POLICY LAB REPORT
Low-agency population interventions
to reduce meat consumption
Authors
James P Reynolds (University of Cambridge)
Andrea Scalco (The Rowett Institute, University of Aberdeen)
Ourega-Zoé Ejebu (Health Economics Research Unit, University of Aberdeen)
Zoi Toumpakari (University of Bristol)
Andrea Smith (University College London)
Fei Lu (University of Reading)
Beth Clark (Newcastle University)
Tarra L Penney (University of Cambridge; York University)
Contents
Executive summary
The problem with high-meat diets
Environmental impact
Health impacts
Shifting the UK diet3
The intention-behaviour gap
Low-agency population interventions
A food systems approach
Could LAPIs reduce meat consumption?
Portion size
Positioning
Availability
Presentation
Taxes and levies
Discounts and subsidies
Food reformulation
Implications for policy and practice
The promise of multi-component interventions
The risk of focusing on isolated settings
Public acceptability of interventions and policies
Conclusions
Acknowledgements
Glossary
References
Appendix: Our approach
This report should be cited as:
Reynolds J.P., Scalco A., Ejebu O., Toumpakari Z., Smith A., Lu F., Clark B., Penney T.L. (2020). Low-agency population interventions to
reduce meat consumption. Report produced for the Global Food Security Programme. September 2020.
Available online at
www.foodsecurity.ac.uk/publications/low-agency-population-interventions-to-reduce-meat-consumption
This report was prepared by Tamsyn Derrick and Maia Elliott on behalf of the Global Food Security programme. Its ndings originate
from a Global Food Security Policy Lab, and do not necessarily reect the policy positions of GFS or its individual partners.
Front cover image: Pixabay
1
insights gained and
the implications for
policy and practice.
Recommendations
and lessons learned
from the current
review are primarily
based on interventions
focusing on a range of
foods, as the evidence on interventions targeting
meat specically was limited. Overall, the evidence
summarised in this report suggests that a number
of these interventions could be implemented to
positively restructure food environments and reduce
meat consumption.
Executive summary
The global demand for meat products is growing.
Despite the increasing popularity of plant-based
diets, their overall prevalence remains low and meat
consumption is rising, with negative consequences
for both human and planetary health. This report
provides an assessment of the evidence for the
effectiveness of low-agency population interventions
(LAPIs; i.e. interventions that requires little or no effort
from the targeted population) at reducing meat
selection, purchase, or consumption. We consider the
effectiveness of these interventions when applied to
red and processed meat, as well as other foods, with
the goal of applying the insights to meat.
An umbrella review of 44 systematic reviews was
conducted to synthesise all the available evidence,
followed by a critical assessment to discuss the wider
Key ndings
(summarised in Figure 1)
Reducing portion sizes of meat products
can reduce the selection, purchase, and/or
consumption of meat.
Pricing strategies such as taxes, subsidies, and
discounts, as well as changing the relative
availability of products at the point of sale,
can change the selection, purchase, and/or
consumption of other foods.
There was limited or mixed research on the
effectiveness of changing the presentation/
position of meat products or reformulating
the ingredients in food containing meat.
Recommendations
These interventions are likely to have
greater impact if they are implemented
simultaneously (i.e. multi-component
interventions) as they can work synergistically
to build healthier food environments and
change social norms.
Interventions should be implemented in
multiple locations where food is purchased
to avoid displaced or compensatory meat
consumption.
Low-agency population interventions are likely
to have high public acceptability because they
maintain freedom of choice.
Figure 1. Summary of the review’s evidence on the effectiveness of low-agency interventions in reducing selection, purchase,
or consumption of food. Tick: Intervention can be effective; question mark: effectiveness of the intervention is unclear.
Will Esayenko/Unsplash
    \r\f \n\t\r\b\t \t
2
The problem with high-meat diets
Environmental impacts
The intensive use of fertilisers and pesticides to
grow grain for feeding livestock, the large use of
natural resources such as land and water, and
production-related emissions, all contribute to
the negative impact of meat production on the
environment. Livestock production uses about 80%
of global agricultural land
2
, the majority of which
could otherwise be used to grow plants for human
consumption or for rewilding. Thus, repurposing this
land could have numerous environmental benets,
including reducing carbon in the atmosphere and
improving biodiversity. The recent Intergovernmental
Panel on Climate Change pointed to the need to
reduce meat consumption to help mitigate the effects
of climate change
3
.
Health impacts
Meat contains numerous essential nutrients and is
a key component of many people’s diets, however
the overconsumption of red and processed meat
increases the risk of mortality and morbidity
Figure 2. Food groups and their impact on health and
environment. The Average Relative Environmental Impact
(y-axis) indicates the average impact of a food group
across ve environmental outcomes relative to the impact
of producing a serving of vegetables. Values of relative risk
of mortality (x-axis) above 1 indicate that consuming an
additional daily serving of a food group is associated with
increased mortality risk, whereas values below 1 indicate
that consumption is associated with lowered mortality risk.
Food groups with a signicant change in risk of mortality are
denoted by solid circles. SSBs = sugar-sweetened beverages.
Source: Clark et al., 2019, published by
PNAS. Licensed under CC BY 4.0. DOI:
10.1073/pnas.1906908116
48
.
(Figure 2). Evidence from population studies suggests
that high meat consumption, particularly red and
processed meat, is associated with increased risk of
chronic diseases such as diabetes
4
, cardiovascular
disease
5
and certain cancers
6-8
. Various governments
(e.g. Norway, UK, Italy, and Brazil) and the wider
health community have already established
recommendations to reduce the consumption of red
and processed meat.
Global demand for meat is projected to grow by 88% from 2010 to 2050
1
, however the overconsumption
and overproduction of meat is already impacting human and planetary health. Efforts to reduce these
impacts include modifying the types (e.g. ruminant meat vs poultry) and amount of meat produced and
consumed. Importantly, the goal here is not to eliminate meat from our diets, but instead to reduce it
to a level that minimises the impact on health and the environment.
Annie Spratt/Unsplash, Rawpixel
Shifting the UK diet
Reducing meat consumption will be a signicant
challenge. In the UK, about 73% of consumers
consider themselves meat eaters, while another
14% consider themselves exitarians (i.e. mainly
vegetarian diet, allowing for occasional meat
dishes)
9
. Whilst vegetarian diets and vegan
diets may be increasing in popularity, the
overall prevalence is still relatively low (3%
and 1% of the UK total population are
vegetarians and vegans, respectively
9
) and
the trend has not yet halted the growing
global demand and the (subsequent)
production of meat
10
.
The intention-behaviour gap
Studies have shown that some meat-
eating consumers are willing to reduce
their meat consumption
11
, yet individuals’
attempts to change their own consumption
are often ineffective due to the strong inuence
of food environments on consumption
12
. This
includes the widespread availability, large portion
sizes, heavy marketing, and the low cost of less
healthy foods. Information-based strategies to
change behaviour tend to be the most popular
13
,
yet simply educating individuals about the risks of
certain behaviours is insufcient to change behaviour
over long periods of time
14
. It is therefore unlikely
that the sole provision of information about the
health and environmental risks associated with meat
consumption will reduce its consumption.
Low-agency population interventions
An alternative approach involves low-agency
population interventions (i.e. interventions require
little or no engagement from individuals). Here, food
environments are designed to encourage individuals
to make healthier and more sustainable food choices
without limiting their freedom of choice. In these
environments, extreme levels of self-control would not
be required to avoid the overconsumption of meat.
Instead, changes to the environment would guide
individuals toward consuming less meat with minimal
conscious engagement and may therefore be more
effective and equitable than other strategies
15
. This
approach can also change norms; being provided with
smaller portion sizes can lead to individuals choosing
smaller portions in other settings
16
.
Low-agency population interventions include taxes on
less healthy foods or nudging strategies like changing
the availability and placement of food products,
reformulating food products and changing portion
sizes. These approaches have been demonstrated
to reduce individuals’ excess consumption of many
types of food (e.g. chocolate, hot meals, crisps)
and therefore have potential for reducing meat
consumption
17-19
.
A food systems approach
Incorporating systems thinking into the design and
evaluation of low-agency interventions may also be
required to shift the UK diet. Systems thinking can be
applied to anticipate, capture, and better understand
the complexity of interacting exposures (e.g. demand
for a specic food such as red meat) and responses
(e.g. expansion of cattle farming) in the context of
the wider food system
20
. Recognising the interrelated
and interdependent nature of the food system helps
to navigate its complexity and identify key areas
which can be targeted effectively using low-agency
interventions.
3
Richard Rutter/Flickr
4
Portion size
Three studies (one set in a restaurant, the other two
set in labs) have demonstrated that interventions
that reduce the portion size of meat, also reduce the
consumption of meat products
21
. Systematic reviews
that investigated reducing the portions of foods in
general provide similar results: reducing portion sizes
leads to reductions in the amount of food that is
consumed
22,23
. The effectiveness of reducing portion
sizes for portions that are already small is less certain
than the evidence of reducing the size of large
portions. Individuals also tend to select larger portions
of food when given the option, suggesting that even
if they do not consume the whole portion they are
still likely to choose it. This creates the demand for
more food to be produced, potentially increasing food
waste.
Positioning
There is mixed evidence that repositioning meat
to make it less prominent compared to other foods
reduces the selection or purchasing of meat
21
.
Repositioning meat and other food products has been
tested in multiple settings (e.g. changing the order
in an online meal booking system; removing meat
options from a restaurant menu and repositioning to
a board 3.5 metres away; moving the target food to
the last item in a breakfast buffet) and these different
methods of intervening may account for the mixed
results
21,24
. While there is insufcient evidence to
determine the most effective method of repositioning
food options, moving meat options from menus
to a specials board in restaurants may be effective
at reducing demand. Further research is needed to
reduce the uncertainties.
Availability
There is limited evidence evaluating whether
reducing the number or proportion of meat options
decreases selection, purchase, or consumption.
However, increasing the availability of meat-free
options has been shown to reduce the consumption
of red, processed, and white meat in several studies
21
.
Some of these interventions were accompanied
by additional components (e.g. the provision of
This section provides an overview of the evidence for the potential of low-agency population
interventions (LAPIs) to reduce meat consumption. Systematic reviews investigating the effectiveness
of different LAPIs to change the selection, purchase or consumption of various types of foods were
included in this umbrella review (see Appendix).
information about the health benets of being
vegetarian), which makes it unclear how effective it
would be to only increase the availability of meat-
free options. The majority of research on
availability interventions has instead
focused on other foods (such as
fruit and vegetables) and how
providing healthier options
can increase demand for
these options and reduce
demand for less healthy or
higher energy options
24-29
.
Evidence from other
reviews indicates that
adding or removing
products is an effective
strategy. For example,
increasing the availability
of healthier foods
leads to increases in the
consumption of those foods
in a variety of settings such
as mobile food carts,
cafeterias, and vending
machines
28,30,31
.
Presentation
Changing the sensory
properties of meat is
reported to be effective
at reducing meat
selection. However, in this
review, studies only evaluated
participants’ preferences without
objective purchase or consumption
data
21
. Two different approaches were tested, the rst
involving changing a visual image that accompanies
roast pork: one including the head of the pig while
another did not include the head. Including the head
of the pig led to participants preferring a meat-free
alternative. The second approach was pre-testing
which meat-free options sounded the most and
least desirable from a larger list. When presented
with meat options and the desirable meat-free
options, participants were less likely to select a meat
Could LAPIs reduce meat consumption?
5
option. Furthermore, improving the presentation of
vegetables, salads, and healthy desserts can increase
consumption of these items
31,32
. This suggests that
improving the presentation of non-meat options may
lead to a reduction in meat selection.
Taxes and levies
There were no systematic reviews that focused on the
use of pricing strategies to change meat consumption.
However, pricing strategies such as taxation yielded
promising results with other food groups. Taxes on
energy-dense foods including meat (e.g. minced
beef) were proposed as an effective measure that
could signicantly reduce consumption and was
recommended as part of a comprehensive strategy
to prevent obesity
18,19,33,34
. Taxes on saturated
fat (contained in meat products) may,
however, result in unintended compensatory
purchasing behaviour (i.e. increased
consumption of foods high in sodium,
sugar and calories). This could reduce the
potential health impacts of food taxes,
although they do achieve the primary
aim of reducing saturated fat intake
19
.
Price increases on other less healthy
foods were mostly found to reduce
sales or consumption of the targeted
product, and in all cases this was linked
with increased sales or consumption of
fruits or vegetables
35
. It is unclear what the
minimum increase in price should be to result
in a meaningful reduction in meat purchases.
However, research on other foods suggests that
a tax rate of 20% has positive impacts
36
whereas
further research indicates that a 40% increase in price
could lead to a 6% decrease in the consumption of
high-salt foods
37
. While there may be limited evidence
for pricing strategies for meat, the initial evidence
from other food groups suggests that increasing
the price via taxation is an effective strategy, and
therefore should be trialled on meat to conrm its
effectiveness.
Discounts and subsidies
Another scal intervention involves reducing
the prices of meat-alternatives via discounts or
subsidies, with a view to reducing the purchase
and consumption of meat. Most studies report
that lowering the price of healthier foods increases
purchasing and consumption of these foods
(e.g. fruits and vegetables, grains) or decreases
purchasing and consumption of less healthy foods
35
.
Pairing subsidies on healthy foods with taxation
on less healthy foods was recommended to be the
most effective strategy to improve healthy food
consumption and diet, particularly where taxes were
larger
34
. Combining food taxes with subsidies would
also enable consumers to switch to more healthy
products without incurring additional costs
18
.
Other ndings on subsidies were mixed. Subsidies
on healthy foods (e.g. fruits and vegetables) could
result in unintended compensatory purchasing.
One study indicated that a fruit and vegetable
subsidy may have unintended compensatory effects
including a decrease in sh consumption, and a bre
subsidy could also decrease sh and increase sugar
consumption
19
. This evidence suggests that reducing
the prices of meat substitutes may increase the
consumption or purchasing of the targeted foods,
however it is unclear whether this strategy alone
(without a tax on meat products) would lead to
reduced meat purchasing.
Food reformulation
Reformulation of meals may have the potential to
reduce meat intake via similar routes to reducing
portion size. However, no reviews have yet examined
this intervention within the context of meat. For
other foods, Sisnowski et al. (2017) report a case
in Washington State where, following a new menu
labelling regulation, chain restaurants reformulated
their foods to have lower calories
33
. However, the
interventions failed to achieve a signicant effect on
consumption. Further research is needed before any
reliable conclusions can be drawn.
S O C I A L . C U T, Sebastian Holgado/Unsplash, Steve Buissinne/Pixabay
6
Implications for policy and practice
This critical assessment details what the outcomes of the umbrella review mean for policy and practice.
Three implications are discussed within the wider context of reducing meat consumption, and how
these ndings may be applicable within the general population.
The promise of multi-component interventions
Interventions targeting multiple aspects of the food
environment at different levels (multi-component
interventions) appear to mutually reinforce
each other and are most likely to change dietary
behaviours
31,37,38
. Dietary behaviours are complex
and shaped by close physical surroundings, as well as
the wider environment (including cultural, economic
and political inuences). Whilst multi-component
interventions are more effective in changing the
selection, purchase or consumption of foods, longer-
term impacts remain unclear. Further reviews looking
at the effectiveness of multi-component interventions
are needed.
Noticeably, multi-component interventions commonly
include an educational component. Whilst education
is a common approach to changing behaviour,
there is limited evidence of the effectiveness of an
approach entirely reliant on education, especially in
the long term. Education needs to be accompanied by
interactions at multiple levels of the food environment
in order to achieve sufcient and sustainable inuence
on dietary choices or intake. This also highlights that
multi-component interventions need to function in
synergy to achieve their intended outcomes.
Dietary behaviours may also be improved by
increasing the availability of and access to healthier
choices – not just independently, but together. This
may increase familiarity with new or disliked foods,
positively shape preferences, and could eventually
drive changes in social norms and intake. Other
factors might also play a simultaneous role, for
example: cultural norms are key determinants in
dietary behaviours and could be used to foster healthy
behaviour change. This added complexity of repeated
exposure could also drive change through consumer
choices, which over time could create new demands
and modify preferences and social norms. The
commercial food system can then react and adapt to
meet changes in consumer demands and reinforce
these dietary changes.
With this vast complexity it is clear that interventions
or policies that modify multiple different aspects of
this system have a greater potential for success. Whilst
the existing literature suggests that multi-component
interventions have the potential to inuence dietary
choice and intake, there is a noticeable dearth of such
studies specically targeting meat-related outcomes.
The risk of focusing on isolated settings
Low-agency interventions that focus solely on isolated
settings may displace individuals’ consumption rather
than reducing it.
Several systematic reviews focused on interventions
within specic isolated settings, such as the
workplace
21,25,39
, schools
38,40
, restaurants
21,41
, retail
grocery stores
26
, residential care
32,42
and hospitals
32,42
.
None of the settings targeted suppliers, highlighting
a clear gap in the implementation of low-agency
interventions further up the supply chain. By
Ella Olsson/Unsplash, Rawpixel
7
focusing on isolated settings, the outcomes of the
interventions are limited to the setting examined,
e.g. the sales of fruit and vegetables from a
worksite cafeteria
39
. Hence, it was not considered
whether individuals altered other aspects of their
consumption throughout the day.
A few studies did explore overall consumption
throughout the day
40,43
. The results suggest
that individuals are likely to have engaged with
compensatory eating behaviours later in the day
(e.g. “I was good at lunch when I ate the apple, so
now I deserve a sausage roll”), or even within a single
eating occasion (“I chose the vegetable soup as a
starter so now I deserve the steak as a main dish”), as
a response to a nutritional intervention. This indicates
the need to intervene in multiple settings, and
multiple parts of the food system, at the same time
rather than focusing on isolated settings.
Pairing different interventions together across
different settings to address displacement of meat
consumption should be further explored to guide
the design of future interventions. Most systematic
reviews included in our report acknowledged that
the effectiveness of intervention strategies may be
limited to the setting in which they were implemented
(e.g. effective nudge strategies in schools might be
different from effective strategies in the workplace).
They also highlighted the importance of adapting
each intervention strategy to the corresponding
environment and target group.
Focusing on isolated settings is also poorly aligned
with the idea of a complex food system. Individuals
interact with multiple settings on a daily basis, hence
nudging strategies would need to be implemented
synergistically across these settings to reduce
meat consumption whilst avoiding unintended
consequences. This highlights the need for a food
systems approach when implementing food system
interventions.
Public acceptability of interventions and policies
The acceptability of low-agency interventions in the
population could be difcult to ascertain and may not
include direct investigations of acceptability, as these
interventions usually target non-conscious processes
in decision making. Public acceptability of policies
is also often complicated by current politics and
ideology. Existing evidence has shown higher levels of
acceptability for ‘soft’, high-agency interventions such
as educational approaches
13,44
. Low-agency strategies
that maintain freedom of choice such as those
described above are likely to be more widely accepted
by the public than high-agency interventions that limit
freedom of choice, e.g. by placing restrictions on fast-
food outlets.
It is also important to understand acceptability
from the perspectives of government and industry
(producers, manufacturers, processors, supermarkets,
etc.), as uptake is a key challenge in the process of re-
shaping food systems. Industry stakeholders are more
likely to use and endorse low-cost techniques or those
that do not compromise prots. However, current
strategies usually focus on public acceptability without
assessing acceptability from different stakeholders
and at different levels of the system, i.e. from food
production to food consumption.
Conclusions
This umbrella review and critical assessment suggests
several promising routes for reducing the selection,
purchasing, and consumption of meat. Research on
both meat and non-meat foods suggests that several
interventions are effective. Reducing the portion
size of meals appears to be effective at reducing
consumption. Increasing the number of healthier
foods and decreasing the number of less healthy
foods can increase selection of the healthier foods (i.e.
Availability interventions). Increasing the price of less
healthy foods and decreasing the price of healthier
foods appears to be effective in changing purchasing,
particularly when implemented together. Further
approaches such as reducing the prominence of meat
in restaurants and improving the presentation of meat
alternatives also show promising results.
Rawpixel
8
Whilst there has been less research conducted on
the effectiveness of some of these interventions
(i.e., taxation, discounts) at changing the selection,
purchasing, or consumption of meat specically, the
evidence from testing these interventions on other
foods suggests these interventions are effective
and could be applied to meat. Overall, the evidence
summarised in this report suggests that restructuring
the food environment through multiple approaches
can create environments that encourage individuals
to choose foods with an overall reduced impact on
both the environment and health, without removing
freedom of choice. A key point is that in isolation
these interventions may have small effects, yet when
combined with other interventions, there is a potential
for greater impact at the population level.
A majority of the UK public already supports many of
these interventions when applied to other less healthy
food and drinks
13
. Considering that the interventions
described in this report allow for meaningful
reductions in meat demand without removing
freedom of choice, they may have the benet of
being both effective and acceptable to the public.
Unlike the public, stakeholders working to produce and
sell meat products throughout the food system are
likely to oppose such interventions
45
. If interventions
successfully reduce the demand for meat, then these
stakeholders should receive support to transition to
sustainable business models that support human and
planetary health.
Research and activities that actively elicit input from
stakeholders at all stages of the food system could
prove valuable in forming a joint sense of responsibility
for enacting food system change. Structural challenges,
such as food supply chains transcending national and
institutional boundaries, or food security programs
adopting a production-centric approach, are largely
considered too complex and far removed from an
individual stakeholder’s control. Only by incorporating
the different sustainability needs and wants of all
stakeholders (from farmers to suppliers, supermarkets,
and consumers) will mutually agreeable sustainability
objectives become achievable
46
.
Whilst this report provides evidence on a range of
interventions and policy options available to address
the overconsumption of meat, the recommendations
and lessons learned from the systematic reviews come
from intervention studies that have focused on food
generally, with only a few specically focused on meat.
Furthermore, it is less clear what action would be
effective further up the supply chain, as the umbrella
review did not yield any reviews of interventions at
that level. The evidence base for interventions aiming
to reduce meat demand is less mature than needed,
yet the urgency with which we need to address the
combined challenges of improving both health and
environmental sustainability will mean moving forward
under uncertainties. While further research is needed to
reduce these uncertainties, the evidence summarised in
this report should provide enough condence for policy
makers to take judicious action now.
Louis Hansel/Unsplash
9
This study was funded by the Global Food Security (GFS) programme as part of a GFS Policy Lab. The report
was critically reviewed by a number of experts, including Professor Jennie Macdiarmid (The Rowett Institute
– University of Aberdeen), Dr Christine Potter (University of Oxford) and Dr Sophie Attwood (World Resources
Institute). The authors declare no conicts of interest with respect to the authorship or publication of this
manuscript.
Acknowledgements
Glossary
Technical terms
Choice architecture
The way food choices are presented to consumers. This can be altered to nudge
behaviour in a particular direction.
Critical synthesis
A critical assessment of evidence that goes beyond description to include a degree
of analysis and conceptual innovation.
Low-agency population
An intervention that requires little or no effort from the targeted population to be
intervention (LAPI)
Systematic review
A replicable method of searching for all scientic research on a specic topic.
Umbrella review
A systematic review of systematic reviews.
Interventions
Availability
Adding or removing the number of products to increase, decrease, or alter their
range, variety or number.
Discounts
Reducing the usual price of the targeted product.
Portion size
Alter the portion size (typically reducing) of food or drink products.
Position
Altering the position, proximity, or accessibility of products.
Presentation
Altering the visual, tactile, auditory, or olfactory properties of products.
Subsidies
Providing money to businesses to lower the price of targeted products.
Taxation
Adding a tax or levy on a product or one of its ingredients with the aim of
increasing the price of the product.
Zoe Schaeffer/Unsplash
10
References
Searchinger, T., Waite, R., Hanson, C., Ranganathan, J.,
Dumas, P., & Matthews, E. . Creating a sustainable food
future: A menu of solutions to feed nearly 10 billion
people by 2050. (World Food Institute., Washington,
D.C, 2018).
Ritchie, H. Hannah Ritchie, a.org/
agricultural-land-b�y-global-diets (2017).
IPCC. Climate Change and Land. (WMO & UNEP, 2019).
Pan, A., Sun, Q., Bernstein, A.M., et al. Red meat
consumption and risk of type 2 diabetes: 3 cohorts of
US adults and an updated meta-analysis. American
Journal of Clinical Nutrition 94, 1088-1096 (2011).
Micha, R., Wallace, S.K., & Mozaffarian D. . Red and
processed meat consumption and risk of incident
coronary heart disease, stroke, and diabetes mellitus: a
systematic review and meta-analysis. Circulation 121,
2271-2283 (2010).
Zheng, W., & Lee S.A. . Well-done meat intake,
heterocyclic amine exposure, and cancer risk. Nutrition
& Cancer 61, 437-446 (2009).
Sinha, R., Cross, A.J., Graubard, B.I., Leitzmann, M.F., &
Schatzkin, A. . Meat intake and mortality: a prospective
study of over half a million people. Archive of
International Medicine 169, 562-571 (2009).
Pan, A., Sun, Q., Bernstein, A. M., Schulze, M. et al.
Red meat consumption and mortality: Results from
2 prospective cohort studies. Archive International
Medicine 172, 555-563 (2012).
YouGov. Is the future of food exitarian? ,
ougov.co.uk/topics/resources/articles-
reports/2019/03/18/future-food-exit�arian (2019).
Daniel, C. R., Cross, A. J., Koebnick, C., & Sinha, R. .
Trends in meat consumption in the USA. Public Health
Nutrition 14, 575-583 (2011).
Stubbs, R. J., S. E. Scott, & Duarte, C. . Responding to
food, environment and health challenges by changing
meat consumption behaviours in consumers. Nutrition
Bulletin 43, 125-134 (2018).
Sheeran, P., & Webb, T. L. . The intention-behavior gap.
Social and Personality Psychology Compass 10, 503-
518 (2016).
Reynolds, J. P. et al. Public acceptability of nudging
and taxing to reduce consumption of alcohol,
tobacco, and food: A population-based survey
experiment. Soc Sci Med 236, 112395, doi:10.1016/j.
socscimed.2019.112395 (2019).
Hollands, G. J. et al. The impact of communicating
genetic risks of disease on risk-reducing health
behaviour: systematic review with meta-analysis. BMJ
352, i1102, doi:10.1136/bmj.i1102 (2016).
Adams, J., Mytton, O., White, M. & Monsivais, P. Why
Are Some Population Interventions for Diet and Obesity
More Equitable and Effective Than Others? The Role
of Individual Agency. PLOS Medicine 13, e1001990,
doi:10.1371/journal.pmed.1001990 (2016).
Robinson, E., Henderson, J., Keenan, G. S. & Kersbergen,
I. When a portion becomes a norm: Exposure to a
smaller vs. larger portion of food affects later food
intake. Food Quality and Preference 75, 113-117,
doi:https://doi.org/10.1016/j.foodqual.2019.02.013
(2019).
Kloss, L., Meyer, J.D., Graeve, L. & Vetter, W. . Sodium
intake and its reduction by food reformulation in the
European Union—A review. NFS Journal 1, 9-19 (2015).
Thow, A. M., Jan, S., Leeder, S., & Swinburn, B. . Vol. 88
(World Health Organisation, 2010).
Eyles, H., Ni Mhurchu, C., Nghiem, N. & Blakely,
T. Food pricing strategies, population diets,
and non-communicable disease: a systematic
review of simulation studies. PLoS medicine 9,
e1001353-e1001353, doi:10.1371/journal.
pmed.1001353 (2012).
Bhunnoo, R., & Poppy, G. M. . A national approach for
transformation of the UK food system. . Nature Food 1,
6-8 (2020).
Bianchi, F., Garnett, E., Dorsel, C., Aveyard, P. & Jebb,
S. A. Restructuring physical micro-environments to
reduce the demand for meat: a systematic review
and qualitative comparative analysis. The Lancet
Planetary Health 2, e384-e397, doi:10.1016/S2542-
5196(18)30188-8 (2018).
Hollands, G. J. et al. Portion, package or tableware
size for changing selection and consumption of food,
alcohol and tobacco. Cochrane Database Syst Rev
2015, CD011045-CD011045, doi:10.1002/14651858.
CD011045.pub2 (2015).
Zlatevska, N., Dubelaar, C. & Holden, S. S. Sizing up the
Effect of Portion Size on Consumption: A Meta-Analytic
Review. Journal of Marketing 78, 140-154, doi:10.1509/
jm.12.0303 (2014).
Wilson, A. L., Buckley, E., Buckley, J. D. & Bogomolova, S.
Nudging healthier food and beverage choices through
salience and priming. Evidence from a systematic
review. Food Quality and Preference 51, 47-64,
doi:https://doi.org/10.1016/j.foodqual.2016.02.009
(2016).
25Allan, J., Querstret, D., Banas, K. & de Bruin, M.
Environmental interventions for altering eating
behaviours of employees in the workplace: a systematic
review. Obes Rev 18, 214-226, doi:10.1111/obr.12470
(2017).
11
Adam, A. & Jensen, J. D. What is the effectiveness of
obesity related interventions at retail grocery stores and
supermarkets? -a systematic review. BMC public health
16, 1247-1247, doi:10.1186/s12889-016-3985-x
(2016).
Arno, A. & Thomas, S. The efcacy of nudge theory
strategies in inuencing adult dietary behaviour: a
systematic review and meta-analysis. BMC Public Health
16, 676, doi:10.1186/s12889-016-3272-x (2016).
Grech, A. & Allman-Farinelli, M. A systematic literature
review of nutrition interventions in vending machines
that encourage consumers to make healthier choices.
Obes Rev 16, 1030-1041, doi:10.1111/obr.12311
(2015).
Ni Mhurchu, C., Aston, L. M. & Jebb, S. A. Effects of
worksite health promotion interventions on employee
diets: a systematic review. BMC Public Health 10, 62,
doi:10.1186/1471-2458-10-62 (2010).
Hsiao, B. S., Sibeko, L. & Troy, L. M. A Systematic Review
of Mobile Produce Markets: Facilitators and Barriers
to Use, and Associations with Reported Fruit and
Vegetable Intake. J Acad Nutr Diet 119, 76-97.e71,
doi:10.1016/j.jand.2018.02.022 (2019).
Appleton, K. M. et al. Increasing vegetable intakes:
rationale and systematic review of published
interventions. Eur J Nutr 55, 869-896, doi:10.1007/
s00394-015-1130-8 (2016).
Ottrey, E. & Porter, J. Hospital menu interventions: a
systematic review of research. Int J Health Care Qual
Assur 29, 62-74, doi:10.1108/ijhcqa-04-2015-0051
(2016).
Sisnowski, J., Street, J. M. & Merlin, T. Improving food
environments and tackling obesity: A realist systematic
review of the policy success of regulatory interventions
targeting population nutrition. PLoS One 12, e0182581,
doi:10.1371/journal.pone.0182581 (2017).
Niebylski, M. L., Redburn, K. A., Duhaney, T. & Campbell,
N. R. Healthy food subsidies and unhealthy food
taxation: A systematic review of the evidence. Nutrition
31, 787-795, doi:10.1016/j.nut.2014.12.010 (2015).
Gittelsohn, J., Trude, A. C. B. & Kim, H. Pricing Strategies
to Encourage Availability, Purchase, and Consumption
of Healthy Foods and Beverages: A Systematic Review.
Prev Chronic Dis 14, E107, doi:10.5888/pcd14.170213
(2017).
Wright, A., Smith, K. E. & Hellowell, M. Policy lessons
from health taxes: a systematic review of empirical
studies. BMC Public Health 17, 583, doi:10.1186/
s12889-017-4497-z (2017).
Hyseni, L. et al. Systematic review of dietary salt
reduction policies: Evidence for an effectiveness
hierarchy? PLoS One 12, e0177535, doi:10.1371/
journal.pone.0177535 (2017).
Evans, C. E., Christian, M. S., Cleghorn, C. L., Greenwood,
D. C. & Cade, J. E. Systematic review and meta-analysis
of school-based interventions to improve daily fruit
and vegetable intake in children aged 5 to 12 y. Am J
Clin Nutr 96, 889-901, doi:10.3945/ajcn.111.030270
(2012).
Hendren, S. & Logomarsino, J. Impact of worksite
cafeteria interventions on fruit and vegetable
consumption in adults: A systematic review.
International Journal of Workplace Health
Management 10, 134-152, doi:10.1108/
IJWHM-12-2016-0089 (2017).
Driessen, C. E., Cameron, A. J., Thornton, L. E., Lai, S. K.
& Barnett, L. M. Effect of changes to the school food
environment on eating behaviours and/or body weight
in children: a systematic review. Obes Rev 15, 968-982,
doi:10.1111/obr.12224 (2014).
Valdivia Espino, J. et al. Community-Based Restaurant
Interventions to Promote Healthy Eating: A Systematic
Review. Preventing Chronic Disease 12, doi:10.5888/
pcd12.140455 (2015).
Abbott, R. A. et al. Effectiveness of mealtime
interventions on nutritional outcomes for the elderly
living in residential care: a systematic review and meta-
analysis. Ageing Res Rev 12, 967-981, doi:10.1016/j.
arr.2013.06.002 (2013).
Grieger, J. A., Wycherley, T. P., Johnson, B. J. & Golley, R.
K. Discrete strategies to reduce intake of discretionary
food choices: a scoping review. International Journal
of Behavioral Nutrition and Physical Activity 13, 57,
doi:10.1186/s12966-016-0380-z (2016).
Petrescu, D. C., Hollands, G. J., Couturier, D.-L., Ng, Y.-L.
& Marteau, T. M. Public Acceptability in the UK and
USA of Nudging to Reduce Obesity: The Example of
Reducing Sugar-Sweetened Beverages Consumption.
PLoS One 11, e0155995, doi:10.1371/journal.
pone.0155995 (2016).
Estrade, M. et al. A qualitative study of independent fast
food vendors near secondary schools in disadvantaged
Scottish neighbourhoods. BMC Public Health 14, 793,
doi:10.1186/1471-2458-14-793 (2014).
Jesus, G.-G. & Hallie, E. What Can Be: Stakeholder
Perspectives for a Sustainable Food System. Journal
of Agriculture, Food Systems, and Community
Development 8, doi:10.5304/jafscd.2019.084.010
(2019).
Shea, B. J. et al. AMSTAR 2: a critical appraisal tool for
systematic reviews that include randomised or non-
randomised studies of healthcare interventions, or both.
BMJ 358, j4008, doi:10.1136/bmj.j4008 (2017).
48Clark, Michael A., Springmann, Marco, Hill, Jason &
Tilman, David. Multiple health and environmental
impacts of foods. Proceedings of the National
Academy of Sciences 116, 23357, doi:10.1073/
pnas.1906908116 (2019).
12
Appendix
Our approach
This report provides a comprehensive overview
of the effectiveness of low-agency population
interventions to reduce the selection, purchase and/or
consumption of meat products. The results presented
are a combination of two different approaches to
synthesising the existing evidence from systematic
reviews. First, an umbrella review was conducted
to synthesise existing information from systematic
reviews of low-agency population interventions aiming
to reduce the selection, purchase and consumption of
meat. Second, a critical assessment of that evidence
was conducted to draw a range of considerations that
support the interpretation of the systematic reviews.
Twelve databases from a wide range of disciplines
were searched for systematic reviews of interventions
in any settings that targeted meat products but also
other types of food, in order to accumulate more
evidence and develop insights that could also be
applied to meat (see ‘The Umbrella Review Method’).
Eligible interventions were those that required little
or no engagement from individuals, including:
environment modications to cue behaviour change,
modied or amended choice architecture (proximity,
availability, shape of product), changing the default
available products (i.e. changing the status quo
products), reformulated food products (i.e. reduced
meat content), changed portion sizes, or altered
food prices using levies, subsidies or discounts. Once
databases were searched, relevant systematic reviews
were screened for eligibility. Eligible papers were then
graded for quality using the appraisal tool AMSTAR
47
and all relevant information to the review was
extracted.
The search yielded 44 systematic reviews that were
judged eligible. These systematic reviews investigated
the effectiveness of one or more eligible interventions
at changing the selection, purchase, or consumption
of food. Meat consumption-related outcomes were
specically investigated in one review
21
, with seven
further reviews including interventions that reported
meat intake (as part of a composite meal) as an
outcome.
StockSnap/Pixabay, Jeff Siepman/Unsplash
13
The Umbrella review method
Eligibility criteria
Studies were included if they were systematic reviews, evaluated the effectiveness of low-agency population
interventions in “real world” or laboratory settings, and measured the selection, purchase, or consumption of
any food.
Databases searched
ABI/INFORM, AGRICOLA, ASSIA, Campbell Library, Cochrane Library, EconLit, MEDLINE, OpenGrey, PsycINFO,
PubAg, Scopus, and Web of Science. Databases were searched up to October 2018.
Search terms
(accessib*
OR
availab*
OR
“choice architecture”
OR
inuence
OR
intervention
OR
levies
OR
levy
OR
“low
agency”
OR
“low agentic”
OR
“low engagement”
OR
nudg*
OR
order*
OR
placement
OR
portion size*
OR
position*
OR
price*
OR
proximity
OR
reposition*
OR
reformulat*
OR
stealth
OR
tax*
OR
pric*
OR
“physical
micro-environments”
OR
Procur*
OR
Produc*) AND (consumption
OR
purchas*
OR
reduction
OR
selection
OR
preference*
OR
choice*
OR
intake
OR
demand
OR
sales
OR
eat*
OR
intention*
OR
buy*) AND (beef
OR
diet*
OR
meal*
OR
food*
OR
lamb
OR
meat*
OR
pork
OR
sausage*
OR
steak*
OR
mince
OR
burger*
OR
veal
OR
bacon
OR
ham) AND (systematic review search terms from SIGN
https://www.sign.ac.uk/search- lters.html
)
Screening and selection of eligible studies
20,195 potentially relevant studies
on the basis of the title
13,785 studies screened based
on title and abstract
292 full-text studies assessed
for eligibility
44 included in the umbrella review
6,410 duplicate studies removed
13,479 studies excluded on the basis
of title and abstract (studies were
not LAPIs)
248 excluded based on the inclusion
and exclusion criteria
Global Food Security (GFS) is a multi-agency programme,
hosted by UK Research and Innovation, bringing together
the main UK funders of research and training relating to
food. GFS publications provide balanced analysis of food
security issues on the basis of current evidence, for use
by policy-makers and practitioners.
This report does not necessarily reect the policy
positions of the Global Food Security programme’s
individual partners.
For further information please visit:
www.foodsecurity.ac.uk
Email:
info@foodsecurity.ac.uk
@FoodSecurityUK