Changing the environment: Removing HFSS items in prominent areas of stores in Nottinghamshire

Abstract This study examines the change in exposure to high-fat, salt, or sugar products (HFSS) after the implementation of a policy restricting the placement of HFSS items in prime locations in England that came into legislation in October 2022. 132 observations were conducted in 2022 and 2023, using a food environment survey. Supermarkets (SM), chain convenience stores (CSS), and independent convenience stores (ICS) were observed in the highest and lowest socioeconomic districts (SED) in Nottinghamshire. Descriptive statistics were used to analyse changes in exposures in prime locations by product category, the policy’s inclusion criteria, the Food Standard Agency’s Nutrient Profile Score (NPS), and the Nova classification. Exposure defined as is the presence of a product at a prime location in stores. A decrease in exposure to restricted products in both SED in SM and CCS was observed. No notable changes were observed in the ICS due to their exemption from the policy. In all SM, the observed exposure to products restricted by the policy was reduced from 39% to 14%. The study found that the policy was successful in reducing exposure to high-sugar products such as biscuits and chocolate. NPS and NOVA showed that exposure rates were notably higher in less healthy and ultra-processed food (UPF) categories compared to the exposure to products restricted due to the policy’s exemption criteria. Exposure to alcohol products increased after the policy’s implementation, with a 20-percentage point increase in alcohol exposure in all SM checkout areas. The study suggests that the policy may have narrowed the differences in environments between the SEDs, highlighted by the findings in the ICS, whereby exposure to less healthy products was higher in the lower SED. The policy also created an opportunity for the alcohol industry to increase its exposure. Shortfalls in the policy’s design were identified through the use of the NPS and Nova classification system. Key messages • Despite the equitable outcomes in socioeconomic districts, loopholes in policy design allow the alcohol industry to exploit prime locations and undermine health objectives. • Policy success is evident in HFSS reduction; however, continued exposure to HFSS items exempt from the policy, and UPF products highlight policy design flaws that undermine health objectives.