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Background The public health community has become increasingly critical of the role that powerful corporations play in driving unhealthy diets, one of the leading contributors to the global burden of disease. While a substantial amount of work has examined the political strategies used by dominant processed food manufacturers that undermine public health, less attention has been paid to their use of market strategies to build and consolidate power. In this light, this paper aimed to systematically review and synthesise the market strategies deployed by dominant processed food manufacturers to increase and consolidate their power. Methods A systematic review and document analysis of public health, business, legal and media content databases (Scopus, Medline, ABI Inform, Business Source Complete, Thomas Reuters Westlaw, Lexis Advance, Factiva, NewsBank), and grey literature were conducted. Data extracted were analysed thematically using an approach informed by Porter’s ‘Five Forces’ framework. Results 213 documents met inclusion criteria. The market strategies ( n =21) and related practices of dominant processed food manufacturers identified in the documents were categorised into a typological framework consisting of six interconnected strategic objectives: i) reduce intense competition with equivalent sized rivals and maintaining dominance over smaller rivals; ii) raise barriers to market entry by new competitors; iii) counter the threat of market disruptors and drive dietary displacement in favour of their products; iv) increase firm buyer power over suppliers; v) increase firm seller power over retailers and distributors; and vi) leverage informational power asymmetries in relations with consumers. Conclusions The typological framework is well-placed to inform general and jurisdiction-specific market strategy analyses of dominant processed food manufacturers, and has the potential to assist in identifying countervailing public policies, such as those related to merger control, unfair trading practices, and public procurement, that could be used to address market-power imbalances as part of efforts to improve population diets.

Despite global recommendations for governments to implement a comprehensive suite of policies to address obesity, policy adoption has been deficient globally. This paper utilised political science theory and systems thinking methods to examine the dynamics underlying decisions regarding obesity prevention policy adoption within the context of the Australian state government initiative, Healthy Together Victoria (HTV) (2011-2016). The aim was to understand key influences on policy processes, and to identify potential opportunities to increase the adoption of recommended policies. Data describing government processes in relation to the adoption of six policy interventions considered as part of HTV were collected using interviews (n = 57), document analyses (n = 568) and field note observations. The data were analysed using multiple political science theories. A systematic method was then used to develop a Causal Loop Diagram (CLD) for each policy intervention. A simplified meta-CLD was generated from synthesis of common elements across each of the six policy interventions. The dynamics of policy change could be explained using a series of feedback loops. Five interconnected balancing loops served to reduce the propensity for policy change. These pertained to an organisational norm of risk aversion, and the complexity resulting from a whole-of-government policy approach and in-depth stakeholder consultation. However, seven virtuous reinforcing loops helped overcome policy resistance through policy actor capabilities that were improved over time as policy actors gained experience in advocating for change. Policy processes for obesity prevention are complex and resistant to change. In order to increase adoption of recommended policies, several capabilities of policy actors, including policy skills, political astuteness, negotiation skills and consensus building, should be fostered and strengthened. Strategies to facilitate effective and broad-based consultation, both across and external to government, need to be implemented in ways that do not result in substantial delays in the policy process.

The simultaneous increases in obesity in almost all countries seem to be driven mainly by changes in the global food system, which is producing more processed, affordable, and effectively marketed food than ever before. This passive overconsumption of energy leading to obesity is a predictable outcome of market economies predicated on consumption-based growth. The global food system drivers interact with local environmental factors to create a wide variation in obesity prevalence between populations. Within populations, the interactions between environmental and individual factors, including genetic makeup, explain variability in body size between individuals. However, even with this individual variation, the epidemic has predictable patterns in subpopulations. In low-income countries, obesity mostly affects middle-aged adults (especially women) from wealthy, urban environments; whereas in high-income countries it affects both sexes and all ages, but is disproportionately greater in disadvantaged groups. Unlike other major causes of preventable death and disability, such as tobacco use, injuries, and infectious diseases, there are no exemplar populations in which the obesity epidemic has been reversed by public health measures. This absence increases the urgency for evidence-creating policy action, with a priority on reduction of the supply-side drivers.

Background As part of efforts to address high levels of overweight and obesity, the provision of nutrition information (e.g., through nutrition labels and nutrition claims) on food packages has increasingly become an important policy option. This study aimed to assess the influence of nutrition claims relating to fat, sugar, and energy content on product packaging on several aspects of food choices to understand how they contribute to the prevention of overweight and obesity. Methods A systematic literature review was conducted using the online databases EBSCOhost Global Health, EBSCOhost Medline, ScienceDirect, Scopus, PsycINFO and Embase. Studies were included if they measured the influence of nutrition claims relating to fat, sugar, and energy content on outcomes related to body weight, and were published between January 2003 and April 2018. Results Eleven studies were included in the review. Results showed that nutrition claims can influence the knowledge of consumers with respect to perceived healthfulness of products, as well as expected and experienced tastiness of food products – making food products with nutrition claims seem healthier and less tasty. Nutrition claims can make the appropriate portion size appear to be larger and lead to an underestimation of the energy content of food products. Nutrition claims can also influence food purchase intentions, moderated by the perceived healthfulness of the relevant food products and the health consciousness of individuals. Nutrition claims were also found to have an impact on food purchases, to influence ‘consumption guilt’ (i.e., feeling of guilt associated with eating), and to increase consumption, moderated by the weight status of individuals. These influences were shown to vary depending on the type of claim and food carrying the claim. Conclusions There is evidence that, while nutrition claims may lead some consumers to improve their nutrition knowledge and select healthier options, it may also lead consumers to increase food consumption and overall energy intake. This may run counter to efforts to address overweight and obesity.

Obesity interventions can result in weight loss, but accurate prediction of the bodyweight time course requires properly accounting for dynamic energy imbalances. In this report, we describe a mathematical modelling approach to adult human metabolism that simulates energy expenditure adaptations during weight loss. We also present a web-based simulator for prediction of weight change dynamics. We show that the bodyweight response to a change of energy intake is slow, with half times of about 1 year. Furthermore, adults with greater adiposity have a larger expected weight loss for the same change of energy intake, and to reach their steady-state weight will take longer than it would for those with less initial body fat. Using a population-averaged model, we calculated the energy-balance dynamics corresponding to the development of the US adult obesity epidemic. A small persistent average daily energy imbalance gap between intake and expenditure of about 30 kJ per day underlies the observed average weight gain. However, energy intake must have risen to keep pace with increased expenditure associated with increased weight. The average increase of energy intake needed to sustain the increased weight (the maintenance energy gap) has amounted to about 0·9 MJ per day and quantifies the public health challenge to reverse the obesity epidemic.

At a country level, population obesity prevalence is often associated with economic affluence, reflecting a potential adverse outcome concomitant with economic growth. We estimated the pattern and strength of the empirically observed relationship between national income and adult obesity prevalence, and the moderating role of countries' macro-environments on this relationship. We assembled data on national obesity prevalence, income and a range of variables that characterize macro-environments related to 147 countries from multiple international organizations and databases. We used a Bayesian hierarchical model to estimate the relationship (elasticities) between national income (using Gross Domestic Product Per Capita, GDPPC) and adult obesity prevalence, and the moderating effects of five different dimensions (globalization orientation, demographic characteristics, economic environment, labor market characteristics, and strength of health policies) of countries' macro-environments on the income elasticities. Using the latest (2019-2024) available national income growth projections from the International Monetary Fund, we forecast future global trends in obesity prevalence. Over the 40-years 1975-2014, adult obesity prevalence increased at a declining rate with GDPPC across the 147 countries. The mean income elasticity estimates were 1.23 (95% credible interval 1.04-1.42) for males and 1.01 (0.82-1.18) for females. The elasticities were positively associated with the extent of political globalization and negatively associated with urbanization and share of agriculture in the national GDP. Income based projections indicate that obesity prevalence would continue to grow at an average annual rate of 2.47% across the studied countries during 2019-2024. Population obesity prevalence exhibits a positive relationship with national income and there is no evidence that the relationship, while weakening, actually turns negative at higher income levels (\"obesity Kuznets curve\"). Based on current trends, global obesity prevalence will continue to increase during 2019-2024, with the rate of growth higher in low- and middle-income countries. As most people currently live in low- and middle-income countries with rising incomes, our findings underscore the urgent societal imperatives for effective policy initiatives, especially those that target the concomitant \"nutrition transition\" process with economic affluence, to break or at least further weaken the positive relationship of population obesity prevalence with national income.

This paper aims to estimate the consequences of an additional 20% tax on sugar-sweetened beverages (SSBs) on health and health care expenditure. Participants were adult (aged > = 20) Australians alive in 2010, who were modelled over their remaining lifetime. We used lifetable-based epidemiological modelling to examine the potential impact of a 20% valoric tax on SSBs on total lifetime disability-adjusted life years (DALYs), incidence, prevalence, and mortality of obesity-related disease, and health care expenditure. Over the lifetime of adult Australian alive in 2010, seemingly modest estimated changes in average body mass as a result of the SSB tax translated to gains of 112,000 health-adjusted life years for men (95% uncertainty interval [UI]: 73,000-155,000) and 56,000 (95% UI: 36,000-76,000) for women, and a reduction in overall health care expenditure of AUD609 million (95% UI: 368 million- 870 million). The tax is estimated to reduce the number of new type 2 diabetes cases by approximately 800 per year. Twenty-five years after the introduction of the tax, there would be 4,400 fewer prevalent cases of heart disease and 1,100 fewer persons living with the consequences of stroke, and an estimated 1606 extra people would be alive as a result of the tax. The tax would generate an estimated AUD400 million in revenue each year. Governments should consider increasing the tax on sugared drinks. This would improve population health, reduce health care costs, as well as bring in direct revenue.

Background: There is increasing recognition that power imbalances that favour corporations, especially those active in unhealthy commodity industries, over other actors are central to the ways in which corporations influence population health. However, existing frameworks for analysing corporate strategies and practices that impact on health do not incorporate concepts of power in consistent ways. This paper aimed to review the ways in which corporate power has been incorporated into such frameworks, and to propose a revised framing of the commercial determinants of health (CDoH) that makes concepts of power explicit. Methods: We conducted a narrative review of frameworks that identify corporate strategies and practices and explain how these influence population health. Content analysis was conducted to identify explicit references to different qualities of power – its origins, nature, and manifestations. Results: Twenty-two frameworks were identified, five of which used theories of power. A wide range of contexts that shape, and are shaped by corporate power were discussed, as were a diversity of corporate, social and ecological outcomes. A variety of material and ideational sources of power was also covered. We proposed an integrated ‘Corporate Power and Health’ framework to inform analysis of the CDoH, organised around key questions on power set out by Foucault. The proposed framework draws from a number of well-established corporate power theories and synthesises key features of existing CDoH frameworks. Conclusion: Public health advocates, researchers and policy-makers would likely be better placed to understand and address the CDoH by engaging with theories of power to a greater extent, and by explicitly incorporating concepts of corporate power in analyses of how the deployment of corporate strategies and practices influence population health.

To evaluate the trends in the healthiness of packaged food purchases of Australian consumers before and after the introduction of the Health Star Rating (HSR) nutrition labels. Panel data analysis and difference-in-differences analysis. The Australian Government endorsed HSR nutrition labels for voluntary implementation on packaged foods in June 2014. We analyse the packaged food purchases of households across all major supermarkets before (January 2014 to June 2014) and after (June 2014-Dec 2018) the introduction of HSR. 6284 members of a panel of households across Australia reporting their grocery purchases to a market research company (Nielsen Homescan panel). The healthiness of household food purchases exhibited a U-shaped trend - decreasing from 2014 to 2017, and then increasing from 2018, corresponding to the time when a higher proportion of products were HSR-labelled. Households that purchased a higher proportion of HSR-labelled products had healthier household purchases overall. Further, the healthiness of households' category-specific food purchases was positively associated with the proportion of HSR-labelled products in categories where HSR was adopted, relative to control categories where HSR was not adopted. In Australia, once a substantial number of packaged food products adopted the voluntary HSR summary indicator, we observed an increasing trend in the healthiness of household food purchases. Widespread adoption of a nutrition summary indicator, such as HSR, on packaged food is likely to be beneficial for population health.