The Effectiveness of Partnerships With Commercial Actors to Improve Food Environments: A Systematic Review.

Partnerships with commercial actors have been proposed as a policy approach to create healthier food environments. We conducted a systematic review to assess their effectiveness for improving food environments and population health at state, national, or international levels. We searched in 14 databases and two websites for real-world evaluations published between 2010 and 2020. Study quality was appraised using a modified Newcastle-Ottawa Scale. Data were synthesized narratively by outcome (human, food environment, policy content, and implementation progress), considering their effect direction. Seventeen studies reporting on seven PPPs in four countries were included. Most studies (n = 14) involved food reformulation, especially salt reduction. Three focused on specific settings (the eating out-of-home sector, schools, and convenience stores). There was mixed evidence that partnerships make people buy fewer calories or more school meals (n = 3 studies) or reduce product sodium content (n = 6). Some positive effects were described in one uncontrolled study each for decreasing trans-fatty acid intake and for making healthier options more available in school cafeterias, but these studies had important limitations. Five document analyses highlighted shortcomings in the partnerships, including their limited scope, failure to add value to ongoing actions, varying participation levels, and lack of implementation, monitoring, and reporting. Alternative policy approaches should be considered. This systematic review is registered on PROSPERO as CRD42020170963.