The increasing availability of unhealthy processed food products is linked to rising rates of non-communicable diseases and obesity in low- and middle-income countries. Voluntary actions (VAs) are often adopted in lieu of regulating the composition, production, marketing and sale of unhealthy commodities, but their effectiveness is unclear. This realist review examines VAs adopted by the food and beverage industry in low- and middle-income countries. We developed a conceptual framework and followed a three-stage search to identify literature and VAs and, adhering to the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines, we produced a synthesized analysis of VAs. VAs, often initiated in response to governments’ efforts to introduce regulations, were difficult to evaluate due to vague language and a lack of enforcement mechanisms. The review found no evidence indicating that VAs are effective in safeguarding public health. Yet their implementation has resulted in weaker responses and policy substitution, and so we suggest that VAs have the potential to negatively influence public health and policy. The United Nations should rescind their endorsement of industry involvement and mandatory measures should be favoured over VAs.

不健康加工食品的供应量增加与低收入和中等收入国家非传染性疾病和肥胖率上升有关。通常采用自愿行动 (VA) 来代替对不健康商品的成分、生产、营销和销售进行监管，但其有效性尚不清楚。这篇现实主义评论考察了低收入和中等收入国家食品和饮料行业采用的 VA。我们开发了一个概念框架，并遵循三阶段搜索来识别文献和 VA，并遵循现实主义和元叙事证据综合：不断发展的标准 (RAMESES) 指南，我们对 VA 进行了综合分析。VA，通常是为了响应政府引入法规的努力而发起的，由于语言含糊和缺乏执行机制，难以评估。该审查没有发现任何证据表明 VA 可有效保护公众健康。然而，它们的实施导致了较弱的反应和政策替代，因此我们认为 VA 有可能对公共卫生和政策产生负面影响。联合国应该取消他们对行业参与的认可，强制性措施应该比自愿协议更受青睐。