Changing our food environment – Potential for non-regulatory policy approaches to improve health outcomes

Changing our food environment – Potential for non-regulatory policy approaches to improve health outcomes

e16 studies (siRNA knockdown and plasmid overexpression) demonstrated BAMBI was a negative regulator of adipogenesis (determined by morphology, lipid ...

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e16 studies (siRNA knockdown and plasmid overexpression) demonstrated BAMBI was a negative regulator of adipogenesis (determined by morphology, lipid accumulation, gene & protein expression, insulin sensitivity, adipokine secretion, all p < 0.05) that modulated sensitivity to paracrine factors. Carboxypeptidase X-1 (CPX-1) was up-regulated 22-fold by FGF-1 (p < 0.01). CPX-1 lacks catalytic activity but contains a putative collagen binding domain leading us to posit a role in extracellular matrix (ECM) remodelling, an essential process for efficient adipogenesis. We found that CPX-1 protein was secreted and bound collagen. CPX-1 knockdown abolished adipogenesis, altered collagen expression and organisation and promoted constitutive activation of FAK, MEK and ERK. These data suggest CPX-1 plays a key role both sensing and regulating ECM. Additional studies revealed CPX-1 acts downstream of BAMBI and independent of, yet complementary to, PPAR. Collectively these studies identify a novel BAMBICPX-1 pathway that modulates ECM remodelling and intracellular signalling independent of the canonical PPAR pathway. Further elaboration of this novel pathway may reveal new therapeutic strategies. http://dx.doi.org/10.1016/j.orcp.2013.12.530 32 The policies and approaches we need to change food environments globally Corinna Hawkes World Cancer Research Fund International, London, United Kingdom This presentation will present the NOURISHING framework of food policy actions needed to address obesity. NOURISHING was developed by WCRF International with the objectives of formalising a comprehensive policy package to address obesity through food policy; providing global level recommendations within which policy makers have the flexibility to select specific policy options suitable for their national/local contexts and populations; and of providing a framework through which the evidence for each of the fields of action and policy options can be systematically categorised, updated, interpreted and ultimately communicated to policy-makers. NOURISHING covers three policy domains: behaviour change communication; food environments; and food systems. The presentation will

Abstracts explain the rationale for including each of these domains, and the policy areas within them-and why each is necessary for an effective, public health approach to obesity prevention. http://dx.doi.org/10.1016/j.orcp.2013.12.531 33 Changing our food environment — Potential for non-regulatory policy approaches to improve health outcomes Bruce Neal The George Institute for Global Health, NSW, Australia The food environment provides enormous quantities of cheap and convenient, processed and restaurant foods to consumers. These foods are often high in salt, added sugar and fat and are typically delivered in large energy-dense portions. A predominance of these types of foods has been identified as a key driver of diet-related ill health around the world. This problem is well understood by public health, government, industry and consumers alike. However, while Australian agencies like the National Health and Medical Research Council and the National Heart Foundation have provided specific guidance about optimal dietary intake, there has been little effective action taken to change the diet of the community. Most programs that have been implemented to date have relied upon interventions seeking to achieve individual behaviour modification. Recent examples include the ‘‘Measure up’’, ‘‘Swap it, don’t stop it’’, ‘‘8700’’ and ‘‘FoodSwitch’’ initiatives. All have achieved significant coverage but there is good evidence of improved health outcomes for none. Key issues are unrealistic expectations about the capacity to achieve individual behaviour change, over-optimistic assumptions about uptake, the voluntary nature of the programs and the absence of robust evaluation of key outcomes. While voluntary interventions directed towards individuals can be effective when intensively applied to target groups, there is little evidence that they have a positive impact upon the dietary pattern of the population as a whole. Interventions that seek to change the food environment, rather than individuals’ behaviours, are widely advocated as more likely to produce real health gains for the community. On this basis, in 2009, the Australian Federal Government established the Food and Health Dialogue as a public private partnership between government, public

ANZOS 2013 abstracts health and the food industry. The Dialogue seeks to address poor dietary habits and make healthier food choices easier and more accessible for all Australians through a program of work focussed on food reformulation. In theory this approach has significant potential to deliver large public gains but in practice rather little has been achieved. The key challenges to effective implementation have been the entirely voluntary nature of the initiative, the strong commercial disincentives to industry participation and the absence of any clearly defined timelines or metrics for success. There is an urgent need for more creative thinking about food and health because the current paradigm of individual responsibility and soft touch government is failing the Australian community. Real change is likely to require a more resourceintensive strategy and only limited health gains will be effectively delivered by public—private partnerships. Government will need to consider whether some public funding might be better applied to legislative approaches designed to control the excesses of the food industry in the same way that they are applied to industries marketing products like tobacco, alcohol and automotive vehicles which can also result in a large burden of disease. http://dx.doi.org/10.1016/j.orcp.2013.12.532 34 Potential of food and beverage taxes and subsidies to change behaviour and prevent disease Anne Marie Thow University of Sydney, Eveleigh, NSW, Australia There is growing international evidence to suggest that subsidies for healthy foods and taxes on less healthy foods is an effective measure to change food prices and consumer behaviour, based on two systematic reviews of the literature on fiscal intervention (2000-2009; 2009-2012). The quality of evidence is improving but continues to rely heavily on modelled and self-reported evidence. The options for fiscal intervention most likely to improve diets and reduce body weight are soft drink taxes, fruit and vegetable subsidies, and combinations of nutrient profiling taxes and subsidies. These strategies have been found to be highly effective for taxes and subsidies in the range of 15-35%. These options for intervention are also the least administratively burdensome and are less likely to have negative differential effects such as regressivity.

e17 Another critical dimension of fiscal intervention is effective implementation and administration. These interventions must be coherent with the national (and global) fiscal policy context. Case studies of implementation success and failure indicate that: (1) taxes can be effective in changing prices of target foods; (2) it is important to align proposals for public health nutrition taxation with the priorities of the Ministry of Finance and to use an existing tool such as excise taxation; (3) taxes targeting single nutrients are complex to administer and may have unintended consequences; (4) fiscal intervention may be more sustainable where government commitment to health is explicit; and (5) a tax that affects a majority proportion of the food industry is likely to be unfeasible. http://dx.doi.org/10.1016/j.orcp.2013.12.533 35 Effectiveness of price reduction and behaviour change strategies for improving fruit, vegetable and beverage consumption: Results from the Supermarket Healthy Eating for LiFe (SHELf) randomised controlled trial Kylie Ball 1,∗ , Sarah McNaughton 1 , Cliona Ni Mhurchu 2 , Ha Le 1 , Nick Andrianopoulos 1 , Victoria Inglis 3 , Christina Pollard 4 , David Crawford 1 1 Deakin

University, Burwood, VIC, Australia 2 University of Auckland, Auckland, New Zealand 3 Murray Goulburn Co-Operative Ltd, Melbourne, Australia 4 Curtin University, Perth, Australia Aim: To evaluate the effects of price reductions and skills-based behaviour change strategies on women’s purchase and consumption of fruits, vegetables, and low-joule beverages. Methods: A randomised controlled trial was conducted in the supermarket setting over three months. Participants were recruited from low and high socioeconomic areas and randomly allocated to one of four intervention arms: skills-based behaviour change, delivered via mailed resource packs and an online forum; 20% price reduction on fresh, tinned and frozen fruits, vegetables, lowjoule carbonated soft drinks and water; a combined behaviour change + price reduction intervention; or control (no intervention). Outcomes, assessed with supermarket sales data and self-report surveys,