Interventions to promote healthy eating: a systematic scoping review of regulatory approaches

Abstract Background Nutrient-poor diets, especially if high in fat and sugar, are associated with an estimated 70 000 excess deaths annually in the UK. Multifactorial strategies are needed to address this burden of ill health. Government regulations provide a framework for action, setting standards that can be monitored. In this systematic scoping review, we considered the effectiveness of regulatory interventions to promote healthy eating. Methods The review (PROSPERO #CRD42013002998) comprised a systematic scoping review of regulatory interventions directed at healthy eating, and two in-depth reviews on (1) regulatory strategies to reduce artificial trans-fats in food and (2) school-based fruit and vegetable initiatives. As a systematic scoping review, we followed Cochrane and other systematic review guidance, but the search was designed to be comprehensive rather than specific, and data were synthesised to map the published work. We systematically searched for studies of regulations, rules, and legislation (regulation) to affect healthy eating. Regulations might seek to affect dietary behaviour (food consumption) or to control the nutritional content of food (food production) by specifying levels of individual nutrients such as artificial trans-fats or salt. Regulations to facilitate healthier choices may alter food environments though labelling, calorie display, marketing or advertising controls, food served in schools or child care, zoning and urban planning regulations, restrictions to benefits schemes, and taxes or subsidies. Population-level initiatives and targeting population subgroups were included. Outcomes could be long term, intermediate, or short term. Primary research studies with a recognisable research method were included; those of indirect and non-regulatory interventions were excluded. We searched Medline, Embase, ISI Web of Knowledge, and EconLit from their start dates to the end of December, 2012; Google Scholar for grey literature, including unpublished research or government reports; and bibliographies by hand. 10% of titles and abstracts were independently double screened. A data extraction form, which also assessed risk of bias, was derived from Cochrane Effective Practice and Organisation of Care guidelines, with a subsample of studies extracted in duplicate. Findings We screened 38 162 de-duplicated records, of which 80 were included in the scoping review. Eligible studies were analysed by narrative synthesis because of their h