Impact on purchasing behaviour of implementing junk free checkouts: a pre–post study

Background: Removing unhealthy products from checkouts will arguably reduce impulse purchasing, but evidence is lacking. In 2015, Tesco Express stores implemented so-called healthy checkouts; products high in sugar, fat, or salt (defined by national Nutrient Profiling Model criteria) were removed from in-queue areas. We aimed to compare the purchasing of unhealthy foods before and after its introduction. Methods: Tesco provided store-level sales data for 1151 Tesco Express stores in England over two 8 week periods (May–July in 2014 and 2015). We used paired t tests to examine whether spend on unhealthy foods (biscuits, cakes, crisps, confectionary) as a proportion of total spend changed in 2015 versus 2014. Analyses were repeated for the quantity of unhealthy products sold. Unannounced store visits (n=41) were conducted by three researchers (in London, the South East, the North West, and Yorkshire and Humber) to measure compliance (ie, whether prohibited products were displayed in-queue). Findings: Complete sales data were available for 1101 stores (96%). Mean overall spend increased in 2015 compared with 2014 (£666 079·70 [SD 406 385·00] vs £653 786·59 [SD 447 580·77], p<0·0001). The proportion of total spend from unhealthy foods decreased in 2015 versus 2014 (8·03% [SD 2·07] vs 8·21% [2·17], p<0·0001). Spend on biscuit products as a proportion of total spend decreased (0·98% [0·29] in 2015 versus 0·99% [0·30] in 2014, p=0·003), whereas proportionate spend on crisps increased (2·39% [0·64] vs 2·36% [0·66], p<0·0001). There was no change for cakes. Confectionary accounted for the largest proportion of unhealthy product spend and showed the biggest reduction (3·91% of total spend [SD 1·16] in 2015 vs 4·12% [1·24] in 2014, p<0·0001). Results were similar for quantity of unhealthy products sold. Instore visits revealed that only 16 of the visited stores (39%) were fully compliant. Interpretation: Tesco's healthy checkouts initiative led to a small reduction in sales of unhealthy foods, largely accounted for by confectionary products. These findings suggest that removal of unhealthy products from checkouts might lead to healthier purchasing behaviour. However, store compliance was poor, suggesting scope for improvement. Funding: Tesco plc. The funder had no role in the study design, analysis, or interpretation of data.