Placing fruit and vegetable sections near supermarket entrances increases the amount purchased and may improve the quality of women's diets, according to a new study funded by the National Institute for Health and Care Research (NIHR).
Published in the journal PLOS Medicine , the results of the study showed that the placement of such produce near store entrances led to approximately 2,525 extra portions of fruit and vegetables being purchased per store, per week. This contrasted with substantial declines in population-level fruit and vegetable purchasing and intake over the study period, which coincided with the COVID-19 pandemic and the cost-of-living crisis.
The researchers say that Government regulations to curb the promotion of unhealthy foods should consider requiring the placement of a fruit and vegetable section at store entrances – as well as limiting the placement of unhealthy foods in locations such as checkouts, aisle-ends and store entrances to maximise their health benefit.
The study was led by researchers from the Centre for Food Policy at City St George's, University of London and the MRC Lifecourse Epidemiology Centre at the University of Southampton, and working with other researchers from the University of Southampton, University of Leeds and Deakin University, Australia.
Obesity and poor diet are major public health concerns and retailers' marketing strategies, often through product placement in stores, have a major impact on food choices. Previous studies have shown that less than 1% of placement promotions are for fruit and vegetables. Many supermarkets do place fresh fruit and vegetables where customers encounter them on entering the store, but it is less common in discount and small supermarket chains.
The researchers carried out the trial in 36 stores (18 intervention and 18 control) of a discount supermarket chain in England, between March 2018 and May 2022. In total, 580 women customers aged 18 to 60 years took part in the study (280 in the intervention, and 300 in the control). This group was targeted because improving their diets improves their own health, and the short and long-term health of their children. Women within this age group are also still primarily responsible for domestic food-related tasks that influence their partners' and families' diets.
Analysis showed that differences in the intervention group compared to the predicted store-level sales of fruit and vegetables were equivalent to around 2,525 extra portions per store, per week. These figures could translate to clinically meaningful improvements to population health because an increase of 50g of fruit and vegetables per day (1 portion is 80g) has been associated with 20% reduction in all-cause mortality.
The results also suggest that after six months of exposure to the intervention, the nutritional benefit may be slightly higher for families who mostly shopped at the study store and where the woman shopper has no formal post-school educational qualifications. Women's dietary quality improved after six months of exposure to the intervention, compared to women not exposed to the intervention.
Professor Christina Vogel, lead author of the study and Director of the Centre for Food Policy at City St George's, University of London and Adjunct Professor at the University of Southampton, said:
"The food industry and the public are trapped in a 'junk food cycle', where unhealthy foods are cheap to make, profitable to market, appealing to eat and affordable to buy. To counter this, our study shows that placing fruit and vegetables at the entrances of discount supermarkets increased fresh fruit and vegetable sales.
"These results are important given population-level declines in fruit and vegetable sales and intake in the UK over the period of the study, due to COVID-19 and other issues. During the same period, UK household purchasing of fruit fell 7.2% and 5.3% for vegetables. On average, households are purchasing fewer than four portions of fruit and vegetables per day for the entire family.
"Given our findings, the Government should consider expanding the UK Food (Promotions and Placement) regulations in England to require the positioning of fresh produce sections near store entrances in all large food stores to boost fruit and vegetable sales and improve the nation's diet."
Professor Adam Briggs, Director of NIHR's Public Health Research (PHR) Programme, said:
"Poor diet remains a leading cause of ill health and inequalities in the UK and tackling this requires action across a range of policy areas. WRAPPED's promising results show how small changes in our supermarket layouts can impact our shopping habits and encourage healthier diets that can help prevent obesity and diet-related disease. It's a great example of how carefully involving retailers in research can help deliver practical real-world insights."
