The nature of UK supermarkets' policies on checkout food and associations with healthfulness and type of food displayed: cross-sectional study

Background: Food choices are often determined by stimuli from our immediate surroundings, including strategic placement in shops to encourage impulse purchases. One example of this is food in shop checkout areas. Recently a number of UK supermarkets have voluntarily committed to providing healthier checkout foods. The aim of this study was to document the nature of current UK supermarket checkout food policies; determine whether there are any differences in the healthfulness and type of food displayed at checkouts in supermarkets according to the presence or nature of policies; and determine whether supermarkets are adhering to their checkout food policies. Methods: Survey of checkout food policies. Cross-sectional observations in 69 supermarkets (covering 14 store formats) in the East of England in Feb-May 2017 of the number and type of checkout foods on each 'checkout journey' (each possible route through the checkout area). Checkout foods were categorised as less healthy or healthier, using the UK Food Standard's Agency's Nutrient Profile Model, and into food groups. Checkout food policies were categorised as clear and consistent, vague or inconsistent, or absent. Results: Checkout food policies differed between store formats in some supermarket groups. Across the 14 store formats included, two had no checkout food policy, six had 'clear and consistent' policies, and six 'vague or inconsistent' policies. In supermarkets with clear and consistent policies there were a median of 13 products per checkout journey, of which 35% were less healthy. Comparable figures for supermarkets with vague or inconsistent, and absent policies were 15 (57%) and 39 (90%) respectively (ps for trend < 0.001). Whilst most supermarkets with a clear and consistent checkout food policy were fully adherent to their policy, those with vague or inconsistent policies were not. Conclusions: Most UK supermarkets have checkout food policies, but not all are clear and consistent. Supermarkets with clear and consistent policies display fewer checkout foods and a lower proportion of these are less healthy than in other supermarkets. Supermarkets with clear and consistent policies adhere well to these. More stores should be encouraged to develop a clear and consistent checkout food policy. This may require non- voluntary intervention.