Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption (Review)

Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM (2019)

Cochrane - DOI: 10.1002/14651858.CD012573.pub3.

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Evidence Categories

• Care setting: Workplace setting
• Care setting: Commercial food environment
• Population group: General Population
• Population group: General population
• Intervention: Policy / environmental: Availability
• Outcome: Healthy Eating: Energy selected
• Outcome: Healthy eating: Chocolate intake

Type of Evidence

Systematic Review

Aims

The authors state:

• "1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products."
• "2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants."

Findings

The authors state:

• "included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products;"
• "The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and all studies were conducted in high-income countries, predominantly in the USA (14/24)."
• "10 studies (five availability, and five proximity) were conducted in a wide range of field settings including shops, restaurants/cafeterias, offces, and vending machines in schools."
• "Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks."
• "For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD −1.13 (95% confidence interval (CI) −1.90 to −0.37) (low certainty evidence)." 
• "For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD −0.55 (95% CI −1.27 to 0.18) (low certaintyevidence)."
• "Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line."
• "For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD −0.65 (95% CI −1.29 to −0.01) (very low certainty evidence)."
• "For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD −0.60 (95% CI −0.84 to −0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias."

Conclusions