Angela Dickinson

The UK food system has been subject to a range of external pressures over recent years, and particularly influenced by austerity policies, the Covid‐19 pandemic, exit of the UK from the European Union, geopolitical instability, increasing energy prices, and cyber attacks. These disturbances have resulted in high levels of inflation and a cost‐of‐living crisis, presenting challenges to household budgets and food affordability. Support structures that have traditionally supported pensioner age households (PAH) to access food, such as community lunch clubs and meals on wheels services, have been adversely affected by austerity measures, and thus have been in decline since 2010. Many community lunch groups which were forced to close during the pandemic have not re‐opened. This article explores how disruptions to the food system have impacted how PAH interact with the food places and spaces they have traditionally relied on. The challenges presented by food system disruptions are explored through a secondary analysis of and critical reflection on data from four empirical qualitative studies undertaken in the south‐east of England over the past decade. This secondary analysis focuses on place, in particular, in relation to changes in food acquisition practices. Both the studies and exploration are underpinned by a theoretical framework developed to model food system vulnerability in later life. The studies include an ethnographic study exploring the vulnerability of older people in the UK food system undertaken before the pandemic, two studies exploring food practices undertaken during the pandemic, and a study undertaken post‐pandemic examining the use of food aid by older people. These studies demonstrate how the places PAH use to source food are in flux. The cost‐of‐living crisis has led to an increase in the number of older people using food aid such as food larders, social supermarkets/pantries supplying surplus food, and community cafes producing low‐cost or free food. However, these sources do not meet all their food needs and are supplemented by purchasing food from supermarkets. This increases the complexity of the food environment PAH on lower incomes engage with and could amplify their risk of being food insecure. Governments and food providers need to be better prepared for future major disruptions to the food system, and be particularly aware of, and be prepared to support, the needs of PAH.

Longer life expectancy and growing income inequality have prompted an increasing interest in understanding the impact of ageing on nutritional requirements in order to optimise intakes, increase the number of years lived in good health and reduce morbidity and associated health and social care costs. Food insecurity reduces access to nutritious and healthy food. Understanding the evidence base on the impacts of food insecurity and the maintenance of food security for older people is crucial to informing policy and intervention. The increase in numbers of older people experiencing food insecurity is a public health emergency and is associated with under and malnutrition. Food insecurity can be experienced at any stage of the life course but has been more widely studied with families and children where poverty is a major driver. Food insecurity in later life has been less well explored by academics, but differs from that experienced in earlier years due to additional complexities, as physical and cognitive health amplify the impact of poverty. Additionally, factors which can appear to be relatively small in impact can act in a cumulative way to push people towards food insecurity. This review will draw on research about older people’s food practices, contexts and experiences in relation to food insecurity in later life and offers a model of food insecurity that has the potential to guide focused public health efforts in order to support the older population to be food secure.

Introduction: Nutrition information practice is fundamental to the process of nutritional self‐management for people living with Type 2 diabetes (PLWT2DM). Lay‐led, peer support groups have been proposed as a mechanism offering a source of nutrition information. However, there is limited research exploring how support groups facilitate nutrition information practices in PLWT2DM. The aim of this study was to explore the accessibility, acceptability and effectiveness of lay‐led peer support groups in the nutrition information practice of PLWT2DM. Methods: The study took a mixed methods qualitative approach through the lens of practice theory and information practice. Twenty participants (19 were PLWT2DM and one partner) were interviewed following a 4‐week diary data collection period where peer support interactions relating to nutrition information practices were recorded by participants. Data were analysed using thematic analysis. Results: Participants used their experiences of advice from a dietitian and structured education sessions to emphasise the relative influence of peer support groups on their nutrition information practices. Particularly their accessibility, ongoing nature and facilitatory environment enabling social interactions. However, key competencies participants needed were feeling that diabetes was an embodied (integrated) part of everyday life, group communication skills and facilitation skills (considered essential for group leaders). Conclusion: Peer support groups provide a useful addition to the nutrition information landscape of PLWT2DM. However, the stage of disease embodiment (integration) and skills in social interaction impacted on their perceived effectiveness. Dietitians need to consider the benefit and potential longevity of peer support for PLWT2DM particularly since the COVID‐19 pandemic, as a shift towards online formats for peer support groups have changed their availability and possible effectiveness.

Using two new common ( Phaseolus ) dry bean varieties developed for UK growing conditions, the BeanMeals project explored how to pursue ‘fork to farm’ systemic innovation in the food system to transform institutional catering and home-cooking towards healthier diets with lower environmental impact, while also enhancing local and national enterprise. Action research, underpinned by a new systems thinking framework, centred on six primary schools and ten households in Leicester and Leicestershire (UK), set against a review of city-, county- and national-level school food policies. Three demand scenarios were developed, based on increasing UK average daily consumption from 8.5 g to either 17, 34 or 50 g, together with three enterprise opportunities (‘Community Enterprise’, ‘Artisanal Entrepreneurs’ and ‘Food Giants’), to satisfy these demands in different ways. The benefits and trade-offs of scaling UK beans were analysed, including assessments of overall benefits to health, benefits to the environment (which depend on the methods of land conversion and weed management used), and economic benefits (which depend on the scaling method employed). This article is part of the theme issue ‘Transforming terrestrial food systems for human and planetary health’.

Background: In the past five years the UK food system has been severely impacted by a combination of events including the pandemic, geopolitical | POSTER

Background: The consumption of a healthy balanced diet is the cornerstone of treatment for people living with type 2 diabetes (PLWT2DM). The United Kingdom recommends a standardised voluntary front‐of‐pack food labelling system which uses the green–amber–red colour coding to indicate the presence of nutrients in a food item. Research with PLWT2DM suggests that they may find it challenging to interpret the information on food labels. This paper draws from a larger study exploring nutrition information practices for PLWT2DM. The aim of this paper is to explore the experiences of using nutrition information found on food labels among PLWT2DM and their partners/carers.Methods: This study used a qualitative and mixed methods design, using a solicited 4‐week unstructured diary followed by a qualitative interview with each participant. The theoretical framework drew on practice theory. Data were analysed using thematic analysis.Results: Nineteen PLWT2DM and one partner took part. Data consisted of 19 diaries and interviews. Almost all participants used food labels to help manage their condition; however, the colour‐coding link with traffic lights appeared to overemphasise the need to avoid foods with red labels. Participants' beliefs about sugar influenced their food choices which in turn could impact on their nutritional intake. Highly developed mathematical skills were needed to interpret information about portion sizes.Conclusions: Healthcare professionals and patient support groups should focus more on educating PLWT2DM about how to interpret food labels so that they are able to apply these to their own food choices. Future research and development of subsequent versions of the food labelling system should include PLWT2DM to ensure that labels are both clear and relevant to them.

In recent years, Meals on Wheels (MoW) services have been in a state of decline as austerity policies have become entrenched. However, this decline is occurring with little knowledge of the impact withdrawal of MoW services has on the health and well-being of those who use them. The pandemic has raised awareness of precarity and vulnerability in relation to food that affects many people in the UK and other Westernised countries and this provides further context for the analysis presented. This paper presents findings of a mixed methods ethnographic study drawing on qualitative interviews and visual methods underpinned by social practice theory to explore the household food practices of older people receiving MoW services. Interviews were conducted with 14 older people receiving MoW, eight MoW staff delivering MoW services in the east of England and one expert. The Covid-19 pandemic interrupted the study, and once the first lockdown began visits to the homes of older people were terminated and the remaining interviews were undertaken by telephone. The study found that a number of threats accumulated to change food practices and moved people towards vulnerability to food insecurity. Threats included difficulty accessing food and cooking due to sensory and physical challenges. The MoW service increased participants' coping capacity. As well as benefiting from the food provided, the relational aspect of the service was important. Brief encounters between MoW staff built caring relationships that developed over time to ensure older people felt valued and cared for. The study demonstrates how MoW services make a positive contribution to food practices, supporting vulnerable adults to continue living well in their own homes and protecting them from food insecurity and ill-being. Local authorities looking to make cost savings through ending MoW services should consider the impact this would have on the well-being of older residents.

This article discusses the development and use of the solicited unstructured diary-interview method to explore the everyday tacit and mundane nutrition information activities (NIA) of people who have type 2 diabetes. Diary completion was followed by individual qualitative interviews with individuals (n = 18) and one couple. Diary entry styles ranged from succinct daily logs of their NIA to extensive prose reflecting on the nutrition information they used and associated practices. Development of the method incorporated piloting and advice from lay groups who checked acceptability and understanding of the research tools, and highlighted the need for regular contact between the researcher and participants throughout the diary completion phase. Participants engaged positively with the diary approach. The findings highlight the extent to which the everyday NIA is mundane and thus unavailable for academic exploration. The diary-interview method exposed these practices to both the researcher and participant, and supported them to reflect on the practices they engage in every day in order to self-manage their type 2 diabetes. Although this article draws on an example from health, the article demonstrates how the diary-interview method has utility for researchers exploring other everyday tacit and mundane experiences.

The older population is particularly susceptible to malnutrition, which currently affects 1.3 million people aged 65+ in the United Kingdom. Malnutrition is an outcome of food insecurity and despite demographic changes that have led to a rise in numbers of older people, we know very little about how older people become vulnerable to food insecurity. The aim of this study was therefore to explore older people's everyday food practices in order to expose the strengths and challenges within local and national food systems, and better understand how food insecurity might arise in later life. This empirical study operationalised practice theory using a multi-method ethnographic approach with 25 households aged 60–94 years, comprising interviews, observation, visual methods and food logs. A model of vulnerability developed by Schröder-Butterfill and Marianti framed data collection and analysis. Analysis revealed the assets and adaptations older households used to protect themselves from threats to food security. Factors ranging from changes to physical and mental health, and structural factors such as supermarket design, moved households towards food insecurity. Smaller everyday ‘trivia’, e.g. lack of seating and accessible toilets in supermarkets, accumulated to shift people towards vulnerability. Vulnerability is structured by the habitus but is a fluid, relational, temporal and socially constructed state, and people moved towards and away from vulnerability. We have developed a model that accommodates this fluidity, incorporates the concept of ‘cumulative trivia’ and suggests how the ‘aggregation of marginal gains’ could counter-balance and address trivial threats. This model demonstrates to policy makers and those working in public health how vulnerability to food insecurity operates and where interventions could be applied to support households to achieve food security and avoid becoming malnourished.