Abstract
BACKGROUND: Retail food environments have largely become settings which promote less healthy foods to their customers. In an effort to prompt healthier choices, the UK Government introduced regulations in October 2022 restricting most retailers in England from promoting products high in fat, sugar, or salt (HFSS) at store entrances, aisle-ends, and checkouts, and their online equivalents. Evidence is needed on how businesses approach compliance and adapt to these regulations. This study used in-depth interviews to examine business responses and generate insights to support effective implementation. METHODS: This cross-sectional qualitative study involved semi-structured interviews with 22 business representatives responsible for interpreting and implementing the regulations. The interviews were conducted via MS Teams/Zoom between August 2021-April 2022, prior to the implementation of regulations. Preparations to implement changes and predicted impact on businesses' promotional practices were examined. Six researchers collected and analysed the data using an inductive thematic approach. RESULTS: Participants' reactions to regulatory compliance varied according to perceived commercial impact and resource availability. While some businesses explored opportunities for healthful promotions and invested in layout changes, a significant proportion planned to comply only to the letter of the law and were testing alternative strategies for unhealthy promotions. Trade bodies played a crucial role in preparations, supporting member businesses to interpret the regulations and fostering a unified approach to compliance. Anticipated barriers to compliance included challenges such as accurately assessing product scores, reformulating products to meet standards, and ensuring consistent store-level adherence within large businesses. To enhance the regulations' impact, participants called for (i) smaller in-scope businesses to receive additional technical support from the government, (ii) manufacturers be required to share detailed nutrient information with retailers or a centralised product nutrient profile repository be established, and (iii) out-of-home businesses be required to comply. CONCLUSIONS: These mandated regulations hold potential to shift food retailers' priorities from solely profit maximisation, to also supporting public health. However further government action is needed to ensure effective compliance for all business types and sizes. A consistent, long-term policy approach aligned with other food policies and informed by industry expertise to optimise implementation could better support obesity reduction.