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We from Africa, Asia, Europe, the Pacific and the Americas, met in Bellagio, Italy, in June 2013, under the auspices of the International Obesity Task Force and the International Union of Nutritional Sciences, to examine the trends in obesity, actions taken, and the barriers to achieving healthy food policies in Bangladesh, Brazil, Chile, China, India, Mexico, Singapore, South Africa, Thailand, and the Pacific Islands.

Globalization and modern market economies have brought benefits of improved health and welfare. However, these same forces have also created major negative consequences, including shifts towards unhealthy dietary patterns that are underpinning the rise in obesity and non-communicable diseases (NCDs). Four out of five deaths from diet-related NCDs occur in low- and middle-income countries and their toll of premature death and disability is a major impediment to economic and human well-being.

The country presentations highlighted a range of positive actions that had been attempted, such as taxes on unhealthy beverages, interpretative front-of-pack labels, regulations on food marketing to children and healthy food policies in schools. However, these policies have faced major challenges in their development and implementation, especially due to: (i) pushbacks from Big Food; (ii) government limitations; (iii) incipient civil society support; and (iv) insufficient demand from an informed public.

The influence of Big Food in preventing public policy initiatives was clearly outlined by Dr Margaret Chan, Director-General of World Health Organization (WHO; June 2013):

‘Research has documented these tactics well. They include front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that confuses the evidence and keeps the public in doubt. Tactics also include gifts, grants, and contributions to worthy causes that cast these industries as respectable corporate citizens in the eyes of politicians and the public. They include arguments that place the responsibility for harm to health on individuals, and portray government actions as interference in personal liberties and free choice.’

The limitations of governments include: weak political structures; inadequate transparency, conflict of interest management and accountability in decision-making; low planning capacity; and a lack of willingness to protect public policy development from vested interests.

Also in many countries, the civil society organizations calling for healthy food policies are few in number, weakly coordinated and minimally resourced to make the case for stronger controls to promote public health. This results in insufficient support from an informed public for government policies. Healthy food policies do not yet command full public support in many countries and this can in part be attributed to the competing influences of Big Food.

This Bellagio Conference considered that the actions of Big Food have been the most significant force in blocking public health efforts to promote healthy food policies and reduce obesity in many parts of the world. It calls upon all sections of society to take specific actions to protect its citizens, especially children, and its healthy food environments from Big Food's misuse of its corporate power to undermine healthy food policies.

Specific actions for sectors of society to counter the undermining influence of Big Food on healthy food policies

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  2. Specific actions for sectors of society to counter the undermining influence of Big Food on healthy food policies

Governments

  • Transparency and accountability mechanisms – to provide public access to information on potential commercial influences on policymaking and ensure accountabilities for actions.
  • Policies as a high priority – to ensure that effective healthy food policies are high priority components of comprehensive obesity and NCD action plans
  • Relationships with private sector – to ensure that interactions with Big Food in relation to healthy food policies are transparent and that conflicts of interest are carefully managed
  • Relationships with civil society – to build strong relationships with public interest civil society organizations to support healthy food policies
  • Evaluation, research, monitoring – to build the evidence to inform healthy food policies

World Health Organization

  • Multisectoral actions – to utilize the mandate provided to the United Nations (UN) and WHO (UN Political Resolution on NCDs) to strengthen multisectoral actions for advancing global nutrition goals
  • Partnership norms – to develop norms for government engagement with the private sector (especially Big Food) so that partnerships are not detrimental to the nutrition goals
  • Civil society strengthening – to assist member states in partnering with civil society organizations that act as voices of the people and watchdogs of food industry behaviour
  • Evidence updates – to update the scientific evidence on nutrition and health and provide clear, contemporary guidance for national actions to enhance public health nutrition

Other international agencies

  • Agricultural policies – to support governments to ensure that agricultural policies are nutrition-sensitive and support healthy food environments
  • Trade policies – to support governments to ensure that trade and investment agreements do not impede the protection of existing healthy food systems or promotion of public health nutrition

Civil society organizations

  • Coalition building – to strengthen public interest coalitions to support healthy food policies
  • Watchdog role – to demand transparency from governments and serve as a watchdog on Big Food in relation to their impact on government activities
  • Collaboration across nutrition issues – to support endeavours and collaborations between organizations addressing undernutrition and obesity to create healthier global food systems

Researchers

  • Strategic research – to undertake strategic (policy-relevant) research and monitoring in areas of high relevance to healthy food policies
  • Knowledge translation – to ensure that knowledge translation and exchange mechanisms are in place to actively translate the evidence into appropriate formats for the right people

Foundations and funders

  • Support civil society – to support work that increases the capabilities, capacities and impacts of civil society and create a community movement for healthy food policies
  • Support research – to support research, monitoring and knowledge translation on food policies
  1. The author has no conflicts of interest to declare