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To achieve WHO's target to halt the rise in obesity and diabetes, dramatic actions are needed to improve the healthiness of food environments. Substantial debate surrounds who is responsible for delivering eff ective actions and what, specifi cally, these actions should entail. Arguments are often reduced to a debate between individual and collective responsibilities, and between hard regulatory or fi scal interventions and soft voluntary, education-based approaches. Genuine progress lies beyond the impasse of these entrenched dichotomies. We argue for a strengthening of accountability systems across all actors to substantially improve performance on obesity reduction. In view of the industry opposition and government reluctance to regulate for healthier food environments, quasiregulatory approaches might achieve progress. A four step accountability framework (take the account, share the account, hold to account, and respond to the account) is proposed. The framework identifi es multiple levers for change, including quasiregulatory and other approaches that involve government-specifi ed and government-monitored progress of private sector performance, government procurement mechanisms, improved transparency, monitoring of actions, and management of confl icts of interest. Strengthened accountability systems would support government leadership and stewardship, constrain the infl uence of private sector actors with major confl icts of interest on public policy development, and reinforce the engagement of civil society in creating demand for healthy food environments and in monitoring progress towards obesity action objectives.

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Reducing the extent and persuasive power of marketing unhealthy foods to children worldwide are important obesity prevention goals. Research is limited to understand how brand mascots and cartoon media characters influence children's diet. We conducted a systematic review of five electronic databases (2000–2014) to identify experimental studies that measured how food companies' mascots and entertainment companies' media characters influence up to 12 diet-related cognitive, behavioural and health outcomes for children under 12 years. Eleven studies met the inclusion criteria. Studies used 21 unique popular media characters, but no brand mascots. Results suggest that cartoon media character branding can positively increase children's fruit or vegetable intake compared with no character branding. However, familiar media character branding is a more powerful influence on children's food preferences, choices and intake, especially for energy-dense and nutrient-poor foods (e.g. cookies, candy or chocolate) compared with fruits or vegetables. Future research should use a theoretically grounded conceptual model and larger and more diverse samples across settings to produce stronger findings for mediating and moderating factors. Future research can be used to inform the deliberations of policymakers, practitioners and advocates regarding how media character marketing should be used to support healthy food environments for children.

Objective: Transnational food, beverage and restaurant companies, and their corporate foundations, may be potential collaborators to help address complex public health nutrition challenges. While UN system guidelines are available for private-sector engagement, non-governmental organizations (NGO) have limited guidelines to navigate diverse opportunities and challenges presented by partnering with these companies through public-private partnerships (PPP) to address the global double burden of malnutrition. Design: We conducted a search of electronic databases, UN system websites and grey literature to identify resources about partnerships used to address the global double burden of malnutrition. A narrative summary provides a synthesis of the interdisciplinary literature identified. Results: We describe partnership opportunities, benefits and challenges; and tools and approaches to help NGO engage with the private sector to address global public health nutrition challenges. PPP benefits include: raising the visibility of nutrition and health on policy agendas; mobilizing funds and advocating for research; strengthening food-system processes and delivery systems; facilitating technology transfer; and expanding access to medications, vaccines, healthy food and beverage products, and nutrition assistance during humanitarian crises. PPP challenges include: balancing private commercial interests with public health interests; managing conflicts of interest; ensuring that co-branded activities support healthy products and healthy eating environments; complying with ethical codes of conduct; assessing partnership compatibility; and evaluating partnership outcomes. Conclusions: NGO should adopt a systematic and transparent approach using available tools and processes to maximize benefits and minimize risks of partnering with transnational food, beverage and restaurant companies to effectively target the global double burden of malnutrition.

SummaryGovernment action is essential to increase the healthiness of food environments and reduce obesity, diet-related non-communicable diseases (NCDs), and their related inequalities. This paper proposes a monitoring framework to assess government policies and actions for creating healthy food environments. Recommendations from relevant authoritative organizations and expert advisory groups for reducing obesity and NCDs were examined, and pertinent components were incorporated into a comprehensive framework for monitoring government policies and actions. A Government Healthy Food Environment Policy Index (Food-EPI) was developed, which comprises a 'policy' component with seven domains on specific aspects of food environments, and an 'infrastructure support' component with seven domains to strengthen systems to prevent obesity and NCDs. These were revised through a week-long consultation process with international experts. Examples of good practice statements are proposed within each domain, and these will evolve into benchmarks established by governments at the forefront of creating and implementing food policies for good health. A rating process is proposed to assess a government's level of policy implementation towards good practice. The Food-EPI will be pre-tested and piloted in countries of varying size and income levels. The benchmarking of government policy implementation has the potential to catalyse greater action to reduce obesity and NCDs.

Objective: To review the available literature on accountability frameworks to construct a framework that is relevant to voluntary partnerships between government and food industry stakeholders. Design: Between November 2012 and May 2013, a desk review of ten databases was conducted to identify principles, conceptual frameworks, underlying theories, and strengths and limitations of existing accountability frameworks for institutional performance to construct a new framework relevant to promoting healthy food environments. Setting: Food policy contexts within high-income countries to address obesity and diet-related non-communicable diseases. Subjects: Eligible resources (n 26) were reviewed and the guiding principles of fifteen interdisciplinary frameworks were used to construct a new accountability framework. Results: Strengths included shared principles across existing frameworks, such as trust, inclusivity, transparency and verification; government leadership and good governance; public deliberations; independent bodies recognizing compliance and performance achievements; remedial actions to improve accountability systems; and capacity to manage conflicts of interest and settle disputes. Limitations of the three-step frameworks and 'mutual accountability' approach were an explicit absence of an empowered authority to hold all stakeholders to account for their performance. Conclusions: We propose a four-step accountability framework to guide government and food industry engagement to address unhealthy food environments as part of a broader government-led strategy to address obesity and diet-related non-communicable diseases. An independent body develops clear objectives, a governance process and performance standards for all stakeholders to address unhealthy food environments. The empowered body takes account (assessment), shares the account (communication), holds to account (enforcement) and responds to the account (improvements).

BackgroundAltering food store environments is a promising approach to encourage healthy product purchases by consumers to improve their diet quality and health. Food store owners and managers are intermediaries to ensure that environmental changes are enacted. Despite their role as gatekeepers to implement and sustain healthy food environment changes, no systematic review has been published that examines food store owner and manager (retailer) data. Thus a review of retailer information available within the expansive United States (US) food environment literature was the purpose of this research.MethodsThe PRISMA protocol was used. A search strategy, including published articles from years 1980–2017, was applied to six databases to locate relevant articles that addressed the perspective of food store retailers in the US. Data were extracted, organized, and agreed upon between two authors based on pre-designed constructs: (1) a social-ecological model to capture factors that influence retailer decision making; and (2) a marketing-mix and choice-architecture framework to examine perspectives of applied (or the prospective application of) strategies at the store-level. Study quality was assessed using quality criteria checklists for qualitative and quantitative research.ResultsThirty-one articles met inclusion criteria and most studies (n = 22) were qualitative and conducted in urban food stores (n = 23). Multiple social-ecological factors influenced retailer decision making and ability or willingness to use marketing-mix and choice-architecture strategies to improve consumers’ healthy choices to support dietary quality. These factors included: conflicting training outcomes to enhance retailers’ knowledge and skills (individual, n = 9); the importance of trust (interpersonal, n = 8); views about marketing-mix and choice-architecture strategies in the food environment (n = 25); consumer demand or demographics (community, n = 19); supplier and food store management variables (systems or sectors, n = 18); local and federal policy (n = 8); and support for community health (norms/values, n = 8).ConclusionsResearch partnerships can support favorable business and public health outcomes to align with retailers’ business models and available resources. A participatory and translational approach to food environment research will likely maximize public health impact. Urban and rural food store retailers are important actors for future research to inform the feasibility of store retailers to apply MMCA strategies that are profitable and promote health.Electronic supplementary materialThe online version of this article (10.1186/s12966-019-0767-8) contains supplementary material, which is available to authorized users.