Concepts and critical perspectives for food environment research: A global framework with implications for action in low- and middle-income countries

Malnutrition in all its forms currently affects one in three people globally and is considered one of the greatest public health challenges of our time. Low- and middle-income countries (LMICs) are increasingly facing a double burden of malnutrition that includes undernutrition, as well as increasing overweight, obesity and diet related non-communicable diseases. The role of food environments in shaping transitioning diets and the double burden of malnutrition in LMICs is increasingly gaining policy attention. However, food environment research to date has predominantly been undertaken in response to obesity and associated diet-related non-communicable diseases in high-income countries (HICs). Empirical research in LMICs is in its infancy. There is a need to create a cohesive research agenda to facilitate food environment research and inform action across the globe, particularly with regard to LMICs. In this paper, we address three fundamental questions: First, how can the food environment be defined and conceptualised in a way that captures the key dimensions that shape food acquisition and consumption globally? Second, how can existing knowledge and evidence from HICs be leveraged to accelerate food environment research in LMICs? Third, what are the main challenges and opportunities in doing so? We conduct a brief synthesis of the food environment literature in order to frame our critical perspectives, and introduce a new definition and conceptual framework that includes external and personal domains and dimensions within the wider food environment construct. We conclude with a discussion on the implications for future research in LMICs.