Last updated: 10/09/2024
Ban HFSS price promotions in out of home (OOH) businesses
Ban all price promotions (eg, was/now prices, introductory prices, temporary price reductions) of HFSS foods for large out of home businesses such as restaurants, coffee shops, fast food outlets (medium, small and micro businesses are excluded)
- Moderate impact on obesity
A percentage estimate of how much the policy would reduce national obesity rates
- Relative reduction in obesity prevalence: 2%
- High evidence quality
A rating of the strength of evidence, accounting for both reliability and validity of the evidence
- Reliability and validity rating: 4/5
- Very low cost to governments
Cost to UK and devolved governments over 5 years
- Cost to governments over 5 years: £0.5m
- Benefit to governments per year: £1bn
What is the policy?
This policy relates to restrictions on all price promotions for food and drinks that are classified as high in fat, sugar, or salt (HFSS) and labelled as discretionary. It would apply to non-retail food businesses, but not those classified as medium, small or micro businesses.
Price promotions include both volume offers (multi-buys, combinations, bulk discounts, etc.) as well as temporary price reductions (aka reference pricing cuts like ‘Was/Now’ prices or comparisons to other retailer prices). Research shows that temporary price reductions might be one of the most popular forms of promotions for discretionary food categories in retail settings.
Discretionary items are a subset of HFSS products that contribute to high intake of calories, fats, and sugars and displace nutrient-rich foods. This includes confectionery, sweet biscuits, savoury snacks, cakes, pastries, puddings and sugar-containing soft drinks.
Recent context
In the UK Government’s initial consultation in 2019 on HFSS promotion restrictions, it decided to only consider volume promotions instead of all price promotions to limit potential cost-of-living increases. While the UK Government intended to include the OOH sector alongside retailers in this same consultation, The Food (Promotion and Placement) (England) Regulations 2021 exempted OOH businesses from certain restrictions. The only scenario where OOH premises are included in volume promotion restrictions are for free refills of high-sugar drinks – promoting free refills would be restricted under the UK Government volume promotion legislation. There have been minimal further attempts to extend restrictions to this sector.
In terms of business size, these regulations would apply to <1% of all OOH businesses. However these large businesses account for around a third of calories in the OOH sector, suggesting a large social return on the policy.
The Scottish Government is currently consulting on introducing regulations to restrict promotions of HFSS foods in both OOH and take home businesses. They propose that price and location restrictions (both instore and online) will apply to a qualifying business including OOH such as takeaway, home delivery services, restaurants, cafes, coffee shops, bakeries, sandwich shops and workplace canteens (including online sales).
Case studies
The Tobacco Advertising and Promotions Act, UK
To reduce the impact of smoking as a public health issue, governments have employed various strategies to reduce tobacco consumption. In the UK, the Tobacco Advertising and Promotion Act 2002 was introduced to restrict the marketing practices of tobacco companies, which included the routine deployment of price promotions to attract customers. The Act specifically bans all price promotions, including promotional discounts and buy-one-get-one-free offers, as well as gifts, prizes, or other rewards with tobacco purchases. This ban took effect in 2003 and was part of a much broader set of measures to restrict tobacco marketing which included restrictions on advertising on billboards, print and broadcast media.
Implementation involved the development of legislation and regulation, in which guidelines were established to define what constitutes a price promotion and the penalties for violations. The responsibility for enforcement was placed on local trading standards officers, who monitor compliance and impose penalties for breaches. Similar bans are in place in approximately 78 countries worldwide.
There is evidence that UK price promotion restrictions on tobacco products were associated with long-term reduction in adult smokers’ awareness of pricing and promotions following the ban. Harris et al. (2006) reported that declines in tobacco marketing awareness were greater in channels regulated by the new law and specifically, declines in awareness of tobacco pricing were greater in the UK (-16%, CI -18, -15) than the other three countries not affected by the ban. This was based on data from a large-scale nationally representative sample of smokers in each of the four countries.
However, there is a lack of evidence on the impact of the Tobacco Advertising and Promotions Act 2002 on customer behaviour, such as the number of new smokers or tobacco sales. Reducing smoking through regulation requires a comprehensive set of measures because tobacco manufacturers have responded to partial bans by redirecting resources from restricted areas to unrestricted ones. The effectiveness of a pricing-only regulation on its own remains unclear.
This case study illustrates that regulatory control of pricing promotions can help reduce the visibility of products harmful to health. However, the effectiveness of this approach may depend on the implementation of more comprehensive marketing restrictions.
Considerations for implementation
Refining this policy for implementation would require considering and identifying any examples of OOH businesses that would be exempt from restrictions for feasibility purposes and developing guidelines for monitoring and enforcing compliance with the policy.
Estimating the population impact
We estimated that this policy would reduce the prevalence of adult UK obesity rates by approximately 2%
Estimating the per-person impact
We estimated that this policy would reduce average daily calorie intake by approximately 5 kcal per person
We used data from the Scottish Government Impact Assessment as well as data for population diet calorie contributions from the retail and OOH sector. From the impact estimates, a policy affecting in-home purchases of adults (contributing around 1,700 calories) reduces daily calories intake by 88 calories. We assume that if a similar policy is implemented in the OOH sector (contributing ~ 296 calories) affecting large OOH businesses which contribute a third of the total calories per day from the sector, then it would lead to a proportional decrease of ~5 calories from a person’s daily energy intake. We do not account additionally for compensation here as it is accounted for in the modelling of the impact assessment.
This policy is not applicable to micro, small and medium businesses and is applicable only to large businesses in the OOH sector. Furthermore, the foods in scope of this policy are those defined as HFSS as per Schedule 1 of The Food (Promotion and Placement) (England) Regulations 2021. The impact of the policy is likely to be slightly overestimated because we are unable to determine the proportion of HFSS foods sold in the OOH sector.
Estimating the population reach
In our analytical model, we applied the effect sizes to people living with overweight or obesity. For adults, that is people aged 18 or above with a BMI of 25+ and for children, this is children with a BMI percentile of 85 and above. We are in the process of modelling the effects for children and will publish this data once complete.
Changes in the prevalence of people living with obesity
Table 1 shows the percentage reduction of adults moving from BMI ≥ 30 into a healthier BMI category following introduction of this policy (five-year follow up). Approximately 2% of adults living with obesity would move into a healthier BMI category. We are in the process of modelling the impact for children and will update findings upon completion.
| Adults (England and Wales) | Children (England and Wales) | Adults (Scotland) | Children (Scotland) |
| 2% | Analysis in progress | 2% | Analysis in progress |
Cost and benefits
Cost over 5 years
We estimated that this policy would cost the governments approximately £0.5 million over five years
We commissioned HealthLumen to estimate the cost of the policy to both industry and governments over a five-year period.
Table 2 below shows a breakdown of costs. The upfront direct costs to the governments are estimated at £0.1 million, with an annual cost of £0.1 million thereafter. The initial costs to the food industry are estimated at about £5 million, with annual costs of £1.5 million thereafter. We used the UK Government Impact Assessment to establish the costs.
| Group affected | Cost | Horizon | Detail |
| Costs | |||
| Government | £0.1m | One-off | Enforcement costs (initial) |
| Government | £0.4m | Annual (5 years) | Enforcement costs (ongoing) |
| Industry (Retail) | £0.2m | One-off | Familiarisation costs |
| Industry (Retail) | £1m | One-off | Product assessment costs (initial, for current products) |
| Industry (Retail) | £1.5m | One-off | Knowledge sharing costs |
| Industry (Retail) | £2m | One-off | IT system costs |
| Industry (Retail) | £1.4m | Annual (5 years) | Ongoing product assessments |
| Industry (Retail) | £7.8m | Annual (5 years) | Lost profits |
| Industry (Manufacturers) | £10.3m | Annual (5 years) | Lost profits |
Total annual benefit
We estimated that this policy would have an annual benefit of approximately £1 billion
Using analysis conducted by the Tony Blair Institute and Frontier Economics we estimate this policy would result in benefits of approximately £1 billion per year. Approximately two-thirds of this saving would benefit individuals (via quality-adjusted life years, and informal social care). The remaining third relates to savings that benefit the state via NHS treatment costs, productivity and formal social care. See our Methods page for more information about the cost breakdowns.
Impact on disease incidence
We commissioned HealthLumen to report disease incidence avoided if the policy were implemented. These estimates do not represent the total health benefits. The specific diseases selected are those where there is good evidence that living with obesity is associated with the development of the disease.
Table 3 presents a summary of disease incidence avoided.
| Disease | Incidence avoided |
| Type 2 diabetes | 4,900 |
| Hypertension | 5,300 |
| Coronary heart disease | 1,800 |
| Colorectal cancer | Not statistically significant |
| Gall bladder disease | 7,100 |
| Ovarian cancer | Not statistically significant |
| Stroke | Not statistically significant |
| Liver cancer | Not statistically significant |
| Depression | Not statistically significant |
| Musculoskeletal disease | 2,100 |
Behind the averages: impact on inequalities
There is limited literature directly addressing the effects of this specific policy on inequalities. Nonetheless, we can look to wider literature to infer what impacts this policy could have on different population groups. For example, evidence suggests that people from higher-income households eat out more regularly than those from lower-income households, meaning that they may be impacted more frequently by the intervention. Other research has also shown similar policies, such as bans on price promotions in retail settings, have greater impacts on lower-income households.
Rating the strength of evidence
We asked experts working in the fields of obesity, food, and health research to rate the strength of the evidence base for each policy, taking into account both reliability (size and consistency) and validity (quality and content) of the evidence. Policies were rated on a Likert scale of 1–5 (none, limited, medium, strong, and very strong evidence base). The Blueprint Expert Advisory Group rated this policy as having a Strong evidence base.
Ban on all HFSS price promotions in food retail businesses
Ban all price promotions (e.g. was/now prices, introductory prices, temporary price reductions) of HFSS foods in the retail sector excluding small and micro businesses