title: Economic instruments for obesity prevention: results of a scoping review and modified Delphi survey.
abstract: BACKGROUND
  Comprehensive, multi-level approaches are required to address obesity. One important target for intervention is the economic domain. The purpose of this study was to synthesize existing evidence regarding the impact of economic policies targeting obesity and its causal behaviours (diet, physical activity), and to make specific recommendations for the Canadian context.
  
  
  METHODS
  Arksey and O'Malley's (2005) methodological framework for conducting scoping reviews was adopted for this study and this consisted of two phases: 1) a structured literature search and review, and 2) consultation with experts in the research field through a Delphi survey and an in-person expert panel meeting in April 2010.
  
  
  RESULTS
  Two key findings from the scoping review included 1) consistent evidence that weight outcomes are responsive to food and beverage prices. The debate on the use of food taxes and subsidies to address obesity should now shift to how best to address practical issues in designing such policies; and 2) very few studies have examined the impact of economic instruments to promote physical activity and clear policy recommendations cannot be made at this time. Delphi survey findings emphasised the relatively modest impact any specific economic instrument would have on obesity independently. Based on empirical evidence and expert opinion, three recommendations were supported. First, to create and implement an effective health filter to review new and current agricultural polices to reduce the possibility that such policies have a deleterious impact on population rates of obesity. Second, to implement a caloric sweetened beverage tax. Third, to examine how to implement fruit and vegetable subsidies targeted at children and low income households.
  
  
  CONCLUSIONS
  In terms of economic interventions, shifting from empirical evidence to policy recommendation remains challenging. Overall, the evidence is not sufficiently strong to provide clear policy direction. Additionally, the nature of the experiments needed to provide definitive evidence supporting certain policy directions is likely to be complex and potentially unfeasible. However, these are not reasons to take no action. It is likely that policies need to be implemented in the face of an incomplete evidence base.
authors: Faculty of Physical Education and Health, University of Toronto, 55 Harbord Street, Toronto, ON M5S2W6, Canada. guy.faulkner@utoronto.ca
authors: Guy E J
authors: GE
authors: Faulkner
authors: Paul
authors: P
authors: Grootendorst
authors: Van Hai
authors: VH
authors: Nguyen
authors: Tatiana
authors: T
authors: Andreyeva
authors: Kelly
authors: K
authors: Arbour-Nicitopoulos
authors: M Christopher
authors: MC
authors: Auld
authors: Sean B
authors: SB
authors: Cash
authors: John
authors: J
authors: Cawley
authors: Peter
authors: P
authors: Donnelly
authors: Adam
authors: A
authors: Drewnowski
authors: Laurette
authors: L
authors: Dubé
authors: Roberta
authors: R
authors: Ferrence
authors: Ian
authors: I
authors: Janssen
authors: Jeffrey
authors: J
authors: Lafrance
authors: Darius
authors: D
authors: Lakdawalla
authors: Rena
authors: R
authors: Mendelsen
authors: Lisa M
authors: LM
authors: Powell
authors: W Bruce
authors: WB
authors: Traill
authors: Frank
authors: F
authors: Windmeijer
mesh_terms: D001835:Body Weight; D003697:Delphi Technique; D004032:Diet / Q000191:economics*; D019422:Dietary Sucrose / Q000191:economics; D015444:Exercise; D005522:Food Services / Q000191:economics*; D005523:Food Supply / Q000191:economics*; D005638:Fruit; D006801:Humans; D018673:Nutrition Policy / Q000191:economics*; D009765:Obesity / Q000191:economics* / Q000517:prevention & control; D011203:Poverty; D011640:Public Policy; D013660:Taxes; D014675:Vegetables
chemical_list: D019422:Dietary Sucrose