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Economic instruments for obesity prevention: results of a scoping review and modified delphi survey

Guy EJ Faulkner1*, Paul Grootendorst2, Van Hai Nguyen2, Tatiana Andreyeva3, Kelly Arbour-Nicitopoulos4, M Christopher Auld5, Sean B Cash6, John Cawley7, Peter Donnelly1, Adam Drewnowski8, Laurette Dubé9, Roberta Ferrence10, Ian Janssen11, Jeffrey LaFrance12, Darius Lakdawalla13, Rena Mendelsen14, Lisa M Powell15, W Bruce Traill16 and Frank Windmeijer17

Author Affiliations

1 Faculty of Physical Education and Health, University of Toronto, 55 Harbord Street, Toronto ON, M5S 2W6, Canada

2 Leslie L. Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto ON, M5S 3M2, Canada

3 Rudd Center for Food Policy & Obesity, Yale University, Department of Psychology, 309 Edwards Street, New Haven CT, 06520-8369, USA

4 Department of Kinesiology, McMaster University, 1280 Main Street West, Hamilton ON, L8S 4K1, Canada

5 Department of Economics, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada

6 Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston MA, 02111, USA

7 Departments of Policy Analysis and Management, and Economics, Cornell University, 3M24 MVR Hall, Ithaca NY, 14853, USA

8 Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, WA 98195-3410, USA

9 Desautels Faculty of Management, McGill University, 1001 Sherbrooke St West, Montreal QC, H3A 1G5, Canada

10 Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, 33 Russell St., Toronto ON, M5S 2S1, Canada

11 School of Kinesiology and Health Studies Queen's University, 28 Division St. Kingston ON, K7L 3N6, Canada

12 Department of Economics, Monash University, Building H4, Room 47 Sir John Monash Road, Caulfield, Victoria 3145, Australia

13 Schaeffer Center for Health Policy and Economics, University of Southern California, 3335 S. Figueroa St, Unit A, Los Angeles, CA 90089-7273, USA

14 Ryerson University, School of Nutrition, 350 Victoria Street, Toronto ON, M5B 2N8, Canada

15 Institute for Health Research and Policy University of Illinois at Chicago, 1747 W. Roosevelt Road, Chicago, IL 60608, USA

16 Department of Food Economics and Marketing, University of Reading Whiteknights PO Box 237, Reading RG6 6AR, UK

17 Department of Economics, University of Bristol, 8 Woodland Road, Bristol BS8 1TN, UK

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International Journal of Behavioral Nutrition and Physical Activity 2011, 8:109  doi:10.1186/1479-5868-8-109

Published: 6 October 2011

Abstract

Background

Comprehensive, multi-level approaches are required to address obesity. One important target for intervention is the economic domain. The purpose of this study was to synthesize existing evidence regarding the impact of economic policies targeting obesity and its causal behaviours (diet, physical activity), and to make specific recommendations for the Canadian context.

Methods

Arksey and O'Malley's (2005) methodological framework for conducting scoping reviews was adopted for this study and this consisted of two phases: 1) a structured literature search and review, and 2) consultation with experts in the research field through a Delphi survey and an in-person expert panel meeting in April 2010.

Results

Two key findings from the scoping review included 1) consistent evidence that weight outcomes are responsive to food and beverage prices. The debate on the use of food taxes and subsidies to address obesity should now shift to how best to address practical issues in designing such policies; and 2) very few studies have examined the impact of economic instruments to promote physical activity and clear policy recommendations cannot be made at this time. Delphi survey findings emphasised the relatively modest impact any specific economic instrument would have on obesity independently. Based on empirical evidence and expert opinion, three recommendations were supported. First, to create and implement an effective health filter to review new and current agricultural polices to reduce the possibility that such policies have a deleterious impact on population rates of obesity. Second, to implement a caloric sweetened beverage tax. Third, to examine how to implement fruit and vegetable subsidies targeted at children and low income households.

Conclusions

In terms of economic interventions, shifting from empirical evidence to policy recommendation remains challenging. Overall, the evidence is not sufficiently strong to provide clear policy direction. Additionally, the nature of the experiments needed to provide definitive evidence supporting certain policy directions is likely to be complex and potentially unfeasible. However, these are not reasons to take no action. It is likely that policies need to be implemented in the face of an incomplete evidence base.