Reducing health harms of foods high in fat, sugar, or salt: consultation analysis

4. Identifying categories of food and drink to target (Qs 2-4)

4.1. The consultation paper proposed that the above mandatory measures target foods defined as ‘discretionary’ and sought views on (i) whether restrictions should only target ‘discretionary’ foods, (ii) whether ice-cream and dairy desserts should be treated as ‘discretionary’ foods and (iii) the overall approach to defining categories and exclusions of foods/products.

Targeting discretionary foods

4.2. The consultation paper proposed that the mandatory restriction measures for promotion and marketing of HFSS foods should target a number of discretionary food categories. Respondents were asked whether they felt this policy should only target these food categories. 

Question 2: Should this policy only target discretionary foods? [confectionery, sweet biscuits, crisps, savoury snacks, cakes, pastries, puddings and soft drinks with added sugar]

Overview

4.3. A fifth of organisation respondents (21%) and a quarter of individual respondents (26%) agreed with the proposed definition of foods to be targeted. However, more than a quarter of organisation respondents (29%) and nearly a third of individual respondents (32%) felt that there are additional categories that should be targeted by restrictions. 

4.4. Meanwhile, 13% of organisation respondents and nearly a third of individual respondents (32%) indicated that no foods should be targeted. A very small number of respondents (3% of organisations and 3% of individuals) indicated that fewer foods should be targeted. Over a third of organisation respondents (34%) indicated ‘other’ or did not provide a tick box answer. The full breakdown of responses is provided in Table 4.1 below.

Table 4.1 Responses to question 2 ^[28]

Answer	Organisations		Individuals
	n	%	n	%
Yes	20	21%	162	26%
No – there are additional categories that should be targeted	27	29%	206	32%
No–fewer categories should be targeted	3	3%	17	3%
No – no foods should be targeted	12	13%	199	32%
Don’t know	1	1%	1	0%
Other	21	23%	7	1%
Not answered	10	11%	2	0%
Conflicting answers[29]	0	0%	38	7%
Total	94	100%	632	100%

Organisation respondents overview

4.5. Breaking down the findings further from the responses in the table above, it was possible to see different views in the responses from different types of organisation. More than two-fifths (44%) of the non-industry organisation respondents indicated that additional foods should be targeted, and nearly a third (31%) agreed with the discretionary foods as listed (i.e. a ‘yes’ response). More than half (52%) of the industry organisation respondents indicated ‘other’ or did not answer the question. More than a quarter (28%) indicated that no foods should be targeted. A full breakdown of these responses is provided in Annex 2, Table A2.2.

Views in relation to ‘Yes’ responses 

4.6. Agreement among individual and non-industry organisation respondents centered on the feeling that these are the foods that lack nutritional benefits and are therefore the most relevant to target. Some public and third sector respondents saw it as a ‘starting point’ to which additional categories could be added in future.

Views in relation to ‘No – there are additional categories that should be targeted’ responses 

4.7. Many individuals responding to this answer option listed the foods that they thought should be included without explaining why, although few explained that they thought the foods were unhealthy and therefore action needs to be taken in relation to promotion and marketing of the foods. 

4.8. Some public and third sector respondents felt that more foods that are HFSS should be considered and that, while a focus on discretionary foods was good, it was not sufficient given the scale of the public health issue. Few held concern that categorising foods as discretionary or non-discretionary was arbitrary and could provide a potential loophole. It was, therefore, suggested that there should be flexible legislation to allow additional foods to be added.

4.9. It should be cautioned that it was not always clear whether respondents believed that the items they referred to should be included in their entirety (e.g. all ready meals) or only those that are HFSS (e.g. only HFSS ready meals). A number of respondents specifically noted that these types of food should be included if they met the description of being HFSS but other respondents did not. Since a number of respondents interpreted this question in a broader sense of identifying any foods for inclusion rather than in the narrower sense of defining ‘categories’, responses should be interpreted with caution. The foods most frequently proposed for inclusion (each by few individual respondents and few organisation respondents^[30]) included (ranked in order of frequency with the most frequent first):

• Ready meals;
• Processed foods;
• Fast food;
• Cereals;
• Ice cream;
• Yoghurt;
• Anything high in fat, sugar or salt;
• Ice cream and dairy desserts (i.e. distinct from ice-cream alone);
• Takeaways;
• Cereal bars;
• Milkshakes;
• Meat (processed meat, red meat);
• Artificial sweeteners; and
• Dairy.

Views in relation to ‘No – fewer categories should be targeted’ responses 

4.10. Only 20 respondents selected this response (17 individuals and 3 organisations) and, overall, there was little similarity among responses. Both industry organisation respondents that selected this answer option noted that ‘discretionary’ foods that had low levels of added sugar should be excluded from restrictions.  Among the individual respondents that provided an explanation, few suggested that only those discretionary foods that were highly processed/containing artificial ingredients should be included.

Views in relation to ‘No – no foods should be targeted’ responses 

4.11. Many of those that indicated that no foods should be targeted did so because they disagreed with the proposal to implement mandatory measures to restrict the marketing and promotion of HFSS foods.

4.12. Some industry organisation respondents suggested that should restrictions go ahead, rather than targeting specific categories, it would be preferable to set the levels of fat, sugar and salt considered to be too high. Any foods reaching that threshold, should be included. In the case of soft drinks, few suggested that legislation should be aligned with the Soft Drinks Industry Levy threshold.

Other considerations

4.13. There was concern among some organisation respondents about the introduction of a new method of categorisation that applied to Scotland only and suggestion that consistency across the UK was needed to avoid complication and confusion for manufacturers, retailers and customers. Some of which (mostly public and third sector and other organisations but also one manufacturer and one industry representative body) suggested that categorisation should be based on the levels of fat, sugar or salt within the products. The Ofcom Nutrient Profiling Model (NPM)^[31] was suggested as a way to better define unhealthy foods, unify the approach with that of the rest of the UK and better complement existing reformulation efforts and approaches.

4.14. Few industry organisation respondents requested clarity on definitions of included foods and felt unable to comment fully until this was available. Few felt that consumers needed to be educated on how to understand a balanced diet and that ‘demonising’ individual products or macro-nutrients was not beneficial. They felt a better approach was to have access to the full marketing and promotional toolkit and work in partnership to ‘nudge’ consumers to healthier choices.

Conflicting Views 

4.15. A software error on the Citizen Space platform allowed respondents to choose more than one response to the question. For the most part, multiple responses were resolved (see Annex 3 for further details). However, 38 respondents (all individuals) selected more than one answer option where it was not possible to determine from their explanation to the question whether a specific answer option best fit their view. Many of these restated disagreement with the introduction of mandatory restrictions in relation to the promotion and marketing of these foods. Few repeated suggestions regarding alternative approaches to the measures such as educating people to make their own choices, lowering the cost of healthy food and encouraging healthier lifestyles.

Treatment of ice-cream and dairy desserts 

4.16. The consultation paper discusses whether ice-cream and dairy desserts should be considered as discretionary foods. This category was noted to include a greater proportion of non-discretionary foods than the other discretionary food categories, as some will contribute positively to the diet because they contain beneficial nutrients such as calcium. It was noted that, while it may be possible to define this category to exclude non-discretionary foods, this might be onerous for businesses to implement, which could undermine the overall effectiveness of the policy. Respondents were asked whether the policy should treat ice-cream and dairy desserts as discretionary foods.   

Question 3: Should this policy treat ice-cream and dairy desserts as discretionary foods?

Overview

4.17. Two-fifths (40%) of organisation respondents agreed with the inclusion of
ice-cream and dairy desserts as discretionary foods. A quarter (25%) disagreed, and another quarter (25%) did not provide a tick box answer. Meanwhile, among individuals there was a fairly even split in the number of respondents agreeing and disagreeing. Overall, more individual respondents disagreed (47%) than agreed (43%). Table 4.2 displays the results.

Table 4.2 Responses to question 3

Answer	Organisations		Individuals
	n	%	n	%
Yes	38	40%	270	43%
No	24	25%	295	47%
Don’t know	9	10%	54	9%
Not answered	23	25%	10	2%
Conflicting answers[32]	0	0%	3	0%
Total	94	100%	632	100%

Organisation respondents overview

4.18. Breaking down the findings further from the responses in the table above, it was possible to see different views in the responses from different types of organisation. More than three-fifths (62%) of the non-industry organisation respondents agreed with the inclusion of ice-cream and dairy desserts. More than two-fifths (44%) of the industry organisation respondents did not provide a tick box answer and a third (33%) disagreed. A full breakdown of these responses is provided in Annex 2, Table A2.3.

Views in favour of treating ice-cream and dairy desserts as discretionary food

4.19. Many of the individual respondents and many of the public and third sector respondents that considered ice-cream and dairy desserts should be treated as discretionary foods indicated that these foods are HFSS. It was suggested that for the proposed approach to be credible these foods should be treated the same as the discretionary categories already identified. It was also noted that these foods are discretionary in the sense that they are not essential to a healthy diet. More generally few individuals noted that these foods are ‘unhealthy’.

4.20. Few individual respondents and few non-industry organisation respondents specifically noted that only those ice-creams and dairy desserts identified as being HFSS should be included as discretionary foods. Few respondents (from various organisation types) suggested that the NPM could be used when considering dairy product inclusion by helping to define those that are less healthy.

Views against treating ice-cream and dairy desserts as discretionary food

4.21. Close to half of the individuals and few of the organisations that considered ice-cream and dairy desserts should not be treated as discretionary food held this view on the basis of their disagreement with the broader proposal to implement mandatory measures and, therefore, disagreement with any food being targeted as discretionary.

4.22. Few individuals respondents and some organisation respondents (of all types) noted that these foods should not be included as they have some nutritional value and are more likely to be eaten as part of a meal rather than as a snack.

4.23. Other reasons for disagreement included:

• Few individual respondents and one manufacturer respondent indicated that these foods do not need to be included on the basis that they are consumed occasionally and, therefore, are not a main contributor to the problem of obesity; and
• Few individual respondents and few non-industry organisation respondents indicated that there is wide variation in the levels of fat, sugar and salt in these foods and it is too difficult to separate the types of ice-cream and dairy desserts that are healthy from those that are unhealthy.

Other considerations

4.24. The main points raised by individual respondents who gave a ‘don’t know’ response or did not tick an option but provided an explanation, each expressed by few, included: that there was so much variation in these types of food that it may not be appropriate to treat them all as discretionary; that they were unsure whether the nutritional value of these foods would outweigh their levels of fat, sugar or salt; and that they were unsure whether these foods were consumed in sufficient quantities to be deemed significant in contributing to overweight/obesity.

4.25. Few organisation respondents (from various sectors) requested more clarity on the definition of ‘dairy desserts’. There was concern, for example, that yoghurts could be included which may impact on population level calcium intake.

Approach to defining categories and exclusions  

4.26. The consultation paper proposed an approach to defining the foods that would be subject to restrictions on a ‘by category’ basis, which would require clear definitions for each category, drawing on expert technical advice. It was stated that the approach would take into account that nutritional information may only be available for pre-packaged foods, as well as evidence on both the frequency of consumption and the contribution discretionary foods make to population-level calorie and nutrient intakes. 

4.27. It was proposed that any exceptions would also be clearly defined and an example was given that the ‘confectionery’ category would not include sugar-free sweets on the basis that they are not high in fat, sugar or salt.  Respondents’ views were sought on this approach. 

Question 4: Please comment on our approach to defining categories and exclusions of particular foods/products from those definitions (paragraphs 9-11)?

Overview

4.28. In total 533 respondents (78 organisations; 455 individuals) gave a specific response to this question (i.e. excluding blanks, ‘no comment’ and ‘don’t know’ answers). There was no particular type of respondents that chose not to answer.^[33]

4.29. Although this was an open question (i.e. not a tick box question), written explanations were analysed to try to quantify what proportion indicated overall agreement and disagreement with the approach. It is important to note that a number of respondents gave no overall indication, but instead made a specific point or points in relation to the content of the approach. Therefore, their overall stance (if indeed they had one) for this question is not known. The figures below, therefore, provide only a rough indication and should be interpreted with caution.

4.30. Half of the organisation respondents gave a written explanation that indicated agreement with the approach to defining categories and exclusions, close to a third did not give an overall indication and nearly a fifth indicated disagreement. Meanwhile close to half of the individual respondents indicated disagreement with the approach^[34], nearly a third indicated agreement and nearly a quarter did not give an overall indication. 

4.31. Breaking down the organisation respondents described above, two-thirds of the non-industry organisation respondents gave a written explanation that indicated agreement with the approach and close to a third gave no overall indication. Close to half of the industry organisation respondents gave no overall indication and over a quarter disagreed.

Agreement with the approach to defining categories and exclusions

4.32. Most individual respondents and some organisation respondents that agreed with the approach described in the consultation document simply stated that they agreed or thought the approach was sensible or reasonable. 

4.33. Few respondents (few individuals, some other organisations, few public sector, few manufacturers and few industry representative bodies) noted the need for expert advice to determine inclusion and exclusion of foods/products. A few respondents (few public sector and one other organisation) specifically cautioned that this advice should be unbiased.

4.34. Few individual and few public sector respondents specifically flagged that clear categories and guidance is needed to ensure the approach is appropriate.

4.35. Few individual respondents and few non-industry organisation respondents reiterated the suggestion to include certain foods. Artificial sweeteners were most frequently cited (but by few individuals and few other organisations).

Disagreement with the approach to defining categories and exclusions

4.36. Nearly three-quarters of the individual respondents that disagreed with the approach indicated that this was on the basis that they disagreed with the overall proposal of introducing mandatory restrictions and, therefore, by default disagreed with an approach to categorising foods to be targeted by mandatory measures.

4.37. Other reasons for disagreement were somewhat varied with little similarity. Few individual respondents and one manufacturer respondent indicated that it was difficult to categorise products in the way outlined and that the approach was too complex. Some industry representative body respondents noted an expert technical group was needed to identify which foods are subject to regulation; few thought a UK-wide approach was needed to define discretionary foods; and few noted the foods to be included needed to be explicitly clear so that non-technical staff within industry could implement changes. Similarly, few felt that the categories were too wide and could consequently target some foods with nutritional benefit.

4.38. There was also concern among few individual respondents that products would be altered to avoid falling under the proposed restrictions. The concern was that this might increase the levels of artificial ingredients used in products, which in turn could have a negative impact on health. Few individual respondents also indicated that the approach was either too wide – trying to encompass too many foods – or too narrow – missing some foods that are HFSS.

Other considerations

4.39. Respondents that gave no overall indication of their agreement or disagreement with the approach to defining categories and exclusions tended to flag one or more specific points in relation to the approach. Most frequently (but by few individual respondents, few industry organisation respondents and one public sector respondent), the responses emphasised the importance of engaging expert advice in order to further define the foods to be targeted and those to be excluded. Developing clear guidelines to provide clarity to all was also emphasised (by few manufacturer respondents and few public sector respondents). The importance of seeking further feedback prior to implementation was flagged by few industry organisation respondents. The need for all foods to have clear nutritional information was also highlighted by few individual respondents, with reference made to a traffic light system that is easy to understand. 

4.40. Few of the respondents (few individuals, a manufacturer and a public sector organisation) that gave no overall indication suggested that foods should be defined for inclusion based on methods other than ‘by category’ such as by their levels of fat, sugar and salt or their overall nutritional value. In contrast, there was also suggestion from a public sector respondent that the NPM is over ten years old and does not reflect current dietary recommendations and, therefore, the bespoke method put forward by the consultation paper was more appropriate. 

4.41. Other considerations flagged by some manufacturer respondents included that the approach should be consistent with other guidelines or restrictions – e.g. Soft Drinks Industry Levy or Public Health England’s single serve calorie cap. One small manufacturer suggested that consideration be given to how to target the largest category brands contributing the highest share of the public health problem.

4.42. Few organisation respondents (few non-industry, one retailer and one manufacturer) expressed concern about exclusions for sugar-free products based on health concerns and a perceived continuation of promotion of low nutrient food as a consequence and the reinforcement of traditional discretionary food consumption behaviours.

4.43. Some retailer respondents felt that the approach has the potential for confusion among customers and staff regarding which products are in scope and why. Few felt that messages needed to be consistent across the UK to be effective in directing healthy choices.

4.44. In respect of the acknowledgement made in the consultation paper that nutritional information may only be available for pre-packaged food, few individual respondents and few non-industry organisation respondents felt that although difficult it was necessary to consider how nutritional information could be obtained for non pre-packaged foods so they could also be included within restrictions.