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Actions to address different forms of malnutrition are typically managed by separate communities, policies, programmes, governance structures, and funding streams. By contrast, double-duty actions, which aim to simultaneously tackle both undernutrition and problems of overweight, obesity, and diet-related non-communicable diseases (DR-NCDs) have been proposed as a way to effectively address malnutrition in all its forms in a more holisitic way. This Series paper identifies ten double-duty actions that have strong potential to reduce the risk of both undernutrition, obesity, and DR-NCDs. It does so by summarising evidence on common drivers of different forms of malnutrition; documenting examples of unintended harm caused by some undernutrition-focused programmes on obesity and DR-NCDs; and highlighting examples of double-duty actions to tackle multiple forms of malnutrition. We find that undernutrition, obesity, and DR-NCDs are intrinsically linked through early-life nutrition, diet diversity, food environments, and socioeconomic factors. Some evidence shows that programmes focused on undernutrition have raised risks of poor quality diets, obesity, and DR-NCDs, especially in countries undergoing a rapid nutrition transition. This Series paper builds on this evidence to develop a framework to guide the design of double-duty approaches and strategies, and defines the first steps needed to deliver them. With a clear package of double-duty actions now identified, there is an urgent need to move forward with double-duty actions to address malnutrition in all its forms. [ABSTRACT FROM AUTHOR]

Major scholars in the field, on the basis of a 3-day consensus, created an in-depth review of current knowledge on the role of diet in cardiovascular disease (CVD), the changing global food system and global dietary patterns, and potential policy solutions. Evidence from different countries and age/race/ethnicity/socioeconomic groups suggesting the health effects studies of foods, macronutrients, and dietary patterns on CVD appear to be far more consistent though regional knowledge gaps is highlighted. Large gaps in knowledge about the association of macronutrients to CVD in low- and middle-income countries particularly linked with dietary patterns are reviewed. Our understanding of foods and macronutrients in relationship to CVD is broadly clear; however, major gaps exist both in dietary pattern research and ways to change diets and food systems. On the basis of the current evidence, the traditional Mediterranean-type diet, including plant foods and emphasis on plant protein sources provides a well-tested healthy dietary pattern to reduce CVD. [ABSTRACT FROM AUTHOR]

Prevention of obesity requires policies that work. In this Series paper, we propose a new way to understand how food policies could be made to work more effectively for obesity prevention. Our approach draws on evidence from a range of disciplines (psychology, economics, and public health nutrition) to develop a theory of change to understand how food policies work. We focus on one of the key determinants of obesity: diet. The evidence we review suggests that the interaction between human food preferences and the environment in which those preferences are learned, expressed, and reassessed has a central role. We identify four mechanisms through which food policies can affect diet: providing an enabling environment for learning of healthy preferences, overcoming barriers to the expression of healthy preferences, encouraging people to reassess existing unhealthy preferences at the point-of-purchase, and stimulating a food-systems response. We explore how actions in three specific policy areas (school settings, economic instruments, and nutrition labelling) work through these mechanisms, and draw implications for more effective policy design. We find that effective food-policy actions are those that lead to positive changes to food, social, and information environments and the systems that underpin them. Effective food-policy actions are tailored to the preference, behavioural, socioeconomic, and demographic characteristics of the people they seek to support, are designed to work through the mechanisms through which they have greatest effect, and are implemented as part of a combination of mutually reinforcing actions. Moving forward, priorities should include comprehensive policy actions that create an enabling environment for infants and children to learn healthy food preferences and targeted actions that enable disadvantaged populations to overcome barriers to meeting healthy preferences. Policy assessments should be carefully designed on the basis of a theory of change, using indicators of progress along the various pathways towards the long-term goal of reducing obesity rates. [ABSTRACT FROM AUTHOR]

Background International recommendations urge governments to implement population-based strategies to reduce the burden of obesity. This study assesses the development and implementation of the obesity strategy in England 2008-2011, Healthy Weight, Healthy Lives (HWHL). The aim was to identify if stakeholders perceived HWHL to have made any difference to the action to address obesity in England, with the ultimate objective of identifying insights that could inform the development and implementation of future obesity strategies in England and elsewhere. Methods Qualitative study using semi-structured interviews and thematic framework analysis. 40 stakeholders involved in the development and implementation of the obesity strategy were interviewed. Results Evidence from this study suggests that HWHL was perceived to have made a positive difference to efforts to address obesity in England. It was credited with creating political buyin, engaging more stakeholders, stimulating and facilitating action, enhancing knowledge and changing attitudes. But it was reported to have failed to fully catalyse action across all government departments and sectors, or to develop adequate mechanisms for learning about the effectiveness of the different elements and actions in the Strategy. Key elements of the Strategy contributing towards to the perceived positive differences included its multi-faceted, inclusive nature; governance structures; monitoring programme to assess progress against national and local targets; child-focus; and funding. The development of the Strategy was said to be stimulated and aided by the prior synthesis of a critical mass of scientific evidence. Conclusions The English experience of HWHL lends support to the recommendations to develop population-based obesity strategies. It indicates that in order to stimulate comprehensive, inter-sectoral action, obesity strategies need to take a population-based, multi-faceted approach, be implemented through a clear governance structure, follow a systematic process of aligning goals, objectives and agendas between government departments and sectors with a stake in obesity, and have a clear system of reporting changes in obesity rates against a target. In order to design effective policies and to build the case for continued investment, obesity strategies also need to incorporate a national framework for learning and evaluation from the outset. [ABSTRACT FROM AUTHOR]

Aims: There is strong evidence that diets high in salt are bad for health and that salt reduction strategies are cost effective. However, whilst it is clear that most people are eating too much salt, obtaining an accurate assessment of population salt intake is not straightforward, particularly in resource poor settings. The objective of this study is to identify what approaches governments are taking to monitoring salt intake, with the ultimate goal of identifying what actions are needed to address challenges to monitoring salt intake, especially in low and middle-income countries. Methods and Results: A written survey was issued to governments to establish the details of their monitoring methods. Of the 30 countries that reported conducting formal government salt monitoring activities, 73% were high income countries. Less than half of the 30 countries, used the most accurate assessment of salt through 24 hour urine, and only two of these were developing countries. The remainder mainly relied on estimates through dietary surveys. Conclusions: The study identified a strong need to establish more practical ways of assessing salt intake as well as technical support and advice to ensure that low and middle income countries can implement salt monitoring activities effectively. [ABSTRACT FROM AUTHOR]

Abstract: In light of the shift in policy paradigm in agriculture from state intervention to market liberalisation and globalisation, this paper develops a series of hypotheses on the relationship between agricultural policies and consumer diets. The first hypothesis is that the paradigm shift has led to greater specialisation of production, so changing the ability and incentive for producers to supply certain foods relative to others. Second, the shift has affected farmgate prices (both up and down), so creating opportunities for the industries which purchase farm commodities (the food consuming industries – FCIs) to substitute lower priced ingredients, thereby influencing the nutritional quality and content of foods available in the marketplace. Third, it has increased the ability of the FCIs to “add value” through product innovation and marketing, creating a market characterised by highly differentiated products targeted to individualised preferences, thus increasing the acceptability of a wider variety and quantity of food products. The changing agricultural policy paradigm has therefore altered the environment in which consumers make their food choices, in the form of food availability, affordability and acceptability. Nevertheless, the paper finds no clear pattern when it comes to health; the changes have affected both “unhealthy” and “healthy” foods and ingredients. The key process of importance for health, then, is not whether the “ingredients” produced by agriculture are healthy or not, but how they are substituted, transformed, distributed and marketed through the supply chain (e.g. vegetable oils into transfats). This leads to an important implication: that policies to intervene directly in agricultural production to promote healthy eating are unlikely to be effective or efficient if they do not take into account how foods are processed, distributed and marketed through the supply chain. In practice, this means that the potential for policy interventions in agriculture to improve diets is limited – but nevertheless potentially important where it exists given the upstream nature of the change. Incentives could be created for the FCIs to substitute “healthier” ingredients in their products, and/or to sell more of them, in instances where these changes can be passed all the way to the consumer. Greater investment could also be made in fruit and vegetable production for local markets. Along with testing the hypotheses established in this paper, the research priority should to identify the incentives that influence the products produced by the FCIs, with the objective of finding those most amenable to leveraging the supply chain towards healthier eating. [Copyright &y& Elsevier]

ObjectiveTo identify pledges made by the food industry to change food marketing to children worldwide, examine their content and discuss their potential to reduce the harmful effects of food marketing to children.DesignA search for pledges and specific commitments made by participating companies and a content analysis of their scope and criteria used to define the marketing covered or excluded.SettingGlobal.SubjectsFood industry pledges.ResultsBetween 2005 and 2009, the food industry developed thirteen pledges on food marketing to children, involving fifty-two food companies. Two of the pledges were global, two were regional and nine applied to specific countries. Three were specific to the soft drinks industry and to the fast-food industry, with the rest being food industry wide. Ten of the pledges required companies to publish individual commitments; a total of eighty-two such commitments were published, many of which extended beyond the minimum standards set in the pledges. All pledges included definitions of children and child-targeted media, as well as the communication channels and marketing techniques covered, and permitted companies to set criteria for foods that are exempted from any restrictions. There were many similarities between the pledges and individual commitments; however, there were also many differences.ConclusionsThe development of pledges on food marketing to children in such a short span of time is impressive. However, limitations and inconsistencies in the pledges and commitments suggest that the food industry has a long way to go if its pledges are to comprehensively reduce the exposure and power of marketing to children. [ABSTRACT FROM AUTHOR]

Abstract: Sugar-sweetened beverages are widely believed to be contributing to the growing prevalence of overweight and obesity around the world. One of the channels used by industry to encourage greater consumption and preferences for soft drinks is schools. But governments around the world are taking action to limit the availability of soft drinks in schools. More than 30 national and subnational governmental bodies have made efforts to restrict availability, and the soft drinks industry has also taken some limited voluntary action. Most government-led efforts—with some exceptions—restrict the availability of any drink with added sugar, but the voluntary pledges take less-restrictive approaches. There is little consensus on artificially sweetened drinks. Policies vary in other ways, too, presenting an opportunity to study the effects of different policy approaches on short- and long-term consumption and attitudes. In the meantime, the widespread condemnation of soft drinks in schools suggests that it is within the industry''s interests to take more comprehensive action. [Copyright &y& Elsevier]

Sales promotions are widely used to market food to adults, children, and youth. Yet, in contrast to advertising, practically no attention has been paid to their impacts on dietary behaviors, or to how they may be used more effectively to promote healthy eating. This review explores the available literature on the subject. The objective is to identify if and what literature exists, examine the nature of this literature, and analyze what can be learned from it about the effects of sales promotions on food consumption. The review finds that while sales promotions lead to significant sales increases over the short-term, this does not necessarily lead to changes in food-consumption patterns. Nevertheless, there is evidence from econometric modeling studies indicating that sales promotions can influence consumption patterns by influencing the purchasing choices of consumers and encouraging them to eat more. These effects depend on the characteristics of the food product, sales promotion, and consumer. The complexity of the effects means that sales promotions aiming to encourage consumption of nutritious foods need to be carefully designed. These conclusions are based on studies that use mainly sales data as a proxy for dietary intake. The nutrition (and economics) research communities should add to this existing body of research to provide evidence on the impact of sales promotions on dietary intake and related behaviors. This would help support the development of a sales promotion environment conducive to healthy eating. [ABSTRACT FROM AUTHOR]

Objectives. To identify potential impacts of the Central America-Dominican Republic-Free Trade Agreement (CAFTA-DR) on food consumption patterns associated with the nutrition transition, obesity, and diet-related chronic diseases. Methods. Examination of CAFTA-DR agreement to identify measures that have the potential to affect food availability and retail prices. Results. CAFTA-DR includes agreements on tariffs, tariff-rate quotas (TRQs), and sanitary and phytosanitary regulations with direct implications for the availability and prices of various foods. Agreements on investment, services, and intellectual property rights (IPR) are also relevant because they create a business climate more conducive to long-term investment by the transnational food industry. Trade liberalization under CAFTA-DR is likely to increase availability and lower relative prices of two food groups associated with the nutrition transition: meat and processed foods. These outcomes are expected to occur as the direct result of increased imports from the United States and increased production by U.S. companies based in Central America, and the indirect result of increased domestic meat production (due to increased availability of cheaper animal feed) and increased production of processed foods by domestic companies (due to a more competitive market environment). Conclusions. CAFTA-DR is likely to further the nutrition transition in Central America by increasing the consumption of meat; highly processed foods; and new, non-traditional foods. The public health community should be more aware of the implications of trade agreements for dietary health. Governments and related stakeholders should assess the coherence between changes fostered by specific trade agreements with national policies on diet and nutrition. [ABSTRACT FROM AUTHOR]

Five decisions by supermarket operators have important dietary implications: the location of their outlets; the foods they sell; the prices they charge; the promotional strategies they use; and the nutrition-related activities they implement. These decisions influence food accessibility, availability, prices and desirability, which in turn influence the decisions consumers make about food. Based on a comprehensive literature review, this article finds that the dietary implications are both positive – supermarkets can make a more diverse diet available and accessible to more people – and negative – supermarkets can reduce the ability of marginalised populations to purchase a high-quality diet, and encourage the consumption of energy-dense, nutrient-poor highly-processed foods. Overall, the most universally applicable dietary implication is that supermarkets encourage consumers to eat more, whatever the food. [ABSTRACT FROM AUTHOR]

The pressure to regulate the marketing of high-energy, nutrient-poor foods to young people has been mounting in light of concern about rising worldwide levels of overweight and obesity. In 2004, the World Health Organization called on governments, industry, and civil society to act to reduce unhealthy marketing messages. Since then, important changes have taken place in the global regulatory environment regarding the marketing of food to young people. Industry has developed self-regulatory approaches, civil society has campaigned for statutory restrictions, and governments have dealt with a range of regulatory proposals. Still, there have been few new regulations that restrict food marketing to young people. Despite calls for evidence-based policy, new regulatory developments appear to have been driven less by evidence than by ethics. (Am J Public Health. 2007;97:1962-1973. doi: 10.2105/AJPH.2006.101162) [ABSTRACT FROM AUTHOR]

Trade liberalization remains at the forefront of debates around globalization, particularly around the impact on agriculture and food. These debates, which often focus on how poorer countries can ‘trade their way’ out of poverty, pay limited attention to dietary health, especially in the light of the WHO's Global Strategy for Diet, Physical Activity and Health (2004), which warned that future health burdens will be increasingly determined by diet-related chronic diseases. This article examines the diet transition as the absent factor within debates on liberalizing trade and commerce. We describe the evolution of trade agreements, noting those relevant to food. We review the association between trade liberalization and changes in the global dietary and disease profile. We illustrate some of the complex linkages between trade liberalization and the ‘diet transition’, illustrated by factors such as foreign direct investment, supermarketization and cultural change. Finally, we offer three scenarios for change, suggesting the need for more effective ‘food governance’ and engagement by public health advocates in policy making in the food and agriculture arena. [ABSTRACT FROM PUBLISHER]

Agriculture and health are linked in many ways. First, agriculture is essential for good health: it produces the world's food, fibre and materials for shelter; in many countries it is also an important source of livelihood among the poor. At the same time, agriculture can be linked with poor health, including malnutrition, malaria, foodborne illnesses, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), livestock-related diseases, chronic diseases and occupational ill-health. Health also affects agriculture: people's health status influences the demand for agricultural outputs, and in agricultural communities, poor health reduces work performance, reducing income and productivity and perpetuating a downward spiral into ill-health. This paper presents an overview of the bidirectional links between agriculture and health with a focus on the developing world. It develops a conceptual framework that brings together the various links between agriculture and health into a single broad framework. The framework comprises the core components of the agricultural supply chain (producers, systems and outputs), key health concerns and the mechanisms of common interaction between the agricultural and health components: income, labour, environment and access — all key social determinants of health. These links between agriculture and health present an opportunity for the two sectors to work together to find solutions to each other's problems. Yet the health and agricultural sectors remain poorly coordinated. Leadership from global health and agricultural institutions is needed to build policies and good governance to facilitate integration, while capacity building is needed at all levels to help translate the conceptual links into comprehensive action on the ground. Health and agricultural researchers likewise need to work more closely together to achieve common goals. [ABSTRACT FROM AUTHOR]

In a "nutrition transition", the consumption of foods high in fats and sweeteners is increasing throughout the developing world. The transition, implicated in the rapid rise of obesity and diet-related chronic diseases worldwide, is rooted in the processes of globalization. Globalization affects the nature of agri-food systems, thereby altering the quantity, type, cost and desirability of foods available for consumption. Understanding the links between globalization and the nutrition transition is therefore necessary to help policy makers develop policies, including food policies, for addressing the global burden of chronic disease. While the subject has been much discussed, tracing the specific pathways between globalization and dietary change remains a challenge. To help address this challenge, this paper explores how one of the central mechanisms of globalization, the integration of the global marketplace, is affecting the specific diet patterns. Focusing on middle-income countries, it highlights the importance of three major processes of market integration: (I) production and trade of agricultural goods; (II) foreign direct investment in food processing and retailing; and (III) global food advertising and promotion. The paper reveals how specific policies implemented to advance the globalization agenda account in part for some recent trends in the global diet. Agricultural production and trade policies have enabled more vegetable oil consumption; policies on foreign direct investment have facilitated higher consumption of highly-processed foods, as has global food marketing. These dietary outcomes also reflect the socioeconomic and cultural context in which these policies are operating. An important finding is that the dynamic, competitive forces unleashed as a result of global market integration facilitates not only convergence in consumption habits (as is commonly assumed in the "Coca-Colonization" hypothesis), but adaptation to products targeted at different niche markets. This convergence-divergence duality raises the policy concern that globalization will exacerbate uneven dietary development between rich and poor. As high-income groups in developing countries accrue the benefits of a more dynamic marketplace, lower-income groups may well experience convergence towards poor quality obseogenic diets, as observed in western countries. Global economic polices concerning agriculture, trade, investment and marketing affect what the world eats. They are therefore also global food and health policies. Health policy makers should pay greater attention to these policies in order to address some of the structural causes of obesity and diet-related chronic diseases worldwide, especially among the groups of low socioeconomic status. [ABSTRACT FROM AUTHOR]

Objective: To examine the role of foreign direct investment (FDI) in the nutrition transition, focusing on highly processed foods.Design: Data on FDI were identified from reports/databases and then compiled and analysed. A review of published literature on FDI into the food sector was conducted.Setting: The nutrition transition is a public health concern owing to its connection with the rising burden of obesity and diet-related chronic diseases in developing countries. Global health leaders are calling for action to address the threat. Highly processed foods often have considerable fat, sugar and salt content, and warrant closer examination.Results: FDI into food processing, service and retail has risen rapidly since the 1980s, mainly from transnational food companies (TFCs) in developed countries. As FDI has risen, so has the proportion invested in highly processed foods for sale in the host market. FDI has proved more effective than trade in generating sales of highly processed foods, and enables TFCs to cut costs, gain market power and obtain efficiencies in distribution and marketing. The amount of FDI targeted at developing countries is increasing; while a disproportionate share enters the larger developing economies, foreign affiliates of TFCs are among the largest companies in low- and low- to middle-income countries. The effect of FDI is to make more highly processed foods available to more people. FDI has made it possible to lower prices, open up new purchasing channels, optimise the effectiveness of marketing and advertising, and increase sales.Conclusion: FDI has been a key mechanism in shaping the global market for highly processed foods. Notwithstanding the role of demand-side factors, it has played a role in the nutrition transition by enabling and promoting the consumption of these foods in developing countries. Empirical data on consumption patterns of highly processed foods in developing countries are critically needed, but since FDI is a long-term investment vehicle, it is reasonable to assume that availability and consumption of highly processed foods will continue to increase. FDI can, however, bring considerable benefits as well as risks. Through its position 'upstream', FDI would therefore be an appropriate entry-point to implement a range of public health policies to 'redirect' the nutrition transition. [ABSTRACT FROM AUTHOR]

Chronic diseases are the largest cause of death in the world. In 2002, the leading chronic diseases—cardiovascular disease, cancer, chronic respiratory disease, and diabetes—caused 29 million deaths worldwide. Despite growing evidence of epidemiological and economic impact, the global response to the problem remains inadequate. Stakeholders include governments, the World Health Organization and other United Nations bodies, academic and research groups, nongovernmental organizations, and the private sector. Lack of financial support retards capacity development for prevention, treatment, and research in most developing countries. Reasons for this include that up-to-date evidence related to the nature of the burden of chronic diseases is not in the hands of decision makers and strong beliefs persist that chronic diseases afflict only the affluent and the elderly, that they arise solely from freely acquired risks, and that their control is ineffective and too expensive and should wait until infectious diseases are addressed. The influence of global economic factors on chronic disease risks impedes progress, as does the orientation of health systems toward acute care. We identify 3 policy levers to address these impediments elevating chronic diseases on the health agenda of key policymakers, providing them with better evidence about risk factor control, and persuading them of the need for health systems change. A more concerted, strategic, and multisectoral policy approach, underpinned by solid research, is essential to help reverse the negative trends in the global incidence of chronic disease. [ABSTRACT FROM AUTHOR]

The recently adopted World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) provides a basis for comprehensive national and complementary international actions to control tobacco use and exposure to tobacco smoke. The development of the FCTC followed many decades of debate about how best to tackle an increasingly global public health problem. This process included World Health Assembly (WHA) Resolutions addressing various components of tobacco control, the completion of major epidemiological and economic reviews on the extent of the problem and its future course, and considerations on how best to approach it from a policy perspective. The World Health Report of 2002 documented the role of nutrition, diet and physical inactivity in contributing, along with tobacco, to the major causes of chronic disease such as cardiovascular diseases, diabetes and cancer. In response, WHO's member states called for the development of a global strategy for diet, physical activity and health in WHA Resolution 55.23.

While the Millennium Development Goals (MDGs; 2000-2015) focused primarily on poverty reduction, hunger and infectious diseases, the proposed Sustainable Development Goals (SDGs) and targets pay more attention to nutrition and non-communicable diseases (NCDs). One of the 169 proposed targets of the SDGs is to reduce premature deaths from NCDs by one third; another is to end malnutrition in all its forms. Nutrition-related NCDs (NR-NCDs) stand at the intersection between malnutrition and NCDs. Driven in large part by remarkable transformations of food systems, they are rapidly increasing in most low and middle income countries (LMICs). The transformation to modern food systems began in the period following World War II with policies designed to meet a very different set of nutritional and food needs, and continued with globalization in the 1990s onwards. Another type of food systems transformation will be needed to shift towards a healthier and more sustainable diet -- as will meeting many of the other SDGs. The process will be complex but is necessary. Communities concerned with NCDs and with malnutrition need to work more closely together to demand food systems change. [ABSTRACT FROM AUTHOR]

While the Millennium Development Goals (MDGs; 2000–2015) focused primarily on poverty reduction, hunger and infectious diseases, the proposed Sustainable Development Goals (SDGs) and targets pay more attention to nutrition and non-communicable diseases (NCDs). One of the 169 proposed targets of the SDGs is to reduce premature deaths from NCDs by one third; another is to end malnutrition in all its forms. Nutrition-related NCDs (NR-NCDs) stand at the intersection between malnutrition and NCDs. Driven in large part by remarkable transformations of food systems, they are rapidly increasing in most low and middle income countries (LMICs). The transformation to modern food systems began in the period following World War II with policies designed to meet a very different set of nutritional and food needs, and continued with globalization in the 1990s onwards. Another type of food systems transformation will be needed to shift towards a healthier and more sustainable diet – as will meeting many of the other SDGs. The process will be complex but is necessary. Communities concerned with NCDs and with malnutrition need to work more closely together to demand food systems change. [ABSTRACT FROM AUTHOR]

Infants born into families experiencing socioeconomic disadvantage follow a high-risk trajectory for obesity and poor health in later life. Differences in early childhood food experiences may be contributing to these inequalities. This study aimed to explore the factors that influence parental decisions on when, how and what food to introduce over the first 18 months of their child's life and identify differences according to families' social position. Particular attention was given to social and environmental determinants within and outside the home. This research utilised a longitudinal qualitative methodology, with interviews and photo-elicitation exercises completed by participants when their children were 4–6; 10–12 and 16–18 months of age. Participants were parents (61 mothers; 1 father), distributed across low, medium and high socioeconomic position (SEP). During analysis, observable differences in factors directing parents to home-prepared or commercial foods were identified. Factors that undermined the provision of home-prepared meals included lack of time after returning to work, insufficient support from partners, uncertainty around infant and young child feeding (defined as the introduction and provision of solids) and an implicit trust in the messaging on branded products. These factors directed parents towards commercial foods and were most persistent among families experiencing socioeconomic disadvantage due to barriers accessing formal childcare, less flexible working conditions and fathers being less involved in infant feeding. To facilitate an enabling environment for healthy infant and young child feeding practices and address dietary inequalities, immediate steps that policy makers and healthcare providers can take include: i) changing the eligibility criteria for shared parental leave, ii) aligning claims on commercial infant food labels with international best practices, and iii) improving access to formal childcare. [ABSTRACT FROM AUTHOR]

The article focuses on the need and global implementation of food policies of governments to promote better health practices. It mentions the meeting of the United Nations (UN) in which it declare the need for member states to implement cost-effective, multisectoral and population-wide interventions to reduce the impact unhealthy eating. It also explores the changes in the food system across the world. Samples of food policies being implemented by member states are also presented which include teaching cooking skills in schools, providing food subsidies, and promoting fruits and vegetables consumption.

In this article the author discusses the important role of packaging as a marketing vehicle in promoting a food product. She explains that packaging has several important functions such as to market the product in the food industry and to extend the shelf-life of the product for transport and display that can influence consumer choices. However, the author believes that food packaging can mislead children and parents into thinking that the product is healthy when it is not.

Rates of childhood overweight and obesity continue to rise in England, along with a growing gap in obesity prevalence between children in the most and least deprived areas. To address child obesity, the UK government is increasingly considering how to intervene in the (food) environments that shape people's purchases, rather than focusing solely on individual health behaviors. With the COVID-19 pandemic and subsequent lockdowns having rapidly reconfigured life in the UK, it is important to understand how these changes may have impacted food practices and engagement with food environments. This remote, longitudinal qualitative study seeks to explore how the COVID-19 pandemic and its impacts are shaping families relationships with the food and the food environment. A sample of 60–80 parents/carers of school or nursery-aged children will be recruited from across three case study sites in England to take part in semi-structured interviews and set of flexible creative activities at three time points over the course of a year. Findings will provide practical policy insights for England's obesity prevention strategy as well as methodological insights in terms of conducting research into lived experience remotely. [ABSTRACT FROM AUTHOR]

Interpretive nutrition labels provide simplified nutrient-specific text and/or symbols on the front of pre-packaged foods, to encourage and enable consumers to make healthier choices. This type of labelling has been proposed as part of a comprehensive policy response to the global epidemic of non-communicable diseases. However, regulation of nutrition labelling falls under the remit of not just the health sector but also trade. Specific Trade Concerns have been raised at the World Trade Organization's Technical Barriers to Trade Committee regarding interpretive nutrition labelling initiatives in Thailand, Chile, Indonesia, Peru and Ecuador. This paper presents an analysis of the discussions of these concerns. Although nutrition labelling was identified as a legitimate policy objective, queries were raised regarding the justification of the specific labelling measures proposed, and the scientific evidence for effectiveness of such measures. Concerns were also raised regarding the consistency of the measures with international standards. Drawing on policy learning theory, we identified four lessons for public health policy makers, including: strategic framing of nutrition labelling policy objectives; pro-active policy engagement between trade and health to identify potential trade issues; identifying ways to minimize potential 'practical' trade concerns; and engagement with the Codex Alimentarius Commission to develop international guidance on interpretative labelling. This analysis indicates that while there is potential for trade sector concerns to stifle innovation in nutrition labelling policy, care in how interpretive nutrition labelling measures are crafted in light of trade commitments can minimize such a risk and help ensure that trade policy is coherent with nutrition action. [ABSTRACT FROM AUTHOR]

In this article the authors discuss the aspects of pubic-private partnerships with an aim to address the unhealthy diets, obesity and chronic disease. They note that partnership does not extend to create and organization, but involves an explicit shared governance structured hosted by one of the partners. The authors point out that the transparency is needed in terms of interest involve in the partnership.

Background: International recommendations urge governments to implement population-based strategies to reduce the burden of obesity. This study assesses the development and implementation of the obesity strategy in England 2008-2011, Healthy Weight, Healthy Lives (HWHL). The aim was to identify if stakeholders perceived HWHL to have made any difference to the action to address obesity in England, with the ultimate objective of identifying insights that could inform the development and implementation of future obesity strategies in England and elsewhere.Methods: Qualitative study using semi-structured interviews and thematic framework analysis. 40 stakeholders involved in the development and implementation of the obesity strategy were interviewed.Results: Evidence from this study suggests that HWHL was perceived to have made a positive difference to efforts to address obesity in England. It was credited with creating political buy-in, engaging more stakeholders, stimulating and facilitating action, enhancing knowledge and changing attitudes. But it was reported to have failed to fully catalyse action across all government departments and sectors, or to develop adequate mechanisms for learning about the effectiveness of the different elements and actions in the Strategy. Key elements of the Strategy contributing towards to the perceived positive differences included its multi-faceted, inclusive nature; governance structures; monitoring programme to assess progress against national and local targets; child-focus; and funding. The development of the Strategy was said to be stimulated and aided by the prior synthesis of a critical mass of scientific evidence.Conclusions: The English experience of HWHL lends support to the recommendations to develop population-based obesity strategies. It indicates that in order to stimulate comprehensive, inter-sectoral action, obesity strategies need to take a population-based, multi-faceted approach, be implemented through a clear governance structure, follow a systematic process of aligning goals, objectives and agendas between government departments and sectors with a stake in obesity, and have a clear system of reporting changes in obesity rates against a target. In order to design effective policies and to build the case for continued investment, obesity strategies also need to incorporate a national framework for learning and evaluation from the outset. [ABSTRACT FROM AUTHOR]

The authors look at the implications of the taxation of palm oil for public health in India. They reference a study by Sanjay Basu and colleagues published within the issue on the effects of a 20% palm oil tax on serum cholesterol and mortality from coronary heart disease and cerebrovascular disease in the country. They cite that the study investigated the effects of the tax on food security. They note the need to consider the economic benefits of palm oil trade and production.

Transitioning towards sustainable diets is imperative to avoid the worst effects of climate change, environmental degradation, and malnutrition. In South Africa, households most vulnerable to food insecurity employ various strategies to access food. These include purchasing hampers; a combination of staple foods sold in bulk at a discounted price, which are cake wheat flour, super maize meal, white sugar, cooking oil, and white parboiled rice. We explore the barriers and opportunities for hampers to advance sustainable diets in the context of Cape Town. Our findings show hampers contain energy-dense, nutrient-poor foods. Furthermore, we find that brand loyalty plays an important role in households' purchase of hampers. We conclude there is potential to leverage hampers to become a sustainable strategy through which people can access healthier food by working with retailers to offer nutritious and sustainably produced alternatives. Such change would require challenging retailers' and consumers' understanding of what 'necessities' are. [ABSTRACT FROM AUTHOR]

Objective: To quantify progress with the initiation of salt reduction strategies around the world in the context of the global target to reduce population salt intake by 30% by 2025. Methods: A systematic review of the published and grey literature was supplemented by questionnaires sent to country program leaders. Core characteristics of strategies were extracted and categorised according to a pre-defined framework. Results: A total of 75 countries now have a national salt reduction strategy, more than double the number reported in a similar review done in 2010. The majority of programs are multifaceted and include industry engagement to reformulate products (n = 61), establishment of sodium content targets for foods (39), consumer education (71), front-of-pack labelling schemes (31), taxation on high-salt foods (3) and interventions in public institutions (54). Legislative action related to salt reduction such as mandatory targets, front of pack labelling, food procurement policies and taxation have been implemented in 33 countries. 12 countries have reported reductions in population salt intake, 19 reduced salt content in foods and 6 improvements in consumer knowledge, attitudes or behaviours relating to salt. Conclusion: The large and increasing number of countries with salt reduction strategies in place is encouraging although activity remains limited in low- and middle-income regions. The absence of a consistent approach to implementation highlights uncertainty about the elements most important to success. Rigorous evaluation of ongoing programs and initiation of salt reduction programs, particularly in low- and middle- income countries, will be vital to achieving the targeted 30% reduction in salt intake. [ABSTRACT FROM AUTHOR]

Despite isolated areas of improvement, no country to date has reversed its obesity epidemic. Governments, together with a broad range of stakeholders, need to act urgently to decrease the prevalence of obesity. In this Series paper, we review several regulatory and non-regulatory actions taken around the world to address obesity and discuss some of the reasons for the scarce and fitful progress. Additionally, we preview the papers in this Lancet Series, which each identify high-priority actions on key obesity issues and challenge some of the entrenched dichotomies that dominate the thinking about obesity and its solutions. Although obesity is acknowledged as a complex issue, many debates about its causes and solutions are centred around overly simple dichotomies that present seemingly competing perspectives. Examples of such dichotomies explored in this Series include personal versus collective responsibilities for actions, supply versus demand-type explanations for consumption of unhealthy food, government regulation versus industry self-regulation, top-down versus bottom-up drivers for change, treatment versus prevention priorities, and a focus on undernutrition versus overnutrition. We also explore the dichotomy of individual versus environmental drivers of obesity and conclude that people bear some personal responsibility for their health, but environmental factors can readily support or undermine the ability of people to act in their own self-interest. We propose a reframing of obesity that emphasises the reciprocal nature of the interaction between the environment and the individual. Today’s food environments exploit people’s biological, psychological, social, and economic vulnerabilities, making it easier for them to eat unhealthy foods. This reinforces preferences and demands for foods of poor nutritional quality, furthering the unhealthy food environments. Regulatory actions from governments and increased efforts from industry and civil society will be necessary to break these vicious cycles. [ABSTRACT FROM AUTHOR]

This paper provides an outline of a new interdisciplinary project called FixOurFood, funded through UKRI's 'Transforming UK food systems' programme. FixOurFood aims to transform the Yorkshire food system to a regenerative food system and will work to answer two main questions: (1) What do regenerative food systems look like? (2) How can transformations be enabled so that we can achieve a regenerative food system? To answer these questions, FixOurFood will work with diverse stakeholders to change the Yorkshire food system and use the learning to inform change efforts in other parts of the UK and beyond. Our work will focus on shifting trajectories towards regenerative dynamics in three inter‐related systems of: healthy eating for young children, hybrid food economies and regenerative farming. We do this by a set of action‐orientated interventions in schools and the food economy, metrics, policies and deliverables that can be applied in Yorkshire and across the UK. This article introduces the FixOurFood project and concludes by assessing the potential impact of these interventions and the importance we attach to working with stakeholders in government, business, third sector and civil society. [ABSTRACT FROM AUTHOR]

The vulnerability of the urban poor to the recent food and fuel price crisis has been widely acknowledged. The unfolding global financial crisis, which brings higher unemployment and underemployment, is likely to further intensify this vulnerability. This paper reviews the evidence concerning the disproportionate vulnerability of the urban compared with the rural poor to these types of shocks. It reviews some of the unique characteristics of urban life that could make the urban poor particularly susceptible to price and financial shocks and summarizes the evidence regarding the disproportionate vulnerability of the urban poor. The focus is on impacts on poverty, food insecurity, and malnutrition. The review shows that although the urban poor are clearly one of the population groups most affected by the current land previous) crises, the rural poor, landless, and net buyers are in no better position to confront the crisis without significant suffering. The poorest of the poor are the ones who will be most affected, irrespective of the continent, country, or urban or rural area where they live. The magnitude and severity of their suffering depends on their ability to adapt and on the specific nature, extent, and duration of the coping strategies they adopt. A better understanding of how these coping strategies are used and staggered is critical to help design triggers for action that can prevent households from moving to more desperate measures. Using these early coping strategies as early warning indicators could help prevent dramatic losses in welfare [ABSTRACT FROM AUTHOR]

Objective: Local governments have integral roles in contributing to public health. One recent focus has been on how local governments can impact community nutrition by engaging food service outlets to improve their food offer. The Healthier Catering Commitment (HCC) is an initiative where London local governments support takeaways and restaurants to meet centrally defined nutrition criteria on their food options. Using the case of HCC, the current study aims to provide (1) practical learnings of how local governments could facilitate and overcome barriers associated with implementing healthy food service initiatives in general, and (2) specific recommendations for enhancements for HCC.Design: Key informant, semi-structured interviews were conducted with local government staff involved in HCC, exploring barriers and facilitators to HCC implementation in food businesses. A thematic analysis approach was used, with results presented according to a logic pathway of ideal implementation in order to provide practical, focused insights.Setting: Local governments implementing HCC.Participants: Twenty-two individuals supporting HCC implementation.Results: Facilitators to implementation included flexible approaches, shared resourcing and strategically engaging businesses with practical demonstrations. Barriers were limited resources, businesses fearing negative customer responses and low uptake in disadvantaged areas. Key suggestions to enhance implementation and impact included offering additional incentives, increasing HCC awareness and encouraging recruited businesses to make healthy changes beyond initiative requirements.Conclusions: In order to facilitate the implementation of healthy food initiatives in food outlets, local governments would benefit from involving their environmental health team, employing community-tailored approaches and focusing on supporting businesses in disadvantaged areas. [ABSTRACT FROM AUTHOR]

Background: Evidence indicates that early life is critical for determining future obesity risk. A sharper policy focus on pregnancy and early childhood could help improve obesity prevention efforts. This study aimed to systematically identify and categorise policy levers used in England with potential to influence early life course (pregnancy, 0–5 years) and identify how these interface with energy balance behaviours. The objective is to identify gaps and where further policy actions could most effectively focus. Methods: A behavioural science approach was taken using the Capability-Opportunity-Motivation-Behaviour (COM-B) model and Behaviour Change Wheel (BCW) framework. The key determinants of energy balance in the early years were identified from the Foresight Systems Map. Policy actions were scoped systematically from available literature, including any health or non-health policies which could impact on energy balance behaviours. Foresight variables and policy actions were considered in terms of COM-B and the BCW to determine approaches likely to be effective for obesity prevention and treatment. Existing policies were overlaid across the map of key risk factors to identify gaps in obesity prevention and treatment provision. Results: A wide range of policy actions were identified (n = 115) to address obesity-relevant risk factors. These were most commonly educational or guidelines relating to environmental restructuring (i.e. changing the physical or social context). Scope for strengthening policies relating to the food system (e.g. the market price of food) and psychological factors contributing to obesity were identified. Policies acted via all aspects of the COM-B model, but there was scope for improving policies to increase capability through skills acquisition and both reflective and automatic motivation. Conclusions: There is substantial policy activity to address early years obesity but much is focused on education. Scope exists to strengthen actions relating to upstream policies which act on food systems and those targeting psychological factors contributing to obesity risk. [ABSTRACT FROM AUTHOR]

The article reports on the effects of undernutrition, obesity, and climate change to public health. Topics mentioned include the prevention of higher obesity and undernutrition rates, the promotion of public health and well being, and the contribution of urban design, transportation, and land use to undernutrition, obesity, and climate change.

The article reports on the EAT-Lancet Commission's account on healthy diets from tenable food systems. It mentions that the commission incorporates scientific targets for the systems with the aim of rendering perimeters for curbing the degradation of environment evoked by food production. An overview of the uncertainty for food lines is also presented.

Overweight and obesity continue to increase globally. In England, as in many other countries, this disproportionately affects people who experience socioeconomic deprivation. One factor blamed for inequalities in obesity is unhealthy food provisioning environments (FPEs), leading to a focus on policies and interventions to change FPEs. This paper aims to provide insights into how FPE policies could more effectively tackle inequalities in obesity by addressing a key research gap: how the structural contexts in which people live their lives influence their interaction with their FPEs. It aims to understand how low-income families engage with FPEs through in-depth focused ethnographic research with 60 parents across three locations in England: Great Yarmouth, Stoke-on-Trent, and the London Borough of Lewisham. Analysis was guided by sociological perspectives. FPEs simultaneously push low-income families towards unhealthy products while supporting multiple other family needs, such as social wellbeing. FPE policies and interventions to address obesity must acknowledge this challenge and consider not just the makeup of FPEs themselves but how various structural contexts shape how people come to use them. [ABSTRACT FROM AUTHOR]

In May 2010, 192 Member States endorsed Resolution WHA63.14 to restrict the marketing of food and non-alcoholic beverage products high in saturated fats, trans fatty acids, free sugars and/or salt to children and adolescents globally. We examined the actions taken between 2010 and early 2016 -- by civil society groups, the World Health Organization (WHO) and its regional offices, other United Nations (UN) organizations, philanthropic institutions and transnational industries -- to help decrease the prevalence of obesity and diet-related noncommunicable diseases among young people. By providing relevant technical and policy guidance and tools to Member States, WHO and other UN organizations have helped protect young people from the marketing of branded food and beverage products that are high in fat, sugar and/or salt. The progress achieved by the other actors we investigated appears variable and generally less robust. We suggest that the progress being made towards the full implementation of Resolution WHA63.14 would be accelerated by further restrictions on the marketing of unhealthy food and beverage products and by investing in the promotion of nutrient-dense products. This should help young people meet government-recommended dietary targets. Any effective strategies and actions should align with the goal of WHO to reduce premature mortality from noncommunicable diseases by 25% by 2025 and the aim of the UN to ensure healthy lives for all by 2030. [ABSTRACT FROM AUTHOR]

Background Countries across Europe have introduced a wide variety of policies to improve nutrition. However, the sheer diversity of interventions represents a potentially bewildering smorgasbord. We aimed to map existing public health nutrition policies, and examine their perceived effectiveness, in order to inform future evidence-based diet strategies. Methods We created a public health nutrition policy database for 30 European countries . National nutrition policies were classified and assigned using the marketing "4Ps" approach Product (reformulation, elimination, new healthier products); Price (taxes, subsidies); Promotion (advertising, food labelling, health education) and Place (schools, workplaces, etc.). We interviewed 71 senior policy-makers, public health nutrition policy experts and academics from 14 of the 30 countries, eliciting their views on diverse current and possible nutrition strategies. Results Product Voluntary reformulation of foods is widespread but has questionable impact. Twelve countries regulate maximum salt content in specific foods. Denmark, Austria, Iceland and Switzerland have effective trans fats bans. Price EU School Fruit Scheme subsidies are almost universal, but with variable implementation. Taxes are uncommon. However, Finland, France, Hungary and Latvia have implemented 'sugar taxes' on sugary foods and sugar-sweetened beverages. Finland, Hungary and Portugal also tax salty products. Promotion Dialogue, recommendations, nutrition guidelines, labelling, information and education campaigns are widespread. Restrictions on marketing to children are widespread but mostly voluntary. Place Interventions reducing the availability of unhealthy foods were most commonly found in schools and workplace canteens. Interviewees generally considered mandatory reformulation more effective than voluntary, and regulation and fiscal interventions much more effective than information strategies, but also politically more challenging. Conclusions Public health nutrition policies in Europe appear diverse, dynamic, complex and bewildering. The "4Ps" framework potentially offers a structured and comprehensive categorisation. Encouragingly, the majority of European countries are engaged in activities intended to increase consumption of healthy food and decrease the intake of "junk" food and sugary drinks. Leading countries include Finland, Norway, Iceland, Denmark, Hungary, Portugal and perhaps the UK. However, all countries fall short of optimal activities. More needs to be done across Europe to implement the most potentially powerful fiscal and regulatory nutrition policies. [ABSTRACT FROM AUTHOR]

The article discusses the dominance of big food and beverage companies in South Africa, as well as their implication in unhealthy eating. It relates the companies' development of strategies, as well as a range of health and wellness initiatives, to increase the availability, affordability and acceptability of their foods in the country. This article also calls on the South African government to act immediately to mitigate the adverse health effects in the food environment.

The article examines the effect of the adoption of a healthy diet on population health, agricultural production, trade, the economy and livelihoods. A computable general equilibrium approach was used to assess the complex inter-relation between agricultural trade, patterns of food consumption, health and development. It is suggested that there is a substantial variation in the benefits of a healthy diet policy between different populations.

Background: Countries across Europe have introduced a wide variety of policies to improve nutrition. However, the sheer diversity of interventions represents a potentially bewildering smorgasbord. We aimed to map existing public health nutrition policies, and examine their perceived effectiveness, in order to inform future evidence-based diet strategies.Methods: We created a public health nutrition policy database for 30 European countries. National nutrition policies were classified and assigned using the marketing "4 Ps" approach Product (reformulation, elimination, new healthier products); Price (taxes, subsidies); Promotion (advertising, food labelling, health education) and Place (schools, workplaces, etc.). We interviewed 71 senior policy-makers, public health nutrition policy experts and academics from 14 of the 30 countries, eliciting their views on diverse current and possible nutrition strategies.Results: Product Voluntary reformulation of foods is widespread but has variable and often modest impact. Twelve countries regulate maximum salt content in specific foods. Denmark, Austria, Iceland and Switzerland have effective trans fats bans. Price EU School Fruit Scheme subsidies are almost universal, but with variable implementation.Taxes are uncommon. However, Finland, France, Hungary and Latvia have implemented 'sugar taxes' on sugary foods and sugar-sweetened beverages. Finland, Hungary and Portugal also tax salty products. Promotion Dialogue, recommendations, nutrition guidelines, labelling, information and education campaigns are widespread. Restrictions on marketing to children are widespread but mostly voluntary. Place Interventions reducing the availability of unhealthy foods were most commonly found in schools and workplace canteens. Interviewees generally considered mandatory reformulation more effective than voluntary, and regulation and fiscal interventions much more effective than information strategies, but also politically more challenging.Conclusions: Public health nutrition policies in Europe appear diverse, dynamic, complex and bewildering. The "4 Ps" framework potentially offers a structured and comprehensive categorisation. Encouragingly, the majority of European countries are engaged in activities intended to increase consumption of healthy food and decrease the intake of "junk" food and sugary drinks. Leading countries include Finland, Norway, Iceland, Denmark, Hungary, Portugal and perhaps the UK. However, all countries fall short of optimal activities. More needs to be done across Europe to implement the most potentially powerful fiscal and regulatory nutrition policies. [ABSTRACT FROM AUTHOR]