Obesity, inequality and the weekly shop: who stands to benefit from the healthy food standard?
www.nesta.org.uk/blog/obesity-inequality-and-the-weekly-shop/
www.nesta.org.uk/blog/obesity-inequality-and-the-weekly-shop/
In the UK, around two-thirds of people are living with excess weight and obesity. This reduces quality of life and places a severe burden on our economy and society. To change that we need to see effective policies that reduce obesity across the population.
Obesity also disproportionately affects those in our most deprived communities and contributes to a gap in healthy life expectancy. To address these inequalities, government policy should tackle obesity through system-wide changes while delivering the steepest benefits to disadvantaged groups. We cannot allow the health divide between the richest and the poorest to grow.
The healthy food standard (HFS), part of the UK government’s 10 Year Health plan, is a key example of a system-wide change that’s already on the table. It will introduce mandatory health reporting for all large food businesses and set targets for improvement. Ideally rolled out in supermarkets first, (as the Commons Health and Social Care Committee has recommended) it's therefore essential the policy combats inequalities by pushing supermarkets across all locations and consumer bases to sell healthier food.
To investigate this, we analysed recent consumer data which tracked where households buy their calories to eat at home across Great Britain. We also analysed food purchases across different indicators used to measure inequality:
All results and conclusions presented here are Nesta’s independent analysis of data from Worldpanel by Numerator’s Take-Home Purchase Panel GB for 1 January - 31 December 2024. This is self-reported data tracking where households buy their calories to eat at home across Great Britain.
No matter how much money we make or what socioeconomic group we fall into, the overwhelming majority of the food we buy to eat at home usually comes from the exact same places. Across all income groups in Great Britain, over 90% of calories purchased for take-home consumption come from the 11 largest grocery retailers.
A similar pattern is seen when households are grouped by social grade, with the proportion ranging from 93% among the lowest social grade (E) to 97% among the highest social grades (AB). In England the finding that the majority of calories are purchased at major supermarkets also holds when looking at the Index of Multiple Deprivation (IMD): more than 93% of calories across all deciles - from the most affluent to the most deprived - are bought from large retailers. Comparable analysis has not yet been done for Scotland and Wales. Altogether, this shows that people buy the majority of the food they eat at home from major retailers, with limited variation based on what they earn or their socioeconomic group.
Across all income groups, social classes, and levels of deprivation, over 90% of food calories purchased to eat at home come from the top 11 grocery retailers.
This set of three stacked bar charts illustrates the share of food calories purchased by households in Great Britain for in-home consumption, categorised by three different socioeconomic indicators. In all three charts, the vast majority of the bar (representing over 90%) is coloured blue, indicating that the top 11 grocery retailers are the primary source of calories for all groups.
In all three charts, the remaining small proportion of calories (less than 10% combined) is attributed to bargain stores and freezer centres, convenience stores and other retail outlets, showing very little variation across different demographic segments.
Outside of these top 11 grocery retailers, bargain stores and freezer centres account for roughly 5% of calories purchased, while convenience stores make up only ~1%. Note, bargain stores and freezer centres, convenience stores and other categories exclude the top 11 supermarkets - including their smaller convenience format stores like 'express, local or little'.
We also calculated the share of food calorie purchases from top 11 supermarkets as a percentage of total calories purchased (both take-home and out-of-home). Across all social groups, large grocery retailers account for over ~80% of food calories. This varies slightly across social grades and income groups.
The reality of where we shop isn’t drastically different across England, Scotland or Wales either. Applying the policy to major grocery retailers will cover the vast majority of food purchased across Great Britain.
Across all incomes and social grades, the 11 largest retailers account for 90% of food calories purchased for consumption at home in Wales and 91% in Scotland, only slightly lower than across Great Britain (93%). This suggests households in Scotland and Wales are likely to benefit from the policy to a similar extent as those elsewhere in Great Britain. Therefore, devolved governments have good reason to adopt a similar approach to implementation.
Across England, Scotland and Wales, the top 11 supermarkets account for over 90% of in-home calories purchased.
This horizontal stacked bar chart compares the share of food calories purchased for in-home consumption across three nations: England, Scotland, and Wales. In all three nations, the blue segment representing 'top 11 supermarkets' dominates the bar, accounting for over 90% of total calorie purchases. The remaining small proportions are split between bargain stores and freezer centres, convenience stores, and other retailers.
The visual demonstrates that regardless of which nation in Great Britain households are in, the vast majority of their calorie purchases are sourced from the same major grocery retailers. Notably, Scotland and Wales rely marginally more on bargain and freezer stores for their calories (6% and 7% respectively) compared to England (4%). Convenience stores also see slightly higher usage in Wales, where they contribute to 2% of calories purchased, compared to 1% in both Scotland and England.
It’s often assumed that people living in rural areas struggle to access large grocery retailers and rely heavily on local convenience stores. In fact, the data tells a different story: across all areas and in all nations, the majority of calories (over 90%) are purchased from large grocery retailers while purchases from convenience stores are low (~1-2%). What’s more, separate research Nesta commissioned in Scotland - due to be released later this month - shows that overall, 96% of addresses are within 15 minutes’ driving time to one of the top 11 retailers while 72% were within a 15 mins journey by public transport and 67% a 15 mins walk.
Policymakers can be confident that health targets for supermarkets will successfully reach families in both urban centres and rural communities throughout Great Britain.
More deprived areas see higher rates of obesity than the least deprived areas (the obesity prevalence gap between the most and least deprived areas is 14 percentage points in England). When looking at households across Great Britain, we also observed a slight social gradient in the healthiness of food purchases. Looking at their health score (we used a sales-weighted converted nutrient profile model (SWA cNPM), which is our recommended metric to measure and report on healthiness of sales and to set health targets), we found that higher-income households make healthier purchases (67) compared to lower-income households (65), and higher social grade groups purchase healthier purchases (67) compared to lower social grades (64).
Healthiness of food purchased to eat at home by annual household income and social class in Great Britain.
Two bar charts displaying the sales-weighted average converted nutrient profile model (SWA cNPM) scores for food purchased for in-home consumption, segmented by annual household income and social class respectively. The data reveals a small social gradient in the healthiness of food purchases across both metrics; higher-income households record scores of 67, compared to 65 in the lowest income bracket, while higher social grades (AB) record scores of 67, compared to 64 in the lowest social grade (E).
Given that lower-income and social grade groups still purchase over 90% of their take-home calories from the top 11 grocery retailers, setting targets there offers the greatest scope to improve diets. They also stand to gain the most from how the policy works: by requiring retailers to make small changes to how they sell, promote and develop food, it makes healthier food the easiest option - rather than something shoppers have to seek out. Approaches which depend on people changing their behaviour and committing effort to doing so risk widening inequalities.
Alongside addressing inequality, it is crucial that the HFS makes the biggest, positive difference to people’s lives and avoids any unintended consequences. We wouldn’t want to see major supermarket chains hit health targets by only driving improvements in more affluent areas.
When we looked at deprivation in England, we found that even if retailers improved the healthiness of their sales over and above the target in just the 20% most affluent areas (by reaching a health score - SWA cNPM - of 70), while leaving less affluent areas unchanged, no retailer would overall be able to reach a health target of 69. If all retailers were to reach the health target of 69, retailers must have made improvements such that people across all social groups will have benefitted from the policy. The government could require retailers to report performance across different geographic locations to help ensure this.
Progression towards a SWA cNPM target of 69 by outperforming in wealthiest areas.
A line chart showing the projected Sales-Weighted Average converted Nutrient Profile Model (SWA cNPM) scores for major grocery retailers (represented by letters A through K) against a target score of 69. The chart illustrates a hypothetical scenario where retailers attempt to meet this target by disproportionately improving the healthiness of their sales in the wealthiest 10% and 20% of areas, while leaving sales in less affluent areas unchanged. The lines trend upwards but doesn't meant the target threshold. This demonstrates that even if retailers were to significantly over-perform in these wealthiest areas, no individual retailer would reach the overall health target of 69, indicating that widespread improvements across all social groups are necessary to meet the HFS goal.
The HFS is the most impactful policy currently available for improving the food environment - if implemented effectively, it could reduce adult and childhood obesity by around 20%.
The results of this analysis should give confidence to policymakers that the HFS will cover the majority of food for everyone, regardless of income, occupation or location. By demonstrating that shopping habits are consistent across all demographics, our data confirms that the HFS can serve as a powerful, equitable lever.
The HFS provides a strong foundation needed to halve obesity and close the health gap. Ultimately, a government that puts the implementation of the HFS at the heart of their prevention agenda would send a bold signal on obesity, shifting responsibility for change from individuals to the food industry at large. This will go a long way to guaranteeing the essentials of healthy eating and distributing good health for all.
