Characteristics of supermarket-based interventions in high-income countries, aimed at improving the dietary quality and environmental sustainability of diets of people living with obesity and/or overweight and food insecurity: A Scoping Review

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.