Last updated: 10/09/2024
Introduce healthiness targets for large retailers
Regulate large retailers to change their sales-weighted converted NPM score to ≥ 69 across their entire food product portfolio
- Very high impact on obesity
A percentage estimate of how much the policy would reduce national obesity rates
- Relative reduction in obesity prevalence: 25%
- Moderate evidence quality
A rating of the strength of evidence, accounting for both reliability and validity of the evidence
- Reliability and validity rating: 3/5
- Very low cost to governments
Cost to UK and devolved governments over 5 years
- Costs to governments over 5 years: £0.2m
- Benefit to governments per year: £16bn
What is the policy?
This policy refers to setting a target of increasing the sales-weighted average nutrient profiling model (NPM) score of the food product portfolio of the largest food retailers in the UK.
The policy sets a clear outcome while granting retailers the flexibility to determine the means of achieving it, such as through reformulation, pricing strategies, promotional activities, or product availability adjustments. Retailers are mandated to elevate their sales-weighted average converted NPM score to 69 or less (up from the current average of 67) across their entire food product range by 2030.
This policy recommendation aims to maximise impact, by encouraging system-wide action across the food and beverage industry, focusing on the retail, manufacturing and Food to Go sectors. Targets must be mandatory to achieve the required impact, underpinned by data reporting and monitored by a government body with the power to enforce proportional financial penalties for non-compliance. There should be a phased introduction with targets effective only after mandatory reporting has been in place for sufficient time. The implementation plan includes further detail.
Recent context
Since 2006, the UK Government has published reports setting a series of voluntary targets for industry, aimed at reducing salt, sugar and calorie consumption. Although these targets have demonstrated some reductions, especially in the consumption of salt, their impact has been limited. Ten out of the 11 largest retailers in the UK have already set their own different health targets, which have not had the desired impact due to either the type of products targeted or the level at which targets are set.
This policy recommendation aims to maximise impact, by encouraging system-wide action across the food and beverage industry. By incentivising retailers to enhance the nutritional quality of their offerings through subtle adjustments, the policy seeks to facilitate healthier consumer choices without imposing upfront costs.
As health policy is devolved in Scotland, Northern Ireland and Wales, Westminster should work collaboratively with the devolved governments to either replicate the Westminster policy or give their consent for Westminster to legislate nationally. Both options require consultation with, and agreement from, the devolved nations’ current governments and approval from their respective Parliament/Senedd.
Case studies
Salt reduction strategy, UK
The UK Food Standards Agency’s (FSA’s) initial salt reduction strategy ran from 2003 to 2010 and aimed to lower the population’s salt intake. The programme successfully reduced the average daily salt intake from 9.5 grams in 2000-2001 to 8.6 grams in 2008, primarily through industry collaboration. This reduction resulted in health benefits, including lowering blood pressure and reductions in coronary heart disease deaths.
The salt reduction programme began as an FSA-owned strategy (2001-2003) with targets published in 2006 covering 85 food types across 30 different categories. The aim was to encourage gradual, stepwise reductions in salt content, making it more acceptable to consumers. This approach included extensive consultation with food manufacturers and consideration of the technical feasibility of reducing salt in various food products. By 2008, many companies had significantly reduced salt levels, with some exceeding the targets initially thought achievable.
Considerations for implementation
To ensure maximum compliance and impact, the targets should be mandatory and use a singular headline metric as a mandated target for ease of implementation and to reduce complexity on businesses.
The headline NPM target must be a sales-weighted average (SWA). Additional key supplementary metrics that are recommended to be collected include aggregated NPM scores at varying regional levels and total calories sold per retailer.
An effective data collection and monitoring regime will need to be designed and put in place before the enforcement of targets. There should be a proportional penalty framework (to be refined during the consultation process) similar to that established for the Groceries Supply Code of Practice.
It is recommended that the FSA, alongside the devolved nations’ equivalents, be made responsible for enforcement of the policy.
Estimating the population impact
We estimated that this policy would reduce the prevalence of adult UK obesity rates by approximately 25%
Estimating the per-person impact
We estimated that this policy would reduce average daily calorie intake by approximately 78 kcal per person
- The evidence supporting this policy is reported in Nesta’s report – Targeting the health of the nation, developed from a comprehensive analysis of 2021 food purchasing data of 30,000 GB households from Kantar’s Worldpanel. Utilising both nutritional information and sales data, sales weighted averages for health metrics were calculated, classifying products as either ‘healthy’ or ‘unhealthy’.
- Various scenarios were then modelled to ascertain achievable targets for retailers, ensuring no decline in total food sales value and assuming that NPM score is strongly correlated with calorie content.
- The selected targets prioritise ambitious yet attainable outcomes, modelling their impact on population weight with scenarios where the total value of food sold is not decreasing, and a significant reduction in calories is being estimated.
- In contrast to the original report which modelled the impact of this policy over three years, we modelled the impact of mandatory targets over a five-year period (to align with all other policies in this toolkit). This explains the difference in impacts reported here, versus the original report.
- Note: All analysis and interpretation was conducted independently of Kantar Worldpanel. Kantar has not independently verified the findings.
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+. We included this population in the modelling because large supermarket chains affected by this policy account for 90% of all food/drink purchases for in-home consumption, and the majority of people shop at these chain stores.
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). Nearly a quarter of adults in the UK would move to a healthier BMI category as a result of this policy.
We are in the process of analysing the impact of this policy for children and will update the toolkit when this is complete.
| Adults (England and Wales) | Children (England and Wales) | Adults (Scotland) | Children (Scotland) |
| 25% | In progress | 24% | In progress |
Cost and benefits
Cost over 5 years
We estimated that this policy would cost the governments approximately £0.2 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 costs to the governments are estimated at approximately a one-off £72k for local authorities and trading standards, and a £32k annual cost for the continued enforcement of the policy. The costs to the food industry are estimated at a £45 million one-off cost for transitioning operations to comply with the policy, followed by bi-annual £3.3 million cost for product assessment.
| Group affected | Cost | Horizon | Detail |
| Costs | |||
| Government | £0.1m | Annual (5 years) | Enforcement costs |
| Government | £72k | One-off | Enforcement costs to local authorities and trading standards (three hours per local authority and store visits) |
| Industry (Retailer) | £3.1m | One-off | Product assessment (30 minutes of managerial time per product) |
| Industry (Retailer) | £0.1m | One-off | Familiarisation costs (10 hours of managerial time per store, and 12 for those with online stores) |
| Industry (Retailer) | £42.1m | One-off | Store planning and arrangement (two sales assistants and retail cashiers taking 12 hours) |
| Industry (Retailer) | £0.7m | One-off | Knowledge sharing costs |
| Industry (Retailer) | £10.8m | Ongoing (every two years) | Product assessment costs for new and reformulated products (one hour of manager time plus one hour of manager time for stores with online presence) |
Total annual benefit
We estimated that this policy would have an annual benefit of approximately £16 billion
Based on analyses conducted by Frontier Economics, this policy would result in a cost saving of approximately £16 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 Health Lumen to report disease incidence avoided if the policy were implemented. Table 3 presents a summary of cases avoided. These estimates do not represent the total health benefit. 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 the disease incidence avoided (rounded to the nearest 100).
| Disease | Incidence avoided |
| Type 2 diabetes | 81,300 |
| Hypertension | 43,300 |
| Coronary heart disease | 22,500 |
| Colorectal cancer | 6,100 |
| Gall bladder disease | 96,300 |
| Ovarian cancer | Not statistically significant |
| Stroke | 12,100 |
| Liver cancer | 800 |
| Depression | 700 |
| Musculoskeletal disease | 33,200 |
Behind the averages: impact on inequalities
The proposed policy would aim to facilitate easier access to healthier choices without imposing additional costs on retailers or consumers. The flexibility inherent in the policy, combined with a well-structured transition period, mitigates the likelihood of businesses passing on any incurred costs to consumers, in contrast to the common outcome observed with other policies, like new taxes. As a result, the policy not only promotes healthier choices but also fosters equality in access and affordability to nutritious foods, regardless of socioeconomic status.
There is some evidence that people with a lower socioeconomic status shop more frequently at convenience stores which tend to stock smaller ranges and more expensive unhealthy food options than larger supermarkets. We have analysed this trend with our dataset to evaluate the distribution of volume weighted purchases by households across the Index of Multiple Deprivation (IMD) and income groups, segmented by different store levels. We found that there is an increase in purchases in the non-chosen stores in more deprived areas or lower income groups. Hence there is evidence that this policy would benefit all IMD and income groups, but would have slightly greater benefit for people from higher IMD and income groups.
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 Medium evidence base.
Tax sugar and salt sold in processed foods
Introduce a £3/kg tax on sugar and a £6/kg tax on salt sold for use in processed foods or in restaurants and catering businesses