The food industry is neither friend, nor foe, nor partner

Interactions Between Nutrition Professionals and Industry: A Scoping Review

BACKGROUND

In recent years, interactions between nutrition professionals (NPs) and the food industry, such as sponsorship arrangements, have raised concerns, particularly as these may negatively impact the trustworthiness and credibility of the nutrition profession. This study aimed to map the literature and identify knowledge gaps regarding interactions between NPs and industry. We sought to examine the nature of such interactions and NPs perspectives about these, as well as the risks and solutions.

METHODS

We conducted a scoping review according to a pre-registered protocol, searching eight electronic databases and grey literature sources in March 2021 to identify documents for inclusion. Two independent reviewers screened citations for inclusion and conducted data extraction. Quantitative and qualitative syntheses were conducted.

RESULTS

We identified 115 documents for analysis, published between 1980 to 2021, with a majority from the United States (n=59, 51%). Only 32% (n=37) were empirical studies. The food industry was the most frequent industry type discussed (n=91, 79%). We identified 32 types of interactions between NPs and industry, such as continuing education provided by industry and sponsorship of professional bodies and health and nutrition organizations. The financial survival of nutrition organizations and continuing education access for NPs were the most frequently cited advantages of industry-NPs interactions. On the other hand, undermining public trust, NPs credibility and public health nutrition recommendations were pointed out as risks of these interactions. Following a code of ethics, policies, or guidelines was the most frequently proposed solution for managing these interactions.

CONCLUSION

Despite the increasing attention given to this issue, few empirical papers have been published to date. There is a need for more research to better and systematically document industry interactions with NPs and the impacts associated with these, as well as more research on effective management strategies. Registry Name and Number: Interactions between nutrition professionals and industry actors: A scoping review protocol. doi:10.17605/OSF.IO/Q6PUA.

Engaging with the Private Sector for Noncommunicable Disease Prevention and Control: Is it Possible to Create "Shared Value?"

Noncommunicable diseases (NCDs) are the leading cause of premature mortality worldwide. Corporate interests are sometimes well-aligned with public health, but profiteering from the consumption of products that are known to be the major contributors to the noncommunicable disease burden undermines public health. This paper describes the key industry actors shaping the NCD landscape; highlights the unhealthy commodities' impact on health and the growing burden of NCDs; and outlines challenges and opportunities to reduce exposure to those risk factors. Corporations deploy a wide array of strategies to maximize profits at the expense of health, including sophisticated marketing techniques, interference in the policy-making process, opposition and distortion of research and evidence, and whitewashing of health-harming activities through corporate social responsibility initiatives. There can be no shared value for industries that sell goods that harm health irrespective of consumption patterns (such as tobacco and likely alcohol), so government actions such as regulation and legislation are the only viable policy instruments. Where shared value is possible (for example, with the food industry), industry engagement can potentially realign corporate interests with the public health interest for mutual benefit. Deliberate, careful, and nuanced approaches to engagement are required.

Food democracy, health disparities and the New York City trans fat policy

OBJECTIVE

To investigate food democracy and health disparities in the New York City (NYC) trans fat policy process.

DESIGN

Texts from semi-structured interviews, public testimony and comments on the policy were analysed using categorization and thematic coding. A priori content analysis for themes of food democracy was followed by open, axial and selective coding for sub-themes on health disparities. Data and method triangulation and respondent validation were used to establish data dependability, trustworthiness and representativeness.

SETTING

NYC.

PARTICIPANTS

Interviews from a purposive, snowballed sample of thirty-three participants included restaurateurs, scientists, health and consumer advocates, consumers and policy makers. Additionally, 261 pages of transcript from public testimony of fifty-three participants and a purposive sample of public comments on the policy from a pool of 2157 were analysed.

RESULTS

Principles of food democracy involving inclusive citizenship, access to information, collaborative participation and focus on collective good were well represented in the data. Additionally, sub-themes linked to health disparities included: government responsibility for fairer access to healthier foods; recognition that people made choices based on circumstances; concern for vulnerable groups; and outrage with a food industry viewed as unconcerned for public health.

CONCLUSIONS

Principles of food democracy present in the successful process of adoption of the 2006 NYC trans fat policy addressed nutrition-related health. Food democracy is a contemporary food system and policy approach with potential for public health benefits in reducing nutrition-related health disparities.

Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review

Background

The limited integration of ethics in nutrition-related public health policies and interventions is one major concern for those who have the task of implementing them. Ethical challenges that are overlooked during the development of such interventions could raise serious ethical issues during their implementation and even after. As a result, these decision makers need technical support and ethical guidance for adaptation of interventions to local (cultural, social, economic, etc.) contexts.

Aim

The goal of this scoping review is to delineate and “map” the range of ethical issues in nutrition-related public health interventions, as well as the range of the various fields in which they may arise.

Methods

A scoping review of empirical research and conceptual literature was conducted following the framework of Arksey and O’Malley. Searches using PubMed with Medical Subject Headings (MeSH) categories and Advanced Search Builder as well as in the Global Health Library were performed. The final sample consists of 169 publications.

Results

The ethics of public health prevention or treatment of obesity and non-communicable diseases is the most explicitly and frequently discussed subject. In comparison, ethical issues raised by public health interventions in the fields of undernutrition, breastfeeding, vitamin/mineral supplementation and food fortification, food security, food sustainability and food safety are addressed in a lower proportion of the sample. The results illustrate the various natures, types, and scopes of existing public health nutrition-related interventions, and the various ethical issues that may be raised by these interventions, in addition to the numerous and different contexts in which they may be implemented.

Discussion

The ethical issues faced in the development and implementation of nutrition-related public health interventions are varied and cannot be equated with, nor generalized about, when dealing with specific activities in this field. More importantly, these ethical issues cannot be managed without a careful consideration for the complexity of contexts in which nutrition-related interventions are expected to be implemented. These interventions engage a variety of actors with diverse perspectives and interests. We discuss these challenges and also comment on the importance of considering ethical impacts in the monitoring and evaluation of such interventions.

Conclusion

General ethical frameworks or recommendations–although useful–cannot be expected to provide policy makers, implementators and other public health personnel with sufficient practical ethical guidance as they cannot consider and anticipate the particularities of all specific nutrition-related public health interventions and the complexity of the contexts in which they are implemented. Further research is needed in order to develop more targeted ethical frameworks.

Stakeholder insights on the planning and development of an independent benchmark standard for responsible food marketing

A mixed methods qualitative survey investigated stakeholder responses to the proposal to develop an independently defined, audited and certifiable set of benchmark standards for responsible food marketing. Its purpose was to inform the policy planning and development process. A majority of respondents were supportive of the proposal. A majority also viewed the engagement and collaboration of a broad base of stakeholders in its planning and development as potentially beneficial. Positive responses were associated with views that policy controls can and should be extended to include all form of marketing, that obesity and non-communicable diseases prevention and control was a shared responsibility and an urgent policy priority and prior experience of independent standardisation as a policy lever for good practice. Strong policy leadership, demonstrable utilisation of the evidence base in its development and deployment and a conceptually clear communications plan were identified as priority targets for future policy planning. Future research priorities include generating more evidence on the feasibility of developing an effective community of practice and theory of change, the strengths and limitations of these and developing an evidence-based step-wise communications strategy.

Support of public-private partnerships in health promotion and conflicts of interest

OBJECTIVES

Public-private partnerships (PPPs) are considered key elements in the development of effective health promotion. However, there is little research to back the enthusiasm for these partnerships. Our objective was to describe the diversity of visions on PPPs and to assess the links between the authors and corporations engaged in such ventures.

METHODS

We reviewed the scientific literature through PubMed in order to select all articles that expressed a position or recommendation on governments and industries engaging in PPPs for health promotion. We included any opinion paper that considered agreements between governments and corporations to develop health promotion. Papers that dealt with healthcare provision or clinical preventive services and those related to tobacco industries were excluded. We classified the articles according to the authors' position regarding PPPs: strongly agree, agree, neutral, disagree and strongly disagree. We related the type of recommendation to authors' features such as institution and conflicts of interest. We also recorded whether the recommendations were based on previous assessments.

RESULTS

Of 46 papers analysed, 21 articles (45.6%) stated that PPPs are helpful in promoting health, 1 was neutral and 24 (52.1%) were against such collaborations. 26 papers (57%) set out conditions to assure positive outcomes of the partnerships. Evidence for or against PPPs was mentioned in 11 papers that were critical or neutral (44%) but not in any of those that advocated collaboration. Where conflicts were declared (26 papers), absence of conflicts was more frequent in critics than in supporters (86% vs 17%).

CONCLUSIONS

Although there is a lack of evidence to support PPPs for health promotion, many authors endorse this approach. The prevalence of ideas encouraging PPPs can affect the intellectual environment and influence policy decisions. Public health researchers and professionals must make a contribution in properly framing the PPP issue.

The time for an updated Canadian Food Guide has arrived

Canada has published food guides since 1942 and the latest version, Eating Well with Canada’s Food Guide (EWCFG), was released in 2007. The EWCFG is largely based on meeting nutrient requirements, while we are now in need of a food guide with strong guidance on the role of diet in the prevention of chronic diseases. This article systematically analyses the process and assumptions behind the EWCFG and presents suggestions for needed revisions to the next food guide.

'Language is the source of misunderstandings'--impact of terminology on public perceptions of health promotion messages

BACKGROUND

The high level of premature death due to non-communicable diseases has been associated with unhealthful lifestyles, including poor diet. The effectiveness of public health strategies designed to promote health via messages focusing on food and diets depends largely on the perception of the messages by the public. The aim of this study was to explore public perceptions of language commonly used to communicate concepts linking health, food and the diet.

METHODS

This study is a qualitative and semi-quantitative cross-sectional survey exploring public perceptions of terms used to improve eating habits within public health strategies. We recruited adults with no background in nutrition or health-care, from May to July 2013, from urban areas of varying deprivation (n = 12) in Glasgow and Edinburgh, UK. Four key prompt-terms used to convey the idea of improving health through diet were selected for testing: Healthy Eating, Eating for Health, Balanced Diet and Nutritional Balance. Consumer understanding of these terms was explored using mixed-methods, including qualitative focus groups (n = 17) and an interviewer-led word-association exercise (n = 270).

RESULTS

The word-association exercise produced 1,386 individual responses from the four prompt-terms, with 130 unique responses associated with a single term. Cluster analysis revealed 16 key themes, with responses affected by prompt-term used, age, gender and socio-economic status. Healthy Eating was associated with foods considered 'healthy' (p <0.05); Eating for Health and Balanced Diet with negative connotations of foods to avoid (both p <0.001) and Nutritional Balance with the benefits of eating healthily (p <0.01). Focus groups revealed clear differences in perceptions: Eating for Health = positive action one takes to manage existing medical conditions, Healthy Eating = passive aspirational term associated with weight management, Balanced Diet = old fashioned, also dieting for weight loss, Nutritional Balance = maximising physical performance. Food suppliers use Healthy Eating terminology to promote weight management products. Focus group participants welcomed product reformulation to enhance food health properties as a strategy to overcome desensitisation to health-messages.

CONCLUSIONS

Public perceptions of messages communicating concepts linking health, food and the diet are influenced by terminology, resulting in confusion. To increase individual commitment to change eating habits in the long term, public health campaigns need strengthening, potentially by investing in tailored approaches to meet the needs of defined groups of consumers.