Health Without Barriers: Community-Engaged Adaptation of a Whole Family-Inclusive Intensive Health Behavior and Lifestyle Program in Rural Colorado.

The relationship between health professionals and commercial industries has long been a topic of debate and scrutiny, including beyond the scientific community. A growing body of evidence has demonstrated how various industry practices and engagement can shape professional practices, decision-making and public health policy in Australia and globally. This also includes efforts by industry to produce and disseminate favourable research outputs. However, most of this research has occurred in the context of the pharmaceutical industry and their engagement with physicians. More recently, attention has expanded to include the food industry, which similarly has strong commercial interests in shaping dietary behaviours and public perceptions of food and nutrition. In this context, foods and drinks harmful to health, such as ultraprocessed foods, and the political tactics used by this industry to promote them have become a major focus of public and academic debate. Despite this increasing awareness and the importance of good nutrition for public health, limited empirical research exists on the extent and nature of industry interactions with nutrition professionals (hereafter NP), particularly in the Australian context. Existing research has largely focused on the food industry’s role in nutrition policy development, demonstrating influence on key policymaking decisions through access to decisionmakers; however, there has been limited attention to its influence on nutrition professionals. Australia’s food system is highly industrialised with food manufacturing representing the nation’s largest manufacturing sector. Nationally representative data indicate that ultraprocessed foods account for 42 % of total energy intake, contributing to a variety of detrimental public health outcomes. Given the strong presence of food industry actors in Australia, many of the issues identified in physicians’ engagement with the pharmaceutical industry, such as biased prescribing behaviour or consultation, may also apply to other health professionals and their interaction with the food industry – yet this remains an important gap in the academic literature. Dietitians, nutritionists and other health professionals who provide dietary advice play a central role in supporting public health agendas. In Australia, dietitians are regulated professionals with protected titles requiring accredited university training and ongoing professional development, whereas nutritionists operate under an unregulated title with variable qualifications and no mandatory credentialing body. The national dietetics workforce has expanded sevenfold over the past three decades, underscoring their growing importance as a credible source of nutrition information. NP are also potential intermediaries between the food industry and the public, and their credibility can lend weight to nutritional or food recommendations. Hence, the food industry is likely to have a vested interest in cultivating and leveraging these relationships, to increase public trust in and ultimately consumption of their products. Hamel
identify a range of active and passive interactions between NP and industry. Active interactions describe practices where both professionals and industry contribute to the relationship. This includes receiving compensation for endorsing industry products to clients or the broader public or being employed by industry directly or for consultation services. Passive interactions do not involve direct engagement by NP, instead, they entail receiving targeted communication or gifts, samples and educational material from the industry. The limited research on this issue indicates that NP have mixed opinions about interactions with the food industry. While they recognise potential benefits, such as career opportunities and the possibility of improving food quality, they are also aware of the risks to their professional independence. Previous research has shown that important avenues of influence for industry are educational events facilitated through professional bodies. In Australia, several professional bodies and networks represent or support NP (see Table ). They differ in their scope, eligibility requirements for membership and the benefits they provide; this ranges from managing the accreditation needed to access government payments for services to providing professional development. Hence, the relationships between industry, professional bodies and networks and NP are important to examine. Similar to attending industry-sponsored educational events, receiving industry gifts has been connected to influencing prescribing behaviour by health professionals in other fields, irrespective of the economic value of the gift.