Table 1 Six policy recommendations based on stakeholder views

 All business staff (managers, employees), business types (retailers, manufacturers, wholesalers) and enforcers require access to a free, accurate and mobile HFSS calculator. It should be inclusive of cultural foods and regularly updated to ensure consistent, effective implementation and enforcement of this legislation.

‘Everyone wants the government to have a way of centrally holding the nutrient profiling scores for products (i.e., composition of foods database) so that retailers and enforcers can access it. Government can do more to facilitate information about what is an unhealthy food.’ (11007, Business, Retailer)

 Details about the purpose of the legislation could improve understanding and receptivity to comply within the spirit of the legislation. In particular, the regulations should add details about which products can or should be promoted, how businesses can determine products’ HFSS scores and how enforcers obtain information to define a qualifying business.

Using evidence from thorough legislation evaluation (recommendation 3) is critical to inform legislation refinement to improve its effectiveness.

‘The way the UK regulations are written a lot of the time are in a very literal style that sets out a number of rules but if you look at many of the EU regulations, they have this introductory text that sets out what the point is and what the purpose of the regulations are, and under EU regulations there is a requirement for you to interpret the legislation with regard to its intention. The [UK] approach can be very literal in terms of what does the regulations say, and if it doesn’t say that, then you’re allowed to do it [ … ] but maybe some introductory texts to cut out any loopholes.’ (13013, Enforcer, Trading Standards)

 Short-term evaluation should assess (i) legislation implementation and enforcement activities across all business types; (ii) changes in sales and purchasing patterns across all HFSS categories and alternative products (fruit, vegetable, alcohol etc.) in qualifying and exempt businesses; and (iii) differences by consumer and regional demographics to examine the impact on inequalities.

Long-term evaluation should assess changes in societal attitudes, dietary patterns and obesity rates, as well as business outcomes and broader food system changes.

‘The main thing for us is monitoring data that’s collected through health services, particularly around children, young people, and regular weighing and things like that. You can look at the amount of these products that are sold as well to monitor whether or not that goes up or down, whether or not there appear to be shifts. Supermarkets have amazing data that can drill right down to individuals. Obviously the weight thing is a bit of a longer term, but you could immediately monitor the sale of these products particularly in relation to healthier products.’ (12042, Health, Charity)

 Specific guidance for smaller businesses that is culturally accessible and additional funding for local authorities to support smaller retailers who do not have in-house legal support would increase awareness and compliance amongst all store types.

Incentives for small retailers and their suppliers to improve the healthfulness of the foods they offer could be considered, in recognition of their small profit margins and low customer demand for healthy foods.

‘Smaller businesses do need more support in understanding the legislation [and] some funding for supporting those smaller businesses. And some very clear guidance, aimed at smaller shops because they’ve got a smaller floor area, they’ve got narrow aisles, they’ve got end of aisles nearer to tills. [Previously] the Government funded for business support visits. That would help enormously. But I’m not going to hold my breath for that one … ’ (13039, Enforcer, Environmental Health)

 Additional resources for local authorities are essential to enable enforcers to become familiar with the new legislation, to provide support to all business types and to make visits to premises. This resource could be provided in the form of government funding for local authorities to conduct a HFSS legislation-specific project with targeted outcomes.

‘We’ve not got the resource to go and do the things on a daily basis that we desperately need to do. I suppose eventually, if we’ve got the scope to do it we’ll possibly pick it up as a project, a bit of project work to see what compliance rates are like.’ (13034, Enforcer, Trading standards)

 A long-term roadmap for food and health is necessary to unify stakeholders’ priorities and timescales around the required action to achieve the collective desire for a food system that ensures healthy, sustainable diets for all within the next 20–30 years. It should build on work invested into Henry Dimbleby’s National Food Strategy review and the Obesity Health Alliance’s 10-year healthy weight strategy and be led by a statutory body such as the Food Standards Agency.

‘It’s just trying to find the sweet spot of, you know, you’ve had the Public Health England targets for a reduction in salt, for example. You’ve then got the HFSS now, you’ve got traffic light labelling that we look at, and then we’ve got our internal reformulation criteria as well. So it’s working within all of those, which can be quite complex. [ … ] [an] other thing we do look at is portion size.[ … ] It doesn’t change the score because it’s based on 100 grams but it’s one of those other things that we do because it's the right thing to do to offer consumer choice.’ (11079, Business, Manufacturer)