Learning from Latin America: toward stronger regulation of unhealthy food marketing

Abstract

Childhood obesity in Latin America and the Caribbean continues to rise, driven in part by increased access to ultraprocessed products and pervasive unhealthy food marketing. For more than two decades, the World Health Organization has called on governments to regulate such practices. While prior research has focused largely on policy design and adoption, less attention has been given to implementation, monitoring, and evaluation, critical stages of the policy cycle. This study addresses this gap by examining experiences in Argentina, Chile, Ecuador, Peru, and Uruguay. We report findings from the qualitative component of a mixed-methods study based on a descriptive qualitative design. Data were generated through semistructured interviews with 22 key informants from diverse institutional sectors and analyzed using qualitative content analysis. Across all cases, implementation processes were shaped by sustained industry interference and, in some cases, political instability and broader systemic disruptions. Informants highlighted that countries’ capacity to withstand these pressures depended on two interrelated domains: governance arrangements and institutional capacity. Overall, the effectiveness and sustainability of unhealthy food marketing regulations depend on strong health governance, adequate institutional capacity, comprehensive regulatory frameworks, and exposure-based monitoring approaches that reduce regulatory ambiguity and strengthen child protection.

Contribution to Health Promotion.

• Effective protection of children from unhealthy food marketing requires a technically robust Ministry of Health, free from conflict of interest, to lead policy implementation and monitoring.

• Regulations targeting children through specific media, techniques, or age groups are complex and costly to monitor, particularly due to rapid industry adaptation.

• Robust monitoring systems are essential to refine regulatory frameworks and to ensure effectiveness in protecting children.

• Exposure-based approaches (e.g. banning all food marketing during predefined time slots across channels) simplify enforcement by reducing chidren's exposure over extended periods.

Introduction

Over the past decades, obesity rates have rapidly risen in low- and middle-income countries, particularly among children in many Latin America and the Caribbean (LAC) countries (Ferreira et al. 2024). In this region, the number of children living with obesity has increased significantly (Molina et al. 2022) driven by multiple interacting factors, including the “nutritional transition from a traditional diet to a westernized one” (Ferreira et al. 2024). This transition has been accompanied by increased pervasive marketing practices that stimulate desire, shape preferences, and induce their consumption (Chemas-Velez et al. 2020, Finlay et al. 2022, World Health Organization 2022).

Since 2004, international organizations, such as the World Health Organization (WHO), have called on governments to protect children from unhealthy food marketing (UFM) (World Health Organization 2004), particularly marketing for ultraprocessed products (UPPs) that are energy dense, nutrient poor, and high in sugar, sodium, and fats (Monteiro et al. 2019). UFM is increasingly recognized as a key commercial determinant of health, contributing to unhealthy dietary patterns and adverse health outcomes across the life course (Kickbusch et al. 2016, Fanzo et al. 2021, Gilmore et al. 2023). In response, WHO and other international bodies have issued technical guidance to support countries in the design, implementation, and monitoring of marketing regulations (World Health Organization 2012, 2021, 2023a, 2023b).

Evidence suggests that mandatory marketing regulations can reduce children’s exposure to UFM and, in some contexts, influence purchasing and consumption patterns, particularly when regulations are comprehensive, exposure based, and supported by effective monitoring systems (Alfraidi et al. 2023).

In LAC, eight countries have adopted some form of mandatory marketing regulation. However, these regulatory frameworks vary widely in scope and strength, including differences in the age group protected; the media, channel, and persuasive techniques regulated; the nutritional criteria applied; and the severity of sanctions (Théodore et al. 2025).

While a growing body of literature has examined the political, legal, and economic factors shaping the design and adoption of UFM regulations (Fisher et al. 2021, Sing et al. 2023, UNICEF. Nutrition and Child Development Section 2023, Sing et al. 2025), considerably less attention has been paid to how these regulations are implemented, monitored, and evaluated in practices. These stages of the policy cycle (Knill and Tosun 2008) are critical for assessing compliance, identifying industry adaptation strategies, and refining regulatory frameworks over time (Peters et al. 2013, Taillie et al. 2019). Monitoring and evaluation are particularly challenging in the context of contemporary marketing ecosystems, where digital platforms and rapidly evolving persuasive strategies complicate surveillance and enforcement (Tatlow-Golden et al. 2021, Boyland et al. 2024).

Chile stands out in the region as an early adopter of a comprehensive regulatory package, and broad restrictions on UFM, including time-based bans on television advertising (Popkin et al. 2021). Its experience has been extensively documented over the years (Rodríguez-Osiac et al. 2018, Correa et al. 2019, Corvalán et al. 2019, Carpentier et al. 2020, Correa et al. 2020, Villalobos Dintrans et al. 2020, Jensen et al. 2021, Smith Taillie et al. 2021, Sing et al. 2022, Acosta-Concha-Fernández et al. 2023, Mediano et al. 2023, Rebolledo et al. 2023, Sing et al. 2025). By contrast, there is limited empirical literature documenting how other countries have navigated the practical challenges of implementing, monitoring, and evaluating UFM regulations.

To address this gap, drawing on qualitative data from key informants, this article examines the experiences of five countries in implementing, monitoring, and evaluating mandatory marketing regulations to protect children and adolescents from UFM.

Materials and methods

Study context and overall methodology

This study was conducted in collaboration with the United Nations Children’s Fund (UNICEF; Nutrition and Child Development Section, Mexico), as part of a broader mixed-methods initiative aimed at understanding how UFM regulations are implemented, monitored, and evaluated and generating evidence-based recommendations to strengthen regulations protecting children and adolescents from UFM. The overall research methodology has been described in detail elsewhere (Théodore et al. 2025). Briefly, the mixed-methods comprised (i) a literature review (Van De Goor et al. 2017), (ii) online surveys, (iii) country selection based on regulatory standards, and (iv) in-depth interviews, which constitute the focus of the present article.

Eight countries with mandatory UFM regulation were initially considered. Five countries (Argentina, Chile, Ecuador, Peru, and Uruguay) were ultimately selected based on financial and time constraints, as well as the relative strength of their regulatory frameworks for food marketing. Mexico, Panama, and Costa Rica were also excluded from the study. Mexico was not included because the objective was to draw on the experiences of other countries, whereas Panama and Costa Rica were excluded due to the incipient stage of their regulatory frameworks.

Setting

The selected countries differ substantially in the ambition, scope, and enforcement of their regulatory approaches to UFM (see Supplementary Appendix A).

Chile and Argentina represent the most comprehensive regulatory frameworks. Chile implemented an integrated regulatory package in 2016 combining school food policies, front-of-package warning labels, and broad restrictions on UFM. Marketing of foods exceeding nutritional thresholds is prohibited on television between 6:00 a.m. and 10:00 p.m., regardless of audience composition. Argentina has progressively aligned with this approach, extending protection to children and adolescents under 18 years of age and regulating multiple marketing channels, including social media, through consumer protection and fair-trade legislation.

In contrast, Ecuador and Peru have embedded UFM provisions within the Food Sovereignty Law (2011) and the Law for the Promotion of Healthy Eating for Children (2017), respectively, resulting in more limited protection. In both countries, regulations focus on warning labels and school environments, and Ecuador does not comprehensively restrict persuasive marketing techniques or marketing across media platforms. Such techniques, including premium offers, promotional characters (both brand equity and licensed characters), and celebrity endorsers, are designed to appeal to children’s emotions or perceived credibility (Boyland et al. 2012). In Peru, celebrity endorsements are prohibited on processed food labels, and food promotion is banned in school bars.

Uruguay represents the weakest regulatory context. Although the General Media Law approved in 2015 included provisions to regulate UFM directed at children, these articles were never implemented due to constitutional challenges following a change in government, leaving school-based restrictions as the primary operative measure.

Qualitative research design

This article reports on the qualitative component of a mixed-methods study, drawing on key informants’ perspectives to examine how mandatory regulatory frameworks aimed at protecting children and adolescents from UFM are implemented, monitored, and evaluated in the region. Specifically, the study explored how these processes unfold in practice and identified the conditions that, according to informants, enable or constrain implementation and operation across the selected countries?

A descriptive qualitative approach was employed, as defined by Creswell and Creswell (2023), focusing on generating a comprehensive, data-driven description of participant’s accounts and organizing these into analytically meaningful thematic categories. This approach was selected to capture how regulatory frameworks are understood and enacted in practice within complex institutional and political and governance contexts, without exposing explanatory or theory-driven interpretations at the analytic stage.

The methodology of this study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (Tong et al. 2007).

Participants and sampling

Semistructured interviews were conducted with 22 key informants from government agencies, civil society organizations (CSOs), academia, and international agencies, including the Pan American Health Organization (PAHO/WHO). A purposive sampling strategy was used to ensure representation from diverse institutional perspectives involved in, or closely observing, the design, implementation, monitoring, and evaluation of UFM regulations. Eligible participants included individuals with direct (“doers”) or indirect (“observers”) involvement, particularly on the latter three stages. Recruitment was conducted through academic networks, an online survey, and snowball sampling (Flick 2022), whereby initial informants referred to additional informants with relevant experience across institutional sectors and countries.

Individuals with current or past ties to the agrifood industry were excluded due to well- documented concerns regarding industry interference and conflicts of interest in public health policymaking (Gomes 2015, Gómez 2019, Mialon 2020, Ojeda et al. 2020, Van Tulleken 2025). This exclusion criterion aligns with WHO guidance and principles established under the Framework Convention on Tobacco Control (World Health Organization 2003) and was deemed essential to protect the integrity of the evidence.

Data generation

Data were generated through semistructured, in-depth interviews, guided by an interview protocol designed to explore policymaking processes related to the regulation of marketing directed at children and adolescents. The interview guide comprised three main modules (see Supplementary Appendix B): (i) policy design, used as the entry point to the subject, (ii) implementation and monitoring, and (iii) evaluation. Each module included questions addressing mechanisms, resources, perceived facilitators and barriers, challenges, and lessons learned, as well as selected indicators for assessing implementation. The interview guide was piloted and refined prior to data collection.

Interviews were conducted in Spanish between January and April 2023 via Zoom or WhatsApp, depending on participant availability and connectivity. Interviews lasted between 48 and 94 minutes and were conducted by two trained researchers (A.C.A.-G. and F.L.T.). All interviews were audiorecorded and manually transcribed verbatim.

Data analysis

Data analysis followed a descriptive qualitative analytic approach, aimed at systematically organizing and summarizing participants’ accounts rather than generating explanatory theory.

Three researchers participated in the analysis: one expert in qualitative methods (F.L.T.) and two public health experts (A.C.A.-G. and R.D.). Transcripts were read in full and segmented into meaningful units. Coding was primarily inductive and data driven, allowing categories and subcategories to emerge from participants’ narratives rather than being imposed a priori (see Supplementary Appendix C). Each coder was assigned to one or two countries, and all coding was systematically reviewed by the expert in qualitative methods to ensure consistency and analytical rigor. For each interview, a structured summary sheet was prepared to capture key points relevant to implementation, monitoring, evaluation, governance arrangements, institutional capacity, and industry interference. These summaries supported cross-interview and cross-country synthesis. Data were organized in analytic matrices using Microsoft Excel to facilitate comparison across informants, sectors, and countries.

Analysis proceeded interactively, with comparisons conducted within countries, across sectors, and across countries. This process supported the identification of recurrent patterns and contextual differences shaping the implementation, monitoring, and evaluation of UFM regulations.

Regular analytic meetings were held to refine the coding structure, ensure analytic consistency, and strengthen interpretive coherence. To enhance credibility and trustworthiness (FitzPatrick 2019), preliminary findings were shared with a subset of country-level participants for feedback and validation.

Ethical considerations

All procedures conducted in this study were approved by the Institutional Review Board (IRB) of the National Institute of Public Health of Mexico on 24 October 2022 (CI: 1824) and were carried out in full compliance with ethical standards. Prior to participation, all participants provided signed informed consent via email. To protect informants’ anonymity and confidentiality, their names were replaced with identification codes in both the audio files and the transcripts. These materials were accessible exclusively to the qualitative research team and were securely stored under password protection on the lead researcher’s computer.

Following a brief description of the informants and country-specific practices related to implementation, monitoring, sanctioning, and evaluation, the Results section synthesizes cross-context challenges and highlights two cross-cutting factors identified by informants as shaping these processes: governance arrangements and institutional capacity and innovations.

Results

Informant description

Of the 71 individuals invited via email, 22 key informants participated in the interviews, representing Argentina (n = 4), Chile (n = 6), Ecuador (n = 3), Peru (n = 4), and Uruguay (n = 5). Identifying informants was particularly challenging in Ecuador. In two cases, individuals who had initially agreed to participate later withdrew: one due to “regulatory/institutional issues” in Argentina and the other because of political crises during the period of virtual fieldwork in Peru.

Only the Argentina sample included informants from all sectors (Table 1). In Chile, the informants were experienced professionals from government and academia with extensive expertise in UFM regulation. Our sample in Chile did not include representatives from CSOs, likely reflecting their limited participation across the UFM policy cycle. In contrast, CSOs played a predominant role in Ecuador and Peru, serving as a counterbalance to authorities, with some members in Peru also holding positions in the Ministry of Health and Congress. Informants’ years of experience working on the protection of children from marketing and mandatory marketing regulation varied from 3 to 37 years, with a median of 10 years.

Table 1.

Main characteristics of the informants interviewed.

Country	Interview number	Sector(s) in which the informant works or has worked	Years of experience in the field	Public policy involvement stage
Argentina	Int.1	CSOa	5	Implementation and external evaluation
Argentina	Int.2	International agency	7	Advocacy
Argentina	Int.3	Academy; international agency; CSO	10	Advocacy, design, and implementation
Argentina	Int.4	Government	6	Design
Chile	Int.5	Academyb; governmentb	10	Design and evaluation
Chile	Int.6	Academyb; governmentb	17	Design, implementation, monitoring, and design of law and government regulations
Chile	Int.7	Government (Ministry of Health)b	11	Design, evaluation, and implementation
Chile	Int.8	International agency; government	15	Design, implementation, monitoring, and evaluation
Chile	Int.9	Academyb	12	Evaluation
Chile	Int.10	Academyb; government (Ministry of Health)b	15	Design, monitoring, and evaluation
Ecuador	Int.11	CSOs	12	Advocacy, design, and external monitoring
Ecuador	Int.12	Academy; CSO	13	External monitoring
Ecuador	Int.13	CSO	6	Design, advocacy, implementation, and monitoring
Peru	Int.14	CSOb; Congressb	37	Design, implementation, and evaluation
Peru	Int.15	Governmentb (Ministry of Consumer Protection)	10	Implementation and monitoring
Peru	Int.16	Government (Ministry of Health)a; CSOb	7	Advocacy, design, and implementation
Peru	Int. 17	CSO (Ministry of Health)b; Congressb; governmentb	5	Advocacy, implementation, and monitoring
Uruguay	Int.18	Government (Ministry of Health)b	6	Implementation, monitoring, and evaluation
Uruguay	Int. 19	Academy	17	Research on exposure and power of marketing
Uruguay	Int. 20	Government (Ministry of Health)	10	Advocacy, design, and implementation
Uruguay	Int.21	CSO	3	Advocacy, design, and implementation
Uruguay	Int.22	Government (Ministry of Social Development—National Institute of Alimentation)	5	Advocacy

^aCSO, civil society organizations.

^bSector affiliation when involved in the design, implementation, or monitoring and evaluation of public policy related to marketing.

Monitoring, sanctioning, and evaluation practices across countries

At the time of the interviews, informants reported that state-led monitoring of UFM was in place only in Chile and Peru, with varying degrees of institutionalization. In Chile, the age of protection was set at 14 years, reflecting the limited evidence available at the time and precedents from tobacco regulation, despite technical challenges in defining child-directed marketing. As one informant explained, the cutoff followed extensive debate informed by earlier regulatory experience with tobacco regulation. However, the informant noted that “all advertising shifted toward those over 14” and noted that subsequent studies show such marketing also influences the behavior of children and adolescents. Considering emerging evidence, the informant added that the WHO now recommends extending recommended protection up to 18 years (int.6).

In Peru, informants described the existence of a formal monitoring system, with enforcement often triggered by complaints-based rather than systematic surveillance. Although sanctions had been applied in some cases, informants reported that authorities were unable to provide precise evidence of the extent of noncompliance by the food industry or the range of violations identified [“we do not have that type of information” (int.15)].

In contrast, Argentina was described as being in an early implementation phase, in which monitoring and sanctioning mechanisms were largely absent at the time of data collection. As one CSO informant summarized: “there is no state monitoring; the issue of imposing sanctions is still not effective” (int.3).

In Uruguay, monitoring, particularly within school settings, was disrupted during the Coronavirus disease 2019 (COVID-19) pandemic, and informants described current efforts as still incipient . The creation of a monitoring and evaluation unit within the ministry of public health was viewed as a positive step; however, informants emphasized that implementation remained weak and slow: “we are still very timid on this issue” (int.20).

Finally, in Ecuador and Peru, CSOs partially compensated for weak state-led monitoring. Respondents highlighted the role of citizen oversight and academic institutions, in identifying violations, including through “monitoring of packaged food products to assess compliance with advertising warning requirements” (int.17). At the same time, they pointed to the absence of government-led monitoring systems in some contexts, such as in Ecuador: “if you go to the Ministry of Health’s website, there is no monitoring of marketing” (int.12).

Only in Chile did informants report the existence of studies examining population-level effects and impacts of UFM regulations, in conjunction with broader measures to improve the food environment. According to informants, academic studies conducted by universities in Chile and internationally have documented reductions in exposure to marketing, particularly among children (int.5) following the implementation of UFM regulations, in conjunction with other regulations.

Although Peruvian law provides for the establishment of a Nutrition, Overweight, and Obesity Observatory, none of the informants reported the conduct of evaluations or monitoring activities through this structure.

Common challenges: industry interference and political changes

Regardless of the level of protection established in the national regulatory framework, all countries face at least two common challenges. The first was sustained interference from the agrifood industry throughout the policy cycle, including the implementation and monitoring phase. The Argentine example is illustrative, with industry actors requesting repeated extensions during the 2022 FIFA World Cup in Qatar, thereby interfering with the implementation process. In Ecuador, by contrast, the lack of monitoring was described as noncoincidental and linked to industry influence: “I think there is, I mean, it’s not a coincidence. I think it’s part of the lobbying that the industry does […] to prevent these kinds of monitoring activities” (int.11).

The second challenge relates to political changes and policy discontinuity. Shifts in government were described as weakening efforts across the policy cycle, particularly in politically polarized contexts. A Uruguayan informant explained that when administrations change, policies are often perceived as “not mine, it belonged to another administration” (int.19), leading to the reassessment or stagnation of regulations aimed at protecting children and adolescents from UFM. In Argentina, the change of government was perceived as delaying implementation and weakening the policy, as the new administration would encounter “only partial implementation—some products covered and others not.” According to the informant, this incomplete rollout “makes it easier to roll the law back,” whereas full implementation prior to the political transition “would have been easier to sustain” (int. 2).

Overall, countries varied in their capacity to resist food industry’s pressure and manage conflicts of interest, as well as in their ability to sustain policy progress over time. These differences were reflected in governance arrangements, institutional capacity, and innovations identified across countries.

Key enabling and constraining conditions shaping the implementation, monitoring, and evaluation of UFM regulations across Latin America, as derived from interviews with informants in the five countries, are summarized in Table 2.

Table 2.

Key enabling and constraining conditions shaping the implementation, monitoring, and evaluation of UFM regulations across Latin America.

País	Legal framework and general considerations	Implementation	Monitoring, sanctioning and evaluation	Enabling conditions according to informants	Constraining conditions according to informants
Argentina	Comprehensive UFM regulation embedded in the Healthy Eating Promotion Law, covering traditional and digital media (including influencers), packaging, schools and public spaces. Protection applies to children and adolescents under 18	Gradual implementation with repeated extensions. Industry interference and limited interinstitutional coordination reported	No formal monitoring system at the time of fieldwork; complex and fragmented sanctioning responsibilities	Comprehensive legal framework covering multiple media, persuasive techniques, packaging, schools, and public spaces, with protection extended to children and adolescents under 18 Early technical clarity of the regulation, perceived by informants as internally coherent and well aligned with labeling and school food measures Engagement of CSOs, academia, and international agencies in advocacy, design, and external evaluation, contributing to technical grounding	Repeated implementation extensions granted to industry, particularly during the early phase, generating regulatory ambiguity and undermining enforcement capacity Lack of transparency regarding exemptions, with authorities declining to disclose which companies or products benefited from extensions Fragmented governance and federal structure, with monitoring and enforcement responsibilities dispersed across national and subnational jurisdictions, leading to uneven application Absence of a formal, centralized monitoring system at the time of fieldwork, limiting the operationalization of sanctions
Chile	Strong statutory framework integrating labeling, marketing restrictions, and school food policies. Time-based ban on TV and cinema advertising (06:00–22:00). Protection applies to children under 14	Widely described as successful and progressive, supported by strong political commitment, clear timelines, and local execution	Highly structured monitoring system combining trained inspectors, AI-based surveillance and external evaluations Academic studies document reduced marketing exposure, particularly among children (Chile and international evidence)	Strong and integrated statutory framework, combining labeling, marketing restrictions, and school food policies, with clear timelines and binding mandates. Centralized governance within the Ministry of Health, supported by an established nationwide network of regional health authorities (SEREMI) High institutional capacity for monitoring and enforcement, including trained inspectors, standardized enforcement criteria, and peer-review mechanisms for interpretive decisions Innovative monitoring infrastructure, combining AI-based surveillance with manual field monitoring across multiple media Sustained academic evaluation, documenting reductions in children’s exposure to UFM and supporting policy credibility Initial industry training and communication, facilitating compliance during early implementation	High financial and human resource demands of continuous, multichannel monitoring systems Adaptive industry strategies, requiring ongoing regulatory refinement and monitoring updates Protection limited to children under 14 years of age. Falling short of WHO recommendation to extend protection up 10–18 years
Ecuador	Weak regulatory framework limited to misleading marketing and school environments, with partial packaging restrictions	Implementation is largely driven by CSOs, with minimal state enforcement	No formal state monitoring system; external monitoring conducted by CSOs	Existence of a legal basis within the Food Sovereignty Law, including specific prohibitions on misleading marketing and restrictions in school environments Active civil society and academic involvement, partially compensating for weak state monitoring through external oversight and evidence generation Availability of international technical guidance, recognized by informants as a potential support for stronger implementation	Weak and fragmented regulatory design, with UFM provisions embedded in broader legislation not primarily intended for marketing regulation Absence of government-led, systematic monitoring, including no continuous surveillance of marketing exposure Institutional capacity constraints, including chronic understaffing, lack of dedicated funding, and limited decision-making authority within the Ministry of Health Low political prioritization, identified as a central barrier to implementation and enforcement
Peru	Limited regulation focused on packaging (ban on characters) and advertising truthfulness; no comprehensive media bans	Formal implementation through industry communication and training; reported compliance, though loopholes persist	Monitoring led by Indecopi, mainly complaint-based, with no systematic governmental impact evaluation. No evaluations or monitoring activities reported through the Nutrition, Overweight, and Obesity Observatory, despite its legal mandate	Formal legal mandate under the Healthy Eating Law, providing predictability and legal authority Defined role for Indecopi, which conducts monitoring and applies sanctions under its consumer protection mandate Preimplementation industry communication, including information sessions and formal letters outlining compliance requirements and sanctions Civil society and academic monitoring, identifying violations and supporting enforcement through complaints	Narrow scope of regulation, largely confined to packaging, advertising truthfulness, and school settings, with limited coverage of media channels and persuasive techniques and ensuring the truthfulness Predominantly complaint-based monitoring, rather than proactive or systematic surveillance Limited institutional resources, with enforcement constrained by insufficient budget and staffing, particularly post-COVID Nonoperational evaluation structures, notably the Nutrition, Overweight, and Obesity Observatory, despite its legal mandate
Uruguay	Very limited regulation mainly confined to schools. Broader marketing provisions stalled due to constitutional challenges	Low compliance and weak implementation due to technical complexity, poor dissemination, and lack of sanctions	Sporadic monitoring prior to the pandemic; no sanctions applied; only small-scale external evaluations	Recognized technical capacity within the Ministry of Health, with informants emphasizing strong expertise at the technical level Emerging institutional initiatives, including plans to establish a regulatory enforcement unit Academic and CSO engagement, contributing to limited monitoring and external evaluation	Extremely limited regulatory scope, with effective protection confined almost exclusively to school settings Nonimplementation of broader marketing provisions, stalled by constitutional challenges and political change Absence of clear sanctions and enforcement authority, particularly where enforcement would require one state institution to sanction another Irregular and interrupted school-based monitoring, exacerbated by the COVID-19 pandemic Weak political commitment, repeatedly identified as the primary barrier to effective implementation

Governance arrangements

In this study, governance arrangements refer to how formal authority and responsibilities for UFM regulation are distributed, coordinated, and exercised across institutions and levels of government, as described by informants.

The involvement of the Ministry of Health varied across countries according to governance structures and institutional responsibilities related to food regulation and monitoring, as reported by informants across institutional sectors. In Chile, all activities related to the implementation and monitoring of UFM regulations are managed by a single agency within the Ministry of Health, which has “set clear deadlines” (int.3). This unitary governance structure, together with the pre-existing network of Regional Ministerial Secretariats (SEREMI), was described as facilitating nationwide implementation, monitoring, and enforcement. Responsibility for UFM monitoring was incorporated into the Ministry’s existing mandate for food safety and sanitary regulation, becoming “one additional task” and overseeing compliance across the country (int.6). Together, this governance and enforcement architecture was perceived by informants as providing Chile with a comparatively strong foundation for sustaining UFM regulation over time.

In contrast, in Argentina, Peru, Uruguay, and Ecuador, responsibilities for the implementation and/or monitoring of UFM regulations are dispersed across multiple departments within the Ministry of Health, often combined with the involvement of and/or other ministries, such as the Ministry of Education, telecommunication authorities, and/or school systems (Peru, Uruguay, and Ecuador) and, in federal contexts, with substantial subnational autonomy (Argentina).

In Argentina, informants highlighted coordination and communication gaps within the Ministry of Health, which were perceived to hinder effective enforcement. As one informant explained, implementation involved multiple entities, including the National Healthy Eating Program and the National Food Institute under the National Administration of Drugs, Food and Medical Technology (ANMAT, by its Spanish acronym), but “some things were not handled well,” particularly the lack of information on which companies requested implementation extensions and the reasons for those requests (int.3). These challenges were compounded by the country’s decentralized governance structure, which grants substantial autonomy to provincial health authorities, a feature informants identified as complicating coordination and enforcement. As a result, monitoring of advertising and point-of-sale restrictions “depends on each jurisdiction,” leading to uneven enforcement across the country (int.1). Taken together, these governance and coordination constraints may contribute to fragmented monitoring and enforcement of UFM regulations. Beyond administrative fragmentation, informants emphasized that political constraints further shaped how these governance arrangements were exercised in practice. In Uruguay, an informant pointed to a lack of “political will,” particularly when enforcement would require “one state institution… sanctioning another,” such as in school settings (int.20). Taken together, institutional dispersion, subnational autonomy, and perceived political reluctance were described by informants as constraining the consistent implementation, monitoring, and enforcement of UFM regulations. In Peru, informants described a split governance arrangement in which the General Food Law designates the Ministry of Health as the competent authority for implementing marketing regulations, while monitoring of food and beverage marketing is carried out by the consumer protection authority (Indecopi) under its consumer protection mandate. According to one informant, Indecopi is responsible for monitoring marketing and labeling and has identified violations—often through complaints filed by organizations—resulting in sanctions “at first instance” for noncompliance (int.15).

Institutional capacity

Institutional capacity is understood here as the availability and continuity of human, technical, innovative, and financial resources, as well as operational systems, required to implement, monitor, and adapt UFM regulations.

Among the countries studied, only Chilean informants consistently reported the progressive development of an effective regulatory framework to protect children under 14 years of age. This was attributed in part to high levels of industry compliance following implementation, facilitated by an initial phase of education and training targeting both food companies and enforcement personnel nationwide. Central to this approach was the standardization of enforcement criteria, with inspectors trained “to standardize capacities and enforcement rules,” building on long-standing expertise in sanitary food regulation (int.6). This institutional capacity is underpinned by a decentralized but coordinated system of regional health offices, staffed by of “inspectors” who are “experts in these areas” (int.6), ensuring that interpretive decisions, such as whether a cartoon character targets children, were applied consistently, so that “the character either complies or does not comply” (int.6). This process also involved the prior definition and illustration of prohibited UFM practices, particularly regarding creative content and persuasive techniques. Informants emphasized that enforcement required substantial interpretative work, especially given that companies tend to operate “at the edge” of regulatory definitions, where boundaries are inherently difficult to specify (int.9). To address this challenge, a peer-review process for difficult-to-interpret cases was established through collaboration between the central office and regional offices.

Another key innovation was the implementation of nationwide, continuous multichannel monitoring, supported by artificial intelligence (AI). An informant explained that monitoring combined automated systems, where “robots (…) capture advertisement from the media,” with manual procedures for formats that cannot be detected algorithmically, such as large-scale outdoor marketing, which is “captured by humans” through structured fieldwork (int.7). This hybrid approach allowed authorities to track marketing across diverse media environments while also highlighting inherent coverage limits, as “there is no single company that sees everything” (int.7).

According to informants, collectively, these strategies facilitated enforcement by strengthening institutional capacity and enabled the identification of industry strategies seeking “alternative ways to continue advertising and marketing in the face of the ban” (int.5). Over time, recognition of these strategies supported the progressive refinement of monitoring guidelines and the identification of regulatory loopholes, leading to the strengthening of television marketing regulations.

In addition, the office developed a highly reactive monitoring system to respond to the rapidly changing nature of marketing practices. Because marketing “changes constantly,” enforcement must be able to act “quickly” to be effective (int.9). While centralized access to marketing data facilitated timely detection, inspection level enforcement was delayed due to competing demands and limited capacity, meaning that inspectors occasionally arrived after campaigns—typically short lived—had already ended.

Informants also emphasized the high costs and resource demands of such systems, including the need for both AI-based and manual methods, trained personnel, and sustained funding.

In sum, a dedicated office within the Chilean Ministry of Health, supported by its network of regional health offices, was perceived as central to the implementation, monitoring, and adaptation of UFM facilitating the implementation and evaluation of UFM regulations.

In Argentina, informants consistently identified the extensions granted to large companies during the 2022 FIFA World Cup in Qatar, which coincided with the initial phase of implementation, as a major obstacle to monitoring compliance. The absence of publicly available information on which products and companies benefited from these extensions created widespread uncertainty, with one informant noting that authorities refused to disclose “which products were granted extensions and which were not” (int.1). As a result, staff were unable to distinguish between genuinely noncompliant products and those operating under authorized exemptions, thereby undermining enforcement capacity. These challenges were compounded by unclear institutional responsibilities across jurisdictions. Informants emphasized that it remained unresolved “who will be responsible for monitoring compliance across different jurisdictions” (int.3), further weakening implementation in a federal context where subnational authorities play a key role. Taken together, regulatory opacity and fragmented accountability substantially constrained Argentina’s institutional capacity to monitor and enforce UFM regulations during the early implementation period.

In Peru, enforcement was described primarily framed as a legal matter, with an informant from Indecopi emphasizing that companies comply with the regulation mainly because it is legally mandated (int.15). However, as currently designed, the UFM regulatory framework remains limited, as monitoring and sanctioning rely primarily on citizen complaints, complemented by occasional retail outlet inspections conducted by Indecopi to verify labeling, and marketing compliance. Beyond enforcement activities, Indecopi also undertook informational actions aimed at facilitating compliance. Informants reported that the institution conducted information sessions and sent letters to companies ahead of the regulation’s entry into force, specifying implementation dates, and outlining the fines and sanctions associated with noncompliance (int.15). While the same informant noted that Indecopi reported that the institution has made “considerable efforts” to enforce the regulation, these efforts were constrained by limited institutional resources, with enforcement activities described as “suffering from a lack of a strong budget,” a situation the informant linked to broader post-COVID resource constraints affecting public institutions (int.15).

In Uruguay, informants recalled that the media law regulating food marketing was never enforced, meaning that, in practice, children’s protection relies almost exclusively on school-based restrictions. As one informant noted, “regarding marketing, Uruguay has not been able to make adequate progress in addressing the problems we face in this area” (int.22). Several informants emphasized that these limitations should not be attributed to a lack of technical capacity within the Ministry of Health, which was widely regarded as competent and committed. As one informant explained, “at the technical level, the work is very good… what is often lacking is political commitment” (int.19). Focusing specially on schools, an informant identified three main weaknesses in UFM implementation: the absence of a dedicated regulatory enforcement structure, limited legal clarity combined with a lack of sanctions, and insufficient communication regarding what constitutes marketing (int.19). Although monitoring activities were reported, these were described as irregular, and no sanctions were applied to noncompliant schools due to the health authority’s lack of mandate. Informants noted that this situation was expected to change in 2024 with the creation of a regulatory enforcement unit.

In Ecuador, informants described limited institutional capacity to monitor and enforce UFM regulations, driven by shortages of financial, technical, and human resources, alongside weak political prioritization. A CSO informant noted the absence of dedicated funding to support systematic monitoring, emphasizing that there is no “daily and continuous monitoring system” to assess marketing exposure over time, even for television, which would otherwise be relatively easy to monitor (int.13). Capacity constraints were also reflected in chronic understaffing within the Ministry of Health. While informants acknowledged the presence of technically competent and motivated personnel, teams were described as “severely understaffed,” with some staff “left working alone,” and lacking both decision-making power and financial backing (int.22). Informants framed political commitment as a key condition shaping the development and sustainability of institutional capacity for UFM regulation in Ecuador (int.13) as one informant stressed, “if there is no political will, then implementation is unlikely to happen.”

Across all five countries, CSOs were joined by academia and international agencies, which played a critical role in advancing UFM regulation. These actors contributed to the generation and synthesis of evidence on marketing practices (particularly in Peru, Uruguay, and Ecuador) and to the evaluation of changes in children’s exposure to UFM and related purchasing and consumption outcomes, particularly in Chile. International agencies, including PAHO and UNICEF, further supported implementation by fostering regional collaboration and facilitating the exchange of technical and strategic knowledge, a contribution that proved particularly important in the context of a strong and sustained private-sector opposition. As one informant emphasized, progress was enabled by a “regional alliance.” In contexts of limited state capacity, these actors were perceived as partially compensating for institutional gaps rather than replacing formal regulatory authority.

Discussion

Drawing on key informants’ testimonies, this study examined the progress of, and the conditions enabling or constraining, the implementation, monitoring, and evaluation of mandatory regulations to protect children and adolescents from UFM across five countries in Latin America. At the time of the fieldwork, only Chile and Peru had government-led monitoring systems in place, albeit with important differences in scope and institutionalization. In contrast, monitoring activities in Ecuador and Uruguay, and to some extent in Peru, relied largely on CSOs, while Argentina experienced repeated delays in implementation and Uruguay was in the process of developing its monitoring framework.

Overall, the findings suggest that implementation processes across all studied countries were shaped by persistent industry interference and, in some cases, by political instability and systemic disruptions. Informants consistently highlighted the pervasiveness of industry interference and corporate political activity, including during implementation and evaluation processes, particularly in Ecuador and Uruguay. These dynamics reflect patterns well documented in the LAC region (Mialon et al. 2020, Lara-Mejía et al. 2025) and underscore the structural challenges faced by governments seeking to advance UFM regulation. The case of Uruguay illustrates how sustained industry opposition can undermine regulatory efforts even after formal adoption. According to informants, such opposition contributed to the failure of the General Media Law approved in 2015, highlighting the vulnerability of public health regulations to political and commercial resistance. More broadly, political changes at the national level emerged as a critical constraining factor, particularly when government transitions favored proindustry agendas. Through well-documented mechanisms, such as regulatory capture, lobbying, and revolving doors, these shifts limited governments’ regulatory capacity, contributing to delays, compromises, or partial implementation of public health policies. These dynamics are consistent with the literature on corporate influence in health policymaking (Savell et al. 2014, Ulucanlar et al. 2016).

In addition to political and commercial pressures, informants pointed to major systemic disruptions as further constraints on implementation processes. Global crises, such as the COVID-19 pandemic, as well as large-scale international events, including the Qatar FIFA World Cup in the case of Argentina, were described as diverting institutional attention and resources, thereby slowing or interrupting policies that were in the process of implementation or consolidation.

Countries’ capacity to resist these dynamics depended on processes operating within two interrelated domains: governance arrangements and institutional capacity. The main findings reported by informants are synthesized in Table 3.

Table 3.

Enabling and constraining conditions shaping UFM regulation implementation in Latin America, by governance arrangements and institutional capacity.

	Enabling conditions	Constraining conditions
Governance arrangements	Clear allocation of responsibilities Centralized governance structures with clearly defined leadership (Chile: Ministry of Health with SEREMI network) Defined enforcement mandates assigned to specific agencies (Peru: Indecopi, SEREMI network)	Fragmented or unclear governance Dispersed responsibilities across national and subnational levels, leading to uneven enforcement (Argentina) Weak or absent coordination mechanisms across institutions (Argentina, Ecuador, Uruguay, Peru)
	Institutionalized coordination mechanisms Internal coordination within the health sector facilitating consistent implementation (Chile) Early communication and training with regulated actors supporting initial compliance (Chile, Peru)	Limited enforcement authority Absence of clear sanctioning power or institutional reluctance to sanction other state bodies (Uruguay, Ecuador) Nonoperational evaluation or oversight bodies despite formal mandates (Peru)
	Engagement of nonstate actors Active involvement of civil society, academia, and international agencies contributing to advocacy, technical design, and external evaluation (Argentina, Chile, Ecuador, Peru Uruguay)	Political and institutional instability Repeated implementation extensions and exemptions undermining regulatory predictability (Argentina) Political change and constitutional challenges stalling implementation (Uruguay, Argentina)
Institutional capacity	Human resources and technical capacity Availability of trained inspectors and specialized staff supporting monitoring and enforcement (Chile) Strong individual-level technical expertise within the Health Ministry, even where broader systems are weak (Uruguay)	Insufficient human and financial resources Chronic understaffing, limited budgets, and reduced institutional capacity, particularly post-COVID (Ecuador, Peru) High resource demands associated with continuous, multichannel monitoring systems (Chile)
	Legal and regulatory capacity Comprehensive and coherent regulatory frameworks enabling action across media, settings, and persuasive techniques (Argentina, Chile) Clear legal mandates providing predictability and authority to enforce regulations (Peru)	Weak or narrow regulatory design Narrow scope of protection excluding key media or age groups (Peru, Uruguay, Ecuador; Chile limited to under 14) and ensuring the truthfulness (Peru, Ecuador)
	Innovation and monitoring infrastructure capacity Use of advanced monitoring tools, including AI-based surveillance combined with field inspections (Chile) Evidence generation and monitoring innovations led by academia and CSOs in contexts of weak state capacity (Ecuador, Uruguay)	Limited innovation and monitoring infrastructure Absence or weak formal, centralized monitoring systems (Argentina, Ecuador, Peru, Uruguay) Reliance on complaint-based monitoring rather than proactive surveillance (Peru)
	Territorial or subnational capacity Nationwide implementation networks enabling consistent territorial enforcement (Chile)	Territorial inequities Uneven implementation across regions due to federal structures or weak subnational capacity (Argentina) Irregular and intermittent monitoring of school-based settings at the local level (Uruguay)

With respect to governance arrangements, conditions facilitating implementation and effective functioning, including monitoring, were characterized by clear designation of the leading authority and well-defined enforcement mandates. Even within centralized systems, effective internal coordination mechanisms proved critical and were perceived as suboptimal in Argentina. Communication with and training of regulated entities emerged as important monitoring strategies; however, the lack of additional resources to support these time- and labor-intensive processes constituted a significant constraint. In contexts where implementation or evaluation faced difficulties, nonstate actors played a counterbalancing role by generating monitoring data on compliance with UFM regulations and assessing children’s exposure to marketing.

Regarding institutional capacity, key enabling conditions included the availability of skilled human resources and technical capacity supported by adaptive conceptual tools, such as clear definitions of prohibited marketing practices, as well as instrumental tools, including AI, that enable near real-time monitoring across territories rather than reliance on complaints or sporadic inspections. The ability to ensure territorial coverage through nationwide implementation networks also emerged as a critical factor.

Our findings are consistent with the framework developed by Baker et al. (2018), which identifies key conditions required to sustain political commitment to nutrition across different levels, including institutional commitment supported by a legal framework, coordination mechanisms, and implementation instruments, as an operational commitment enabled by adequate resource allocation and effective implementation strategies. The framework also emphasizes embedded commitment, defined as the integration of nutrition objectives within broader policy agendas. This framework provides a useful lens for interpreting the experiences of the countries examined in this study.

Chile illustrates how the alignment of several of these conditions can strengthen regulatory effectiveness. The generation of robust data to monitor children’s exposure to UFM has been central to reinforcing child protection (Taillie et al. 2019). This evidence base has supported sustained institutional commitment, reflected in the leadership of public officials and parliamentarians, as well as the progressive development and refinement of the legal framework, including tools such as the exposure logic for television advertising. The Ministry of Health played a central coordinating role, supported by a governance structure based on a nationwide network of regional offices. Detailed and evolving implementation guidelines, combined with extensive training, were critical for effective implementation. Monitoring was further strengthened through mechanisms to address complex advertising cases, the progressive clarification of violative practices, the integration of AI, and strong coordination between central and regional levels. The presence of academics within governmental structures also contributed to the robustness of monitoring and regulatory refinement. Together, these elements illustrate strong institutional and operational commitment. However, despite these advances, Chile’s current regulation still falls short of WHO recommendations (World Health Organization 2010) calling for protection up to 18 years of age.

It is essential not only to regulate marketing industry practices but also to establish effective monitoring systems. Peru provides a particularly illustrative case. Although it was among the first countries in the region to adopt legislation promoting healthy eating across multiple settings, its initial project to comprehensively regulate marketing—addressing both exposure beyond school environments and the persuasive power of marketing strategies—was ultimately abandoned. At the time of the interviews, political uncertainty and limited institutional commitment constrained implementation. The Ministry of Health’s role was largely confined to defining technical criteria, with enforcement restricted to sanctioning violations under a relatively permissive marketing law. Monitoring activities were neither comprehensive nor systematic, primarily due to budgetary constraints reported by informants from the consumer protection sector. Limited interinstitutional coordination further weakened enforcement. In this context, civil society actors emerged as the primary drivers of monitoring and advocacy, indicating gaps in both institutional and operational commitment.

Regulating marketing from a child exposure perspective, rather than focusing solely on UFM specifically targeted at children, offers greater protection, as demonstrated in Chile (Carpentier et al. 2020) and significantly simplifies the monitoring process. By restricting marketing in certain spaces, this approach reduces the need for subjective interpretation of content and limits opportunities for industry circumvention. It also lowers monitoring costs and complexity while preventing the continual adaptation of marketing strategies aimed at protected populations. This approach aligns with bioethical arguments (Boyland 2023) emphasizing evidence of harm, children’s heightened vulnerability, and the obligation to protect them, as well as with broader analyses of harmful markets (Satz 2010) that justify strong regulatory intervention.

Finally, despite the progress in several countries, common challenges remain, particularly the need to coordinate actions across nations, given the global nature of marketing. Transnational corporations drive global marketing campaigns that increasingly rely on digital platforms, which remain difficult to regulate and monitor at the national level. Extending protection to individuals up to 18 years of age, as recommended by the WHO, remains a critical priority.

Through this qualitative study, we examined the real-world experiences of selected countries in their efforts to protect children from UFM, drawing on insights that are not readily available in published literature by integrating the perspectives of individuals who participated in or closely observed the process. However, in some countries, such as Peru and Ecuador, it was not possible to interview informants from all relevant sectors or key stakeholders. Despite this constraint, the diversity of country cases provided sufficient depth and variation to generate robust informative insights into the implementation and operation of UFM regulations.

Conclusion

Derived from the study, several key lessons emerge.

First, the presence of a strong Ministry of Health with sustained technical capacity and minimal conflict of interest, responsible for not only defining technical criteria for UFM regulation but also coordinating implementation and establishing nationwide monitoring mechanisms nationwide, appears to be a critical factor in promoting policy adherence and enhancing protection for children. However, such institutional configuration may not be readily transferable to all national contexts, particularly in the short term.

Second, when monitoring is not led by a health institution, UFM monitoring systems tend to prioritize administrative enforcement of legal violations rather than the systematic assessment of children’s exposure to UFM (Peru).

Third, more comprehensive UFM regulatory frameworks, characterized by broader age-based protection, wider coverage of media channels and persuasive techniques, and temporal restrictions pose substantial monitoring challenges. These challenges reflect the dynamic nature of marketing strategies and the considerable human and financial resources required for effective oversight. Nevertheless, the systematic generation of monitoring data remains essential to identify emerging industry practices aimed at circumventing regulation and to inform timely, evidence-based regulatory adjustments.

Finally, exposure-based regulatory approaches, which prohibit all forms of UFM during defined time periods and across specified channels, substantially simplify monitoring processes by removing the need to assess intent, content, or audience targeting. By offering more consistent and comprehensive protection, such approaches warrant careful consideration by countries seeking to strengthen the effectiveness and enforceability of UFM regulations.

Author contributions

Florence L. Théodore (Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Supervision, Writing—original draft), Alondra Coral Aragón-Gama (Formal analysis, Investigation, Writing—review & editing), Regina Durán (Data curation, Formal analysis, Writing—review & editing), Lorena Rodríguez Osiac (Writing—review & editing), and Lizbeth Tolentino-Mayo (Conceptualization, Funding acquisition, Project administration, Supervision, Writing—review & editing)

Supplementary material

Supplementary material is available at Health Promotion International online.

Appendix A. Comparative analysis of key laws and decrees regulating UFM across five countries

Appendix B. In-depth interview guide with stakeholders (English translation).

Appendix C. The coding tree (English translation).

Conflicts of interest

None declared.

Funding

This research was financially supported by the United Nations Children’s Fund Mexico (UNICEF Mexico) under Contract No. 43356393, dated 20 September 2022.

Data availability

The data underlying this article cannot be shared publicly due to the need to protect the privacy of individuals who participated in the study.