Enabling UK consumers to increase their
consumption of fruit and vegetables
For
National Farmers Union (NFU)
Report prepared by: Dr Louise Manning
The Royal Agricultural University,
Cirencester, Gloucestershire, GL7 6JS
Issue: 01
Telephone: +44 (0)1285 889 906
Fax: +44 (0) 1285 650219
Date of Issue: 20/03/2016
Email: [email protected]
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Enabling UK consumers to increase their
consumption of fruit and vegetables 2
1. Executive Summary
1.1.
Introduction
The aim of this study was to undertake a desktop review to determine the constraining and the
enabling factors that influence United Kingdom (UK) consumer consumption of fruit and
vegetables (F&V)1 with a view to providing options for action on how such consumption could be
increased. The objectives of the study were to consider:

The degree of consumer engagement with policy initiatives such as the “5-A-DAY”, “Change
for Life” and the “Eatwell plate” (now the Eatwell Guide) and whether purchasing and
consumption of F&V has changed over the timeline of the projects;

The factors in the literature that are identified as constraining and enabling factors in the
consumption of F&V; and

The potential options for actions that could be implemented at policy, industry and
personal levels to increase the consumption of F&V in the UK.
A holistic approach was used in the study to draw together themes from a range of academic and
policy literature. Recommendations in this Executive Summary are considered in terms of positive
action that can be taken by government, retailers, food service and the farming and processing
sector in order to play their respective roles in enabling the increased consumption of F&V in the
UK. It is important to note the difference between the determination of what is considered as F&V
generally and what is considered F&V in terms of health campaigns such as the UK’s 5-A-DAY
initiative. Whilst potatoes may be considered more generally to be within the scope of horticulture
and thus as F&V, they are excluded from being defined as F&V in the Eatwell plate (now the Eatwell
Guide) and 5-A-DAY initiative.
Increased consumption of F&V is considered to be a critical step to prevent excessive weight gain.
The MacKinsey Global Institute (MKI) report of 2014 determined that obesity is one of the top
three global social burdens generated by human beings: smoking and armed violence, war and
terrorism as two issues represented a direct economic impact of $2.1 trillion each, with obesity
sitting third at $2 trillion per annum, well above climate change at $1 trillion. In a debate in the
House of Commons in 2016, Dr. Sarah Wollaston stated:
“9p in every £1 we spend in the NHS is spent on diabetes. We estimate from the evidence that
the Health Committee took during our hearings that the overall cost of obesity to the NHS is
now £5.1 billion a year, and the wider costs to society have been estimated to be as high as
£27 billion, although the estimates vary. We simply cannot afford to take no action…..
Source: First Report from the Health Committee, Session 2015-16. Childhood obesity—brave and bold action, HC 465.]
In 1990 the World Health Organisation (WHO) recommended a minimum consumption of 400g
of F&V per day and in the UK this has translated into the 5-A-DAY initiative and other initiatives
globally (see Section 4.2). However, the impact of these public health initiatives (PHI) on
increasing F&V consumption on a sustained basis remains modest (Rekhy and McConchie 2014).
The various interventions to promote the consumption of F&V have been initiated by government,
industry and not-for-profit organisations. Many of these have conducted informational and
1
The term F&V includes fruit, vegetables (including potatoes) and salad products
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educational PHI with mixed results. Success has been reported for those PHI which have forged
partnerships between industry, retail, government and not-for-profit organisations promoting
public health (Rekhy and McConchie 2014) see Section 4.4.
Whilst the relative affordability of calories in energy dense foods compared to nutrient rich foods
has been suggested as a primary constraint, this report demonstrates that the landscape with
regard to enabling nutrition through F&V consumption is in fact more nuanced and multifaceted
than conventionally protrayed. Thus whilst F&V affordability is important, there are other positive
steps that can be taken to increase the level of F&V consumption in the UK.
For example, there are disparities between purchasing and consumption. Defra statistics highlight
that there is a disparity in F&V purchase between average and low income households and an
overall reduction in F&V purchase between 2011 and 2014 (see Section 3.1). From a health
perspective this reduction in F&V consumption has contributed to a fall in fibre intake (7.1%
between 2011 and 2014) and also in a range of micronutrients notably Vitamin B6 and
folate.However it should be noted that a proportion of this reduction is the drop in consumption
of fruit juice which is currently included within the 5-A-DAY campaign.
However, it is important to note that purchasing statistics alone have limited value in measuring
actual F&V consumption as they do not take into account wastage in the home. Some studies
suggested the cost of F&V wastage in the home is £2.6 billion per year (FSP, 2015). This equates
in the WRAP 2008 report to 5.1 million individual potatoes a day, 4.4 million apples and 2.8
million tomatoes just to name three examples, although indications are that this wastage has
reduced in more recent years (see Section 3.1). Improving storage of F&V in the home is a crucial
step to lengthen shelf-life and maintain the quality of F&V. Combining the purchasing and wastage
figures from different reports (FSP, 2015; DFFR, 2015) equates to an average consumption of
241g per day per person, equivalent to three out of the five recommended F&V portions a day.
This 2016 report commissioned by the National Farmers Union (NFU) has considered the
proactive steps that can be taken to facilitate increased consumption of F&V. These include:

CHOICE ARCHITECTURE which is relevant to community environment, retail store, food
service, work place canteen and school canteen layout and managing portion control with
a view to influencing choice, promoting convenience and increasing nutrient-rich food
availability (see Section 3.2.2). A study involved with changing food service layout and
information at the point of purchase saw sales of healthy foods rise 41% after 3 months
(Thorndike et al. 2014).

REFORMULATION - including more F&V in convenience options and other food offerings.
Relatively simple changes such as the increased used of F&V in convenience foods could
make a significant improvement to the nutrient profile of meals (see Section 5.8).

INFORMATION - reminding people at the point of purchase about their choices, drawing
attention to social norms and framing information.
Choice architecture can be described as the informational or physical structure of the
environment that influences the way in which choices are made including reducing the portion
size of unhealthy foods and changing the relative pricing of foods (Dodds, 2014; Thaler and
Sunstein, 2008). However “nutrition doesn’t sell, but convenience and taste do” (Hanks et al.
2012:1) thus choice architecture has to include making F&V more convenient as food options.
Similarly society wide changes in consumption from “three meals a day” to “ready to go”, and
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“convenient” now supports a more “food grazing” lifestyle. The concept of consumers “shelfgrazing” in retail stores is being demonstrated with the increase in shopping for food multiple
times a week, whilst only 18% of UK households now plan their meals for the week ahead (Coop, nd). Reasons highlighted for this, including not wanting to buy too far in advance, reflect
uncertain weekly schedules, a wish to move away from menu planning and concerns over food
waste. In fact, certain food items may have increased perceptions of value for the very reason
that they reduce the need for making food planning decisions (Vohs et al. 2014). Yet, shelf grazing
can create a problem for retailers in terms of aligning the product offering and the buying
behaviour of shoppers. A mismatch can lead to increased shrinkage especially in short shelf-life
products, particularly F&V. In this context, shrinkage describes the loss in margin or profitability
incurred for a food retailer in terms of product spoilage, theft or wastage.
Current F&V shrinkage levels vary between 4.8% and 15% of retail sales (see 3.2.1) (Buzby et al.
2015; Buck and Minvielle, 2013) Criticially, shrinkage levels influence retail space allocations as
retail food stores seek the best financial return for the shelf space available in a given location. A
study in ten countries concluded that there was a relationship between a lower national body
mass index (BMI) and a higher percentage of shelf space allocated to F&V products (Norman et
al. 2014). The term food swamps can be used to describe this crowding out of F&V not only in
terms of F&V to snack food ratio on retail shelves, but also with fast food outlet density leading to
the swamping of nutrient-rich foods by energy dense alternatives.
A range of global and national PHI have been described in sections four, five and six of this report
and the enabling and constraining factors that have influenced the success of PHI and the
mechanisms such as the Public Health Responsibility Deal (PHRD) that have sought to engage
voluntary support from industry. The evidence suggests that current PHI in the UK have failed to
move the general public to an average consumption of five portions of F&V per person per day as
recommended by the WHO. Therefore new and innovative options need to be developed and
implemented in order to increase F&V consumption. These form the basis of the choice
architecture, reformulation and information options for action contained in this executive
summary.
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1.2.
Options for action - Government
Choice architecture

Revisit planning regulations with regard to enabling choice architecture at community level
and ensuring that nutrient-rich foods are not simply “swamped out” by energy-dense food
alternatives.

Redesign the layout of food service areas and the positioning of food products in public
areas such as schools, hospitals, government workplaces in order to have increased F&V
availability at the start of the buffet setting, or the use of convenient options for F&V
products in vending machines.

Undertake a feasibility study to determine applicability within the UK policy environment
for the development of an equivalent Community Food Projects Competitive Grants
Programme (CFPCGP) in order to implement a nutrition incentive based approach as has
been developed in the United States (US) where it currently involves 110 community
based partners, 730 community health care centres, hospitals and food hubs (see Section
4.3).

Promote increased visibility of F&V within schools with an associated choice architecture
strategy in the food service setting.
Reformulation

Provide an enabling environment for food reformulation for example, through the Public
Health Responsibility Deal.
Information

Develop a cohesive strategy for enabling of F&V consumption with a view to promoting the
need for increased fibre and micronutrient consumption to ensure the nation’s health in
addition to existing initiatives (see Table 14).
1.3.
Options for action – Retailers
Choice architecture

Introduce mechanisms such as the use of floor markers, grocery trolley/cart or basket
mirrors, sectioning out parts of the trolley and labelling as a F&V area in the trolley or
basket and/or trolley or basket placards to reinforce the social norms associated with F&V
choice. Use of such placards in one study increased the spending on F&V by 12.4% in one
store and 7.5% in another with no net increase in spending (see 3.2.2). Provide information
for consumers on the top five F&V items purchased in the store on shelf markers or visual
boards.

Revisit policies on shelf space allocation to F&V in store in terms of fixture location, product
category location, item location within categories, off-shelf displays and point of sale
promotional support (Yang and Chen, 1999). This should include a review of the frequency
of display and the positioning of F&V especially convenience, snack options of F&V in the
store layout.
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
Address the positioning of retail products on shelf especially snack products as positioning
has been shown to influence choice so that F&V are not disregarded (See Table 2).

Improve the use of shelf labels that identify nutrient-rich products, provide more
information on healthy meal ideas and recipes and consider a rewards programme for
purchasing healthy products (see Table 4).
Reformulation

Build health into existing food products with a programme of reformulation and refocus
especially ready-meals and revitalising the components of meal deal options to ensure
there is an increased featuring of convenience F&V products.

Increase the proportion of F&V snacks available as the trend increases to replace meals
with snack alternatives. Work specifically with supply chain partners to develop childcentred F&V snack products that are “fun shaped” for example, animals, letters etc. “fun
named” or with fun characters and positioned in a way in store to increase child purchasing
requests (see 3.2.1).
Information

Embed storage instructions on pre-packed F&V outer packaging so it can be seen on
purchase and when stored “in pack” in the home. It is important that this is visible when
the packaging is still intact on pre-packed F&V and is available at the point of purchase for
loose fruit for example, via information on bags, shelf cards, stickers that can be applied
to clear bags, paper bags with storage information. The size of print on pack and on instore
information is an important consideration so that all customers can access the
information. Improve understanding by customers of the need to refrigerate F&V to ensure
shelf-life in the home when it is often displayed in ambient conditions in-store. The ambient
display of produce is often confusing for consumers in this regard when the
recommendation is to then refrigerate food at home.

Promote product tastings, recipe cards featuring F&V that are ideal accompaniments for
ready-meals and promote the presence of healthy ingredients in convenience food options.

Increase staff knowledge about healthy food choices and nutrition. In one study (FMI,
2010) only 35% of shoppers felt that supermarkets enabled them to make healthy food
choices for their children, and only a quarter of shoppers felt that grocery store staff were
knowledgeable about nutrition or nutrition supplements.
1.4.
Options for Food Service
Choice Architecture

Redesign the layout of food service areas and positioning of food products in order to have
increased F&V availability at the start of the buffet and use convenient options for F&V
products on buffets.

Increase the proportion of F&V items available for children by develop F&V options that
are “fun shaped” for example, animals, letters etc. “fun named” or with fun characters and
positioned in a way on the menu or table information to increase child purchasing requests
(see 3.2.1).
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Reformulation

Through menu development and recipe reformulation increase the range of food products
that contain F&V, and more specifically in “ready-to-go” products being offered in the food
service environment.
Information

Implement the labelling of food products in vending machines, buffets, and on menus with
red, yellow and green coding to signify the health benefits, or lack of them to people
choosing both meal and snack options. This has already begun with some food service
businesses promoting F&V based products for say under 350 calories for a meal option.
1.5.
Options for the Farming and Processing Sector
Choice architecture

Implement growing techniques that improve substrate and soil nutrient value and
mechanisms for increasing the nutrient content of the F&V grown, harvested, stored and
processed in the UK.

Work with other sector partners to develop a demand led strategy that could encompass
the development of new crop varieties, the need for new forms of packaging, promotion
and presentation and the mechanisms for promoting health messages to a multidimensional audience.
Reformulation

Build health into existing food products with a programme of reformulation and refocus
especially ready-meals and convenience products.

Increase the proportion of F&V snacks available as the trend increases to replace meals
with snack alternatives. Work specifically with supply chain partners to develop childcentred F&V snack products that are “fun shaped” for example, animals, letters etc. “fun
named” or with fun characters and positioned in a way in store to increase child purchasing
requests (see 3.2.1).

Identify new ways of delivering convenience to consumers through further processing of
F&V so it can compete as a convenience product.
Information

Embed storage instructions on pre-packed F&V so it can be seen on purchase and when
stored in the home.
1.6.
Summary
The factors that influence F&V consumption are complex and often interacting and influence
particular demographic groups in different ways. The challenge of reducing diet related
malnutrition (DRM) sits at a nexus of public policy, corporate responsibility and individual
responsibility. The report that forms an output of this study has provided the background and
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Enabling UK consumers to increase their
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context for the options for action proposed in this executive summary that have focused on
governance, social responsibility at policy and corporate level and the role that the horticultural
sector and others can play in facilitating increased consumption of F&V.
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Contents
1.
Executive Summary
2
1.1.
Introduction
2
1.2.
Options for action - Government
5
1.3.
Options for action – Retailers
5
1.4.
Options for Food Service
6
1.5.
Options for the Farming and Processing Sector
7
1.6.
Summary
7
Contents
9
List of Tables
11
List of Figures
12
2.
Aims and objectives of the study
13
3.
Introduction
15
3.1.
Background
15
3.2.
Diet related malnutrition (DRM)
17
3.2.1.
Background
17
3.2.2.
Choice architecture and nudging
18
3.2.3.
Factors influencing food orientated behaviour
24
3.2.4.
status
Relationship between the density and type of food outlets and general obesity
28
3.3.
4.
Summary
Global public health initiatives to promote healthy eating
29
31
4.1.
Introduction
31
4.2.
Global Public Health Initiatives (PHI)
32
4.1.
US Policy provision to increase consumption of F&V by low income households
33
4.2.
Dietary Public Health Initiatives (PHI): 5-A-DAY programmes
37
4.2.1.
Global overview
37
4.2.2.
The UK 5-A-DAY programme
40
4.3.
Summary
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41
Enabling UK consumers to increase their
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5.
UK Government policy initiatives to promote healthy eating
42
5.1.
Introduction
42
5.2.
Level of knowledge about nutrient content
43
5.3.
The School Fruit and Vegetable Scheme (SFVS) and School Food Standards
48
5.4.
Information and evaluation of the Eatwell plate
48
5.5.
Healthier Food Choice Awards
50
5.6.
Change4Life
51
5.7.
PHE’s sugar reduction package
53
5.8.
Nutrient profiling
53
5.9.
Summary
54
6.
Inter-related UK Government public health initiatives
55
6.1.
Introduction
55
6.2.
Health and Wellbeing boards
55
6.3.
The Public Health Responsibility Deal (PHRD)
56
6.4.
F6 – Fruit and Vegetable Pledge in the PHRD
59
6.5.
Summary
59
7.
Options for action that can enable increased consumption of F&V in the UK
60
7.1.
Options for action - Government
60
7.2.
Options for action – Retailers
60
7.3.
Options for Food Service
61
7.4.
Options for the Farming and Processing Sector
62
7.5.
Summary
63
8.
Conclusions
64
9.
References
66
10. Appendix 1. Delivery Plans for the organisations pledged to F6 of the Public Health
Responsibility Deal (PHRD)
78
11.
Appendix 2 – 2015 updates on F6 pledge in PHRD
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Enabling UK consumers to increase their
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List of Tables
Table 1. The contribution of F&V and potatoes to nutrient intake per person per day from
household purchases (Adapted from DFFR, 2015; EU, 1990) ....................................................... 16
Table 2. The influence of positioning on food choice (Adapted from Keller et al. 2015) ............. 20
Table 3. Supermarkets as an enablers of healthy eating (Adapted from FMI, 2010) .................. 20
Table 4. Shopper interest in various services that might be provided by the supermarket where
they shop most often (Source: FMI, 2010) ...................................................................................... 21
Table 5. When are F&V eaten (Adapted from PBHF, 2010) ........................................................... 22
Table 6. Top five favourite family F&V as reported by mothers (Adapted from PBHF, 2010) ...... 22
Table 7. Barriers to increased F&V Consumption (Adapted from PBHF, 2010) ............................ 23
Table 8. Enabling the appeal of F&V snack products aimed at children (Baker et al. 2015) ...... 25
Table 9. Dual strategies of prevention ............................................................................................. 32
Table 10. Dual strategies of intervention ......................................................................................... 32
Table 11. Examples of Global Public Health Initiatives (Adapted from: OEDC, 2014; WCRFI,
2015) .................................................................................................................................................. 35
Table 12: Global PHI F&V promotion campaigns ............................................................................. 37
Table 13. Development of the 5-A-DAY programme in the UK ....................................................... 39
Table 14. Drivers, trends and events that could influence micronutrient intakes in the UK
(Adapted from Miller et al. 2016) ..................................................................................................... 44
Table 15: Potatoes and 5-A-DAY F&V commonly eaten in the UK (identified from National Diet
and Nutrition Survey data) and EFSA-approved health claims for micronutrients they contain. . 44
Table 16. Vitamin content of selected UK fruits and vegetables (per 100g) ................................ 47
Table 17. Mineral content of selected UK fruits and vegetables (per 100g) ................................ 47
Table 18. Criteria in the Healthier Choices Food Award (Source: WRS, 2015) ............................. 50
Table 19: Evaluation of Year One Change4Life ............................................................................... 52
Table 20. PHRD core commitments and pledges (Source: DH, 2011a) ........................................ 57
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List of Figures
Figure 1: Development of Local Supply Chain Networks and Regional Food Hubs (Source:
Wholesome Wave, 2015c) ................................................................................................................ 36
Figure 2. The Eatwell Plate (Source: NHS, 2015a) .......................................................................... 42
Figure 3. The Eatwell Guide (Source: Govt.uk, 2016) ..................................................................... 50
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2. Aims and objectives of the study
The aim of this study was to undertake a desktop review to determine the constraining and the
enabling factors that influence United Kingdom (UK) consumer consumption of fruit and
vegetables (F&V)2 with a view to providing options for action on how such consumption could be
increased. In this study the term F&V includes fruit, vegetables and salad products as defined by
the 5-A-DAY initiative as well as consideration of potatoes. Clarification is given throughout the
report as to whether the term F&V refers to the inclusion of potatoes or not as with the 5-A-DAY
initiative. Potatoes are included in this report as they fall within the wider definition of horticulture
as used by the National Farmers Union (NFU). The objectives of the study were to consider:

The degree of consumer engagement with policy initiatives such as the “5-A-DAY”, “Change
for Life” and the “Eatwell plate” (now the Eatwell Guide) and whether purchasing and
consumption of F&V has changed over the timeline of the projects;

The factors in the literature that are identified as constraining and enabling factors in the
consumption of F&V; and

The potential options for actions that could be implemented at policy, industry and
personal levels to increase the consumption of F&V in the UK.
This project involved a desktop review to draw together, in a holistic approach, themes from a
range of academic and policy literature. A holistic research approach has been used that
considers that health and diet-related malnutrition (DRM) is influenced by community, the
environment in which we live and the local (and wider) economy. This follows the work of Forget
and Lebel (2001) and others. The underlying research questions are:
1. What are the global initiatives that followed the World Health Organisation (WHO)
recommendation of 400g per day F&V consumption ?
2. How has UK public policy developed to encourage adults to consume 400g of F&V? daily?
3. What is the impact of the policy initiatives and whether adults are meeting the WHO
recommendations?
4. What actions have the food industry taken to encourage consumers to meet the F&V
consumption agenda?
5. In the academic-scientific/government literature what are the identified enabling and
constraining factors with regard to F&V consumption?
6. What is the role of UK growers in meeting the needs of consumers of F&V?
The area of science that relates to F&V consumption, choice and personal behaviour is crossdisciplinary and this requires engagement by researchers from a range of disciplines and with
complementary expertise. The authors of the report are from a range of backgrounds:

2
Dr Louise Manning, Senior Lecturer in Food Policy and Management at Harper Adams
University.
The term F&V includes fruit, vegetables (including potatoes) and salad products
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
Dr Josie Kelly, Lecturer, specialising in Business and Government Relations, at Aston
Business School.

Sara Stanner, Science Director at the British Nutrition Foundation (BNF).
The factors that influence F&V consumption are complex and often interacting and influence
particular demographic groups in different ways. The challenge of reducing DRM sits at a nexus
of public policy, corporate responsibility and individual responsibility. The report that forms an
output of this study will provide options for action focused on governance, social responsibility at
policy and corporate level and the role that the horticultural sector and others can play in
facilitating increased consumption of F&V.
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3. Introduction
3.1.
Background
Sufficient daily consumption of fruit and vegetables (F&V) could help prevent major diseases for
example, type-II diabetes, obesity and certain cancers. The World Health Organisation (WHO)
recommended in 1990, a minimum consumption of 400g of F&V per day (WHO, 1990). In 2003,
in the United Kingdom (UK), this translated into the “5-A-DAY”campaign encouraging the
consumption of 80g of five different F&V daily with potato consumption not included in this
category. This approach is mirrored in similar schemes around the world for example, France,
Germany, New Zealand (see Section 4.2). The relative affordability of energy dense foods (high in
sugar, fats and salt) compared to nutrient rich foods such as F&V, is implicated in socioeconomic
disparities in the incidence of diet related malnutrition (DRM), often presented as obesity
(Appelhans et al. 2012), thus suggesting poor nutrition (both under and over consumption of
calories) is a particular issue for low-income households. However, this is just one in a
multifaceted set of factors that contribute to the growth of an obesogenic environment (Lake and
Townsend 2006; Lake et al. 2010). The 2014 Defra Food Statistics Pocketbook highlights that:

UK household purchases of F&V were 1.1% lower in 2013 than 2012, a reduction of 9.7%
since their peak in 2006. This was 24% of household food purchase.

F&V purchases [not consumption] equated to an average 4.0 portions per person per day
falling to 3.2 portions per day for the lowest income households.

Nearly three times as much food and drink high in fat and/or sugar was purchased (22%)
compared to the Eatwell plate percentage of 8% of daily consumption (FSP, 2014).
The Defra Family Food Report (DFFR) for 2014 published in December 2015 reported that potato
purchases continue their long term downward trend with a 10.1% reduction since 2011 and 18%
lower than a decade earlier. Overall purchases of F&V reduced between 2011 and 2014 (but it
should be noted that this downward trend included the drop in fruit juice purchase), but
consumers spent 4.4% more on fresh and processed vegetables and 7.8% more on fresh and
processed fruit. Apple sales were up 8% in 2014 compared to 2011 and conversely fruit juice
sales down 15.1% over the same time period (DFFR, 2015). Fibre intake declined in 2014 at an
average of 14.2 grams per person per day compared to a recommendation of 18g per person per
day (when measured as non-starch polysaccharide). This was a 7.1 per cent fall from 2010 (DFFR,
2015). The Defra Family Food Report for 2014 determined that:

Overall purchase of fruit increased to 2006 but then fell 14% compared with 2007.
Purchases of vegetables peaked in 2005 and then fell 5.2% in the same time period.

Lowest income households (decile 1), purchased 11.3% less fruit and 6.6% less
vegetables in 2014 than in 2007. This group purchase the least F&V.

Income decile 2 households purchased 20% less for both F&V in 2014 than in 2007
(DFFR, 2015).
Poor dietary choices not only manifest in obesity, which is currently the main public health focus
in the UK, but can also lead to inadequate micronutrient intakes, with implications for health
(Miller et al. 2016:1).
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Miller et al. (2016) suggest that recent dietary survey data and measurements of status
biomarkers have highlighted folate, vitamin D, calcium, iron and iodine to be amongst the
micronutrients of most concern for particular subgroups of the UK population. Groups that are
vulnerable to inadequate micronutrient intake include not only lower socioeconomic groups, but
also ethnic minorities and adolescents. Furthermore, of particular concern are teenage girls and
women of childbearing age because of their high requirements for some specific micronutrients
and the impact that poor micronutrient intakes can have on the health and wellbeing of their
offspring (Miller et al. 2016). Table 1 highlights the contribution in terms of % of micronutrient
intake per person per day as derived from household purchases. It should be noted that this does
not reflect actual consumption because firstly food waste has not been taken into consideration
and also the average is factored across a household so does not take into account variations
between individual consumption.
Table 1. The contribution of F&V and potatoes to nutrient intake per person per day from
household purchases (Adapted from DFFR, 2015; EU, 1990)
Food type
Fat
(g)
Sodium
(mg)
Iron
(mg)
Energy
(kcal)
Non-milk
extrinsic
sugars
(g)
Calcium
(mg)
Folate
(µg)
Vitamin A
(retinol
equiv) (µg)
Vitamin C
(mg)
βcarotene
(µg)
Fresh potatoes
42
0
3.6
0
1.6
0.2
7.8
0
6.9
0
Fresh green
vegetables
4.7
0
8.9
0
2.2
0
13
14
6.0
85
Other fresh
vegetables
17
0
15
0.2
7.8
0.3
18
241
6.6
1447
Fresh fruit
44
0
9.4
0.4
66
0.2
11
5.2
15
31
Sub total
107.7
0
36.9
0.6
77.6
0.7
49.8
260.2
34.5
1563
5.6
0
4.4
0.8
3.3
7.0
21.0
31.6
48.6
69.6
Processed fruit
51
4.7
9.4
2.6
14
0.2
11
2.5
12
14
Processed
vegetables
125
0.7
24
5.2
171
0.8
22
48
6.1
261
All
283.7
5.4
70.3
8.4
262.6
1.7
82.8
310.7
52.6
1838
All F&V as % of
total nutrient
intake
14.8
8.1
8.3
10.6
11.3
17.1
34.9
37.7
74.1
81.8
Total household
intake
1916
67
848
79
2319
10
237
824
71
2246
14
200
800
60
Average intake per person per day
Fresh F&V as %
of total nutrient
intake
EU Reference
Value for daily
allowance
800
Accordingly any conclusions drawn need to be considered cautiously. The term “nutrient rich” is
well illustrated in Table 1 with the contribution of all F&V to folate, vitamin A and vitamin C and βcarotene intake clearly demonstrated at 37.7%, 74.1% and 81.8% respectively. Interestingly, the
choice to consume processed rather than fresh F&V can lead to higher fat intake per person per
day attributed to all F&V from 0.8% to 10.6% and non-milk extrinsic sugars from zero to 8.1%.
Undoubtedly, these factors are at play in the evidence that over the four year period from 2010
to 2013, intakes of most vitamins and minerals declined, notably Vitamin B6 and folate, with
decreases of 13 and 8.1 per cent respectively (DFFR, 2015). Accordingly, one in five people in the
UK now have a vitamin D status below the level deemed adequate (SACN 2015a cited by Miller
et al. 2016).
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Enabling UK consumers to increase their
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The FSP (2014) and DFFR (2015) sources report purchasing statistics rather than actual
consumption of F&V. Home food waste reduces what is actually consumed by family members
collectively and statisticial analysis at the household level cannot account for variations in
individual consumption. Defra estimates that 22% of edible F&V purchased are wasted (FSP,
2015). Therefore whilst DFFR (2015) states that 2176g of F&V are purchased per person per
week (311g per person per day), using the Defra estimate of 22% waste this figure reduces to
241g of F&V per person per day only 60% of the WHO recommended 400g of F&V i.e. only 3 out
of 5 recommended portions. A study carried out by WRAP in 2007 considered food thrown away
by consumers in the home (WRAP, 2008). A follow on 2013 WRAP report Helping Consumers
reduce fruit and vegetable waste: Final Report concluded that non-consumed food is worth £2.6
billion annually, representing 27% of household waste by weight and 21% of overall waste by
cost. By 2012, there had been a reduction in fruit and vegetable wastage to 1.4 million individual
bananas per day from 1.7 million in 2007 and 1.5 million individual tomatoes per day down from
2.0 million in 2007 (WRAP, 2013). The study did not differentiate according to size or weight of
individual items. Improving storage in the home, especially refrigeration of F&V, would greatly
reduce wastage and help to bridge the F&V gap between what is purchased and what is
consumed. Whilst storage instructions are provided on pre-packed F&V, there is little information
for F&V sold loose (free-flow). The WRAP report produced in 2008 provided recommendations for
supporting consumers to reduce F&V waste. These recommendations also have value in
maintaining the intrinsic quality of F&V including taste and flavour and ensuring that more of the
F&V fruit purchased is actually eaten. Where storage advice was available on pre-packed
products, the report describes that it was often on the reverse of the label, only visible when
breaking the integrity of the packaging, and also in small print. The report notes that storage
advice should be included on the packaging of all pre-packaged products for example, “keep
refrigerated”, and more advice should be given at the point of purchase for loose F&V. This could
be in terms of shelf cards and information on paper bags.
A further theme highlighted in the report was the confusion of consumers when they saw product
on display in stores at ambient temperatures with storage advice on the pack to “keep
refrigerated”. The report suggests that only 23%-28% of people store fruit in a fridge so through
education there is the potential to improve behaviour in the home with regard to storage.
Ultimately the eating of low quality F&V is likely to discourage repeat purchase.
3.2.
3.2.1.
Diet related malnutrition (DRM)
Background
DRM which includes obesity, affected 3 million people in the UK in 2007 costing in excess of
£13bn and corresponding to about 10% of the expenditure on health and social care in that year
(Elia and Stratton, 2009). More widely across the European Union (EU) about 20 million people
are affected by DRM, costing EU governments up to €120 billion annually (Freijer et al. 2012).
This cost to a UK social health service free at the point of use is only set to increase. In a time of
governmental austerity with a stark focus on public spending and against a backdrop of nation
states in the EU struggling to service public debt this is a major challenge. In a debate in the House
of Commons in 2016, Dr. Sarah Wollaston stated:
“9p in every £1 we spend in the NHS is spent on diabetes. We estimate from the evidence
that the Health Committee took during our hearings that the overall cost of obesity to the
NHS is now £5.1 billion a year, and the wider costs to society have been estimated to be
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Enabling UK consumers to increase their
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as high as £27 billion, although the estimates vary. We simply cannot afford to take no
action…..
As the Minister will recognise from the evidence presented by Public Health England,
price promotions will need to form an extraordinarily important part of the childhood
obesity strategy if it is to be effective. It is a staggering fact that around 40% of what we
spend on our consumption of food and drink at home is spent on price promotions.
Unfortunately, however, they do not save us as much money as we assume. They
encourage us to consume more… we should have a centrally-led programme of
reformulation across foods and drinks, and that what manufacturers want is a level
playing field. The trouble with reformulation is that it takes time; there has been an
effective programme on salt, but that has happened very gradually, over a 10-year period.”
Source: First Report from the Health Committee, Session 2015-16. Childhood obesity—brave and bold action, HC 465.]
The MacKinsey Global Insititute (MGI) report entitled ‘Overcoming obesity: an initial economic
analysis’ (Dobbs et al. 2014), states that obesity is one of the top three global social burdens
generated by human beings when measured in terms of the estimated annual global direct
economic impact and the required investments to mitigate the burden. In their study, smoking,
and armed violence war and terrorism each represent a direct economic impact of $2.1 trillion,
with obesity sitting at $2 trillion per annum which is 2.8% of global gross domestic product (GDP).
This figure in their study placed obesity well above climate change at $1 trillion and poor water
and sanitation at $0.1 trillion. The MGI report also considered potential interventions to address
obesity that are being discussed or piloted. Of the 74 interventions only three explicitly refer to
F&V: school canteen layout, workplace canteen layout and the prominence of healthy alternatives
(this is more fully discussed in the next section) and considering subsidies on F&V to influence
cost. The cost/benefit analysis undertaken by Dobbs et al. (2014) identified the following three
options in order of impact on obesity: portion control, reformulation, and high calorie
food/beverage availability closely followed in similar order of impact by weight management
programmes, parental education, school curriculum and healthy meals. Subsidies were not
highlighted as of value in the cost benefit analysis undertaken in this study.
3.2.2.
Choice architecture and nudging
Choice architecture can be described as the informational or physical structure of the
environment that influences the way in which choices are made (Thaler and Sunstein, 2008).
Choice architecture is said to include reducing the portion size of unhealthy foods and changing
the relative pricing of foods (Dodds, 2014). When considering public food service layout,
Thorndike et al. (2014) suggested that choice architecture, i.e. the strategy used in health
promotion within public food service, can provide an environment that will actively influence
eating behaviour. In their study, cafeteria items were labelled green (healthy); yellow (less
healthy); or red (unhealthy) and the cafeteria layout rearranged in order to improve accessibility
to healthy items. The results showed that after 3 months of implementing this strategy, sales of
red items had decreased by 24% and two years later has still fallen by 20%. Green sales increased
by 41% after 3 months of implementing the changes to 46% two years later. In a study that looked
at layout of foods in food service and the order they are presented in a self-serve buffet, splitting
the F&V items into separate bowls and changing the order of serving to salad, then dressing, then
pasta, bread and meatballs saw a change in consumption of F&V from 19% in the control (i.e.
unchanged format with pasta, then, bread, then meatballs) to 33% in the amended layout
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(Kongsbak et al. 2016). Hanks et al. (2012:1) argue that: “Nutrition does not sell, but
convenience and taste do.”
On this basis they designed a study, involving 11,000 students, where healthier foods were made
more convenient in order to identify if this led to individuals selecting and eating healthier foods.
The convenience buffet line that included healthier food options and flavoured milk increased
sales of healthier food by 18% and the proportion of less healthy food decreased by 37%.
Interestingly consumption of flavoured milks increased as did levels of waste so not all the
healthier food chosen was eaten, but consumption of unhealthy options did reduce overall. Thus
convenience has a role to play in influencing choice behaviour, but it did not in this study drive
increased consumption of F&V. The authors argued that one reason for this could be that
convenience is generally associated with sweet, salty and fatty foods rather than healthful
alternatives. This could then be intrepreted that there were palatability issues with the chosen
food for some individuals which prevented consumption.
With a view to the UK, Park and Papadaki (2016), considered the nutritional value of food in
vending machines on a university campus. 82% of students in the study used vending machines
to snack between meals and the authors determined that most foods that were available in the
vending machines were of low nutritional quality. In a second study in a United States (US)
university, the vending machines were stocked with a ratio of red (28.5%), yellow (43%), and green
(28.5%) snack food items where red represents unhealthy and green healthy snack items (Caruso
et al. 2014). Purchasers stated they were most influenced by hunger (42%), convenience (41%)
and taste (10%), with red items selected at the highest frequency (59%) compared with green
items (8%). These studies show that although a higher proportion of healthy snack foods might
be made available, individuals may still opt for the less healthful choice. Rearranging the
environment surrounding food choices has increasingly been discussed in the context of
‘‘nudging’’ (Keller et al. 2015). Nudging refers to the purposeful changes within choice
architecture:
“that influence peoples' behaviour by making changes in the environment that guide and
enable individuals to make choices almost automatically. This can be done by simplifying
the information provided or by offering default choices in a way that facilitates socially
desirable decisions” (Lehner et al. 2015:2).
The Keller et al. (2015) study looked at the effect of position change on snack bar choice (see
Table 2) showing that positioning of food products influenced consumers’ choices. This is of
interest when considering options to increase the consumption of F&V products other than using
coercive policy approaches such as laws and bans. Lehner et al. (2015) list a number of so-called
“nudge tools” aimed at changing behaviour including the use of defaults i.e.

Changing the standard choice through reformulation of food products to include more F&V;

Changing layouts and features of different environments; and

Reminding people about their choices, drawing attention to social norms and framing
information and issuing warnings.
Examples have been outlined previously in this report with regard to food service and at retail
level too where choice architecture can incorporate nudge tools.
Payne et al. (2015) assessed the efficacy of a retail level intervention in two retail case studies
with the aim of increasing spending on F&V without increasing overall shopper budgets. The study
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incorporated the use of grocery cart (trolley) placards that detail the number of produce items
purchased at a particular store i.e. they reinforce the social norm for that community. Just over
970,000 transactions were analysed in the study with and without the use of placards and their
use increased spending on F&V by 12.4% per day per person in one store and 7.5% in another.
This increase in spending occurred without a change in total food spending. The conclusion was
that grocery cart placards were of value in increasing F&V consumption. The placard carried the
statement:
“In this store most people choose at least x produce items” with the x denoting the number.
In addition the placard listed the top ten F&V purchased in the store. The term “most people” was
used so that those purchasing above this amount would not feel that they had to reduce purchase
levels.
Table 2. The influence of positioning on food choice (Adapted from Keller et al. 2015)
ACTIVE CHANGE IN PRESENTATION AND IMPACT
SOURCE
Increasing distance to chocolate snacks reduced intake
Maas et al. (2012)
Amending layout of a self-service buffet changed F&V consumption from 19% to 33%
Kongsbak et al. (2016)
Increasing availability of healthy snacks (75% versus 25%) enhanced probability of choosing
them
van Kleef et al. (2012)
Effort of unwrapping food or picking up with tongs reduced consumption of fruity and chocolate
snacks
Brunner (2013)
Apple bar selected almost three times more often when placed in the middle set of boxes than
when on the left demonstrating rearranging snacks on shelf influences consumer choice
Keller et al. (2015)
As consumption increases it is important to reflect this in the number of portions identifed on the
placard for example, increasing by 5 to 6 portions etc. Further retail interventions that have been
used to increase the consumption of F&V include mirrors on the shopping carts, arrows on the
store floor nudging customers towards the F&V aisle and yellow tape sectioning out the
cart/trolley3.
In a study reported in 2010, 58% of grocery shoppers said that store employees were readily
available when they needed help, but just a quarter of shoppers felt that grocery store staff were
knowledgeable about nutrition (FMI, 2010). There is therefore an opportunity for grocery stores
to increase the knowledge of their staff in order to assist shoppers in making more healthful
choices. This study differentiated between a group of consumers who stated they eat healthy
meals most days and those who stated they do not and asked a series of questions with regard
to how the retailer enabled them to make healthy food choices (Table 3).
Table 3. Supermarkets as an enablers of healthy eating (Adapted from FMI, 2010)
EAT HEALTHY MEALS MOST DAYS
DO
DO NOT
TOTAL
Helps me make healthy food choices
60%
34%
50%
Helps me make healthy choices for children
41%
25%
35%
Provides information on food and beverages that help manage
specific health concerns
44%
28%
38%
Promotes healthy living
61%
39%
53%
http://www.nytimes.com/2013/08/28/dining/wooing-us-down-the-produceaisle.html?pagewanted=all
3
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Stocks a wide variety of healthful foods and beverages
79%
60%
72%
Store employees are knowledgeable about nutrition
29%
17%
25%
Store employees are knowledgeable about nutrition supplements
30%
19%
26%
Store employees are readily available when I need them
64%
49%
58%
Table 4. Shopper interest in various services that might be provided by the supermarket where
they shop most often (Source: FMI, 2010)
INTEREST
SERVICE OR PROGRAME
1
Coupons for healthy products
2
Shelf labels that identify healthy products
3
Product sampling or tasting in store
4
Healthy meal ideas and recipes
5
Reward programmes for purchasing healthy products
6
Freshly prepared healthy meals
7
Programmes that recommend healthier options for products purchased
8
Recipes for special health concerns;
9
In-store cooking demonstrations for healthy meals,
10
Information on how to treat common health concerns
11
Information on how to prevent common health concerns
12
Hands on cooking lessons for preparing healthy meals
13
Health screening services
14
Weight loss or diet plan services
15
Nutritional counselling for adults
16
Personalised wellness plans
INTERESTED SHOPPERS (%)
More than 80%
70% to 80%
60% to 70%
50% to 60%
40% to 50%
The three lowest overall responses are highlighted identifying that customers felt supermarkets
could do more to ensure store employees are knowledgeable about nutrition and nutrition
supplements and supermarkets could do more to help customers make healthy choices for their
children. These results demonstrate that there is much more that can be done by supermarkets
and their employees to promote the concept of healthy eating to customers in retail stores. In the
FMI (2010) study of 2559 respondents, shoppers were interested in their local supermarket
providing a range of services (Table 4) that all have considerable merit in increasing F&V
consumption through an integrated choice architecture programme that is delivered at retail store
level. The top five services of interest in the FMI study could be adapted for F&V, for example
coupons for F&V products, shelf labels that identify healthy products, product sampling or tasting
in store especially of F&V snack foods and convenience foods that have been reformulated to
include more F&V, healthy meal ideas and recipes and a reward programme for purchasing
healthy products. These are all worthy of consideration by retailers as are many of the other
elements contained within Table 4.
In the year ending March 2014, global snack sales totalled $374 billion annually an increase of
2% year on year (Nielsen, 2014). Interestingly the DFFR (2015) notes that in the UK confectionary
purchases when eating out are down 21% since 2011, and biscuit and chocolate sales are down
14%. In the Nielson (2014) on-line survey of 30,000 consumers in 60 countries, 76% of
respondents stated they eat snacks often or sometimes to satisfy hunger between meals or a
craving, 45% of consumer snacks as a meal alternative with many replacing breakfast (52%),
lunch (43%) and dinner (40%) i.e. snacks are often a quick “meal alternative”.
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Enabling UK consumers to increase their
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As to motivational reasons for snacking, respondents stated that drivers included: to improve
mood (64%), as a reward (53%) and due to stress (44%). In Europe, the top snacks identified were
fresh fruit (63%), chocolate (61%), cheese (58%), yogurt (54%), vegetables (49%),
cookies/biscuits (45%). However it should be noted that this survey is with a subset of the total
population (i.e. those on-line) and the results may not translate to the food choices of the wider
public. In another study when asked if they ate healthy snacks on most days: 15% strongly agreed,
36% agreed, but 48% responded “not so much” perhaps indicating either a level of uncertainty or
that they might not want to disclose their eating activities to the researchers (FMI, 2010).
The US Produce for Better Health Foundation (PBHF) undertook a study in 2010 and considered
when F&V are eaten in the home and if consumption is a mealtime or a snack event (Table 5).
The data shows that fruit is eaten more evenly throughout the day and is often considered to be
a snack item. It should be noted that in this research, fruit juice was represented 38% of all fruit
classified as being consumed in the home, with fresh fruit representing 46%. Vegetables are
primarily consumed at lunch and the evening meal in particular, although the study noted that
vegetable consumption from evening meals is gradually reducing (PBHF, 2010).
Table 5. When are F&V eaten (Adapted from PBHF, 2010)
BREAKFAST (%)
LUNCH (%)
DINNER (%)
SNACKS (%)
Vegetables
2
31
66
1
Fruit
44
24
17
15
CONSUMED IN HOME (5)
CONSUMED IN RESTAURANTS (5)
OTHER (%)
Vegetables
75%
15%
10%
Fruit
89%
3%
8%
All meals
84%
11%
8%
Note potatoes are
included in this category
in this study
Therefore, if consumers decide to replace the evening meal with a snack food choices this
decision could impact particularly on total vegetable intake. For vegetables, 45% of all those
consumed in the home were fresh followed by frozen (11%), canned (10%) and homemade or
homegrown (25%). It was not clear in the study what consitituted homemade vegetables. The
report also considered the role of mothers’ knowledge and opinions with reference to F&V
consumption and differentiated between Generation X mothers (those born between 1965 and
1979) and Generation Y mothers (those born between 1980 and 1990). When asked what was
the favourite family fruit or vegetable there was a general similarity between the two groups in the
US survey (Table 6) in terms of the types of F&V consumed. Being a US study, corn is identified as
a favourite vegetable i.e. sweetcorn, or corn-on-the-cob. Interestingly, most Generation X mothers
believe that their families eat too little fruit (54%:49%) and too few vegetables (63%:54%).
Generation Y mothers are slightly more likely to believe their families already consume too many
F&V. Further Generation Y mothers were less likely to feel it was important to include F&V in their
family’s meals and snacks (87%:91%) and they were also less likely to want to include a greater
variety of F&V in their family’s meals (75%:79%). When asked what they considered as barriers to
increased F&V consumption Generation X and Generation Y mothers answered slightly differently
(Table 7).
Table 6. Top five favourite family F&V as reported by mothers (Adapted from PBHF, 2010)
FRUIT
GENERATION
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X
VEGETABLES
Y
X
Y
Enabling UK consumers to increase their
consumption of fruit and vegetables 23
First
Apples (32%)
Second
Third
Apples (28%)
Broccoli (19%)
Carrots (18%)
Bananas (22%)
Bananas (23%)
Corn (17%)
Corn (17%)
Strawberries (12%)
Strawberries (11%)
Green Beans (14%)
Green Beans (15%)
Grapes (8%)
Oranges (9%)
Carrots (13%)
Broccoli (12%)
Pineapple (4%)
Grapes (5%)
Potatoes (6%)
Potatoes (6%)
Fourth
Fifth
Table 7. Barriers to increased F&V Consumption (Adapted from PBHF, 2010)
GENERATION
AGREE WITH STATEMENT
X (%)
AGREE WITH STATEMENT
Y (%)
Members of the family have different F&V likes and dislikes
63
64
I need ideas about new ways to prepare F&V
50
49
There is not a good range of F&V available in restaurants
46
41
Fruit are too expensive
38
43
Vegetables are too expensive
30
34
We already eat enough F&V
26
27
Vegetables are time consuming to purchase and prepare
20
22
Quality product is not available in local stores
19
16
Fruits are time consuming to purchase and prepare
15
14
Vegetables are not appetising
15
15
Fruits are not appetising
7
8
Key barriers that are worthy of further consideration in developing strategies to increase F&V
consumption are:

Members of the family having different F&V likes and dislikes;

Needing ideas about new ways to prepare F&V;

There not being a good range of F&V available in restaurants (more for Generation X than
Generation Y); and

F&V being too expensive (more for Generation Y than Generation X).
Generation Y mothers were much more likely to identify a need for financial support to be able to
include F&V in family meals and snacks (29%) compared to Generation X mothers (11%) and
spousal or family support was identified to be a barrier to including F&V in the family diet by
Generation X mothers (30%) compared to Generation Y mothers (27%) (PHBF, 2010). Different
ideas and recipes were also suggested as a valuable support to enable more F&V consumption.
Whilst Generation X and Generation Y mothers both gave “staying healthy” as an important reason
for eating F&V, the health benefits associated with F&V and the beneficial compounds found in
F&V are most often correctly identified by Generation X mothers.
Generation X mothers are more likely to use the internet as a source of information at 30%
compared with health care providers or dietitians at around 10%. For Generation Y mothers, 89%
would use the internet as a source of information about nutrition compared with health care
providers or dietitians at around 40% with only 3% considering the supermarket as a source of
nutritional information in both groups. Again this suggests that in this study mothers did not see
the supermarket environment as a space where nutritional information and advice could be
accessed.
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Enabling UK consumers to increase their
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This section of the report demonstrates the multiplicity of social and environmental factors that
influence food environments and the potential for choice architecture in the home, and in retail
and food service environments. The next section of the report goes on to discuss other influencers
of F&V purchase and consumption.
3.2.3.
Factors influencing food orientated behaviour
As food availability has increased so has eating frequency, sometimes described as continuous
grazing which is linked to increased eating opportunities, especially outside the home, driven by
the proliferation of “fast “outlets and the availability of “ready to go” foods often high in salt or
sugar to enhance palatability and extend shelf-life for example, cakes, cookies, chocolate bars,
crisps etc. (Colles et al. 2008). In this consumption environment there is limited access to F&V
and when available, F&V are often sourced globally (for example, bananas) so may not be offering
a business opportunity for the UK grower. The pattern of food consumption throughout the day is
important in terms of when and where the food is firstly purchased and then consumed. Thus the
availability of, and the opportunities for purchase and consumption of F&V at the times of demand
is crucial. Eating continuously throughout the day instead of eating planned meals can influence
what individuals believe to be the norm in terms of calorie intake and portion size (Bulik et al.
2007).
Kofman et al. (2010:1938) define grazing behaviour as: “repeated episodes of consumption of
smaller quantities over a long period of time with accompanying feelings of loss of control”.
An alternative definition is that grazing involves the repeated consumption of smaller amounts of
food over an extended period of time (Carter and Jansen, 2012) and they argue that grazing is a
relatively neglected high risk eating behaviour that can cause weight gain. This behaviour is seen
in many patients who present themselves for bariatric surgery (Colles et al. 2008; Kofman et al.
2010) and the behaviour can continue afterwards too, especially in those individuals who have
an eating disorder. This snacking trend has led to a rise in processed products specifically
marketed as healthy snacks, breakfast replacement cereal bars and single portion breakfast
items. Therefore, it is important in a culture that is socially moving towards grazing rather than
meal time eating that more nutrient-rich grazing or snack options are available. 26% of consumers
purchase pre-cut F&V due to the convenience of these items and 20% of consumers would like
to see more ready-to-eat single-serve F&V offerings become available on the market (Levesque,
2013 cited by Baker et al. 2015). Beets et al. (2014) undertook a study to consider in part the
snack selections made by children and determined that:

When fruit was the only snack selection on offer 21% of the children chose not to select a
snack at all;

When there was a choice of three snacks, fruit (sliced or whole) was seldom selected (6%)
when served simultaneously with a sugar-sweetened snack (57%), and a flavoured salty
snack (37%); and

In the fruit-only option, children were more likely to select sliced apples/oranges than
whole fruit.
When whole fruit was offered, the options were apples, oranges and bananas, sliced fruit was
oranges and apples, but this shows clearly that fruit was not the primary choice compared to other
snack products. Many food products targeted towards children have appealing names or are
shaped to have a fun appeal such as dinosaurs, letters, smiley faces, bears. Considering this, and
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building on the work of others (Table 8), Baker et al. (2015) developed what were considered
child-friendly pre-cut produce items i.e. F&V snacks shaped as butterflies, flowers, teddy bears
and so on. The study concluded that parents and caregivers, who were the focus of the study,
considered these shapes more visually appealing and were 34% more likely to select children
friendly shaped samples. Two thirds of parent participants perceived regular shaped cut fruit and
vegetables to be child friendly showing that marketing bite sized pre-cut F&V is an attractive
option for shoppers. There was also a willingness to pay extra for children friendly shaped F&V
samples showing that the development of a marketing strategy of this kind had the potential to
achieve increased selection and consumption of F&V by adult carers expecially women. Baker et
al. (2015) argue that as well as cost being a decision influencing factor, fun, peer acceptability of
lunch box contents, availability and convenience also all play a part.
Table 8. Enabling the appeal of F&V snack products aimed at children (Baker et al. 2015)
GENERATION
Children preferred fun-shaped to regular-shaped vegetables.
Selected vegetables twice as often when they had fun names (for example, in the school lunch line) and
increased their intake of F&V by 85% or more.
When children request the purchase of specific items at the store, around half of their purchase
requests are granted by parents.
A greater proportion of children’s purchase requests are met early in the shopping experience leading to
consideration of where F&V are situated in the store.
Positioning child friendly foods at eye level has been shown to increase children’s purchase requests.
Use of front-of-package characters and CF packaging
SOURCE
Olsen et al. (2012)
Wansink et al. (2012)
Jansen et al. (2010)
Ebster et al. (2009)
O’Dougherty et al. (2006)
Ebster et al. (2009)
Ebster et al. (2009)
Nicholls and Cullen, (2004)
Availability and price have affected social eating norms around what is deemed appropriate
consumption in terms of the amount, portion size, or specific food choices driven very strongly by
defined cultural practices and rules (Higgs 2015). Sturm and Datar (2005), determined in their
US study, that lower real prices for F&V were related to a significantly lower gain in body mass
index (BMI) in children between kindergarten and third grade; with half of that effect found
between kindergarten and first grade. Powell and Bao (2009) assert that a 10% increase in the
price of F&V was associated with a 0.7% increase in child BMI. In this latter study, the relationship
between F&V prices and fast food prices with BMI were significantly stronger both economically
and statistically among low- versus high-socioeconomic status children.
A retailer report produced by the Coperative Group in 2015 stated that:
“The biggest change in retailing over the past 50 years was the advent of self- selection of
products with the customer no longer handing over a list and relying on the shop keeper to
serve them”. (Co-op, nd)
Therefore the concept of food shopping with a pre-determined set of meals for each day through
a week has been replaced with an increasing consumer attitude of “shelf grazing” . The Co-op
report illustrates this with the following statistics:

35% of purchasers tend to adopt a ‘grazing’ shopping mentality, shopping for food multiple
times a week and 3% of the nation shop for food every day;

Only 19% of UK households plan their meals for the week ahead – with 31% deciding on
the day what to eat and 7% deciding on what to eat when in store.
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The reasons stated for the decline of menu planning include: not knowing what to buy that far in
advance (32%), uncertain weekly schedule (22%), menu planning considered as killing
spontaneity (20%) and getting stuck in a food rut (14%). The factors that have led to a decline in
the big weekly shop include: efforts to reduce food waste (1 in 4) and 27% of respondents stating
a big weekly shop no longer fits in with a busy lifestyle (Co-op, nd). Decision fatigue is the concept
that faced with continual multiple choices, decision making becomes more draining. Growing
decision fatigue is an issue with citizens of industrialised societies, as a result of information
overload, and the consumer’s “relative transaction costs in terms of time and energy for becoming
informed and how receptive they are to the message” (Kastberg, 2015 citing Caswell and
Mojduszka, 1996:1248). Making multiple choices can impair subsequent self-control which can
exhibit itself as less physical stamina, reduced persistence in the face of failure, more
procrastination and so forth (Vohs et al. 2014). Indeed, they propose that if certain food options
are seen as preventing the need to make complex decisions they are perceived as providing value.
Category management is the retail process of managing product categories such as F&V as
strategic business units within a retail store (Desrochers et al. 2003). Category management as
an activity involves customising the category by store location and region as well as co-ordinating
pricing and promotion strategies to produce improved sales and profits as well as deliver better
value to consumers (Desrochers et al. 2003; Bandyopadhyay et al. 2009) and to shareholders
too. Pricing and promotion strategies aim to minimise shrinkage and ensure optimum cost
effectiveness in the retail sector. In this context, shrinkage describes the loss in margin or
profitability incurred for a food retailer in terms of product spoilage, theft or wastage. More simply,
shrinkage is:
“The cash value of products that a retailer has bought, but that it neither sold nor has in stock
or the intended sales income that was not and cannot be realised” (Buck and Minvielle, 2013;
ECR, 2004)
Shrinkage can fall into four categories: internal theft, external theft, inter-company fraud and
process failures such as a deterioration in product value over the time the product is in-store.
Shrinkage can be measured by individual item or stock keeping unit (SKU) and also via a particular
supply chain route (ECR, 2004). It can be reported as a percentage of turnover, cost price and
retail price (ECR, 2004). The shrinkage for the fresh produce department is second-highest (4.8%
of retail sales) after meat at 16% (Buzby et al. 2015). For meat, a proportion of the losses are due
to theft from retail shelves as meat is often a high value item especially compared to fresh
produce. With F&V much of the shrinkage can be attributed to the inherent perishable nature and
deterioration in quality whilst on shelf. However, promoting F&V choice at retail level requires a
full and well-stocked range to be available so meeting such consumers’ choice expectations
increases the risk of products going past the duration date marked on the packaging (ECR, 2004).
Novel ideas of promoting F&V whilst reducing shrinkage will deliver increased financial returns to
the retailer and the wider supply chain. In a US study, it has been estimated that for the years
2005/2006 annual supermarket shrinkage averaged 11.4% for fresh fruit and 9.7% for fresh
vegetables by weight rather than value of retail sales (Buzby et al. 2009). In a study published in
2015, considering US supermarket estimated shrinkage and loss for F&V provided data as
follows: radishes 23%; leaf lettuce 20%; apples, grapefruit and avocados 19%; spinach 18%;
cauliflower and mushrooms 17%; plums, oranges, kiwi, pears 15%; strawberries and tomatoes
14%; cucumbers 12%; head lettuce, potatoes 8%: and cabbage, carrots broccoli and onions 7%
(Buzby et al. 2015). Shrinkage rates (including markdown) can vary widely: Buck and Minvielle,
(2013) suggest 3 to 5% by volume for fresh produce at best-practice retailers, 6 to 8% among
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average performers, and 9 to 15% at under-performing retailers. Thus the impact of shrinkage
rates of F&V compared to other other foods will influence both the retail shelf space allocated
and the number of SKU on offer. Shelf space allocation between F&V and other food products
and its relationship with the health status of people who live in surrounding communities is a
factor worth considering. Rose et al. (2009) investigated the F&V to snack food ratio at the retail
shelf space level. In their study in New Orleans, they identified that in convenience, drug and
general merchandise stores the ratio was nearly 0. The ratio improved in groceries and
supermarkets to small groceries (ratio 0.29), middle sized groceries (0.42) and supermarkets
(0.66). Thus in many retail settings healthful snacks are simply “crowded out” by unhealthy
alternatives or not present at all. Evidence from a ten country study on the shelf space devoted
to eight categories of foods, and the relationship to mean population BMI concluded that a higher
percentage of shelf space devoted to F&V products in their different forms was associated with a
lower national BMI (Norman et al. 2014).
Five aspects of shelf space allocation can influence the financial performance of a retail store:
fixture location, product category location, item location within categories, off-shelf display, and
point of sale (POS) promotional support (Yang and Chen, 1999). POS information in food retail
stores, with particular emphasis on F&V is the use of shelf labels and/or signage that specifies
healthy food choices, based on established criteria (Glanz and Yaroch, 2004) i.e. as a concept it
interfaces with literature previously described on choice architecture. It is important too to
consider that often manufacturers of branded product and retailers can have divergent profit
objectives. A manufacturer wants to maximise the profits of its own branded products on the
shelves (Bandyopadhyay et al. 2009) which may actually be in competition with the own-label
retailer branded alternatives. Conversely the retailer wants to maximise the profit of the whole
product category. Glanz et al. (2012) suggest several in-store marketing strategies such as
increasing availability, affordability, prominence, and promotion of healthful foods and/or
restricting or de-marketing unhealthy foods.
Healthy choice POS support can be used through the use of single or multiple communication
options such as posters, shelf labels or “menu and/or signage specifying that food items are good
sources of F&V choices, often along with recipes and/or food demonstrations.” (Glanz and Yaroch,
2004). In Baltimore US, a multicomponent intervention was used to reduce environmental
barriers to purchasing health food options in a supermarket (Lee et al. 2015). This
multicomponent intervention (as has also been described previously in association with other
studies in this report) included: shelf labels and in-store displays promoting healthy foods, sales
and promotions on healthy foods, in-store taste tests, increasing healthy food products,
community outreach events to promote the intervention, and employee training. The impact of
these multiple interventions was mixed and one factor recommended as requiring closer attention
was the conflict between limited employee time availability and low profit margins at store level
and the ability to integrate the intervention goals in order to promote healthful eating.
Dodds et al. (2014) in their study concluded that there was no evidence to suggest a single activity
such as energy labelling or single traffic light labelling on fast food was effective in reducing the
energy of fast food items chosen from hypothetical fast food menus. Sharpe and Staelin (2010)
considered the consumption effect of bundling. the practice of combining a set of foods, often
three items in order to promote a discount for example, meal deals in food service and retail
stores. They concluded that the value derived by consumers was not only the promotional effects
of the bundle itself, but also the reduction in ordering costs to the individual. This reflects the
notion of decision fatigue already described in this section. Although their study focused on fast
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food rather than “meal deals” in the retail grocery environment, if bundled options do not feature
F&V products, this will cause consumers to potentially disengage from single F&V products where
they actually have to make a decision what they combine them with. Further, if the meal deal
items suggested are energy dense then this will raise the calorie content of the meal option as
marketed.
3.2.4. Relationship between the density and type of food outlets and general obesity
status
In the wider context of food sales when considering both retail shelf allocation and also the total
number of food outlets in a given location, two terms have been defined in the literature, namely
food desert and food swamp. The term food swamp is less widely used than the term food desert,
The USDA define food deserts as:
“urban neighbourhoods and rural towns without ready access to fresh, healthy, and affordable
food. Instead of supermarkets and grocery stores, these communities may have no food access
or are served only by fast food restaurants and convenience stores that offer few healthy,
affordable food options” (USDA, nd).
Rose et al. (2009) describe a food swamp as:
“an area where relatively large amounts of energy dense snack foods inundate healthy food
options”.
This term suggests that where there is an extensive amount of energy-dense offerings available
this inundates, or swamps out, the relatively few nutrient rich and/or healthy food choices
available. In another example, a food swamp has been said to indicate “low-income, urban
communities that have a plethora of fast food outlets (FFO), convenience stores, mini marts, gas
stations, and liquor stores that sell food.” (Taylor and Ard, 2015:102). A study conducted in
Mexico concluded that excessive access and exposure to unhealthy foods and drinks, or “food
swamps,” may be a greater concern than food deserts for obesity-prevention policy (BridleFitzpatrick, 2015). These definitions and the wider discussion on shelf space ratio in vending
machines and on retail shelves in this report brings into question the potential for there to be a
relationship between the density of food outlets and density of energy dense foods and the
general obesity status of a given community
Residents of low-income, minority, and rural US neighbourhoods are affected by poor access to
healthy food (Jetter and Cassady, 2006; Larson et al. 2009). The lack of availability, and often
relatively high cost, of healthy foods in small grocery stores located in low income, deprived
neighbourhoods as well as limited transport options, may be a deterrent to healthier eating among
very low income consumers. Another factor could be the higher density of FFO (Celnick et al. 2012;
FPH 2005). Celnik et al. (2012) identify that FFO in the UK tend to be located in areas of higher
deprivation where people are under greater economic pressure and time stress. In these areas,
obesity is more frequent and awareness or concern over the links between food choices and
health tend to be low. In a study in New Orleans, the provision of fresh produce by small urban
food stores located within 100m of residences seems to encourage greater uptake of fresh F&V
(Bordor et al. 2007). Increased fast food purchasing is found to be associated with lower
education, blue-collar employment, and low household income (Thornton et al. 2011). The
existence of more types of food outlet in an area, including supermarkets, is associated with
higher BMI (Shier et al. 2012). Conversely, Zick et al. (2009) determined a strong association
between increasing neighbourhood retail food options and lower BMI/obesity risk with the
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magnitude of the effects varying with a lower influence in low income areas. Hutchinson et al.
(2012) say the relationship is nuanced and impact can be measured by comparing the relative
amounts of healthy (for example, F&V) to unhealthy foods (for example, energy-dense snacks) i.e.
the ratio as explored by Rose et al. (2009) previously. Hutchinson et al. concluded that higher
quality food environments, not food store types, decrease the risk of obesity and overweight.
With specific emphasis on FFO, Fraser et al. (2012) identified an association between area level
deprivation and fast food density but not between BMI, and FFO access in pregnant women in
Bradford, UK. However, Polsky et al. (2016) in their work in Toronto, Canada found a direct
relationship between the proportion of FFO relative to all restaurants and excess weight,
particularly in areas with high volumes of FFO. There is a body of research that has also found a
relationship between the density of FFO and obesity in children. Cetateanu and Jones (2014)
suggest a positive association between the density of unhealthy food outlets in a neighbourhood
and the prevalence of overweight and obesity in children. A second study showed that higher
levels of FFO saturation were associated with increased levels of childhood obesity in both urban
and poor areas (Newman et al. 2014). The work of Fraser and Edwards (2010) in Leeds, UK
concludes that firstly there is a positive relationship between the density of FFO per area and the
obesity status of children and secondly there is also a significant association between FFO density
and areas of higher deprivation. However, Lee in her (2012) US study concluded that differential
exposure to food outlets did not independently explain child weight gain over time and that other
social factors were of influence too. In the UK, the Faculty of Public Health argues that improving
access to affordable, good quality foods for those with limited transport would improve health
(FPH, 2005). They suggest that such concerns must be considered in the planning and
regeneration of town centres and residential areas. Caraher et al. (2014) undertook research
determining the location of FFOs around secondary schools and the influence of fast-food
availability on the food choices of school children in an inner-London borough. The findings were:

The students reported use of the FFOs, including: “stories” of skipping lunch in order to
save money and eat after school at the outlets.

At lunchtime the FFOs were less likely to be used by school students in areas near schools
that have a “closed gate” policy.

Food from FFOs was high in fat, saturated fat and salt, but these are not the only source
of such foods, with many of the students reporting buying from shops near the school or
on the way to or from school.
With a view to local policy context the study concluded that action was required to improve both
the food offered in schools and the immediate environment around the school in order to tackle
fast-food and other competitive foods on offer outside the school. This requires an integrated
public health solution approach where public health and planning services work together to
deliver multiple benefit.
3.3.
Summary
The aim of this study is to undertake a desktop review to determine the enabling and constraining
factors that influence UK consumer consumption of F&V with a view to providing options for action
on how such consumption could be increased. Thus whilst this section has provided a background
and context to the report the study is not focusing on the wider socio-economic factors that create
the obseogenic environment. This report seeks, based on a rational underpinned by research, to
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review the opportunities for increasing F&V consumption in the UK. As this introduction shows
such opportunities sit within the scope of governmental responsibility, corporate policy and
personal responsibility too in terms of choice architecture at food service, food retail and urban
planning levels. The next section of the report focuses on global public health initatives (PHI) to
promote healthy eating.
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4. Global public health initiatives to promote healthy
eating
4.1.
Introduction
Before discussing the global policy initatives that have been developed to promote healthy eating
it is important to distinguish between the strategies that drive both prevention and intervention.
Rose (2008) stated that the challenge in the modern medical environment is that in an era of risk
screening and then treatment, semi-quantitative and quantitative risk assessment as well as riskbenefit and cost-benefit analysis is often focused, rather than on the population as a whole,
instead on those most at risk. This approach of focusing on those most at risk can ultimately have
limited overall impact on the health status of the population as a whole.
With specific focus on diet related malnutrition (DRM), in a population that is influenced, as
outlined in the previous section with different environmental and social factors, individuals in that
population will have various degrees of diet related risk. Therefore the risk:benefit and cost benefit
analysis approach for determining the appropriate public health interventions that could be
adopted may only reflect action to be taken for those individuals at extreme risk, such as the use
of bariatric surgery, which at a population level can only improve the lives of a few. Instead
implementing policy instruments that enable whole population shift may well have more overall
impact on society than simply focusing on reducing risk in a much smaller high risk group.
Therefore Rose (2008) argues that there is a disease prevention paradox where a particular policy
instrument or measure could bring large benefits to the community as a whole, but actually offer
little personal reward to each participating individual. If this is the case then an individual’s
response to this type of public health initiative (PHI) is unlikely to be motivated powerfully at the
individual level by the prospect of better personal health especially where the reward for changing
behaviour may not be readily visible.
Therefore governments may well follow a dual policy approach with firstly wider policy instruments
that benefit the community as a whole (for example, the United Kingdom (UK) salt reduction
strategy of 2006) as well as targetted policy instruments that focus on low numbers of high risk
individuals (for example, obesity intervention through surgery). Thus, it is critical to distinguish
between the causal factors of incidence of DRM at the population level and the causal factors
that may differ the risk for specific individuals. Furthermore, a given population or sub-population
may not experience the same causal factors that work at the individual level, such as genetic
susceptibility to weight gain, mental health status employment and education status. Accordingly,
those developing global PHI need to recognise that such instruments must be developed to act at
both the individual and population level. Rose (2008) described this dual approach as individual
based strategies and population based strategies (Tables 9 and 10).
This means when comparing PHI from one country to another both individual based and/or
population based strategies may be employed. Population-based PHI can be divided into three
broad components: government structures to support policies and interventions for example,
funding, public health monitoring systems and so forth, population wide policies and initiatives
that influence the food environment for example, laws and regulations, taxes and subsidies, social
marketing campaigns, restrictions on marketing unhealthy food and community based
interventions for example, initiatives at community, or school level (WHO, 2012). Thus particular
policy approaches will vary in terms of the communities and the individuals that the different
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interventions might influence and affect and the mechanism of how each intervention works as
well as the degree of benefit derived at an individual or population level needs to be fully
understood.
Table 9. Dual strategies of prevention
INDIVIDUAL BASED STRATEGIES
POPULATION BASED STRATEGIES
Identify individuals at high risk screening
Identify important risk factors for the community
(prevalence)
Intervene only in individuals at high risk
Policy to reduce risk factor irrespective of individual risk
Risk-benefit balance individually assessed
Risk-benefit balance for whole community
Table 10. Dual strategies of intervention
INDIVIDUAL INTERVENTION
POPULATION INTERVENTION
Individuals identified
Yes
No
Potential benefits for individual
Large
Small
Potential benefits for population
Small
Large
Understanding of effects
Good
Poor
The World Health Organisation (WHO) recommended in 1990, a minimum consumption of 400g
of fruit and vegetables (F&V) per day per person (WHO, 1990). This section of the report considers
the global PHI that spin out from that 400g per day WHO recommendation of F&V consumption
and how successful the PHI have been and if not, the reasons why.
4.2.
Global Public Health Initiatives (PHI)
Over the last twenty years, obesity as a condition has become socially normalised. Until 1980,
less than 10% of the population was obese in Organisation for Economic Co-operation and
Development (OECD) countries (OEDC, 2014). However nearly thirty-five years later, across the
OECD (34 countries) 18% of the adult population is now defined as obese. This varies between
countries with more than one in three adults in Mexico, New Zealand and the United States (US),
and more than one in four in Australia, Canada, Chile and Hungary being defined as obese (OEDC,
2014). Hawkes et al. (2015) proposed four mechanisms through which food policies can affect
diet: (1) providing an enabling environment for learning of healthy preferences, (2) overcoming
barriers to the expression of healthy preferences, (3) encouraging people to reassess existing
unhealthy preferences at the point-of-purchase, and (4) stimulating a food-systems response.
They concluded that food-policy actions that lead to positive changes to food, social, and
information environments and the systems that underpin them were the most effective. This
meant that food-policy actions needed to be:
“tailored to the preference, behavioural, socioeconomic, and demographic characteristics
of the people they seek to support, are designed to work through the mechanisms through
which they have greatest effect, and are implemented as part of a combination of mutually
reinforcing actions. Moving forward, priorities should include comprehensive policy
actions that create an enabling environment for infants and children to learn healthy food
preferences and targeted actions that enable disadvantaged populations to overcome
barriers to meeting healthy preferences.” (Hawkes et al. 2015)
Allender et al. (2011:271) in their paper considering policy change to create supportive
environments state that:
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“Identification of the least resistant parts of the policy nexus within a local government and
targeting evidence towards this entry point would resent a strategic approach to successful
policy change.”
Potential policy strategies that could be employed are: the use of social marketing, the provision
of healthier food at low cost and the taxation of unhealthy food, although the latter are far more
intrusive methods of “nudging” than the use of social marketing (Allender et al. 2011). Obesity is
estimated to be responsible for 1% to 3% of total health expenditure in most countries (5% to 10%
in the US) and costs will rise rapidly in coming years as obesity-related diseases set in (OEDC,
2014). Goodman et al. (2014) highlight that in order to define community health and identify the
stakeholders and agents that play a role in developing a community health policy the concept of
what a community is needs to be defined. The authors citing MacQueen et al. (2001) consider the
weakness in describing not only what community is, but also the perceptions of different potential
collaborators of what a community looks like in practice, and this can ultimately undermine the
assessment of how community collaborations actually play a role in achieving public health
objectives. Lebel (2003) suggests that rather than the biomedical approach to assessing health
there should be an ‘ecosystem approach’ whereby health is also considered as being influenced
by community, environment and the local (and wider) economy. Clearly, from a public health policy
perspective, access to, and the take up of, nutrient-rich foods by disadvantaged communities as
well as society as a whole needs to be considered a priority for government. Table 11 contains
examples of global obesity orientated PHI.
Frieden et al. (2010) suggest that the food environment can improve nutrition through a threefold strategy: altering relative food prices, shifting exposure to food, and improving the image of
healthy food and making unhealthy food less attractive.
“Policy strategies that are of value include: tax policies, pricing strategies, influencing exposure
and access to healthy food, zoning restrictions to limit the density of FFO, voluntary
advertisement restrictions, banning certain food advertisements especially those aimed at
children at certain times, counter-advertising, improving the image of healthy foods, and eating
out” (Frieden et al. 2010).
Panjwani and Caraher (2014) assert that despite widespread recognition of the scale of the
problem, in no country has incidence of obesity been reversed purely by public health measures.
Many health disparities in the US are linked to inequalities in education and income (Drewnowski
and Specter 2004) where high-fat, energy-dense diets are more affordable than diets based on
lean meats, fish, fresh vegetables, and fruit. The association between poverty and obesity may be
mediated, in part, by the low cost of energy-dense foods and may be reinforced by the high
palatability of sugar and fat they contain. A theme that has arisen elsewhere in the literature
decribed in this report.
4.1.
US Policy provision to increase consumption of F&V by low income
households
The 1996 Federal Agriculture Improvement and Reform Act (FAIR) established new authority for
the use of federal grants to support the development of Community Food Projects, and the Farm
Security and Rural Investment Act of 2002 re-authorized the programme (USDA, 2015a). Thus
the Community Food Projects Competitive Grant Program (CFPCGP) was introduced under FAIR to
address food insecurity in the US through the development of community food projects that
focused on low-income communities. As stated by (USDA, 2015a):
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“Community Food Projects are designed to increase food security in communities by bringing
the whole food system together to assess strengths, establish linkages, and create systems that
improve the self-reliance of community members over their food needs.”
The CFPCGP is designed to develop long-term planning, capacity and solutions that:

Meet the needs of low-income people by increasing their access to fresher, and more
nutritious food;

Promote comprehensive responses to local food, farm, and nutrition issues;

Meet specific state, local, or neighbourhood food and agricultural needs for infrastructure
improvement and development. This required linkages to develop between two or more
sectors of the food system these can involve for-profit and nonprofit organisations that are
working together;

Plan for long-term solutions; and

Create entrepreneurial projects and innovative marketing activities that mutually benefit
agricultural producers and low-income consumers.
The US Department of Agriculture (USDA) National Institute of Food and Agriculture (NIFA) is the
body that through the Food Insecurity Nutrition Incentive (FINI) Programme (established by the
US Agriculture Act of 2014) is allocating funding in a competitive grant system (Wholesome Wave,
2015a). The grants, managed by NIFA and USDA’s Food and Nutrition Service (FNS, aim to
support projects that provide F&V incentives to participants in the Supplemental Nutrition
Assistance Program (SNAP). The USDA will allocate $20 million for fiscal year 2016, $20 million
for 2017, and $25 million for fiscal year 2018. Of the amount available each fiscal year, 90% of
funds are expected to be made available for grants and 10% is expected to be retained by USDA
for evaluation purposes (Wholesome Wave, 2015a). In this context, the term “incentive” is said
to mean any financial or non-financial inducement that would increase the purchase and
consumption of eligible F&V by SNAP clients. Examples of allowable financial incentives include,
but are not limited to, vouchers for eligible F&V or benefits redeemable for having purchased F&V
and direct point of sale discounts on eligible F&V (USDA, 2015b). Non-financial incentives that
can form part of the programmes include: free portions of eligible F&V and nutritional education.
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Table 11. Examples of Global Public Health Initiatives (Adapted from: OEDC, 2014; WCRFI,
2015)
COUNTRY
PUBLIC HEALTH INITIATIVES
Chile
Chile’s law on food labelling and advertising, introduced in 2012, aims at limiting access to potentially unhealthy food for children, and covers
advertisement on media, point-of-sale marketing, promotions and the school environment. The law is currently being implemented. In 2015 the
Chilean authority approved the regulatory norms required for the law’s implementation.
Denmark
The tax on saturated fat introduced in Denmark in October 2011 reduced the consumption of the taxed products by 10% to 15% in the first nine
months, with demand partially shifting from high- price supermarket to discount stores. The revenues raised between November 2011 and January
2012 were more than 96% of those originally forecasted. However, the tax was abolished in November 2012, amidst political controversy and lobby
pressures. The Code of Responsible Food Marketing Communication was issued by the Forum of Responsible Food Marketing Communication, a
cooperation between Danish industry organisations of the food and beverage, retail and media sectors. The Code is a voluntary, self-regulatory
initiative effective since January 2008, applicable to food and beverage marketing to children aged 13 and under via media outlets (TV, radio,
internet, SMS, newspapers, comic books). The Code sets guideline limits for salt, sugar and fat content in ten food categories. It is recommended that
food products exceeding these limits should not be marketed to children. Food manufacturers themselves determine if their products are suitable for
marketing to children. Compliance is checked by the secretariat of the Forum. The Danish government follows the results of the Code, and annual
status meetings are held between the Danish Veterinary and Food Administration and the Forum.
France
Tax on soft drinks implemented in France. The degree to which the tax was passed on to consumers varied from 60% for fruit drinks to 100% for
carbonated drinks. All television advertising (targeted at children or adults) for processed food and drinks, or food and drinks containing added fats,
sweeteners and/or salt, must be accompanied by a message on the principles of dietary education as approved by the National Institute of Health
Education. The messages were defined by a 2007 Decree: "For your health, eat at least five fruits and vegetables a day"; "For your health, exercise
regularly"; "For your health, avoid eating too many foods that are high in fat, sugar or salt"; "For your health, avoid snacking between meals".
Hungary
The Public Health Tax on Food Products introduced in Hungary in 2011 led to a 29% price increase, and a 27% drop in sales, for the taxed products.
It is estimated that 40% of food manufacturers reformulated their products by reducing or eliminating the ingredients associated with the tax
although there are some questions on validity of the results.
Iceland
Iceland passed a law banning advertising in programmes aimed at children aged less than 12 in 2013. Advertising, sponsorship, teleshopping and product
placement of foods high in fats, sugars and salt, as defined by a nutrient profiling model, are prohibited during children’s TV and radio programmes
where over 50% of the audience are under 18 years old (Children’s Commercial Communications Code, 2013 revision). In addition, there is an overall
limit on advertising of foods high in fats, sugars and salt adverts at any time of day to no more than 25% of sold advertising time and to only one in
four advertisements. Remaining advertising targeted at children under the age of 13 must not include nutrient or health claims or include licensed
characters.
Iran
Broadcast advertising of soft drinks has been prohibited since 2004. In 2014, in the context of the Iranian Fifth Five-Year Development Plan (20112015), the Ministry of Health and Medical Education prepared a list of 24 food items to be prohibited from advertising in all media. The list has been
sent to the Commerce, Industry and Finance ministries for approval.
Ireland
In 2012, the Irish Department of Health estimated that a 10% tax on sugar sweetened beverages (SSBs) would reduce calorie intake by 2.1 Kcal per
week, on average (with a greater reduction in young people), and translate into 10 000 fewer obese adults. Based on this evidence, the Department
of Health proposed a 20% tax on SSBs during the discussion of the 2014 budget, but the tax has not been adopted.
Japan
In Japan, a programme of health examinations to identify people at risk for the metabolic syndrome and prevent its chronic disease consequences
has been in place since 2008. Starting in 2013, insurers’ contributions to cover care for the elderly will be linked with insurers’ achievement of
coverage targets for such health examinations.
Mexico
Mexico has adopted one of the most comprehensive government programs. A National Strategy for the Prevention and Control of Overweight, Obesity
and Diabetes was launched in the second half of 2013. The policy has three pillars: improved public health and surveillance; better medical care for
people with chronic diseases; regulation and fiscal measures. During the first phase of the strategy, the Mexican authorities have launched a media
campaign aimed at raising public awareness of obesity and related chronic diseases. At the same time, a number of states started piloting the use of
new technologies and non-economic incentives for physicians with the objective of increasing uptake and compliance to medical prescriptions for
people with diabetes, high blood pressure and other related chronic diseases. Mexico is also reinforcing its regulatory framework on food advertising
to children, labelling of processed food, availability of food in schools and taxation of unhealthy food. In January 2014, Mexico implemented a new
tax levied at a rate of 8% on food with an energy content exceeding 275 Kcal per 100g, and 1 peso (EUR 0.06) per litre on sugar-sweetened
beverages. Revenues are expected to support public health programs, although they are not formally earmarked. The tax was met with strong
opposition by the industries concerned, but was relatively well accepted by the Mexican population. New regulations were introduced to protect
children from exposure to advertising of potentially unhealthy foods. They ban the advertising of potentially unhealthy foods, on radio and TV, during
hours in which children are a significant component of the audience (between 07:00 and 19:30 during week- ends, and between 14:30 and 19:30
during week days) exceptions are programmes such as sport events. Restrictions will apply in cinemas showing movies aimed at children, but do not
cover billboards and the Internet.
Norway
The government already restricts all broadcast advertising to children through legislation in Norway (Broadcasting Act 1992). A voluntary initiative
agreed in 2013 calls on industry to follow standards (set largely by government) on a further range of communications channels. It applies to
marketing to children under the age of 13. In 2011, the Ministry of Health signed a Memorandum of Cooperation with the Federation of Food
Enterprises and the Association of Soft Drink Companies to encourage companies not to advertise soft drinks to children aged 12 and under. The
Memorandum applies to soft drink marketing in movie theatres and on TV if the audience consists of at least 50% children, and includes marketing
activities on the internet and in the press.
UK
Advertising and product placement of foods high in fats, sugars and salt, as defined by a nutrient profiling model, is prohibited during TV and radio
programmes that have 20% or more viewers under 16 years old relative to the general viewing population (includes sponsorship of TV programmes).
The restrictions came into force in February 2007, with a phased implementation by advertisers by end of 2008.
US
The US government has proposed to overhaul food nutrition labels, in particular to revise serving sizes, display calories more prominently, and include
information on added sugars. If approved, food manufacturers will have two years to implement the new labels. A further multi-stakeholder example
is the DrinkUp campaign promoted in 2013 by the Partnership for a Healthier America, chaired by the First Lady of the United States, and including a
large number of business and civil society partners. The campaign had a scientific data-drive design, and early monitoring data show it has had some
success in increasing water drinking.
The grants are intended to help eligible private nonprofit entities that need a one-time infusion of
federal assistance to establish and carry out multipurpose community food projects (USDA,
2015a). There are three categories of projects within the FINI scheme (USDA, 2015c). These are:
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
FINI Pilot Projects (awards not to exceed a total of $100,000 over one year);

Multi-year, community-based FINI Projects (awards not to exceed a total of $500,000 over
no more than four years); and

Multi-year, FINI Large-Scale Projects (awards of $500,000 or more over no more than four
years).
All FINI projects must increase the purchase of F&V by low-income consumers participating in
SNAP by providing incentives as previously described at the point of purchase. One such project
is Wholesome Wave. Founded in 2007, in the following year it piloted the Double Value Coupon
Programme at 12 markets in three states (Wholesome Wave, 2015b). As this programme evolved,
it spread nationally across the US to become the National Nutrition Incentive Network and
encompassed many initiatives including the Fruit and Vegetable Prescription Programme and
Healthy Food Commerce Initiative.
Figure 1: Development of Local Supply Chain Networks and Regional Food Hubs (Source:
Wholesome Wave, 2015c)
The collaborative approach now has more than 110 community based partners in 38 states and
DC and is implemented at more than 730 farmers markets, dozens of community health care
centres, hospitals and food hubs throughout the US. These initatives can be summarised as:

A national network of nutrition incentive programmes that provide a monetary incentive
when low-income consumers spend their federal nutrition benefits at farmers markets and
other retail outlets on fresh F&V;

Providing families affected by diet-related diseases (such as obesity and type II diabetes)
with a prescription for F&V to be spent at participating farmers markets and retail outlets;
and

Healthy food commerce investments improving the supply chain for local food by working
with food hubs to structure investments and enter large wholesale markets (Figure 1).
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4.2.
Dietary Public Health Initiatives (PHI): 5-A-DAY programmes
4.2.1.
Global overview
The most widely adopted global dietary PHI are the 5-A-DAY programmes that were developed to
increase F&V consumption towards the WHO recommendation of at least 5-A-DAY or 400g per
day.
Table 12: Global PHI F&V promotion campaigns
COUNTRY
FRUIT AND VEGETABLE
PROGRAMME
TARGET AUDIENCE
COORDINATION
MAIN ACTIVITIES
Australia
Go for 2 and 5
General population, school
children, young children, low
income groups, household
shopper
Government, NGOs
and private sector
Media campaign, school canteen accreditation,
school fruit and vegetable week, nursery
scheme, low-income project
Canada
Fruits and Veggies - Mix it up!™
General Population,
schoolchildren
NGOs
Media campaign and educational material
Denmark
6 om dagen
General Population,
schoolchildren, workers,
consumers, catering
Government, NGOs
and private sector
Media campaign and educational material,
worksite interventions, school fruit scheme
France
10 par jour
General population,
schoolchildren, consumers,
workers
Government
Media campaign and educational material
Germany
5 am tag
General population
NGOs
Media campaigns, educational materials
Hungary
3 a day ('Eat 3 types of fruits and
vegetables 3 times a day for your
health')
General population, children,
young people, household
shoppers
Government, research
institutes
Media campaign, educational materials,
supermarket promotions, cooking shows, tastetesting at school
Japan
Vegefru-7
General population
Government, private
sector
Media campaign, educational materials,
supermarket tours, harvesting tours.
Netherlands
2+2
General population, children
New Zealand
5 a day
General population, children
NGOs, private sector
Media campaign, school programme,
educational materials
Norway
5 om dagen
General population,
schoolchildren, consumers,
workers
Government, NGOs,
private sector
School fruit scheme
Poland
5 a day
General population
NGOs, research
institutes, private
sector
Media campaign, promotion activities in
nurseries and schools
Spain
5 al dia
General population, children
Sweden
5 om dan
General population,
schoolchildren, consumers,
workers
Government, NGOs,
research institutes,
private sector
Series of activities involving health, nutrition,
education and commercial sectors
Switzerland
5 am tag/ par jour/ al giorno
General population,
schoolchildren, consumers,
workers
Government, NGOs,
research institutes,
private sector
Media campaign and educational materials, food
giveaway sessions in public places
UK
5 a day
General population, school
children
Government
Media campaign, educational materials, school
fruit scheme, local community projects, logo for
retail sector
US
-5 a day
-5 to 9 a day for better health
-Fruits and Veggies- More Matters
General population, mothers,
children
Government, NGOs,
private sector,
research institute
Media campaign, educational materials, logo for
retail sector
Media campaign, interactive website for children
Media campaign and educational materials,
activities for children, symposia, events with
agriculture sector
(Adapted from Hawkes 2013, Pomerleau et al. 2005, Rekhy & McConchie 2014)
This type of intervention was first launched in the US in 1991, and has been embraced by several
other countries. However, the impact of these initiatives on increasing F&V consumption on a
sustained basis remains modest (Rekhy and McConchie 2014). Various global interventions to
promote the consumption of F&V have been initiated by government, industry and not-for-profit
organisations (see Table 12). These informational and educational campaigns have had mixed
results. Success has been reported for those campaigns which have forged partnerships between
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industry, retail, government and not-for-profit organisations promoting public health (Rekhy and
McConchie 2014). Evidence from campaigns worldwide also suggests that interventions are more
effective when the campaign is sustained, targeted, interactive, focused on behaviour change,
sets goals, has clear messages and uses multiple channels (Rekhy & McConchie 2014).
In New Zealand, the 5+ A Day programme, launched in 1995, was primarily aimed at children.
Educational materials promoting F&V consumption were developed and linked to the curriculum
within nurseries and schools. The involvement of the food industry has been reported to have
contributed to the success of the programme.

By 2012, the proportion of the population who reported consuming 5 portions of F&V per
day had risen from 15% (in 1995) to 38% (Rekhy and McConchie 2014).

Denmark has seen one of the largest increases in F&V intake, generated through its 6-ADAY initiative, which promoted consumption by increasing the accessibility of F&V in
schools, restaurants and workplaces. Between 1995 and 2004, fruit intake rose by 58%
and 75% and vegetable intake increased by 29% and 41% in 4 to 10 year olds and 11 to
75 year olds, respectively (Danish National Centre for Social Research, 2005). Average
intakes of F&V between 2003 and 2008 amongst Danish adults were reported to be 445g
per person per day, higher than the minimum WHO recommendation (Danish National
Centre for Social Research 2009).

Another intervention that is perceived to be successful was the ‘Food Dudes’ programme
in the UK, which was aimed at children. Behaviour change techniques were incorporated
within the programme, including the use of role models and rewards. Controlled
intervention studies within schools in the UK, Italy and US have reported increases in F&V
intakes of between 60 and 200% with this programme (Rekhy and McConchie 2014). A
range of such global schemes have been compared by country, the target audience, coordination and the main activities employed (Table 12).
A detailed review (Pomerleau et al. 2005) of intervention studies that included a control group,
promoting F&V consumption in adults and children, mainly in Europe and the US, indicated that
the average impact of such interventions on consumption is between 0.2 and 0.6 portions per
day. However, this review excluded national or large-scale promotional interventions. For children,
it concluded that a multi-faceted focused approach seemed the most effective: specific F&V
messages (not embedded in a ‘healthy eating’ message), hands on skill building (as opposed to
passive learning), active provision of F&V at school lunch times and formal involvement of
parents, teachers and peers seem to lead to the most successful results. In adults, face-to-face
counselling seemed effective but costly. Printed, individually tailored information, and particularly
individually tailored computer-based information that can individualise feedback, also
demonstrated a beneficial effect.
The review also looked at barriers, for example, on an individual level people may perceive they
eat enough or that these foods have a high cost, or that personal and family eating habits may be
difficult to change. Environmental barriers can include lack of access, limited variety, poor quality
and high cost, lack of preparation skills and time. One of the main barriers in schools is
competition with other school priorities such as emphasis on academic attainment, aspects of
the curriculum or other activities and not allowing food at break times. One of the limitations
highlighted was the lack of robust research in social marketing campaigns, so that the degree of
changes in attitude and consumption directly attributable to the campaign cannot be determined.
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Brunello et al. (2014) suggest that the European School Fruit campaign has restrained the
consumption of junk food in the sub-group of the population that can be described as wealthier
families which is actually less likely to be exposed to overweight and obesity problems, so the
European School Fruit campaign has not been effective at all for the sub-group of the population
that is more at risk
The UK 5-A-DAY programme, a collaboration with private and public partners, was launched by
the government in 2003 with an aim to increase access to and awareness of the health benefits
F&V, and to target groups with the lowest intake, such as younger members of the population.
The development of the UK 5-A-DAY programme is described in Table 13.
Table 13. Development of the 5-A-DAY programme in the UK
YEAR
DETAIL OF ACTIVITIES RELATING TO 5-A DAY
1990
World Health Organization (WHO) identifies nutritional requirement of 400g fruit and
vegetables per day, or five portions of 80g each.
Nutritional Requirement
1998 Acheson Report: Independent Inquiry into Inequalities in Health
1999 Saving Lives: Our Healthier Nation
2000
UK, NHS Plan/Cancer Plan set five portions of fruit and vegetables as a consumption
target to address prominence of preventable disease
Daily Target
2000-2001
Five a day Pilot studies utilise community level interventions to assess potential to
address incidents of low consumption.
Pilot Study
2003 Food & Health Action Plan
2003 Tackling Health Inequalities
2003
‘5-A-DAY; Just Eat More (fruit & veg)’ used as a trademark for industry labelling and
health promotion purposes to aid consumers.
Logo & Promotional
Tool
2003
5-A-DAY Community Action Plan is rolled out to 66 Primary Care Trusts to support and
develop local initiatives to increase access to and awareness of fruit and vegetable
consumption.
Umbrella of Community
Intervention
2004 Choosing Health: Making Healthy Choices Easier
2008 Healthy Weight, Healthy Lives
2008 Food Matters: Towards a Strategy for the 21st Century
2008
5-A-DAY to remain as a promotion and local intervention, but to be part of a more
integrated approach to the choice of healthy lifestyle, such as ‘Change4Life’, as
advocated in ‘Food Matters’, and ‘Healthy Weight, Healthy Lives’.
2016
DH established an external reference group to provide advice on possible criteria for
extending the 5-a-day logo and indicator scheme to include composite foods in 2011.
Recommendations from Public Health England (PHE) are awaited.
Food strategy as part of
well being
The ultimate objective was to reach 5 portions a day for the whole of the UK population by 2015.
The UK 5-A-DAY policy objective has not been achieved. By 2003, the 5-A-DAY programme had
distinct five strands:

National School Fruit Scheme;

‘5-A-DAY’ community initiatives;

Communications programme (including multi-media communications and 5-A-DAY logo);

Work with industry; and

A national/local partnership (SACN, 2003).
These were stated to be underpinned by an evaluation and monitoring programme. 5-A-DAY
initiatives were developed based on the objectives of a) an increase of F&V consumption, b) an
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increase in awareness or knowledge, c) a change in attitudes and beliefs, and d) an increase in
access to F&V. An expansion subsequently to 66 Primary Care Trusts (PCTs) (most deprived 20%)
was funded to the total cost of £10 million (£150,000 from The Big Lottery Fund). 5-A-DAY
coordinator posts were commonly established to aid the development of strategies in local areas,
utilising a range of local initiatives. ‘Cook & Eat’ sessions, ‘Sow & Grow’ schemes, school specific
consultations, ‘Food Co-ops’, transport and home delivery systems and ‘community cafes’ were
created (Bremner et al. 2006). The differential levels of links developed included: formal links
with national campaigns (obesity, smoking, heart disease for example), as well as local 5-A-DAY
initiatives linking with local strategies and messages.
4.2.2.
The UK 5-A-DAY programme
Evaluation of the UK 5-A-DAY programme between 2003 and 2005 indicated that there was
improvement in the awareness of the recommended portion sizes of F&V and an overall small
increase in F&V consumption. A final review of local initiatives in the 66 PCTS, compared to
matched control areas (Bremner et al. 2006), showed improvements had been made in the
consumption of F&V, but in general these were not significant compared with established control
areas. It did show that there was enhanced improvement in certain groups, particularly those
groups that had the poorest levels of consumption of F&V, such as those on low income, those
living in areas of deprivation, men, and younger people. However, caution was expressed in
attributing this to the initiatives alone since widespread and local messages concerning F&V and
health were being disseminated throughout. The key findings of the review were as follows:

Knowledge of 5-A-DAY messages increased in both intervention and control groups, as did
an understanding of the health implications of increased F&V consumption;

Overall consumption of F&V increased, but only marginally in both groups. For the
intervention groups consumption increased from 3.36 to 3.64 portions. Control groups
increased from 3.49 to 3.64 portions showing little difference between the intervention
and the control response;

Women were more aware of the recommended portions;

In areas of deprivation, people had lower levels of F&V at the start, but were amongst the
largest improvers over the survey period; and

Factors affecting consumption remained unchanged over the survey period.
Two thirds of PCTs worked in partnership with other PCTs and offered a range of local
programmes, most popular of which were working with school age children, cook and eat activities
and media campaigns. The programme highlighted the importance of a ‘multi-pronged’ approach
when disseminating information. It also advocated joined up organisation and partnerships.
However, following the funding from the initiative programme, less than 15% of the PCTs had
secured funding to continue the activities. A more recent robust economic analysis (Capacci et al.
2012), has looked at the effects of the F&V programme campaign alongside price changes and
market forces over time. The study found that the campaign could explain a rise in consumption
of, on average, + 0.3 portions per person, with a range of +0.2 - 0.7 portions for differential income
groups. The real price of F&V has increased over time and this may have offset the benefit of the
5-A-DAY campaign, particularly for low income families. Overall purchases of fruit peaked in 2006
but have fallen 14% since 2007, whilst purchases of vegetables peaked in 2005 and have fallen
5% since 2007 (see Section 3.1).
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4.3.
Summary
Public Health England (PHE) established an external reference group to support PHE activity to
refresh messages to encourage consumption of more F&V. The reference group recently
supported PHE to consider the possible extension of the 5-A-DAY logo and portion indicator to
include composite foods, although as no consensus could be reached there are no plans to extend
this at present. In light of the Scientific Advisory Committee on Nutrition’s (SACN) Carbohydrate
and Health report (SACN 2015b), the reference group has also helped to reassess the advice on
fruit juice and smoothies, including whether additional messages (such as recommended portion
size and frequency) are needed for fruit juices and smoothies carrying the 5-A-DAY logo. This has
led to the recent recommendation to consume a maximum of 150ml of fruit juice and smoothies
(together) daily. The next section of the report goes on to consider other UK healthy eating
initiatives including the School Fruit and Vegetable Scheme (SFVS), and the Eatwell plate (recently
updated to the Eatwell Guide).
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5. UK Government policy initiatives to promote healthy
eating
5.1.
Introduction
The most recent National Diet and Nutrition Survey (NDNS) found only 30% of adults and 41% of
older adults met the 5-A-DAY recommendation. On average, adults consumed 4.1 portions and
older adults consumed 4.6 portions of F&V per day (Bates et al. 2014). Mean consumption of fruit
and vegetables for children aged 11 to 18 years was 3.0 portions per day for boys and 2.7 portions
per day for girls. Ten per cent of boys and 7% of girls in this age group met the 5-A-DAY
recommendation (Bates et al. 2014). Government advice on healthy eating is primarily in terms
of the 5-A-DAY message and the Eatwell plate see Figure 2 (DFFR, 2015).
Figure 2. The Eatwell Plate (Source: NHS, 2015a)
The Eatwell plate (now the Eatwell Guide) has been designed to highlight the different types of
food that make up our diet, and shows the proportions we should eat them in to have a healthy,
balanced diet. It is important to note that although the imagery is a plate with a knife and fork it
is not designed to represent the components of a given meal. This is encapsulated in the following
statement:
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“It's a good idea to try to get this balance right every day, but you don't need to do it at every
meal. You might find it easier to get the balance right over a longer period, like a week” (NHS,
2015a).
In 2012, the FSA carried out a survey, Food and You (FSA 2014a), in which UK consumers were
quizzed on their knowledge of healthy eating messages. 86% of participants correctly said the
recommendation for F&V was five portions a day. However, only half of survey respondents
reported eating five portions of F&V on the previous day. Therefore, although the UK 5-A-DAY
initiative has greatly improved knowledge and awareness, this has not translated into sustained
improvements in F&V consumption. There are many possible reasons for this, including the
consumer focus on fat and sugars rather than micronutrients and fibre. The most recent FSA
consumer attitudes tracking survey reported the main food issues of concern to be the amount of
sugar in food (52% or respondents), food waste (49%) and the amount of salt in food (47%) (FSA
2014b). Relatively little importance seems to be given by consumers to the overall micronutrient
density or fibre content of foods (possibly linked to these not being part of front-of-pack labelling).
Potential barriers to the purchase and consumption of F&V include the perception that F&V are
expensive and less value for money compared to processed foods high in fat and sugars and the
concern over the level of perishability of fresh produce. Highly perishable F&V may not be bought
as frequently and are generally, higher in cost. The accessibility and variety of F&V on offer may
also limit intake within certain population groups. The variety of the type of F&V available but also
the tastes, textures and how they can be eaten may encourage F&V consumption. Cooking skills,
namely knowledge on how to prepare and cook different F&V, have been shown to impact
purchases and intakes. F&V that is familiar and requires minimal preparation time and effort,
tend to be preferred. Pre-prepared and ready-to-eat F&V are also more appealing to the timepressured consumer. Retailers who offer recipes, preparation and cooking instructions,
demonstrations and/or tastings for fruits and vegetables may help to encourage purchasing
(Rekhy & McConchie 2014).
Miller et al. (2016) proposed that a number of trends and events are likely to influence
micronutrient intakes and status in the UK, the drivers of which include emerging scientific
research, localised changes within the food chain, demographic changes, government initiatives
and their impact, and changes in consumer attitudes and behaviour. These themes are drawn
together in their study (Table 14). Further Miller et al. (2016) cite a Defra report that concluded
that in the UK average concentrations of copper, magnesium and sodium in vegetables, and the
average concentrations of copper, iron and potassium in fruit, had decreased significantly
between the 1930s and the 1980s (Mayer 1997). A number of the themes in Table 14 are
explored further in subsequent sections of this report.
5.2.
Level of knowledge about nutrient content
Knowledge about the nutritional content and associated benefits to health for specific F&V can
influence purchases and consumption, although this is not thought to be a major pathway to elicit
behavioural change (Rekhy & McConchie 2014). More subtle and proactive approaches may be
needed, including increasing the accessibility, variety and visibility of F&V in retail and food service
outlets and in the home and workplace. Replacing offerings of foods high in fats and sugars with
F&V at point of purchase locations (such as at the checkout), in vending machines and food
service outlets may encourage consumption (Rekhy & McConchie 2014). Strategies to make
consumers feel like they are getting good value for money (such as, bonus packs, promotional
deals) may increase purchasing and help to establish a change in behaviour which could continue
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beyond the time period of the money saving offer. Leveraging the ‘natural’ and ‘freshness’
qualities of F&V in promotional materials and activities could also help to attract consumers and
increase consumption (Produce for Better Health Foundation 2012).
Table 14. Drivers, trends and events that could influence micronutrient intakes in the UK
(Adapted from Miller et al. 2016)
MAIN DRIVERS
TRENDS AND EVENTS
Changes in consumer attitudes
and behaviour




Changes in purchasing behaviour
Continued diversification of diets due to widening socio-demographic spectrum
Increasing consumer trends (for example, desire for “natural” and “additive-free” products)
Revision of mandatory fortification polices
Demographic changes



Ageing population
Increasing immigration
Increasing income equality
Emerging scientific research


Development of new and improved status biomarkers and monitoring tools
Increasing understanding of intake levels required to promote health at different life stages and
within different population groups
Increasing understanding of genetic and epigenetic influences on micronutrient status
Increasing understanding of the type of interventions with greatest impact in increasing
micronutrient intakes for specific population groups
Technology development of crop varieties, animal products and/or food products with higher
nutrient density or bioavailability



Environmental and process
changes in the food chain
Farming


Increasing soil nutrient depletion affecting crops (see Morris and Sands 2006; Davis 2009;
Fernàndez-Marín et al. 2014).
Continuation of crop selection based on yield rather than micronutrient content
Selection of varieties with the primary aim of shelf-life and robustness in an extended supply
chain rather than micronutrient content
Changes in use of biotechnology tools which might not have been developed with optimising
nutrition as the driving factor
Changes in geographic sourcing of food and feed ingredients
Manufacturing and retail
initiatives



Changes in voluntary fortification
Product innovations impacting on nutrient density
Processing innovations impacting on nutrient density for example, innovative heat treatment etc.
Government initiatives




Revision of Dietary Reference Values (DRVs)
Revision of healthy eating guidelines and shifting focus onto dietary patterns
Increased action to tackle obesity and promote physical activity
Increase in public health communications concerning specific nutrients (for example, vitamin D,
fibre, free sugars and/or fat)
Revision of mandatory fortification policies




A Regulation on Nutrition and Health Claims (Regulation (EC) No. 1924/2006) (European
Commission (EC) 2007) came into force in the European Union (EU) in 2007. Permitted nutrition
claims, for example, low in fat, high in fibre are listed in an Annex to the Regulation. A 'nutrition
claim' means any claim which states, suggests or implies that a food has particular beneficial
nutritional properties, for example, source of vitamin C or high in fibre.
Table 15: Potatoes and 5-A-DAY F&V commonly eaten in the UK (identified from National Diet
and Nutrition Survey data) and EFSA-approved health claims for micronutrients they contain.
FRUIT/VEGETABLE
SOURCE OF
EXAMPLES OF GENERIC HEALTH CLAIMS
Apples
Fibre
Note: No health claims for fibre in general have yet been approved (specific fibres associated with some cereal grains
and sugar beet have been approved)
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Bananas
Vitamin B6
Potassium
Manganese
Vitamin B6 contributes to the normal function of the immune system
Vitamin B6 contributes to the reduction of tiredness and fatigue
Potassium contributes to normal muscle function
Potassium contributes to the maintenance of normal blood pressure
Manganese contributes to the maintenance of normal bones
Manganese contributes to the normal formation of connective tissue
Fibre
Grapes
Fibre
Oranges
Vitamin C (rich
in)
Thiamin
Folate
Vitamin C contributes to the normal function of the immune system
Vitamin C contributes to the protection of cells from oxidative stress
Thiamin contributes to normal functioning of the nervous system
Thiamin contributes to the normal function of the heart
Folate contributes to the reduction of tiredness and fatigue
Folate contributes to normal blood formation
Fibre
Pears
Fibre
Broccoli
Vitamin C (rich
in)
Vitamin K (rich
in)
Folate (rich in)
Potassium†
Manganese†
Fibre
Carrots
Vitamin A (rich
in)
Vitamin C contributes to the normal function of the immune system
Vitamin C contributes to the protection of cells from oxidative stress
Vitamin K contributes to normal blood clotting
Vitamin K contributes to the maintenance of normal bones
Folate contributes to the reduction of tiredness and fatigue
Folate contributes to normal blood formation
Potassium contributes to normal muscle function
Potassium contributes to the maintenance of normal blood pressure
Manganese contributes to the maintenance of normal bones
Manganese contributes to the normal formation of connective tissue
Vitamin A contributes to the maintenance of normal skin
Vitamin A contributes to the maintenance of normal vision
Fibre
Onions
Fibre
Peas*
Vitamin C
Vitamin K (rich
in)
Thiamin (rich
in)
Niacin
Folate
Manganese
Fibre
Tomatoes
Vitamin C
Vitamin C contributes to the normal function of the immune system
Vitamin C contributes to the protection of cells from oxidative stress
Vitamin K contributes to normal blood clotting
Vitamin K contributes to the maintenance of normal bones
Thiamin contributes to normal functioning of the nervous system
Thiamin contributes to the normal function of the heart
Niacin contributes to normal psychological function
Niacin contributes to the maintenance of normal skin
Folate contributes to the reduction of tiredness and fatigue
Folate contributes to normal blood formation
Manganese contributes to the maintenance of normal bones
Manganese contributes to the normal formation of connective tissue
Vitamin C contributes to the normal function of the immune system
Vitamin C contributes to the protection of cells from oxidative stress
Fibre
Potatoes – main crop
(old)
Thiamin
Potassium
Thiamin contributes to normal functioning of the nervous system
Thiamin contributes to the normal function of the heart
Potassium contributes to normal muscle function
Potassium contributes to the maintenance of normal blood pressure
Fibre has been calculated as AOAC/100kcal rather than per 100g *Boiled and frozen, not canned †Raw/steamed
broccoli
A ‘health claim’ is any statement about a relationship between a food and health, for example,
vitamin C contributes to the reduction of tiredness and fatigue. To make a health claim, criteria
must be met. For example, to make a generic claim relating to the vitamin or mineral content of
a food, that nutrient must be present in significant amounts:

At least 15% Nutrient Reference Value (NRV) per 100g or 100ml (except drinks);
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
At least 7.5% NRV per 100ml (drinks only); and

At least 15% NRV if package contains a single portion size.
Health claims are used to inform the public about the health benefits of a food or drink and the
Regulation is designed to protect consumers against misleading claims, harmonise claims made
across the EU and to encourage innovation in the food industry. The Regulation covers all foods,
drinks and dietary supplements sold in the EU and applies to all commercial communications
including the food label itself, advertorials and other promotional materials including websites.
The scientific assessment of evidence for health claims is carried out by the European Food Safety
Authority (EFSA), an independent scientific body whose role is to provide scientific advice to the
European Commission (EC). Currently, only a relatively small proportion of submitted health
claims have been given positive opinions by EFSA and added to the EC’s list of accepted claims.
Failure to reach positive opinions on claims can occur for several reasons including insufficient
characterisation of the food or component and insufficient evidence from human studies
submitted to support the claim. Unless a claim appears on the official ‘approved’ list
(http://ec.europa.eu/nuhclaims/) it cannot be used. For those who wish to have a currently nonauthorised claim considered, a process exists which is summarised in Buttriss (2015).
There is good evidence to suggest eating at least five portions of F&V a day can help to reduce
the risk of heart disease, stroke, type II diabetes, certain cancers and obesity (NHS 2015b) despite
limited health claims relating to specific F&V. Examples of generic health claims that can be
associated with potatoes and most commonly eaten F&V have been drawn together (Table 15).
The table has been compiled with the most frequenty eaten F&V as identified in the National Diet
and Nutrition Survey. A fuller list of claims that could be used for UK F&V can be found in terms
of vitamins (Table 16) and minerals (Table 17). Evidence shows there are significant health
benefits to getting at least five portions of F&V every day, so reference to this could be made in
supporting literature (for example, the use of phrases such as an apple contributes to the 5-a-day
target or Eating 5 or more portions of fruit and veg is linked with lower risk of chronic disease).
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Table 16. Vitamin content of selected UK fruits and vegetables (per 100g)
VITAMIN A (AS
CAROTENE) (µG)
Apples (raw)
Asparagus (boiled)
Beetroot (boiled)
Broad beans (boiled)
Broccoli (boiled)
Brussel Sprouts (boiled)
Carrots (old, boiled)
Cauliflowers (boiled)
Cucumbers (raw)
Lettuce (raw)
Onions (boiled)
Parsnips (boiled)
Pears (raw)
Peas (frozen, boiled)
Red peppers (raw)
Potatoes (main crop, old, boiled, flesh)
Raspberries (raw)
Spinach (mature, boiled)
Strawberries (raw)
Tomatoes (raw)
14
389
27
145
598
320
11100
Tr
74
60
5
30
14
276
580
Tr
6
3840
Tr
349
THIAMIN (mg)
0.04
0.12
0.01
0.03
0.04
0.07
0.09
0.09
0.03
0.14
0.03
0.07
0.03
0.40
0.07
0.21
0.03
0.06
0.02
0.04
FOLATE
(µG)
VITAMIN B6
(mg)
Tr
173
110
32
34
110
8
48
14
60
8
41
6
31
75
18
33
81
61
23
0.07
0.07
0.04
0.08
0.11
0.19
0.04
0.15
0.01
0.02
0.07
0.09
0.04
0.07
0.23
0.06
0.06
0.09
0.03
0.06
NIACIN (& TRYPT)
(mg)
0.1
1.4
0.4
3.8
1.4
0.5
0.4
0.9
0.3
0.6
0.5
1.1
0.3
2.5
0.6
0.9
0.8
1.5
0.7
0.7
VIT C (mg)
VIT K (µG)
6
10
5
20
44
60
3
30
2
1
4
10
3
12
126
9
32
8
57
22
5.6
51.8
No value
11.4
135.0
127.0
5.5
28.5
20.9
129.0
No value
No value
3.6
39.0*
1.6
No value
No value
575.0
3.0
6.0
Those highlighted in yellow can be described as a ‘source’ (i.e. provide at least 15% of the Nutrient Reference Value
per 100g) *value given for fresh, no value for frozen
Table 17. Mineral content of selected UK fruits and vegetables (per 100g)
Potassium (mg)
Apples (raw)
Asparagus (boiled)
Beetroot (boiled)
Broad beans (boiled)
Broccoli (boiled)
Brussel Sprouts (boiled)
Carrots (boiled)
Cauliflowers (boiled)
Cucumbers (raw)
Lettuce (raw)
Onions (boiled)
Parsnips (boiled)
Pears (raw)
Peas (frozen, boiled)
Red peppers (raw)
Potatoes (main crop (old), boiled, flesh)
Raspberries (raw)
Spinach (mature, boiled)
Strawberries (raw)
Tomatoes (raw)
100
220
510
190
212
310
166
215
156
222
105
350
105
177
216
365
170
230
170
223
Manganese (mg)
Tr
0.2
0.9
0.2
0.2
0.2
0.1
0.1
0.1
0.1
0.1
0.3
0.1
0.4
0.1
0.1
0.4
0.5
0.3
0.1
Magnesium
(mg)
4
13
16
19
14
13
8
12
10
9
7
23
5
27
11
18
19
34
12
8
Iron (mg)
0.1
0.6
0.8
0.8
0.6
0.5
0.3
0.5
0.3
0.1
0.3
0.6
0.1
1.8
0.4
0.3
0.7
1.6
0.3
0.2
Zinc (mg)
Tr
0.7
0.5
0.7
0.4
0.03
0.1
0.2
0.1
0.2
0.2
0.3
0.1
0.8
0.2
0.2
0.3
0.5
0.1
0.1
Calcium (mg)
5
25
29
18
35
20
31
19
21
24
25
50
7
37
7
6
25
160
17
8
Those highlighted can be described as a source (i.e. provide at least 15% of the Nutrient Reference Value per 100g)
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5.3.
The School Fruit and Vegetable Scheme (SFVS) and School Food
Standards
Looking specifically at the School Fruit and Vegetable Scheme (SFVS); within England, 4–6 yearold children who attend a Local Education Authority (LEA) maintained infant, primary or special
school are eligible to receive a free piece of fruit or free vegetables each school day (DH, 2010a).
While participation in the SFVS is voluntary, schools are encouraged to participate. The most
recent evaluation of the scheme found that children receiving the SFVS ate more F&V in 2008
compared with 2004 when the scheme was initiated, although changes may partly be explained
by the introduction of school food standards. It was suggested that effects of the intervention do
not carry over into the home environment (Weichselbaum & Buttriss, 2014). In addition, reviews
suggest that increases may be short-term and evidence for long-term behaviour change is weak.
Indeed, statistics suggest the impact of such programmes and the background of substantial
increases in general awareness, are not reflected in the 5-A-DAY F&V targets being met (HSCIC
2014). Thus participation in the SFVS was positively associated with F&V consumption so in any
one area, those children who participated in the SFVS consumed more F&V. However, children
living in deprived areas still consumed less F&V than children living in more advantaged areas:
the mean daily frequency of F&V consumed, and rates of consumption of F&V five times or more
per day, decreased as deprivation increased (Hughes et al. 2012).
Statutory school food standards apply to local authority maintained schools, academies that
opened prior to 2010 and academies and free schools in England entering into a funding
agreement (DE, 2015). The school food standards have been developed to ensure that food
provided to pupils in school is nutritious and of high quality; to promote good nutritional health in
all pupils; to protect those who are nutritionally vulnerable and to promote good eating behaviour.
The revised standards for school food came into force on 1 January 2015 and are set out in the
requirements for School Food Regulations 2014. The School Food Standards for lunches state
with regard to F&V that there must be:




One or more portions of vegetables or salad offered as an accompaniment every day;
One or more portions of fruit offered every day;
A dessert containing at least 50% fruit two or more times each week; and
At least three different fruits and three different vegetables each week (School Food
Standards, 2015)
5.4.
Information and evaluation of the Eatwell plate
Food-based dietary guidelines (FBDG) constitute simple, evidence-based policy recommendations
for the general population on healthy eating as a means of preventing nutritional deficiencies,
decreasing the risk of non-communicable diseases and improving public health (Brown et al.
2011; EFSA 2010). FBDG indicate what consumers should be eating in terms of foods rather than
nutrients, and provide a framework that can be used in meal planning (EUFIC 2009). The
development of FBDG is largely based on combining evidence on recommended nutrient intakes,
popular relevant foods and desirable population health outcomes. In the UK, the FBDG are
presented as a plate, referred to as the Eatwell plate, with eight associated healthy eating tips,
which includes ‘eat plenty of fruit and vegetables’ (NHS 2015a). Evaluation of FBDG is relatively
complex. A number of different methods may be used to monitor the effectiveness of an
established dietary guideline to ascertain whether the population is meeting set national targets,
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for example 5-A-DAY, or proportions of the food groups being consumed in the average diet. Data
is typically used from national surveys of individual intakes or household food consumption data
(FAO 1998). Another aspect of evaluating a dietary guideline is the proportion of the population
meeting the nutrient guidelines. Such data can be obtained only from dietary surveys of
individuals.
The National Diet and Nutrition Survey (NDNS) and food survey data has been used to determine
the extent to which consumers meet the Eatwell plate guidelines (Harland et al. 2012). As the
Eatwell plate (with the exception of F&V) is not quantified in terms of specific portion sizes (g per
day), evaluations are typically based on achievement of healthy eating recommendations in terms
of nutrients (such as fat and fibre) rather than consumption of foods. The percentage of the adult
population achieving an intake of 5 or more portions of F&V a day was 30%, with 28% meeting
total and saturated fatty acid targets, and only 19% achieving the previous recommendation for
fibre intake (18 g/day of non starch polysaccharide (NSP) fibre). Compared to older NDNS data,
there has been some progress in increasing F&V intake but in comparison to guidelines, there
appears to be an overall shortfall. It would seem that further focus is required to achieve the F&V
target.
Whilst the Eatwell plate communicates the principle of a healthy, balanced diet, consumers still
appear to have difficulty putting this into practice (Harland et al. 2012). The recent SACN
Carbohydrates and Health report, recommends that the average intake, across the UK population,
of free sugars should not exceed 5% of total dietary energy intake (SACN 2015b). SACN also
recommended the retention of the current reference value for total carbohydrate (50% of total
dietary energy from carbohydrate) and an increase in dietary fibre intake to 30 g/day. Public
Health England (PHE) has established an external reference group to consider the potential
impact of the new dietary reference values on the Eatwell plate and associated healthy eating
messaging. PHE has conducted in-house and externally commissioned modelling work to inform
the proportion of the food categories depicted within the Eatwell plate. A revised version of the
Eatwell plate was published by PHE in March 2016. The model, now known as the Eatwell Guide,
continues to encourage consumption of F&V but fruit juice is no longer depicted in the F&V
segment which itself has been resized compared to the previous visual (Figure 2) to reflect current
government advice on a healthy balanced diet. Although included in the new hydration
messaging, fruit juice and smoothies are now restricted to 150 ml/day (together). This is because
the SACN definition of free sugars includes the sugars naturally occurring in fruit juice. Public
health messages to limit fruit juice and smoothies consumption, may impact negatively on both
sales of fruit juice and whole fruit if consumers are not clear about the definition of free sugars
and the health benefits of consuming fruit. Some organisations such as the British Nutrition
Foundation (BNF) have expressed concern that confusion about the health effects of total vs free
sugars amongst consumers could also have implications for the perception of the health
attributes of fruit.
The Eatwell Guide was issued on the 17th March 2016 as the report was being finalised (Figure
3) with the following dietary messages:



Eat at least 5 portions of a variety of F&V every day.
Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates; choosing
wholegrain versions where possible.
Have some dairy or dairy alternatives (such as soya drinks); choosing lower fat and lower
sugar options.
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



Eat some beans, pulses, fish, eggs, meat and other proteins (including 2 portions of fish
every week, one of which should be oily).
Choose unsaturated oils and spreads and eat in small amounts.
Drink 6-8 cups/glasses of fluid a day.
If consuming foods and drinks high in fat, salt or sugar have these less often and in small
amounts.
Figure 3. The Eatwell Guide (Source: Govt.uk, 2016)
5.5.
Healthier Food Choice Awards
The DH (2011a:4) states in its report on the Public Health Responsibility Deal (see Section 6.3)
that:
“By working in partnership, public health, commercial, and voluntary organisations can agree
practical actions to secure more progress, more quickly, with less cost than legislation”.
The Healthier Choices Food Awards are an example of this approach. At a local authority level,
many authorities have developed a healthier food choice award. One example is in Worcestershire
where food service businesses who have achieved level 5 in the Food Hygiene Rating Scheme
and prepare food at that premises can apply for an award scheme the Healthier Choices Food
Award. The award has two levels SILVER and GOLD (Table 18) The scope of the award includes
seasonal and local food, managing food waste, as well as elements of healthy food and nutrition.
Table 18. Criteria in the Healthier Choices Food Award (Source: WRS, 2015)
SILVER


Maintain Level 5 Food Hygiene Rating
Make plenty of fruit and vegetables available
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GOLD


Silver plus
Use local suppliers
(minimum of five
Enabling UK consumers to increase their
consumption of fruit and vegetables 51








Keep the levels of sugar, salt and unhealthy fats in foods to a minimum
Offer a variety of protein and carbohydrate choices
Offer healthier drink options
Offer healthier children’s choices
Offer smaller portions
Provide customers with information on food allergens
Keep food waste to a minimum
Ask for customer feedback
MEMBERSHIP INCLUDES:

An accreditation visit including feedback on what is required if criteria are not met.

A certificate and window sticker to display in the food premises.

A digital logo to use on menus, website and in promotional leaflets and advertising.

A guidance pack with tips and advice on how to meet all the criteria and market the award.

A workshop place run by Environmental Health Officers and a Nutritionist covering food safety,
health and safety and how to offer healthier choices, plus an opportunity for networking and
sharing best practice.

Additional post accreditation mystery customer visit.

Business promotion – a listing of business details and award level on the WRS website and
promotion on social media pages and with WRS partners.

Discounted fee for nutritional analysis of recipes

Discounted rates for CIEH Healthier Food and Special Diets course or Food Allergen awareness
course.

items on the
menu)
Use food that is in
season (minimum
of one menu item
that includes
seasonal product
MEMBERSHIP INCLUDES:

Upgrade to Gold
Standard using
locally sourced,
seasonal food

Free nutritional
analysis of three
recipes
Mechanisms such as local authority mediated healthier Food Choice Awards offer another
mechanism to communicate to consumers with regards to healthy food and nutrition.
5.6.
Change4Life
Change4Life is a social marketing campaign, originally launched in 2009, and is part of a wider
strategy to reduce childhood obesity. It reflects the change of policy initiatives to a more integrated
population approach to healthy lifestyle, but still includes a behavioural change objective of
increasing consumption of F&V. Working with public and private sector partners such as food
companies and supermarkets, it involves a wide range of activities including mass media,
branded materials, partners and website-based information/activities (DH 2010b). Change4Life
encourages F&V consumption as one of its key health behaviours. F&V often feature in the
campaign as ‘swaps’ (for example, healthier snacks) or as suggested additions to composite
dishes. Evaluations to assess the impact of Change4Life are limited and hampered with
challenges due to the complexity of factors which could be exerting an effect and the fact that
related interventions have been introduced at the same time. Evaluation has tended to focus on
increasing awareness and knowledge, or changes in claimed behaviour rather than evaluation of
changes in actual behaviour or markers of health.
Public health interventions often report increases in awareness and knowledge, with translation
to actual behavioural changes proving to be more difficult (Bremner 2006). Government-led
evaluations of Change4Life have suggested an increased level of awareness of the campaign and
sustained level of interest in the resources and activities. Evaluation of the first year of
Change4Life was reported by the Department of Health (DH) as a success, with over 400 000
families joining (and around 44 000 families still involved after 6 months) and 1 million mothers
claiming to have made changes to their child’s behaviour as a result of the scheme (DH 2011b).
By April 2013, 1,937,406 families had signed up, accounting for more than 2.5 million people.
The programme has delivered over 300,000 personal activity plans and over a million people
have downloaded Change4Life apps (DH 2014). The DH has evaluated the programme (Table
19).
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Shopping basket analysis looking at the difference between families involved in Change4Life
relative to a control group found a change particularly in beverage purchases; Change4Life
families favoured low fat milk and low sugar drinks. In addition, purchasing data from a
representative panel of shoppers showed a 9% reduction of sugary carbonated beverage
purchases during a Change4Life television campaign to swap sugary carbonated beverages for
diet versions, milk or water (DH 2014).
The second year (with a government change in summer 2010) was reported as the year of
consolidation. The marketing budget was reduced, with commercial partners being asked to take
greater responsibility. Other changes since 2010 have included more focus on a life-course
approach including Start4Life, which encourages healthy eating and activity habits from birth, and
a separate programme for adults in mid-life. Moving from a child-based to a whole family approach
recognised that parental modelling is important in determining behaviours. Guidance now focuses
on providing practical advice on how people live their lives and attention is given to the family as
a whole, instead of focusing primarily on the child. Change4Life is now also more focused on local
initiatives. Online engagement has largely replaced printed materials and more investment has
been made in social and digital media (DH, 2011b).
Table 19: Evaluation of Year One Change4Life
YEAR ONE
TARGET
YEAR ONE
ACHIEVEMENT
Reach (% of all mothers of children under 11 who had opportunity to see the
advertising campaign)
99%
99%
Awareness (% of all mothers with children under 11 who recalled seeing the
Change4Life advertising)
87%
87%
Logo recognition (% of all mothers with children under 11 who recognised the
Change4Life logo)
44%
88%
100,000
346,609
1,500,000
1,992,456
Sign-up (total number of families who joined Change4Life)
200,000
413,466
Sustained interest (total number of families who were proven to still be
interacting with Change4Life six months after joining)
33,333
44,833
Response to How are the Kids? (total number of questionnaires returned
electronically, by post or from face-to-face marketing)
Total responses (including website visits, telephone calls, returned
questionnaires)
Source: (DH 2011b)
An independent study (Croker et al. 2012) systematically evaluated a single but integral
component of the programme, family information packs, and concluded that whilst the packs
resulted in higher awareness of the campaign there were few positive effects on behaviour. The
authors put forward a number of reasons for this. Firstly, the multiplicity of the messages; they
argue that campaigns with a narrower focus are more effective than those targeting multiple
behaviours. Inclusion of multiple target behaviours may reduce the perception of the importance
of any single behaviour and could lead people to focus on the ones they are achieving already
rather than the ones where behaviour change might make a bigger impact. Secondly, the authors
commented that the materials seemed focused on children where the intended focus was the
family, or the parent that may be the gatekeeper of diet. There is also some question as to whether
research on behavioural theory and social marketing concepts was actively translated and
adhered to in the campaign intervention design (Piggin & Lee 2011). Furthermore the campaign
should be viewed in a context where obesity issues have been raised up the national agenda.
Obesity prevention is a long-term strategy, although it is interesting to see recent indications of a
plateau in child obesity prevalence rates that may have occurred prior to the commencement of
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Change4Life. Changes attributed to the campaign may be, in part, a result of an on-going trend
that preceded the campaign.
Despite the difficulties in the evaluation of the campaign, Change4Life has been admired for its
modern approach, enlisting celebrities and embracing new technology to help reach the younger
generation. Various mobile apps have been produced, including, most recently, an app to reveal
the sugar content (translated as sugar cubes) of everyday foods and drinks using barcode
scanning technology (NHS 2016). However, the impact of this on a population scale will, again,
be hard to quantify due to other concurrent activities aimed at reducing the nation’s intake of
sugars as the next section outlines.
5.7.
PHE’s sugar reduction package
In the recent review of Carbohydrate and Health, SACN concluded that the recommended average
population maximum intake of free sugars should be halved: it should not exceed 5% of total
dietary energy. SACN also recommended that consumption of sugars sweetened drinks should be
minimised by both adults and children (SACN 2015b). The term "sugars sweetened" is used to
reflect the multiple types of sugar that are used as sweeteners in such beverages and not just the
use of sucrose as an ingredient. The intake of sugars across all population groups are currently
above recommendations, contributing between 12 to 15% of energy. In June 2014, PHE published
‘Sugar reduction: Responding to the challenge’. This set out what PHE would do to review the
evidence across a broad range of areas and identify those where action is most likely to be
effective in reducing sugar intakes. In Oct 2015, the findings from this review were published in
the ‘Sugar reduction: Evidence for action’ report (PHE 2014a; 2014b). The report draws
conclusions about what drives the consumption of sugar and advises on actions that could be
implemented to change intake. These include the environment that influences food choice
continuing the theme already considered in this report of choice architecture; food supply and
changes that could be made to this; as well as knowledge and training; and local action. This
strategic approach has been seen previously with government targets and campaigns to reduce
the level of salt and fat in consumers’ diets (for example, FSA salt campaign). As highlighted
earlier in this report (section 5.1) government campaigns and initiatives that focus on individual
aspects inevitably generate awareness but can simplify the complexity of health and nutrition
messaging to consumers especially with regard to fibre and micronutrient intake. For example,
the focus on sugar can make consumers think that items with high sugar content like fruit juice
are unhealthy when as part of an overall balanced diet this is not the case. It is important that
government messages reinforce the need for a balanced diet, containing plenty of F&V.
5.8.
Nutrient profiling
Nutrient profiling of foods, described as the science of ranking foods based on their nutrient
content is the basis for regulating nutrition labels, health claims, and also the marketing and
advertising of food to children. A number of nutrient profile models have now been developed by
research scientists, regulatory agencies, and by the food industry. Whereas some of these models
have focused on nutrients to limit, others have emphasized nutrients known to be beneficial to
health, or some use a combination of both. Although nutrient profile models are often tailored to
specific goals, the development process ought to follow the same science-driven rules. These
include the selection of index nutrients and reference amounts, the development of an
appropriate algorithm for calculating nutrient density, and the validation of the chosen nutrient
profile model against healthy diets. It is extremely important that nutrient profiles be validated
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rather than merely compared to prevailing public opinion. Regulatory agencies should act only
when they are satisfied that the scientific process has been followed, that the algorithms are
transparent, and that the profile model has been validated with respect to objective measures of
a healthy diet (Drewnowski and Fulgoni, 2008).
The consumption of fruit is generally associated with better health, but so is higher socioeconomic
status (SES). Most previous studies, including the work described above, when evaluating
consumption of fruit have not separated 100% fruit juice and whole fruit, which may conceal
interesting patterns in consumption across the demographic profile in a given community.
Consumption patterns for whole fruit versus 100% fruit juice showed different gradients by race/
ethnicity, education, and income (Drewnowski and Rehm 2015; Francou, et al. 2015). Any advice
to replace 100% juice with whole fruit as part of what is considered healthy eating may thus pose
a challenge to the economically disadvantaged and some minority groups, whose fruit
consumption falls well short of national goals already.
5.9.
Summary
Steps to enable healthy food choices, including increased provision of F&V in supermarkets,
canteens and restaurants as well as other initiatives described in this report, are needed to help
encourage behaviour change. Retailers are being increasingly urged to remove products high in
fat and sugars from the checkout area. If these products are replaced with ready-to-eat F&V
products (see Section 3.2.1), purchases of these foods could increase. Other changes employed
by retailers and suppliers, including increased promotion and marketing of F&V, as discussed in
this report, could help to shift purchases away from products high in fat and sugars towards F&V.
Educating health professionals, employers, the general public and those who have opportunities
to influence food choices in different sectors (for example, catering and leisure) on the benefits
of F&V and how to prepare and cook different types of produce could also bring benefits to the
nation’s health.
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6. Inter-related UK Government public health initiatives
6.1.
Introduction
A healthy, varied diet is the cornerstone for ensuring adequate micronutrient intakes (Miller et al.
2016). ‘Healthy’ has common-sense everyday meaning in the food industry often being used to
describe foods that are ‘good for health reasons’. However the definition of a healthy or balanced
diet can stretch to include foodstuffs which as individual items have questionable nutritional
benefit. Healthy as a term therefore lacks scientific definition and is used extensively by food
producers/retailers to direct consumers in particular direction towards certain goods (Lobstein
and Davies 2009). Specialist weight loss interests frame dietary advice by reference to being
‘healthy’, which implies some foods are best avoided. The healthiness of a food depends upon
how much we eat of it, how often, what our nutritional needs are, and what else we eat in the diet.
There is no single complete food that provides all the nutrients we need. Therefore, a variety of
foods in the diet and an eye on portion size has been suggested as underpinning a healthy diet.
In many cases, healthful foods are defined by the absence of problematic ingredients—fat, sugar,
and sodium—rather than by the presence of any beneficial nutrients or micro-nutrients they might
contain (Drewnowski 2015). Drenowski asserts that past attempts to quantify the nutrient density
of foods have been based on a variety of calories-to-nutrient scores, nutrients-per-calorie indexes,
and nutrient-to-nutrient ratios. These need to then translate into government policy and marketing
practice especially with the interaction between government and industry.
6.2.
Health and Wellbeing boards
Historically, statutory responsibility for health care and social care was divided between National
Health Service (NHS) bodies and local government authorities. The Health and Social Care Act
2012 established health and wellbeing boards (HWBs) as a forum where key leaders from the
health and care system would work together to improve the health and wellbeing of their local
population and reduce health inequalities (LGA, 2015). HWBs are intended to lead the integrated
assessment of local needs to inform both NHS health and local authority social care
commissioners (Coleman et al. 2014). In their study they found that HWBs vary greatly in their
structure and approach towards health and social care integration with heavy dependence on
voluntary agreements to co-operatively align the strategic plans of the many different new
statutory bodies (Coleman et al. 2014). Aylott et al. (2008) considered the 2007 Foresight Report
on obesity and the implications of the recommendations for local government identifying four local
government areas of responsibility that have a role in tackling the problem of obesity. These were
responsibilities for planning, children’s services, adult social care and parks and leisure. At local
level, local authorities have a much stronger role in shaping services, and have taken over
responsibility for local population health improvement (Gov.uk, 2015). The HWBs brought
together local commissioners of health and social care, and other individuals to agree an
integrated way of improving local health and well-being. Clinical commissioning groups work with
local authorities through the HWBs. The management health and wellbeing at local level needs a
co-ordinated policy approach that covers a range of local government responsibilities. The role of
Joint Strategic Needs Assessments (JSNAs) and Health and Wellbeing Strategies (HWSs) have the
potential to provide a strong basis for integrated local policies for health improvement, to address
the wider determinants of health and to reduce inequities (Tomlinson et al. 2013). Tomlinson et
al. (2013) stated that:
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“There has been a welcome joining up of the rhetoric around health, the environment and
land use or spatial planning in both the English Public Health White Paper and the National
Planning Policy Framework but this is not being followed through into practical guidance
needed by local authorities, health bodies and developers about how to deliver this at the
local level.”
In summary, the changes to the national planning framework, the abolition of the regional aspect
of planning (critical for conurbations with similar public health challenges), multiple agencies
involved in public health and the wide ranging remit of public health has made action on
obesogenic environments difficult to establish. Herrick (2009) determines that in the UK
especially there is a shift in patterns of accountability from public policy management towards a
congested state with multiple levels of actors including corporate organisations. An advantage
could be the development of an entrepreneurial approach to health, but the negative in this
situation is a question over the legitimacy and authority of public health policy when the food and
drink industry itself is involved in determining solutions. Herrick (2009) proposes that “health” as
an issue and the cultural norms that surround the concept has the potential to deliver brand
value. Free market thinking demands that consumers be free to choose to consume products
whilst understanding that over-excess can cause health problems; in other words, that consumers
should acknowledge their own personal responsibility.
Corporate social responsibility (CSR) has also been put forward as having a role in promoting
healthy diets and addressing some of the issues described in this report. CSR as a form of
governance can have many structures (Gond et al. 2011, Rayman-Bacchus and Walsh, 2016):

CSR as a form of government. The replacement of government acting in the public interest
by organisations discharging their own social responsibility objectives.

Self-governing CSR. Predicated on voluntary agreements and self-regulation instead of
government regulation, which works via business, instead of a ‘top-down’ command and
control policy approach.

CSR facilitated by government. Governments can promote specific social and economic
corporate behaviour through establishing economic and political incentives such as
exemptions, benefits for organisations, such as planning laws and tax incentives.

CSR as a partnership with government. Corporate investment that promises public, social
and economic benefits beyond the value of such investment as derived solely by the
organisation. For example, infrastructure or utility investment in food retail stores in
neighbourhoods that are poorly served such as combining the building of doctor’s
surgeries, health centres within the development plans of a retail store, paid for by the
retailer. The retailer may benefit by increased income in the in-store pharmacy, but the
government benefits too with improved health care infrastructure in an area that was not
historically services.

CSR as regulated by government. This approach leads governments to regulate to ensure
corporate compliance through legislation to ensure public interest is served but crucially
to also encourage firms’ social responsibility ambitions to exceed regulatory expectations.
The link between CSR and government regulation is discussed in the next section.
6.3.
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In 2011 the UK Government worked towards introducing a voluntary agreement in England with
the food and drink industry to enhance their social responsibility activities by signing up to the
Public Health Responsibility Deal (PHRD) and to promote ‘healthier choices’ and to provide their
customers with greater knowledge of the nutritional content of their food (Hasham et al. 2012).
Yet, this approach has attracted considerable criticism; particularly concerning the voluntary
nature of the PHRD, the role of industry in setting the targets for reduction in salt, fats and sugar
in foodstuff and determining advertising, particular directed towards children. The government
set out policy targets and priorities in the PHRD and business partners, academics, voluntary
organisations, were encouraged to make voluntary pledges contributing to the strategy in five
distinct networks – food, alcohol, physical activity, health at work and behaviour change. The UK
Department of Health report on the PHRD (DH, 2011a) identifies three central elements: core
commitments, collective and individual pledges, and supporting pledges. Individual businesses
can sign up to the core commitments, collective agreed action and individual organisational
pledges. Table 20 contains the core commitments and the supporting pledges that have been
developed.
Table 20. PHRD core commitments and pledges (Source: DH, 2011a)
THE CORE COMMITMENTS
The business community, voluntary sector and NGOs have already done a
great deal to help people achieve a healthier diet, increase their levels of
physical activity, drink sensibly and understand the health risks of their
lifestyle choices. Signatories to the Public Health Responsibility Deal will
work in support of the following core commitments in relation to their
customers and staff, where relevant.
We recognize that we have a vital role to play in improving people’s health.
We will encourage and enable people to adopt a healthier diet.
We will foster a culture of responsible drinking, which will help people to
drink within guidelines.
We will encourage and assist people to become more physically active.
We will actively support our workforce to lead healthier lives.
THE SUPPORTING PLEDGES
a) We will support the approach of the Public Health
Responsibility Deal and encourage other organizations to sign
up.
b) We acknowledge that the Deal’s strength comes from
organizations of different types across varying sectors working
together to improve people’s health.
c) We will contribute to the monitoring and evaluation of
progress against the pledges.
d) Where we offer people information to help make healthier
choices, we will use messages which are consistent with
Government public health advice.
e) We will broaden and deepen the impact of the Public
Health Responsibility Deal by working to develop further
pledges in support of the five core commitments.
The PHRD is a wide ranging top-level policy initiative aimed at reconfiguring public health
interventions, particularly in areas of alcohol and obesity although in this report F&V are
considered specifically. The government invited the food and drink industry to express its
assurance and social responsibility commitment to a number of specific pledges, which included
measures to encourage people to adopt a heathier diet, take more exercise and drink alcohol
more responsibly (Buttriss, 2011; DH, 2011a; Jebb, 2012). However, the social responsibility
strategies of the food and drink industry and their commitment to the PHRD are potentially
contradictory in light of their primary obligation to return value to shareowners. The challenge is
that the products that are the most profitable tend to be those manufactured and processed
foodstuffs of low nutritional value and often the self-same products that the PHRD, Eatwell plate,
and the Change4Life public health education campaigns encourage consumers to reduce in their
diet (Gilmore et al. 2011; Hasham et al. 2012).
In this context, do food manufactures, retail and food service companies have the capacity to
balance their responsibilities to their shareowners and to other stakeholders? In addition to their
now widened role in the development of complex social policy, can they address the socioeconomic factors that frame an individual’s behaviour and actions? In times when governments
possess limited direct policy instruments, the use of ‘soft power’, such as encouraging firms and
individuals to exercise social responsibility, may provide in itself an innovative driver to address
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challenges such as obesity. In the government’s policy document Healthy Lives, Healthy People,
(CM7985 2010 – DH, 2010b), this was explained in the following terms:
“When central government needs to act, we will balance the freedoms of individuals and
organisations with the need to avoid harm to others. We will aim to make voluntary
approaches work before resorting to regulation”. (CM7985 para 2.19)
The PHRD demonstrates the implementation of government led social responsibility through
business led CSR initiatives which over time can at first complement, and then even take over
roles previously seen as the responsibility of the state. The aim of an approach is to construct a
governance policy that combines individual and business responsibility where neither individual,
business nor government can resolve the challenges single-handedly. Voluntary CSR approaches,
in the absence of “command and control” government legislation and policy, can be seen as a
means to deregulate and unburden business so that it can thrive and grow.
Three distinct strategies can be used by food corporations to nutritionally engineer and market
their products namely: the reformulation of foods to reduce levels of food components of concern,
the micronutrient fortification of products to address micronutrient deficiencies, and
the functionalisation of products that claim to provide optimal nutrition and health benefits
(Durand et al. 2015; Scrinis, 2016). They argue that such nutritional strategies gain scientific
legitimacy by drawing upon the dominant nutritional ideology of ‘nutritionism’, which is
characterised by a reductive focus on nutrients as a way of understanding a food's effects on
dietary health. Further food and beverage corporations promote these nutritional strategies as an
important part of their CSR agendas as evidence that they are addressing the health issues
associated with both over-nutrition and under-nutrition. However, these corporations are also
using such nutritional strategies to legitimise and grow global markets for their products (Durand
et al. 2015; Scrinis, 2016). Benelam and Stanner (2015) conclude that:
“Many popular UK meals would benefit from changes to improve their nutrient profile
and that this could be helped by more consideration of cooking instructions for preprepared meal components and a greater focus on healthier ingredients in recipes.
Homemade dishes tended to be higher in fruit and vegetables and in fibre, but were also
higher in saturates. Relatively simple changes to the meals analysed, such as adding
plenty of vegetables when cooking using a jarred sauce or swapping standard for lean
mince when cooking a meat dish, could make a significant improvement to meals.
Routes to communicate such simple changes to consumers should be used by retailers,
manufacturers and caterers, and by health professionals wherever possible”. (Benelam
and Stanner, 2015:325)
Knai et al. (2015) evaluated the PHRD food pledges in terms of (i) the evidence of the
effectiveness of the specific interventions in the pledges and (ii) the likelihood that the pledges
have brought about actions among organisations that would not otherwise have taken place. The
study highlighted that most interventions reported by organisations seemed either clearly (37%)
or possibly (37%) already underway, regardless of the PHRD. Durand et al. (2015) also concur
with this statement. Knai et al. (2015) concluded that whilst some of the PHRD food interventions
could be effective, if fully implemented, the most effective strategies to improve diet, such as food
pricing strategies, restrictions on marketing, and reducing sugar intake, were not reflected in the
PHRD food pledges. They went further to state that:
“it was difficult to establish the quality and extent of implementation of RD pledge
interventions due to the paucity and heterogeneity of organisations’ progress reports….
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Irrespective of the nature of a public health policy to improve nutritional health, pledges
or proposed actions need to be evidence-based, well-defined, and measurable, pushing
actors to go beyond. “
This report has considered the pledges made under F6 the PHRD F&V pledge.
6.4.
F6 – Fruit and Vegetable Pledge in the PHRD
The PHRD pledge that is of interest with regard to increasing F&V consumption is F6 – the fruit
and vegetable pledge. The F6 pledge is as follows:
"We will do more to create a positive environment that supports and enables people to increase
their consumption of F&V." (DH, 2015)
The words ‘positive environment’ can be seen to refer to the wider consideration of choice
architecture as previously described in this report. This pledge is designed to mobilise action
across the food retail and food service industry to encourage increased consumption of F&V
aiming at the 5-A-DAY target. This pledge looks at F&V in all its consumed forms: fresh, frozen,
canned, dried, and juiced products, as well as F&V in composite products. Taken together with a
range of action by other partners, including government, primarily through the 5 A DAY work and
Change4Life, this should help people eat more F&V (DH, 2015). The scope of the pledges
includes:
(1)
Making F&V more widely available across all food outlets;
(2)
Making it easier for consumers to achieve their 5 A DAY target, for example, by
incorporating F&V into composite dishes or meals;
(3)
Encouraging people to increase F&V consumption through incentives or other
marketing activities; and
(4)
Providing information to encourage consumption and advice to develop
practical skills relevant to F&V consumption.
Once an industry partner has signed up to the pledge they are asked to report annually on their
progress. There are currently 48 partners across the food sector committed to this pledge. The
delivery plans for these partners have been collated (Appendix 1) and the 2015 updates
(Appendix 2).
6.5.
Summary
This section of the report has considered further public health initiatives (PHI) and more
specifically the role of CSR in consort with public health initiatives to achieve progress towards
increasing the consumption of F&V. Section 7 draws many of the themes outlined in the report
together as options for action at government, retailer, food service and farming and processor
levels. These options for action have been developed with an appreciation that they will only have
value in enabling the increased consumption of F&V if there is a recognition at consumer level of
the personal responsibility for ensuring individual, and household health and wellbeing.
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7. Options for action that can enable increased
consumption of F&V in the UK
Having undertaken the desktop study that underpins the report, a series of options for action have
been identified in this section of the report that individually or collectively, as part of a conserted
multiple intervention approach have the potential to increase the consumption of F&V in the UK.
7.1.
Options for action - Government
Choice architecture

Revisit planning regulations with regard to enabling choice architecture at community level
and ensuring that nutrient-rich foods are not simply “swamped out” by energy-dense food
alternatives.

Redesign the layout of food service areas and the positioning of food products in public
areas such as schools, hospitals, government workplaces in order to have increased F&V
availability at the start of the buffet setting, or the use of convenient options for F&V
products in vending machines.

Undertake a feasibility study to determine applicability within the UK policy environment
for the development of an equivalent Community Food Projects Competitive Grants
Programme (CFPCGP) in order to implement a nutrition incentive based approach as has
been developed in the United States (US) where it currently involves 110 community
based partners, 730 community health care centres, hospitals and food hubs (see Section
4.3).

Promote increased visibility of F&V within schools with an associated choice architecture
strategy in the food service setting.
Reformulation

Provide an enabling environment for food reformulation for example, through the
Public Health Responsibility Deal.
Information

Develop a cohesive strategy for enabling of F&V consumption with a view to promoting the
need for increased fibre and micronutrient consumption to ensure the nation’s health in
addition to existing initiatives (see Table 14).
7.2.
Options for action – Retailers
Choice architecture

Introduce mechanisms such as the use of floor markers, grocery trolley/cart or basket
mirrors, sectioning out parts of the trolley and labelling as a F&V area in the trolley or
basket and/or trolley or basket placards to reinforce the social norms associated with F&V
choice. Use of such placards in one study increased the spending on F&V by 12.4% in one
store and 7.5% in another with no net increase in spending (see 3.2.2). Provide information
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for consumers on the top five F&V items purchased in the store on shelf markers or visual
boards.

Revisit policies on shelf space allocation to F&V in store in terms of fixture location, product
category location, item location within categories, off-shelf displays and point of sale
promotional support (Yang and Chen, 1999). This should include a review of the frequency
of display and the positioning of F&V especially convenience, snack options of F&V in the
store layout.

Address the positioning of retail products on shelf especially snack products as positioning
has been shown to influence choice so that F&V are not disregarded (See Table 2).

Improve the use of shelf labels that identify nutrient-rich products, provide more
information on healthy meal ideas and recipes and consider a rewards programme for
purchasing healthy products (see Table 4).
Reformulation

Build health into existing food products with a programme of reformulation and refocus
especially ready-meals and revitalising the components of meal deal options to ensure
there is an increased featuring of convenience F&V products.

Increase the proportion of F&V snacks available as the trend increases to replace meals
with snack alternatives. Work specifically with supply chain partners to develop childcentred F&V snack products that are “fun shaped” for example, animals, letters etc. “fun
named” or with fun characters and positioned in a way in store to increase child purchasing
requests (see 3.2.1).
Information

Embed storage instructions on pre-packed F&V outer packaging so it can be seen on
purchase and when stored “in pack” in the home. It is important that this is visible when
the packaging is still intact on pre-packed F&V and is available at the point of purchase for
loose fruit for example, via information on bags, shelf cards, stickers that can be applied
to clear bags, paper bags with storage information. The size of print on pack and on instore
information is an important consideration so that all customers can access the
information. Improve understanding by customers of the need to refrigerate F&V to ensure
shelf-life in the home when it is often displayed in ambient conditions in-store. The ambient
display of produce is often confusing for consumers in this regard when the
recommendation is to then refrigerate food at home.

Promote product tastings, recipe cards featuring F&V that are ideal accompaniments for
ready-meals and promote the presence of healthy ingredients in convenience food options.

Increase staff knowledge about healthy food choices and nutrition. In one study (FMI,
2010) only 35% of shoppers felt that supermarkets enabled them to make healthy food
choices for their children, and only a quarter of shoppers felt that grocery store staff were
knowledgeable about nutrition or nutrition supplements.
7.3.
Options for Food Service
Choice Architecture
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
Redesign the layout of food service areas and positioning of food products in order to have
increased F&V availability at the start of the buffet and use convenient options for F&V
products on buffets.

Increase the proportion of F&V items available for children by develop F&V options that
are “fun shaped” for example, animals, letters etc. “fun named” or with fun characters and
positioned in a way on the menu or table information to increase child purchasing requests
(see 3.2.1).
Reformulation

Through menu development and recipe reformulation increase the range of food products
that contain F&V, and more specifically in “ready-to-go” products being offered in the food
service environment.
Information

Implement the labelling of food products in vending machines, buffets, and on menus with
red, yellow and green coding to signify the health benefits, or lack of them to people
choosing both meal and snack options. This has already begun with some food service
businesses promoting F&V based products for say under 350 calories for a meal option.
7.4.
Options for the Farming and Processing Sector
Choice architecture

Implement growing techniques that improve substrate and soil nutrient value and
mechanisms for increasing the nutrient content of the F&V grown, harvested, stored and
processed in the UK.

Work with other sector partners to develop a demand led strategy that could encompass
the development of new crop varieties, the need for new forms of packaging, promotion
and presentation and the mechanisms for promoting health messages to a multidimensional audience.
Reformulation

Build health into existing food products with a programme of reformulation and refocus
especially ready-meals and convenience products.

Increase the proportion of F&V snacks available as the trend increases to replace meals
with snack alternatives. Work specifically with supply chain partners to develop childcentred F&V snack products that are “fun shaped” for example, animals, letters etc. “fun
named” or with fun characters and positioned in a way in store to increase child purchasing
requests (see 3.2.1).

Identify new ways of delivering convenience to consumers through further processing of
F&V so it can compete as a convenience product.
Information

Embed storage instructions on pre-packed F&V so it can be seen on purchase and when
stored in the home.
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7.5.
Summary
The study and this associated report have addressed the underlying research questions:
The underlying research questions are:
1. What are the global initiatives that followed the World Health Organisation (WHO)
recommendation of 400g per day F&V consumption ?
2. How has UK public policy developed to encourage adults to consume 400g of F&V? daily?
3. What is the impact of the policy initiatives and whether adults are meeting the WHO
recommendations?
4. What actions have the food industry taken to encourage consumers to meet the F&V
consumption agenda?
5. In the academic-scientific/government literature what are the identified enabling and
constraining factors with regard to F&V consumption?
6. What is the role of UK growers in meeting the needs of consumers of F&V?
Options for action have been put forward as a result have been outlined by sector. The next
section draws together the conclusions from the report.
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8. Conclusions
The aim of this study was to undertake a desktop review to determine the constraining and the
enabling factors that influence United Kingdom (UK) consumer consumption of fruit and
vegetables (F&V)4 with a view to providing options for action on how such consumption could be
increased. The objectives of the study were to consider:

The degree of consumer engagement with policy initiatives such as the “5-A-DAY”, “Change
for Life” and the “Eatwell plate” (now the Eatwell Guide) and whether purchasing and
consumption of F&V has changed over the timeline of the projects;

The factors in the literature that are identified as constraining and enabling factors in the
consumption of F&V; and

The potential options for actions that could be implemented at policy, industry and
personal levels to increase the consumption of F&V in the UK.
A holistic approach was used in the study to draw together themes from a range of academic and
policy literature. In 1990 the World Health Organisation (WHO) recommended a minimum
consumption of 400g of F&V per day and in the UK this has translated into the 5-A-DAY initiative
and other initiatives globally (see Section 4.2). However, the impact of these public health
initiatives (PHI) on increasing F&V consumption on a sustained basis remains modest (Rekhy and
McConchie 2014). Success has been reported for those PHI which have forged partnerships
between industry, retail, government and not-for-profit organisations promoting public health
(Rekhy and McConchie 2014) see Section 4.4.
Whilst the relative affordability of energy dense foods compared to nutrient rich foods has been
suggested as a primary constraint, this report demonstrates that the landscape with regard to
enabling F&V consumption is in fact much more nuanced and multifaceted. Thus whilst
affordability is important, there are other positive steps that can be taken that show the potential
to make a real difference and increase the level of F&V consumption in the UK. This 2016 report
commissioned by the National Farmers Union (NFU) has considered the proactive steps that can
be taken to facilitate increased consumption of F&V. These include:

Choice architecture which is relevant to community environment, retail store, food service,
work place canteen and school canteen layout and managing portion control with a view
to influencing choice, promoting convenience and high calorie food/beverage availability
(see Section 3.2.2).

Reformulation - including more F&V in convenience options and other food offerings.
Relatively simple changes such as adding plenty of vegetables when cooking … could
make a significant improvement to the nutrient profile of meals (Benelam and Stanner,
2015).

Information - reminding people at the point of purchase about their choices, drawing
attention to social norms and framing information.
A range of global and national public health initatives have been described in sections four, five
and six of this report and the enabling and constraining factors that have influenced the success
4
The term F&V includes fruit, vegetables (including potatoes) and salad products
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of policy initiatives and the mechanisms such as the Public Health Responsibility Deal (PHRD)
that have sought to engage voluntary support from industry. The evidence suggests that current
PHI in the UK have failed to move the general public to average consumption of five portions of
F&V per person per day as recommended by the WHO therefore new and innovative methods
need to be developed, and implemented in order to increase consumption. These form the basis
for the options for action in the executive summary.
The factors that influence F&V consumption are complex and often interacting and influence
particular demographic groups in different ways. The challenge of reducing diet related
malnutrition (DRM) sits at a nexus of public policy, corporate responsibility and individual
responsibility.
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10.Appendix 1. Delivery Plans for the organisations pledged to F6 of the Public Health
Responsibility Deal (PHRD)
COMPANY
DATE
JOINED RD
DATE
SIGNED F6
DELIVERY PLAN
Aldi
10-Mar-11
01-Jan-13
ALDI is committed to encouraging customers to eat more fresh fruit and vegetables. We recognise the importance of a balanced diet which
includes a healthy mix of fresh fruit and veg. In addition to everyday low pricing, we run our fortnightly Super 6 fruit and veg offer. It’s a smart,
simple offer based on providing customers with a choice of 6 popular fruit and vegetables at fantastic prices. It means they can eat better for
less. We are working on helping our customers increase the amount of fruit and veg in their daily diets. Through a combination of national TV
advertising and in-store promotions including our popular leaflet, we can show customers how they can easily afford a wide-range of fruit and
vegetables, and how they can include these in the meals they eat. We also strongly promote fruit and vegetables through our official social
media channels including a dedicated Super 6 app on Facebook. We currently feature the 5 a day logo on our products and plan to dedicate
more space in-store to our fruit and veg category.
ARAMARK
14-Feb-13
14-Dec-13
ARAMARK will be launching a new health and wellbeing programme across its business from January 2014. In developing this programme,
we have taken the Responsibility Deal target areas as a key decision making factor. The key actions we will be taking that support this pledge
are: • All sites to have fruit available daily (whole fruit/ fruit salads) and where appropriate vegetable crudités as a chilled choice. • Menu
identifiers and shelf barkers used to promote products that contain part of your 5 a day. • Fruit to be displayed near other impulse buys in as
many sites as possible where space allows. • Fruit to be competitively priced and where possible, cheaper than confectionery. • Improve
display and range of fruit to make it more appealing to the customer. • All appropriate healthy choices on our menus contain part of your 5 a
day as a standard. • Our 2014 wellbeing activity planner for the company will focus on a priority health and nutrition topic each month. Many of
these topics will reference the importance of getting your 5 a day for example, healthy eating guide, vitamins and minerals, heart health. •
Table top marketing at point of sale – educating and reminding customers on what 1 of their 5 a day is and how they can achieve it,
particularly helping them to understand what a portion looks like. • Work towards meal deals to include fruit as an alternative to confectionery.
• Work towards offering salad/ vegetable alternative as a side dish for all main courses (instead of chips etc.). • Look into increasing vegetable
content within appropriate recipes
Artizian
29-Jun-11
13-May-14
No information provided on delivery plan for F6 pledge
23-Oct-13
Bartlett Mitchell takes the health and wellbeing of its customer seriously and as a fresh food contract caterer have signed up to the Fruit and
Vegetable pledge as it is an integral part of r decision making when developing menus. Each of our restaurants have a full range of fresh fruits
and seasonal vegetables available at all times and consider the nutritional benefit for its customers when putting together it's daily and weekly
menu to make sure we get the right balance for its customers.
Bartlett Mitchell Ltd
Bidvest 3663
08-Jul-11
01-Jan-13
3663 will do more to create a positive environment that supports and enables people to increase their consumption of fruit and vegetables,
and pledge to: Encourage customers to increase the procurement of products suitable for 5 a day through a variety of price promotions.
Provide Practical advice to customers on how to increase fruit and vegetable consumption within the 3663 Health and Wellbeing brochure,
which is due for publication in January 2013. Label relevant own brand product packaging as suitable for 5 a day where applicable, in
alignment with CMI 5 a day guidance.
Booker Group plc
10-Mar-11
07-Dec-12
Booker understands the importance of a balanced diet in maintaining good health and, within this, the key role played by fruit and vegetables.
We will introduce 5-a-day labelling wherever it is applicable on our range of own label foods. We will promote fruits and vegetables across our
wide customer base of small and medium sized retailers and caterers nationwide. We will further develop prominent fresh fruit and vegetable
displays within our branches.
Enabling UK consumers to increase their
consumption of fruit and vegetables 79
Brakes
04-Nov-11
British Frozen Food
Federation
07-Jun-11
CH&Co Catering Limited
12 July,
2011
19-Nov-13
CHCo currently supports the Fruit and Vegetable pledge in the following ways: Using its Veg Plot initiative to raise the profile and appetite for
vegetarian meals Using its Veg Plot 3 initiative to focus on consciously increasing the number of portions of fruit or vegetables customers
consume within its restaurants, rewarding multiple portion purchases with cash discounts to build new habits Highlighting the number of
portions of fruit or vegetables contained within a serving of a dish (whether meat/fish based or vegetarian) with clear labelling Creating a more
farmers market display approach in many of its restaurants, with raw ingredients featuring prominently, making them more accepted and the
norm for customers to see and therefore buy Increasing portion sizes of prepared fruit or vegetables to 80g to ensure that they count Using its
Wellbeing being well healthy eating initiative to highlight one changing ingredient each week (usually a fruit or vegetable) that is seasonal, and
makes a positive contribution to their health. This then features with the range of dishes on offer Running Wellbeing being well days where
customers can get more information about how to balance their diets and the benefits of this Working with nutritionist, Amanda Ursell, to
provide accessible information for customers and to underpin the initiatives above Our target for the next year is to: Increase the value of each
of these initiatives for our customers; making them more widespread and consistently in focus to the point where they are visible in 100% of
our staff restaurant (Business Industry) sites (clients permitting)Further increase awareness and understanding among our own staff through a
structured training plan, to give greater confidence when dealing with and cooking for their customers, Look for and consider other ways of
taking the pledge forward within CHCo.
Co-operative Group (The)
07-Mar-11
15-Nov-12
We are committed to helping our customers make healthier food choices for themselves and their families. This includes encouraging
customers to increase their consumption of fruit and vegetables through a variety of actions. Our pre-packed fruit and vegetables carry a 5-aday message in a green dot, as does pure juice and eligible canned, dried and frozen products. Suitable Co-operative brand composite
products; for example, ready meals, carry a 5a-day message on front of pack subject to meeting nutritional criteria based on IGD Composite
Foods Guidance. We offer a range of ready to cook and prepared vegetable products and our lunchtime meal deals include salads, prepared
fruit pots and pure juice options. Our simply value range includes a variety of fresh, frozen and canned fruit vegetable lines. We run
informative 5-a-day messages on till screens and on Co-operative radio. The Co-operative Food website has a dedicated 5 a day section
which links to an interactive seasonal wheel highlighting which fruit vegetables are in season each month. We also emphasise seasonal
recipes each month to encourage customers to use a variety of different produce. http://www.co-operative.coop/food/food-anddrink/food/Taste-the-seasons Fruit and vegetables lines are always included in promotional packages. The deals are included in promotional
leaflets and feature in the Healthier Deals section of our website. Frozen vegetables are always included in promotion offer as a convenient
way to get 5 a day. We ensure that at least 30% of our food promotions are for healthy offerings. As part of our sustainability education
programme, Green Schools Revolution, The Co-operatives unique from Farm to Fork scheme enables primary school children to benefit from
an interactive learning session and a hand-on tour of our farms to see how food including fruit and vegetables are grown. Children also learn
about the importance of eating a varied and balanced diet in order to make good food choices. Over 75,000 primary school children have
20/03/2016
15-Nov-12
Brakes and our fresh produce specialists, Pauleys have an extensive range of fresh, frozen, canned and dried fruits and vegetables as well as
juices. These are easily identified within our main sales brochure the list and our on line product information the list on-line. The same range of
products will be available to all caterers. Our Brakes website will have a section devoted to fruits and vegetables with an associated fact
sheet. Pauleys website is entirely devoted to fresh produce. We will encourage our customers to include more fruits and vegetables in dishes
and on menus by providing recipes including fruits and vegetables to be published in our regular promotions and on our website. We will also
work with the charity Behaviour Change through the Dabble with your Dinner campaign, which will provide tips and hints to include more fruits
and vegetables in popular dishes and meals. Where appropriate we will undertake promotions including fruits and vegetables to encourage
and enable caterers to serve and include more in their recipes and on menus.
The British Frozen Food Federation (BFFF) will provide tasty, healthy and convenient recipes on its consumer website to help to encourage
and promote the increased consumption of fruit and vegetables. BFFF are redeveloping and relaunching the BFFF consumer website to: ensure it will be more consumer friendly to attract increased traffic of consumers looking for meal solutions-provide healthy recipes, that will be
clearly signposted and, when meeting the required criteria, use the 5-a-day logo-facts on frozen will be provided with links to help consumers
understand 5-a-day and easily access Change4Life and other DH advice-independent academic research will be provided to support
consumers in making informed healthy choices
Enabling UK consumers to increase their
consumption of fruit and vegetables 80
attended a From Farm to Fork visit. http://www.co-operative.coop/farms/from-farm-to-fork/ In addition to continuing existing activities in 2013
we will explore new ways of changing consumer behaviour and develop initiatives to make it easier for people to buy, try, cook, eat and enjoy
a wider range of fruit and vegetables. We will: Use incentives to encourage customers to try more fruit and vegetables, for example money off
coupons and direct mail. Incentivise customers through our unique Membership scheme by awarding extra bonus points on purchases of fruit
and vegetables. Communicate the 5 a day message more prominently in store, on our website, on digital media and on our products.
Introduce new and exciting products containing at least one of your 5 a day. Feature information and recipes incorporating fruit or vegetables
in customer and staff publications and communications. This will include features on our own Farms and how and where fruit and vegetables
are grown. Incorporate further signposting for healthy eating including fruit and vegetables along with food labelling information within the
lesson plans for our Co-operative From Farm to Fork scheme.
Compass Group UK & Ireland
10-Mar-11
18-Mar-14
No information provided on delivery plan for F6 pledge
Coventry and Warwickshire
NHS Partnership Trust
02-Mar-12
01-May-14
Coventry and Warwickshire Partnership Trust are committed to the promotion of healthy lifestyle choices and as a Trust, we are aspiring to
change habits and encourage 5 a day We plan to review and extend the salad bars at St Michaels Hospital restaurant at Warwick, Brooklands
Hospital Coffee Bar at Birmingham and at the Jepson Bistro in Nuneaton. We Plan to meet with the food suppliers for these areas, they will be
asked to support us by supplying good quality seasonal fruit and vegetables. At each location, we will promote and raise awareness by
providing material that will support healthy eating. Will also focus on seasonal fruit and provide fruit salad pots and promotion of fruit of the
week
Dine Contract Catering Ltd
15-Feb-13
01-Nov-13
We will do more to create a positive environment that supports and enables people to increase their consumption of fruit and vegetables. We
will deliver this pledge using a 4-point plan; 1. From Sept 2013 we will increase the vegetable content of our new composite dishes by 15% baseline current content and new recipe information will be available on the extranet for monitoring purposes. 2. From Sept 2013 we will sell
all of our main meals with an accompanying portion of vegetables or salad. 3. Throughout the year we will run promotions to encourage
increased consumption of fruit and vegetables. For example; meal deals, price incentive to take a fruit based pudding with main meal; extra
serving of salad or vegetables free with main meal (over and above portion included); promotional cards at certain sites to collect stamps for
the number of fruit and veg portions taken in a week, collect 15 stamps in a week and get a free lunch. 4. Throughout the year we will publish
quarterly info shots highlighting the importance of consuming more fruit and veg, and how this translates directly as a health benefit to the
individual.
Empower 2 Excel
22-Feb-13
22-Feb-13
no information provided
Feel Good Drinks
31-Jan-13
13-Feb-13
Feel Good Drinks manufactures a range of fruit based drinks with no artificial ingredients and no added sugars. During the coming year we will
increase marketing investment to raise awareness of our brand and encourage consumers to try the products and switch from sugar based
drinks to our fruit based products. We will work with our retailer partners to ensure that fruit based drinks are available in the widest
distribution and that consumers are offered every opportunity to select our drinks. We will continue to innovate into new pack formats and new
flavours to encourage wider uptake and consumption of our healthy ingredients. Our target is to increase volumes by a minimum of 10%
during this year, equivalent to an additional 1M portions of fruit consumed.
Food Dudes Health Ltd
28-Feb-14
24-Oct-14
Developed by leading behavioural psychologists from Bangor University, the Food Dudes programme has been proven to deliver long lasting
changes in children's eating habits. Our pledge is to continue delivering long lasting increases in fruit and vegetable consumption among
Nursery & Primary school aged children who undertake the Food Dudes programme. Food Dudes is a unique award-winning Healthy Eating
programme for children that combines leading behavioural science techniques with fun activities to deliver outcomes that are unrivalled by any
other scheme available, by driving a massive increase in Fruit & Vegetable consumption and a reduction in consumption of high fat and sugar
foods and snacks. Food Dudes is a key component of a community-based childhood obesity prevention strategy. As a targeted intervention
Food Dudes is: - High impact - High feasibility - Highly cost effective - Supported by high quality research evidence - Able to deliver
quantifiable outcomes with local results published for each programme
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Enabling UK consumers to increase their
consumption of fruit and vegetables 81
Gather & Gather
30-Aug-11
17-Feb-14
Helping our customers reach their 5 a day target is an obvious priority here at Gather & Gather. For many of our customers 2 of their 3 meals
a day will be eaten in our restaurants and we therefore have a responsibility to positively influence their choices. In April 2014 we launch our 5
a day campaign where we provide our restaurants & cafes with stickers and information to label products which meet either 1 or 2 or your 5 a
day. Should it prove successful it will continue to run throughout the year. To incentivise teams, they will have the chance submit recipes and
photos of full meals they have served which they think may meet 3 of your 5 a day, this can be challenging. Education is key here and we've
empowered our managers and supervisors with enough information on "what counts" to make decisions on what to advertise, however any
queries they do have will be directed straight to our own Registered Nutritionist. As a business standard, all of our restaurants offer fresh fruit
in bowls and fresh fruit pots form part of our standardized grab & go range. Where meal deals are available fresh fruit will always be available
as a snack option and its competitively priced in comparison to those less healthy snacks. Sites with the facilities also offer fresh juices and
smoothies which will be marketed as 1 of your 5 a day only.
General Mills UK
10-Mar-11
15-Nov-12
General Mills has been proudly promoting the Department of Health’s 5 A Day message through the much loved Green Giant brand for many
years in the UK. The Fruit and Vegetable Pledge is an opportunity to confirm our continued support to promoting the 5 A Day message,
encouraging children to establish positive eating habits early on in life and doing our part to get more families eating more vegetables .A new
Green Giant Steam Locked Goodness message and media campaign, running from September featuring Green Giant Salt Free Sweetcorn,
will remind parents that canned vegetables are one of the most convenient and tasty ways to ensure children get 1 more of their 5 A Day. The
campaign will be supported online via the Green Giant website Facebook page and will include recipe ideas and the promotion of healthy
lifestyle habits.
Guide Dogs for the Blind
20-May-13
05-Jun-13
Guide Dogs for the Blind are committed to encouraging staff to eat more fruit and vegetables in order to achieve their 5 a day. Guide Dogs
recognize the importance of inspiring staff to implement a healthy balance diet which includes a mix of fruit and vegetables. Guide Dogs will
create a positive environment that supports and encourages staff to increase their consumption of fruit and vegetables through easily
available information and advice on healthy eating, promotional poster displays and workshops.
Harbour & Jones Ltd
12-Mar-13
20-Apr-13
Healthy eating and providing our customers with the information to make informed food choices is a priority at Harbour & Jones, which is why
we started investing three years ago in our own bespoke nutrition project called Nourish & Flourish. This doesn’t just involve providing
nutritional information but also aims to make information more accessible to customers by highlighting key health benefits such as one of your
five a day. Supported by our full-time H&J nutritionist, we have been educating our chefs and customers in a number of ways including
providing one-to-one tuition, onsite support, educational packs and roadshows. We’ve been educating our customers about why it’s important
to eat five portions of fruit and veg a day and we do this in a number of ways. We label our Grab & Go products with stickers indicating when
they contain 1 or 2 portions of the 5 a day -helping customers reach their target. We have developed our own smart phone app which means
our customers can find out even more about the food they eat in their staff restaurant just by looking at their phone. Using the latest nutritional
databases our app allows customers to view key information about the food on offer such as fat, calorie and salt content, as well as read
advice about maintaining a healthy diet and the importance of eating your five a day. Launching later in the year we'll be running a fantastic
fruit offer every Friday. Every time a bottle of water is purchased, we’ll give away a free piece of fruit. We will educate our staff on how to
merchandise fruit so that it makes customers more likely to buy. We’ll be continuing our Meat Free Mondays that highlight the health benefits
of eating vegetables and encourages customers to eat their five a day through yummy vegetarian options.
Iceland Foods Ltd
25/3/2011
15-Nov-12
Iceland Foods is committed to continuing to provide a wide range of quality fresh and frozen fruit vegetables at affordable prices, across our
764 stores high street stores. To meet this fruit and vegetable pledge Iceland is planning: to continue to indicate a "5 a day logo" and portion
indicators, on appropriate products; to review our Iceland website to include new 5 a day information tips, as well as link to the British Frozen
Foods Federation (BFFF) Website; highlighting how frozen fruit and vegetables are value for money, convenient, offer all round year
availability and are just as nutritious as fresh; new social media features to encourage customer conversation; to introduce money off coupons
at the till and will monitor the uptake of deals; continued new product development and range review; continued incorporation within ready
meal ranges.
20/03/2016
Enabling UK consumers to increase their
consumption of fruit and vegetables 82
Jamie Oliver Food Foundation
27-Sep-13
05-May-15
The Jamie Oliver Food Foundation promotes the consumption of fruits and vegetables in a number of different ways. The Kitchen Garden
Project, a set of resources that empowers primary school teachers to engage children in growing and learning about fruits and vegetables is
currently running in over 245 schools across the UK with the aim to be in 1,500 schools by the end of 2015. We also have a community-based
cookery programme, the Ministry of Food, with four centres and numerous outreach projects in the UK, and four centres and two food trucks
in Australia. The programme teaches adults the basic cooking skills and nutrition they need to give them the confidence to cook from scratch
and make better food choices. The Jamie Oliver Food Foundation provides nutrition messaging and resources to the Ministry of Food staff to
ensure they’re teaching nutrition accurately. The Fifteen Apprentice Programme is a social enterprise that gives unemployed young people the
training they need to become professional chefs. The programme began with Fifteen restaurants in London, and has franchises in Cornwall
and Amsterdam, where we aim to make sure that all children’s dishes are exemplary in terms of nutrition. The restaurants also offer at least
two of a child’s five a day on their menu. At Jamie Oliver HQ, we offer free fruit to staff on a daily basis and have produced fun and engaging
nutritional resources to teach both children and adults about nutrition and the benefits of fruits and vegetables. The resources are available
through Jamie Oliver Food Foundation programming.
LIDL UK Gmbh
08-Feb-12
15-Nov-12
Lidl will:- increase the number of prepared vegetable and salad lines, including trialling vegetable soup mix;- building on our activity supporting
Red Tractor week (24 30 September 2012), increase a number of new promotional activities featuring fruit and vegetables on billboards, from
September launch rebranded fun sized apples, pears and bananas with new packaging to appeal strongly to children use Facebook to
promote fruit and vegetables and provide free fruit for competitors at the Lidl sponsored Bananaman Triathlon and other sporting events. rebranding of all our fruit and vegetable items - the new packaging containing nutrition and health information and the number of 5 a day
portions.
LITTLE TINKLERS NURSERY
20-Jun-13
08-Jul-13
Little Tinklers Nursery is a private childcare provider primarily offering care for children from birth to five years. We also offer a holiday club
that cares for children aged 5 - 13 years. Little Tinklers pledges to ensure that children in our care receive a wholesome and healthy start by
offering : - A balanced and healthy menu every day for lunch, tea and snack times - Meals include servings of fresh fruit and vegetables each
day - Children have access to a wide range of raw fruit and vegetables each snack time - Staff set a good example by eating and sitting with
the children and show good table manners - Staff use snack and meal times to encourage independence in making healthy choices - Staff talk
about and help the children understand the need for healthy eating - Children have opportunity to try new and different / varied fruits /
vegetables - Children have the opportunity to cook with fruit and vegetables - The Nursery will provide parents with details each day of meals /
snacks the children have enjoyed - Menus are changed weekly and are displayed in the entrance foyer - All staff are trained to Level 2 in Food
Safety - Little Tinklers has been awarded ' Healthy pathways' status - Staff encourage healthy habits with the children such as teeth brushing
and hand washing
Marks & Spencer
04-Mar-11
15-Nov-12
MS are committed to supporting our customers to eat more fruit and vegetables and will continue to drive this through: Promotions - to
encourage customers to buy more fruit and vegetables Product continued reformulation of products to increase the fruit and vegetable content
of recipe dishes and to provide convenient health products, particularly at lunch, making it easy for customers to increase their consumption
Labelling continue to use and increase our 5 a day labelling, with a practical steer on portion sizes on basic vegetables and fruit, across our
healthy food ranges We will also launch healthy recipes online to inspire customers to try and cook with different vegetables
Mars (UK)
10-Mar-11
01-Sep-13
At Mars Food UK, we are passionate about providing enjoyable healthy food that combines great taste with good nutrition and we are
dedicated to Better Food Today, A Better World Tomorrow. The latest National Diet and Nutrition Survey found that the average consumption
of fruit and vegetables was 3.1 and 3.0 for women and men respectively. Helping the population to increase their fruit and vegetable
consumption to achieve the target of 5-a-day is an area where Mars Food has been contributing to and will continue to do so. For many years,
Mars Dolmio brand tomato sauces have contributed to the target, each serving providing 1 of your 5 a day, highlighting the important role that
composite products can play in helping the nation increase their consumption of fruit and vegetables. New product development of Dolmio
Sauce for Meatballs (3 varieties) in 2012 also contain 1 of your 5 a day. The innovation of Dolmio PastaVita ready meals in 2011, with each
meal containing 1 of your 5 a day, provided a new way for consumers to have a healthy meal containing 300 to 340 calories which are low in
fat, contain no artificial colours, flavours or preservative and are ready in 90 seconds. We also believe that our brand Uncle Bens has a role to
20/03/2016
Enabling UK consumers to increase their
consumption of fruit and vegetables 83
play and that rice based meals can offer an excellent way of providing the family with a healthy meal. Mars Food will continue to contribute to
increasing the nations fruit and vegetable consumption by Providing 1 of your 5 a day per serving in our Dolmio sauces NPD in 2013Providing
recipes on our Uncle Bens brand website to help increase the consumption of fruit and vegetables Providing education to our employees on
the benefits of eating 5 a day Continuing to ensure that fruit and vegetables are readily available in staff canteens and staff shops.
Morrisons (Wm Morrison
Supermarkets Plc)
10-Mar-11
15-Nov-12
We will revamp the produce department in more of our stores to encourage customers to increase their consumption of fruit and vegetables.
This will include new layouts, extended choice and exciting innovations. Vegetables will be placed on ice to ensure the best condition of the
product and misting technology will be used to optimise freshness. Exciting new lines will be added to give fruit and vegetables more of a wow
factor and displays will enhance the market feel. Our experience to date indicates that this could increase sales of fruit and vegetables by an
average of 14%, helping customers get nearer their 5-a-day. We are also committed to including at least one portion of fruit and vegetables in
children’s ready meals when our new range of children’s food launches next year. Going forward we plan to look at the potential of behaviour
change approaches to get more people buying fruit and vegetables.
PhunkyFoods
18-Jun-13
28-Jun-13
We pledge to inform and motivate staff, pupils, parents and the wider schools community within our existing partner primary schools about
increasing their fruit and vegetable consumption via the Phunky Foods Programme (PFP). This includes, but is not limited to; - increasing 5-aday information and practical guidance on all teacher training material - incorporating additional 5-a-day lesson plans for all year groups on the
PFP - adding more parental blogs on the 5-a-day message, and additional recipe blogs for practical inclusion of fruit and vegetables in
everyday recipes - Promoting our new 5-a-day information through our newsletters - 5-a-day cooking workshops run through our communitybased programmes by our regional Community Support Workers in partnership with our schools.
Portsmouth City Council
28-May-14
13-Aug-14
Portsmouth City Council recognises the need for its employees to eat a healthy balanced diet. A balanced diet is an important part of helping
its employees to feel their best and is therefore committed to supporting its employees by: Providing and promoting fresh fruit and salad
options within its staff cafe facilities. Promoting fresh fruit with meal deal packages. Promoting natural unsweetened fruit drinks. Working with
partners (for example, health service and suppliers) to encourage staff to consider healthy balanced diet options.
Princes Limited
25-Jun-13
13-Apr-14
Princes has for many years been one of the UKs leading suppliers of canned fruit and vegetables and we incorporate the Department of
Health’s 5 A Day message onto our products wherever possible, encouraging healthy eating habits. Over 170 of our branded products count
towards consumers One of 5 A Day and we intend to grow this in 2013/14 with new variants of pure fruit juice, canned fruit and vegetables.
We are also the largest purchaser of British grown vegetables for use in canning. All of our canned fruit and vegetables and pure juice
products are regularly promoted in stores and above the line to encourage consumer consumption. We also highlight the nutritional strengths
of canned food as well as convenience and minimal waste messaging. We also supply where possible differing pack formats (for
example,200ml juice) to increase consumption opportunities for our consumers and aim to increase our smaller pack size portfolio in the
coming year. We launched in April 2013 a range of fruit in jelly targeted for children’s consumption that highlights the 5 A Day message and is
the first brand to use natural fruit juice in the jelly.
RehabWorks (since 3 July,
2014)
03-Apr-14
03-Jul-14
No Links
Restaurant Group Plc
23-Oct-14
23-Oct-14
In many of our main lunch meals, such as pasta or wraps we offer a side of salad, as an alternative to fries to allow customers to make a
healthier choice. We will aim to roll this out across our menus, so that any time fries are offered, the customer can change this to a side salad.
Garfunkels offer a trip to the salad bar or a corn on the cob with any kid’s meal. We pledge to roll out an offer of salad or veg with any kid’s
meal across all our kid’s menus to encourage kids to get their 5aday and make it easier for parents. We are also working on making it easier
for our customers to make healthy choices by adding a logo onto our menus to highlight any dish that contains at least one of your 5aday.
These pledges will increase the fruit and vegetable content of our dishes and give dishes with fruit and vegetables more prominence on the
menu, allowing customers to make healthier choices.
20/03/2016
Enabling UK consumers to increase their
consumption of fruit and vegetables 84
Sainsbury's Supermarket Ltd
10-Mar-11
10-Mar-11
Our mission is to make the healthier choice the easiest choice for our customers and colleagues and a key part of this is helping them achieve
their 5 A Day. For a number of years, we have used many channels to promote fruit and vegetables to our customers. These include using a 5
A Day logo on pack and on our recipe tip cards plus giving customers inspirational ideas about how they can achieve their 5 A Day through
our in-store leaflets, magazines and our website. We also ensure price is not a barrier to fruit and vegetable consumption through ongoing instore price promotions, targeted coupon at till offers and through our value basics range which includes many low cost produce items,
including fresh, frozen, dried and canned. We are constantly developing our products to provide easy ways for customers to eat more fruit and
vegetables. This includes increasing the vegetable content our products (such as soups, sauces and ready meals) and also introducing new
healthier snacking options. For example, we recently added seven different 80g fruit bags to our £3 meal deal promotion, to encourage
customers to achieve one of their 5 A Day and to eat more fruit at lunchtime. We are now developing exciting plans to build on this activity
even further through various marketing channels and new product launches in the new year.
SecureHealth Ltd
27-Mar-13
27-Mar-15
Through our ongoing Health & Wellbeing program for all staff we provide regular information updates on areas such as sleep, stress, weight
management, and healthy eating. As part of the healthy eating initiatives we have had presentations on nutrition and 'eating for energy'. Staff
have been encouraged to attend these events and feedback has been very positive about the content and the introduction of changes into
diets. The benefits of fruit and vegetables is regularly expressed in these sessions.
Signalling Solutions Limited
08-Oct-14
20-Oct-14
Awareness of the benefits of a healthy diet is important for employee well-being which is why we, in SSL, encourage healthy eating amongst
our employees with our "Free Fruit Days". This is documented and published in our Sustainability Action Plan. SSL understand the pressures
of the industry in which we operate and we strive to maintain and improve our employee health, diet and well-being wherever possible in
conjunction with our supply chain.
Sodexo
10-Mar-11
19-Apr-13
Over the past few months we've made significant progress in support of this pledge on both fruit and vegetable intake. Activities include;
Modifying existing recipes and creating new recipes, offer price promotions to customers at point of sale, upselling, providing recipes and
factual information on 5 a day, as well as employee training. e.g We have bundle meals and promotions for example, free fruit with every
boxed salad available to all of our food outlets, with more than 100 site actively promoting this. Over the next year we will promoting this
across a further 700 sites. Promoting fruit with a meal deal. Our food offer for this year has been focused on promoting 5 a day and will
continue over the summer to include information around what constitutes a portion and the quantity used within our dishes. Through our
employee newsletter on nutrition and health, our Dietitians have written several articles around the promotion of 5 a day for our employees
and in our staff restaurants. Our summer healthier eating campaign known as 'Matt Dawson's be part of it' engaged with chefs, clients and
consumers on using fruit and vegetable within tasty recipes that followed our nutrition, health and wellbeing philosophy, Healthwise's. We
launched a fruity Friday campaign in our staff restaurants which has seen the consumption of fruit sales increase. In the coming year, such
activities will continue across our outlets and monitored.
Southend Borough Council
28-Mar-14
17-Jul-14
No Link
Southern Co-operative (The)
02-Sep-11
02-Sep-11
We are committed to helping our customers make healthier food choices for themselves and their families. This includes encouraging
customers to increase their consumption of fruit and vegetables through a variety of actions. Our pre-packed fruit and vegetables carry a 5-aday message in a green dot, as does pure juice and eligible canned, dried and frozen products. Suitable Co-operative brand composite
products; for example, ready meals, carry a 5a-day message on front of pack subject to meeting nutritional criteria based on IGD Composite
Foods Guidance. We offer a range of ready to cook and prepared vegetable products and our lunchtime meal deals include salads, prepared
fruit pots and pure juice options. Our simply value range includes a variety of fresh, frozen and canned fruit vegetable lines. Fruit and
vegetables lines are always included in promotional packages. The deals are included in promotional leaflets and feature in the Healthier
Deals section of our website. Frozen vegetables are always included in promotion offer as a convenient way to get 5 a day. We ensure that at
least 30% of our food promotions are for healthy offerings. We will continue to support initiatives such as Create and Cook and Fresh Fruit
Friday to encourage the use of locally supplied produce and target young people through these activities. In addition to continuing existing
activities in 2013 we will explore new ways of changing consumer behaviour and develop initiatives to make it easier for people to buy, try,
20/03/2016
Enabling UK consumers to increase their
consumption of fruit and vegetables 85
cook, eat and enjoy a wider range of fruit and vegetables. In line with The Co-operative Retail Trading Group we will: Use incentives to
encourage customers to try more fruit and vegetables, for example money off coupons and direct mail. Communicate the 5 a day message
more prominently in store, on our website, on digital media and on our products. Introduce new and exciting products containing at least one
of your 5 a day. Feature information and recipes incorporating fruit or vegetables in customer and staff publications and communications. This
will include features on our own Farms and how and where fruit and vegetables are grown. Incorporate further signposting for healthy eating
including fruit and vegetables along with food labelling information within the lesson plans for our Co-operative From Farm to Fork scheme.
Speiuss Ltd
19-Dec-12
19-Dec-12
No Link
Starbucks Coffee Company
30-Aug-11
31-May-13
Starbucks Coffee Company is continuing to work hard to help our customers reach the recommended five potions or fruit and vegetables a
day. All of our salads constitute one of the recommended five per day. We also offer fruit salad, constituting two of the five per day, and fresh
bananas in store, and are looking at increasing our fresh fruit offering. In addition, we are reformulating some of our products to include a
higher proportion of fruit and vegetables. For instance, our recently reformulated breakfast pot now contains enough fruit to represent one of
the recommended five per day. We continue to work hard to incorporate more fruit and vegetables into our other dishes. We are also
committed to providing our customers with all the information they need to make healthier decisions. All of our fresh food and menu board
products display calorific and saturated fat information, and salt and sodium content is included on all fresh food products. We continue to
work hard to ensure our customers have access to all the health information they need in making decisions. Starbucks Coffee Company also
actively promotes fruit and vegetable options in store. For example, we are highlighting our range of salads as our summer feature this year,
driving healthier menu choices. We look forward to other promotions of our fruit and vegetable products this summer, which we anticipate will
help our customers reach their five a day.
Subway International B.V.
10-Mar-11
10-Mar-11
The SUBWAY brand continues to partner with Heart Research UK to promote a healthy heart and lifestyle. At the core of the SUBWAY
brands health offering is the range of nine Low Fat Subs which are actively promoted by the brand. Our Low Fat Range forms the backbone of
our sales with around four in ten Subs sold in the UK and Ireland coming from this selection. Each of the Low Fat Subs contain less than 370
calories* and come with five standard salad items (lettuce, tomato, red onion, cucumber and green peppers) which combined equal one of the
Government's recommended 5-a-day portions of fruit and vegetables. In addition to these standard salad items, customers are encouraged to
add any additional salad options at no extra cost. The SUBWAY Kids Pak was reformulated in the summer 2013. In addition to the four Low
Fat 4-inch Sub options, the Kids Pak provides two of a child's recommended 5-a-day allowance of fruit and vegetables when choosing both
the BEAR Pure Fruit Yo-Yos and Capri Sun Fruit Crush Drink as part of their Kids Pak meal. As part of the Government's Responsibility Deal
saturated fat reduction pledge, the SUBWAY brand has also reduced the saturated fat in their Kids Pak by over 70% to offer a healthier option
to consumers with children. During 2014 the SUBWAY brand is trialling fresh apples as an offering in selected SUBWAY stores and we hope
to introduce apples as part of our product range nationwide later in the year. *Fat and calorie content refers to regular 6-inch Subs on Italian or
wheat bread prepared to standard recipe. For full nutritional information see subway.co.uk .
Tesco PLC
10-Mar-11
10-Mar-11
Increasing the fruit and vegetable content of our products and communicating this to our customers through our product labelling. This will
include: reviewing the fruit and vegetable content of ready meals or prepared meals in order to identify opportunities to increase fruit and veg
content phasing out half portion labelling from our own brand products so that the minimum portion a customer will eat if there is a 5 a day
"ping" is one portion2. Encouraging our customers to buy fruit and veg, including through price and promotions, new ranges and the
positioning of fruit and veg in store. Initiatives in this area include: Including fruit snack packs in our meal deals and putting single portions of
fruit at the front of our concept stores launching new, healthy ranges that include a minimum of one portion of fruit and vegetables (for
example, Eat, Live, Enjoy range) introducing new brands into our canned vegetable range to boost the appeal of canned produce moving our
frozen fruit to the dessert section to help encourage customers to choose frozen fruits as a dessert option3. Educating and informing our
customers and staff about eating more fruit and vegetables. Using our customer and staff publications to promote fruit and vegetable
consumption
20/03/2016
Enabling UK consumers to increase their
consumption of fruit and vegetables 86
The Health Insurance Group
14-Feb-13
14-Feb-13
The Health Insurance Group has been promoting the Department of Health’s ‘5 A Day’ message to staff in the UK. The Fruit and Vegetable
Pledge is an opportunity to confirm our continued support to promoting the ‘5 A Day’ message, encouraging staff to establish positive eating
habits and doing our part to get more families eating more vegetables. We believe this has a positive effect on their home and working life. We
are planning to have ‘fruit days’ in the office to promote this to staff and encourage them to eat more fruit. This will be backed up by an internal
communications campaign to promote the benefits of achieving ‘5 a day’.
The Truscott Arms
20-May-13
20-May-13
Within the next three months we will set up a system so that there is a staff fruit bowl daily, available in the staff room for free. We will also
ensure that the free staff meal provided each day includes at least one vegetable.
The Walton Centre NHS
Foundation Trust
22-Jan-13
22-Jan-13
The Trust is committed to the implementation of its Health and Wellbeing Strategy Work Well the Walton Way developed in April 2011.The
Trust will: Raise awareness of healthy eating through poster campaigns, Intranet health promotion banners and Trust Newsletters Promote
participation in the Trusts Weight Management Course educating staff on food content and labelling Work with restaurant external provider on
healthy options available for staff including fruit and vegetables Gain accreditation of the Work Place Wellbeing Charter by March 2013Sign up
as a local supporter for Change4lifeProvide free fruit for staff who work nights, on call and the late shift Encourage staff to act as role models
in particular with patients
University of Sheffield
16-Apr-13
16-Apr-13
We have introduced a number of initiatives in order to promote the consumption of Fruit & Vegetables in our cafes & dining rooms. These
include the option of two pieces of fresh fruit as an alternative to other snacks in our “Meal Deals”. Introducing “self-service” of vegetables with
main courses to encourage consumption of larger portions of vegetables but without additional charge. We are adapting our recipes to
increase the fruit or vegetable content in appropriate dishes as well as featuring more vegetable based dishes & salads on our menus. Our
delivered hospitality menus are currently under review & it is proposed that more emphasis will be placed on the provision of freshly prepared
salad based dishes, vegetable based soups, fruit platters, fresh fruit smoothie shots & juices, fruit compotes etc.
Waitrose
10-Mar-11
10-Mar-11
Waitrose supports the overall principle of the fruit and vegetable pledge. We share the Governments aspiration to improve the health of the
nation. Helping people lead a healthy lifestyle has been at the heart of our nutrition strategy for the past ten years. This includes encouraging
customers to combine a balanced diet with exercise and offering a free nutrition advice service. We commit to using a range of approaches to
encourage our customers to increase their fruit and vegetable consumption including fresh, frozen and canned. We aim to encourage
increased fruit and vegetable intake by: The introduction of new Fresh Produce Advisors in the majority of our branches in 2013. The
Specialists will train for a City Guilds Level 3 Diploma in Retail Skills and will gain knowledge on merchandising display standards, product,
seasonality and food preparation, which will enable them to provide our customers with expert information on what to buy and how to use it.
Continued regular promotions to encourage variety, choice and diversity in the weekly shopping basket. This applies across multi-buys and
multi-category. This will be highlighted in branch through point of sale information and further supported with recipes and coupons in Waitrose
Weekend. Making it easier and more appealing for customers to choose pre-prepared fruit and vegetable products. Highlighting positive
aspects such as quality and taste to our customers through labelling and signage plus bespoke activity to showcase best in season through
seasonal recipe cards. The production of our inspirational Harvest Magazine six times a year - a dedicated magazine with a high majority of
vegetable based recipes - to encourage our customers to cook dishes with vegetables. Providing inspiration and information through the
newly launched Waitrose TV channel including How to video recipe demonstrations. Content will be added to the channel through 2013 to
encourage fruit and vegetable intake and through the 5 a day pages on waitrose.com demonstrating how easy it is to reach 5 a day. Helping
consumers understand what counts towards their 5 a day target through use of our 5 a day logo on fresh, frozen, dried and canned fruits and
vegetables and juices. As part of improving consumers understanding, we have extended our on-pack logo to quantify and clearly
communicate the recommended portions for example, 150ml serving of juice, 10 cherry tomatoes, 30g dried fruit, 80g sweet corn kernels.
Extend our range of LOVE life healthy products. Nutritional criteria for the range states that products must contribute at least of 1 of your 5 a
day and in many cases 2 of your 5 a day, for example in chilled soups.
20/03/2016
Enabling UK consumers to increase their
consumption of fruit and vegetables 87
Wellbeing People
Source (DH, 2015b)
20/03/2016
05-Feb-13
05-Feb-13
During the coming year Wellbeing People will increase staff awareness of our brand and encourage all staff to recognise the importance of a
healthy balanced diet by eating more fresh fruit and vegetables. We will provide 'healthy eating top tips and recipes from our in house
nutritionist via regular bulletins, to encourage wider uptake and consumption of healthy ingredients. Our target is to increase staff and
customer consumption volumes throughout the coming year.
20/03/2016
NUMBER OF PRODUCT LINES:
3. HOW MANY STORES OR OUTLETS (FOOD
MANUFACTURERS SHOULD STATE PRODUCT
LINES) WERE INVOLVED IN YOUR PLEDGE
ACTIVITY?
(X) OTHER - IF OTHER, PLEASE SPECIFY.
(IX) OBTAINING FEEDBACK FROM CUSTOMERS
ON WHETHER THEY INCREASED THEIR FRUIT
AND VEGETABLE INTACT, AND WHICH
INITIATIVE WORKED BEST
(VIII) EMPLOYEE TRAINING OR WELLBEING
INITIATIVES TO ENCOURAGE INTAKE
(VII) PROVIDING INFORMATION (WEB, TV,
RADIO, PRINT)
(VI) PROVIDING FACTUAL INFORMATION ON
LEAFLETS OR POSTERS OR ON PACK FOR
EXAMPLE, LOGOS INDICATING FRUIT AND
VEGETABLE CONTENT
(V) PROVIDING RECIPES OR TIP CARDS
(IV) PROMOTIONS AT POINT OF SALE - ON
PACK, IN AISLE, ON MENU
(III) OFFER PRICE PROMOTIONS OR OFFERS TO
CUSTOMERS
(II) CREATING NEW PRODUCTS OR RECIPES
(I) REFORMULATING PRODUCTS OR
MODIFYING RECIPES
1) WITHIN YOUR PLEDGE ACTIVITY DID YOU
INCLUDE ACTION ON FRUIT AND/OR
VEGETABLES?
Enabling UK consumers to increase their
consumption of fruit and vegetables 88
11.Appendix 2 – 2015 updates on F6 pledge in PHRD
2) DID YOUR FRUIT AND/OR VEGETABLES PLEDGE ACTIVITY INVOLVE ANY OF THE FOLLOWING? PLEASE INDICATE Y/N.
Aldi
y/y
y
y
y
y
y
y
y
y
n
n
678
n/k
ARAMARK
y/y
y
y
y
n
y
y
y
y
n
n/a
350
100
Artizian
No
information
provided
Bartlett Mitchell Ltd
n/n
n
y
y
y
y
y
y
y
y
n/a
85
n/k
Bidvest 3663
y/y
n/a
y
y
n/a
y
y
y
n/a
n/a
n/a
n/a
Fresh, Frozen,
Chilled,
Booker Group plc
y/y
n/a
n/
a
y
y
n/a
y
n/a
y
n/a
n/a
202
60
Enabling UK consumers to increase their
consumption of fruit and vegetables 89
Brakes
y/y
n/a
n/
a
We have
worked with
the Children's
Food Trust to
develop and
publish
vegetarian
recipes to help
schools meet
the
requirement to
offer
vegetarian
dishes without
dairy products;
all these
recipes include
lots of
vegetables
During the
relabelling of
products to meet
the requirements
of the Food
Information
Regulations, we
have included the
five-a-day logo on
canned, frozen
and dried fruit and
vegetables,
wherever
appropriate. We
also continue to
use the five-a-day
logo in our lists
and brochures
n/a
n/a
n/a
We continue to link to Dabble with
Your Dinner and Eat Seasonably, who
promote the inclusion of more fruit
and vegetables in dishes.
Up to
25000
catering
outlets
each
month
15 different
product lines
over 12
months
http://eatseasonably.co.uk/
British Frozen Food
Federation
y/y
n
y
n
n
Yes
y
y
n
n
n
n/a
4
CH&Co Catering
Limited
y/y
y
n/
a
n
y
n
y
y
y
n
Y - We have been involved in a piece
of academic study to monitor the
effectiveness of a new way of
encouraging customers to eat more
veg because they think that they are
being odd by not doing so. more
information will be released as the
results become clear.
100
n/a
Co-operative Group
(The)
y/y
n
y
y
y
y
y
y
y
Continue
d to
issue
coupons
at till for
the fruit
& veg
category
at key
times
througho
ut 2014.
all
n/a
Compass Group UK &
Ireland
y/y
y
y
y
y
y
y
y
y
y
1500
n/a
20/03/2016
n
Enabling UK consumers to increase their
consumption of fruit and vegetables 90
Coventry and
Warwickshire NHS
Partnership Trust
y/y
y
y
y
y
y
y
y
y
n/a
n/a
4
Dine Contract
Catering Ltd
y/y
n
y
n
y
y
n
y
y
n
n/a
100%
Empower 2 Excel
no
information
provided
n
y
y
y
n
y
y
y
n
n
20000
24
Feel Good Drinks
y/n
Food Dudes Health
Ltd
no
information
supplied/
organisation
no longer
active.
Gather & Gather
y/y
y
y
y
y
y
y
y
y
n
n
280
n/a
General Mills UK
n/y
n/a
y
y
y
y
y
y
y
y
n/a
2500+
15+
Guide Dogs for the
Blind
y/y
N
n
y
n
y
y
y
y
y
n/a
26
0
Harbour & Jones Ltd
y/y
n
y
y
y
y
y
y
y
y
n/a
28
n/a
Iceland Foods Ltd
y/y
y
y
y
y
n
y
y
y
n
n/a
850
72
Jamie Oliver Food
Foundation
y/y
y
y
n
n
y
y
y
y
y
n/a
0
0
LIDL UK Gmbh
y/y
y
y
y
y
y
y
n
y
n
y Healthy Tills
610
130
LITTLE TINKLERS
NURSERY
y/y
y
y
n
n
y
y
y
y
n
n/a
1
60MEALS YEAR
Marks & Spencer
Y/Y
Y
Y
Y
Y
Y
Y
Y
Y
N
n/a
all stores
n/a
Mars (UK)
y/y
n/a
y
n/a
n/a
y
y
n/a
y
n/a
n/a
n/a
n/a
Morrisons (Wm
Morrison
Supermarkets Plc)
y/y
y
y
y
y
n/a
n/a
n/a
n/a
n/a
N/A
500+
50+
PhunkyFoods
y/y
n
y
n
n
y
y
y
y
n
n/a
228
primary
20/03/2016
unsure
Enabling UK consumers to increase their
consumption of fruit and vegetables 91
schools
n/a
Portsmouth City
Council
y/y
y
y
y
y
y
y
y
y
y
n/a
2
10
Princes Limited
y/y
n
y
y
y
y
y
y
y
n
n/a
0
200
RehabWorks (since 3
July, 2014)
No Links
Restaurant Group Plc
n/y
y
n
y
y
n
n
n
n
n
n/a
280
0
Sainsbury's
Supermarket Ltd
y/y
y
y
y
y
y
y
y
n
n
Our 2015 'Love your Freezer'
campaign encouraged people to use
frozen ingredients to create quick,
tasty and nutritious family meals, with
a particular focus on using fruit and
vegetables. In January 2015 we
introduced two new My Goodness!
sandwiches to our range - which
include an 80g portion of fruit and
veg, counting as one of your five-a-day.
We overcame technical challenges
and achieved this without any
compromise to texture or taste. In May
2014, we introduced a range of five
different salad sprinkles, all priced at
50p and made up of a combination of
fruit, nuts, seeds, herbs and spices.
They were introduced to encourage
customers to eat salad more
frequently, and to date we have sold
over 200,000 sprinkle sachets. We
continue to give our customers meal
deal inspiration through recipe cards
and we highlight which recipes are
green and amber on the traffic light
labels and contribute to 5-a-day.
Additionally, we promote the
consumption of fruit and vegetables
through advice and tips on our Live
Well for Less website and magazine.
1300
SecureHealth Ltd
y/y
n
n
n
n
n
n
n
y
n
n/a
0
Signalling Solutions
Limited
No Update
20/03/2016
0
Enabling UK consumers to increase their
consumption of fruit and vegetables 92
Sodexo
y/y
y
y
y
y
y
y
n
y
y
n/a
792-1070
Southend Borough
Council
y/y
n
n
n
n
y
n
y
y
y
y - No other details
24
Southern Cooperative (The)
y/y
n
y
y
y
y
y
y
n
n
n/a
All
0
Speiuss Ltd
No Link
Starbucks Coffee
Company (since 31
May, 2013)
No 2015
update
Subway International
B.V.
y/y
n
n
y
y
n
y
y
y
y
Yes - We promote our range of Salads
during the summer months. Our
salads count as two portions of the 5
A Day target.
1946
93
Tesco PLC (since 10
March, 2011)
y/y
y
y
y
y
y
y
y
y
n
n/a
All Stores
0
The Health Insurance
Group (since 14
February, 2013)
y/y
n
n
n
n
n
n
n
y
n
n/a
0
0
The Truscott Arms
No Updates
The Walton Centre
NHS Foundation
Trust
y/y
20/03/2016
During 2014 the Trust continued to
raise awareness of healthy eating
through poster campaigns the Trust
intranet and the weekly newsletter.
There is active participation of staff in
a weekly weight management
programme. The Trust continues to
work with the external provider of the
bistro and coffee shop on healthy
options for staff. A fruit and vegetable
stall attends the Trust 3 times a week.
The Trust have engaged with the local
community and have provided food
banks on a regular basis throughout
the year. Participating in "dechox"
during March 2015, staff can swap a
chocolate bar for a piece of fruit. All
proceeds will go to a food bank for
Easter. The Trust have achieved
0
Enabling UK consumers to increase their
consumption of fruit and vegetables 93
Investors in People Good Practice
Award: Health and Wellbeing.
University of Sheffield
y/y
y
y
y
y
y
n
n
y
n
n/a
The Edge
Dining
Room &
Delivered
Hospitality
0
Waitrose (since 10
March, 2011)
y/y
y
y
y
y
y
y
y
y
n
n/a
336
0
Wellbeing People
y/y
y
y
y
y
y
y
y
y
n
We provide fresh fruit twice weekly to
all staff and have reached 1,000 fruit
boxes delivered to our customers in
Jan2015. We gather feedback in the
form of testimonials on our website.
3
0
20/03/2016