Density regulations limit the number of licenses that are issued to permit the sale of alcohol. Places with a high alcohol outlet density have higher rates of violence, injuries, and drunk-driving fatalities than those with a low density of such establishments (8,13). Furthermore, where the number of alcohol outlets increases, so does the level of drinking (17,18). Similarly, where alcohol outlet density has been reduced, the health consequences associated with problem drinking have decreased (19,20).

Density restrictions work in 2 ways. First, they reduce the frequency of cues related to drinking. Second, density restrictions make alcohol less accessible, effectively increasing the cost of getting it. When the costs of drinking go up, drinkers (including alcoholics) will moderate consumption (21).

Easy access to foods high in calories and low in nutritional value is a stimulus of hunger and the desire to eat (22). However, proximal cues are often perceived in ways that are difficult or impossible for people to recognize (23). People often experience the illusion that their desires for food develop solely from within, based on true need, rather than being stimulated by external cues (24).

The ubiquitous presence of food undermines people’s ability to control impulsive eating behaviors, which are triggered by a physiologic reflexive dopamine reaction (25). Limiting the density of food outlets, in particular outlets that primarily sell food items high in calories and low in nutritional value, could help reduce consumption of such foods. Density limits could be applied to food outlets by type of food sold; a few localities already have ordinances in place that restrict the opening of new fast-food outlets (26). Such ordinances could be expanded to cover convenience stores or specialty food outlets devoted to the sale of foods high in discretionary calories (eg, doughnut shops, ice cream parlors).

Licensing and outlet density restrictions may also help curb sales of food in places that are not primarily food outlets. Licenses are typically required only for food outlets that that sell perishable food. Outlets selling food that doesn’t spoil, such as highly processed candies, salty snacks, sugar-sweetened beverages, and foods that do not need refrigeration, are generally not required to be licensed or inspected. Establishments with vending machines typically do not obtain food licenses. Consequently, hardware stores, bookstores, worksites, gas stations, schools, and other nonfood outlets and public venues are increasingly likely to sell nonperishable foods or have vending machines (27).

Although restricting exposure to low-nutrient snack foods may help control obesity by reducing the appetitive stimulation they generate (28), a question arises as to whether limiting the accessibility of these types of foods places an undue burden or cost on people who are not overweight and not easily tempted (ie, “moderate” eaters). The ubiquity of unhealthy food was lower before 1980, and no evidence seems to suggest that consumers were unduly burdened. Today, a minority of people in developed countries could be considered “moderate” eaters, if normal weight for height is a marker of moderate eating (1).

Much attention is devoted to increasing the availability of fresh fruits and vegetables in low-income areas designated as “food deserts,” defined as areas whose residents live more than one-half mile from a supermarket and do not have access to a vehicle (29). Less than 5% of the American population lives in areas than can be classified as food deserts, yet 67% are overweight or obese. Nevertheless, just as in some localities all establishments that serve alcohol are required to serve food and nonalcoholic beverages, a policy that requires food outlets to have some minimum number of healthy options may be a policy alternative. However, obesity is less the result of eating insufficient healthy foods and more the consequence of eating too many unhealthy ones. Restrictions on unhealthy foods are more promising than promotion of healthy foods in controlling obesity (30,31).

Many efforts in the United States have attempted to reduce the impulsive consumption of alcohol and drinking while driving. In California gas stations, the sale of beer is prohibited from iced barrels or from temporary displays placed within 5 feet of the front door or the cash register (32). Although the evidence on the effectiveness of measures regulating displays and presentation is patchy, research shows that after New Mexico banned drive-through alcohol outlets in 1998, sales of alcohol decreased and rates of alcohol-use–related fatalities continued to decrease (33,34). In most localities, to discourage its immediate consumption, alcohol cannot be sold through a drive-through window.

The restrictions used for alcohol control could be applied to food outlets to discourage impulse purchases of low-nutrient foods. Vendors pay supermarkets slotting fees to put their products where they are easily noticed, such as at eye level, on end aisles, and on special floor displays, which block aisles and require customers to stop and take notice. Saliently placed products sell in greater volume than in less salient areas; end-aisle displays account for 30% of all supermarket sales (35). To counter the influence of salience, foods that are high in calories and low in nutritional value may be restricted to locations such as the back of store, behind the counter, or at locations other than end aisles or eye-level displays. Regulations could also be established concerning which foods may be displayed at the cash register or in other prime locations of a grocery store or other food outlet, as well as which foods can be sold through a drive-through window.

Alcoholic beverages are classified by their percentage of alcohol content, and the US government defines a standard drink as containing 0.6 oz of alcohol. Therefore, based on their concentration of alcohol, standard drink sizes are 12 ounces for a glass of beer, 5 ounces for a glass of wine, and 1.5 ounces for a “shot” of 80-proof liquor. These standard portion sizes have been established to allow people to estimate their risk of inebriation based on the number of drinks consumed. In 8 American states, laws prohibit selling larger quantities per drink without also increasing the price (36). Furthermore, incentives such as lowered taxes and relaxed regulation of sales have been extended to alcoholic drinks with lower alcohol content such as “near beer,” an approach that has been effective in reducing alcohol-related harms (8).

Larger servings of food have been associated with higher energy intake, regardless of serving method and the characteristics of individual eaters (37-39). The increase in portion sizes during the past 3 decades in the United States is well documented (40) and problematic because people tend to underestimate portion size (41) and cannot easily judge how much they have consumed (42).

Although menu labeling that specifies the caloric content of specific dishes is required in US restaurants with 20 or more outlets, choosing healthy foods in the appropriate quantity is still difficult for people (43). Default serving sizes by volume or weight for all foods could be established internationally. The US Food and Drug Administration has created Reference Amounts Customarily Consumed (RACCs) based on what people ate in the 1980s (44). Although RACCs do not provide precise calorie counts, using these as guidelines would help reduce overall consumption. No specialized training or equipment other than a measuring cup or a kitchen scale would be required for adherence to portion control standards.

Default portion sizes could be applied to all foods, but maximum serving sizes should be set for foods that are high in calories and low in nutritional value, such as sugar-sweetened beverages and deep-fried foods. Portion control is intended to help people gauge how much they have eaten. Some people who are large or very active may find a standard portion insufficient. Just as people can order more than 1 drink, people would be free to order more than 1 portion.

Problem drinkers (including binge drinkers and heavy chronic drinkers) tend to choose cheaper alcoholic beverages because they seek to maximize ethanol intake for the money they spend (11,45). In the United States, the top 10% of drinkers spend approximately $0.78 per drink compared with $4.75 per drink for the bottom 50% of drinkers (46). This fact provides a strong rationale for the use of measures that increase the price of the cheapest drinks. Policies used abroad may offer useful lessons in this area. For example, in Poland, Luxembourg, and Belgium, establishments that sell alcoholic beverages for off-premise consumption are subject to a general ban on below-cost sales, which also applies to sales of alcohol (47). Many Canadian provinces use “social reference pricing,” which sets minimum prices per unit of pure ethanol to ensure that alcohol prices do not fall below a certain threshold, making alcoholic beverages more expensive and reducing their consumption among problem drinkers. In Germany, the “Apple Juice” law states that in outlets that sell alcohol for on-premise consumption, at least 1 alcohol-free beverage must be cheaper than the cheapest alcoholic beverage available. In Switzerland in some cantons (ie, provinces), all restaurants are obliged by law to offer at least 3 nonalcoholic drinks that are cheaper than the cheapest alcoholic beverage of the same quantity (47).

Restrictions on on-premise alcohol price promotions are also common. Many US states and localities prohibit “specials,” such as “all-you-can-drink” nights and “ladies drink free” nights (36). These prohibitions discourage drunkenness, binge drinking, and other alcohol-related problems (48).

Foods that are high in calories and low in nutritional value could be subject to a higher tax. Fruits and vegetables could be required to be less expensive than foods such as candies, cakes, or French fries that can exacerbate or increase the risk of chronic diseases. Restrictions on “all you can eat” one-price buffets should also be considered, because the more people eat, the lower the cost per calorie. This is an incentive to overconsume. Buffet costs could be based on the weight of the food purchased, and buffet items could be served in controlled portion sizes to reduce the risk of people overeating. In supermarkets, specials such as “10 for $10” or “2 for the price of 1” can be prohibited for foods with a low-nutrient profile.

Warning labels on alcohol bottles and tobacco packages have been moderately effective in increasing awareness of the respective risks of alcohol and tobacco use, although the effect of labeling on actual drinking and smoking behavior remains contested (49,50). Nevertheless, the value of warning labels as a means to improve awareness and understanding and to shift perceptions and attitudes on the risks of particular goods is undeniable. Counter-advertising as a means to reduce consumption has proven effective in modern times for tobacco control (51). In the mid-19th century, the temperance movement had a campaign maligning alcohol as “demon rum” and widely circulated materials about the harms, both spiritual and physical, associated with alcohol use. Historians have credited these efforts with contributing to a precipitous reduction in alcohol consumption (52).

Although nutrition labeling is mandatory in the United States, warnings are not. The use of traffic light labeling — placing red, yellow, and green circles to respectively signify large, medium, and small amounts of fats, sugars, and salt — increases the frequency with which people can identify healthier products (53). Whether this information ultimately changes consumer behavior sufficiently to reduce overweight and obesity is still unknown. Signs and symbols to convey that consuming certain foods in excess could increase the risk of heart disease (eg, high-fat foods) or other chronic diseases (eg, hypertension, diabetes) may help consumers make choices at the point of purchase. Because warning symbols have never been used to help people avoid a specific chronic disease from food consumption, research in this area is warranted.

A limited number of mass media campaigns exist that discourage people from eating too much or that highlight the importance of refraining from eating foods with little nutritive value. We are not aware of formal evaluations of these campaigns, but they may have an effect if they are salient and reach a large number of consumers.