Relative contributions of recommended food environment policies to improve population nutrition: results from a Delphi study with international food policy experts

Objective: To determine weightings for the relative contributions of nineteen widely recommended good practice food environment policies to improve population nutrition, based on evidence of effectiveness and expert ratings, to facilitate benchmarking of the implementation of food environment policies globally. Design: A two-round Delphi study was performed in 2015, whereby international food policy experts (nRound127, nRound221) compared effectiveness of all possible pairs of policy domains and good practice policies within domains to improve population nutrition according to the Saaty scale (1 to 9). Weightings for each domain and policy were derived from expert ratings based on the Analytic Hierarchy Process method. Setting: International. Subjects: Food policy experts. Results: Out of the seven policy domains, Food Prices and Food Promotion received the highest weightings for impact on improving population nutrition, while Food Trade received the lowest weighting. Among the nineteen specific policies, taxing unhealthy foods (3·8 (0·7)), healthy food provision in schools (2·8 (0·4)) and minimizing taxes on healthy foods (2·6 (0·4)) were given the highest weightings, while nutrient declarations on packaged foods (1·2 (0·2)) and healthy food policies in private-sector workplaces (1·0 (0·2)) received the lowest weightings (mean (95 % CI)). Conclusions: Expert-derived weightings on the relative contributions of recommended food environment policies to improve population nutrition will facilitate monitoring and benchmarking the implementation of these policies by governments among countries globally. Additional weightings for contributions of policies to reducing nutrition inequalities and improving consumer and child rights could be developed in the future.