Dr Rebecca Stone

In westernised countries, food insecurity (FI), poorer diet quality, and obesity are disproportionately represented in groups experiencing socio-economic disadvantage. Grocery stores are one promising arena for intervention; however how these settings can facilitate purchasing of healthier, more sustainable food in people living with obesity (PLWO) and FI remains unclear. Using an online survey (N=583), adults residing in England or Scotland with a body mass index of ≥30kg/m2 self-reported on FI, diet quality, and their experiences of shopping in a grocery store for healthy and sustainable food. Using structural equation modelling, greater FI was directly associated with barriers from the food environment (e.g., price), food preparation practices, lower healthy diet knowledge and physical ill-health. Moreover, greater FI was indirectly associated with poorer diet quality via poorer mental health and greater experiences of self-stigma associated with being food insecure. Grocery store interventions based on price or incentivisation were ranked most helpful in supporting healthier, more sustainable purchasing. These findings highlight the challenges faced by this group when shopping and underscore the need for policy development relating to price and affordability at a population-level, and for clinicians to offer tailored, holistic approaches to obesity treatment that acknowledges and minimises stigma and mental health.

In westernised countries, food insecurity (FI) is robustly associated with low diet quality, and obesity. Grocery stores are one promising arena for interventions to facilitate purchasing of healthier, more environmentally sustainable food. However, we currently lack understanding of the barriers experienced by people living with obesity (PLWO) and FI when shopping for such food. Using an online survey (N = 583), adults residing in England or Scotland with a body mass index of ≥ 30 kg/m2 self-reported on FI, diet quality, and their experiences of shopping in a grocery store for healthy and environmentally sustainable food. Participants also ranked different grocery store interventions on their helpfulness in supporting healthier, more environmentally sustainable purchasing. Structural equation modelling revealed that greater experiences of FI were directly associated with greater experiences of barriers from the food environment (e.g., price), food preparation practices, lower healthy diet knowledge and physical ill-health. Moreover, greater experiences of FI were indirectly associated with lower diet quality via mental ill-health and greater experiences of anticipated stigma associated with being food insecure. Grocery store interventions based on price/ incentivisation were ranked most helpful in supporting healthier, more environmentally sustainable purchasing. These findings highlight the challenges faced by PLWO and with greater experiences of FI when shopping for healthy and environmentally sustainable food. Findings also underscore the need for policy development relating to price and affordability at a population-level, and for policymakers and healthcare professionals to consider how to address mental health and how to minimise anticipated stigma experienced by this vulnerable group.

Background Children’s tendency to eat while they are emotional, irrespective of satiety, is termed emotional eating (EE). EE develops early in childhood and has been associated with maternal modelling of EE and food parenting practices. In addition, individual differences in a child’s appetitive traits (ie, food approach behaviors) are related to the development of EE. Objective The objective of this study was to examine whether or not the previously identified mediating relationship between maternal EE and child EE via maternal use of food as a reward, food for emotion regulation, or restriction of food for health reasons varies as a function of child food approach. Design A cross-sectional online questionnaire study was conducted. Participants/setting One hundred eighty-five mothers of children aged between 3 and 5 years were recruited between January 2020 and March 2020 from advertisements placed on social media in the United Kingdom. Main outcome measure Questionnaires assessed child EE, child food approach tendencies, maternal EE, and food parenting practices. Statistical analyses performed Using PROCESS version 3.4, model 14, moderated mediations were employed to assess whether or not child food approach tendencies moderated the mediating effect of controlling food parenting practices between maternal EE and child EE. Results This study found the relationship between maternal reports of maternal EE and child EE was mediated by maternal use of food as a reward, but only for children with high food approach tendencies (B = .05, 95% CI 0.010 to 0.101; R2 = 48%). This study also found the relationship between maternal EE and child EE was mediated by maternal use of restriction for health reasons, but only when children showed medium (B = .02, 95% CI 0.004 to 0.072) to high (B = .06, 95% CI 0.016 to 0.110; R2 = 51%) food approach tendencies. Conclusions The potential for the intergenerational transmission of EE via the use of food as a reward and food restriction may be exacerbated when a child has higher food approach behaviors.

Emotional eating (EE; defined as overeating irrespective of satiety and in response to emotional states) develops within childhood, persists into adulthood, and is linked with obesity. The origins of EE remain unclear, but parental behaviours (e.g., controlling feeding practices and modelling) and child characteristics (e.g., temperament) are often implicated. To date, the interaction between these influences has not been well investigated. This study explores whether the relationship between parent and child EE is shaped by parental feeding practices, and if the magnitude of this relationship varies as a function of child temperament. Mothers (N = 244) of 3–5-year-olds completed questionnaires about their EE, feeding practices, their children's EE and temperament. Results showed that parental use of food to regulate children's emotions fully mediated the relationship between parent and child EE, and using food as a reward and restricting food for health reasons partially mediated this relationship. Analyses demonstrated that the mediated relationship between parent and child EE via use of food as a reward and restriction of food for health reasons varied as a function of child negative affect, where high child negative affect moderated these mediations. These findings suggest child EE may result from interrelationships between greater parent EE, use of food as a reward, restriction of food for health reasons and negative affective temperaments, but that greater use of food for emotion regulation may predict greater child EE irrespective of child temperament.

In 2025, around one in seven UK households struggle to afford to buy nutritious foods like fruits, vegetables, and lean meat and are said to be experiencing food insecurity. Families living on a low income are often forced to buy cheaper, less healthy foods, high in fat, salt, sugar and calories, which, when eaten regularly, can lead to an increase in body weight. This highlights a serious problem called dietary inequality, where not everyone within society has the equal access to healthy foods. Researchers from the Food Insecurity in People Living with Obesity (FIO Food) Project are working alongside policymakers, supermarkets and those who have experienced the struggle to afford healthy food, to help find solutions to support citizens living on a low income, purchase healthier food from the supermarket. When we all work together, we can create a world where healthier food is accessible and available for everyone.

Lower income households are at greater risk of food insecurity and poor diet quality. In high-income countries, food insecurity is associated with higher levels of obesity, and the global cost of living crisis is likely to have exacerbated existing dietary inequalities for people living with obesity (PLWO) and food insecurity. However, there is a paucity of research on the impact of the cost of living crisis on food purchasing and food preparation practices for PLWO and food insecurity. Using an online survey (N = 583) of adults residing in England or Scotland with a body mass index (BMI) of ≥ 30kg/m2, participants self-reported on food insecurity, diet quality, perceived impact of the cost of living crisis, and their responses to this in terms of food purchasing behaviours and food preparation practices. Regression analyses found that participants more impacted by the cost of living crisis reported greater experiences of food insecurity. Additionally, food insecurity was associated with greater use of specific purchasing behaviours (i.e., use of budgeting, use of supermarket offers) and food preparation practices (i.e., use of energy-saving appliances, use of resourcefulness). Exploratory analyses indicated that greater impact of the cost of living crisis and use of budgeting were associated with poorer diet quality, whereas greater use of meal planning was associated with better diet quality. These findings highlight the fragility of food budgets and the coping strategies used by PLWO and food insecurity during the cost of living crisis. Policy measures and interventions are urgently needed that address the underlying economic factors contributing to food insecurity, to improve access to and affordability of healthier foods for all.

Lower income households are at greater risk of food insecurity and poor diet quality. In high-income countries, food insecurity is associated with higher levels of obesity, and the global cost of living crisis is likely to have exacerbated existing dietary inequalities for people living with obesity (PLWO) and food insecurity. However, there is a paucity of research on the impact of the cost of living crisis on food purchasing and food preparation practices for PLWO and food insecurity. Using an online survey (N = 583) of adults residing in England or Scotland with a body mass index (BMI) of ≥ 30kg/m2, participants self-reported on food insecurity, diet quality, perceived impact of the cost of living crisis, and their responses to this in terms of food purchasing behaviours and food preparation practices. Regression analyses found that participants more impacted by the cost of living crisis reported greater experiences of food insecurity. Additionally, food insecurity was associated with greater use of specific purchasing behaviours (i.e., use of budgeting, use of supermarket offers) and food preparation practices (i.e., use of energy-saving appliances, use of resourcefulness). Exploratory analyses indicated that greater impact of the cost of living crisis and use of budgeting were associated with poorer diet quality, whereas greater use of meal planning was associated with better diet quality. These findings highlight the fragility of food budgets and the coping strategies used by PLWO and food insecurity during the cost of living crisis. Policy measures and interventions are urgently needed that address the underlying economic factors contributing to food insecurity, to improve access to and affordability of healthier foods for all.

Lower income households are at greater risk of food insecurity and poor diet quality than higher income households. In high-income countries, food insecurity is associated with high levels of obesity, and in the UK specifically, the cost of living crisis (i.e., where the cost of everyday essentials has increased quicker than wages) is likely to have exacerbated existing dietary inequalities. There is currently a lack of understanding of the impact of the current UK cost of living crisis on food purchasing and food preparation practices of people living with obesity (PLWO) and food insecurity, however this knowledge is critical in order to develop effective prevention and treatment approaches to reducing dietary inequalities. Using an online survey (N = 583) of adults residing in England or Scotland with a body mass index (BMI) of ≥30 kg/m2, participants self-reported on food insecurity, diet quality, perceived impact of the cost of living crisis, and their responses to this in terms of food purchasing behaviours and food preparation practices. Regression analyses found that participants adversely impacted by the cost of living crisis reported experiencing food insecurity. Additionally, food insecurity was associated with use of specific purchasing behaviours (i.e., use of budgeting, use of supermarket offers) and food preparation practices (i.e., use of energy-saving appliances, use of resourcefulness). Exploratory analyses indicated that participants adversely impacted by the cost of living crisis and who used budgeting had low diet quality, whereas use of meal planning was associated with high diet quality. These findings highlight the fragility of food budgets and the coping strategies used by PLWO and food insecurity during the cost of living crisis. Policy measures and interventions are urgently needed that address the underlying economic factors contributing to food insecurity, to improve access to and affordability of healthier foods for all.

Background: In 2022, legislation in England restricted products high in fat, sugar, or salt (HFSS) in prominent store locations. This study explores retail sector (including enforcement of legislation in retail) responses to the legislation’s implementation. Methods: Four major UK retailers – ASDA, Morrisons, Sainsbury’s and Tesco - completed business-level online surveys. Interviews were conducted with representatives from three retailers (n=13; Asda, Morrisons, Sainsbury’s), the British Retail Consortium (n=1), and primary authority enforcement (n=1) (N=15). Data were collected between July and November 2024. Findings informed co-production workshops (n=3) to develop policy recommendations. Results: Stakeholders supported legislation aims but voiced concerns about complexities with interpretation and implementation, limited communication with government, access to product nutrition data, and delays to guidance. Retailers utilised various HFSS product promotional strategies while achieving compliance. Retailers reported very limited enforcement. These findings were synthesised and facilitated the development of seven policy recommendations through co-production workshops between academics and the Institute of Grocery distribution. Conclusion: HFSS legislation represents a landmark shift in regulation of the retail food environment, but clearer, timely guidance, data provision, and transparent co-production with actors cognisant of the food sector is needed to ensure legislation can be effectively implemented, enforced and evaluated.

Emotional eating (EE) is defined as overeating, irrespective of satiety and in response to emotional states. EE develops early, is stable and has been linked with obesity in children and adults. Evidence suggests that EE in children is partially shaped by controlling feeding practices such as restriction of food or use of food as a reward. Additionally, parent EE has been related to child EE through behavioural modelling. Little research has considered the role of children’s individual differences (e.g. temperament and appetitive traits) alongside parental characteristics in the development of child EE. The current study examined the relationships between parent and child characteristics with child EE. Parents (n=254) of 3-5-year-olds completed questionnaires about their own EE and feeding practices and their children’s eating behaviour and temperament. Partial correlations (controlling for parent BMI and SES) indicate that parent EE, controlling feeding practices, child negative affect and child appetitive traits were all significantly positively correlated with greater child EE. Findings suggest that child EE is related to a complex interplay between parent and child characteristics and this requires further investigation.

Emotional eating (EE) is defined as eating in response to negative emotions (e.g., sadness and boredom). Child temperament and parental feeding practices are predictive of child EE and may interact to shape child EE. Previous research has demonstrated that children eat more when they are experiencing sadness, however, boredom-EE (despite how common boredom is in children) has yet to be explored experimentally using remote methodologies. The current study explores whether feeding practices and child temperament interact with mood to predict children's snack selection in an online hypothetical food choice task. Using online experimental methods, children aged 6-9-years (N = 347) were randomised to watch a mood-inducing video clip (control, sadness, or boredom). Children completed a hypothetical food choice task from images of four snacks in varying portion sizes. The kilocalories in children's online snack choices were measured. Parents reported their feeding practices and child's temperament. Results indicated that the online paradigm successfully induced feelings of boredom and sadness, but these induced feelings of boredom and sadness did not significantly shape children's online food selection. Parental reports of use of restriction for health reasons (F = 8.64, p = .004, n2 = 0.25) and children's negative emotionality (F = 6.81, p = .009, n2 = 0.020) were significantly related to greater total kilocalorie selection by children. Three-way ANCOVAs found no evidence of any three-way interactions between temperament, feeding practices, and mood in predicting children's online snack food selection. These findings suggest that children's hypothetical snack food selection may be shaped by non-responsive feeding practices and child temperament. This study's findings also highlight different methods that can be successfully used to stimulate emotional experiences in children by using novel online paradigms, and also discusses the challenges around using online methods to measure children's intended food choice.

Emotional eating (EE; defined as overeating irrespective of satiety and in response to emotional states), develops early, is stable and has been linked with obesity in children and adults. Child EE is partially shaped by controlling parental feeding practices such as instrumental or emotional feeding. Parent EE and child EE are frequently correlated, potentially via behavioural modelling. However, little research has considered the role of child temperament alongside parental characteristics in the development of child EE. This study examined the relationships between parent EE, feeding practices and child temperament in predicting child EE. Mothers (N=244) of 3-5-year-olds completed questionnaires about their own EE, feeding practices and their children's eating behaviour and temperament. Results showed that controlling feeding practices (specifically using food as a reward, using food for emotion regulation and restriction of food for health reasons) mediated the relationship between parent EE and child EE. When this model was extended to include child temperament, using moderated mediations, negative affect moderated the mediating effect of feeding practices (specifically food as a reward and restriction of food for health reasons) on child EE but only when negative affect was high. These findings highlight the complex interrelationships between parental eating, child feeding and child temperament in determining child EE.

Eating habits in the UK need to change to become healthier and more sustainable for the environment. However, it is unknown whether such dietary changes are plausible for those experiencing lower food security (FS) given the higher prices of these foods. Using Food and You 2 Wave 4 data, a secondary data analysis was conducted to identify whether there are differences between FS levels on dietary behaviours in favour of health and sustainability. Participants were adults (aged 16+years) residing in England, Wales, or Northern Ireland (N=5584). Data were analysed using logistic regressions with high FS as the reference group. Odds ratios (OR) were weighted and adjusted for covariates. The adjusted model indicated that those with low FS were more likely to have increased fruit/vegetable intake in the last 12 months compared to high FS (OR 1.40;95%CI 1.13-1.73, p=.002, and were less likely to be willing to reduce their processed food intake in the next 12 months compared to high FS (0.80;0.65-0.99, p=.042). Those with very low FS were more likely to have increased fruit/vegetable intake in the past 12 months compared to high FS (1.45;1.13-1.86, p =.004), and less likely to have reduced their meat/poultry/fish intake in the last 12 months compared to high FS (0.73;0.55-0.95, p=.021). These findings suggest that FS is associated with healthier, more sustainable dietary behaviours. Research is needed to identify ways to support those with lower FS to change their dietary behaviours, particularly reducing intake of processed food and meat/poultry/fish.

In westernised countries, food insecurity (FI), poorer diet quality, and obesity are disproportionately represented in groups experiencing socio-economic disadvantage. Grocery stores are one promising arena for intervention; however how these settings can facilitate purchasing of healthier, more sustainable food in people living with obesity (PLWO) and FI remains unclear. Using an online survey (N=583), adults residing in England or Scotland with a body mass index of ≥30kg/m2 self-reported on FI, diet quality, and their experiences of shopping in a grocery store for healthy and sustainable food. Using structural equation modelling, greater FI was directly associated with barriers from the food environment (e.g., price), food preparation practices, lower healthy diet knowledge and physical ill-health. Moreover, greater FI was indirectly associated with poorer diet quality via poorer mental health and greater experiences of self-stigma associated with being food insecure. Grocery store interventions based on price or incentivisation were ranked most helpful in supporting healthier, more sustainable purchasing. These findings highlight the challenges faced by this group when shopping and underscore the need for policy development relating to price and affordability at a population-level, and for clinicians to offer tailored, holistic approaches to obesity treatment that acknowledges and minimises stigma and mental health.

Children who emotionally eat (EE) tend to consume palatable foods that are high in sugar and fat. How EE develops remains unclear, but children’s temperament and parental feeding practices may interact to shape child EE. To date, no research has explored these interaction effects on EE experimentally. Furthermore, most research has explored EE in response to generic ‘negative’ mood rather than specific negative emotions, such as boredom, which has never been explored in this context. This study aimed to explore interactions between induced mood condition (sadness, boredom, control), parent-reported non-responsive feeding practices and parent-reported child temperament (negative affect, surgency, effortful control) in predicting kilocalories consumed by children aged 4–5-years in a laboratory setting. Using three-way ANOVA, the interactions between mood state, parental feeding practice and child temperament were assessed. Results indicated that children who experienced boredom consumed significantly more total kilocalories than children in the control condition. Additionally, children with high negative affect who also had parents who reported high use of food for emotion regulation consumed significantly more kilocalories from sweet food when experiencing boredom compared to control condition, and children with high negative affect who also had parents who reported low use of food as a reward consumed significantly more kilocalories from sweet food when experiencing boredom compared to control condition. These findings suggest that feelings of boredom differentially predict children’s snack food intake, and that child negative affect and non-responsive feeding practices play an important role in the expression of this relationship.

Emotional eating (EE) in children is the tendency to consume food that is energy dense and palatable, and this typically occurs in response to emotions that are negative (e.g. sadness). EE is a common eating behaviour that develops early in childhood, and there is strong evidence to indicate that EE has low heritability estimates, suggesting that this eating behaviour is highly dependent on a child’s environment. Moreover, EE is reliably associated with the development of childhood obesity, and so understanding what predicts this eating behaviour in children is important. This chapter presents an overview of how child EE is defined, how child EE is measured, and the theories that underpin the development of EE. This chapter then considers the different predictors of child EE in relation to parent factors, child temperament, and the emotional context in which they interact. The parent factors that are discussed relate to parental modelling of EE and parental feeding practices (i.e. use of non-responsive feeding practices, food to regulate emotions, food as a reward, restriction of food).

Emotional eating (EE) reflects a tendency to overeat typically palatable foods, regardless of satiety, and in response to experiences of negative emotions. There is evidence of EE emerging in childhood and being predictive of obesity throughout life. Experimental research has explored children’s EE in relation to negative mood (e.g., sadness), but never in response to the experience of boredom, despite its prevalence in children. Established predictors of child EE include children’s temperament and parental feeding practices, however, it is unknown whether children’s snack consumption differs between mood states when considered alongside child temperament and parental feeding practices. Using online experimental methods, children aged 6-9-years (N=347) were randomised to watch a mood-inducing video clip (sadness, boredom, or control). Children then completed a hypothetical food-choice task from a selection of four snacks that varied in portion size: chocolate buttons, carrot batons, crisps, and gummy bears. The kilocalories associated with children’s snack choices were measured; outcome variables were kilocalories from sweet snacks, savoury snacks, and the overall total. Parents reported on their feeding practices and child’s temperament. Three-way ANCOVAs found no evidence of any three-way interactions between child temperament, parental feeding practices and mood for any of the outcome variables. These findings suggest that snack food selection may not be differently predicted by interactions between mood, feeding practices and temperament. However, this may reflect methodological weaknesses with the hypothetical food-choice task used.

There is a "data revolution" where data are generated by many aspects of public life, and though not originally intended for research, these data can be repurposed for research applications. However, in social research relating to nutrition and health, academic-industry data sharing partnerships are rare. This exploratory research uses insights from a case study of a successful academic-industry data sharing partnership in social research to produce a pilot framework to aid the generation of industry-academia data sharing collaborations. Ten participants were interviewed: six from the University of Leeds, and four from a large UK supermarket, Sainsbury’s Plc, from different roles across the partnership. We used semi-structured interviews and analysed data using deductive reflexive thematic analysis. The resultant themes were organised into a preliminary framework based on the Data Sharing Pyramid (how raw data is transformed into wisdom through processing and interpretation). Our preliminary insights form the - Academia-Industry Partnership (AIP) framework - which constitutes four components: 1) the Research Infrastructure Foundation, where participants emphasised the importance of investing time and resources before starting research; 2) the Data Sharing Process, which involves applying principles of the research infrastructure foundation and robust data governance to enable sharing of novel commercially sensitive data; 3) the Research Process, which captured how shared data is used and the resulting outputs and impacts; and 4) the Partnership Strategy which focused on nurturing the partnership across all areas of the framework. This study uniquely uses a real-world case study to develop a preliminary framework, facilitating shared learnings for the development of data sharing partnerships in social research to further the use of commercial data for public good.

Background In 2022, legislation in England restricted products high in fat, sugar, or salt (HFSS) in prominent store locations. This study explores retail sector (including enforcement of legislation in retail) responses to the legislation’s implementation. Methods Four major UK retailers – ASDA, Morrisons, Sainsbury’s and Tesco − completed business-level online surveys. Interviews were conducted with representatives from three retailers (n = 13; Asda, Morrisons, Sainsbury’s), the British Retail Consortium (n = 1), and primary authority enforcement (n = 1) (N = 15). Data were collected between July and November 2024. Findings informed co-production workshops (n = 3) to develop policy recommendations. Results Stakeholders supported legislation aims but voiced concerns about complexities with interpretation and implementation, limited communication with government, access to product nutrition data, and delays to guidance. Retailers utilised various HFSS product promotional strategies while achieving compliance. Retailers reported very limited enforcement. These findings were synthesised and facilitated the development of seven policy recommendations through co-production workshops between academics and the Institute of Grocery distribution. Conclusion HFSS legislation represents a landmark shift in regulation of the retail food environment, but clearer, timely guidance, data provision, and transparent co-production with actors cognisant of the food sector is needed to ensure legislation can be effectively implemented, enforced and evaluated.

The high prevalence of food insecurity in the United Kingdom has been exacerbated by the cost-of-living crisis. In high-income countries, those experiencing food insecurity struggle to buy and consume foods that meet Government healthy eating recommendations, and are at increased risk of obesity, linked to poor diet quality. Individuals in high-income countries purchase most of their food to consume at home from supermarkets, making this an important context within which healthier and environmentally sustainable food purchasing should be supported. However, the lived experience of supermarket food purchasing in people living with obesity and food insecurity has not been explored in depth. Adults, living in England and Scotland, who self-identified as living with obesity and food insecurity and looking to reduce their weight, were recruited to take part in semi-structured interviews (n = 25) or focus groups (n = 8) to explore their experience of shopping for food in the supermarket. Using thematic analysis, four main themes were generated: 1) the Restricted Consumer; restrictions around the type of food purchased, where food can be purchased and the resulting emotional toll, 2) the Conscious Consumer; decision making and effortful practices both in preparation of and during the shopping trip, 3) Mitigating the Rising Cost of Food; agency and actions taken to mitigate high food prices, 4) Stigma; instances of perceived and/or experienced weight and poverty-related stigma and the physical actions and cognitive social comparisons used to minimise stigma. Findings provide insights for evidence-based policy on the need for upstream changes within the wider food system to address the social determinants of health and support people living with obesity and food insecurity to eat healthier and more sustainable diets.

The high prevalence of food insecurity in the United Kingdom has been exacerbated by the cost-of-living crisis. In high-income countries, those experiencing food insecurity struggle to buy and consume foods that meet Government healthy eating recommendations, and are at increased risk of obesity, linked to poor diet quality. Individuals in high-income countries purchase most of their food to consume at home from supermarkets, making this an important context within which healthier and environmentally sustainable food purchasing should be supported. However, the lived experience of supermarket food purchasing in people living with obesity and food insecurity has not been explored in depth. Adults, living in England and Scotland, who self-identified as living with obesity and food insecurity and looking to reduce their weight, were recruited to take part in semi-structured interviews (n = 25) or focus groups (n = 8) to explore their experience of shopping for food in the supermarket. Using thematic analysis, four main themes were generated: 1) the Conscious Consumer; decision making and effortful practices both in preparation of and during the shopping trip, 2) the Restricted Consumer; restrictions around the type of food purchased, where food can be purchased and the resulting emotional toll, 3) Mitigating the Rising Cost of Food; agency and actions taken to mitigate high food prices, 4) Stigma; instances of perceived and/ or experienced weight and poverty-related stigma and the physical actions and cognitive social comparisons used to minimise stigma. Findings provide insights for evidence-based policy on the need for upstream changes within the wider food system to address the social determinants of health and support people living with obesity and food insecurity to eat healthier and more sustainable diets.

Background: Food insecurity (lack of reliable access to affordable and nutritious food) is a major concern in high-income countries because it increases the risk of poor nutrition, obesity and associated adverse health outcomes. Healthier diets are often also more environmentally sustainable (hereafter; sustainable), an important factor in reducing climate change. Practice-based interventions are therefore urgently needed to support people living with food insecurity and obesity to access and afford healthier and sustainable foods. Supermarkets are a key area for intervention, as purchasing can be an antecedent to consumption. However, the retailers’ perspectives on the feasibility of implementing affordability interventions is often overlooked and under-researched. Therefore, this study explored the perspectives, views, and experiences of major UK supermarket senior nutritionists on the acceptability and feasibility of using affordability interventions for healthier and more sustainable food in the supermarket.Methods: We recruited seven UK senior supermarket nutritionists who represented 85% of the UK grocery market share. We used semi-structured interviews and analysed the data using a reflective thematic analysis approach.Results: Supermarket nutritionists perceived that their business did prioritise health and environmental sustainability for customers. However, there were several challenges encountered when trying to promote healthier and more sustainable food in the supermarket environment, including profitability concerns, unpredictability of intervention outcomes, control over own-brand products, perceived intention-behaviour gap, and a belief that they are already implementing affordability interventions. Differences in how supermarkets approach the evaluation of interventions also emerged, as well as a willingness to collaborate with academics and other retailers to optimise the evaluation of interventions. Lastly, supermarket nutritionists raised the need for an operationalised definition for sustainable food products.Conclusions: Affordability interventions to support customers to purchase healthier and more sustainable food require supermarkets to consider multiple challenges. Findings highlight the need for upstream intervention that mandates and facilitates multi-lever approaches to health and sustainability without compromising commercial viability, along with practice-based approaches to implementation and evaluation.

Good health is viewed as essential to enable citizens to live fulfilling lives, shape communities, and drive economic growth. However, health is socially patterned. Low socioeconomic status is associated with an increased risk of non-communicable diseases, where poor dietary patterns and diet-related obesity are likely contributors. Food purchasing can be influenced by many factors, including cost and income. Most food purchased to be consumed at home is acquired from supermarkets, and any increase in food prices disproportionately impacts low-income households, contributing to food insecurity. This study explored the factors that helped and hindered people living with obesity and food insecurity in purchasing healthy, environmentally sustainable food from supermarkets. Semi-structured interviews (n = 25) and focus groups (n = 7) were conducted between June and December 2023 with adults living in Scotland and England who self-identified as living with obesity and food insecurity. Using thematic analysis, six main themes were identified: (1) Supermarket deals: perceptions surrounding the good, the bad, and the ugly side of supermarket offers and promotions; (2) Skepticism about supermarkets and the wider food system: questioning supermarket pricing motives but recognizing the role of the wider food system in food pricing; (3) Other peoples’ role in enhancing or undermining healthy diet intentions: the impact of others in shaping food purchases; (4) Financial restrictions facing non-UK nationals: additional challenges faced by those with no recourse to public funds; (5) The overwhelming in-store supermarket experience: sensory overload and attempts to prevent unintended, impulse purchases; (6) Unconscious, environmentally sustainable shopping practices: cost saving practices that lead to environmentally sustainable purchasing patterns and behaviors as a unintentionally created outcome of budget maximizing strategies. However, such strategies, that is, limiting food waste and purchasing less meat, although beneficial for environmental sustainability, do not necessarily indicate that a healthier diet is being purchased or consumed. While views on some factors believed to help or hinder healthy, environmentally sustainable food purchases varied, there was general agreement amongst participants on the need for upstream changes, including having access to adequate benefits and wages.

Background: Food insecurity (lack of reliable access to affordable and nutritious food) is a major concern in high-income countries because it increases the risk of poor nutrition, obesity and associated adverse health outcomes. Healthier diets are often also more environmentally sustainable (hereafter; sustainable), an important factor in reducing climate change. Practice-based interventions are therefore urgently needed to support people living with food insecurity and obesity to access and afford healthier and sustainable foods. Supermarkets are a key area for intervention, as purchasing can be an antecedent to consumption. However, the retailers’ perspectives on the feasibility of implementing affordability interventions is often overlooked and under-researched. Therefore, this study explored the perspectives, views, and experiences of major UK supermarket senior nutritionists on the acceptability and feasibility of using affordability interventions for healthier and more sustainable food in the supermarket.Methods: We recruited seven UK senior supermarket nutritionists who represented 85% of the UK grocery market share. We used semi-structured interviews and analysed the data using a reflective thematic analysis approach.Results: Supermarket nutritionists perceived that their business did prioritise health and environmental sustainability for customers. However, there were several challenges encountered when trying to promote healthier and more sustainable food in the supermarket environment, including profitability concerns, unpredictability of intervention outcomes, control over own-brand products, perceived intention-behaviour gap, and a belief that they are already implementing affordability interventions. Differences in how supermarkets approach the evaluation of interventions also emerged, as well as a willingness to collaborate with academics and other retailers to optimise the evaluation of interventions. Lastly, supermarket nutritionists raised the need for an operationalised definition for sustainable food products.Conclusions: Affordability interventions to support customers to purchase healthier and more sustainable food require supermarkets to consider multiple challenges. Findings highlight the need for upstream intervention that mandates and facilitates multi-lever approaches to health and sustainability without compromising commercial viability, along with practice-based approaches to implementation and evaluation.

Individuals participate in research for numerous reasons, however, the global economic downturn may have driven some to participate solely for monetary recompense. While inauthentic participation is more widely recognised in quantitative survey studies, it is increasingly becoming an issue in qualitative research. Drawing on our experiences and supported by the wider literature, we highlight ways in which inauthentic participation can be identified and addressed. We argue it is pertinent researchers are aware of the risks and potential impact of inauthentic participants and recommend researchers consider this phenomenon from study planning stages onwards. We identify Universities and ethics committees as well placed to provide training and ensure, where necessary, mitigation plans are in place before granting study approvals. We suggest funders and publishers request inauthentic participation be considered and reported. These recommendations would establish awareness, prevent wasting valuable project resources, increase transparency of reporting and ensure data integrity is protected.

Food insecurity (FI), is defined as unreliable access to healthy and nutritious food, and is a major health concern in higher-income countries, primarily due to its association with an increased risk of obesity. Adherence to healthy eating recommendations promotes both a healthier and more environmentally sustainable diet. Supermarket-based interventions may influence population-level food purchasing behaviour, an antecedent to consumption, however, it is unclear whether there are specific characteristics that supermarket-based interventions should employ to resonate with vulnerable groups. This scoping review aimed to explore the characteristics of supermarket-based interventions that sought to support healthier and/or more environmentally sustainable food purchasing for people living with obesity and overweight (PLWO/Ow) and/or FI. A systematic literature search identified 35 studies, representing 43 interventions, eligible for inclusion. Most interventions focused on supporting the purchase of healthy food items, with three aimed at increasing the purchase of plant-based foods. No study applied a validated measure of FI. Area-level demographic data were used to identify FI related characteristics (i.e., area of low income, low socio-economic status) and in some cases, those living with obesity. Interventions utilised the behaviour change levers of price (n=8), promotion (n=2), placement (n=7), nudges (n=4) and education (n=2), or a combination of these (n=20). High heterogeneity in the way behavioural change levers were operationalised and combined, alongside the use of proxy measures to identify FI and PLWO/Ow, presents a challenge for determining intervention characteristics which best support changes in purchasing patterns in favour of heathy, sustainable food items in this population.

Abstract

Background The United Kingdom faces complex economic and structural challenges that have disrupted food pricing, contributing to widespread food insecurity. These fluctuations diminish the affordability and accessibility of healthy, nutrient-dense foods among vulnerable groups. In high-income countries, food insecurity is associated with higher levels of obesity, and in the UK specifically, the cost of living crisis, where the cost of food has increased quicker than wages, is likely to have exacerbated existing dietary inequalities. This qualitative paper explores insights of people living with obesity and food insecurity, in an ethnically diverse community, to develop further understanding on their food shopping experiences. Methods A secondary analysis of qualitative data from four focus groups (8–11 participants per group; 92% female) was undertaken with participants who self-reported as living with obesity and food insecurity (n = 39) and were attempting to reduce their weight. Results Three themes and eight subthemes were generated using deductive and reflexive thematic analysis: (1) the Conscious Consumer, reflects the preparation and planning participants undertook by participants to maximise their limited resources. Subthemes include advanced meal planning, and price-comparison shopping. Despite these efforts, participants frequently encountered barriers to being able to purchase nutritionally balanced foods. (2) the Restricted Consumer highlights how structural and systemic limitations, including time pressures due to work or caregiving responsibilities, further constrained participants’ food purchasing choices. and (3) Mitigating the rising cost of food, describes the actions required to manage the challenges in purchasing foods with rising costs. Subthemes include substituting affordable, less-healthy products for costlier fresh produce and bulk buying of staple items. Conclusions Findings challenge societal beliefs that people living on low incomes need to budget more carefully to afford a healthy diet. People living with obesity and food insecurity often report experiencing cognitive dissonance. In this context, participants faced difficult and emotive trade-offs, as they recognised the suboptimal nutritional value of their food purchases but felt compelled by necessity to buy unhealthier food that matched their budget. Findings provide further insights to support healthy, sustainable food purchasing, as part of transforming the UK food system.

Introduction: Food insecurity (lack of reliable access to affordable and nutritious food) is a major concern in high-income countries because it increases the risk of poor nutrition, obesity and associated adverse health outcomes. Healthier diets are often also more environmentally sustainable (hereafter; sustainable), an important factor in reducing climate change. Practice-based interventions are therefore urgently needed to support people living with food insecurity and obesity to access and afford healthier and sustainable foods. Supermarkets are a key area for intervention, as purchasing can be an antecedent to consumption. However, the retailers’ perspectives on the feasibility of implementing affordability interventions is often overlooked and under-researched. Therefore, this study explored the perspectives, views, and experiences of major UK supermarket senior nutritionists on the acceptability and feasibility of using affordability interventions for healthier and sustainable food in the supermarket. Methods: We recruited seven UK senior supermarket nutritionists who represented 85% of the UK grocery market share. We used semi-structured interviews and analysed the data using a reflective thematic analysis approach. Results: Supermarket nutritionists perceived that their business did prioritise health and environmental sustainability for customers. However, there were several challenges encountered when trying to promote healthier and more sustainable food in the supermarket environment, including profitability concerns, unpredictability of intervention outcomes, control over own-brand products, perceived intention-behaviour gap, and a belief that they are already implementing affordability interventions. Differences in how supermarkets approach the evaluation of interventions also emerged, as well as a willingness to collaborate with academics and other retailers to optimise the evaluation of interventions. Lastly, supermarket nutritionists raised the need for an operationalised definition for sustainable food products. Discussion: Affordability interventions to support customers to purchase healthier and more sustainable food require supermarkets to consider multiple challenges. Findings highlight the need for upstream intervention that mandates and facilitates multi-lever approaches to health and sustainability without compromising commercial viability, along with practice-based approaches to implementation and evaluation.

Individuals participate in research for numerous reasons, however, the global economic downturn may have driven some to participate solely for monetary recompense. While inauthentic participation is more widely recognised in quantitative survey studies, it is increasingly becoming an issue in qualitative research. Drawing on our experiences and supported by the wider literature, we highlight ways in which inauthentic participation can be identified and addressed. We argue that pertinent researchers are aware of the risks and potential impact of inauthentic participants and recommend researchers consider this phenomenon from study planning stages onwards. We identify institutions, including Universities, as well placed to provide training and ensure, where necessary, mitigation plans are in place. We suggest ethics committees, funders and publishers request inauthentic participation be considered and reported. These recommendations would establish awareness of this phenomenon, prevent wasting valuable project resources, increase transparency of reporting and ensure data integrity is protected.

At both UK and global level, dietary consumption patterns need to change to address environmental, health and inequality challenges. Despite considerable policy interventions, the prevalence of overweight and obesity in the United Kingdom has continued to rise with obesity now a leading cause of mortality and morbidity. Obesity prevalence is greater among those on lower incomes and the current UK food system, including government policy, does not effectively address this. Current behavioural approaches, without the support of structural changes in the system, may even widen the inequalities gap. Hence, using behavioural insights from those living with obesity and food insecurity, the project will explore potential avenues that can be applied in the food system to promote healthier choices in the food retail environment. The National Food Strategy report recommends that the UK food system should ensure "safe, healthy, affordable food; regardless of where people live or how much they earn". However, the association between food insecurity and the development of obesity is not well understood in relation to purchasing behaviours in the UK retail food environment, nor is the potential effectiveness of interventions that seek to prevent and reduce the impact of diet-induced health harms. The FIO Food (Food insecurity in people living with obesity - improving sustainable and healthier food choices in the retail food environment) project provides a novel and multi-disciplinary collaborative approach with co-development at the heart to address these challenges. Using four interlinked work packages, the FIO Food project will combine our knowledge of large-scale population data with an understanding of lived experiences of food shopping for people living with obesity and food insecurity, to develop solutions to support more sustainable and healthier food choices in the UK retail food environment.

Background: The United Kingdom faces complex economic and structural challenges that have disrupted food pricing, contributing to widespread food insecurity. These fluctuations diminish the affordability and accessibility of healthy, nutrient-dense foods among vulnerable groups. In high-income countries, food insecurity is associated with higher levels of obesity, and in the UK specifically, the cost of living crisis, where the cost of food has increased quicker than wages, is likely to have exacerbated existing dietary inequalities. This qualitative paper explores insights of people living with obesity and food insecurity, in an ethnically diverse community, to develop further understanding on their food shopping experiences.Methods: A secondary analysis of qualitative data from four focus groups (8–11 participants per group; 92% female) was undertaken with participants who self-reported as living with obesity and food insecurity (n=39) and were attempting to reduce their weight. Results: Three themes and eight subthemes were generated using deductive and reflexive thematic analysis: (1) the Conscious Consumer, reflects the preparation and planning participants undertook by participants to maximise their limited resources. Subthemes include advanced meal planning, and price-comparison shopping. Despite these efforts, participants frequently encountered barriers to being able to purchase nutritionally balanced foods. (2) the Restricted Consumer highlights how structural and systemic limitations, including time pressures due to work or caregiving responsibilities, further constrained participants’ food purchasing choices. and (3) Mitigating the rising cost of food, describes the actions required to manage the challenges in purchasing foods with rising costs. Subthemes include substituting affordable, less-healthy products for costlier fresh produce and bulk buying of staple items. Conclusions: Findings challenge societal beliefs that people living on low incomes need to budget more carefully to afford a healthy diet. People living with obesity and food insecurity often report experiencing cognitive dissonance. In this context, participants faced difficult and emotive trade-offs, as they recognised the suboptimal nutritional value of their food purchases but felt compelled by necessity to buy unhealthier food that matched their budget. Findings provide further insights to support healthy, sustainable food purchasing, as part of transforming the UK food system.

Background: People experiencing food insecurity (FI) are more likely to live with obesity and purchase foods of lower dietary quality. Retail campaigns have the potential to influence food purchasing behaviours. Still, little is known about how the retailers’ messaging is perceived by people living with obesity (PLWO) and FI. This qualitative paper explores the insights of PLWO and FI on two national online and in-store campaigns targeted at i) supporting customers with increased food prices, and ii) promoting the consumption of healthier and more environmentally sustainable meals. Methods: Participants who self-reported as living with obesity and FI (n=39) expressed their perceptions of campaign images, from one retailer, through four in-person focus groups. Findings from the focus groups were then presented to the retail partner in an online participatory workshop. Themes were generated using reflexive thematic analysis.Results: Five themes and 12 subthemes were generated from the focus groups: (i) ‘Do I have the resources needed?’ Finances and, or time influenced participants’ food purchasing. (ii) ‘Do I know what it means?’ Participants did not always understand the images presented. (iii) ‘Do I trust it?’ Participants questioned whether the prices or images in the campaigns were authentic. (iv) ‘Do I want it?’ Participants questioned whether the food presented in the images appealed to them. (v) ‘Recommendations for future promotional communications’. Participants outlined how they wanted messaging to apply to them by using ethnically diverse food images that are suitable for a range of health conditions. From the retail partner participatory workshop we identified one theme and three subthemes. (i) ‘It is a conundrum’, the diverse needs of subgroups for national campaigns make it challenging for retailers to communicate healthy sustainable food promotions.Conclusions: These findings provide insights for retailers on the need for tailored communications, that reflect the requirements of different customers, to support PLWO and FI to purchase healthier and more sustainable foods. Acknowledging and addressing the inherent complexity of promoting healthier and more environmentally sustainable food is vital to making meaningful improvements to the food environment.