Peter Scarborough

Background: The rise of video-based social media platforms and the shift toward a video-first content strategy by social media companies have altered how people consume and engage with food-related content. However, little is known about how young adults experience, interpret, and are influenced by food-related videos on social media across different national and cultural contexts. Objective: This paper explores how young adults in Jamaica and the United Kingdom experience, interpret, and are influenced by food-related videos on social media. Methods: Twelve focus groups (online and in-person, 6 in Jamaica and 6 in the United Kingdom) were conducted between August and November 2024. Sixty participants attended the focus groups; after excluding data from 7 individuals suspected of misrepresenting their eligibility, the final dataset included 53 participants aged 18‐25 years. Discussions explored their experiences with food-related videos. Transcripts were analyzed using reflexive thematic analysis as the foundation, complemented by framework analysis, and the constant comparison method to facilitate cross-national and cross-cultural comparison. Results: Our analysis generated four themes: (1) young adults balance algorithmic influence with personal curation; (2) young adults engage with food-related videos for relaxation, amusement, and learning; (3) young adults evaluate food-related content through inquiry and strategy—using quick credibility checks such as comparing sources, reviewing comments, assessing transparency, and considering cultural context before deciding whether to trust or ignore content; and (4) food choices form at the intersection of online and offline worlds. A unified high-order theme, “a journey of influence,” captures how young adults move from exposure to evaluation and filter digital experiences through offline realities, leading to change or continuity in dietary attitudes and behaviors. Although this journey was consistent in Jamaica and UK focus groups, the ways young adults interpreted food-related content varied culturally. Conclusions: This cross-national qualitative study showcases how and why young adults engage with food-related videos on social media, and how these interactions shape their attitudes and behaviors toward food and nutrition. Our conceptual map visualizes the influence of food-related videos as a dynamic process unfolding across digital and offline environments, identifying 3 decision points for intervention: exposure, evaluation, and contextualization. These findings highlight opportunities to design youth-responsive digital nutrition interventions that recognize young adults’ agency and the sociocultural and material realities that shape their food choices and eating habits.

Background: The SALIENT consortium aimed to bring together research, government and food system stakeholders to co-design, implement and evaluate public-facing food system interventions targeting health and sustainability whilst maintaining affordability and commercial viability. A total of 40 organizations engaged with SALIENT; 8 progressed to deliver and evaluate a total of 10 interventions. We conducted an evaluation to understand how and why the SALIENT stakeholder engagement process worked for different organizations and to inform future food system intervention research. Methods: Using theory-based evaluation principles, a theory of change (ToC) was developed to describe how the SALIENT process was expected to function. A total of 38 semi-structured interviews were conducted with government partners, researchers and food system representatives. Data were thematically analysed and interpreted in relation to the ToC. Results: Findings highlighted the fragmented nature of existing health and sustainability actions across the food system, shaped by differing priorities, agendas and constraints of stakeholders. Power dynamics influenced stakeholder participation, with engagement strongest when research was aligned with core stakeholder goals and offered them tangible benefits. Whilst pragmatic co-design processes built trust and feasibility, they sometimes led to interventions with limited potential to address critical uncertainties in the evidence base. Academic processes were often perceived as misaligned with stakeholders’ practical needs. Conclusions: Long-term government direction, stronger accountability, and incentives are needed to foster meaningful collaboration between researchers and food system stakeholders. Future partnerships should balance flexibility with rigour, build trust through sustained relationships, and establish strong governance, communication and evaluation processes early to generate robust, scalable evidence for meaningful food system change.

Food and beverage (F&B) manufacturers can support or hinder the transition towards a more sustainable food system. Yet, there is limited evidence about their potential to improve the nutritiousness and reduce the environmental impact of the F&B sector. Here we develop an approach to estimate the nutritional quality and environmental impact of the product lines of 44 major F&B manufacturers in the UK. We find considerable variation in terms of nutritional quality and environmental impacts across manufacturers operating within the same food retail category and within existing F&B product portfolios. We identify how changing the types of product sold by these manufacturers offers potential for nutritional and environmental benefits. For some of the F&B manufacturers assessed, changes to 10% or less of their product line could deliver more than half of the potential gains in nutritional quality or sustainability.

Background: In March 2016, a tiered tax was announced on industries manufacturing or importing sugar-sweetened beverages in the United Kingdom. The Soft Drinks Industry Levy was implemented in April 2018 with two tiers: £0.18/l on drinks containing ≥ 5 g/100 ml and < 8 g/100 ml of added sugar, £0.24/l on drinks containing ≥ 8 g/100 ml of added sugar, with no levy on drinks containing < 5 g/100 ml of added sugar. The Soft Drinks Industry Levy is a complex intervention that acts as a disruptor in the commercial food system. As such, it demanded an evaluation that went beyond a narrow focus on a single outcome to incorporate assessment of a range of theorised intervention effects and their dynamic inter-relationships, taking a ‘systems’ perspective. Objectives: We undertook formative work over 6 months to underpin the evaluation, leading to five work packages, which aimed to evaluate: Work package 1: impacts on formulation, marketing, prices, purchases and consumption of sugar-sweetened beverages, and early health impacts. Work package 2: estimated impacts on medium- to long-term health outcomes. Work package 3: estimated economic impacts on food and other industries, His Majesty’s Treasury, health and social care systems. Work package 4: impacts on key stakeholders: the public, policy-makers and industry. Work package 5: the wider implications of the Soft Drinks Industry Levy in a synthesis of all findings and other evaluations. Methods: Work package 1 adopted a natural experimental evaluation design and used quantitative methods, including interrupted time series analysis. Work package 2 employed epidemiological modelling to simulate longer-term health outcomes. Work package 3 used micro- and macroeconomic modelling to estimate the net costs and benefits of the Soft Drinks Industry Levy and to simulate longer-term economic outcomes. Work package 4 used qualitative methods to explore acceptability and impacts of the Soft Drinks Industry Levy for diverse stakeholders. Work package 5 synthesised findings from this and other evaluations of the Soft Drinks Industry Levy and identified implications for policy and further research. Results: Our evaluation shows that the Soft Drinks Industry Levy: incentivised reduction in sugar purchased in soft drinks and in food and drinks overall; was associated with reduced inequalities in sugar purchased from soft drinks, with a 1.6% point reduction in prevalence of obesity in Year 6 girls, and with a 12% reduction in hospital admissions for carious tooth extractions in children and adolescents up to 18 years; was viewed favourably by policy-makers and the public; and did not have lasting negative impacts on the economic performance of soft drinks companies. Based on changes in sugar consumption observed, epidemiological modelling suggested that the Soft Drinks Industry Levy will lead to health gains and to net monetary benefit to the health sector, as well as to reductions in health inequalities. The Soft Drinks Industry Levy was forecast to produce a 0.004% cumulative gross domestic product loss to the United Kingdom economy over a 22-year period. Nevertheless, the Soft Drinks Industry Levy represents good value for money when balancing the overall health benefits against the economic impacts. The results of this evaluation are consistent with the results of studies undertaken by others. Limitations: There were limitations of all the studies we undertook, which are detailed in each of the 18 publications referenced in this report. Since we commenced this research, newer methods have become available for evaluations of interventions in complex adaptive systems. We have taken a narrative approach to triangulating and synthesising findings from our diverse range of studies. The use of more formal methods, such as contribution analysis or process tracing, may have strengthened causal inference. Future work: Government is strengthening the Soft Drinks Industry Levy, by reducing the lower levy threshold to 4.5 mg of sugar per 100 ml of soft drink, increasing the levy rates over time in line with inflation, and including milk-based drinks, and the benefits of such changes should, when implemented, be evaluated. The principles underlying the Soft Drinks Industry Levy could be applied to similar levies on other unhealthy foods, and the benefits of these also need to be modelled. Meanwhile, the longer-term impacts of the Soft Drinks Industry Levy, including industry adaptations, should be monitored, including its impacts on the sugar and soft drinks markets in the United Kingdom and globally. Further research is also needed on the implications of rising levels on non-sugar sweeteners in soft drinks and on ways to reduce the sweetness of all foods. Conclusions: The Soft Drinks Industry Levy was a novel, tiered sugar-sweetened beverage tax that incentivised industry reformulation to remove sugar from soft drinks. It was effective in incentivising reformulation and was associated with observed and projected future health benefits. Although it is estimated that the Soft Drinks Industry Levy had costs for the United Kingdom economy, these were mitigated by benefits for the public, the National Health Service and other sectors. The Soft Drinks Industry Levy has been positively received by the public, policy-makers and, to an extent, industry, and offers a model for future fiscal food policy in the United Kingdom and internationally. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 16/130/01.

Background: Effective interventions are needed to promote environmentally sustainable food choices. Online grocery shops offer a way to study and evaluate these on a large scale. We examine the impact of eco-labels and price discounts on the sustainability of grocery purchases on a UK supermarket website using a browser extension (plug-in). Methods: Participants recruited from the UK Prolific panel were randomised in a 2x3 parallel design testing the effects of (i) price discounts (£1, £0.50, or none) offered on more sustainable alternative products for up to 3 items in their basket, and (ii) eco-labels (A-G environmental impact scale). The primary outcome was the average sustainability score of purchased products. Scores were calculated by mapping product ingredients to life cycle assessment databases, with lower scores indicating more environmental sustainability. The same score was used to construct the eco-labels. The trial was registered on the International Standard Randomised Controlled Trial Number registry (ISRCTN18800054). Findings: Of 6342 eligible participants recruited between 15/04/2024 and 14/04/2025, 1835 downloaded the browser extension and shopped at least once in the trial period. Discounts on more sustainable alternatives led to more environmentally sustainable grocery purchases (for £0.50 discount β= -0.36, p=0.43; for £1 discount β= -0.97, p=0.03). Eco-labels had no effect on the environmental impact of baskets on their own (β=0.06, p=0.88), however, the £1 discount was more than twice as effective for participants who were also shown the eco-labels. The nutritional profile of purchases was similar across study arms. The impact of the interventions varied depending on participant characteristics. Most strikingly young single men reacted adversely to eco-labels but were more likely to respond to price discounts than men and women at other life stages. Interpretation: Price incentives, especially in combination with eco-labels, are more promising than eco-labels alone in promoting more sustainable online grocery purchases.

Shifting diets away from high levels of meat and dairy is increasingly considered an important part of climate mitigation, yet the best pathways for achieving these reductions without compromising nutrition, health or affordability remain unclear. Here, in a representative sample of Scottish adults, we evaluate 33 pathways to meeting the UK Climate Change Committee’s recommendations to reduce meat and dairy consumption by 20% by 2030, increasing to a 35% reduction in meat by 2050. The pathways incorporate existing dietary guidance, and modelled outcomes include intakes of 54 nutrients, obesity, type 2 diabetes, cardiovascular disease, all-cause mortality, diet costs, greenhouse gas emissions, freshwater use, land use and eutrophication. Nearly all pathways were estimated to benefit most nutritional, health and environmental outcomes without increasing diet costs. Benefits were greater when reductions targeted high consumers of red meat and when meat and dairy were replaced gram for gram with foods such as vegetables, beans, eggs and plant-based dairy alternatives.

Understanding the environmental impacts of food products is essential for a sustainable food systems transformation, yet such information remains sparse and non-standardized. Here we analyse nearly 475,000 products across 74 countries, quantifying the impacts on land use, greenhouse gas emissions, biodiversity loss, eutrophication, and water stress. We find that the ranking of category-level environmental impacts is consistent across countries, with the highest impacts observed in categories such as animal products, coffee, nuts and seeds, and the lowest in fruits, vegetables, and beverages. However, the absolute impacts of products within categories vary across geographies due to differences in product composition and ingredient sourcing patterns. For some products, sourcing differences can substantially alter footprints, sometimes outweighing compositional differences, highlighting the potential for targeted supply chain interventions. Our study provides a robust, comparable methodology for estimating product-level environmental impacts that can support policies aimed at shifting demand toward lower-footprint foods.

Background: The United Kingdom Soft Drinks Industry Levy was introduced in April 2018, resulting both in changes in sugar levels in drinks and purchases of drinks. Both mechanisms could impact on the incidence and prevalence of raised body weight, diabetes and diet-related diseases, and therefore, have implications for economic costs to the health sector. Objectives: To model future impacts of the Soft Drinks Industry Levy on population health and health sector costs and to estimate net monetary benefit to the health system. Design and methods: Proportional multistate lifetable modelling study – open and closed cohort analyses. Setting and population: All children and adults in the United Kingdom. Intervention: The Soft Drinks Industry Levy is a two-tier levy of £0.18/l on drinks with between 5 and 8 g of total sugars/100 ml and of £0.24/l on drinks with ≥ 8 g of total sugars/100 ml. Main outcome measures: We evaluated impact of the sugar reduction on: (1) prevalence of overweight and obesity, obesity-related diseases and dental health out to 2050 and (2) lifetime population health (measured in quality-adjusted life-years), change in costs to the health sector and the resulting net monetary benefit. Data sources: We estimated a per person reduction in sugar from a previously published interrupted time series analysis, which found an 8.0 g/household/week (95% confidence interval 2.4 to 13.6) reduction in sugar at 1 year after implementation. Our multistate lifetable model is parameterised using data from population health monitoring surveys, the Global Burden of Disease project, the Human Mortality Database and the Office for National Statistics. Health sector costs were obtained from Department of Health and Social Care budget allocations. Results: The model predicts that the Soft Drinks Industry Levy will reduce the prevalence of overweight and obesity in the United Kingdom by 0.18% points (95% uncertainty interval: 0.059 to 0.31) for males and by 0.20% points (0.064 to 0.34) for females. In the first 10 years of implementation, the reductions in sugar and overweight/obesity are predicted to prevent 270,000 (35,000–600,000) dental caries, 12,000 (3700–20,000) cases of type 2 diabetes, 3800 (1200–6700) cases of cardiovascular diseases and 350 (110–590) cases of obesity-related cancer. For the current United Kingdom population, it is estimated that the Soft Drinks Industry Levy will add 200,000 quality-adjusted life-years (63,500–342,000) over their lifetime and avert £174 million (£53.6–319) in their costs of health care (discounted at United Kingdom Treasury rates). At a United Kingdom Treasury value of £60,000 per quality-adjusted life-year, it is estimated that the Soft Drinks Industry Levy will produce a net monetary benefit of £12.2 billion (£3.88–20.8) for the health system. Limitations: Modelled results assume that the effect of the Soft Drinks Industry Levy remains constant into the future. The longevity of the effect of the Soft Drinks Industry Levy has not been tested. Conclusion: This study of the United Kingdom Soft Drinks Industry Levy tiered tax on sugar content provides further evidence that sugar-sweetened beverage taxes have the potential to achieve meaningful improvements in population health and reduce health sector spending. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 16/130/01.

SUMMARY: Background: Consumption of sugar-sweetened beverages (SSBs) is associated with weight, weight gain and incidence of a number of chronic diseases. The World Health Organization recommends taxation on SSBs to reduce consumption. In 2018 the United Kingdom introduced the Soft Drinks Industry Levy (SDIL), a tiered tax on manufacturers and importers of SSBs. We aimed to review the consequences of the SDIL across all potential outcomes, informed by a systems thinking approach, to understand the range and importance of its effects. Methods: We undertook a systematic scoping review of empirical studies of the SDIL. We used a conceptual systems map of the hypothesised pathways of effect to inform data extraction and narrative synthesis. Findings are presented in an evidence map and their consistency assessed. Results: 38 studies met our inclusion criteria. The SDIL was consistently associated with reformulation of soft drinks to reduce sugar content. It was also consistently associated with: reduced purchasing of sugar from eligible drinks without increasing purchasing of substitute products such as alcohol and confectionary; longer-term improvements in acute and chronic health outcomes; and reduced health and social care costs, with few negative economic impacts for industry. Conclusions: By systematically mapping all outcomes evaluated, we have demonstrated the systemic and interconnected impacts of the SDIL. Further research should seek deeper understanding of how to evaluate such interventions as events in complex adaptive systems.