ObjectiveTo evaluate the implementation of the Uruguayan healthy snacking initiative in primary and secondary schools in the capital, and to explore the factors underlying compliance from the perspective of school principals.DesignA mixed-method approach was used, which included semi-structured interviews with school principals and a survey of the foods and beverages sold and advertised in the schools.SettingPrimary and secondary schools in Montevideo (the capital city of Uruguay).ParticipantsSchool principals.ResultsThe great majority of the schools did not comply with the initiative. Exhibition of non-recommended products was the main cause for non-compliance, followed by advertising of non-recommended products through promotional activities of food and beverage companies. Although school principals were aware of the healthy snack initiative and showed a positive attitude towards it, the majority lacked knowledge about its specific content. Factors underlying compliance with the healthy snacking initiative were related to its characteristics, characteristics of the schools, and external factors such as family habits and advertising.ConclusionsResults showed that the rationale underlying the selling of products at schools favours the availability of ultra-processed products and constitutes the main barrier for the promotion of healthy dietary habits among children and adolescents. Strategies aimed at facilitating the identification of unhealthy foods and beverages and provision of incentives to canteen managers to modify their offer are recommended.

Interventions aimed at changing dietary patterns should be designed based on the main motives underlying the food choices of specific target populations. The aim of the present study was to identify motives underlying food choice and barriers to healthy eating among consumers in two socioeconomic levels in Uruguay. Eleven focus groups were carried out with a total of 76 participants. Six of the groups involved low income participants and the others were conducted with middle income participants. Discussions were held around frequently consumed products, motives underlying food choices and barriers to healthy eating. Results confirmed the strong influence of income level on motives underlying food choice and barriers to the adoption of healthy eating. Low income participants described their choices as mainly driven by economic factors and satiety, whereas convenience was the main determinant of food selection for middle income participants. Implications for the design of public policies targeted at each group are discussed.

Objective: To analyze the content of the marketing of commercial foods for infants and young children on packages and social media. Design: Commercial foods targeted at children, regarded as potential breast-milk-substitutes according to the Uruguayan breastfeeding standard, were considered: dairy products; teas, juices and bottled waters; glucose solutions; cereals and mixtures of fruits and vegetables. All the products sold at forty-four retail outlets were purchased. A Facebook search was performed to identify accounts of these products. For each account, all the content posted by the brands between July 2017 and July 2019 was recorded. The visual and textual information included in the packages and Facebook posts was analyzed using content analysis. Products were classified using the nutrient profile model of the Pan American Health Organization. Setting: Montevideo, Uruguay. Results: Seventy-six unique commercial foods targeted at infants and young children were identified, 96% of which were excessive in sugar. Packages frequently included textual and visual elements to convey health-related associations, including images of fruits and vegetables, nutrient content claims, and endorsement logos. Ten Facebook accounts were identified, which generated 302 posts. Parents and caregivers were the main target audience of the posts, which mainly included content related to fun and social aspects of food consumption. Additionally, the posts frequently conveyed the idea that products would contribute to children’s growth and development. Conclusions: Results suggest the need to implement comprehensive regulations on the marketing of commercial foods targeted at children, regarded as potential breast-milk-substitutes according to the Uruguayan breastfeeding standard.

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Objective: The information displayed on the packages of feeding bottles and teats commercialized in Montevideo (Uruguay) was analyzed using content analysis with the goal of identifying key marketing practices that may discourage breastfeeding. Design: The study was conducted as part of the periodic assessment performed by the Uruguayan government to monitor the marketing of breast-milk substitutes. All the feeding bottles and teats sold in 44 retail outlets selling breast-milk substitutes were purchased. The information available on the packages was analyzed using content analysis and descriptive statistics. Setting: Montevideo, Uruguay. Results: A total of 197 feeding bottles and 71 teats were found. The majority of the packages included information to enable caregivers to adequately use the products, including recommended age, instructions on how to use the products and instructions on the use of hygienic practices. However, the packages frequently included information that implied that bottle-feeding was equivalent to breastfeeding, particularly from a physiological perspective, or that idealized product use. Idealizations included ability to reduce colic, improvements in the feeding experience and improvements in children’s health, wellbeing and development. Statements on the superiority of breastfeeding were infrequent. Conclusions: Results from the present work showed the high prevalence of marketing practices on the packages of feeding bottles and teats that may discourage breastfeeding. Stricter and more detailed regulations seem necessary to enable caregivers to make informed feeding decisions for infants.