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Are food and drink retailers within NHS venues adhering to NICE Quality standard 94 guidance on childhood obesity? A cross-sectional study of two large secondary care NHS hospitals in England
  1. Alice James1,
  2. Laura Birch2,
  3. Peter Fletcher3,
  4. Sally Pearson4,
  5. Catherine Boyce4,
  6. Andy R Ness2,
  7. Julian P Hamilton-Shield2,
  8. Fiona E Lithander2
  1. 1 Faculty of Health Sciences, University of Bristol, Bristol, UK
  2. 2 NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
  3. 3 Department of General and Old Age Medicine, Cheltenham General Hospital, Gloucestershire, UK
  4. 4 Department of Clinical Strategy, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
  1. Correspondence to Dr Fiona E Lithander; fiona.lithander{at}


Objective To assess whether the food and drink retail outlets in two major National Health Service (NHS) district general hospitals in England adhere to quality statements 1–3 of the UK National Institute for Health and Care Excellence (NICE) quality standard 94.

Design Cross-sectional, descriptive study to assess the food and drink options available in vending machines, restaurants, cafes and shops in two secondary care hospitals.

Main outcome measures Adherence to quality statement 1 whereby the food and drink items available in the vending machines were classified as either healthy or less healthy using the Nutrient Profiling Model (NPM). Compliance with quality statements 2 and 3 was assessed through the measurement of how clearly the shops, cafes and restaurants displayed nutrition information on menus, and the availability and prominent display of healthy food and drink options in retail outlets, respectively.

Results Adherence to quality statement 1 was poor. Of the 18 vending machines assessed, only 7 (39%) served both a healthy food and a healthy drink option. Neither hospital was compliant with quality statement 2 wherein nutritional information was not available on menus of food providers in either hospital. There was inconsistent compliance with quality standard 3 whereby healthy food and drink options were prominently displayed in the two main hospital restaurants, but all shops and cafes prioritised the display of unhealthy items.

Conclusions Neither hospital was consistently compliant with quality statements 1–3 of the NICE quality standard 94. Improving the availability of healthy foods and drinks while reducing the display and accessibility to less healthy options in NHS venues may improve family awareness of healthy alternatives. Making it easier for parents to direct their children to healthier choices is an ostensibly central component of our healthcare system.

  • paediatrics
  • paediatric endocrinology

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  • Contributors AJ and JPHS designed and collected the data. PF, SP and CB supervised and oversaw AJ during the data collection period. LB calculated and analysed the nutrient model scores. FEL, LB and ARN supervised the data analyses and prepared the manuscript. All authors revised the manuscript and approved the final version.

  • Funding National Institute of Health Research (NIHR) Bristol Nutrition Biomedical Research Unit.

  • Disclaimer This is an independent opinion from a Biomedical Research Unit (now Centre) in the National Institute for Health Research Biomedical Research Centre and Unit Funding Scheme. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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