Supermarkets, do they make the healthy choice the easy choice? A review of the healthfulness of the supermarket food environment.

The over consumption of high fat, sugar, and salt foods increases population risk of overweight, obesity and diet-related noncommunicable diseases. The food environment mediates consumer food choices and thus plays an important role in diet quality and related health outcomes. The built food environment, where most people in high-income countries access their food, has been found to be obesogenic. The aim of this review was to investigate the healthfulness of the supermarket food environment. Supermarkets are an important source of healthy foods in the built food environment. However, there are disparities in access to supermarkets, and in several countries, supermarkets located in areas of higher deprivation have an unhealthier consumer food environment. This double burden limits access to healthy foods amongst lower socio-economic groups, contributing to widening disparities in food-related ill health. There is a strong body of evidence supporting improved purchase of healthy foods by increasing the healthfulness of the supermarket consumer food environment. Voluntary measures co-designed with retailers to improve the healthfulness of the supermarket consumer food environment through restriction of product placement and private label reformulation have led to an increase in healthier food purchases. However, evidence also shows that mandatory, structural changes are most effective for improving disparities in the access to healthy food. Future research and policy related to the food environment should consider equitable access to healthy sustainable foods in built and online supermarkets.