Benchmarking the nutrition-related commitments and practices of major Belgian food companies by industry and over time (2019-2023)

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The aim of this study was to evaluate and benchmark the transparency, specificity, and comprehensiveness of nutrition-related commitments and associated practices of leading food companies in Belgium, as well as changes over time between 2019 and 2023/2024. Methods: The Business Impact Assessment on Obesity and population-level nutrition (BIA-Obesity) was applied to assess commitments related to product formulation, labelling, promotion, accessibility, relationships with other organizations and corporate nutrition strategy among 32 major packaged food and non-alcoholic beverage manufacturers (n = 21), supermarkets (n = 5), and quick-service restaurants (QSR) (n = 6). Publicly available data on commitments were collected and company representatives invited to verify and supplement the information. A standardized scoring framework comprising around 60 indicators was used to assess the commitments. Company product portfolios were evaluated using Nutri-Score, the NOVA classification, and the WHO Europe Nutrient Profile Model. In addition, supermarket shelf-space allocation, and QSR density near schools were assessed. Results were compared to the 2019 BIA-Obesity Belgium to evaluate progress. Results: Sixty-three percent of companies (20/32) fully participated in the assessment process. Overall commitment scores ranged from 0–82%, with a median of 40%; supermarkets scored highest (median = 51%) and quick-service restaurants (QSRs) lowest (median = 15%). Product accessibility remained the weakest domain across sectors. Since 2019, 18 of 25 companies improved their scores, while 3 remained stable and 5 declined. Compared to 2019, all supermarkets increased the proportion of products rated Nutri-Score A or B and reduced those rated D or E. Compared to 2019, all supermarkets increased the proportion of products rated Nutri-Score A or B and reduced those rated D or E, while among packaged food companies, 40% increased A or B products and 60% reduced D or E products. Despite these improvements, ultra-processed foods remained prominent in high-visibility areas, such as supermarket checkouts. Conclusions: Despite some slight improvements since 2019, company commitments and practices in Belgium fall short of best practice benchmarks. Voluntary measures are insufficient to ensure meaningful progress. Stronger government regulations are urgently needed to create healthier food environments. Business impact assessment BIA-Obesity INFORMAS food industry nutrition policy product reformulation marketing to children front-of-pack labelling food environment Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background According to the latest food consumption survey conducted by Sciensano, the Belgian public health institute, in 2022, approximately 49% of the adult population was categorized as overweight, including 18% who were classified as obese 1 . The economic impact of obesity extends beyond healthcare to significant societal costs, primarily due to associated non-communicable diseases (NCDs) 2 . Obesity increases the risk and severity of NCDs such as heart disease, diabetes, and certain cancers, thereby escalating healthcare expenses and impacting the overall economy through increased medical costs and reduced workforce productivity 3 , 4 . These consequences highlight the need for targeted public health interventions and policies to prevent obesity-related conditions and reduce their economic burden on society. Unhealthy food choices are influenced by a complex interplay of factors including individual habits, economic constraints, and the surrounding food environment 5 . Dietary habits often form early in life and can persist due to cultural preferences and routines that favour high-calorie, nutrient-poor foods. Economically, healthier food options are perceived as less accessible and more expensive, leading those with limited budgets to opt for cheaper, energy-dense foods 6 . Moreover, the food environment in most countries is dominated by the high availability of ultra-processed foods, further encouraging unhealthy dietary patterns 7 . This availability is often supported by aggressive marketing strategies that promote such options more than healthier alternatives. Monitoring commitments and practices by food industry actors is essential for increasing accountability 8 , 9 . The World Health Organization (WHO) emphasizes the need for independent oversight to ensure industry pledges—such as those on reformulation, marketing restrictions, and improved labelling—translate into measurable improvements or in the absence of those improvements, lead to stronger government regulations. The Sustainable Development Goals (SDGs), particularly SDG 2 (Zero Hunger) and SDG 3 (Good Health and Well-Being), call for stronger governance to align corporate actions with public health objectives 10 , 11 . Transparent monitoring frameworks, as advocated by WHO, may help track progress, identify gaps, and ensure that commitments are transparent, specific and measurable, and if they do not lead to meaningful changes in the food environment, they provide a strong case for government regulations 8 , 9 . The Business Impact Assessment on Obesity (BIA-Obesity) 9 is a standardized tool developed by the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) 8 to evaluate food companies’ commitments and practices in improving population nutrition and preventing obesity. Alongside the global Access to Nutrition Index (ATNI) which benchmarks companies at international level, it enables benchmarking at national levels. In 2019, Belgium conducted its first BIA-Obesity, assessing major packaged food and non-alcoholic beverage manufacturers, supermarkets, and quick-service restaurants across areas such as product formulation, labelling, marketing, accessibility, and corporate nutrition strategies 12 . The results showed a median overall score for the commitments of just 34%, with supermarkets (46%) and manufacturers (45%) scoring higher than quick-service restaurants (14%), which showed major gaps in marketing restrictions and accessibility 12 . Similar BIA studies in Australia 13 and New Zealand 14 have been used to monitor company performance over time and evaluate policy impact. In Australia, the BIA has been applied to both the commercial sector 13 and institutional settings 15 , such as universities, to assess nutrition, equity, and sustainability of food environments. In Canada, repeated assessments have helped track industry progress and inform government policy on food system improvements 16 . Building on the foundation set by BIA-Obesity 2019 in Belgium 12 , this current study monitors the commitments and practices related to population nutrition of these companies. It aims to analyse the progress made since the last assessment and identify ongoing challenges related to creating healthy food supply and marketing environments in the context of Belgium. Methods The Business Impact Assessment on Obesity (BIA-Obesity) evaluates the nutrition-related commitments and practices of food industry actors. This assessment was conducted using the BIA-Obesity tool and process developed by INFORMAS 8 , 9 , an international research network that monitors food environments across over 40 countries. The methodology is adapted from the Access to Nutrition Index (ATNI), which benchmarks nutrition commitments, performance, and disclosure practices of global food and beverage manufacturers. The 2023–2024 assessment was implemented in Belgium, analyzing current company commitments up to February 2024. The evaluation included sector-specific indicators for commitments and practices, tailored to Belgium’s regulatory and market environment. Ethical approval was obtained from the Human Ethics Committee at UZ Gent (reference number (ONZ-2022-0453), and informed consent was secured from representatives of participating companies. For non-participating companies, the evaluation was based solely on publicly available information. The study was conducted in accordance with the Declaration of Helsinki. Company Selection Company selection was based on market share data from Euromonitor. Selection criteria ensured at least 50% market coverage in Belgium for each sector (Table 1 ). However, this threshold could not be met in the QSR sector in Belgium, due to the presence of numerous smaller, independent operators. We evaluated 32 companies in (21 packaged food and non-alcoholic beverage manufacturers, 6 quick-service restaurants, 5 supermarkets). Table 1 The market shares per food industry as determined by Euromonitor and most sold product categories of companies included in the study (Belgium, Euromonitor, 2021) Companies Market share (%) * Most sold (own-brand) product categories (%) Packaged food manufacturers N = 19 Danone Dairy Products and Alternatives (12.3) Nestle Dairy Products and Alternatives (1.3), Non-alcoholic beverages (6.0), Confectionary (4.5) McCain Processed Fruit and Vegetables (6.9) Mars Confectionary (6.2), Rice, Pasta and Noodles (9.6), Sauces, Dressings and Condiments (5.9) Pepsico Non-alcoholic beverages (6.4), Savoury snack foods (32.9) Nomad food-Iglo Processed Fruits & vegetables (8.9), Soup (6.8) Mondelez Snacks (14.5), Confectionary (20), Savoury snack foods (7.9) Unilever Cooking Ingredients and Meals (7.0), Sauces, Dressings and Condiments (17.0), Soup (23.5) Royal Friesland Campina Dairy Products and Alternatives (5.4) Kellogg´s Breakfast Cereals (40.1) Ferrero Snacks (5.2), Confectionary (5.8), Sweet Spreads (29.1) Dr. Oetker Ready Meal (6.5) Bel group Dairy Products and Alternatives (4.5), Sweet Spreads (29.1) Ter Beke- What´s Cooking Ready Meal (7.0) Lactalis Dairy Products and Alternatives (5.2) Monde Nissin Processed Meat, Seafood and Alternatives to Meat (0.5), Cooking Ingredients and Meals (0.4), Ready Meal (0.8) Casa Tarradellas Processed Meat, Seafood and Alternatives to Meat (6.6) Baronie Confectionary (6.0) Roger and Roger Savoury snacks (7.5) Non-alcoholic beverage manufacturers N = 4 Coca Cola 27.3 PepsiCo 6.4 Nestle 6.0 Suntory 3.8 Supermarkets N = 5 66.1 Colruyt 20.5 Carrefour 15.7 Delhaize 15.6 Aldi 8.6 Lidl 5.7 Quick-Service Restaurants N = 6 9.2 McDonald´s 2.4 Quick 1.8 Lunch Garden 1.7 Vanherpe Food Group- Panos 1.3 Yum! / Pizza Hut 1.1 Exki 0.9 *Overall market shares not available in Euromonitor for packaged food companies, only by food category Assessment of the commitments The BIA-Obesity tool was adapted to the Belgian context to ensure relevance within the national regulatory and policy landscape. Indicators that overlapped with existing European or national legislation, such as mandatory on-pack ingredient lists and mandatory standards for trans-fat content in foods—were excluded, as companies are already required to meet these standards. In addition, since in-store restaurants are uncommon in Belgian supermarkets, related menu labelling indicators were not applicable and were therefore omitted for supermarkets. The remaining components of the tool were tailored to align with national initiatives and industry commitments, including the Belgian Pledge, Nutri-Score front-of-pack labelling, and the Convention for a Balanced Diet. The assessment focused on the transparency, specificity, and comprehensiveness of publicly available commitments that exceeded legal requirements. A structured scoring framework comprising around 60 adapted indicators was applied to evaluate company policies across relevant areas of action. All commitments were systematically catalogued and scored using standardized procedures. The full list of adapted indicators and scoring criteria is available in Annex 1. A summary is available in Table 2 . Nutrition-related commitments were collected between March 2023 and February 2024. Publicly available information was retrieved from company and brand websites, corporate reports, industry pledges, and relevant media. Where possible, companies were contacted directly via email or professional networks and invited to verify and complete the collected information. All relevant documents and webpages were archived through downloads and screenshots. Companies were invited to review and complete the data via email correspondence and follow-up calls. Those that agreed to participate received a summary report on the scores allocated for the commitments and were asked to provide additional documentation where relevant. Commitments were then entered into a standardized database and scored based on the BIA-Obesity indicators. Companies that did not respond or declined participation were assessed based on public information only. The domain scores were subsequently weighted according to the criteria outlined in Table 3 , resulting in a final BIA-Obesity score calculated out of 100 points. Weightings were derived from INFORMAS guidelines and expert consultations, ensuring they aligned with sectoral impact on nutrition 9 . To ensure reliability, a sample of company commitments was double-scored by an independent researcher, with a 95% agreement rate. Discrepancies were resolved through consultation with a third researcher. Table 2 BIA-Obesity 2023/2024- Belgium, domains, key indicator categories Domain Domain description Key indicators Corporate nutrition strategy Overarching commitment to improving population nutrition for obesity and NCD prevention • Commitment to nutrition and health in corporate strategy • Reporting against nutrition and health objectives and targets • Key Performance Indicators of senior managers linked to nutrition targets Product formulation Commitment to addressing nutrients of concern (sodium, saturated fat, added/free sugars) and portion size in the development and reformulation of products • Targets and actions related to the reduction of sodium, saturated fat, sugar and portion size/energy content across portfolio • Engagement with government-led initiatives related to product formulation (e.g., the Convention for a Balanced Diet) Nutrition labelling Commitment to providing comprehensive nutrition information across settings • Commitment to implement the Nutri-Score across the product portfolio • Provide online nutrition information • Use of nutrition and health claims on healthy products only Product and brand promotion Commitment to reducing the promotion of less healthy products on broadcast, digital and other non-broadcast media • Broadcast and non-broadcast media policy • Use of marketing techniques that appeal to children and adolescents • Sponsorships, in-store promotion practices, and products featured in catalogues • Only advertise or display ‘healthy’ sides and ‘healthy’ drinks in (children’s) combination meals Product accessibility Commitment towards addressing the availability, affordability and distribution of healthier and less healthy products • Increasing the proportion of healthy products in the product portfolio • Support of fiscal policies (e.g. a tax on sugar-sweetened beverages) • Pricing and discounting strategies • Check-outs free from unhealthy items • Not provide free refills for sugary drinks Relationships with other organisations Policies and disclosures regarding funding or support for political parties, government agencies, professional organizations, external research, philanthropic groups, nutrition programs and active lifestyle programs • Disclosure and transparency of relevant relationships • Accessibility of relevant information • No political donations or declaration of those in real-time Table 3 The weighting of the indicators for three sectors BIA-Obesity domains Packaged food and Beverage manufacturers Chain restaurants and catering companies Supermarkets Corporate nutrition strategy 10 10 10 Product formulation 30 25 25 Nutrition labelling 20 15 15 Product and brand promotion 30 25 25 Product accessibility 5 20 20 Relationships with other organisations 5 5 5 TOTAL 100 100 100 Assessment of the practices In addition to assessing commitments, the BIA-Obesity 2023–2024 evaluation examined selected company practices to determine the extent to which public commitments translate to improved performance in practice. A set of key performance indicators (KPIs) was used, selected based on international benchmarking tools, regulatory relevance, and data availability. Practices were assessed using established classification systems and objective measurements. This included an analysis of the nutritional quality and processing level of products, in-store product placement, and density of QSR around schools. Nutri-Score, officially implemented in Belgium in 2019 17 , was used to evaluate the nutritional quality of products, while the NOVA system 18 captured the level of processing of products in company’s portfolios. The WHO Europe Nutrient Profile Model 19 was applied to identify products not permitted to be marketed to children. Accessibility was assessed through shelf-space allocation and checkout placement in supermarkets, as previously published 20 , as well as the density of fast-food outlets near schools using geospatial mapping (Table 4 ). Table 4 Assessment criteria and measurement approaches for observed practices by industry Area of Assessment Industry Tool / Classification System Measurement Approach Product Healthiness Packaged food and non-alcoholic beverage manufacturers, Supermarkets Nutri-Score classification 17 Distribution of products across Nutri-Score A to E categories Packaged food and non-alcoholic beverage manufacturers, Supermarkets NOVA classification 18 Proportion of products classified as ultra-processed (NOVA 4) Marketing Practices Packaged food and non-alcoholic beverage manufacturers, Supermarkets WHO Nutrient Profile Model 19 Identification of products not permitted to be marketed to children according to the WHO Europe nutrient profile model Product Accessibility Supermarkets Supermarket shelf-space allocation 20 Cumulative linear shelf length ratio for healthy compared to unhealthy foods Supermarkets Checkout placement 20 Proportion of foods that are ultra-processed at checkout areas Fast-Food Accessibility Quick Service Restaurants Density of quick-service restaurants (QSRs) Assessment of the distance and density of quick-service restaurants near schools (using geospatial mapping) Statistical Analysis Commitment scores were calculated in Excel based on the INFORMAS methodology, as detailed in Annex 1. Median overall and domain-specific scores were reported for each sector. Intersectoral comparisons were conducted to identify relative performance across food manufacturers, supermarkets, and quick-service restaurants, with examples of leading and lagging companies highlighted. To assess progress over time, results on commitments and practices from the 2023–2024 assessment were compared with those from the 2019 Belgian BIA-Obesity evaluation. This comparison focused on overall median scores and selected key indicators that were retained across both assessments, particularly within the domains of product formulation, labelling, and marketing to children. Only indicators that remained consistent in scope and scoring between the two assessments were included in the longitudinal comparison. Results Commitments – overall scores In total, 32 companies were assessed in the BIA-Obesity 2023/2024 study, covering packaged food manufacturers, non-alcoholic beverage manufacturers, supermarkets, and quick-service restaurants (Fig. 1 ). Among these, 63% (20/32) fully engaged with the research process, including all five supermarkets, providing feedback and validation at various stages. An additional 9% (3/32) initially agreed to participate but did not provide feedback within the required timeframe. For the remaining 28% (9/32), multiple contact attempts were made, but no response was received. However, no company explicitly refused to participate. Company participation had a notable impact on scores. The median overall score for companies who participated (N-20) based solely on publicly available commitments was 31%, but increased to 52% after company engagement, highlighting the value of transparency and active participation in the assessment process. The overall BIA-Obesity scores ranged from 0–82%, with a median score of 40%. Across sectors, supermarkets had the highest overall score (median = 51%), followed by packaged food and non-alcoholic beverage manufacturers (median = 45%), while QSRs had the lowest median score (15%) (Fig. 1 ). Group 1: Full engagement with the process (N = 20); Group 2: Accepted participation, but contributions not received in time (N = 3); Group 3: Due to Lack of contact, the assessment of commitments was based on publicly available information only (N = 9). Commitments by Sector Packaged Food and Non-Alcoholic Beverage Manufacturers The median score for this sector was 45%, with scores ranging from 0–82%. Danone led with 82%, while Roger & Roger scored 0%. Corporate Nutrition Strategy was the strongest domain (63%), while Product Accessibility (20%) was the weakest. Although some companies actively engaged with reformulation and labeling, several companies had minimal or no commitments across all domains, indicating opportunities for further improvement. Quick-Service Restaurants (QSRs) QSRs had the lowest median score (15%), ranging from 2% (Lunch Garden) to 32% (McDonald’s). Corporate Nutrition Strategy (44%) was the best-performing domain, while Product and Brand Promotion (5%) and Relationships with Other Organizations (6%) were the weakest. Only McDonald’s and Quick engaged with the study, while the remaining four companies did not respond. Quick scored highest in Corporate Nutrition Strategy (72%), while McDonald’s led in Product Formulation (45%). However, no QSRs had commitments to menu labeling, reflecting a gap in transparency. Supermarkets Supermarkets had the highest median score (51%), ranging from 38–65%. Delhaize (65%) and Colruyt (52%) were the top performers. Corporate Nutrition Strategy (87%) was the highest-scoring domain, while Product Accessibility (11%) was the weakest. All five supermarkets actively engaged with the research process, demonstrating greater transparency than other sectors. Commitments by Policy Domain Corporate Nutrition Strategy The Corporate Nutrition Strategy domain had the highest median score (63%, range = 0–100%), reflecting widespread commitments in this area. Danone achieved the maximum score (100%), demonstrating a comprehensive approach to population nutrition. As a sector, supermarkets performed best (median = 87%), followed by packaged food and beverage manufacturers (63%), while QSRs had the lowest median score (44%). Several companies regularly published national reports detailing objectives and progress. However, companies with the lowest scores lacked any publicly available information on nutrition-related commitments. Product Formulation The median score for Product Formulation was 50% (range = 0–93%), with supermarkets scoring highest (67%), followed by food and beverage manufacturers (50%), and QSRs (17%). Nine of the 21 food and beverage manufacturers and all five supermarkets had integrated Nutri-Score into their reformulation strategies, signalling a commitment to product improvement. Additionally, 14 of 21 food and beverage manufacturers and all supermarkets had targets for reducing added sugar and sodium, and 14 of 21 food and beverage manufacturers and all supermarkets had portion size reduction targets. However, only one of seven QSRs had similar targets, indicating an area for improvement. Nutrition Labeling The median score for Nutrition Labeling was 33% (range = 0–96%), showing variation in the extent of commitments across sectors. Supermarkets (median = 50%) performed better than food and beverage manufacturers (median = 37%) and QSRs (median = 14%). A packaged food manufacturer obtained the highest score (96%) for applying Nutri-Score across own-brand products and online platforms. In contrast, two QSRs and two packaged food manufacturers had no commitments in this domain. While 9 of 21 food and beverage manufacturers and all supermarkets committed to implementing Nutri-Score, only one of six QSRs provided any nutritional information online, and none had commitments to labeling their menu boards in-store. Product and Brand Promotion The median score for Product and Brand Promotion was 36% (range = 0–80%). Food and beverage manufacturers had the highest median score (48%), followed by supermarkets (36%), while QSRs scored the lowest (5%). Nine companies (3 QSRs, 6 food and beverage manufacturers) had no commitments to reducing marketing towards children. While all supermarkets, 14 food and beverage manufacturers, and 3 QSRs were signatories of the Belgian Pledge, none had policies covering children up to 18 years old. Product Accessibility The Product Accessibility domain had the lowest median score (11%, range = 0–60%), highlighting the lack of strong commitments to improving access to healthier foods. Food and beverage manufacturers had the highest median score (20%), followed by supermarkets (8%), while QSRs had the lowest score (6%). Eight companies, including one QSR and three packaged food manufacturers, had no commitments in this area. Some supermarkets committed to price promotions on Nutri-Score A/B products or banning unhealthy items at checkouts, while a few manufacturers supported taxation on unhealthy products. McDonald’s pledged to remove free refills for soft drinks, signalling progress in reducing sugary beverage consumption. Relationships with Other Organizations The median score for this domain was 25% (range = 0–89%), with supermarkets scoring the highest (39%), followed by food and beverage manufacturers (33%), and QSRs (8%). Two QSRs and four packaged food manufacturers had no publicly available information in this domain. While a few companies made commitments not to engage in political donations, transparency in corporate lobbying and external partnerships remains limited. Practices Product Healthiness Based on Nutri-Score The Nutri-Score classification revealed substantial differences in product healthiness across food and non-alcoholic beverage manufacturers and supermarket own-brand portfolios. When grouped by Nutri-Score category, only a minority of companies had a high proportion of products rated A or B. Notably, Iglo (94%), Ter Beke (81%), and Danone (76%) led with the healthiest portfolios. Among supermarkets, Delhaize had the highest share of Nutri-Score A&B products (56%), followed by Lidl (50%) and Colruyt and Carrefour (both 45%) (Fig. 2 ). Conversely, several companies had almost no products rated Nutri-Score A or B. These included Baronie and Roger & Roger (0%), Ferrero (1%), and Bel Group (2%), indicating portfolios dominated by less healthy products. Among beverage companies, Spadel (48%) had had the highest share of Nutri-Score A&B products. Products rated Nutri-Score C formed a substantial share of the portfolios for several manufacturers. For instance, Dr. Oetker (37%), Kellogg’s (60%), and Unilever (40%) had large proportions of products in this mid-tier category. Within the supermarket sector, products rated C accounted for 22–32% of the range, suggesting that moderate nutritional quality makes up a significant portion of own-brand offerings. At the lower end of the scale, products rated D or E were heavily represented in some portfolios. Baronie (100%), Ferrero (93%), Bel (91%), and Mondelez (78%) had the highest proportions of less healthy products. Among supermarkets, D&E products made up 22–30% of portfolios, with Colruyt and Carrefour each at 27–29%, and Aldi slightly higher at 30%. In contrast, Ter Beke (2%), Spadel (3%), and Danone (3%) had the lowest shares of products in the D&E category (Fig. 2 ). Overall, while some companies showed promising results with high proportions of Nutri-Score A and B products, many portfolios remain skewed toward lower nutritional quality. These findings underscore the need for stronger reformulation targets and portfolio-wide improvement strategies across both manufacturers and retailers. Marketing Eligibility and Level of Processing of Products An assessment of company product portfolios using the WHO Nutrient Profile Model revealed that the vast majority of products from most manufacturers and supermarkets were not permitted to be marketed to children. Several manufacturers—Baronie, Ferrero, and Roger & Roger—had 100% of their portfolios falling outside the permitted threshold, followed closely by Mondelez (97%) and Friesland Campina (96%). In contrast, Ter Beke (5%), Iglo (14%), and McCain (58%) had the lowest shares of non-permitted products, suggesting a relatively healthier product mix. Among supermarkets, Delhaize had the lowest proportion of products not permitted for marketing to children (50%), while Aldi (69%) and Lidl (65%) had the highest (Fig. 3 ). The NOVA classification showed similar patterns in levels of processing. Many manufacturers had portfolios dominated by ultra-processed foods, with Roger & Roger, Ter Beke, Baronie, Mondelez, and Ferrero all exceeding 96%. Notably, Kellogg’s (99%) and Dr. Oetker (94%) also ranked among the highest. By contrast, Lactalis (7%), Friesland Campina (18%), and Bel (25%) had the lowest proportions of ultra-processed products. Supermarket own-brand portfolios reflected moderate levels of processing, with Delhaize (41%) scoring lowest, followed by Carrefour (46%) and Colruyt (47%), while Aldi (61%) and Lidl (63%) had the highest (Fig. 3 ). These findings underscore the widespread reliance on ultra-processed foods across the Belgian market and the limited eligibility of products for marketing to children under WHO criteria. They highlight the continued need for reformulation, portfolio diversification, and stronger regulation of product composition and marketing practices. Proximity and Expansion of Quick-Service Restaurants Near Schools The availability of quick-service restaurants (QSRs) in proximity to schools was analyzed using Locatus 2022 data 21 , revealing that over 50% of outlets from all five assessed QSR chains were located within 500 meters of a primary school in at least one region (Flanders, Wallonia, or Brussels). The growth of QSRs in Belgium between 2018 and 2022 was also assessed, showing a significant expansion in the sector (Table 5 ). EXKi experienced the highest growth rate (121.1%), followed by Pizza Hut (55.9%) and McDonald's (53.6%) (Table 5 ). Panos remained the chain with the highest number of outlets (119 in 2022) despite having a relatively lower growth rate of 30.2%. The increasing presence of QSRs near schools raises concerns about the accessibility of fast food to children and the potential impact on dietary habits. Table 5 Outlet Growth by Quick Service Restaurants and the number of outlets in 2018 and 2022 Restaurant 2018 Outlets within 500m Near Schools 2022 Outlets within 500m Near Schools Growth % Panos 106 119 12.3% McDonald´s 56 104 85.7% Quick 76 76 0.0% Exki 19 36 89.5% Pizza Hut Delivery 20 51 155% Pizza Hut 68 57 -16.2% In-Store Product Placement and Shelf Space Allocation in Supermarkets The allocation of shelf space to healthy versus unhealthy products was assessed across supermarket chains. As reported in a peer-reviewed study 20 , the average healthy/unhealthy shelf space ratio across supermarkets in Flanders was 0.36 (95% CI: 0.33–0.39), meaning that for every 10 meters of shelf space for unhealthy products, only 3.6 meters were allocated to healthier options. Considerable variation was observed between retailers: Aldi had the highest ratio at 0.45 (95% CI: 0.38–0.52), while Carrefour had the lowest at 0.25 (95% CI: 0.22–0.28). When adjusting for supermarket size, Carrefour and Colruyt had the highest total shelf space dedicated to fresh and frozen fruits and vegetables, while Aldi had the lowest. However, for unhealthy products, Carrefour had the highest total shelf space allocation, while Aldi had the lowest 20 . The prominence of healthy vs. unhealthy products in key supermarket areas (e.g., checkouts and endcaps) was also analyzed. The healthy/unhealthy shelf length ratio was lowest in high-visibility areas such as checkouts and front-end aisle displays, while it was highest in low-visibility areas along the store perimeter. Colruyt had the highest ratio of healthy products in high-visibility areas, likely due to their commitment to keeping checkout zones free from unhealthy foods, while Delhaize had the highest ratio of healthy products in low-visibility areas. In contrast, Delhaize and Carrefour had the highest proportion of ultra-processed foods at checkouts, reinforcing the need for stronger commitments in product placement strategies 20 . Comparison of commitments and practices between 2019 and 2023 To assess progress in company commitments and performance, we compared the BIA-Obesity results from 2019 and 2023/2024 for the 25 companies included in both assessments. This comparison highlights improvements, stability, or declines in commitments and actual practices related to nutrition and obesity prevention. Changes in Commitments Among the 25 companies assessed in both 2019 and 2023/2024, 18 showed improvements in their overall BIA-Obesity scores, three remained unchanged, and five experienced a decline. Notably, all companies with lower scores in 2023/2024 did not engage in the assessment process, meaning their results were based solely on publicly available data (Fig. 4 ). Among packaged food and beverage manufacturers, McCain demonstrated the largest improvement (+ 11 points), with notable progress in nutrition labelling and brand promotion. This included the introduction of time-bound targets for sodium and saturated fat reduction, as well as an expansion of Nutri-Score labelling on the front-of-pack of food products. In contrast, Unilever and Friesland Campina showed declines of -12 and − 15 points, respectively, likely reflecting their lack of participation in the 2023/2024 cycle after having engaged in 2019. Coca-Cola and Kellogg’s scores remained stable, indicating no substantial change in commitments over time. Quick-service restaurants showed more varied results. Quick improved significantly (+ 13 points), reflecting new commitments in corporate nutrition strategy and product reformulation, such as gradual salt reduction targets in menu development. McDonald’s score declined slightly (-3 points), while Exki experienced a substantial drop (-22 points) due to the absence of publicly available nutrition-related commitments in the most recent assessment Among supermarkets, four out of five improved their overall scores. Delhaize’s score increased from 60–65%, supported by stronger commitments in product accessibility and formulation. For instance, the retailer enhanced the visibility of healthier products through in-store placement and promotional strategies. Colruyt and Carrefour also showed modest improvements, while Lidl’s score remained unchanged at 50%, indicating no major strategic shifts in nutrition-related policies. Changes in practices The nutritional quality of product portfolios was assessed by comparing the proportion of products classified as Nutri-Score A and B (healthiest options) and D and E (least healthy) between 2019 and 2023/2024 for the 19 companies included in both assessments. For QSR no data on nutritional quality of product portfolios was available. Results indicate a mixed pattern of change. Between 2019 and 2023/2024, 12 out of 19 companies reduced the share of D&E products in their portfolios, suggesting progress in improving the least healthy items. This includes substantial reductions by Friesland Campina (–64 percentage points), Danone (–13 pp), and Delhaize (–17 pp). However, reductions were not universal. For instance, Nestlé, Mars, and Mondelez reported slight increases in the proportion of D&E products (Fig. 5 ). Conversely, only 7 out of 19 companies increased their share of A&B products over the same period. Danone and Friesland Campina demonstrated the most significant gains (+ 29 pp and + 65 pp, respectively), followed by Lidl (+ 22 pp) and Delhaize (+ 17 pp). In contrast, several companies—including McCain (–51 pp), Dr. Oetker (–23 pp), and Kellogg’s (–20 pp)—reported considerable decreases in the share of healthier products. These trends suggest that while some reformulation efforts focused on reducing the least healthy items, relatively few companies made substantial efforts to increase the availability of the healthiest products in their portfolios (Fig. 5 ). At the sectoral level, supermarkets generally outperformed packaged food and beverage manufacturers. In 2023/2024, supermarkets had higher median shares of A&B products (median = 48%) and lower shares of D&E products (median = 26%) compared to food and beverage manufacturers (median A&B = 33%; median D&E = 39%) (Fig. 5 ). This indicates some progress in the healthiness of supermarket own-brand products and highlights the potential of retail-led nutrition strategies. Nevertheless, even among supermarkets, the proportion of D&E products remained substantial, especially in high-visibility areas such as checkouts. Together, these findings underline the need for companies not only to reduce the prevalence of the least healthy products but also to invest in expanding their healthier offerings. The analysis of products permitted and not permitted to be marketed to children, based on the WHO Nutrient Profile Model, revealed variable trends between 2019 and 2023 across companies. Among packaged food and beverage manufacturers, most showed only modest changes or persistent non-compliance. Ferrero, Mondelez, and Kellogg’s maintained extremely high proportions of products not permitted to be marketed to children (≥ 92%) across both years. Conversely, Ter Beke demonstrated a substantial improvement, reducing the proportion of non-permitted products from 50% in 2019 to just 5% in 2023, reflecting a shift toward healthier product offerings. Similarly, Danone saw a reduction from 83–70%, and Iglo improved slightly from 18–14%. However, several companies, including Coca-Cola, Nestlé, and PepsiCo, remained consistently high in non-permitted product proportions, indicating limited progress in aligning portfolios with child-directed marketing standards (Fig. 6 ). Among supermarkets, the share of own-brand products permitted to be marketed to children declined notably. In 2019, Aldi and Lidl had the highest proportion of permitted products (82% and 78%, respectively), followed by Delhaize (70%). By 2023, these figures had sharply dropped to below 1% for all three retailers, suggesting either changes in product formulation or a shift in portfolio classification under the WHO model. Carrefour and Colruyt also saw decreases in the proportion of permitted products—from 69–43% and from 66–38%, respectively—indicating a general trend toward less alignment with healthy marketing standards in the retail sector. These findings highlight the need for more stringent and sustained reformulation strategies and marketing policies across both manufacturers and retailers to ensure that products targeted at children meet established nutritional criteria (Fig. 6 ). Discussion This study assessed the commitments and practices of major food industry actors in Belgium regarding their impact on population nutrition. The findings highlight a mixed picture of some limited progress, stagnation, and regression across different sectors, underscoring the need for continuous monitoring and in particular stronger government regulations, especially in the areas of food marketing and food accessibility. The results indicate that while several companies improved their commitments, transparency remains a key challenge. A significant number of companies either did not engage with the assessment or had minimal publicly available commitments, leading to lower scores. This is consistent with previous assessments in other countries 12 , 13 , 14 , 22 , where companies that actively participated in the process generally achieved higher scores. The voluntary nature of commitments also raises concerns about accountability, as companies may selectively disclose policies while failing to implement meaningful changes. Corporate nutrition strategies remained the strongest domain across all sectors, as companies are keen to present themselves as proactive in addressing nutrition challenges. However, other areas, such as product accessibility and responsible marketing, showed weak commitments, suggesting a lack of concrete action beyond corporate positioning. A comparison of the 2019 and 2023/2024 results reveals both improvements and setbacks 12 . Notably, 18 out of 25 companies improved their overall scores, reflecting a growing recognition of the need for corporate responsibility in public health. However, five companies recorded lower scores, primarily due to a lack of engagement in the recent assessment, leading to reliance on publicly available data that may not fully capture internal initiatives. Packaged food and beverage manufacturers showed mixed progress. Danone and McCain recorded notable improvements, driven by stronger commitments in product formulation, nutrition labeling, and responsible marketing. In contrast, Unilever and Friesland Campina experienced declines, likely due to a lack of engagement in the 2023/2024 assessment, rather than an actual regression in policies. For quick-service restaurants, Quick showed the largest improvement, particularly in corporate nutrition strategy and product formulation, while McDonald’s and Exki recorded declines, the latter significantly due to missing publicly available commitments. Among supermarkets, Delhaize, Colruyt, and Carrefour showed progress, particularly in product accessibility and formulation, whereas Lidl remained stable, suggesting limited new initiatives. Beyond commitments, company performance in product healthiness and marketing showed both progress and areas of concern. Most companies reduced the proportion of products with Nutri-Score D&E, indicating some improvements in the least healthy products. However, the proportion of Nutri-Score A&B products decreased in most companies, suggesting that reformulation efforts primarily focused on removing the worst-performing products rather than expanding the healthiest options. While several companies reduced the percentage of products not permitted for marketing to children, the progress was inconsistent. Some manufacturers—such as Ferrero—maintained 100% non-compliance, while others made slight improvements. The findings highlight the need for stricter, industry-wide marketing restrictions to ensure responsible practices. Among quick-service restaurants, changes were limited. The proximity of QSR outlets to schools remained unchanged, with over 50% of outlets still located within 500 meters of primary schools, raising concerns about fast-food accessibility to children. Supermarkets showed the most notable improvements, particularly in product portfolios, with increased availability of Nutri-Score A&B products and a reduction in Nutri-Score D&E products. Additionally, all supermarkets improved the proportion of products permitted to be marketed to children. However, unhealthy products continued to dominate checkout areas and promotional displays, demonstrating the ongoing influence of in-store marketing strategies. Similar BIA-Obesity assessments have been conducted in other high-income countries, offering useful benchmarks for interpreting the Belgian findings. In Ireland, the overall median score across all companies was 28%, with sector-specific medians of 37% for packaged food and beverage manufacturers, 18% for supermarkets, and just 9% for quick-service restaurants 23 . These figures are lower than those observed in Belgium, where the median overall score was 40%, with 45% for packaged food and beverage manufacturers, 51% for supermarkets, and 15% for quick-service restaurants. In Australia, the overall scores were also lower than in Belgium. The median sector scores were 50% for packaged food and beverage manufacturers​, 46% for supermarkets​ and just 36% for quick-service restaurants 13 . These findings reinforce a consistent international pattern: while corporate nutrition strategy tends to be the best-performing domain, product accessibility and affordability remain the weakest areas across all countries. This highlights a persistent gap between high-level commitments and concrete actions to improve equitable access to healthier foods. Conclusion In conclusion, while some companies have made limited progress in their nutrition-related commitments and practices, these changes are not consistent across the industry. Persistent gaps in product accessibility, responsible marketing, and transparency reveal the limitations of relying on voluntary approaches. Although such commitments may demonstrate corporate engagement, they often fall short of translating into tangible improvements in food environments. Without regulatory oversight, there is a risk that self-regulation becomes a mechanism to delay or weaken more impactful government action. Moreover, even if limited progress was observed, product portfolios across the Belgian market remain largely of poor nutritional quality with a high proportion of ultra-processed foods. In addition, most products on the Belgian market are not suitable for marketing to children. Strengthened regulation and continued independent monitoring are therefore essential to ensure that corporate strategies align with public health goals and contribute to measurable outcomes. Future research should continue to evaluate the alignment between commitments and actual practices, and support cross-country comparisons to inform more effective policy responses for creating healthier food environments. Abbreviations ATNI Access to Nutrition Index BIA Business impact assessment INFORMAS International Network for Food and Obesity Research Monitoring and Action Support QSR Quick service restaurant NCDs noncommunicable diseases WHO World Health Organization Declarations Ethics approval and consent to participate Ethical approval was obtained from the Human Ethics Committee at UZ Gent (reference number (ONZ-2022-0453), and informed consent was secured from representatives of participating companies. The study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials The (raw) data and materials are available from the authors upon reasonable request to [email protected] Competing interests The authors declare they do not have competing interests in regards to this study Funding The study was funded by the FEAST project (www.feast.eu) Authors' contributions S.V. received the funding and designed the study and supervised S.D. S.D. did the data collection and analysis and wrote the paper. All authors agreed with the last version of the manuscript. Acknowledgements The authors want to acknowledge the company representatives who contributed to the collection and verification of commitments. References Moyersoen I, Bel S, Lebacq T, Versele V, Vasquez MS, Van Campenhout E, et al. Weight status and weight-related behaviours in the Belgian population - Food consumption survey 2022–2023. Brussels: Sciensano; 2024. Available from: https://www.sciensano.be/sites/default/files/fcs_en_report_2_nv.pdf Gorasso V, Moyersoen I, Van der Heyden J, De Ridder K, Vandevijvere S, Vansteelandt S, et al. Health care costs and lost productivity costs related to excess weight in Belgium. BMC Public Health. 2022;22(1):1693. doi:10.1186/s12889-022-14105-9 World Health Organization. Non communicable diseases. 2024 [cited 2024 Dec 23]. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases Nyberg ST, Batty GD, Pentti J, Virtanen M, Alfredsson L, Fransson EI, et al. Obesity and loss of disease-free years owing to major noncommunicable diseases: a multicohort study. Lancet Public Health. 2018;3(10):e490–7. Swinburn B, Egger G. The runaway weight gain train: too many accelerators, not enough brakes. BMJ. 2004;329(7468):736–9. doi:10.1136/bmj.329.7468.736 Daniel C. Is healthy eating too expensive?: How low-income parents evaluate the cost of food. Soc Sci Med. 2020;248:112823. doi:10.1016/j.socscimed.2020.112823 Mertens E, Colizzi C, Peñalvo JL. Ultra-processed food consumption in adults across Europe. Eur J Nutr. 2022;61(3):1521–39. doi:10.1007/s00394-021-02733-7 Swinburn B, Sacks G, Vandevijvere S, Kumanyika S, Lobstein T, Neal B, et al. INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support): overview and key principles. Obes Rev. 2013;14:1–12. Sacks G, Vanderlee L, Robinson E, Vandevijvere S, Cameron AJ, Ni Mhurchu C, et al. BIA-Obesity (Business Impact Assessment—Obesity and population-level nutrition): a tool and process to assess food company policies and commitments related to obesity prevention and population nutrition at the national level. Obes Rev. 2019;20(S2):78–89. Weeks WB, Weinstein JN, Lavista JM. All Sustainable Development Goals Support Good Health and Well-Being. Int J Public Health. 2023;68:1606901. doi:10.3389/ijph.2023.1606901 United Nations. Sustainable Development Goal 2: Zero Hunger. [cited 2025 Mar 25]. Available from: https://sdgs.un.org/goals/goal2 Van Dam I, Reimes N, Vandevijvere S. Benchmarking the nutrition-related commitments and practices of major Belgian food companies. Int J Behav Nutr Phys Act. 2022;19:43. doi:10.1186/s12966-022-01269-1 Sacks G, Robinson E, Cameron AJ, Vanderlee L, Vandevijvere S, Swinburn B. Benchmarking the nutrition-related policies and commitments of major food companies in Australia, 2018. Int J Environ Res Public Health. 2020;17(17):6118. Kasture A, Vandevijvere S, Robinson E, Sacks G, Swinburn B. Benchmarking the commitments related to population nutrition and obesity prevention of major food companies in New Zealand. Int J Public Health.2019;64(8):1147–57 Sacks G, Chan J, Mann D, et al. Benchmarking the healthiness, equity and environmental sustainability of university food environments in Australia, 2021/22. BMC Nutr. 2025;11:38. doi:10.1186/s40795-025-01029-x Gaucher-Holm A, Chan J, Sacks G, et al. Food and beverage manufacturing and retailing company policies and commitments to improve the healthfulness of Canadian food environments. BMC Public Health. 2024;24:2419. doi:10.1186/s12889-024-19864-1 Nutri-Score Europe. [cited 2025 Mar 25]. Available from: https://nutriscore-europe.com/ Monteiro CA, Cannon G, Levy R, Moubarac J-C, Jaime P, Martins AP, et al. NOVA. The star shines bright. World Nutr. 2016;7(1–3):28–38. World Health Organization. WHO Regional Office for Europe nutrient profile model. Copenhagen: WHO Regional Office for Europe; 2015. Available from: https://www.who.int/publications/i/item/9789289000152 Vandevijvere S, Van Dam I, Inaç Y, Smets V. Unhealthy food availability, prominence and promotion in a representative sample of supermarkets in Flanders (Belgium): a detailed assessment. Arch Public Health. 2023;81(1):154. doi:10.1186/s13690-023-01175-3 Locatus. Locatus Data: Retail proximity and outlet distribution. Locatus; 2022. Available from: https://www.locatus.com Ng S, Sacks G, Kelly B, Yeatman H, Robinson E, Swinburn B, et al. Benchmarking the transparency, comprehensiveness and specificity of population nutrition commitments of major food companies in Malaysia. Glob Health. 2020;16:1–19. Steele MM, Hussey S, Vandevijvere S, Jani A, Harrington JM. Food companies’ commitments on population nutrition, health and sustainability in Ireland. Cork: FEAST–University College Cork; 2024. Available from: https://feast2030.eu/sites/default/files/feast/resources_files/2024/FEAST_WP3_Report_Food-companies-commitments-on-population-nutrition-health-and-sustainability-in-Ireland_R_20241216.pdf Additional Declarations No competing interests reported. Supplementary Files Annex1.docx Cite Share Download PDF Status: Published Journal Publication published 30 Apr, 2026 Read the published version in BMC Nutrition → Version 1 posted Editorial decision: Revision requested 13 Aug, 2025 Reviews received at journal 04 Aug, 2025 Reviewers agreed at journal 06 Jul, 2025 Reviews received at journal 26 Jun, 2025 Reviewers agreed at journal 02 Jun, 2025 Reviewers invited by journal 02 Jun, 2025 Editor assigned by journal 28 May, 2025 Editor invited by journal 08 May, 2025 Submission checks completed at journal 07 May, 2025 First submitted to journal 07 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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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-6514148","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":466029743,"identity":"ee9bf518-559b-4de2-a4e6-7c567d6a5c0a","order_by":0,"name":"Sara Dastoum","email":"","orcid":"","institution":"Sciensano (Belgium)","correspondingAuthor":false,"prefix":"","firstName":"Sara","middleName":"","lastName":"Dastoum","suffix":""},{"id":466029744,"identity":"d6e0cd5a-8ede-4aad-b3ad-45a7be174b37","order_by":1,"name":"stefanie vandevijvere","email":"data:image/png;base64,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","orcid":"","institution":"Sciensano (Belgium)","correspondingAuthor":true,"prefix":"","firstName":"stefanie","middleName":"","lastName":"vandevijvere","suffix":""}],"badges":[],"createdAt":"2025-04-23 15:53:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6514148/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6514148/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40795-026-01310-7","type":"published","date":"2026-04-30T15:57:20+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83917211,"identity":"b3c8c5a0-d653-4ead-8e1c-d3bafb96fca4","added_by":"auto","created_at":"2025-06-04 12:55:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32537,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eBusiness Impact assessment on Obesity and Population Nutrition (BIA-Obesity) Belgium 2023/2024. for A: Packaged food, B: Non-alcoholic beverage manufacturers, C: Quick Service Restaurants, D: Supermarkets\u003cbr\u003e\nGroup 1: Full engagement with the process (N=20); Group 2: Accepted participation, but contributions not received in time (N=3); Group 3: Due to Lack of contact, the assessment of commitments was based on publicly available information only (N=9).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6514148/v1/27642918b71c8876af46fe8e.png"},{"id":83917206,"identity":"7410ae31-4888-45c9-80d7-b8e778be058f","added_by":"auto","created_at":"2025-06-04 12:55:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":45061,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe proportion of products with Nutri-Score A\u0026amp;B, C and D\u0026amp;E within the portfolios of the selected packaged food and beverage manufacturers and Supermarkets (Nutritrack Belgium, 2023).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6514148/v1/1ea5e35fdb13c7d389b23231.png"},{"id":83917590,"identity":"8e6e138d-116a-480d-a66a-4ff58c798d38","added_by":"auto","created_at":"2025-06-04 13:03:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":44146,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eProportion of Products Not Permitted to Be Marketed to Children and Classified as Ultra-Processed (NOVA 4) Across Selected Food Companies and Supermarkets in Belgium (2023/2024).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6514148/v1/767cbb73e8fb1b5232900fe8.png"},{"id":83917208,"identity":"db1d2427-e796-46f2-866e-24c3fe2e51bd","added_by":"auto","created_at":"2025-06-04 12:55:17","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":45294,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe comparison of companies´ overall score between BIA-Obesity 2023 with BIA-Obesity 2019\u003c/em\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6514148/v1/7211e5ff522f9564f185b429.png"},{"id":83917212,"identity":"bbcbe318-9e77-490f-a63a-5e9764114946","added_by":"auto","created_at":"2025-06-04 12:55:17","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":32806,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eNutri-score ratings of the selected companies (Packaged food and soft drink manufacturers) between 2019 and 2023 .\u003c/em\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6514148/v1/bcb15fe1ef17bbf9d0915599.png"},{"id":83918754,"identity":"3cf70d0e-4d40-43a5-8975-ffe6b92ea9cc","added_by":"auto","created_at":"2025-06-04 13:11:17","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":38895,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe comparison of the percentage of products that are permitted to be marketed to children in 2019 and 2023.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6514148/v1/406c476e76f0fa97693abfda.png"},{"id":108437739,"identity":"ed484bb0-6cd1-4248-a5c1-47c17d2e084e","added_by":"auto","created_at":"2026-05-04 16:03:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":579417,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6514148/v1/4b62cac0-bf43-420d-a117-ad7cf359c38d.pdf"},{"id":83917592,"identity":"c570341b-1420-4216-97ca-7f59f4e53650","added_by":"auto","created_at":"2025-06-04 13:03:17","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":84920,"visible":true,"origin":"","legend":"","description":"","filename":"Annex1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6514148/v1/dfae513db3789fb4a399342c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Benchmarking the nutrition-related commitments and practices of major Belgian food companies by industry and over time (2019-2023)","fulltext":[{"header":"Background","content":"\u003cp\u003eAccording to the latest food consumption survey conducted by Sciensano, the Belgian public health institute, in 2022, approximately 49% of the adult population was categorized as overweight, including 18% who were classified as obese \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. The economic impact of obesity extends beyond healthcare to significant societal costs, primarily due to associated non-communicable diseases (NCDs)\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Obesity increases the risk and severity of NCDs such as heart disease, diabetes, and certain cancers, thereby escalating healthcare expenses and impacting the overall economy through increased medical costs and reduced workforce productivity\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. These consequences highlight the need for targeted public health interventions and policies to prevent obesity-related conditions and reduce their economic burden on society.\u003c/p\u003e \u003cp\u003eUnhealthy food choices are influenced by a complex interplay of factors including individual habits, economic constraints, and the surrounding food environment \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Dietary habits often form early in life and can persist due to cultural preferences and routines that favour high-calorie, nutrient-poor foods. Economically, healthier food options are perceived as less accessible and more expensive, leading those with limited budgets to opt for cheaper, energy-dense foods\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Moreover, the food environment in most countries is dominated by the high availability of ultra-processed foods, further encouraging unhealthy dietary patterns\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. This availability is often supported by aggressive marketing strategies that promote such options more than healthier alternatives.\u003c/p\u003e \u003cp\u003eMonitoring commitments and practices by food industry actors is essential for increasing accountability\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The World Health Organization (WHO) emphasizes the need for independent oversight to ensure industry pledges\u0026mdash;such as those on reformulation, marketing restrictions, and improved labelling\u0026mdash;translate into measurable improvements or in the absence of those improvements, lead to stronger government regulations. The Sustainable Development Goals (SDGs), particularly SDG 2 (Zero Hunger) and SDG 3 (Good Health and Well-Being), call for stronger governance to align corporate actions with public health objectives\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Transparent monitoring frameworks, as advocated by WHO, may help track progress, identify gaps, and ensure that commitments are transparent, specific and measurable, and if they do not lead to meaningful changes in the food environment, they provide a strong case for government regulations\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe Business Impact Assessment on Obesity (BIA-Obesity)\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e is a standardized tool developed by the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS)\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e to evaluate food companies\u0026rsquo; commitments and practices in improving population nutrition and preventing obesity. Alongside the global Access to Nutrition Index (ATNI) which benchmarks companies at international level, it enables benchmarking at national levels.\u003c/p\u003e \u003cp\u003eIn 2019, Belgium conducted its first BIA-Obesity, assessing major packaged food and non-alcoholic beverage manufacturers, supermarkets, and quick-service restaurants across areas such as product formulation, labelling, marketing, accessibility, and corporate nutrition strategies\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. The results showed a median overall score for the commitments of just 34%, with supermarkets (46%) and manufacturers (45%) scoring higher than quick-service restaurants (14%), which showed major gaps in marketing restrictions and accessibility\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Similar BIA studies in Australia\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e and New Zealand\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e have been used to monitor company performance over time and evaluate policy impact.\u003c/p\u003e \u003cp\u003eIn Australia, the BIA has been applied to both the commercial sector\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e and institutional settings\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, such as universities, to assess nutrition, equity, and sustainability of food environments. In Canada, repeated assessments have helped track industry progress and inform government policy on food system improvements\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBuilding on the foundation set by BIA-Obesity 2019 in Belgium\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, this current study monitors the commitments and practices related to population nutrition of these companies. It aims to analyse the progress made since the last assessment and identify ongoing challenges related to creating healthy food supply and marketing environments in the context of Belgium.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe Business Impact Assessment on Obesity (BIA-Obesity) evaluates the nutrition-related commitments and practices of food industry actors. This assessment was conducted using the BIA-Obesity tool and process developed by INFORMAS\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, an international research network that monitors food environments across over 40 countries. The methodology is adapted from the Access to Nutrition Index (ATNI), which benchmarks nutrition commitments, performance, and disclosure practices of global food and beverage manufacturers. The 2023\u0026ndash;2024 assessment was implemented in Belgium, analyzing current company commitments up to February 2024. The evaluation included sector-specific indicators for commitments and practices, tailored to Belgium\u0026rsquo;s regulatory and market environment.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003ewas obtained from the Human Ethics Committee at UZ Gent (reference number (ONZ-2022-0453), and informed consent was secured from representatives of participating companies. For non-participating companies, the evaluation was based solely on publicly available information. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eCompany Selection\u003c/h2\u003e \u003cp\u003eCompany selection was based on market share data from Euromonitor. Selection criteria ensured at least 50% market coverage in Belgium for each sector (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). However, this threshold could not be met in the QSR sector in Belgium, due to the presence of numerous smaller, independent operators. We evaluated 32 companies in (21 packaged food and non-alcoholic beverage manufacturers, 6 quick-service restaurants, 5 supermarkets).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe market shares per food industry as determined by Euromonitor and most sold product categories of companies included in the study (Belgium, Euromonitor, 2021)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompanies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarket share (%) *\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMost sold (own-brand) product categories (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePackaged food manufacturers \u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDanone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDairy Products and Alternatives (12.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNestle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDairy Products and Alternatives (1.3), Non-alcoholic beverages (6.0), Confectionary (4.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMcCain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProcessed Fruit and Vegetables (6.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMars\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConfectionary (6.2), Rice, Pasta and Noodles (9.6), Sauces, Dressings and Condiments (5.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePepsico\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-alcoholic beverages (6.4), Savoury snack foods (32.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNomad food-Iglo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProcessed Fruits \u0026amp; vegetables (8.9), Soup (6.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMondelez\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSnacks (14.5), Confectionary (20), Savoury snack foods (7.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnilever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCooking Ingredients and Meals (7.0), Sauces, Dressings and Condiments (17.0), Soup (23.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoyal Friesland Campina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDairy Products and Alternatives (5.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKellogg\u0026acute;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBreakfast Cereals (40.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFerrero\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSnacks (5.2), Confectionary (5.8), Sweet Spreads (29.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDr. Oetker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReady Meal (6.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBel group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDairy Products and Alternatives (4.5), Sweet Spreads (29.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTer Beke- What\u0026acute;s Cooking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReady Meal (7.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLactalis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDairy Products and Alternatives (5.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonde Nissin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProcessed Meat, Seafood and Alternatives to Meat (0.5), Cooking Ingredients and Meals (0.4), Ready Meal (0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCasa Tarradellas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProcessed Meat, Seafood and Alternatives to Meat (6.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaronie\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConfectionary (6.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoger and Roger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSavoury snacks (7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-alcoholic beverage manufacturers\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoca Cola\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePepsiCo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNestle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuntory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSupermarkets\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColruyt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarrefour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelhaize\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAldi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLidl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQuick-Service Restaurants\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMcDonald\u0026acute;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuick\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLunch Garden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVanherpe Food Group- Panos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYum! / Pizza Hut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExki\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*Overall market shares not available in Euromonitor for packaged food companies, only by food category\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessment of the commitments\u003c/h3\u003e\n\u003cp\u003eThe BIA-Obesity tool was adapted to the Belgian context to ensure relevance within the national regulatory and policy landscape. Indicators that overlapped with existing European or national legislation, such as mandatory on-pack ingredient lists and mandatory standards for trans-fat content in foods\u0026mdash;were excluded, as companies are already required to meet these standards.\u003c/p\u003e \u003cp\u003eIn addition, since in-store restaurants are uncommon in Belgian supermarkets, related menu labelling indicators were not applicable and were therefore omitted for supermarkets. The remaining components of the tool were tailored to align with national initiatives and industry commitments, including the Belgian Pledge, Nutri-Score front-of-pack labelling, and the Convention for a Balanced Diet.\u003c/p\u003e \u003cp\u003eThe assessment focused on the transparency, specificity, and comprehensiveness of publicly available commitments that exceeded legal requirements. A structured scoring framework comprising around 60 adapted indicators was applied to evaluate company policies across relevant areas of action. All commitments were systematically catalogued and scored using standardized procedures. The full list of adapted indicators and scoring criteria is available in Annex 1. A summary is available in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eNutrition-related commitments were collected between March 2023 and February 2024. Publicly available information was retrieved from company and brand websites, corporate reports, industry pledges, and relevant media. Where possible, companies were contacted directly via email or professional networks and invited to verify and complete the collected information. All relevant documents and webpages were archived through downloads and screenshots.\u003c/p\u003e \u003cp\u003eCompanies were invited to review and complete the data via email correspondence and follow-up calls. Those that agreed to participate received a summary report on the scores allocated for the commitments and were asked to provide additional documentation where relevant. Commitments were then entered into a standardized database and scored based on the BIA-Obesity indicators. Companies that did not respond or declined participation were assessed based on public information only. The domain scores were subsequently weighted according to the criteria outlined in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, resulting in a final BIA-Obesity score calculated out of 100 points. Weightings were derived from INFORMAS guidelines and expert consultations, ensuring they aligned with sectoral impact on nutrition \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. To ensure reliability, a sample of company commitments was double-scored by an independent researcher, with a 95% agreement rate. Discrepancies were resolved through consultation with a third researcher.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBIA-Obesity 2023/2024- Belgium, domains, key indicator categories\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDomain description\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKey indicators\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorporate nutrition strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverarching commitment to improving population nutrition\u003c/p\u003e \u003cp\u003efor obesity and NCD prevention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Commitment to nutrition and health in corporate strategy\u003c/p\u003e \u003cp\u003e\u0026bull; Reporting against nutrition and health objectives and targets\u003c/p\u003e \u003cp\u003e\u0026bull; Key Performance Indicators of senior managers linked to nutrition targets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProduct formulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommitment to addressing nutrients of concern (sodium, saturated\u003c/p\u003e \u003cp\u003efat, added/free sugars) and portion size in the development\u003c/p\u003e \u003cp\u003eand reformulation of products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Targets and actions related to the reduction of sodium, saturated fat, sugar and portion size/energy content across portfolio\u003c/p\u003e \u003cp\u003e\u0026bull; Engagement with government-led initiatives related to product formulation (e.g., the Convention for a Balanced Diet)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutrition labelling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommitment to providing comprehensive nutrition information\u003c/p\u003e \u003cp\u003eacross settings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Commitment to implement the Nutri-Score across the product portfolio\u003c/p\u003e \u003cp\u003e\u0026bull; Provide online nutrition information\u003c/p\u003e \u003cp\u003e\u0026bull; Use of nutrition and health claims on healthy products only\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProduct and brand promotion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommitment to reducing the promotion of less healthy products\u003c/p\u003e \u003cp\u003eon broadcast, digital and other non-broadcast media\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Broadcast and non-broadcast media policy\u003c/p\u003e \u003cp\u003e\u0026bull; Use of marketing techniques that appeal to children and adolescents\u003c/p\u003e \u003cp\u003e\u0026bull; Sponsorships, in-store promotion practices, and products featured in catalogues\u003c/p\u003e \u003cp\u003e\u0026bull; Only advertise or display \u0026lsquo;healthy\u0026rsquo; sides and \u0026lsquo;healthy\u0026rsquo; drinks in (children\u0026rsquo;s) combination meals\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProduct accessibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommitment towards addressing the availability, affordability\u003c/p\u003e \u003cp\u003eand distribution of healthier and less healthy products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Increasing the proportion of healthy products in the product portfolio\u003c/p\u003e \u003cp\u003e\u0026bull; Support of fiscal policies (e.g. a tax on sugar-sweetened beverages)\u003c/p\u003e \u003cp\u003e\u0026bull; Pricing and discounting strategies\u003c/p\u003e \u003cp\u003e\u0026bull; Check-outs free from unhealthy items\u003c/p\u003e \u003cp\u003e\u0026bull; Not provide free refills for sugary drinks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelationships with other organisations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePolicies and disclosures regarding funding or support for political\u003c/p\u003e \u003cp\u003eparties, government agencies, professional organizations, external\u003c/p\u003e \u003cp\u003eresearch, philanthropic groups, nutrition programs and active\u003c/p\u003e \u003cp\u003elifestyle programs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Disclosure and transparency of relevant relationships\u003c/p\u003e \u003cp\u003e\u0026bull; Accessibility of relevant information\u003c/p\u003e \u003cp\u003e\u0026bull; No political donations or declaration of those in real-time\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe weighting of the indicators for three sectors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBIA-Obesity domains\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePackaged food and Beverage manufacturers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChain restaurants and catering companies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSupermarkets\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorporate nutrition strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProduct formulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutrition labelling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProduct and brand promotion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProduct accessibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelationships with other organisations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTOTAL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eAssessment of the practices\u003c/h3\u003e\n\u003cp\u003eIn addition to assessing commitments, the BIA-Obesity 2023\u0026ndash;2024 evaluation examined selected company practices to determine the extent to which public commitments translate to improved performance in practice. A set of key performance indicators (KPIs) was used, selected based on international benchmarking tools, regulatory relevance, and data availability.\u003c/p\u003e \u003cp\u003ePractices were assessed using established classification systems and objective measurements. This included an analysis of the nutritional quality and processing level of products, in-store product placement, and density of QSR around schools. Nutri-Score, officially implemented in Belgium in 2019\u003csup\u003e17\u003c/sup\u003e, was used to evaluate the nutritional quality of products, while the NOVA system\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e captured the level of processing of products in company\u0026rsquo;s portfolios. The WHO Europe Nutrient Profile Model\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e was applied to identify products not permitted to be marketed to children. Accessibility was assessed through shelf-space allocation and checkout placement in supermarkets, as previously published\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, as well as the density of fast-food outlets near schools using geospatial mapping (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssessment criteria and measurement approaches for observed practices by industry\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea of Assessment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndustry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTool / Classification System\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMeasurement Approach\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProduct Healthiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePackaged food and non-alcoholic beverage manufacturers, Supermarkets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNutri-Score classification\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDistribution of products across Nutri-Score A to E categories\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePackaged food and non-alcoholic beverage manufacturers, Supermarkets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNOVA classification\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProportion of products classified as ultra-processed (NOVA 4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarketing Practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePackaged food and non-alcoholic beverage manufacturers, Supermarkets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWHO Nutrient Profile Model\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIdentification of products not permitted to be marketed to children according to the WHO Europe nutrient profile model\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProduct Accessibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupermarkets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupermarket shelf-space allocation \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCumulative linear shelf length ratio for healthy compared to unhealthy foods\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupermarkets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCheckout placement \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProportion of foods that are ultra-processed at checkout areas\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFast-Food Accessibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuick Service Restaurants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDensity of quick-service restaurants (QSRs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssessment of the distance and density of quick-service restaurants near schools (using geospatial mapping)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eCommitment scores were calculated in Excel based on the INFORMAS methodology, as detailed in Annex 1. Median overall and domain-specific scores were reported for each sector. Intersectoral comparisons were conducted to identify relative performance across food manufacturers, supermarkets, and quick-service restaurants, with examples of leading and lagging companies highlighted.\u003c/p\u003e \u003cp\u003eTo assess progress over time, results on commitments and practices from the 2023\u0026ndash;2024 assessment were compared with those from the 2019 Belgian BIA-Obesity evaluation. This comparison focused on overall median scores and selected key indicators that were retained across both assessments, particularly within the domains of product formulation, labelling, and marketing to children. Only indicators that remained consistent in scope and scoring between the two assessments were included in the longitudinal comparison.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCommitments \u0026ndash; overall scores\u003c/h2\u003e \u003cp\u003eIn total, 32 companies were assessed in the BIA-Obesity 2023/2024 study, covering packaged food manufacturers, non-alcoholic beverage manufacturers, supermarkets, and quick-service restaurants (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among these, 63% (20/32) fully engaged with the research process, including all five supermarkets, providing feedback and validation at various stages. An additional 9% (3/32) initially agreed to participate but did not provide feedback within the required timeframe. For the remaining 28% (9/32), multiple contact attempts were made, but no response was received. However, no company explicitly refused to participate.\u003c/p\u003e \u003cp\u003eCompany participation had a notable impact on scores. The median overall score for companies who participated (N-20) based solely on publicly available commitments was 31%, but increased to 52% after company engagement, highlighting the value of transparency and active participation in the assessment process.\u003c/p\u003e \u003cp\u003eThe overall BIA-Obesity scores ranged from 0\u0026ndash;82%, with a median score of 40%. Across sectors, supermarkets had the highest overall score (median\u0026thinsp;=\u0026thinsp;51%), followed by packaged food and non-alcoholic beverage manufacturers (median\u0026thinsp;=\u0026thinsp;45%), while QSRs had the lowest median score (15%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eGroup 1: Full engagement with the process (N\u0026thinsp;=\u0026thinsp;20); Group 2: Accepted participation, but contributions not received in time (N\u0026thinsp;=\u0026thinsp;3); Group 3: Due to Lack of contact, the assessment of commitments was based on publicly available information only (N\u0026thinsp;=\u0026thinsp;9).\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCommitments by Sector\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePackaged Food and Non-Alcoholic Beverage Manufacturers\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe median score for this sector was 45%, with scores ranging from 0\u0026ndash;82%. Danone led with 82%, while Roger \u0026amp; Roger scored 0%. Corporate Nutrition Strategy was the strongest domain (63%), while Product Accessibility (20%) was the weakest. Although some companies actively engaged with reformulation and labeling, several companies had minimal or no commitments across all domains, indicating opportunities for further improvement.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eQuick-Service Restaurants (QSRs)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eQSRs had the lowest median score (15%), ranging from 2% (Lunch Garden) to 32% (McDonald\u0026rsquo;s). Corporate Nutrition Strategy (44%) was the best-performing domain, while Product and Brand Promotion (5%) and Relationships with Other Organizations (6%) were the weakest. Only McDonald\u0026rsquo;s and Quick engaged with the study, while the remaining four companies did not respond. Quick scored highest in Corporate Nutrition Strategy (72%), while McDonald\u0026rsquo;s led in Product Formulation (45%). However, no QSRs had commitments to menu labeling, reflecting a gap in transparency.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSupermarkets\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eSupermarkets had the highest median score (51%), ranging from 38\u0026ndash;65%. Delhaize (65%) and Colruyt (52%) were the top performers. Corporate Nutrition Strategy (87%) was the highest-scoring domain, while Product Accessibility (11%) was the weakest. All five supermarkets actively engaged with the research process, demonstrating greater transparency than other sectors.\u003c/p\u003e\n\u003ch3\u003eCommitments by Policy Domain\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eCorporate Nutrition Strategy\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe Corporate Nutrition Strategy domain had the highest median score (63%, range\u0026thinsp;=\u0026thinsp;0\u0026ndash;100%), reflecting widespread commitments in this area. Danone achieved the maximum score (100%), demonstrating a comprehensive approach to population nutrition. As a sector, supermarkets performed best (median\u0026thinsp;=\u0026thinsp;87%), followed by packaged food and beverage manufacturers (63%), while QSRs had the lowest median score (44%). Several companies regularly published national reports detailing objectives and progress. However, companies with the lowest scores lacked any publicly available information on nutrition-related commitments.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eProduct Formulation\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe median score for Product Formulation was 50% (range\u0026thinsp;=\u0026thinsp;0\u0026ndash;93%), with supermarkets scoring highest (67%), followed by food and beverage manufacturers (50%), and QSRs (17%). Nine of the 21 food and beverage manufacturers and all five supermarkets had integrated Nutri-Score into their reformulation strategies, signalling a commitment to product improvement. Additionally, 14 of 21 food and beverage manufacturers and all supermarkets had targets for reducing added sugar and sodium, and 14 of 21 food and beverage manufacturers and all supermarkets had portion size reduction targets. However, only one of seven QSRs had similar targets, indicating an area for improvement.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eNutrition Labeling\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe median score for Nutrition Labeling was 33% (range\u0026thinsp;=\u0026thinsp;0\u0026ndash;96%), showing variation in the extent of commitments across sectors. Supermarkets (median\u0026thinsp;=\u0026thinsp;50%) performed better than food and beverage manufacturers (median\u0026thinsp;=\u0026thinsp;37%) and QSRs (median\u0026thinsp;=\u0026thinsp;14%). A packaged food manufacturer obtained the highest score (96%) for applying Nutri-Score across own-brand products and online platforms. In contrast, two QSRs and two packaged food manufacturers had no commitments in this domain. While 9 of 21 food and beverage manufacturers and all supermarkets committed to implementing Nutri-Score, only one of six QSRs provided any nutritional information online, and none had commitments to labeling their menu boards in-store.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eProduct and Brand Promotion\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe median score for Product and Brand Promotion was 36% (range\u0026thinsp;=\u0026thinsp;0\u0026ndash;80%). Food and beverage manufacturers had the highest median score (48%), followed by supermarkets (36%), while QSRs scored the lowest (5%). Nine companies (3 QSRs, 6 food and beverage manufacturers) had no commitments to reducing marketing towards children. While all supermarkets, 14 food and beverage manufacturers, and 3 QSRs were signatories of the Belgian Pledge, none had policies covering children up to 18 years old.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eProduct Accessibility\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe Product Accessibility domain had the lowest median score (11%, range\u0026thinsp;=\u0026thinsp;0\u0026ndash;60%), highlighting the lack of strong commitments to improving access to healthier foods. Food and beverage manufacturers had the highest median score (20%), followed by supermarkets (8%), while QSRs had the lowest score (6%). Eight companies, including one QSR and three packaged food manufacturers, had no commitments in this area. Some supermarkets committed to price promotions on Nutri-Score A/B products or banning unhealthy items at checkouts, while a few manufacturers supported taxation on unhealthy products. McDonald\u0026rsquo;s pledged to remove free refills for soft drinks, signalling progress in reducing sugary beverage consumption.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eRelationships with Other Organizations\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe median score for this domain was 25% (range\u0026thinsp;=\u0026thinsp;0\u0026ndash;89%), with supermarkets scoring the highest (39%), followed by food and beverage manufacturers (33%), and QSRs (8%). Two QSRs and four packaged food manufacturers had no publicly available information in this domain. While a few companies made commitments not to engage in political donations, transparency in corporate lobbying and external partnerships remains limited.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePractices\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eProduct Healthiness Based on Nutri-Score\u003c/h2\u003e \u003cp\u003eThe Nutri-Score classification revealed substantial differences in product healthiness across food and non-alcoholic beverage manufacturers and supermarket own-brand portfolios. When grouped by Nutri-Score category, only a minority of companies had a high proportion of products rated A or B. Notably, Iglo (94%), Ter Beke (81%), and Danone (76%) led with the healthiest portfolios. Among supermarkets, Delhaize had the highest share of Nutri-Score A\u0026amp;B products (56%), followed by Lidl (50%) and Colruyt and Carrefour (both 45%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConversely, several companies had almost no products rated Nutri-Score A or B. These included Baronie and Roger \u0026amp; Roger (0%), Ferrero (1%), and Bel Group (2%), indicating portfolios dominated by less healthy products. Among beverage companies, Spadel (48%) had had the highest share of Nutri-Score A\u0026amp;B products.\u003c/p\u003e \u003cp\u003eProducts rated Nutri-Score C formed a substantial share of the portfolios for several manufacturers. For instance, Dr. Oetker (37%), Kellogg\u0026rsquo;s (60%), and Unilever (40%) had large proportions of products in this mid-tier category. Within the supermarket sector, products rated C accounted for 22\u0026ndash;32% of the range, suggesting that moderate nutritional quality makes up a significant portion of own-brand offerings.\u003c/p\u003e \u003cp\u003eAt the lower end of the scale, products rated D or E were heavily represented in some portfolios. Baronie (100%), Ferrero (93%), Bel (91%), and Mondelez (78%) had the highest proportions of less healthy products. Among supermarkets, D\u0026amp;E products made up 22\u0026ndash;30% of portfolios, with Colruyt and Carrefour each at 27\u0026ndash;29%, and Aldi slightly higher at 30%. In contrast, Ter Beke (2%), Spadel (3%), and Danone (3%) had the lowest shares of products in the D\u0026amp;E category (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOverall, while some companies showed promising results with high proportions of Nutri-Score A and B products, many portfolios remain skewed toward lower nutritional quality. These findings underscore the need for stronger reformulation targets and portfolio-wide improvement strategies across both manufacturers and retailers.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMarketing Eligibility and Level of Processing of Products\u003c/h2\u003e \u003cp\u003eAn assessment of company product portfolios using the WHO Nutrient Profile Model revealed that the vast majority of products from most manufacturers and supermarkets were not permitted to be marketed to children.\u003c/p\u003e \u003cp\u003eSeveral manufacturers\u0026mdash;Baronie, Ferrero, and Roger \u0026amp; Roger\u0026mdash;had 100% of their portfolios falling outside the permitted threshold, followed closely by Mondelez (97%) and Friesland Campina (96%). In contrast, Ter Beke (5%), Iglo (14%), and McCain (58%) had the lowest shares of non-permitted products, suggesting a relatively healthier product mix. Among supermarkets, Delhaize had the lowest proportion of products not permitted for marketing to children (50%), while Aldi (69%) and Lidl (65%) had the highest (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe NOVA classification showed similar patterns in levels of processing. Many manufacturers had portfolios dominated by ultra-processed foods, with Roger \u0026amp; Roger, Ter Beke, Baronie, Mondelez, and Ferrero all exceeding 96%. Notably, Kellogg\u0026rsquo;s (99%) and Dr. Oetker (94%) also ranked among the highest. By contrast, Lactalis (7%), Friesland Campina (18%), and Bel (25%) had the lowest proportions of ultra-processed products. Supermarket own-brand portfolios reflected moderate levels of processing, with Delhaize (41%) scoring lowest, followed by Carrefour (46%) and Colruyt (47%), while Aldi (61%) and Lidl (63%) had the highest (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese findings underscore the widespread reliance on ultra-processed foods across the Belgian market and the limited eligibility of products for marketing to children under WHO criteria. They highlight the continued need for reformulation, portfolio diversification, and stronger regulation of product composition and marketing practices.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eProximity and Expansion of Quick-Service Restaurants Near Schools\u003c/h2\u003e \u003cp\u003eThe availability of quick-service restaurants (QSRs) in proximity to schools was analyzed using Locatus 2022 data \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, revealing that over 50% of outlets from all five assessed QSR chains were located within 500 meters of a primary school in at least one region (Flanders, Wallonia, or Brussels). The growth of QSRs in Belgium between 2018 and 2022 was also assessed, showing a significant expansion in the sector (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). EXKi experienced the highest growth rate (121.1%), followed by Pizza Hut (55.9%) and McDonald's (53.6%) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePanos remained the chain with the highest number of outlets (119 in 2022) despite having a relatively lower growth rate of 30.2%. The increasing presence of QSRs near schools raises concerns about the accessibility of fast food to children and the potential impact on dietary habits.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOutlet Growth by Quick Service Restaurants and the number of outlets in 2018 and 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRestaurant\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2018 Outlets within 500m Near Schools\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2022 Outlets within 500m Near Schools\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGrowth %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePanos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMcDonald\u0026acute;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuick\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExki\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePizza Hut Delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e155%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePizza Hut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-16.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eIn-Store Product Placement and Shelf Space Allocation in Supermarkets\u003c/h2\u003e \u003cp\u003eThe allocation of shelf space to healthy versus unhealthy products was assessed across supermarket chains. As reported in a peer-reviewed study\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, the average healthy/unhealthy shelf space ratio across supermarkets in Flanders was 0.36 (95% CI: 0.33\u0026ndash;0.39), meaning that for every 10 meters of shelf space for unhealthy products, only 3.6 meters were allocated to healthier options. Considerable variation was observed between retailers: Aldi had the highest ratio at 0.45 (95% CI: 0.38\u0026ndash;0.52), while Carrefour had the lowest at 0.25 (95% CI: 0.22\u0026ndash;0.28). When adjusting for supermarket size, Carrefour and Colruyt had the highest total shelf space dedicated to fresh and frozen fruits and vegetables, while Aldi had the lowest. However, for unhealthy products, Carrefour had the highest total shelf space allocation, while Aldi had the lowest\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe prominence of healthy vs. unhealthy products in key supermarket areas (e.g., checkouts and endcaps) was also analyzed. The healthy/unhealthy shelf length ratio was lowest in high-visibility areas such as checkouts and front-end aisle displays, while it was highest in low-visibility areas along the store perimeter. Colruyt had the highest ratio of healthy products in high-visibility areas, likely due to their commitment to keeping checkout zones free from unhealthy foods, while Delhaize had the highest ratio of healthy products in low-visibility areas. In contrast, Delhaize and Carrefour had the highest proportion of ultra-processed foods at checkouts, reinforcing the need for stronger commitments in product placement strategies\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eComparison of commitments and practices between 2019 and 2023\u003c/h2\u003e \u003cp\u003eTo assess progress in company commitments and performance, we compared the BIA-Obesity results from 2019 and 2023/2024 for the 25 companies included in both assessments. This comparison highlights improvements, stability, or declines in commitments and actual practices related to nutrition and obesity prevention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eChanges in Commitments\u003c/h2\u003e \u003cp\u003eAmong the 25 companies assessed in both 2019 and 2023/2024, 18 showed improvements in their overall BIA-Obesity scores, three remained unchanged, and five experienced a decline. Notably, all companies with lower scores in 2023/2024 did not engage in the assessment process, meaning their results were based solely on publicly available data (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAmong packaged food and beverage manufacturers, McCain demonstrated the largest improvement (+\u0026thinsp;11 points), with notable progress in nutrition labelling and brand promotion. This included the introduction of time-bound targets for sodium and saturated fat reduction, as well as an expansion of Nutri-Score labelling on the front-of-pack of food products. In contrast, Unilever and Friesland Campina showed declines of -12 and \u0026minus;\u0026thinsp;15 points, respectively, likely reflecting their lack of participation in the 2023/2024 cycle after having engaged in 2019. Coca-Cola and Kellogg\u0026rsquo;s scores remained stable, indicating no substantial change in commitments over time.\u003c/p\u003e \u003cp\u003eQuick-service restaurants showed more varied results. Quick improved significantly (+\u0026thinsp;13 points), reflecting new commitments in corporate nutrition strategy and product reformulation, such as gradual salt reduction targets in menu development. McDonald\u0026rsquo;s score declined slightly (-3 points), while Exki experienced a substantial drop (-22 points) due to the absence of publicly available nutrition-related commitments in the most recent assessment\u003c/p\u003e \u003cp\u003eAmong supermarkets, four out of five improved their overall scores. Delhaize\u0026rsquo;s score increased from 60\u0026ndash;65%, supported by stronger commitments in product accessibility and formulation. For instance, the retailer enhanced the visibility of healthier products through in-store placement and promotional strategies. Colruyt and Carrefour also showed modest improvements, while Lidl\u0026rsquo;s score remained unchanged at 50%, indicating no major strategic shifts in nutrition-related policies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eChanges in practices\u003c/h2\u003e \u003cp\u003eThe nutritional quality of product portfolios was assessed by comparing the proportion of products classified as Nutri-Score A and B (healthiest options) and D and E (least healthy) between 2019 and 2023/2024 for the 19 companies included in both assessments. For QSR no data on nutritional quality of product portfolios was available.\u003c/p\u003e \u003cp\u003eResults indicate a mixed pattern of change. Between 2019 and 2023/2024, 12 out of 19 companies reduced the share of D\u0026amp;E products in their portfolios, suggesting progress in improving the least healthy items. This includes substantial reductions by Friesland Campina (\u0026ndash;64 percentage points), Danone (\u0026ndash;13 pp), and Delhaize (\u0026ndash;17 pp). However, reductions were not universal. For instance, Nestl\u0026eacute;, Mars, and Mondelez reported slight increases in the proportion of D\u0026amp;E products (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConversely, only 7 out of 19 companies increased their share of A\u0026amp;B products over the same period. Danone and Friesland Campina demonstrated the most significant gains (+\u0026thinsp;29 pp and +\u0026thinsp;65 pp, respectively), followed by Lidl (+\u0026thinsp;22 pp) and Delhaize (+\u0026thinsp;17 pp). In contrast, several companies\u0026mdash;including McCain (\u0026ndash;51 pp), Dr. Oetker (\u0026ndash;23 pp), and Kellogg\u0026rsquo;s (\u0026ndash;20 pp)\u0026mdash;reported considerable decreases in the share of healthier products. These trends suggest that while some reformulation efforts focused on reducing the least healthy items, relatively few companies made substantial efforts to increase the availability of the healthiest products in their portfolios (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAt the sectoral level, supermarkets generally outperformed packaged food and beverage manufacturers. In 2023/2024, supermarkets had higher median shares of A\u0026amp;B products (median\u0026thinsp;=\u0026thinsp;48%) and lower shares of D\u0026amp;E products (median\u0026thinsp;=\u0026thinsp;26%) compared to food and beverage manufacturers (median A\u0026amp;B\u0026thinsp;=\u0026thinsp;33%; median D\u0026amp;E\u0026thinsp;=\u0026thinsp;39%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). This indicates some progress in the healthiness of supermarket own-brand products and highlights the potential of retail-led nutrition strategies. Nevertheless, even among supermarkets, the proportion of D\u0026amp;E products remained substantial, especially in high-visibility areas such as checkouts.\u003c/p\u003e \u003cp\u003eTogether, these findings underline the need for companies not only to reduce the prevalence of the least healthy products but also to invest in expanding their healthier offerings.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe analysis of products permitted and not permitted to be marketed to children, based on the WHO Nutrient Profile Model, revealed variable trends between 2019 and 2023 across companies. Among packaged food and beverage manufacturers, most showed only modest changes or persistent non-compliance. Ferrero, Mondelez, and Kellogg\u0026rsquo;s maintained extremely high proportions of products not permitted to be marketed to children (\u0026ge;\u0026thinsp;92%) across both years. Conversely, Ter Beke demonstrated a substantial improvement, reducing the proportion of non-permitted products from 50% in 2019 to just 5% in 2023, reflecting a shift toward healthier product offerings. Similarly, Danone saw a reduction from 83\u0026ndash;70%, and Iglo improved slightly from 18\u0026ndash;14%. However, several companies, including Coca-Cola, Nestl\u0026eacute;, and PepsiCo, remained consistently high in non-permitted product proportions, indicating limited progress in aligning portfolios with child-directed marketing standards (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAmong supermarkets, the share of own-brand products permitted to be marketed to children declined notably. In 2019, Aldi and Lidl had the highest proportion of permitted products (82% and 78%, respectively), followed by Delhaize (70%). By 2023, these figures had sharply dropped to below 1% for all three retailers, suggesting either changes in product formulation or a shift in portfolio classification under the WHO model. Carrefour and Colruyt also saw decreases in the proportion of permitted products\u0026mdash;from 69\u0026ndash;43% and from 66\u0026ndash;38%, respectively\u0026mdash;indicating a general trend toward less alignment with healthy marketing standards in the retail sector. These findings highlight the need for more stringent and sustained reformulation strategies and marketing policies across both manufacturers and retailers to ensure that products targeted at children meet established nutritional criteria (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the commitments and practices of major food industry actors in Belgium regarding their impact on population nutrition. The findings highlight a mixed picture of some limited progress, stagnation, and regression across different sectors, underscoring the need for continuous monitoring and in particular stronger government regulations, especially in the areas of food marketing and food accessibility.\u003c/p\u003e \u003cp\u003eThe results indicate that while several companies improved their commitments, transparency remains a key challenge. A significant number of companies either did not engage with the assessment or had minimal publicly available commitments, leading to lower scores. This is consistent with previous assessments in other countries\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, where companies that actively participated in the process generally achieved higher scores. The voluntary nature of commitments also raises concerns about accountability, as companies may selectively disclose policies while failing to implement meaningful changes.\u003c/p\u003e \u003cp\u003eCorporate nutrition strategies remained the strongest domain across all sectors, as companies are keen to present themselves as proactive in addressing nutrition challenges. However, other areas, such as product accessibility and responsible marketing, showed weak commitments, suggesting a lack of concrete action beyond corporate positioning.\u003c/p\u003e \u003cp\u003eA comparison of the 2019 and 2023/2024 results reveals both improvements and setbacks \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Notably, 18 out of 25 companies improved their overall scores, reflecting a growing recognition of the need for corporate responsibility in public health. However, five companies recorded lower scores, primarily due to a lack of engagement in the recent assessment, leading to reliance on publicly available data that may not fully capture internal initiatives.\u003c/p\u003e \u003cp\u003ePackaged food and beverage manufacturers showed mixed progress. Danone and McCain recorded notable improvements, driven by stronger commitments in product formulation, nutrition labeling, and responsible marketing. In contrast, Unilever and Friesland Campina experienced declines, likely due to a lack of engagement in the 2023/2024 assessment, rather than an actual regression in policies.\u003c/p\u003e \u003cp\u003eFor quick-service restaurants, Quick showed the largest improvement, particularly in corporate nutrition strategy and product formulation, while McDonald\u0026rsquo;s and Exki recorded declines, the latter significantly due to missing publicly available commitments. Among supermarkets, Delhaize, Colruyt, and Carrefour showed progress, particularly in product accessibility and formulation, whereas Lidl remained stable, suggesting limited new initiatives.\u003c/p\u003e \u003cp\u003eBeyond commitments, company performance in product healthiness and marketing showed both progress and areas of concern. Most companies reduced the proportion of products with Nutri-Score D\u0026amp;E, indicating some improvements in the least healthy products. However, the proportion of Nutri-Score A\u0026amp;B products decreased in most companies, suggesting that reformulation efforts primarily focused on removing the worst-performing products rather than expanding the healthiest options. While several companies reduced the percentage of products not permitted for marketing to children, the progress was inconsistent. Some manufacturers\u0026mdash;such as Ferrero\u0026mdash;maintained 100% non-compliance, while others made slight improvements. The findings highlight the need for stricter, industry-wide marketing restrictions to ensure responsible practices.\u003c/p\u003e \u003cp\u003eAmong quick-service restaurants, changes were limited. The proximity of QSR outlets to schools remained unchanged, with over 50% of outlets still located within 500 meters of primary schools, raising concerns about fast-food accessibility to children.\u003c/p\u003e \u003cp\u003eSupermarkets showed the most notable improvements, particularly in product portfolios, with increased availability of Nutri-Score A\u0026amp;B products and a reduction in Nutri-Score D\u0026amp;E products. Additionally, all supermarkets improved the proportion of products permitted to be marketed to children. However, unhealthy products continued to dominate checkout areas and promotional displays, demonstrating the ongoing influence of in-store marketing strategies.\u003c/p\u003e \u003cp\u003eSimilar BIA-Obesity assessments have been conducted in other high-income countries, offering useful benchmarks for interpreting the Belgian findings. In Ireland, the overall median score across all companies was 28%, with sector-specific medians of 37% for packaged food and beverage manufacturers, 18% for supermarkets, and just 9% for quick-service restaurants\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. These figures are lower than those observed in Belgium, where the median overall score was 40%, with 45% for packaged food and beverage manufacturers, 51% for supermarkets, and 15% for quick-service restaurants.\u003c/p\u003e \u003cp\u003eIn Australia, the overall scores were also lower than in Belgium. The median sector scores were 50% for packaged food and beverage manufacturers​, 46% for supermarkets​ and just 36% for quick-service restaurants\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. These findings reinforce a consistent international pattern: while corporate nutrition strategy tends to be the best-performing domain, product accessibility and affordability remain the weakest areas across all countries. This highlights a persistent gap between high-level commitments and concrete actions to improve equitable access to healthier foods.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, while some companies have made limited progress in their nutrition-related commitments and practices, these changes are not consistent across the industry. Persistent gaps in product accessibility, responsible marketing, and transparency reveal the limitations of relying on voluntary approaches. Although such commitments may demonstrate corporate engagement, they often fall short of translating into tangible improvements in food environments. Without regulatory oversight, there is a risk that self-regulation becomes a mechanism to delay or weaken more impactful government action. Moreover, even if limited progress was observed, product portfolios across the Belgian market remain largely of poor nutritional quality with a high proportion of ultra-processed foods. In addition, most products on the Belgian market are not suitable for marketing to children. Strengthened regulation and continued independent monitoring are therefore essential to ensure that corporate strategies align with public health goals and contribute to measurable outcomes. Future research should continue to evaluate the alignment between commitments and actual practices, and support cross-country comparisons to inform more effective policy responses for creating healthier food environments.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eATNI Access to Nutrition Index\u003c/p\u003e\n\u003cp\u003eBIA Business impact assessment\u003c/p\u003e\n\u003cp\u003eINFORMAS International Network for Food and Obesity Research Monitoring and Action Support\u003c/p\u003e\n\u003cp\u003eQSR Quick service restaurant\u003c/p\u003e\n\u003cp\u003eNCDs noncommunicable diseases\u003c/p\u003e\n\u003cp\u003eWHO World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eEthical approval was obtained from the Human Ethics Committee at UZ Gent (reference number (ONZ-2022-0453), and informed consent was secured from representatives of participating companies. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe (raw) data and materials are available from the authors upon reasonable request to [email protected]\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors declare they do not have competing interests in regards to this study\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe study was funded by the FEAST project (www.feast.eu)\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eS.V. received the funding and designed the study and supervised S.D. S.D. did the data collection and analysis and wrote the paper. All authors agreed with the last version of the manuscript.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors want to acknowledge the company representatives who contributed to the collection and verification of commitments.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMoyersoen I, Bel S, Lebacq T, Versele V, Vasquez MS, Van Campenhout E, et al. Weight status and weight-related behaviours in the Belgian population - Food consumption survey 2022–2023. Brussels: Sciensano; 2024. Available from: https://www.sciensano.be/sites/default/files/fcs_en_report_2_nv.pdf\u003c/li\u003e\n \u003cli\u003eGorasso V, Moyersoen I, Van der Heyden J, De Ridder K, Vandevijvere S, Vansteelandt S, et al. Health care costs and lost productivity costs related to excess weight in Belgium. BMC Public Health. 2022;22(1):1693. doi:10.1186/s12889-022-14105-9\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Non communicable diseases. 2024 [cited 2024 Dec 23]. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases\u003c/li\u003e\n \u003cli\u003eNyberg ST, Batty GD, Pentti J, Virtanen M, Alfredsson L, Fransson EI, et al. Obesity and loss of disease-free years owing to major noncommunicable diseases: a multicohort study. Lancet Public Health. 2018;3(10):e490–7.\u003c/li\u003e\n \u003cli\u003eSwinburn B, Egger G. The runaway weight gain train: too many accelerators, not enough brakes. BMJ. 2004;329(7468):736–9. doi:10.1136/bmj.329.7468.736\u003c/li\u003e\n \u003cli\u003eDaniel C. Is healthy eating too expensive?: How low-income parents evaluate the cost of food. Soc Sci Med. 2020;248:112823. doi:10.1016/j.socscimed.2020.112823\u003c/li\u003e\n \u003cli\u003eMertens E, Colizzi C, Peñalvo JL. Ultra-processed food consumption in adults across Europe. Eur J Nutr. 2022;61(3):1521–39. doi:10.1007/s00394-021-02733-7\u003c/li\u003e\n \u003cli\u003eSwinburn B, Sacks G, Vandevijvere S, Kumanyika S, Lobstein T, Neal B, et al. INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support): overview and key principles. Obes Rev. 2013;14:1–12.\u003c/li\u003e\n \u003cli\u003eSacks G, Vanderlee L, Robinson E, Vandevijvere S, Cameron AJ, Ni Mhurchu C, et al. BIA-Obesity (Business Impact Assessment—Obesity and population-level nutrition): a tool and process to assess food company policies and commitments related to obesity prevention and population nutrition at the national level. Obes Rev. 2019;20(S2):78–89.\u003c/li\u003e\n \u003cli\u003eWeeks WB, Weinstein JN, Lavista JM. All Sustainable Development Goals Support Good Health and Well-Being. Int J Public Health. 2023;68:1606901. doi:10.3389/ijph.2023.1606901\u003c/li\u003e\n \u003cli\u003eUnited Nations. Sustainable Development Goal 2: Zero Hunger. [cited 2025 Mar 25]. Available from: https://sdgs.un.org/goals/goal2\u003c/li\u003e\n \u003cli\u003eVan Dam I, Reimes N, Vandevijvere S. Benchmarking the nutrition-related commitments and practices of major Belgian food companies. Int J Behav Nutr Phys Act. 2022;19:43. doi:10.1186/s12966-022-01269-1\u003c/li\u003e\n \u003cli\u003eSacks G, Robinson E, Cameron AJ, Vanderlee L, Vandevijvere S, Swinburn B. Benchmarking the nutrition-related policies and commitments of major food companies in Australia, 2018. Int J Environ Res Public Health. 2020;17(17):6118.\u003c/li\u003e\n \u003cli\u003eKasture A, Vandevijvere S, Robinson E, Sacks G, Swinburn B. Benchmarking the commitments related to population nutrition and obesity prevention of major food companies in New Zealand. Int J Public Health.2019;64(8):1147–57\u003c/li\u003e\n \u003cli\u003eSacks G, Chan J, Mann D, et al. Benchmarking the healthiness, equity and environmental sustainability of university food environments in Australia, 2021/22. BMC Nutr. 2025;11:38. doi:10.1186/s40795-025-01029-x\u003c/li\u003e\n \u003cli\u003eGaucher-Holm A, Chan J, Sacks G, et al. Food and beverage manufacturing and retailing company policies and commitments to improve the healthfulness of Canadian food environments. BMC Public Health. 2024;24:2419. doi:10.1186/s12889-024-19864-1\u003c/li\u003e\n \u003cli\u003eNutri-Score Europe. [cited 2025 Mar 25]. Available from: https://nutriscore-europe.com/\u003c/li\u003e\n \u003cli\u003eMonteiro CA, Cannon G, Levy R, Moubarac J-C, Jaime P, Martins AP, et al. NOVA. The star shines bright. World Nutr. 2016;7(1–3):28–38.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. WHO Regional Office for Europe nutrient profile model. Copenhagen: WHO Regional Office for Europe; 2015. Available from: https://www.who.int/publications/i/item/9789289000152\u003c/li\u003e\n \u003cli\u003eVandevijvere S, Van Dam I, Inaç Y, Smets V. Unhealthy food availability, prominence and promotion in a representative sample of supermarkets in Flanders (Belgium): a detailed assessment. Arch Public Health. 2023;81(1):154. doi:10.1186/s13690-023-01175-3\u003c/li\u003e\n \u003cli\u003eLocatus. Locatus Data: Retail proximity and outlet distribution. Locatus; 2022. Available from: https://www.locatus.com\u003c/li\u003e\n \u003cli\u003eNg S, Sacks G, Kelly B, Yeatman H, Robinson E, Swinburn B, et al. Benchmarking the transparency, comprehensiveness and specificity of population nutrition commitments of major food companies in Malaysia. Glob Health. 2020;16:1–19.\u003c/li\u003e\n \u003cli\u003eSteele MM, Hussey S, Vandevijvere S, Jani A, Harrington JM. Food companies’ commitments on population nutrition, health and sustainability in Ireland. Cork: FEAST–University College Cork; 2024. Available from: https://feast2030.eu/sites/default/files/feast/resources_files/2024/FEAST_WP3_Report_Food-companies-commitments-on-population-nutrition-health-and-sustainability-in-Ireland_R_20241216.pdf \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Business impact assessment, BIA-Obesity, INFORMAS, food industry, nutrition policy, product reformulation, marketing to children, front-of-pack labelling, food environment","lastPublishedDoi":"10.21203/rs.3.rs-6514148/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6514148/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eMonitoring commitments and practices by food industry actors is essential for increasing accountability. The aim of this study was to evaluate and benchmark the transparency, specificity, and comprehensiveness of nutrition-related commitments and associated practices of leading food companies in Belgium, as well as changes over time between 2019 and 2023/2024.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eThe Business Impact Assessment on Obesity and population-level nutrition (BIA-Obesity) was applied to assess commitments related to product formulation, labelling, promotion, accessibility, relationships with other organizations and corporate nutrition strategy among 32 major packaged food and non-alcoholic beverage manufacturers (n\u0026thinsp;=\u0026thinsp;21), supermarkets (n\u0026thinsp;=\u0026thinsp;5), and quick-service restaurants (QSR) (n\u0026thinsp;=\u0026thinsp;6). Publicly available data on commitments were collected and company representatives invited to verify and supplement the information. A standardized scoring framework comprising around 60 indicators was used to assess the commitments. Company product portfolios were evaluated using Nutri-Score, the NOVA classification, and the WHO Europe Nutrient Profile Model. In addition, supermarket shelf-space allocation, and QSR density near schools were assessed. Results were compared to the 2019 BIA-Obesity Belgium to evaluate progress.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eSixty-three percent of companies (20/32) fully participated in the assessment process. Overall commitment scores ranged from 0\u0026ndash;82%, with a median of 40%; supermarkets scored highest (median\u0026thinsp;=\u0026thinsp;51%) and quick-service restaurants (QSRs) lowest (median\u0026thinsp;=\u0026thinsp;15%). Product accessibility remained the weakest domain across sectors. Since 2019, 18 of 25 companies improved their scores, while 3 remained stable and 5 declined. Compared to 2019, all supermarkets increased the proportion of products rated Nutri-Score A or B and reduced those rated D or E. Compared to 2019, all supermarkets increased the proportion of products rated Nutri-Score A or B and reduced those rated D or E, while among packaged food companies, 40% increased A or B products and 60% reduced D or E products. Despite these improvements, ultra-processed foods remained prominent in high-visibility areas, such as supermarket checkouts.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eDespite some slight improvements since 2019, company commitments and practices in Belgium fall short of best practice benchmarks. Voluntary measures are insufficient to ensure meaningful progress. Stronger government regulations are urgently needed to create healthier food environments.\u003c/p\u003e","manuscriptTitle":"Benchmarking the nutrition-related commitments and practices of major Belgian food companies by industry and over time (2019-2023)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-04 12:55:12","doi":"10.21203/rs.3.rs-6514148/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-13T08:12:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-04T11:28:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"257948321267420134079184438942336972007","date":"2025-07-06T11:57:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-26T05:22:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338454874480316921194995321522921730519","date":"2025-06-02T21:22:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-02T17:52:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-28T11:33:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-08T04:36:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-07T14:29:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nutrition","date":"2025-05-07T14:28:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4f86feee-a527-4d70-aba3-cc6d6afb6a8f","owner":[],"postedDate":"June 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T16:02:03+00:00","versionOfRecord":{"articleIdentity":"rs-6514148","link":"https://doi.org/10.1186/s40795-026-01310-7","journal":{"identity":"bmc-nutrition","isVorOnly":false,"title":"BMC Nutrition"},"publishedOn":"2026-04-30 15:57:20","publishedOnDateReadable":"April 30th, 2026"},"versionCreatedAt":"2025-06-04 12:55:12","video":"","vorDoi":"10.1186/s40795-026-01310-7","vorDoiUrl":"https://doi.org/10.1186/s40795-026-01310-7","workflowStages":[]},"version":"v1","identity":"rs-6514148","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6514148","identity":"rs-6514148","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}