��Ī - Pablo Monsivais

Opinion: A varied diet can prevent diabetes – but can you afford it?

Anonymous — Wed, 20 Jul 2016 15:03:09 +0000

In a study of over 25,000 adults with detailed information about their eating habits, people with a greater diversity of foods in their diet showed a 30% lower risk of developing type 2 diabetes over a ten-year period. Unfortunately, the diets with more variety were 18% more expensive than the less-varied ones.

A healthy diet is critical for preventing and managing type 2 diabetes. Type 2 diabetes affects around 415m adults globally; a figure that is expected to rise to 643m by 2040, mostly in low- and middle-income countries. So governments should support their citizen’s ability to eat well.

For several decades now, governments have recommended that people eat a varied diet. Global five-a-day campaigns stress the consumption of a variety of fruits and vegetables. The theory goes that consuming a variety of foods ensures that a person receives all the necessary vitamins, minerals and phytochemicals that are needed for the body to function and stay healthy. But, what do we really mean by a varied diet and what is its relationship with diabetes?

A varied diet is a healthier diet

Although dietary guidelines have for a long time recommended eating a variety of foods, scientists are not sure exactly what it is about eating a varied diet that might promote health. There has been research on how the variety of foods relate to the nutritional quality of a person’s diet, but little is known about whether the diversity of the diet is related to risk of chronic diseases such as type 2 diabetes.

For example, there are no studies on whether a diet containing foods from all five food groups reduces a person’s risk of type 2 diabetes. We also don’t know whether the variety of foods within each of the five food groups is important for health.

People’s diets vary in terms of the different food groups. For example, one person’s diet might consist mainly of meat and grains while another person’s might contain dairy, vegetables and fruit. Diets also vary in the variety of foods within each food group. We were interested in analysing whether the recommendation to consume a wide range of different foods within each food group would have an impact on the risk of developing diabetes.

To do this, we used data collected from middle and older-aged British adults who reported their lifestyles, including their eating habits, when they entered the study and were followed for about ten years. We found that people who routinely ate from all five food groups had a 30% lower risk of type 2 diabetes than people who only ate three food groups or fewer. Also, people eating the widest variety of fruits and vegetables and dairy products also greatly reduced their risk of diabetes compared with people who had a less varied diet. These results could not be explained by other potential risk factors, such as body weight, occupation, income and education, as we took these factors into account in our analysis.

The bill, please

Research shows that healthy eating is expensive. The price gap between more and less healthy foods is growing in the UK and higher food costs may prevent people from eating a healthier diet, particularly those on low incomes. But what about a more varied diet? Is that more expensive, too?

Most epidemiological studies don’t have information about consumer food costs, but our study did because we linked the dietary data to retail food prices. We found that diets containing all five food groups were on average 18% more costly than diets containing three food groups or fewer. And diets with more variety within each of the five food groups were more costly than diets that contained less variety within each food group.

So, while diverse diets may help prevent chronic diseases, health policymakers will need to acknowledge that the adoption of more varied diets, particularly those containing the most variety of vegetables and fruits, may be substantially more costly and may worsen existing socioeconomic inequalities in diet.

What government can do

Financial incentives can improve food choices and some local authorities are experimenting with taxes on unhealthy foods, including on sugar-sweetened beverages. These are a good start, but financial approaches are no silver bullet.

Tweaking food prices may just be fiddling around the edges if governments don’t also deal with systemic issues such as agricultural policies that are out-of-sync with the dietary priorities most governments advocate. And our neighbourhood environments, supermarket shelves and portion sizes may be promoting overconsumption of primarily processed, energy-dense foods.

The government, the private sector and civil society need to bring policy coherence across the food system, including agriculture, business and health. Easy, affordable access to a varied diet will benefit everyone’s health now and in the future.

Pablo Monsivais, Senior University Lecturer, ��Ī and Annalijn I Conklin, Research Scholar in Global Health & Policy, University of California, Los Angeles

This article was originally published on The Conversation. Read the original article.

The opinions expressed in this article are those of the individual author(s) and do not represent the views of the ��Ī.

Pablo Monsivais (MRC Epidemiology Unit) and Annalijn I. Conklin (University of California, Los Angeles) discuss what sort of diet can reduce your risk of developing type 2 diabetes.

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Neighbourhoods with more takeaways amplify social inequalities in unhealthy eating and obesity

cjb250 — Wed, 11 May 2016 18:00:57 +0000

The study from the Centre for Diet and Activity Research (CEDAR) at the ��Ī, suggests that policies to improve the food environment in towns and cities could be helpful in tackling social inequalities in diet and health.

Nearly two-thirds of adults are overweight or obese in the UK, and it is thought that this may be due in part to increased takeaway food consumption: the amount spent on takeaway foods over the past decade has risen by almost a third (29%) in the UK, where £28 billion worth of takeaway foods are now purchased annually.

To observe the relationships between neighbourhoods, education, diet and obesity, researchers at CEDAR used data from a cohort of almost 6,000 adults aged 29–62 years in ��Īshire. Individuals were asked about their highest educational attainment, eating patterns, were weighed and measured by trained researchers, and had the density of takeaway outlets in their home and work neighbourhoods calculated. The results are published today in the American Journal of Clinical Nutrition.

For the first time the researchers observed consistent differences in diet and weight by education at all levels of neighbourhood exposure to takeaway outlets. Furthermore, where exposure to takeaway outlets was greatest, differences in diet and weight across education groups were most pronounced. In other words the availability of takeaways seemed to be amplifying existing social inequalities.

Individuals with greatest exposure to takeaway outlets consumed around a third more unhealthy takeaway food per day if they were the poorest educated (47g per day) than if they were highest educated (36g per day). Over a year, this is the equivalent of over 4kg of extra unhealthy food. The least educated also had the greatest risk of obesity where the exposure to takeaway outlets was highest.

The findings confirm previous studies showing that takeaway food consumption, weight and the likelihood of being obese are all associated with either living or working near high numbers of takeaway food outlets. They also strengthen the evidence showing that eating takeaways and being obese are linked to socioeconomic disadvantage, indicated by a low level of education.

“Neighbourhoods are clearly important in shaping what all of us eat, no matter how educated we are,” explains Dr Thomas Burgoine from CEDAR, part of the Medical Research Council Epidemiology Unit at the ��Ī. “But this effect appears to be much greater for those with lower levels of education.”

Compared to those least exposed and most educated, those most exposed and least educated were over three times more likely to be obese. Dr Burgoine says: “This double burden of neighbourhood and individual level disadvantage goes some way to explaining current UK socioeconomic inequalities in levels of obesity – in other words, why we see more obesity in disadvantaged groups.”

The researchers used low educational attainment as an indicator of individual level disadvantage. Low educational attainment is commonly associated with lacking behavioural and economic resources, such as cooking skills, food and nutrition knowledge, adequate cooking equipment and a shopping budget that affords healthy purchases, which may increase the influence of an unhealthy neighbourhood food environment.

Dr Pablo Monsivais, senior author of the study, adds: “Higher educational attainment brings with it many advantages, including more money to spend on fresh, healthier foods, as well as better knowledge of food and nutrition, and the tendency to dedicate more time to preparing meals at home, which we know are healthier than those bought out of the home. Without these advantages, people may be more vulnerable to their environment.”

The findings suggest that efforts to improve diets and health by regulating the number of takeaway outlets on our high streets might be particularly effective for those of lower socioeconomic status and therefore help to reduce inequalities in diet and obesity. Such policies are already beginning to be implemented in a number of UK regions and in south Los Angeles, for example. In the UK, people living in deprived neighbourhoods are generally exposed to higher numbers of takeaway food outlets.

“Our results suggest that these policies will be effective across socioeconomic groups, but, critically, particularly for the most disadvantaged. This could help to reduce socioeconomic inequalities in diet and health,” says Dr Monsivais. “This is important because attempts to encourage more healthy living at an individual level have largely failed to reduce health inequalities. This failure has been attributed to such initiatives proving especially ineffective among disadvantaged populations.”

The study was funded by the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council, the NIHR and the Wellcome Trust.

Reference
Burgoine, T et al. Does neighborhood fast-food outlet exposure amplify inequalities in diet and obesity? A cross-sectional study. Am J Clin Nutr; 11 May 2016; DOI: 10.3945/ajcn.115.128132

People who live or work near to a greater number of takeaway outlets are more likely to eat more takeaway food and to be overweight, but new research indicates that neighbourhoods that are saturated with fast food outlets may be particularly unhealthy for people who are socioeconomically disadvantaged.

Neighbourhoods are clearly important in shaping what all of us eat, no matter how educated we are. But this effect appears to be much greater for those with lower levels of education.

Thomas Burgoine

Graham Holliday

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Opinion: Local takeaways create a double burden for obesity

Anonymous — Wed, 11 May 2016 08:13:24 +0000

People in the UK are spending more than ever on takeaway food and there’s good reason to believe that this is contributing to the nation’s obesity problem. Two-thirds of UK adults are either overweight or obese.

But the amount of excess weight the nation is carrying isn’t equal. On average, people in socially disadvantaged groups – those less educated or on lower incomes – are more likely to be overweight. This can be explained by the fact that the socially disadvantaged tend to have less time for cooking, less knowledge about healthy eating and less money for healthy food. Levels of takeaway food consumption are also greater in disadvantaged groups.

Disadvantage can also be environmental. We know that disadvantaged neighbourhoods tend to have greater numbers of takeaway outlets. Although all UK neighbourhoods have become less healthy in the last two decades, disadvantaged neighbourhoods have become unhealthier fastest. It would seem to make sense then that unequal neighbourhoods could be contributing to unequal waistlines.

“But I never use my local takeaway”

This, of course, assumes that neighbourhood food access influences what people eat and how much they weigh. A growing body of evidence suggests that it does. In an analysis, using data on nearly 6,000 people from the Fenland Study in ��Īshire, we showed that the greatest neighbourhood exposure to takeaway food was linked to consuming the equivalent of an additional serving of French fries per week and nearly doubling one’s odds of obesity.

We might like to believe that we make entirely free choices about what, when and where to eat. And we often hear from people that they never use their local takeaway outlets. But given that we need to buy our food from somewhere, we’re all influenced to some degree by what’s on offer within our environment. For people living or working in areas full of takeaways but short on healthier options, unhealthy choices are likely to be the easiest or only option. Among our ��Īshire adults, as many as 47 takeaway outlets were present within just a mile of one person’s home. And growth in the takeaway sector over two decades outpaced that of supermarkets, convenience stores and restaurants, so our environment has become more imbalanced towards greater availability of takeaway food.

Understanding levels of influence

Our new study explores the interplay between social disadvantage and access to neighbourhood takeaway outlets. We used low educational attainment as a marker of social disadvantage – so it’s also an indication of lacking the social, economic, behavioural and psychological resources that might leave people more vulnerable to their environment. For example, less well off consumers are particularly price sensitive, and may be disproportionately affected by the lure of takeaways serving large portions at low prices.

This picture of the effects of a disadvantageous unhealthy neighbourhood being compounded by social disadvantage came through clearly in our analysis. People with the greatest exposure to takeaway outlets consumed a third more unhealthy takeaway food per day if they were the least educated than if they were highest educated. These differences would add up over a year to an additional consumption of over 4kg of unhealthy food. By comparison, people with least exposure to takeaway outlets consumed only a fifth more takeaway food if they were least educated.

In the paper, we also compared the odds of being obese for those facing this double burden of individual and neighbourhood disadvantage. We found that those least educated and most exposed to takeaways were three times more likely to be obese than the most educated and least exposed.

So while neighbourhood takeaway food access is important in shaping everyone’s diet and weight, the effects seem to be greater for those with less education. This means that where takeaways are most abundant, inequalities in diet and obesity are likely to be amplified.

What’s the takeaway message?

The good news is that this situation can be addressed. Fixing the food environment alone isn’t going to cure the obesity crisis, but healthier food choices can be better supported by modifying and shaping the geography of food access across our neighbourhoods.

Our results suggest that if we reduce takeaway access in particular, this will not only benefit all social groups, but will also minimise differences in consumption between social groups. Changing neighbourhoods may seem like a radical step, and there may be challenges, but such efforts are currently underway and are endorsed by NICE, Public Health England, the Greater London Authority and the Academy of Medical Royal Colleges.

Traditional individually-focused efforts, such as improving nutrition knowledge and cooking skills, may also be important but their success will be limited if we continue to live in neighbourhoods that make unhealthy choices the easy and cheap option. The effects of takeaway food outlet access on diet and weight and the implications of this access for social inequalities are now being realised by researchers and public health bodies and constitute a potentially important point of intervention for improving the health of all of us.

Thomas Burgoine, Career Development Fellow (Post-doctoral Research Associate), ��Ī and Pablo Monsivais, Senior University Lecturer, ��Ī

This article was originally published on The Conversation. Read the original article.

The opinions expressed in this article are those of the individual author(s) and do not represent the views of the ��Ī.

Thomas Burgoine and Pablo Monsivais (Centre for Diet and Activity Research) discuss how takeaways can make social inequality worse.

Jeremy Tarling

Fish and chips

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Opinion: Obesity: stop accusing the poor of making bad choices

Anonymous — Wed, 09 Mar 2016 12:58:24 +0000

Last month, the UK health secretary, Jeremy Hunt, called childhood obesity “a national emergency”, but the government has once again delayed publishing its strategy aimed at combating it.

Obesity is much more common in people with less money and education and this socioeconomic gap is getting larger. An unhealthy diet is a leading risk factor for weight gain and chronic disease and there are marked socioeconomic differences in the types of food consumed.

Dietary inequalities of a different sort were also a concern 80 years ago. In 1936, John Boyd Orr, a Scottish doctor, published Food, Health and Income, which systematically described British eating habits in a way that was unprecedented and critically important both for nutrition science and public health.

Britain in the 1930s was rife with diseases related to malnutrition, particularly among the poor. Studies conducted in impoverished areas of Durham and London found rickets in as many as 80% of children, and inequalities in nutrition manifested themselves in height differences of up to five inches (about 13cm) between the lower and higher socioeconomic classes of school-age children.

New appreciation for food and health

This was also the dawn of modern nutrition science. Although the health benefit of specific foods had been known for centuries, the chemical constituents in food that supported growth and health – what we now call vitamins – were only being discovered in the 1910s and 20s. These discoveries spurred a new wave of science and medicine aimed at understanding the potential for better nutrition to alleviate disease.

John Boyd Orr. Wikimedia Commons

Boyd Orr’s analysis used this latest understanding of “nutritional adequacy” to assess whether people were consuming enough of the nutrients needed for good health. He also surveyed diets among people according to their income. This revealed striking differences in diet, notably in the foods and nutrients important for growth and health – what Boyd Orr called “protective foods”, such as fresh milk, vegetables, fruit, fresh fish and meat.

These foods were consumed much more by middle- and higher-income households – enough to support good health. But lower-income families (about one third of the population) consumed less-healthy diets, consisting principally of potatoes, bread, sugar, margarine and condensed milk. Even with enough of these foods, people were malnourished and vulnerable to disease.

Poor diet, not poor choices

Unlike much of the discussion of the topic today, Food, Health and Income did not talk about “unhealthy habits” or “poor choices”. On the contrary, Boyd Orr recognised that protective foods were more costly and in many cases out-of-reach of low-income families. He argued for improved policies to better enable healthier diets, especially among the poor. He also realised that progress on food and health could only come from a reappraisal of policies across all of government.

But what does any of this have to do with present day efforts to improve diets and combat obesity? At first glance, the public health problem with food has inverted. While in the past, socioeconomic disadvantage was associated with malnutrition and stunting, today disadvantage is linked to obesity. The modern problem appears to be overconsumption. But this superficial analysis misses the bigger point that healthier, protective foods are still less accessible for many.

While the poorest in society today typically receive sufficient calories, they frequently don’t eat enough healthy foods. This isn’t because they lack the knowledge, skills or willingness to make healthy decisions, but because of the influence of our social and economic circumstances in shaping food choices.

Real choice for people on low incomes and living in deprived areas may be limited. For instance, poor neighbourhoods tend to be saturated with takeaways and other shops selling unhealthy foods. While supermarkets provide healthier options, the importance of price may limit poorer people to make healthier choices. Calorie for calorie, healthier foods are three times more costly than less-healthy foods.

These environments are of our own making, through agriculture policy, product formulation, portion sizes, advertising, pricing strategies, taxation, and how our neighbourhoods, workplaces and schools are designed.

Now, as in Boyd Orr’s time, the policies and practices that determine the price, quality and availability of food are often at cross-purposes with health. Yet the arguments and government policies on diet and obesity are largely based on the notion of individual “choices”. These are exemplified in public health campaigns designed to encourage and educate us to choose healthier options. This approach has largely failed, because we have yet to address the unhealthy context in which choices are made.

Getting the bigger picture

There are promising signs of more constructive polices. Last autumn, Public Health England’s sugar reduction strategy provided evidence and recommendations for action to improve food environments. The test will be whether the government is prepared to take bold action in the much-delayed obesity strategy. Boyd Orr’s report was also delayed by the government in 1936, but his vision for coordinated food and agriculture policy aligned for the public’s health is as relevant today as it was then.

Pablo Monsivais, Senior University Lecturer, ��Ī

This article was originally published on The Conversation. Read the original article.

The opinions expressed in this article are those of the individual author(s) and do not represent the views of the ��Ī.

Pablo Monsivais (Centre for Diet and Activity Research) discusses obesity and the influence of socioeconomic circumstances in shaping food choices.

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The rise of the takeaway

cjb250 — Wed, 01 Apr 2015 23:01:00 +0000

In a study published today in the journal Health & Place, researchers from the Centre for Diet and Activity Research (CEDAR), at the ��Ī, analysed the change in density of takeaway food outlets across Norfolk between 1990 and 2008 and how this related to levels of neighbourhood socioeconomic deprivation.

Takeaway food outlets, such as fish and chip shops, kebab shops, and Indian and Chinese takeaways, primarily offer ready-to-eat, energy-dense foods that are associated with higher total energy and fat intakes. Frequent consumption of takeaway food has been associated with excess weight gain over time.Previous studies have shown that people of low socioeconomic status and living in deprived areas are more likely to be overweight and consume unhealthy diets than other sectors of the population. One possible explanation could be that more unhealthy food environments – for example, a greater density of takeaway food outlets – could be contributing to unhealthy lifestyle choices. Last year, a team at CEDAR showed that people who lived and worked near a high number of takeaway outlets tended to eat more takeaway food and were more likely to be obese than those less exposed.

��Ī researchers used Yellow Pages telephone directories to collect data on the number and location of takeaway food outlets across six time points from 1990 to 2008. The researchers then mapped these onto electoral ward boundaries for Norfolk, a large county with a resident population in 2001 of almost 800,000 people.

Over the 18 year period, the number of takeaway food outlets rose by 45%, from 265 to 385 outlets. This equated to an increase from 2.6 outlets to 3.8 outlets per 10,000 residents. The highest absolute increase in density of outlets was in areas of highest deprivation, which saw an increase from 4.6 outlets to 6.5 outlets per 10,000 residents (a 43% increase).

This is in contrast to areas of least deprivation, which saw an increase from 1.6 to 2.1 per 10,000 residents over the time period (a 30% increase).

PhD student Eva Maguire, lead author of the study from CEDAR, ��Ī said: “The link we’ve seen between the number of takeaway food outlets and area deprivation is consistent with other reports, but this is the first time the changes over time have been studied in the UK. There were differences in the densities of takeaway outlets as far back as we looked, but these differences also became more extreme.”

Dr Pablo Monsivais, also from CEDAR, added: “The growing concentration of takeaway outlets in poorer areas might be reinforcing inequalities in diet and obesity, with unhealthy neighbourhoods making it more difficult to make healthy food choices. Our findings suggest that it might be time for local authorities to think hard about restrictions on the number and location of outlets in a given area, particularly deprived areas.”

In 2012, the Greater London Authority proposed the idea to limit the percentage of store frontage dedicated to takeaway food outlets on high streets in the Capital. Such initiatives have been endorsed by bodies including Public Health England, the National Institute for Health and Care Excellence (NICE) and the Academy of Medical Royal Colleges.

The researchers also looked at the spread of supermarkets. Although they found an increase in the number of supermarkets over the same time period, from 31 to 40 (an increase of 29%), the proportion of supermarkets in deprived areas did not differ significantly from other types of areas.

Although the study was only carried out in Norfolk, the county shares characteristics with other areas of the UK and so the researchers believe the findings will be generalizable across the country.

Reference
Maguire ER et al. Area deprivation and the food environment over time: a repeated cross-sectional study on takeaway outlet density and supermarket presence in Norfolk, UK, 1990 – 2008. Health & Place; 2 April 2015.

The number of takeaway food outlets has risen substantially over the past two decades, with a large increase seen in areas of socioeconomic disadvantage, according to a study carried out across Norfolk by researchers at the ��Ī.

The growing concentration of takeaway outlets in poorer areas might be reinforcing inequalities in diet and obesity, with unhealthy neighbourhoods making it more difficult to make healthy food choices

Pablo Monsivais

Stevie Spiers

Hot, Takeaway, Fresh

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Price gap between more and less healthy foods grows

fpjl2 — Thu, 09 Oct 2014 06:05:28 +0000

A new study, published today in the journal PLOS One, tracked the price of 94 key food and beverage items from 2002 to 2012. Its findings show that more healthy foods were consistently more expensive than less healthy foods, and have risen more sharply in price over time.

Food prices in the UK have risen faster than the price of other goods in recent years, and this new research shows that the increase has been greater for more healthy foods, making them progressively more expensive over time.

While less healthy foods had a slightly greater price rise relative to 2002, the absolute increase was significantly more for more healthy foods - a total average increase of £1.84 per 1000kcal for more healthy food across the decade, compared to £0.73 for less healthy food.

In 2002, 1000 kcal of more healthy foods – as defined by criteria devised for the UK government – cost an average of £5.65, compared to purchasing the same quantity of energy from less healthy food at £1.77. By 2012 this cost had changed to £7.49 for more healthy and £2.50 for less healthy foods.

Researchers from the Centre for Diet and Activity Research (CEDAR) at the ��Ī who conducted the study say that this trend could result in people increasingly turning to less healthy food.

“Food poverty and the rise of food banks have recently been an issue of public concern in the UK, but as well as making sure people don’t go hungry it is also important that a healthy diet is affordable,” said lead author Nicholas Jones.

“The increase in the price difference between more and less healthy foods is a factor that may contribute towards growing food insecurity, increasing health inequalities, and a deterioration in the health of the population.” The cost of diet-related ill health to the National Health Service has been estimated to be £5.8 billion annually.

The 94 foods and beverages in the study were taken from the Office of National Statistics’ Consumer Price Index ‘basket’: the list of items used to measure inflation in the UK. The items included in the study were those which remained in the ‘basket’ for every year of the decade analysed.

To match nationwide food prices to nutrient content for each of the foods, the researchers combined datasets from the Consumer Price Index and from the National Diet and Nutrition Survey. This novel link allowed them to establish which foods were either more or less healthy using an objective assessment of the foods’ nutrient content, as defined by the UK Food Standards Agency’s FSA-Ofcom nutrient profiling model.

“The finding shows that there could well be merit in public health bodies monitoring food prices in relation to nutrient content, hopefully taking into account a broader selection of foods than we were able to in this study,” said Nicholas Jones.

The study’s authors say their finding that more healthy food is more expensive tallies with work from similar high income nations. They point to other studies indicating that the EU’s Common Agricultural Policy - which subsidises production of certain goods such as dairy, oil and sugar - has the potential to affect public health by influencing the availability and price of foods.

“To help achieve long-term improvements in eating habits, we need to address the high and rising prices of healthier foods, which is likely to be influenced by a number of factors including agricultural policy and production, food distribution, and retail pricing strategies,” said senior author Dr Pablo Monsivais from CEDAR in ��Ī.

“Additionally, there is growing evidence that targeted subsidies can promote healthy eating for people on low incomes.”

Novel use of UK national data finds a growing gap between the prices of more and less healthy foods between 2002 and 2012. Healthy foods in 2012 were three times more expensive per calorie than less healthy foods.

We need to address the high and rising prices of healthier foods, which is likely to be influenced by a number of factors including agricultural policy and production, food distribution, and retail pricing strategies

Pablo Monsivais

JMiu

Doughnut

Selected foods and price changes per 1000kcals

More healthy	2002	2012
Tinned tomatoes	£4.71	£9.60
Baked beans	£1.05	£2.05
Semi-skimmed milk	£1.07	£1.73
Less healthy	2002	2012
Frozen pizza	£2.10	£1.58
Ice cream	£1.50	£1.57
Pork sausages	£1.90	£2.69

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�������������Ī - Pablo Monsivais

Opinion: A varied diet can prevent diabetes – but can you afford it?

A varied diet is a healthier diet

The bill, please

What government can do

Neighbourhoods with more takeaways amplify social inequalities in unhealthy eating and obesity

Opinion: Local takeaways create a double burden for obesity

“But I never use my local takeaway”

Understanding levels of influence

What’s the takeaway message?

Opinion: Obesity: stop accusing the poor of making bad choices

New appreciation for food and health

Poor diet, not poor choices

Getting the bigger picture

The rise of the takeaway

Price gap between more and less healthy foods grows

��Ī - Pablo Monsivais