# Tool for assessing food industry commitments and practices to address the double burden of malnutrition: a Delphi study

## TL;DR

A new tool was developed to assess food companies' commitments to address both undernutrition and diet-related diseases in low- and middle-income countries.

## Contribution

The study introduces eight new indicators for evaluating food industry practices related to the double burden of malnutrition.

## Key findings

- Eight indicators were selected through a Delphi study to assess food industry practices related to the double burden of malnutrition.
- The indicators cover areas like breastmilk substitutes, complementary foods, and corporate strategies.
- The extended BIA-Obesity tool can help monitor and promote favorable industry practices in low- and middle-income countries.

## Abstract

Many low- and middle-income countries face a double burden of malnutrition, i.e., a co-occurrence of undernutrition with overweight, obesity, or other diet-related noncommunicable diseases. In an increasingly connected global food system, multinational and domestic food industry actors – through their commercial practices and corporate political activity – both contribute to the double burden of malnutrition and hold potential to address it. Systematic monitoring of relevant industry commitments and practices may help to hold industry accountable and foster constructive engagement. The Business Impact Assessment - Obesity and population-level nutrition (BIA-Obesity) tool has been developed to assess and benchmark food companies’ commitments and practices related to obesity and support for healthy diets at a national level.

To enable the application of BIA-Obesity for countries facing a double burden of malnutrition, this study aimed to identify and select relevant best practice indicators for assessing food company commitments and practices regarding the double burden of malnutrition, with a focus on indicators not currently captured by the BIA-Obesity tool. A three-round Delphi study was conducted between April and October 2024, involving an international panel of experts.

From 52 invited experts, 30 contributed to our expert panel (response rate 58%). Based on a systematic review, 16 best practice indicators addressing the double burden of malnutrition were proposed. Consensus (i.e., group agreement of 75% or higher) for inclusion was reached for 8 indicators covering the production, distribution and marketing of (i) breastmilk substitutes and (ii) complementary foods, (iii) breastfeeding support and (iv) parental leave for employees, (v) food fortification, (vi) use of traditional foods, (vii) use of discounts and donations, and (viii) healthy diets at work. One additional indicator on corporate strategy was included as an overarching indicator.

Food industry action may complement other efforts to address the double burden of malnutrition, such as public policies and investments. Tools like the extended BIA-Obesity framework can be used for a systematic monitoring of relevant industry commitments and practices and may help to disseminate and establish favourable industry practices as part of broader efforts to address the double burden of malnutrition in low- and middle-income countries.

Not applicable.

The online version contains supplementary material available at 10.1186/s12992-025-01175-8.