COVID-19 is an infectious disease caused by the recently discovered SARS-CoV-2, for which there is still no vaccine or provenly effective treatment ¹1. Rafaell RMR, Neto M, Carvalho MMB, David HMSL, Acioli S, Faria MGA. Epidemiologia, políticas públicas e pandemia de Covid-19: o que esperar no Brasil? Rev Enferm UERJ 2020; 28:e49570.. Considering that the novel coronavirus has high transmissibility and that transmission occurs through close personal contact or contact with contaminated surfaces ²2. World Health Organization. Q&A on coronaviruses (COVID-19). https://www.who.int/news-room/q-a-detail/q-a-coronaviruses (acessado em 23/Mai/2020).
https://www.who.int/news-room/q-a-detail... , physical distancing is the best available strategy to curtail its spread. Thus, since community transmission of COVID-19 was declared in Brazil, non-essential economic activities were suspended and essential activities had to adopt specific rules for functioning ³3. Brasil. Decreto nº 10.282, de 20 de março de 2020. Regulamenta a Lei nº 13.979, de 6 de fevereiro de 2020, para definir os serviços públicos e as atividades essenciais. Diário Oficial da União 2020; 20 mar..

As of this writing, there was no evidence that the numbers of cases and deaths were decreasing in the country. Nevertheless, government initiatives to relax social distancing were making inroads in various states and municipalities, loosening the previously adopted economic restrictions ¹1. Rafaell RMR, Neto M, Carvalho MMB, David HMSL, Acioli S, Faria MGA. Epidemiologia, políticas públicas e pandemia de Covid-19: o que esperar no Brasil? Rev Enferm UERJ 2020; 28:e49570..

In-person service in food establishments away from home has been banned or limited by decrees or ordinances during most of the time since the pandemic’s onset ⁴4. Decretos do Governo de SP com medidas de prevenção e combate ao novo coronavírus. SP Notícias 2020; 26 mar. https://www.saopaulo.sp.gov.br/spnoticias/decretos-do-governo-de-sp-com-medidas-de-prevencao-e-combate-ao-novo-coronavirus/.
https://www.saopaulo.sp.gov.br/spnoticia... ^,55. Rio de Janeiro. Decreto nº 47.102, de 1º de junho de 2020. Dispõe sobre as medidas de enfrentamento da propagação do novo coronavírus (COVID-19), em decorrência da situação de emergência em saúde, e dá outras providências. Diário Oficial do Estado do Rio de Janeiro 2020; 2 jun.. As a result, bars, restaurants, snack bars, and similar food services adopted or stepped up their presence in the digital environment, especially with food delivery apps (in this article we simplify this term to designate delivery services for foods and beverages that are ready to consume, that is, that dispense with any stage of preparation by the consumer) ⁶6. Soupin E. Com cariocas de quarentena, pedidos de delivery disparam no Rio. G1 2020; 19 mar. https://g1.globo.com/rj/rio-de-janeiro/noticia/2020/03/19/com-cariocas-de-quarentena-pedidos-de-delivery-disparam-no-rio.ghtml.
https://g1.globo.com/rj/rio-de-janeiro/n... . Meanwhile, customers interested in food prepared away from home also began to rely more on delivery and takeaway services via these apps ⁷7. 99 Food. Serviço ganha novos públicos e ajuda a manter bares e restaurantes em operação durante a pandemia. Gazeta do Povo 2020; 29 abr. https://www.gazetadopovo.com.br/conteudo-publicitario/99-food/servico-ganha-novos-publicos-e-ajuda-a-manter-bares-e-restaurantes-em-operacao-durante-a-pandemia/.
https://www.gazetadopovo.com.br/conteudo... ^,88. Frabasile D, Campos E, Buldrini R. Coronavírus: como o iFood está lidando com o aumento da demanda por delivery. Época Negócios 2020; 3 abr. https://epocanegocios.globo.com/Startup/noticia/2020/04/coronavirus-como-o-ifood-esta-lidando-com-o-aumento-da-demanda-por-delivery.html.
https://epocanegocios.globo.com/Startup/... .

For the reasons just mentioned, social distancing during the COVID-19 pandemic may be contributing to the expansion of food delivery app use in Brazil. Thus, based on this moment in the health crisis, it is important to reflect on the possible repercussions for health and nutrition from the more widespread practice of purchasing food online.

Food delivery and consumers’ health

Delivery apps are part of the digital food environment ⁹9. Granheim SI. The digital food environment. UNSCN Nutrition 2019; 44:116-21., as convenient channels for online purchases ¹⁰10. Pigatto G, Machado JGCF, Negreti AS, Machado LM. Have you chosen your request? Analysis of online food delivery companies in Brazil. Br Food J 2017; 119:639-57.. This expands the possibilities for food purchases, improving the availability and accessibility of foods prepared away from home ¹¹11. Maimaiti M, Zhao X, Jia M, Ru Y, Zhu S. How we eat determines what we become: opportunities and challenges brought by food delivery industry in a changing world in China. Eur J Clin Nutr 2018; 72:1282-6.. Still, consumers’ health can be affected negatively, since the nutritional composition of foods and beverages available on such platforms must be similar to those in physical establishments ¹²12. Keeble M, Adams J, Sacks G, Vanderlee L, White CM, Hammond D, et al. Use of online food delivery services to order food prepared away-from-home and associated sociodemographic characteristics: a cross-sectional, multi-country analysis. Int J Environ Res Public Health 2020; 17:5190.. Since eating out is part of Brazilians’ diet and the nutritional profile is high in calories and low in nutrients ¹³13. Bezerra IN, Souza AM, Pereira RA, Sichieri R. Consumo de alimentos fora do domicílio no Brasil. Rev Saúde Pública 2013; 47 Suppl 1:200s-11., food purchases via apps may contribute to the consumption of unhealthy foods and to the development of associated chronic noncommunicable diseases ¹²12. Keeble M, Adams J, Sacks G, Vanderlee L, White CM, Hammond D, et al. Use of online food delivery services to order food prepared away-from-home and associated sociodemographic characteristics: a cross-sectional, multi-country analysis. Int J Environ Res Public Health 2020; 17:5190..

According to a study in Belo Horizonte (Minas Gerais State, Brazil), some 80% of food establishments using the two most widely used apps were selling ultra-processed beverages, 38% were selling ultra-processed snacks, and 33% were selling ice cream products. Meanwhile, only 16% marketed meals that predominantly contained vegetables and greens, and only 4% sold fruits or fruit-based preparations (unpublished observations) ¹⁴14. Horta PM, Souza JPM, Rocha LL, Mendes LL. Digital food environment of a Brazilian metropolis: food availability and marketing strategies used by delivery apps. Public Health Nutr 2020; (Online ahead of print).. It is also known that foods based on ultra-processed foods, such as pizzas, hamburgers, and other kinds of snacks are among the most frequently ordered categories on the online platforms ¹⁵15. iFood; Box 1824. A revolução da alimentação na era digital. https://revolucaodelivery.ifood.com.br/#/ (acessado em 14/Mai/2019).
https://revolucaodelivery.ifood.com.br/#... ^,1616. Delivery Much. Diagnóstico do delivery de comida no interior do Brasil em 2018. https://blog.deliverymuch.com.br/delivery-much-franquia/ (acessado em 24/Mai/2020).
https://blog.deliverymuch.com.br/deliver... . Thus, the food delivery digital environment can be understood as a food swamp ¹⁷17. Mui Y, Jones-Smith J, Thornton R, Porter KP, Gittelsohn J. Relationships between vacant homes and food swamps: a longitudinal study of an urban food environment. Int J Environ Res Public Health 2017; 14:1426.. After all, since it does not depend on physical distance between the food establishments and the customers, it concentrates a higher proportion of points of sale for unhealthy compared to healthy foods.

Another key factor is that the dynamics of online food choices differ from the experience of food purchases at in-person establishments. For example, studies on the online purchase of supermarket items suggest a decrease in the acquisition of unhealthy foods on impulse, but also evidence of hesitation in the purchase of fresh foods ¹⁸18. Pitts SBJ, Ng SW, Blitstein JL, Gustafson A, Niculescu M. Online grocery shopping: promise and pitfalls for healthier food and beverage purchases. Public Health Nutr 2018; 21:3360-76.. Despite the scarcity of similar studies that analyze the online purchase of ready-to-eat food, food apps display features that can channel consumers to unhealthy foods. Their interface simulates a food court in which certain choices may seem more attractive due to the illustrations, promos, combos, free delivery, and especially algorithmic programming that highlights foods and promos based on previous purchases and on what persons with similar profiles are inclined to order.

Intensification of food delivery app use during the pandemic

Growing access to internet and smart mobile devices and a more widespread digital culture are contributing factors to the popularization of food delivery apps in Brazil ¹⁰10. Pigatto G, Machado JGCF, Negreti AS, Machado LM. Have you chosen your request? Analysis of online food delivery companies in Brazil. Br Food J 2017; 119:639-57.. The 26.6 million orders delivered in November 2019 by iFood, the market leader in Latin America, illustrate this expansion ¹⁹19. iFood chega a 26,6 milhões de pedidos no mês de novembro. E-Commerce Brasil 2019; 16 dez. https://www.ecommercebrasil.com.br/noticias/ifood-chega-a-266-milhoes-de-pedidos-no-mes-de-novembro/ (acessado em 30/Jul/2020).
https://www.ecommercebrasil.com.br/notic... .

According to Bezerra et al. ¹³13. Bezerra IN, Souza AM, Pereira RA, Sichieri R. Consumo de alimentos fora do domicílio no Brasil. Rev Saúde Pública 2013; 47 Suppl 1:200s-11., the eating-out rate in Brazil correlates positively with income and negatively with age. The proportion of food delivery app users is also higher in young adults, in socioeconomic classes A and B (60%), and in the region with the highest income concentration, the Southeast (61%) ²⁰20. Instituto Qualibest. Consumo de comida delivery por aplicativo. https://www.institutoqualibest.com/download/uso-de-apps-de-delivery-de-comida/ (acessado em 24/Mai/2020).
https://www.institutoqualibest.com/downl... . In addition, in state capitals and metropolitan areas, online delivery includes a considerably higher market share (39.5%) when compared to the countryside (6.9%) ¹⁶16. Delivery Much. Diagnóstico do delivery de comida no interior do Brasil em 2018. https://blog.deliverymuch.com.br/delivery-much-franquia/ (acessado em 24/Mai/2020).
https://blog.deliverymuch.com.br/deliver... .

The current moment of physical distancing may be catalyzing the adoption of food delivery in cities where this option is available, because as long as the food services follow health and hygiene guidelines ²¹21. Associação Brasileira de Bares e Restaurantes. Cuidados de higiene no delivery para bares e restaurantes na crise do novo coronavírus. https://drive.google.com/file/d/1u3vSZDLAqDJeVTLROp5WM5WcTED1tpKV/view (acessado em 24/Mai/2020).
https://drive.google.com/file/d/1u3vSZDL... , this technological solution is safer than eating out. Thus, more Brazilians may be opting to receive food at home. The apps have thus invested in such strategies as discounts, promos, and free delivery during the pandemic ⁶6. Soupin E. Com cariocas de quarentena, pedidos de delivery disparam no Rio. G1 2020; 19 mar. https://g1.globo.com/rj/rio-de-janeiro/noticia/2020/03/19/com-cariocas-de-quarentena-pedidos-de-delivery-disparam-no-rio.ghtml.
https://g1.globo.com/rj/rio-de-janeiro/n... .

The delivery companies have not disclosed the consolidated data on the pandemic’s impact on their sales. However, iFood, for example, confirmed an increase in the demand for delivery along with the spread of COVID-19. That is, the demand began in São Paulo and Rio de Janeiro, reached the other states, and then spread across the countryside. Customers also began to purchase larger amounts per order, more frequently, and at different moments than the normal peak purchasing hours. This includes breakfast, afternoon snacks, and lunch; in this case, one important explanation is the possibility of payment with food allowance cards ⁸8. Frabasile D, Campos E, Buldrini R. Coronavírus: como o iFood está lidando com o aumento da demanda por delivery. Época Negócios 2020; 3 abr. https://epocanegocios.globo.com/Startup/noticia/2020/04/coronavirus-como-o-ifood-esta-lidando-com-o-aumento-da-demanda-por-delivery.html.
https://epocanegocios.globo.com/Startup/... .

Although average users of food delivery apps have a privileged socioeconomic profile compared to Brazil’s general population, the questions posed here are not limited to persons with higher purchasing power. Even before the pandemic, food delivery companies were investing in measures to diversify their customer base, such as the program that digitized the prato feito (literally “done dish”, a staple Brazilian lunch usually consisting of rice, beans, an economic meat or poultry serving, and a serving of vegetables) in 40 Brazilian cities, delivering marmitas (disposable prato feito lunch pails) with prices starting at BRL 10.00 (or about USD 2.00). In addition to the increase in sales, this initiative aimed to attract more customers from economic classes C and D ²²22. Wolf G. iFood Loop: como a startup de refeições quer 'digitalizar o PF'. O Estado de S. Paulo 2020; 29 jan. https://link.estadao.com.br/noticias/inovacao,ifood-loop-como-a-startup-de-refeicoes-quer-digitalizar-o-pf,70003176441.
https://link.estadao.com.br/noticias/ino... .

The food delivery industry also adopted similar strategies to those already used by the food industry to expand the ultra-processed food market in the low and middle-income population ²³23. Monteiro CA, Cannon G. The impact of transnational "Big Food" companies on the South: a view from Brazil. PLoS Med 2012; 9:e1001252.. Such strategies include raising multimillion-dollar investments, acquisition of smaller companies in other countries, and heavy investment in advertising ²⁴24. Bertão N. Com apetite de unicórnio, iFood quer se reinventar. Exame 2017; 14 dez. https://exame.com/revista-exame/com-apetite-de-unicornio/.
https://exame.com/revista-exame/com-apet... . Thus, like the intensification of ultra-processed food purchases by the lower-income population ²⁵25. Instituto Brasileiro de Geografia e Estatística. POF 2017-2018: alimentos frescos e preparações culinárias predominam no padrão alimentar nacional. Agência IBGE Notícias 2020; 3 abr. https://agenciadenoticias.ibge.gov.br/agencia-sala-de-imprensa/2013-agencia-de-noticias/releases/27298-pof-2017-2018-alimentos-frescos-e-preparacoes-culinarias-predominam-no-padrao-alimentar-nacional.
https://agenciadenoticias.ibge.gov.br/ag... , it is possible that lower socioeconomic classes may also start to purchase food more often in the digital environment.

In the current context, the attraction and retention of customers that were not using delivery platforms regularly are reaching audiences with different profiles from the habitual, including older persons, one of the key risk groups for COVID-19, who may be experimenting with online food purchases ⁷7. 99 Food. Serviço ganha novos públicos e ajuda a manter bares e restaurantes em operação durante a pandemia. Gazeta do Povo 2020; 29 abr. https://www.gazetadopovo.com.br/conteudo-publicitario/99-food/servico-ganha-novos-publicos-e-ajuda-a-manter-bares-e-restaurantes-em-operacao-durante-a-pandemia/.
https://www.gazetadopovo.com.br/conteudo... .

Final remarks

Measures have been defended in the field of public health nutrition that discourage the consumption of ultra-processed foods, such as front-of-package warnings, increased taxes on sugary beverages, and regulation of food advertising and environments ²⁶26. Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, et al. The global syndemic of obesity, undernutrition, and climate change: the Lancet Commission report. Lancet 2019; 393:791-846.. However, despite the food delivery industry’s rapid growth, which may be propelled in the pandemic’s context, there are still no proposals for specific measures to encourage purchase of meals based on natural or minimally processed foods and to discourage the purchase of foods based on ultra-processed products.

In this sense, the adoption of some interventions could protect health. For example, banning food deliveries to schools, surtaxes on combos sold at lower prices than the sum of their components and large servings whose prices represent an economic advantage over the purchase of smaller servings, regulating the use of push algorithms, and regulating the use of food allowance cards from the Workers’ Food Program.

The food delivery industry will probably emerge stronger from the health crisis, and online food purchasing, especially via apps, may be part of many Brazilians’ daily routine after the pandemic. Although it is beyond the scope of this article, this highlights the need for greater attention to various public health aspects interrelated to this phenomenon, such as delivery workers’ labor rights and the environmental impact of disposable packaging to transport meals. As for consumers’ health, we emphasize the need for studies on food purchasing practices via apps in order to identify potential nutritional impacts, as well as to define and support priority measures to promote adequate and healthy eating via this digital channel.

Acknowledgments

L. V. Botelho is a scholar of the Academic Excellence Program (CAPES/MEC).

References

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History