Conceptualizing the commercial determinants of dietary behaviors associated with obesity: A systematic review using principles from critical interpretative synthesis

Abstract

Introduction Unhealthy diet is an important preventable risk factor for overweight and obesity. Identifying the key drivers of an unhealthy diet is an important public health aim. “Big Food” has been identified as an influential factor shaping dietary behavior and obesity, and their practices have broadly been labeled as the “commercial determinants of obesity,” but there is a lack of definitions and conceptualizations for these terms. This review aimed to synthesize literature on the commercial determinants of dietary behavior associated with obesity. It presents the development of an integrative definition and a conceptual framework involving potential influences on dietary behavior, and it examines the prevalence of certain narratives within papers that focus on children and adolescents. Methods Four electronic databases (Ovid MEDLINE, PubMed, Web of Science, and Scopus) were searched up to December 2020. Eighty‐one articles met the inclusion criteria: they were published in a peer‐reviewed academic journal, described a practice from the food/beverage industry in relation to dietary behavior or obesity. Data were integrated using critical interpretative synthesis. Results The commercial determinants of dietary behavior are conceptualized in terms of three corporate spheres of action—political and legal; production, processing and design; and marketing and preference shaping—which enable powerful food industry to successfully pursue their business, market, and political objectives. The most frequently reported sphere of action targeting children and adolescents was marketing and preference shaping. Conclusions In the included literature, the commercial determinants of dietary behavior associated with obesity have been conceptualized as being part of a complex system where corporate practices are enabled by power structures. The proposed framework can facilitate a structured identification and systematic study of the impact of specific aspects of food industry's strategies and increase opportunities for primary prevention by anticipating industry responses and by discouraging corporate practices that harm health.

The influence of unhealthy food and beverage marketing through social media and advergaming on diet‐related outcomes in children—A systematic review

“…The global increase in childhood obesity 1 coincides with the marked increases in the food and beverage industry's budget for marketing aimed at children 2 . Of the various ways in which commercial determinants influence health, 3 marketing and preference shaping is used especially often to target children and adolescents 4 . From a marketing perspective, this makes sense because children are more susceptible to media and marketing influences than adults, and once a child has developed a preference for a food or brand, they may remain a lifelong buyer 5 .…”

“… 2 Of the various ways in which commercial determinants influence health, 3 marketing and preference shaping is used especially often to target children and adolescents. 4 From a marketing perspective, this makes sense because children are more susceptible to media and marketing influences than adults, and once a child has developed a preference for a food or brand, they may remain a lifelong buyer. 5 Indeed, several systematic reviews demonstrated the effectiveness of food marketing through different media channels, for example, television or the Internet, on children's food attitudes, preferences, and consumption.…”

Relation between the food environment and oral health—systematic review

“…However, conceptualizations of the commercial determinants of dietary behaviors and obesity also point to more indirect ways of influencing dietary behaviors. 2 , 35 These strategies in the political and legal spheres include framing the evidence and debate, such as in the media or public consultations 36 influencing the policymaking process, such as lobbying against a sugar tax, 37 and limiting corporate liability, such as keeping prices low so that they do not reflect the true costs of the damage caused by consumption. 38 Future studies and systematic reviews could substantiate these conceptualizations with empirical evidence to further strengthen the evidence base on the commercial determinants of oral health.…”

Using group model building to frame the commercial determinants of dietary behaviour in adolescence – proposed methods for online system mapping workshops

“…This is partly because traditional evidence models have been criticised for being ill-suited to account for the “real-life” contexts in which health decisions are made and the broader systems in which policies and interventions take place [ 3 , 4 ]. Therefore, a “complex systems approach” has been advocated as a way of understanding the many influential factors and different sectors, and their interactions that affect complex health issues like diet and obesity [ 5 ]. Incorporating systems thinking methods into policymaking has the potential to increase policy efficacy and better anticipate unintended consequences of well-intentioned practices from other contexts [ 6 ].…”

“…The commercial determinants of obesity are strategies used by the food and beverage industry to produce, promote and increase the sales of their products, sometimes at the expense of public health, especially where their promotion strategies particularly target children and adolescents with foods high in salt, fats, sugar and energy density through integrated marketing techniques [ 5 ]. Incorporating systems thinking can actively foster dialogue between diverse stakeholders and enlighten the mechanisms by which commercial drivers influence core dietary behaviour and can affect health a long time into the future.…”