Development of Sodium Targets for Fast-Food Restaurants and an Investigation of their Feasibility

Abstract

Background: New Zealanders consume excessive amounts of sodium (~3,373-3,544 mg/day) which is associated with hypertension, the leading risk factor of cardiovascular disease. Fast-food consumption continues to grow, especially in younger age groups. Consequently, there have been strong calls to reformulate fast-foods to contain less sodium. While the New Zealand Heart Foundation has developed targets for in-home packaged foods, there are currently no sodium reformulation targets for fast-food in New Zealand. Objectives: Firstly, to develop sodium targets for appropriate categories to be used by New Zealand fast-food chains. Secondly, to conduct qualitative research to investigate the potential feasibility of, and barriers and facilitators to implementing and monitoring such targets according to expert stakeholders (that is, New Zealand Government agencies, public health promotion organisations, food scientists and public health experts). Method: Nutritrack fast-food data for 2019 was used to calculate the mean sodium content of different fast-food categories. Several percentage reductions of the mean of relevant subcategories were trialled, in five per cent increments (that is, reductions of 5%, 10%, 15%...). If 33.3%±10% of products were meeting the percentage reduction, the sodium target was set at that level as it was determined to be feasible yet aspirational according to Australia’s Healthy Food Partnership criteria for targets. If Heart Foundation 2020 sodium targets were available for specific categories, then those targets were used. Interviews were then conducted with 12 expert stakeholders to investigate the potential feasibility, implementation, and monitoring of the fast-food sodium targets. Fast-food industry representatives were not interviewed in this research. Results: Targets were developed for ten categories (21 subcategories) of fast-food. For two of these categories, Heart Foundation targets were used. Many targets were a 20-50% reduction going up to a 75% reduction and the lowest a 4% increase from the mean (Heart Foundation target for pies). Across subcategories for which targets were developed using the Healthy Food Partnership’s criteria, targets were met by 30-38% of products. The experts interviewed for this study agreed that sodium reduction targets for the fast-food sector in New Zealand are needed and feasible (with suggestions provided to improve feasibility). Key barriers described by participants included unequal participation by industry and lack of government willpower to implement a such a programme. Conclusion: The sodium targets presented in this thesis are the first developed for the New Zealand fast-food setting. The next step should involve revision of these targets with further technical expertise, followed by Ministry of Primary-led consultation with industry to finalize targets and address any industry perceived barriers, after which targets should be implemented. As the programme expands, stepwise reductions should be made utilizing updated intake data and a broader database of nutritional information of products. A government-led approach with cross-government collaboration, collaborative advocacy by non-governmental organisations and academics, threats of making targets mandatory, stepwise reductions and a robust monitoring system are critical to the success of the implementation of sodium reformulation targets across fast-food chains.