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Nick Kane
Impact of increasing the relative availability of meat-free options on food selection: two natural field experiments and an online randomised trial
Background: Increasing the availability of lower energy-density foods is a promising intervention to encourage healthier food purchasing but few studies have examined the effect of increasing availability of meat-free meals to promote more sustainable purchasing. We report three studies, all examining the impact of altering the availability of meat-free meals on meal selection. Methods: Study 1 (a natural experiment in one university cafeteria) examined the impact of altering the ratio of meat-free meals (one meat-free and two meat, to two meat-free and one meat) on weekly sales of meals containing meat. Study 2 (a natural experiment in 18 worksite cafeterias) examined the impact on meat-free meal sales of a menu change designed to increase the availability of meat-free meals. Study 3 (an online study of 2205 UK-representative adults) compared meal selections when participants were randomised to ranges comprised of (a) one meat-free, three meat options; (b) two meat-free, two meat; or (c) three meat-free, one meat. Results: Study 1 suggested a significant decrease in the proportion of sales of meat options when the availability of meat-free options increased (− 19.9 percentage points; 95%CIs:-25.2,-14.6), with no evidence of changes to meat-based meal sales in other university cafeterias during the same period. Findings from Study 2 were mixed: multilevel regressions found no evidence of an increase in meat-free meals following the menu change (2.3 percentage points; 95%CIs: − 1.3,5.9), while interrupted time-series analyses suggested sales did increase (2.3; 95%CIs: 0.4,4.2), but implementation of the planned change was limited. In Study 3 reducing meat-free options from 50 to 25% reduced participants’ selection of meat-free options (odds ratio 0.35; 95%CIs: 0.26,0.46), while increasing meat-free options from 50 to 75% increased meat-free selections (odds ratio 2.43; 95%CIs: 1.94,3.04). There was no evidence effects were moderated by gender, socioeconomic status or usual meat consumption. Conclusion: Increasing the availability of meat-free options is effective at reducing meat selection and purchasing for different ratios of meat to meat-free options. The magnitude of the effect is uncertain, but with no evidence of differences in response by demographic groups when directly tested. Trial registration: Study 3: Open Science Framework; https://osf.io/ze9c6; 6/8/2020.
Is altering the availability of healthier vs. less-healthy options effective across socioeconomic groups? A mega-analysis
Background: Availability interventions have been hypothesised to make limited demands on conscious processes and, as a result, to be less likely to generate health inequalities than cognitively-oriented interventions. Here we synthesise existing evidence to examine whether the impact of altering the availability of healthier vs. less-healthy options differs by socioeconomic position. Methods: Individual-level data (21,360 observations from 7,375 participants) from six studies (conducted online (n = 4) and in laboratories (n = 2)) were pooled for mega-analysis. Multilevel logistic regressions analysed the impact of altering the availability of healthier options on selection of a healthier (rather than a less-healthy) option by socioeconomic position, assessed by (a) education and (b) income. Results: Participants had over threefold higher odds of selecting a healthier option when the available range was predominantly healthier compared to selections when the range offered was predominantly less-healthy (odds ratio (OR): 3.8; 95%CIs: 3.5, 4.1). Less educated participants were less likely to select healthier options in each availability condition (ORs: 0.75–0.85; all p < 0.005), but there was no evidence of differences in healthier option selection by income. Compared to selections when the range offered was predominantly less-healthy, when predominantly healthier options were available there was a 31% increase in selecting healthier options for the most educated group vs 27% for the least educated. This modest degree of increased responsiveness in the most educated group appeared only to occur when healthier options were predominant. There was no evidence of any differential response to the intervention by income. Conclusion: Increasing the proportion of healthier options available increases the selection of healthier options across socioeconomic positions. Availability interventions may have a slightly larger beneficial effect on those with the highest levels of education in settings when healthier options predominate.
Evaluation of physical activity calorie equivalent (PACE) labels' impact on energy purchased in cafeterias: A stepped-wedge randomised controlled trial
Background Penletamseectoan-fairnmatlhyastisalslhuegagdeinsgteledvethlsaatruerseinprgepsehnytsediccaolrarecctitvlyit:y calorie equivalent (PACE) labels results in people selecting and consuming less energy. However, the meta-analysis included only 1 study in a naturalistic setting, conducted in 4 convenience stores. We therefore aimed to estimate the effect of PACE labels on energy purchased in worksite cafeterias in the context of a randomised study design. Methods and findings A stepped-wedge randomised controlled trial (RCT) was conducted to investigate the effect of PACE labels (which include kcal content and minutes of walking required to expend the energy content of the labelled food) on energy purchased. The setting was 10 worksite cafeterias in England, which were randomised to the order in which they introduced PACE labels on selected food and drinks following a baseline period. There were approximately 19,000 workers employed at the sites, 72% male, with an average age of 40. The study ran for 12 weeks (06 April 2021 to 28 June 2021) with over 250,000 transactions recorded on electronic tills. The primary outcome was total energy (kcal) purchased from intervention items per day. The secondary outcomes were: energy purchased from non-intervention items per day, total energy purchased per day, and revenue. Regression models showed no evidence of an overall effect on energy purchased from intervention items, -1,934 kcals per site per day (95% CI -5,131 to 1,262), p = 0.236, during the intervention relative to baseline, equivalent to -5 kcals per transaction (95% CI -14 to 4). There was also no evidence for an effect on energy purchased from non-intervention items, -5 kcals per site per day (95% CI -513 to 504), p = 0.986, equivalent to 0 kcals per transaction (95% CI -1 to 1), and no clear evidence for total energy purchased -2,899 kcals per site (95% CI -5,810 to 11), p = 0.051, equivalent to -8 kcals per transaction (95% CI -16 to 0). Study limitations include using energy purchased and not energy consumed as the primary outcome and access only to transactionlevel sales, rather than individual-level data. Conclusion Overall, the evidence was consistent with PACE labels not changing energy purchased in worksite cafeterias. There was considerable variation in effects between cafeterias, suggesting important unmeasured moderators.
Acceptability of policies to reduce consumption of red and processed meat: A population-based survey experiment
Policies to reduce meat consumption are needed to help achieve climate change targets, and could also improve population health. Public acceptability can affect the likelihood of policy implementation. This study estimated the acceptability of policies to reduce red and processed meat consumption, and whether acceptability differed when policies were framed as benefitting health or the environment. In an online experiment, 2215 UK adults rated the acceptability of six policies, presented in a randomised order. Prior to rating policies, participants were randomised to one of two framing conditions, with policy outcomes described either as benefitting health or the environment. Regression models examined differences in the primary outcome – policy acceptability (rated on a 7-point scale) – by framing. Labels were the most accepted policy (48% support), followed by a media campaign (45%), reduced availability (40%) and providing incentives (38%). Increasing price (27%) and banning advertising (26%) were the least accepted. A substantial proportion of participants neither supported nor opposed most policies (26–33%), although this fell to 16% for increasing price. There was no evidence that framing policy benefits from a health or environment perspective influenced acceptability (−0.06, 95%CIs: 0.18,0.07). Fewer than half of the UK sample expressed support for any of six policies to reduce meat consumption, regardless of framing measures as benefitting health or the environment. Conversely, fewer than half expressed opposition, with the exception of price, suggesting considerable scope to influence public opinion in support of meat reduction measures to meet environmental and health goals.
Testing the effect of a dynamic descriptive social norm message on meat-free food selection in worksite cafeterias: a randomized controlled trial
Background: Overconsumption of meat is a threat to planetary health. Meat consumption is socially and culturally patterned, and interventions using social norms could be a promising strategy to encourage meat reduction. Methods: We developed and tested the effectiveness of a dynamic descriptive social norm message displayed in worksite cafeterias (N = 25, intervention = 12, control = 13) to increase meat-free meal selection. The message was developed based on existing evidence and in collaboration with the catering company operating the cafeterias. The message communicated a specific change in target behavior, using a relevant and relatable referent group, grounding the desired behavior change in time and place, and included a clear call to action. The social norm messages were displayed in each intervention cafeteria for 8 weeks on free-standing banners, posters, and floor stickers. We compared the change in weekly percentage of meat-free meal sales (measured as number of meals sold) between intervention and control cafeterias through linear mixed-effects models. We conducted fidelity checks in intervention cafeterias and interviewed customers to assess perceptions of the intervention. Results: There was no evidence that the intervention led to an increase in sales of meat-free meals (− 2.22 percentage point change, 95% CIs [− 7.33, 2.90], p = 0.378). Pre-intervention baseline sales of meat-free meals varied by site, but there was no evidence the intervention was differentially effective for sites with higher vs. lower baselines. There was also no evidence that the intervention changed overall meal sales. The intervention was implemented with high fidelity, though out of 155 customers interviewed, 57% reported that they did not notice the messages, and only 2% correctly recalled the message. Conclusions: There was no evidence that empirically informed and co-created dynamic descriptive social norm messages increased selection of meat-free meals in worksite cafeterias. This could be due to low salience of the intervention in a busy, fast-paced environment, or the strength of existing eating habits in a workplace cafeteria. The findings suggest that norm messaging interventions, when delivered as an isolated intervention, may not be effective to change a complex and socially grounded dietary behavior such as meat consumption. Trial registration: OSF Registries, Registered September 23, 2022, https://osf.io/h7zkf
Preventing type 2 diabetes: A research agenda for behavioural science
Aims: The aim of this narrative review was to identify important knowledge gaps in behavioural science relating to type 2 diabetes prevention, to inform future research in the field. Methods: Seven researchers who have published behaviour science research applied to type 2 diabetes prevention independently identified several important gaps in knowledge. They met to discuss these and to generate recommendations to advance research in behavioural science of type 2 diabetes prevention. Results: A total of 21 overlapping recommendations for a research agenda were identified. These covered issues within the following broad categories: (a) evidencing the impact of whole population approaches to type 2 diabetes prevention, (b) understanding the utility of disease-specific approaches to type 2 diabetes prevention such as Diabetes Prevention Programmes (DPPs) compared to generic weight loss programmes, (c) identifying how best to increase reach and engagement of DPPs, whilst avoiding exacerbating inequalities, (d) the need to understand mechanism of DPPs, (e) the need to understand how to increase maintenance of changes as part of or following DPPs, (f) the need to assess the feasibility and effectiveness of alternative approaches to the typical self-regulation approaches that are most commonly used, and (g) the need to address emotional aspects of DPPs, to promote effectiveness and avoid harms. Conclusions: There is a clear role for behavioural science in informing interventions to prevent people from developing type 2 diabetes, based on strong evidence of reach, effectiveness and cost-effectiveness. This review identifies key priorities for research needed to improve existing interventions.
Explaining the effect on food selection of altering availability: two experimental studies on the role of relative preferences
Background: Increasing the availability of healthier or plant-based foods increases their selection. The current studies aimed to examine the extent to which relative preferences account for food selections following availability interventions. In particular, (a) whether increasing the availability of lower-energy options increases the likelihood that individuals’ highest-ranked option is lower-energy, and (b) the extent to which selections reflect individuals’ highest-ranked option from the available range. Methods: UK adults (Study 1: n = 1976; Study 2: n = 1078) took part in within-subjects online studies. In both studies, the order of preference between food options was established by participants choosing the option that they would prefer “to eat right now” from every possible pairing within a pool of eight options. Then, participants were shown either predominantly higher-energy options (three higher- and one lower-energy) or predominantly lower-energy options (vice versa), presented in a random order. Results: When predominantly lower-energy options were presented, the odds of the highest-ranked option being a lower-energy option increased ten-fold (Study 1: odds ratio: 10.1; 95%CI: 8.9,11.4; Study 2: odds ratio: 10.4; 95%CI: 7.4,14.7), compared to when predominantly higher-energy options were available. In both studies, around 90% of selections reflected the highest-ranked option in the range offered in the studied availability conditions (range 88–92%). Conclusions: These studies suggest that increased availability of lower-energy options increases the likelihood of an individual’s highest-ranked option being lower-energy, and that the highest-ranked option has the greatest likelihood of selection. As such, preferences may be a key contributor to the effects of altering availability on food selections. Trial registration: ISRCTN (http://www.isrctn.com/ISRCTN27598623; 3/12/19 [Study 1]; http://www.isrctn.com/ISRCTN61010183; 20/4/20 [Study 2]).
Glassware design and drinking behaviours: a review of impact and mechanisms using a new typology of drinking behaviours
Much of the global burden of disease is attributable to unhealthy behaviour, including excessive consumption of alcohol and sugar-sweetened beverages. Developing effective methods to change these drinking behaviours could inform policies to improve population health. In line with an increasing interest in environmental-level interventions–i.e., changing the environment in which a behaviour occurs in order to change the behaviour of interest–this review first describes the existing evidence of the impact of glassware design (including capacity and shape) on drinking behaviours (e.g., at the ‘micro’ level–including sip size, as well as at the macro level–including amount consumed). The roles of two sets of possible underlying mechanisms–perception and affordance–are also explored. Finally, this review sets out a provisional typology of drinking behaviours to enable more systematic approaches to the study of these behaviours. While there is a paucity of evidence–in particular on measures of consumption–this growing evidence base suggests promising targets for novel interventions involving glassware design to reduce the consumption of drinks that harm health. Trial registration:ISRCTN.org identifier: ISRCTN10456720.
Impact of increasing the availability of healthier vs. less-healthy food on food selection: a randomised laboratory experiment
Background: Environmental cues shape behaviour, but few studies compare the impact of targeting healthier vs. less-healthy cues. One online study suggested greater impact on selection from increasing the number of less-healthy (vs. healthier) snacks. The current study aimed to: (1) extend the previous study by using physically-present snacks for immediate consumption; (2) explore responsiveness by socio-economic position; (3) investigate possible mediators (response inhibition, food appeal) of any socio-economic differences in selection. Methods: In a between-subjects laboratory experiment UK adults (n = 417) were randomised according to their ID number (without blinding) to one of three ranges of options: Two healthier, two less-healthy [“Equal”] (n = 136); Six healthier, two less-healthy [“Increased Healthier”] (n = 143); Two healthier, six less-healthy [“Increased Less-Healthy”] (n = 138). Participants completed measures of response inhibition and food appeal, and selected a snack for immediate consumption from their allocated range. The primary outcome was selection of a healthier (over less-healthy) snack. Results: The odds of selecting a less-healthy snack were 2.9 times higher (95%CIs:1.7,5.1) in the Increased Less-Healthy condition compared to the Equal condition. The odds of selecting a healthier snack were 2.5 times higher (95%CIs:1.5,4.1) in the Increased Healthier (vs. Equal) condition. There was no significant difference in the size of these effects (− 0.2; 95%CIs:-1.1,0.7). Findings were inconclusive with regard to interactions by education, but the direction of effects was consistent with potentially larger impact of the Increased Healthier condition on selection for higher-educated participants, and potentially larger impact of the Increased Less-Healthy condition for less-educated participants. Conclusions: A greater impact from increasing the number of less-healthy (over healthier) foods was not replicated when selecting snacks for immediate consumption: both increased selections of the targeted foods with no evidence of a difference in effectiveness. The observed pattern of results suggested possible differential impact by education, albeit not statistically significant. If replicated in larger studies, this could suggest that removing less-healthy options has the potential to reduce health inequalities due to unhealthier diets. Conversely, adding healthier options could have the potential to increase these inequalities. Trial registration: ISRCTN: ISRCTN34626166; 11/06/2018; Retrospectively registered.
Are meat options preferred to comparable vegetarian options? An experimental study
Objective: Reducing meat consumption would have substantial benefits both in terms of health and environmental impact, but meat options may be more attractive to customers than meat-free options. This study tested this by presenting UK adults (n = 540) with a series of pictures showing two meal options and asking them to select which they would prefer to eat right now. They completed this task for every possible pair from a pool of six comparator meat-based options and six target options (66 pairs). Participants all saw identical comparator options, and were randomised to see the same pictures of target options but with descriptions that suggested they were either meat-based or vegetarian. Results: Selections were used to rank the options for each individual from 1 (most-selected) to 12 (least-selected). Vegetarian target options were ranked worse [by 1.23 places (95% CI: 1.02, 1.44)] than meat target options. Higher self-reported consumption of meat predicted worse mean rankings of target options when these were vegetarian, but not when target options were meat-based. This suggests meat options are preferred to equivalent vegetarian options and may be more likely to be selected. This has implications for interventions aiming to reduce meat consumption to make diets healthier and more sustainable.
Size and shape of plates and size of wine glasses and bottles: impact on self-serving of food and alcohol
Background: The physical properties of tableware could influence selection and consumption of food and alcohol. There is considerable uncertainty, however, around the potential effects of different sizes and shapes of tableware on how much food and alcohol people self-serve. These studies aimed to estimate the impact of: 1. Plate size and shape on amount of food self-served; 2.Wine glass and bottle size on amount of wine self-poured. Methods: 140 adults participated in two laboratory studies—each using randomised within-subjects factorial designs—where they self-served food (Study 1) and wine (Study 2): Study 1: 3 plate sizes (small; medium; large) × 2 plate shapes (circular; square). Study 2: 3 wine glass sizes (small; medium; large) × 2 wine bottle sizes (75 cl; 50 cl). Results: Study 1: There was a main effect of plate size: less was self-served on small (76 g less, p < 0.001) and medium (41 g less, p < 0.001) plates, compared to large plates. There was no evidence for a main effect of plate shape (p = 0.46) or a size and shape interaction (p = 0.47). Study 2: There was a main effect of glass size: less was self-served in small (34 ml less, p < 0.001) and medium (17 ml less, p < 0.001) glasses, compared to large glasses. There was no evidence of a main effect of bottle size (p = 0.20) or a glass and bottle size interaction (p = 0.18). Conclusions: Smaller tableware (i.e. plates and wine glasses) decreases the amount of food and wine self-served in an initial serving. Future studies are required to generate estimates on selection and consumption in real world settings when numerous servings are possible. Protocol registration information: OSF (https://osf.io/dj3c6/) and ISRCTN (https://doi.org/10.1186/ISRCTN66774780).
Impact of altering the available food options on selection: Potential mediation by social norms
Increasing the availability of lower-energy foods increases their selection. The current studies examine the extent to which this effect could be mediated by social norms – assessed by perceived popularity of foods – which may be implied by their relative availability. Study 1 (Online): 2340 UK adults estimated the perceived popularity of products. Participants were randomised to see photos of cafeteria shelves varying in the availability of lower-energy options (1/4 lower-energy; 1/2 lower-energy; 3/4 lower-energy) and fullness of shelves (fuller; emptier). Study 2 (Laboratory): 139 English adults were asked to select a snack. Participants were randomised to select from trays varying in the availability of the lower-energy option (1/3 lower-energy; 2/3 lower-energy) and fullness of tray (fuller; emptier). In Study 1, evidence for an interaction was found, such that when shelves were fuller, a higher proportion of lower-energy options led to greater perceived popularity of lower-energy products (1/4 lower-energy: 40.9% (95%CIs: 40.1,41.8); 3/4 lower-energy: 47.2% (46.3,48.0)), whereas when shelves were emptier, a higher proportion of lower-energy options led to lower perceived popularity (1/4 lower-energy: 48.4% (47.5,49.2); 3/4 lower-energy: 39.2% (38.3,40.0)). In Study 2, when the tray was fuller, participants were more likely – albeit non-significantly – to select a lower-energy snack when 2/3 of the available snacks were lower-energy (35.7% (18.5,52.9)) than when 1/3 were lower-energy (15.4% (4.2,26.5)). For emptier trays, lower-energy selections decreased as the relative availability of lower-energy snacks increased (1/3 lower-energy snacks: 36.0% (17.9,54.1); 2/3 lower-energy snacks: 27.8% (13.9,41.7)). These studies provide novel evidence that social norms may mediate the impact of availability on food selection. In addition, they suggest that the effect of availability may be moderated by display layout through its impact on perceived product popularity.
Retraction notice to “Effects of environmental impact and nutrition labelling on food purchasing: An experimental online supermarket study” [Appetite 180 (2023) 106312] (Appetite (2023) 180, (S0195666322004032), (10.1016/j.appet.2022.106312))
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of Authors. It was determined post-publication that errors had been made with the labelling of products in the experimental supermarket. The labels on some products were inaccurate. As a result, the findings in the paper are now in question.
Effects of environmental impact labels on the sustainability of food purchases: A randomised controlled trial in an experimental online supermarket
Providing consumers with product-specific environmental impact information for food products (ecolabels) may promote more sustainable purchasing, needed to meet global environmental targets. This UK study (N = 1051 participants) investigated the effectiveness of different ecolabels using an experimental online supermarket platform, comparing three labels against control (no label). Significant reductions were found in the environmental impact score (EIS) for all labels compared to control (labels presented: values for four environmental indicators [-3.9 percentiles, 95%CIs: -5.3, -2.6]; a composite score [taking values from A to E; -3.9, 95%CIs: -5.2,-2.5]; or both together [-3.2, 95%CIs: -4.5, -1.9]). Providing ecolabels is a promising intervention to promote the selection of more sustainable products.
Effects of environmental impact and nutrition labelling on food purchasing: An experimental online supermarket study
Nutrition labels and ecolabels can support consumers to make healthier and more sustainable choices, and the former is now widespread. But there is no information on the impact of ecolabels in the presence of nutrition labels. The aims of this study were primarily to examine whether (1) ecolabels are effective at promoting sustainable purchasing behaviour if presented alongside nutrition labels; (2) and secondarily, whether nutrition labels are effective at promoting healthier purchasing if presented alongside ecolabels. Participants (N = 2730) visited an experimental online supermarket platform, and were randomised to see products with (1) environmental impact labels only; (2) nutrition (NutriScore) labels only; (3) both environmental and nutrition labels; (4) no labels. Linear regressions compared the mean environmental impact scores (EIS; primary outcome) and health scores of products in participants’ shopping baskets across each condition. Compared to control (no labels) there were significant reductions in the EIS when environmental impact labels were presented: Alone (−1.3, 95%CI: −2.3 to −0.4) or With nutrition labels (−2.0, 95%CI: −2.9 to −1.0), with no evidence of differences in effectiveness between these two conditions. There was no evidence of an impact of nutrition labels on either the EIS or the healthiness of purchases, both when nutrition labels were shown alone and when ecolabels were also present. Environmental impact labels may be effective at encouraging more sustainable purchases alone or when used alongside nutrition labels. This adds to the evidence base on the feasibility and effectiveness of environmental impact labelling as an important measure to change dietary behaviour to improve planetary health.
Effects of environmental impact labels on the sustainability of food purchases: Two randomised controlled trials in an experimental online supermarket
Providing consumers with product-specific environmental impact information for food products (ecolabels) may promote more sustainable purchasing, needed to meet global environmental targets. Two UK studies investigated the effectiveness of different ecolabels using an experimental online supermarket platform. Study 1 (N = 1051 participants) compared three labels against control (no label), while Study 2 (N = 4979) tested four designs against control. Study 1 found significant reductions in the environmental impact score (EIS) for all labels compared to control (labels presented: values for four environmental indicators [-3.9 percentiles, 95%CIs: -5.2,-2.6]; a composite score [taking values from A to E; -3.9, 95%CIs: -5.2,-2.5]; or both together [-3.2, 95%CIs: -4.5,-1.9]). Study 2 showed significant reductions in EIS compared to control for A-E labels [-2.3, 95%CIs: -3.0,-1.5], coloured globes with A-E scores [-3.2, 95%CIs:-3.9,-2.4], and red globes highlighting’worse’ products [-3.2, 95%CIs:-3.9,-2.5]. There was no evidence that green globes highlighting’better’ products were effective [-0.5, 95%CIs:-1.3,0.2]. Providing ecolabels is a promising intervention to promote the selection of more sustainable products.
Healthy eating interventions conducted in small, local restaurants and hot food takeaways: a systematic review
Objective: This systematic review investigates the characteristics, effectiveness and acceptability of interventions to encourage healthier eating in small, independent restaurants and takeaways. Design: We searched five databases (CENTRAL, MEDLINE, Embase, CINAHL and Science Citation Index and Social Science Citation Index) in June 2022. Eligible studies had to measure changes in sales, availability, nutritional quality, portion sizes or dietary intake of interventions targeting customer behaviour or restaurant environments. We evaluated study quality using the Mixed Methods Appraisal Tool. Results are synthesised narratively, and interventions' impact on personal autonomy is assessed using the Nuffield intervention ladder. Setting: Small, independent or local restaurants or hot food takeaway outlets, with no restrictions by year or country. Participants: Anyone selling or purchasing food in intervention settings (e.g. restaurant staff/owners, customers). Results: We screened 4624 records and included 12 studies describing 13 interventions in 351 businesses. Most studies were of poor quality. Customer-level intervention components mostly operated on the lower rungs of the Nuffield ladder, and most had limited positive effects on increasing demand, measured as sales or orders of healthy options. Whilst rare, most interventions measuring business outcomes operated on higher ladder rungs and showed small positive results. There was insufficient evidence to investigate differences in impact by intervention intrusiveness. Acceptability was greater for interventions that were low-effort, inexpensive and perceived as not negatively impacting on customer satisfaction. Conclusions: Despite some evidence of small positive effects of healthy eating interventions on healthier purchases or restaurant/hot food takeaway practices, a weak evidence base hinders robust inference.