To assess food industry commitments and practices, the ‘Business Impact Assessment on Obesity and population-level nutrition’ (BIA-Obesity) was applied, as developed by the International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) and previously described in detail by Sacks et al. (10,18). The tool assesses the transparency, comprehensiveness and specificity of commitments as well as practices across six domains, namely: ‘Corporate nutrition strategy’, ‘Product formulation’, ‘Nutrition labelling’, ‘Product and brand promotion’, ‘Product accessibility and eventually ‘Relationships with other organisations’ (18).
All indicators within these domains relate to commitments that go beyond legislative requirements. As a result indicators and scoring criteria need to be adapted to the local context prior to implementation of the tool. Indicators related to the on-pack disclosure of the ingredients list and nutritional declaration were removed as this is regulated by the European Union (32). As it is not common in France for supermarkets to have in-store restaurants, indicators relating to menu-labelling were removed for this food industry. Furthermore, non-alcoholic beverages containing added sugars or sweeteners in France are subject to a tax (33). Consequently, commitments to increase prices of sugary beverages compared to healthier drinks were not taken into account. Since the provision of unlimited refills was banned in France in 2017 (34) the indicator relating to commitments of quick-service restaurants to not provide free refills was removed. Lastly, the indicator regarding the publication of political donations was removed as in France legal persons (including, and in particular, companies) are not authorized to pay any donation or any benefit in kind to political parties (35). The remaining indicators were adapted to suit the French regulatory environment and take into account relevant industry pledges and voluntary government-led initiatives (i.e. Nutri-Score).
This study was approved by the Human Ethics Committee of the University of Ghent (number: 2019/0780). Informed consent to participate in the study was obtained from relevant company representatives.
Selection of food companies
Food companies with a combined market share of over 34% among packaged food manufacturers (35%), non-alcoholic beverage manufacturers (52%), supermarkets (48%) and quick-service restaurants (50%) were selected using French Euromonitor 2018 market share data (Table 1) (36). For packaged food manufactures, an additional selection was conducted based on companies’ market share within specific food categories to ensure that the most prominent companies per food category were covered by the selection (‘Breakfast cereals’, ‘Baked goods’ ‘Confectionery’, ‘Ice-cream and frozen desserts’, ‘Processed Fruit and Vegetables’, ‘Processed Meat and Seafood’, ‘Sweet biscuits and cereal bars’, ‘Drinking milk products’, ‘Yoghurts’, ‘Savoury snacks’ and ‘Ready meals’). Three additional companies were included based on this extra selection (Kellogg’s, Barilla and Bonduelle).
Table 1: The market shares per food industry as determined by Euromonitor and most sold product categories of companies included in the study (France, Euromonitor, 2018).
Packaged food manufacturers
|
Companies
|
Market share (%)
|
Most sold (own-brand) product categories
|
Lactalis
|
3.4
|
Dairy
|
Mondelēz
|
2.9
|
Bread & bakery products, Confectionary, Savoury snack foods
|
Nestlé
|
2.6
|
Dairy, Confectionary, Non-alcoholic beverages
|
Ferrero
|
2.1
|
Confectionary, Bread & bakery products, Cereal & grain products
|
Fleury Michon
|
1.9
|
Meat & fish products, Convenience foods
|
Danone
|
1.6
|
Dairy, Non-alcoholic beverages
|
Unilever
|
1.3
|
Dairy, Sauces, Convenience foods
|
Savencia
|
1.3
|
Dairy, Confectionary, Meat & fish products
|
Bel
|
1.2
|
Fruit & vegetable products, Dairy
|
Panzani
|
1.0
|
Cereal & grain products, Convenience foods, Sauces
|
Barilla 1
|
0.9
|
Bread & bakery products, Cereal & grain products, Sauces
|
Bonduelle 2
|
0.6
|
Fruit & vegetable products, Convenience foods
|
Kellogg’s 3
|
0.5
|
Cereal & grain products, Savoury snack foods
|
William Saurin
|
0.3
|
Convenience foods, Meat & fish products
|
N=14
|
21.6 4
|
|
Non-alcoholic beverage manufacturers
|
Coca-Cola
|
17.2
|
Non-alcoholic beverages
|
PepsiCo
|
8.8
|
Non-alcoholic beverages, Savoury snack foods, Cereal & grain products
|
Orangina Suntory
|
7.6
|
Non-alcoholic beverages
|
Eckes-Granini
|
3.9
|
Non-alcoholic beverages
|
Fruité Entreprises
|
4.0
|
Non-alcoholic beverages
|
Andros
|
2.0
|
Fruit & vegetable products, Dairy, Bread & bakery products, Non-alcoholic beverages
|
N= 6
|
43.5 5
|
|
Supermarkets
|
E. Leclerc
|
11.1
|
Dairy, Fruit & vegetable products, Meat & fish products
|
Intermarché
|
9.8
|
Dairy, Fruit & vegetable products, Bread & bakery products
|
Carrefour
|
8.8
|
Dairy, Fruit & vegetable products, Meat & fish products
|
Auchan
|
8.2
|
Meat & fish products, Fruit & vegetable products, Dairy
|
Super U
|
5.2
|
Meat & fish products, Fruit & vegetable products, Dairy
|
Lidl
|
4.4
|
|
N= 6
|
47.5
|
|
Quick-service restaurants
|
McDonald's
|
32.2
|
Burgers
|
KFC
|
4.1
|
Burgers
|
Quick
|
3.9
|
Burgers
|
Burger King
|
2.9
|
Burgers
|
Paul
|
2.6
|
Bread & bakery products, Convenience foods
|
La Brioche Dorée
|
2.1
|
Bread & bakery products, Convenience foods
|
Domino's Pizza
|
1.9
|
Pizza
|
N = 7
|
49.7
|
|
1: The largest market share within the Euromonitor food category ‘Baked goods’.
2: The largest market share within the Euromonitor food category ‘Processed Fruit and Vegetables’.
3: The largest market share within the Euromonitor food category ‘Breakfast cereals’.
4 and 5: Excluding the supermarkets as food and beverage manufacturers (market share foods: 13.2%; market share beverages: 8.2%).
Data collection and analyses
Nutrition-related commitments
Publicly available commitments and policies were collected between June 2019 and December 2020. Relevant information was collected from company websites, company reports, brand websites and relevant industry pledges and initiatives. Per selected company, screenshots were taken of relevant webpages and relevant documents were downloaded.
Subsequently, the information was entered in an Excel spreadsheet per BIA-Obesity indicator. A report summarizing the collected information as well as the preliminary scoring was compiled per company. Company representatives were contacted via various channels, including meetings with industry associations (ANIA and L'Alliance 7), phone call inquiries, contact information on company/brand websites and LinkedIn. Companies willing to verify and complete the collected data were sent the summary reports after signing a written informed consent. For all additional information some kind of evidence was required. Upon request companies could sign non-disclosure agreements prior to sharing sensitive internal documents. For companies that refused participation or failed to share feedback in time, the assessment was based solely on publicly available information. Supermarkets were assessed as both retailers and food manufacturers (own-brand products).
The nutrition-related commitments were scored in Excel. Supplementary file 1 provides examples of how scores were assigned for BIA-Obesity indicators. All company commitments were scored by IVD and two companies per food industry (a total of eight companies) were blindly re‑scored by YZ. Discrepancies were discussed till an agreement was obtained. The final BIA-Obesity scores per domain were weighted as recommended by INFORMAS (Supplementary file 2).
Median scores (range), overall and per BIA-Obesity domain, were calculated for each food industry and across food industries. For companies that verified and completed the public information, median scores before and after participation were calculated. A one-tailed Wilcoxon signed-rank test was conducted to compare scores before and after participation. A two-tailed Wilcoxon rank-sum test was used to compare scores of companies that engaged with the process to scores of those that did not engage.
Practices
For some of the BIA-Obesity policy domains, a set of key performance indicators was selected to assess company practices on population nutrition. The selected indicators, as well as the sources where the data were derived from and the years, are presented in below in table 2. For the domains on ‘Corporate nutrition strategy’ and ‘Relationships with other organisations’, no performance indicators were included. For the domains ‘Nutrition labelling’ and ‘Product accessibility’ no performance data were available at the time of assessment. For the other BIA-Obesity domains, specific indicators were included, dependent on data availability and feasibility of the assessment. An overview of the different performance indicators can be found in table 2.
Table 2: An overview of the performance indicators per food industry and ‘Business Impact assessment on Obesity and Population Nutrition’ (BIA-Obesity) domain. The data source and the year of data collection are specified per indicator.
Food Industry
|
BIA-Obesity Domain
|
Performance indicators
|
Data sources
|
Years
|
Food and beverage manufacturers
|
Product formulation
|
For full product portfolio:
- Median Nutri-Score
- % of products with Nutri-Score A and B
- % of products with Nutri-Score D and E
- % of products that are ultra-processed
|
Open Food Facts data France 1
|
2018
|
|
Product and brand promotion
|
For full product portfolio:
- % of products not-permitted to be marketed to children according to the World Health Organisation Regional Office for Europe nutrient profile model (WHO-Model)
|
Open Food Facts data France 1
|
2018
|
Supermarkets
|
Product formulation
|
For full own-brand product portfolio:
- Median Nutri-Score
- % of Nutri-Score A and B
- % of Nutri-Score D and E
- % of products that are ultra-processed
|
Open Food Facts data France 1
|
2018
|
|
Product and brand promotion
|
For full own-brand product portfolio:
- % of products not permitted to be marketed to children according to the WHO-Model
For all food products:
- % of promotions for foods that are ultra-processed
- % of promotions for fresh fruit and vegetables
- % of promotions with promotional characters
- % of promotions with discounts
- % of promotions with incentive offers
|
Open Food Facts data France 1
Supermarket circulars
|
2018
October 2019 – March 2020
|
Quick‑service restaurants
|
Product formulation
|
For meals and food portfolio online:
- Median Nutri-Score
- % of meals with Nutri-Score A and B
- % of meals with Nutri-Score D and E
|
Company websites
|
2019 2
|
|
Product and brand promotion
|
For meals and food portfolio online:
- % of foods and meals not-permitted to be marketed to children according to the WHO-Model
|
Company websites
|
2019 2
|
- Verified using Mintel GNPD (Global New Products Database) data or nutritional values from brand or supermarket websites.
- 2018 for KFC. No data available for Brioche Dorée and Quick.
Product formulation
For packaged food and non-alcoholic beverage manufacturers and supermarkets (own-brand products), the healthiness of the complete product portfolios was analysed using Open Food Facts data for France in 2018. As Open Food Facts cannot guarantee the accuracy and completeness of the data, the nutritional data of all products that could be found on Mintel GNPD (Global New Products Database), on brand websites or supermarket websites were verified using aforementioned sources. Duplication of products was avoided by ensuring that each barcode appeared only once.
For quick‑service restaurants, the nutritional information per 100g was obtained from the national brand websites in 2019, where possible (Burger King, Domino's Pizza, McDonald’s and Paul). For KFC no nutritional information was available per 100g and no portion sizes were specified on the national website, so an online table with nutritional information from 2018 was used. On the website of Brioche Dorée and Quick no nutritional information was available per 100g and portion sizes were not defined. As a result the product portfolios of Brioche Dorée and Quick could not be analysed.
The healthiness of the entire portfolios or menus of all selected food companies was analysed using the Nutri-Score, which is the official front-of-pack labelling system in place in France since March 2017 (21). The proportion of products with Nutri-Score A, B, C, D and E was determined, as well as the median Nutri-Score across the company’s portfolio or menu. When calculating the Nutri-Score for non-alcoholic beverages, it was assumed that no juices had a fruit and vegetable content above 40% as the data sources and product ingredient lists did not allow for a distinction to be made between the fruit and vegetable content of different juices. To check the viability of this assumption, a Pearson correlation coefficient was calculated between the Nutri-Score available through Open Food Facts and the calculated Nutri-Score for non‑alcoholic beverages. A strong correlation was observed between both Nutri-scores (R=0.84, p<0.0001). In addition, a correlation between the Open Food Facts Nutri-Score and the calculated Nutri-Score was also conducted for the entire dataset. A very strong correlation was observed between the calculated Nutri-Score and the Nutri-Score displayed within Open Food Facts (R=0.98, p<0.0001).
The company’s portfolios were also analysed in relation to the proportion of ultra-processed foods (according to the NOVA classification (37)) and products not-permitted to be marketed to children according to the World Health Organisation Europe nutrient profile model (WHO-Model (31)). The NOVA-classification distinguishes products based on their level of processing (unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods) (37). The proportion of portfolios that are ultra-processed (NOVA), the proportion of products not-permitted to be marketed to children (WHO-Model), as well as the median Nutri-Score and the proportion of products with Nutri-Score A and B and D and E, were examined by company.
Product and brand promotion
Food promotions in the flyers of the six biggest supermarkets in France were collected online from the weekly/two-weekly circulars over a six month period (October 2019 – March 2020). All promotions were entered into a database and manually classified according to the NOVA-classification and the 17 food categories of the WHO-model (Supplementary file 3). Per product the following information was recorded: product- and brand name, type of promotional character, the level of discount, type of incentive offer, if the product was a fresh fruit or vegetable, whether the product was a fresh meat or fish product and the Nutri-Score (38). The proportion of promotions for ultra-processed foods, foods with promotional characters, incentive offers or discounts and the proportion of promotions for fresh fruits and vegetables were calculated. Data were analysed separately per supermarket.
The relationship between commitments and practices
Correlations between commitments and practices were calculated applying the Spearman's rank correlation coefficient. Correlations were calculated between commitments made within the domain ‘Product formulation’ and the proportion of products within the portfolio with Nutri-Score A and B and D and E. Correlations between the domain ‘Product formulation’ and the proportion of ultra-processed products were also calculated. Lastly, correlations between commitments within the domain ‘Product and brand promotion’ and the proportion of products not-permitted to be marketed to children according to the WHO-model were assessed. No correlation could be calculated between the healthiness of products promoted in supermarket flyers and commitments to have a minimum proportion of products promoted in regular catalogues to be healthier products as no such commitments were in place among selected supermarkets in France.
R-values >0.5 were considered to represent a strong correlation. P-values <0.05 were considered statistically significant. All analyses were performed using Microsoft Excel and SAS 9.4 (Cary, USA, 2018).