Transforming Grocery Stores: Empowering Healthier Choices

Grocery shopping can be a minefield of temptation, with sugary beverages, candy, and salty snacks strategically placed to lure unsuspecting shoppers. However, small changes in the "choice architecture" of these environments can help people make healthier decisions and avoid unplanned impulse purchases. The food industry's tactics to promote unhealthy products disproportionately impact low-income and minority communities, undermining efforts to address nutrition-related health disparities. Implementing evidence-based policies and strategies can create grocery store environments that empower all shoppers to make healthier choices.

Reclaiming the Grocery Aisle: A Path to Improved Health and Equity

Combating the Lure of Unhealthy Temptations

Grocery stores, convenience stores, and other food retailers are designed to maximize sales of cheap, energy-dense, and nutrient-poor products. These marketing tactics target all shoppers, but have the most significant impact on low-income and minority communities. Much like the tobacco industry, the food industry has a history of aggressively targeting these vulnerable populations, including those who rely on Supplemental Nutrition Assistance Program (SNAP) benefits. This ubiquitous food environment undermines efforts to improve nutrition-related health and health equity.

Transforming the Grocery Landscape

One effective strategy to combat this challenge is to strategically place healthy food and beverages in highly visible and accessible locations within grocery stores. A study conducted at Massachusetts General Hospital demonstrated the power of this approach, where the implementation of traffic light labels (green=healthy; yellow=less healthy; red=unhealthy) and the relocation of healthy items to eye-level and convenient locations led to a sustained increase in healthy food choices by hospital visitors and employees over a two-year period. This model has been replicated in various retail settings, including low-income communities, with similar positive results.

Policy Interventions for Healthier Environments

While some supermarkets have voluntarily implemented health-promoting programs, such as the Guiding Stars system used in Hannaford grocery stores, these efforts are sporadic and lack coordination. Comprehensive policies are needed to ensure that a healthy food environment is equitably available in all stores and communities. The city of Berkeley, California, took a significant step in this direction with the implementation of a first-of-its-kind healthy checkout ordinance, which required large stores to limit the types of food and beverages in checkout lanes to include only unsweetened beverages and foods with minimal added sugars or sodium. This policy resulted in a 125% increase in healthy food and beverage checkout lanes within one year, demonstrating the feasibility and effectiveness of such interventions.

Unlocking the Potential of Evidence-Based Policies

Beyond healthy checkout policies, there are three evidence-based food environment policies that, if implemented broadly, could significantly transform the U.S. food landscape and improve the health of all Americans. First, healthy placement policies that stock healthier options in checkout lanes, aisle endcaps, and front-of-store locations have been shown to help shoppers make healthier choices. Second, simple and easily visible front-of-package labeling systems, such as traffic lights, guiding stars, or warning labels, can further empower consumers to make informed decisions. Third, policies that tax sugar-sweetened beverages, a major contributor to obesity and cardiovascular disease, have been effective in reducing consumption, as demonstrated by the 35% decrease in taxed beverage sales in Philadelphia two years after the implementation of a 1.5-cents-per-ounce tax.

Collaboration for Healthier Innovations

While policy interventions are crucial, the food industry must also play a role in driving positive change. By innovating healthier products that are low in added sugars, sodium, and unhealthy fats, and ensuring these options are affordable, the industry can contribute to a healthier food environment. The implementation of healthy placement standards and front-of-package labeling could incentivize manufacturers to reformulate their products to align with these policies, though it will be important to monitor for any unintended consequences, such as new marketing strategies aimed at circumventing regulations.

Empowering Healthier Choices for All

The food industry's tactics to promote unhealthy products have created an environment that undermines the health and well-being of all Americans, with the most significant impact on low-income and minority communities. Implementing evidence-based policies and strategies to transform grocery store environments can empower shoppers to make healthier choices, ultimately improving nutrition-related health outcomes and promoting health equity. While the food industry may be reluctant to voluntarily improve its choice architecture, it is up to cities, states, and the federal government to take action and create a food environment that supports the health and well-being of all.