Background Health inequalities between the North-East (NE) of England and the rest of England are widening. Data from 2021–22 shows that the NE has the highest prevalence of childhood overweight and obesity. Local authorities in England have responsibility for health improvement. There is a large body of evidence showing a clear relationship between planning and health. In the NE, Newcastle and Gateshead adopted two distinctly different policies to modify the food environment through the same mechanism of restricting the opening for hot-food takeaway outlets. We took an econometric approach that aimed to empirically evaluate the effectiveness of these two policies.

Methods First, we developed a conceptual model to identify and detail how planning policy developed to restrict the number of hot-food takeaway outlets may impact on inequalities in body weight. Next, we used the model to empirically evaluate the effectiveness of these two implemented policies. We used data from the UK Government’s Food Standards Agency, Food Hygiene Rating scheme, to characterise the out-of-home food environment, and children weight data from the nationally mandated, National Childhood Measurement Programme. We then employed a quasi-experimental approach (difference-in-difference) to estimate how these two types of planning policy impacted on the number of takeaways compared to other local authorities without planning guidance related to the food environment in place. Then we explored how these policies have impacted on inequalities in childhood overweight and obesity.

Results Restricting the opening of new takeaways within 400 m of schools has no impact on the food environment in the short term (3 years after introduction of the policy). However, a ban on any new takeaway outlets in the local authority, as implemented by Gateshead Council, led to a significant reduction of 14% in the proportion of takeaways and a significant reduction of 11% in the density of outlets. We found a significant reduction in childhood overweight and obesity in Gateshead for the 2^nd and 3^rd most deprived quintiles (which had the highest concentration of outlets pre-policy).

Conclusion Planning policy has the potential to be a low cost-mechanism to modify the food environment to improve health and reduce health inequalities. However, the policy needs to be carefully developed bringing together planning and public health colleagues to avoid loopholes and potential challenges which could be costly for cash-strapped local authorities.