can afford to eat,
which consumer practices and preferences to
the healthiness of their food choices and the
food are shaped. Figure 7 provides an overview
willingness to consume ‘socially responsible’
of the drivers that the literature highlights are
food products. Food prices shape where
important and their relative importance. The
people eat and whether they eat in the
drivers at the top of the triangle are those that
home or outside of it (Appleton, 2016). The
have high-quality evidence and are perceived
perception that healthier choices are more
as consistently important in the literature, while
expensive is a major barrier to making healthier
the drivers at the bottom are those that have the
decisions about food (An, 2013; Griffith
least evidence to support their importance in the
et al., 2015; Howse et al., 2018; Pechey &
literature.
Monsivais, 2016). The price of food influences
consumers’ willingness to purchase Fairtrade
There is strong evidence that and organic products (An, 2013; Bondy &
the cost of food is an important Talwar, 2011; Jensen et al., 2011). Costs also
predictor of food purchases shape the consumption of meat and meat
replacements. Studies have cited cost as
There is strong evidence that the cost of food driving the frequency of meat consumption, the
has an effect on consumer purchases, with willingness to consume meat substitutes, as
increasing cost decreasing the likelihood of well as consumption of vegetarian products,
consuming certain food products (Akaichi et with a lower price preferred (Akaichi et al.,
al., 2016; Appleton et al., 2017; Edwards et al., 2016; Appleton, 2016; Font i Furnols et al.,
2010; European Food Safety Authority, 2019; 2011). Although cost is a major barrier to the
Figure 7 Overview of the strength of the evidence on the different drivers of trends and patterns in
consumer practices and preferences and their coverage in the literature
High-
quality and
consistent
COST AVAILABILITY & MARKETING &
evidence CONVENIENCE ADVERTISING
High-quality
but mixed
FOOD SYSTEM WHERE & HOW FOOD FOOD
evidence ACTORS WE BUY FOOD SAFETY INFORMATION
COUNTRY OF FOOD SUPPLY-SIDE DRIVERS OF

ORIGIN QUALITY TECH
CONSUMPTION
Depends on and interacts
Moderate with personal level
evidence differences such as
ONLINE income, gender, age,
PURCHASES education, habit and time.
Source: RAND Europe analysis. There is high-quality and consistent evidence that the factors at the top of the
triangle are important drivers of consumption. The factors in the middle have high-quality sources with mixed
evidence regarding the relative importance of the factor in driving consumption practices. The factors at the bottom
of the triangle have moderate evidence illustrating the relative importance of the factor but are either not widely
covered in the academic literature or lack high-quality sources.
purchase of ethical and sustainable products, with other factors. These include taste,
a number of studies have shown that some availability, the perceived healthiness of foods
consumers are willing to pay a price premium and the frequency with which certain food
for products with ethical and sustainable labels types and products are already consumed
(e.g. Fairtrade) (see Akaichi et al., 2016). (Apostolidis & McLeay, 2019; Edwards et al.,
2010; Jensen et al., 2011; Kamar et al., 2016).
However, the relative importance of cost as a
driver of consumer purchases also interacts
17
Costs are also relative to income level and, in Wills et al., 2019).20 Marketing and advertising
many instances, income differences explain a increases the consumption of unhealthy foods
lot of the observed dietary health differences in children (Cairns et al., 2009; Chambers et
(Appleton et al., 2017; Barton et al., 2015; Bondy al., 2015), adolescents (Kamar et al., 2016)
& Talwar, 2011; Cribb et al., 2011; Edwards et and young adults (Buchanan et al., 2018). In
al., 2010; Hawkesworth et al., 2017; Levin, 2014; addition, a significant amount of money is
Palma et al., 2017; Pearson et al., 2018; Pechey spent by food companies on marketing each
& Monsivais, 2016; Rekhy & McConchie, 2014; year, with the companies producing the top
Thomas et al., 2019; Townshend & Lake, 18 brands in the UK spending more than £143
2017). Food products that are more expensive million in 2016 on marketing unhealthy foods
and have higher-quality health outcomes are (O’Dowd, 2017).21
associated with more consumption in higher
In particular, there is some high-quality
income groups (Darmon & Drewnowski, 2015).
evidence around the negative impacts of
There is also some evidence that changes in
advertising has on children and young people
relative prices drive households’ decisions to
(Buchanan et al., 2018; Griffith et al., 2015;
change the quantities of the different food
MacGregor & Bicquelet, 2016). For example,
groups that they buy (Griffith et al., 2015). In
each additional hour of commercial TV that
general, those in low-income groups often have
children in the UK watch is associated with
less expensive food expenditure practices,
a 27 per cent increased likelihood of buying
consume less healthy food and less fruits and
unhealthy food and drink (Boyland et al., 2018).
vegetables (Appleton, 2016; Barton et al., 2015;
A systematic review found that the most
de Ridder et al., 2017; Hawkesworth et al.,
persuasive marketing techniques for children
2017; Levin, 2014; Levin et al., 2012; Thomas et
are premium offers, the use of promotional
al., 2019; Townshend & Lake, 2017; Whybrow et
characters, nutritional and health claims,22 the
al., 2018).
theme of taste and the emotional appeal of
fun (Jenkin, Madhvani, Signal, & Bowers, 2014;
Marketing and advertising have Buchanan et al., 2018).
a significant effect on food Particular forms of marketing and advertising
purchases, especially for children are also cited to be more effective. For
and young people example, digital marketing has a strong positive
association with unhealthy energy drink
There is strong evidence that consumer
consumption for young people (Buchanan et al.,
choices are significantly influenced by
2018) and media narratives can help endorse
marketing and advertising (Buchanan et al.,
and challenge established notions about
2018; Cairns et al., 2009; Kamar et al., 2016;
food (Happer & Wellesley, 2019; MacGregor &
Kavallari et al., 2011; Kearney, 2010; Roberto et
Bicquelet, 2016). While the impact of traditional
al., 2015; Saltmarsh, 2014; Vinther et al., 2016;
media (i.e. television, radio, newspapers) on
20 Food advertising, marketing and food promotion is used interchangeably in the literature (Buchanan et al., 2018;
Cairns et al., 2009; Griffith et al., 2018; Kamar et al., 2016).
21 Unhealthy foods are defined as crisps, confectionary, junk food and sugary drinks.
22 Although health and nutrition claims are typically aimed at an adult audience, they are also commonly found in
advertising to children and emerging evidence suggests that children are influenced by this information (Dixon et al.,
2014).
food consumption also relies on whether media Howse et al., 2018; Jensen et al., 2011; Kamar
narratives align with existing beliefs, there is et al., 2016; Moore et al., 2010; Paddock et al.,
strong evidence that traditional media can 2017; Roberto et al., 2015; Stephens et al., 2018;
create uncertainty about established narratives Townshend & Lake, 2017; Vinther et al., 2016;
by, for example, making consumers doubt the Walmsley et al., 2018). For example, consumers
scientific basis for the environmental benefits are more likely to increase their consumption
of a vegetarian diet (Happer & Wellesley, 2019). of certain food types (such as meat, fruit and
There is also some emerging, albeit weaker, eggs) if they perceive that it is convenient
evidence in the grey literature that the role (Appleton, 2016) and easily accessible in
of television is increasingly being replaced supermarkets and convenience stores (Howse
by social media, particularly for younger et al., 2018; Jensen et al., 2011; Kamar et al.,
segments of the population (i.e. millennials 2016; Walmsley et al., 2018), in the home
and subsequent generations), as youth are (Cook, O’Reilly, DeRosa, Rohrbach, & Spruijt-
influenced by social media behaviours and the Metz, 2015; Stephens et al., 2018), at work or
sharing culture around food, for example on in schools (Kamar et al., 2016; Stephens et al.,
Instagram (wbcsd, 2018). 2018) or in local neighbourhoods (Paddock et
al., 2017; Stephens et al., 2018; Townshend &
However, while marketing and advertising
Lake, 2017).
have some effect, it is difficult to isolate the
effects on specific diet-related practices. The The availability of certain foods in environments
effectiveness of marketing and advertising frequently visited by consumers also influences
campaigns for certain segments of the consumption. In particular, the presence of
population depends on other factors such relatively cheaper and unhealthy food increases
as the political and socio-economic context their consumption and hence the quality of
in which marketing operates, accessibility people’s diets (Griffith et al., 2015; Mansfield &
and availability of food, meal patterns, as Savaiano, 2017; Moore et al., 2010; Roberto et
well as packaging, product design and price al., 2015; Townshend & Lake, 2017, Stephens
(Buchanan et al., 2018; Cairns et al., 2009; et al., 2018). For example, school environments
MacGregor & Bicquelet, 2016; Webb & Byrd- facilitate healthy food choices if healthy options
Bredbenner, 2015). Peoples’ purchasing are readily available and promoted within the
decisions depend on knowledge and prior school environment (Mansfield & Savaiano,
experience; for example, marketing effects 2017). This also applies to supermarkets and
tend to be stronger for unfamiliar brands and other food outlets, where the availability of
products (Chandon, 2013). healthy choices in supermarkets and the general
availability of different food outlets have an
The scope for consumers to influence on healthy food choices (Marshall et
al., 2018; Stephens et al., 2018; Walmsley et al.,
make decisions in a given 2018; Xin et al., 2019), although this might differ
food environment depends on based on whether the food outlet is online or
availability and convenience of offline. For example, the convenience of online
food and food outlets ordering and home delivery is a major factor
affecting consumers’ decision to purchase
There is strong evidence that food-related
organic box schemes (Hashem et al., 2018;
decisions in certain environments depend on
Jilcott Pitts et al., 2018; Munson et al., 2017)
the availability and convenience of food and
and in general, availability is an important driver
food outlets (Appleton, 2016; Cook et al., 2015;
19
for the choice to consume organic products and vegetables in ‘structured and formal care
(Hashem et al., 2018). However, it is not just settings’ (e.g. at school) rather than at home
the presence of foods that drive food decisions (Mak et al., 2012). However, this is contrasted
but also the lack of alternatives (Jensen et al., with weaker evidence that eating at school has
2011; Kamar et al., 2016; Paddock et al., 2017; less of an impact on food-related practices than
Stephens et al., 2018; Vinther et al., 2016). For the consumption of fruits and vegetables at
example consumers are more likely to choose home (Tanton et al., 2015; Tyrrell et al., 2017).
meat options when there are no vegetarian Similarly, the consumption of food in certain
options available (Vinther et al., 2016). environments increases the likelihood of eating
certain food products. For example, meat
However, the availability and convenience of
consumption was found to be more likely in a
food in different food environments is not
restaurant than when eating at home (Horgan
as dominant in shaping food consumption
et al., 2019). In one study, young adults stated
choices as cost. Instead, availability and
being aware of how the physical environment
convenience are associated and interplay
shapes their food choices, stating awareness of
with other factors such as advertising, the
techniques to make food more appealing, such
food culture (such as the ‘grab it and go’ food
as the placement of snack foods, displays in
culture) and the consumption patterns of
supermarkets and convenience stores (Howse
peers, portion sizes and price (Kamar et al.,
et al., 2018). However, although there is a
2016; Roberto et al., 2015; Roe et al., 2016;
growing evidence base on the influence of the
Wills et al., 2019; Ziauddeen et al., 2018).
built and micro environment on consumption,
there is some mixed evidence (e.g. regarding the
The built and micro food impact of structured and formal care settings on
environments have an influence children’s fruit and vegetable consumption) and
on consumption important gaps that require further investigation,
such as the impact of socio-demographic
There is evidence from high-quality sources differences in access to fast-food outlets and
that the built food environment and the food the impact of planning policies to restrict fast-
architecture23 influences where we buy and food outlets near schools (Townshend & Lake,
eat food24 and shapes individuals’ food-related 2017).
decisions (Burgoine et al., n.d.; Horgan et al.,
2019; Moore et al., 2010; Roberto et al., 2015; Food environments interact with other
Tyrrell et al., 2017; Ziauddeen et al., 2018). drivers in multiple ways. First, the influence
Eating at home and at school or university of food environments depends on the social
is generally associated with healthier food relationships and cultures that facilitate certain
choices than eating in food outlets, ‘on the go’ consumption patterns. Food environments
and at leisure places (Blow et al., 2019; Mak are socially and culturally embedded, and so
et al., 2012; Shareck et al., 2018; Tanton et the social relationships and cultures created
al., 2015; Tyrrell et al., 2017; Ziauddeen et al., in certain food outlets and when eating
2018). Children are more likely to consume fruit with friends are an important driver of food
practices and consumption (Allman-Farinelli
23 Food architecture is defined by Roberto et al as the placement of food items in supermarkets, the price of products
and the strategies used to promote foods (Roberto et al., 2015).
24 This includes both food prepared and consumed at home and out-of-home sources (Townshend & Lake, 2017)
et al., n.d.; Blow et al., 2019; Meah & Watson, environment (MacKay, 2011; Roberto et al.,
2011; Wills et al., 2019). In addition, factors 2015). In addition, although there is less trust
such as age, availability and accessibility, wider in the food industry than other sources of
social changes, class, lifestyle and food culture information on food-related risks (European
trends, and the preferences of consumers Food Safety Authority, 2019), there is strong
interact with the food environment (Allman- evidence that manufacturers and retailers
Farinelli et al., n.d.; Roe et al., 2016; Tanton et can help create or damage consumer trust in
al., 2015; Ziauddeen et al., 2018). food (J. Barnett et al., 2016; Houghtaling et al.,
2019; Jackson, 2010; Marshall et al., 2018),
Different actors have important for instance through scandals such as the
horsemeat scandal. Retailers also guide the
roles in shaping the food food market in terms of education/information
environments that frame the food campaigns (e.g. enhanced promotion of
choices made by consumers healthy products and how to use them),
labelling (e.g. shelf labelling, particularly
Different food system actors, including
using nutrition summary scores) and price
the food industry, the government, civil
promotions (e.g. ‘buy one get one free’, other
society and the individual, all work together
multi-purchase or multipack discounts, basic
to either constrain and or enable the food
discount offers and meal deals) (Cameron
consumption practices of individuals and the
et al., 2016; Howse et al., 2018; Sparks &
biological, psychological, social, and economic
Burt, 2017), and there is potential for the food
vulnerabilities and opportunities that promote
industry to promote healthy food environments
the consumption of certain foods (Jackson,
(Roberto et al., 2015).
2010; Roberto et al., 2015). Although the
literature cites a variety of food system actors In addition, there is some evidence that big
as being important in influencing the food food industry players, such as transnational
environment and consumption practices, there food corporations, play a significant role in
is no evidence on their relative importance. driving demand for processed foods, the
fast-food market, and a Western lifestyle
There is strong, but not extensive, evidence on
globally, which is driven by global marketing
the distinct role of the food industry in shaping
campaigns (Baker & Friel, 2016; Kearney,
the food environment and consumption
2010). For example, evidence suggests that
practices in the academic literature, although
ultra-processed food sales have increased
the grey literature deals with this in more detail
rapidly in most middle-income countries (Baker
(Food & Drink Federation, n.d.; GrantThornton,
& Friel, 2016). Another factor that shapes the
2017; USDA, 2018). The food industry is
food environment is also the influence that
shaped by and responds to consumer demand,
lobbying from the food industry, including
but manufacturers and retailers also shape
manufacturers of prepared and processed
and change consumption practices in the UK.
foods, has on enabling or challenging policies
The food industry in the UK can determine
and interventions aimed at changing consumer
the ingredients and content of food25 and the
demand (Roberto et al., 2015).
placement and availability of food in the food
25 Determining the content of food is within the limits of existing food regulations, for example regulations that specify
mandatory food compositional standards.
21
Figure 8 Overview of the food systems actors that the literature cites as important in shaping
consumption practices in the UK
Friends Family Supermarkets
Fast-food
takeaways
Social media
CONSUMER
UK food Restaurants
Traditional media MEDIA
processing
industry
Cafe
UK food
UK FOOD retailing
industry Mobile vendors
INDUSTRY
Non-governmental
organisations Transnational Corner shops
food
OTHER corporations
Civil society IMPORTANT Convenience
organisations ACTORS stores
FOOD
AUTHORITIES
Schools Market stalls
Online food
National government Local councils delivery schemes
High-quality evidence also indicates that a significant role in shaping consumption

changes in the food environment depend on practices (the role of culture and norms is dealt
the ability and willingness of national and with in more detail in Chapter 4). For example:
local government to implement policy such
• Both traditional and social media are major
as specific food-related guidelines, mandatory
sources of food marketing, which has a
reformulation and taxation, information and
significant effect on food purchases.
education campaigns, and national policies
such as trade liberalisation policies that • Consumption practices are socially and
affect costs (Bitler & Wilde, 2014; Kearney, culturally embedded, and individual food
2010; Roberto et al., 2015; R. D. Smith et choices are influenced by the consumption
al., 2018). Often, information and education practices of friends and family that
campaigns depend on implementation and contribute to creating and reinforcing social
administration by civil society organisations norms and habits.
and non-governmental organisations (Rekhy & Figure 8 provides an overview of the different
McConchie, 2014). actors that the literature cites are important
Other food system actors, such as the in influencing the food environment and
media, family, friends and schools, also have consumption practices.26
26 The specific role of the food processing sector is beyond the scope of this report.
Figure 9 Overall differences in trust in sources of food information in the EU in 2010 and 2019
90%
80%
70%
60%
50% 2010
40% 2019
30%
20%
10%
0%
s
s
ts
rs
try
s
s
er
ie
ie
n
n
is
ile
tio
tio
c
rit
rm
nt
du
en
ta
ho
sa
itu
ie
Fa
re
in
ag
Sc
ni
ut
st
od
ga
in
la
ty
o
Fo
fo
fe
or
EU
na
sa
e
io
er
Th
at
um
d
o
N
Fo
ns
Co
Source: European Food Safety Authority, 2010, 2019
There is some evidence that of front-of-pack labelling is challenging for

consumers when there are different formats
clear and simple information
used on different food products (Draper et
can influence consumers’ food al., 2013). The source of food information
purchases and its influence on consumer trust is not
Some studies highlight the role of information, widely covered in the academic literature,
including guidelines and labelling, in driving but the grey literature reports on the types of
food purchasing (Apostolidis & McLeay, 2016; information that consumers find more reliable.
Christoph et al., 2016; D. A. Cohen & Lesser, There is moderate evidence that consumers
2016; Ghvanidze et al., 2017; Hodgkins et al., most frequently get information on food from
2019; Omar et al., 2014; Palma et al., 2017; television (69 per cent of respondents in the
Saltmarsh, 2014). In the UK, 36 per cent EU and 61 per cent respondents in the UK),
of consumers have made changes to their followed by the Internet (46 per cent in the EU
consumption practices at least once in their and 56 per cent in the UK), newspapers and
life based on food information (European Food magazines (38 per cent in the EU and 41 per
Safety Authority, 2019). cent in the UK), and family and social circles
(36 per cent in the EU and 33 per cent in the
There is strong evidence that how information UK). Younger respondents in the EU prefer
is provided influences the relative importance information from social media and the Internet
of information for consumers. Consumers (European Food Safety Authority, 2019). The
tend to act on information when it is provided source of information also affects the trust that
in clear and simple formats (Hodgkins et al., consumers in the EU have in food information
2019; Kelly et al., 2016). For example, the use (European Food Safety Authority, 2010, 2019).
23
Figure 9 illustrates overall differences in trust in value information on nutritional quality more
different sources of food information amongst than information on the social responsibility
EU citizens between 2010 and 2019.27 of products and their ecological impact
(Hodgkins et al., 2019; Omar et al., 2014).While
While these response categories were not
information has some effect on consumers’
measured in the European Food Safety
food practices, it is difficult to isolate the
Barometer survey in 2010 (European Food
effects of specific types of information and
Safety Authority, 2010), EU citizens also cite
the extent to which consumers only state that
the trust that they have in non-governmental
they value particular types of information. The
organisations (NGOs) (56 per cent), journalists
influence of information is also likely to depend
(50 per cent) and influencers, celebrities and
on consumer beliefs and values, as well as
bloggers (19 per cent) in 2019 (European Food
factors in the wider food environment (Webb &
Safety Authority, 2019).
Byrd-Bredbenner, 2015).
There are differences between the value
that different consumers place on different
information. High-income consumers,
Although most consumers think
those willing to buy expensive products that food in the UK is safe, food
and consumers that are health conscious safety is a concern for some
when making consumption and purchasing consumers when choosing food
decisions are more likely to use packaging
Consumers in the UK and in the rest of Europe
information (Ghvanidze et al., 2017; Palma
cite that food safety is a concern when choosing
et al., 2017). The type of label will also
food (Balcombe et al., 2010; European Food
have different importance for consumers.
Safety Authority, 2019; FSA, 2019b; Jackson,
Fat content labels are important for all
2010; Saltmarsh, 2014). For example, 41 per
consumers, origin labels and carbon footprint
cent of UK respondents say that they are
labels have a moderate impact across all
interested in food safety when choosing food
consumer groups, while brand, point of
(European Food Safety Authority, 2019) and 60
purchase (i.e. labels enabling consumers
per cent of UK consumers say they look at the
to assess healthiness of foods) and
hygiene rating of food outlets when choosing
production method labels are significantly but
where to consume food (FSA, 2019b). However,
comparatively less important for consumer
there is no uniform food safety concern that
choices (Apostolidis & McLeay, 2019).
is prevalent in all countries and across all
The review process did not come across consumer groups. Areas of general food safety
academic evidence exploring the type of concern include: the presence of antibiotics,
information that can change food practices. hormone or steroid residues in meat; pesticide
However, a European Food Safety Authority residues in food; environmental pollutants
European-wide study cites that two-thirds in fish, meat or dairy; and additives such as
of all European citizens have changed their colours, preservatives and flavourings that are
consumption as a result of information on food used in food and drinks (European Food Safety
risks (European Food Safety Authority, 2019). Authority, 2019; FSA, 2019b; Jackson, 2010;
Evidence also exists that some consumers Saltmarsh, 2014).
27 The European Food Safety Barometer in 2010 asked a similar question to the Food Safety Barometer in 2019, but this
should be taken with some caution as the question wording and response options differed in 2010 and 2019.
The importance that consumers place on the case of home delivery boxes or farmers
each issue depends on personal differences, markets, fruits and vegetables delivered
such as emotions and habit, as well as directly from farmers are considered to be of a
questions of identity, culture and belonging higher quality than that found in supermarkets
(FSA, 2019). In addition, the types and levels (S. Hashem et al., 2018; Mansfield & Savaiano,
of concern can be shaped by the type of 2017). It should be noted that perceived quality
products consumed. For example, consumers relates to a consumer’s own perception of what
frequently cite safety as a concern when quality is.
choosing meat products (such as beef and
chicken) (Jackson, 2010; W. Verbeke et al., Consumers consider the country
2010), shellfish, and takeaway food that has
been reheated (FSA, 2019a). There are also
of origin of food products, as they
some concerns around eggs, unwashed and associate the country of origin
frozen vegetables, bread, cooked sliced meats, with food quality and safety
and sandwiches that are pre-prepared (FSA,
When consumers are asked, some evidence
2019a). Although not widely covered in the
exists that country of origin of food products is
academic literature, there is strong evidence
an important stated preference (Apostolidis &
in the grey literature that food safety concerns
McLeay, 2019; European Food Safety Authority,
are also shaped by food environments.
2019; Font i Furnols et al., 2011; FSA, 2019b;
Consumers are less likely to be worried
Ghvanidze et al., 2017). Consumers tend to
about food prepared in their own home and
say they prefer British, UK or Irish products
perceive that consuming food in the out-of-
rather than products that come from elsewhere
home sector increases the likelihood of being
when purchasing intentions are analysed (FSA,
exposed to food safety risks (FSA, 2019a).
2019b). The perception amongst many UK
Food safety is likely to be an increasing
consumers is that products that are nationally
concern with the increasing diversification and
or locally sourced are of higher quality (FSA,
fragmentation of food consumption channels
2019b). For example, in the most recent
due to the growth of the online food market.
Food and You survey published by the Food
Standards Agency, approximately half of the
Perceived food quality might respondents said that they had greater trust
be an important driver for some in the quality of food produced in the UK
consumers’ choices (FSA, 2019b). The exception is when a food
product is perceived to be of higher quality
There is moderate evidence that perceived food when sourced from a particular region, such as
quality is an important driver for consumer Mediterranean olive oil (Kavallari et al., 2011).
choice, with studies citing that consumers Country of origin also relates to perceptions
look for ‘freshness’, taste and sensory and of food safety and food security, as UK and
visual appeal when making food decisions EU consumers tend to perceive that locally
(Apostolidis & McLeay, 2019; S. Hashem et al., and nationally sourced food follows stricter
2018; Mansfield & Savaiano, 2017; K. H. Ng hygiene standards than those products that
et al., 2015; Patterson et al., 2012; Wills et al., are internationally procured (European Food
2019). Food quality is a reason for consumers Safety Authority, 2019; FSA, 2019b). The origin
choosing organic products, for example, country of products is particularly important
because organic products are perceived to be when consumers make decisions about the
‘fresher’, have greater sensory appeal and, in
25
types of meat they purchase as origin labels 2015). Some evidence indicates that these
are perceived to be associated with food safety perceptions may not necessarily influence
(Apostolidis & McLeay, 2019; Font i Furnols et the consumption choices of individuals in
al., 2011). a significant way (W. Verbeke et al., 2010)
because many consumers feel like they lack
There is limited evidence knowledge and awareness or are uncertain
about what each technology is and so tend
that consumers consider the to take a position of neutrality when faced
technologies used in food with decisions based on food technologies
production processes when (FSA, 2016). More recent evidence suggests
making food-related decisions that consumers’ perceptions of agri-
food technologies may act as a barrier to
There is some evidence in the literature that
consumption (Wim Verbeke et al., 2015). For
the public is sometimes concerned with
example, in one study investigating consumer
the supply-side technologies used in food
reactions towards the concept of cultured
production, including technologies involved
meat in three EU countries (including the UK),
in the production of some functional foods,28
reactions included disgust, considerations
irradiation, and cultured and mechanically
of unnaturalness and uncertainty over the
separated meat (FSA, 2016; Wim Verbeke et
long-term consequences of a shift from
al., 2015). When prompted, some consumers
traditional to cultured meat production and
say that they support technologies that can
consumption (Wim Verbeke et al., 2015).
strengthen the health benefits of certain food
However, consumers did acknowledge that
products without being excessively invasive
there are potential societal benefits associated
(e.g. the application of muscle profiling in
with cultured meat (Wim Verbeke et al., 2015).
beef production), but are resistant to food
Consumers are wary of novel technologies
technologies that they perceive to be ‘unnatural’
such as genetic modification, cloning and
or that involve excessive manipulation (e.g.
nanotechnology, which they perceive to contain
processed beef) (W. Verbeke et al., 2010; Wim
significant technological intervention but little
Verbeke et al., 2015). This reflects that there
direct benefit to consumers (Wim Verbeke
are different preferences related to different
et al., 2015). Attitudes also change when
technologies in the UK. The Food Standards
confronted with issues such as the bovine
Agency (FSA, 2016) finds that consumers in
spongiform encephalopathy crisis in the 1990s
the UK perceive that mechanically separated
or the horsemeat scandal in 2013, which can
meat is relatively acceptable and does not
lead to an increase in awareness that may
drive consumption and purchasing patterns.
affect practices, although this is only likely
However, technologies such as irradiation and
to be short term (Food Safety News, 2019;
cultured meat production are perceived in
Murray, 2018).
less favourable terms to consumers because
the technologies are perceived as unnatural
and invasive (FSA, 2016; Wim Verbeke et al.,
28 While there is no formally agreed definition, ‘functional foods’ can be defined as foods that contain biologically active
components, which can enhance health or reduce the risk of disease beyond ordinary nutritional effects. Functional
foods can be natural food or processed food that has been modified by technological or biotechnological methods
(del Castillo et al., 2018).
Emerging evidence indicates that of the barriers to the use of instant delivery is
the unwillingness of consumers to pay a lot
online food purchases enabled
of money for these services (Dablanc et al.,
by digital technologies (either 2017). However, different types of consumers
grocery shopping or takeaway are driven by different trends related to
consumption) will become an online purchases, as convenience shoppers
important driver for consumption might aim for time savings while those who
trends in the future seek variety might look for novel brands and
products (Nguyen et al., 2018).
There is some evidence in the academic
literature that the changing digital landscape There are also some suggestions in the
(in terms of increased availability of computers, literature that online food purchases influence
tablets and mobile phones) has increased the types of foods consumed by individuals;
instant deliveries, on-demand delivery, rush however, it appears to be a ‘double-edged
deliveries, flexible transport services and peer- sword’ as online shopping can drive both
to-peer logistics in the UK (Allen et al., 2017; healthy and unhealthy food consumption. For
Dablanc et al., 2017; Nguyen et al., 2018; O’Neill example, it can reduce the likelihood of buying
et al., 2019; Sparks & Burt, 2017). However, to unhealthy foods due to a reduction in impulse
date, the role of the changing digital landscape purchases and can be a way to overcome
and its influence on consumption trends is not healthy food accessibility challenges. However,
widely covered (Dablanc et al., 2017). it can also increase the chances of buying
unhealthy products, since consumers may be
This literature finds that the general rise in more reluctant or unable to buy fresh products
e-commerce combined with the changing online (Jilcott Pitts et al., 2018). There is
habits of consumers has contributed to the evidence suggesting that in an offline setting,
growth in online food purchases. The growth customers with lower self-control may be more
in online food shopping is also driven by the susceptible to marketing of unhealthy foods;
product range available, the lower prices however, the evidence is lacking around the
offered and convenience (i.e. that consumers types of individuals who make healthy and
can save time when not having to physically unhealthy online purchases.
shop) (Dablanc et al., 2017). Conversely, some
27
4
Individual and social differences
– how do different people make
decisions about food?
Although we can see broad trends in attitudes al., 2017; Barton et al., 2015; Bondy & Talwar,
and consumption practices, as well as 2011; Cribb et al., 2011; Edwards et al., 2010;
common system level and environmental Hawkesworth et al., 2017; Levin, 2014; Palma
drivers, the way people respond to them differs et al., 2017; Pearson et al., 2018; Pechey &
depending on who they are, their experiences, Monsivais, 2016; Rekhy & McConchie, 2014;
beliefs, attitudes and other characteristics. Thomas et al., 2019; Townshend & Lake,
There is no one, generalisable, public, rather 2017). A systematic review considering the
there are multiple ‘food publics’29 (Darnton, environmental determinants of a healthy diet
2016) and understanding these differences found that low socio-economic status (in terms
is crucial both in understanding the changing of education level, work status and income)
food environment and thinking about is the single most consistent risk factor for
how policies can be developed to change not adhering to a healthy diet (de Ridder et al.
consumption practices. Individual differences 2017). Data from multiple studies and surveys
can be driven by social factors and constructs, indicates that compared to those with higher
but also by psychological factors; we discuss socio-economic status, individuals with lower
both of these in this chapter. Figure 10 socio-economic status tend to obtain a greater
provides an overview of the complex factors proportion of energy from less healthy foods
that constitute individual and social level and beverages (i.e. sugar-sweetened drinks,
differences. red meat products – such as processed meat,
pies and sausages – whole milk, processed
Socio-demographic factors are potatoes and takeaway foods) and fewer foods
associated with a healthy diet (i.e. fruit and
associated with consumption in vegetables, brown/wholemeal bread, breakfast
predictable ways cereal, oil-rich fish, white fish and complex
There is strong evidence that lower incomes, carbohydrates) (Barrett et al., 2017; Barton et
economic deprivation and lower levels of al., 2015; Cribb et al., 2011; Defra, 2017; Pechey
education are associated with a poorer diet & Monsivais, 2016; Wrieden et al., 2013). Socio-
and being overweight/obese (Appleton et economic differences affect children too. A
higher level of parental education is associated
29 The term ‘food publics’ is used to emphasise that in the evidence base on food and consumption, the public is
not a single entity, but rather composed of different subgroups with different socio-demographic characteristics,
experiences, beliefs, attitudes and other characteristics (Darnton, 2016).
Figure 10 Overview of the drivers of individual and social differences that influence food
consumption
ent and wider d

environm rivers
Food
One off
Trends
events
Relative
Heuristics income
Beliefs and Emotional

Education values response Age
Cooking
skills and
Time
Habits knowledge
Taste
Preferences Cultural
Deprivation and social
norms
Social Economic
shocks shocks
Mental
health
Source: RAND Europe analysis. The inner circle illustrates the values, beliefs, preferences and emotions of
consumers related to food that drive consumption practices. The second circle illustrates the individual and
social differences that drive consumption practices. The outer circle illustrates that the inner and second circle is
influenced by and interacts with the food environment and other drivers.
with higher fruit and vegetable consumption in There are various other factors, such as
preschoolers (Cribb et al., 2011; Lee et al., 2018; age and gender, that have been found to be
Volland, 2019), and in lower-income families, associated with the consumption of a healthy
children are more likely to have poor diets diet. Survey evidence from the UK and globally
(Pearson et al., 2018). (from 266 surveys across 113 countries)
29
indicates that women tend to have slightly Beliefs and values can inform
greater consumption of healthier foods (Defra,
consumption, and health concerns
2017; Micha et al., 2015). Women are also
more likely to pay more for healthy foods
are a greater driver of choice than
and use food labels (Balcombe et al., 2010; other (e.g. environmental) issues
Christoph et al., 2016; Rekhy & McConchie, Consumers, when asked, often cite the
2014). Age differences are also associated with importance of values and beliefs in driving their
dietary differences (Palma et al., 2017; Price et food choices. However, there are differences
al., 2016). The same global survey also found in the relative importance of different values
that intake of more healthy foods was generally such as health, environmental concerns and
higher in older adults (Micha et al., 2015). animal welfare for consumers. There is strong
Some studies find a correlation between age evidence that health concerns are a bigger
and fruit and vegetable consumption, where driver of consumption than environmental
fruit and vegetable consumption increases with concerns (e.g. sustainability) (Appleton et al.,
age until 60–65, after which it starts to decline 2017; Blow et al., 2019; Ghvanidze et al., 2017;
(Appleton et al., 2017; Rekhy & McConchie, S. Hashem et al., 2018; Mylan, 2018; K. H. Ng
2014). Older individuals also tend to consume et al., 2015). Purchase of organic food boxes,
healthier foods overall, although it is not clear for example, are in part driven by ethical and
whether this a true age effect or a cohort political motivations, such as growing concerns
effect (Appleton et al., 2017; Lam & Adams, over the globalised and industrialised food
2017). Analysis of UK food purchase data system, and the lack of transparency in food
(controlling for equivalised income)30 found origin; however, perceived health benefits are
that consumption of healthier foods (e.g. fruit also a key motivator (S. Hashem et al., 2018).
and vegetables, oil-rich fish and fibre) was Similar trends are seen in meat reduction, with
lower and consumption of less healthy foods health perceptions being the most prominent
was higher in Scotland than in England, and influence, and only limited significance placed
this discrepancy was greater for lower-income on environmental concerns and animal welfare
groups (Barton et al., 2015). However, evidence (Appleton et al., 2017; Clark et al., 2016; Jackson,
for these factors is less clear, particularly 2010; Mylan, 2018); although differences exist
as these studies are not all adequately depending on gender, age, education and
controlled. Despite these socio-demographic familiarity with and interest in the issue (Clark
differences, diets remain unhealthy across all et al., 2016; Garnett et al., 2015). Evidence
groups. Collectively, these findings suggest on the socio-demographic characteristics
that existing policies have not adequately of individuals with health and environmental
addressed food inequalities. concerns suggests that these tend to be female
and younger (Latvala et al., 2012; Su et al., 2019;
WRAP, 2015; YouGov: Eating Better, 2019),
but more good-quality and controlled studies
are needed to determine this relationship.
30 A measure of household income that takes into account the differences in a household’s size and composition
(Eurostat, 2018).
‘Food identities’31 can be fluid depending on Food decisions are rarely the
interactions between social change, practices,
outcome of conscious deliberation
trends and the food environment (Roe et al.,
2016). Beliefs and values also drive level of
and influenced by habitual
engagement with policy actions. For example, mechanisms and emotions
those concerned about healthy eating are There is strong evidence that our choices about
more likely to derive value from food labelling what foods to buy and eat are often made
(Ghvanidze et al., 2017). unconsciously and driven by unconscious
However, while consumers cite the importance mechanisms such as heuristics. Choices
of values and beliefs in driving their food about food are a combination of reflective
choices, values are often less significant than (i.e. deliberate and self-conscious) and
other factors such as taste, cost or convenience automatic (i.e. rapid and driven by unconscious
(Apostolidis & McLeay, 2019; Garnett et al., mechanisms and biases) decision making.
2015; Vinther et al., 2016). Consumers highlight Food ‘choice’ is in reality often not a rational
values and beliefs as important when making ‘choice’ per se but an unconscious response
food decisions, but there is still a significant to a food setting or environment mediated
value-action gap between what people believe through personal and social experiences and
and what they actually consume in practice factors (Gutjar et al., 2015; Wansink & Sobal,
(YouGov: Eating Better, 2019). There is strong 2007). Thus, the extent to which people are
evidence to suggest that in addition to other able to consciously control and regulate their
important factors (e.g. price, quality and practices varies significantly (being driven by
availability), one reason for this is because emotions, mental health and habit), and is an
the extent to which people respond to social important determinant of their consumption
and environmental labelling depends not just decisions. In addition, heuristics are influenced
on attitudes towards those issues but the by the external food environment; the design
extent to which people feel they can make a of menus and food products, as well as the
difference (Ghvanidze et al., 2016; Sleddens surroundings in restaurants and supermarkets,
et al., 2015; Spencer et al., 2014). People may act as contextual cues that subconsciously
feel a lack of agency with regard to issues such influence food choices (D. Cohen & Babey,
as sustainability and animal welfare in a food 2012).
system dominated by large powerful companies Emotions are an important factor influencing
(Howse et al., 2018). In addition, confidence is consumption. Eating is often emotional
positively associated with individuals changing (Jackson, 2010; Lu et al., 2013), pleasurable
their diets (Hardcastle et al., 2015) and many (den Uijl et al., 2016) and a social experience
consumers deal with socially responsible food (Carey, Bell, Duff, Sheridan, & Shields, 2011;
decisions with a degree of cynicism (Happer & Köster & Mojet, 2015), and memories and
Wellesley, 2019). Thus, interventions aimed at feelings about foods can influence food
changing consumption patterns should develop choices (Piqueras-Fiszman & Jaeger, 2016;
an individuals’ confidence to change diets Robinson, 2014; Uprichard et al., 2013). People
(Hardcastle et al., 2015). express emotional responses to food choices,
31 ‘Food identity’ is defined as a way of characterising regular or preferred food consumption and food production based
on what is eaten, purchased, produced, and how people perceive the value and purpose of food (Roe, Sarlöv Herlin, &
Speak, 2016).
31
feeling guilt about their consumption decisions as 12 months (Sahota et al., 2016) and children
(e.g. consuming takeaway meals) (Blow et al., copy what parents eat. Lack of knowledge, time
2019) and moralising certain types of foods and money can affect parents’ ability to change
(e.g. snack food being construed negatively their own consumption patterns (Mazarello
or healthy food being described as ‘sensible’) Paes et al., 2015; Rekhy & McConchie, 2014).
(Stephens et al., 2018) and associating others Social norms are also ingrained and can be
with aspects of their identity (e.g. masculinity) hard to change; for example, people eat larger
(Stephens et al., 2018). portions on larger plates due to the social norm
of ‘cleaning one’s plate’ (Chandon, 2013).
Mental health can also be a driver of
consumption. Adults with low levels of well-
being, high stress or depression tend to eat Individual and social factors
less well (Devonport et al., 2019; Russell et al., interact with contextual factors
2016), and childhood abuse is associated with
Wider socio-economic changes and
being obese as an adult (Hemmingsson et al.,
events can impact on personal values and
2014; Russell et al., 2016).
norms
Habits are an important driver of consumption
Individuals do not behave in isolation when
(Blow et al., 2019; de Ridder et al., 2017; K. H.
making food choices. Socio-economic and
Ng et al., 2015; Rekhy & McConchie, 2014) and
environmental context can influence an
can be difficult to change (Gardner et al., 2011).
individuals’ ability to exercise choice (Mansfield
Habit strength and level of self-regulation will
& Savaiano, 2017), and can also affect values
vary between individuals, which will influence
and norms and how these govern behaviour
their ability to be able to make the food choices
(Hardcastle et al., 2015; Puelles et al., 2016).
they would rationally wish to – for example,
Economic shocks can also drive changes in
to eat more healthily (de Ridder et al., 2017;
consumption. For example, during economic
McDermott et al., 2015; Sleddens et al., 2015).
crisis, consumers are more likely to use
Beyond this, people have to want to change
discount supermarkets and exercise more
what they eat. Self-regulation strategies in which
conscious decision making around price,
people control their food intake and change
control and time spent shopping (Puelles et
eating patterns are effective only when people
al., 2016). Similarly, one-off events, such as the
want to and are planning to change their eating
horsemeat scandal, can affect consumer levels
practices (de Ridder et al., 2017; Sleddens et
of trust in labelling and information as a whole,
al., 2015). Although people tend to struggle to
having impacts on consumption decisions
prioritise long-term benefits over short-term
(J. Barnett et al., 2016). Trustworthiness
pleasure, long-term gains are the focus of most
of food providers is an important driver for
healthy eating messages (Evans et al., 2017).
consumption for many individuals (J. Barnett
et al., 2016; Garnett et al., 2015; Happer &
Cultural and social norms can Wellesley, 2019; Jackson, 2010; Jensen et al.,
influence eating behaviours 2011; Price et al., 2016; Spencer et al., 2014).
There is some high-quality evidence that Time and resources are also important
cultural and social norms can influence eating contextual factors for consumers
practices (Köster & Mojet, 2015; Skeer et al.,
2016) and are established early in life. Ethnic As the pace of life and daily routine has
differences in dietary intake are seen as early increased in the past years, there are
increasing demands among consumers that 2016; Konttinen et al., n.d.; Stephens et al.,
the preparation of food is convenient and 2018; Which?, 2013; Wills et al., 2019). The
saves time (Blow et al., 2019; Howse et al., extent to which individuals can make choices
2018; Jilcott Pitts et al., 2018, 2018; Rekhy & based on their preferences depends on their
McConchie, 2014). Time and convenience (i.e. social and personal circumstances, and
food perceived to be ‘quick’ and ‘easy’ to cook) interrelated factors such as availability and
are important drivers of consumption choices accessibility, cost and convenience, the wider
(Appleton, 2016; Howse et al., 2018; Jilcott food architecture, and advertisements and
Pitts et al., 2018), particularly for lower-income educational campaigns (Apostolidis & McLeay,
individuals who often lack time (Howse et al., 2019; Kamar et al., 2016; Stephens et al., 2018;
2018). Lack of cooking skills and/or confidence Wills et al., 2019).
can also affect consumption, as people that
are less confident or able are more likely to Given the differences between
consume processed/unhealthy foods (Lam &
Adams, 2017; Sprake et al., 2018) and less able
individuals, segmentation
to eat diversely (K. H. Ng et al., 2015). However, approaches can be useful in
this evidence tends to come from cross- analysing consumption practices,
sectional studies and it is not clear whether but the groupings are typically
educational interventions could be effective in context specific
addressing these challenges.
Reflecting the wide range of different attitudes
Changes in personal and social and practices across the population, many
circumstances can change practices and studies look to divide the population into
affect consumption patterns groups to analyse their consumption practices,
which can provide useful insights. Studies use
There is some evidence that changes to a diverse range of segmentation approaches32.
diet are found to happen following social The vast majority of these are based on either
shocks such as divorce, separation, becoming practices or attitudes depending on the nature
widowed, moving house or having children and focus of the study (Apostolidis & McLeay,
(O’Neill et al., 2019; Rekhy & McConchie, 2014; 2019; Font i Furnols et al., 2011; Hardcastle et
Vinther et al., 2016). This can reflect sense of al., 2015; Shareck et al., 2018). For example,
responsibility (e.g. providing ‘proper’ food for one study investigated three clusters – meat
your family) but also exposure to new ideas, eaters, meat reducers and vegetarians – and
for example children bringing new practices, their preference for meat and meat substitutes
like vegetarianism, into the home (O’Neill et (Apostolidis & McLeay, 2019). Another study
al., 2019), or changes in available income looked at three clusters of eating behaviours,
(Thomas et al., 2019). However, there is ‘impulsive involved’, ‘uninvolved’, and ‘rational,
strong evidence that suggests that changes health conscious’, and their association with
in personal and social circumstance interact consumption of unhealthy food (Hardcastle et
with the preferences and taste of consumers al., 2015).
to influence their food-related practices (Bailey
et al., 2015; Garnett et al., 2015; Kamar et al.,
32 Segmentation analysis involves dividing consumers into homogeneous groups or ‘segments’, which are assumed to
behave in the same way (C. Barnett & Mahony, 2011).
33
There are also a few examples focusing markets, restaurants serving international
specifically on socio-demographics, such as cuisine) (Roe et al., 2016). Box 5 below provides
income group (e.g. Smith et al. 2018). However, an overview of different types of segmentation
the extent to which demographic variables approaches described in the literature.
are aligned with identified clusters varies.
However, segmentation approaches are usually
On the one hand, some segmentations find
highly context-specific and dependent upon
that socio-demographic variables provide
the variables included in the analysis and need
a poor explanation of differences in food
to be applied to representative population level
attitudes and practices (Ghvanidze et al., 2017;
data in order to make generalisations. For
Kehlbacher et al., 2019; Piqueras-Fiszman &
example, one study creates a cluster of the
Jaeger, 2016). For example, consumers have
food advertising in different magazines, but
been found to be concerned with nutritional
only for two magazines and did not investigate
information about food products independently
the effects of food advertising on the readers
of how price sensitive they are, contradicting
of the magazines (Spencer et al., 2014).
other studies that find that price sensitive
The segmentation approach using urban
consumers are less focused on the nutrition
‘foodscapes’ is innovative but based on small
content of products (Ghvanidze et al., 2017). In
scale data from one city in the UK (Roe et al.,
addition, another study investigating emotional
2016). In addition, several of the segmentation
associations to food finds that behavioural
studies are of moderate quality and lack a
variables might be more effective at capturing
statistically significant sample (Apostolidis
segmentations than socio-demographic
& McLeay, 2016; Palma et al., 2017; Price
differences (Piqueras-Fiszman & Jaeger, 2016).
et al., 2016; Roe et al., 2016). A review of
On the other hand, others find that one or more
segmentation approaches emphasises the
socio-demographic variables are aligned with
potential of this type of analysis to help support
their segmentation categories (Apostolidis
effective communication of messages and
& McLeay, 2019; Font i Furnols et al., 2011;
understanding differences and nuances in
Puelles et al., 2016; Sprake et al., 2018).
behaviour and practices (C. Barnett & Mahony,
Although most segmentation approaches 2011). In addition, segmentation approaches
focus on characterising groups in terms of their are often used in commercial settings for
attitudes and behaviours, there are some novel marketing purposes, and so although they
approaches. For example, one study looks can help to identify consumption patterns,
at seasonal and temporal changes in food- the extent to which they can be applied to
related content of two UK magazines over the the public sector to affect change is less
course of the year, producing three clusters of clear (C. Barnett & Mahony, 2011). Therefore,
magazine content reflecting the food behaviour care needs to be taken to reflect on the
of young women: vegetarianism, convenience assumptions and rationale underpinning
eating and weight control (Spencer et al., segmentation methods and that superficial
2014). Another study investigated differences application of segmentations to support
in food practices and attitudes across different policy development and implementation can
geographical ‘urban foodscapes’ in Newcastle, be counterproductive, and potentially even in
identifying seven foodscape character types tension with the aims of policy action to deliver
(e.g. fast food takeaway landscape, farmer’s wider public good.
Box 5 Examples of segmentation approaches found in the literature
Emotional associations: One study investigated emotional

association to meals, comparing responses to ‘memorable’ and
‘routine’ meals. The study found two clusters: the first cluster, which
accounted for the majority of people, showed strong positive and
weak negative emotional associations with meals; by contrast, the
smaller second cluster showed less difference between the level
of positive and negative emotional associations. Psychographic
variables, such as level of engagement in meals, and their difficulty in
describing feelings, accounted better for these differences than socio-
demographic factors (Piqueras-Fiszman & Jaeger, 2016).
Seasonal food behaviours: Another study used glossy magazines, Glamour and Cosmopolitan,
to look at different food practices during the year based on food advertising and identified three
clusters: ‘party time’ was related to Christmas and advertising of coffee, cheese, vegetarian
meat substitutes and alcohol; ‘bikini body’ was related to the summer months and had little
advertising for conventional food with a strong focus on dieting; ‘going steady’ was associated
with the new year and related to foods consumed every day and convenience products
(Spencer et al., 2014).
Meat consumption: In a 2019 study of meat consumption, six segments were identified: price
conscious, healthy eaters, taste driven, green, organic and vegetarian consumers. The work
finds statistically significant differences between the segments based on gender, age, income
and household structure (Apostolidis & McLeay, 2016).
Prestige: A study from 2017 identified four segments based on their prestige-buying practices,
i.e. seeking to distinguish oneself from lower-class individuals based on food purchases and
weekly fruit and vegetable spending: ‘ambitious shoppers’, ‘utilitarian buyers’, ‘affluent elitists’
and ‘prestige lovers’ (Palma et al., 2017).
Urban ‘foodscapes’: Another study used the interactions between food, space and people
to determine urban foodscape character segments in the landscape of fast-food takeaway,
food outlets and retailers serving international cuisine, and farmer’s markets. The first type
is residential, easily accessible and visibly cluttered. The second segmentation is marked by
cultural symbols and decorations and has a heterogeneous and undistinguished architecture.
The final type has the visual characteristics of an open market and is designed for individuals to
spend time in the food environment (Roe et al., 2016).
35
5 Interventions – how can policymakers

influence food consumption decisions?
Given the importance of food consumption Price and ingredients:

practices to both health and the environment, Interventions that change the
and the power of actors in the system from ingredients of foods that are
retailers to manufacturers to influence the available or the prices of those
content and sales of food, it is crucial to foods, making it easier and
understand what levers policymakers have more economical to make better
available to influence consumption decisions, choices.
and how effective they are. This can help
There is a continuum here across these
policymakers enable people to make healthier
possible approaches reflecting the extent to
and more sustainable choices. Interventions
which the different approaches emphasise
have been grouped into three overarching
personal choice and freedoms, and also the
categories:
potential challenges in implementation. Table
Knowledge and information: 4 below presents a summary of interventions
Interventions that affect the reviewed for this study and evidence of their
knowledge and information effectiveness.33
available to people about food
from advertising to labelling and
other information.
Food environment: Interventions
that change the food environment
– from small changes to the
layout and prominence of food
to the types of food available in
places people spend a lot of time,
like at work and in school.
36 Food consumption in the UK 37
Table 4 Summary of interventions to change food consumption and evidence of their effectiveness
Intervention Effectiveness Strength of evidence Comments and caveats Key sources
Jepson et al., 2010; Muzaffar et al., 2018; Rekhy &

School education Moderate–high Moderate–high Interactive/experiential learning is most effective
McConchie, 2014; Dudley et al., 2015
Online approaches are likely less effective than phone/

Education in healthcare setting Moderate Moderate–high Jepson et al., 2010; Kelly et al., 2016; Harris et al., 2011
in person
and information
Limitations to campaign design (e.g. TV only, not

Knowledge
Mass media campaigns Low–moderate Low–moderate online) – better designed campaigns might be more Afshin et al., 2015; Kite et al., 2018; Wakefield et al., 2010
effective
Traffic light approaches are more effective than just Afshin et al., 2015; Campos, Doxey, & Hammond, 2011;
Labelling in supermarkets Low–moderate Moderate but mixed
information provision Cecchini & Warin, 2016; Shangguan Siyi et al., 2015
Labelling in restaurants/fast- (Littlewood et al., 2016; Magnusson, 2010; Wright &

Low Moderate but mixed More studies needed in real-world settings
food settings Bragge, 2018; Long et al., 2015; Sinclair et al., 2014
Limitations in both evaluation and policy design limit Afshin et al., 2015; Chambers et al., 2015; Galbraith-Emami
Advertising regulation Unclear but likely moderate Low
our knowledge of effectiveness & Lobstein, 2013; Mills et al., 2013
Mandatory approaches most effective; combining Coyle et al., 2009; Evans et al., 2012; Afshin et al., 2015;
Food provision in schools Moderate–high Moderate–high
with education approaches also effective Niebylski et al., 2014
Main effect is on fruit and vegetable intake, more Afshin et al., 2015; Geaney et al., 2013; Gudzune et
Worksite well-being Low Moderate–high limited evidence on other outcomes; significant al., 2013; Jepson et al., 2010; Niebylski et al., 2014;
Food environment
variability in intervention design limits generalisability Schliemann & Woodside, 2019
Bucher et al., 2016; Cadario & Chandon, 2019; Hartmann-

Micro environment – placement, Effectiveness likely depends on context; acceptability
Low–moderate Low–moderate but mixed Boyce et al., 2018; Hollands et al., 2015; Houghtaling et al.,
portion size of ‘nudges’ to public also a concern
2019
Food provision in other public

Unclear Low Very little evidence identified Niebylski et al., 2014
settings
No evidence of policy implementation and evaluation Afshin et al., 2015; Beaulac et al., 2009; Cobb et al., 2015;
Built food environment Unclear but likely moderate Low
identified Fleischhacker et al., 2011
Afshin et al., 2017; Eyles et al., 2012; Hartmann-Boyce et

content of food
Taxes, subsidies and price al., 2018; Ng et al., 2012; Niebylski et al., 2014; Thow et al.,
Low–moderate Moderate Understanding of substitution effects limited
Cost and
changes 2010; Andreyeva et al., 2010; Niebylski et al., 2015; Smith

et al., 2018; Wright et al., 2017
Substitution effects unclear; can be driven by other Federici et al., 2019; Grieger et al., 2017; Hashem et al.,
Reformulation of food Moderate Moderate
changes (price changes, labelling requirements) 2019
Source: RAND Europe analysis. All target participants are adults (19 years old and above) and children (up to 18 years old), except for interventions in schools that target children. Depth of shading of the rows provides an indication of the most promising (darker) and least
promising (lighter) interventions based on the current evidence. ‘Effectiveness’ is defined as the ability to achieve the desired behaviour changes, i.e. to reduce food consumption or otherwise change dietary behaviours and/or increase awareness or knowledge related to
healthy/sustainable food consumption.
Knowledge and information 2012). Similarly, high-profile campaigns by

NGOs, such as the ‘Behind the Brands’ ranking,
There are a range of interventions that pushed food companies to develop policies
can affect the knowledge and information around sustainability (D. Smith, 2014). There
available to people to support their decisions is a paucity of evidence around the impact of
and actions regarding food. Provision of other public figures in delivery campaigns.
information can be at a broad scale, through
Existing evaluations vary in quality and there
mass media campaigns or labelling schemes.
are also limitations in campaign design.
It can also be more targeted, through learning
Many campaigns continue to target individual
and skills development in schools or healthcare
behaviours rather than upstream and social
interventions. Restricting advertising can
determinants of poor diet/obesity, and most
also change the information addressed to
campaigns are conducted through television
individuals. Based on existing evidence, it
with limited use of new media (J Kite et al.,
appears that more targeted, accessible and
2018). Mass media campaigns are more likely
understandable information is the most
to be successful when combined with actions
effective in changing consumption.
to increase availability and access to products
and services that enable people to act on
Mass media campaigns can change
the messages received. It is also noted that
knowledge and beliefs, but it’s less clear
campaigns are typically more effective when
whether they can change actions
the target behaviour is one-off or episodic (e.g.
There is a lot of evidence to suggest that vaccination) rather than ongoing and habitual
campaigns can have an impact on intermediate as in the case of consumption practices
outcomes, such as knowledge and attitudes. (Wakefield et al., 2010). Media campaigns
However, evidence is still limited as to whether are also hindered through competition with
campaigns can influence behaviour change marketing activities with competing and
(J Kite et al., 2018). Some studies, however, opposing messages (Wakefield et al., 2010).
do suggest potential effectiveness of mass Information campaigns also rely on personal
media campaigns (A. Afshin et al., 2015) on agency in changing practices and evidence
increased fruit and vegetable consumption consistently indicates that they tend to have
for example (Dixon et al., 1998; Erinosho et greater impact in individuals with higher socio-
al., 2012; Lutz et al., 1999) and in reducing the economic status, and thus possibly widen
consumption of unhealthy foods (Jenkin et al., inequalities (Friel et al., 2015; McGill et al.,
2014). In the UK, a national campaign targeting 2015).
salt intake was associated with a reduction in
the proportion of adults who reported adding Food labelling may have some effect on
salt at the table, from 32.5 per cent in 2003 to consumption and traffic light approaches
23.2 per cent in 2007 (Sutherland et al., 2013). are the most effective
There is some evidence that the messenger
There is mixed evidence across several
can shape the effectiveness of campaigns. For
systematic reviews, which on balance suggests
example, celebrity endorsements can provide
that it is likely that food labelling can influence
support to media campaigns, although this
diet (A. Afshin et al., 2015; Campos et al.,
may be short term. For example, the celebrity
2011; Cecchini & Warin, 2016; Shangguan Siyi
chef Jamie Oliver helped to promote the UK
et al., 2015). Specifically, labelling may help
government’s school meals campaigns around
consumers select healthier food products, but
healthy eating in schools (Chapman & Rayner,
39
it is less clear that they affect calorie intake or engage with labelling information (Malloy-Weir
consumption (potentially since several factors & Cooper, 2017). Box 6 provides an overview of
in addition to calorie content, e.g. salt content, some of the main food labelling schemes in the
affects the healthiness of foods, and also due UK and evidence of their effectiveness.
to the ‘halo effect’)34 (Cecchini & Warin, 2016).
Traffic light schemes35 are more effective Labelling in restaurants and fast-food
than other approaches such as guideline settings can reduce calorie consumption
daily amounts (where the proportion of the
Evidence on the effect of food labelling in
recommended daily amount of sugar, fat or
restaurants and fast-food settings is mixed,
other food groups contained in a product is
if largely positive. Several reviews have
provided) (Cecchini & Warin, 2016; Magnusson,
concluded that there are significant effects of
2010). While most of the evidence relates
menu labelling in terms of calories consumed
to health, there is some emerging evidence
(Littlewood et al., 2016; Magnusson, 2010; B.
related to labelling for sustainability and other
Wright & Bragge, 2018). However, others are
non-health issues, but so far this is very limited
more equivocal (Long et al., 2015; Sinclair et al.,
(Garnett et al., 2015). For example, carbon
2014). There is some suggestion that studies
labels have been trialled by UK supermarket
in real-world settings show smaller effects on
Tesco since 2008; consumers support the
consumption than in experimental settings
use of such labels but report finding them
(Long et al., 2015). Some evidence suggests
hard to understand and interpret (Gadema &
that menu labelling with calories alone is less
Oglethorpe, 2011).
effective than when contextual or interpretive
Although nutritional labels are associated with nutrition information is provided (Sinclair et
a healthier diet, the impact of labelling per se al., 2014). The difference in effectiveness is
is less clear; it may be that individuals who are comparable to the greater efficacy of a traffic
interested in healthy eating are more likely to light approach in a supermarket setting. It
seek out and use nutrition labels (Campos et has also been found that labels may only
al., 2011). Use of food labelling information is have effects in certain population subgroups,
particularly high among individuals with health with some evidence that women may use
conditions and special dietary requirements menu labels whereas men do not (Sinclair et
and notably lower among children, adolescents, al., 2014). Calories consumed are reduced
older adults and people in lower socio- most significantly in restaurant and fast-food
economic groups (Campos et al., 2011). settings as a result of food labelling, with
smaller changes observed in coffee shops
Barriers to people using and acting on labelling
(Littlewood et al., 2016).
information include a lack of motivation and
attention (Garnett et al., 2015) and not feeling
Interactive learning in schools can change
like they have the requisite knowledge to
consumption
make decisions based on labels (Chandon,
2013; Christoph et al., 2016). Levels of literacy Review evidence indicates that education
and numeracy may also impact on ability to interventions in schools seem to be effective
34 The ‘halo effect’ describes the tendency of consumers to generalise a piece of information found on a food label to
the whole food product (Emrich et al., 2015).
35 ‘Traffic light’ schemes are when foods are labelled as ‘red’, ‘amber’ or ‘green’ based on their content of different food
groups such as sugar, salt and fat (Magnusson, 2010)
Box 6 Examples of front-of-pack food labelling interventions used in the UK and their effectiveness
Health-focused nutritional labels

Guideline Daily Amount labels display information about the product including calories and
key nutrients and their percentage contribution to daily adult requirements. The Guideline Daily
Amount labelling scheme is non-interpretive, in that it does not provide an evaluative judgement
about the nutritional quality of a product.
Front-of-pack traffic light labelling is an intervention introduced by the UK Food Standards Agency
in 2006. Traffic light labelling is an interpretive scheme that provides information about key
nutrients but aims to also provide advice and help consumers interpret the information using a
traffic light scheme. The labels consist of three colour-coded lights that indicate the level of fat,
saturated fat, sugar and salt in the product. A red light indicates a high level of the nutrient, an
amber light indicates a medium level and a green light indicates a low level. In 2016, traffic light
labelling was displayed on approximately two-thirds of UK products (Morrison, 2016).
Sustainability and ethical labels
There are a variety of sustainable and ethical labels on the market. A few examples are provided
below:
Red Tractor is a food assurance scheme operated by Assured Food Standards, an independent
organisation, and was launched in 2000. The label recognises UK food and drink that has been
produced to a high quality across the food chain, and as such is traceable.
Carbon Footprint is operated by the Carbon Trust. It informs consumers about the carbon
footprint of a product.
RSPCA Assured is a farm assurance scheme that was introduced by the Royal Society for the
Prevention of Cruelty to Animals in 1994. The aim of the scheme is to improve farm animal
welfare and offers assured traceability across the whole supply chain. In 2018, there were 1,301
RSPCA Assured labelled products on the market (RSPCA Assured, 2018).
Marine Stewardship Council is a sustainable seafood eco-label that was established by the
World Wildlife Fund and Unilever in 1996 and has operated as a not-for-profit since 1999.
The label operates as a certification scheme for sustainable fisheries and to help promote
sustainable fishing to maintain seafood stocks. In 2018, just under one-third of all seafood
bought in the UK retail sector had a Marine Stewardship Council label (Clark, 2019).
Evidence of effectiveness
There is considerable evidence from systematic reviews comparing different types of health-
focused nutritional labelling interventions on consumer understanding and behaviour. The
evidence suggests that nutritional front-of-pack labels can improve the consumption of
healthier food (Campos et al., 2011; Cecchini & Warin, 2016; Shangguan et al., 2019). Traffic
light schemes appear to be the most effective at changing consumer practices (Cecchini
& Warin, 2016). However, there is likely to be a bidirectional relationship, in that labels may
improve diet but use of labels is also likely to be greatest in individuals that are already health
conscious (Campos et al., 2011). Moreover, the evidence also consistently indicates that use of
labels is greatest in individuals with a higher income and education level, and thus may serve to
widen health inequalities.
41
Box 6 Examples of front-of-pack food labelling interventions used in the UK and their effectiveness
(continued)
There is less evidence around the use and understanding of sustainable and ethical labels by
consumers. Existing evidence suggests that in general, consumers have limited awareness of
sustainability labels and level of use is low (Garnett et al., 2015; Grunert et al., 2014). There also
appears to be confusion due to the existence of multiple labels (Grunert et al., 2014). A study
investigating the use of carbon labels in the UK found that consumer demand for such labels
is high but understanding is low (Gadema & Oglethorpe, 2011). In addition, there appears to
be a value-action gap in that consumers report high concern for sustainability and demand for
such labels, but this does not translate into a change in practices due to competing issues of
perceived quality and price (Grunert et al., 2014). A recent survey commissioned by the Marine
Stewardship Council found a high demand (83 per cent) for independent ethical labels but that
consumers prioritise price before sustainability (Askew, 2018).
in changing consumption habits (Dudley et al., measured effects up to four weeks after the
2015; Jepson et al., 2010; Muzaffar et al., 2018; intervention (Caraher et al., 2013).
Rekhy & McConchie, 2014). Interventions
are diverse and tend to focus on developing Nutrition advice and support in a
students’ knowledge and skills, and many healthcare setting can change eating
have a particular focus on increasing the habits
consumption of fruit and vegetables (Jepson
There is good-quality evidence that providing
et al., 2010; Muzaffar et al., 2018; Rekhy
nutrition counselling and support through
& McConchie, 2014). The most effective
general practitioners and other similar settings
interventions are those that have simple and
can help change consumption (Jepson et al.,
unambiguous messages, are more intensive
2010). The mode of delivery also matters.
or longer running and involve wider family
Most evidence is on in-person counselling
members (Rekhy & McConchie, 2014). Most
(Jepson et al., 2010); there is limited evidence
notably, interactive, experiential learning is
that telehealth approaches can be effective
most effective (Dudley et al., 2015; Rekhy &
(Kelly et al., 2016) and that online, e-learning
McConchie, 2014).
approaches may not be (Harris et al., 2011).
However, evaluation evidence suggests
that information campaigns to increase the It is likely that advertising regulation
consumption of fruit and vegetables have could impact consumption, but currently
mostly changed consumption over the short the evidence is limited
term but not on a sustained, longer-term basis The effectiveness of advertising regulation
(e.g. effects were not maintained at 12 months) is currently poorly understood. This is partly
(Rekhy & McConchie, 2014; Upton et al., 2013). due to limitations in the ways in which policies
Similarly, an evaluation of a cooking intervention have been implemented, and partly due to a
delivered in English primary schools found lack of good-quality evaluations of their impact
positive impacts on consumption but only (A. Afshin et al., 2015; Chambers et al., 2015;
Galbraith-Emami & Lobstein, 2013; Mills et al., environment, public settings other than schools
2013). – e.g. hospitals) are too limited to draw any
concrete conclusions.
One limitation of policy implementation is
comprehensiveness. For example, in the
UK, statutory scheduling (restrictions on the
Changing the food available in schools
can have a significant impact on children’s
times of marketing to children of foods high
consumption
in fat, sugar or salt) were more than offset
by increased advertising of these products The provision of fruit and vegetables in schools
in other hours, so that overall exposure to may increase overall fruit consumption
such marketing did not change in children according to an evaluation of one programme
and substantially increased in adults (Jean in the US, although a systematic review of 27
Adams, Tyrrell, et al., 2012). Another limitation programmes found only moderate increases
is that regulations are often limited to certain in fruit consumption (Coyle et al., 2009; Evans
media – for example, many do not cover online et al., 2012). Other interventions focus on
advertising (A. Afshin et al., 2015). the healthiness of school meals, i.e setting
standards or developing guidelines on the
Nonetheless, there is strong evidence that
nutritional content of school food provision, and
advertising influences the food preferences
changing school food procurement in line with
and choices of children (Cairns et al., 2009),
healthier eating. Overall, the interventions are
and more limited evidence that this may be true
generally effective in increasing intake of healthy
for adults too (Mills et al., 2013). This implies
foods and reducing intake of unhealthy foods
that advertising regulation could be effective.
(Afshin et al., 2015; Niebylski et al., 2014), and
Indeed, there is evidence that advertising
one systematic review found that interventions
restrictions are associated with a moderate
that focused on restricting unhealthy foods
reduction in smoking (Wilson et al., 2012).
(e.g. through restrictions or bans) were
generally effective in decreasing levels of being
Food environment overweight/obese (A. Afshin et al., 2015).
Changing the availability of food through Governmental and school policies appeared
adjustments to the food environment more effective compared to voluntary
is another policy approach to changing programs, and changing procurement policies
consumption that is now receiving more seems more effective than setting nutrition
attention. This can include changes in provision standards (A. Afshin et al., 2015). Interventions
of food in places that people spend much that bring together changes in food provision
of their time – schools, hospitals and the with educational interventions are found to be
workplace – as well as changing the built particularly effective in improving children’s
environment and the types of food outlets consumption and health (Evans et al., 2012;
readily available to people where they live. Niebylski et al., 2014).
Changes can also be made to the environment
on a ‘micro’ level – for example, changing Worksite well-being programmes
the placement of food or portion size within can have impacts on consumption,
shops, restaurants and other food outlets. specifically fruit and vegetable intake
Changes in the food environment seem broadly
There is strong evidence that worksite well-
effective in changing food consumption,
being interventions can have a small positive
though the evidence in some settings (the built
effect on healthy eating, most notably on fruit
43
and vegetable intake (Afshin et al., 2015; Geaney There is growing evidence that the
et al., 2013; Gudzune et al., 2013; Jepson et local food environment can affect
al., 2010; Niebylski et al., 2014; Schliemann & consumption. Policy actions to address
Woodside, 2019). There is also some evidence the built food environment have not been
that workplace well-being initiatives can impact widely implemented or evaluated
on wider outcomes such as preventing weight
There is very limited evidence on the impact
gain, reducing fat intake, aiding weight loss
of policies aiming to regulate or change the
and reducing cholesterol (Gudzune et al., 2013;
environment in terms of density or prevalence
Schliemann & Woodside, 2019).
of fast-food outlets or to address food deserts.
However, not all programmes are equally There is a strong association between obesity
effective and there is significant variation in the and access to unhealthy food – for example,
nature of the wellness programmes making through a high concentration of unhealthy
it difficult to draw overarching conclusions. fast-food outlets. However, many studies are
The quality of evaluations is also poor, with cross-sectional so the direction of causality is
limited duration of follow-up, small sample unclear and the correlation may be mediated
sizes and other issues limiting the strength by socio-economic status and educational
of the evidence particularly in terms of long- attainment (A. Afshin et al., 2015; Beaulac et
term outcomes. More evidence is needed al., 2009; Cobb et al., 2015; Fleischhacker et
on the characteristics of effective workplace al., 2011). In addition, although there are few
interventions (A. Afshin et al., 2015; Geaney et longitudinal studies (A. Afshin et al., 2015; Cobb
al., 2013; Gudzune et al., 2013; Schliemann & et al., 2015), emerging evidence indicates that
Woodside, 2019). Emerging evidence suggests the local food environment may have moderate
that interventions are more likely to be effective effects on consumption (Caspi et al., 2012).
when tailored for the workforce in question and However, there are some limitations in the
to capitalise on the social and environmental evidence, in part due to the low quality of many
context of the particular workplace, as well existing studies (Cobb et al., 2015), and also
as when multifaceted and supported by because understanding and measuring what
management (Schliemann & Woodside, 2019). constitutes the relevant environment can be
challenging (Williams et al., 2014). This needs
There is little research on the effect of to be better understood to support effective
changing food provision and procurement policy development. There are no examples
in other public settings such as hospitals of evaluations or reported implementation of
Some individual studies show positive effects policy interventions addressing the built food
when improving the quality of food provided environment in the academic literature.
in hospitals and in food delivered at home to
low-income older people (M. L. Niebylski et al., Changes in the micro environment, or
2014). There are also studies using university ‘nudges’, such as food placement and
canteens and other settings as experimental
portion size, can be effective in some
settings for changes in food placement (e.g.
contexts
Hollands et al., 2015; Walmsley et al., 2018), There is mixed evidence of the effectiveness
but there are no identified studies looking at of changes to the micro environment – the
changes in procurement policy in these wider specific ways in which food is presented and
settings. located within a food outlet – on changing food
consumption. Most evidence looks at portion
size and food placement in different settings with perceived effectiveness, suggesting that
(e.g. supermarkets, canteens). On balance, it individuals are poor judges of which nudges
is likely that there are some moderate effects are effective (Cadario & Chandon, 2019).
on consumption from these types of ‘nudges’ More generally, there is also less support for
(Bucher et al., 2016; Cadario & Chandon, 2019; interventions perceived as more intrusive and
Hartmann-Boyce et al., 2018; Hollands et al., that target individuals rather than businesses
2015; Houghtaling et al., 2019). (Diepeveen et al., 2013).
Evidence suggests that these types of
interventions may work better in some Cost and content of food
contexts than others. For example, some
Changing the cost and content of food
studies show significant effects of changes
available is another possible policy measure
in food placement in schools (Driessen et al.,
that can change consumption. There is
2014) and changes in prominence and portion
some evidence that these approaches can
sizes for meat (Bianchi et al., 2018). The use
be effective; although in the case of price
of end of aisle displays and shelf placement
changes, the difference in price has to be quite
in supermarkets is known to increase sales,
significant to make an impact and this depends
with an estimated 30 per cent of supermarket
on the income level of the person. However,
sales coming from aisle ends, although this
understanding of the overall effectiveness of
likely interacts with price, price promotion and
these changes is limited by the complexity of
number of display locations among others
possible substitution effects; when content or
(Garrido-Morgado & González-Benito, 2015;
cost of foods change, industry and consumers
Glanz et al., 2012; Nakamura et al., 2014).
may change their behaviour but not necessarily
However, other studies looking at placement
in the way that is intended.
and portion size in a range of settings including
self-service restaurants and grocery stores
Food taxes and subsidies can affect
found no conclusive evidence on changes in
consumption, but the changes in price
consumption (Skov et al., 2013; Walmsley et al.,
need to be relatively large to make a
2018).
difference
Evidence and conclusions on the effectiveness
Systematic reviews suggest that taxes
of changes to the micro environment are in
and subsidies can affect purchasing and
part limited by a lack of good quality studies
consumption, encouraging the consumption of
and the fact that many studies are conducted
healthier foods and reducing the consumption
in a lab rather than a real-world setting (Bucher
of less healthy options (Afshin et al., 2017;
et al., 2016; Driessen et al., 2014; Hartmann-
Eyles et al., 2012; Hartmann-Boyce et al., 2018;
Boyce et al., 2018; Skov et al., 2013). The
Ng et al., 2012; Niebylski et al., 2014; Thow et
acceptability of nudges to consumers is also
al., 2010). However, the size of price changes
a possible concern (Cadario & Chandon,
needs to be quite significant (at least 20 per
2019; Diepeveen et al., 2013). For example,
cent) to make a difference (Andreyeva et al.,
the acceptance of a nudge has been found
2010; Niebylski et al., 2015; Smith et al., 2018;
to be inversely related to its effectiveness,
Wright et al., 2017). There is evidence that
with less acceptance of for example portion
subsidies might lead to bigger changes in
and package size reductions compared with
consumption than taxation. A meta-analysis
those that act to inform consumers (Cadario &
suggests a 10 per cent subsidy/price reduction
Chandon, 2019). However, approval increased
45
increases consumption of healthy foods by 14 also unhealthy) foods; and producers may
per cent, while a 10 per cent tax/price increase replace a particular target product with other
reduces consumption of unhealthy foods by unhealthy content (for example, reducing sugar
7 per cent (Afshin et al., 2017). Moreover, the but increasing fat). These behaviours are not
evidence typically shows data for purchasing well understood and typically not incorporated
decisions (which is used as a proxy for into modelling studies (Eyles et al., 2012; Smith
consumption) but there is less evidence on et al., 2018; Thow et al., 2010).
actual consumption (A Afshin et al., 2017;
However, some studies do account for these
Hartmann-Boyce et al., 2018). Evidence
cross price effects, and still show that taxes
suggests that consumption of food away from
may have an effect on consumption (e.g.
home and soft drinks, juice and meats more
Briggs et al. 2016). In addition, there are some
generally may be most responsive to price
studies based on real-world data, showing for
changes (Andreyeva et al., 2010).
example that the sugar levy has decreased the
The impact of taxes is mixed and socio- sugar content of sugar-sweetened beverages
economic factors also affect response to by 22 per cent (Public Health England, 2019)
policy actions. Price changes through taxes or and comparably that minimum pricing on
subsidies are regressive and disproportionately alcohol in Scotland is delivering the intended
have more impact on those with lower incomes reductions in alcohol sales (O’Donnell et al.,
(Barrett et al., 2017; McGill et al., 2015) because 2019).
they spend a larger proportion of their income
The way that financial instruments affect
on food and because they tend to buy relatively
supply chains are complex and may vary.
cheaper foods (Jensen et al., 2011; Thow et al.,
Subsidies at early stages in the supply chain
2010). However, some studies argue that this
(e.g. agricultural subsidies) are not a good
cost may be outweighed by the health benefits
predictor of consumption patterns (Alston et
that tend to be larger for lower-income groups
al., 2008; Garnett et al., 2015). Where the costs
given higher levels of consumption of products
of other interventions are borne is sometimes
such as sugary drinks (Barrett et al., 2017;
unclear and costs may or may not be passed
McGill et al., 2015). These groups are also less
on to the consumer as intended, e.g. by shifting
likely to engage with labelling (Campos et al.,
to other products.
2011).
Reformulation of foods may alter
Impacts of taxes and subsidies on the consumption and a number of policy
food system as a whole can be complex approaches can motivate industry to
and are not fully understood change the content of their products
An important limitation of studies investigating
Changing the content of food, reducing fat or
taxes or subsidies is that many of these are
sugar for example, can be effective in changing
based on models that may in some cases
intake and producing positive health outcomes
not consider shifts in consumption within or
(Federici et al., 2019; Grieger et al., 2017; K. M.
across food categories in response to taxes
Hashem et al., 2019). The evidence is stronger
and subsidies (An, 2013; Garnett et al., 2015;
for salt reduction than for sugar and fats, and
Thow et al., 2010). Substitution is an important
evidence is based on modelling studies that
issue that is not fully understood. Taxes/price
might not take into account substitution as
increases can lead to substitution at two levels:
noted above (Federici et al., 2019; Grieger et al.,
consumers may buy different (and potentially
2017; K. M. Hashem et al., 2019).
There is a diversity of approaches to most of the included interventions are aimed at

encourage industry to change its behaviour, changing consumption to improve health. This
each with varying levels of effectiveness. reflects the level of evidence available in the
Voluntary approaches, such as the Public literature. It is difficult to identify good-quality
Health Responsibility Deal36 are one way of evaluation evidence on interventions aiming to
implementing these changes, but industry improve sustainable or ethical consumption.
responses to this are mixed; an evaluation of The case studies were also chosen to provide
this programme suggests that companies examples across the three intervention
have not used the most effective strategies categories aimed at targeting: knowledge and
and overall the programme has had low information, food environment, and cost and
additionality (see Section 5.4 for more detail on content of food. Three of these are national
the Responsibility Deal) (Knai et al., 2015; Reeve level interventions and one was targeted at
& Magnusson, 2015). Regulatory approaches, the north east of England. The case studies
including restrictions and standards, pricing, highlight examples that worked and some that
and labelling requirements, can also drive did not, with evidence as to why.
industry to reformulate products (Hendry et
al., 2015; Hyseni et al., 2016; Shangguan et al.,
2019). In particular, ‘upstream’, population-wide
The Public Health
mandatory approaches, such as maximum
Responsibility Deal
limits or restrictions, seem to be the most
effective in driving significant changes in
What is the intervention?
consumption, such as reductions in salt The Public Health Responsibility Deal was
consumption and levels of trans fats in food an initiative launched in March 2011 by the
(Hendry et al., 2015; Hyseni et al., 2016). Department of Health (now the Department
Labelling can also drive reformulation through of Health and Social Care) (Department of
a desire to show healthier content of food Health, n.d.). The PHRD has since closed with
(Mhurchu et al., 2017). the initiatives being taken forward through
other government policy such as the Childhood
Obesity Plan.
Case studies
This section presents four brief case study What is the target population and what did
examples of specific interventions used the intervention aim to do?
in the UK to influence food consumption The Responsibility Deal was a national-level
decisions and the evaluation evidence on public–private partnership that aimed to
their effectiveness. The specific case study encourage food companies (e.g. retailers,
examples represent a selection based on manufacturers, caterers and out-of-home
the availability of evaluation evidence in the outlets) and other actors (e.g. third sector and
literature. The aim was to present interventions non-governmental organisations) to contribute
that have been applied on a wider scale and to improving public health. It involves voluntary
draw lessons from these. It is notable that agreements between the government and
36 The Public Health Responsibility Deal was a voluntary approach in which businesses and other organisations could
sign up to commitments that would improve public health. Launched in March 2011, partners signing up set out a
series of pledges that they commit to deliver, spanning topics such as food, alcohol, physical activity and health at
work (Knai et al., 2015).
47
various actors (i.e. corporate sector, academia Knai et al. (2015) aimed to determine the
and voluntary organisations) to commit and effectiveness and added value of these
sign up to achieving actions set out in pledges various interventions and used the concept of
in the areas of food, alcohol, health at work and ‘additionality’ to establish the counterfactual.37
physical activity. ‘Additionality’ was defined as the extent to
which a given activity was brought about by
What is the category of intervention? the Responsibility Deal versus it would have
In the area of food, there were eight pledges, happened anyway or was already happening.
each proposing a number of interventions The counterfactual was derived from assessing
across the different categories of policy organisations’ delivery plans to ascertain what
interventions identified for this study actions organisations would have taken in the
(knowledge and information, food environment, absence of the Responsibility Deal.
and cost and content of food), and each having The interventions may not reflect the
varying numbers of signatories. Organisations most effective strategies to improve diet:
that committed to a pledge were asked to The authors found that the majority of
develop a delivery plan and report on their Responsibility Deal food pledges included
progress in the spring of each year. in the evaluation consisted of interventions
that focused on knowledge and information
What was the effect of the intervention? provision, which do not reflect the most
An evaluation of six food pledges was effective strategies to improve diet (e.g. out-
conducted in 2015 (Knai et al., 2015). The of-home calorie labelling and front-of-pack
authors evaluated the following pledges: out- nutrition labelling versus reformulation of
of-home calorie labelling, salt reduction, calorie products to reduce salt). They also found a lack
reduction, front-of-pack nutrition labelling, fruit of interventions around reducing sugar intake,
and vegetable consumption, and saturated reducing the marketing of less healthy foods
fats. Each of these pledges contained various and pricing (e.g. taxes and subsidies), all of
interventions to promote greater/increased which have a growing evidence base around
consumption of a healthier diet, including their effectiveness at encouraging healthier
interventions to reduce food consumption of choices. The authors concluded that pledge
less healthy food/drink/ingredients, change implementation is unlikely to have much effect
dietary practices, and increase awareness on encouraging the consumption of healthier
or knowledge related to healthier food diets in England.
consumption. Examples of interventions under
Progress reports were of poor quality or
these pledges include: provision of information
unavailable: Some of the interventions
at point of choice; reformulation activities
mentioned in the delivery plans included in the
around salt and saturated fat; reformulation of
study may have been effective at improving the
recipes and menus; and prominently promoting
consumption of healthier diets if implemented
fruit and vegetables in retail. An evaluation of
correctly. However, the authors found it hard to
the pledge on reducing levels of trans fatty
evaluate whether targets were being met due
acids in the food supply was conducted in
to the poor quality or unavailability of progress
2017 (Knai et al., 2017).
reports. Therefore, the authors highlighted
37 The counterfactual provides an estimate of what would have occurred without the intervention.
the importance of designing well-defined, Organic, the Health Education Trust and the
quantitative targets that are evidence-based to Royal Society for Public Health.
ensure that once implemented, public health
policies have a positive effect on population What is the target population and what did
health. the intervention aim to do?
The Responsibility Deal was found to have Food for Life is a national programme that
low additionality: Moreover, where the authors initially started as a school-focused initiative
could assess, they found that the Responsibility to improve food in schools but in its second
Deal had relatively low additionality, in that phase has also expanded its remit to other
most of the interventions included in the settings (e.g. hospitals, workplaces, care
research were likely not developed as a result homes and universities). The aim is to promote
of the Responsibility Deal programme. Only 26 the micro food environment or define food
per cent of interventions were ‘likely’ brought culture in these settings to make food healthier
about by the Responsibility Deal, suggesting and more sustainable. The programme
that organisations had mostly committed to adopts a ‘whole settings approach’, with
interventions that had already happened or schools, nurseries, hospitals, care homes, food
were already underway when the Responsibility providers and the wider community working
Deal started. together to implement the programme. As
of June 2015, 5,208 schools, 31 workplaces,
A range of factors are required for a voluntary
20 hospitals and 2 care home groups across
approach: The authors highlight that a
England were enrolled in the programme.
number of factors are important to ensure
the success of a voluntary approach (as
What is the category of intervention?
opposed to a regulatory measure), many of
The initiative spans several policy categories,
which were not met by the Responsibility Deal.
including providing knowledge and information
These include: having well-defined, evidence-
and changing the food environment. The
based quantitative targets; involvement of
programme adopts a ‘whole settings approach’
public and civil society organisations in the
and focuses on four objectives: (1) support
development and monitoring of the pledges;
around access to healthy and sustainable food;
and clear sanctions for not demonstrating
(2) providing skills and knowledge; (3) enabling
progress against targets. In the case of the
a change in food culture within schools;
Responsibility Deal, the majority (95 per cent)
and (4) enabling a change in culture across
of signatories were from the corporate food
the wider health and education systems. A
sector, which raises concerns about the
key mechanism is to encourage all school
motivations to promote health objectives.
stakeholders to be involved (i.e. pupils, staff,
parents and the wider community). The
Food for Life programme employs two mechanisms that
schools programme work together to achieve these objectives. One
is an awards scheme to encourage schools to
What is the intervention? make changes to promote a culture of good
The Food for Life schools programme is an food. The scheme aims to encourage changes
initiative launched in 2007 that is led by the to people and the environment both within and
Soil Association in collaboration with other beyond schools. Schools work towards bronze,
charities, including Focus on Food, Garden silver and gold awards. To date, 1,087 Food for
49
Life awards have been achieved by schools. performance and pupil behaviour; and
The programme also uses a Food for Life commitment to the provision of better-
Catering Mark to encourage school caterers to quality school catering, among others. It was
improve the quality and provenance of school also found that the whole school approach
meals. The label is recognised as a sign of produced benefits that were greater than if it
food quality and sustainability and acts as an had been a single component programme.
accreditation mechanism.
The programme has helped to promote long-
term changes in the food culture of schools
What was the effect of the intervention? that engaged: The Phase 2 evaluation, using a
Two evaluations of the Food for Life survey of schools and case studies, found that
programme have been conducted: Phase 1 Food for Life has continued to have a positive
between 2007 and 2011 and Phase 2 between impact on food cultures within schools and
2013 and 2015. The Phase 1 evaluation remains relevant to schools. The programme
focused on evaluating the programme in helps to facilitate a sustained engagement in
schools, and Phase 2 expanded to cover school food activities. Schools that engaged
settings beyond schools, including hospitals, with the programme show long-term changes
workplaces, care homes and universities. in their food culture, with the programme
The Phase 1 evaluation found overall that the becoming embedded in their ethos. A number
programme was having a positive impact on of factors facilitated these positive changes,
pupils and schools. Specifically, it resulted in including having commitment from school
improved awareness of food, sustainability staff, in particular school leaders. Embedding
and healthy eating; positive trends in school
the Food for Life ethos was also found to from investing in Food for Life, particularly
protect against staff turnover. those supporting some of the more vulnerable
individuals. Healthy and sustainable food is
The programme has promoted healthier
not always the cheapest option and a legacy of
practices: Pupils in Food for Life schools
catering systems driven by low cost provision
consumed more fruit and vegetables than
prevents the switch to healthier options.
pupils in comparison schools. There was also
The motivation to drive change often relies
a ‘spillover’ effect in that fruit and vegetable
on having a leading figure, which may not
consumption was also higher at home,
always be present, and also renders progress
showing a positive spread of the programme
vulnerable to changes in personnel. Another
into the wider community.
challenge is around the delivery of the whole
The programme has successfully scaled settings approach, with some organisations
up to other settings beyond schools: There choosing to only deliver certain aspects of the
is potential for the programme to extend programme, which acts to prevent embedded
beyond the school setting (e.g. nurseries, care and long-term change.
homes and hospitals), with evidence that the
programme has helped to improve the quality
of the food served. Change4Life convenience
store programme
The programme provides a positive social
return on investment: The evaluation found
What is the intervention?
that for every £1 spent on Food for Life, there is
The Change4Life convenience store
social value of £4.41 created over a three-year
programme is an initiative launched in 2008
period in terms of the value created for health,
by the Department of Health (Department
education and the environment.
of Health, 2010). It is part of the wider
There were several challenges with the Change4Life programme, a national health
programme: The evaluation found that there promotion programme.
are some challenges associated with achieving
sustained impacts from the Food for Life What is the target population and what did
programme. Achieving long-term impact may the intervention aim to do?
depend on several factors, such as the initial Change4Life aimed to increase the provision
motivation for engaging with the programme. of fresh fruit and vegetables in convenience
Factors likely to promote long-term stores, particularly in deprived areas. Located
engagement include a committed leadership at the heart of many deprived communities,
and embedding the food policy within the convenience stores are often important outlets
school through committed staff. If the main for low-income individuals but also those
motivation is to gain an award, then this is less individuals who use it for ‘top-up’ shopping.
likely to deliver long-term impacts. Results also A pilot phase of the project was conducted
showed that it seems more difficult to engage in the north east of England, an area with
and maintain the commitment of secondary high deprivation and high use of convenience
schools. The evaluation also speculated that stores.
schools with the most long-term positive
impact and progress may be those that had What is the category of intervention?
a pre-existing commitment to this priority.
The intervention spans across several policy
Financial barriers prevent all organisations
categories; it aims to primarily improve the
51
food environment (by increasing access to concludes that the overall pattern of change
healthy food) but also provide knowledge and was consistent across stores.
information to increase awareness of healthy
The intervention is unlikely to have had long-
diets. The policy had three main objectives:
term effects on customers’ consumption
• To increase the access and availability of fruit and vegetables: The early-stage
of fresh fruit and vegetables in deprived evaluation concluded that the programme
areas. was effective at achieving its objectives,
suggesting that there was an improvement in
• To increase the sales of fresh fruit and
customers’ perception of the quality, selection
vegetables, through increased range,
and visibility of fruit and vegetables, and sales
quality and better communication in shops.
of fruit and vegetables increased. However,
• To improve awareness of fruit and the evaluation conducted two years after
vegetables to consumers through the initial implementation concludes that overall
Change4Life brand. the intervention is unlikely to have had a
Interventions were introduced in two substantial or long-term effect on customers’
categories: intensive interventions in 17 consumption of fruit and vegetables.
‘demonstration’ stores and less intensive in 70 The intervention was found to have low
‘roll-out’ stores. A wide range of interventions ‘fidelity’: There was low availability of branded
were introduced: provision of chiller cabinets Change4Life, point-of-sale materials and
to help shops stock a wider range of fruits and equipment (e.g. a branded chill cabinet) and
vegetables; changes to the shop layout to place these were not used appropriately by all stores.
fruit and vegetables more prominently at the In addition, this equipment was not long lasting
front of shops (also to address ‘impulse’ buys); and was not replaced, and there was a lack of
expanding the space for fruit and vegetables; financial support for food waste in the early
and promotional activities such as provision stages. The evaluation found a number of
of a leaflet to houses within a one-mile radius possible reasons for why the intervention was
of the shops to raise awareness of the new unsuccessful.
scheme. Both types of stores had similar
There was poor communication between
interventions but these were slightly less
stakeholders: There was evidence that one
extensive for the roll-out stores.
barrier to successful delivery of the intervention
was communication with different actors, and
What was the effect of the intervention?
particularly between local level teams and
Several evaluations of the programme were
national level oversight. Better communication,
conducted. A small-scale evaluation during the
both at the outset and on an ongoing basis,
early phases of the programme was conducted
could improve the chances of success for this
in 2010 (Department of Health, 2010). An
type of intervention (Adams et al., 2012).
evaluation into the long-term implementation
of the programme was conducted in 2012 There was a lack of clarity around roles and
(Jean Adams, Halligan, et al., 2012). It should responsibilities: There was some lack of
be noted that there was considerable variation clarity regarding the intended links between
between the types of stores that were involved health workers, schools and community
(e.g. size, business model, existing links with organisations. It was suggested that this
the community) but nonetheless the evaluation was because a number of aspects of the
intervention were added retrospectively (e.g.
the health worker component), which led to What was the effect of the intervention?
lack of clarity around roles and responsibilities. Early evidence suggests that the levy has
reduced the consumption of sugar from
The Soft Drinks drinks subject to the levy: In 2019, Public
Industry Levy Health England published the second progress
report for the sugar reduction programme,
What is the intervention? which it oversees on behalf of government.
The report also included data on changes seen
The Soft Drinks Industry Levy (SDIL) is an
in drinks that are subject to the SDIL (Public
initiative that was announced by the chancellor
Health England, 2019) between 2015 and 2018.
of the exchequer in March 2016 and came in to
Specifically, the report states that there has
force, through legislation, in April 2018 (Public
been a 28.8 per cent reduction in total sugar
Health England, 2019).
content per 100ml for purchased retailer own
brand and manufacturer branded soft drinks
What is the target population and what did
that are subject to the levy. A similar reduction
the intervention aim to do?
was seen for drinks sold through the out-of-
SDIL or the ‘sugar tax’ is a legislated national home sector. Although there has been an
level initiative that aims to encourage increase in sales of drinks subject to the levy
individuals to reduce their consumption of of 10.2 per cent, there has been a reduction in
sugar. total sugar content of the drinks sold of 21.6
per cent. There has also been a shift in sales
What is the category of intervention? towards lower sugar products (below 5g per
The main aim of the policy is to encourage 100ml) that have no levy attached. The calorie
the reformulation of soft drinks to reduce content of drinks subject to the levy fell by
their added sugar content. It does this via a 20.5 per cent. Analysis by socio-economic
two-tiered ‘levy’ or tax on manufacturers and group of head of household shows that the
importers of specific soft drinks (excluding total sugar purchased per household from
some products such as fruit juice, milk-based drinks subject to SDIL has decreased in all
drinks and alcohol). There is a charge of 18p groups, but this reduction is smallest in the
per litre if the drink contains 5g of total sugar lowest socio-economic group. The report
or more per 100ml and 24p per litre if the drink states that the analysis has not accounted
contains 8g of total sugar or more per 100ml. for other factors that could be causing
Other objectives of the policy were to: this difference, such as price changes and
• Reduce the portion size of a product likely household characteristics (such as size and
to be consumed in a single occasion family composition) but concludes that further
analysis is required to understand the observed
• Shift consumers’ purchasing patterns changes.
towards lower or no added sugar products.
53
6
Reflections – what does the evidence say
about food consumption in the UK, and
what should policymakers do next?
This chapter reflects on the evidence regarding importantly, changing consumption to ensure it
the trends and drivers of food consumption is healthier and more sustainable.
and their implications for policy, as well as the
different interventions to change consumption A minority of consumers increasingly care
and evidence of their effectiveness. The but most diets still fall short of nutritional
chapter first summarises the key messages on guidelines and many consumers do not
food consumption arising from the evidence always act in line with their beliefs
in the literature. It then presents an overview There is good evidence that policymakers
of different interventions and evidence of their are increasingly aware of the negative
effectiveness. Finally, the chapter concludes environmental impacts of food production
with a summary of key evidence gaps in the systems (Apostolidis & McLeay, 2016; Lang
existing literature and, based on this, proposes & Mason, 2018) and some consumers
a number of possible priority areas for action are increasingly aware of the health and
and for further research. sustainability issues related to their food
practices (FSA, 2019b, 2019a; WRAP, 2015).
What do we know about food This is reflected in the increasing sales of
consumption? ethical and sustainable produce, and increasing
numbers of plant-based, particularly vegetarian
Food matters – the food individuals eat and ‘flexitarian’, diets (George, 2019).
influences health and the environment There is strong evidence to suggest that
Unhealthy and nutritionally poor diets lead to although diets are slowly becoming less
ill health, including cardiovascular disease, unhealthy, UK consumption still falls well short
diabetes, cancer, obesity and associated poor of nutritional guidelines. Trends show small
health and mortality (Ashkan Afshin et al., 2019; reductions in the consumption of salt and sugar,
WHO, 2014). The current food system and and even slight reductions in the consumption
people’s food practices have negative impacts of fruit, vegetables and fibre. The UK population
on the environment, leading to greenhouse gas also consumes some of the highest amounts of
emissions, deforestation and biodiversity loss processed and ultra-processed food in Europe
(Garnett et al., 2015). Addressing these complex (Carlos Augusto Monteiro et al., 2018).
challenges requires changing how food is Although survey evidence indicates that an
produced to ensure it is more sustainable, and, increasing number of individuals consider
ethics, sustainability and health to be important
issues, these are still likely to be a minority and around healthy diets and socially responsible
individuals do not always act in line with their consumption – are predictably modulated by
views and beliefs. Factors such as income, socio-economic differences. However, it should
price and perceived quality are currently some be noted that on average all socio-economic
of the main barriers to sustainable and ethical groups continue to consume an unhealthy
consumption. Moreover, there remains a diet. The literature also indicates that there are
majority of the population that lacks awareness a variety of socio-demographic differences
and understanding of how their food observed across these trends, including
practices (e.g. meat consumption) impact the around age and gender; however, the evidence
environment, and who demonstrate resistance around the impact of these is less strong or
to the idea of personal change in food practices mixed, and studies are not always adequately
(Garnett et al., 2015). controlled. There is some evidence to suggest
that younger consumers are more likely to eat
There are predictable socio-economic outside of the home, shop online and to eat
differences across broad consumption more sustainably, but good-quality academic
trends but the impact of wider socio- studies around these questions are lacking.
demographic factors is less clear Table 5 provides a summary of the evidence in
There is strong evidence, including both the literature reviewed on socio-demographic
academic and from surveys, that broad differences in food consumption practices.
consumption trends in the UK – particularly
Table 5 Availability (volume) of evidence in the literature on socio-demographic differences in food

consumption practices and response to interventions.
Availability
Quality of of
evidence academic
evidence
Barrett et al., 2017;

Lower incomes, economic Barton et al., 2015;
deprivation and lower levels Cribb et al., 2011; de
Widely
of education are associated High Ridder et al., 2017;
covered
with a poorer diet and being Defra, 2017; Pechey
overweight/obese & Monsivais, 2016;
Wrieden et al., 2013
Balcombe et al.,
Women tend to have slightly 2010; Christoph
Trends
greater consumption of Some et al., 2016; Defra,
Moderate
healthier foods and pay more evidence 2017; Micha et
Diet
for healthy foods al., 2015; Rekhy &
McConchie, 2014
Older individuals tend to

Appleton et al.,
consume healthier foods
Low– Some 2017; Lam &
overall, although it is not clear
moderate evidence Adams, 2017; Micha
whether this a true age effect
et al., 2015
or a cohort effect
55
Availability
Quality of of
evidence academic
evidence
The out-of-home food

environment (including
for example restaurants,
takeaway and fast-food Adams et al., 2015;
places) is increasingly Some Nielsen, Siega-Riz, &
Moderate
a major part of the diet evidence Popkin, 2002; Tyrrell
of younger adults and et al., 2017
Out of home
adolescents compared to
older adults, whose preferred
location is home
Latvala et al.,
Individuals with health and 2012; Su et al.,
Some
environmental concerns tend Low 2019; WRAP, 2015;
evidence
to be female and younger YouGov: Eating
Better, 2019
Beliefs and
values Ethically certified food is more
Not widely
commonly purchased by older Low Mintel, 2019a
covered
consumers (aged 55 or more)
Costs shape what people High Widely Appleton, 2016;

can afford to eat; those in covered Barton et al.,
low-income groups often 2015; Darmon &
have less expensive food Drewnowski, 2015;
expenditure practices, de Ridder et al.,
consume less healthy food 2017; Griffith et al.,
and less fruits and vegetables 2015; Hawkesworth
et al., 2017; Levin,
Price 2014; Levin et al.,
2012; Thomas et al.,
2019; Townshend
& Lake, 2017;
Drivers Whybrow et al., 2018
There is strong evidence High Widely Boyland et al., 2018;

that advertising negatively covered Buchanan et al.,
influences the food 2018; Cairns et al.,
preferences and choices of 2009; Chambers et
children and young people al., 2015; Griffith et
al., 2015; Happer
Marketing and & Wellesley, 2019;
advertising Kamar et al., 2016;
MacGregor &
Bicquelet, 2016
Time and convenience (i.e. Moderate Some Appleton, 2016;

food perceived to be ‘quick’ and evidence Howse et al., 2018;
Individual/ ‘easy’ to cook) are important Jilcott Pitts et al.,
social drivers of consumption 2018
differences Time and choices, particularly for lower-
convenience income individuals who often
lack time
Availability
Quality of of
evidence academic
evidence
Information campaigns also High Widely Chandon, 2013;

rely on personal agency covered Christoph et al.,
in changing practices, 2016; Friel et al.,
and evidence consistently 2015; Garnett et al.,
Interventions indicates that they tend 2015; McGill et al.,
to have greater impact in 2015
individuals with higher socio-
economic status and thus
possibly widen inequalities
Knowledge Use of food labelling High Widely Campos et al., 2011

and information is particularly covered
information high among individuals with
health conditions and special
dietary requirements and
notably lower among children,
adolescents, older adults
and people in lower socio-
economic groups
Labels in restaurants and Low– Not widely Sinclair et al., 2014

fast-food settings may moderate covered
only have effects in certain
population subgroups, with
some evidence that women
may use menu labels
whereas men do not
Price changes through taxes Moderate Some Barrett et al., 2017;

or subsidies are regressive evidence Jensen et al., 2011;
and disproportionately have McGill et al., 2015;
more impact on those with Thow et al., 2010
lower incomes because they
spend a larger proportion
of their income on food and
because they tend to buy
relatively cheaper foods; even
Cost and
where taxes are regressive,
content
those on lower incomes may
still benefit proportionately
more from subsidies on fruit
and vegetables if they buy
them
Source: RAND Europe analysis. This table is a summary of the evidence on socio-demographic differences in food
consumption cited in the literature reviewed. It serves to highlight the differences and nuances in behaviour and
practices related to food. It is not intended as a segmentation and cannot be used to draw predictable conclusions
about consumption behaviour.
57
The food environment is changing but The food environment, which is likely
the full impact of this on consumption is shaped by powerful food system actors, is
unclear a significant driver of consumption
The food environment is changing and There is strong and consistent evidence that,
becoming increasingly diverse and in addition to price and perceived value for
fragmented, with impacts on what people eat. money as some of the primary drivers, the food
In particular, the growth of the out-of-home environment in terms of availability, marketing
sector is significant, with implications for the and advertising has a significant influence on
consumption of salt, sugar and fat (Caraher consumption (Public Health England, 2017).
& Hughes, 2019). In addition, although most Although many individuals are aware that
consumers continue to source their food from eating a healthy diet and being physically
large ‘traditional’ supermarkets, other forms of active is necessary, they are constrained by the
retailer (e.g. mini supermarkets) are increasing current food environment. There is a strong
in popularity (FSA, 2019b). In particular, association between obesity and access to
individuals are increasingly shopping for unhealthy food – for example, through the built
food online and using food delivery services, environment (e.g. through a high concentration
including supermarket home delivery and other of fast-food outlets) (Public Health England,
forms of home delivery (e.g. vegetable boxes, 2017). The micro environment (e.g. through
Hello Fresh and Amazon Fresh). Although use food placement and portion sizes) can also
currently remains low, this is a trend that is influence consumption; the use of end of aisle
predicted to increase (FSA, 2019b). displays and shelf placement in supermarkets
is known to impact on purchasing decisions
Despite the increasing importance of the online
(Glanz et al., 2012). Manufacturers, retailers
grocery shopping market, there is currently a
and transnational food corporations play a
lack of research evidence around the impact of
big role in encouraging the consumption of
digitalisation and its influence on consumption
unhealthy and processed foods. For example,
(Dablanc et al., 2017). The evidence around
marketing and advertising by industry and
how online shopping and home delivery affects
retailers has a significant effect on food
consumption and consumer diets is lacking.
purchases, particularly driving the consumption
To date, studies that have found mixed results,
of unhealthy food in children and young
with some evidence that online shopping can
people (Buchanan et al., 2018; Griffith et al.,
drive both healthy and unhealthy choices.
2015; MacGregor & Bicquelet, 2016). However,
For example, shopping online can reduce the
retailers can also be key actors in promoting
likelihood of buying unhealthy foods due to a
healthy food environments (Roberto et al.,
reduction in impulse purchases and can be a
2015). Given the mixed evidence and lack of
way to overcome healthy food accessibility
controlled studies, more good-quality research
challenges. However, it can also increase the
is needed on the impact of specific food
chances of buying unhealthy products, since
system actors.
consumers may be more reluctant or able to
buy fresh products online (Jilcott Pitts et al.,
2018). It is also not clear to what extent online
consumers differ from offline consumers in
terms of other factors such as price sensitivity
(e.g. propensity to engage with offers) (Munson
et al., 2017).
Food decisions are not always targeted and have an influential messenger,
consciously deliberated and are but there is less evidence that they can change
determined by culture, social environment behaviours. Similarly, food labelling does seem
and sense of identity, and what we eat is to help some consumers choose healthier
often a matter of habit and convenience products, but their use may also be limited
to health-conscious individuals, with lower
Although there are a number of broad trends
use in children, adolescents, older adults and
that affect consumption, there are a myriad
individuals of lower socio-economic status.
of cultural, societal and personal factors that
Consistent evidence indicates that provision
lead to different ‘food publics’ with different
of knowledge and information may have a
values and practices. In addition to socio-
greater impact on individuals with higher socio-
economic status (e.g. income and education),
economic status, and may possibly serve to
demographic factors such as gender and
widen inequalities if used in isolation (Friel
age also strongly affect values and beliefs,
et al., 2015; McGill et al., 2015). Therefore,
leading to differences in terms of health and
policies around education and information
sustainable consumption. Food decisions
provision alone are unlikely to be sufficient to
are not always the outcome of conscious
change behaviours (since these are contingent
deliberation; habit, time and convenience are
on action by individuals). Although there is
also powerful drivers of consumption and can
scope to use the provision of knowledge and
make it difficult for many individuals to exercise
information to raise awareness, for example of
choice and change consumption. Therefore, it
sustainability issues around consumption, their
is particularly important for policy responses
use should be combined with other approaches
to take into account these personal factors.
to enable collective behaviour change across
However, population segmentation approaches,
all population groups.
which could be used to determine appropriate
responses, are usually highly context specific
Policymakers can help to provide
and need to be used with caution in their
environments that enable people to make
application to policy design and implementation.
healthy and sustainable food choices
more easily
Overview of interventions and
There are a variety of interventions that can
their likely effectiveness affect the food environment, spanning from the
provision of healthy foods in public settings, to
Knowledge and information can increase changes to the built food environment (e.g. the
awareness but the ability to change availability of fast-food outlets) and ‘nudges’
behaviours is limited by social, economic to change consumer behaviour through the
and personal factors micro environment (e.g. the presentation
Although some individuals do exercise choice of food in supermarkets). Changing the
using information such as food labels, their food environment through this spectrum
ability to choose is limited by cost, time of interventions broadly seems effective at
and wider influences both in terms of the changing consumption practices, but there is
food environment and at a personal level. currently a lack of good-quality studies. There
In addition, food decisions are not always is good evidence that interventions in settings
conscious and therefore may not be actively such as schools and the workplace can help
information driven. Mass media campaigns to increase fruit and vegetable consumption,
can increase awareness, particularly if they are but evidence is lacking for other public settings
59
such as hospitals or universities. Although significant changes in consumption compared

there is an association between access to with voluntary approaches.
unhealthy food and obesity, few policies that
address the built food environment have been There is often little evidence on the
implemented or evaluated. ‘Nudges’ to change longer-term outcomes of interventions
consumers’ purchasing behaviour by altering
Studies and evaluations often do not take into
food placement and portion size appear to
account the longer-term outcomes of specific
be effective in certain contexts, such as in
interventions. Most interventions are evaluated
supermarkets and in schools, but the evidence
within a short timeframe, which limits the
is limited by a lack of good-quality studies.
ability to assess whether their effectiveness
is long lasting. Another limitation is that many
Changing the cost and content of evaluations focus on intermediate rather than
food can be effective at changing ultimate outcomes – for example, looking at
consumption but the complexity of
changes in views or awareness rather than
possible substitution effects is not yet
actions. Building the evidence base through
fully understood
more comprehensive evaluations and more
The evidence suggests that subsidies and longitudinal studies that enable us to look at
taxation can encourage the consumption of active changes in behaviour would support
healthier foods. However, data are mostly based more evidence-based interventions in this
on modelling studies rather than real-world space.
data. Therefore, more good-quality evidence
is needed to better understand some of the
Possible priority areas for further
complex substitution effects. The evidence also
suggests that the size of the price change needs
consideration by policymakers
to be significant (at least 20 per cent) to drive There are a number of different trends, drivers,
changes. Generally, initiatives to encourage the individual differences and interventions related
reformulation of food – to reduce the content to food and food consumption that are dealt
of salt, sugar and fat – also appear to be with in the academic literature. However, there
effective at encouraging healthier consumption. are still significant gaps in the evidence base.
Emerging evidence indicates that the SDIL has Some factors have high-quality evidence
reduced the consumption of sugar, although but are not extensively written about in the
possible substitution effects remain unknown. academic literature. Other factors have low- or
Contrary to expectation, initial evaluation results moderate-quality evidence in the academic
of SDIL found that the reduction in sugar literature. Table 6 gives an overview of areas
consumption has been smallest in individuals explored in the literature on food consumption
from lower socio-economic groups (who are behaviours and practices and illustrates both
expected to be affected the most by price the quality and availability of the evidence
increases). This discrepancy between expected for each factor. Building on this, we identify a
effects of price increases and observed number of key evidence gaps in the existing
behaviour suggests that other factors than literature in Box 7. Based on these key evidence
price may influence the effects of subsidies gaps, there are a number of priority areas
and taxation. The evidence so far suggests that policymakers could consider, which are
that ‘upstream’, population-wide mandatory presented below and summarised in Box 8.
approaches, such as maximum limits or
restrictions, seem most effective in driving
60 Food consumption in the UK 61
Table 6 Availability (volume) of evidence in the literature on food consumption practices and interventions
Relevant to chapter
Individual/social
Quality of Availability of
Interventions
Factor Evidence base
differences
evidence academic evidence
Drivers
Trends
Demographic variables Analyses do often not control for the interaction of these with other factors High Strong 
Trends
Ethical and environmental Unclear whether these concerns influence consumption

High Strong  
concerns A value-action gap persists
Online purchases The role of increased online and out-of-home purchasing is not well understood Moderate Not widely covered  
Built and micro food environment Growing but mixed evidence base on the impact of the built environment on consumption High Not widely covered  
Drivers, individual/social differences
Food actors High-quality but not extensive evidence on the relative importance of different actors High Not widely covered 
Strong evidence on the type of information that is provided to food consumers, but a lack of academic
Food information High Some evidence 
evidence exploring the type of information that can change food practices
Consumers state the importance of the provenance of food when choosing certain food products
Country of origin Moderate Not widely covered  
(particularly meat) but there is not a lot of evidence
Food quality There is moderate evidence that perceived food quality is an important driver for consumer choice Moderate Some evidence 
Online purchases The role of the changing digital landscape and its influence on food consumption is not widely covered Moderate Not widely covered  
Segmentation Often specific to a particular context and not always generalisable across a population Moderate Not widely covered 
Limited evidence that consumers consider technologies in food production processes when making food- Not widely covered
Supply-side technologies Low–moderate 
related decisions
Evidence is still limited regarding whether it can influence behaviour change
Mass media campaigns Limitations to campaign design (e.g. TV only, not online); better designed campaigns might be more Moderate Not widely covered  
effective
Food labelling Evidence on the effect of food labelling in fast-food settings, supermarkets and restaurants is mixed Low-moderate Some evidence  
Can impact consumption but the evidence is limited

Advertising regulation Low–moderate Some evidence  
Limitations in both evaluation and policy design limit our knowledge of effectiveness
Interventions
Food provision and procurement Little research on the effects

Mixed Not widely covered  
in other public settings Very little evidence identified
Changes in the micro environment Mixed evidence and effectiveness of these interventions depends on context Low Not widely covered  
Built food environment Policy actions to address the built food environment have not been widely implemented or evaluated Low Not widely covered  
Reformulation of food Substitution effects unclear; can be driven by other changes (price changes, labelling requirements) Moderate Not widely covered  
Taxes and subsidies Understanding of substitution effects limited Moderate High  

Box 7 Summary of key evidence gaps in the existing literature
Trends
• The effect of demographic variables on consumption is not well understood as analyses
are often not adequately controlled for the interaction of these variables with other factors
(e.g. correlation between age and wealth).
• Research indicates some differences in consumer practices when shopping online
compared to offline, but the overall effects of the changing food environment on
consumption, such as increased online and out-of-home purchasing, is not well
understood. For example, patterns and frequency of use of different types of outlet are not
clear, and the ways in which food options are presented affect consumption in an online
setting are not well established.
• The extent to which ethical and environmental concerns influence consumption is unclear
beyond information on purchasing data on specific food types (e.g. Fairtrade). Similarly,
though some consumers increasingly care about the provenance of their food and
production methods, the relative importance of these considerations and their influence on
consumption are unknown.
• A value-action gap persists and there is some evidence on why this might be the case;
however, there is very little evidence on how and when that gap can be closed.
Drivers
• The role of digital technology, both in terms of a route to purchase food, and as a source of
information and a vehicle for advertising, is not well understood and is likely to continue to
increase in importance. More evidence is needed on how new technologies and new and
existing platforms (e.g. social media) impact on consumption.
• Although there is a growing evidence base on the influence of the built and micro
environment on consumption, there are still important gaps that require further
investigation, such as the impact of socio-demographic differences in access to fast-food
outlets and the impact of planning policies on consumption.
• Although the literature cites a variety of food system actors as being important in
influencing the food environment and consumption practices, there is no evidence on their
relative importance.
Social differences
• Some of the evidence around social differences in consumption comes from cross-
sectional data, which means it is unclear whether interventions could effectively address
those differences by changing those personal factors or circumstances. More longitudinal
data would be helpful to better understand whether interventions can be effective in
changing consumption.
63
Box 7 Summary of key evidence gaps in the existing literature (continued)
Interventions
• Many evaluations of the effectiveness of interventions are limited to short-term or
intermediate outcomes, which limits their usefulness. Examples include evaluation of
healthy eating campaigns, which often look at changes in attitudes or knowledge rather
than consumption; and evaluations of workplace well-being initiatives, which often have a
poor evaluation design, small sample sizes and only short-term follow-up. More long-term
evaluations looking at ultimate intended outcomes are needed. More generally, the quality
of evaluations could be improved.
• Interventions aiming to change information availability, either through healthy eating
campaigns or restriction of advertising, often focus on traditional media and do not target
new media. This may limit their effectiveness and makes it difficult to establish whether
these types of interventions could work if they were more comprehensive.
• Most evidence on interventions is focused on health outcomes rather than other types of
consumption behaviours (e.g. more sustainable or ethical consumption).
• There is some suggestion that studies in real-world settings may show different effects
on consumption than in experimental settings, typically with smaller effects seen in a real-
world context. More real-world data is therefore needed. Examples here include provision
of calorie information in food outlets and changes in food pricing.
• There is very limited evidence on the effect of changes in the food available in settings
such as hospitals or food delivered at home to low-income, older people. Given that
changes in provision in schools and, to a lesser extent, workplace settings have an effect
on consumption, this merits further investigation.
• There is very limited evidence on the impact of policies aiming to regulate or change the
environment in terms of density or prevalence of fast-food outlets or to address food
deserts. There is a strong association between obesity and access to unhealthy food,
for example through a high concentration of unhealthy fast-food outlets. However, many
studies are cross-sectional so the direction of causality is unclear, and the correlation
may be mediated by socio-economic status and educational attainment. This needs to be
better understood to support effective policy development. There are also no examples of
evaluations or reported implementation of policy interventions addressing the built food
environment in the academic literature, which is an important gap.
A ‘whole systems’ approach is needed to most effective at changing consumer diets

change food consumption and related practices rather than isolated
interventions (Apostolidis & McLeay, 2016;
Taken together, the evidence suggests
de Bakker & Dagevos, 2012; Mozaffarian et
that a combination of coordinated and
al., 2012; Nederkoorn et al., 2011). There is
complementary approaches across the
a myriad of complex and interacting drivers
spectrum of policy categories is likely to be
that influence the actions and decisions that Interventions are increasingly targeting the
individuals take, and targeting these in isolation content of food (directly or indirectly such as
is unlikely to be effective. Therefore, although through taxes) – for example, the soft drinks
information can serve to raise awareness industry levy and reformulation as part of the
and even change values (as in the case of the PHRD – and emerging evidence suggests that
increase in socially and ethically responsible some of these are effective, particularly when
diets), other factors such as income and price mandatory. However, to date, there are few
remain important barriers to behaviour change, policies or examples of evaluations that target the
and likely require additional policy responses built and micro environment and the availability
to address. In addition to economic factors, of unhealthy food. Although there is strong
many other factors (including habit, time and evidence to suggest that product placement
convenience) impact on consumption, with in supermarkets has a strong influence on
food decisions often far from purely conscious purchase decisions, evidence and conclusions
and knowledge led. There are also important on the effectiveness of changes to the micro
socio-demographic differences, individual environment are in part limited by a lack of good-
differences and continued inequalities across quality studies and the fact that many studies
the trends, drivers and likely responses to are conducted in a lab rather than a real-world
policy that need to be taken into account. In setting (Bucher et al., 2016; Driessen et al., 2014;
particular, the evidence strongly suggests that Hartmann-Boyce et al., 2018; Skov et al., 2013).
policies around education alone are unlikely to
Both policy and research as yet does not
be sufficient to change actions and may even
effectively reflect changing modes of
serve to widen inequalities (since these are
consumption and information sources,
contingent on action by individuals). Therefore,
particularly in relation to online and out of
combining information and knowledge
home. For example, most media campaigns
provision with population-level approaches
are conducted through television (J Kite et
focusing on the food environment, and the cost
al., 2018), with evidence on the use of newer,
and content of food, could help to promote
online media lacking (James Kite et al., 2016).
healthier food choices across the population.
Evidence on the purchase of food through
Figure 11 shows a conceptual framework online routes is also currently limited. Both
that illustrates the multitude of drivers of food policy and research need to progress to
consumption and their interaction. Drivers ensure adequate information is available and
include individual level, at the level of the food appropriate policy responses are in place to
environment and wider, contextual drivers. The reflect our changing food environment.
figure highlights the importance of targeting
multiple drivers, both at the individual level but Gather real-world evidence around
also the food environment, in order to change subsidies, taxes and reformulation
practices. programmes to better understand
potential substitution effects
Invest in evaluations of the effectiveness Although emerging evidence shows that prices,
of interventions that target the wider (and subsidies and reformulation of foods can
changing) food environment positively change consumption, it is important
Despite awareness by a majority of individuals of to conduct more real-world evaluations and
the need for a healthy diet, for most people the studies to better understand the impacts of
ability to change is limited by their environment. these policies. Currently, our understanding
65
Figure 11 Conceptual framework illustrating the drivers of food consumption and their interaction
WIDER DRIVERS OF FOOD SYSTEM

Food retail and provisioning subsystem
Advertising/marketing - price promotions
FOOD ENVIRONMENT
CONSUMER
Agricultural production subsystem

Food transformation subsystem
Changing political context
Values and Culture and Technology

Information beliefs norms
Policy interventions
Emotional
Time Food
Labelling responses
quality
CONSUMPTION Purchasing
Knowledge
Marketing power
and skills
Food
safety
Preferences
Rules and Habit
guidance Social
context and Availability and
experiences convenience
Retail and
consumption
setting Accessibility
Affordability
Food storage, transport and trade subsystem

Food system actors
Retailers - Manufacturers - Food services/caterers/hospitality
of the overall effectiveness of these types regulatory approaches, including restrictions

of interventions is limited by a lack of and standards, pricing and labelling
understanding of possible substitution requirements, seem most effective in driving
effects. Studies based on real-world data – significant changes in consumption. However,
for example initial evaluations of the SDIL these are only initial evaluations, and many
and minimum pricing on alcohol – are studies are based on modelling, which may
showing positive emerging effects. Similarly, not adequately account for substitution
reformulation initiatives can adopt different effects. Therefore, more evaluations of
approaches with varying levels of success; this type of initiative that take into account
whereas voluntary programmes have led to substitution effects are warranted.
mixed responses from industry, mandatory
Collect evidence on longer-term to eat a diverse (and typically healthier) diet.

outcomes and more longitudinal data However, this does not necessarily mean that
an educational intervention to improve cooking
It is notable that there is relatively limited good-
skills will improve or diversify the consumption
quality evaluative evidence on the effectiveness
practices of individuals, since it may be that
of interventions available in the literature. In
the relationship between cooking skills and
particular, we note that most evaluations of
dietary choice is related to underlying attitudes,
interventions only include short-term follow-up
preferences or salience. Longitudinal data would
and many often look at intermediate rather
help us to better understand how changes,
than final outcomes. For example, evaluations
whether personal, societal, economic or due to
of healthy eating campaigns may only look at
interventions, causally influence consumption.
changes in attitudes rather than changes in
consumption, and we know from wider literature Improving the evidence base through longer-
that these are not always aligned. Even when term follow-up and increased longitudinal
ultimate outcomes such as health consumption data would not just help us to understand
are analysed, these are often only in the short whether existing interventions are working or
term. For example, evaluations of changes in what the trends are. It would also enable us
consumption after healthy foods are made more to better design policies that are effective at
prominent in a canteen setting often only look changing consumption. There also is likely
at the period immediately following the change to be scope for learning across contexts and
is made. Whether those healthier behaviours purposes. For example, if we have conclusive
persist over the long term is not clear. evidence on how and when changes in pricing
affect consumption of unhealthy products, it
In identifying the case studies, it became
is likely that there will be learning from this to
apparent that there are relatively few large-
support the development of policies aiming
scale interventions that have been evaluated,
to affect the consumption of less sustainable
and that most of those that have tended to be
or ethical foods, if desired. It is, however,
health interventions, rather than interventions
important to emphasise that conducting
aiming to improve ethical or sustainable
longitudinal research should form an ongoing
consumption practices. What is also largely
activity alongside implementing interventions
absent is longitudinal data on consumption.
to address food consumption. Therefore,
This is problematic since it is difficult to draw
interventions with evaluation built in from the
effective conclusions on what might change
beginning can, and should, be implemented
consumption practices based on cross-sectional
alongside investment in longitudinal research.
data. For example, we may have evidence that
those with better cooking skills are more likely
67
Box 8 Summary of possible priority areas for further consideration by policymakers
Priority area 1: A ‘whole systems’ approach is needed to change food consumption

• A combination of coordinated and complementary approaches across the spectrum of
policy categories is likely to be most effective at changing consumer diets to ensure they
are sustainable, affordable and healthy.
• Combining individual-level policies (e.g. information and knowledge provision) with
collective, population-level approaches (e.g. focusing on the food environment, and cost
and content of food) could help to promote sustainable, affordable and healthier food
choices.
Priority area 2: Invest in evaluations of the effectiveness of interventions that target the
wider (and changing) food environment
• Although individuals are often aware that eating a healthy diet and being physically active
is necessary, many are constrained and influenced by their food environment (i.e. the
availability of food, marketing, advertising, food placement and portion sizes).
• More evaluations of interventions, supported by good-quality real-world data, are needed
that target the built and micro food environment (including online and out of home) to
address the availability of unhealthy food.
Priority area 3: Gather real-world evidence around subsidies, taxes and reformulation
programmes to better understand the potential substitution effects
• Understanding of the overall effectiveness of prices, subsidies and reformulation of foods
is limited by a lack of understanding of possible substitution effects.
• It would be important to conduct more real-world evaluations and studies to better
understand the impacts of these policies.
Priority area 4: Collect evidence on longer-term outcomes and more longitudinal data
• Most evaluations of interventions only include short-term follow-up and many often look at
intermediate rather than final outcomes.
• Collecting longitudinal data and evidence on the longer-term outcomes of interventions
would help to better understand what factors can result in changes in consumption
practices. This should form an ongoing activity alongside implementing interventions to
address food consumption.
69
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91
Annex A. Approach and methodology
Aims and overarching approach We combined these elements to identify four

overarching aims and objectives, which are to
RAND Europe was commissioned by Defra to collate evidence on:
provide a state-of-the art review of consumer
1. Trends related to consumer food practices
attitudes and practices38 to food in the UK, in
and attitudes and to the changing food
support of Defra’s broad programme of work
environment (e.g. out-of-home sector,
across food and consumers. The review is not
online retail models) in the UK and through
intended to feed into any one specific stream
international comparisons.
of work, rather to provide a resource that
Defra can draw upon to inform their overall 2. Drivers of consumption (e.g. the role of
strategy and support multiple strands of work. information or food system actors).
The objectives of the study are to identify the 3. Policy interventions that can influence food
strengths of existing evidence regarding: consumption decisions.
• The drivers of consumer food practices. 4. Differences between groups, or ‘food
• The trends related to food consumption39 publics’ (Darnton, 2016), across the
patterns in the UK, including international trends, drivers and policy interventions (i.e.
comparisons. segmentation).
• The role of information in food The focus of this study is on identification of
consumption practices. existing evidence and evidence gaps within
high-quality (primarily academic) literature.
• The role of different food systems actors
The study approach consisted of a rapid
(e.g. producers, retailers, service providers)
evidence assessment (REA). REAs are similar
and their relationship to consumer
to systematic reviews in taking a robust and
practices.
replicable approach to searching and reviewing
• The role and relevance of socio-economic the literature. However, they take a slightly
and socio-demographic factors in food more pragmatic approach to the scope and
practices and consumption patterns. coverage of literature, limiting study inclusion by
• The trends related to the changing food using a range of criteria that can be adjusted in
environment (including the out-of-home response to the volume of literature identified,
sector, online retail models and other food enabling them to be conducted within a more
consumption models) and associated limited timeframe. The remaining sections set
opportunities and challenges. out our approach across five tasks:
1. Scoping allowing for emergent issues to be explored.

2. Conducting searches Table 7 lists the industry, consumer and policy
stakeholder organisations we spoke with.
3. Screening
4. Extraction and quality review At inception, we also held telephone meetings
with four of our expert advisors and a face-
5. Analysis.
to-face workshop with one (Table 8). The aim
An overview of the range and nature of the of these meetings was to collect input on our
literature included is provided in Section A.7. study design, with a particular focus on:
Finally, in Section A.8 we set out some caveats
• The scope, focus and coverage of
and limitation of the approach.
our literature review and conceptual
framework.
Scoping
• Existing key sources that should be
In order to finalise and refine the study included in the literature review.
methodology and approach, the study team
• Examples of relevant interventions that
engaged with Defra, an expert advisory group
may not be codified in the literature (e.g.
and wider stakeholders. We aimed to ensure
new and emerging initiatives).
the focus and remit of the review addresses
policy issues of interest to key actors, does not • Key stakeholders from government,
duplicate other ongoing efforts, and provides industry, charities and the private sector in
useful and actionable outputs and evidence to this area that we should consult.
support policy and decision making.
We engaged with 17 stakeholders, including:
stakeholders from industry, consumer
groups, charities, and policymakers likely
to have an interest in the outcomes of this
work; and academic experts. The aim of this
engagement process was to: (1) understand
the existing policy and research landscape
in this area; (2) identify other ongoing work
within Defra in order to ensure that this study
is complementary to other efforts; (3) identify
evidence that would support decision makers
outside of Defra; and (4) discuss key issues,
topics of interest and any areas of controversy
we should be aware of. The interviews with
non-academic stakeholders in particular were
used to identify any sources of non-academic
literature, surveys and information, and new
and emerging trends we should be aware of.
Interviews were conducted by telephone and
lasted up to one hour. The interviews were
semi-structured, thereby ensuring a similar set
of questions were asked of all interviewees but
93
Table 7 Stakeholder organisations consulted during the inception phase
Organisation
Academia
Centre for Food Policy, City, University of London
Cardiff University
Charities and member organisations
IGD
Caroline Walker Trust
British Nutrition Foundation
Consumer organisations
Which?
Government
Public Health England

Food Standards Agency
Social Science Expert Group
Defra
Industry
The Food and Drink Federation
Table 8 Expert advisory group
Name Role Department and University
Professor Monique Food, Consumer Behaviour and Health (FCBH)

Director
Raats Research Centre, University of Surrey
Principal Research Food, Consumer Behaviour and Health (FCBH)

Dr Lada Timotijevic
Fellow Research Centre, University of Surrey
Food, Consumer Behaviour and Health (FCBH)

Dr Bernadette Egan Senior Research Fellow
Research Centre, University of Surrey
Public Health Nutrition

Reader
Dr Alizon Draper Food, Nutrition & Public Health, University of
Head of Division
Westminster
Dr Ariane Kehlbacher Lecturer Food Economics, University of Reading

All consultations with both academic experts databases: Scopus, Academic Science
and wider stakeholders were conducted Complete and PubMed. For all searches, the
under the principles of informed consent in publication timeframe was restricted to 2009
line with the requirements of the EU General onwards to capture literature from the past
Data Protection Regulation requirements and ten years, and only high-quality academic
the Ethical Assurance for Social Research in publications (books, book chapters, articles
Government principles. Interview notes were and reviews) published in English were
solely for the reference of the research team considered. Beyond the formal searches, we
and participants were only acknowledged also used ‘snowballing’ to identify additional
for their contribution in the report with their articles from reference lists of selected articles.
express permission. A total of 3,063 potentially relevant studies
were identified for screening.
Conducting searches
Screening
We developed a search strategy with expert
input from RAND Knowledge Services and We screened articles by title and abstract for
based on the feedback from the stakeholder relevance against predefined inclusion and
consultations in the scoping phase (Table 9). exclusion criteria (Table 10).
The search was conducted in the following
Table 9 Search strings for the rapid evidence assessment
Topic Search terms
TITLE-ABS-KEY (( consum* OR customer* OR public*) w/3 (TITLE-ABS-KEY

Consumer
(attitude* OR opinion* OR choice* OR decision* OR perception* OR practice*
1 practices and
OR behavio* OR demand* OR buy* OR purchas* OR preference* OR value* OR
attitudes
plan* OR prepar*)))
2 Food TITLE-ABS-KEY (food* OR diet*OR eat* OR meal)
TITLE-ABS-KEY (trend* OR pattern* OR change* OR shift* OR evolution OR

3 Trends
longitudinal)
TITLE-ABS-KEY (driver* OR cause* OR factor* OR reason* OR determinant* OR

4 Drivers
influenc*)
TITLE-ABS-KEY (typolog* OR segment* OR social OR economic* OR socio-

5 Typologies economic* OR cluster* OR income OR demograph* OR educat* OR employ*
OR occupation* OR geog* OR ethnic* OR religio* OR cultur* OR age)
TITLE-ABS-KEY (environment* OR access* OR availab* OR home OR online OR

6 Environments courier* OR “out of home” OR out-of-home OR deliver* OR retail* OR takeaway*
OR take-away* OR convenien* OR prepar*)
ALL (“United Kingdom” OR UK OR Scotland OR England OR Wales OR

7 Country
“Northern Ireland” OR “Great Britain”)
ALL (intervention* OR program* OR package* OR initiative* OR scheme* OR

8 Interventions regulat* OR inform* OR educat* OR incentive* OR levy OR tax* OR label* OR
certif* OR accredit* OR assurance*OR policy OR policies OR claim OR financ*)
Search strings were: (A) (1 AND 2 AND (3 OR 4 OR 5 OR 6) AND 7); (B) (1 AND 2 AND 8)
95
Table 10 Inclusion and exclusion criteria for the literature review
Criterion Include Exclude
Studies addressing trends in consumer Studies addressing impact of food,

attitudes and practices in relation to diet, or consumption patterns on
food consumption, drivers of those health and health-related behaviours
practices (including different actors), (exclusion does not include health as a
Topic relevance
differences by consumer groupings/ driver of consumption)
segmentation, policies/interventions Studies addressing the relationship
to change food consumption and their between socio-economic factors and
effectiveness health
UK, or UK with international

Geographical location Non-UK
comparators
2009 or earlier (with some exceptions,

e.g. any seminal studies referenced in
Year of publication 2010 onwards
multiple publications within the ten-
year timeframe)
Purely theoretical/conceptual work or

opinion pieces
Academic publications, focusing on
Study characteristics Non-academic publications (with some
empirical evidence or syntheses
exceptions, e.g. good quality reviews in
the grey/industry literature)
Language English Other languages
The inclusion/exclusion criteria were applied in our inclusion criteria to make the extraction
three stages: and review process more manageable. We
identified a particularly high volume of studies
1. Criteria were applied on the titles. Those
looking at policy interventions. Therefore, we
appearing to fit the criteria, or where there
limited our review of policy interventions to a
is uncertainty, were included.
‘review of reviews’, covering only good-quality
2. The abstracts of these titles were read reviews of policy interventions and excluding
and inclusion criteria applied again. Those primary studies. However, at the analysis stage,
fitting the criteria or those where there was any key primary studies identified in reviews
uncertainty were included. In these first were explored further where required. This
two stages, we were overinclusive to avoid led to a total of 203 publications meeting the
excluding potentially relevant studies. inclusion and exclusion criteria.
3. Reviewers retrieved full reports of studies
passing the first round. Each criterion was Extraction and quality review
then applied again at the full text level.
In this stage, information was extracted from
Following screening, a total of 484 studies were each included publication to facilitate cross-
identified as meeting these initial inclusion analysis against the key study questions and
and exclusion criteria. Due to the volume themes, and the quality of the studies included
of literature identified, we further restricted assessed to inform that analysis.
Following piloting, researchers independently • International comparators (examples

recorded data about each selected paper of international practice in measuring
meeting the inclusion criteria, including both trends)
general information on the publication and
3. Evidence on drivers of food consumption
information on the elements of each study
• External drivers
question it addresses. We captured information
from each included study in a standard • Personal and household level drivers
template in Excel covering the different 4. Policy interventions (including evidence of
elements of our conceptual framework and in effectiveness)
line with the aims and objectives of this study:
• Type of policy intervention
1. General information about the evidence • Description of the intervention and
source application
• Author, year and study title • Evidence of effectiveness
• Brief summary
5. Segmentation
• Study type (e.g. experimental/
• Approaches to segmentation
randomised controlled trial, cohort/
• Evidence on validity
longitudinal, cross-sectional/factorial,
meta-analysis, synthesis) 6. Quality review (Table 11)
• Methodology (e.g. qualitative data 7. Other comments
collection, quantitative data collection,
mixed methods)
• Publication type (e.g. journal article, In parallel to the data extraction, we also
review, book chapter) reviewed the methodological quality of
included studies. Quality appraisal helps to
• Coverage of study (temporal,
identify variation in quality and relevance
geographic)
between studies. There is no one perfect
2. Evidence on trends in consumer practices approach to quality review and the approach
and attitudes taken depends on the nature of the studies to
• Trends in types of food purchased/ be reviewed.
consumed Following feedback from our expert advisors,
• Trends in attitudes, values and beliefs we assessed the methodological quality of
• Trends in channels through which food included studies against the following quality
is purchased/consumed criteria40 (Table 11) using a RAG/traffic light
• Trends in purchasing frequency and system (green: addressed clearly; amber:
volume addressed but some gaps; red: poor/not
addressed).41
• Other trends
40 Adapted from Sirriyeh et al., 2012.

41 Good-quality sources in this context are considered to be those where the rating against the criteria set out for our
quality review is predominantly ‘green’ (though likely with some ‘amber’ elements in most cases) and there are no ‘red’
characteristics.
97
Table 11 Criteria for quality review of studies
Examples of
Stage Red Amber Green
criteria
Study design: Statement of aims/ No General reference to Explicit statement of

is the study objectives in main mention aims/objectives at aims/objectives in
well designed body of report some point in the report main body of report
to meet the
research aims/
questions?
Clear description of No General description of Specific description of
research setting/ mention research problem in the the research problem
scope of review target population, e.g. and target population
‘among young people in the context of the
buying food online’ study, e.g. ’young
people aged 12–18
in London purchasing
food from online
courier services’
Sample: is Evidence of sample No Basic explanation for Explicit statement of

the sampling size considered in mention choice of sample size data being gathered
approach terms of analysis until information
appropriate and (statistical power) Evidence that size of redundancy/saturation
well justified? (quantitative the sample has been was reached or to fit
studies only) considered in study exact calculations for
design analytical requirements
Representative No Sample is limited but Sample includes

sample of target statement represents some of individuals to represent
group of a of target the target group or a cross section of
reasonable size group representative but very the target population,
small considering relevant
factors
Examples of
criteria
Data collection: Description of No Brief or incomplete Detailed description of

is the data procedure for data mention description of data each stage of the data
collection collection collection procedure but collection procedure,
approach with limited detail, or including when, where
appropriate and states some stages in and how data were
well justified? details but omits others gathered
Rationale for No Basic, limited Detailed explanation

choice of data mention explanation of rationale of rationale for choice
collection tool(s) for choice of data of data collection
collection tool(s), e.g. tool(s), e.g. relevance
based on use in a prior to the study aims
similar study and assessments
of tool quality either
statistically, e.g. for
reliability and validity,
or relevant qualitative
assessment
Detailed No Some recruitment Complete data

recruitment data mention information but not regarding number
complete account of approached, number
the recruitment process, recruited, attrition data
e.g. recruitment figures where relevant, method
but no information on of recruitment
strategy used
Statistical No Limited or flawed Suitable and thorough

significance tests statistical statistical assessment statistical assessment
used and/or effect testing used used
sizes computed
(quantitative
studies only)
Fit between stated No Method, structure Method, structure

research question research or content of data or content of data
and method, question collection only collection selected
format and content stated addresses some is the most suitable
of data collection aspects of the research approach to attempt
question, or there answer the research
is a more suitable question
alternative that could
have been used or used
in addition
99
Examples of
criteria
Analysis: Good justification No Basic explanation for Detailed explanation

are data for analytical mention choice of analytical for choice of analytical
appropriately method selected method, and reasonable method based on
analysed in light of research fit to research questions nature of research
and findings questions question(s)
adequately
corroborated?
Assessment No Limited attempt to Use of a range of

of reliability of mention assess reliability, e.g. methods to assess
analytical process reliance on one method reliability, e.g.
(qualitative studies triangulation, multiple
only) researchers, varying
research backgrounds
Interpretation: Strengths and No Limited discussion Discussion of strengths

does the limitations critically mention of some of the and limitations of
interpretation discussed key strengths and all aspects of study
of the findings weaknesses of the including design,
adequately study but with some methods procedure,
reflect the issues omitted sample and analysis
assumptions
made, Alternative
limitations of explanations for the
the method data considered and
and any issues the generalisability
related to of the conclusions
generalisability? explored/justified
These criteria were chosen as they have been framework set out in our evidence extraction
developed to assess studies with diverse approach in Section A.5.
research designs (i.e. qualitative, quantitative,
Each element of the framework was explored
mixed method). Out of these, 11 of the criteria
initially by a member of the study team to
apply to qualitative studies and 10 apply
identify the key trends and issues emerging.
to quantitative studies, but all 12 items are
The findings were then discussed with other
applicable where mixed methods have been
members of the team and then further
employed. The quality criteria were piloted by
explored. Through an iterative process of
the study team across a sample of studies to
analysis and discussion we were able to
ensure consistency of application. Each of the
identify a set of key emerging findings that are
three team members then applied the criteria
set out in this document.
independently to each study, assigning a rating
across all 12 criteria. As well as analysing the literature identified,
we also used targeted searches to explore
in further depth any specific areas emerging
Analysis as potentially important, or to test whether
Evidence was brought together using a additional information could be identified
framework synthesis approach based on the to address specific gaps. These targeted
searches, conducted in Google Scholar, expert consultation. This will help us to hone
focused primarily on identifying systematic and refine our final messages to ensure they
reviews and, though not included in the formal provide a nuanced and balanced picture of the
extraction and quality review process, all existing evidence.
sources identified in this way were carefully
reviewed for the quality and robustness of Summary of the literature
their approach. Examples of targeted searches
conducted include ‘obesogenic environment
identified
systematic review’ and ‘systematic review Following screening and quality review, a total
workplace wellness’. These targeted searches, of 169 sources (including existing reviews)
together with evidence identified to support were reviewed. Figure 12 shows a flow diagram
other elements of the study such as the showing the steps taken during the systematic
introduction section, contributed an additional search to arrive at the final number of articles.
25 sources to the review overall.
Included studies consisted of 157 academic
This study sets out emerging findings based on sources (journal articles, book chapters and
our internal review of the literature. This will be conference proceedings) and 12 grey reports
further tested in the next stage of the project (6 policy and industry reports, surveys). Table
through an interim workshop with Defra, 12 shows the breakdown of studies included in
discussion with our expert advisors and further the analysis.
Figure 12 Flow diagram summarising number of studies identified and excluded at different stages
in the review process
Systematic searches of online Consultation with Snowballing

databases (Scopus, Academic policy and academic
Science Complete and Pubmed) stakeholders (July 2019)
(2009–2019)
Potentially relevant identified Literature not relevant based

literature (n=3063) on title/abstract screening
(n=2579)
Literature meeting initial

Literature excluded following
inclusion/exclusion criteria
refinement of criteria (n=281)
(n=484)
Literature meeting refined Literature excluded following

inclusion/exclusion criteria quality review and because
(n=203) unable to access (n=34)
Final literature included in

analysis (n=169)
101
Table 12 Summary of study types and methodologies
Publication type Study type Method
37 non-systematic reviews (e.g.

evidence syntheses, narrative
reviews)
59 reviews
16 systematic reviews
5 meta-analyses
157 academic sources
1 commentary
68 quantitative studies
94 empirical research 16 qualitative
10 mixed method
6 surveys
12 ‘grey’ literature reports –
6 policy and industry reports
Of the 169 included studies, relatively few were Caveats and limitations
poor quality. Thirty-three received three or more
‘red’ ratings on the quality criteria, and only The analysis presented here is subject to a
ten received six or more ‘reds’. These sources number of caveats and limitations related to
were used minimally and as supplementary the approach, the scope of the literature and
material in the analysis conducted. Sixty-one the analysis. Key caveats and limitations are
high-quality studies, with six or more ‘green’ outlined below.
ratings were identified. These studies were
particularly prioritised in our studies. However, Comprehensiveness of the search
the overall assessment of the strength of the strategy
evidence was qualitative, taking into account The study takes a REA approach rather than
both the quality of individual studies, the applying a systematic review. This places
number of studies reinforcing the point and, limitations on the coverage of literature included
particularly, the existence (or otherwise) of in the study. There may be important studies
prior systematic review evidence suggesting that have not been included, either because they
confidence in a particular finding. These factors were not identified through our search strategy
have been combined together to give an overall or because they fell outside of our inclusion
assessment of the status of the existing criteria (e.g. by date). We note that the volume of
evidence across different areas. literature in the field here has been a significant
In addition to these systematic searches, a challenge and we have had to place additional
number of targeted searches were conducted limitations on the scope of our approach to
at the analysis stage, as described in Section make the study feasible within timeframes –
A.6. This contributed an additional 25 sources, for example, by focusing on reviews of policy
primarily systematic reviews. interventions. However, we are confident,
based on the approach taken and our expert
consultation process, that our analysis provides
a fair and relatively representative picture of the have not been fully explored within the scope
current state of the evidence. of this report. We have balanced length and
complexity with comprehensiveness, aiming to
Focus on academic literature provide an overall picture of the key emerging
issues with a focus on the study questions
Through our interviews at the scoping stage,
identified for this work.
we were advised that the focus on academic
literature may have some limitations. For
example, there may be evidence on new and
Emphasis and bias
emerging trends in consumption, as well as on In any analysis, there is potential for the biases
policy interventions, in industry research and of those conducting the analysis, whether
grey literature that is not captured in academic conscious or subconscious, to influence the
literature, and these other sources may offer final output. Consultation, though beneficial
different approaches and perspectives (for in many ways, also runs the risk of skewing
example, on segmentation). However, following findings and analysis based on the particular
discussion with Defra we determined that views of those consulted. We have used clear
the primary focus of this work should be on methodological approaches such as a formal
academic literature both to address gaps in extraction template to help try and ensure a
their knowledge with regard to this literature consistent approach to the identification and
and to ensure our focus on high-quality work. prioritisation of information across the study
We have, however, attempted to address this team. We have also been careful to reflect on
limitation by drawing on some reviews from the input of expert informants in light of their
the grey literature and snowballing to include particular opinions and viewpoints. However,
wider key sources. Regardless of the source of we inevitably will have focused on those
evidence, all included literature was subject to issues of most interest to Defra and to others
quality review ensuring that even where non- consulted, and our thinking has been shaped
academic sources are used, we have assessed by the conceptual framework developed at
the quality and reliability of the evidence and the outset and the views and input of our
take this into account in our assessment of the expert advisors. We anticipate this has largely
final message communicated in our report. been beneficial in providing guidance and
structure within what is a vast and complex
Depth and comprehensiveness of analysis literature. However, there may also have been
implications for the coverage and emphasis of
Because of the complexity and richness of the
the review.
literature, it is likely that there are a number of
elements even within the studies included that

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Food consumption

Published by the RAND Corporation, Santa Monica, Calif., and Cambridge, UK

RAND Europe is a not-for-profit research organisation that helps to improve

Limited Print and Electronic Distribution Rights

Introduction and objectives of the The study approach consisted of a rapid

Figure 1 Food consumption trends in the UK in relation to dietary guidelines

No change/reduction Reduction Reduction Reduction

There are socio-demographic differences The out-of-home food environment is

Trend 1: What people consume still falls short of dietary guidelines

Trend 3: The out-of-home food environment is increasingly common

COUNTRY OF FOOD SUPPLY-SIDE DRIVERS OF

Friends Family Supermarkets

Source: RAND Europe analysis.

ent and wider d

Beliefs and Emotional

Price and ingredients: This There is a continuum across these possible

Intervention Effectiveness Strength of evidence Comments and caveats Key sources

Jepson et al., 2010; Muzaffar et al., 2018; Rekhy &

Online approaches are likely less effective than phone/

Limitations to campaign design (e.g. TV only, not

Labelling in restaurants/fast- (Littlewood et al., 2016; Magnusson, 2010; Wright &

variability in intervention design limits generalisability Schliemann & Woodside, 2019

Bucher et al., 2016; Cadario & Chandon, 2019; Hartmann-

Food provision in other public

Afshin et al., 2017; Eyles et al., 2012; Hartmann-Boyce et

changes 2010; Andreyeva et al., 2010; Niebylski et al., 2015; Smith

Reflections – what does the understood. Digitalisation is diversifying the

Table 2 Availability (volume) of evidence in the literature on socio-demographic differences in food

Barrett et al., 2017;

Older individuals tend to

Beliefs and Ethically certified food is

Costs shape what people High Widely Appleton, 2016;

There is strong evidence High Widely Boyland et al., 2018;

Time and convenience (i.e. Moderate Some Appleton, 2016;

Information campaigns also High Widely Chandon, 2013;

Knowledge Use of food labelling High Widely Campos et al., 2011

Labels in restaurants and Low– Not widely Sinclair et al., 2014

Price changes through taxes Moderate Some Barrett et al., 2017;

Ethical and environmental Unclear whether these concerns influence consumption

Can impact consumption but the evidence is limited

Food provision and procurement Little research on the effects

Taxes and subsidies Understanding of substitution effects limited Moderate High  

Source: RAND Europe analysis.

Box 2 Summary of key evidence gaps in the existing literature

Box 2 Summary of key evidence gaps in the existing literature (continued)

Box 3 Summary of possible priority areas for further consideration by policymakers

Priority area 1: A ‘whole systems’ approach is needed to change food consumption

Figure 1 Food consumption trends in the UK in relation to dietary guidelines vi

Table 1 Summary of interventions to change food consumption and evidence

Box 1 Summary of UK trends in food consumption and attitudes

Defra Department for Environment, Food and Rural Affairs

NGO Non-governmental organisation

REA Rapid evidence assessment

RSPCA Royal Society for the Prevention of Cruelty to Animals

SDIL Soft Drinks Industry Levy

WHO World Health Organisation

Glossary of food certifications used in this report

1 Why food consumption matters

Figure 5 Overview of the food system

Water Chemicals Money

Figure 1 Food consumption trends in the UK in relation to dietary guidelines vi