Canadian front-of-package (FOP) labelling regulations aim to improve dietary patterns by identifying foods high in sodium, sugars and/or saturated fat with a ‘high in’ FOP nutrition symbol. However, child-appealing marketing on product packaging may undermine these efforts. Therefore, this study (1) compared the prevalence of FOP symbols between products with child-appealing and non-child appealing packaging in the Canadian food supply and (2) identified the number and types of FOP symbols on products with child-appealing packaging (CAP).

Using the University of Toronto’s Food Label Information and Price 2017 database, 5850 packaged foods were analysed, 746 of which had CAP. Products were assessed against FOP labelling regulations.

Large grocery retailers by market share in Canada.

Foods and beverages available in 2017. Results: 74·4 % of products with CAP would require a ‘high in’ FOP symbol, significantly higher than the 65·7 % of products with non-CAP. Notably, 54·4 % of products with CAP exceeded FOP labelling thresholds for sugars compared with 37·8 % of products with non-CAP.

Findings highlight a policy gap in Canadian nutrition regulations, as CAP remains a major source of marketing of unhealthy foods to children, undermining the impact of FOP labelling. To address this, food packaging should be included in Canada’s marketing restrictions, and products displaying a ‘high in’ FOP symbol should be automatically restricted from marketing to children. This study underscores the urgent need to harmonise Canadian nutrition regulations to synergistically promote healthier food choices among children and improve their health.

Explore adolescents’ recall of food and beverage advertisements in digital media, while evaluating associations between socio-demographic characteristics and advertisement recall.

Recruitment took place using a two-stage cluster probability-based sampling approach. Thirty-nine high schools stratified by type (public v. private) were included, with one class within each grade randomly selected, wherein attending students (n 1542; age range: 11–19 years) received a paper-and-pencil questionnaire for completion in their homes. Participants indicated their spontaneous recall of food and beverage advertisements on social media and provided socio-demographic information. Individual responses to an open-ended question were graphically represented using a world cloud, after which the data were analysed through content analysis based on inductive coding.

The study was conducted in Montevideo, the capital city of Uruguay, which is a high-income South American country with a high prevalence of overweight and obesity among adolescents.

A total of 1542 adolescents attending public and private high schools participated.

Almost nine of ten adolescents (87·6 %) reported having seen a food or beverage advertisement on digital media and more than three of four (76·1 %) could spontaneously recall at least one such advertisement. The three most frequently used words for spontaneous recall were ‘McDonalds’, ‘Coke’ and ‘burgers’, whereas the three most frequently mentioned product categories were ‘Fast-food and fast-food restaurants’, ‘soft drinks’ and ‘savoury snacks’. Some socio-demographic differences emerged.

The findings stress the need to implement mandatory regulatory approaches to reduce adolescent exposure to digital marketing of unhealthy foods and beverages.

To describe changes in the community food environment between 2010 and 2022 in all municipalities in the state of Rio Grande do Sul (RS), Brazil, and to evaluate the possible associated sociodemographic inequities.

This ecological study was based on an analysis of the distribution and density of food retail establishments between 2010 and 2022 and their associations with the sociodemographic characteristics of the municipalities. Sociodemographic and food retail variables were extracted from secondary government databases. The establishments were classified according to the degree of processing of the foods they predominantly sold. Non-parametric tests and linear and Prais–Winsten regressions were used to analyse data.

State of RS, Brazil.

All 497 municipalities.

There was a significant reduction in overall food retail density (Coef.: –2·97; 95 % CI: –3·34, –2·61; P < 0·001). The greatest reduction occurred in establishments that sourced ultra-processed foods (Coef.: –3·34; 95 % CI: –3·65, –3·02; P < 0·001), which, despite the decrease, remained the most widely present. In 2022, the density of these establishments (median: 24·5; min/max: 4·4–124·8) was twice the density of establishments supplying fresh/minimally processed foods and culinary ingredients (median: 13·1; min/max: 0·0–95·8). Cities with greater social vulnerability had lower densities of establishments and greater reductions in the density of establishments over the evaluated period.

The reduction in food retail outlets disproportionately affected the most vulnerable municipalities and negatively impacted the availability of healthy foods. These findings reinforce the need for food and nutrition policies that promote equity in the food environment.

Food environments can influence dietary behaviours. Promotion of foods high in fats, salt and sugars is a barrier to healthy eating. We explore advertising by deprivation in an English city.

Using a cross-sectional design, we describe the prevalence of outdoor advertising, the types of products advertised and the UK Nutrient Profile Modelling scores for advertised foods and non-alcoholic beverages. Differences in outdoor advertising prevalence by area deprivation were assessed using χ2 tests.

Six areas in each of five deprivation strata were randomly selected from all 482 Leeds neighbourhoods (England) (n 30 neighbourhoods).

Eligible outdoor advertisement assets (intentionally placed permanent/semi-permanent advertisements visible from the street) were photographed in May–June 2023.

A total of 295 outdoor advertising assets were recorded. The most deprived quintile had the highest number of advertising assets (n 74). Bus shelters were the most prevalent asset (n 68). The number of food adverts differed significantly by deprivation level. The two most deprived areas had higher than expected exposure, while the two least deprived areas had lower than expected exposure (P < 0·01). Data were insufficient to compare compliance against a hypothetical Healthier Food Advertising Policy; however, bus shelters were most likely to display high in fats, salt and sugars food adverts.

Food advertising in Leeds is unequally distributed, with more food adverts in more deprived areas. Similar inequalities may exist in other cities, but data are scarce. Unhealthy adverts are most prevalent on bus shelters, highlighting an important asset for policy focus.

This study aimed to adapt and validate a Food Retail Environment Analysis Protocol in Shiraz, Iran.

The protocol was developed by integrating the Nutrition Environment Measurement Survey in Stores with the food retail module from the International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring, and Action Support. After translating, synthesising and back-translating the protocol, a panel of experts reviewed and refined it to ensure cultural and contextual appropriateness. Its validity was assessed through expert evaluation, and the pre-final version was field-tested to assess reliability across different food retail environments.

Shiraz City, a metropolis in Iran

Nine food retail stores, including kiosks, small- and medium-sized food retailers (comparable to convenience stores) and large food retailers (comparable to grocery stores).

Content and face validity were assessed using the content validity ratio (0·64–1), content validity index (0·78–1) and item impact score (2·84–4·83). Reliability testing by two researchers showed a 93·77 % agreement and an intraclass correlation coefficient of 0·89–1. The protocol includes fourteen food groups, most of which are categorised as either healthy or unhealthy. It evaluates product availability, prominence, quality, pricing and both in-store and out-of-store food promotions.

The validated protocol effectively assesses diverse retail food environments, offering essential data for evaluating policies and guiding interventions to improve healthy food access. It is adaptable for broader regional or international application in public health and food policy contexts.

American diets are increasingly based on ultra-processed foods (UPF). Current research, particularly on socio-economic differentials, is lacking. This study aimed to provide an updated examination of US household purchases of UPF and how this differs by race–ethnicity, household income and household education.

The NielsenIQ Consumer Panel 2020 was utilised for analysis. Each food and beverage product purchased by US households was assigned a level of processing under the Nova level of processing classification system. The volume of UPF purchased overall and by food group was determined for each Nova processing group and examined by race–ethnicity, education and income. Results were stratified by race–ethnicity within each income group. A P value < 0·0001 was considered significant.

This study analysed data from the Nielsen IQ Consumer Panel 2020 which recorded household food purchases in the USA.

The Nielsen IQ Homescan Consumer Panel is a nationally representative longitudinal survey of around 35 000 and 60 000 US households.

Of 33 054 687 products purchased by 59 939 US households in 2020, 48 % of foods and 38 % of beverages were considered UPF. Categories with the highest proportion of purchases deriving from UPF included carbonated soft drinks (90 %), mixed dishes and soups (81 %) and sweets and snacks (71 %). Slightly higher but statistically significant proportions of UPF purchases occurred in the lowest income and education groups and among non-Hispanic whites.

It is concerning that household purchases of UPF in the USA are high. Policies that reduce consumption of UPF may help reduce diet-related health inequalities.

To evaluate the prevalence of advertisements for ultra-processed products outside food outlets in Montevideo (Uruguay) and explore the patterns of these advertisements across areas with different socio-economic statuses (SES).

Cross-sectional field survey of advertisements of ultra-processed products outside food outlets. The percentage of outlets featuring any type of advertisement of ultra-processed products on the exterior part of the outlets was calculated, at the aggregate level and separately by type of outlet and type of product. Comparisons were made considering the SES of the tract where outlets were located.

106 census tracts in Montevideo, differing in geographical location and SES.

Outlets selling foods and beverages, located within the selected census tracts.

30·7 % of the 1217 food outlets identified in the field survey featured some type of exterior advertisement of ultra-processed products. Sweetened beverages (specifically soda) were the most frequently advertised ultra-processed product category, followed by ice cream. After adjusting for the type of outlet, medium SES tracts exhibited the highest prevalence of ultra-processed product advertisements outside food outlets (36·0 %). Differences in the prevalence of advertisements of specific categories with SES were also found, which may reflect variations in the types and characteristics of food outlets.

Results from this work suggest the frequent presence of exterior advertisements of ultra-processed products and highlight the need to develop effective policies to reduce their use as part of a comprehensive set of strategies to discourage the consumption of ultra-processed products.

To develop and evaluate the validity and reliability of the Street Food and Beverage Tool (SFBT).

This methodological study contains two phases: (a) tool development, which involves conducting a systematic review followed by expert evaluation of the items, the creation of a nutritional healthfulness index (NH), and pilot testing; and (b) evaluation of the Tool’s Validity and Reliability. Content validity was judged by an external technical group, which evaluated the adequacy and pertinence of each tool item. Construct validity was evaluated around schools by testing the hypothesis: In high-income areas, there will be greater availability of healthy food and beverages at street food outlets (SFO), as measured by the NH index. Inter-rater and test–retest reliabilities were assessed outside subway stations. Pearson’s correlation, Cohen’s kappa and Content validity Indexes were used for reliability and validation. A multinomial regression model was used to estimate construct validity.

Mexico City, Mexico.

80 SFO at subway station exits and 1066 around schools from diverse income areas.

The SFBT content validity index was satisfactory. The construct validity of the NH index indicated higher values in higher-Social Development Index areas. The NH index showed a positive linear correlation between raters and across the first and second evaluations. The majority of item availability (>60 %) showed moderate to strong kappa values for inter-rater and test–retest reliability.

The SFBT is a reliable and valid tool for assessing the availability of foods and beverages. Compared to other tools, it can measure the nutritional quality of SFO expressed as an NH index.

This systematic review investigates the characteristics, effectiveness and acceptability of interventions to encourage healthier eating in small, independent restaurants and takeaways.

We searched five databases (CENTRAL, MEDLINE, Embase, CINAHL and Science Citation Index and Social Science Citation Index) in June 2022. Eligible studies had to measure changes in sales, availability, nutritional quality, portion sizes or dietary intake of interventions targeting customer behaviour or restaurant environments. We evaluated study quality using the Mixed Methods Appraisal Tool. Results are synthesised narratively, and interventions’ impact on personal autonomy is assessed using the Nuffield intervention ladder.

Small, independent or local restaurants or hot food takeaway outlets, with no restrictions by year or country.

Anyone selling or purchasing food in intervention settings (e.g. restaurant staff/owners, customers).

We screened 4624 records and included 12 studies describing 13 interventions in 351 businesses. Most studies were of poor quality. Customer-level intervention components mostly operated on the lower rungs of the Nuffield ladder, and most had limited positive effects on increasing demand, measured as sales or orders of healthy options. Whilst rare, most interventions measuring business outcomes operated on higher ladder rungs and showed small positive results. There was insufficient evidence to investigate differences in impact by intervention intrusiveness. Acceptability was greater for interventions that were low-effort, inexpensive and perceived as not negatively impacting on customer satisfaction.

Despite some evidence of small positive effects of healthy eating interventions on healthier purchases or restaurant/hot food takeaway practices, a weak evidence base hinders robust inference.

The creation of a healthy food environment is highly dependent on the policies that governments choose to implement. The objective of this study is to compare the level of implementation of current public policies aimed at creating healthy food environments in Burkina Faso with international good practice indicators.

This evaluation was carried out using the Food-EPI tool. The tool has two components (policy and infrastructure support), thirteen domains and fifty-six good practice indicators adapted to the Burkina Faso context.

Burkina Faso.

Expert evaluators divided into two groups: the group of independent experts from universities, NGO and civil society and the group of experts from various government sectors.

Among the fifty-six indicators, it was assessed the level of implementation as ‘high’ for six indicators, ‘medium’ for twenty-four indicators, ‘low’ for twenty-two indicators and ‘very low’ for four indicators. High implementation level indicators include strong and visible political support, targets on exclusive breastfeeding and complementary feeding, strong and visible political support for actions to combat all forms of malnutrition, monitoring of exclusive breastfeeding and complementary feeding indicators, monitoring of promotion and growth surveillance programmes and coordination mechanism (national, state and local government). The indicators on menu labelling, reducing taxes on healthy foods, increasing taxes on unhealthy foods and dietary guidelines are the indicators with a ‘very low’ level of implementation in Burkina Faso.

The general results showed that there is a clear need for further improvements in policy and infrastructure support to promote healthy food environments.

To quantify and compare concurrent within-person trends in lifestyle risks, nutrition status and drivers of food choice among urban migrants in Central Asia.

We collected panel data on household structure, drivers of food choice, nutrition knowledge and diverse measures of nutrition status and lifestyle risk from urban migrants at 0, 3, 6 and 9 months using harmonised methodology in two cities. Trends were analysed using mixed-effects models and qualitatively compared within and between cities.

Ulaanbaatar, Mongolia, and Almaty, Kazakhstan.

200 adults (22–55 years) who migrated to these cities within the past 2 years.

Adjusting for age and sex, each month since migration was positively associated with fasting TAG in Almaty (0·55 mg/dl; 95 % CI: 0·13, 0·94) and BMI (0·04 kg/m2; 95 % CI: 0·01, 0·07), body fat (0·14 %; 95 % CI: 0·01, 0·26) and fasting glucose (0·04 mmol/l; 95 % CI: 0·02, 0·05) and lipids in Ulaanbaatar (P < 0·05). In Almaty, nutrition knowledge (measured using an objective 20-point scale) declined despite improvements in diet quality (measured by Prime Diet Quality Score). The influence of food availability, price and taste on food choice increased in Almaty (P < 0·05). Upon multivariable adjustment, nutrition knowledge was positively associated with diet quality in Almaty and adherence to ‘acculturated’ diet patterns in both cities (P < 0·05). Different trends in smoking, sleep quality and generalised anxiety were observed between cities.

Findings indicate heterogeneous shifts in nutrition, lifestyles and drivers of food choice among urban migrants in Central Asia and provide an evidence base for focused research and advocacy to promote healthy diets and enable nutrition-sensitive food environments.

Over recent decades, the commercial ultra-processed food industry has grown, making snacks high in energy, added sugar, saturated fat and sodium affordable and accessible to consumers. Dietary patterns high in ultra-processed snacks are concerning as this can result in negative health outcomes. This study aims to provide insight into available snack products in South African supermarkets, and the marketing thereof, which can be used to support policy development aimed at improving the healthfulness of the food supply and consumption patterns.

This was an observational cross-sectional, mixed-method study.

Secondary data from six major supermarket chains (eight stores) in three different suburbs in Cape Town, South Africa was analysed to evaluate the nutritional composition of snack products (n 3837). The same eight supermarkets were revisited to obtain information on marketing via an observational checklist. Qualitative interviews were also conducted with store managers.

Majority (89 %) of the products assessed either contained non-sugar sweeteners or were high in sugar, saturated fat or sodium. These snack items that are high in nutrients of concern to limit were available at checkout areas in all stores and were found in high-traffic areas, and several in-store promotional strategies such as branded displays, special offers and combo-deals were commonly found.

The current South African supermarket environment encourages consumers to purchase unhealthy snacks. Most snacks assessed in this study cannot be recommended for regular consumption due to the nutritional composition being high in nutrients linked to poor health outcomes. There is a need for regulation of the in-store marketing of unhealthy snacks in South Africa. Retail settings are potential intervention points for limiting exposure to these unhealthy products.

In this paper, we examined whether there are inequalities in access to food retail (by type and healthiness) across local government areas (LGA) in Greater Melbourne and by LGA grouped based on their distance from the central business district and Growth Area designation. We also examined whether these inequalities persisted over time.

This is a secondary analysis of a repeated cross-sectional census of food outlets collected at four time points (2008, 2012, 2014 and 2016) across 31 LGA. Using Geographical Information Systems, we present a spatial analysis of food retail environments in Melbourne, Australia, at these four times over eight years.

Greater Melbourne, Australia.

31 LGA in Greater Melbourne.

Findings show significant inequalities in access to healthy food retail persisting over time at the LGA level. Residents in lower density urban growth areas had the least access to healthy food retail. Unhealthy food retail was comparatively more accessible, with a temporal trend indicating increased accessibility over time in urban growth areas only.

Accessibility to food outlets, particularly healthy food outlets and supermarkets, in Greater Melbourne is not equal. To identify and address health inequalities associated with rapid urban growth, further understanding of how people interact with the food environment needs to be explored.

This review aimed to (i) synthesise evidence of the impact of publicly procured school meals programmes on nutritional outcomes of children/adolescents (5–18 years) in sub-Saharan Africa and (ii) identify challenges and facilitators to implementing effective school meals programmes.

Mixed-methods systematic review (n 7 databases). Nutritional outcomes assessed were anthropometrics (underweight, stunting, wasting, overweight/obesity), micronutrient deficiencies, food consumed and food environment. Qualitative findings were coded using a nine-step school food system framework: production of food, wholesale and trading, transportation and storage, processing and distribution, food preparation, distribution to students, student stakeholders, community involvement and infrastructure support.

Sub-Saharan Africa.

Children/adolescents (5–18 years), parents, school personnel and government officials.

Thirty-three studies (twenty-six qualitative, seven quantitative) from nine sub-Saharan African countries were included. Six studies found a positive impact of publicly procured school meals programmes on nutritional outcomes (wasting (n 1), stunting (n 3), underweight (n 1), vitamin A intake (n 1) and dietary diversity (n 1)). Fifty-three implementation challenges were identified, particularly during food preparation (e.g. training, payment), distribution to students (e.g. meal quantity/quality/diversity, utensils) and infrastructure support (e.g. funding, monitoring, coordination). Implementation facilitators were identified (n 37) across processing and distribution (e.g. programme coordination), student stakeholders (e.g. food preferences, reduced stigma) and community involvement (e.g. engagement, positive perceptions). Included policy recommendations targeted wholesale and trading, food preparation, student stakeholders and infrastructure support in nine, fifteen and twenty-five studies, respectively.

As many challenges remain, strengthening implementation (and therefore the nutritional impact) of school meals programmes in sub-Saharan Africa requires bold commitment and improved coordination at multiple levels of governance.

Evaluate the 5-year changes in the consumers’ food environment in the area of a health promotion service in Brazilian primary health care. Our hypothesis is that the consumers’ food environment in the areas with primary healthcare services has changes that may favour healthy eating habits over time.

Longitudinal study.

The territory around the primary healthcare services in Belo Horizonte, Minas Gerais, Brazil.

All food stores and open-air food markets that sell fruits and vegetables around the primary healthcare services in 2013 (n 272) and in 2018 (n 265).

Fruit diversity increased by 13·4 % (P < 0·001) and vegetables variety and quality by 16·1 % (P = 0·003) and 12·5 % (P < 0·001), respectively. Corn snacks showed an increase in availability (13·5 %; P = 0·002). The increase in advertising was observed for fruits and vegetables (34·6 %; P < 0·001) and ultra-processed foods (47·6 %; P < 0·001). Supermarkets showed an increase in the Healthy Food Store Index (three points; P < 0·001), while fruits and vegetables stores showed a decrease of one point in the index (P < 0·001).

The unequal changes in the consumers’ food environment according to the food stores types demonstrate the importance of food supply policies that promote a healthy environment and favour the maintenance of traditional healthy food retailers.

Healthy food retail programmes (HFRP) in the USA generally aim to increase healthy foods access to improve diet quality and health, yet the impact is mixed. These programmes primarily target adults, even though adolescents frequently and independently visit stores to purchase snacks. This study’s aims are to explore successes and challenges of implementing HFRP (Aim 1) and examine how HFRP can be tailored to adolescents (Aim 2).

One-time, virtual, semi-structured interviews with individuals who were involved in a HFRP, followed by a socio-demographic characteristics survey. Interviews were designed based on the RE-AIM framework and the Hexagon Tool and analysed using Braun and Clark’s (2006) thematic analysis approach. Descriptive statistics were used to summarise participants’ socio-demographic characteristics.

New York City (NYC).

Adults (18 years or older) who have designed, implemented and/or evaluated an HFRP in NYC and speak/understand English (n 21).

Aim 1: For successes, strategies to build relationships with the community were most discussed. Regarding challenges, securing reliable funding was the hardest to overcome. Suggested solutions included designing profitable HFRP, targeting shortcomings in food distribution systems and increasing consumer demand. Aim 2: Most participants had not considered adolescents in previous HFRP but suggested involving youth in developing HFRP to encourage youth-driven solutions and promote youth advocacy.

Future HFRP should focus on activities that help store owners purchase affordable healthy foods from distributors, which translates to affordability for customers. Federal and local policies can assist by funding complementary programmes. Additionally, adolescents should be considered in these efforts.

We aimed to understand what influences parents’ purchasing behaviours when shopping for groceries online and potential ways to improve the healthiness of online grocery platforms.

We conducted semi-structured interviews, guided by the Marketing Mix framework. Reflexive thematic analysis was used to analyse data.

Online interviews were conducted with primary grocery shoppers.

Parents (n 14) or caregivers (n 2) using online grocery platforms at least every 2 weeks.

Most participants perceived purchasing healthy food when shopping for groceries online to be more challenging compared to in physical stores. They expressed concerns about the prominence of online marketing for unhealthy food. Participants from lower socio-economic backgrounds often depended on online supermarket catalogues to find price promotions, but healthy options at discounted prices were limited. Across socio-economic groups, fresh items like meat and fruit were preferred to be purchased instore due to concerns about online food quality.

Participants believed online grocery platforms should make healthy foods more affordable and supported regulations on supermarket retailers to promote healthy options and limit unhealthy food promotion online.

Participants had varied experiences with online grocery shopping, with both positive and negative aspects. Efforts to improve population diets need to include mechanisms to create health-enabling online grocery retail platforms. Government interventions to restrict marketing of unhealthy foods and promote marketing of healthy options on these platforms warrant investigation.