Institutional food environments are an important dimension of the contemporary debate on healthy and sustainable diets, within the scope of public health and regulation. A variety of initiatives address this agenda with a particular focus on schools and hospitals, as spaces that shape habits during decisive phases of life and have the capacity to make healthy eating accessible to millions of people.
In Brazil, this debate has been advancing and pointing to new frontiers along its institutional trajectory. The Dietary Guidelines for the Brazilian Population, published by the Ministry of Health in 2014 and widely recognized as an international reference, incorporates the NOVA classification as the organizing axis of its recommendations — an innovation that has influenced dietary guidelines in other countries and international organizations. The Guidelines recommend that the population avoid ultra-processed foods and guide public policies in food education, health, and school feeding.
From a regulatory standpoint, Brazil has accumulated important experiences, which can still be expanded, refined, and consolidated in an integrated manner. One example of such experience is the PNAE — National School Feeding Program, which has recently undergone a series of regulatory adjustments aimed at reducing the presence of ultra-processed foods in school menus. A resolution by the FNDE — National Fund for the Development of Education, approved in 2025, reduced the limit of ultra-processed foods in PNAE menus from 20% to 15%, with a goal of reaching 10% by 2026, and Bill PL 4.501/2020, currently under consideration in the Senate, proposes to ban their sale in school canteens nationwide, with criteria based on the Dietary Guidelines. At the state and municipal levels, the process is advancing unevenly, with different degrees of regulation in force concerning the sale of foods in school canteens and various bills under consideration.
Hospital environments are another frontier where experiences can still be tested and developed. The Technical Note “Pediatric hospital environment as a promoter of adequate and healthy eating,” published by Instituto Desiderata in partnership with the Rio de Janeiro Center of the Alliance for Adequate and Healthy Eating, brings together current legislation, scientific evidence, and analysis of the experience of the Getúlio Vargas Filho Pediatric Hospital (Niterói-RJ) to propose guidelines that make hospitals spaces that promote the human right to food. Among the recommendations are: a ban on the offering of ultra-processed foods in hospital food services, including canteens, vending machines, and any commercial promotion activities; prioritization of fresh and minimally processed foods; encouragement of the purchase of products from family farming; and support for breastfeeding.
Defending and deepening this agenda requires a coordinated strategy to drive the development and implementation of public policies for building healthier food environments — in schools, hospitals, and other institutional spaces. It also requires strengthening the civil society organizations that sustain this struggle based on the scientific evidence that has supported this debate and pointed out the advances that are possible.
The Alliance for Adequate and Healthy Eating is one of the organizations at the forefront of this process. The organization brings together entities and individuals to strengthen collective actions that contribute to promoting adequate and healthy eating and to realizing the human right to adequate food, based on the public interest. Operating at all three levels of government — federal, state, and municipal — the organization functions as a space for coordinating thematic centers and working groups, fostering democratic governance, dialogue-based conflict resolution, and decentralized political advocacy.
The Alliance is supported by Ibirapitanga in efforts to equip and strengthen the actions of its centers and working groups, improve its internal governance, and broaden its political advocacy from a national perspective. This support also enables the strengthening of participatory management and the expansion of the Alliance’s capacity for mobilization around the main regulatory agendas in the field of food.
Over the past two years, the Alliance has been a leading advocate for the expansion of taxation on ultra-processed products and sugar-sweetened beverages. More broadly, it has been coordinating efforts toward the advancement of regulatory measures involving cross-cutting issues such as: the effective enforcement of the ban on advertising directed at children; the restriction of advertising of ultra-processed foods; the improvement of information on food labels; the approval of fiscal measures that promote adequate and healthy eating; the promotion, protection, and support of healthy eating in institutional environments, especially in schools; and the monitoring of practices and policies that encourage eating behaviors harmful to health.
At Ibirapitanga’s invitation, the initiative identified studies and guidelines that have been contributing to the production and dissemination of knowledge about institutional food environments, undergoing transformation through regulatory experiences focused on restricting ultra-processed foods in schools and hospitals. The seven studies published between 2022 and 2026 in Brazilian and international journals provide current overviews of the debate, assess impacts and effects of regulatory interventions, and point to pathways for improving public policies in Brazil and worldwide.
Policies and interventions to create healthy school food environments: WHO guideline
World Health Organization (WHO), 2025. Document prepared by the Department of Nutrition and Food Safety under the leadership of Francesco Branca and coordinated by Katrin Engelhardt.
Official WHO guideline that brings together evidence-based recommendations for creating healthy school food environments. The document guides governments on policies such as restrictions on the marketing and advertising of food and beverages to children, nutritional standards for foods offered in schools, and food and nutrition education measures.
Impact of multi-component school food environment interventions on adiposity and food consumption in children and adolescents: systematic review and meta-analysis
Luisa Arantes Vilela, Camila Kümmel Duarte, Luana Lara Rocha, Brenda da Cunha Carvalho, Ariene Silva do Carmo, Lúcia Helena Almeida Gratão, Thales Philipe Rodrigues da Silva, Milene Cristine Pessoa, and Larissa Loures Mendes. PubMed, 2025.
Systematic review with meta-analysis assessing the effect of multi-component interventions in school food environments on indicators of adiposity and food consumption among children and adolescents. The study, conducted by Brazilian researchers, supports the hypothesis that combined changes in the school environment — food availability, advertising regulation, and educational actions — produce measurable effects on the health of children and adolescents, strengthening the case for integrated policies.
The effectiveness of interventions to improve environmentally sustainable and healthy dietary behaviours among European adults: a systematic review
Hikaru Sato and John Oldroyd. ScienceDirect, 2025.
Systematic review examining the effectiveness of interventions aimed at promoting dietary behaviors that are simultaneously healthy and environmentally sustainable among European adults. The study broadens the scope of the debate by articulating human health and sustainability — an increasingly central systemic agenda in contemporary food policies — and offers insights for considering dietary transitions in broader institutional and population contexts.
Are the laws restricting the sale of food and beverages in school cafeterias associated with obesity in adolescents in Brazilian state capitals?
Maíra Macário de Assis, Milene Cristine Pessoa, Lucia Helena Almeida Gratão, Ariene Silva do Carmo, Mariana Zogbi Jardim, Cristiane de Freitas Cunha, Tatiana Resende Prado Rangel de Oliveira, Luana Lara Rocha, Uriel Moreira Silva, Larissa Loures Mendes. Food Policy / ScienceDirect, 2023.
Study assessing the association between the existence of laws restricting the sale of foods and beverages in school cafeterias and the prevalence of obesity in adolescents from public and private schools in Brazilian state capitals. The analysis drew on data from ERICA — Study of Cardiovascular Risks in Adolescents, with a sample of 19,024 adolescents between 12 and 17 years old enrolled in 486 schools across the 27 capitals, and applied multilevel logistic regression models. The results show that adolescents covered by laws restricting the sale of foods and beverages in school cafeterias had an 11% lower chance of being obese.
Do Brazilian regulatory measures promote sustainable and healthy eating in the school food environment?
Luana Lara Rocha, Nayhanne Gomes Cordeiro, Mariana Zogbi Jardim, Aline Yukari Kurihayashi, Patrícia Chaves Gentil, Giorgia Castilho Russo, and Larissa Loures Mendes. BMC Public Health / Springer, 2023.
Brazilian study that assesses to what extent the set of regulatory instruments in force in the country — with particular emphasis on PNAE — actually promotes healthy and sustainable eating in school environments. The analysis exposes both advances and gaps in the national normative framework and contributes to the diagnosis of weaknesses that still compromise the realization of the human right to adequate food in Brazilian schools.
Influence of food and regulatory environments on the consumption of ultra-processed foods by adolescents: a multilevel analysis in Brazilian capitals based on the National School Health Survey, 2019
Laura Luciano Scaciota, Mayra Barata Figueiredo, Maria Alvim Leite, Giovanna Calixto Andrade, Luiza Antoniazzi Gomes de Gouveia, Catarina Machado Azeredo, Maria Laura da Costa Louzada, Fernanda Rauber, Renata Bertazzi Levy. Cadernos de Saúde Pública, 2026.
Pioneering study that applies multilevel analysis to 81,362 adolescents based on data from PeNSE — National School Health Survey 2019. The results show that attending schools with regulatory coverage on the sale of foods and beverages was associated with a reduction in the ultra-processed food consumption score, and that each additional point in the score for the availability of these products in cafeterias was associated with increased consumption. These are the first results in Brazil to assess the direct effect of school regulation on adolescents’ food consumption, and they reinforce the recommendation for a mandatory federal law that standardizes the restriction of ultra-processed foods in cafeterias of public and private schools throughout the country.
Hospital-Based Food Environment Interventions to Improve Workforce Dietary Behaviour: A Systematic Literature Review
Kawther al-Tamimi, Louise van Herwerden, Malika Abdul, and Jennifer Utter. PubMed Central, 2023.
Systematic review on interventions in hospital food environments aimed at improving the dietary habits of health professionals. The study provides evidence on a still under-explored frontier of food environment policies and points to ways for these institutions — whose mission is health promotion — to stop reproducing, in their food services, dietary patterns that contradict the principles they defend.
