Objective: To progress nutrition policy change and develop more effective advocates, it is useful to consider real-world factors and practical experiences of past advocacy efforts to determine the key barriers to and enablers of nutrition policy change. The present review aimed to identify and synthesize the enablers of and barriers to public policy change within the field of nutrition. Design: Electronic databases were searched systematically for studies examining policy making in public health nutrition. An interpretive synthesis was undertaken. Setting: International, national, state and local government jurisdictions within high-income, democratic countries. Results: Sixty-three studies were selected for inclusion. Numerous themes were identified explaining the barriers to and enablers of policy change, all of which fell under the overarching category of 'political will', underpinned by a second major category, 'public will'. Sub-themes, including pressure from industry, neoliberal ideology, use of emotions and values, and being visible, were prevalent in describing links between public will, political will and policy change. Conclusions: The frustration around lack of public policy change in nutrition frequently stems from a belief that policy making is a rational process in which evidence is used to assess the relative costs and benefits of options. The findings from the present review confirm that evidence is only one component of influencing policy change. For policy change to occur there needs to be the political will, and often the public will, for the proposed policy problem and solution. The review presents a suite of enablers which can assist health professionals to influence political and public will in future advocacy efforts.

Influencing public policy change can be difficult and complex, particularly for those with limited power and resources. For any one issue there may be several groups, including the commercial sector and public health advocates advocating from different policy perspectives. However, much of the public health advocacy literature and tools available for those wanting to improve their practice is based on research from one specific perspective of an issue. This approach deprives advocates of potential insight into the most effective levers for this complex and difficult process. To provide a more comprehensive insight into effective levers for influencing public health policy change, a conceptual model for poorly-resourced advocates was developed. The model was developed through the integration and synthesis of policy process and network theories with the results from three studies conducted previously by the authors: a systematic literature review; a social network analysis of influential actors in Australian nutrition policy; plus in-depth interviews with a sample of these actors who had diverse perspectives on influencing nutrition policy. Through understanding the key steps in this model advocates will be better equipped to increase political and public will, and affect positive policy change.

The food industry is often described as having more power and influence in nutrition policymaking than nutrition professionals, scientists and other practitioners working for the public interest; yet authors often allude to this point as an assumed truth, rather than an evidence-based fact. This paper applies social network analysis techniques to provide a concise evidence-based demonstration of the food industry's capacity to influence nutrition policymaking networks in Australia. Network analysis using four rounds of data collection was undertaken, and the capacity of individual actors and occupational categories to influence policy decision makers were analysed. Network graphs were developed using cluster analysis to identify the structure of clusters and the path distance of actors from decision makers. The assumed advantage for the 'food industry' was present both strategically in overall network position and with respect to the number of direct access points to 'decision makers', whereas 'nutrition professionals' were densely clustered together with limited links to key 'decision makers'. The results demonstrate that the food industry holds the strategic high ground in advocating their interests to policymakers in the contexts studied. Nutrition professionals may be hampered by their reliance on strong ties with other nutrition professionals as well as limited direct links to 'decision makers'.

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There is limited research into the nutrition policy process in high-income countries. While there has been a small increase in the use of policy process theory from 2003, an opportunity to expand its use is evident. We suggest that nutrition policy making would benefit from a pragmatic approach that ensures those trying to influence or understand the policy-making process are equipped with basic knowledge around these theories.