Can independent takeaways change to offer healthier food? : an exploration of the challenges for independent takeaways and public health

Abstract

Background Meals from independent takeaways in the UK are generally characterised by large portion sizes and contain high levels of energy and salt. Regular consumption is associated with weight-gain, obesity and diet-related diseases. It has been suggested that low-agency interventions that reduce the obesogenic nature of our food environments have the potential to equitably improve dietary intake at population level. The research described in my thesis sought to: determine the frequency and socio-demographic correlates of eating takeaway meals and the association between habitual consumption of such meals and daily energy intake; identify the operational challenges of intervention delivery in takeaway contexts; and evaluate interventions targeted at takeaways for feasibility, acceptability, and, where possible, potential impact. Methods A multi-method approach was used. The UK National Diet and Nutrition Survey (NDNS) was analysed to identify frequency and socio-demographic correlates of those eating takeaways and the relationship between habitual consumption and mean daily energy intake. Subsequent studies included: interviews with practitioners with experience of delivering interventions in takeaways; testing of a salt reduction intervention that used a reducedholed salt shaker; and mixed-method evaluation of the feasibility and acceptability of two interventions to improve the availability of healthier takeaway meals, one multi-criteria local authority-led and one promoting smaller portion meals led by an industry supplier. Results Analyses of NDNS data showed that 20% of adults ate takeaways at least once per week. The proportion of all participants eating takeaway meals regularly was highest in young adults (19–29 years). For children, more boys than girls were regular consumers, with consumption most prevalent in children from less-affluent households. Children and adults who ate takeaways regularly consumed more per-day than those who ate rarely. In children, there was an interaction with socio-economic position, where greater frequency of consumption of takeaway meals was associated with higher mean daily energy intake in those from lessaffluent households. ii The perceived barriers to implementation of interventions to improve food offered by takeaways were limited funding and difficulties engaging with traders. The perceived facilitators of increasing the potential effectiveness of interventions were delivering intensive, interactive and tailored interventions with clear and specific information, and providing setting specific incentives, whilst accounting for practical, primarily financial, constraints of running a takeaway. A reduced-holed shaker (5-holed) delivered on average 33.7% of the salt of a traditional shaker (17-holed) in controlled conditions. However, in takeaways there was no difference in absolute sodium content of meals, despite the relative sodium content being significantly lower in meals served using the reduced-holed shaker. The recruitment rate for the local authority-led training intervention was low. Among those attending, the changes subsequently made were those that required minimal effort or cost to the business. Least popular changes included the use of products more difficult to source from suppliers or perceived to be unpopular with customers. The supplier-led intervention achieved a higher recruitment rate, with those takeaways followed-up reporting an increased proportion of smaller portion meals sold. Discussion UK independent takeaways are ubiquitous and broadly provide a nutritionally poor offering. As a nation, we are high consumers of takeaway food and for many they constitute a component of their habitual diet. Interventions that require the voluntary engagement of traders are unlikely to yield significant improvements in the nutritional quality of the food. Further work should explore upstream structural policy-led interventions that require individuals to use a low-level of agency to benefit, as these interventions are established to have a greater impact and are more likely to reduce existing health inequalities.