Causal loop diagramming the dynamics that shape food environments in Dutch supermarkets.

BACKGROUND: Food-retail environments are often dominated by unhealthy products, which facilitates unhealthy diets. Limited insight into the factors in the commercial food system that cause this issue makes effective health interventions in retail settings difficult. This study explores the factors and dynamics of the Dutch commercial food system that determine the availability of healthy and unhealthy food in Dutch supermarkets. METHODS: The study developed and analysed a causal loop diagram (CLD) of the factors and dynamics that determine in-store food availability. Data was collected through semi-structured interviews with food system professionals (n = 14) and a focus group with academic experts (n = 6), based on the leading question 'what determines the in-store availability of a product?' Transcripts were qualitatively coded to identify factors and their interactions. These were visualised in a CLD and subsequently examined to identify causal loops and other dynamics. RESULTS: The CLD revealed a core feedback loop between in-store product availability, sales, and pricing, and how this interacted with consumer behaviour and production and supply. Products that sell well and have large profit margins are made more available. Consumers generally buy products that are tasty and affordable, while products with low production and supply costs have better profit margins. These factors favour abundant availability of products consisting of cheap and highly palatable unhealthy ingredients, leading to a reinforcing feedback loop that disadvantages availability of more costly and perishable healthy products. Competition and innovation further emphasise this dynamic, as producers strive to reduce costs and increase palatability in a race to the bottom. Societal interest in health presents a minor feedback loop that favours healthy products due to their positive public image. CONCLUSIONS: Our findings show that the prevalence of unhealthy products compared to healthy ones is deeply ingrained in the current system dynamics. Policy recommendations include facilitating sustainable corporate governance models, adjusting financial incentives via taxes and subsidies, and enforcing a 'level playing field' for healthier business practices.