Health impacts of takeaway management zones around schools in six different local authorities across England: a public health modelling study using PRIMEtime

Background: In England, the number of takeaway food outlets (takeaways) has been increasing for over two decades. Takeaway management zones around schools are an effective way to restrict the growth of new takeaways but their impacts on population health have not been estimated. Methods: To model the impact of takeaway management zones on health, we used estimates of change in and exposure to takeaway outlets (across home, work, and commuting buffers) based on a previous evaluation suggesting that 50% of new outlets were prevented from opening because of management zones. Based on previous cross-sectional findings, we used changes in takeaway exposure to estimate changes in BMI, from 2018 to 2040. Finally, we used PRIMEtime, a proportional multistate lifetable model, and BMI change to estimate the impact of the intervention, in a closed-cohort of adults (25-64 years), in terms of incidence of 12 non-communicable diseases, obesity prevalence, quality-adjusted life years (QALYs) and healthcare costs saved by 2040 in six selected local authorities across the rural-urban spectrum in England (Wandsworth, Manchester, Blackburn with Darwen, Sheffield, North Somerset, and Fenland). Results: By 2031, compared to no intervention, reductions in outlet exposure ranged from 3 outlets/person in Fenland to 28 outlets/person in Manchester. This corresponded to per person reductions in BMI of 0.68 and 0.08 kg/m2, respectively. Relative to no intervention, obesity prevalence was estimated to be reduced in both sexes in all LAs, including by 2.3 percentage points (PP) (95% uncertainty interval:2.9PP, 1.7PP) to 1.5PP (95%UI:1.9PP, 1.1PP) in males living in Manchester and Wandsworth by 2040, respectively. Model estimates showed reductions in incidence of disease, including type II diabetes (eg: 964 (95%UI:1565, 870) fewer cases /100,000 population for males in Manchester)), cardiovascular diseases, asthma, certain cancers and low back pain. Savings in healthcare costs (millions(pounds)) ranged from 0.90 (95%UI: 1,23, 0.54) in Fenland to 5.44 (95%UI:3.87, 7.45) in Manchester. Gains in QALYs/100,000 person were broadly similar across local authorities. Conclusions: Takeaway management zones in England have the potential to meaningfully contribute towards reducing obesity prevalence and associated healthcare burden in the adult population, both at the local level and across the rural-urban spectrum ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study is funded by the National Institute for Health Research (NIHR) Public Health Research Programme (Project number: NIHR130597). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Derived data on projection of takeaway outlet growth is available upon request.