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Background The promotion of healthy lifestyles has high priority on the global public health agenda. Evidence on the real-world (cost-)effectiveness of policies addressing nutrition and physical activity is needed. To estimate short-term policy impacts, quasi-experimental methods using observational data are useful, while simulation models can estimate long-term impacts. We review the methods, challenges and potential synergies of both approaches for the evaluation of nutrition and physical activity policies. Methods We performed an integrative review applying purposive literature sampling techniques to synthesize original articles, systematic reviews and lessons learned from public international workshops conducted within the European Union Policy Evaluation Network. Results We highlight data requirements for policy evaluations, discuss the distinct assumptions of instrumental variable, difference-in-difference, and regression discontinuity designs and describe the necessary robustness and falsification analyses to test them. Further, we summarize the specific assumptions of comparative risk assessment and Markov state-transition simulation models, including their extension to microsimulation. We describe the advantages and limitations of these modelling approaches and discuss future directions, such as the adequate consideration of heterogeneous policy responses. Finally, we highlight how quasi-experimental and simulation modelling methods can be integrated into an evidence cycle for policy evaluation. Conclusions Assumptions of quasi-experimental and simulation modelling methods in policy evaluations should be credible, rigorously tested and transparently communicated. Both approaches can be applied synergistically within a coherent framework to compare policy implementation scenarios and improve the estimation of nutrition and physical activity policy impacts, including their distribution across population sub-groups.

To help health economic modelers respond to demands for greater use of complex systems models in public health. To propose identifiable features of such models and support researchers to plan public health modeling projects using these models. A working group of experts in complex systems modeling and economic evaluation was brought together to develop and jointly write guidance for the use of complex systems models for health economic analysis. The content of workshops was informed by a scoping review. A public health complex systems model for economic evaluation is defined as a quantitative, dynamic, non-linear model that incorporates feedback and interactions among model elements, in order to capture emergent outcomes and estimate health, economic and potentially other consequences to inform public policies. The guidance covers: when complex systems modeling is needed; principles for designing a complex systems model; and how to choose an appropriate modeling technique. This paper provides a definition to identify and characterize complex systems models for economic evaluations and proposes guidance on key aspects of the process for health economics analysis. This document will support the development of complex systems models, with impact on public health systems policy and decision making.

This book, the product of a multi-year knowledge-exchange effort led by WHO staff, represents the first in-depth global treatment of health taxes as an independent domain of social policy.

ObjectiveTo identify what dimensions of socioeconomic position (SEP) are most closely associated with childhood obesity in Finland, leveraging population-wide data among the whole child population aged 2–17 years in Finland.DesignRegistry-based study.SettingData from several administrative registries linked on individual level covering the whole of Finland were used. Data on height and weight measurements in 2018 were obtained from the Register of Primary Health Care visits and data on sociodemographic and socioeconomic indicators (2014–2018) from Statistics Finland.ParticipantsChildren aged 2–17 years with valid height and weight measurements performed at the child health clinic or school healthcare in 2018 (final n=194 423).Main outcome measuresObesity was defined according to WHO Growth Reference curves. Sociodemographic and socioeconomic indicators were linked on individual level for adults (both parents) who lived in the same household (42 predictors). Boosted regression model was used to analyse the contribution of SEP to obesity.ResultsFrom socioeconomic indicators, annual household income (12.6%) and mother and father’s educational level (12.6% and 8.1%, respectively) had the highest relative influence on obesity risk. The relative influence of a child’s sex was 7.7%.ConclusionsThe parents’ SEP was inversely associated with obesity among the offspring. A remarkable number of objective SEP indicators were analysed with parents’ education and household income finally being the indicators most strongly associated with obesity among children. In future research, more attention should be paid to reliable and objective ways of measuring educational status and income rather than on developing new SEP indicators. Administrative registries with information on both healthcare and socioeconomic indicators can in future provide better opportunities to assess the influence of SEP on various health risks.

Background Beverage and food taxes have become a popular ‘best buy’ public health intervention in the global battle to tackle noncommunicable diseases. Though many countries have introduced taxes, mainly targeting products containing sugar, there is great heterogeneity in tax design. For taxes levied as import tariffs, there is limited evidence of effectiveness in changing the price and sale of taxed products, while the evidence base is stronger for excise taxes levied as a fixed amount per quantity of product. This paper examines the effect of the Bermuda Discretionary Foods Tax, which was based on import tariff changes, on retail prices and sales of sugar-sweetened beverages (SSBs), and on selected fruits and vegetables that benefited from a tariff reduction. Methods We used weekly electronic point-of-sale data from a major food retailer in Bermuda. We assessed historical weekly sales and price data using an interrupted time series design on 2,703 unique products between the dates of January 2018 through January 2020, covering 103 weeks. Results By January 2020, the average price per ounce of SSBs increased by 26.0%, while the price of untaxed beverages (including waters and non-added sugar drinks) remained constant. The increasing price of SSBs was the sole observable structural driver of SSB market share, responsible for a decrease in the market share by nearly eight percentage points by the end of the study period. The subsidy on fruits and vegetables was ineffective in changing prices and sales, due to the relatively small 5% import tax decrease. Conclusions The tax was largely passed through to consumers. However, several factors mitigated the impact of the tax on the prices paid for SSBs by consumers, including the specific design of the tax, price promotions and consumer responses. The experience of Bermuda provides important lessons for the planning of similar taxes in the future.

Biological mechanisms underlying the association between obesity and depression remain unclear. We investigated the role of metabolites and DNA methylation as mediators of the relationship between childhood obesity and subsequent poor mental health in the English Avon Longitudinal Study of Parents and Children. Obesity was defined according to United Kingdom Growth charts at age 7 years and mental health through the Short Mood and Feelings Questionnaire (SMFQ) completed at age 11 years. Metabolites and DNA methylation were measured by nuclear magnetic resonance spectroscopy and Illumina array in blood at the age of 7 years. The associations between obesity and SMFQ score, as continuous count data or using cut-offs to define depressive symptoms (SMFQ >7) or depression (SMFQ >11), were tested using adjusted Poisson and logistic regression. Candidate metabolite mediators were identified through metabolome-wide association scans for obesity and SMFQ score, correcting for false-discovery rate. Candidate DNA methylation mediators were identified through testing the association of putative BMI-associated CpG sites with SMFQ scores, correcting for look-up false-discovery rate. Mediation by candidate molecular markers was tested. Two-sample Mendelian randomization (MR) analyses were additionally applied to test causal associations of metabolites with depression in independent adult samples. 4,018 and 768 children were included for metabolomics and epigenetics analyses, respectively. Obesity at 7 years was associated with a 14% increase in SMFQ score (95% CI: 1.04, 1.25) and greater odds of depression (OR: 1.46 (95% CI: 0.78, 2.38) at 11 years. Natural indirect effects (mediating pathways) between obesity and depression for tyrosine, leucine and conjugated linoleic acid were 1.06 (95% CI: 1.00, 1.13, proportion mediated (PM): 15%), 1.04 (95% CI: 0.99, 1.10, PM: 9.6%) and 1.06 (95% CI: 1.00, 1.12, PM: 13.9%) respectively. In MR analysis, one unit increase in tyrosine was associated with 0.13 higher log odds of depression (p = 0.1). Methylation at cg17128312, located in the FBXW9 gene, had a natural indirect effect of 1.05 (95% CI: 1.01,1.13, PM: 27%) as a mediator of obesity and SMFQ score. Potential biologically plausible mechanisms involving these identified molecular features include neurotransmitter regulation, inflammation, and gut microbiome modulation. These results require replication in further observational and mechanistic studies.

BackgroundTaxes on discretionary foods and sugar-sweetened beverages have emerged as a strategy for health promotion. Between 2018-2019, the Bermuda government introduced a phased sugar tax on imported sugar-sweetened beverages, confectionery, products containing cocoa and pure sugar. The aim of this study was to conduct a qualitative evaluation of perceptions of the tax among the general population and key stakeholders.MethodsWe conducted a survey of the general population (N = 400), and semi-structured interviews with key informants (N = 14) from the government, food and beverage, and health sectors to understand awareness, acceptability, and perceived impact of the tax after implementation. Summary statistics and thematic analysis were conducted for the general population survey data, and thematic analysis using the framework method was conducted for key informant interviews.ResultsGeneral population respondents had high awareness of the sugar tax (94%) but lower awareness of the healthy food subsidy (32%). Most respondents (67%) felt the tax was not an appropriate way to motivate healthier consumption behaviour largely due to perceptions the tax would not be effective (44%), and due to the high price of healthy food (20%). However, nearly half (48%) of respondents reported consuming fewer taxed products, primarily for health reasons but also motivated by price increases. Key informants indicated there was high awareness, but limited understanding of the tax policy. Most informants expressed support for taxation as a health promotion strategy, conditional on policy implementation. The tax was not believed to have had an impact on consumption. Factors include the lack of clear price differentiation and the absence of accompanying health education or health promotion. No informants were aware of use of tax revenues for health purposes and tax revenue was reportedly re-directed after implementation.ConclusionsThere was high awareness, but limited acceptability of the tax as implemented. Clarity in the tax policy, appropriateness of the tax mechanism, and use of revenue in alignment with the tax aim are critical components for acceptance. The absence of complementary education and health promotion further affected acceptance and may limit potential health impacts. The lessons learned in Bermuda can inform similar policies in other settings.

Background Taxes on discretionary foods and sugar-sweetened beverages have emerged as a strategy for health promotion. Between 2018–2019, the Bermuda government introduced a phased tax on imported sugar-sweetened beverages, confectionery, products containing cocoa and pure sugar, and eliminated import duties on select healthy food items. The aim of this study was to conduct an mixed methods evaluation of perceptions of the tax among the general population and key stakeholders. Methods We conducted a survey of the general population (N = 400), and semi-structured interviews with key informants (N = 14) from the government, food and beverage, and health sectors to understand awareness, acceptability, and perceived impact of the tax after implementation. Survey data was analysed using thematic analysis, summary statistics, and Chi-squared tests. Key informant interviews were analysed using the framework method. Results General population respondents had high awareness of the sugar tax (94%) but low awareness of the healthy food subsidy (32%). Most respondents (67%) felt the tax was not an appropriate way to motivate healthier consumption due to beliefs the tax would not be effective (44%), and because of the high price of healthy food (20%). However, nearly half (48%) reported consuming fewer taxed products, primarily for health reasons but also motivated by price increases. Key informants indicated there was high awareness but limited understanding of the tax policy. Informants expressed support for taxation as a health promotion strategy, conditional on policy implementation. The lack of clear price differentiation between taxed and un-taxed products and the absence of accompanying health education were key factors believed to affect the impact of the tax. No informants were aware of use of tax revenues for health purposes and tax revenue was reportedly re-directed to other priorities after implementation. Conclusions There was high awareness, but limited acceptability of the Bermuda sugar tax as implemented. Clarity in the tax policy, appropriateness of the tax mechanism, and use of revenue in alignment with the tax aim are critical components for acceptance. The absence of complementary education and health promotion affected acceptance and may limit potential health impacts. The lessons learned in Bermuda can inform similar policies in other settings.

Background Government actions play a critical role in shaping healthy food environments, which can improve population's diet and decrease the burden of disease. This study aims to determine and compare the level of policy implementation for healthy food environments in Italy with reference to international benchmarks and make prioritized recommendations based on the identified implementation gaps. Methods The Healthy Food Environment Policy Index (Food-EPI) tool from the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) was adapted for the Italian context. This tool includes two components, thirteen domains and fifty good practice indicators, which were verified with experts from National Health Institute (NHI). Evidence for implementation was gathered and summarized for all fifty indicators from data sources such as governmental websites, non-government organizations publications and websites and via direct contact with government officials. After collecting all evidence, experts from the NHI verified the completeness and accuracy of it. The evidence document will be presented to stakeholders, aiming to seek consensus on the priority actions to be implemented by the Italian Government to improve food environments. Results The evidence for policy implementation concerning Italy varied among domains and indicators. We found the highest level of evidence within three domains: Food Composition (2/2 indicators), Food Labelling (3/4 indicators) and Food Promotion (4/5 indicators). The domains with less identified evidence were Food Prices (1/4 indicators), Food Retail (0/4 indicators), Food Trade and Investment (0/2 indicators) and Platforms and Interaction (1/4 indicators). Conclusions The evidence summarization and the upcoming stakeholders' meeting to rate the level of implementation for each indicator in Italy, have the potential to improve government commitment to shape healthier food environments. Key messages Food environment policies, implemented by the government, play a key role in the health of the population, decreasing the burden of disease. Several food environment policies have been implemented and supported by the Italian government but there are still some priority actions to be taken towards healthier food environments.

Childhood obesity is one of the most pressing global public health issues, with rates increasing fastest in countries at low levels of income. Obesity occurring during childhood is likely to persist throughout the life course, and it is a cause of increased disease risk from the early years of life. This supplement is the result of collaborations involving a large and multidisciplinary group of researchers that were established in the context of the ongoing European Horizon 2020 project Science and Technology in childhood Obesity Policy (STOP). The aim, as in the entire STOP project, is to generate evidence that can support better policies to tackle the problem of childhood obesity in Europe and elsewhere. Quality of life and health well-being concerning children needs to consider personalized, population, and planetary facets to tackle childhood obesity at early stages of life, for in-deep phenotyping, integrating personalized medicine and precision public health interventions at global levels. This supplement contributes to this aim. © 2021 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.

Background: Urban environmental design is increasingly considered influential for health and wellbeing, but evidence is mostly based on adults and single exposure studies. We evaluated the association between a wide range of urban environment characteristics and health behaviours in childhood. Methods: We estimated exposure to 32 urban environment characteristics (related to the built environment, traffic, and natural spaces) for home and school addresses of 1,581 children aged 6-11 years from six European cohorts. We collected information on health behaviours including total amount of overall moderate-to-vigorous physical activity, physical activity outside school hours, active transport, sedentary behaviours and sleep duration, and developed patterns of behaviours with principal component analysis. We used an exposure-wide association study to screen all exposure-outcome associations, and the deletion-substitution-addition algorithm to build a final multi-exposure model. Results: In multi-exposure models, green spaces (Normalized Difference Vegetation Index, NDVI) were positively associated with active transport, and inversely associated with sedentary time (22.71 min/day less (95 %CI -39.90, -5.51) per interquartile range increase in NDVI). Residence in densely built areas was associated with more physical activity and less sedentary time, and densely populated areas with less physical activity outside school hours and more sedentary time. Presence of a major road was associated with lower sleep duration (-4.80 min/day (95 %CI -9.11, -0.48); compared with no major road). Results for the behavioural patterns were similar. Conclusions: This multicohort study suggests that areas with more vegetation, more building density, less population density and without major roads are associated with improved health behaviours in childhood. The research leading to these results has received funding from the European Community's Seventh Framework Programme [FP7/2007–2013] under grant agreement no 308333 – the HELIX project, from the European Union’s Horizon 2020 research and innovation programme [Grant Agreement No. 733206 LifeCycle], and from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 774548 – STOP project (http://www.stopchildobesity.eu/). The STOP Consortium is coordinated by Imperial College London and includes 24 organisations across Europe, the United States and New Zealand. The content of this publication reflects only the views of the authors, and the European Commission is not liable for any use that may be made of the information it contains.

Introduction Metabolomics may identify biological pathways predisposing children to the risk of overweight and obesity. In this study, we have investigated the cord blood metabolic signatures of rapid growth in infancy and overweight in early childhood in four European birth cohorts. Methods Untargeted liquid chromatography-mass spectrometry metabolomic profiles were measured in cord blood from 399 newborns from four European cohorts (ENVIRONAGE, Rhea, INMA and Piccolipiu). Rapid growth in the first year of life and overweight in childhood was defined with reference to WHO growth charts. Metabolome-wide association scans for rapid growth and overweight on over 4500 metabolic features were performed using multiple adjusted logistic mixed-effect models and controlling the false discovery rate (FDR) at 5%. In addition, we performed a look-up analysis of 43 pre-annotated metabolites, previously associated with birthweight or rapid growth. Results In the Metabolome-Wide Association Study analysis, we identified three and eight metabolites associated with rapid growth and overweight, respectively, after FDR correction. Higher levels of cholestenone, a cholesterol derivative produced by microbial catabolism, were predictive of rapid growth (p = 1.6 x 10(-3)). Lower levels of the branched-chain amino acid (BCAA) valine (p = 8.6 x 10(-6)) were predictive of overweight in childhood. The area under the receiver operator curve for multivariate prediction models including these metabolites and traditional risk factors was 0.77 for rapid growth and 0.82 for overweight, compared with 0.69 and 0.69, respectively, for models using traditional risk factors alone. Among the 43 pre-annotated metabolites, seven and five metabolites were nominally associated (P < 0.05) with rapid growth and overweight, respectively. The BCAA leucine, remained associated (1.6 x 10(-3)) with overweight after FDR correction. Conclusion The metabolites identified here may assist in the identification of children at risk of developing obesity and improve understanding of mechanisms involved in postnatal growth. Cholestenone and BCAAs are suggestive of a role of the gut microbiome and nutrient signalling respectively in child growth trajectories. This research was supported by European Commission Horizon 2020 Grant to the ‘STOP Project’ (Grant ref. 774548). This study was funded by the European Union Social Fund and the Hellenic Ministry of Health (“Programme of prevention and early diagnosis of obesity and neurodevelopment disorders in preschool-age children in the prefecture of Heraklion, Crete, Greece’ MIS number 349580, NSRF 2007-2013). Additional funding from the National Institute of Environmental Health Sciences (NIEHS) supported Dr. Chatzi (R01ES030691, R01ES029944, R01ES030364, R21ES029681, R21ES028903 and P30ES007048). The ENVIRONAGE birth-cohort is supported by the EU Program ‘Ideas’ (ERC-2012-StG-310898) and the FWO (G082317N), a PhD fellowship of the Bijzonder Onderzoeksfonds (BOF) at Hasselt University supported MD Alfano. We acknowledge support from the Spanish Ministry of Science, Innovation and Universities, ‘Centro de Excelencia Severo Ochoa 2013-2017”, SEV-2012-0208 and ‘Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement de la Generalitat de Catalunya’ (2017SGR595). O.R. was supported by a UKRI Future Leaders Fellowship (MR/S03532X/1).

Food reformulation aimed at improving the nutritional properties of food products has long been viewed as a promising public health strategy to tackle poor nutrition and obesity. This paper presents a review of the empirical evidence (i.e., modelling studies were excluded) on the impact of food reformulation on food choices, nutrient intakes and health status, based on a systematic search of Medline, Embase, Global Health and sources of grey literature. Fifty-nine studies (in 35 papers) were included in the review. Most studies examined food choices (n = 27) and dietary intakes (n = 26). The nutrients most frequently studied were sodium (n = 32) and trans fatty acids (TFA, n = 13). Reformulated products were generally accepted and purchased by consumers, which led to improved nutrient intakes in 73% of studies. We also conducted two meta-analyses showing, respectively, a -0.57 g/day (95%CI, -0.89 to -0.25) reduction in salt intake and an effect size for TFA intake reduction of -1.2 (95% CI, -1.79 to -0.61). Only six studies examined effects on health outcomes, with studies on TFA reformulation showing overall improvement in cardiovascular risk factors. For other nutrients, it remains unclear whether observed improvements in food choices or nutrient intakes may have led to an improvement in health outcomes.

Background The food environment has been found to impact population dietary behaviour. Our study aimed to systematically review the impact of different elements of the food environment on dietary intake and obesity. Methods We searched MEDLINE, Embase, PsychInfo, EconLit databases to identify literature that assessed the relationship between the built food environments (intervention) and dietary intake and obesity (outcomes), published between database inception to March 26, 2020. All human studies were eligible except for those on clinical sub-groups. Only studies with causal inference methods were assessed. Studies focusing on the food environment inside homes, workplaces and schools were excluded. A risk of bias assessment was conducted using the CASP appraisal checklist. Findings were summarized using a narrative synthesis approach. Findings 58 papers were included, 55 of which were conducted in high-income countries. 70% of papers focused on the consumer food environments and found that in-kind/financial incentives, healthy food saliency, and health primes, but not calorie menu labelling significantly improved dietary quality of children and adults, while BMI results were null. 30% of the papers focused on the neighbourhood food environments and found that the number of and distance to unhealthy food outlets increased the likelihood of fast-food consumption and higher BMI for children of any SES; among adults only selected groups were impacted - females, black, and Hispanics living in low and medium density areas. The availability and distance to healthy food outlets significantly improved children's dietary intake and BMI but null results were found for adults. Interpretation Evidence suggests certain elements of the consumer and neighbourhood food environments could improve populations dietary intake, while effect on BMI was observed among children and selected adult populations. Underprivileged groups are most likely to experience and impact on BMI. Future research should investigate whether findings translate in other countries.

The STOP project aims at expanding and consolidating the multi-disciplinary evidence base upon which effective and sustainable policies can be built to prevent and manage childhood obesity. STOP also aims at creating the conditions for evidence to translate into policy and for policy to translate into impacts on the ground. The primary focus of STOP is on the cumulative impacts of multiple and synergistic exposures in vulnerable and socially disadvantaged children and their families, which must be a priority target for the fight against childhood obesity in Europe to reach a tipping point and succeed. STOP will identify critical stages in childhood at which interventions can be most effective and efficient. STOP is covering the whole umbrella of different research disciplines, to be able to understand and produce useful policy recommendations for complex issues such as childhood obesity. It is providing basic clinic research insights, comprehensive epidemiological data, study and overview of different public health-oriented measurements, understanding of stakeholders networking and effective communication. It builds on the observation that many interventions deployed by governments have failed to improve health-related behaviours in a sustained way over the life cycle. Little has been done to combine and triangulate different sources of biological, socio-economic and behavioural data to look at the overall, long-term consequences of an intervention on nutrition and metabolic health. Therefore, among other things, STOP focuses on the core idea that obesity has multiple and diverse characterisations, and therefore that one-size-fits-all policy approaches to childhood obesity are bound to fail, and the scientific component of the project is designed to recognise diversity and support the development of tailored solutions.

There is widespread recognition that trade and investment agreements (TIAs) can affect health services, access to medicines, NCD prevention (particularly related to tobacco, alcohol and unhealthy food) and health systems structures. In addition, these binding international economic agreements can constrain the policy space available for innovative, evidence-based health policymaking. Although TIAs can have positive outcomes for employment and economic growth, these benefits are only likely to accrue when governments are pro-active in implementing complementary policies to mitigate impacts on other sectors and to address potential inequalities arising. The aim of this panel session is to examine the ways in which TIAs can be designed to achieve economic goals while also protecting public health, and identify complementary policy measures that may be needed as well as strategies for strategic policy engagement. This panel will be hosted by the UK-PRP PETRA Network (Prevention of the noncommunicable disease using trade agreements). The UK will be negotiating a range of new TIAs over the coming years, representing a window of opportunity for strategic engagement with policymakers regarding how public health can be protected and promoted within these agreements. There is an emerging global body of evidence regarding how consideration of health can be integrated into TIAs, both textually and through strategic engagement with policymakers before and during the negotiation phase. Experience to date indicates common global challenges and opportunities for health and trade, as well as significant potential for cross country learning regarding trade and health. The panel discussion will use the UK experience as a springboard to address these global issues. The expert panel, drawn from the PETRA Network with expertise in political economy, trade law, economics and public health advocacy, will provide brief overview of the current issues in trade and health and how public health can be protected in trade agreements. The 5-minute panel presentations will briefly summarise how inclusions in TIAs can support and protect policy space for health systems and health services, access to medicines, NCD prevention, and nutrition and food systems. The session will then open for a roundtable discussion among participants regarding 1) country-specific examples and questions regarding health protections; 2) experiences related to health-trade policy engagement; 3) lessons for elevating health on the political agenda, particularly regarding trade. (Note that if there are more than 16 participants, then the workshop will split into small groups for discussion with panel/ PETRA Network resource people. The panel session and discussion will provide the basis for a planned public health-oriented briefing note by the PETRA Network on including public health considerations in trade and investment agreements. Key messages Including consideration of health in trade and investment, agreements can protect policy autonomy for public health and promote good public health outcomes; In order to promote consideration of public health in trade and investment agreements, strategic engagement with trade policymakers before and during the negotiation period is critical.

Background The UK salt reduction programme started in 2005, consisting of education campaigns and a reformulation strategy. This programme is often cited as an example of a successful public health programme, and used as a model for other programmes. This study aims at assessing how the programme succeeded in reducing sodium intakes, and whether success was even across socioeconomic (SES) groups. Methods Food intakes for the UK adult population were derived from food diaries in the UK National Diet and Nutrition Survey for 2008/09 (Y1) and 2016/17 (Y9). Year-specific sodium densities of foods were used to calculate the quantity-weighted average sodium density of all food and beverage consumed by the population. Using a decomposition approach (Griffith et al., Economica, 2017), changes in sodium density were attributed to either changes in food composition (change in sodium density), or changes in behaviour (type and quantity of food products consumed), stratifying by SES. Results The programme was linked to a 16% decrease in sodium intakes between Y1 and Y9, while sodium density decreased by 15%. This decrease was largely driven by reformulation (-12mg/100g), while changes in food choices had a smaller impact (-2mg/100g). This finding was consistent across SES groups, whether stratified by education or income, with no significant differences between SES groups in behavioural responses to the programme (changes in food choices). Conclusions Changing people's food environment, through reformulation to reduce the sodium density of foods, had a larger impact on sodium intakes in the UK population than efforts to change food choices, and produced consistent impacts across SES groups. Key messages Reformulation led to a consistent reduction of the sodium density of food consumed across SES. There was no evidence of adverse equity impact from changes in behaviour.

Background Educational campaigns are often used to guide populations having a healthier diet. Current diets can be improved by limiting high sodium intakes, known to be the most important modifiable risk for high blood pressure. The UK launched a sodium reduction programme in 2005, consisting of educational campaigns and a reformulation strategy. The educational campaigns aimed at helping population make healthier choices towards manufactured foods, and reduce their use of table salt. The reformulation strategy gave manufacturers voluntary targets as an incentive to reduce the sodium content of their foods, and thus improve the composition of foods people can choose from. This study aims at analysing how changes in food composition and in consumer choice contributed to changes in the sodium density of foods consumed. Methods Using food diaries from the National Diet and Nutrition Survey in 2008/09 and 2016/17, we estimated the average quantity of food products eaten by the UK population. We calculated the sodium density of all foods (excluding drinks) consumed using year-specific nutrient information from the UK Nutrient Databank. Changes in sodium density between 2008/09 and 2016/17 were decomposed into changes in consumer choice and changes in food composition (reformulation of existing products and product renewal, i.e. the difference in sodium content between foods exiting and entering the market). Results The sodium density of solid foods was reduced by 15%. Reformulation resulted in a 13% decrease in sodium density. Categories contributing to most of the decrease were breads and meat and fish products. Product renewal led to a 3% decrease in the sodium density, mostly from the renewal of fruit- and vegetable-based products. In opposition to the effect of reformulation and product renewal, consumers switching between products led to a 1% increase in sodium density of solid foods consumed. This increase was the result of adverse choices in the sauces and condiment category (where consumers switched to products with higher sodium) and favourable choices in the meat and fish, and the grain-based products categories. Conclusion Overall, the reduction in the sodium density of foods consumed was driven by reformulation. Besides for sauces and condiments, consumers made favourable choices towards products with lower sodium content. However, the relative contribution of changes in composition and changes in behaviour differed by category. Attitudes and food preference by product category should be considered in the design of educational campaigns.

Background Childhood obesity has been shown to affect human capital and social outcomes later in life. Yet, evidence of the causal nature of this link is scarce and pathways are not well understood. We aimed to investigate the effect of childhood obesity on cognitive performance in adolescence and educational attainment in early adulthood. Methods We used data of three longitudinal UK cohorts: the1958 National Child Development Study (NCDS; n=5346), the 1970 British Cohort Study (BCS70; n=6790) and the Avon Longitudinal Study of Parents and Children (ALSPAC; n=5373) which includes children born in1991–92. We used ordinary least squares and logistic regression, value-added sex-stratified models, and mendelian randomisation models to explore the effect of childhood body-mass index (BMI; Z score and BMI category at age 11 years or at 16 years) on cognitive performance (Maths and English scores at age 16 years) and educational attainment (tertiary qualification at age 23 years). Results In ALSPAC, female individuals who had been overweight at age 11 years scored 1·00 point (95% CI –1·58 to –0·36; p=0·028) less on their maths GCSE exam than their healthy-weight peers, and girls who had been obese at age 11 years scored 1·66 points (–3·15 to –0·18; p=0·0021) less. Female individuals who had been obese at age 11 years were less likely to graduate from university than their healthy-weight peers (odds ratio [OR] 0·75, 95% CI 0·59 to 0·97; p=0·030); the effect on graduation for those who had been overweight was less conclusive (OR 0·85, 0·71 to 1·01; p=0·060). Male individuals who had been overweight scored 1·21 points (95% CI –2·84 to –0·81; p=0·0011) less and those who had been obese 2·24 points (95% CI –3·46 to –1·02; p Conclusion Our findings are robust to various causal methods and might help inform interventions to address this issue. Cross-cohort comparisons suggest that there might be a generational effect of overweight and obesity on educational outcomes. The youngest cohort was more susceptible to the negative consequences of childhood overweight and obesity, but the oldest cohorts were not. This needs to be explored in further research.

Background and aimsThis paper describes the data resource profile of South Asia Biobank (SAB), which was set up in South Asia from November 2018 to March 2020, to identify the risk factors and their complex interactions underlying the development of type-2 diabetes mellitus, cardiovascular disease and other chronic diseases in South Asians.Data resource basicsThis cross-sectional population-based study has recruited 52713 South Asian adults from 118 surveillance sites at five centres of excellence in South Asia (Bangladesh, North India, South India, Pakistan and Sri Lanka). Structured assessments of participants included six complementary domains: i). Registration and consent; ii). Questionnaire (information on behavioural risk factors, personal and family medical history, medications, socioeconomic status); iii). Physical measurements (height, weight, waist and hip circumference and bio-impedance for body fat composition, blood pressure, cardiac evaluation, retinal photography, respiratory evaluation); iv). Biological samples (blood and urine); v). Physical activity monitoring and vi). Dietary intake by a 24-hour recall. Aliquots of whole blood, serum, plasma, and urine were put into storage at −80°C for further analysis.Key resultsThe prevalence of obesity is 6.6% in Bangladesh, 19.7% in India, 33.9% in Pakistan and 15.7% in Sri Lanka. The prevalence of diabetes is 11.5%, 27.7%, 25.3%, and 24.8%, and the prevalence of hypertension is 26.7%, 36.9%, 44.5%, 35.0% in Bangladesh, India, Pakistan and Sri Lanka respectively.Collaboration and data accessSAB is the first comprehensive biobank of South Asian individuals. Collected data are available to the global scientific community upon request.

Current evidence of the impact of childhood obesity on human capital development does not point in a consistent direction, and its interpretation is challenging. We carried out a systematic review of studies from high-income countries that used robust causal inference approaches to assess the impact of childhood overweight and obesity on outcomes typically linked to human capital development in economics. Global Health, Medline and EconLit were used to search for peer-reviewed papers. Three reviewers independently assessed study quality using the Newcastle-Ottawa Scale. Nineteen papers representing 22 studies met the inclusion criteria. Included studies were categorized based on three components of human capital: cognitive performance (n = 18), measured through test scores; educational attainment (n = 3), through grade progression and college completion; and labour market outcomes (n = 1), through wages. We find that childhood overweight and obesity hinder education outcomes, with effects mostly observed at older ages of exposure measurement (12+ years). Girls with overweight and obesity experienced larger negative effects and more often than boys. Future research should elucidate the pathways through which childhood obesity impacts human capital development, to support policies that may mitigate those impacts, thus averting social costs that are currently widespread, increasing and unaccounted for.

Food reformulation policies aimed at reducing the risk of diet-related non-communicable diseases have been implemented in many countries. The degree of success of reformulation policies in changing the range of food options available to consumers has been a function of the design of these policies. Our objective was to review the different factors making the design and implementation of a food reformulation policy effective at improving populations’ diets and health. In this narrative review, we present a logic model of the action of reformulation policies on consumer behaviour, dietary intake and population health. We set out how policy design could drive outcomes, and highlight the role for governments and public health agencies in promoting food reformulation that is effective in improving diet and health. The key drivers of success for reformulation policies include strong incentives, a tight implementation strategy, a focus on the overall nutritional quality of food products, rather than on individual nutrients, and effective monitoring and evaluation. Additionally, policies should mark the distinction between product reformulation and product differentiation, which have different nutrition and health outcomes.

In an effort to promote population health, governments and businesses are promoting food reformulation initiatives. In most instances, these initiatives have focused on reducing the amount of individual nutrients such as trans-fatty acids (TFA) or sodium, and generally they have been successful at doing so. However, the impact of single-nutrient reformulation on the broader nutrient profile of foods, and on the overall quality of people's diet, remains unclear. We have undertaken a systematic review of evidence of the impact of single-nutrient reformulation on the overall nutrient profile of foods, covering both peer-reviewed studies and grey literature. The outcome of interest was the nutrient composition of the reformulated food or food category. Only 17 studies reported the effect of initiatives on reformulated products’ nutrient profile (44 studies reported on only the targeted nutrient). Results are heterogeneous. Six studies investigated the impact of TFA reduction initiatives, showing different impacts on the reformulated products’ fat profile, with saturated fats (SFA) decreasing in parallel in some studies, but increasing in others. Similarly, when sodium was reduced, sugar, SFA and calories changed in different directions in different studies. Six studies assessed the effect of mandatory calorie labelling in restaurants, two leading to a reduction in energy intake, one to an increase in sugar and a decrease in unsaturated fatty acids, suggesting a worsened nutrient profile. Of the companies participating in England's sugar reformulation initiative, only 13% also reduced total energy. Results highlight the limited research on the effect of reformulation strategies on the overall nutrient composition of foods. Only 28% of the studies that analyse the impact of policies incentivising single nutrient reformulation report the effect on the foods’ complete nutrient profile after reformulation. Over a third of the studies show that reducing the targeted nutrient comes at a cost – namely other nutrients may be increased. To produce the desire health impact, reformulation policies must incentivise improvements of the overall nutrient profile of products.

Aim Concerns have been raised about the impact of alcohol sports sponsorship on harmful consumption, with some countries banning this practice or considering a ban. We review evidence on the relationship between exposure to alcohol sports sponsorship and alcohol consumption. Methods Search of electronic databases (PubMed, Cochrane Library, Google Scholar and International Alcohol Information Database) supplemented by hand searches of references and conference proceedings to locate studies providing data on the impact of exposure to alcohol sports sponsorship and outcomes relating to alcohol consumption. Results Seven studies met inclusion criteria, presenting data on 12,760 participants from Australia, New Zealand, the UK, Germany, Italy, Netherlands and Poland. All studies report positive associations between exposure to alcohol sports sponsorship and self-reported alcohol consumption, but the statistical significance of results varies. Two studies found indirect exposure to alcohol sports sponsorship was associated with increased levels of drinking amongst schoolchildren, and five studies found a positive association between direct alcohol sports sponsorship and hazardous drinking amongst adult sportspeople. Conclusion These findings corroborate the results of previous systematic reviews that reported a positive association between exposure to alcohol marketing and alcohol consumption. The relationship between alcohol sports sponsorship and increased drinking amongst schoolchildren will concern policymakers. Further research into the effectiveness of restrictions on alcohol sports sponsorship in reducing harmful drinking is required.

Background We assessed whether body mass index (BMI) affects social and socio-economic outcomes. Methods We used Mendelian randomization (MR), non-linear MR and non-genetic and MR within-sibling analyses, to estimate relationships of BMI with six socio-economic and four social outcomes in 378 244 people of European ancestry in UK Biobank. Results In MR of minimally related individuals, higher BMI was related to higher deprivation, lower income, fewer years of education, lower odds of degree-level education and skilled employment. Non-linear MR suggested both low (bottom decile, 24.6 kg/m2) BMI, increased deprivation and reduced income. Non-genetic within-sibling analysis supported an effect of BMI on socio-economic position (SEP); precision in within-sibling MR was too low to draw inference about effects of BMI on SEP. There was some evidence of pleiotropy, with MR Egger suggesting limited effects of BMI on deprivation, although precision of these estimates is also low. Non-linear MR suggested that low BMI (bottom three deciles, 30.7 kg/m2) reduces the odds of cohabitation in women. Both non-genetic and MR within-sibling analyses supported this sex-specific effect of BMI on cohabitation. In men only, higher BMI was related to lower participation in leisure and social activities. There was little evidence that BMI affects visits from friends and family or having someone to confide in. Conclusions BMI may affect social and socio-economic outcomes, with both high and low BMI being detrimental for SEP, although larger within-family MR studies may help to test the robustness of MR results in unrelated individuals. Triangulation of evidence across MR and within-family analyses supports evidence of a sex-specific effect of BMI on cohabitation.

ObjectiveTo assess whether body mass index (BMI) has a causal effect on social and socioeconomic factors, including whether both high and low BMI can be detrimental.DesignMendelian Randomization, using genetic variants for BMI to obtain unconfounded estimates, and non-linear Mendelian Randomization.SettingUK Biobank.Participants378,244 men and women of European ancestry, mean age 57 (SD 8 years).Main outcome measuresTownsend deprivation index, income, age completed full time education, degree level education, job class, employment status, cohabiting relationship status, participation in leisure and social activities, visits from friends and family, and having someone to confide in.ResultsHigher BMI was causally associated with higher deprivation, lower income, fewer years of education, lower odds of degree-level education and skilled employment. For example, a 1 SD higher genetically-determined BMI (4.8kg/m2 in UK Biobank) was associated with £1,660 less income per annum [95%CI: £950, £2,380]. Non-linear Mendelian Randomization provided evidence that both low BMI (bottom decile, 2) and high BMI (top seven deciles, >24.6kg/m2) can increase deprivation and reduce income. In men only, higher BMI was related to lower participation in leisure and social activities. There was no evidence of causal effects of BMI on visits from friends and family or in having someone to confide in. Non-linear Mendelian Randomization analysis showed that low BMI (bottom three deciles, 2) reduces the odds of cohabiting with a partner or spouse for men, whereas high BMI (top two deciles, >30.7kg/m2) reduces the odds of cohabitation with a partner or spouse for women.ConclusionsBMI affects social and socioeconomic outcomes, with both high and low BMI being detrimental for some measures of SEP. This suggests that in addition to health benefits, maintaining healthy ranges of BMI across the population could have benefits both for individuals and society.

In response to observed growing inequalities in income and other dimensions of well-being, including health, the OECD launched an initiative on Inclusive Growth in 2012. The objective was to help governments find ways to make economic growth more inclusive, so that it translates into meaningful gains in living standards across key dimensions of well-being and different socioeconomic groups. This paper links health to the overall inclusive growth agenda. It assesses the two-way relationship between health and socioeconomic factors. An empirical health production function is specified, using data from 35 OECD countries for the period 1990-2015. This is complemented by a review of the related empirical literature, as well as successful policies across OECD countries.

Background: Self-report bias in surveys of alcohol consumption is widely documented; however, less is known about the distribution of such bias by socioeconomic status (SES) and about the possible impact on social disparities. This study aims to assess social disparities in hazardous drinking (HD) and to analyze how correcting alcohol consumption data for self-report bias may affect estimates of disparities. Methods: National survey data from 13 countries, Canada, England, Finland, France, Germany, Hungary, Ireland, Japan, Korea, New Zealand, Spain, Switzerland and USA, are used to examine social disparities in HD by SES and education level. Defining HD as drinking above 3 drinks/day for men and 2 for women, social disparities were assessed by calculating country-level concentration indexes. Aggregate consumption data were used to correct survey-based estimates for self-report bias. Results: Survey data show that more-educated women are more likely than less-educated women to engage in HD, while the opposite is observed in men in most countries. Large discrepancies in alcohol consumption between survey-based and aggregate estimates were found. Correcting for self-report bias increased estimates of social disparities in women, and decreased them in men, to the point that gradients were reversed in several countries (from higher rates in low education/SES men to an opposite pattern). Conclusion: This study provides evidence of a likely misestimation of social disparities in HD, in both men and women, due to self-report bias in alcohol consumption surveys. This study contributes to a better knowledge of the social dimensions of HD and to the targeting of alcohol policies.

Summary Reduction of the non-communicable disease (NCD) burden is a global development imperative. Sustainable Development Goal (SDG) 3 includes target 3·4 to reduce premature NCD mortality by a third by 2030. Progress on SDG target 3·4 will have a central role in determining the success of at least nine SDGs. A strengthened effort across multiple sectors with effective economic tools, such as price policies and insurance, is necessary. NCDs are heavily clustered in people with low socioeconomic status and are an important cause of medical impoverishment. They thereby exacerbate economic inequities within societies. As such, NCDs are a barrier to achieving SDG 1, SDG 2, SDG 4, SDG 5, and SDG 10. Productivity gains from preventing and managing NCDs will contribute to SDG 8. SDG 11 and SDG 12 offer clear opportunities to reduce the NCD burden and to create sustainable and healthy cities.

Health care expenditure per person, after accounting for changes in overall price levels, began to slow in many OECD countries in the early-to-mid 2000s, well before the economic and fiscal crisis. Using available estimates from the OECD’s System of Health Accounts (SHA) database, we explore common trends in health care expenditure since 1996 in a set of 22 OECD countries. We assess the extent to which the trends observed are the results of cyclical economic influences, and the respective contributions of changes in relative prices, health care volumes and coverage to the slowdown in health care expenditure growth. Our analysis suggests that cyclical factors may account for a little less than one half of the estimated slowdown in health care spending since the crisis, suggesting that structural changes have contributed to the trends. Before the crisis the slowdown in health care expenditure growth was accounted for by health care prices growing less than general prices and a reduction in care volumes, whereas the latter accounts for most of the steeper deceleration after the crisis. Although both privately and publically financed health care expenditure grew at a reduced pace during the study period, the sharp post-crisis deceleration happened mostly in the public component. When examined by function, the slowdown in publicly-financed expenditure has been largest in curative and rehabilitative care (particularly after the crisis) and in medical goods (especially pharmaceuticals), whereas the deceleration in the privately financed component is largely in medical goods (including pharmaceuticals). We conclude that structural changes in publicly financed health care have constrained the growth of care volumes (especially) and prices leading to a marked reduction in health care expenditure growth rates, beyond what could be expected based on cyclical economic fluctuations. We examine a range of government policies enacted in a selection of OECD countries that likely contributed to the structural changes observed in our analysis.

Nutrition is affected by numerous environmental and societal causes. This paper starts with a simple framework based on three domains: nutritional quality, economic viability, and environmental sustainability, and calls for an integrated approach in research to simultaneously account for all three. It highlights limitations in the current understanding of each domain, and how they influence one another. Five research topics are identified: measuring the three domains (nutritional quality, economic viability, environmental sustainability); modeling across disciplines; furthering the analysis of food systems in relation to the three domains; connecting climate change and variability to nutritional quality; and increasing attention to inequities among population groups in relation to the three domains. For an integrated approach to be developed, there is a need to identify and disseminate available metrics, modeling techniques, and tools to researchers, practitioners, and policy makers. This is a first step so that a systems approach that takes into account potential environmental and economic trade-offs becomes the norm in analyzing nutrition and food-security patterns. Such an approach will help fill critical knowledge gaps and will guide researchers seeking to define and address specific research questions in nutrition in their wider socioeconomic and environmental contexts.

Summary The USA has exceptional levels of health-care expenditure, but growth has slowed dramatically in recent years, amidst major efforts to close the coverage gap with other countries of the Organisation for Economic Co-operation and Development (OECD). We reviewed expenditure trends and key policies since 2000 in the USA and five other high-spending OECD countries. Higher health-sector prices explain much of the difference between the USA and other high-spending countries, and price dynamics are largely responsible for the slowdown in expenditure growth. Other high-spending countries did not face the same coverage challenges, and could draw from a broader set of policies to keep expenditure under control, but expenditure growth was similar to the USA. Tightening Medicare and Medicaid price controls on plans and providers, and leveraging the scale of the public programmes to increase efficiency in financing and care delivery, might prevent a future economic recovery from offsetting the slowdown in health sector prices and expenditure growth.

Taxes, subsidies and welfare benefits may provide financial incentives to encourage healthy behaviors or discourage less healthy ones. Historically, taxes have been used in many countries to deter behaviors like tobacco smoking or harmful alcohol use. More recently, an increasing number of governments have sought to expand the scope for the use of fiscal measures in health promotion to foods and beverages high in fat, salt or sugar. A strong public health rationale, supported by a growing body of evidence of the health impacts of taxes and other fiscal measures, adds to the more traditional rationale for the use of commodity taxes, which hinges on their revenue-generating potential and their ability to address the costs imposed by consumers of health-related commodities on other individuals. Despite limitations in the existing evidence base, reviewed in this paper, taxes have been shown to generate significant health gains when applied to tobacco products and alcoholic beverages. In the case of foods and non-alcoholic beverages, the effects tend to build up over time and are stronger in people with lower socio-economic status. However, a number of potentially undesirable effects suggest that governments should exercise caution in planning and implementing taxes on health-related commodities. In particular, commodity taxes are generally regressive, and this is especially the case for taxes on tobacco, foods and non-alcoholic beverages, although the actual size of the tax burden involved is relatively modest. In addition, taxes may negatively impact on economic efficiency and social welfare, and may incentivize illicit activities.

Background Childhood obesity has been shown to affect human capital—ie, an individual's ability to contribute economically to society—and social outcomes later in life. Yet, evidence of the causal nature of this link is scarce and the pathways are not well understood. We aimed to investigate the effect of childhood obesity and overweight on cognitive performance in adolescence and educational attainment in early childhood. Methods This study was a secondary analysis of two longitudinal UK cohort studies: the Avon Longitudinal Study of Parents and Children (ALSPAC), which included children born in 1991–92 in the former county of Avon, UK, and the National Child Development Study (NCDS), which included children born in 1958 in England, Scotland, and Wales. All children from singleton births, of European ancestry, and without developmental delays were included in our analyses. We obtained data on childhood body-mass index (BMI; Z score and BMI category at age 11 years), cognitive performance (maths scores at age 16 years), and educational attainment (tertiary qualification at age 23 years). We used ordinary least squares and logistic regression, value-added sex-stratified models, and mendelian randomisation models to explore the effect of childhood overweight and obesity on educational outcomes. The Managing Ethico-social, Technical and Administrative issues in Data Access ethics committee approved this project. Findings In ALSPAC (n=5373), female individuals who had been overweight at age 11 years scored 1·00 point (95% CI −1·58 to −0·36; p=0·028) less on their maths GCSE exam than their healthy-weight peers, and girls who had been obese at age 11 years scored 1·66 points (–3·15 to −0·18; p=0·0021) less. Female individuals who had been obese at age 11 years were less likely to graduate from university than their healthy-weight peers (odds ratio [OR] 0·75, 95% CI 0·59 to 0·97; p=0·030); the effect on graduation for those who had been overweight was less conclusive (OR 0·85, 0·71 to 1·01; p=0·060). Male individuals who had been overweight scored 1·21 points (95% CI −2·84 to −0·81; p=0·0011) less and those who had been obese 2·24 points (95% CI −3·46 to −1·02; p Interpretation Overweight and obesity in the ALSPAC cohort were linked with lowered educational outcomes, especially for female individuals. Our findings are robust to various causal methods and might help to inform interventions to address this issue. Cross-cohort comparisons suggest that there might be a generational effect of overweight and obesity on educational outcomes, since the younger cohort was susceptible to some negative consequences of childhood obesity but the older cohort was not; this needs to be explored in further research. Funding Health Foundation's Social and Economic Value of Health Programme (award 809008).

Background The food environment is a modifiable enabler of dietary choices that can have a great impact on the prevention of childhood obesity in the UK. It is defined as a combination of physical, economic, political, and sociocultural surroundings as well as opportunities and conditions that influence food choice. Many interventions have been undertaken at the school level but evidence of their effectiveness in the reduction of childhood obesity is scarce. Therefore, we aimed to synthesise and evaluate the evidence of food environmental interventions around and within schools to determine effective parameters that can aid in childhood obesity prevention. Methods We searched CINAHL, Embase, Global Health, MEDLINE, Scielo, and Cochrane databases. The considered population were children aged 18 years or younger. Interventions focused on modification of the food environment in schools to prevent obesity and improve dietary intake. Outcomes included anthropometrical measures and dietary intake. The protocol was registered with PROSPERO (CRD42019125039). A second reviewer did a reliability check on 10% of abstracts, bias, and full-text review. Findings Between Jan 1, 2000, to Feb 12, 2019, we retrieved 4307 studies, of which 21 were included after screening. Interventions (13; 62%), policies (two; 10%), and laws (three; 14%) from eight countries, including the UK, were included. Four (19%) interventions focused on vending machines. Study designs included natural experiments (one; 5%), quasi-experiments (two; 6%), non-randomised (one; 5%), and randomised (four; 19%). The main outcomes were body-mass index z score (13; 62%) and dietary intake (n=4, 19%). A positive association (p=0·0451) was found in 15 (71%) studies between 0·89% and 1·29% reduction in obesity prevalence. The most frequent interventions were vending machines, school stores, cafeterias, and menu offering regulations. Interpretation Identified effective interventions in the prevention of childhood obesity were banning of sugary drinks in schools and an increase in availability and accessibility of fruits and vegetables for children from an early age. Multisystem approaches, such as stringent and monitored school meal programmes, alongside the collaboration, training, education, and integration of the school staff, parents, and students, increased acceptability and adaptability according to the local needs and sustainability of the food environment interventions. Changes in the environment lead to individual behaviour modifications. Funding European Commission (H2020 SC2).

Background There are increasing calls for the food industry to take greater responsibility for the food environment as obesity rates rise. The public health community remains sceptical of the efficacy of food industry collaboration, making this a polarising topic in public health. We present a novel approach to engaging industry partners through an academically-funded call for innovations. Methods The Science and Technology in childhood Obesity Policy (STOP) project is a European Commission funded project that includes €600 000 for four industry-led innovations that aim to improve the food environment. The call for applications focused on three areas: new food concepts, food retail environment, and digital solutions. We graded projects using six categories: relevance, innovation, transferability, quality, value, and management. We generated descriptive statistics using application details from call documents and the grades from the evaluation process. Findings In total, 27 applications were received. The size of the companies ranged from 21 start-ups to five small or medium-sized enterprises, and one large company. We received applications from 24 technology companies, two food companies, and one food retailer. The proposed projects included 20 digital solutions, five new food concepts and two food retail innovations. On average, food concepts (64·8%) and digital solutions (55·8%) received higher overall grades than food retail innovations (52·4%). Three digital solutions and one new food concept were selected for funding. Interpretation Academic control over the selection of industry partners and terms of the partnership ensured that health was the central component of any partnership and reduced undue industry influence. The benefits of the call for applicants—financial assistance, academic expertise, and public relations potential—were sufficient to generate interest from industry partners. However, the lack of applications from food companies suggests that the collective offering was insufficient to entice key food industry partners. Future academic-led calls would benefit from wider dissemination of the call, larger budgets, and a more targeted approach. Funding This work was funded by a European Commission Horizon 2020 Grant, no 774548. No financial support was received from the food industry.