Front-of-package nutrition labelling policies in Uruguay, Mexico and Argentina

Front-of-package nutrition labelling policies in Uruguay, Mexico and Argentina | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Front-of-package nutrition labelling policies in Uruguay, Mexico and Argentina Laís Amaral Mais, Paula Véliz, Ana María Narvaéz-Olaya, Fabio Silva Gomes, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6691348/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim: To document and analyse the processes of discussion, approval and implementation of front-of-package nutrition labelling regulations in Uruguay, Mexico and Argentina to provide insight into the strengthening of regulatory frameworks to prevent children overweight in Latin America and the Caribbean. Subject and methods: The study included a desk review and interviews with key stakeholders from government, international organizations, civil society and academia. A deductive-inductive analysis of the interviews was carried out and the data were triangulated with data from the desk review. The results were reported by stages of the political process and central themes. Results: It is necessary to analyse the health and nutrition, political and regulatory context of each country, as well as to safeguard the regulatory process against industry interference and guarantee social participation without conflicts of interest. Discussions on the details of the regulatory instrument should be based on scientific evidence. The support of international organizations throughout the regulatory process lend credibility and facilitates the sharing of lessons learned. Corporate political activities are very similar between countries and should be prevented, monitored, managed and exposed. The implementation and evaluation stages are as important as the approval of the regulations and should be incorporated at the start of the discussions to ensure their effectiveness. Conclusion: Each country has its own particularities, which must be considered throughout the regulatory process, although it is extremely important to learn from previous regulatory processes and benefit from successful experiences and possible improvements, guaranteeing human’s rights over commercial interests. front-of-package nutrition labelling obesity prevention malnutrition children and adolescents policy process Latin America and the Caribbean 1. Introduction Non-communicable diseases (NCD) are responsible for 80.7% of deaths per year in the Americas [ 1 ]. The prevalence of overweight is 8.6% [ 2 ] and 30% [ 3 ] among children under five years of age and among children and adolescents between 5 and 19 years of age, respectively. In addition to increasing the risk of developing NCD and premature death [ 4 ], overweight and obesity represent high costs related to health care, caregiving, school and work absenteeism, as well as premature mortality [ 5 ]. In 2019, global costs attributable to obesity were estimated at more than US $ 990 billion per year [ 6 ]. This situation is directly related to changes in food environments, with unhealthy food and beverage products that have become physically and economically accessible, aggressively promoted and advertised [ 7 ]. These changes favour the increased consumption of processed foods with excess harmful nutrients and ultra-processed food products to the detriment of healthy eating [ 8 , 9 ]. Unhealthy diets infringe on girls' and boys' rights to health and adequate food, as well as the right to appropriate information and consumer protection against misleading information on food and beverage labels. The United Nations Committee for the Protection of Human Rights, the World Health Organization (WHO) and the Pan American Health Organization (PAHO) recommend that Member States adopt a set of public policies to promote healthy eating. Such policies are a mechanism to protect these rights by generating healthy environments and promoting the reduction of malnutrition, especially among children and adolescents. One of the regulatory measures recommended to promote healthier food choices is the implementation of front-of-package nutrition warning labelling (FoPNWL), indicating excessive amounts of nutrients harmful to health, such as sodium, sugars and total, saturated and trans fats [ 5 , 10 – 12 ]. Front-of-package nutrition labelling (FoPNL) is defined as a nutritional information tool presented in a simplified form on the front of the package of pre-packaged foods and beverages [ 13 , 14 ]. FoPNL systems are defined by their purpose and information provided. The FoPNWL is an example of a nutrient-specific interpretive system, which provides nutritional information for one or more nutrients/ingredients for guidance [ 11 ]. By identifying critical excess nutrients and the presence of other harmful ingredients [ 10 ], FoPNWL has the potential to help consumers understand the nutritional content of products and make healthier choices. Consequently, it can also encourage the reduction of such nutrients in the food portfolio [ 15 ]. Uruguay, Mexico and Argentina are three countries in the Latin American (LA) region that have approved and implemented the FoPNWL system using black octagons [ 5 , 16 ]. The characteristics of the graphic model, nutrient profile model and related regulatory measures are presented in Table 1 . In the LA region, there is substantial scientific evidence which shows the efficacy and effectiveness of the FoPNWL and reinforces its application. In Chile, the first country to implement nutrition warnings on the front of the package in 2016 [ 17 ], the population's knowledge of the Law [ 18 ], its correct interpretation and use [ 19 ] was demonstrated, in addition to the reduction of sugars, saturated fats and sodium content [ 20 , 21 ] and the reduction in the purchase of products "high in" critical nutrients [ 22 , 23 ]. The elimination of products with warning labels from advertising aimed at children and school environments, as required by Chilean Law, has reduced the consumption of critical nutrients by children and adolescents in schools [ 24 ]. In Uruguay, the immediate effects of the implementation of the decree showed a high degree of awareness and approval of the measure by the Uruguayan population, as well as a significant level of use of the FoPNL for food purchases [ 25 , 26 ]. In Mexico, as the Law is more recent, predictive analyses were made, which showed that the Mexican FoPNL has the potential to reduce the prevalence of obesity and the associated costs [ 27 ]. And in Argentina, an opinion survey showed knowledge and acceptance of the of the Law [ 28 ]. Considering that the LA region is the most advanced worldwide in terms of the implementation of FoPNWL regulations, the objective of this study was to document and analyse the processes of discussion, approval and implementation of the FoPNWL regulations in Uruguay, Mexico and Argentina to provide insight into the processes of strengthening regulatory frameworks in the region aimed at providing clear and easily understood nutrition information to consumers to prevent child and adolescent overweight and obesity in LAC. 2. Methods This study was based on a qualitative analysis including a desk review and interviews with key stakeholders. All data were collected in Spanish and/or English in the first semester of 2023. Uruguay, Mexico and Argentina were the LA countries chosen for this study because their FoPNL regulations are based on the octagon warning label design and came into force between 2021 and 2022. For the desk review, multiple sources were considered: official documents, legal publications, scientific articles, books, press releases, publications on websites and social networks, policy briefs and other relevant documents to understand the processes of discussion, approval and implementation of FoPNL regulations in Uruguay, Mexico and Argentina. These documents were identified through discussions with local experts and online searches. Six key stakeholders were identified from each country included in this study. The inclusion criteria were: to be or have been a representative of the government, an international organization, civil society or academia without commercial conflicts of interest (CoI), and to have followed and/or actively participated in the processes of discussion, approval and/or implementation of FoPNL regulations in Uruguay, Mexico and/or Argentina. Being an industry representative and having commercial CoI were considered exclusion criteria. Participation was voluntary and stakeholders were contacted by email or phone. All participants signed a digital written informed consent form. The semi-structured interviews took place in the first semester of 2023, lasted from half an hour to an hour and a half, were conducted online via the Teams platform, based on an interview guide specially developed for this study (Appendix 1), and were transcribed verbatim via the Teams platform and reviewed by LAM and AMNO. A content analysis of the interviews was carried out and the relevant information was extracted and organized into themes, based on a deductive-inductive analysis. The selected themes were: type of regulatory instrument; role of stakeholders; industry interference; response to industry interference; collaboration and support; human and children's rights; challenges, difficulties and threats; strengths and lessons learned; and next steps. The stages of the policy process were analysed using Knill and Tosun's (2008) [ 36 ] policy cycle model: 1) Context/agenda setting: the stage of identifying a social problem based on social, economic, cultural and ideological factors; 2) Policy discussion/formulation: stage of identification, exploration and discussion of multiple courses of action to address the problems identified, with the definition of the objective, instruments and configuration of the policy; 3) Policy adoption: the policy approval stage; 4) Policy implementation: the stage of transforming the policy into programs or actions and their application; and 5) Policy evaluation: the stage of evaluation of the policy, its processes and impacts by experts, with the identification of problems in the design and/or implementation [ 16 ]. The data were triangulated with information from the desk review to construct the case studies of the three countries analysed. The information is deidentified (Supplementary Materials 1 and 2). The study was funded by the United Nations Children's Fund (UNICEF) Regional Office for Latin America and the Caribbean (LAC) and was approved by the Research Ethics Committee of the University of São Paulo (USP) in Brazil (No. 6.589.062). 3. Results The case studies of each country analysed by the stages of the policy process and the themes that emerged from the desk review and key stakeholder interviews are presented above. The citations related to the stages of the policy process are presented in Supplementary Material 1 and the central themes in Supplementary Material 2, with an indication by code based on the country and the number of the order of appearance in the text, for example 'URU29, 'MEX32', 'ARG05'. 3.1 Uruguay 1) Context/agenda setting (dup: 3 ?) Between 2006 and 2013, there was an increase in the prevalence of overweight, obesity and NCD in Uruguay, which was closely related to a decrease in consumption of healthy foods and an increase in the consumption of ultra-processed food products (URU1). In addition, the previous mandatory Uruguayan nutrition labelling of packaged foods regulation did not meet its objectives of adequately informing consumers, since the majority of the population did not read the nutritional information on the packages because of the size of the font and the use of technical terms [ 37 , 38 ]. Faced with this dire nutrition and health situation, in 2013, the government, civil society, international organizations and the food and beverage industry committed to the development of actions to improve the food environment, which included regulatory measures, however, these were not formalized [ 39 ]. In the same year, the Law No. 19,140 "Protection of the Health of the Child and Adolescent Population through the Promotion of Healthy Eating Habits" was created, which aimed to protect the health of the child and adolescent population through the promotion of healthy eating habits in the educational environment [ 40 ]. The implementation of FoPNL was included in the agreement with policy recommendations for the prevention and control of obesity signed by the Southern Common Market ( Mercado Común del Sur - MERCOSUR) in September 2015 [ 41 ], and in the national strategy for the achievement of the Sustainable Development Goals (SDGs), built from the participatory process "Social dialogue: Uruguay towards the future", launched the following month by the Uruguayan government [ 42 ]. The analysis of interviews indicated that the presidential government which took office in 2015 was very committed to public health issues and included among the national health objectives, the promotion of healthy eating habits from improved food environments. In 2016, the "Food Guide for the Uruguayan Population" [ 43 ] was published, which is based on the Nova food classification system [ 44 ], including discouragement of the consumption of ultra-processed food products and the recommendation of a diet based on fresh and minimally processed foods (URU2). 2) Policy discussion/formulation (dup: 4 ?) From 2016 to 2018, the design process of the Uruguayan FoPNL Standard took place, with the creation of an interdisciplinary and interinstitutional working group (WG) by the Ministry of Public Health, with the participation of different Ministries, other government bodies, the academia and international organizations [ 37 , 45 ]. The work was based on local scientific evidence, generated by the Interdisciplinary Nucleus "Food and Well-Being" of the University of the Republic ( Universidad de la República - UDELAR), to justify all the decisions on FoPNL policy [ 46 – 49 ]. The group selected a FOPNWL system with the PAHO nutrient profile model as the most appropriate for the Uruguayan reality, which was drafted in a draft decree (URU3). International consultations were held with the World Trade Organization (WTO) and a public consultation happened in June 2017, opened by the Ministry of Industry, Energy and Mining [ 50 ]. Based on the contributions received, the final version of the decree was drafted in November 2017. In June of the following year, an agreement was published among the MERCOSUR health ministers on the general principles of the FoPNL to be implemented by the member countries of the bloc [ 51 ] and the proposed decree formulated in Uruguay was in line with this. 3) Policy adoption (dup: 5 ?) In August 2018, the Executive power signed the Decree No. 272/018, with more flexible limits for sugars, sodium and total and saturated fats than the PAHO model, an extended deadline of 18 months for its entry into force (in March 2020) and the provision for the modification of the decree in case of the approval of a regulation in MERCOSUR [ 52 ]. 4) Policy implementation (dup: 6 ?) With the approval of the decree, Uruguay immediately submitted a request to MERCOSUR to initiate the development of a regional technical regulation on the FoPNL based on FoPNWL [ 53 ]. In parallel, the Uruguayan Ministry of Public Health made procedural changes necessary to support the implementation of the decree and included the warnings in a public campaign on healthy eating [ 54 , 55 ]. In June 2019, the Food Industry Chamber ( Cámara Industrial de Alimentos - CIALI) requested a one-year postponement for the entry into force of the decree with the justification that the time was insufficient to change packaging and reformulate products, in addition to the lack of printing capacity for the new packaging in the country [ 56 ], which was granted. On March 1, 2020, the same day that the decree became mandatory, it was suspended by the president, with a 120-day postponement of its entry into force, and an inter-ministerial WG was created to review it with a focus on the harmonization with MERCOSUR [ 57 ]. With the difficulty of reaching a consensus from the WG and with the publication of studies showing public acceptance of the policy and the immediate effects of its implementation [ 25 , 26 ], in June 2020 the Ministries of Public Health and of Industry, Energy and Mining announced that the FoPNL policy would be maintained, but with some changes [ 45 ]. From the discourse analysis, the postponement of the implementation of the Decree and for the new government and the technical changes that made it less rigorous had to do with the lobbying of the food and beverage industry (URU4, URU5). Decree No. 246/020 was published in September 2020, with changes in the nutrient profile model and in the declaration basis, which became 100 g or 100 ml, justified by an adaptation for Chile's nutrient profile and to enable harmonization with MERCOSUR [ 58 ].The intention was to further weaken the criteria that had already been made flexible, but the changes culminated in a nutrient profile model that would label more products with warnings, and a few days before its entry into force on February 1, 2021, another Decree No. 034/021 was approved with other changes in the nutrient profile model, further weakening the limits for solid products [ 59 ]. The explanation of the Ministry of Public Health was that the new decree would maintain the number of labelled products but based on 100 g or 100 ml [ 58 ]. The Ministries of Public Health and of Industry, Energy and Mining were summoned in Parliament to explain the changes and the process that culminated in approving the Decree of 2021 [ 45 ]. For government and civil society representatives, the changes in these decrees were not justified, leading to the belief that economic interests and industry pressure interfered with government decisions and overrode public health interests, especially concerning to the nutrient profile model (URU6, URU7, URU8). 5) Policy evaluation (dup: 7 ?) Since 2020, the year Decree No. 272/018 was expected to come into force, academia has been conducting data surveys to understand the implementation of the policy by the industry and how consumers are using the nutritional information (URU9). As a result of monitoring the implementation of the Decree, civil society has publicly countered arguments and denounced the food and beverage industry for non-compliance or consumer deception. As the bromatological control and registration of food in Uruguay is the responsibility of each of the 19 departments of the territorial units, there was a great fragmentation in the control of the implementation of the Decree. Thus, there is a joint work between the government and international organizations to build a single food registry for the whole country in 2023 with the commitment of all Uruguayan departments (URU10). Type of regulatory instrument According to the discourse analysis, at the time of the discussions in the WG, the establishment of the FoPNL policy as a decree was the recommendation of the Ministry's legal advisors, as it was the fastest and most efficient process to advance the policy. In addition, as with other sectors, food regulations in the country have been issued as decrees, including the bromatological regulation, with which the other decrees are associated (URU11, URU12). Thus, the option of the decree meant instability during the different governments and a fragility of being easily modifiable, as occurred throughout the Uruguayan process of approval and implementation of the FoPNL policy, leading to technical weaknesses [ 38 ]. According to a government representative, there is a work to pass a law on healthy food environments based on the FoPNL in order not to have the fragility of a decree, as it happened with the FoPNL Decree (URU13). Role of stakeholders The Uruguayan Executive government, with the Ministry of Health as the leader and the Ministry of Industry as the co-leader, organized and coordinated the intersectoral and interdisciplinary WG that discussed and developed the original FoPNL Decree, with the participation of representatives from academia and international organizations (URU14, URU15). In addition, government agents also participated in the inter-ministerial WG created in 2020 to discuss the next steps regarding the Decree in the new Uruguayan administration. The role of academia, especially from the Interdisciplinary Nucleus "Food and Well-being" of the UDELAR, was to generate scientific evidence to base the technical discussions and support decision-making on the draft decree on the FoPNL, based on the participation in the processes of discussion and design of the Standard. Representatives from academia and government reported that all technical decisions were based on specific studies to answer the questions regarding the Decree and highlighted the importance of having local evidence for decision making (URU16, URU17). Uruguayan civil society, through the Alliance for Non-Communicable Diseases ( Alianza de Enfermedades no Transmisibles - ENT) (the Alliance ENT), took a more active role in the FoPNL process in 2020, when changes in the Decree and in the policy's implementation deadlines began. In the same year, the Alliance ENT launched a mass and digital media campaign in defense of the FoPNL, with the aim of keeping the population informed and stimulating critical behaviour in relation to the current situation and the food and beverages consumed. According to the constant changes in the regulations and their implementation, the campaign messages were adapted [ 37 , 38 , 60 ]. Based on the scientific evidence, civil society sensitized government agents through meetings, and the Uruguayan population through press conferences on the issue, and confronted the food and beverage industry, which at the time was lobbying hard against the implementation of the measure (URU18). Between October and November 2020, with the aim of finding out the population's opinion on the FoPNL and its willingness to change its purchasing behaviour in the face of the new labels, civil society conducted a survey. The results showed the population's knowledge and agreement with the measure, ease of understanding the information, and change in purchasing behaviour [ 37 ]. In May 2021, another survey was conducted with the Uruguayan population to know their opinion on aspects of the FoPNL and their possible behaviour towards it, which showed the ease of reading the labels and the change in the intention to purchase products with octagons [ 38 ]. International organizations played a very important role in the Uruguayan FoPNL process: the participation in the WG for the drafting of the 2018 Decree, the generation and compilation of scientific evidence for use in advocacy at different key moments, the production of educational materials to raise awareness among the population, the publication of a joint position paper [ 61 ], the organization of a seminar and meetings with government agents to defend the maintenance of the original Decree, the launch of a digital campaign and press interviews, and support to the government in the process of monitoring compliance with the Standard by updating the national food registry database and the implementation of a single registry at the national level [ 45 ]. Industry interference Interference from the food and beverage industry occurred throughout the entire FoPNL regulatory process in Uruguay. During the design stage of the Standard, the argument used was that the FoPNWL stigmatizes foods and generates fear and confusion among consumers, with the proposal of the traffic-light labelling model as a more appropriate alternative to inform them. Criticism was also made of the PAHO nutrient profile model, arguing that it labels too many products too harshly and does not encourage reformulation. The economic narrative of job losses, rising food and beverage prices due to reduced sales and the closure of companies in the country was also present, including in public speeches in the press from CIALI and the Association of Importers and Warehouse Wholesalers ( Asociación de Importadores y Mayoristas de Almacén - AIMA) [ 37 , 38 , 62 ] (URU19). The food and beverage industry was internationally articulated for the submission of its contributions to the Uruguayan public consultation, according to the discourse analysis (URU20). The arguments presented had to do with the fact that the FoPNL do not contribute to the reduction of obesity and NCD prevalence, since they are multifactorial diseases and require other measures, such as the promotion of physical activity and nutritional education. In addition, the industry defended self-regulation and asked for more time for the application of the regulations, the adaptation of their products from reformulation and the change of packaging. As an alternative to the PAHO nutrient profile model, the industry recommended limits based on portions of consumption and different by food category, as in the case of dairy products [ 37 , 38 , 62 ] (URU21). In the public consultation and at the stage of the changes in the FoPNL Decree, the food and beverage industry claimed lack of scientific evidence for the selection of the warning system [ 62 ] and even questioned the results of experimental studies developed by academia without CoI [ 63 ]. It is important to note that the discourse did not always come directly from an industry representative, but also from spokespersons from academia and scientific societies linked to the production of food products, as reported by a government representative (URU22). The argument of disharmony with international agreements, especially MERCOSUR, was used by both the industry and the government, from public consultation, in legal actions, to questioning after the approval and implementation of the Decree, justifying changes in technical aspects and in the deadline for its entry into force [ 37 , 38 , 62 ] (URU23, URU24). The food and beverage industry carried out actions against civil society throughout the process. In the form of a legal action, the president of CIALI filed a complaint for defamation and libel against the coordinator of the Alliance ENT, in addition to intimidating actions and threats through social networks when civil society exposed the non-compliance of the Decree by some companies [ 38 ]. As a result of the various changes in the decrees and their implementation deadlines due to pressure from the food and beverage industry, there was an inequality in the timing of implementation of the FoPNL by the companies, which generated confusion for consumers (URU25, URU26). Response to industry interference Once the deadline changes were made in a few days and some food and beverage industries had already changed their packaging, the generation of scientific evidence to base the Uruguayan Standard and to verify the immediate positive effects of its implementation were essential to maintain the policy with its technical characteristics and its force in 2020. Its use ranged from publications in scientific journals, to press releases and technical reports with simple language translating the scientific evidence for the population and decision makers (URU27). The mass and digital media campaign developed by the Uruguayan civil society exposed all the changes in the implementation deadlines of the FoPNL Decree to become evident the interference that the government was suffering. According to the discourse analysis, the space occupied by academia and civil society in the press was an important strategy to counter the arguments and narrative of the food and beverage industry (URU28). The joint work for a common goal between academia, civil society and international organizations guaranteed by inter-institutional spaces and the formation of alliances was registered by a representative of academia as an important strategy to strengthen evidence, arguments, tactics and activities in favour of the approval and the implementation of an adequate and effective FoPNL policy (URU29). Collaboration and support Uruguayan civil society used evidence, arguments, experiences and lessons learned from the FoPNL regulatory processes, mainly in Chile and Brazil, but also in Peru, Mexico, Argentina and Colombia. Information was exchanged through meetings and events, and declarations were signed, with regional support especially facilitated by the Healthy Latin America Coalition ( Coalición Latinoamérica Saludable - CLAS). In the specific case of MERCOSUR, there was collaboration between the civil societies of Uruguay, Argentina and Brazil for the exchange of information, since, at the beginning, not all countries were allowed to participate in the official meetings [ 38 ]. According to a civil society representative, such collaboration was essential to have information on what was happening in the official MERCOSUR meetings and to prepare for advocacy in Uruguay (URU30). In addition, there was technical and political advocacy work for the signing of the agreement of the MERCOSUR health ministers on the recommendations for an effective FoPNL, which, according to a representative of the academia, served as a political endorsement to move forward with the Uruguayan process independently of the other countries of the bloc [ 51 ] (URU31). From international organizations, in 2020, PAHO, UNICEF and FAO held meetings with representatives of the Executive and Legislative powers to highlight the benefits of the FoPNL for the health and well-being of adults and children [ 64 ], and a position paper was published and disseminated in all countries of the region in an attempt to give greater coverage to what Uruguay was advocating for [ 61 ]. According to a civil society representative, regional progress on FoPNL is seen as a push for more and more countries to have the strength to initiate discussions and implement effective regulatory measures, in addition to strengthening those countries that have already implemented the measure (URU32). Human and children's rights Human rights, especially the rights to adequate food, information and children's, were considered at the beginning and during the FoPNL discussions in Uruguay. Issues such as health protection, food habit formation, stimulus to consumption from advertising strategies on packaging, and the occurrence of NCD in children at an increasingly early age were addressed. According to the discourse analysis, it is the duty of the State to develop policies that guarantee the full exercise of the right to food of the entire population, especially children and adolescents (URU33, URU34). Challenges, difficulties and threats According to a government representative, placing the issue on the public agenda was a major challenge at the beginning of the Uruguayan regulatory process, with the construction of the confluence of interests and joint, intersectoral and interdisciplinary work with health objectives between governmental and academic agents (URU35). The generation of scientific evidence was also seen as a challenge by a representative of the academia, because at the time of the beginning of the discussions, there was still nothing published on FoPNWL, which created the evident need to develop local evidence (URU36). One challenge highlighted was the facilitated entry of the food and beverage industry into the government and the linkages and funding of civil society activities, events and associations, which generated division among organizations and discourses against scientific evidence during the discussion of the Decree, according to a civil society representative (URU37). An attempt was made during the public consultation to argue that MERCOSUR regulations would be an obstacle, when the Ministries of Economy and Foreign Affairs and the food and beverage industry claimed concern with potential negative consequences of the regulation on trade in MERCOSUR [ 45 ]. This culminated in changes to the final Decree. After its approval, the lack of harmonization in MERCOSUR was also used as the main argument in a legal action against the Decree No. 272/018 by a group of eight Uruguayan food importers. A Uruguayan producer of processed meats also filed a legal action against the Decree, justified by the limitation of the right to property, freedom of industry and commerce [ 65 ]. The need for harmonization with the bloc was once again used when the new government suspended the Decree No. 272/018 in March 2020 [ 57 ], and by the inter-ministerial WG in its recommendation for a delay in the implementation by July 2021 [ 45 ]. The changes promoted in the Decree No. 246/020 in relation to the nutrient profile model and in the declaration’s basis were justified as an attempt to harmonize with MERCOSUR [ 58 ]. Finally, as part of Decree No. 272/018, it was established that the national regulation will be modified in the event of the approval of a FoPL regional regulation at the MERCOSUR level [ 59 ]. With the approval of a decree that went through so many changes in the nutrient profile model without justifications and without being based on scientific evidence, according to a civil society representative, there was a weakening of the policy and a detriment to products aimed at children, especially dairy products, which ceased to have labels of excess sugars and saturated fats [ 38 ] (URU38). From the academia's point of view, the lack of involvement and awareness of the entire political system and the discontinuity of the government's actions were a major difficulty, as it culminated in many changes and delays in the Decree originally proposed by the interdisciplinary and inter-institutional WG in 2018; both the 18-month extension for the entry into force of the policy, which coincided with the start of the new government, as well as the discussion without the involvement of the entire political system. In the end, it was a political decision, without the participation of the technical team or representatives of academia or civil society. In addition, the lack of problematization of the need to regulate food environments in the political system was also seen as a difficulty (URU39, URU40). Finally, the Ministry of Health's oversight challenge is described, due to the lack of prioritization and qualified personnel. It was only after the Alliance ENT put pressure on and took on the role of supervising the policy at the points of sale that the Ministry presented partial results for a small percentage of products. Thus, for the products that were not complying with the Decree, a new extension was granted by the government. Civil society demanded transparency and participation in the processes of control and supervision of the implementation of the measure [ 38 ]. Strengths and lessons learned A strength and a lesson learned considered by a government representative was that the Uruguayan policy, especially at the time of the technical discussions in the WG, was driven by several institutions and strongly led by the Ministry of Health, especially because the project was based on national and international scientific evidence (URU41). From the point of view of international organizations, the continuous generation of scientific evidence on the effects of the policy is necessary (URU42). From the civil society, the coordination of the joint work was considered a strength, since it gave public visibility to the topic and allowed to guide it in society, with reflections and questioning, including a strong presence in the press (URU43). The need to have a communication team with targeted strategies to counteract the industry narrative and translate the scientific evidence for the population was also highlighted, since it is a cultural change issue (URU44). The frequent strategies of the food and beverage industry were highlighted, which generates the need for action at the territorial level from civil society and international organizations for greater capillarity and effectiveness (URU45). Uruguay's decision to move forward with a decree and not having discussions of the FoPNL issue throughout the political system resulted in the discontinuity of the policy and changes in the norm. Thus, an important learning highlighted from the academia was the need to involve and empower the entire political system so that the discussion is strengthened (URU46). Next steps For Uruguay, it is important to advance in legislative frameworks that have continuity from the promotion of healthy eating and the regulation of food environments based on the FoPNL rules, such as the regulation of food and beverage advertising. The government is working on a bill with the concept of healthy food environments that contributes to the right to food (URU47). From the point of view of civil society, the improvement of the technical aspects of FoPNL Decree should focus on a stricter nutrient profile model, like the PAHO’s; the regulation of advertising strategies on food and beverage packaging; the inclusion of the information on sugars in the nutrition facts panel and the standardization of the names of sugars in the list of ingredients; and the inclusion of a cautionary legend about the presence of sweeteners and caffeine in the products. In addition, it is necessary to restrict the advertising, promotion and sponsorship of unhealthy foods and beverages, especially for children and adolescents; and to prohibit the sale and advertising of these products in specific environments, such as educational centres, health institutions and state and non-state public agencies [ 38 ]. 3.2 Mexico 1) Context/agenda setting (dup: 8 ?) Proposed by the Mexican Council of the Consumer Products Industry ( Consejo Mexicano de la Industria de Productos de Consumo - ConMéxico) [ 66 ], which represents the largest producers of ultra-processed food products in the country, in 2014, the Guideline Daily Amounts (GDA) [ 67 ] were implemented, a FoPNL system proven ineffective to support the Mexican population in making dietary choices based on their use and understanding [ 68 , 69 ]. The Mexican GDA was neither elaborated nor discussed with experts in the field, representatives of civil society or academia (MEX1), and its approval process lacked transparency and scientific evidence [ 70 ]. In 2016, the Mexican government declared an epidemiological emergency due to high levels of obesity and diabetes [ 71 ] and in November 2017, the Ministry of Health requested the National Institute of Public Health ( Instituto Nacional de Salud Pública - INSP) to form the "Committee of National Academic Experts on Front-of-Package Labelling of Food and Non-Alcoholic Beverages for Better Health", with 31 professionals without CoI to work on the development of an effective FoPNL system [ 72 ]. In October 2018, the Forum "The policy against obesity in Chile, the best example for the Mexican Legislative" took place in the Chamber of Deputies. Subsequently, during the new administration, with the support of a group of experts, the Federal Commission for Protection against Health Risks ( Comisión Federal para la Protección contra Riesgos Sanitarios - COFEPRIS) prepared a working document and conducted a regulatory impact analysis. Thus, according to international organization and government representatives, with the change of the federal government and the Congress in 2019, there was greater concern and commitment to address the determinants of NCD with a public health approach and based on scientific evidence. Among the priority issues was the food labelling (MEX2, MEX3). In addition to the growing evidence against the GDA and the worrying epidemiological situation of the Mexican population, the time came for the mandatory revision of the Mexican Official Standard NOM-051-SCFI/SSA1-2010, General Labelling Specifications for Pre-Packaged Foods and Non-Alcoholic Beverages-Commercial and Sanitary Information (hereafter NOM-051) (which should occur every five years). For that, there was great support from academia through INSP and a push from civil society, represented by the Alliance for Healthy Eating ( Alianza por la Salud Alimentaria ), with support from PAHO and UNICEF, to adopt the most beneficial option for the population (MEX4, MEX5). 2) Policy discussion/formulation (dup: 9 ?) Discussions for the modification of the General Health Law (GHL) and the NOM-051 were initiated in 2018 and 2019, in the Legislative and Executive powers, respectively. The modification of the GHL was marked by the working table "Obesity in Mexico: a policy to combat the epidemic" in the Chamber of Deputies in February 2019, with the presence of representatives of the Ministries of Health and Economy and driven by civil society [ 73 ]. In July of the same year, INSP and UNICEF convened the Expert Forum "Regional experiences in the implementation of nutritional warning labelling in the face of food industry interference" to support the process of amending the GHL and the NOM-051. The experiences and lessons learned in the process of designing, implementing and evaluating the FoPNWL in LAC countries, with emphasis on the tactics and arguments of the food and beverage industry, were presented to decision-makers from both the Legislative and Executive powers [ 74 ]. In August 2019, the public hearing "Front-of-package nutrition labelling and healthy diet choices" of the Open Parliament was organized, with the participation of representatives from academia, civil society, international organizations and the food and beverage industry. With the resumption of congressional sessions in September 2019, the discussion for the modification of the GHL was reactivated and UNICEF prepared a technical note for legislators of the Chamber of Deputies and the Senate [ 75 , 76 ]. COFEPRIS coordinated the work tables for the discussions on the modification of the NOM-051, based on the presentation of the draft document, with technical support from INSP, PAHO y UNICEF. The process followed the legal procedures for the modification of NOMs, starting with the formation of an inter-institutional technical WG for the analysis and review of the preliminary draft of the NOM modification, with the participation of representatives from government, academia, civil society, international organizations and the food and beverage industry. The public consultation was opened in October 2019, with the publication of the "Draft Amendment to Mexican Official Standard NOM-051-SCFI/SSA1-2010, General Labelling Specifications for Pre-packaged Foods and Non-Alcoholic Beverages-Commercial and Sanitary Information" in the Official Journal of the Federation ( Diario Oficial de la Federación - DOF), together with the consultation of the Regulatory Impact Matrix ( Matriz de Impacto Regulatorio - MIR) for the analysis of the costs and benefits of NOM-051 [ 77 ]. By the close of December of the same year, the consultation received more than 5,200 comments. In the same month, the meetings of the technical WG were resumed, with the review, analysis, discussion and resolution of the comments on the preliminary draft of the NOM-051 from the public consultation. The nutrient profile model was the only point on which a consensus could not be reached, so it was submitted for voting and approval by the National Consultative Committees for Standardization of COFEPRIS and the Ministry of Economy [ 78 ]. In January 2020, COFEPRIS and the Ministry of Economy approved the modification of the NOM-051 [ 79 ], which was threatened in the following month by a provisional suspension of an appeal, by the Confederation of Industrial Chambers of the United Mexican States ( Confederación de Cámaras Industriales de los Estados Unidos Mexicanos - CONCAMIN), which delayed the publication of the process by ten days. In March, CONCAMIN ordered the delay of the implementation of the FoPNL by at least three years due to the COVID-19 pandemic, which did not occur [ 71 ]. 3) Policy adoption (dup: 10 ?) In October 2019, the Chamber of Deputies and the Senate approved the amendments and additions to the GHL, with its publication in the DOF in the following month, with the following modifications: the definition of FoPNL and how it should be presented on the packaging [ 31 ]. With the GHL approved, in March 2020 the modification of the NOM-051 [ 32 ] was published in the DOF, shortly after the publication of the responses to some of the comments received in the public consultation on the preliminary draft [ 80 ]. 4) Policy implementation (dup: 11 ?) According to the nutrient profile model chosen, the implementation of the Standard will be given in three progressive phases of adaptation, to support food and beverage producers in the transition to the new rules [ 32 ]. Since the approval of the FoPNL policy, several food and beverage industries have filed several appeals with the Mexican Supreme Court of Justice ( Suprema Corte de Justicia de la Nación - SCJN) against the measure, arguing, for example, about the violation of the right to equality and discrimination. So far, all the appeals filed were denied [ 81 ]. Questioned by Mexican civil society, the United Nations Special Rapporteurs on the Right to Food and the Right to Health sent a letter to the Alliance for Healthy Eating in November 2022, which was shared with the Mexican Ministers, to express their concern about the appeals of the food and beverage industry to the SCJN [ 82 ]. Different experts and organizations dedicated to food, nutrition, public health, human rights and consumer rights have filed amicus curiae briefs and letters to the SCJN to defend the Mexican FoPNL policy [ 83 ]. 5) Policy evaluation (dup: 12 ?) From academia, there is a need to generate evidence on a permanent basis. Thus, studies are being developed to measure the impact of the FoPNL, especially on product reformulation by the food and beverage industry and on decision-making and change in purchases by consumers of different age and population groups, which is shown to be positive (MEX6). Type of regulatory instrument In Mexico, the various actors that participated in the discussions of the FoPNL had different visions of the most appropriate and possible type of regulation for the country. According to a civil society representative, the Ministry of Health proposed a specific law, as in Chile. Some civil society organizations proposed to focus only on the modification of the NOM-051, and others saw the importance of the modification at the level of the law, considering that it is hierarchically superior to the NOM (MEX7, MEX8). Role of stakeholders In Mexico, academia, represented by INSP, was always very involved in the process of modifying the NOM-051, including as technical support for the Executive power from the Secretaries of Health and Economy and COFEPRIS (MEX9). From the academia's point of view, appointing INSP as the coordinator of the national group of experts on food labelling was strategic, as it was responsible for generating scientific evidence throughout the process, developing the draft proposal and participating in the NOM-051 modification sessions, all based on discussions with national and international advocacy and research actors without CoI (MEX10). Mexican civil society and international organizations worked closely with academia throughout the entire FoPNL discussion process, both in the Legislative and the Executive powers. They participated in technical discussions, carried out advocacy actions with legislators, publicized the scientific evidence produced by the academia, conducted communication campaigns to generate favourable public opinion and lobbied for an effective FoPNL (MEX11). According to civil society and government representatives, during the WG discussions, there was the signing of a confidentiality statement that prohibited participants from going public, which favoured internal work in support of the academia in confrontations with the food and beverage industry (MEX12, MEX13). Industry interference Industry interfered throughout the discussion and approval processes of the Mexican Law and Standard, and continues to interfere in the implementation process. They had a performance in the Congress, from lobbying with legislators to try to block the proposal and the discussion of the GHL. Other initiatives were presented by legislators and there were times when it was impossible to vote in the commissions due to the lack of a majority. But, when the Law was approved in the commissions, they began to act through the media to discredit the FoPNWL, with false and confusing arguments for the population. The interference in the process of updating the NOM-051 with the WG was done in compliance with the regulations and, although the other participants had a very coherent position and made it difficult to use their arguments, sometimes the industry would pressure or try to convince members of the Executive power with arguments that seemed to be supported by science (MEX14). According to international organization and government representatives, the food and beverage industry was always in disagreement and tried to misinterpret scientific evidence (MEX15, MEX16). The industry did not always act directly. It relied on professional and research groups with CoI to defend its narrative, used its own non-government organization (NGO) to serve as the public face and defend its arguments, and used industry chambers to avoid directly exposing its brands. Among the arguments used by the industry throughout the process is the fact that they were not heard, which is not true, since at least 60% of the members of the WG were from the food and beverage sector. Regarding the chosen FoPNL system, there was a questioning that it was not based on scientific and technical evidence, even when the nutrient profile was adapted from the PAHO model, and during the work meetings, 170 national and international scientific articles were submitted to support the FoPNL, in addition to the position and recommendations of recognized international organizations, such as FAO, UNICEF, PAHO and WHO. The issue of impacts on intellectual property and trademark rights were brought up because of the restriction on the use of characters and other images, which had to be weighed against the best interest of the child and his or her right to health. The lack of scientific evidence on the cautionary legend about the presence of sweeteners was also used as an argument against the Standard, even with the presentation of scientific evidence on the metabolic effects of the consumption of the ingredient and the position of national organizations against the use of sweeteners by the children [ 84 ]. The presentation of more than 140 appeals was initiated at the end of the discussions at the working tables and continues to occur, even after the approval of the Law and the Standard for the FoPNL, with arguments of lack of scientific evidence and commercial limitations [ 85 ] (MEX17). According to a representative of an international organization, the arguments focus on the unconstitutionality of the process to question the nutrient profile model of the FoPNL and the restriction of the use of characters (MEX18). Response to industry interference Since the adoption of the GDA in 2014, Mexican civil society has denounced its approval process without transparency or social participation, in addition to the FoPNL system itself, which was not effective. Internal letters from WHO and PAHO to the Ministry of Health and COFEPRIS were made public in The New York Times stating that the GDA was inadequate. Through a request for access to information from civil society, the existence of a WG was questioned, to which COFEPRIS itself replied through official letters that there were no working meetings or such a group. According to a civil society representative, through Foreigner Legal Assistance of the United States, information was obtained confirming the absence of WG for the approval of the GDA, and the presence of communication between COFEPRIS and Coca-Cola (MEX19). Mexican civil society also filed appeals on how the GDA violated the right to information, health and children's rights. Due to the influence of the industry on some SCJN ministers, civil society lost the battle, but they won it in public opinion (MEX20). The exposure of the industry interference also occurred from discussions in the Legislative power by civil society, which was also denounced by legislators with respect to heavy lobbying in the Congress (MEX21). Specially to defend the caffeine and sweetener cautionary legends and the regulation of characters and other images, the main argument used by civil society, academia and international organizations was the best interest of children, which should be put before any other interest, including the commercial ones. The evidence shows the need to protect children from infant advertising and the potential harm caused by the consumption of caffeine and sweeteners during childhood [ 75 ]. All the strategies and arguments used to refute the industry and to defend the FoPNWL in the technical roundtables were based on national and international scientific evidence. According to a representative of the academia, the strategy was to generate studies based on the needs of the process, with a focus on the best available evidence (MEX22). The Alliance for Healthy Eating produced the series "Excessive Lies in Industry Arguments" based on scientific evidence to expose ten myths of the food and beverage industry about the Mexican FoPNL [ 86 ]. When the measure was implemented, campaigns were carried out to stimulate the consumption of healthy foods and discourage the consumption of ultra-processed food products, with messages such as "Consume food, preferably without labels and with fewer labels", in addition to promoting the FoPNL and denouncing companies that violated it (MEX23). Collaboration and support Before the start of the discussions, in 2018, the Forum "The policy against obesity in Chile, the best example for the Mexican Legislative" took place in the Chamber of Deputies, with the participation of a Chilean researcher who participated in the formulation of the evidence to support the design of the Chilean FoPNL. Subsequently, at the beginning of a new administration and to support the process of modifying the GHL and the NOM-051 in Mexico, the Expert Forum "Regional experiences in the implementation of nutritional warning labelling in the face of interference by the food industry" was promoted, with the participation of representatives of international organizations such as PAHO, UNICEF and the World Cancer Research Fund International (WCRF), academia from Chile and Uruguay, civil society from Brazil, Peru and Mexico, and the government of Ecuador, with the exchange of experiences, arguments and lessons learned. As a result of this forum, the document "Experiences on the design and implementation of nutrition warning labelling in Latin America and the Caribbean" was published with 15 general recommendations for Mexico [ 74 ]. From the point of view of civil society, the collaboration was also clear in the publication of public statements in favour of the Mexican FoPNL, specific discussions with researchers and advocates from other countries in the region and the exchange of local evidence (MEX24, MEX25). International organizations published documents, press releases and public talks in favour of the adoption of the FoPNWL [ 75 , 87 – 91 ]. Human and children's rights The modification of the NOM-051 brings a focus on human rights and the best interests of children, with information also related to health. Since the preschool and school-age population groups are those with the highest proportion of calories from ultra-processed food products in their diets, the FoPNL has a particular benefit for them [ 75 ]. The focus on children is very visible in the mini warning labels for small packages, the caffeine and sweetener cautionary legends, as well as the restriction of characters on the packaging of products high in critical nutrients. The work of civil society was closely connected with the network for children's rights in Mexico and with UNICEF (MEX26), and evidence was generated on children's understanding of the FoPNWL (MEX27). Challenges, difficulties and threats According to a representative of the academia, at the beginning of the discussions, the work of diverse actors including government, academia and civil society organizations, implied a challenge to have a common vision on the FoPNL process. The different ways of operating, concerns and mistrust had to be put aside to advance the joint work for public health (MEX28). Industry interference throughout the process was recognized as a major challenge during the FoPNL discussions, both at the Legislative and Executive levels (in the WG and directly with the Presidency and his office), as well as at the international level. The Mexican industry filed objections to the regulation to the WTO [ 92 ] and used the Codex Alimentarius and international connections to argue about rights and trade barriers. According to a representative of the academia, sitting at the table with equal voice and vote with the objective of having a beneficial norm for the population and that all participants in the discussions were satisfied was a great challenge (MEX29). From the point of view of academia, the appeals filed by the food and beverage industries are seen as a threat to the FoPNL, since an unfavourable decision could jeopardize the entire policy or some of its most important elements for public health and the protection of children. It must be considered a battle of the legal departments of the largest food and beverage industries in the world against the small legal department of the Ministry of Health in the SCJN. Thus, the government, academia, international organizations and representatives of other countries are attentive to what is happening in the discussions of the appeals (MEX30). Strengths and lessons learned In the Mexican process, the adequate time to appear in the press to lobby public opinion, the exposure of the industry interference throughout the process, the alliance with authorities, researchers and international organizations committed to science, and the generation and use of scientific evidence as a basis for discussion were important lessons learned [ 93 ]. From the point of view of an international organization, the synchronization of the work in the Legislative and the Executive powers was essential to strengthen the FoPNL and reduce the likelihood of legal challenges (MEX31). From academia, the intensity of the discussions between the strategic actors was recorded and how important it is to know how to communicate and sell health messages to convince the need for a FoPNWL policy. In addition, despite the initial difficulty of having a common vision, learning from the formation of links and organization between civil society, academia and government was essential for the approval of an appropriate standard for Mexico (MEX32, MEX33). The criteria established in the Mexican Standard for the FoPNL are seen as a strength, made possible by the change of experiences and recommendations from other countries, with the adaptation of the PAHO nutrient profile model, the adoption of cautionary legends for caffeine and sweeteners and mini warning labels for small packages, and the prohibition of characters and other nutritional images and endorsements. The approval of the Mexican FoPNL policy was commemorated by international organizations [ 88 ] and considered one of the best in the world [ 79 ]. The importance of accompanying the implementation of the policy with communication campaigns was highlighted, since there is an impression that it took a long time to do so in order to stimulate the use of the FoPNL by the population. In addition, the NCD policy will help the government to align other food policies, such as the regulation of school environments and the advertising in other channels (MEX34). Next steps The food and beverage industries are filing many appeals against the Mexican FoPNL policy. Thus, the efforts of the civil society, academia, international organizations and the government to defend the FoPNL continue. Another important step is to disseminate the Standard and make the population aware of it and use it appropriately. To this end, the Mexican government has implemented various campaigns [ 94 ] and, in particular, is working with UNICEF Mexico on the "Heroes for Health" [ 95 ] campaign on social networks aimed at children. However, the importance of a broader campaign for the whole population and of having evaluations of each campaign was registered by a representative of an international organization. The progress of other public policies linked or harmonized with the FoPNL Standard for the creation of a robust and efficient package of measures is in the plans of civil society, academia and UNICEF for Mexico, such as the case of food advertising aimed at children and adolescents, based on the recommendations of PAHO and UNICEF, and school environments (MEX35, MEX36). The constant generation of scientific evidence is essential for the argumentation in legal proceedings, but also for a possible revision of the Standard in five years, as provided by the Law. The evaluation of the NCD policy is being conducted by INSP, especially on product reformulation by the food and beverage industry, the effects on the economy and jobs, and the change in purchasing behaviour by consumers. 3.3 Argentina 1) Context/agenda setting With the launch of PAHO's "Action Plan for the Prevention of Obesity in Children and Adolescents" in 2014 [ 96 ], the approval of the Chilean Healthy Eating Law in 2015 [ 17 ], the start of the work of some civil society organizations and some legislators on the issue of regulation of food environments and the understanding of the FoPNL as a gateway to the regulation of food environments, discussions in Argentina on the FoPNL began (ARG1, ARG2). Since 2015, the FoPNL issue of became part of the agenda of different legislators. With the approval of the Chilean Law, the FoPNWL was incorporated into various bills, some of them advised by civil society organizations with no CoI, which had already been working on the issue [ 97 ]. With the change of government in December 2015, a new management was assumed in the Ministry of Health and the National Directorate for Health Promotion and Control of Chronic Noncommunicable Diseases and the National Advisory Commission on Healthy Eating and Obesity Prevention were implemented, with an intersectoral sub commission on NCD. From the point of view of an international organization, the new Minister of Health had the FoPNL as the main item on his agenda, with specific resources earmarked for its progress (ARG3). 2) Policy discussion/formulation According to a representative of an international organization, at the beginning of the discussions, the Argentine economic crisis was used, especially by the food and beverage industry, as one of the obstacles to progress on the issue, as if the FoPNL was irrelevant to the challenge of poverty and hunger, since it would not solve the real problem (ARG4, ARG5). Representatives of different government ministries and secretariats, civil society organizations, academia, international organizations and the food and beverage industry participated in the National Advisory Commission on Healthy Eating and Obesity Prevention, with the leadership of the Ministry of Health (NACHEOP). Discussions about FoPNL were based on international evidence and experience, in addition to valuing and encouraging the generation of local evidence, as reported by a government representative (ARG6). From the Ministry of Health and civil society, literature review studies on the FoPNL [ 98 ] and on the effectiveness of graphic designs [ 99 , 100 ] and nutrient profile models [ 101 , 102 ] were developed. All studies proved that the adoption of octagonal warnings applied using the nutrient profile model recommended by PAHO was the most appropriate for the Argentine population. In 2019, the 2nd National Nutrition and Health Survey ( 2ª Encuesta Nacional de Nutrición y Salud - ENNyS 2), conducted by the Ministry of Health, generated valuable information on the health, nutrition and food consumption status of the population, as well as information on beliefs, opinions and use of food labels [ 103 ]. To advise legislators on their bills, a document was developed by the NACHEOP, with declaration of CoI, with the best FoPNL standards based on the FoPNWL and the PAHO nutrient profile model, in parallel to the actions of the Executive power (ARG7). The Ministry of Health, civil society organizations and international organizations played an important role in this advice so that the best evidence was used and the bills were unified into an ideal one (ARG8). According to a government representative, the support of civil society was essential to provide it with tools and increase its knowledge since the presentation of its draft law on the FoPNL (ARG9). With the transformation of the Ministry of Health into the Government Secretariat of Health completed in 2019, the loss of power generated by this situation, and the change of government in 2020, the discussion of a unified bill was initiated, based on local and international evidence and experiences generated over many years of work. A representative of an international organization told about the union of legislators from different political parties to reach a consensus on this bill (ARG10). At that time, public opinion, the new political decision-makers and the legislators were already convinced of the importance of the FoPNL Law. The unified bill received a positive opinion in the Health and Industry Committees on October 22, 2020, and was sent to the Senate, which gave it half sanction on October 29, 2020, with 64 votes in favour and three against it. It was then forwarded to the Chamber of Deputies, where it was referred to four committees [ 97 ] (ARG11). 3) Policy adoption On July 13, 2021, the bill was discussed and approved in the internal committees of the Chamber of Deputies, and on October 26 of the same year, the day of the vote for the approval of the Law in the same Chamber, according to a representative of an international organization, the technical knowledge acquired on food environments, nutrition and FoPNL, as a result of the support provided by the Ministry of Health, international and civil society organizations (ARG12), was clearly noticeable in the speeches of the legislators. The Healthy Food Promotion Law was passed with 200 affirmative votes, 22 negative votes and 16 abstentions. According to the discourse of some deputies, the Law is a tool for health prevention and for guaranteeing the rights of the Argentines, based on legitimate access to clear, precise and understandable information that allows the promotion of healthy food consumption [ 104 ]. Its regulation was published in March 2022. On March 2nd, 2022, the Executive power issued a decree regulating the Law, which established that the Ministry of Health has the authority to enforce it [ 97 ]. 4) Policy implementation The first and the second stages of the implementation of the Law of Healthy Food were initiated in August 2022 and May 2023, with major deadlines for small and medium-sized companies ( pequeñas y medianas empresas - PyMES), respectively. In all cases, the companies were allowed to request an extension of 180 days [ 34 , 35 ]. According to the discourse analysis, the industry is bombarding the Ministry of Health with requests for extensions of the implementation of the Law (ARG13). It is necessary to consider that Argentina has a federal organization and, therefore, a part of the Law - the implementation of the FoPNL - is incorporated in the Food Code and is applicable in the whole country, but there must be secondary regulations, such as the regulation of school feeding, which depend on each province. The implementation plan of the Ministry of Health ensures the issuance of complementary regulations, such as advertising and sponsorship and food education in schools, when necessary to ensure enforcement and control authority, in addition to the registration of sanctions throughout the national territory. Civil society is working at the provincial level to raise awareness and train governments for the full implementation of the Law throughout the country (ARG14), together with the development of the "Regulatory Map of Front-of-Package Labelling in Argentina" by the Foundation for the Development of Sustainable Policies ( Fundación para el Desarrollo de Políticas Sustentables - Fundeps) and the Argentine Society for Nutrition and Real Food ( Sociedad Argentina de Nutrición y Alimentos Reales - SANAR) [ 105 ]. In addition, as the Law involves different government actors, the Ministry of Health has technical WG with the Ministry of Education, the Ministry of Social Development, the Ministry of Economy, the Federal Health Council and the Federal Education Council to ensure the comprehensive implementation of the Law (ARG15). 5) Policy evaluation The Ministry of Health has set up a comprehensive monitoring plan to evaluate all aspects of the Law. Based on the national food and beverage database, a research on the modification of the composition of products is being carried out in partnership with the Federation of Graduates in Nutrition ( Federación de Graduados en Nutrición - FAGRAN). In addition, using data from national surveys, food consumption habits will be evaluated, with the inclusion of questions on the subject in the next surveys for comparison purposes. In conjunction with PAHO and UNICEF, monitoring research on advertising, promotion and sponsorship is being planned. UNICEF is also finalizing a study to determine the initial effects of the policy's implementation. From the civil society, they are working to evaluate compliance with the implementation, the reformulation of food and the effects of the Law in relation to knowledge, understanding, modification in the perception and the consumption of food. In addition, there is monitoring to assess non-compliance with the Law, with consequent litigation and exposure actions to alert the population to the need to defend their rights. Type of regulatory instrument Argentina had the opportunity to discuss and approve its FoPNL Standard at three different levels: in the Legislative power (National Congress), in the Executive power and at the MERCOSUR level. MERCOSUR would only regulate food labelling, without including the package of measures with the regulation of advertising, school environments and public procurement. From the Legislative power, from the point of view of civil society, it was necessary to convince decision-makers of the importance of clearly establishing the graphic system and the nutrient profile model, but it was the best way, since it is the representation of the people (ARG16, ARG17). As the Chilean and the Peruvian FoPNL Laws did not define the labelling system or the nutrient profile model, leaving such regulation to the regulatory authority in the Executive power, Argentina considered such previous experiences to include all aspects of the FoPNL established by law [ 97 ]. Role of stakeholders The Ministry of Health of Argentina played a role in generating evidence to support the initial discussions on the FoPNL, participating in internal and MERCOSUR discussion groups, coordinating the NACHEOP, advising legislators, leading the technical roundtable for the regulation and in the implementation team of the Law, generating technical documents to support its implementation, and accompanying the monitoring plan of the Law. A government representative reported the support offered to legislators and how they collaborated to avoid the industry interference throughout the process (ARG18). The main role of the legislators was the presentation of bills on the FoPNL, participation in meetings with civil society and international organizations, discussions on the subject in Congress and voting in the House and Senate committees, until the approval of the Healthy Food Law. A report by a government representative shows the importance of the popular mobilization and the presence of the FoPNL issue in the press (ARG19). Civil society played an important role before and during the discussions of the Law, generating evidence free of CoI, understanding the regulatory and legal context and the industry's arguments, accompanying the discussions in MERCOSUR, participating in the FoPNL subcommittee, drafting the recommendatory document, unifying the draft law, advising legislators and exposing the industry interference. A civil society representative highlighted the importance of the work of translating the technical knowledge for the different legislators, who incorporated the vocabulary and showed full knowledge of the subject at the time of voting on the Law (ARG20, ARG21). In addition, the role of civil society was definitive in the construction of the mass media campaign as a way of supporting parliamentarians in passing the Law and raising awareness among the Argentine population of its importance in 2022 [ 106 ]. FIC Argentina, SANAR, Fundeps, FAGRAN, Consumidores Argentinos and Consciente Colectivo worked on the campaign as a transdisciplinary consortium. Despite having very different profiles, these organizations were complementary and built a unique and very clear narrative, according to the discourse analysis (ARG22). Civil society worked closely with the government and international organizations, especially PAHO, UNICEF, the Food and Agriculture Organization of the United Nations (FAO), the International Development Research Centre (IDRC), the Global Health Advocacy Incubator (GHAI) and Bloomberg Philanthropies, which had the role of participating in the technical discussions of the FoPNL subcommittee and in the legislature, publishing technical documents and positions, facilitating contact between countries in the region, and providing technical and financial support for research, advocacy and communication projects. From the point of view of civil society, having the same discourse from all these actors was of great importance during the process (ARG23). Since the approval of the Law, civil society continues to follow its implementation, exposing violations and monitoring its first effects in Argentina. Industry interference Industry interference permeated the entire process of discussion and approval of the Argentine Law, and continues in the implementation process. During the discussions, the industry took part in the FoPNL subcommittee of the Ministry of Health, public hearings and informative meetings in the Legislative committees as stakeholders involved in the issue, in addition to direct meetings with decision-makers. According to a representative of an international organization, the Ministry of Health considered it less harmful to have the official participation of the industry in the discussions than to take the risk of suffering actions external to the process (ARG24). Often, the disinformation narrative of the industry came from health professionals, experts and academics who had credibility with the population and parliamentarians, but had ties to the industry and did not declare CoI (ARG25). In addition to funding professionals and researchers, the industry funded publications, congresses and scientific events. A government representative reported the case of a meeting of the Argentine Society of Nutrition, where the entire panel was composed of industry representatives, while the government was invited to speak for a very short time (ARG26). From the point of view of civil society, until the Senate's approval, the media only gave space to professionals paid by the industry, which meant that only one voice was heard (ARG27). Initially, the industries defended the GDA graphic design, with a very permissive per-serving nutrient profile model. Later in the process, the industry tried to push for a parallel project by the Executive's National Food Commission, which is interministerial, with 'high in' octagons and Chile's nutrient profile model, but with the possibility of adapting to the Brazilian model, in addition to addressing only the FoPNL and no other regulatory measures. Arguments against the FoPNWL and the PAHO nutrient profile model said that reformulation would not be possible, that all foods would be labelled and people would have no choice, that positive nutrients would be made invisible, that the industry would not incorporate good quality nutrients because of the ban on claims, that the octagons frightened the population, that they did not provide information but demonized the foods. Among the arguments, the MERCOSUR was placed as the ideal instance to discuss FoPNL regulations, and that to advance otherwise would mean a barrier to trade (ARG28, ARG29). The Argentine economic crisis added to the COVID-19 pandemic was also used by the industry to try to prevent discussions on the FoPNL, linked to job losses, the retraction of economic activity and the closure of companies. In addition, the issue of the FoPNL was placed by the industries as a demand of the Argentine middle/upper class, since a large part of the population was suffering from poverty and hunger. The tactics used by the industry were reported by an interviewee from an international organization: voluntary agreements to avoid regulation; direct lobbying; exposure, intimidation and defamation of civil society and government actors; corporate social responsibility program; and threats of litigation (ARG30). The industry also often agreed with the policy and discussions, without direct resistance. But resistance to some of the most central points brought the discussion to a standstill, especially from major industries, which are the ones that determine the public agenda and are necessary in other government matters (ARG31). According to one civil society interviewee, the Healthy Food Law was, for a time, used as a 'bargaining chip' between industry and government. Subsequent to the approval of the Law, as there is an article in the Law where the companies could request extensions in the implementation deadline, many extensions were given to the companies. According to a civil society representative, the State was not transparent in relation to the extensions, causing confusion for consumers (ARG32). Also, according to government reports, the industry initiated a strategy of sending administrative claims to the Ministry of Health and precautionary measures (ARG33). In addition, industry is already taking advantage of the loopholes, such as the use of double fronts on packaging and the maintenance of promotional strategies for products with the FoPNL. Response to industry interference Civil society and the Argentine government used strategies to confront and expose the industry interference and CoI throughout the FoPNL process, which was facilitated by the exchange of information and experience among countries in the region. At the beginning of the discussions in the FoPNL subcommittee of the Ministry of Health, all the participants had to publicly sign a declaration of CoI, which made the positions of the industries and the organizations and professionals linked to them very clear. According to a representative of an international organization, just before the Law was passed in the Senate, there was an attempt by Coca-Cola to send an e-mail to the President of the Republic changing specific points of the Healthy Food Law, which was disarticulated in a civil society action. After a training on sweeteners to health professionals in 2016, civil society exposed the financing of the development and coordination of the event and publications of the speakers by Coca-Cola, which was not disclosed in the communication of the training (ARG34). Regional and national scientific evidence was used to counterargue the arguments used by the industry throughout the process [ 107 , 108 ], such as the loss of jobs and the ineffectiveness of the PAHO nutrient profile model. In addition, events were held with the participation of representatives of civil society, academia and international organizations from Argentina and the region to explain the importance of the FoPNL Law. Civil society used its social networks to expose the CoI of professionals with links to the food and beverage industry. Collaboration and support From the Argentine civil society and government, there were important exchanges of evidence, experiences, arguments and recommendations with countries that have already made progress in FoPNL policies in the LAC region, such as Chile, Peru, Uruguay, Brazil, Mexico, Colombia and the Caribbean. There were formal and informal meetings, participation in events and workshops, signing of national and regional documents, collaborative projects [ 110 ] and parliamentary debates. These contacts were favoured and facilitated by international organizations such as PAHO, UNICEF, CLAS and funding agencies (ARG35). From the discourse analysis, Argentina's Healthy Food Law is considered a result for the region, which cannot be thought of in isolation from everything that happened in other countries (ARG36), and the contagion and collaboration effect in the region is impressive (ARG37). At the MERCOSUR level, there were also exchanges between Argentina, Brazil and Uruguay, with the encouragement of the participation of the Argentine civil society in this space, which was not allowed before, in order to monitor the technical discussions (ARG38). In the end, Uruguay and Brazil advanced in their national regulations and there was no consensus among the countries and the discussion is in the hands of the coordinators and no longer in the hands of the technical teams. Human and children's rights The Argentine Law is based on a human rights approach, especially the right to healthy food, as a way of achieving an adequate state of health for the entire population, and the right to information, as a way of knowing what one eats [ 34 , 35 ]. In addition, the policy arose within the framework of PAHO's "Plan of Action for the Prevention of Obesity in Children and Adolescents", which focuses on the rights of children and adolescents [ 96 ], as well as the regulation of advertising, promotion and sponsorship, and food environments of the Law. Compulsory food education is incorporated at all three levels (kindergarten, primary and secondary education) for public and private schools throughout the country. From the government's point of view, children and adolescents are subjects to be protected and need to eat well to promote healthy growth, which is facilitated by clear information (ARG39, ARG40). From civil society organizations, the narrative used in the campaign focused on human and children's rights in a powerful and innovative way, in order to raise awareness among the population and legislators (ARG41, ARG42). Challenges, difficulties and threats The economic, social and political situation in Argentina, especially during the COVID-19 pandemic, put the focus on other urgent issues, such as the need for vaccines and the situation of poverty and hunger, which was used by the industry as an argument to slow down the progress of the FoPNL discussions. From the point of view of civil society, it is necessary to consider what we eat and its impact on health even in times of crisis and that the food policy agenda is unique, focusing on access to safe and healthy food, but the narrative was distorted by the industry (ARG43, ARG44). At the beginning of the discussion, one challenge was to achieve political support to promote and carry it forward, considering that there was no alignment in the government, but very opposing positions in the Executive and Legislative powers and a strong lobbying from the food and beverage industries (ARG45). At that time, it was also registered as a challenge by a representative of an international organization to build capacity on a very technical and difficult issue such as the FoPNL, which takes time and resources (ARG46). Other challenges have to do with achieving full implementation of the Law that includes different levels of government in a federal country, establishing effective control, surveillance and sanction mechanisms, and improving some complementary regulations to make them more specific. The main challenge was the industry interference throughout the process, with economic and legal arguments, confusing information disseminated by professionals with CoI, threats, corporate social responsibility, lobbying and cooptation of the mainstream media. The feeling of going one step forward and two steps back because of the obstacles placed by the industry was reported by a representative of an international organization (ARG47). Strengths and lessons learned The approval of the Healthy Food Law in Argentina was the result of a combination of factors: a robust civil society that worked in coalition and with international organizations, an executive government that put the issue on the agenda and provided resources and time, and the work with the entire political system that generated a unified bill among legislators from different political parties from different provinces who were trained in NCD (ARG48). The generation of local evidence without CoI, in addition to the support of international evidence and experiences, was a learning process highlighted by representatives of the government, civil society and international organizations. The importance of considering other food policies in the country for consistency was also reported by a government representative. And since the final decision is political, there must be political support to carry the process forward, even with all the industry interference (ARG49). The work of the civil society network was also highlighted, both regionally and nationally, especially in relation to the mass media campaign to support the approval of the Law in the legislature. The work was done among various organizations with different profiles, and supported by funding agencies, which made it possible to organize and prioritize the work with common objectives (ARG50, ARG51). One civil society representative reported the feeling of being in a group of superheroes, with each organization having its own superpower (ARG52). The work of civil society was also essential to sensitize the Argentine population to the importance of the FoPNL, both in the translation of scientific knowledge and in generating a social movement of public pressure on decision-makers. Next steps In addition to achieving full implementation of the Law throughout Argentina by strengthening the government's capacity to oversee, monitor and evaluate it (ARG53), it is important that the population takes ownership of the Law and demands that the government assume its responsibility to monitor, oversee and evaluate it. From the point of view of a government representative, the Healthy Food Law is an educational and cultural issue so that people can assimilate the new regulations (ARG54). 4. Discussion This study analysed the processes of discussion, approval and implementation of FoPNL policies in three countries in the LAC region. From the analyses, it was identified that the types of regulatory instruments approved were different in each of the countries, being a decree from the Executive power of Uruguay, the modification of a general law from the Legislative power and a regulation from the Executive power of Mexico, and a law from the Legislative power of Argentina. The justifications for the selection of each regulation are related to health and nutrition, political and regulatory context of each country at the time of the decision [ 109 , 110 ]. In addition, according to the type of regulatory instrument, the regulatory processes included different stages and governmental actors. It is important to note that, in the case of Uruguay, the election by an Executive decree, which did not involve the entire political system and was crossed by two different governments, resulted in multiple changes in the characteristics of the FoPNL and in its implementation timeframe. Such instability led the legislature and the civil society to begin a fight for a law that includes other aspects of protection of the food environment, such as the regulation of advertising of unhealthy foods and beverages [ 38 , 45 ]. The Mexican and Argentine processes have already involved agents of the Executive and Legislative powers of different political parties, with the identification and leadership of at least one political actor, which has enabled the process to cross governments and remain active and sustainable [ 5 ]. Although the FoPNL is primarily responsibility of the health sector, it is necessary to consider the interests of other parties, especially in public consultations [ 111 ]. In addition, as the discussions of the measure began when Chile, Peru, Uruguay and other countries in the region already had their FoPNL processes advanced, Mexico and Argentina were able to take advantage of the experiences, scientific evidence, arguments and lessons learned to build a more appropriate and effective process, in addition to improving the technical aspects of the measure [ 16 , 112 ]. The use of a FoPNL with clear criteria for the identification of unhealthy foods and beverages and connected to other regulatory measures to protect the food environment was of great importance to strengthen national food and nutrition policies [ 5 , 111 ]. The existence of public consultations on the regulations of each country, enabling the participation of any citizen in the process of public policy making, was a key element in the processes of the three countries analysed [ 5 , 110 ]. All the regulatory processes investigated, especially the policy design stages, were led by government agents, with the Ministry or the Secretariat of Health as a central actor, in addition to the participation of other bodies, such as the economy and the industry [ 5 ]. Academia, civil society and international organizations played an important role in the technical discussions and in the development of the draft of the FoPNL. In this regard, academia and civil society in each country generated local scientific evidence without CoI to justify the choice of each criteria included in the proposed regulations. But it was not only the studies prior to the approval of the measure that were important [ 110 , 113 ]. In Uruguay, for example, the publication of immediate results of the implementation of the Decree was decisive for it to be maintained in 2020, after the change of the government [ 25 , 26 ]. Thus, it is necessary that the generation of scientific evidence be permanent for the maintenance and improvement of the policy, and to respond to possible legal challenges. The joint, coordinated and complementary work of academia, civil society and international organizations throughout the regulatory process made the difference, especially in advocacy and communication actions, which were based on scientific evidence translated into simpler language. Such actions were useful in supporting governments to move forward with the processes, to expose the food and beverage industry interference, and to raise public awareness at key moments [ 110 , 113 , 114 ]. In addition, it is necessary to highlight the importance of international organizations in supporting the activities of civil society organizations, and in facilitating and promoting the connection between researchers and actors working to defend the protection of public health and children in the countries of the LAC region in order to exchange experiences [ 16 ]. The establishment and maintenance of this alliance with a common vision was not always simple, as it was composed of professionals with different backgrounds and experiences, coming from different organizations with specific roles. But, in reality, the strength of such an alliance lies precisely in the differences and complementarities, in addition to the great public visibility achieved for the issue. Beyond the participation of these actors, the food and beverage industry also took part in different ways in the FoPNL regulatory processes in the countries analysed, always practicing very similar corporate political activities. In Mexico and Argentina, for example, the industry participated in the WG that designed the policy, which is not advisable. Likewise, the government demanded the declaration of CoI from all participants at that stage, which was essential to expose its position against the FoPNWL. In Uruguay, the industry was not part of the design stage of the Decree, but the lobbying had great strength in the Executive power, which may have caused the "regulatory chill", which occurs when legal uncertainty or the threat of legal challenge dissuades the government from acting [ 115 ]. It is important to note that the industry narrative did not always come from direct representatives; health and nutrition professionals, societies and academics were also frequent spokespersons, especially in the press. Therefore, it is necessary to identify and monitor them from civil society. The arguments used by the food and beverage industry were practically the same in all three countries. The narrative against the FoPNWL focused on the stigmatization of foods and the generation of fear and confusion for consumers, and against the PAHO nutrient profile model and focused on the labelling of many foods and beverages and the impossibility of reformulation. Economic arguments of job losses and business closures were also very common, as well as the proposal of alternatives such as self-regulation, the promotion of physical activity, nutrition education and other less effective FoPNL models, such as the GDA, the nutrition traffic light and portion-based nutrition information. The request for more time for implementation also occurred in the three regulatory processes: in Mexico, related to the Covid-19 pandemic, and in Uruguay and Argentina, with the justification of the need for harmonization with MERCOSUR [ 110 , 114 ]. The industry narrative was used in campaigns, interviews and other communication actions to confuse the population, and also in legal actions against politics, government and civil society, often justified by trademark and free trade rights. Likewise, after the approval and the beginning of the implementation of the policy, the industry continued to question, as in the cases of the appeals in Mexico and the extensions and administrative claims in Argentina. As part of the role of academia and civil society, the scientific evidence generated was used to confront the narrative of the food and beverage industry, especially in the press and through communication campaigns. In addition, transparency and CoI policies adopted by governments also supported the processes against industry interference [ 110 , 111 , 113 ], such as the confidentiality agreement of the Mexican WG and the mandatory declaration of participants in the Argentine WG. Having clear, measurable, short-term and achievable objectives is recommended. The objectives of the Uruguayan, Mexican and Argentinean policies focus on providing clear and simple nutritional information to promote informed and healthy food choices [ 5 , 16 , 110 , 114 ], which is directly connected to the guarantee of human rights. Throughout the regulatory process in the three countries, human rights were part of the narrative constructed by the government, civil society and international organizations, mainly because they were superior to commercial rights, which the food and beverage industry defends so much. FoPNL is related to the right to information, as a way of knowing what one eats; to the right to health and food, as a way of achieving a good state of health based on a conscious and healthy diet; and the right of children and adolescents, considering the need to protect them in their physical and psychological development processes and the formation of eating habits. The incorporation of technical complements to FoPNL, such as mini warning labels and cautionary legends for sweeteners and caffeine, and of complementary regulatory measures, such as the restriction of advertising to children, the prohibition of the sale of products with FoPNL in schools and in public purchases, was made possible and reinforced by the focus on children's rights incorporated in the discussions of the three countries analysed [ 5 , 114 ]. Planning the monitoring, inspection and evaluation processes from the initial discussions of the policy is essential, since the effectiveness of the measure lies in its proper implementation and not only in its approval. In the first place, communication campaigns should be developed to teach and stimulate the use of the FoPNL by the population, since it is not always intuitive [ 113 ]. In addition, the implementation plan should consider all governmental bodies and actors involved in the monitoring and inspection processes, as in the case of Uruguay and Argentina, which are organized in provinces with decentralized processes. Penalties for non-compliance with the measure should serve as an example so that companies do not do it anymore, and encourage them to comply with the measure to avoid being exhibited for non-compliance. Evaluation of the standard requires investment from the government so that data can be collected periodically to verify the impacts of the FoPNL and the needs for policy improvement [ 5 , 114 ], as has already been demonstrated in Uruguay. Finally, although it is extremely relevant to learn from the above regulatory processes, each country has its own particularities, which must be considered throughout the discussion, approval and implementation processes of the policy. Territorial, population, political and regulatory characteristics should be evaluated, and a study of potential allies and opponents of the policy should be made. 5. Conclusion The high prevalence of overweight, obesity and NCD related to inadequate nutrition in all age groups in the Americas, including children and adolescents, requires urgent actions to modify the food environment to discourage the consumption of unhealthy foods and beverages. The adoption of an FoPNWL is recommended by international organizations and experts on the subject as a cost-effective measure that ensures the protection and promotion of human rights related to health, healthy eating, adequate information and, especially, to children and adolescents. As demonstrated in the cases of Uruguay, Mexico and Argentina, the processes of discussion, approval and implementation of FoPNL policies can be less or more extensive, depending on the political context, type of regulatory instrument used, design and basis of the proposed policy, political processes established and actors involved. The cases analysed reflect the actions of various key actors in the defense of an effective FoPNL policy, and the opposition of the food and beverage industry through corporate political activities that attempt to slow down, weaken or impede the policy. The results also indicate that well-articulated research, advocacy and communication actions between academia, civil society and international organizations are essential to achieve an effective FoPNL policy. The accumulation of evidence, experiences and lessons learned over the last few years in LA has led to an improvement in FoPNL policies, culminating in greater protection and better realization of the rights of populations to health, to adequate and healthy food, to information and to the protection of children and adolescents, especially when such policies were associated with synergistic regulatory measures, such as the restriction of advertising, the regulation of institutional food environments and the taxation of unhealthy food and beverage products. Other countries that are working to move forward with effective FoPNWL policies will benefit from these and other experiences and their elements of success and potential improvement, ensuring the preponderance of human and children's rights over commercial interests to deliver better health and nutrition for the entire population. Declarations Funding The study was funded by the United Nations Children's Fund for Latin America and the Caribbean (UNICEF LACRO). Ethics, consent to participate and consent to publish All participants signed a digital informed consent form. The study was approved by the Research Ethics Committee of the University of São Paulo (USP) in Brazil (No. 6.589.062). Authors' contributions Conceptualization: LAM, PV, AMNO; methods: LAM, PV, AMNO, FSG; formal analysis: LAM; supervision: PV, AMNO; drafting - preparation of the original draft: LAM; writing - proofreading and editing: LAM, PV, AMNO, FSG, RS, MA. Declaration of conflicts of interest The authors declare no conflicts of interest. Data availability Data will be available on request from the author, since the whole transcription of the interviews may make the participant recognizable. Acknowledgements We would like to thank the key actors who participated in the interviews and the UNICEF officers in the country offices in Uruguay (Nora Oliveira), México (Fiorella Espinosa) y Argentina (Verónica Patrón) for their support in the documentary analysis and data review. Clinical trial number Not applicable. References Pan-American Health Organization (PAHO). Enfermedades no transmisibles: hechos y cifras. Washington, D.C.: PAHO; 2019. United Nations Children’s Fund (UNICEF), World Health Organization (WHO), World Bank Group. Levels and trends in child malnutrition. Joint Child Malnutrition Estimates - Key findings of the 2023 edition. 2023. United Nations Children’s Fund (UNICEF). 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Manual para la aplicación del decreto n° 272/018 sobre rotulado frontal de alimentos. MSP, Montevideo (2019). Uruguay. Ministerio de Salud Pública (MSP). Resolución MSP n° 136, aplicación del Decreto 272/018, relativo al rotulado de alimentos. MSP, Montevideo (2019). De Armas R. Industrias solicitaron al gobierno que postergue un año el etiquetado de alimentos. El Observador. 2019. Uruguay. Presidencia de la Republica. Decreto n° 091/020. Prórroga del plazo establecido en el art. 11 del decreto 272/018, referente al rotulado de alimentos y creación de una comisión de trabajo multidisciplinaria. IMPO, Montevideo (2020). Uruguay. Parlamento del Uruguay. Versión taquigráfica de la Comisión de Salud Pública y Asistencia Social de la Cámara de Diputados. Sesión del día 24 de febrero de 2021. Parlamento del Uruguay, Montevideo (2021). Uruguay. Presidencia de la República. Decreto n° 034/021. Sustitución del anexo del decreto nº 246/020, relativo al rotulado de alimentos y creación de comisión interministerial, integración y funciones. IMPO, Montevideo (2021). Alianza de Enfermedades no Transmisibles (ENT). Etiquetado Uy. Available at: . United Nations Children’s Fund (UNICEF), Pan-American Health Organization (PAHO), Food and Agriculture Organization of the United Nations (FAO). Rotulado frontal de alimentos: postura de OPS, UNICEF y FAO. Ares G, Bove I, Díaz R, Moratorio X, Benia W, Gomes FS. Argumentos de la indústria alimentaria em contra el etiquetado frontal de advertências nutricionales en Uruguay. Rev Panam Salud Publica. 2020;44:e20. Barquet P. Gobierno procura ganar tiempo y zafar del lobby para definir el dilema del etiquetado. El País. 2020. Pan-American Health Organization (PAHO). OPS, UNICEF y FAO respaldan pronta implementación del Decreto sobre Etiquetado Nutricional de Alimentos. Montevideo: PAHO; 2020. Uruguay. Ministerio de Salud Pública (MSP). Ref. n° 001–3–7334– 2020. MSP, Montevideo (2021). Berruecos P. Lanzan campaña de etiquetado de bebidas: Checa y Elige. Monchi Time. 2013. Mexico. Diario Oficial de la Federación. Modificación a la Norma Oficial Mexicana NOM-051-SCFI/SSA1-2010, Especificaciones generales de etiquetado para alimentos y bebidas no alcohólicas preenvasados. Información comercial y sanitaria. Ciudad de México (2014). Stern D, Tolentino-Mayo L, Barquera S. Revisión del etiquetado frontal: análisis de las Guías Diarias de Alimentación (GDA) y su comprensión por estudiantes de nutrición en México. 1ª ed, Instituto Nacional de Salud Pública (INSP), Cuernavaca; 2011. Tolentino-Mayo L, Patiño SRG, Bahena-Espina L, Ríos V, Barquera S. Conocimiento y uso del etiquetado nutrimental de alimentos y bebidas industrializados en México. Salud Publica Mex. 2018;60(3). Carriedo A, Mena C, Nieto C, Alcalde J, Barquera S. Case 7. Participation of non-state actors in developing a food labelling policy in Mexico. In: Mwatsama M, editor. Public health and the food and drinks industry: The governance and ethics of interaction - Lessons from research, policy and practice. UK Health Forum; 2018. p. 80–88. White M, Barquera S. Mexico adopts food warning labels, why now? Health Syst Reform. 2020;6(1):e1752063. Comité de Expertos Académicos Nacionales del Etiquetado Frontal de Alimentos y Bebidas no Alcoholicas para uma Mejor Salud. Sistema de etiquetado frontal de alimentos y bebidas para México: una estrategia para la toma de decisiones saludables. Salud Publica Mex. 2018;60(4):479-486. Alianza por la Salud Alimentaria. Morena encabeza mesa de trabajo para analizar y fortalecer las estrategias de combate al sobrepeso, obesidad y diabetes. 2019. Instituto Nacional de Salud Pública (INSP), United Nations Children’s Fund (UNICEF). Experiencias sobre el diseño y la implementación del etiquetado nutricional de advertencia en América Latina y el Caribe. Panamá; 2020. United Nations Children’s Fund (UNICEF). Nota técnica: un etiquetado nutrimental frontal claro y de fácil comprensión protege a niñas, niños y adolescentes en México. Mexico City: UNICEF; 2019. United Nations Children’s Fund (UNICEF). Etiquetado frontal: una medida esencial para combatir el sobrepeso y la obesidad; 2019. Mexico. Diario Oficial de la Federación (DOF). Proyecto de Modificación a la Norma Oficial Mexicana NOM-051-SCFI/SSA1-2010, Especificaciones generales de etiquetado para alimentos y bebidas no alcohólicas preenvasados. Información comercial y sanitaria. México, D. F. (2019). Munguía A, Cruz-Casarrubias C, Zúñiga J, Guzmán-Pérez G, Contreras-Manzano A, Tolentino-Mayo L et al. Experiencias y lecciones aprendidas de la implementación del etiquetado frontal de advertencia en México. In: Peralta DG, Hernández RU, Carballo JM, editors. Derecho, comercio y etiquetado nutricional: reflexiones y experiencias desde América Latina. Bogota: Editorial Dejusticia; 2022. p. 240-270. United Nations Children’s Fund (UNICEF). UNICEF: El etiquetado frontal de alimentos y bebidas aprobado en México, “de los mejores del mundo”; 2020. Available at: . Mexico. Secretaría de Economía. Respuesta a los comentarios recibidos al Proyecto de Modificación a la Norma Oficial Mexicana PROY-NOM-051-SCFI/SSA1-2010, Especificaciones generales de etiquetado para alimentos y bebidas no alcohólicas preenvasados. Información comercial y sanitaria. México, D. F.: Secretaría de Economía (2020). Celis F. Amparos continúan a dos años de etiquetado de alimentos; pleno de SCJN resolverá tres. Axis Negocios. 2023. United Nations Human Rights Special Procedures. Special Rapporteurs, Independent Experts & Working Groups. Mandatos del Relator Especial sobre el derecho a la alimentación y de la Relatora Especial sobre el derecho de toda persona al disfrute del más alto nivel posible de salud física y mental. Etiquetado frontal de advertencia en México; 2022. El Poder del Consumidor. Relatores especiales de las Naciones Unidas defienden etiquetado de advertencia frente a amparos de la industria en la Suprema Corte de Justicia de la Nación en México. 2022. Instituto Nacional de Salud Pública (INSP), United Nations Children’s Fund (UNICEF). Nota técnica: argumentos de la industria de alimentos y bebidas y contraargumentos basados en evidencia científica, en el marco de la modificación del etiquetado nutricional frontal en México. Panamá; 2021. Usla H, Gutiérrez AL. Este jueves inicia el nuevo etiquetado de alimentos… y 50 empresas ya se ampararon. El Financiero. 2020. Alianza por la Salud Alimentaria. Te contamos la verdad sobre los mitos que la industria de la comida chatarra quiere que creas sobre el nuevo etiquetado en México. Food and Agriculture Organization of the United Nations (FAO). Agencias de Naciones Unidas celebran la aprobación por la Cámara de Diputados a la modificación de la Lay General de Salud en cuanto a etiquetado de alimentos; 2019. Food and Agriculture Organization of the United Nations (FAO), United Nations Children’s Fund (UNICEF), Pan-American Health Organization (PAHO). Carta de felicitaciones al presidente de México por la aprobación de la modificación de la NOM-051; 2020. Pan-American Health Organization (PAHO). Etiquetado frontal de advertencia, un paso urgente para enfrentar epidemia de sobrepeso y obesidad en México; 2019. Pan-American Health Organization (PAHO). La modificación de la norma oficial mexicana con las especificaciones generales del etiquetado frontal es uno de los mayores logros de salud pública de México en los últimos tiempos; 2020. Pan-American Health Organization (PAHO). Reconocimiento a México por sus avances en la implementación del sistema de etiquetado frontal; 2022. World Trade Organization (WTO). Comité de Obstáculos Técnicos al Comercio, México–proyecto de modificación a la norma oficial mexicana NOM-051-SCFI/SSA1-2010: especificaciones generales de etiquetado para alimentos y bebidas no alcohólicas preenvasados, doc. OMC G/TBT/W/715. 4 de marzo de 2020. Alianza por la Salud. Evidencia científica de respaldo al etiquetado de advertencia en México. Gobierno de México presenta compaña que busca generar consciencia sobre la alimentación saludable. Infobae. 2021. Héroes por la Salud. Available from: . Pan-American Health Organization (PAHO). Plan de acción para la prevención de la obesidad en la niñez y la adolescencia. Washington, D.C.: PAHO (2014). Cerra B, Castronuovo L, Guarnieri L, Tiscornia MV, Pizarro ME. Derechos humanos y etiquetado de alimentos en Argentina: actores sociales e intereses económicos. In: Peralta DG, Hernández RU, Carballo JM, editors. Derecho, comercio y etiquetado nutricional: reflexiones y experiencias desde América Latina. Editorial Bogota: Dejusticia; 2022. p. 346-374. Argentina. Ministerio de Salud y Desarrollo Social. Secretaría de Gobierno de Salud. Etiquetado nutricional frontal de alimentos (2018). Argentina. Ministerio de Salud. Dirección Nacional de Abordaje Integral de las Enfermedades No Transmisibles. Investigación – Etiquetado nutricional frontal: Informe de resultados (2020). Castronuovo L, Tiscornia MV, Guarnieri L, Martins E, Gomes FS, Allemandi L. Efficacy of different front-of-package labelling systems in changing purchase intention and product healthfulness perception for food products in Argentina. Rev Panam Salud Publica. 2022;46:e137. Argentina. Ministerio de Salud. Dirección Nacional de Abordaje Integral de las Enfermedades No Transmisibles. Análisis del nivel de concordancia de sistemas de perfil de nutrientes con las Guías Alimentarias para la Población Argentina (2020). Tiscornia MV, Castronuovo L, Guarnieri L, Martins E, Allemandi L. Evaluación de los sistemas de perfiles nutricionales para la definición de una política de etiquetado frontal en Argentina. Rev Argent Salud Publica. 2020;12:e17. Argentina. Ministerio de Salud y Desarrollo Social. Secretaría de Gobierno de Salud. 2ª Encuesta Nacional de Nutrición y Salud (ENNyS 2) – Resumen Ejecutivo (2019). “Diputados sancionó el etiquetado frontal y aprobó el alivio fiscal para entidades sen fines de lucro”. Diputados Argentina. 2021. Fundación para el Desarrollo de Políticas Sustentables (Fundeps), Sociedad Argentina de Nutrición y Alimentos Reales (SANAR). Mapa Normativo del Etiquetado Frontal en Argentina. Fundación InterAmericana del Corazón (FIC Argentina), Fundación Salud Natural Argentina (SANAR), Fundación para el Desarrollo de Políticas Sustentables (Fundeps), Consumidores Argentinos, Federación Argentina de Graduados en Nutrición (FAGRAN) #EtiquetadoClaroYa. Available from: . Coalición Nacional para Prevenir la Obesidad en Niños, Niñas y Adolescentes. Mitos y realidades del etiquetado frontal de advertencia. 2020. Coalición Nacional para Prevenir la Obesidad en Niños, Niñas y Adolescentes. Conflicto de interés e interferencia de la industria de alimentos en el diseño de políticas de alimentación saludable. 2020. Fundación Interamericana del Corazón (FIC Argentina), Instituto Brasileiro de Defesa do Consumidor (Idec). Promoción de políticas de etiquetado frontal de alimentos en Brasil y Argentina. 2019. United Nations Children’s Fund (UNICEF). UNICEF Technical Guide - Front-of-pack nutrition labelling: A ‘how-to’ guide for countries; 2021. Jones A, Neal B, Reeve B, Mhurchu CN, Thow AM. Front-of-pack nutrition labelling to promote healthier diets: current practice and opportunities to strengthen regulation worldwide. BMJ Glob Health. 2019;4:e001882. Crosbie E, Gomes FS, Olvera J, Patiño SRG, Hoeper S, Carriedo A. A policy study on front-of-pack nutrition labelling in the Americas: emerging developments and outcomes. Lancet Reg Health Am. 2023;18:100400. Instituto Nacional de Salud Pública (INSP), United Nations Children’s Fund (UNICEF). Review of current labelling regulations and practices for food and beverage targeting children and adolescents in Latin America countries (Mexico, Chile, Costa Rica and Argentina) and recommendations for facilitating consumer information. 2016. United Nations Children’s Fund (UNICEF). Policy brief: Front-of-pack nutrition labelling of foods and beverages (2022). World Health Organization Europe (WHO EURO) Key considerations for the use of law to prevent noncommunicable diseases in the who European region: report of an intensive legal training and capacity-building workshop on law and noncommunicable diseases – Moscow, 30 May-3 June 2016. WHO EURO, Copenhague (2017). Table Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6691348","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":485161696,"identity":"5816bb63-b391-4783-a681-0d84790af685","order_by":0,"name":"Laís Amaral Mais","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIie2QMWrDMBSGnwgki1utgkBzBXsyIYRcxcJDlh7AQygOAnUxmVUIOYMnQzYbgbPoAAUtNr2AupRMpSK0aQtO67FQfSAh0Pt4/3sADscf5BpQ+v4crBuTAPgfX363AcNPBbFAqF7KGcTHV7yPMpLMwKqYhPcVCx52chKOWAnHpIBwXHYrHuUEah1sFV03z4UM9lkdoUxpmG6iC8GoDTPUSAC1XQqJ8sdbf4C4Bl9dCIZbG+xVLwRu7SxbufhdITQltoAKQq2SStpDaTmhGx0L0tol18s4V3VU2Vm8adatYLx8MuZFzwWOq8asZvP8wKrmmOib0OtWTnzZDDvdpT0/Cd+461vocDgc/4g3JVpmBSCAJLEAAAAASUVORK5CYII=","orcid":"","institution":"United Nations Children's Fund for Latin America and the Caribbean (UNICEF LACRO)","correspondingAuthor":true,"prefix":"","firstName":"Laís","middleName":"Amaral","lastName":"Mais","suffix":""},{"id":485161697,"identity":"f80b5ab6-9e6c-488e-8c86-35860f74ce05","order_by":1,"name":"Paula Véliz","email":"","orcid":"","institution":"United Nations Children's Fund for Latin America and the Caribbean (UNICEF LACRO)","correspondingAuthor":false,"prefix":"","firstName":"Paula","middleName":"","lastName":"Véliz","suffix":""},{"id":485161700,"identity":"fbe7aa4a-d667-4975-bfdf-b3050f10fda9","order_by":2,"name":"Ana María Narvaéz-Olaya","email":"","orcid":"","institution":"United Nations Children's Fund for Latin America and the Caribbean (UNICEF LACRO)","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"María","lastName":"Narvaéz-Olaya","suffix":""},{"id":485161701,"identity":"979ed54c-1427-4bfa-a06d-5926776530b6","order_by":3,"name":"Fabio Silva Gomes","email":"","orcid":"","institution":"Pan American Health Organization (PAHO)","correspondingAuthor":false,"prefix":"","firstName":"Fabio","middleName":"Silva","lastName":"Gomes","suffix":""},{"id":485161702,"identity":"328d5b3f-aeea-4e47-935c-668568180c5b","order_by":4,"name":"Romain Sibille","email":"","orcid":"","institution":"United Nations Children's Fund for Latin America and the Caribbean (UNICEF LACRO)","correspondingAuthor":false,"prefix":"","firstName":"Romain","middleName":"","lastName":"Sibille","suffix":""},{"id":485161704,"identity":"eddcee86-6b83-4641-a533-c8a07938be13","order_by":5,"name":"Maaike Arts","email":"","orcid":"","institution":"United Nations Children's Fund for Latin America and the Caribbean (UNICEF LACRO)","correspondingAuthor":false,"prefix":"","firstName":"Maaike","middleName":"","lastName":"Arts","suffix":""}],"badges":[],"createdAt":"2025-05-18 11:08:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6691348/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6691348/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93567707,"identity":"b44e6441-38b6-40fe-a8a0-1f48de11d607","added_by":"auto","created_at":"2025-10-15 08:39:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":944248,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6691348/v1/dc74cda0-aed1-4c27-a2d2-0a4f3679df22.pdf"},{"id":86792961,"identity":"ebb6a103-5025-48ab-be0b-81ef25e92561","added_by":"auto","created_at":"2025-07-15 15:09:32","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":63048,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementarymaterialsDPH.docx","url":"https://assets-eu.researchsquare.com/files/rs-6691348/v1/664d12780430393168159979.docx"},{"id":86792968,"identity":"98a6e176-200e-4836-b15b-1ddc7f640d6a","added_by":"auto","created_at":"2025-07-15 15:09:32","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":156810,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6691348/v1/0de24d94c8da12a328de0399.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Front-of-package nutrition labelling policies in Uruguay, Mexico and Argentina","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eNon-communicable diseases (NCD) are responsible for 80.7% of deaths per year in the Americas [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]. The prevalence of overweight is 8.6% [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e] and 30% [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e] among children under five years of age and among children and adolescents between 5 and 19 years of age, respectively.\u003c/p\u003e\n\u003cp\u003eIn addition to increasing the risk of developing NCD and premature death [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e], overweight and obesity represent high costs related to health care, caregiving, school and work absenteeism, as well as premature mortality [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]. In 2019, global costs attributable to obesity were estimated at more than US\u003cspan\u003e$\u003c/span\u003e 990 billion per year [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThis situation is directly related to changes in food environments, with unhealthy food and beverage products that have become physically and economically accessible, aggressively promoted and advertised [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]. These changes favour the increased consumption of processed foods with excess harmful nutrients and ultra-processed food products to the detriment of healthy eating [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eUnhealthy diets infringe on girls\u0026apos; and boys\u0026apos; rights to health and adequate food, as well as the right to appropriate information and consumer protection against misleading information on food and beverage labels. The United Nations Committee for the Protection of Human Rights, the World Health Organization (WHO) and the Pan American Health Organization (PAHO) recommend that Member States adopt a set of public policies to promote healthy eating. Such policies are a mechanism to protect these rights by generating healthy environments and promoting the reduction of malnutrition, especially among children and adolescents. One of the regulatory measures recommended to promote healthier food choices is the implementation of front-of-package nutrition warning labelling (FoPNWL), indicating excessive amounts of nutrients harmful to health, such as sodium, sugars and total, saturated and trans fats [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eFront-of-package nutrition labelling (FoPNL) is defined as a nutritional information tool presented in a simplified form on the front of the package of pre-packaged foods and beverages [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]. FoPNL systems are defined by their purpose and information provided. The FoPNWL is an example of a nutrient-specific interpretive system, which provides nutritional information for one or more nutrients/ingredients for guidance [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. By identifying critical excess nutrients and the presence of other harmful ingredients [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e], FoPNWL has the potential to help consumers understand the nutritional content of products and make healthier choices. Consequently, it can also encourage the reduction of such nutrients in the food portfolio [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eUruguay, Mexico and Argentina are three countries in the Latin American (LA) region that have approved and implemented the FoPNWL system using black octagons [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. The characteristics of the graphic model, nutrient profile model and related regulatory measures are presented in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eIn the LA region, there is substantial scientific evidence which shows the efficacy and effectiveness of the FoPNWL and reinforces its application. In Chile, the first country to implement nutrition warnings on the front of the package in 2016 [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e], the population\u0026apos;s knowledge of the Law [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e], its correct interpretation and use [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e] was demonstrated, in addition to the reduction of sugars, saturated fats and sodium content [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e] and the reduction in the purchase of products \u0026quot;high in\u0026quot; critical nutrients [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. The elimination of products with warning labels from advertising aimed at children and school environments, as required by Chilean Law, has reduced the consumption of critical nutrients by children and adolescents in schools [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. In Uruguay, the immediate effects of the implementation of the decree showed a high degree of awareness and approval of the measure by the Uruguayan population, as well as a significant level of use of the FoPNL for food purchases [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]. In Mexico, as the Law is more recent, predictive analyses were made, which showed that the Mexican FoPNL has the potential to reduce the prevalence of obesity and the associated costs [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]. And in Argentina, an opinion survey showed knowledge and acceptance of the of the Law [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eConsidering that the LA region is the most advanced worldwide in terms of the implementation of FoPNWL regulations, the objective of this study was to document and analyse the processes of discussion, approval and implementation of the FoPNWL regulations in Uruguay, Mexico and Argentina to provide insight into the processes of strengthening regulatory frameworks in the region aimed at providing clear and easily understood nutrition information to consumers to prevent child and adolescent overweight and obesity in LAC.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThis study was based on a qualitative analysis including a desk review and interviews with key stakeholders. All data were collected in Spanish and/or English in the first semester of 2023. Uruguay, Mexico and Argentina were the LA countries chosen for this study because their FoPNL regulations are based on the octagon warning label design and came into force between 2021 and 2022.\u003c/p\u003e\u003cp\u003eFor the desk review, multiple sources were considered: official documents, legal publications, scientific articles, books, press releases, publications on websites and social networks, policy briefs and other relevant documents to understand the processes of discussion, approval and implementation of FoPNL regulations in Uruguay, Mexico and Argentina. These documents were identified through discussions with local experts and online searches.\u003c/p\u003e\u003cp\u003eSix key stakeholders were identified from each country included in this study. The inclusion criteria were: to be or have been a representative of the government, an international organization, civil society or academia without commercial conflicts of interest (CoI), and to have followed and/or actively participated in the processes of discussion, approval and/or implementation of FoPNL regulations in Uruguay, Mexico and/or Argentina. Being an industry representative and having commercial CoI were considered exclusion criteria. Participation was voluntary and stakeholders were contacted by email or phone. All participants signed a digital written informed consent form. The semi-structured interviews took place in the first semester of 2023, lasted from half an hour to an hour and a half, were conducted online via the \u003cem\u003eTeams\u003c/em\u003e platform, based on an interview guide specially developed for this study (Appendix 1), and were transcribed \u003cem\u003everbatim\u003c/em\u003e via the \u003cem\u003eTeams\u003c/em\u003e platform and reviewed by LAM and AMNO.\u003c/p\u003e\u003cp\u003eA content analysis of the interviews was carried out and the relevant information was extracted and organized into themes, based on a deductive-inductive analysis. The selected themes were: type of regulatory instrument; role of stakeholders; industry interference; response to industry interference; collaboration and support; human and children's rights; challenges, difficulties and threats; strengths and lessons learned; and next steps. The stages of the policy process were analysed using Knill and Tosun's (2008) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] policy cycle model: 1) Context/agenda setting: the stage of identifying a social problem based on social, economic, cultural and ideological factors; 2) Policy discussion/formulation: stage of identification, exploration and discussion of multiple courses of action to address the problems identified, with the definition of the objective, instruments and configuration of the policy; 3) Policy adoption: the policy approval stage; 4) Policy implementation: the stage of transforming the policy into programs or actions and their application; and 5) Policy evaluation: the stage of evaluation of the policy, its processes and impacts by experts, with the identification of problems in the design and/or implementation [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe data were triangulated with information from the desk review to construct the case studies of the three countries analysed. The information is deidentified (Supplementary Materials 1 and 2).\u003c/p\u003e\u003cp\u003eThe study was funded by the United Nations Children's Fund (UNICEF) Regional Office for Latin America and the Caribbean (LAC) and was approved by the Research Ethics Committee of the University of S\u0026atilde;o Paulo (USP) in Brazil (No. 6.589.062).\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eThe case studies of each country analysed by the stages of the policy process and the themes that emerged from the desk review and key stakeholder interviews are presented above. The citations related to the stages of the policy process are presented in Supplementary Material 1 and the central themes in Supplementary Material 2, with an indication by code based on the country and the number of the order of appearance in the text, for example 'URU29, 'MEX32', 'ARG05'.\u003c/p\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Uruguay\u003c/h2\u003e\u003c/div\u003e\n\u003ch3\u003e1) Context/agenda setting (dup: 3 ?)\u003c/h3\u003e\n\u003cp\u003eBetween 2006 and 2013, there was an increase in the prevalence of overweight, obesity and NCD in Uruguay, which was closely related to a decrease in consumption of healthy foods and an increase in the consumption of ultra-processed food products (URU1). In addition, the previous mandatory Uruguayan nutrition labelling of packaged foods regulation did not meet its objectives of adequately informing consumers, since the majority of the population did not read the nutritional information on the packages because of the size of the font and the use of technical terms [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFaced with this dire nutrition and health situation, in 2013, the government, civil society, international organizations and the food and beverage industry committed to the development of actions to improve the food environment, which included regulatory measures, however, these were not formalized [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In the same year, the Law No. 19,140 \"Protection of the Health of the Child and Adolescent Population through the Promotion of Healthy Eating Habits\" was created, which aimed to protect the health of the child and adolescent population through the promotion of healthy eating habits in the educational environment [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe implementation of FoPNL was included in the agreement with policy recommendations for the prevention and control of obesity signed by the Southern Common Market (\u003cem\u003eMercado Com\u0026uacute;n del Sur\u003c/em\u003e - MERCOSUR) in September 2015 [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], and in the national strategy for the achievement of the Sustainable Development Goals (SDGs), built from the participatory process \"Social dialogue: Uruguay towards the future\", launched the following month by the Uruguayan government [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe analysis of interviews indicated that the presidential government which took office in 2015 was very committed to public health issues and included among the national health objectives, the promotion of healthy eating habits from improved food environments. In 2016, the \"Food Guide for the Uruguayan Population\" [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] was published, which is based on the Nova food classification system [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], including discouragement of the consumption of ultra-processed food products and the recommendation of a diet based on fresh and minimally processed foods (URU2).\u003c/p\u003e\n\u003ch3\u003e2) Policy discussion/formulation (dup: 4 ?)\u003c/h3\u003e\n\u003cp\u003eFrom 2016 to 2018, the design process of the Uruguayan FoPNL Standard took place, with the creation of an interdisciplinary and interinstitutional working group (WG) by the Ministry of Public Health, with the participation of different Ministries, other government bodies, the academia and international organizations [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The work was based on local scientific evidence, generated by the Interdisciplinary Nucleus \"Food and Well-Being\" of the University of the Republic (\u003cem\u003eUniversidad de la Rep\u0026uacute;blica\u003c/em\u003e - UDELAR), to justify all the decisions on FoPNL policy [\u003cspan additionalcitationids=\"CR47 CR48\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. The group selected a FOPNWL system with the PAHO nutrient profile model as the most appropriate for the Uruguayan reality, which was drafted in a draft decree (URU3).\u003c/p\u003e\u003cp\u003eInternational consultations were held with the World Trade Organization (WTO) and a public consultation happened in June 2017, opened by the Ministry of Industry, Energy and Mining [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Based on the contributions received, the final version of the decree was drafted in November 2017.\u003c/p\u003e\u003cp\u003eIn June of the following year, an agreement was published among the MERCOSUR health ministers on the general principles of the FoPNL to be implemented by the member countries of the bloc [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] and the proposed decree formulated in Uruguay was in line with this.\u003c/p\u003e\n\u003ch3\u003e3) Policy adoption (dup: 5 ?)\u003c/h3\u003e\n\u003cp\u003eIn August 2018, the Executive power signed the Decree No. 272/018, with more flexible limits for sugars, sodium and total and saturated fats than the PAHO model, an extended deadline of 18 months for its entry into force (in March 2020) and the provision for the modification of the decree in case of the approval of a regulation in MERCOSUR [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003e4) Policy implementation (dup: 6 ?)\u003c/h3\u003e\n\u003cp\u003eWith the approval of the decree, Uruguay immediately submitted a request to MERCOSUR to initiate the development of a regional technical regulation on the FoPNL based on FoPNWL [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. In parallel, the Uruguayan Ministry of Public Health made procedural changes necessary to support the implementation of the decree and included the warnings in a public campaign on healthy eating [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn June 2019, the Food Industry Chamber (\u003cem\u003eC\u0026aacute;mara Industrial de Alimentos\u003c/em\u003e - CIALI) requested a one-year postponement for the entry into force of the decree with the justification that the time was insufficient to change packaging and reformulate products, in addition to the lack of printing capacity for the new packaging in the country [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e], which was granted.\u003c/p\u003e\u003cp\u003eOn March 1, 2020, the same day that the decree became mandatory, it was suspended by the president, with a 120-day postponement of its entry into force, and an inter-ministerial WG was created to review it with a focus on the harmonization with MERCOSUR [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. With the difficulty of reaching a consensus from the WG and with the publication of studies showing public acceptance of the policy and the immediate effects of its implementation [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], in June 2020 the Ministries of Public Health and of Industry, Energy and Mining announced that the FoPNL policy would be maintained, but with some changes [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. From the discourse analysis, the postponement of the implementation of the Decree and for the new government and the technical changes that made it less rigorous had to do with the lobbying of the food and beverage industry (URU4, URU5).\u003c/p\u003e\u003cp\u003eDecree No. 246/020 was published in September 2020, with changes in the nutrient profile model and in the declaration basis, which became 100 g or 100 ml, justified by an adaptation for Chile's nutrient profile and to enable harmonization with MERCOSUR [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e].The intention was to further weaken the criteria that had already been made flexible, but the changes culminated in a nutrient profile model that would label more products with warnings, and a few days before its entry into force on February 1, 2021, another Decree No. 034/021 was approved with other changes in the nutrient profile model, further weakening the limits for solid products [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. The explanation of the Ministry of Public Health was that the new decree would maintain the number of labelled products but based on 100 g or 100 ml [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. The Ministries of Public Health and of Industry, Energy and Mining were summoned in Parliament to explain the changes and the process that culminated in approving the Decree of 2021 [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. For government and civil society representatives, the changes in these decrees were not justified, leading to the belief that economic interests and industry pressure interfered with government decisions and overrode public health interests, especially concerning to the nutrient profile model (URU6, URU7, URU8).\u003c/p\u003e\n\u003ch3\u003e5) Policy evaluation (dup: 7 ?)\u003c/h3\u003e\n\u003cp\u003eSince 2020, the year Decree No. 272/018 was expected to come into force, academia has been conducting data surveys to understand the implementation of the policy by the industry and how consumers are using the nutritional information (URU9). As a result of monitoring the implementation of the Decree, civil society has publicly countered arguments and denounced the food and beverage industry for non-compliance or consumer deception.\u003c/p\u003e\u003cp\u003eAs the bromatological control and registration of food in Uruguay is the responsibility of each of the 19 departments of the territorial units, there was a great fragmentation in the control of the implementation of the Decree. Thus, there is a joint work between the government and international organizations to build a single food registry for the whole country in 2023 with the commitment of all Uruguayan departments (URU10).\u003c/p\u003e\u003cp\u003e\u003cem\u003eType of regulatory instrument\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAccording to the discourse analysis, at the time of the discussions in the WG, the establishment of the FoPNL policy as a decree was the recommendation of the Ministry's legal advisors, as it was the fastest and most efficient process to advance the policy. In addition, as with other sectors, food regulations in the country have been issued as decrees, including the bromatological regulation, with which the other decrees are associated (URU11, URU12).\u003c/p\u003e\u003cp\u003eThus, the option of the decree meant instability during the different governments and a fragility of being easily modifiable, as occurred throughout the Uruguayan process of approval and implementation of the FoPNL policy, leading to technical weaknesses [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. According to a government representative, there is a work to pass a law on healthy food environments based on the FoPNL in order not to have the fragility of a decree, as it happened with the FoPNL Decree (URU13).\u003c/p\u003e\u003cp\u003e\u003cem\u003eRole of stakeholders\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe Uruguayan Executive government, with the Ministry of Health as the leader and the Ministry of Industry as the co-leader, organized and coordinated the intersectoral and interdisciplinary WG that discussed and developed the original FoPNL Decree, with the participation of representatives from academia and international organizations (URU14, URU15). In addition, government agents also participated in the inter-ministerial WG created in 2020 to discuss the next steps regarding the Decree in the new Uruguayan administration.\u003c/p\u003e\u003cp\u003eThe role of academia, especially from the Interdisciplinary Nucleus \"Food and Well-being\" of the UDELAR, was to generate scientific evidence to base the technical discussions and support decision-making on the draft decree on the FoPNL, based on the participation in the processes of discussion and design of the Standard. Representatives from academia and government reported that all technical decisions were based on specific studies to answer the questions regarding the Decree and highlighted the importance of having local evidence for decision making (URU16, URU17).\u003c/p\u003e\u003cp\u003eUruguayan civil society, through the Alliance for Non-Communicable Diseases (\u003cem\u003eAlianza de Enfermedades no Transmisibles\u003c/em\u003e - ENT) (the Alliance ENT), took a more active role in the FoPNL process in 2020, when changes in the Decree and in the policy's implementation deadlines began. In the same year, the Alliance ENT launched a mass and digital media campaign in defense of the FoPNL, with the aim of keeping the population informed and stimulating critical behaviour in relation to the current situation and the food and beverages consumed. According to the constant changes in the regulations and their implementation, the campaign messages were adapted [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBased on the scientific evidence, civil society sensitized government agents through meetings, and the Uruguayan population through press conferences on the issue, and confronted the food and beverage industry, which at the time was lobbying hard against the implementation of the measure (URU18).\u003c/p\u003e\u003cp\u003eBetween October and November 2020, with the aim of finding out the population's opinion on the FoPNL and its willingness to change its purchasing behaviour in the face of the new labels, civil society conducted a survey. The results showed the population's knowledge and agreement with the measure, ease of understanding the information, and change in purchasing behaviour [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In May 2021, another survey was conducted with the Uruguayan population to know their opinion on aspects of the FoPNL and their possible behaviour towards it, which showed the ease of reading the labels and the change in the intention to purchase products with octagons [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eInternational organizations played a very important role in the Uruguayan FoPNL process: the participation in the WG for the drafting of the 2018 Decree, the generation and compilation of scientific evidence for use in advocacy at different key moments, the production of educational materials to raise awareness among the population, the publication of a joint position paper [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e], the organization of a seminar and meetings with government agents to defend the maintenance of the original Decree, the launch of a digital campaign and press interviews, and support to the government in the process of monitoring compliance with the Standard by updating the national food registry database and the implementation of a single registry at the national level [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eIndustry interference\u003c/em\u003e\u003c/p\u003e\u003cp\u003eInterference from the food and beverage industry occurred throughout the entire FoPNL regulatory process in Uruguay. During the design stage of the Standard, the argument used was that the FoPNWL stigmatizes foods and generates fear and confusion among consumers, with the proposal of the traffic-light labelling model as a more appropriate alternative to inform them. Criticism was also made of the PAHO nutrient profile model, arguing that it labels too many products too harshly and does not encourage reformulation. The economic narrative of job losses, rising food and beverage prices due to reduced sales and the closure of companies in the country was also present, including in public speeches in the press from CIALI and the Association of Importers and Warehouse Wholesalers (\u003cem\u003eAsociaci\u0026oacute;n de Importadores y Mayoristas de Almac\u0026eacute;n\u003c/em\u003e - AIMA) [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e] (URU19).\u003c/p\u003e\u003cp\u003eThe food and beverage industry was internationally articulated for the submission of its contributions to the Uruguayan public consultation, according to the discourse analysis (URU20). The arguments presented had to do with the fact that the FoPNL do not contribute to the reduction of obesity and NCD prevalence, since they are multifactorial diseases and require other measures, such as the promotion of physical activity and nutritional education. In addition, the industry defended self-regulation and asked for more time for the application of the regulations, the adaptation of their products from reformulation and the change of packaging. As an alternative to the PAHO nutrient profile model, the industry recommended limits based on portions of consumption and different by food category, as in the case of dairy products [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e] (URU21).\u003c/p\u003e\u003cp\u003eIn the public consultation and at the stage of the changes in the FoPNL Decree, the food and beverage industry claimed lack of scientific evidence for the selection of the warning system [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e] and even questioned the results of experimental studies developed by academia without CoI [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt is important to note that the discourse did not always come directly from an industry representative, but also from spokespersons from academia and scientific societies linked to the production of food products, as reported by a government representative (URU22).\u003c/p\u003e\u003cp\u003eThe argument of disharmony with international agreements, especially MERCOSUR, was used by both the industry and the government, from public consultation, in legal actions, to questioning after the approval and implementation of the Decree, justifying changes in technical aspects and in the deadline for its entry into force [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e] (URU23, URU24).\u003c/p\u003e\u003cp\u003eThe food and beverage industry carried out actions against civil society throughout the process. In the form of a legal action, the president of CIALI filed a complaint for defamation and libel against the coordinator of the Alliance ENT, in addition to intimidating actions and threats through social networks when civil society exposed the non-compliance of the Decree by some companies [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAs a result of the various changes in the decrees and their implementation deadlines due to pressure from the food and beverage industry, there was an inequality in the timing of implementation of the FoPNL by the companies, which generated confusion for consumers (URU25, URU26).\u003c/p\u003e\u003cp\u003e\u003cem\u003eResponse to industry interference\u003c/em\u003e\u003c/p\u003e\u003cp\u003eOnce the deadline changes were made in a few days and some food and beverage industries had already changed their packaging, the generation of scientific evidence to base the Uruguayan Standard and to verify the immediate positive effects of its implementation were essential to maintain the policy with its technical characteristics and its force in 2020. Its use ranged from publications in scientific journals, to press releases and technical reports with simple language translating the scientific evidence for the population and decision makers (URU27).\u003c/p\u003e\u003cp\u003eThe mass and digital media campaign developed by the Uruguayan civil society exposed all the changes in the implementation deadlines of the FoPNL Decree to become evident the interference that the government was suffering. According to the discourse analysis, the space occupied by academia and civil society in the press was an important strategy to counter the arguments and narrative of the food and beverage industry (URU28).\u003c/p\u003e\u003cp\u003eThe joint work for a common goal between academia, civil society and international organizations guaranteed by inter-institutional spaces and the formation of alliances was registered by a representative of academia as an important strategy to strengthen evidence, arguments, tactics and activities in favour of the approval and the implementation of an adequate and effective FoPNL policy (URU29).\u003c/p\u003e\u003cp\u003e\u003cem\u003eCollaboration and support\u003c/em\u003e\u003c/p\u003e\u003cp\u003eUruguayan civil society used evidence, arguments, experiences and lessons learned from the FoPNL regulatory processes, mainly in Chile and Brazil, but also in Peru, Mexico, Argentina and Colombia. Information was exchanged through meetings and events, and declarations were signed, with regional support especially facilitated by the Healthy Latin America Coalition (\u003cem\u003eCoalici\u0026oacute;n Latinoam\u0026eacute;rica Saludable -\u003c/em\u003e CLAS). In the specific case of MERCOSUR, there was collaboration between the civil societies of Uruguay, Argentina and Brazil for the exchange of information, since, at the beginning, not all countries were allowed to participate in the official meetings [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. According to a civil society representative, such collaboration was essential to have information on what was happening in the official MERCOSUR meetings and to prepare for advocacy in Uruguay (URU30). In addition, there was technical and political advocacy work for the signing of the agreement of the MERCOSUR health ministers on the recommendations for an effective FoPNL, which, according to a representative of the academia, served as a political endorsement to move forward with the Uruguayan process independently of the other countries of the bloc [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] (URU31).\u003c/p\u003e\u003cp\u003eFrom international organizations, in 2020, PAHO, UNICEF and FAO held meetings with representatives of the Executive and Legislative powers to highlight the benefits of the FoPNL for the health and well-being of adults and children [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e], and a position paper was published and disseminated in all countries of the region in an attempt to give greater coverage to what Uruguay was advocating for [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. According to a civil society representative, regional progress on FoPNL is seen as a push for more and more countries to have the strength to initiate discussions and implement effective regulatory measures, in addition to strengthening those countries that have already implemented the measure (URU32).\u003c/p\u003e\u003cp\u003e\u003cem\u003eHuman and children's rights\u003c/em\u003e\u003c/p\u003e\u003cp\u003eHuman rights, especially the rights to adequate food, information and children's, were considered at the beginning and during the FoPNL discussions in Uruguay. Issues such as health protection, food habit formation, stimulus to consumption from advertising strategies on packaging, and the occurrence of NCD in children at an increasingly early age were addressed. According to the discourse analysis, it is the duty of the State to develop policies that guarantee the full exercise of the right to food of the entire population, especially children and adolescents (URU33, URU34).\u003c/p\u003e\u003cp\u003e\u003cem\u003eChallenges, difficulties and threats\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAccording to a government representative, placing the issue on the public agenda was a major challenge at the beginning of the Uruguayan regulatory process, with the construction of the confluence of interests and joint, intersectoral and interdisciplinary work with health objectives between governmental and academic agents (URU35). The generation of scientific evidence was also seen as a challenge by a representative of the academia, because at the time of the beginning of the discussions, there was still nothing published on FoPNWL, which created the evident need to develop local evidence (URU36).\u003c/p\u003e\u003cp\u003eOne challenge highlighted was the facilitated entry of the food and beverage industry into the government and the linkages and funding of civil society activities, events and associations, which generated division among organizations and discourses against scientific evidence during the discussion of the Decree, according to a civil society representative (URU37).\u003c/p\u003e\u003cp\u003eAn attempt was made during the public consultation to argue that MERCOSUR regulations would be an obstacle, when the Ministries of Economy and Foreign Affairs and the food and beverage industry claimed concern with potential negative consequences of the regulation on trade in MERCOSUR [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. This culminated in changes to the final Decree. After its approval, the lack of harmonization in MERCOSUR was also used as the main argument in a legal action against the Decree No. 272/018 by a group of eight Uruguayan food importers. A Uruguayan producer of processed meats also filed a legal action against the Decree, justified by the limitation of the right to property, freedom of industry and commerce [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. The need for harmonization with the bloc was once again used when the new government suspended the Decree No. 272/018 in March 2020 [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], and by the inter-ministerial WG in its recommendation for a delay in the implementation by July 2021 [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The changes promoted in the Decree No. 246/020 in relation to the nutrient profile model and in the declaration\u0026rsquo;s basis were justified as an attempt to harmonize with MERCOSUR [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. Finally, as part of Decree No. 272/018, it was established that the national regulation will be modified in the event of the approval of a FoPL regional regulation at the MERCOSUR level [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWith the approval of a decree that went through so many changes in the nutrient profile model without justifications and without being based on scientific evidence, according to a civil society representative, there was a weakening of the policy and a detriment to products aimed at children, especially dairy products, which ceased to have labels of excess sugars and saturated fats [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] (URU38).\u003c/p\u003e\u003cp\u003eFrom the academia's point of view, the lack of involvement and awareness of the entire political system and the discontinuity of the government's actions were a major difficulty, as it culminated in many changes and delays in the Decree originally proposed by the interdisciplinary and inter-institutional WG in 2018; both the 18-month extension for the entry into force of the policy, which coincided with the start of the new government, as well as the discussion without the involvement of the entire political system. In the end, it was a political decision, without the participation of the technical team or representatives of academia or civil society. In addition, the lack of problematization of the need to regulate food environments in the political system was also seen as a difficulty (URU39, URU40).\u003c/p\u003e\u003cp\u003eFinally, the Ministry of Health's oversight challenge is described, due to the lack of prioritization and qualified personnel. It was only after the Alliance ENT put pressure on and took on the role of supervising the policy at the points of sale that the Ministry presented partial results for a small percentage of products. Thus, for the products that were not complying with the Decree, a new extension was granted by the government. Civil society demanded transparency and participation in the processes of control and supervision of the implementation of the measure [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eStrengths and lessons learned\u003c/em\u003e\u003c/p\u003e\u003cp\u003eA strength and a lesson learned considered by a government representative was that the Uruguayan policy, especially at the time of the technical discussions in the WG, was driven by several institutions and strongly led by the Ministry of Health, especially because the project was based on national and international scientific evidence (URU41). From the point of view of international organizations, the continuous generation of scientific evidence on the effects of the policy is necessary (URU42).\u003c/p\u003e\u003cp\u003eFrom the civil society, the coordination of the joint work was considered a strength, since it gave public visibility to the topic and allowed to guide it in society, with reflections and questioning, including a strong presence in the press (URU43). The need to have a communication team with targeted strategies to counteract the industry narrative and translate the scientific evidence for the population was also highlighted, since it is a cultural change issue (URU44).\u003c/p\u003e\u003cp\u003eThe frequent strategies of the food and beverage industry were highlighted, which generates the need for action at the territorial level from civil society and international organizations for greater capillarity and effectiveness (URU45).\u003c/p\u003e\u003cp\u003eUruguay's decision to move forward with a decree and not having discussions of the FoPNL issue throughout the political system resulted in the discontinuity of the policy and changes in the norm. Thus, an important learning highlighted from the academia was the need to involve and empower the entire political system so that the discussion is strengthened (URU46).\u003c/p\u003e\u003cp\u003e\u003cem\u003eNext steps\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFor Uruguay, it is important to advance in legislative frameworks that have continuity from the promotion of healthy eating and the regulation of food environments based on the FoPNL rules, such as the regulation of food and beverage advertising. The government is working on a bill with the concept of healthy food environments that contributes to the right to food (URU47).\u003c/p\u003e\u003cp\u003eFrom the point of view of civil society, the improvement of the technical aspects of FoPNL Decree should focus on a stricter nutrient profile model, like the PAHO\u0026rsquo;s; the regulation of advertising strategies on food and beverage packaging; the inclusion of the information on sugars in the nutrition facts panel and the standardization of the names of sugars in the list of ingredients; and the inclusion of a cautionary legend about the presence of sweeteners and caffeine in the products. In addition, it is necessary to restrict the advertising, promotion and sponsorship of unhealthy foods and beverages, especially for children and adolescents; and to prohibit the sale and advertising of these products in specific environments, such as educational centres, health institutions and state and non-state public agencies [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Mexico\u003c/h2\u003e\u003c/div\u003e\n\u003ch3\u003e1) Context/agenda setting (dup: 8 ?)\u003c/h3\u003e\n\u003cp\u003eProposed by the Mexican Council of the Consumer Products Industry (\u003cem\u003eConsejo Mexicano de la Industria de Productos de Consumo\u003c/em\u003e - ConM\u0026eacute;xico) [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e], which represents the largest producers of ultra-processed food products in the country, in 2014, the Guideline Daily Amounts (GDA) [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e] were implemented, a FoPNL system proven ineffective to support the Mexican population in making dietary choices based on their use and understanding [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. The Mexican GDA was neither elaborated nor discussed with experts in the field, representatives of civil society or academia (MEX1), and its approval process lacked transparency and scientific evidence [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn 2016, the Mexican government declared an epidemiological emergency due to high levels of obesity and diabetes [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e] and in November 2017, the Ministry of Health requested the National Institute of Public Health (\u003cem\u003eInstituto Nacional de Salud P\u0026uacute;blica -\u003c/em\u003e INSP) to form the \"Committee of National Academic Experts on Front-of-Package Labelling of Food and Non-Alcoholic Beverages for Better Health\", with 31 professionals without CoI to work on the development of an effective FoPNL system [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn October 2018, the Forum \"The policy against obesity in Chile, the best example for the Mexican Legislative\" took place in the Chamber of Deputies. Subsequently, during the new administration, with the support of a group of experts, the Federal Commission for Protection against Health Risks (\u003cem\u003eComisi\u0026oacute;n Federal para la Protecci\u0026oacute;n contra Riesgos Sanitarios\u003c/em\u003e - COFEPRIS) prepared a working document and conducted a regulatory impact analysis.\u003c/p\u003e\u003cp\u003eThus, according to international organization and government representatives, with the change of the federal government and the Congress in 2019, there was greater concern and commitment to address the determinants of NCD with a public health approach and based on scientific evidence. Among the priority issues was the food labelling (MEX2, MEX3).\u003c/p\u003e\u003cp\u003eIn addition to the growing evidence against the GDA and the worrying epidemiological situation of the Mexican population, the time came for the mandatory revision of the Mexican Official Standard NOM-051-SCFI/SSA1-2010, General Labelling Specifications for Pre-Packaged Foods and Non-Alcoholic Beverages-Commercial and Sanitary Information (hereafter NOM-051) (which should occur every five years). For that, there was great support from academia through INSP and a push from civil society, represented by the Alliance for Healthy Eating (\u003cem\u003eAlianza por la Salud Alimentaria\u003c/em\u003e), with support from PAHO and UNICEF, to adopt the most beneficial option for the population (MEX4, MEX5).\u003c/p\u003e\n\u003ch3\u003e2) Policy discussion/formulation (dup: 9 ?)\u003c/h3\u003e\n\u003cp\u003eDiscussions for the modification of the General Health Law (GHL) and the NOM-051 were initiated in 2018 and 2019, in the Legislative and Executive powers, respectively. The modification of the GHL was marked by the working table \"Obesity in Mexico: a policy to combat the epidemic\" in the Chamber of Deputies in February 2019, with the presence of representatives of the Ministries of Health and Economy and driven by civil society [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn July of the same year, INSP and UNICEF convened the Expert Forum \"Regional experiences in the implementation of nutritional warning labelling in the face of food industry interference\" to support the process of amending the GHL and the NOM-051. The experiences and lessons learned in the process of designing, implementing and evaluating the FoPNWL in LAC countries, with emphasis on the tactics and arguments of the food and beverage industry, were presented to decision-makers from both the Legislative and Executive powers [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn August 2019, the public hearing \"Front-of-package nutrition labelling and healthy diet choices\" of the Open Parliament was organized, with the participation of representatives from academia, civil society, international organizations and the food and beverage industry. With the resumption of congressional sessions in September 2019, the discussion for the modification of the GHL was reactivated and UNICEF prepared a technical note for legislators of the Chamber of Deputies and the Senate [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCOFEPRIS coordinated the work tables for the discussions on the modification of the NOM-051, based on the presentation of the draft document, with technical support from INSP, PAHO y UNICEF. The process followed the legal procedures for the modification of NOMs, starting with the formation of an inter-institutional technical WG for the analysis and review of the preliminary draft of the NOM modification, with the participation of representatives from government, academia, civil society, international organizations and the food and beverage industry.\u003c/p\u003e\u003cp\u003eThe public consultation was opened in October 2019, with the publication of the \"Draft Amendment to Mexican Official Standard NOM-051-SCFI/SSA1-2010, General Labelling Specifications for Pre-packaged Foods and Non-Alcoholic Beverages-Commercial and Sanitary Information\" in the Official Journal of the Federation (\u003cem\u003eDiario Oficial de la Federaci\u0026oacute;n\u003c/em\u003e - DOF), together with the consultation of the Regulatory Impact Matrix (\u003cem\u003eMatriz de Impacto Regulatorio\u003c/em\u003e - MIR) for the analysis of the costs and benefits of NOM-051 [\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e]. By the close of December of the same year, the consultation received more than 5,200 comments.\u003c/p\u003e\u003cp\u003eIn the same month, the meetings of the technical WG were resumed, with the review, analysis, discussion and resolution of the comments on the preliminary draft of the NOM-051 from the public consultation. The nutrient profile model was the only point on which a consensus could not be reached, so it was submitted for voting and approval by the National Consultative Committees for Standardization of COFEPRIS and the Ministry of Economy [\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn January 2020, COFEPRIS and the Ministry of Economy approved the modification of the NOM-051 [\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e], which was threatened in the following month by a provisional suspension of an appeal, by the Confederation of Industrial Chambers of the United Mexican States (\u003cem\u003eConfederaci\u0026oacute;n de C\u0026aacute;maras Industriales de los Estados Unidos Mexicanos\u003c/em\u003e - CONCAMIN), which delayed the publication of the process by ten days. In March, CONCAMIN ordered the delay of the implementation of the FoPNL by at least three years due to the COVID-19 pandemic, which did not occur [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003e3) Policy adoption (dup: 10 ?)\u003c/h3\u003e\n\u003cp\u003eIn October 2019, the Chamber of Deputies and the Senate approved the amendments and additions to the GHL, with its publication in the DOF in the following month, with the following modifications: the definition of FoPNL and how it should be presented on the packaging [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWith the GHL approved, in March 2020 the modification of the NOM-051 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] was published in the DOF, shortly after the publication of the responses to some of the comments received in the public consultation on the preliminary draft [\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003e4) Policy implementation (dup: 11 ?)\u003c/h3\u003e\n\u003cp\u003eAccording to the nutrient profile model chosen, the implementation of the Standard will be given in three progressive phases of adaptation, to support food and beverage producers in the transition to the new rules [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSince the approval of the FoPNL policy, several food and beverage industries have filed several appeals with the Mexican Supreme Court of Justice (\u003cem\u003eSuprema Corte de Justicia de la Naci\u0026oacute;n\u003c/em\u003e - SCJN) against the measure, arguing, for example, about the violation of the right to equality and discrimination. So far, all the appeals filed were denied [\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e]. Questioned by Mexican civil society, the United Nations Special Rapporteurs on the Right to Food and the Right to Health sent a letter to the Alliance for Healthy Eating in November 2022, which was shared with the Mexican Ministers, to express their concern about the appeals of the food and beverage industry to the SCJN [\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e]. Different experts and organizations dedicated to food, nutrition, public health, human rights and consumer rights have filed \u003cem\u003eamicus curiae\u003c/em\u003e briefs and letters to the SCJN to defend the Mexican FoPNL policy [\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003e5) Policy evaluation (dup: 12 ?)\u003c/h3\u003e\n\u003cp\u003eFrom academia, there is a need to generate evidence on a permanent basis. Thus, studies are being developed to measure the impact of the FoPNL, especially on product reformulation by the food and beverage industry and on decision-making and change in purchases by consumers of different age and population groups, which is shown to be positive (MEX6).\u003c/p\u003e\u003cp\u003e\u003cem\u003eType of regulatory instrument\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIn Mexico, the various actors that participated in the discussions of the FoPNL had different visions of the most appropriate and possible type of regulation for the country. According to a civil society representative, the Ministry of Health proposed a specific law, as in Chile. Some civil society organizations proposed to focus only on the modification of the NOM-051, and others saw the importance of the modification at the level of the law, considering that it is hierarchically superior to the NOM (MEX7, MEX8).\u003c/p\u003e\u003cp\u003e\u003cem\u003eRole of stakeholders\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIn Mexico, academia, represented by INSP, was always very involved in the process of modifying the NOM-051, including as technical support for the Executive power from the Secretaries of Health and Economy and COFEPRIS (MEX9). From the academia's point of view, appointing INSP as the coordinator of the national group of experts on food labelling was strategic, as it was responsible for generating scientific evidence throughout the process, developing the draft proposal and participating in the NOM-051 modification sessions, all based on discussions with national and international advocacy and research actors without CoI (MEX10).\u003c/p\u003e\u003cp\u003eMexican civil society and international organizations worked closely with academia throughout the entire FoPNL discussion process, both in the Legislative and the Executive powers. They participated in technical discussions, carried out advocacy actions with legislators, publicized the scientific evidence produced by the academia, conducted communication campaigns to generate favourable public opinion and lobbied for an effective FoPNL (MEX11). According to civil society and government representatives, during the WG discussions, there was the signing of a confidentiality statement that prohibited participants from going public, which favoured internal work in support of the academia in confrontations with the food and beverage industry (MEX12, MEX13).\u003c/p\u003e\u003cp\u003e\u003cem\u003eIndustry interference\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIndustry interfered throughout the discussion and approval processes of the Mexican Law and Standard, and continues to interfere in the implementation process. They had a performance in the Congress, from lobbying with legislators to try to block the proposal and the discussion of the GHL. Other initiatives were presented by legislators and there were times when it was impossible to vote in the commissions due to the lack of a majority. But, when the Law was approved in the commissions, they began to act through the media to discredit the FoPNWL, with false and confusing arguments for the population.\u003c/p\u003e\u003cp\u003eThe interference in the process of updating the NOM-051 with the WG was done in compliance with the regulations and, although the other participants had a very coherent position and made it difficult to use their arguments, sometimes the industry would pressure or try to convince members of the Executive power with arguments that seemed to be supported by science (MEX14). According to international organization and government representatives, the food and beverage industry was always in disagreement and tried to misinterpret scientific evidence (MEX15, MEX16).\u003c/p\u003e\u003cp\u003eThe industry did not always act directly. It relied on professional and research groups with CoI to defend its narrative, used its own non-government organization (NGO) to serve as the public face and defend its arguments, and used industry chambers to avoid directly exposing its brands.\u003c/p\u003e\u003cp\u003eAmong the arguments used by the industry throughout the process is the fact that they were not heard, which is not true, since at least 60% of the members of the WG were from the food and beverage sector. Regarding the chosen FoPNL system, there was a questioning that it was not based on scientific and technical evidence, even when the nutrient profile was adapted from the PAHO model, and during the work meetings, 170 national and international scientific articles were submitted to support the FoPNL, in addition to the position and recommendations of recognized international organizations, such as FAO, UNICEF, PAHO and WHO. The issue of impacts on intellectual property and trademark rights were brought up because of the restriction on the use of characters and other images, which had to be weighed against the best interest of the child and his or her right to health. The lack of scientific evidence on the cautionary legend about the presence of sweeteners was also used as an argument against the Standard, even with the presentation of scientific evidence on the metabolic effects of the consumption of the ingredient and the position of national organizations against the use of sweeteners by the children [\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe presentation of more than 140 appeals was initiated at the end of the discussions at the working tables and continues to occur, even after the approval of the Law and the Standard for the FoPNL, with arguments of lack of scientific evidence and commercial limitations [\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e] (MEX17). According to a representative of an international organization, the arguments focus on the unconstitutionality of the process to question the nutrient profile model of the FoPNL and the restriction of the use of characters (MEX18).\u003c/p\u003e\u003cp\u003e\u003cem\u003eResponse to industry interference\u003c/em\u003e\u003c/p\u003e\u003cp\u003eSince the adoption of the GDA in 2014, Mexican civil society has denounced its approval process without transparency or social participation, in addition to the FoPNL system itself, which was not effective. Internal letters from WHO and PAHO to the Ministry of Health and COFEPRIS were made public in The New York Times stating that the GDA was inadequate. Through a request for access to information from civil society, the existence of a WG was questioned, to which COFEPRIS itself replied through official letters that there were no working meetings or such a group. According to a civil society representative, through Foreigner Legal Assistance of the United States, information was obtained confirming the absence of WG for the approval of the GDA, and the presence of communication between COFEPRIS and Coca-Cola (MEX19). Mexican civil society also filed appeals on how the GDA violated the right to information, health and children's rights. Due to the influence of the industry on some SCJN ministers, civil society lost the battle, but they won it in public opinion (MEX20).\u003c/p\u003e\u003cp\u003eThe exposure of the industry interference also occurred from discussions in the Legislative power by civil society, which was also denounced by legislators with respect to heavy lobbying in the Congress (MEX21).\u003c/p\u003e\u003cp\u003eSpecially to defend the caffeine and sweetener cautionary legends and the regulation of characters and other images, the main argument used by civil society, academia and international organizations was the best interest of children, which should be put before any other interest, including the commercial ones. The evidence shows the need to protect children from infant advertising and the potential harm caused by the consumption of caffeine and sweeteners during childhood [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e]. All the strategies and arguments used to refute the industry and to defend the FoPNWL in the technical roundtables were based on national and international scientific evidence. According to a representative of the academia, the strategy was to generate studies based on the needs of the process, with a focus on the best available evidence (MEX22). The Alliance for Healthy Eating produced the series \"Excessive Lies in Industry Arguments\" based on scientific evidence to expose ten myths of the food and beverage industry about the Mexican FoPNL [\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhen the measure was implemented, campaigns were carried out to stimulate the consumption of healthy foods and discourage the consumption of ultra-processed food products, with messages such as \"Consume food, preferably without labels and with fewer labels\", in addition to promoting the FoPNL and denouncing companies that violated it (MEX23).\u003c/p\u003e\u003cp\u003e\u003cem\u003eCollaboration and support\u003c/em\u003e\u003c/p\u003e\u003cp\u003eBefore the start of the discussions, in 2018, the Forum \"The policy against obesity in Chile, the best example for the Mexican Legislative\" took place in the Chamber of Deputies, with the participation of a Chilean researcher who participated in the formulation of the evidence to support the design of the Chilean FoPNL.\u003c/p\u003e\u003cp\u003eSubsequently, at the beginning of a new administration and to support the process of modifying the GHL and the NOM-051 in Mexico, the Expert Forum \"Regional experiences in the implementation of nutritional warning labelling in the face of interference by the food industry\" was promoted, with the participation of representatives of international organizations such as PAHO, UNICEF and the World Cancer Research Fund International (WCRF), academia from Chile and Uruguay, civil society from Brazil, Peru and Mexico, and the government of Ecuador, with the exchange of experiences, arguments and lessons learned. As a result of this forum, the document \"Experiences on the design and implementation of nutrition warning labelling in Latin America and the Caribbean\" was published with 15 general recommendations for Mexico [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFrom the point of view of civil society, the collaboration was also clear in the publication of public statements in favour of the Mexican FoPNL, specific discussions with researchers and advocates from other countries in the region and the exchange of local evidence (MEX24, MEX25).\u003c/p\u003e\u003cp\u003eInternational organizations published documents, press releases and public talks in favour of the adoption of the FoPNWL [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan additionalcitationids=\"CR88 CR89 CR90\" citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eHuman and children's rights\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe modification of the NOM-051 brings a focus on human rights and the best interests of children, with information also related to health. Since the preschool and school-age population groups are those with the highest proportion of calories from ultra-processed food products in their diets, the FoPNL has a particular benefit for them [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e]. The focus on children is very visible in the mini warning labels for small packages, the caffeine and sweetener cautionary legends, as well as the restriction of characters on the packaging of products high in critical nutrients. The work of civil society was closely connected with the network for children's rights in Mexico and with UNICEF (MEX26), and evidence was generated on children's understanding of the FoPNWL (MEX27).\u003c/p\u003e\u003cp\u003e\u003cem\u003eChallenges, difficulties and threats\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAccording to a representative of the academia, at the beginning of the discussions, the work of diverse actors including government, academia and civil society organizations, implied a challenge to have a common vision on the FoPNL process. The different ways of operating, concerns and mistrust had to be put aside to advance the joint work for public health (MEX28).\u003c/p\u003e\u003cp\u003eIndustry interference throughout the process was recognized as a major challenge during the FoPNL discussions, both at the Legislative and Executive levels (in the WG and directly with the Presidency and his office), as well as at the international level. The Mexican industry filed objections to the regulation to the WTO [\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e] and used the \u003cem\u003eCodex Alimentarius\u003c/em\u003e and international connections to argue about rights and trade barriers. According to a representative of the academia, sitting at the table with equal voice and vote with the objective of having a beneficial norm for the population and that all participants in the discussions were satisfied was a great challenge (MEX29).\u003c/p\u003e\u003cp\u003eFrom the point of view of academia, the appeals filed by the food and beverage industries are seen as a threat to the FoPNL, since an unfavourable decision could jeopardize the entire policy or some of its most important elements for public health and the protection of children. It must be considered a battle of the legal departments of the largest food and beverage industries in the world against the small legal department of the Ministry of Health in the SCJN. Thus, the government, academia, international organizations and representatives of other countries are attentive to what is happening in the discussions of the appeals (MEX30).\u003c/p\u003e\u003cp\u003e\u003cem\u003eStrengths and lessons learned\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIn the Mexican process, the adequate time to appear in the press to lobby public opinion, the exposure of the industry interference throughout the process, the alliance with authorities, researchers and international organizations committed to science, and the generation and use of scientific evidence as a basis for discussion were important lessons learned [\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e]. From the point of view of an international organization, the synchronization of the work in the Legislative and the Executive powers was essential to strengthen the FoPNL and reduce the likelihood of legal challenges (MEX31).\u003c/p\u003e\u003cp\u003eFrom academia, the intensity of the discussions between the strategic actors was recorded and how important it is to know how to communicate and sell health messages to convince the need for a FoPNWL policy. In addition, despite the initial difficulty of having a common vision, learning from the formation of links and organization between civil society, academia and government was essential for the approval of an appropriate standard for Mexico (MEX32, MEX33).\u003c/p\u003e\u003cp\u003eThe criteria established in the Mexican Standard for the FoPNL are seen as a strength, made possible by the change of experiences and recommendations from other countries, with the adaptation of the PAHO nutrient profile model, the adoption of cautionary legends for caffeine and sweeteners and mini warning labels for small packages, and the prohibition of characters and other nutritional images and endorsements. The approval of the Mexican FoPNL policy was commemorated by international organizations [\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e] and considered one of the best in the world [\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe importance of accompanying the implementation of the policy with communication campaigns was highlighted, since there is an impression that it took a long time to do so in order to stimulate the use of the FoPNL by the population. In addition, the NCD policy will help the government to align other food policies, such as the regulation of school environments and the advertising in other channels (MEX34).\u003c/p\u003e\u003cp\u003e\u003cem\u003eNext steps\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe food and beverage industries are filing many appeals against the Mexican FoPNL policy. Thus, the efforts of the civil society, academia, international organizations and the government to defend the FoPNL continue. Another important step is to disseminate the Standard and make the population aware of it and use it appropriately. To this end, the Mexican government has implemented various campaigns [\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e] and, in particular, is working with UNICEF Mexico on the \"Heroes for Health\" [\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e] campaign on social networks aimed at children. However, the importance of a broader campaign for the whole population and of having evaluations of each campaign was registered by a representative of an international organization.\u003c/p\u003e\u003cp\u003eThe progress of other public policies linked or harmonized with the FoPNL Standard for the creation of a robust and efficient package of measures is in the plans of civil society, academia and UNICEF for Mexico, such as the case of food advertising aimed at children and adolescents, based on the recommendations of PAHO and UNICEF, and school environments (MEX35, MEX36).\u003c/p\u003e\u003cp\u003eThe constant generation of scientific evidence is essential for the argumentation in legal proceedings, but also for a possible revision of the Standard in five years, as provided by the Law.\u003c/p\u003e\u003cp\u003eThe evaluation of the NCD policy is being conducted by INSP, especially on product reformulation by the food and beverage industry, the effects on the economy and jobs, and the change in purchasing behaviour by consumers.\u003c/p\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Argentina\u003c/h2\u003e\u003c/div\u003e\n\u003ch3\u003e1) Context/agenda setting\u003c/h3\u003e\n\u003cp\u003eWith the launch of PAHO's \"Action Plan for the Prevention of Obesity in Children and Adolescents\" in 2014 [\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e], the approval of the Chilean Healthy Eating Law in 2015 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the start of the work of some civil society organizations and some legislators on the issue of regulation of food environments and the understanding of the FoPNL as a gateway to the regulation of food environments, discussions in Argentina on the FoPNL began (ARG1, ARG2).\u003c/p\u003e\u003cp\u003eSince 2015, the FoPNL issue of became part of the agenda of different legislators. With the approval of the Chilean Law, the FoPNWL was incorporated into various bills, some of them advised by civil society organizations with no CoI, which had already been working on the issue [\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWith the change of government in December 2015, a new management was assumed in the Ministry of Health and the National Directorate for Health Promotion and Control of Chronic Noncommunicable Diseases and the National Advisory Commission on Healthy Eating and Obesity Prevention were implemented, with an intersectoral sub commission on NCD. From the point of view of an international organization, the new Minister of Health had the FoPNL as the main item on his agenda, with specific resources earmarked for its progress (ARG3).\u003c/p\u003e\n\u003ch3\u003e2) Policy discussion/formulation\u003c/h3\u003e\n\u003cp\u003eAccording to a representative of an international organization, at the beginning of the discussions, the Argentine economic crisis was used, especially by the food and beverage industry, as one of the obstacles to progress on the issue, as if the FoPNL was irrelevant to the challenge of poverty and hunger, since it would not solve the real problem (ARG4, ARG5).\u003c/p\u003e\u003cp\u003eRepresentatives of different government ministries and secretariats, civil society organizations, academia, international organizations and the food and beverage industry participated in the National Advisory Commission on Healthy Eating and Obesity Prevention, with the leadership of the Ministry of Health (NACHEOP). Discussions about FoPNL were based on international evidence and experience, in addition to valuing and encouraging the generation of local evidence, as reported by a government representative (ARG6).\u003c/p\u003e\u003cp\u003eFrom the Ministry of Health and civil society, literature review studies on the FoPNL [\u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e] and on the effectiveness of graphic designs [\u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e] and nutrient profile models [\u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e101\u003c/span\u003e, \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e] were developed. All studies proved that the adoption of octagonal warnings applied using the nutrient profile model recommended by PAHO was the most appropriate for the Argentine population.\u003c/p\u003e\u003cp\u003eIn 2019, the 2nd National Nutrition and Health Survey (\u003cem\u003e2\u0026ordf; Encuesta Nacional de Nutrici\u0026oacute;n y Salud\u003c/em\u003e - ENNyS 2), conducted by the Ministry of Health, generated valuable information on the health, nutrition and food consumption status of the population, as well as information on beliefs, opinions and use of food labels [\u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo advise legislators on their bills, a document was developed by the NACHEOP, with declaration of CoI, with the best FoPNL standards based on the FoPNWL and the PAHO nutrient profile model, in parallel to the actions of the Executive power (ARG7). The Ministry of Health, civil society organizations and international organizations played an important role in this advice so that the best evidence was used and the bills were unified into an ideal one (ARG8). According to a government representative, the support of civil society was essential to provide it with tools and increase its knowledge since the presentation of its draft law on the FoPNL (ARG9).\u003c/p\u003e\u003cp\u003eWith the transformation of the Ministry of Health into the Government Secretariat of Health completed in 2019, the loss of power generated by this situation, and the change of government in 2020, the discussion of a unified bill was initiated, based on local and international evidence and experiences generated over many years of work. A representative of an international organization told about the union of legislators from different political parties to reach a consensus on this bill (ARG10). At that time, public opinion, the new political decision-makers and the legislators were already convinced of the importance of the FoPNL Law.\u003c/p\u003e\u003cp\u003eThe unified bill received a positive opinion in the Health and Industry Committees on October 22, 2020, and was sent to the Senate, which gave it half sanction on October 29, 2020, with 64 votes in favour and three against it. It was then forwarded to the Chamber of Deputies, where it was referred to four committees [\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e] (ARG11).\u003c/p\u003e\n\u003ch3\u003e3) Policy adoption\u003c/h3\u003e\n\u003cp\u003eOn July 13, 2021, the bill was discussed and approved in the internal committees of the Chamber of Deputies, and on October 26 of the same year, the day of the vote for the approval of the Law in the same Chamber, according to a representative of an international organization, the technical knowledge acquired on food environments, nutrition and FoPNL, as a result of the support provided by the Ministry of Health, international and civil society organizations (ARG12), was clearly noticeable in the speeches of the legislators. The Healthy Food Promotion Law was passed with 200 affirmative votes, 22 negative votes and 16 abstentions. According to the discourse of some deputies, the Law is a tool for health prevention and for guaranteeing the rights of the Argentines, based on legitimate access to clear, precise and understandable information that allows the promotion of healthy food consumption [\u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e]. Its regulation was published in March 2022.\u003c/p\u003e\u003cp\u003eOn March 2nd, 2022, the Executive power issued a decree regulating the Law, which established that the Ministry of Health has the authority to enforce it [\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003e4) Policy implementation\u003c/h3\u003e\n\u003cp\u003eThe first and the second stages of the implementation of the Law of Healthy Food were initiated in August 2022 and May 2023, with major deadlines for small and medium-sized companies (\u003cem\u003epeque\u0026ntilde;as y medianas empresas\u003c/em\u003e - PyMES), respectively. In all cases, the companies were allowed to request an extension of 180 days [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. According to the discourse analysis, the industry is bombarding the Ministry of Health with requests for extensions of the implementation of the Law (ARG13).\u003c/p\u003e\u003cp\u003eIt is necessary to consider that Argentina has a federal organization and, therefore, a part of the Law - the implementation of the FoPNL - is incorporated in the Food Code and is applicable in the whole country, but there must be secondary regulations, such as the regulation of school feeding, which depend on each province. The implementation plan of the Ministry of Health ensures the issuance of complementary regulations, such as advertising and sponsorship and food education in schools, when necessary to ensure enforcement and control authority, in addition to the registration of sanctions throughout the national territory. Civil society is working at the provincial level to raise awareness and train governments for the full implementation of the Law throughout the country (ARG14), together with the development of the \"Regulatory Map of Front-of-Package Labelling in Argentina\" by the Foundation for the Development of Sustainable Policies (\u003cem\u003eFundaci\u0026oacute;n para el Desarrollo de Pol\u0026iacute;ticas Sustentables\u003c/em\u003e - Fundeps) and the Argentine Society for Nutrition and Real Food (\u003cem\u003eSociedad Argentina de Nutrici\u0026oacute;n y Alimentos Reales\u003c/em\u003e - SANAR) [\u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn addition, as the Law involves different government actors, the Ministry of Health has technical WG with the Ministry of Education, the Ministry of Social Development, the Ministry of Economy, the Federal Health Council and the Federal Education Council to ensure the comprehensive implementation of the Law (ARG15).\u003c/p\u003e\n\u003ch3\u003e5) Policy evaluation\u003c/h3\u003e\n\u003cp\u003eThe Ministry of Health has set up a comprehensive monitoring plan to evaluate all aspects of the Law. Based on the national food and beverage database, a research on the modification of the composition of products is being carried out in partnership with the Federation of Graduates in Nutrition (\u003cem\u003eFederaci\u0026oacute;n de Graduados en Nutrici\u0026oacute;n\u003c/em\u003e - FAGRAN). In addition, using data from national surveys, food consumption habits will be evaluated, with the inclusion of questions on the subject in the next surveys for comparison purposes. In conjunction with PAHO and UNICEF, monitoring research on advertising, promotion and sponsorship is being planned. UNICEF is also finalizing a study to determine the initial effects of the policy's implementation.\u003c/p\u003e\u003cp\u003eFrom the civil society, they are working to evaluate compliance with the implementation, the reformulation of food and the effects of the Law in relation to knowledge, understanding, modification in the perception and the consumption of food. In addition, there is monitoring to assess non-compliance with the Law, with consequent litigation and exposure actions to alert the population to the need to defend their rights.\u003c/p\u003e\u003cp\u003e\u003cem\u003eType of regulatory instrument\u003c/em\u003e\u003c/p\u003e\u003cp\u003eArgentina had the opportunity to discuss and approve its FoPNL Standard at three different levels: in the Legislative power (National Congress), in the Executive power and at the MERCOSUR level. MERCOSUR would only regulate food labelling, without including the package of measures with the regulation of advertising, school environments and public procurement. From the Legislative power, from the point of view of civil society, it was necessary to convince decision-makers of the importance of clearly establishing the graphic system and the nutrient profile model, but it was the best way, since it is the representation of the people (ARG16, ARG17).\u003c/p\u003e\u003cp\u003eAs the Chilean and the Peruvian FoPNL Laws did not define the labelling system or the nutrient profile model, leaving such regulation to the regulatory authority in the Executive power, Argentina considered such previous experiences to include all aspects of the FoPNL established by law [\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eRole of stakeholders\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe Ministry of Health of Argentina played a role in generating evidence to support the initial discussions on the FoPNL, participating in internal and MERCOSUR discussion groups, coordinating the NACHEOP, advising legislators, leading the technical roundtable for the regulation and in the implementation team of the Law, generating technical documents to support its implementation, and accompanying the monitoring plan of the Law. A government representative reported the support offered to legislators and how they collaborated to avoid the industry interference throughout the process (ARG18).\u003c/p\u003e\u003cp\u003eThe main role of the legislators was the presentation of bills on the FoPNL, participation in meetings with civil society and international organizations, discussions on the subject in Congress and voting in the House and Senate committees, until the approval of the Healthy Food Law. A report by a government representative shows the importance of the popular mobilization and the presence of the FoPNL issue in the press (ARG19).\u003c/p\u003e\u003cp\u003eCivil society played an important role before and during the discussions of the Law, generating evidence free of CoI, understanding the regulatory and legal context and the industry's arguments, accompanying the discussions in MERCOSUR, participating in the FoPNL subcommittee, drafting the recommendatory document, unifying the draft law, advising legislators and exposing the industry interference. A civil society representative highlighted the importance of the work of translating the technical knowledge for the different legislators, who incorporated the vocabulary and showed full knowledge of the subject at the time of voting on the Law (ARG20, ARG21).\u003c/p\u003e\u003cp\u003eIn addition, the role of civil society was definitive in the construction of the mass media campaign as a way of supporting parliamentarians in passing the Law and raising awareness among the Argentine population of its importance in 2022 [\u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e]. FIC Argentina, SANAR, Fundeps, FAGRAN, \u003cem\u003eConsumidores Argentinos\u003c/em\u003e and \u003cem\u003eConsciente Colectivo\u003c/em\u003e worked on the campaign as a transdisciplinary consortium. Despite having very different profiles, these organizations were complementary and built a unique and very clear narrative, according to the discourse analysis (ARG22).\u003c/p\u003e\u003cp\u003eCivil society worked closely with the government and international organizations, especially PAHO, UNICEF, the Food and Agriculture Organization of the United Nations (FAO), the International Development Research Centre (IDRC), the Global Health Advocacy Incubator (GHAI) and Bloomberg Philanthropies, which had the role of participating in the technical discussions of the FoPNL subcommittee and in the legislature, publishing technical documents and positions, facilitating contact between countries in the region, and providing technical and financial support for research, advocacy and communication projects. From the point of view of civil society, having the same discourse from all these actors was of great importance during the process (ARG23).\u003c/p\u003e\u003cp\u003eSince the approval of the Law, civil society continues to follow its implementation, exposing violations and monitoring its first effects in Argentina.\u003c/p\u003e\u003cp\u003e\u003cem\u003eIndustry interference\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIndustry interference permeated the entire process of discussion and approval of the Argentine Law, and continues in the implementation process. During the discussions, the industry took part in the FoPNL subcommittee of the Ministry of Health, public hearings and informative meetings in the Legislative committees as stakeholders involved in the issue, in addition to direct meetings with decision-makers. According to a representative of an international organization, the Ministry of Health considered it less harmful to have the official participation of the industry in the discussions than to take the risk of suffering actions external to the process (ARG24).\u003c/p\u003e\u003cp\u003eOften, the disinformation narrative of the industry came from health professionals, experts and academics who had credibility with the population and parliamentarians, but had ties to the industry and did not declare CoI (ARG25). In addition to funding professionals and researchers, the industry funded publications, congresses and scientific events. A government representative reported the case of a meeting of the Argentine Society of Nutrition, where the entire panel was composed of industry representatives, while the government was invited to speak for a very short time (ARG26). From the point of view of civil society, until the Senate's approval, the media only gave space to professionals paid by the industry, which meant that only one voice was heard (ARG27).\u003c/p\u003e\u003cp\u003eInitially, the industries defended the GDA graphic design, with a very permissive per-serving nutrient profile model. Later in the process, the industry tried to push for a parallel project by the Executive's National Food Commission, which is interministerial, with 'high in' octagons and Chile's nutrient profile model, but with the possibility of adapting to the Brazilian model, in addition to addressing only the FoPNL and no other regulatory measures.\u003c/p\u003e\u003cp\u003eArguments against the FoPNWL and the PAHO nutrient profile model said that reformulation would not be possible, that all foods would be labelled and people would have no choice, that positive nutrients would be made invisible, that the industry would not incorporate good quality nutrients because of the ban on claims, that the octagons frightened the population, that they did not provide information but demonized the foods.\u003c/p\u003e\u003cp\u003eAmong the arguments, the MERCOSUR was placed as the ideal instance to discuss FoPNL regulations, and that to advance otherwise would mean a barrier to trade (ARG28, ARG29). The Argentine economic crisis added to the COVID-19 pandemic was also used by the industry to try to prevent discussions on the FoPNL, linked to job losses, the retraction of economic activity and the closure of companies. In addition, the issue of the FoPNL was placed by the industries as a demand of the Argentine middle/upper class, since a large part of the population was suffering from poverty and hunger.\u003c/p\u003e\u003cp\u003eThe tactics used by the industry were reported by an interviewee from an international organization: voluntary agreements to avoid regulation; direct lobbying; exposure, intimidation and defamation of civil society and government actors; corporate social responsibility program; and threats of litigation (ARG30).\u003c/p\u003e\u003cp\u003eThe industry also often agreed with the policy and discussions, without direct resistance. But resistance to some of the most central points brought the discussion to a standstill, especially from major industries, which are the ones that determine the public agenda and are necessary in other government matters (ARG31). According to one civil society interviewee, the Healthy Food Law was, for a time, used as a 'bargaining chip' between industry and government.\u003c/p\u003e\u003cp\u003eSubsequent to the approval of the Law, as there is an article in the Law where the companies could request extensions in the implementation deadline, many extensions were given to the companies. According to a civil society representative, the State was not transparent in relation to the extensions, causing confusion for consumers (ARG32). Also, according to government reports, the industry initiated a strategy of sending administrative claims to the Ministry of Health and precautionary measures (ARG33). In addition, industry is already taking advantage of the loopholes, such as the use of double fronts on packaging and the maintenance of promotional strategies for products with the FoPNL.\u003c/p\u003e\u003cp\u003e\u003cem\u003eResponse to industry interference\u003c/em\u003e\u003c/p\u003e\u003cp\u003eCivil society and the Argentine government used strategies to confront and expose the industry interference and CoI throughout the FoPNL process, which was facilitated by the exchange of information and experience among countries in the region. At the beginning of the discussions in the FoPNL subcommittee of the Ministry of Health, all the participants had to publicly sign a declaration of CoI, which made the positions of the industries and the organizations and professionals linked to them very clear.\u003c/p\u003e\u003cp\u003eAccording to a representative of an international organization, just before the Law was passed in the Senate, there was an attempt by Coca-Cola to send an e-mail to the President of the Republic changing specific points of the Healthy Food Law, which was disarticulated in a civil society action. After a training on sweeteners to health professionals in 2016, civil society exposed the financing of the development and coordination of the event and publications of the speakers by Coca-Cola, which was not disclosed in the communication of the training (ARG34).\u003c/p\u003e\u003cp\u003eRegional and national scientific evidence was used to counterargue the arguments used by the industry throughout the process [\u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e], such as the loss of jobs and the ineffectiveness of the PAHO nutrient profile model. In addition, events were held with the participation of representatives of civil society, academia and international organizations from Argentina and the region to explain the importance of the FoPNL Law. Civil society used its social networks to expose the CoI of professionals with links to the food and beverage industry.\u003c/p\u003e\u003cp\u003e\u003cem\u003eCollaboration and support\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFrom the Argentine civil society and government, there were important exchanges of evidence, experiences, arguments and recommendations with countries that have already made progress in FoPNL policies in the LAC region, such as Chile, Peru, Uruguay, Brazil, Mexico, Colombia and the Caribbean. There were formal and informal meetings, participation in events and workshops, signing of national and regional documents, collaborative projects [\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e] and parliamentary debates. These contacts were favoured and facilitated by international organizations such as PAHO, UNICEF, CLAS and funding agencies (ARG35). From the discourse analysis, Argentina's Healthy Food Law is considered a result for the region, which cannot be thought of in isolation from everything that happened in other countries (ARG36), and the contagion and collaboration effect in the region is impressive (ARG37).\u003c/p\u003e\u003cp\u003eAt the MERCOSUR level, there were also exchanges between Argentina, Brazil and Uruguay, with the encouragement of the participation of the Argentine civil society in this space, which was not allowed before, in order to monitor the technical discussions (ARG38). In the end, Uruguay and Brazil advanced in their national regulations and there was no consensus among the countries and the discussion is in the hands of the coordinators and no longer in the hands of the technical teams.\u003c/p\u003e\u003cp\u003e\u003cem\u003eHuman and children's rights\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe Argentine Law is based on a human rights approach, especially the right to healthy food, as a way of achieving an adequate state of health for the entire population, and the right to information, as a way of knowing what one eats [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In addition, the policy arose within the framework of PAHO's \"Plan of Action for the Prevention of Obesity in Children and Adolescents\", which focuses on the rights of children and adolescents [\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e], as well as the regulation of advertising, promotion and sponsorship, and food environments of the Law. Compulsory food education is incorporated at all three levels (kindergarten, primary and secondary education) for public and private schools throughout the country. From the government's point of view, children and adolescents are subjects to be protected and need to eat well to promote healthy growth, which is facilitated by clear information (ARG39, ARG40).\u003c/p\u003e\u003cp\u003eFrom civil society organizations, the narrative used in the campaign focused on human and children's rights in a powerful and innovative way, in order to raise awareness among the population and legislators (ARG41, ARG42).\u003c/p\u003e\u003cp\u003e\u003cem\u003eChallenges, difficulties and threats\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe economic, social and political situation in Argentina, especially during the COVID-19 pandemic, put the focus on other urgent issues, such as the need for vaccines and the situation of poverty and hunger, which was used by the industry as an argument to slow down the progress of the FoPNL discussions. From the point of view of civil society, it is necessary to consider what we eat and its impact on health even in times of crisis and that the food policy agenda is unique, focusing on access to safe and healthy food, but the narrative was distorted by the industry (ARG43, ARG44).\u003c/p\u003e\u003cp\u003eAt the beginning of the discussion, one challenge was to achieve political support to promote and carry it forward, considering that there was no alignment in the government, but very opposing positions in the Executive and Legislative powers and a strong lobbying from the food and beverage industries (ARG45). At that time, it was also registered as a challenge by a representative of an international organization to build capacity on a very technical and difficult issue such as the FoPNL, which takes time and resources (ARG46).\u003c/p\u003e\u003cp\u003eOther challenges have to do with achieving full implementation of the Law that includes different levels of government in a federal country, establishing effective control, surveillance and sanction mechanisms, and improving some complementary regulations to make them more specific. The main challenge was the industry interference throughout the process, with economic and legal arguments, confusing information disseminated by professionals with CoI, threats, corporate social responsibility, lobbying and cooptation of the mainstream media. The feeling of going one step forward and two steps back because of the obstacles placed by the industry was reported by a representative of an international organization (ARG47).\u003c/p\u003e\u003cp\u003e\u003cem\u003eStrengths and lessons learned\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe approval of the Healthy Food Law in Argentina was the result of a combination of factors: a robust civil society that worked in coalition and with international organizations, an executive government that put the issue on the agenda and provided resources and time, and the work with the entire political system that generated a unified bill among legislators from different political parties from different provinces who were trained in NCD (ARG48).\u003c/p\u003e\u003cp\u003eThe generation of local evidence without CoI, in addition to the support of international evidence and experiences, was a learning process highlighted by representatives of the government, civil society and international organizations. The importance of considering other food policies in the country for consistency was also reported by a government representative. And since the final decision is political, there must be political support to carry the process forward, even with all the industry interference (ARG49).\u003c/p\u003e\u003cp\u003eThe work of the civil society network was also highlighted, both regionally and nationally, especially in relation to the mass media campaign to support the approval of the Law in the legislature. The work was done among various organizations with different profiles, and supported by funding agencies, which made it possible to organize and prioritize the work with common objectives (ARG50, ARG51). One civil society representative reported the feeling of being in a group of superheroes, with each organization having its own superpower (ARG52). The work of civil society was also essential to sensitize the Argentine population to the importance of the FoPNL, both in the translation of scientific knowledge and in generating a social movement of public pressure on decision-makers.\u003c/p\u003e\u003cp\u003e\u003cem\u003eNext steps\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIn addition to achieving full implementation of the Law throughout Argentina by strengthening the government's capacity to oversee, monitor and evaluate it (ARG53), it is important that the population takes ownership of the Law and demands that the government assume its responsibility to monitor, oversee and evaluate it. From the point of view of a government representative, the Healthy Food Law is an educational and cultural issue so that people can assimilate the new regulations (ARG54).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study analysed the processes of discussion, approval and implementation of FoPNL policies in three countries in the LAC region. From the analyses, it was identified that the types of regulatory instruments approved were different in each of the countries, being a decree from the Executive power of Uruguay, the modification of a general law from the Legislative power and a regulation from the Executive power of Mexico, and a law from the Legislative power of Argentina. The justifications for the selection of each regulation are related to health and nutrition, political and regulatory context of each country at the time of the decision [\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e, \u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e]. In addition, according to the type of regulatory instrument, the regulatory processes included different stages and governmental actors.\u003c/p\u003e\u003cp\u003eIt is important to note that, in the case of Uruguay, the election by an Executive decree, which did not involve the entire political system and was crossed by two different governments, resulted in multiple changes in the characteristics of the FoPNL and in its implementation timeframe. Such instability led the legislature and the civil society to begin a fight for a law that includes other aspects of protection of the food environment, such as the regulation of advertising of unhealthy foods and beverages [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Mexican and Argentine processes have already involved agents of the Executive and Legislative powers of different political parties, with the identification and leadership of at least one political actor, which has enabled the process to cross governments and remain active and sustainable [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although the FoPNL is primarily responsibility of the health sector, it is necessary to consider the interests of other parties, especially in public consultations [\u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e]. In addition, as the discussions of the measure began when Chile, Peru, Uruguay and other countries in the region already had their FoPNL processes advanced, Mexico and Argentina were able to take advantage of the experiences, scientific evidence, arguments and lessons learned to build a more appropriate and effective process, in addition to improving the technical aspects of the measure [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e]. The use of a FoPNL with clear criteria for the identification of unhealthy foods and beverages and connected to other regulatory measures to protect the food environment was of great importance to strengthen national food and nutrition policies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe existence of public consultations on the regulations of each country, enabling the participation of any citizen in the process of public policy making, was a key element in the processes of the three countries analysed [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAll the regulatory processes investigated, especially the policy design stages, were led by government agents, with the Ministry or the Secretariat of Health as a central actor, in addition to the participation of other bodies, such as the economy and the industry [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Academia, civil society and international organizations played an important role in the technical discussions and in the development of the draft of the FoPNL. In this regard, academia and civil society in each country generated local scientific evidence without CoI to justify the choice of each criteria included in the proposed regulations. But it was not only the studies prior to the approval of the measure that were important [\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e]. In Uruguay, for example, the publication of immediate results of the implementation of the Decree was decisive for it to be maintained in 2020, after the change of the government [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Thus, it is necessary that the generation of scientific evidence be permanent for the maintenance and improvement of the policy, and to respond to possible legal challenges.\u003c/p\u003e\u003cp\u003eThe joint, coordinated and complementary work of academia, civil society and international organizations throughout the regulatory process made the difference, especially in advocacy and communication actions, which were based on scientific evidence translated into simpler language. Such actions were useful in supporting governments to move forward with the processes, to expose the food and beverage industry interference, and to raise public awareness at key moments [\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e]. In addition, it is necessary to highlight the importance of international organizations in supporting the activities of civil society organizations, and in facilitating and promoting the connection between researchers and actors working to defend the protection of public health and children in the countries of the LAC region in order to exchange experiences [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The establishment and maintenance of this alliance with a common vision was not always simple, as it was composed of professionals with different backgrounds and experiences, coming from different organizations with specific roles. But, in reality, the strength of such an alliance lies precisely in the differences and complementarities, in addition to the great public visibility achieved for the issue.\u003c/p\u003e\u003cp\u003eBeyond the participation of these actors, the food and beverage industry also took part in different ways in the FoPNL regulatory processes in the countries analysed, always practicing very similar corporate political activities. In Mexico and Argentina, for example, the industry participated in the WG that designed the policy, which is not advisable. Likewise, the government demanded the declaration of CoI from all participants at that stage, which was essential to expose its position against the FoPNWL. In Uruguay, the industry was not part of the design stage of the Decree, but the lobbying had great strength in the Executive power, which may have caused the \"regulatory chill\", which occurs when legal uncertainty or the threat of legal challenge dissuades the government from acting [\u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e]. It is important to note that the industry narrative did not always come from direct representatives; health and nutrition professionals, societies and academics were also frequent spokespersons, especially in the press. Therefore, it is necessary to identify and monitor them from civil society.\u003c/p\u003e\u003cp\u003eThe arguments used by the food and beverage industry were practically the same in all three countries. The narrative against the FoPNWL focused on the stigmatization of foods and the generation of fear and confusion for consumers, and against the PAHO nutrient profile model and focused on the labelling of many foods and beverages and the impossibility of reformulation. Economic arguments of job losses and business closures were also very common, as well as the proposal of alternatives such as self-regulation, the promotion of physical activity, nutrition education and other less effective FoPNL models, such as the GDA, the nutrition traffic light and portion-based nutrition information. The request for more time for implementation also occurred in the three regulatory processes: in Mexico, related to the Covid-19 pandemic, and in Uruguay and Argentina, with the justification of the need for harmonization with MERCOSUR [\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe industry narrative was used in campaigns, interviews and other communication actions to confuse the population, and also in legal actions against politics, government and civil society, often justified by trademark and free trade rights. Likewise, after the approval and the beginning of the implementation of the policy, the industry continued to question, as in the cases of the appeals in Mexico and the extensions and administrative claims in Argentina.\u003c/p\u003e\u003cp\u003eAs part of the role of academia and civil society, the scientific evidence generated was used to confront the narrative of the food and beverage industry, especially in the press and through communication campaigns. In addition, transparency and CoI policies adopted by governments also supported the processes against industry interference [\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e, \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e], such as the confidentiality agreement of the Mexican WG and the mandatory declaration of participants in the Argentine WG.\u003c/p\u003e\u003cp\u003eHaving clear, measurable, short-term and achievable objectives is recommended. The objectives of the Uruguayan, Mexican and Argentinean policies focus on providing clear and simple nutritional information to promote informed and healthy food choices [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e], which is directly connected to the guarantee of human rights. Throughout the regulatory process in the three countries, human rights were part of the narrative constructed by the government, civil society and international organizations, mainly because they were superior to commercial rights, which the food and beverage industry defends so much. FoPNL is related to the right to information, as a way of knowing what one eats; to the right to health and food, as a way of achieving a good state of health based on a conscious and healthy diet; and the right of children and adolescents, considering the need to protect them in their physical and psychological development processes and the formation of eating habits. The incorporation of technical complements to FoPNL, such as mini warning labels and cautionary legends for sweeteners and caffeine, and of complementary regulatory measures, such as the restriction of advertising to children, the prohibition of the sale of products with FoPNL in schools and in public purchases, was made possible and reinforced by the focus on children's rights incorporated in the discussions of the three countries analysed [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePlanning the monitoring, inspection and evaluation processes from the initial discussions of the policy is essential, since the effectiveness of the measure lies in its proper implementation and not only in its approval. In the first place, communication campaigns should be developed to teach and stimulate the use of the FoPNL by the population, since it is not always intuitive [\u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e]. In addition, the implementation plan should consider all governmental bodies and actors involved in the monitoring and inspection processes, as in the case of Uruguay and Argentina, which are organized in provinces with decentralized processes. Penalties for non-compliance with the measure should serve as an example so that companies do not do it anymore, and encourage them to comply with the measure to avoid being exhibited for non-compliance. Evaluation of the standard requires investment from the government so that data can be collected periodically to verify the impacts of the FoPNL and the needs for policy improvement [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e], as has already been demonstrated in Uruguay.\u003c/p\u003e\u003cp\u003eFinally, although it is extremely relevant to learn from the above regulatory processes, each country has its own particularities, which must be considered throughout the discussion, approval and implementation processes of the policy. Territorial, population, political and regulatory characteristics should be evaluated, and a study of potential allies and opponents of the policy should be made.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe high prevalence of overweight, obesity and NCD related to inadequate nutrition in all age groups in the Americas, including children and adolescents, requires urgent actions to modify the food environment to discourage the consumption of unhealthy foods and beverages. The adoption of an FoPNWL is recommended by international organizations and experts on the subject as a cost-effective measure that ensures the protection and promotion of human rights related to health, healthy eating, adequate information and, especially, to children and adolescents.\u003c/p\u003e\u003cp\u003eAs demonstrated in the cases of Uruguay, Mexico and Argentina, the processes of discussion, approval and implementation of FoPNL policies can be less or more extensive, depending on the political context, type of regulatory instrument used, design and basis of the proposed policy, political processes established and actors involved. The cases analysed reflect the actions of various key actors in the defense of an effective FoPNL policy, and the opposition of the food and beverage industry through corporate political activities that attempt to slow down, weaken or impede the policy. The results also indicate that well-articulated research, advocacy and communication actions between academia, civil society and international organizations are essential to achieve an effective FoPNL policy.\u003c/p\u003e\u003cp\u003eThe accumulation of evidence, experiences and lessons learned over the last few years in LA has led to an improvement in FoPNL policies, culminating in greater protection and better realization of the rights of populations to health, to adequate and healthy food, to information and to the protection of children and adolescents, especially when such policies were associated with synergistic regulatory measures, such as the restriction of advertising, the regulation of institutional food environments and the taxation of unhealthy food and beverage products.\u003c/p\u003e\u003cp\u003eOther countries that are working to move forward with effective FoPNWL policies will benefit from these and other experiences and their elements of success and potential improvement, ensuring the preponderance of human and children's rights over commercial interests to deliver better health and nutrition for the entire population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was funded by the United Nations Children\u0026apos;s Fund for Latin America and the Caribbean (UNICEF LACRO).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics, consent to participate and consent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants signed a digital informed consent form.\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Research Ethics Committee of the University of S\u0026atilde;o Paulo (USP) in Brazil (No. 6.589.062).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: LAM, PV, AMNO; methods: LAM, PV, AMNO, FSG; formal analysis: LAM; supervision: PV, AMNO; drafting - preparation of the original draft: LAM; writing - proofreading and editing: LAM, PV, AMNO, FSG, RS, MA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of conflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be available on request from the author, since the whole transcription of the interviews may make the participant recognizable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the key actors who participated in the interviews and the UNICEF officers in the country offices in Uruguay (Nora Oliveira), M\u0026eacute;xico (Fiorella Espinosa) y Argentina (Ver\u0026oacute;nica Patr\u0026oacute;n) for their support in the documentary analysis and data review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePan-American Health Organization (PAHO). 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Washington, D.C.: PAHO (2014).\u003c/li\u003e\n\u003cli\u003eCerra B, Castronuovo L, Guarnieri L, Tiscornia MV, Pizarro ME. Derechos humanos y etiquetado de alimentos en Argentina: actores sociales e intereses econ\u0026oacute;micos. In: Peralta DG, Hern\u0026aacute;ndez RU, Carballo JM, editors. Derecho, comercio y etiquetado nutricional: reflexiones y experiencias desde Am\u0026eacute;rica Latina. Editorial Bogota: Dejusticia; 2022. p. 346-374.\u003c/li\u003e\n\u003cli\u003eArgentina. Ministerio de Salud y Desarrollo Social. Secretar\u0026iacute;a de Gobierno de Salud. Etiquetado nutricional frontal de alimentos (2018).\u003c/li\u003e\n\u003cli\u003eArgentina. Ministerio de Salud. Direcci\u0026oacute;n Nacional de Abordaje Integral de las Enfermedades No Transmisibles. Investigaci\u0026oacute;n \u0026ndash; Etiquetado nutricional frontal: Informe de resultados (2020).\u003c/li\u003e\n\u003cli\u003eCastronuovo L, Tiscornia MV, Guarnieri L, Martins E, Gomes FS, Allemandi L. Efficacy of different front-of-package labelling systems in changing purchase intention and product healthfulness perception for food products in Argentina. Rev Panam Salud Publica. 2022;46:e137.\u003c/li\u003e\n\u003cli\u003eArgentina. Ministerio de Salud. Direcci\u0026oacute;n Nacional de Abordaje Integral de las Enfermedades No Transmisibles. An\u0026aacute;lisis del nivel de concordancia de sistemas de perfil de nutrientes con las Gu\u0026iacute;as Alimentarias para la Poblaci\u0026oacute;n Argentina (2020).\u003c/li\u003e\n\u003cli\u003eTiscornia MV, Castronuovo L, Guarnieri L, Martins E, Allemandi L. Evaluaci\u0026oacute;n de los sistemas de perfiles nutricionales para la definici\u0026oacute;n de una pol\u0026iacute;tica de etiquetado frontal en Argentina. Rev Argent Salud Publica. 2020;12:e17.\u003c/li\u003e\n\u003cli\u003eArgentina. Ministerio de Salud y Desarrollo Social. Secretar\u0026iacute;a de Gobierno de Salud. 2\u0026ordf; Encuesta Nacional de Nutrici\u0026oacute;n y Salud (ENNyS 2) \u0026ndash; Resumen Ejecutivo (2019).\u003c/li\u003e\n\u003cli\u003e\u0026ldquo;Diputados sancion\u0026oacute; el etiquetado frontal y aprob\u0026oacute; el alivio fiscal para entidades sen fines de lucro\u0026rdquo;. Diputados Argentina. 2021.\u003c/li\u003e\n\u003cli\u003eFundaci\u0026oacute;n para el Desarrollo de Pol\u0026iacute;ticas Sustentables (Fundeps), Sociedad Argentina de Nutrici\u0026oacute;n y Alimentos Reales (SANAR). Mapa Normativo del Etiquetado Frontal en Argentina.\u003c/li\u003e\n\u003cli\u003eFundaci\u0026oacute;n InterAmericana del Coraz\u0026oacute;n (FIC Argentina), Fundaci\u0026oacute;n Salud Natural Argentina (SANAR), Fundaci\u0026oacute;n para el Desarrollo de Pol\u0026iacute;ticas Sustentables (Fundeps), Consumidores Argentinos, Federaci\u0026oacute;n Argentina de Graduados en Nutrici\u0026oacute;n (FAGRAN) #EtiquetadoClaroYa. Available from: \u0026lt;https://etiquetadoclaroya.org/\u0026gt;.\u003c/li\u003e\n\u003cli\u003eCoalici\u0026oacute;n Nacional para Prevenir la Obesidad en Ni\u0026ntilde;os, Ni\u0026ntilde;as y Adolescentes. Mitos y realidades del etiquetado frontal de advertencia. 2020.\u003c/li\u003e\n\u003cli\u003eCoalici\u0026oacute;n Nacional para Prevenir la Obesidad en Ni\u0026ntilde;os, Ni\u0026ntilde;as y Adolescentes. Conflicto de inter\u0026eacute;s e interferencia de la industria de alimentos en el dise\u0026ntilde;o de pol\u0026iacute;ticas de alimentaci\u0026oacute;n saludable. 2020.\u003c/li\u003e\n\u003cli\u003eFundaci\u0026oacute;n Interamericana del Coraz\u0026oacute;n (FIC Argentina), Instituto Brasileiro de Defesa do Consumidor (Idec). Promoci\u0026oacute;n de pol\u0026iacute;ticas de etiquetado frontal de alimentos en Brasil y Argentina. 2019.\u003c/li\u003e\n\u003cli\u003eUnited Nations Children\u0026rsquo;s Fund (UNICEF). UNICEF Technical Guide - Front-of-pack nutrition labelling: A \u0026lsquo;how-to\u0026rsquo; guide for countries; 2021.\u003c/li\u003e\n\u003cli\u003eJones A, Neal B, Reeve B, Mhurchu CN, Thow AM. Front-of-pack nutrition labelling to promote healthier diets: current practice and opportunities to strengthen regulation worldwide. BMJ Glob Health. 2019;4:e001882.\u003c/li\u003e\n\u003cli\u003eCrosbie E, Gomes FS, Olvera J, Pati\u0026ntilde;o SRG, Hoeper S, Carriedo A. A policy study on front-of-pack nutrition labelling in the Americas: emerging developments and outcomes. Lancet Reg Health Am. 2023;18:100400.\u003c/li\u003e\n\u003cli\u003eInstituto Nacional de Salud P\u0026uacute;blica (INSP), United Nations Children\u0026rsquo;s Fund (UNICEF). Review of current labelling regulations and practices for food and beverage targeting children and adolescents in Latin America countries (Mexico, Chile, Costa Rica and Argentina) and recommendations for facilitating consumer information. 2016.\u003c/li\u003e\n\u003cli\u003eUnited Nations Children\u0026rsquo;s Fund (UNICEF). Policy brief: Front-of-pack nutrition labelling of foods and beverages (2022).\u003c/li\u003e\n\u003cli\u003eWorld Health Organization Europe (WHO EURO) Key considerations for the use of law to prevent noncommunicable diseases in the who European region: report of an intensive legal training and capacity-building workshop on law and noncommunicable diseases \u0026ndash; Moscow, 30 May-3 June 2016. WHO EURO, Copenhague (2017).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"front-of-package nutrition labelling, obesity prevention, malnutrition, children and adolescents, policy process, Latin America and the Caribbean","lastPublishedDoi":"10.21203/rs.3.rs-6691348/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6691348/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e To document and analyse the processes of discussion, approval and implementation of front-of-package nutrition labelling regulations in Uruguay, Mexico and Argentina to provide insight into the strengthening of regulatory frameworks to prevent children overweight in Latin America and the Caribbean.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubject and methods:\u003c/strong\u003e The study included a desk review and interviews with key stakeholders from government, international organizations, civil society and academia. A deductive-inductive analysis of the interviews was carried out and the data were triangulated with data from the desk review. The results were reported by stages of the political process and central themes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e It is necessary to analyse the health and nutrition, political and regulatory context of each country, as well as to safeguard the regulatory process against industry interference and guarantee social participation without conflicts of interest. Discussions on the details of the regulatory instrument should be based on scientific evidence. The support of international organizations throughout the regulatory process lend credibility and facilitates the sharing of lessons learned. Corporate political activities are very similar between countries and should be prevented, monitored, managed and exposed. The implementation and evaluation stages are as important as the approval of the regulations and should be incorporated at the start of the discussions to ensure their effectiveness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Each country has its own particularities, which must be considered throughout the regulatory process, although it is extremely important to learn from previous regulatory processes and benefit from successful experiences and possible improvements, guaranteeing human’s rights over commercial interests.\u003c/p\u003e","manuscriptTitle":"Front-of-package nutrition labelling policies in Uruguay, Mexico and Argentina","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-15 15:09:28","doi":"10.21203/rs.3.rs-6691348/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3d34bc47-c546-4f53-a89b-cd6bd2f37b83","owner":[],"postedDate":"July 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-03T12:54:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-15 15:09:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6691348","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6691348","identity":"rs-6691348","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}