Policy makers and public health organisations called to engage with Food EPI recommendations | World Obesity Federation

Policy makers and public health organisations called to engage with Food EPI recommendations

NewsPolicy makers and public health organisations called to engage with Food EPI recommendations

The Science and Technology in childhood obesity (STOP) project has recently released an innovative study in the Lancet medical journal.

The study is the first to systematically assess and monitor the level of food environment policy and infrastructure support implementation in European countries using a validated and adapted tool (the Healthy Food Environment Policy Index- Food-EPI). This tool was developed by The International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) to aid national governments in their development of healthier food environments.

As well as being part of STOP, the research was also involved with the Policy Evaluation Network (PEN) aimed at advancing the evidence base for public policies impacting on dietary behaviour, physical activity, and sedentary behaviour in Europe (JPI Healthy Diet for a Healthy Lifestyle). The participating countries in the research (Estonia, Finland, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Slovenia, and Spain) are the result of the project partnership.

In the past decades, the number of people living with overweight, obesity, and diet-related non-communicable diseases (NCDs) has risen. This increase has been associated with widening exposure to obesogenic food environments in Europe and globally.

The food environment refers to the physical, economic, political, and sociocultural context in which consumers engage with the food system to make their decisions about acquiring, preparing and consuming food. Over past decades, food environments have become increasingly unhealthy, for example ultra-processed foods are now widely available. Previous research from the European Union revealed that there is potential for the EU to improve its policies influencing food environments.

The aim of this study was to evaluate food policy implementation in European countries and identify priority actions for governments to create healthy food environments. The Food-Epi tool and process guided the analysis in each country (Slovenia and Portugal aligned the process with the evaluation of national Food and Nutrition action plans).  

The Food-EPI tool includes seven policy domains representing characteristics of food environments:

  • food composition,
  • food labelling,
  • food promotion,
  • food prices,
  • food provision,
  • food retail, and
  • food trade and investment.

There are also six infrastructure support domains:

  • leadership,
  • governance,
  • monitoring and intelligence,
  • funding and resources,
  • platforms for interaction, and
  • health-in-all policies.


Findings revealed that Finland had the highest proportion (32% n=7/22) of policies influencing food environments with a high level of implementation, whereas Slovenia and Poland had the highest proportion of policies rated at low implementation (42% n=10/24 and 36% n =9/25 respectively). Retail was rated the lowest policy domain and the lowest rated infrastructure domain was ‘health-in-all policies’ (Table 1).  The only policy domains whereby a country was rated as ‘high’ was food composition (Portugal and Finland) and food provision (Finland). Finland had high implementation across the board for infrastructure domains, except for funding (Table 1).

Table 1: Level of policy infrastructure support and implementation in European countries - Pineda et al (2022)

Overall, the implementation of preventative policies remains low with slow progress, but small improvement has been observed for recent years. The improvement of school environments was high on European countries' priorities as well as the need to regulate marketing to children. These were key priorities for consulted experts, along with fruit and vegetable subsides and unhealthy food and beverage taxation. 

There is much potential for European countries to improve their food policies and infrastructure support influencing food environments. The key next steps are to distribute the recommendations of the study to policy makers and the uptake of recommendations by public health organisations. A systems approach is essential to support enabling of healthier food environments to tackle obesity and NCDs in European countries. 

More about this

The full study, ‘Policy implementation and priorities to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): A pooled level analysis across eleven European countries’ is available to read from The Lancet Regional Health, Europe.

Full Study