Enabling UK consumers to increase their consumption of ... Report complete.pdf · Enabling UK consumers to increase their consumption of fruit and vegetables 4 20/03/2016 “convenient”

Enabling UK consumers to increase their

consumption of fruit and vegetables

For

National Farmers Union (NFU)

Report prepared by: Dr Louise Manning

Issue: 01

Date of Issue: 20/03/2016

The Royal Agricultural University,

Cirencester, Gloucestershire, GL7 6JS

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consumption of fruit and vegetables 2

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1. Executive Summary

1.1. Introduction

The aim of this study was to undertake a desktop review to determine the constraining and the

enabling factors that influence United Kingdom (UK) consumer consumption of fruit and

vegetables (F&V)1 with a view to providing options for action on how such consumption could be

increased. The objectives of the study were to consider:

The degree of consumer engagement with policy initiatives such as the “5-A-DAY”, “Change

for Life” and the “Eatwell plate” (now the Eatwell Guide) and whether purchasing and

consumption of F&V has changed over the timeline of the projects;

The factors in the literature that are identified as constraining and enabling factors in the

consumption of F&V; and

The potential options for actions that could be implemented at policy, industry and

personal levels to increase the consumption of F&V in the UK.

A holistic approach was used in the study to draw together themes from a range of academic and

policy literature. Recommendations in this Executive Summary are considered in terms of positive

action that can be taken by government, retailers, food service and the farming and processing

sector in order to play their respective roles in enabling the increased consumption of F&V in the

UK. It is important to note the difference between the determination of what is considered as F&V

generally and what is considered F&V in terms of health campaigns such as the UK’s 5-A-DAY

initiative. Whilst potatoes may be considered more generally to be within the scope of horticulture

and thus as F&V, they are excluded from being defined as F&V in the Eatwell plate (now the Eatwell

Guide) and 5-A-DAY initiative.

Increased consumption of F&V is considered to be a critical step to prevent excessive weight gain.

The MacKinsey Global Institute (MKI) report of 2014 determined that obesity is one of the top

three global social burdens generated by human beings: smoking and armed violence, war and

terrorism as two issues represented a direct economic impact of $2.1 trillion each, with obesity

sitting third at $2 trillion per annum, well above climate change at $1 trillion. In a debate in the

House of Commons in 2016, Dr. Sarah Wollaston stated:

“9p in every £1 we spend in the NHS is spent on diabetes. We estimate from the evidence that

the Health Committee took during our hearings that the overall cost of obesity to the NHS is

now £5.1 billion a year, and the wider costs to society have been estimated to be as high as

£27 billion, although the estimates vary. We simply cannot afford to take no action…..

Source: First Report from the Health Committee, Session 2015-16. Childhood obesity—brave and bold action, HC 465.]

In 1990 the World Health Organisation (WHO) recommended a minimum consumption of 400g

of F&V per day and in the UK this has translated into the 5-A-DAY initiative and other initiatives

globally (see Section 4.2). However, the impact of these public health initiatives (PHI) on

increasing F&V consumption on a sustained basis remains modest (Rekhy and McConchie 2014).

The various interventions to promote the consumption of F&V have been initiated by government,

industry and not-for-profit organisations. Many of these have conducted informational and

1 The term F&V includes fruit, vegetables (including potatoes) and salad products



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educational PHI with mixed results. Success has been reported for those PHI which have forged

partnerships between industry, retail, government and not-for-profit organisations promoting

public health (Rekhy and McConchie 2014) see Section 4.4.

Whilst the relative affordability of calories in energy dense foods compared to nutrient rich foods

has been suggested as a primary constraint, this report demonstrates that the landscape with

regard to enabling nutrition through F&V consumption is in fact more nuanced and multifaceted

than conventionally protrayed. Thus whilst F&V affordability is important, there are other positive

steps that can be taken to increase the level of F&V consumption in the UK.

For example, there are disparities between purchasing and consumption. Defra statistics highlight

that there is a disparity in F&V purchase between average and low income households and an

overall reduction in F&V purchase between 2011 and 2014 (see Section 3.1). From a health

perspective this reduction in F&V consumption has contributed to a fall in fibre intake (7.1%

between 2011 and 2014) and also in a range of micronutrients notably Vitamin B6 and

folate.However it should be noted that a proportion of this reduction is the drop in consumption

of fruit juice which is currently included within the 5-A-DAY campaign.

However, it is important to note that purchasing statistics alone have limited value in measuring

actual F&V consumption as they do not take into account wastage in the home. Some studies

suggested the cost of F&V wastage in the home is £2.6 billion per year (FSP, 2015). This equates

in the WRAP 2008 report to 5.1 million individual potatoes a day, 4.4 million apples and 2.8

million tomatoes just to name three examples, although indications are that this wastage has

reduced in more recent years (see Section 3.1). Improving storage of F&V in the home is a crucial

step to lengthen shelf-life and maintain the quality of F&V. Combining the purchasing and wastage

figures from different reports (FSP, 2015; DFFR, 2015) equates to an average consumption of

241g per day per person, equivalent to three out of the five recommended F&V portions a day.

This 2016 report commissioned by the National Farmers Union (NFU) has considered the

proactive steps that can be taken to facilitate increased consumption of F&V. These include:

CHOICE ARCHITECTURE which is relevant to community environment, retail store, food

service, work place canteen and school canteen layout and managing portion control with

a view to influencing choice, promoting convenience and increasing nutrient-rich food

availability (see Section 3.2.2). A study involved with changing food service layout and

information at the point of purchase saw sales of healthy foods rise 41% after 3 months

(Thorndike et al. 2014).

REFORMULATION - including more F&V in convenience options and other food offerings.

Relatively simple changes such as the increased used of F&V in convenience foods could

make a significant improvement to the nutrient profile of meals (see Section 5.8).

INFORMATION - reminding people at the point of purchase about their choices, drawing

attention to social norms and framing information.

Choice architecture can be described as the informational or physical structure of the

environment that influences the way in which choices are made including reducing the portion

size of unhealthy foods and changing the relative pricing of foods (Dodds, 2014; Thaler and

Sunstein, 2008). However “nutrition doesn’t sell, but convenience and taste do” (Hanks et al.

2012:1) thus choice architecture has to include making F&V more convenient as food options.

Similarly society wide changes in consumption from “three meals a day” to “ready to go”, and



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“convenient” now supports a more “food grazing” lifestyle. The concept of consumers “shelf-

grazing” in retail stores is being demonstrated with the increase in shopping for food multiple

times a week, whilst only 18% of UK households now plan their meals for the week ahead (Co-

op, nd). Reasons highlighted for this, including not wanting to buy too far in advance, reflect

uncertain weekly schedules, a wish to move away from menu planning and concerns over food

waste. In fact, certain food items may have increased perceptions of value for the very reason

that they reduce the need for making food planning decisions (Vohs et al. 2014). Yet, shelf grazing

can create a problem for retailers in terms of aligning the product offering and the buying

behaviour of shoppers. A mismatch can lead to increased shrinkage especially in short shelf-life

products, particularly F&V. In this context, shrinkage describes the loss in margin or profitability

incurred for a food retailer in terms of product spoilage, theft or wastage.

Current F&V shrinkage levels vary between 4.8% and 15% of retail sales (see 3.2.1) (Buzby et al.

2015; Buck and Minvielle, 2013) Criticially, shrinkage levels influence retail space allocations as

retail food stores seek the best financial return for the shelf space available in a given location. A

study in ten countries concluded that there was a relationship between a lower national body

mass index (BMI) and a higher percentage of shelf space allocated to F&V products (Norman et

al. 2014). The term food swamps can be used to describe this crowding out of F&V not only in

terms of F&V to snack food ratio on retail shelves, but also with fast food outlet density leading to

the swamping of nutrient-rich foods by energy dense alternatives.

A range of global and national PHI have been described in sections four, five and six of this report

and the enabling and constraining factors that have influenced the success of PHI and the

mechanisms such as the Public Health Responsibility Deal (PHRD) that have sought to engage

voluntary support from industry. The evidence suggests that current PHI in the UK have failed to

move the general public to an average consumption of five portions of F&V per person per day as

recommended by the WHO. Therefore new and innovative options need to be developed and

implemented in order to increase F&V consumption. These form the basis of the choice

architecture, reformulation and information options for action contained in this executive

summary.



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1.2. Options for action - Government

Choice architecture

Revisit planning regulations with regard to enabling choice architecture at community level

and ensuring that nutrient-rich foods are not simply “swamped out” by energy-dense food

alternatives.

Redesign the layout of food service areas and the positioning of food products in public

areas such as schools, hospitals, government workplaces in order to have increased F&V

availability at the start of the buffet setting, or the use of convenient options for F&V

products in vending machines.

Undertake a feasibility study to determine applicability within the UK policy environment

for the development of an equivalent Community Food Projects Competitive Grants

Programme (CFPCGP) in order to implement a nutrition incentive based approach as has

been developed in the United States (US) where it currently involves 110 community

based partners, 730 community health care centres, hospitals and food hubs (see Section

4.3).

Promote increased visibility of F&V within schools with an associated choice architecture

strategy in the food service setting.

Reformulation

Provide an enabling environment for food reformulation for example, through the Public

Health Responsibility Deal.

Information

Develop a cohesive strategy for enabling of F&V consumption with a view to promoting the

need for increased fibre and micronutrient consumption to ensure the nation’s health in

addition to existing initiatives (see Table 14).

1.3. Options for action – Retailers

Choice architecture

Introduce mechanisms such as the use of floor markers, grocery trolley/cart or basket

mirrors, sectioning out parts of the trolley and labelling as a F&V area in the trolley or

basket and/or trolley or basket placards to reinforce the social norms associated with F&V

choice. Use of such placards in one study increased the spending on F&V by 12.4% in one

store and 7.5% in another with no net increase in spending (see 3.2.2). Provide information

for consumers on the top five F&V items purchased in the store on shelf markers or visual

boards.

Revisit policies on shelf space allocation to F&V in store in terms of fixture location, product

category location, item location within categories, off-shelf displays and point of sale

promotional support (Yang and Chen, 1999). This should include a review of the frequency

of display and the positioning of F&V especially convenience, snack options of F&V in the

store layout.



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Address the positioning of retail products on shelf especially snack products as positioning

has been shown to influence choice so that F&V are not disregarded (See Table 2).

Improve the use of shelf labels that identify nutrient-rich products, provide more

information on healthy meal ideas and recipes and consider a rewards programme for

purchasing healthy products (see Table 4).

Reformulation

Build health into existing food products with a programme of reformulation and refocus

especially ready-meals and revitalising the components of meal deal options to ensure

there is an increased featuring of convenience F&V products.

Increase the proportion of F&V snacks available as the trend increases to replace meals

with snack alternatives. Work specifically with supply chain partners to develop child-

centred F&V snack products that are “fun shaped” for example, animals, letters etc. “fun

named” or with fun characters and positioned in a way in store to increase child purchasing

requests (see 3.2.1).

Information

Embed storage instructions on pre-packed F&V outer packaging so it can be seen on

purchase and when stored “in pack” in the home. It is important that this is visible when

the packaging is still intact on pre-packed F&V and is available at the point of purchase for

loose fruit for example, via information on bags, shelf cards, stickers that can be applied

to clear bags, paper bags with storage information. The size of print on pack and on instore

information is an important consideration so that all customers can access the

information. Improve understanding by customers of the need to refrigerate F&V to ensure

shelf-life in the home when it is often displayed in ambient conditions in-store. The ambient

display of produce is often confusing for consumers in this regard when the

recommendation is to then refrigerate food at home.

Promote product tastings, recipe cards featuring F&V that are ideal accompaniments for

ready-meals and promote the presence of healthy ingredients in convenience food options.

Increase staff knowledge about healthy food choices and nutrition. In one study (FMI,

2010) only 35% of shoppers felt that supermarkets enabled them to make healthy food

choices for their children, and only a quarter of shoppers felt that grocery store staff were

knowledgeable about nutrition or nutrition supplements.

1.4. Options for Food Service

Choice Architecture

Redesign the layout of food service areas and positioning of food products in order to have

increased F&V availability at the start of the buffet and use convenient options for F&V

products on buffets.

Increase the proportion of F&V items available for children by develop F&V options that

are “fun shaped” for example, animals, letters etc. “fun named” or with fun characters and

positioned in a way on the menu or table information to increase child purchasing requests

(see 3.2.1).



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Reformulation

Through menu development and recipe reformulation increase the range of food products

that contain F&V, and more specifically in “ready-to-go” products being offered in the food

service environment.

Information

Implement the labelling of food products in vending machines, buffets, and on menus with

red, yellow and green coding to signify the health benefits, or lack of them to people

choosing both meal and snack options. This has already begun with some food service

businesses promoting F&V based products for say under 350 calories for a meal option.

1.5. Options for the Farming and Processing Sector

Choice architecture

Implement growing techniques that improve substrate and soil nutrient value and

mechanisms for increasing the nutrient content of the F&V grown, harvested, stored and

processed in the UK.

Work with other sector partners to develop a demand led strategy that could encompass

the development of new crop varieties, the need for new forms of packaging, promotion

and presentation and the mechanisms for promoting health messages to a multi-

dimensional audience.

Reformulation


especially ready-meals and convenience products.






Identify new ways of delivering convenience to consumers through further processing of

F&V so it can compete as a convenience product.

Information

Embed storage instructions on pre-packed F&V so it can be seen on purchase and when

stored in the home.

1.6. Summary

The factors that influence F&V consumption are complex and often interacting and influence

particular demographic groups in different ways. The challenge of reducing diet related

malnutrition (DRM) sits at a nexus of public policy, corporate responsibility and individual

responsibility. The report that forms an output of this study has provided the background and



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context for the options for action proposed in this executive summary that have focused on

governance, social responsibility at policy and corporate level and the role that the horticultural

sector and others can play in facilitating increased consumption of F&V.



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Contents

1. Executive Summary 2

1.1. Introduction 2

1.2. Options for action - Government 5

1.3. Options for action – Retailers 5

1.4. Options for Food Service 6

1.5. Options for the Farming and Processing Sector 7

1.6. Summary 7

Contents 9

List of Tables 11

List of Figures 12

2. Aims and objectives of the study 13

3. Introduction 15

3.1. Background 15

3.2. Diet related malnutrition (DRM) 17

3.2.1. Background 17

3.2.2. Choice architecture and nudging 18

3.2.3. Factors influencing food orientated behaviour 24

3.2.4. Relationship between the density and type of food outlets and general obesity

status 28

3.3. Summary 29

4. Global public health initiatives to promote healthy eating 31

4.1. Introduction 31

4.2. Global Public Health Initiatives (PHI) 32

4.1. US Policy provision to increase consumption of F&V by low income households 33

4.2. Dietary Public Health Initiatives (PHI): 5-A-DAY programmes 37

4.2.1. Global overview 37

4.2.2. The UK 5-A-DAY programme 40

4.3. Summary 41



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5. UK Government policy initiatives to promote healthy eating 42


5.2. Level of knowledge about nutrient content 43

5.3. The School Fruit and Vegetable Scheme (SFVS) and School Food Standards 48

5.4. Information and evaluation of the Eatwell plate 48

5.5. Healthier Food Choice Awards 50

5.6. Change4Life 51

5.7. PHE’s sugar reduction package 53

5.8. Nutrient profiling 53

5.9. Summary 54

6. Inter-related UK Government public health initiatives 55


6.2. Health and Wellbeing boards 55

6.3. The Public Health Responsibility Deal (PHRD) 56

6.4. F6 – Fruit and Vegetable Pledge in the PHRD 59

6.5. Summary 59

7. Options for action that can enable increased consumption of F&V in the UK 60

7.1. Options for action - Government 60

7.2. Options for action – Retailers 60

7.3. Options for Food Service 61

7.4. Options for the Farming and Processing Sector 62

7.5. Summary 63

8. Conclusions 64

9. References 66

10. Appendix 1. Delivery Plans for the organisations pledged to F6 of the Public Health

Responsibility Deal (PHRD) 78

11. Appendix 2 – 2015 updates on F6 pledge in PHRD 88



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List of Tables

Table 1. The contribution of F&V and potatoes to nutrient intake per person per day from

household purchases (Adapted from DFFR, 2015; EU, 1990) ....................................................... 16

Table 2. The influence of positioning on food choice (Adapted from Keller et al. 2015) ............. 20

Table 3. Supermarkets as an enablers of healthy eating (Adapted from FMI, 2010) .................. 20

Table 4. Shopper interest in various services that might be provided by the supermarket where

they shop most often (Source: FMI, 2010) ...................................................................................... 21

Table 5. When are F&V eaten (Adapted from PBHF, 2010) ........................................................... 22

Table 6. Top five favourite family F&V as reported by mothers (Adapted from PBHF, 2010) ...... 22

Table 7. Barriers to increased F&V Consumption (Adapted from PBHF, 2010) ............................ 23

Table 8. Enabling the appeal of F&V snack products aimed at children (Baker et al. 2015) ...... 25

Table 9. Dual strategies of prevention ............................................................................................. 32

Table 10. Dual strategies of intervention ......................................................................................... 32

Table 11. Examples of Global Public Health Initiatives (Adapted from: OEDC, 2014; WCRFI,

2015) .................................................................................................................................................. 35

Table 12: Global PHI F&V promotion campaigns ............................................................................. 37

Table 13. Development of the 5-A-DAY programme in the UK ....................................................... 39

Table 14. Drivers, trends and events that could influence micronutrient intakes in the UK

(Adapted from Miller et al. 2016) ..................................................................................................... 44

Table 15: Potatoes and 5-A-DAY F&V commonly eaten in the UK (identified from National Diet

and Nutrition Survey data) and EFSA-approved health claims for micronutrients they contain. . 44

Table 16. Vitamin content of selected UK fruits and vegetables (per 100g) ................................ 47

Table 17. Mineral content of selected UK fruits and vegetables (per 100g) ................................ 47

Table 18. Criteria in the Healthier Choices Food Award (Source: WRS, 2015) ............................. 50

Table 19: Evaluation of Year One Change4Life ............................................................................... 52

Table 20. PHRD core commitments and pledges (Source: DH, 2011a) ........................................ 57



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List of Figures

Figure 1: Development of Local Supply Chain Networks and Regional Food Hubs (Source:

Wholesome Wave, 2015c) ................................................................................................................ 36

Figure 2. The Eatwell Plate (Source: NHS, 2015a) .......................................................................... 42

Figure 3. The Eatwell Guide (Source: Govt.uk, 2016) ..................................................................... 50



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2. Aims and objectives of the study




increased. In this study the term F&V includes fruit, vegetables and salad products as defined by

the 5-A-DAY initiative as well as consideration of potatoes. Clarification is given throughout the

report as to whether the term F&V refers to the inclusion of potatoes or not as with the 5-A-DAY

initiative. Potatoes are included in this report as they fall within the wider definition of horticulture

as used by the National Farmers Union (NFU). The objectives of the study were to consider:








This project involved a desktop review to draw together, in a holistic approach, themes from a

range of academic and policy literature. A holistic research approach has been used that

considers that health and diet-related malnutrition (DRM) is influenced by community, the

environment in which we live and the local (and wider) economy. This follows the work of Forget

and Lebel (2001) and others. The underlying research questions are:

1. What are the global initiatives that followed the World Health Organisation (WHO)

recommendation of 400g per day F&V consumption ?

2. How has UK public policy developed to encourage adults to consume 400g of F&V? daily?

3. What is the impact of the policy initiatives and whether adults are meeting the WHO

recommendations?

4. What actions have the food industry taken to encourage consumers to meet the F&V

consumption agenda?

5. In the academic-scientific/government literature what are the identified enabling and

constraining factors with regard to F&V consumption?

6. What is the role of UK growers in meeting the needs of consumers of F&V?

The area of science that relates to F&V consumption, choice and personal behaviour is cross-

disciplinary and this requires engagement by researchers from a range of disciplines and with

complementary expertise. The authors of the report are from a range of backgrounds:

Dr Louise Manning, Senior Lecturer in Food Policy and Management at Harper Adams

University.




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Dr Josie Kelly, Lecturer, specialising in Business and Government Relations, at Aston

Business School.

Sara Stanner, Science Director at the British Nutrition Foundation (BNF).


particular demographic groups in different ways. The challenge of reducing DRM sits at a nexus

of public policy, corporate responsibility and individual responsibility. The report that forms an

output of this study will provide options for action focused on governance, social responsibility at

policy and corporate level and the role that the horticultural sector and others can play in

facilitating increased consumption of F&V.



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3. Introduction

3.1. Background

Sufficient daily consumption of fruit and vegetables (F&V) could help prevent major diseases for

example, type-II diabetes, obesity and certain cancers. The World Health Organisation (WHO)

recommended in 1990, a minimum consumption of 400g of F&V per day (WHO, 1990). In 2003,

in the United Kingdom (UK), this translated into the “5-A-DAY”campaign encouraging the

consumption of 80g of five different F&V daily with potato consumption not included in this

category. This approach is mirrored in similar schemes around the world for example, France,

Germany, New Zealand (see Section 4.2). The relative affordability of energy dense foods (high in

sugar, fats and salt) compared to nutrient rich foods such as F&V, is implicated in socioeconomic

disparities in the incidence of diet related malnutrition (DRM), often presented as obesity

(Appelhans et al. 2012), thus suggesting poor nutrition (both under and over consumption of

calories) is a particular issue for low-income households. However, this is just one in a

multifaceted set of factors that contribute to the growth of an obesogenic environment (Lake and

Townsend 2006; Lake et al. 2010). The 2014 Defra Food Statistics Pocketbook highlights that:

UK household purchases of F&V were 1.1% lower in 2013 than 2012, a reduction of 9.7%

since their peak in 2006. This was 24% of household food purchase.

F&V purchases [not consumption] equated to an average 4.0 portions per person per day

falling to 3.2 portions per day for the lowest income households.

Nearly three times as much food and drink high in fat and/or sugar was purchased (22%)

compared to the Eatwell plate percentage of 8% of daily consumption (FSP, 2014).

The Defra Family Food Report (DFFR) for 2014 published in December 2015 reported that potato

purchases continue their long term downward trend with a 10.1% reduction since 2011 and 18%

lower than a decade earlier. Overall purchases of F&V reduced between 2011 and 2014 (but it

should be noted that this downward trend included the drop in fruit juice purchase), but

consumers spent 4.4% more on fresh and processed vegetables and 7.8% more on fresh and

processed fruit. Apple sales were up 8% in 2014 compared to 2011 and conversely fruit juice

sales down 15.1% over the same time period (DFFR, 2015). Fibre intake declined in 2014 at an

average of 14.2 grams per person per day compared to a recommendation of 18g per person per

day (when measured as non-starch polysaccharide). This was a 7.1 per cent fall from 2010 (DFFR,

2015). The Defra Family Food Report for 2014 determined that:

Overall purchase of fruit increased to 2006 but then fell 14% compared with 2007.

Purchases of vegetables peaked in 2005 and then fell 5.2% in the same time period.

Lowest income households (decile 1), purchased 11.3% less fruit and 6.6% less

vegetables in 2014 than in 2007. This group purchase the least F&V.

Income decile 2 households purchased 20% less for both F&V in 2014 than in 2007

(DFFR, 2015).

Poor dietary choices not only manifest in obesity, which is currently the main public health focus

in the UK, but can also lead to inadequate micronutrient intakes, with implications for health

(Miller et al. 2016:1).



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Miller et al. (2016) suggest that recent dietary survey data and measurements of status

biomarkers have highlighted folate, vitamin D, calcium, iron and iodine to be amongst the

micronutrients of most concern for particular subgroups of the UK population. Groups that are

vulnerable to inadequate micronutrient intake include not only lower socioeconomic groups, but

also ethnic minorities and adolescents. Furthermore, of particular concern are teenage girls and

women of childbearing age because of their high requirements for some specific micronutrients

and the impact that poor micronutrient intakes can have on the health and wellbeing of their

offspring (Miller et al. 2016). Table 1 highlights the contribution in terms of % of micronutrient

intake per person per day as derived from household purchases. It should be noted that this does

not reflect actual consumption because firstly food waste has not been taken into consideration

and also the average is factored across a household so does not take into account variations

between individual consumption.

Table 1. The contribution of F&V and potatoes to nutrient intake per person per day from

household purchases (Adapted from DFFR, 2015; EU, 1990)

Food type Energy

(kcal)

Non-milk

extrinsic

sugars

(g)

Calcium

(mg)

Fat

(g)

Sodium

(mg)

Iron

(mg)

Folate

(µg)

Vitamin A

(retinol

equiv) (µg)

Vitamin C

(mg)

β-

carotene

(µg)

Average intake per person per day

Fresh potatoes 42 0 3.6 0 1.6 0.2 7.8 0 6.9 0

Fresh green

vegetables

4.7 0 8.9 0 2.2 0 13 14 6.0 85

Other fresh

vegetables

17 0 15 0.2 7.8 0.3 18 241 6.6 1447

Fresh fruit 44 0 9.4 0.4 66 0.2 11 5.2 15 31

Sub total 107.7 0 36.9 0.6 77.6 0.7 49.8 260.2 34.5 1563

Fresh F&V as %

of total nutrient

intake

5.6 0 4.4 0.8 3.3 7.0 21.0 31.6 48.6 69.6

Processed fruit 51 4.7 9.4 2.6 14 0.2 11 2.5 12 14

Processed

vegetables

125 0.7 24 5.2 171 0.8 22 48 6.1 261

All 283.7 5.4 70.3 8.4 262.6 1.7 82.8 310.7 52.6 1838

All F&V as % of

total nutrient

intake

14.8 8.1 8.3 10.6 11.3 17.1 34.9 37.7 74.1 81.8

Total household

intake

1916 67 848 79 2319 10 237 824 71 2246

EU Reference

Value for daily

allowance

800 14 200 800 60

Accordingly any conclusions drawn need to be considered cautiously. The term “nutrient rich” is

well illustrated in Table 1 with the contribution of all F&V to folate, vitamin A and vitamin C and β-

carotene intake clearly demonstrated at 37.7%, 74.1% and 81.8% respectively. Interestingly, the

choice to consume processed rather than fresh F&V can lead to higher fat intake per person per

day attributed to all F&V from 0.8% to 10.6% and non-milk extrinsic sugars from zero to 8.1%.

Undoubtedly, these factors are at play in the evidence that over the four year period from 2010

to 2013, intakes of most vitamins and minerals declined, notably Vitamin B6 and folate, with

decreases of 13 and 8.1 per cent respectively (DFFR, 2015). Accordingly, one in five people in the

UK now have a vitamin D status below the level deemed adequate (SACN 2015a cited by Miller

et al. 2016).



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The FSP (2014) and DFFR (2015) sources report purchasing statistics rather than actual

consumption of F&V. Home food waste reduces what is actually consumed by family members

collectively and statisticial analysis at the household level cannot account for variations in

individual consumption. Defra estimates that 22% of edible F&V purchased are wasted (FSP,

2015). Therefore whilst DFFR (2015) states that 2176g of F&V are purchased per person per

week (311g per person per day), using the Defra estimate of 22% waste this figure reduces to

241g of F&V per person per day only 60% of the WHO recommended 400g of F&V i.e. only 3 out

of 5 recommended portions. A study carried out by WRAP in 2007 considered food thrown away

by consumers in the home (WRAP, 2008). A follow on 2013 WRAP report Helping Consumers

reduce fruit and vegetable waste: Final Report concluded that non-consumed food is worth £2.6

billion annually, representing 27% of household waste by weight and 21% of overall waste by

cost. By 2012, there had been a reduction in fruit and vegetable wastage to 1.4 million individual

bananas per day from 1.7 million in 2007 and 1.5 million individual tomatoes per day down from

2.0 million in 2007 (WRAP, 2013). The study did not differentiate according to size or weight of

individual items. Improving storage in the home, especially refrigeration of F&V, would greatly

reduce wastage and help to bridge the F&V gap between what is purchased and what is

consumed. Whilst storage instructions are provided on pre-packed F&V, there is little information

for F&V sold loose (free-flow). The WRAP report produced in 2008 provided recommendations for

supporting consumers to reduce F&V waste. These recommendations also have value in

maintaining the intrinsic quality of F&V including taste and flavour and ensuring that more of the

F&V fruit purchased is actually eaten. Where storage advice was available on pre-packed

products, the report describes that it was often on the reverse of the label, only visible when

breaking the integrity of the packaging, and also in small print. The report notes that storage

advice should be included on the packaging of all pre-packaged products for example, “keep

refrigerated”, and more advice should be given at the point of purchase for loose F&V. This could

be in terms of shelf cards and information on paper bags.

A further theme highlighted in the report was the confusion of consumers when they saw product

on display in stores at ambient temperatures with storage advice on the pack to “keep

refrigerated”. The report suggests that only 23%-28% of people store fruit in a fridge so through

education there is the potential to improve behaviour in the home with regard to storage.

Ultimately the eating of low quality F&V is likely to discourage repeat purchase.

3.2. Diet related malnutrition (DRM)

3.2.1. Background

DRM which includes obesity, affected 3 million people in the UK in 2007 costing in excess of

£13bn and corresponding to about 10% of the expenditure on health and social care in that year

(Elia and Stratton, 2009). More widely across the European Union (EU) about 20 million people

are affected by DRM, costing EU governments up to €120 billion annually (Freijer et al. 2012).

This cost to a UK social health service free at the point of use is only set to increase. In a time of

governmental austerity with a stark focus on public spending and against a backdrop of nation

states in the EU struggling to service public debt this is a major challenge. In a debate in the House

of Commons in 2016, Dr. Sarah Wollaston stated:

“9p in every £1 we spend in the NHS is spent on diabetes. We estimate from the evidence

that the Health Committee took during our hearings that the overall cost of obesity to the

NHS is now £5.1 billion a year, and the wider costs to society have been estimated to be



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as high as £27 billion, although the estimates vary. We simply cannot afford to take no

action…..

As the Minister will recognise from the evidence presented by Public Health England,

price promotions will need to form an extraordinarily important part of the childhood

obesity strategy if it is to be effective. It is a staggering fact that around 40% of what we

spend on our consumption of food and drink at home is spent on price promotions.

Unfortunately, however, they do not save us as much money as we assume. They

encourage us to consume more… we should have a centrally-led programme of

reformulation across foods and drinks, and that what manufacturers want is a level

playing field. The trouble with reformulation is that it takes time; there has been an

effective programme on salt, but that has happened very gradually, over a 10-year period.”

Source: First Report from the Health Committee, Session 2015-16. Childhood obesity—brave and bold action, HC 465.]

The MacKinsey Global Insititute (MGI) report entitled ‘Overcoming obesity: an initial economic

analysis’ (Dobbs et al. 2014), states that obesity is one of the top three global social burdens

generated by human beings when measured in terms of the estimated annual global direct

economic impact and the required investments to mitigate the burden. In their study, smoking,

and armed violence war and terrorism each represent a direct economic impact of $2.1 trillion,

with obesity sitting at $2 trillion per annum which is 2.8% of global gross domestic product (GDP).

This figure in their study placed obesity well above climate change at $1 trillion and poor water

and sanitation at $0.1 trillion. The MGI report also considered potential interventions to address

obesity that are being discussed or piloted. Of the 74 interventions only three explicitly refer to

F&V: school canteen layout, workplace canteen layout and the prominence of healthy alternatives

(this is more fully discussed in the next section) and considering subsidies on F&V to influence

cost. The cost/benefit analysis undertaken by Dobbs et al. (2014) identified the following three

options in order of impact on obesity: portion control, reformulation, and high calorie

food/beverage availability closely followed in similar order of impact by weight management

programmes, parental education, school curriculum and healthy meals. Subsidies were not

highlighted as of value in the cost benefit analysis undertaken in this study.

3.2.2. Choice architecture and nudging

Choice architecture can be described as the informational or physical structure of the

environment that influences the way in which choices are made (Thaler and Sunstein, 2008).

Choice architecture is said to include reducing the portion size of unhealthy foods and changing

the relative pricing of foods (Dodds, 2014). When considering public food service layout,

Thorndike et al. (2014) suggested that choice architecture, i.e. the strategy used in health

promotion within public food service, can provide an environment that will actively influence

eating behaviour. In their study, cafeteria items were labelled green (healthy); yellow (less

healthy); or red (unhealthy) and the cafeteria layout rearranged in order to improve accessibility

to healthy items. The results showed that after 3 months of implementing this strategy, sales of

red items had decreased by 24% and two years later has still fallen by 20%. Green sales increased

by 41% after 3 months of implementing the changes to 46% two years later. In a study that looked

at layout of foods in food service and the order they are presented in a self-serve buffet, splitting

the F&V items into separate bowls and changing the order of serving to salad, then dressing, then

pasta, bread and meatballs saw a change in consumption of F&V from 19% in the control (i.e.

unchanged format with pasta, then, bread, then meatballs) to 33% in the amended layout



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(Kongsbak et al. 2016). Hanks et al. (2012:1) argue that: “Nutrition does not sell, but

convenience and taste do.”

On this basis they designed a study, involving 11,000 students, where healthier foods were made

more convenient in order to identify if this led to individuals selecting and eating healthier foods.

The convenience buffet line that included healthier food options and flavoured milk increased

sales of healthier food by 18% and the proportion of less healthy food decreased by 37%.

Interestingly consumption of flavoured milks increased as did levels of waste so not all the

healthier food chosen was eaten, but consumption of unhealthy options did reduce overall. Thus

convenience has a role to play in influencing choice behaviour, but it did not in this study drive

increased consumption of F&V. The authors argued that one reason for this could be that

convenience is generally associated with sweet, salty and fatty foods rather than healthful

alternatives. This could then be intrepreted that there were palatability issues with the chosen

food for some individuals which prevented consumption.

With a view to the UK, Park and Papadaki (2016), considered the nutritional value of food in

vending machines on a university campus. 82% of students in the study used vending machines

to snack between meals and the authors determined that most foods that were available in the

vending machines were of low nutritional quality. In a second study in a United States (US)

university, the vending machines were stocked with a ratio of red (28.5%), yellow (43%), and green

(28.5%) snack food items where red represents unhealthy and green healthy snack items (Caruso

et al. 2014). Purchasers stated they were most influenced by hunger (42%), convenience (41%)

and taste (10%), with red items selected at the highest frequency (59%) compared with green

items (8%). These studies show that although a higher proportion of healthy snack foods might

be made available, individuals may still opt for the less healthful choice. Rearranging the

environment surrounding food choices has increasingly been discussed in the context of

‘‘nudging’’ (Keller et al. 2015). Nudging refers to the purposeful changes within choice

architecture:

“that influence peoples' behaviour by making changes in the environment that guide and

enable individuals to make choices almost automatically. This can be done by simplifying

the information provided or by offering default choices in a way that facilitates socially

desirable decisions” (Lehner et al. 2015:2).

The Keller et al. (2015) study looked at the effect of position change on snack bar choice (see

Table 2) showing that positioning of food products influenced consumers’ choices. This is of

interest when considering options to increase the consumption of F&V products other than using

coercive policy approaches such as laws and bans. Lehner et al. (2015) list a number of so-called

“nudge tools” aimed at changing behaviour including the use of defaults i.e.

Changing the standard choice through reformulation of food products to include more F&V;

Changing layouts and features of different environments; and

Reminding people about their choices, drawing attention to social norms and framing

information and issuing warnings.

Examples have been outlined previously in this report with regard to food service and at retail

level too where choice architecture can incorporate nudge tools.

Payne et al. (2015) assessed the efficacy of a retail level intervention in two retail case studies

with the aim of increasing spending on F&V without increasing overall shopper budgets. The study



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incorporated the use of grocery cart (trolley) placards that detail the number of produce items

purchased at a particular store i.e. they reinforce the social norm for that community. Just over

970,000 transactions were analysed in the study with and without the use of placards and their

use increased spending on F&V by 12.4% per day per person in one store and 7.5% in another.

This increase in spending occurred without a change in total food spending. The conclusion was

that grocery cart placards were of value in increasing F&V consumption. The placard carried the

statement:

“In this store most people choose at least x produce items” with the x denoting the number.

In addition the placard listed the top ten F&V purchased in the store. The term “most people” was

used so that those purchasing above this amount would not feel that they had to reduce purchase

levels.

Table 2. The influence of positioning on food choice (Adapted from Keller et al. 2015)

ACTIVE CHANGE IN PRESENTATION AND IMPACT SOURCE

Increasing distance to chocolate snacks reduced intake Maas et al. (2012)

Amending layout of a self-service buffet changed F&V consumption from 19% to 33% Kongsbak et al. (2016)

Increasing availability of healthy snacks (75% versus 25%) enhanced probability of choosing

them

van Kleef et al. (2012)

Effort of unwrapping food or picking up with tongs reduced consumption of fruity and chocolate

snacks

Brunner (2013)

Apple bar selected almost three times more often when placed in the middle set of boxes than

when on the left demonstrating rearranging snacks on shelf influences consumer choice

Keller et al. (2015)

As consumption increases it is important to reflect this in the number of portions identifed on the

placard for example, increasing by 5 to 6 portions etc. Further retail interventions that have been

used to increase the consumption of F&V include mirrors on the shopping carts, arrows on the

store floor nudging customers towards the F&V aisle and yellow tape sectioning out the

cart/trolley3.

In a study reported in 2010, 58% of grocery shoppers said that store employees were readily

available when they needed help, but just a quarter of shoppers felt that grocery store staff were

knowledgeable about nutrition (FMI, 2010). There is therefore an opportunity for grocery stores

to increase the knowledge of their staff in order to assist shoppers in making more healthful

choices. This study differentiated between a group of consumers who stated they eat healthy

meals most days and those who stated they do not and asked a series of questions with regard

to how the retailer enabled them to make healthy food choices (Table 3).

Table 3. Supermarkets as an enablers of healthy eating (Adapted from FMI, 2010)

EAT HEALTHY MEALS MOST DAYS

DO DO NOT TOTAL

Helps me make healthy food choices 60% 34% 50%

Helps me make healthy choices for children 41% 25% 35%

Provides information on food and beverages that help manage

specific health concerns

44% 28% 38%

Promotes healthy living 61% 39% 53%

3 http://www.nytimes.com/2013/08/28/dining/wooing-us-down-the-produce-

aisle.html?pagewanted=all



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Stocks a wide variety of healthful foods and beverages 79% 60% 72%

Store employees are knowledgeable about nutrition 29% 17% 25%

Store employees are knowledgeable about nutrition supplements 30% 19% 26%

Store employees are readily available when I need them 64% 49% 58%

Table 4. Shopper interest in various services that might be provided by the supermarket where

they shop most often (Source: FMI, 2010)

INTEREST SERVICE OR PROGRAME INTERESTED SHOPPERS (%)

1 Coupons for healthy products More than 80%

2 Shelf labels that identify healthy products

70% to 80% 3 Product sampling or tasting in store

4 Healthy meal ideas and recipes

5 Reward programmes for purchasing healthy products

6 Freshly prepared healthy meals 60% to 70%

7 Programmes that recommend healthier options for products purchased

8 Recipes for special health concerns;

50% to 60% 9 In-store cooking demonstrations for healthy meals,

10 Information on how to treat common health concerns

11 Information on how to prevent common health concerns

12 Hands on cooking lessons for preparing healthy meals

40% to 50%

13 Health screening services

14 Weight loss or diet plan services

15 Nutritional counselling for adults

16 Personalised wellness plans

The three lowest overall responses are highlighted identifying that customers felt supermarkets

could do more to ensure store employees are knowledgeable about nutrition and nutrition

supplements and supermarkets could do more to help customers make healthy choices for their

children. These results demonstrate that there is much more that can be done by supermarkets

and their employees to promote the concept of healthy eating to customers in retail stores. In the

FMI (2010) study of 2559 respondents, shoppers were interested in their local supermarket

providing a range of services (Table 4) that all have considerable merit in increasing F&V

consumption through an integrated choice architecture programme that is delivered at retail store

level. The top five services of interest in the FMI study could be adapted for F&V, for example

coupons for F&V products, shelf labels that identify healthy products, product sampling or tasting

in store especially of F&V snack foods and convenience foods that have been reformulated to

include more F&V, healthy meal ideas and recipes and a reward programme for purchasing

healthy products. These are all worthy of consideration by retailers as are many of the other

elements contained within Table 4.

In the year ending March 2014, global snack sales totalled $374 billion annually an increase of

2% year on year (Nielsen, 2014). Interestingly the DFFR (2015) notes that in the UK confectionary

purchases when eating out are down 21% since 2011, and biscuit and chocolate sales are down

14%. In the Nielson (2014) on-line survey of 30,000 consumers in 60 countries, 76% of

respondents stated they eat snacks often or sometimes to satisfy hunger between meals or a

craving, 45% of consumer snacks as a meal alternative with many replacing breakfast (52%),

lunch (43%) and dinner (40%) i.e. snacks are often a quick “meal alternative”.



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As to motivational reasons for snacking, respondents stated that drivers included: to improve

mood (64%), as a reward (53%) and due to stress (44%). In Europe, the top snacks identified were

fresh fruit (63%), chocolate (61%), cheese (58%), yogurt (54%), vegetables (49%),

cookies/biscuits (45%). However it should be noted that this survey is with a subset of the total

population (i.e. those on-line) and the results may not translate to the food choices of the wider

public. In another study when asked if they ate healthy snacks on most days: 15% strongly agreed,

36% agreed, but 48% responded “not so much” perhaps indicating either a level of uncertainty or

that they might not want to disclose their eating activities to the researchers (FMI, 2010).

The US Produce for Better Health Foundation (PBHF) undertook a study in 2010 and considered

when F&V are eaten in the home and if consumption is a mealtime or a snack event (Table 5).

The data shows that fruit is eaten more evenly throughout the day and is often considered to be

a snack item. It should be noted that in this research, fruit juice was represented 38% of all fruit

classified as being consumed in the home, with fresh fruit representing 46%. Vegetables are

primarily consumed at lunch and the evening meal in particular, although the study noted that

vegetable consumption from evening meals is gradually reducing (PBHF, 2010).

Table 5. When are F&V eaten (Adapted from PBHF, 2010)

BREAKFAST (%) LUNCH (%) DINNER (%) SNACKS (%)

Vegetables 2 31 66 1

Fruit 44 24 17 15

CONSUMED IN HOME (5) CONSUMED IN RESTAURANTS (5) OTHER (%)

Vegetables 75% 15% 10% Note potatoes are

included in this category

in this study

Fruit 89% 3% 8%

All meals 84% 11% 8%

Therefore, if consumers decide to replace the evening meal with a snack food choices this

decision could impact particularly on total vegetable intake. For vegetables, 45% of all those

consumed in the home were fresh followed by frozen (11%), canned (10%) and homemade or

homegrown (25%). It was not clear in the study what consitituted homemade vegetables. The

report also considered the role of mothers’ knowledge and opinions with reference to F&V

consumption and differentiated between Generation X mothers (those born between 1965 and

1979) and Generation Y mothers (those born between 1980 and 1990). When asked what was

the favourite family fruit or vegetable there was a general similarity between the two groups in the

US survey (Table 6) in terms of the types of F&V consumed. Being a US study, corn is identified as

a favourite vegetable i.e. sweetcorn, or corn-on-the-cob. Interestingly, most Generation X mothers

believe that their families eat too little fruit (54%:49%) and too few vegetables (63%:54%).

Generation Y mothers are slightly more likely to believe their families already consume too many

F&V. Further Generation Y mothers were less likely to feel it was important to include F&V in their

family’s meals and snacks (87%:91%) and they were also less likely to want to include a greater

variety of F&V in their family’s meals (75%:79%). When asked what they considered as barriers to

increased F&V consumption Generation X and Generation Y mothers answered slightly differently

(Table 7).

Table 6. Top five favourite family F&V as reported by mothers (Adapted from PBHF, 2010)

FRUIT VEGETABLES

GENERATION X Y X Y



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First Apples (32%) Apples (28%) Broccoli (19%) Carrots (18%)

Second Bananas (22%) Bananas (23%) Corn (17%) Corn (17%)

Third Strawberries (12%) Strawberries (11%) Green Beans (14%) Green Beans (15%)

Fourth Grapes (8%) Oranges (9%) Carrots (13%) Broccoli (12%)

Fifth Pineapple (4%) Grapes (5%) Potatoes (6%) Potatoes (6%)

Table 7. Barriers to increased F&V Consumption (Adapted from PBHF, 2010)

GENERATION AGREE WITH STATEMENT

X (%)

AGREE WITH STATEMENT

Y (%)

Members of the family have different F&V likes and dislikes 63 64

I need ideas about new ways to prepare F&V 50 49

There is not a good range of F&V available in restaurants 46 41

Fruit are too expensive 38 43

Vegetables are too expensive 30 34

We already eat enough F&V 26 27

Vegetables are time consuming to purchase and prepare 20 22

Quality product is not available in local stores 19 16

Fruits are time consuming to purchase and prepare 15 14

Vegetables are not appetising 15 15

Fruits are not appetising 7 8

Key barriers that are worthy of further consideration in developing strategies to increase F&V

consumption are:

Members of the family having different F&V likes and dislikes;

Needing ideas about new ways to prepare F&V;

There not being a good range of F&V available in restaurants (more for Generation X than

Generation Y); and

F&V being too expensive (more for Generation Y than Generation X).

Generation Y mothers were much more likely to identify a need for financial support to be able to

include F&V in family meals and snacks (29%) compared to Generation X mothers (11%) and

spousal or family support was identified to be a barrier to including F&V in the family diet by

Generation X mothers (30%) compared to Generation Y mothers (27%) (PHBF, 2010). Different

ideas and recipes were also suggested as a valuable support to enable more F&V consumption.

Whilst Generation X and Generation Y mothers both gave “staying healthy” as an important reason

for eating F&V, the health benefits associated with F&V and the beneficial compounds found in

F&V are most often correctly identified by Generation X mothers.

Generation X mothers are more likely to use the internet as a source of information at 30%

compared with health care providers or dietitians at around 10%. For Generation Y mothers, 89%

would use the internet as a source of information about nutrition compared with health care

providers or dietitians at around 40% with only 3% considering the supermarket as a source of

nutritional information in both groups. Again this suggests that in this study mothers did not see

the supermarket environment as a space where nutritional information and advice could be

accessed.



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This section of the report demonstrates the multiplicity of social and environmental factors that

influence food environments and the potential for choice architecture in the home, and in retail

and food service environments. The next section of the report goes on to discuss other influencers

of F&V purchase and consumption.

3.2.3. Factors influencing food orientated behaviour

As food availability has increased so has eating frequency, sometimes described as continuous

grazing which is linked to increased eating opportunities, especially outside the home, driven by

the proliferation of “fast “outlets and the availability of “ready to go” foods often high in salt or

sugar to enhance palatability and extend shelf-life for example, cakes, cookies, chocolate bars,

crisps etc. (Colles et al. 2008). In this consumption environment there is limited access to F&V

and when available, F&V are often sourced globally (for example, bananas) so may not be offering

a business opportunity for the UK grower. The pattern of food consumption throughout the day is

important in terms of when and where the food is firstly purchased and then consumed. Thus the

availability of, and the opportunities for purchase and consumption of F&V at the times of demand

is crucial. Eating continuously throughout the day instead of eating planned meals can influence

what individuals believe to be the norm in terms of calorie intake and portion size (Bulik et al.

2007).

Kofman et al. (2010:1938) define grazing behaviour as: “repeated episodes of consumption of

smaller quantities over a long period of time with accompanying feelings of loss of control”.

An alternative definition is that grazing involves the repeated consumption of smaller amounts of

food over an extended period of time (Carter and Jansen, 2012) and they argue that grazing is a

relatively neglected high risk eating behaviour that can cause weight gain. This behaviour is seen

in many patients who present themselves for bariatric surgery (Colles et al. 2008; Kofman et al.

2010) and the behaviour can continue afterwards too, especially in those individuals who have

an eating disorder. This snacking trend has led to a rise in processed products specifically

marketed as healthy snacks, breakfast replacement cereal bars and single portion breakfast

items. Therefore, it is important in a culture that is socially moving towards grazing rather than

meal time eating that more nutrient-rich grazing or snack options are available. 26% of consumers

purchase pre-cut F&V due to the convenience of these items and 20% of consumers would like

to see more ready-to-eat single-serve F&V offerings become available on the market (Levesque,

2013 cited by Baker et al. 2015). Beets et al. (2014) undertook a study to consider in part the

snack selections made by children and determined that:

When fruit was the only snack selection on offer 21% of the children chose not to select a

snack at all;

When there was a choice of three snacks, fruit (sliced or whole) was seldom selected (6%)

when served simultaneously with a sugar-sweetened snack (57%), and a flavoured salty

snack (37%); and

In the fruit-only option, children were more likely to select sliced apples/oranges than

whole fruit.

When whole fruit was offered, the options were apples, oranges and bananas, sliced fruit was

oranges and apples, but this shows clearly that fruit was not the primary choice compared to other

snack products. Many food products targeted towards children have appealing names or are

shaped to have a fun appeal such as dinosaurs, letters, smiley faces, bears. Considering this, and



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building on the work of others (Table 8), Baker et al. (2015) developed what were considered

child-friendly pre-cut produce items i.e. F&V snacks shaped as butterflies, flowers, teddy bears

and so on. The study concluded that parents and caregivers, who were the focus of the study,

considered these shapes more visually appealing and were 34% more likely to select children

friendly shaped samples. Two thirds of parent participants perceived regular shaped cut fruit and

vegetables to be child friendly showing that marketing bite sized pre-cut F&V is an attractive

option for shoppers. There was also a willingness to pay extra for children friendly shaped F&V

samples showing that the development of a marketing strategy of this kind had the potential to

achieve increased selection and consumption of F&V by adult carers expecially women. Baker et

al. (2015) argue that as well as cost being a decision influencing factor, fun, peer acceptability of

lunch box contents, availability and convenience also all play a part.

Table 8. Enabling the appeal of F&V snack products aimed at children (Baker et al. 2015)

GENERATION SOURCE

Children preferred fun-shaped to regular-shaped vegetables. Olsen et al. (2012)

Selected vegetables twice as often when they had fun names (for example, in the school lunch line) and

increased their intake of F&V by 85% or more.

Wansink et al. (2012)

Jansen et al. (2010)

When children request the purchase of specific items at the store, around half of their purchase

requests are granted by parents.

Ebster et al. (2009)

O’Dougherty et al. (2006)

A greater proportion of children’s purchase requests are met early in the shopping experience leading to

consideration of where F&V are situated in the store.

Ebster et al. (2009)

Positioning child friendly foods at eye level has been shown to increase children’s purchase requests. Ebster et al. (2009)

Use of front-of-package characters and CF packaging Nicholls and Cullen, (2004)

Availability and price have affected social eating norms around what is deemed appropriate

consumption in terms of the amount, portion size, or specific food choices driven very strongly by

defined cultural practices and rules (Higgs 2015). Sturm and Datar (2005), determined in their

US study, that lower real prices for F&V were related to a significantly lower gain in body mass

index (BMI) in children between kindergarten and third grade; with half of that effect found

between kindergarten and first grade. Powell and Bao (2009) assert that a 10% increase in the

price of F&V was associated with a 0.7% increase in child BMI. In this latter study, the relationship

between F&V prices and fast food prices with BMI were significantly stronger both economically

and statistically among low- versus high-socioeconomic status children.

A retailer report produced by the Coperative Group in 2015 stated that:

“The biggest change in retailing over the past 50 years was the advent of self- selection of

products with the customer no longer handing over a list and relying on the shop keeper to

serve them”. (Co-op, nd)

Therefore the concept of food shopping with a pre-determined set of meals for each day through

a week has been replaced with an increasing consumer attitude of “shelf grazing” . The Co-op

report illustrates this with the following statistics:

35% of purchasers tend to adopt a ‘grazing’ shopping mentality, shopping for food multiple

times a week and 3% of the nation shop for food every day;

Only 19% of UK households plan their meals for the week ahead – with 31% deciding on

the day what to eat and 7% deciding on what to eat when in store.



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The reasons stated for the decline of menu planning include: not knowing what to buy that far in

advance (32%), uncertain weekly schedule (22%), menu planning considered as killing

spontaneity (20%) and getting stuck in a food rut (14%). The factors that have led to a decline in

the big weekly shop include: efforts to reduce food waste (1 in 4) and 27% of respondents stating

a big weekly shop no longer fits in with a busy lifestyle (Co-op, nd). Decision fatigue is the concept

that faced with continual multiple choices, decision making becomes more draining. Growing

decision fatigue is an issue with citizens of industrialised societies, as a result of information

overload, and the consumer’s “relative transaction costs in terms of time and energy for becoming

informed and how receptive they are to the message” (Kastberg, 2015 citing Caswell and

Mojduszka, 1996:1248). Making multiple choices can impair subsequent self-control which can

exhibit itself as less physical stamina, reduced persistence in the face of failure, more

procrastination and so forth (Vohs et al. 2014). Indeed, they propose that if certain food options

are seen as preventing the need to make complex decisions they are perceived as providing value.

Category management is the retail process of managing product categories such as F&V as

strategic business units within a retail store (Desrochers et al. 2003). Category management as

an activity involves customising the category by store location and region as well as co-ordinating

pricing and promotion strategies to produce improved sales and profits as well as deliver better

value to consumers (Desrochers et al. 2003; Bandyopadhyay et al. 2009) and to shareholders

too. Pricing and promotion strategies aim to minimise shrinkage and ensure optimum cost

effectiveness in the retail sector. In this context, shrinkage describes the loss in margin or

profitability incurred for a food retailer in terms of product spoilage, theft or wastage. More simply,

shrinkage is:

“The cash value of products that a retailer has bought, but that it neither sold nor has in stock

or the intended sales income that was not and cannot be realised” (Buck and Minvielle, 2013;

ECR, 2004)

Shrinkage can fall into four categories: internal theft, external theft, inter-company fraud and

process failures such as a deterioration in product value over the time the product is in-store.

Shrinkage can be measured by individual item or stock keeping unit (SKU) and also via a particular

supply chain route (ECR, 2004). It can be reported as a percentage of turnover, cost price and

retail price (ECR, 2004). The shrinkage for the fresh produce department is second-highest (4.8%

of retail sales) after meat at 16% (Buzby et al. 2015). For meat, a proportion of the losses are due

to theft from retail shelves as meat is often a high value item especially compared to fresh

produce. With F&V much of the shrinkage can be attributed to the inherent perishable nature and

deterioration in quality whilst on shelf. However, promoting F&V choice at retail level requires a

full and well-stocked range to be available so meeting such consumers’ choice expectations

increases the risk of products going past the duration date marked on the packaging (ECR, 2004).

Novel ideas of promoting F&V whilst reducing shrinkage will deliver increased financial returns to

the retailer and the wider supply chain. In a US study, it has been estimated that for the years

2005/2006 annual supermarket shrinkage averaged 11.4% for fresh fruit and 9.7% for fresh

vegetables by weight rather than value of retail sales (Buzby et al. 2009). In a study published in

2015, considering US supermarket estimated shrinkage and loss for F&V provided data as

follows: radishes 23%; leaf lettuce 20%; apples, grapefruit and avocados 19%; spinach 18%;

cauliflower and mushrooms 17%; plums, oranges, kiwi, pears 15%; strawberries and tomatoes

14%; cucumbers 12%; head lettuce, potatoes 8%: and cabbage, carrots broccoli and onions 7%

(Buzby et al. 2015). Shrinkage rates (including markdown) can vary widely: Buck and Minvielle,

(2013) suggest 3 to 5% by volume for fresh produce at best-practice retailers, 6 to 8% among



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average performers, and 9 to 15% at under-performing retailers. Thus the impact of shrinkage

rates of F&V compared to other other foods will influence both the retail shelf space allocated

and the number of SKU on offer. Shelf space allocation between F&V and other food products

and its relationship with the health status of people who live in surrounding communities is a

factor worth considering. Rose et al. (2009) investigated the F&V to snack food ratio at the retail

shelf space level. In their study in New Orleans, they identified that in convenience, drug and

general merchandise stores the ratio was nearly 0. The ratio improved in groceries and

supermarkets to small groceries (ratio 0.29), middle sized groceries (0.42) and supermarkets

(0.66). Thus in many retail settings healthful snacks are simply “crowded out” by unhealthy

alternatives or not present at all. Evidence from a ten country study on the shelf space devoted

to eight categories of foods, and the relationship to mean population BMI concluded that a higher

percentage of shelf space devoted to F&V products in their different forms was associated with a

lower national BMI (Norman et al. 2014).

Five aspects of shelf space allocation can influence the financial performance of a retail store:

fixture location, product category location, item location within categories, off-shelf display, and

point of sale (POS) promotional support (Yang and Chen, 1999). POS information in food retail

stores, with particular emphasis on F&V is the use of shelf labels and/or signage that specifies

healthy food choices, based on established criteria (Glanz and Yaroch, 2004) i.e. as a concept it

interfaces with literature previously described on choice architecture. It is important too to

consider that often manufacturers of branded product and retailers can have divergent profit

objectives. A manufacturer wants to maximise the profits of its own branded products on the

shelves (Bandyopadhyay et al. 2009) which may actually be in competition with the own-label

retailer branded alternatives. Conversely the retailer wants to maximise the profit of the whole

product category. Glanz et al. (2012) suggest several in-store marketing strategies such as

increasing availability, affordability, prominence, and promotion of healthful foods and/or

restricting or de-marketing unhealthy foods.

Healthy choice POS support can be used through the use of single or multiple communication

options such as posters, shelf labels or “menu and/or signage specifying that food items are good

sources of F&V choices, often along with recipes and/or food demonstrations.” (Glanz and Yaroch,

2004). In Baltimore US, a multicomponent intervention was used to reduce environmental

barriers to purchasing health food options in a supermarket (Lee et al. 2015). This

multicomponent intervention (as has also been described previously in association with other

studies in this report) included: shelf labels and in-store displays promoting healthy foods, sales

and promotions on healthy foods, in-store taste tests, increasing healthy food products,

community outreach events to promote the intervention, and employee training. The impact of

these multiple interventions was mixed and one factor recommended as requiring closer attention

was the conflict between limited employee time availability and low profit margins at store level

and the ability to integrate the intervention goals in order to promote healthful eating.

Dodds et al. (2014) in their study concluded that there was no evidence to suggest a single activity

such as energy labelling or single traffic light labelling on fast food was effective in reducing the

energy of fast food items chosen from hypothetical fast food menus. Sharpe and Staelin (2010)

considered the consumption effect of bundling. the practice of combining a set of foods, often

three items in order to promote a discount for example, meal deals in food service and retail

stores. They concluded that the value derived by consumers was not only the promotional effects

of the bundle itself, but also the reduction in ordering costs to the individual. This reflects the

notion of decision fatigue already described in this section. Although their study focused on fast



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food rather than “meal deals” in the retail grocery environment, if bundled options do not feature

F&V products, this will cause consumers to potentially disengage from single F&V products where

they actually have to make a decision what they combine them with. Further, if the meal deal

items suggested are energy dense then this will raise the calorie content of the meal option as

marketed.

3.2.4. Relationship between the density and type of food outlets and general obesity

status

In the wider context of food sales when considering both retail shelf allocation and also the total

number of food outlets in a given location, two terms have been defined in the literature, namely

food desert and food swamp. The term food swamp is less widely used than the term food desert,

The USDA define food deserts as:

“urban neighbourhoods and rural towns without ready access to fresh, healthy, and affordable

food. Instead of supermarkets and grocery stores, these communities may have no food access

or are served only by fast food restaurants and convenience stores that offer few healthy,

affordable food options” (USDA, nd).

Rose et al. (2009) describe a food swamp as:

“an area where relatively large amounts of energy dense snack foods inundate healthy food

options”.

This term suggests that where there is an extensive amount of energy-dense offerings available

this inundates, or swamps out, the relatively few nutrient rich and/or healthy food choices

available. In another example, a food swamp has been said to indicate “low-income, urban

communities that have a plethora of fast food outlets (FFO), convenience stores, mini marts, gas

stations, and liquor stores that sell food.” (Taylor and Ard, 2015:102). A study conducted in

Mexico concluded that excessive access and exposure to unhealthy foods and drinks, or “food

swamps,” may be a greater concern than food deserts for obesity-prevention policy (Bridle-

Fitzpatrick, 2015). These definitions and the wider discussion on shelf space ratio in vending

machines and on retail shelves in this report brings into question the potential for there to be a

relationship between the density of food outlets and density of energy dense foods and the

general obesity status of a given community

Residents of low-income, minority, and rural US neighbourhoods are affected by poor access to

healthy food (Jetter and Cassady, 2006; Larson et al. 2009). The lack of availability, and often

relatively high cost, of healthy foods in small grocery stores located in low income, deprived

neighbourhoods as well as limited transport options, may be a deterrent to healthier eating among

very low income consumers. Another factor could be the higher density of FFO (Celnick et al. 2012;

FPH 2005). Celnik et al. (2012) identify that FFO in the UK tend to be located in areas of higher

deprivation where people are under greater economic pressure and time stress. In these areas,

obesity is more frequent and awareness or concern over the links between food choices and

health tend to be low. In a study in New Orleans, the provision of fresh produce by small urban

food stores located within 100m of residences seems to encourage greater uptake of fresh F&V

(Bordor et al. 2007). Increased fast food purchasing is found to be associated with lower

education, blue-collar employment, and low household income (Thornton et al. 2011). The

existence of more types of food outlet in an area, including supermarkets, is associated with

higher BMI (Shier et al. 2012). Conversely, Zick et al. (2009) determined a strong association

between increasing neighbourhood retail food options and lower BMI/obesity risk with the



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magnitude of the effects varying with a lower influence in low income areas. Hutchinson et al.

(2012) say the relationship is nuanced and impact can be measured by comparing the relative

amounts of healthy (for example, F&V) to unhealthy foods (for example, energy-dense snacks) i.e.

the ratio as explored by Rose et al. (2009) previously. Hutchinson et al. concluded that higher

quality food environments, not food store types, decrease the risk of obesity and overweight.

With specific emphasis on FFO, Fraser et al. (2012) identified an association between area level

deprivation and fast food density but not between BMI, and FFO access in pregnant women in

Bradford, UK. However, Polsky et al. (2016) in their work in Toronto, Canada found a direct

relationship between the proportion of FFO relative to all restaurants and excess weight,

particularly in areas with high volumes of FFO. There is a body of research that has also found a

relationship between the density of FFO and obesity in children. Cetateanu and Jones (2014)

suggest a positive association between the density of unhealthy food outlets in a neighbourhood

and the prevalence of overweight and obesity in children. A second study showed that higher

levels of FFO saturation were associated with increased levels of childhood obesity in both urban

and poor areas (Newman et al. 2014). The work of Fraser and Edwards (2010) in Leeds, UK

concludes that firstly there is a positive relationship between the density of FFO per area and the

obesity status of children and secondly there is also a significant association between FFO density

and areas of higher deprivation. However, Lee in her (2012) US study concluded that differential

exposure to food outlets did not independently explain child weight gain over time and that other

social factors were of influence too. In the UK, the Faculty of Public Health argues that improving

access to affordable, good quality foods for those with limited transport would improve health

(FPH, 2005). They suggest that such concerns must be considered in the planning and

regeneration of town centres and residential areas. Caraher et al. (2014) undertook research

determining the location of FFOs around secondary schools and the influence of fast-food

availability on the food choices of school children in an inner-London borough. The findings were:

The students reported use of the FFOs, including: “stories” of skipping lunch in order to

save money and eat after school at the outlets.

At lunchtime the FFOs were less likely to be used by school students in areas near schools

that have a “closed gate” policy.

Food from FFOs was high in fat, saturated fat and salt, but these are not the only source

of such foods, with many of the students reporting buying from shops near the school or

on the way to or from school.

With a view to local policy context the study concluded that action was required to improve both

the food offered in schools and the immediate environment around the school in order to tackle

fast-food and other competitive foods on offer outside the school. This requires an integrated

public health solution approach where public health and planning services work together to

deliver multiple benefit.

3.3. Summary

The aim of this study is to undertake a desktop review to determine the enabling and constraining

factors that influence UK consumer consumption of F&V with a view to providing options for action

on how such consumption could be increased. Thus whilst this section has provided a background

and context to the report the study is not focusing on the wider socio-economic factors that create

the obseogenic environment. This report seeks, based on a rational underpinned by research, to



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review the opportunities for increasing F&V consumption in the UK. As this introduction shows

such opportunities sit within the scope of governmental responsibility, corporate policy and

personal responsibility too in terms of choice architecture at food service, food retail and urban

planning levels. The next section of the report focuses on global public health initatives (PHI) to

promote healthy eating.



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4. Global public health initiatives to promote healthy

eating

4.1. Introduction

Before discussing the global policy initatives that have been developed to promote healthy eating

it is important to distinguish between the strategies that drive both prevention and intervention.

Rose (2008) stated that the challenge in the modern medical environment is that in an era of risk

screening and then treatment, semi-quantitative and quantitative risk assessment as well as risk-

benefit and cost-benefit analysis is often focused, rather than on the population as a whole,

instead on those most at risk. This approach of focusing on those most at risk can ultimately have

limited overall impact on the health status of the population as a whole.

With specific focus on diet related malnutrition (DRM), in a population that is influenced, as

outlined in the previous section with different environmental and social factors, individuals in that

population will have various degrees of diet related risk. Therefore the risk:benefit and cost benefit

analysis approach for determining the appropriate public health interventions that could be

adopted may only reflect action to be taken for those individuals at extreme risk, such as the use

of bariatric surgery, which at a population level can only improve the lives of a few. Instead

implementing policy instruments that enable whole population shift may well have more overall

impact on society than simply focusing on reducing risk in a much smaller high risk group.

Therefore Rose (2008) argues that there is a disease prevention paradox where a particular policy

instrument or measure could bring large benefits to the community as a whole, but actually offer

little personal reward to each participating individual. If this is the case then an individual’s

response to this type of public health initiative (PHI) is unlikely to be motivated powerfully at the

individual level by the prospect of better personal health especially where the reward for changing

behaviour may not be readily visible.

Therefore governments may well follow a dual policy approach with firstly wider policy instruments

that benefit the community as a whole (for example, the United Kingdom (UK) salt reduction

strategy of 2006) as well as targetted policy instruments that focus on low numbers of high risk

individuals (for example, obesity intervention through surgery). Thus, it is critical to distinguish

between the causal factors of incidence of DRM at the population level and the causal factors

that may differ the risk for specific individuals. Furthermore, a given population or sub-population

may not experience the same causal factors that work at the individual level, such as genetic

susceptibility to weight gain, mental health status employment and education status. Accordingly,

those developing global PHI need to recognise that such instruments must be developed to act at

both the individual and population level. Rose (2008) described this dual approach as individual

based strategies and population based strategies (Tables 9 and 10).

This means when comparing PHI from one country to another both individual based and/or

population based strategies may be employed. Population-based PHI can be divided into three

broad components: government structures to support policies and interventions for example,

funding, public health monitoring systems and so forth, population wide policies and initiatives

that influence the food environment for example, laws and regulations, taxes and subsidies, social

marketing campaigns, restrictions on marketing unhealthy food and community based

interventions for example, initiatives at community, or school level (WHO, 2012). Thus particular

policy approaches will vary in terms of the communities and the individuals that the different



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interventions might influence and affect and the mechanism of how each intervention works as

well as the degree of benefit derived at an individual or population level needs to be fully

understood.

Table 9. Dual strategies of prevention

INDIVIDUAL BASED STRATEGIES POPULATION BASED STRATEGIES

Identify individuals at high risk screening Identify important risk factors for the community

(prevalence)

Intervene only in individuals at high risk Policy to reduce risk factor irrespective of individual risk

Risk-benefit balance individually assessed Risk-benefit balance for whole community

Table 10. Dual strategies of intervention

INDIVIDUAL INTERVENTION POPULATION INTERVENTION

Individuals identified Yes No

Potential benefits for individual Large Small

Potential benefits for population Small Large

Understanding of effects Good Poor

The World Health Organisation (WHO) recommended in 1990, a minimum consumption of 400g

of fruit and vegetables (F&V) per day per person (WHO, 1990). This section of the report considers

the global PHI that spin out from that 400g per day WHO recommendation of F&V consumption

and how successful the PHI have been and if not, the reasons why.

4.2. Global Public Health Initiatives (PHI)

Over the last twenty years, obesity as a condition has become socially normalised. Until 1980,

less than 10% of the population was obese in Organisation for Economic Co-operation and

Development (OECD) countries (OEDC, 2014). However nearly thirty-five years later, across the

OECD (34 countries) 18% of the adult population is now defined as obese. This varies between

countries with more than one in three adults in Mexico, New Zealand and the United States (US),

and more than one in four in Australia, Canada, Chile and Hungary being defined as obese (OEDC,

2014). Hawkes et al. (2015) proposed four mechanisms through which food policies can affect

diet: (1) providing an enabling environment for learning of healthy preferences, (2) overcoming

barriers to the expression of healthy preferences, (3) encouraging people to reassess existing

unhealthy preferences at the point-of-purchase, and (4) stimulating a food-systems response.

They concluded that food-policy actions that lead to positive changes to food, social, and

information environments and the systems that underpin them were the most effective. This

meant that food-policy actions needed to be:

“tailored to the preference, behavioural, socioeconomic, and demographic characteristics

of the people they seek to support, are designed to work through the mechanisms through

which they have greatest effect, and are implemented as part of a combination of mutually

reinforcing actions. Moving forward, priorities should include comprehensive policy

actions that create an enabling environment for infants and children to learn healthy food

preferences and targeted actions that enable disadvantaged populations to overcome

barriers to meeting healthy preferences.” (Hawkes et al. 2015)

Allender et al. (2011:271) in their paper considering policy change to create supportive

environments state that:



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“Identification of the least resistant parts of the policy nexus within a local government and

targeting evidence towards this entry point would resent a strategic approach to successful

policy change.”

Potential policy strategies that could be employed are: the use of social marketing, the provision

of healthier food at low cost and the taxation of unhealthy food, although the latter are far more

intrusive methods of “nudging” than the use of social marketing (Allender et al. 2011). Obesity is

estimated to be responsible for 1% to 3% of total health expenditure in most countries (5% to 10%

in the US) and costs will rise rapidly in coming years as obesity-related diseases set in (OEDC,

2014). Goodman et al. (2014) highlight that in order to define community health and identify the

stakeholders and agents that play a role in developing a community health policy the concept of

what a community is needs to be defined. The authors citing MacQueen et al. (2001) consider the

weakness in describing not only what community is, but also the perceptions of different potential

collaborators of what a community looks like in practice, and this can ultimately undermine the

assessment of how community collaborations actually play a role in achieving public health

objectives. Lebel (2003) suggests that rather than the biomedical approach to assessing health

there should be an ‘ecosystem approach’ whereby health is also considered as being influenced

by community, environment and the local (and wider) economy. Clearly, from a public health policy

perspective, access to, and the take up of, nutrient-rich foods by disadvantaged communities as

well as society as a whole needs to be considered a priority for government. Table 11 contains

examples of global obesity orientated PHI.

Frieden et al. (2010) suggest that the food environment can improve nutrition through a three-

fold strategy: altering relative food prices, shifting exposure to food, and improving the image of

healthy food and making unhealthy food less attractive.

“Policy strategies that are of value include: tax policies, pricing strategies, influencing exposure

and access to healthy food, zoning restrictions to limit the density of FFO, voluntary

advertisement restrictions, banning certain food advertisements especially those aimed at

children at certain times, counter-advertising, improving the image of healthy foods, and eating

out” (Frieden et al. 2010).

Panjwani and Caraher (2014) assert that despite widespread recognition of the scale of the

problem, in no country has incidence of obesity been reversed purely by public health measures.

Many health disparities in the US are linked to inequalities in education and income (Drewnowski

and Specter 2004) where high-fat, energy-dense diets are more affordable than diets based on

lean meats, fish, fresh vegetables, and fruit. The association between poverty and obesity may be

mediated, in part, by the low cost of energy-dense foods and may be reinforced by the high

palatability of sugar and fat they contain. A theme that has arisen elsewhere in the literature

decribed in this report.

4.1. US Policy provision to increase consumption of F&V by low income

households

The 1996 Federal Agriculture Improvement and Reform Act (FAIR) established new authority for

the use of federal grants to support the development of Community Food Projects, and the Farm

Security and Rural Investment Act of 2002 re-authorized the programme (USDA, 2015a). Thus

the Community Food Projects Competitive Grant Program (CFPCGP) was introduced under FAIR to

address food insecurity in the US through the development of community food projects that

focused on low-income communities. As stated by (USDA, 2015a):



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“Community Food Projects are designed to increase food security in communities by bringing

the whole food system together to assess strengths, establish linkages, and create systems that

improve the self-reliance of community members over their food needs.”

The CFPCGP is designed to develop long-term planning, capacity and solutions that:

Meet the needs of low-income people by increasing their access to fresher, and more

nutritious food;

Promote comprehensive responses to local food, farm, and nutrition issues;

Meet specific state, local, or neighbourhood food and agricultural needs for infrastructure

improvement and development. This required linkages to develop between two or more

sectors of the food system these can involve for-profit and nonprofit organisations that are

working together;

Plan for long-term solutions; and

Create entrepreneurial projects and innovative marketing activities that mutually benefit

agricultural producers and low-income consumers.

The US Department of Agriculture (USDA) National Institute of Food and Agriculture (NIFA) is the

body that through the Food Insecurity Nutrition Incentive (FINI) Programme (established by the

US Agriculture Act of 2014) is allocating funding in a competitive grant system (Wholesome Wave,

2015a). The grants, managed by NIFA and USDA’s Food and Nutrition Service (FNS, aim to

support projects that provide F&V incentives to participants in the Supplemental Nutrition

Assistance Program (SNAP). The USDA will allocate $20 million for fiscal year 2016, $20 million

for 2017, and $25 million for fiscal year 2018. Of the amount available each fiscal year, 90% of

funds are expected to be made available for grants and 10% is expected to be retained by USDA

for evaluation purposes (Wholesome Wave, 2015a). In this context, the term “incentive” is said

to mean any financial or non-financial inducement that would increase the purchase and

consumption of eligible F&V by SNAP clients. Examples of allowable financial incentives include,

but are not limited to, vouchers for eligible F&V or benefits redeemable for having purchased F&V

and direct point of sale discounts on eligible F&V (USDA, 2015b). Non-financial incentives that

can form part of the programmes include: free portions of eligible F&V and nutritional education.



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Table 11. Examples of Global Public Health Initiatives (Adapted from: OEDC, 2014; WCRFI,

2015)

COUNTRY PUBLIC HEALTH INITIATIVES

Chile Chile’s law on food labelling and advertising, introduced in 2012, aims at limiting access to potentially unhealthy food for children, and covers

advertisement on media, point-of-sale marketing, promotions and the school environment. The law is currently being implemented. In 2015 the

Chilean authority approved the regulatory norms required for the law’s implementation.

Denmark The tax on saturated fat introduced in Denmark in October 2011 reduced the consumption of the taxed products by 10% to 15% in the first nine

months, with demand partially shifting from high- price supermarket to discount stores. The revenues raised between November 2011 and January

2012 were more than 96% of those originally forecasted. However, the tax was abolished in November 2012, amidst political controversy and lobby

pressures. The Code of Responsible Food Marketing Communication was issued by the Forum of Responsible Food Marketing Communication, a

cooperation between Danish industry organisations of the food and beverage, retail and media sectors. The Code is a voluntary, self-regulatory

initiative effective since January 2008, applicable to food and beverage marketing to children aged 13 and under via media outlets (TV, radio,

internet, SMS, newspapers, comic books). The Code sets guideline limits for salt, sugar and fat content in ten food categories. It is recommended that

food products exceeding these limits should not be marketed to children. Food manufacturers themselves determine if their products are suitable for

marketing to children. Compliance is checked by the secretariat of the Forum. The Danish government follows the results of the Code, and annual

status meetings are held between the Danish Veterinary and Food Administration and the Forum.

France Tax on soft drinks implemented in France. The degree to which the tax was passed on to consumers varied from 60% for fruit drinks to 100% for

carbonated drinks. All television advertising (targeted at children or adults) for processed food and drinks, or food and drinks containing added fats,

sweeteners and/or salt, must be accompanied by a message on the principles of dietary education as approved by the National Institute of Health

Education. The messages were defined by a 2007 Decree: "For your health, eat at least five fruits and vegetables a day"; "For your health, exercise

regularly"; "For your health, avoid eating too many foods that are high in fat, sugar or salt"; "For your health, avoid snacking between meals".

Hungary The Public Health Tax on Food Products introduced in Hungary in 2011 led to a 29% price increase, and a 27% drop in sales, for the taxed products.

It is estimated that 40% of food manufacturers reformulated their products by reducing or eliminating the ingredients associated with the tax

although there are some questions on validity of the results.

Iceland Iceland passed a law banning advertising in programmes aimed at children aged less than 12 in 2013. Advertising, sponsorship, teleshopping and product

placement of foods high in fats, sugars and salt, as defined by a nutrient profiling model, are prohibited during children’s TV and radio programmes

where over 50% of the audience are under 18 years old (Children’s Commercial Communications Code, 2013 revision). In addition, there is an overall

limit on advertising of foods high in fats, sugars and salt adverts at any time of day to no more than 25% of sold advertising time and to only one in

four advertisements. Remaining advertising targeted at children under the age of 13 must not include nutrient or health claims or include licensed

characters.

Iran Broadcast advertising of soft drinks has been prohibited since 2004. In 2014, in the context of the Iranian Fifth Five-Year Development Plan (2011-

2015), the Ministry of Health and Medical Education prepared a list of 24 food items to be prohibited from advertising in all media. The list has been

sent to the Commerce, Industry and Finance ministries for approval.

Ireland In 2012, the Irish Department of Health estimated that a 10% tax on sugar sweetened beverages (SSBs) would reduce calorie intake by 2.1 Kcal per

week, on average (with a greater reduction in young people), and translate into 10 000 fewer obese adults. Based on this evidence, the Department

of Health proposed a 20% tax on SSBs during the discussion of the 2014 budget, but the tax has not been adopted.

Japan In Japan, a programme of health examinations to identify people at risk for the metabolic syndrome and prevent its chronic disease consequences

has been in place since 2008. Starting in 2013, insurers’ contributions to cover care for the elderly will be linked with insurers’ achievement of

coverage targets for such health examinations.

Mexico Mexico has adopted one of the most comprehensive government programs. A National Strategy for the Prevention and Control of Overweight, Obesity

and Diabetes was launched in the second half of 2013. The policy has three pillars: improved public health and surveillance; better medical care for

people with chronic diseases; regulation and fiscal measures. During the first phase of the strategy, the Mexican authorities have launched a media

campaign aimed at raising public awareness of obesity and related chronic diseases. At the same time, a number of states started piloting the use of

new technologies and non-economic incentives for physicians with the objective of increasing uptake and compliance to medical prescriptions for

people with diabetes, high blood pressure and other related chronic diseases. Mexico is also reinforcing its regulatory framework on food advertising

to children, labelling of processed food, availability of food in schools and taxation of unhealthy food. In January 2014, Mexico implemented a new

tax levied at a rate of 8% on food with an energy content exceeding 275 Kcal per 100g, and 1 peso (EUR 0.06) per litre on sugar-sweetened

beverages. Revenues are expected to support public health programs, although they are not formally earmarked. The tax was met with strong

opposition by the industries concerned, but was relatively well accepted by the Mexican population. New regulations were introduced to protect

children from exposure to advertising of potentially unhealthy foods. They ban the advertising of potentially unhealthy foods, on radio and TV, during

hours in which children are a significant component of the audience (between 07:00 and 19:30 during week- ends, and between 14:30 and 19:30

during week days) exceptions are programmes such as sport events. Restrictions will apply in cinemas showing movies aimed at children, but do not

cover billboards and the Internet.

Norway The government already restricts all broadcast advertising to children through legislation in Norway (Broadcasting Act 1992). A voluntary initiative

agreed in 2013 calls on industry to follow standards (set largely by government) on a further range of communications channels. It applies to

marketing to children under the age of 13. In 2011, the Ministry of Health signed a Memorandum of Cooperation with the Federation of Food

Enterprises and the Association of Soft Drink Companies to encourage companies not to advertise soft drinks to children aged 12 and under. The

Memorandum applies to soft drink marketing in movie theatres and on TV if the audience consists of at least 50% children, and includes marketing

activities on the internet and in the press.

UK Advertising and product placement of foods high in fats, sugars and salt, as defined by a nutrient profiling model, is prohibited during TV and radio

programmes that have 20% or more viewers under 16 years old relative to the general viewing population (includes sponsorship of TV programmes).

The restrictions came into force in February 2007, with a phased implementation by advertisers by end of 2008.

US The US government has proposed to overhaul food nutrition labels, in particular to revise serving sizes, display calories more prominently, and include

information on added sugars. If approved, food manufacturers will have two years to implement the new labels. A further multi-stakeholder example

is the DrinkUp campaign promoted in 2013 by the Partnership for a Healthier America, chaired by the First Lady of the United States, and including a

large number of business and civil society partners. The campaign had a scientific data-drive design, and early monitoring data show it has had some

success in increasing water drinking.

The grants are intended to help eligible private nonprofit entities that need a one-time infusion of

federal assistance to establish and carry out multipurpose community food projects (USDA,

2015a). There are three categories of projects within the FINI scheme (USDA, 2015c). These are:



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FINI Pilot Projects (awards not to exceed a total of $100,000 over one year);

Multi-year, community-based FINI Projects (awards not to exceed a total of $500,000 over

no more than four years); and

Multi-year, FINI Large-Scale Projects (awards of $500,000 or more over no more than four

years).

All FINI projects must increase the purchase of F&V by low-income consumers participating in

SNAP by providing incentives as previously described at the point of purchase. One such project

is Wholesome Wave. Founded in 2007, in the following year it piloted the Double Value Coupon

Programme at 12 markets in three states (Wholesome Wave, 2015b). As this programme evolved,

it spread nationally across the US to become the National Nutrition Incentive Network and

encompassed many initiatives including the Fruit and Vegetable Prescription Programme and

Healthy Food Commerce Initiative.

Figure 1: Development of Local Supply Chain Networks and Regional Food Hubs (Source:

Wholesome Wave, 2015c)

The collaborative approach now has more than 110 community based partners in 38 states and

DC and is implemented at more than 730 farmers markets, dozens of community health care

centres, hospitals and food hubs throughout the US. These initatives can be summarised as:

A national network of nutrition incentive programmes that provide a monetary incentive

when low-income consumers spend their federal nutrition benefits at farmers markets and

other retail outlets on fresh F&V;

Providing families affected by diet-related diseases (such as obesity and type II diabetes)

with a prescription for F&V to be spent at participating farmers markets and retail outlets;

and

Healthy food commerce investments improving the supply chain for local food by working

with food hubs to structure investments and enter large wholesale markets (Figure 1).



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4.2. Dietary Public Health Initiatives (PHI): 5-A-DAY programmes

4.2.1. Global overview

The most widely adopted global dietary PHI are the 5-A-DAY programmes that were developed to

increase F&V consumption towards the WHO recommendation of at least 5-A-DAY or 400g per

day.

Table 12: Global PHI F&V promotion campaigns

COUNTRY FRUIT AND VEGETABLE

PROGRAMME

TARGET AUDIENCE COORDINATION MAIN ACTIVITIES

Australia Go for 2 and 5 General population, school

children, young children, low

income groups, household

shopper

Government, NGOs

and private sector

Media campaign, school canteen accreditation,

school fruit and vegetable week, nursery

scheme, low-income project

Canada Fruits and Veggies - Mix it up!™ General Population,

schoolchildren

NGOs Media campaign and educational material

Denmark 6 om dagen General Population,

schoolchildren, workers,

consumers, catering

Government, NGOs

and private sector

Media campaign and educational material,

worksite interventions, school fruit scheme

France 10 par jour General population,

schoolchildren, consumers,

workers

Government Media campaign and educational material

Germany 5 am tag General population NGOs Media campaigns, educational materials

Hungary 3 a day ('Eat 3 types of fruits and

vegetables 3 times a day for your

health')

General population, children,

young people, household

shoppers

Government, research

institutes

Media campaign, educational materials,

supermarket promotions, cooking shows, taste-

testing at school

Japan Vegefru-7 General population Government, private

sector

Media campaign, educational materials,

supermarket tours, harvesting tours.

Netherlands 2+2 General population, children Media campaign, interactive website for children

New Zealand 5 a day General population, children NGOs, private sector Media campaign, school programme,

educational materials

Norway 5 om dagen General population,


workers

Government, NGOs,

private sector

School fruit scheme

Poland 5 a day General population NGOs, research

institutes, private

sector

Media campaign, promotion activities in

nurseries and schools

Spain 5 al dia General population, children Media campaign and educational materials,

activities for children, symposia, events with

agriculture sector

Sweden 5 om dan General population,


workers

Government, NGOs,

research institutes,

private sector

Series of activities involving health, nutrition,

education and commercial sectors

Switzerland 5 am tag/ par jour/ al giorno General population,


workers

Government, NGOs,

research institutes,

private sector

Media campaign and educational materials, food

giveaway sessions in public places

UK 5 a day General population, school

children

Government Media campaign, educational materials, school

fruit scheme, local community projects, logo for

retail sector

US -5 a day

-5 to 9 a day for better health

-Fruits and Veggies- More Matters

General population, mothers,

children

Government, NGOs,

private sector,

research institute

Media campaign, educational materials, logo for

retail sector

(Adapted from Hawkes 2013, Pomerleau et al. 2005, Rekhy & McConchie 2014)

This type of intervention was first launched in the US in 1991, and has been embraced by several

other countries. However, the impact of these initiatives on increasing F&V consumption on a

sustained basis remains modest (Rekhy and McConchie 2014). Various global interventions to

promote the consumption of F&V have been initiated by government, industry and not-for-profit

organisations (see Table 12). These informational and educational campaigns have had mixed

results. Success has been reported for those campaigns which have forged partnerships between



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industry, retail, government and not-for-profit organisations promoting public health (Rekhy and

McConchie 2014). Evidence from campaigns worldwide also suggests that interventions are more

effective when the campaign is sustained, targeted, interactive, focused on behaviour change,

sets goals, has clear messages and uses multiple channels (Rekhy & McConchie 2014).

In New Zealand, the 5+ A Day programme, launched in 1995, was primarily aimed at children.

Educational materials promoting F&V consumption were developed and linked to the curriculum

within nurseries and schools. The involvement of the food industry has been reported to have

contributed to the success of the programme.

By 2012, the proportion of the population who reported consuming 5 portions of F&V per

day had risen from 15% (in 1995) to 38% (Rekhy and McConchie 2014).

Denmark has seen one of the largest increases in F&V intake, generated through its 6-A-

DAY initiative, which promoted consumption by increasing the accessibility of F&V in

schools, restaurants and workplaces. Between 1995 and 2004, fruit intake rose by 58%

and 75% and vegetable intake increased by 29% and 41% in 4 to 10 year olds and 11 to

75 year olds, respectively (Danish National Centre for Social Research, 2005). Average

intakes of F&V between 2003 and 2008 amongst Danish adults were reported to be 445g

per person per day, higher than the minimum WHO recommendation (Danish National

Centre for Social Research 2009).

Another intervention that is perceived to be successful was the ‘Food Dudes’ programme

in the UK, which was aimed at children. Behaviour change techniques were incorporated

within the programme, including the use of role models and rewards. Controlled

intervention studies within schools in the UK, Italy and US have reported increases in F&V

intakes of between 60 and 200% with this programme (Rekhy and McConchie 2014). A

range of such global schemes have been compared by country, the target audience, co-

ordination and the main activities employed (Table 12).

A detailed review (Pomerleau et al. 2005) of intervention studies that included a control group,

promoting F&V consumption in adults and children, mainly in Europe and the US, indicated that

the average impact of such interventions on consumption is between 0.2 and 0.6 portions per

day. However, this review excluded national or large-scale promotional interventions. For children,

it concluded that a multi-faceted focused approach seemed the most effective: specific F&V

messages (not embedded in a ‘healthy eating’ message), hands on skill building (as opposed to

passive learning), active provision of F&V at school lunch times and formal involvement of

parents, teachers and peers seem to lead to the most successful results. In adults, face-to-face

counselling seemed effective but costly. Printed, individually tailored information, and particularly

individually tailored computer-based information that can individualise feedback, also

demonstrated a beneficial effect.

The review also looked at barriers, for example, on an individual level people may perceive they

eat enough or that these foods have a high cost, or that personal and family eating habits may be

difficult to change. Environmental barriers can include lack of access, limited variety, poor quality

and high cost, lack of preparation skills and time. One of the main barriers in schools is

competition with other school priorities such as emphasis on academic attainment, aspects of

the curriculum or other activities and not allowing food at break times. One of the limitations

highlighted was the lack of robust research in social marketing campaigns, so that the degree of

changes in attitude and consumption directly attributable to the campaign cannot be determined.



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Brunello et al. (2014) suggest that the European School Fruit campaign has restrained the

consumption of junk food in the sub-group of the population that can be described as wealthier

families which is actually less likely to be exposed to overweight and obesity problems, so the

European School Fruit campaign has not been effective at all for the sub-group of the population

that is more at risk

The UK 5-A-DAY programme, a collaboration with private and public partners, was launched by

the government in 2003 with an aim to increase access to and awareness of the health benefits

F&V, and to target groups with the lowest intake, such as younger members of the population.

The development of the UK 5-A-DAY programme is described in Table 13.

Table 13. Development of the 5-A-DAY programme in the UK

YEAR DETAIL OF ACTIVITIES RELATING TO 5-A DAY

1990 World Health Organization (WHO) identifies nutritional requirement of 400g fruit and

vegetables per day, or five portions of 80g each.

Nutritional Requirement

1998 Acheson Report: Independent Inquiry into Inequalities in Health

1999 Saving Lives: Our Healthier Nation

2000 UK, NHS Plan/Cancer Plan set five portions of fruit and vegetables as a consumption

target to address prominence of preventable disease

Daily Target

2000-2001 Five a day Pilot studies utilise community level interventions to assess potential to

address incidents of low consumption.

Pilot Study

2003 Food & Health Action Plan

2003 Tackling Health Inequalities

2003 ‘5-A-DAY; Just Eat More (fruit & veg)’ used as a trademark for industry labelling and

health promotion purposes to aid consumers.

Logo & Promotional

Tool

2003 5-A-DAY Community Action Plan is rolled out to 66 Primary Care Trusts to support and

develop local initiatives to increase access to and awareness of fruit and vegetable

consumption.

Umbrella of Community

Intervention

2004 Choosing Health: Making Healthy Choices Easier

2008 Healthy Weight, Healthy Lives

2008 Food Matters: Towards a Strategy for the 21st Century

2008 5-A-DAY to remain as a promotion and local intervention, but to be part of a more

integrated approach to the choice of healthy lifestyle, such as ‘Change4Life’, as

advocated in ‘Food Matters’, and ‘Healthy Weight, Healthy Lives’.

Food strategy as part of

well being

2016 DH established an external reference group to provide advice on possible criteria for

extending the 5-a-day logo and indicator scheme to include composite foods in 2011.

Recommendations from Public Health England (PHE) are awaited.

The ultimate objective was to reach 5 portions a day for the whole of the UK population by 2015.

The UK 5-A-DAY policy objective has not been achieved. By 2003, the 5-A-DAY programme had

distinct five strands:

National School Fruit Scheme;

‘5-A-DAY’ community initiatives;

Communications programme (including multi-media communications and 5-A-DAY logo);

Work with industry; and

A national/local partnership (SACN, 2003).

These were stated to be underpinned by an evaluation and monitoring programme. 5-A-DAY

initiatives were developed based on the objectives of a) an increase of F&V consumption, b) an



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increase in awareness or knowledge, c) a change in attitudes and beliefs, and d) an increase in

access to F&V. An expansion subsequently to 66 Primary Care Trusts (PCTs) (most deprived 20%)

was funded to the total cost of £10 million (£150,000 from The Big Lottery Fund). 5-A-DAY

coordinator posts were commonly established to aid the development of strategies in local areas,

utilising a range of local initiatives. ‘Cook & Eat’ sessions, ‘Sow & Grow’ schemes, school specific

consultations, ‘Food Co-ops’, transport and home delivery systems and ‘community cafes’ were

created (Bremner et al. 2006). The differential levels of links developed included: formal links

with national campaigns (obesity, smoking, heart disease for example), as well as local 5-A-DAY

initiatives linking with local strategies and messages.

4.2.2. The UK 5-A-DAY programme

Evaluation of the UK 5-A-DAY programme between 2003 and 2005 indicated that there was

improvement in the awareness of the recommended portion sizes of F&V and an overall small

increase in F&V consumption. A final review of local initiatives in the 66 PCTS, compared to

matched control areas (Bremner et al. 2006), showed improvements had been made in the

consumption of F&V, but in general these were not significant compared with established control

areas. It did show that there was enhanced improvement in certain groups, particularly those

groups that had the poorest levels of consumption of F&V, such as those on low income, those

living in areas of deprivation, men, and younger people. However, caution was expressed in

attributing this to the initiatives alone since widespread and local messages concerning F&V and

health were being disseminated throughout. The key findings of the review were as follows:

Knowledge of 5-A-DAY messages increased in both intervention and control groups, as did

an understanding of the health implications of increased F&V consumption;

Overall consumption of F&V increased, but only marginally in both groups. For the

intervention groups consumption increased from 3.36 to 3.64 portions. Control groups

increased from 3.49 to 3.64 portions showing little difference between the intervention

and the control response;

Women were more aware of the recommended portions;

In areas of deprivation, people had lower levels of F&V at the start, but were amongst the

largest improvers over the survey period; and

Factors affecting consumption remained unchanged over the survey period.

Two thirds of PCTs worked in partnership with other PCTs and offered a range of local

programmes, most popular of which were working with school age children, cook and eat activities

and media campaigns. The programme highlighted the importance of a ‘multi-pronged’ approach

when disseminating information. It also advocated joined up organisation and partnerships.

However, following the funding from the initiative programme, less than 15% of the PCTs had

secured funding to continue the activities. A more recent robust economic analysis (Capacci et al.

2012), has looked at the effects of the F&V programme campaign alongside price changes and

market forces over time. The study found that the campaign could explain a rise in consumption

of, on average, + 0.3 portions per person, with a range of +0.2 - 0.7 portions for differential income

groups. The real price of F&V has increased over time and this may have offset the benefit of the

5-A-DAY campaign, particularly for low income families. Overall purchases of fruit peaked in 2006

but have fallen 14% since 2007, whilst purchases of vegetables peaked in 2005 and have fallen

5% since 2007 (see Section 3.1).



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4.3. Summary

Public Health England (PHE) established an external reference group to support PHE activity to

refresh messages to encourage consumption of more F&V. The reference group recently

supported PHE to consider the possible extension of the 5-A-DAY logo and portion indicator to

include composite foods, although as no consensus could be reached there are no plans to extend

this at present. In light of the Scientific Advisory Committee on Nutrition’s (SACN) Carbohydrate

and Health report (SACN 2015b), the reference group has also helped to reassess the advice on

fruit juice and smoothies, including whether additional messages (such as recommended portion

size and frequency) are needed for fruit juices and smoothies carrying the 5-A-DAY logo. This has

led to the recent recommendation to consume a maximum of 150ml of fruit juice and smoothies

(together) daily. The next section of the report goes on to consider other UK healthy eating

initiatives including the School Fruit and Vegetable Scheme (SFVS), and the Eatwell plate (recently

updated to the Eatwell Guide).



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5. UK Government policy initiatives to promote healthy

eating

5.1. Introduction

The most recent National Diet and Nutrition Survey (NDNS) found only 30% of adults and 41% of

older adults met the 5-A-DAY recommendation. On average, adults consumed 4.1 portions and

older adults consumed 4.6 portions of F&V per day (Bates et al. 2014). Mean consumption of fruit

and vegetables for children aged 11 to 18 years was 3.0 portions per day for boys and 2.7 portions

per day for girls. Ten per cent of boys and 7% of girls in this age group met the 5-A-DAY

recommendation (Bates et al. 2014). Government advice on healthy eating is primarily in terms

of the 5-A-DAY message and the Eatwell plate see Figure 2 (DFFR, 2015).

Figure 2. The Eatwell Plate (Source: NHS, 2015a)

The Eatwell plate (now the Eatwell Guide) has been designed to highlight the different types of

food that make up our diet, and shows the proportions we should eat them in to have a healthy,

balanced diet. It is important to note that although the imagery is a plate with a knife and fork it

is not designed to represent the components of a given meal. This is encapsulated in the following

statement:



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“It's a good idea to try to get this balance right every day, but you don't need to do it at every

meal. You might find it easier to get the balance right over a longer period, like a week” (NHS,

2015a).

In 2012, the FSA carried out a survey, Food and You (FSA 2014a), in which UK consumers were

quizzed on their knowledge of healthy eating messages. 86% of participants correctly said the

recommendation for F&V was five portions a day. However, only half of survey respondents

reported eating five portions of F&V on the previous day. Therefore, although the UK 5-A-DAY

initiative has greatly improved knowledge and awareness, this has not translated into sustained

improvements in F&V consumption. There are many possible reasons for this, including the

consumer focus on fat and sugars rather than micronutrients and fibre. The most recent FSA

consumer attitudes tracking survey reported the main food issues of concern to be the amount of

sugar in food (52% or respondents), food waste (49%) and the amount of salt in food (47%) (FSA

2014b). Relatively little importance seems to be given by consumers to the overall micronutrient

density or fibre content of foods (possibly linked to these not being part of front-of-pack labelling).

Potential barriers to the purchase and consumption of F&V include the perception that F&V are

expensive and less value for money compared to processed foods high in fat and sugars and the

concern over the level of perishability of fresh produce. Highly perishable F&V may not be bought

as frequently and are generally, higher in cost. The accessibility and variety of F&V on offer may

also limit intake within certain population groups. The variety of the type of F&V available but also

the tastes, textures and how they can be eaten may encourage F&V consumption. Cooking skills,

namely knowledge on how to prepare and cook different F&V, have been shown to impact

purchases and intakes. F&V that is familiar and requires minimal preparation time and effort,

tend to be preferred. Pre-prepared and ready-to-eat F&V are also more appealing to the time-

pressured consumer. Retailers who offer recipes, preparation and cooking instructions,

demonstrations and/or tastings for fruits and vegetables may help to encourage purchasing

(Rekhy & McConchie 2014).

Miller et al. (2016) proposed that a number of trends and events are likely to influence

micronutrient intakes and status in the UK, the drivers of which include emerging scientific

research, localised changes within the food chain, demographic changes, government initiatives

and their impact, and changes in consumer attitudes and behaviour. These themes are drawn

together in their study (Table 14). Further Miller et al. (2016) cite a Defra report that concluded

that in the UK average concentrations of copper, magnesium and sodium in vegetables, and the

average concentrations of copper, iron and potassium in fruit, had decreased significantly

between the 1930s and the 1980s (Mayer 1997). A number of the themes in Table 14 are

explored further in subsequent sections of this report.

5.2. Level of knowledge about nutrient content

Knowledge about the nutritional content and associated benefits to health for specific F&V can

influence purchases and consumption, although this is not thought to be a major pathway to elicit

behavioural change (Rekhy & McConchie 2014). More subtle and proactive approaches may be

needed, including increasing the accessibility, variety and visibility of F&V in retail and food service

outlets and in the home and workplace. Replacing offerings of foods high in fats and sugars with

F&V at point of purchase locations (such as at the checkout), in vending machines and food

service outlets may encourage consumption (Rekhy & McConchie 2014). Strategies to make

consumers feel like they are getting good value for money (such as, bonus packs, promotional

deals) may increase purchasing and help to establish a change in behaviour which could continue



20/03/2016

beyond the time period of the money saving offer. Leveraging the ‘natural’ and ‘freshness’

qualities of F&V in promotional materials and activities could also help to attract consumers and

increase consumption (Produce for Better Health Foundation 2012).

Table 14. Drivers, trends and events that could influence micronutrient intakes in the UK

(Adapted from Miller et al. 2016)

MAIN DRIVERS TRENDS AND EVENTS

Changes in consumer attitudes

and behaviour Changes in purchasing behaviour

Continued diversification of diets due to widening socio-demographic spectrum

Increasing consumer trends (for example, desire for “natural” and “additive-free” products)

Revision of mandatory fortification polices

Demographic changes Ageing population

Increasing immigration

Increasing income equality

Emerging scientific research Development of new and improved status biomarkers and monitoring tools

Increasing understanding of intake levels required to promote health at different life stages and

within different population groups

Increasing understanding of genetic and epigenetic influences on micronutrient status

Increasing understanding of the type of interventions with greatest impact in increasing

micronutrient intakes for specific population groups

Technology development of crop varieties, animal products and/or food products with higher

nutrient density or bioavailability

Environmental and process

changes in the food chain

Farming

Manufacturing and retail

initiatives

Increasing soil nutrient depletion affecting crops (see Morris and Sands 2006; Davis 2009;

Fernàndez-Marín et al. 2014).

Continuation of crop selection based on yield rather than micronutrient content

Selection of varieties with the primary aim of shelf-life and robustness in an extended supply

chain rather than micronutrient content

Changes in use of biotechnology tools which might not have been developed with optimising

nutrition as the driving factor

Changes in geographic sourcing of food and feed ingredients

Changes in voluntary fortification

Product innovations impacting on nutrient density

Processing innovations impacting on nutrient density for example, innovative heat treatment etc.

Government initiatives Revision of Dietary Reference Values (DRVs)

Revision of healthy eating guidelines and shifting focus onto dietary patterns

Increased action to tackle obesity and promote physical activity

Increase in public health communications concerning specific nutrients (for example, vitamin D,

fibre, free sugars and/or fat)

Revision of mandatory fortification policies

A Regulation on Nutrition and Health Claims (Regulation (EC) No. 1924/2006) (European

Commission (EC) 2007) came into force in the European Union (EU) in 2007. Permitted nutrition

claims, for example, low in fat, high in fibre are listed in an Annex to the Regulation. A 'nutrition

claim' means any claim which states, suggests or implies that a food has particular beneficial

nutritional properties, for example, source of vitamin C or high in fibre.

Table 15: Potatoes and 5-A-DAY F&V commonly eaten in the UK (identified from National Diet

and Nutrition Survey data) and EFSA-approved health claims for micronutrients they contain.

FRUIT/VEGETABLE SOURCE OF EXAMPLES OF GENERIC HEALTH CLAIMS

Apples Fibre Note: No health claims for fibre in general have yet been approved (specific fibres associated with some cereal grains

and sugar beet have been approved)



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Bananas Vitamin B6

Potassium

Manganese

Fibre

Vitamin B6 contributes to the normal function of the immune system

Vitamin B6 contributes to the reduction of tiredness and fatigue

Potassium contributes to normal muscle function

Potassium contributes to the maintenance of normal blood pressure

Manganese contributes to the maintenance of normal bones

Manganese contributes to the normal formation of connective tissue

Grapes Fibre

Oranges Vitamin C (rich

in)

Thiamin

Folate

Fibre

Vitamin C contributes to the normal function of the immune system

Vitamin C contributes to the protection of cells from oxidative stress

Thiamin contributes to normal functioning of the nervous system

Thiamin contributes to the normal function of the heart

Folate contributes to the reduction of tiredness and fatigue

Folate contributes to normal blood formation

Pears Fibre

Broccoli Vitamin C (rich

in)

Vitamin K (rich

in)

Folate (rich in)

Potassium†

Manganese†

Fibre



Vitamin K contributes to normal blood clotting

Vitamin K contributes to the maintenance of normal bones







Carrots Vitamin A (rich

in)

Fibre

Vitamin A contributes to the maintenance of normal skin

Vitamin A contributes to the maintenance of normal vision

Onions Fibre

Peas* Vitamin C

Vitamin K (rich

in)

Thiamin (rich

in)

Niacin

Folate

Manganese

Fibre



Vitamin K contributes to normal blood clotting

Vitamin K contributes to the maintenance of normal bones



Niacin contributes to normal psychological function

Niacin contributes to the maintenance of normal skin





Tomatoes Vitamin C

Fibre



Potatoes – main crop

(old)

Thiamin

Potassium





Fibre has been calculated as AOAC/100kcal rather than per 100g *Boiled and frozen, not canned †Raw/steamed

broccoli

A ‘health claim’ is any statement about a relationship between a food and health, for example,

vitamin C contributes to the reduction of tiredness and fatigue. To make a health claim, criteria

must be met. For example, to make a generic claim relating to the vitamin or mineral content of

a food, that nutrient must be present in significant amounts:

At least 15% Nutrient Reference Value (NRV) per 100g or 100ml (except drinks);



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At least 7.5% NRV per 100ml (drinks only); and

At least 15% NRV if package contains a single portion size.

Health claims are used to inform the public about the health benefits of a food or drink and the

Regulation is designed to protect consumers against misleading claims, harmonise claims made

across the EU and to encourage innovation in the food industry. The Regulation covers all foods,

drinks and dietary supplements sold in the EU and applies to all commercial communications

including the food label itself, advertorials and other promotional materials including websites.

The scientific assessment of evidence for health claims is carried out by the European Food Safety

Authority (EFSA), an independent scientific body whose role is to provide scientific advice to the

European Commission (EC). Currently, only a relatively small proportion of submitted health

claims have been given positive opinions by EFSA and added to the EC’s list of accepted claims.

Failure to reach positive opinions on claims can occur for several reasons including insufficient

characterisation of the food or component and insufficient evidence from human studies

submitted to support the claim. Unless a claim appears on the official ‘approved’ list

(http://ec.europa.eu/nuhclaims/) it cannot be used. For those who wish to have a currently non-

authorised claim considered, a process exists which is summarised in Buttriss (2015).

There is good evidence to suggest eating at least five portions of F&V a day can help to reduce

the risk of heart disease, stroke, type II diabetes, certain cancers and obesity (NHS 2015b) despite

limited health claims relating to specific F&V. Examples of generic health claims that can be

associated with potatoes and most commonly eaten F&V have been drawn together (Table 15).

The table has been compiled with the most frequenty eaten F&V as identified in the National Diet

and Nutrition Survey. A fuller list of claims that could be used for UK F&V can be found in terms

of vitamins (Table 16) and minerals (Table 17). Evidence shows there are significant health

benefits to getting at least five portions of F&V every day, so reference to this could be made in

supporting literature (for example, the use of phrases such as an apple contributes to the 5-a-day

target or Eating 5 or more portions of fruit and veg is linked with lower risk of chronic disease).

https://mail.rau.ac.uk/owa/redir.aspx?SURL=ylBYwwMu_KItCby57whBq-E3vYyq2C9K-w7LBjGsMhw26VGOhD7TCGgAdAB0AHAAOgAvAC8AZQBjAC4AZQB1AHIAbwBwAGEALgBlAHUALwBuAHUAaABjAGwAYQBpAG0AcwAvAA..&URL=http%3a%2f%2fec.europa.eu%2fnuhclaims%2f



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Table 16. Vitamin content of selected UK fruits and vegetables (per 100g)

VITAMIN A (AS

CAROTENE) (µG)

THIAMIN (mg) FOLATE

(µG)

VITAMIN B6

(mg)

NIACIN (& TRYPT)

(mg)

VIT C (mg) VIT K (µG)

Apples (raw)

Asparagus (boiled)

Beetroot (boiled)

Broad beans (boiled)

Broccoli (boiled)

Brussel Sprouts (boiled)

Carrots (old, boiled)

Cauliflowers (boiled)

Cucumbers (raw)

Lettuce (raw)

Onions (boiled)

Parsnips (boiled)

Pears (raw)

Peas (frozen, boiled)

Red peppers (raw)

Potatoes (main crop, old, boiled, flesh)

Raspberries (raw)

Spinach (mature, boiled)

Strawberries (raw)

Tomatoes (raw)

14

389

27

145

598

320

11100

Tr

74

60

5

30

14

276

580

Tr

6

3840

Tr

349

0.04

0.12

0.01

0.03

0.04

0.07

0.09

0.09

0.03

0.14

0.03

0.07

0.03

0.40

0.07

0.21

0.03

0.06

0.02

0.04

Tr

173

110

32

34

110

8

48

14

60

8

41

6

31

75

18

33

81

61

23

0.07

0.07

0.04

0.08

0.11

0.19

0.04

0.15

0.01

0.02

0.07

0.09

0.04

0.07

0.23

0.06

0.06

0.09

0.03

0.06

0.1

1.4

0.4

3.8

1.4

0.5

0.4

0.9

0.3

0.6

0.5

1.1

0.3

2.5

0.6

0.9

0.8

1.5

0.7

0.7

6

10

5

20

44

60

3

30

2

1

4

10

3

12

126

9

32

8

57

22

5.6

51.8

No value

11.4

135.0

127.0

5.5

28.5

20.9

129.0

No value

No value

3.6

39.0*

1.6

No value

No value

575.0

3.0

6.0

Those highlighted in yellow can be described as a ‘source’ (i.e. provide at least 15% of the Nutrient Reference Value

per 100g) *value given for fresh, no value for frozen

Table 17. Mineral content of selected UK fruits and vegetables (per 100g)

Potassium (mg) Manganese (mg) Magnesium

(mg)

Iron (mg) Zinc (mg) Calcium (mg)

Apples (raw)

Asparagus (boiled)

Beetroot (boiled)

Broad beans (boiled)

Broccoli (boiled)

Brussel Sprouts (boiled)

Carrots (boiled)

Cauliflowers (boiled)

Cucumbers (raw)

Lettuce (raw)

Onions (boiled)

Parsnips (boiled)

Pears (raw)

Peas (frozen, boiled)

Red peppers (raw)

Potatoes (main crop (old), boiled, flesh)

Raspberries (raw)

Spinach (mature, boiled)

Strawberries (raw)

Tomatoes (raw)

100

220

510

190

212

310

166

215

156

222

105

350

105

177

216

365

170

230

170

223

Tr

0.2

0.9

0.2

0.2

0.2

0.1

0.1

0.1

0.1

0.1

0.3

0.1

0.4

0.1

0.1

0.4

0.5

0.3

0.1

4

13

16

19

14

13

8

12

10

9

7

23

5

27

11

18

19

34

12

8

0.1

0.6

0.8

0.8

0.6

0.5

0.3

0.5

0.3

0.1

0.3

0.6

0.1

1.8

0.4

0.3

0.7

1.6

0.3

0.2

Tr

0.7

0.5

0.7

0.4

0.03

0.1

0.2

0.1

0.2

0.2

0.3

0.1

0.8

0.2

0.2

0.3

0.5

0.1

0.1

5

25

29

18

35

20

31

19

21

24

25

50

7

37

7

6

25

160

17

8

Those highlighted can be described as a source (i.e. provide at least 15% of the Nutrient Reference Value per 100g)



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5.3. The School Fruit and Vegetable Scheme (SFVS) and School Food

Standards

Looking specifically at the School Fruit and Vegetable Scheme (SFVS); within England, 4–6 year-

old children who attend a Local Education Authority (LEA) maintained infant, primary or special

school are eligible to receive a free piece of fruit or free vegetables each school day (DH, 2010a).

While participation in the SFVS is voluntary, schools are encouraged to participate. The most

recent evaluation of the scheme found that children receiving the SFVS ate more F&V in 2008

compared with 2004 when the scheme was initiated, although changes may partly be explained

by the introduction of school food standards. It was suggested that effects of the intervention do

not carry over into the home environment (Weichselbaum & Buttriss, 2014). In addition, reviews

suggest that increases may be short-term and evidence for long-term behaviour change is weak.

Indeed, statistics suggest the impact of such programmes and the background of substantial

increases in general awareness, are not reflected in the 5-A-DAY F&V targets being met (HSCIC

2014). Thus participation in the SFVS was positively associated with F&V consumption so in any

one area, those children who participated in the SFVS consumed more F&V. However, children

living in deprived areas still consumed less F&V than children living in more advantaged areas:

the mean daily frequency of F&V consumed, and rates of consumption of F&V five times or more

per day, decreased as deprivation increased (Hughes et al. 2012).

Statutory school food standards apply to local authority maintained schools, academies that

opened prior to 2010 and academies and free schools in England entering into a funding

agreement (DE, 2015). The school food standards have been developed to ensure that food

provided to pupils in school is nutritious and of high quality; to promote good nutritional health in

all pupils; to protect those who are nutritionally vulnerable and to promote good eating behaviour.

The revised standards for school food came into force on 1 January 2015 and are set out in the

requirements for School Food Regulations 2014. The School Food Standards for lunches state

with regard to F&V that there must be:

One or more portions of vegetables or salad offered as an accompaniment every day;

One or more portions of fruit offered every day;

A dessert containing at least 50% fruit two or more times each week; and

At least three different fruits and three different vegetables each week (School Food

Standards, 2015)

5.4. Information and evaluation of the Eatwell plate

Food-based dietary guidelines (FBDG) constitute simple, evidence-based policy recommendations

for the general population on healthy eating as a means of preventing nutritional deficiencies,

decreasing the risk of non-communicable diseases and improving public health (Brown et al.

2011; EFSA 2010). FBDG indicate what consumers should be eating in terms of foods rather than

nutrients, and provide a framework that can be used in meal planning (EUFIC 2009). The

development of FBDG is largely based on combining evidence on recommended nutrient intakes,

popular relevant foods and desirable population health outcomes. In the UK, the FBDG are

presented as a plate, referred to as the Eatwell plate, with eight associated healthy eating tips,

which includes ‘eat plenty of fruit and vegetables’ (NHS 2015a). Evaluation of FBDG is relatively

complex. A number of different methods may be used to monitor the effectiveness of an

established dietary guideline to ascertain whether the population is meeting set national targets,



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for example 5-A-DAY, or proportions of the food groups being consumed in the average diet. Data

is typically used from national surveys of individual intakes or household food consumption data

(FAO 1998). Another aspect of evaluating a dietary guideline is the proportion of the population

meeting the nutrient guidelines. Such data can be obtained only from dietary surveys of

individuals.

The National Diet and Nutrition Survey (NDNS) and food survey data has been used to determine

the extent to which consumers meet the Eatwell plate guidelines (Harland et al. 2012). As the

Eatwell plate (with the exception of F&V) is not quantified in terms of specific portion sizes (g per

day), evaluations are typically based on achievement of healthy eating recommendations in terms

of nutrients (such as fat and fibre) rather than consumption of foods. The percentage of the adult

population achieving an intake of 5 or more portions of F&V a day was 30%, with 28% meeting

total and saturated fatty acid targets, and only 19% achieving the previous recommendation for

fibre intake (18 g/day of non starch polysaccharide (NSP) fibre). Compared to older NDNS data,

there has been some progress in increasing F&V intake but in comparison to guidelines, there

appears to be an overall shortfall. It would seem that further focus is required to achieve the F&V

target.

Whilst the Eatwell plate communicates the principle of a healthy, balanced diet, consumers still

appear to have difficulty putting this into practice (Harland et al. 2012). The recent SACN

Carbohydrates and Health report, recommends that the average intake, across the UK population,

of free sugars should not exceed 5% of total dietary energy intake (SACN 2015b). SACN also

recommended the retention of the current reference value for total carbohydrate (50% of total

dietary energy from carbohydrate) and an increase in dietary fibre intake to 30 g/day. Public

Health England (PHE) has established an external reference group to consider the potential

impact of the new dietary reference values on the Eatwell plate and associated healthy eating

messaging. PHE has conducted in-house and externally commissioned modelling work to inform

the proportion of the food categories depicted within the Eatwell plate. A revised version of the

Eatwell plate was published by PHE in March 2016. The model, now known as the Eatwell Guide,

continues to encourage consumption of F&V but fruit juice is no longer depicted in the F&V

segment which itself has been resized compared to the previous visual (Figure 2) to reflect current

government advice on a healthy balanced diet. Although included in the new hydration

messaging, fruit juice and smoothies are now restricted to 150 ml/day (together). This is because

the SACN definition of free sugars includes the sugars naturally occurring in fruit juice. Public

health messages to limit fruit juice and smoothies consumption, may impact negatively on both

sales of fruit juice and whole fruit if consumers are not clear about the definition of free sugars

and the health benefits of consuming fruit. Some organisations such as the British Nutrition

Foundation (BNF) have expressed concern that confusion about the health effects of total vs free

sugars amongst consumers could also have implications for the perception of the health

attributes of fruit.

The Eatwell Guide was issued on the 17th March 2016 as the report was being finalised (Figure

3) with the following dietary messages:

Eat at least 5 portions of a variety of F&V every day.

Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates; choosing

wholegrain versions where possible.

Have some dairy or dairy alternatives (such as soya drinks); choosing lower fat and lower

sugar options.



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Eat some beans, pulses, fish, eggs, meat and other proteins (including 2 portions of fish

every week, one of which should be oily).

Choose unsaturated oils and spreads and eat in small amounts.

Drink 6-8 cups/glasses of fluid a day.

If consuming foods and drinks high in fat, salt or sugar have these less often and in small

amounts.

Figure 3. The Eatwell Guide (Source: Govt.uk, 2016)

5.5. Healthier Food Choice Awards

The DH (2011a:4) states in its report on the Public Health Responsibility Deal (see Section 6.3)

that:

“By working in partnership, public health, commercial, and voluntary organisations can agree

practical actions to secure more progress, more quickly, with less cost than legislation”.

The Healthier Choices Food Awards are an example of this approach. At a local authority level,

many authorities have developed a healthier food choice award. One example is in Worcestershire

where food service businesses who have achieved level 5 in the Food Hygiene Rating Scheme

and prepare food at that premises can apply for an award scheme the Healthier Choices Food

Award. The award has two levels SILVER and GOLD (Table 18) The scope of the award includes

seasonal and local food, managing food waste, as well as elements of healthy food and nutrition.

Table 18. Criteria in the Healthier Choices Food Award (Source: WRS, 2015)

SILVER

Maintain Level 5 Food Hygiene Rating

Make plenty of fruit and vegetables available

GOLD

Silver plus

Use local suppliers

(minimum of five



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Keep the levels of sugar, salt and unhealthy fats in foods to a minimum

Offer a variety of protein and carbohydrate choices

Offer healthier drink options

Offer healthier children’s choices

Offer smaller portions

Provide customers with information on food allergens

Keep food waste to a minimum

Ask for customer feedback

items on the

menu)

Use food that is in

season (minimum

of one menu item

that includes

seasonal product

MEMBERSHIP INCLUDES:

An accreditation visit including feedback on what is required if criteria are not met.

A certificate and window sticker to display in the food premises.

A digital logo to use on menus, website and in promotional leaflets and advertising.

A guidance pack with tips and advice on how to meet all the criteria and market the award.

A workshop place run by Environmental Health Officers and a Nutritionist covering food safety,

health and safety and how to offer healthier choices, plus an opportunity for networking and

sharing best practice.

Additional post accreditation mystery customer visit.

Business promotion – a listing of business details and award level on the WRS website and

promotion on social media pages and with WRS partners.

Discounted fee for nutritional analysis of recipes

Discounted rates for CIEH Healthier Food and Special Diets course or Food Allergen awareness

course.

MEMBERSHIP INCLUDES:

Upgrade to Gold

Standard using

locally sourced,

seasonal food

Free nutritional

analysis of three

recipes

Mechanisms such as local authority mediated healthier Food Choice Awards offer another

mechanism to communicate to consumers with regards to healthy food and nutrition.

5.6. Change4Life

Change4Life is a social marketing campaign, originally launched in 2009, and is part of a wider

strategy to reduce childhood obesity. It reflects the change of policy initiatives to a more integrated

population approach to healthy lifestyle, but still includes a behavioural change objective of

increasing consumption of F&V. Working with public and private sector partners such as food

companies and supermarkets, it involves a wide range of activities including mass media,

branded materials, partners and website-based information/activities (DH 2010b). Change4Life

encourages F&V consumption as one of its key health behaviours. F&V often feature in the

campaign as ‘swaps’ (for example, healthier snacks) or as suggested additions to composite

dishes. Evaluations to assess the impact of Change4Life are limited and hampered with

challenges due to the complexity of factors which could be exerting an effect and the fact that

related interventions have been introduced at the same time. Evaluation has tended to focus on

increasing awareness and knowledge, or changes in claimed behaviour rather than evaluation of

changes in actual behaviour or markers of health.

Public health interventions often report increases in awareness and knowledge, with translation

to actual behavioural changes proving to be more difficult (Bremner 2006). Government-led

evaluations of Change4Life have suggested an increased level of awareness of the campaign and

sustained level of interest in the resources and activities. Evaluation of the first year of

Change4Life was reported by the Department of Health (DH) as a success, with over 400 000

families joining (and around 44 000 families still involved after 6 months) and 1 million mothers

claiming to have made changes to their child’s behaviour as a result of the scheme (DH 2011b).

By April 2013, 1,937,406 families had signed up, accounting for more than 2.5 million people.

The programme has delivered over 300,000 personal activity plans and over a million people

have downloaded Change4Life apps (DH 2014). The DH has evaluated the programme (Table

19).



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Shopping basket analysis looking at the difference between families involved in Change4Life

relative to a control group found a change particularly in beverage purchases; Change4Life

families favoured low fat milk and low sugar drinks. In addition, purchasing data from a

representative panel of shoppers showed a 9% reduction of sugary carbonated beverage

purchases during a Change4Life television campaign to swap sugary carbonated beverages for

diet versions, milk or water (DH 2014).

The second year (with a government change in summer 2010) was reported as the year of

consolidation. The marketing budget was reduced, with commercial partners being asked to take

greater responsibility. Other changes since 2010 have included more focus on a life-course

approach including Start4Life, which encourages healthy eating and activity habits from birth, and

a separate programme for adults in mid-life. Moving from a child-based to a whole family approach

recognised that parental modelling is important in determining behaviours. Guidance now focuses

on providing practical advice on how people live their lives and attention is given to the family as

a whole, instead of focusing primarily on the child. Change4Life is now also more focused on local

initiatives. Online engagement has largely replaced printed materials and more investment has

been made in social and digital media (DH, 2011b).

Table 19: Evaluation of Year One Change4Life

YEAR ONE

TARGET

YEAR ONE

ACHIEVEMENT

Reach (% of all mothers of children under 11 who had opportunity to see the

advertising campaign)

99% 99%

Awareness (% of all mothers with children under 11 who recalled seeing the

Change4Life advertising)

87% 87%

Logo recognition (% of all mothers with children under 11 who recognised the

Change4Life logo)

44% 88%

Response to How are the Kids? (total number of questionnaires returned

electronically, by post or from face-to-face marketing)

100,000 346,609

Total responses (including website visits, telephone calls, returned

questionnaires)

1,500,000 1,992,456

Sign-up (total number of families who joined Change4Life) 200,000 413,466

Sustained interest (total number of families who were proven to still be

interacting with Change4Life six months after joining)

33,333 44,833

Source: (DH 2011b)

An independent study (Croker et al. 2012) systematically evaluated a single but integral

component of the programme, family information packs, and concluded that whilst the packs

resulted in higher awareness of the campaign there were few positive effects on behaviour. The

authors put forward a number of reasons for this. Firstly, the multiplicity of the messages; they

argue that campaigns with a narrower focus are more effective than those targeting multiple

behaviours. Inclusion of multiple target behaviours may reduce the perception of the importance

of any single behaviour and could lead people to focus on the ones they are achieving already

rather than the ones where behaviour change might make a bigger impact. Secondly, the authors

commented that the materials seemed focused on children where the intended focus was the

family, or the parent that may be the gatekeeper of diet. There is also some question as to whether

research on behavioural theory and social marketing concepts was actively translated and

adhered to in the campaign intervention design (Piggin & Lee 2011). Furthermore the campaign

should be viewed in a context where obesity issues have been raised up the national agenda.

Obesity prevention is a long-term strategy, although it is interesting to see recent indications of a

plateau in child obesity prevalence rates that may have occurred prior to the commencement of



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Change4Life. Changes attributed to the campaign may be, in part, a result of an on-going trend

that preceded the campaign.

Despite the difficulties in the evaluation of the campaign, Change4Life has been admired for its

modern approach, enlisting celebrities and embracing new technology to help reach the younger

generation. Various mobile apps have been produced, including, most recently, an app to reveal

the sugar content (translated as sugar cubes) of everyday foods and drinks using barcode

scanning technology (NHS 2016). However, the impact of this on a population scale will, again,

be hard to quantify due to other concurrent activities aimed at reducing the nation’s intake of

sugars as the next section outlines.

5.7. PHE’s sugar reduction package

In the recent review of Carbohydrate and Health, SACN concluded that the recommended average

population maximum intake of free sugars should be halved: it should not exceed 5% of total

dietary energy. SACN also recommended that consumption of sugars sweetened drinks should be

minimised by both adults and children (SACN 2015b). The term "sugars sweetened" is used to

reflect the multiple types of sugar that are used as sweeteners in such beverages and not just the

use of sucrose as an ingredient. The intake of sugars across all population groups are currently

above recommendations, contributing between 12 to 15% of energy. In June 2014, PHE published

‘Sugar reduction: Responding to the challenge’. This set out what PHE would do to review the

evidence across a broad range of areas and identify those where action is most likely to be

effective in reducing sugar intakes. In Oct 2015, the findings from this review were published in

the ‘Sugar reduction: Evidence for action’ report (PHE 2014a; 2014b). The report draws

conclusions about what drives the consumption of sugar and advises on actions that could be

implemented to change intake. These include the environment that influences food choice

continuing the theme already considered in this report of choice architecture; food supply and

changes that could be made to this; as well as knowledge and training; and local action. This

strategic approach has been seen previously with government targets and campaigns to reduce

the level of salt and fat in consumers’ diets (for example, FSA salt campaign). As highlighted

earlier in this report (section 5.1) government campaigns and initiatives that focus on individual

aspects inevitably generate awareness but can simplify the complexity of health and nutrition

messaging to consumers especially with regard to fibre and micronutrient intake. For example,

the focus on sugar can make consumers think that items with high sugar content like fruit juice

are unhealthy when as part of an overall balanced diet this is not the case. It is important that

government messages reinforce the need for a balanced diet, containing plenty of F&V.

5.8. Nutrient profiling

Nutrient profiling of foods, described as the science of ranking foods based on their nutrient

content is the basis for regulating nutrition labels, health claims, and also the marketing and

advertising of food to children. A number of nutrient profile models have now been developed by

research scientists, regulatory agencies, and by the food industry. Whereas some of these models

have focused on nutrients to limit, others have emphasized nutrients known to be beneficial to

health, or some use a combination of both. Although nutrient profile models are often tailored to

specific goals, the development process ought to follow the same science-driven rules. These

include the selection of index nutrients and reference amounts, the development of an

appropriate algorithm for calculating nutrient density, and the validation of the chosen nutrient

profile model against healthy diets. It is extremely important that nutrient profiles be validated



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rather than merely compared to prevailing public opinion. Regulatory agencies should act only

when they are satisfied that the scientific process has been followed, that the algorithms are

transparent, and that the profile model has been validated with respect to objective measures of

a healthy diet (Drewnowski and Fulgoni, 2008).

The consumption of fruit is generally associated with better health, but so is higher socioeconomic

status (SES). Most previous studies, including the work described above, when evaluating

consumption of fruit have not separated 100% fruit juice and whole fruit, which may conceal

interesting patterns in consumption across the demographic profile in a given community.

Consumption patterns for whole fruit versus 100% fruit juice showed different gradients by race/

ethnicity, education, and income (Drewnowski and Rehm 2015; Francou, et al. 2015). Any advice

to replace 100% juice with whole fruit as part of what is considered healthy eating may thus pose

a challenge to the economically disadvantaged and some minority groups, whose fruit

consumption falls well short of national goals already.

5.9. Summary

Steps to enable healthy food choices, including increased provision of F&V in supermarkets,

canteens and restaurants as well as other initiatives described in this report, are needed to help

encourage behaviour change. Retailers are being increasingly urged to remove products high in

fat and sugars from the checkout area. If these products are replaced with ready-to-eat F&V

products (see Section 3.2.1), purchases of these foods could increase. Other changes employed

by retailers and suppliers, including increased promotion and marketing of F&V, as discussed in

this report, could help to shift purchases away from products high in fat and sugars towards F&V.

Educating health professionals, employers, the general public and those who have opportunities

to influence food choices in different sectors (for example, catering and leisure) on the benefits

of F&V and how to prepare and cook different types of produce could also bring benefits to the

nation’s health.



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6. Inter-related UK Government public health initiatives

6.1. Introduction

A healthy, varied diet is the cornerstone for ensuring adequate micronutrient intakes (Miller et al.

2016). ‘Healthy’ has common-sense everyday meaning in the food industry often being used to

describe foods that are ‘good for health reasons’. However the definition of a healthy or balanced

diet can stretch to include foodstuffs which as individual items have questionable nutritional

benefit. Healthy as a term therefore lacks scientific definition and is used extensively by food

producers/retailers to direct consumers in particular direction towards certain goods (Lobstein

and Davies 2009). Specialist weight loss interests frame dietary advice by reference to being

‘healthy’, which implies some foods are best avoided. The healthiness of a food depends upon

how much we eat of it, how often, what our nutritional needs are, and what else we eat in the diet.

There is no single complete food that provides all the nutrients we need. Therefore, a variety of

foods in the diet and an eye on portion size has been suggested as underpinning a healthy diet.

In many cases, healthful foods are defined by the absence of problematic ingredients—fat, sugar,

and sodium—rather than by the presence of any beneficial nutrients or micro-nutrients they might

contain (Drewnowski 2015). Drenowski asserts that past attempts to quantify the nutrient density

of foods have been based on a variety of calories-to-nutrient scores, nutrients-per-calorie indexes,

and nutrient-to-nutrient ratios. These need to then translate into government policy and marketing

practice especially with the interaction between government and industry.

6.2. Health and Wellbeing boards

Historically, statutory responsibility for health care and social care was divided between National

Health Service (NHS) bodies and local government authorities. The Health and Social Care Act

2012 established health and wellbeing boards (HWBs) as a forum where key leaders from the

health and care system would work together to improve the health and wellbeing of their local

population and reduce health inequalities (LGA, 2015). HWBs are intended to lead the integrated

assessment of local needs to inform both NHS health and local authority social care

commissioners (Coleman et al. 2014). In their study they found that HWBs vary greatly in their

structure and approach towards health and social care integration with heavy dependence on

voluntary agreements to co-operatively align the strategic plans of the many different new

statutory bodies (Coleman et al. 2014). Aylott et al. (2008) considered the 2007 Foresight Report

on obesity and the implications of the recommendations for local government identifying four local

government areas of responsibility that have a role in tackling the problem of obesity. These were

responsibilities for planning, children’s services, adult social care and parks and leisure. At local

level, local authorities have a much stronger role in shaping services, and have taken over

responsibility for local population health improvement (Gov.uk, 2015). The HWBs brought

together local commissioners of health and social care, and other individuals to agree an

integrated way of improving local health and well-being. Clinical commissioning groups work with

local authorities through the HWBs. The management health and wellbeing at local level needs a

co-ordinated policy approach that covers a range of local government responsibilities. The role of

Joint Strategic Needs Assessments (JSNAs) and Health and Wellbeing Strategies (HWSs) have the

potential to provide a strong basis for integrated local policies for health improvement, to address

the wider determinants of health and to reduce inequities (Tomlinson et al. 2013). Tomlinson et

al. (2013) stated that:



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“There has been a welcome joining up of the rhetoric around health, the environment and

land use or spatial planning in both the English Public Health White Paper and the National

Planning Policy Framework but this is not being followed through into practical guidance

needed by local authorities, health bodies and developers about how to deliver this at the

local level.”

In summary, the changes to the national planning framework, the abolition of the regional aspect

of planning (critical for conurbations with similar public health challenges), multiple agencies

involved in public health and the wide ranging remit of public health has made action on

obesogenic environments difficult to establish. Herrick (2009) determines that in the UK

especially there is a shift in patterns of accountability from public policy management towards a

congested state with multiple levels of actors including corporate organisations. An advantage

could be the development of an entrepreneurial approach to health, but the negative in this

situation is a question over the legitimacy and authority of public health policy when the food and

drink industry itself is involved in determining solutions. Herrick (2009) proposes that “health” as

an issue and the cultural norms that surround the concept has the potential to deliver brand

value. Free market thinking demands that consumers be free to choose to consume products

whilst understanding that over-excess can cause health problems; in other words, that consumers

should acknowledge their own personal responsibility.

Corporate social responsibility (CSR) has also been put forward as having a role in promoting

healthy diets and addressing some of the issues described in this report. CSR as a form of

governance can have many structures (Gond et al. 2011, Rayman-Bacchus and Walsh, 2016):

CSR as a form of government. The replacement of government acting in the public interest

by organisations discharging their own social responsibility objectives.

Self-governing CSR. Predicated on voluntary agreements and self-regulation instead of

government regulation, which works via business, instead of a ‘top-down’ command and

control policy approach.

CSR facilitated by government. Governments can promote specific social and economic

corporate behaviour through establishing economic and political incentives such as

exemptions, benefits for organisations, such as planning laws and tax incentives.

CSR as a partnership with government. Corporate investment that promises public, social

and economic benefits beyond the value of such investment as derived solely by the

organisation. For example, infrastructure or utility investment in food retail stores in

neighbourhoods that are poorly served such as combining the building of doctor’s

surgeries, health centres within the development plans of a retail store, paid for by the

retailer. The retailer may benefit by increased income in the in-store pharmacy, but the

government benefits too with improved health care infrastructure in an area that was not

historically services.

CSR as regulated by government. This approach leads governments to regulate to ensure

corporate compliance through legislation to ensure public interest is served but crucially

to also encourage firms’ social responsibility ambitions to exceed regulatory expectations.

The link between CSR and government regulation is discussed in the next section.

6.3. The Public Health Responsibility Deal (PHRD)



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In 2011 the UK Government worked towards introducing a voluntary agreement in England with

the food and drink industry to enhance their social responsibility activities by signing up to the

Public Health Responsibility Deal (PHRD) and to promote ‘healthier choices’ and to provide their

customers with greater knowledge of the nutritional content of their food (Hasham et al. 2012).

Yet, this approach has attracted considerable criticism; particularly concerning the voluntary

nature of the PHRD, the role of industry in setting the targets for reduction in salt, fats and sugar

in foodstuff and determining advertising, particular directed towards children. The government

set out policy targets and priorities in the PHRD and business partners, academics, voluntary

organisations, were encouraged to make voluntary pledges contributing to the strategy in five

distinct networks – food, alcohol, physical activity, health at work and behaviour change. The UK

Department of Health report on the PHRD (DH, 2011a) identifies three central elements: core

commitments, collective and individual pledges, and supporting pledges. Individual businesses

can sign up to the core commitments, collective agreed action and individual organisational

pledges. Table 20 contains the core commitments and the supporting pledges that have been

developed.

Table 20. PHRD core commitments and pledges (Source: DH, 2011a)

THE CORE COMMITMENTS

The business community, voluntary sector and NGOs have already done a

great deal to help people achieve a healthier diet, increase their levels of

physical activity, drink sensibly and understand the health risks of their

lifestyle choices. Signatories to the Public Health Responsibility Deal will

work in support of the following core commitments in relation to their

customers and staff, where relevant.

We recognize that we have a vital role to play in improving people’s health.

We will encourage and enable people to adopt a healthier diet.

We will foster a culture of responsible drinking, which will help people to

drink within guidelines.

We will encourage and assist people to become more physically active.

We will actively support our workforce to lead healthier lives.

THE SUPPORTING PLEDGES

a) We will support the approach of the Public Health

Responsibility Deal and encourage other organizations to sign

up.

b) We acknowledge that the Deal’s strength comes from

organizations of different types across varying sectors working

together to improve people’s health.

c) We will contribute to the monitoring and evaluation of

progress against the pledges.

d) Where we offer people information to help make healthier

choices, we will use messages which are consistent with

Government public health advice.

e) We will broaden and deepen the impact of the Public

Health Responsibility Deal by working to develop further

pledges in support of the five core commitments.

The PHRD is a wide ranging top-level policy initiative aimed at reconfiguring public health

interventions, particularly in areas of alcohol and obesity although in this report F&V are

considered specifically. The government invited the food and drink industry to express its

assurance and social responsibility commitment to a number of specific pledges, which included

measures to encourage people to adopt a heathier diet, take more exercise and drink alcohol

more responsibly (Buttriss, 2011; DH, 2011a; Jebb, 2012). However, the social responsibility

strategies of the food and drink industry and their commitment to the PHRD are potentially

contradictory in light of their primary obligation to return value to shareowners. The challenge is

that the products that are the most profitable tend to be those manufactured and processed

foodstuffs of low nutritional value and often the self-same products that the PHRD, Eatwell plate,

and the Change4Life public health education campaigns encourage consumers to reduce in their

diet (Gilmore et al. 2011; Hasham et al. 2012).

In this context, do food manufactures, retail and food service companies have the capacity to

balance their responsibilities to their shareowners and to other stakeholders? In addition to their

now widened role in the development of complex social policy, can they address the socio-

economic factors that frame an individual’s behaviour and actions? In times when governments

possess limited direct policy instruments, the use of ‘soft power’, such as encouraging firms and

individuals to exercise social responsibility, may provide in itself an innovative driver to address



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challenges such as obesity. In the government’s policy document Healthy Lives, Healthy People,

(CM7985 2010 – DH, 2010b), this was explained in the following terms:

“When central government needs to act, we will balance the freedoms of individuals and

organisations with the need to avoid harm to others. We will aim to make voluntary

approaches work before resorting to regulation”. (CM7985 para 2.19)

The PHRD demonstrates the implementation of government led social responsibility through

business led CSR initiatives which over time can at first complement, and then even take over

roles previously seen as the responsibility of the state. The aim of an approach is to construct a

governance policy that combines individual and business responsibility where neither individual,

business nor government can resolve the challenges single-handedly. Voluntary CSR approaches,

in the absence of “command and control” government legislation and policy, can be seen as a

means to deregulate and unburden business so that it can thrive and grow.

Three distinct strategies can be used by food corporations to nutritionally engineer and market

their products namely: the reformulation of foods to reduce levels of food components of concern,

the micronutrient fortification of products to address micronutrient deficiencies, and

the functionalisation of products that claim to provide optimal nutrition and health benefits

(Durand et al. 2015; Scrinis, 2016). They argue that such nutritional strategies gain scientific

legitimacy by drawing upon the dominant nutritional ideology of ‘nutritionism’, which is

characterised by a reductive focus on nutrients as a way of understanding a food's effects on

dietary health. Further food and beverage corporations promote these nutritional strategies as an

important part of their CSR agendas as evidence that they are addressing the health issues

associated with both over-nutrition and under-nutrition. However, these corporations are also

using such nutritional strategies to legitimise and grow global markets for their products (Durand

et al. 2015; Scrinis, 2016). Benelam and Stanner (2015) conclude that:

“Many popular UK meals would benefit from changes to improve their nutrient profile

and that this could be helped by more consideration of cooking instructions for pre-

prepared meal components and a greater focus on healthier ingredients in recipes.

Homemade dishes tended to be higher in fruit and vegetables and in fibre, but were also

higher in saturates. Relatively simple changes to the meals analysed, such as adding

plenty of vegetables when cooking using a jarred sauce or swapping standard for lean

mince when cooking a meat dish, could make a significant improvement to meals.

Routes to communicate such simple changes to consumers should be used by retailers,

manufacturers and caterers, and by health professionals wherever possible”. (Benelam

and Stanner, 2015:325)

Knai et al. (2015) evaluated the PHRD food pledges in terms of (i) the evidence of the

effectiveness of the specific interventions in the pledges and (ii) the likelihood that the pledges

have brought about actions among organisations that would not otherwise have taken place. The

study highlighted that most interventions reported by organisations seemed either clearly (37%)

or possibly (37%) already underway, regardless of the PHRD. Durand et al. (2015) also concur

with this statement. Knai et al. (2015) concluded that whilst some of the PHRD food interventions

could be effective, if fully implemented, the most effective strategies to improve diet, such as food

pricing strategies, restrictions on marketing, and reducing sugar intake, were not reflected in the

PHRD food pledges. They went further to state that:

“it was difficult to establish the quality and extent of implementation of RD pledge

interventions due to the paucity and heterogeneity of organisations’ progress reports….



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Irrespective of the nature of a public health policy to improve nutritional health, pledges

or proposed actions need to be evidence-based, well-defined, and measurable, pushing

actors to go beyond. “

This report has considered the pledges made under F6 the PHRD F&V pledge.

6.4. F6 – Fruit and Vegetable Pledge in the PHRD

The PHRD pledge that is of interest with regard to increasing F&V consumption is F6 – the fruit

and vegetable pledge. The F6 pledge is as follows:

"We will do more to create a positive environment that supports and enables people to increase

their consumption of F&V." (DH, 2015)

The words ‘positive environment’ can be seen to refer to the wider consideration of choice

architecture as previously described in this report. This pledge is designed to mobilise action

across the food retail and food service industry to encourage increased consumption of F&V

aiming at the 5-A-DAY target. This pledge looks at F&V in all its consumed forms: fresh, frozen,

canned, dried, and juiced products, as well as F&V in composite products. Taken together with a

range of action by other partners, including government, primarily through the 5 A DAY work and

Change4Life, this should help people eat more F&V (DH, 2015). The scope of the pledges

includes:

(1) Making F&V more widely available across all food outlets;

(2) Making it easier for consumers to achieve their 5 A DAY target, for example, by

incorporating F&V into composite dishes or meals;

(3) Encouraging people to increase F&V consumption through incentives or other

marketing activities; and

(4) Providing information to encourage consumption and advice to develop

practical skills relevant to F&V consumption.

Once an industry partner has signed up to the pledge they are asked to report annually on their

progress. There are currently 48 partners across the food sector committed to this pledge. The

delivery plans for these partners have been collated (Appendix 1) and the 2015 updates

(Appendix 2).

6.5. Summary

This section of the report has considered further public health initiatives (PHI) and more

specifically the role of CSR in consort with public health initiatives to achieve progress towards

increasing the consumption of F&V. Section 7 draws many of the themes outlined in the report

together as options for action at government, retailer, food service and farming and processor

levels. These options for action have been developed with an appreciation that they will only have

value in enabling the increased consumption of F&V if there is a recognition at consumer level of

the personal responsibility for ensuring individual, and household health and wellbeing.



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7. Options for action that can enable increased

consumption of F&V in the UK

Having undertaken the desktop study that underpins the report, a series of options for action have

been identified in this section of the report that individually or collectively, as part of a conserted

multiple intervention approach have the potential to increase the consumption of F&V in the UK.

7.1. Options for action - Government

Choice architecture

Revisit planning regulations with regard to enabling choice architecture at community level

and ensuring that nutrient-rich foods are not simply “swamped out” by energy-dense food

alternatives.

Redesign the layout of food service areas and the positioning of food products in public

areas such as schools, hospitals, government workplaces in order to have increased F&V

availability at the start of the buffet setting, or the use of convenient options for F&V

products in vending machines.

Undertake a feasibility study to determine applicability within the UK policy environment

for the development of an equivalent Community Food Projects Competitive Grants

Programme (CFPCGP) in order to implement a nutrition incentive based approach as has

been developed in the United States (US) where it currently involves 110 community

based partners, 730 community health care centres, hospitals and food hubs (see Section

4.3).

Promote increased visibility of F&V within schools with an associated choice architecture

strategy in the food service setting.

Reformulation

Provide an enabling environment for food reformulation for example, through the

Public Health Responsibility Deal.

Information

Develop a cohesive strategy for enabling of F&V consumption with a view to promoting the

need for increased fibre and micronutrient consumption to ensure the nation’s health in

addition to existing initiatives (see Table 14).

7.2. Options for action – Retailers

Choice architecture

Introduce mechanisms such as the use of floor markers, grocery trolley/cart or basket

mirrors, sectioning out parts of the trolley and labelling as a F&V area in the trolley or

basket and/or trolley or basket placards to reinforce the social norms associated with F&V

choice. Use of such placards in one study increased the spending on F&V by 12.4% in one

store and 7.5% in another with no net increase in spending (see 3.2.2). Provide information



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for consumers on the top five F&V items purchased in the store on shelf markers or visual

boards.

Revisit policies on shelf space allocation to F&V in store in terms of fixture location, product

category location, item location within categories, off-shelf displays and point of sale

promotional support (Yang and Chen, 1999). This should include a review of the frequency

of display and the positioning of F&V especially convenience, snack options of F&V in the

store layout.

Address the positioning of retail products on shelf especially snack products as positioning

has been shown to influence choice so that F&V are not disregarded (See Table 2).

Improve the use of shelf labels that identify nutrient-rich products, provide more

information on healthy meal ideas and recipes and consider a rewards programme for

purchasing healthy products (see Table 4).

Reformulation


especially ready-meals and revitalising the components of meal deal options to ensure

there is an increased featuring of convenience F&V products.






Information

Embed storage instructions on pre-packed F&V outer packaging so it can be seen on

purchase and when stored “in pack” in the home. It is important that this is visible when

the packaging is still intact on pre-packed F&V and is available at the point of purchase for

loose fruit for example, via information on bags, shelf cards, stickers that can be applied

to clear bags, paper bags with storage information. The size of print on pack and on instore

information is an important consideration so that all customers can access the

information. Improve understanding by customers of the need to refrigerate F&V to ensure

shelf-life in the home when it is often displayed in ambient conditions in-store. The ambient

display of produce is often confusing for consumers in this regard when the

recommendation is to then refrigerate food at home.

Promote product tastings, recipe cards featuring F&V that are ideal accompaniments for

ready-meals and promote the presence of healthy ingredients in convenience food options.

Increase staff knowledge about healthy food choices and nutrition. In one study (FMI,

2010) only 35% of shoppers felt that supermarkets enabled them to make healthy food

choices for their children, and only a quarter of shoppers felt that grocery store staff were

knowledgeable about nutrition or nutrition supplements.

7.3. Options for Food Service

Choice Architecture



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Redesign the layout of food service areas and positioning of food products in order to have

increased F&V availability at the start of the buffet and use convenient options for F&V

products on buffets.

Increase the proportion of F&V items available for children by develop F&V options that

are “fun shaped” for example, animals, letters etc. “fun named” or with fun characters and

positioned in a way on the menu or table information to increase child purchasing requests

(see 3.2.1).

Reformulation

Through menu development and recipe reformulation increase the range of food products

that contain F&V, and more specifically in “ready-to-go” products being offered in the food

service environment.

Information

Implement the labelling of food products in vending machines, buffets, and on menus with

red, yellow and green coding to signify the health benefits, or lack of them to people

choosing both meal and snack options. This has already begun with some food service

businesses promoting F&V based products for say under 350 calories for a meal option.

7.4. Options for the Farming and Processing Sector

Choice architecture

Implement growing techniques that improve substrate and soil nutrient value and

mechanisms for increasing the nutrient content of the F&V grown, harvested, stored and

processed in the UK.

Work with other sector partners to develop a demand led strategy that could encompass

the development of new crop varieties, the need for new forms of packaging, promotion

and presentation and the mechanisms for promoting health messages to a multi-

dimensional audience.

Reformulation


especially ready-meals and convenience products.






Identify new ways of delivering convenience to consumers through further processing of

F&V so it can compete as a convenience product.

Information

Embed storage instructions on pre-packed F&V so it can be seen on purchase and when

stored in the home.



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7.5. Summary

The study and this associated report have addressed the underlying research questions:

The underlying research questions are:

1. What are the global initiatives that followed the World Health Organisation (WHO)

recommendation of 400g per day F&V consumption ?

2. How has UK public policy developed to encourage adults to consume 400g of F&V? daily?

3. What is the impact of the policy initiatives and whether adults are meeting the WHO

recommendations?

4. What actions have the food industry taken to encourage consumers to meet the F&V

consumption agenda?

5. In the academic-scientific/government literature what are the identified enabling and

constraining factors with regard to F&V consumption?

6. What is the role of UK growers in meeting the needs of consumers of F&V?

Options for action have been put forward as a result have been outlined by sector. The next

section draws together the conclusions from the report.



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8. Conclusions




increased. The objectives of the study were to consider:








A holistic approach was used in the study to draw together themes from a range of academic and

policy literature. In 1990 the World Health Organisation (WHO) recommended a minimum

consumption of 400g of F&V per day and in the UK this has translated into the 5-A-DAY initiative

and other initiatives globally (see Section 4.2). However, the impact of these public health

initiatives (PHI) on increasing F&V consumption on a sustained basis remains modest (Rekhy and

McConchie 2014). Success has been reported for those PHI which have forged partnerships

between industry, retail, government and not-for-profit organisations promoting public health

(Rekhy and McConchie 2014) see Section 4.4.

Whilst the relative affordability of energy dense foods compared to nutrient rich foods has been

suggested as a primary constraint, this report demonstrates that the landscape with regard to

enabling F&V consumption is in fact much more nuanced and multifaceted. Thus whilst

affordability is important, there are other positive steps that can be taken that show the potential

to make a real difference and increase the level of F&V consumption in the UK. This 2016 report

commissioned by the National Farmers Union (NFU) has considered the proactive steps that can

be taken to facilitate increased consumption of F&V. These include:

Choice architecture which is relevant to community environment, retail store, food service,

work place canteen and school canteen layout and managing portion control with a view

to influencing choice, promoting convenience and high calorie food/beverage availability

(see Section 3.2.2).

Reformulation - including more F&V in convenience options and other food offerings.

Relatively simple changes such as adding plenty of vegetables when cooking … could

make a significant improvement to the nutrient profile of meals (Benelam and Stanner,

2015).

Information - reminding people at the point of purchase about their choices, drawing

attention to social norms and framing information.

A range of global and national public health initatives have been described in sections four, five

and six of this report and the enabling and constraining factors that have influenced the success




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of policy initiatives and the mechanisms such as the Public Health Responsibility Deal (PHRD)

that have sought to engage voluntary support from industry. The evidence suggests that current

PHI in the UK have failed to move the general public to average consumption of five portions of

F&V per person per day as recommended by the WHO therefore new and innovative methods

need to be developed, and implemented in order to increase consumption. These form the basis

for the options for action in the executive summary.


particular demographic groups in different ways. The challenge of reducing diet related

malnutrition (DRM) sits at a nexus of public policy, corporate responsibility and individual

responsibility.



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http://nifa.usda.gov/program/community-food-projects-competitive-grant-program-cfpcgp

http://nifa.usda.gov/sites/default/files/resources/FAQs%20FY%202016%20RFA.pdf

http://nifa.usda.gov/program/food-insecurity-nutrition-incentive-fini-grant-program

http://apps.ams.usda.gov/fooddeserts/foodDeserts.aspx

http://www.wcrf.org/int/policy/nourishing-framework/restrict-food-marketing

https://www.wholesomewave.org/about-us/

https://www.wholesomewave.org/our-initiatives/healthy-food-commerce-investments



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WRAP (2013), Helping Consumers reduce fruit and vegetable waste: Final Report. November

2013 WRAP

WRAP (2008), Household Food and Drink waste in the United Kingdom 2012: Final Report.

September 2008 WRAP

WRS (2015), Healthier Choices Food Award, Available at:

http://www.worcsregservices.gov.uk/food/healthier-choices-food-award.aspx

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11/02/2016)

Yang, M-H., and Chen, W-C. (1999), A study on shelf space allocation and management,

International Journal of Production Economics, 60-61, 309-317

Zick, C.D., Smith, K.R., Fan, J.X., Brown, B.B., Yamada, I., and Kowaleski-Jones, L. (2009),

Running to the Store? The relationship between neighborhood environments and the risk of

obesity, Social Science and Medicine, 69(10): 1493-1500

http://www.worcsregservices.gov.uk/food/healthier-choices-food-award.aspx

10. Appendix 1. Delivery Plans for the organisations pledged to F6 of the Public Health

Responsibility Deal (PHRD)

COMPANY DATE

JOINED RD

DATE

SIGNED F6

DELIVERY PLAN

Aldi 10-Mar-11 01-Jan-13 ALDI is committed to encouraging customers to eat more fresh fruit and vegetables. We recognise the importance of a balanced diet which includes a healthy mix of fresh fruit and veg. In addition to everyday low pricing, we run our fortnightly Super 6 fruit and veg offer. It’s a smart, simple offer based on providing customers with a choice of 6 popular fruit and vegetables at fantastic prices. It means they can eat better for less. We are working on helping our customers increase the amount of fruit and veg in their daily diets. Through a combination of national TV advertising and in-store promotions including our popular leaflet, we can show customers how they can easily afford a wide-range of fruit and vegetables, and how they can include these in the meals they eat. We also strongly promote fruit and vegetables through our official social media channels including a dedicated Super 6 app on Facebook. We currently feature the 5 a day logo on our products and plan to dedicate more space in-store to our fruit and veg category.

ARAMARK 14-Feb-13 14-Dec-13 ARAMARK will be launching a new health and wellbeing programme across its business from January 2014. In developing this programme, we have taken the Responsibility Deal target areas as a key decision making factor. The key actions we will be taking that support this pledge are: • All sites to have fruit available daily (whole fruit/ fruit salads) and where appropriate vegetable crudités as a chilled choice. • Menu identifiers and shelf barkers used to promote products that contain part of your 5 a day. • Fruit to be displayed near other impulse buys in as many sites as possible where space allows. • Fruit to be competitively priced and where possible, cheaper than confectionery. • Improve display and range of fruit to make it more appealing to the customer. • All appropriate healthy choices on our menus contain part of your 5 a day as a standard. • Our 2014 wellbeing activity planner for the company will focus on a priority health and nutrition topic each month. Many of these topics will reference the importance of getting your 5 a day for example, healthy eating guide, vitamins and minerals, heart health. • Table top marketing at point of sale – educating and reminding customers on what 1 of their 5 a day is and how they can achieve it, particularly helping them to understand what a portion looks like. • Work towards meal deals to include fruit as an alternative to confectionery. • Work towards offering salad/ vegetable alternative as a side dish for all main courses (instead of chips etc.). • Look into increasing vegetable content within appropriate recipes

Artizian 29-Jun-11 13-May-14 No information provided on delivery plan for F6 pledge

Bartlett Mitchell Ltd 23-Oct-13 Bartlett Mitchell takes the health and wellbeing of its customer seriously and as a fresh food contract caterer have signed up to the Fruit and Vegetable pledge as it is an integral part of r decision making when developing menus. Each of our restaurants have a full range of fresh fruits and seasonal vegetables available at all times and consider the nutritional benefit for its customers when putting together it's daily and weekly menu to make sure we get the right balance for its customers.

Bidvest 3663 08-Jul-11 01-Jan-13 3663 will do more to create a positive environment that supports and enables people to increase their consumption of fruit and vegetables, and pledge to: Encourage customers to increase the procurement of products suitable for 5 a day through a variety of price promotions. Provide Practical advice to customers on how to increase fruit and vegetable consumption within the 3663 Health and Wellbeing brochure, which is due for publication in January 2013. Label relevant own brand product packaging as suitable for 5 a day where applicable, in alignment with CMI 5 a day guidance.

Booker Group plc 10-Mar-11 07-Dec-12 Booker understands the importance of a balanced diet in maintaining good health and, within this, the key role played by fruit and vegetables. We will introduce 5-a-day labelling wherever it is applicable on our range of own label foods. We will promote fruits and vegetables across our wide customer base of small and medium sized retailers and caterers nationwide. We will further develop prominent fresh fruit and vegetable displays within our branches.

https://responsibilitydeal.dh.gov.uk/partners/partner/?pa=16



https://responsibilitydeal.dh.gov.uk/deliveryplans/?dp=3867





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Brakes 04-Nov-11 15-Nov-12 Brakes and our fresh produce specialists, Pauleys have an extensive range of fresh, frozen, canned and dried fruits and vegetables as well as juices. These are easily identified within our main sales brochure the list and our on line product information the list on-line. The same range of products will be available to all caterers. Our Brakes website will have a section devoted to fruits and vegetables with an associated fact sheet. Pauleys website is entirely devoted to fresh produce. We will encourage our customers to include more fruits and vegetables in dishes and on menus by providing recipes including fruits and vegetables to be published in our regular promotions and on our website. We will also work with the charity Behaviour Change through the Dabble with your Dinner campaign, which will provide tips and hints to include more fruits and vegetables in popular dishes and meals. Where appropriate we will undertake promotions including fruits and vegetables to encourage and enable caterers to serve and include more in their recipes and on menus.

British Frozen Food

Federation

07-Jun-11 The British Frozen Food Federation (BFFF) will provide tasty, healthy and convenient recipes on its consumer website to help to encourage and promote the increased consumption of fruit and vegetables. BFFF are redeveloping and relaunching the BFFF consumer website to: -ensure it will be more consumer friendly to attract increased traffic of consumers looking for meal solutions-provide healthy recipes, that will be clearly signposted and, when meeting the required criteria, use the 5-a-day logo-facts on frozen will be provided with links to help consumers understand 5-a-day and easily access Change4Life and other DH advice-independent academic research will be provided to support consumers in making informed healthy choices

CH&Co Catering Limited 12 July, 2011

19-Nov-13 CHCo currently supports the Fruit and Vegetable pledge in the following ways: Using its Veg Plot initiative to raise the profile and appetite for vegetarian meals Using its Veg Plot 3 initiative to focus on consciously increasing the number of portions of fruit or vegetables customers consume within its restaurants, rewarding multiple portion purchases with cash discounts to build new habits Highlighting the number of portions of fruit or vegetables contained within a serving of a dish (whether meat/fish based or vegetarian) with clear labelling Creating a more farmers market display approach in many of its restaurants, with raw ingredients featuring prominently, making them more accepted and the norm for customers to see and therefore buy Increasing portion sizes of prepared fruit or vegetables to 80g to ensure that they count Using its Wellbeing being well healthy eating initiative to highlight one changing ingredient each week (usually a fruit or vegetable) that is seasonal, and makes a positive contribution to their health. This then features with the range of dishes on offer Running Wellbeing being well days where customers can get more information about how to balance their diets and the benefits of this Working with nutritionist, Amanda Ursell, to provide accessible information for customers and to underpin the initiatives above Our target for the next year is to: Increase the value of each of these initiatives for our customers; making them more widespread and consistently in focus to the point where they are visible in 100% of our staff restaurant (Business Industry) sites (clients permitting)Further increase awareness and understanding among our own staff through a structured training plan, to give greater confidence when dealing with and cooking for their customers, Look for and consider other ways of taking the pledge forward within CHCo.

Co-operative Group (The) 07-Mar-11 15-Nov-12 We are committed to helping our customers make healthier food choices for themselves and their families. This includes encouraging customers to increase their consumption of fruit and vegetables through a variety of actions. Our pre-packed fruit and vegetables carry a 5-a-day message in a green dot, as does pure juice and eligible canned, dried and frozen products. Suitable Co-operative brand composite products; for example, ready meals, carry a 5a-day message on front of pack subject to meeting nutritional criteria based on IGD Composite Foods Guidance. We offer a range of ready to cook and prepared vegetable products and our lunchtime meal deals include salads, prepared fruit pots and pure juice options. Our simply value range includes a variety of fresh, frozen and canned fruit vegetable lines. We run informative 5-a-day messages on till screens and on Co-operative radio. The Co-operative Food website has a dedicated 5 a day section which links to an interactive seasonal wheel highlighting which fruit vegetables are in season each month. We also emphasise seasonal recipes each month to encourage customers to use a variety of different produce. http://www.co-operative.coop/food/food-and-drink/food/Taste-the-seasons Fruit and vegetables lines are always included in promotional packages. The deals are included in promotional leaflets and feature in the Healthier Deals section of our website. Frozen vegetables are always included in promotion offer as a convenient way to get 5 a day. We ensure that at least 30% of our food promotions are for healthy offerings. As part of our sustainability education programme, Green Schools Revolution, The Co-operatives unique from Farm to Fork scheme enables primary school children to benefit from an interactive learning session and a hand-on tour of our farms to see how food including fruit and vegetables are grown. Children also learn about the importance of eating a varied and balanced diet in order to make good food choices. Over 75,000 primary school children have








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attended a From Farm to Fork visit. http://www.co-operative.coop/farms/from-farm-to-fork/ In addition to continuing existing activities in 2013 we will explore new ways of changing consumer behaviour and develop initiatives to make it easier for people to buy, try, cook, eat and enjoy a wider range of fruit and vegetables. We will: Use incentives to encourage customers to try more fruit and vegetables, for example money off coupons and direct mail. Incentivise customers through our unique Membership scheme by awarding extra bonus points on purchases of fruit and vegetables. Communicate the 5 a day message more prominently in store, on our website, on digital media and on our products. Introduce new and exciting products containing at least one of your 5 a day. Feature information and recipes incorporating fruit or vegetables in customer and staff publications and communications. This will include features on our own Farms and how and where fruit and vegetables are grown. Incorporate further signposting for healthy eating including fruit and vegetables along with food labelling information within the lesson plans for our Co-operative From Farm to Fork scheme.

Compass Group UK & Ireland 10-Mar-11 18-Mar-14 No information provided on delivery plan for F6 pledge

Coventry and Warwickshire

NHS Partnership Trust

02-Mar-12 01-May-14 Coventry and Warwickshire Partnership Trust are committed to the promotion of healthy lifestyle choices and as a Trust, we are aspiring to change habits and encourage 5 a day We plan to review and extend the salad bars at St Michaels Hospital restaurant at Warwick, Brooklands Hospital Coffee Bar at Birmingham and at the Jepson Bistro in Nuneaton. We Plan to meet with the food suppliers for these areas, they will be asked to support us by supplying good quality seasonal fruit and vegetables. At each location, we will promote and raise awareness by providing material that will support healthy eating. Will also focus on seasonal fruit and provide fruit salad pots and promotion of fruit of the week

Dine Contract Catering Ltd 15-Feb-13 01-Nov-13 We will do more to create a positive environment that supports and enables people to increase their consumption of fruit and vegetables. We will deliver this pledge using a 4-point plan; 1. From Sept 2013 we will increase the vegetable content of our new composite dishes by 15% - baseline current content and new recipe information will be available on the extranet for monitoring purposes. 2. From Sept 2013 we will sell all of our main meals with an accompanying portion of vegetables or salad. 3. Throughout the year we will run promotions to encourage increased consumption of fruit and vegetables. For example; meal deals, price incentive to take a fruit based pudding with main meal; extra serving of salad or vegetables free with main meal (over and above portion included); promotional cards at certain sites to collect stamps for the number of fruit and veg portions taken in a week, collect 15 stamps in a week and get a free lunch. 4. Throughout the year we will publish quarterly info shots highlighting the importance of consuming more fruit and veg, and how this translates directly as a health benefit to the individual.

Empower 2 Excel 22-Feb-13 22-Feb-13 no information provided

Feel Good Drinks 31-Jan-13 13-Feb-13 Feel Good Drinks manufactures a range of fruit based drinks with no artificial ingredients and no added sugars. During the coming year we will increase marketing investment to raise awareness of our brand and encourage consumers to try the products and switch from sugar based drinks to our fruit based products. We will work with our retailer partners to ensure that fruit based drinks are available in the widest distribution and that consumers are offered every opportunity to select our drinks. We will continue to innovate into new pack formats and new flavours to encourage wider uptake and consumption of our healthy ingredients. Our target is to increase volumes by a minimum of 10% during this year, equivalent to an additional 1M portions of fruit consumed.

Food Dudes Health Ltd 28-Feb-14 24-Oct-14 Developed by leading behavioural psychologists from Bangor University, the Food Dudes programme has been proven to deliver long lasting changes in children's eating habits. Our pledge is to continue delivering long lasting increases in fruit and vegetable consumption among Nursery & Primary school aged children who undertake the Food Dudes programme. Food Dudes is a unique award-winning Healthy Eating programme for children that combines leading behavioural science techniques with fun activities to deliver outcomes that are unrivalled by any other scheme available, by driving a massive increase in Fruit & Vegetable consumption and a reduction in consumption of high fat and sugar foods and snacks. Food Dudes is a key component of a community-based childhood obesity prevention strategy. As a targeted intervention Food Dudes is: - High impact - High feasibility - Highly cost effective - Supported by high quality research evidence - Able to deliver quantifiable outcomes with local results published for each programme










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Gather & Gather 30-Aug-11 17-Feb-14 Helping our customers reach their 5 a day target is an obvious priority here at Gather & Gather. For many of our customers 2 of their 3 meals a day will be eaten in our restaurants and we therefore have a responsibility to positively influence their choices. In April 2014 we launch our 5 a day campaign where we provide our restaurants & cafes with stickers and information to label products which meet either 1 or 2 or your 5 a day. Should it prove successful it will continue to run throughout the year. To incentivise teams, they will have the chance submit recipes and photos of full meals they have served which they think may meet 3 of your 5 a day, this can be challenging. Education is key here and we've empowered our managers and supervisors with enough information on "what counts" to make decisions on what to advertise, however any queries they do have will be directed straight to our own Registered Nutritionist. As a business standard, all of our restaurants offer fresh fruit in bowls and fresh fruit pots form part of our standardized grab & go range. Where meal deals are available fresh fruit will always be available as a snack option and its competitively priced in comparison to those less healthy snacks. Sites with the facilities also offer fresh juices and smoothies which will be marketed as 1 of your 5 a day only.

General Mills UK 10-Mar-11 15-Nov-12 General Mills has been proudly promoting the Department of Health’s 5 A Day message through the much loved Green Giant brand for many years in the UK. The Fruit and Vegetable Pledge is an opportunity to confirm our continued support to promoting the 5 A Day message, encouraging children to establish positive eating habits early on in life and doing our part to get more families eating more vegetables .A new Green Giant Steam Locked Goodness message and media campaign, running from September featuring Green Giant Salt Free Sweetcorn, will remind parents that canned vegetables are one of the most convenient and tasty ways to ensure children get 1 more of their 5 A Day. The campaign will be supported online via the Green Giant website Facebook page and will include recipe ideas and the promotion of healthy lifestyle habits.

Guide Dogs for the Blind 20-May-13 05-Jun-13 Guide Dogs for the Blind are committed to encouraging staff to eat more fruit and vegetables in order to achieve their 5 a day. Guide Dogs recognize the importance of inspiring staff to implement a healthy balance diet which includes a mix of fruit and vegetables. Guide Dogs will create a positive environment that supports and encourages staff to increase their consumption of fruit and vegetables through easily available information and advice on healthy eating, promotional poster displays and workshops.

Harbour & Jones Ltd 12-Mar-13 20-Apr-13 Healthy eating and providing our customers with the information to make informed food choices is a priority at Harbour & Jones, which is why we started investing three years ago in our own bespoke nutrition project called Nourish & Flourish. This doesn’t just involve providing nutritional information but also aims to make information more accessible to customers by highlighting key health benefits such as one of your five a day. Supported by our full-time H&J nutritionist, we have been educating our chefs and customers in a number of ways including providing one-to-one tuition, onsite support, educational packs and roadshows. We’ve been educating our customers about why it’s important to eat five portions of fruit and veg a day and we do this in a number of ways. We label our Grab & Go products with stickers indicating when they contain 1 or 2 portions of the 5 a day -helping customers reach their target. We have developed our own smart phone app which means our customers can find out even more about the food they eat in their staff restaurant just by looking at their phone. Using the latest nutritional databases our app allows customers to view key information about the food on offer such as fat, calorie and salt content, as well as read advice about maintaining a healthy diet and the importance of eating your five a day. Launching later in the year we'll be running a fantastic fruit offer every Friday. Every time a bottle of water is purchased, we’ll give away a free piece of fruit. We will educate our staff on how to merchandise fruit so that it makes customers more likely to buy. We’ll be continuing our Meat Free Mondays that highlight the health benefits of eating vegetables and encourages customers to eat their five a day through yummy vegetarian options.

Iceland Foods Ltd 25/3/2011 15-Nov-12 Iceland Foods is committed to continuing to provide a wide range of quality fresh and frozen fruit vegetables at affordable prices, across our 764 stores high street stores. To meet this fruit and vegetable pledge Iceland is planning: to continue to indicate a "5 a day logo" and portion indicators, on appropriate products; to review our Iceland website to include new 5 a day information tips, as well as link to the British Frozen Foods Federation (BFFF) Website; highlighting how frozen fruit and vegetables are value for money, convenient, offer all round year availability and are just as nutritious as fresh; new social media features to encourage customer conversation; to introduce money off coupons at the till and will monitor the uptake of deals; continued new product development and range review; continued incorporation within ready meal ranges.








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Jamie Oliver Food Foundation 27-Sep-13 05-May-15 The Jamie Oliver Food Foundation promotes the consumption of fruits and vegetables in a number of different ways. The Kitchen Garden Project, a set of resources that empowers primary school teachers to engage children in growing and learning about fruits and vegetables is currently running in over 245 schools across the UK with the aim to be in 1,500 schools by the end of 2015. We also have a community-based cookery programme, the Ministry of Food, with four centres and numerous outreach projects in the UK, and four centres and two food trucks in Australia. The programme teaches adults the basic cooking skills and nutrition they need to give them the confidence to cook from scratch and make better food choices. The Jamie Oliver Food Foundation provides nutrition messaging and resources to the Ministry of Food staff to ensure they’re teaching nutrition accurately. The Fifteen Apprentice Programme is a social enterprise that gives unemployed young people the training they need to become professional chefs. The programme began with Fifteen restaurants in London, and has franchises in Cornwall and Amsterdam, where we aim to make sure that all children’s dishes are exemplary in terms of nutrition. The restaurants also offer at least two of a child’s five a day on their menu. At Jamie Oliver HQ, we offer free fruit to staff on a daily basis and have produced fun and engaging nutritional resources to teach both children and adults about nutrition and the benefits of fruits and vegetables. The resources are available through Jamie Oliver Food Foundation programming.

LIDL UK Gmbh 08-Feb-12 15-Nov-12 Lidl will:- increase the number of prepared vegetable and salad lines, including trialling vegetable soup mix;- building on our activity supporting Red Tractor week (24 30 September 2012), increase a number of new promotional activities featuring fruit and vegetables on billboards, from September launch rebranded fun sized apples, pears and bananas with new packaging to appeal strongly to children use Facebook to promote fruit and vegetables and provide free fruit for competitors at the Lidl sponsored Bananaman Triathlon and other sporting events. - rebranding of all our fruit and vegetable items - the new packaging containing nutrition and health information and the number of 5 a day portions.

LITTLE TINKLERS NURSERY 20-Jun-13 08-Jul-13 Little Tinklers Nursery is a private childcare provider primarily offering care for children from birth to five years. We also offer a holiday club that cares for children aged 5 - 13 years. Little Tinklers pledges to ensure that children in our care receive a wholesome and healthy start by offering : - A balanced and healthy menu every day for lunch, tea and snack times - Meals include servings of fresh fruit and vegetables each day - Children have access to a wide range of raw fruit and vegetables each snack time - Staff set a good example by eating and sitting with the children and show good table manners - Staff use snack and meal times to encourage independence in making healthy choices - Staff talk about and help the children understand the need for healthy eating - Children have opportunity to try new and different / varied fruits / vegetables - Children have the opportunity to cook with fruit and vegetables - The Nursery will provide parents with details each day of meals / snacks the children have enjoyed - Menus are changed weekly and are displayed in the entrance foyer - All staff are trained to Level 2 in Food Safety - Little Tinklers has been awarded ' Healthy pathways' status - Staff encourage healthy habits with the children such as teeth brushing and hand washing

Marks & Spencer 04-Mar-11 15-Nov-12 MS are committed to supporting our customers to eat more fruit and vegetables and will continue to drive this through: Promotions - to encourage customers to buy more fruit and vegetables Product continued reformulation of products to increase the fruit and vegetable content of recipe dishes and to provide convenient health products, particularly at lunch, making it easy for customers to increase their consumption Labelling continue to use and increase our 5 a day labelling, with a practical steer on portion sizes on basic vegetables and fruit, across our healthy food ranges We will also launch healthy recipes online to inspire customers to try and cook with different vegetables

Mars (UK) 10-Mar-11 01-Sep-13 At Mars Food UK, we are passionate about providing enjoyable healthy food that combines great taste with good nutrition and we are dedicated to Better Food Today, A Better World Tomorrow. The latest National Diet and Nutrition Survey found that the average consumption of fruit and vegetables was 3.1 and 3.0 for women and men respectively. Helping the population to increase their fruit and vegetable consumption to achieve the target of 5-a-day is an area where Mars Food has been contributing to and will continue to do so. For many years, Mars Dolmio brand tomato sauces have contributed to the target, each serving providing 1 of your 5 a day, highlighting the important role that composite products can play in helping the nation increase their consumption of fruit and vegetables. New product development of Dolmio Sauce for Meatballs (3 varieties) in 2012 also contain 1 of your 5 a day. The innovation of Dolmio PastaVita ready meals in 2011, with each meal containing 1 of your 5 a day, provided a new way for consumers to have a healthy meal containing 300 to 340 calories which are low in fat, contain no artificial colours, flavours or preservative and are ready in 90 seconds. We also believe that our brand Uncle Bens has a role to








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play and that rice based meals can offer an excellent way of providing the family with a healthy meal. Mars Food will continue to contribute to increasing the nations fruit and vegetable consumption by Providing 1 of your 5 a day per serving in our Dolmio sauces NPD in 2013Providing recipes on our Uncle Bens brand website to help increase the consumption of fruit and vegetables Providing education to our employees on the benefits of eating 5 a day Continuing to ensure that fruit and vegetables are readily available in staff canteens and staff shops.

Morrisons (Wm Morrison

Supermarkets Plc)

10-Mar-11 15-Nov-12 We will revamp the produce department in more of our stores to encourage customers to increase their consumption of fruit and vegetables. This will include new layouts, extended choice and exciting innovations. Vegetables will be placed on ice to ensure the best condition of the product and misting technology will be used to optimise freshness. Exciting new lines will be added to give fruit and vegetables more of a wow factor and displays will enhance the market feel. Our experience to date indicates that this could increase sales of fruit and vegetables by an average of 14%, helping customers get nearer their 5-a-day. We are also committed to including at least one portion of fruit and vegetables in children’s ready meals when our new range of children’s food launches next year. Going forward we plan to look at the potential of behaviour change approaches to get more people buying fruit and vegetables.

PhunkyFoods 18-Jun-13 28-Jun-13 We pledge to inform and motivate staff, pupils, parents and the wider schools community within our existing partner primary schools about increasing their fruit and vegetable consumption via the Phunky Foods Programme (PFP). This includes, but is not limited to; - increasing 5-a-day information and practical guidance on all teacher training material - incorporating additional 5-a-day lesson plans for all year groups on the PFP - adding more parental blogs on the 5-a-day message, and additional recipe blogs for practical inclusion of fruit and vegetables in everyday recipes - Promoting our new 5-a-day information through our newsletters - 5-a-day cooking workshops run through our community-based programmes by our regional Community Support Workers in partnership with our schools.

Portsmouth City Council 28-May-14 13-Aug-14 Portsmouth City Council recognises the need for its employees to eat a healthy balanced diet. A balanced diet is an important part of helping its employees to feel their best and is therefore committed to supporting its employees by: Providing and promoting fresh fruit and salad options within its staff cafe facilities. Promoting fresh fruit with meal deal packages. Promoting natural unsweetened fruit drinks. Working with partners (for example, health service and suppliers) to encourage staff to consider healthy balanced diet options.

Princes Limited 25-Jun-13 13-Apr-14 Princes has for many years been one of the UKs leading suppliers of canned fruit and vegetables and we incorporate the Department of Health’s 5 A Day message onto our products wherever possible, encouraging healthy eating habits. Over 170 of our branded products count towards consumers One of 5 A Day and we intend to grow this in 2013/14 with new variants of pure fruit juice, canned fruit and vegetables. We are also the largest purchaser of British grown vegetables for use in canning. All of our canned fruit and vegetables and pure juice products are regularly promoted in stores and above the line to encourage consumer consumption. We also highlight the nutritional strengths of canned food as well as convenience and minimal waste messaging. We also supply where possible differing pack formats (for example,200ml juice) to increase consumption opportunities for our consumers and aim to increase our smaller pack size portfolio in the coming year. We launched in April 2013 a range of fruit in jelly targeted for children’s consumption that highlights the 5 A Day message and is the first brand to use natural fruit juice in the jelly.

RehabWorks (since 3 July,

2014)

03-Apr-14 03-Jul-14 No Links

Restaurant Group Plc 23-Oct-14 23-Oct-14 In many of our main lunch meals, such as pasta or wraps we offer a side of salad, as an alternative to fries to allow customers to make a healthier choice. We will aim to roll this out across our menus, so that any time fries are offered, the customer can change this to a side salad. Garfunkels offer a trip to the salad bar or a corn on the cob with any kid’s meal. We pledge to roll out an offer of salad or veg with any kid’s meal across all our kid’s menus to encourage kids to get their 5aday and make it easier for parents. We are also working on making it easier for our customers to make healthy choices by adding a logo onto our menus to highlight any dish that contains at least one of your 5aday. These pledges will increase the fruit and vegetable content of our dishes and give dishes with fruit and vegetables more prominence on the menu, allowing customers to make healthier choices.











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Sainsbury's Supermarket Ltd 10-Mar-11 10-Mar-11 Our mission is to make the healthier choice the easiest choice for our customers and colleagues and a key part of this is helping them achieve their 5 A Day. For a number of years, we have used many channels to promote fruit and vegetables to our customers. These include using a 5 A Day logo on pack and on our recipe tip cards plus giving customers inspirational ideas about how they can achieve their 5 A Day through our in-store leaflets, magazines and our website. We also ensure price is not a barrier to fruit and vegetable consumption through ongoing in-store price promotions, targeted coupon at till offers and through our value basics range which includes many low cost produce items, including fresh, frozen, dried and canned. We are constantly developing our products to provide easy ways for customers to eat more fruit and vegetables. This includes increasing the vegetable content our products (such as soups, sauces and ready meals) and also introducing new healthier snacking options. For example, we recently added seven different 80g fruit bags to our £3 meal deal promotion, to encourage customers to achieve one of their 5 A Day and to eat more fruit at lunchtime. We are now developing exciting plans to build on this activity even further through various marketing channels and new product launches in the new year.

SecureHealth Ltd 27-Mar-13 27-Mar-15 Through our ongoing Health & Wellbeing program for all staff we provide regular information updates on areas such as sleep, stress, weight management, and healthy eating. As part of the healthy eating initiatives we have had presentations on nutrition and 'eating for energy'. Staff have been encouraged to attend these events and feedback has been very positive about the content and the introduction of changes into diets. The benefits of fruit and vegetables is regularly expressed in these sessions.

Signalling Solutions Limited 08-Oct-14 20-Oct-14 Awareness of the benefits of a healthy diet is important for employee well-being which is why we, in SSL, encourage healthy eating amongst our employees with our "Free Fruit Days". This is documented and published in our Sustainability Action Plan. SSL understand the pressures of the industry in which we operate and we strive to maintain and improve our employee health, diet and well-being wherever possible in conjunction with our supply chain.

Sodexo 10-Mar-11 19-Apr-13 Over the past few months we've made significant progress in support of this pledge on both fruit and vegetable intake. Activities include; Modifying existing recipes and creating new recipes, offer price promotions to customers at point of sale, upselling, providing recipes and factual information on 5 a day, as well as employee training. e.g We have bundle meals and promotions for example, free fruit with every boxed salad available to all of our food outlets, with more than 100 site actively promoting this. Over the next year we will promoting this across a further 700 sites. Promoting fruit with a meal deal. Our food offer for this year has been focused on promoting 5 a day and will continue over the summer to include information around what constitutes a portion and the quantity used within our dishes. Through our employee newsletter on nutrition and health, our Dietitians have written several articles around the promotion of 5 a day for our employees and in our staff restaurants. Our summer healthier eating campaign known as 'Matt Dawson's be part of it' engaged with chefs, clients and consumers on using fruit and vegetable within tasty recipes that followed our nutrition, health and wellbeing philosophy, Healthwise's. We launched a fruity Friday campaign in our staff restaurants which has seen the consumption of fruit sales increase. In the coming year, such activities will continue across our outlets and monitored.

Southend Borough Council 28-Mar-14 17-Jul-14 No Link

Southern Co-operative (The) 02-Sep-11 02-Sep-11 We are committed to helping our customers make healthier food choices for themselves and their families. This includes encouraging customers to increase their consumption of fruit and vegetables through a variety of actions. Our pre-packed fruit and vegetables carry a 5-a-day message in a green dot, as does pure juice and eligible canned, dried and frozen products. Suitable Co-operative brand composite products; for example, ready meals, carry a 5a-day message on front of pack subject to meeting nutritional criteria based on IGD Composite Foods Guidance. We offer a range of ready to cook and prepared vegetable products and our lunchtime meal deals include salads, prepared fruit pots and pure juice options. Our simply value range includes a variety of fresh, frozen and canned fruit vegetable lines. Fruit and vegetables lines are always included in promotional packages. The deals are included in promotional leaflets and feature in the Healthier Deals section of our website. Frozen vegetables are always included in promotion offer as a convenient way to get 5 a day. We ensure that at least 30% of our food promotions are for healthy offerings. We will continue to support initiatives such as Create and Cook and Fresh Fruit Friday to encourage the use of locally supplied produce and target young people through these activities. In addition to continuing existing activities in 2013 we will explore new ways of changing consumer behaviour and develop initiatives to make it easier for people to buy, try,









20/03/2016

cook, eat and enjoy a wider range of fruit and vegetables. In line with The Co-operative Retail Trading Group we will: Use incentives to encourage customers to try more fruit and vegetables, for example money off coupons and direct mail. Communicate the 5 a day message more prominently in store, on our website, on digital media and on our products. Introduce new and exciting products containing at least one of your 5 a day. Feature information and recipes incorporating fruit or vegetables in customer and staff publications and communications. This will include features on our own Farms and how and where fruit and vegetables are grown. Incorporate further signposting for healthy eating including fruit and vegetables along with food labelling information within the lesson plans for our Co-operative From Farm to Fork scheme.

Speiuss Ltd 19-Dec-12 19-Dec-12 No Link

Starbucks Coffee Company 30-Aug-11 31-May-13 Starbucks Coffee Company is continuing to work hard to help our customers reach the recommended five potions or fruit and vegetables a day. All of our salads constitute one of the recommended five per day. We also offer fruit salad, constituting two of the five per day, and fresh bananas in store, and are looking at increasing our fresh fruit offering. In addition, we are reformulating some of our products to include a higher proportion of fruit and vegetables. For instance, our recently reformulated breakfast pot now contains enough fruit to represent one of the recommended five per day. We continue to work hard to incorporate more fruit and vegetables into our other dishes. We are also committed to providing our customers with all the information they need to make healthier decisions. All of our fresh food and menu board products display calorific and saturated fat information, and salt and sodium content is included on all fresh food products. We continue to work hard to ensure our customers have access to all the health information they need in making decisions. Starbucks Coffee Company also actively promotes fruit and vegetable options in store. For example, we are highlighting our range of salads as our summer feature this year, driving healthier menu choices. We look forward to other promotions of our fruit and vegetable products this summer, which we anticipate will help our customers reach their five a day.

Subway International B.V. 10-Mar-11 10-Mar-11 The SUBWAY brand continues to partner with Heart Research UK to promote a healthy heart and lifestyle. At the core of the SUBWAY brands health offering is the range of nine Low Fat Subs which are actively promoted by the brand. Our Low Fat Range forms the backbone of our sales with around four in ten Subs sold in the UK and Ireland coming from this selection. Each of the Low Fat Subs contain less than 370 calories* and come with five standard salad items (lettuce, tomato, red onion, cucumber and green peppers) which combined equal one of the Government's recommended 5-a-day portions of fruit and vegetables. In addition to these standard salad items, customers are encouraged to add any additional salad options at no extra cost. The SUBWAY Kids Pak was reformulated in the summer 2013. In addition to the four Low Fat 4-inch Sub options, the Kids Pak provides two of a child's recommended 5-a-day allowance of fruit and vegetables when choosing both the BEAR Pure Fruit Yo-Yos and Capri Sun Fruit Crush Drink as part of their Kids Pak meal. As part of the Government's Responsibility Deal saturated fat reduction pledge, the SUBWAY brand has also reduced the saturated fat in their Kids Pak by over 70% to offer a healthier option to consumers with children. During 2014 the SUBWAY brand is trialling fresh apples as an offering in selected SUBWAY stores and we hope to introduce apples as part of our product range nationwide later in the year. *Fat and calorie content refers to regular 6-inch Subs on Italian or wheat bread prepared to standard recipe. For full nutritional information see subway.co.uk .

Tesco PLC 10-Mar-11 10-Mar-11 Increasing the fruit and vegetable content of our products and communicating this to our customers through our product labelling. This will include: reviewing the fruit and vegetable content of ready meals or prepared meals in order to identify opportunities to increase fruit and veg content phasing out half portion labelling from our own brand products so that the minimum portion a customer will eat if there is a 5 a day "ping" is one portion2. Encouraging our customers to buy fruit and veg, including through price and promotions, new ranges and the positioning of fruit and veg in store. Initiatives in this area include: Including fruit snack packs in our meal deals and putting single portions of fruit at the front of our concept stores launching new, healthy ranges that include a minimum of one portion of fruit and vegetables (for example, Eat, Live, Enjoy range) introducing new brands into our canned vegetable range to boost the appeal of canned produce moving our frozen fruit to the dessert section to help encourage customers to choose frozen fruits as a dessert option3. Educating and informing our customers and staff about eating more fruit and vegetables. Using our customer and staff publications to promote fruit and vegetable consumption







20/03/2016

The Health Insurance Group 14-Feb-13 14-Feb-13 The Health Insurance Group has been promoting the Department of Health’s ‘5 A Day’ message to staff in the UK. The Fruit and Vegetable Pledge is an opportunity to confirm our continued support to promoting the ‘5 A Day’ message, encouraging staff to establish positive eating habits and doing our part to get more families eating more vegetables. We believe this has a positive effect on their home and working life. We are planning to have ‘fruit days’ in the office to promote this to staff and encourage them to eat more fruit. This will be backed up by an internal communications campaign to promote the benefits of achieving ‘5 a day’.

The Truscott Arms 20-May-13 20-May-13 Within the next three months we will set up a system so that there is a staff fruit bowl daily, available in the staff room for free. We will also ensure that the free staff meal provided each day includes at least one vegetable.

The Walton Centre NHS

Foundation Trust

22-Jan-13 22-Jan-13 The Trust is committed to the implementation of its Health and Wellbeing Strategy Work Well the Walton Way developed in April 2011.The Trust will: Raise awareness of healthy eating through poster campaigns, Intranet health promotion banners and Trust Newsletters Promote participation in the Trusts Weight Management Course educating staff on food content and labelling Work with restaurant external provider on healthy options available for staff including fruit and vegetables Gain accreditation of the Work Place Wellbeing Charter by March 2013Sign up as a local supporter for Change4lifeProvide free fruit for staff who work nights, on call and the late shift Encourage staff to act as role models in particular with patients

University of Sheffield 16-Apr-13 16-Apr-13 We have introduced a number of initiatives in order to promote the consumption of Fruit & Vegetables in our cafes & dining rooms. These include the option of two pieces of fresh fruit as an alternative to other snacks in our “Meal Deals”. Introducing “self-service” of vegetables with main courses to encourage consumption of larger portions of vegetables but without additional charge. We are adapting our recipes to increase the fruit or vegetable content in appropriate dishes as well as featuring more vegetable based dishes & salads on our menus. Our delivered hospitality menus are currently under review & it is proposed that more emphasis will be placed on the provision of freshly prepared salad based dishes, vegetable based soups, fruit platters, fresh fruit smoothie shots & juices, fruit compotes etc.

Waitrose 10-Mar-11 10-Mar-11 Waitrose supports the overall principle of the fruit and vegetable pledge. We share the Governments aspiration to improve the health of the nation. Helping people lead a healthy lifestyle has been at the heart of our nutrition strategy for the past ten years. This includes encouraging customers to combine a balanced diet with exercise and offering a free nutrition advice service. We commit to using a range of approaches to encourage our customers to increase their fruit and vegetable consumption including fresh, frozen and canned. We aim to encourage increased fruit and vegetable intake by: The introduction of new Fresh Produce Advisors in the majority of our branches in 2013. The Specialists will train for a City Guilds Level 3 Diploma in Retail Skills and will gain knowledge on merchandising display standards, product, seasonality and food preparation, which will enable them to provide our customers with expert information on what to buy and how to use it. Continued regular promotions to encourage variety, choice and diversity in the weekly shopping basket. This applies across multi-buys and multi-category. This will be highlighted in branch through point of sale information and further supported with recipes and coupons in Waitrose Weekend. Making it easier and more appealing for customers to choose pre-prepared fruit and vegetable products. Highlighting positive aspects such as quality and taste to our customers through labelling and signage plus bespoke activity to showcase best in season through seasonal recipe cards. The production of our inspirational Harvest Magazine six times a year - a dedicated magazine with a high majority of vegetable based recipes - to encourage our customers to cook dishes with vegetables. Providing inspiration and information through the newly launched Waitrose TV channel including How to video recipe demonstrations. Content will be added to the channel through 2013 to encourage fruit and vegetable intake and through the 5 a day pages on waitrose.com demonstrating how easy it is to reach 5 a day. Helping consumers understand what counts towards their 5 a day target through use of our 5 a day logo on fresh, frozen, dried and canned fruits and vegetables and juices. As part of improving consumers understanding, we have extended our on-pack logo to quantify and clearly communicate the recommended portions for example, 150ml serving of juice, 10 cherry tomatoes, 30g dried fruit, 80g sweet corn kernels. Extend our range of LOVE life healthy products. Nutritional criteria for the range states that products must contribute at least of 1 of your 5 a day and in many cases 2 of your 5 a day, for example in chilled soups.









20/03/2016

Wellbeing People 05-Feb-13 05-Feb-13 During the coming year Wellbeing People will increase staff awareness of our brand and encourage all staff to recognise the importance of a healthy balanced diet by eating more fresh fruit and vegetables. We will provide 'healthy eating top tips and recipes from our in house nutritionist via regular bulletins, to encourage wider uptake and consumption of healthy ingredients. Our target is to increase staff and customer consumption volumes throughout the coming year.

Source (DH, 2015b)




20/03/2016

11. Appendix 2 – 2015 updates on F6 pledge in PHRD

2) DID YOUR FRUIT AND/OR VEGETABLES PLEDGE ACTIVITY INVOLVE ANY OF THE FOLLOWING? PLEASE INDICATE Y/N.

1) W

ITH

IN Y

OU

R P

LED

GE

AC

TIV

ITY

DID

YO

U

INC

LUD

E A

CTI

ON

ON

FR

UIT

AN

D/O

R

VEG

ETA

BLE

S?

(I)

REF

OR

MU

LATI

NG

PR

OD

UC

TS O

R

MO

DIF

YIN

G R

ECIP

ES

(II)

CR

EAT

ING

NEW

PR

OD

UC

TS O

R R

ECIP

ES

(III

) O

FFER

PR

ICE

PR

OM

OT

ION

S O

R O

FFER

S T

O

CU

STO

MER

S

(IV

) P

RO

MO

TIO

NS

AT

PO

INT

OF

SALE

- O

N

PA

CK

, IN

AIS

LE, O

N M

ENU

(V)

PR

OV

IDIN

G R

ECIP

ES O

R T

IP C

AR

DS

(VI)

PR

OV

IDIN

G F

AC

TU

AL

INFO

RM

ATI

ON

ON

LEA

FLET

S O

R P

OST

ERS

OR

ON

PA

CK

FO

R

EXA

MP

LE, L

OG

OS

IND

ICA

TIN

G F

RU

IT A

ND

VEG

ETA

BLE

CO

NTE

NT

(VII

) P

RO

VID

ING

INFO

RM

ATI

ON

(W

EB, T

V,

RA

DIO

, PR

INT)

(VII

I) E

MP

LOY

EE T

RA

ININ

G O

R W

ELLB

EIN

G

INIT

IAT

IVES

TO

EN

CO

UR

AG

E IN

TA

KE

(IX

) O

BTA

ININ

G F

EED

BA

CK

FR

OM

CU

STO

MER

S

ON

WH

ETH

ER T

HEY

INC

REA

SED

TH

EIR

FR

UIT

AN

D V

EGET

AB

LE IN

TAC

T, A

ND

WH

ICH

IN

ITIA

TIV

E W

OR

KED

BES

T

(X)

OTH

ER -

IF

OTH

ER,

PLE

ASE

SP

ECIF

Y.

3. H

OW

MA

NY

ST

OR

ES O

R O

UT

LETS

(FO

OD

MA

NU

FAC

TU

RER

S SH

OU

LD S

TATE

PR

OD

UC

T

LIN

ES)

WER

E IN

VO

LVED

IN

YO

UR

PLE

DG

E A

CT

IVIT

Y?

NU

MB

ER O

F P

RO

DU

CT

LIN

ES:

Aldi y/y y y y y y y y y n n 678 n/k

ARAMARK y/y y y y n y y y y n n/a 350 100

Artizian No

information

provided

Bartlett Mitchell Ltd n/n n y y y y y y y y n/a 85 n/k

Bidvest 3663 y/y n/a y y n/a y y y n/a n/a n/a n/a Fresh, Frozen,

Chilled,

Booker Group plc y/y n/a n/

a

y y n/a y n/a y n/a n/a 202 60

https://responsibilitydeal.dh.gov.uk/annualupdates/?au=4770







20/03/2016

Brakes

y/y

n/a

n/

a

We have

worked with

the Children's

Food Trust to

develop and

publish

vegetarian

recipes to help

schools meet

the

requirement to

offer

vegetarian

dishes without

dairy products;

all these

recipes include

lots of

vegetables

During the

relabelling of

products to meet

the requirements

of the Food

Information

Regulations, we

have included the

five-a-day logo on

canned, frozen

and dried fruit and

vegetables,

wherever

appropriate. We

also continue to

use the five-a-day

logo in our lists

and brochures

n/a n/a n/a We continue to link to Dabble with

Your Dinner and Eat Seasonably, who

promote the inclusion of more fruit

and vegetables in dishes.

Up to

25000

catering

outlets

each

month

15 different

product lines

over 12

months

http://eatseasonably.co.uk/

British Frozen Food

Federation

y/y n y n n Yes y y n n n n/a 4

CH&Co Catering

Limited

y/y y n/

a

n y n y y y n Y - We have been involved in a piece

of academic study to monitor the

effectiveness of a new way of

encouraging customers to eat more

veg because they think that they are

being odd by not doing so. more

information will be released as the

results become clear.

100 n/a

Co-operative Group

(The)

y/y n y y y y y y y Continue

d to

issue

coupons

at till for

the fruit

& veg

category

at key

times

througho

ut 2014.

all n/a

Compass Group UK &

Ireland

y/y y y y y y y y y y n 1500 n/a


http://www.dabblewithyourdinner.co.uk/




http://eatseasonably.co.uk/



http://coolcookery.co.uk/







20/03/2016

Coventry and

Warwickshire NHS

Partnership Trust

y/y y y y y y y y y n/a n/a 4 unsure

Dine Contract

Catering Ltd

y/y n y n y y n y y n n/a 100%

Empower 2 Excel no

information

provided

n y y y n y y y n n 20000 24

Feel Good Drinks y/n

Food Dudes Health

Ltd

no

information

supplied/

organisation

no longer

active.

Gather & Gather y/y y y y y y y y y n n 280 n/a

General Mills UK n/y n/a y y y y y y y y n/a 2500+ 15+

Guide Dogs for the

Blind

y/y N n y n y y y y y n/a 26 0

Harbour & Jones Ltd y/y n y y y y y y y y n/a 28 n/a

Iceland Foods Ltd y/y y y y y n y y y n n/a 850 72

Jamie Oliver Food

Foundation

y/y y y n n y y y y y n/a 0 0

LIDL UK Gmbh y/y y y y y y y n y n y Healthy Tills 610 130

LITTLE TINKLERS

NURSERY

y/y y y n n y y y y n n/a 1 60MEALS YEAR

Marks & Spencer Y/Y Y Y Y Y Y Y Y Y N n/a all stores n/a

Mars (UK) y/y n/a y n/a n/a y y n/a y n/a n/a n/a n/a

Morrisons (Wm

Morrison

Supermarkets Plc)

y/y y y y y n/a n/a n/a n/a n/a N/A 500+ 50+

PhunkyFoods y/y n y n n y y y y n n/a 228

primary





























20/03/2016

schools

n/a

Portsmouth City

Council

y/y y y y y y y y y y n/a 2 10

Princes Limited y/y n y y y y y y y n n/a 0 200

RehabWorks (since 3

July, 2014)

No Links

Restaurant Group Plc n/y y n y y n n n n n n/a 280 0

Sainsbury's

Supermarket Ltd

y/y y y y y y y y n n Our 2015 'Love your Freezer'

campaign encouraged people to use

frozen ingredients to create quick,

tasty and nutritious family meals, with

a particular focus on using fruit and

vegetables. In January 2015 we

introduced two new My Goodness!

sandwiches to our range - which

include an 80g portion of fruit and

veg, counting as one of your five-a-day.

We overcame technical challenges

and achieved this without any

compromise to texture or taste. In May

2014, we introduced a range of five

different salad sprinkles, all priced at

50p and made up of a combination of

fruit, nuts, seeds, herbs and spices.

They were introduced to encourage

customers to eat salad more

frequently, and to date we have sold

over 200,000 sprinkle sachets. We

continue to give our customers meal

deal inspiration through recipe cards

and we highlight which recipes are

green and amber on the traffic light

labels and contribute to 5-a-day.

Additionally, we promote the

consumption of fruit and vegetables

through advice and tips on our Live

Well for Less website and magazine.

1300

SecureHealth Ltd y/y n n n n n n n y n n/a 0 0

Signalling Solutions

Limited

No Update














20/03/2016

Sodexo y/y y y y y y y n y y n/a 792-1070 0

Southend Borough

Council

y/y n n n n y n y y y y - No other details 24

Southern Co-

operative (The)

y/y n y y y y y y n n n/a All 0

Speiuss Ltd No Link

Starbucks Coffee

Company (since 31

May, 2013)

No 2015

update

Subway International

B.V.

y/y n n y y n y y y y Yes - We promote our range of Salads

during the summer months. Our

salads count as two portions of the 5

A Day target.

1946 93

Tesco PLC (since 10

March, 2011)

y/y y y y y y y y y n n/a All Stores 0

The Health Insurance

Group (since 14

February, 2013)

y/y n n n n n n n y n n/a 0 0

The Truscott Arms No Updates

The Walton Centre

NHS Foundation

Trust

y/y During 2014 the Trust continued to

raise awareness of healthy eating

through poster campaigns the Trust

intranet and the weekly newsletter.

There is active participation of staff in

a weekly weight management

programme. The Trust continues to

work with the external provider of the

bistro and coffee shop on healthy

options for staff. A fruit and vegetable

stall attends the Trust 3 times a week.

The Trust have engaged with the local

community and have provided food

banks on a regular basis throughout

the year. Participating in "dechox"

during March 2015, staff can swap a

chocolate bar for a piece of fruit. All

proceeds will go to a food bank for

Easter. The Trust have achieved























20/03/2016

Investors in People Good Practice

Award: Health and Wellbeing.

University of Sheffield y/y y y y y y n n y n n/a The Edge

Dining

Room &

Delivered

Hospitality

0

Waitrose (since 10

March, 2011)

y/y y y y y y y y y n n/a 336 0

Wellbeing People y/y y y y y y y y y n We provide fresh fruit twice weekly to

all staff and have reached 1,000 fruit

boxes delivered to our customers in

Jan2015. We gather feedback in the

form of testimonials on our website.

3 0



