Healthier diets for all? A systematic review and meta-analysis examining socioeconomic equity of the effect of increasing availability of healthier foods on food choice and energy intake

Widespread availability of unhealthy food and drink products may contribute to socioeconomic patterning in obesity. Therefore, increasing the availability of healthier foods may be one approach to reducing obesity without widening existing inequalities. This systematic review and meta-analysis examined the impact of increasing the availability of healthier food and drink on consumer behavior among individuals with higher and lower socioeconomic position (SEP). Eligible studies were required to use experimental designs to compare conditions of higher vs lower availability of healthier vs less healthy options on food choice-related outcomes and measure SEP. Thirteen eligible studies were included. Odds of choosing a healthy item were higher when availability was increased for higher (OR = 5.0, 95% CI: 3.3, 7.7) and lower (OR = 4.9, CI: 3.0, 8.0) SEP. Increased availability of healthier foods was also associated with a decrease in energy content of selections for higher (-131 kcal; CI: -76, -187) and lower (-109 kcal; CI: -73, -147) SEP. There was no SEP moderation. Increasing the relative availability of healthier foods may be an equitable and effective approach to improve population-level diet and address obesity, though more research is required testing this in real-world environments.