ENTHUSE – EvaluatiNg The High fat sUgar Salt rEgulations: practice, response and impact across retail settings

Background: Obesity and poor diet constitute two of the greatest threats to population health.

The UK government introduced world-first Food (Promotion and Placement) regulations in England to curb excessive marketing of foods and drinks high in fat, sugar and salt (HFSS) in retail outlets, promote healthier food purchasing and improve population diet.

An in-depth evaluation is necessary to understand implementation of the restrictions on HFSS foods in key promotional locations in retail stores (e.g. checkouts) which came into force in October 2022 and understand price promotion practices before restrictions on volume-based price promotions (e.g. buy-one-get-one-free) come into force in October 2025.

Aim: To adopt a systems approach to evaluate how the Food regulations (Placement component) are being implemented and enforced and its impact on business outcomes, product reformulation and societal attitudes; and to collect baseline data for evaluation of the Promotions component. Public Involvement: Our project has been developed with citizens and our project partners.

A member of the public who regularly does the food shopping for her family is part of the research team.

We will recruit a public contributor panel containing ~10 diverse members from across England who will keep our work relevant and ensure our methods are appropriate for participants and support our varied dissemination activities.

We are also working closely with six local authorities and two representative bodies for businesses – one for retailers and one for wholesalers. Methods: This 30-month project is structured into four interlinked workpackages (WPs).

WP1 provides project coordination and governance, overseeing WP linkage, public involvement and delivering knowledge exchange activities.

WP2 will provide quantitative insights through a cross-sectional observational survey of promotional activities (location and multibuy promotions) in ~240 stores in six case study areas in England (Gateshead, Nottinghamshire, Southampton, Surrey, Southwark and Greenwich).

WP3 will employ a mixed-methods approach to provide new insights into the impact these regulations have had on businesses and investigate citizens shopping practices and interaction with retailers promotional strategies.

WP4 will use commercial data to provide quantitative insights into how manufacturers and retailers have reformulated their products as a result of these regulations, as well as assess products and businesses nutritional profiles and use of volume-based and other price promotions.

This study also runs alongside a complementary NIHR funded study (NIHR156535) which includes mixed-methods analysis of enforcement officer practices across local authorities in England for these regulations.

Anticipated Impact and Dissemination: New insights about how these regulations are being implemented and enforced and their impact on businesses and citizens will be identified.

Key deliverables include: i) real-time feedback to policymakers through briefings; ii) presentations to key stakeholder groups including in-scope businesses, enforcement officers and civil-society organisations; iii) policy brief with recommendations for improving compliance; iv) 5 academic papers; and v) creative, accessible dissemination activities produced with our public contributors and partners.