Peter Scarborough

University of Oxford | OX · Department of Public Health

Understanding and communicating the environmental impacts of food products is key to enabling transitions to environmentally sustainable food systems [El Bilali and Allahyari, Inf. Process. Agric. 5, 456–464 (2018)]. While previous analyses compared the impacts of food commodities such as fruits, wheat, and beef [Poore and Nemecek, Science 360, 987...

Background Models that forecast non-communicable disease rates are poorly designed to predict future changes in trend because they are based on exogenous measures of disease rates. We introduce microPRIME, which forecasts myocardial infarction (MI) incidence, events and prevalence in England to 2035. microPRIME can forecast changes in trend as all...

Objectives In July 2020 the UK Government announced an intention to restrict advertisements for products high in fat, salt or sugar on live broadcast, catch-up and on-demand television before 21:00 hours; and paid for online advertising. As no other jurisdiction has implemented similar regulations, there is no empirical evidence about how they migh...

Objectives Rates of overweight and obesity vary across England, but local rates have not been estimated for over 10 years. We aimed to produce new small area estimates of body mass index (BMI) by age and sex for each lower tier and unitary local authority in England, to provide up-to-date and more detailed estimates for the use of policy-makers and...

Background Mathematical modelling can play a vital role in guiding public health action. In this paper, we provide an overview of the revised and updated PRIMEtime model, a tool for evaluating health and economic impacts of policies impacting on diet and obesity. We provide guidance on populating PRIMEtime with country-specific data; and illustrate...

Background As the World Health Organization urges countries to strengthen their noncommunicable disease monitoring and surveillance activities, setting-specific innovations are emerging. Diet – a key, modifiable risk factor for chronic diseases – is particularly challenging to capture reliably. By socially validating self-report dietary survey tool...

Background Nutrient profile models (NPMs) are algorithms that classify or rank foods according to their nutritional composition. An NPM was developed in 2005 in the UK to regulate marketing of foods to children. The model uses a scoring system that balances points awarded for the protein, fibre, fruit, vegetable, and nut content of foods and drinks...

Taxes and subsidies on foods and nutrients have the potential to promote healthier diets and thereby reduce mortality. In this study, we examine the effects of such policy instruments on Swedish public health. Specifically, we estimate the effects of food and nutrient taxes and subsidies on mortality averted and postponed in Sweden, using both dema...

In recent decades there has been a sustained and substantial shift in human diets across the globe towards including more livestock-derived foods. Continuing debates scrutinize how these dietary shifts affect human health, the natural environment, and livelihoods. However, amidst these debates there remain unanswered questions about how demand for...

Objective To determine if the characteristics of behavioural weight loss programmes influence the rate of change in weight after the end of the programme. Design Systematic review and meta-analysis. Data sources Trial registries, 11 electronic databases, and forward citation searching (from database inception; latest search December 2019). Random...

A nutrient profiling model (NPM) was developed in 2005 in the UK to regulate the marketing of foods to children. It was revised in 2018, but the new version has not been finalised. The Eatwell Guide (EWG) is the UK’s official food-based dietary guidelines. The aim of this study was to evaluate the agreement between the 2005 and 2018 versions of the...

Background The provision and over-consumption of foods high in energy, saturated fat, free sugars or salt are important risk factors for poor diet and ill-health. In the UK, policies seek to drive improvement through voluntary reformulation of single nutrients in key food groups. There has been little consideration of the overall progress by indivi...

Background Low childhood physical activity levels constitute an important modifiable risk for adult non-communicable disease incidence and subsequent socio-economic burden, but few publications have explored age and sex related patterns within the UK population. The aims were to profile child physical activity data from the Health Survey for Englan...

Background Reducing meat consumption could bring health and environmental benefits, but there is little research to date on effective interventions to achieve this. A non-randomised controlled intervention study was used to evaluate whether prominent positioning of meat-free products in the meat aisle was associated with a change in weekly mean sal...

Background Obesity is a leading risk for poor health outcomes in England. We examined best- and worst-case scenarios for the future trajectory of the obesity epidemic. Methods Taking the last 27 years of Health Survey for England data, we determined both position and shape of the adult body mass index (BMI) distribution and projected these paramet...

Background Consumption of free sugars in the UK greatly exceeds dietary recommendations. Public Health England (PHE) has set voluntary targets for industry to reduce the sales-weighted mean sugar content of key food categories contributing to sugar intake by 5% by 2018 and 20% by 2020. The aim of this study was to assess changes in the sales-weight...

Objective To determine changes in household purchases of drinks and confectionery one year after implementation of the UK soft drinks industry levy (SDIL). Design Controlled interrupted time series analysis. Participants Members of a panel of households reporting their purchasing on a weekly basis to a market research company (average weekly numb...

Background Suboptimal diet is the leading cause of global morbidity and mortality. Addressing this problem requires context-specific solutions informed by context-specific data collected by context-specific tools. This study aimed to assess the relative validity of a newly developed brief dietary survey to estimate food intake and adherence to the...

Background Sri Lanka faces the double burden of over- and undernutrition. To tackle this dual challenge, double duty interventions that improve the quality of the Sri Lankan diet in line with national dietary guidelines have been suggested. The success of these interventions depends upon an understanding of the context-specific factors that impact...

Background Sugar-sweetened beverage (SSB) consumption is positively associated with obesity, type 2 diabetes, and cardiovascular disease. The World Health Organization recommends that member states implement effective taxes on SSBs to reduce consumption. The United Kingdom Soft Drinks Industry Levy (SDIL) is a two-tiered tax, announced in March 201...

Objective Online supermarkets are increasingly used both by consumers and as a source of data on the food environment. We compared product availability, nutritional information, front-of-pack (FOP) labelling, price and price promotions for food and drink products between physical and online supermarkets. Design For physical stores we collected dat...

Objective To analyse the health and environmental implications of adopting national food based dietary guidelines (FBDGs) at a national level and compared with global health and environmental targets. Design Modelling study. Setting 85 countries. Participants Population of 85 countries. Main outcome measures A graded coding method was developed...

Health-related claims (HRCs) are statements found on food packets that convey the nutritional quality of a food (nutrition claims) and/or its impact on a health outcome (health claims). Foods carrying HRCs have a slightly improved nutritional profile than foods without HRCs, however, it's unclear whether this translates into dietary improvements. W...

Background Food taxes and subsidies are one intervention to address poor diets. Price elasticity (PE) matrices are commonly used to model the change in food purchasing. Usually a PE matrix is generated in one setting then applied to another setting with differing starting consumptions and prices of foods. This violates econometric assumptions resul...

Objective There are concerns that price promotions encourage unhealthy dietary choices. This review aims to answer the following research questions (RQ1) what is the prevalence of price promotions on foods in high-income settings, and (RQ2) are price promotions more likely to be found on unhealthy foods? Design Systematic review of articles publis...

Background Dietary sugar, especially in liquid form, increases risk of dental caries, adiposity, and type 2 diabetes. The United Kingdom Soft Drinks Industry Levy (SDIL) was announced in March 2016 and implemented in April 2018 and charges manufacturers and importers at £0.24 per litre for drinks with over 8 g sugar per 100 mL (high levy category),...

Background: The consumption of free sugars in the UK is more than double the guideline intake for adults and close to triple for children, with soft drinks representing a significant proportion. The aim of this study was to assess how individual soft drink companies and consumers have responded to calls to reduce sugar consumption, including the s...

Background Traffic-light labelling (TLL) is a promising front-of-pack system to help consumers make informed dietary choices. It has been shown that adopting TLL in Canada, through an optimistic scenario of avoiding, if possible, foods with red traffic lights, could effectively reduce Canadians’ intakes of energy, total fat, saturated fat, and sodi...

Background Food taxes and subsidies are one intervention to address poor diets. Price elasticity (PE) matrices are commonly used to model the change in food purchasing. Usually a PE matrix is generated in one setting then applied to another setting with differing starting consumption and prices of foods. This violates econometric assumptions result...

Background: PRIMEtime CE is a multistate life table model that can directly compare the cost effectiveness of public health interventions affecting diet and physical activity levels, helping to inform decisions about how to spend finite resources. This paper estimates the costs and health outcomes in England of two scenarios: reformulating salt an...

Background: Non-communicable diseases are the leading cause of death in England, and poor diet and physical inactivity are two of the principle behavioural risk factors. In the context of increasingly constrained financial resources, decision makers in England need to be able to compare the potential costs and health outcomes of different public h...

Background/objectives: The goal of this article is to present and demonstrate the applicability of an original method to assess the economic and health impacts of compliance with food-based recommendations. The method takes account of consumers' preferences and the associated adoption cost in the assessment of various recommendations. Subjects/me...

Objectives Traditional methods for creating food composition tables struggle to cope with the large number of products and the rapid pace of change in the food and drink marketplace. This paper introduces foodDB, a big data approach to the analysis of this marketplace, and presents analyses illustrating its research potential. Design foodDB has be...

Objectives To study trends in stroke mortality rates, event rates, and case fatality, and to explain the extent to which the reduction in stroke mortality rates was influenced by changes in stroke event rates or case fatality. Design Population based study. Setting Person linked routine hospital and mortality data, England. Participants 795 869...

Objective To estimate the impact of the UK government’s sugar reduction programme on child and adult obesity, adult disease burden, and healthcare costs. Design Modelling study. Setting Simulated scenario based on National Diet and Nutrition Survey waves 5 and 6, England. Participants 1508 survey respondents were used to model weight change amon...

Restricting children's exposures to marketing of unhealthy foods and beverages is a global obesity prevention priority. Monitoring marketing exposures supports informed policymaking. This study presents a global overview of children's television advertising exposure to healthy and unhealthy products. Twenty‐two countries contributed data, captured...

Background/objectives: It is not known if diets lower in greenhouse gas (GHG) emissions are also healthier. We evaluated the population health implications of changing to more sustainable diets in the UK, France, Finland, Italy and Sweden. Subjects/methods: We developed a life table model to simulate mortality and morbidity from diet-related dis...

The objective is to estimate the number of deaths attributable to cardiovascular diseases and diet-related cancers that could be prevented or delayed in Sweden if adults adhere to the official dietary recommendations. We used an age-group and sex-specific epidemiological macro-simulation model to estimate preventable deaths due to the discrepancies...

Background Health-related claims (HRCs) are statements found on food packets that convey the nutritional quality of a food (nutrition claims) and/or its impact on a health outcome (health claims). The EU stated that HRCs should be regulated such that they can only appear on foods that meet a specified nutrient profile (NP). A NP model has been prop...

Background The consumption of red and processed meat has been associated with increased mortality from chronic diseases, and as a result, it has been classified by the World Health Organization as carcinogenic (processed meat) and probably carcinogenic (red meat) to humans. One policy response is to regulate red and processed meat consumption simil...

Supplementary information. (PDF)

Objective: To estimate the impact of integrating the price of greenhouse gas emissions into the price of food commodities on dietary and weight‐related risk factors and associated disease burden in Australia, as well as on national emissions reductions and public revenues. Methods: We used country‐specific data for Australia to build a coupled mode...

The food system is a major driver of climate change, changes in land use, depletion of freshwater resources, and pollution of aquatic and terrestrial ecosystems through excessive nitrogen and phosphorus inputs. Here we show that between 2010 and 2050, as a result of expected changes in population and income levels, the environmental effects of the...

Background: Sustainable diets are intended to address the increasing health and environmental concerns related to food production and consumption. Although many candidates for sustainable diets have emerged, a consistent and joint environmental and health analysis of these diets has not been done at a regional level. Using an integrated health and...

Both the global average per capita consumption of meat and the total amount of meat consumed are rising, driven by increasing average individual incomes and by population growth. The consumption of different types of meat and meat products has substantial effects on people’s health, and livestock production can have major negative effects on the en...

Objectives Healthcare interventions, and particularly those in public health may affect multiple diseases and significantly prolong life. No consensus currently exists for how to estimate comparable healthcare costs across multiple diseases for use in health and public health cost-effectiveness models. We aim to describe a method for estimating com...

Background: Self-monitoring (SM) of diet and tailored feedback (TF) have been suggested as tools for changing dietary behavior. New technologies allow users to monitor behavior remotely, potentially improving reach, adherence, and outcomes. Objective: We conducted a systematic literature review and meta-analysis to address the following question...

Background Most food in the United Kingdom is purchased in supermarkets, and many of these purchases are routinely tracked through supermarket loyalty card data. Using such data may be an effective way to develop remote public health interventions and to measure objectively their effectiveness at changing food purchasing behavior. Objective The Fr...

BACKGROUND Most food in the United Kingdom is purchased in supermarkets, and many of these purchases are routinely tracked through supermarket loyalty card data. Using such data may be an effective way to develop remote public health interventions and to measure objectively their effectiveness at changing food purchasing behavior. OBJECTIVE The Fr...

The global burden of obesity leads to significant morbidity and has major economic implications. In April 2018, Britain will join a growing number of countries attempting to tackle this using fiscal measures when the UK Soft Drinks Industry Levy is introduced. We review recent evidence from natural experiments of the impact of health-related food a...

Background In the United Kingdom, the Food Standards Agency-Ofcom nutrient profiling model (FSA-Ofcom model) is used to define less-healthy foods that cannot be advertised to children. However, there has been limited investigation of whether less-healthy foods defined by this model are associated with prospective health outcomes. The objective of t...

Supplementary data. (DOCX)

Strengthening the reporting of observational studies in epidemiology (STROBE) statement. (DOC)

Background: In the UK the FSA-Ofcom nutrient profiling model is used to define less-healthy foods that cannot be advertised to children. However there has been limited investigation of whether less-healthy foods defined by this model are associated with prospective health outcomes. The objective of this study was to test whether consumption of less...

Background The majority of food in the United Kingdom is purchased in supermarkets, and therefore, supermarket interventions provide an opportunity to improve diets. Randomized controlled trials are costly, time-consuming, and difficult to conduct in real stores. Alternative approaches of assessing the impact of supermarket interventions on food pu...

There were some errors in the original published article [1]. Firstly relating to the calculation of the confidence intervals for four of the studies included in the meta-analysis, [2, 3, 4, 5] which are detailed below. Secondly one of the papers, Whybrow et al. was incorrectly cited as being published in 2007, when it was published in 2006 [2].

The standard US diet contributes to greenhouse gas emissions (GHGE) from both the food system, and from the health system through its contribution to non-communicable diseases. To estimate the potential for diet change to reduce GHGE and improve public health, we analyzed the effect of adopting healthier model diets in the USA on the risk of diseas...