Abstract:
Background: This study aimed to review the international evidence on scalable, population-level interventions within food environments that a) improve adult diet, and b) improve equity of health outcomes. Methods: An umbrella review was conducted December 2018, covering English-language systematic reviews in Scopus and Cochrane Library Databases from 2007 to 2018. Two authors assessed inclusion/exlcusion criteria and extracted data following the PRISMA protocol. Results: Of 1169 papers, 33 systematic reviews met inclusion criteria. Several food environment interventions were consistently identified to have moderate to strong evidence that they improve adult diet: taxation of unhealthy foods/beverages, subsidizing healthy food, effective front-of-pack labeling of pre-packaged foods/beverages, reformulation of foods to reduce salt content, and reducing density of fast-food restaurants in lower socioeconomic areas. Weaker evidence (mostly due to methodological issues) was found for: environmental interventions in workplaces, limiting food marketing to adults, product availability/ placement in-store, and reducing portion sizes. There was weak evidence that the following improved adult diet: menu labeling in restaurants, and density of fast-food restaurants or supermarkets generally. Little international research examined the impact on equity. Conclusions: Modifying the food environment holds significant promise to improve population diet and reduce noncommunicable diseases. In the UN Decade of Action on Nutrition, governments should consider policies consistently found to improve adult diet, and with the most promise to reduce health inequities, i.e. sugar-sweetened beverage tax, subsidizing healthy food, reducing density of fast food outlets in areas of high deprivation, mandatory labeling of pre-packaged foods and beverages, and salt-reduction through food reformulation.