Restricting promotions of food and drink high in fat, sugar, or salt: consultation analysis

1. Introduction and background

1.1. The Scottish Government committed in Programme for Government 2022-23 to bring forward legislation to restrict 'unhealthier food and drink promotions'. The aim of the policy is to reduce the public health harms associated with the excess consumption of calories, fat, sugar and salt, including the risks of developing type 2 diabetes, various types of cancer and other conditions such as cardiovascular disease. To inform its approach, in July 2022, the Scottish Government consulted on plans to restrict promotions of foods that are high in fat, sugar or salt (HFSS) where these foods are sold to the public. The consultation paper set out the rationale for this approach and the specific aspects of the policy being considered. The consultation closed in September 2022 and its analysis is the subject of this report.

Policy context

1.2. The introduction of a policy restricting promotions of 'unhealthier food and drink' is a key part of creating a food environment that supports healthier choices. This is one element of a wide range of actions to improve diet and support the population to be a healthy weight, set out in the 2018 Diet and Healthy Weight Delivery Plan. The approach is based on concerns that:

• 2 out of 3 adults in Scotland are living with overweight or obesity with unequal distribution in the population – in 2019 70% of adults in the most deprived areas of Scotland were living with overweight or obesity compared to 60% of adults in the least deprived areas;^[3]
• A higher prevalence of excess weight is also seen in some minority ethnic groups. Associated health risks occur at a lower level of excess weight in these groups;^[4]
• There is a higher prevalence of children at risk of overweight or obesity in the most deprived areas (35%) compared to the least deprived areas (22%);^[5]
• As a nation, dietary goals in Scotland have not been met since being set in 1996;^[6]
• The Scottish diet remains too high in calories, fat, sugar and salt which can have serious consequences for health.^[7]

The consultation

1.3. The consultation paper set out proposals for restricting promotions of HFSS foods as a means of changing the food environment that encourages the public to purchase more than they need and to over-consume less healthy food. This consultation follows two previous consultations undertaken by the Scottish Government, in 2017/18 and in 2018/19. The purpose of this (2022) consultation was (i) to hear views on how best to restrict promotions of HFSS food and drink, having refined the proposals in respect of the findings of the previous consultations and other research, and (ii) to take into account recent changes such as the pandemic, EU exit and cost of living increases. The consultation opened on 1^st July and closed on 23^rd September 2022.

1.4. The consultation also took place in the context of a Welsh Government consultation on proposals to restrict promotions of HFSS foods taking place over a similar time period (from 9^th June to 1^st September 2022). Further, the UK Government has put in place regulations to restrict the promotion of targeted foods by location and volume price in England. Location restrictions came into force in England on 1^st October 2022 (i.e. shortly after the Scottish Government consultation closed), with restrictions on volume price delayed 12 months, now due to come into force on 1^st October 2023.

1.5. The 2022 Scottish Government consultation contained 31 questions – 24 were multiple choice (closed) and 7 were open questions. For all questions, space was provided for respondents to provide an explanation for their answer. The questions covered a number of themes:

• Foods that should be subject to restrictions (Questions 1, 2 and 3)
• Price promotions (Questions 4, 5, 6, 7 and 8)
• Location and other non-price promotions (Questions 9, 10, 11, 12 and 13)
• Places that would be subject to restrictions (Questions 14, 15 and 16)
• Exemptions to restrictions (Questions 17, 18, 19, 20 and 21)
• Enforcement and implementation (Questions 22, 23, 24 and 25)
• Legislative framework (Question 26)
• Impact Assessments (Questions 27, 28, 29 and 30)
• Any other comments (Question 31)

1.6. Annex 1 contains a full list of consultation questions.

Aims of this report

1.7. The overall aim of this report was to gain a sense of the balance of opinion among respondents towards the proposals, whilst also presenting an understanding of the breadth and detail of arguments put forward both for and against the proposals.

1.8. The structure of the report follows the structure of the consultation paper, considering the response to each question in turn. Section 2 provides an overview of the respondents to the consultation.^[8] Sections 3-10 summarise the views submitted by respondents in answer to the consultation questions. Section 11 provides insights that do not relate to a specific question. Finally, Annexes 1-3 provide further detail on the consultation questions and the respondents.

Approaches to analysis

Quantitative analysis

1.9. Frequency analysis was undertaken for all multiple choice (closed) questions. The figures are included within the findings. Prior to the main analysis, responses were reviewed for blanks, duplicates, campaign responses,^[9] missing answers and any problems with responses such as misinterpretation of the questions. The purpose of this was to ensure the views of respondents were represented as accurately as possible. Where tick box answers were missing but the comment provided indicated a clear preference, a corresponding tick box answer was imputed and counted in the analysis. For a small number of responses the tick box answer conflicted clearly with the associated open text comment and the tick box answer was changed to match the open text comment.

1.10. The percentages presented in tables have been rounded to the nearest whole number. Consequently, due to rounding error the percentage totals do not always equal 100%.

Qualitative analysis

1.11. The responses given to the open questions and the comment sections of the closed questions were analysed to identify the main themes emerging, the range of views expressed for each question and how views varied by respondent type. In general the responses submitted by organisations were more detailed and lengthy than those submitted by individuals. While the views of respondents are discussed, the accuracy/evidence on which they are based has not been assessed (as this is beyond the scope of the analysis). At times responses were complex and it was not always clear which aspect of the proposals for a given question was being referred to. Additionally, as some questions are inter-related, at times the same point was covered across a number of questions. To facilitate the interpretation of the findings, efforts were made to minimise duplication by integrating duplicated views within the question that most closely relates to that issue.

Comment on the generalisability of the consultation findings

1.12. It should be noted that the purpose of consultation is to understand the range of views expressed and the reasons these views are held. However, caution is needed when interpreting the responses. The consultation was open to anyone wanting to express views on the topic, and individuals and organisations who have a keen interest in the topic and the capacity to respond were more likely to participate than those who do not. This self-selection means that the balance of views of participants cannot be generalised to the wider population; the findings are not intended as being representative of public opinion, rather to offer insights.

Interpretation of the findings

1.13. While efforts have been made to explain and summarise the questions posed within the consultation paper, it should be noted that the full rationale and evidence base for the proposals is not presented within this report. It is therefore advised that the full consultation paper is read in advance of this document to aid interpretation of the findings presented here. Efforts have also been made to provide context on where the proposals for Scotland are aligned or differ to the UK Government regulations for restrictions in England. It should be noted that these descriptions relate to the restrictions that were planned at the time the Scottish Government was conducting its own consultation (i.e. July to September 2022).

1.14. The overall number of responses to the consultation (110) is relatively low. While the insights remain very valuable and the percentages remain a useful tool in gaining a sense of where the balance of opinion lies, these should be considered alongside the actual number of responses holding that viewpoint (presented in the tables within this report).