FIO-FOOD, Food Insecurity in people living with Obesity - improving sustainable and healthier food choices in the retail FOOD environment.

Obesity levels in the UK represent a key public health issue, with 67% of its population living with overweight or obesity. People living with obesity are more likely to experience a range of health issues including heart conditions, and Type 2 diabetes. They are also more likely to be living in areas of high deprivation. Reducing obesity levels has been a public health priority in the UK for decades but we have not yet managed to achieve that goal. This is partly due to the range of factors that influence body weight. One key challenge facing people living with obesity is being able to afford a healthy, balanced diet. Nutritionally poor and energy-dense foods that are often ultra-processed, are cheaper and more readily available. To start to address this challenge, we need better evidence on how to support healthier food purchasing patterns to improve their health and wellbeing, while considering environmental impact and sustainability. Food insecurity is 'the state of being without reliable access to a sufficient quantity of affordable, nutritious food'. Families on low incomes are more likely to be food insecure and they spend a greater proportion (three quarters) of their monthly food budget in supermarkets. Supermarket promotions, advertising, and online product placement decisions can impact this group's access to healthy foods. Importantly, healthy diets also need to be sustainable in terms of greenhouse gas emissions, water consumption, and land use; described as the 'sustainability footprint'. Our research will bring together food insecure people living with obesity, consumers, retailers, policy makers, and academics to co-develop and test strategies that can support future transformative potential in the food system. Our diverse team of academic experts in social science, applied health, obesity, and data science, will combine our knowledge of large-scale population data with an understanding of lived experiences of food shopping for people living with obesity and food to develop practical solutions to promote sustainable and healthier food choices in this group. To achieve this, we have designed an innovative four-part project. Perspective: we will work with people living with obesity and food insecurity to understand the key issues facing them while shopping. We will also engage with the retail sector and policy makers to understand their perspectives too. This will identify limitations and barriers of current strategies and scope out future opportunities for our project to make sure our work remains relevant and useful. Big Data: we will use anonymous large-scale data (from >1.6 million shoppers) obtained from a national high-street supermarket (retailer) to understand what foods people buy, how healthy these purchases are, their sustainability footprints and how these choices vary across different household types including those on low income. This will help identify in- store changes that would encourage healthier and more sustainable food purchasing for people living with obesity and food insecurity. Solution Space: we will use the findings from the first two parts of this project to co-design new approaches and test these in-store and online assess their effect on healthier and sustainable food purchasing behaviours. We will also test and measure the effectiveness of these strategies in a group of people who are actively seeking to lose weight (MoreLife patient cohort) and living with food insecurity. This will help to identify strategies that can help transform supermarkets to promote healthier and more sustainable foods. Delivery: we will engage with food producers, food retailers, patient groups, policy makers, and charity group representatives to ensure our project is relevant and transformative. We will do this by sharing our findings with those groups, using webinars, social media, workshops, and research briefing notes.