Reduce number of takeaways in proximity to schools
Restrict the number of new fast food restaurants opening within 400m of schools
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Very low impact on obesity
Impact refers to the effect on obesity associated with a particular policy intervention.
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Moderate evidence quality
Evidence refers to the effect on obesity associated with a particular policy intervention.
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Very low cost to governments
Cost refers to the effect on obesity associated with a particular policy intervention.
What is the policy?
This policy relates to the authority and success of urban planners in Local Authorities in refusing planning permission for the opening of new takeaway outlets near schools. It is sometimes referred to as the implementation of takeaway management zones or “exclusion” zones. This policy is implemented at a local government level.
Recent context
Modifying the distribution and density of takeaway food outlets in cities and neighbourhoods is becoming an increasingly important element of nutrition and health policy in the UK particularly in relation to children’s weight. The primary objective is to curb the proliferation of takeaway food outlets in proximity to schools within urban and suburban areas across the UK.
The most common type of health-focused planning regulation implemented by Local Authorities (LAs) is takeaway management zones. Waltham Forest was the first LA to adopt one in 2009. By the end of 2017, 35 out of 325 LAs in England had introduced takeaway management zones encircling schools. The takeaway management zones influence the planning approval for new takeaways but have no control on those already in operation. Among 35 English Local Authorities, 26% adopted full management zones, which prohibit all new takeaways, 20% adopted time management zones, imposing restrictions on the operating hours of new takeaways and 54% adopted town centre exempt zones, exempting town centres that overlap with management zones.
In Wales, some local authorities already utilise existing planning powers and have processes in place to restrict the location or number of HFTs. To support the planning system, in 2021 Public Health Wales published guidance for planners to equip them to make conscious decisions regarding the health impacts of policies. However, the Welsh Government recognised in their Healthy Food Environment consultation that there are limits to what can be achieved through the planning system. They are therefore currently exploring other supportive measures such as reviewing licensing and regulation of street trading policies near secondary schools.
In Scotland, the national Diet and Healthy Weight Action Plan detailed support for restricting take-aways near schools and committed to exploring this in the future iteration of Scottish Planning Policy (the now published National Planning Framework 4). This support has not yet translated into action. Research was also carried out by Scottish Government on the relationship between the food environment and the Scottish planning system which indicated that there was at the time no interaction between planning policy and the food environment in so far as seeking to address obesity is concerned.
Case studies
Leeds City Council Takeaway Planning Restrictions
In 2019, Leeds introduced a “Hot Food Takeaway Supplementary Planning Document“, a policy which aims to restrict the opening of new hot food takeaways within 400 metres of Secondary schools.
Manchester City Council Planning Restrictions
Manchester has implemented similar restrictions on hot food takeaways near schools. Planning policies aim to limit the proliferation of fast-food outlets in areas to no more than 10% of all non-residential ground floor frontages in district and local centres.
Bristol City Council bans takeaways near schools
In Bristol, a policy will stop new takeaways from opening within 400m of schools or youth clubs. The policy will also stop three or more takeaways from opening next door to each other.
There are a number of other case studies which illustrate a range of approaches across England in the Sustain Hot Food Takeaways Toolkit.
Considerations for implementing policy
Local Plans are informed by the statutory National Planning Guidelines which underpin the National Planning Framework in each nation. It is clearly stated in the frameworks the relation of planning to health and wellbeing and the role it can play in creating healthier communities. Local policies have to align with the National frameworks.
Other considerations also include the fact this policy does not take into account the whole journey and therefore students’ overall exposure to takeaways. Many school children have access to free public transport so can reach fast food outlets outside the exclusion zone and the 400m exclusion zone is effectively only relevant to lunchtimes and the time immediately before and after the school day.
Estimating the population impact
We estimated this policy would reduce the prevalence of UK obesity rates by x%.
Estimating the per-person impact
We estimated the impact of this policy on using data published in Burgoine et al’s evaluation of this policy in xxxxxxx. This study estimated that after 6 years the policy would result in 30.3%% fewer takeaways opening as would have been if the policy was not implemented. We could not identify high quality data that estimated the effect of this policy on obesity related outcomes (e.g. BMI, calorie intake). We therefore assumed that calore intake for the exposed population would remain constant throughout the intervention period. This is because the policy would result in no additional outlets opening, rather than reducing the existing availability of outlets.
Applying the effects at a population level, key assumptions:
- We model the impact for children in the age group 5 – 17 years all inclusive. We are interested in those children living with excess weight (≥ 85th percentile).
Evidence shows that increased exposure to fast food and takeaway outlets increases BMI in children aged 7 – 14 years.
Cost and benefits
We estimated this policy would cost the government £xx to implement over five years.
5-year cost benefit
The table below shows a breakdown of costs. The direct costs to the Government are estimated as a £xx one off cost and a subsequent £xx annual cost. The costs to the food industry are estimated at a £xx one-off cost for [insert].
5-year cost benefit
We commission Health Lumen to assess the short term benefits of implementing this policy. After five years this policy would see a cost saving to the NHS of £xx . New cases of [insert disease] and [insert disease] would reduce by xx% and xx% respectively.
| Group affected | Cost | Horizon | Detail |
| Costs | |||
| Government | |||
| Government | |||
| HFSS Advertisers | |||
| HFSS Advertisers | |||
| Benefits (5-years) | |||
| Government | |||
| Consumer |
Long term benefits
Based on analyses conducted by Frontier Economics, this policy would result in a cost saving of [insert].
Effect on inequalities
Evidence shows that a greater number of fast food outlets are more likely to be clustered within more deprived areas, and it is well documented that there is a higher prevalence of childhood obesity in areas of deprivation. Therefore any measures to reduce the prevalence of fast food outlets within 400m of school in these areas should have a positive impact on inequalities.
One unintended consequence of the introduction of management zones could be the displacement of takeaways to other areas, such as the periphery of management zones
What works well in combination with this policy?
Sources
| Number of studies | Sample Size | Country (Number of studies) | Age range | Intervention and comparison | Magnitude of effect in SD (95% CI) | Magnitude of effect (calorie intake) | Quality of Evidence* |
|---|---|---|---|---|---|---|---|
| High income countries (lab and field settings); Most studies from USA | High income countries (lab and field settings); Most studies from USA | Intervention: larger-sized portions, package, individual unit or item of tableware Comparison: smaller-sized portions, package, individual unit or item of tableware | Outcome of interest: Consumption; Effect size: SMD -0.60 (95% CI -0.84 to – 0.36, P < 0.001 ) | Mean energy intake on an average snack occasion would be -38 kcal (18.9%) with lower proximity (CI: -53 kcal to -23 kcal) | |||
| High income countries (lab and field settings); Most studies from USA | High income countries (lab and field settings); Most studies from USA | Intervention: larger-sized portions, package, individual unit or item of tableware Comparison: smaller-sized portions, package, individual unit or item of tableware | Outcome of interest: Consumption; Effect size: SMD -0.60 (95% CI -0.84 to – 0.36, P < 0.001 ) | Mean energy intake on an average snack occasion would be -38 kcal (18.9%) with lower proximity (CI: -53 kcal to -23 kcal) |
References
[1] Ejlerskov, Katrine T., Stephen J. Sharp, Martine Stead, Ashley J. Adamson, Martin White, and Jean Adams. “Supermarket Policies on Less-Healthy Food at Checkouts: Natural Experimental Evaluation Using Interrupted Time Series Analyses of Purchases.” Edited by Barry M. Popkin. PLOS Medicine 15, no. 12 (December 18, 2018): e1002712. <https://doi.org/10.1371/journal.pmed.1002712.>
[2] Hollands, Gareth J, Patrice Carter, Sumayya Anwer, Sarah E King, Susan A Jebb, David Ogilvie, Ian Shemilt, Julian P T Higgins, and Theresa M Marteau. “Altering the Availability or Proximity of Food, Alcohol, and Tobacco Products to Change Their Selection and Consumption.” Edited by Cochrane Public Health Group. Cochrane Database of Systematic Reviews, August 27, 2019. <https://doi.org/10.1002/14651858.CD012573.pub2.>
[3] Liu, Peggy J., Steven K. Dallas, Matthew Harding, and Gavan J. Fitzsimons. “The Sales Impact of Featuring Healthy Foods, Indulgent Foods, or Both: Findings from a Large-Scale Retail Field Study.” Journal of the Association for Consumer Research 3, no. 3 (July 2018): 346–63. <https://doi.org/10.1086/698329.>
[4] Restricting Checkout, End-of-Aisle, and Store Entrance Sales of Food and Drinks High in Fat, Salt, and Sugar (HFSS) Impact Assessment (IA) Summary: Intervention and Options RPC Opinion: Fit for Purpose <https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1008423/impact-assessment-restricting-checkout-end-of-aisle-and-store-entrance-sales-of-HFSS.pdf>
[5] Shaw, Sarah C, Georgia Ntani, Janis Baird, and Christina A Vogel. “A Systematic Review of the Influences of Food Store Product Placement on Dietary-Related Outcomes.” Nutrition Reviews, June 1, 2020, nuaa024. <https://doi.org/10.1093/nutrit/nuaa024.>
[6] Whitehead, R., S. Greci, H Thomson, G. Armour, K. Angus, and L. Martin. “The Impact of Non-Price In-Premise Marketing on Food and Beverage Purchasing and Consumer Behaviour: A Systematic Review.” Preprint. Public and Global Health, September 16, 2021. <https://doi.org/10.1101/2021.09.13.21258115.>
Obesity monitoring for children
Continued universal BMI monitoring for children in reception and year 6