The UK has diets with the highest proportion of ultra-processed food in Europe(1). The population’s diet is also too high in carbohydrates, total fats, saturated fats, salt and free sugars and does not meet fibre, protein and potassium recommendations(Reference Lang2). This suboptimal nutrition underlies an increase in diet-related conditions, such as obesity, type 2 diabetes, CVD and several types of cancer, and the financial costs attached to them(Reference Lang2). In the UK, the combined cost of obesity and associated health issues in reducing life expectancy, National Health Service funds and lost workforce productivity is £98 billion yearly(Reference Bradshaw and Dace3).
A major cause of poor diets is the influence of the obesogenic food environment(4). This term describes settings in which unhealthy food is widely accessible, available and affordable, creating conditions that drive people to make unhealthy food choices and fuelling obesity at a population level(Reference Swinburn, Egger and Raza5). These obesogenic environments are largely driven by the power and influence of the food industry, which prioritises producing and promoting ultra-processed food(Reference Lang2). As a result, people’s dietary patterns are shaped in ways that operate beyond individual awareness and control and embed unhealthy foods as the social norm within everyday social practices and routines(Reference Dijksterhuis, Smith and van Baaren6). The lower pricing and targeted marketing of unhealthy food products are particularly concentrated in disadvantaged communities. This systematic targeting, combined with financial constraints that limit the food choices of families living on lower incomes, perpetuates dietary and health inequalities(Reference Vogel, Ntani and Inskip7).
Evidence shows that government-enforced regulatory approaches like the UK Soft Drinks Industry Levy (2018)(Reference Cobiac, Rogers and Adams8) and legislation restricting the promotions of high in fat, sugar and salt products in prominent locations of retail outlets(Reference Muir, Dhuria and Roe9) effectively improve obesogenic food environments by creating a level playing field for the food industry. In contrast, industry-led voluntary or corporate social responsibility initiatives like the Public Health Responsibility Deal (2011–2015) have proven ineffective. Independent evaluations show that companies word their pledges vaguely to enable poor quality progress reports and dodge robust monitoring or prioritise only the easiest health targets, which do not negatively impact their business strategies(Reference Knai, Petticrew and Durand10).
Despite this evidence base, comprehensive government-enforced regulatory interventions to reshape obesogenic food environments remain limited in the UK, with recent proposals for stricter rules repeatedly delayed or discarded(Reference Gregory11). This is because implementing these interventions faces significant barriers, as the food industry acts to protect commercial interests throughout the policy process(Reference Ulucanlar, Lauber and Fabbri12–Reference van de Goor, Hämäläinen and Syed16). Research investigating the involvement of alcohol and tobacco industries in public health policy making shows these industries systematically exercise structural power through argument-based and action-based strategies(Reference Ulucanlar, Fooks and Gilmore13). It is important to investigate whether these strategies are also used by the food industry. Argument-based strategies include framing health issues as matters of individual choice (e.g. tobacco companies promoting ‘freedom to choose’), positioning as legitimate stakeholders (e.g. alcohol industry being ‘part of the solution’) and highlighting economic benefits (e.g. job creation). Action-based strategies involve building coalitions against regulations (e.g. tobacco companies partnering with hospitality associations against smoke-free laws), funding favourable research (e.g. Coca-Cola sponsoring physical activity studies and shifting focus from their products’ role in obesity to sedentary behaviours)(Reference O’Connor17), securing positions on regulatory committees (e.g. a legislator becoming a Tobacco Institute lobbyist(Reference Torrijos and Glantz18), creating legal obstacles to implementation and intimidating public health advocates(Reference Matthes, Alebshehy and Gilmore15).
While many working in the field of public health are calling for stronger government regulation of the food industry, this effort faces significant barriers without greater public support for these policies(Reference Tulatz19). Public support is key because it is one of several factors policymakers consider before implementing a policy, alongside the policy’s likely costs and effectiveness(Reference Cullerton, Donnet and Lee20,Reference Freudenberg and Freudenberg21) . Public support may be limited by a critical disconnect. While research evidence demonstrates that environmental and commercial factors are primary drivers of poor diets, many citizens may largely perceive that individuals are responsible for their food choices(Reference Dhuria, Lawrence and Crozier22,Reference Reynolds, Archer and Pilling23) .
Understanding this disconnect requires examining how responsibility is framed across the key domains that shape public understanding in their everyday lives: public discourse, mass media and government policy(Reference Maani, Petticrew and Galea24,Reference Lupton25) . Research shows that societal framing (e.g. industry manipulation or toxic food environment) in health news articles increases policy support(Reference Coleman, Thorson and Wilkins26–Reference Temmann, Wiedicke and Schaller28), while individual-focused frames (e.g. in obesity) decrease support for government intervention(Reference Oliver and Lee27,Reference Barry, Brescoll and Brownell29) .
However, there is limited comprehensive evidence mapping how responsibility for poor diets is currently framed across these influential domains in the UK. While previous studies have examined responsibility framing in single domains(Reference Baker, Brookes and Atanasova30,Reference Hilton, Patterson and Teyhan31) , a comprehensive synthesis is needed to understand the complete picture of responsibility narratives that citizens encounter. Furthermore, how disadvantaged groups – who bear a disproportionate burden of diet-related ill-health(Reference Marmot32) – are represented within responsibility framing has received limited systematic examination(Reference Temmann, Wiedicke and Schaller28). If responsibility framing fails to acknowledge societal barriers and instead emphasises individual choice, it may perpetuate stigma and reduce support for policies that could address the root causes of dietary inequalities.
This study aims to address these evidence gaps by conducting the first systematic synthesis of how responsibility for poor diets is framed across public perceptions, mass media and government policy in the UK, with particular attention to the representation of socio-economically disadvantaged groups.
Methods
A scoping review with systematic methodology was selected as it allows for rigorous exploration of a broad review question, mapping and summarising the breadth and depth of available evidence across multiple time periods and domains (the public, mass media and the government). This approach enables the identification of patterns and knowledge gaps that would not be captured through primary analysis of contemporary sources alone, thereby informing future research(Reference Tricco, Lillie and Zarin33,Reference Peters, Marnie and Tricco34) . Assessment of the methodological quality of the included studies was not completed(Reference Brien, Lorenzetti and Lewis35).
The review followed the Joanna Briggs Institute methodology for scoping reviews(Reference Peters, Godfrey, Mclnerney, Aromataris and Munn36) and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR)(Reference Tricco, Lillie and Zarin37).
This method was supported by framing theory. Framing refers to the process by which certain aspects of an issue are highlighted, while others are left out, encouraging audiences to think, feel and decide in a particular way(Reference Entman38). We specifically focused on responsibility frames – those that attribute causation and solutions for health problems (in this case, poor diets) to different actors or levels, ranging from individuals and social relationships to broader societal structures(Reference Iyengar39,Reference Semetko and Valkenburg40) .
Review questions
The review questions were: (a) ‘What framing has been used among the public, mass media and government about who is responsible for poor diets in the UK?’; (b) ‘How are disadvantaged groups presented within this framing?’ The questions were developed using the Participants, Concept and Context framework (see online supplementary material, Supplemental Material 1 for detailed definitions of the key terms and components of the review questions).
Search strategy
A full search strategy (see online supplementary material, Supplemental Material 2) was developed utilising search terms from the titles and abstracts (keywords and/or medical subject headings or subject headings) related to food environments, commercial and policy influences, diet and nutrition, media and digital platforms, framing constructs related to responsibility and the UK and combined with the Boolean terms ‘OR’ and ‘AND’. The final search terms were based on previous literature, team discussions and a librarian’s input. The search strategy, including all identified index terms and keywords, was adapted for each database and information source.
The databases included MEDLINE (Ovid), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), Web of Science, EconLit (EBSCOhost) and GEOBASE, covering health, geographic marketing/economic and consumer literature. The reference lists of included literature were screened for further sources. The search strategy limited the publication date to include sources from the year 2000, when literature on environmental influences on diet-related conditions (above all, obesity) emerged. Only English-language literature was included due to the UK focus. The original search strategy was updated twice (November and December 2023) to incorporate terms related to the ‘online food environment’ and then ‘policy’ and ‘news’. These modifications ensured coverage of public, mass media and government framing on who is responsible for food choices and poor diet in the UK. While our search strategy was designed to capture mass media broadly, the identified studies examining media framing of responsibility for poor diets were limited to newspaper coverage, reflecting the current state of the literature in this domain.
Study selection
All identified records were uploaded into EndNote v.20, and duplicates were removed automatically and double-checked (and removed if necessary) manually. NSF assessed titles and abstracts. NSF and NT independently screened the full texts of the selected articles for eligibility, with a percentage agreement at 98·8 %. Discrepancies were resolved through discussion. The inclusion and exclusion criteria are specified in Table 1. The identification process and the search results are presented in a PRISMA flow diagram(Reference Page, McKenzie and Bossuyt41) (Figure 1).
Inclusion and exclusion criteria
PRISMA flow diagram.
Data extraction and analysis
Data were extracted utilising a data extraction tool (see Table 2) developed for this scoping review(Reference Peters, Godfrey, Mclnerney, Aromataris and Munn36). Data extraction captured information about the author[s], year of publication, study aim, type of evidence and study design, study population and context and key findings on responsibility for poor diets. NSF extracted 100 % of the data. Charting the results was iterative, allowing for emergent data throughout the data extraction process and revising and modifying the data extraction tool as necessary. Disagreements were resolved with the rest of the authors (LE, NT, MCP, JB and CV).
Extraction table
A narrative synthesis of findings through basic deductive-inductive qualitative content analysis complemented the tabular data(Reference Pollock, Peters and Khalil42). Content analysis was chosen for its descriptive nature and applicability across study designs(Reference Pollock, Peters and Khalil42). A deductive-inductive approach (deductive first) was selected to synthesise knowledge without prior assumptions(Reference Burns and Grove43). Initial coding was based on the review questions and an analytical framework developed, informed by multilevel health determinants theory(Reference Dahlgren and Whitehead44–Reference Serrano Fuentes46), distinguishing between micro-level, community-level and structural-level factors. This helped systematically categorise the diverse range of influences on food choices identified across studies (see online supplementary material, Supplemental Material 1). Absolute frequencies of outcome types in the literature were used to aid the narrative synthesis of the findings and as a reflection of the current literature available about who is responsible for poor diets in the UK.
The analysis consisted of three phases(Reference Elo and Kyngäs47), and a detailed explanation of how categories, codes and the narrative were created can be seen in online supplementary material, Supplemental Material 3. The phases were (a) preparation (immersing in the data and becoming familiarised with the content), (b) organising (an initial unconstrained framework was used to extract data and modified inductively to address the review questions effectively) and (c) reporting (weaving together the analytic narrative and data extracts).
It is relevant to note that, as is common in scoping reviews, this review included studies with diverse research focuses. Studies were included if they directly examined responsibility attribution for poor diets and if they investigated factors influencing food choices in ways that allowed for interpretation of implied responsibility attributions. For studies in the latter category, we applied the deductive-inductive approach to extract information about implied responsibility. We analysed how factors like food prices or marketing were framed regarding individual agency, interpreting external constraints (e.g. high cost of healthy food) as indicating societal responsibility and personally actionable factors (e.g. motivation) as individual responsibility.
Results
A total of 14 901 records were identified, 14 899 through database searches and two from reference lists. After removing duplicates, 12 884 remained for preselection, of which 12 712 were excluded based on the title and abstract. After applying the inclusion/exclusion criteria, 172 articles were considered for full-text analysis. Of these, 117 articles did not address the review aims, seventeen studied other types of populations and considered other contexts and two did not meet the study type criteria. Thirty-six articles (twenty-seven qualitative, two quantitative, six mixed-methods and one review with meta-synthesis) were included in the final analysis. Figure 1 outlines the flow of studies through the inclusion process, and Table 2 describes the included studies.
Of the thirty-six included studies, twenty-seven explored public perceptions of responsibility and drivers of poor diets; six examined news content related to poor diets and diet-related conditions, especially obesity; and five studied the frames characterising UK government initiatives to address poor diets and diet-related conditions. Two studies(Reference Busam and Solomon-Moore48,Reference Attree49) covered multiple topics and therefore were coded against all relevant themes described below. Also, eleven studies(Reference Attree49–Reference Ulijaszek and McLennan59) directly investigated responsibility attributions, while fifteen studies(Reference Muir, Dhuria and Roe9,Reference Dhuria, Lawrence and Crozier22,Reference Baker, Brookes and Atanasova30,Reference Hilton, Patterson and Teyhan31,Reference Busam and Solomon-Moore48,Reference Backett-Milburn, Wills and Gregory60–Reference Piggin79) examined factors influencing food practices or causes of obesity, from which responsibility attributions could only be inferred.
Framing of responsibility in public perceptions
Twenty-seven studies referred to public perceptions of poor diets and potentially associated conditions like obesity. Thirteen studies identified personal factors as the key determinants, suggesting individual responsibility attributions(Reference Dhuria, Lawrence and Crozier22,Reference Attree49,Reference Crawshaw and Newlove50,Reference Gregg, Patel and Patel52,Reference Thomas-Meyer, Mytton and Adams53,Reference Backett-Milburn, Wills and Gregory60,Reference Barker, Lawrence and Skinner61,Reference Chambers and Traill63,Reference Cook, Powell and Ali64,Reference Douglas, Clark and Craig67,Reference Greener, Douglas and van Teijlingen68,Reference Harden and Dickson70,Reference O’Brien, McConnon and Hollywood75) , such as perceived lack of control over food choices(Reference Thomas-Meyer, Mytton and Adams53,Reference Barker, Lawrence and Skinner61,Reference Lawrence, Skinner and Haslam73) , willpower(Reference Beeken and Wardle62,Reference Chambers and Traill63,Reference Greener, Douglas and van Teijlingen68,Reference Watts, Lloyd-Williams and Bromley77) , self-care(Reference Goldthorpe, Ali and Calam80) and mood when shopping(Reference Dhuria, Lawrence and Crozier22). The influence of parents was identified as part of individual responsibility, specifically their decision-making on food purchases and eating choices, and as role models in healthy eating(Reference Dhuria, Lawrence and Crozier22,Reference Busam and Solomon-Moore48,Reference Gregg, Patel and Patel52,Reference Cook, Powell and Ali64,Reference Devi, Surender and Rayner65,Reference Douglas, Clark and Craig67,Reference Hayter, Draper and Ohly71,Reference Goldthorpe, Ali and Calam80) , food preparation (not cooking from base ingredients) and provision of ready-made meals(Reference Douglas, Clark and Craig67,Reference Khanom, Hill and Morgan72,Reference Lawrence, Skinner and Haslam73) and giving in to children’s requests for unhealthy foods(Reference Backett-Milburn, Wills and Gregory60,Reference Hardcastle and Blake69) .
Three articles studying public perceptions of poor diet identified individual and external factors as the most important in poor diets(Reference Muir, Dhuria and Roe9,Reference Beeken and Wardle62,Reference Swift, Strathearn and Morris76) . These articles showed that citizens viewed responsibility as stemming from food environments providing greater affordability, accessibility and visibility of unhealthy food rather than personal choice(Reference Muir, Dhuria and Roe9,Reference Beeken and Wardle62,Reference Swift, Strathearn and Morris76) . Eleven articles acknowledged both individual and environmental responsibility without prioritising one over the other(Reference Busam and Solomon-Moore48,Reference Timotijevic, Acuna-Rivera and Gemen54,Reference Devi, Surender and Rayner65,Reference Dibsdall, Lambert and Frewer66,Reference Hardcastle and Blake69,Reference Hayter, Draper and Ohly71–Reference Ludwig, Cox and Ellahi74,Reference Watts, Lloyd-Williams and Bromley77,Reference Goldthorpe, Ali and Calam80) .
A range of external factors were identified as influencing eating practices (e.g. shopping, cooking and eating) beyond individual control, suggesting societal responsibility attributions. These included financial constraints, like living on a restricted family budget that constrained healthy food purchases(Reference Busam and Solomon-Moore48–Reference Crawshaw and Newlove50,Reference Harden and Dickson70–Reference Khanom, Hill and Morgan72) , and high costs of healthier food like vegetables and fruits (on many occasions, families would like to buy these products, but felt they could not afford them), compared to energy-dense processed food(Reference Dhuria, Lawrence and Crozier22,Reference Crawshaw and Newlove50,Reference Gregg, Patel and Patel52,Reference Timotijevic, Acuna-Rivera and Gemen54,Reference Backett-Milburn, Wills and Gregory60,Reference Barker, Lawrence and Skinner61,Reference Cook, Powell and Ali64,Reference Dibsdall, Lambert and Frewer66,Reference Douglas, Clark and Craig67,Reference Hardcastle and Blake69–Reference Hayter, Draper and Ohly71,Reference Lawrence, Skinner and Haslam73,Reference O’Brien, McConnon and Hollywood75,Reference Watts, Lloyd-Williams and Bromley77) . Limited time due to, for example, childcare(Reference Barker, Lawrence and Skinner61,Reference Cook, Powell and Ali64,Reference Khanom, Hill and Morgan72,Reference Lawrence, Skinner and Haslam73) and work schedules(Reference Dhuria, Lawrence and Crozier22,Reference Busam and Solomon-Moore48,Reference Backett-Milburn, Wills and Gregory60,Reference Cook, Powell and Ali64,Reference Khanom, Hill and Morgan72,Reference Watts, Lloyd-Williams and Bromley77) influenced families’ ability to undertake home cooking and consume a better diet quality(Reference Dhuria, Lawrence and Crozier22,Reference Busam and Solomon-Moore48,Reference Crawshaw and Newlove50,Reference Cook, Powell and Ali64,Reference Dibsdall, Lambert and Frewer66,Reference Douglas, Clark and Craig67,Reference Hayter, Draper and Ohly71,Reference Lawrence, Skinner and Haslam73,Reference O’Brien, McConnon and Hollywood75,Reference Watts, Lloyd-Williams and Bromley77) . Furthermore, cultural norms reinforcing unhealthy eating patterns(Reference Khanom, Hill and Morgan72,Reference Ludwig, Cox and Ellahi74,Reference Watts, Lloyd-Williams and Bromley77) , unhealthy food industry marketing tactics(Reference Busam and Solomon-Moore48,Reference Crawshaw and Newlove50,Reference Douglas, Clark and Craig67,Reference Khanom, Hill and Morgan72,Reference Goldthorpe, Ali and Calam80) like product placement and promotions on unhealthy food(Reference Dhuria, Lawrence and Crozier22,Reference Hayter, Draper and Ohly71,Reference Lawrence, Skinner and Haslam73) and limited government support to individuals and schools to buy healthier food were cited(Reference Attree49,Reference Gregg, Patel and Patel52,Reference Gregg, Patel and Patel52,Reference Goldthorpe, Ali and Calam80) .
As part of the inferred societal responsibility attribution, the community environment also influenced the diet practices of individuals. For example, schools provided nutrition education and skills to support healthy food choices(Reference Busam and Solomon-Moore48,Reference Timotijevic, Acuna-Rivera and Gemen54,Reference Devi, Surender and Rayner65,Reference Goldthorpe, Ali and Calam80) , and children interacted with friends and imitated their eating practices(Reference Timotijevic, Acuna-Rivera and Gemen54,Reference Hardcastle and Blake69,Reference Hayter, Draper and Ohly71) . Poor access to stores with healthier food options (e.g. no local shops within walking distance or lack of access to transport) led to reliance on takeaway foods(Reference Dhuria, Lawrence and Crozier22,Reference Khanom, Hill and Morgan72) , and a high exposure to unhealthy food due to a saturation of takeaway restaurants and convenience stores in the local areas(Reference Chambers and Traill63,Reference Cook, Powell and Ali64,Reference Douglas, Clark and Craig67,Reference Goldthorpe, Ali and Calam80) was also associated with poorer diets.
Individual factors involved family (e.g. partners and children) pressures for purchasing unhealthy foods, which were preferred by family members, yet not on the shopping list(Reference Dhuria, Lawrence and Crozier22,Reference Crawshaw and Newlove50,Reference Barker, Lawrence and Skinner61,Reference Cook, Powell and Ali64,Reference Douglas, Clark and Craig67,Reference Greener, Douglas and van Teijlingen68,Reference Harden and Dickson70–Reference O’Brien, McConnon and Hollywood75) . Members of the family spoiled children with unhealthy treats like sweets and chocolate, regardless of what the children were allowed at home(Reference Timotijevic, Acuna-Rivera and Gemen54,Reference Cook, Powell and Ali64,Reference Douglas, Clark and Craig67,Reference Harden and Dickson70,Reference Hayter, Draper and Ohly71) . Other studies highlighted historical family influences on diets, mainly individuals who had not been taught to cook or experienced a limited range of foods from childhood showed poorer dietary practices later in life(Reference Barker, Lawrence and Skinner61,Reference Cook, Powell and Ali64,Reference Dibsdall, Lambert and Frewer66,Reference Douglas, Clark and Craig67,Reference Hardcastle and Blake69,Reference Hayter, Draper and Ohly71,Reference Lawrence, Skinner and Haslam73) .
Of studies examining perceptions among specific groups, fourteen focused on groups experiencing disadvantage(Reference Dhuria, Lawrence and Crozier22,Reference Attree49,Reference Crawshaw and Newlove50,Reference Backett-Milburn, Wills and Gregory60,Reference Barker, Lawrence and Skinner61,Reference Cook, Powell and Ali64,Reference Dibsdall, Lambert and Frewer66,Reference Hardcastle and Blake69–Reference Ludwig, Cox and Ellahi74,Reference Goldthorpe, Ali and Calam80) , five included samples with a range of sociodemographic characteristics(Reference Beeken and Wardle62,Reference Chambers and Traill63,Reference Douglas, Clark and Craig67,Reference O’Brien, McConnon and Hollywood75,Reference Watts, Lloyd-Williams and Bromley77) and eight did not specify any indices of deprivation or socio-economic status(Reference Muir, Dhuria and Roe9,Reference Busam and Solomon-Moore48,Reference Gregg, Patel and Patel52–Reference Timotijevic, Acuna-Rivera and Gemen54,Reference Devi, Surender and Rayner65,Reference Greener, Douglas and van Teijlingen68,Reference Swift, Strathearn and Morris76) . Among the studies involving groups experiencing disadvantage, seven identified personal factors as the most important(Reference Dhuria, Lawrence and Crozier22,Reference Attree49,Reference Crawshaw and Newlove50,Reference Backett-Milburn, Wills and Gregory60,Reference Barker, Lawrence and Skinner61,Reference Cook, Powell and Ali64,Reference Harden and Dickson70) . All articles targeting these groups identified income and food prices, time constraints and family influences as the main external factors influencing diet practices. Two of these studies examined comparisons between populations with different educational attainments(Reference Barker, Lawrence and Skinner61,Reference Lawrence, Skinner and Haslam73) . Both articles indicated differences between groups, showing that adults with higher educational attainment held greater levels of control over food choices, received greater social support from their families for healthy eating (e.g. sharing food preferences for healthy eating) and were less constrained by environmental or contextual factors.
Framing of responsibility in UK mass media (press)
The identified studies examining media framing of responsibility for poor diets were limited to newspaper coverage, as no studies examining other media formats were found. Six articles critically analysed UK newspapers’ narratives and discussions around who or what is responsible for poor diets and diet-related conditions. Specifically, one article explored the responsibility for sugar-sweetened beverages(Reference Elliott-Green, Hyseni and Lloyd-Williams57). The remaining five articles investigated who held responsibility for obesity(Reference Baker, Brookes and Atanasova30,Reference Hilton, Patterson and Teyhan31,Reference Busam and Solomon-Moore48,Reference Atanasova and Koteyko55,Reference Brookes and Baker56) .
The media largely portrayed poor diets and obesity as matters of individual responsibility(Reference Baker, Brookes and Atanasova30,Reference Hilton, Patterson and Teyhan31,Reference Atanasova and Koteyko55–Reference Elliott-Green, Hyseni and Lloyd-Williams57) . In particular, individuals lacking self-control(Reference Atanasova and Koteyko55) and knowledge about nutrition and food preparation(Reference Atanasova and Koteyko55) and made poor food and dietary choices, such as dieting(Reference Baker, Brookes and Atanasova30,Reference Hilton, Patterson and Teyhan31) or consuming too much sugar(Reference Elliott-Green, Hyseni and Lloyd-Williams57). Contextual determinants of poor diet received less focus as key causes of health problems, suggesting limited emphasis on societal responsibility. For instance, one study found that only 14 % of British press articles negatively depicted the food industry’s role in promoting sugar consumption(Reference Devi, Surender and Rayner65). Other factors covered in the media included poor food labelling, lack of nutrition education, unhealthy drink and food advertising and promotions and prevalence of fast-food outlets(Reference Hilton, Patterson and Teyhan31,Reference Atanasova and Koteyko55) . The work conducted by Busam and Solomon-Moore(Reference Busam and Solomon-Moore48), who analysed childhood obesity coverage in the media between 2015 and 2020, showed a single exception in the media framing. They identified environmental causes as the primary drivers covered (indicating a focus on societal responsibility), followed by individual lifestyles and biological and medical factors.
The framing of responsibility for poor diets and diet-related conditions differed by the type of newspaper. This finding is particularly important when considering different reader groups. Left-wing broadsheets (The Guardian, The Independent) and left-wing tabloids (Mirror) emphasised the role of the government, food industry and health authorities more than right-leaning broadsheets (Telegraph, Times) and right-wing tabloids (Express, Daily Mail, The Sun), which stressed how citizens can modify their individual behaviours and habits for a better diet and health(Reference Brookes and Baker56,Reference Elliott-Green, Hyseni and Lloyd-Williams57) . The political orientation was derived directly from the classifications provided in the identified studies that analysed news content and media coverage(Reference Hilton, Patterson and Teyhan31,Reference Brookes and Baker56) . In addition, other studies stated that individual responsibility for poor diets was stressed more in sensationalist tabloids (tend to be associated with a working-class readership) (Daily Mail Express, Sunday Mirror, The Sun). Middle-class-oriented newspapers highlighted more societal factors (Guardian, Observer, Independent and Daily Telegraph)(Reference Hilton, Patterson and Teyhan31,Reference Elliott-Green, Hyseni and Lloyd-Williams57) .
Synthesis of these data also identified that the patterns of responsibility and aetiology have changed over time(Reference Baker, Brookes and Atanasova30,Reference Hilton, Patterson and Teyhan31,Reference Brookes and Baker56) . From 1996 to 2010, the focal point shifted from individual to societal responsibility(Reference Hilton, Patterson and Teyhan31). However, that trend has not been sustained. According to more recent research, discussion of food industry responsibility has diminished in the news over time, and obesity has been debated less as a political issue(Reference Baker, Brookes and Atanasova30). Also, the identified studies did not explore news related directly to disadvantaged groups.
Framing of responsibility in UK government policy
Five articles critically examined the language, framing and narratives used in official UK government policy documents concerning poor diets and associated health consequences among the population. The key finding was that all policy initiatives have predominantly focused on persuading individuals to modify their lifestyle choices and behaviours to reduce their personal health risks, especially through diet changes(Reference Attree49,Reference Brookes58,Reference Ulijaszek and McLennan59,Reference Griffin, Phillips and Hillier-Brown78,Reference Piggin79) , reflecting individual responsibility framing.
Early policy documents (late 20th century/early 21st century) like Saving Lives: Our Healthier Nation (1999) or a report by the Controller and Auditor General (head of the National Audit Office) (2001) framed obesity as a societal issue targeting the individual consumer as the agent of change(Reference Ulijaszek and McLennan59), emphasising individual responsibility. Later initiatives, such as Tackling Health Inequalities: A Programme for Action (2003), Choosing Health (2004) and Healthy Start (2004), positioned the government’s role as facilitating greater consumer understanding of healthy food choices(Reference Attree49). This notion of individual responsibility extended beyond those with health issues to family members like parents. Four of the five articles(Reference Attree49,Reference Brookes58,Reference Griffin, Phillips and Hillier-Brown78,Reference Piggin79) showed framing included parental responsibility for moderating children’s food advertising exposure(Reference Brookes58), acting as role models for healthy behaviours(Reference Attree49,Reference Piggin79) or providing nutritional information for parents to make healthier food purchases(Reference Griffin, Phillips and Hillier-Brown78).
Over time, some attempts to acknowledge the importance of external factors of poor diets and diet-related conditions were incorporated into UK government policies, indicating limited recognition of societal responsibility. However, these policies continued to focus on individuals as responsible for poor diets and diet-related conditions without adequately addressing wider environmental or contextual determinants. The following are some key policy developments, though it is not an exhaustive list of all policies during this period. For example, while the House of Commons Health Committee report on obesity (2004) recognised the influence of food industry marketing on children, it still targeted individual consumers and parental responsibility as key to making healthier food choices(Reference Ulijaszek and McLennan59). The Choosing Health: Making Healthy Choices Easier (2004) policy recognised the industry’s role in educating consumers on a healthy diet, and it committed to future partnerships with food companies to promote this educational effort. Finally, Tackling Obesities: Future Choices (2007) reframed obesity as a complex issue requiring system approaches, yet still positioned the individual at the heart of the aetiology and mainly responsible for obesity(Reference Ulijaszek and McLennan59).
Subsequent programmes like Change4Life (2009) (Reference Ulijaszek and McLennan59,Reference Piggin79) , which were oriented towards encouraging children and their parents to live healthier lives(Reference Piggin79), acknowledged the relational nature of obesity and provided educational materials to ‘facilitate’ better lifestyle choices but maintained that rational citizens should take the core action to change(Reference Ulijaszek and McLennan59), reinforcing individual responsibility framing. A broader policy response was initiated in Tackling Obesity: Empowering Adults and Children to Live Healthier Lives (2020), which included environmental measures like calorie labelling in restaurants and a renewed commitment to advertising restrictions. However, much of the framing still emphasised ‘modifiable’ obesity resulting from poor personal choices (which require having information and knowledge)(Reference Brookes58,Reference Griffin, Phillips and Hillier-Brown78) .
Some of these documents provided limited information that applied to the needs of underserved groups, only referring to health inequalities and socio-economically disadvantaged groups in very few documents(Reference Attree49,Reference Ulijaszek and McLennan59,Reference Griffin, Phillips and Hillier-Brown78) . For example, Saving Lives: Our Healthier Nation (1999) attributed lower socio-economic groups’ unhealthy eating to individuals’ attitudes and deficiencies in knowledge. Recently, Griffin et al. (Reference Griffin, Phillips and Hillier-Brown78) criticised the Childhood obesity: a plan for action (2016, 2018 and 2020) initiative for promoting healthier food choices through nutritional labelling without considering food insecurity and poverty issues like food affordability, food bank usage or energy costs of preparing food(Reference Griffin, Phillips and Hillier-Brown78).
Discussion
This scoping review systematically synthesised how responsibility for poor diets and obesity is framed across three different sectors in the UK, paying particular attention to how groups experiencing disadvantage are represented. To our knowledge, this study brings new significant insights, extending previous single-domain framing of responsibility reviews(Reference Temmann, Wiedicke and Schaller28,Reference Attree49) by providing the first comprehensive picture of responsibility narratives across three main arenas to which people are exposed in their everyday life and that influence people’s perceptions of responsibility for poor diets: public discourse, media coverage and policy domains.
Our findings showed that the responsibility for poor diet and obesity is positioned on individuals, with the exception of the left-wing media, which positioned commercial and environmental factors as key drivers of individual behaviour, which should be addressed through government legislation. The studies selected suggested that more recent government policies have included strategies to address some obesogenic drivers, but these are positioned alongside the ongoing narrative that individuals must take stronger action to improve their dietary choices. Specific reference to groups experiencing disadvantage was rarely made but suggested that individuals experiencing disadvantage require more nutrition education and skills to enact healthier food practices.
Studies examining public perceptions of drivers of food choice showed a multifaceted understanding of the issue, acknowledging both personal and environmental factors. Individual responsibility, however, was emphasised more consistently as the main cause of poor diets, with factors such as a lack of willpower, nutrition knowledge, cooking skills or self-control commonly identified. This finding aligns with previous review results on public perceptions of responsibility for obesity(Reference Pitt, Gallegos and Comans81,Reference Paes, Ong and Lakshman82) . Environmental influences, including limited income, food costs, time constraints due to competing demands (e.g. childcare and work schedules), unhealthy food marketing strategies and widespread unhealthy food availability and accessibility, were also acknowledged in the synthesis and are consistent with existing scientific evidence(Reference Pitt, Gallegos and Comans81,Reference Ravikumar, Spyreli and Woodside83–Reference Larson and Story88) . Studies focusing on groups that experience socio-economic disadvantage particularly highlighted personal factors as the most important driver, while family influences, income and food prices were identified as the most important environmental determinants.
Studies analysing media (press) revealed similar patterns of individual responsibility dominating the narrative. Right-leaning, middle-market and sensationalist newspapers particularly highlighted the need for individual lifestyle changes to address poor diets and diet-related health conditions. In contrast, left-wing newspapers placed more emphasis on the role of the food industry and the government. This pattern differs from that in the European media, with German coverage on sugar taxation showing considerably less focus on individual responsibility than in the UK(Reference Moerschel, von Philipsborn and Hawkins89), suggesting that responsibility framing may be culturally situated within political-economic systems. Also, the differences between various types of press outlets suggest that readers are likely to receive different messages about who is responsible for poor diets based on their choice of newspaper. This finding has significant implications, especially for families experiencing socio-economic disadvantage who may have greater exposure to tabloid right-leaning newspapers. These newspapers tend to present obesity and poor diet primarily as individual issues, rarely discussing structural or environmental causes. As a result, readers of these publications may be less likely to support or demand systemic solutions to diet-related health problems(Reference Hilton, Patterson and Teyhan31).
Studies analysing UK government policies consistently frame citizens as holding responsibility for making healthier food choices because such choices can be made rationally and logically. Despite some attempts to recognise environmental drivers over recent years, policies typically focus on providing information and education rather than addressing external factors. This ‘call to action’ approach burdens individuals with the responsibility to modify their dietary practices(90) and may reflect industry influence in policy decision-making(Reference Ulucanlar, Lauber and Fabbri12–Reference van de Goor, Hämäläinen and Syed16,Reference Lelieveldt91) . The narratives in government and media documents likely reflect decades of conservative dominance and neoliberal economic policies that emphasise personal choice while minimising state intervention in social issues(Reference Brookes58). The policy studies also showed little emphasis on health inequalities, though when mentioned, the narrative of individual responsibility was identified. The emphasis on individual responsibility and efforts to provide more lifestyle information to groups experiencing socio-economic disadvantage is unrealistic, unfair and insufficient to prompt meaningful behaviour change with concurrent efforts to address the environmental determinants of dietary inequalities. Citizens experiencing socio-economic disadvantage lack sufficient financial means and face life circumstances, such as irregular work and shift patterns, which limit their capacity to enact the lifestyle changes they are being implored to make(Reference Brookes and Baker56).
Our analysis revealed temporal patterns in responsibility framing across mass media (press) and government policies. While not an initial research focus, these chronological variations emerged as noteworthy findings. Mass media (press) framing shifted from individual responsibility to greater emphasis on societal responsibility from 1996 to 2010. Similarly, the framing within government policy evolved from targeting individual behaviour to approaches that, while still emphasising personal responsibility, increasingly acknowledged environmental influences on dietary choices. Studies exploring public perception spanning 2002–2023 show persistent complexity in how responsibility for food choices is attributed, with no clear pattern emerging. Notably, our analysis revealed a striking scarcity of content addressing socio-economically disadvantaged populations across all three domains. Despite our focus on identifying how these groups are represented within responsibility frames, relevant content was limited in both quantity and depth. This absence constitutes an important finding, suggesting that disadvantaged populations remain largely invisible in mainstream diet responsibility discussions, despite bearing a disproportionate burden of diet-related diseases.
Implications for practice and future research
These findings have significant implications for clarifying the disconnect between scientific evidence and public policy support. Our findings provide crucial evidence of the dominance of individual responsibility narratives across all three domains, which is particularly concerning given that individual responsibility frames effectively reduce public support for health policies(Reference Temmann, Wiedicke and Schaller28). This cross-domain consistency may create strong barriers to policy support, as citizens receive reinforcing messages about individual blame from multiple influential sources simultaneously. Despite robust evidence demonstrating that environmental and commercial factors are primary drivers of poor diets(Reference Ulucanlar, Lauber and Fabbri12,Reference Ulucanlar, Fooks and Gilmore13) , shifting public opinion towards supporting structural interventions will require coordinated efforts across multiple spheres of influence rather than targeting any single domain.
Participatory approaches with citizens, particularly those experiencing disadvantaged circumstances(Reference Pitt, Gallegos and Comans81,Reference Paes, Ong and Lakshman82) , could provide valuable insights into the root causes of poor diets and develop interventions that align with their lived experiences(Reference Milburn92). Individuals with lived experience can provide relevant insights into the systematic barriers and social injustices perpetuated by governments(Reference Knai, Petticrew and Mays93), mass media(Reference Nimegeer, Patterson and Hilton94) and the food industry itself(Reference Black, Moon and Baird95), potentially encouraging these powerful structures to consider meaningful change(Reference Benford and Snow96). Examples include the youth-led movement Bite Back, which empowers young people to confront the junk food industry through media engagement and parliamentary advocacy; this organisation aims to drive policy changes towards a healthier food environment for young people in England(97). Another example is The Food Conversation, the UK’s largest-ever citizen deliberation on food systems, where people engage with government, business and civil society leaders to suggest interventions addressing system leadership, collaboration, power imbalances, farming fairness and local area potential(98).
The disconnect between scientific evidence and public perception warrants further investigation. Future research should examine the interrelationships between media framing, public opinion and policy development to explore whether these domains operate as mutually reinforcing systems. Priority areas include investigating mechanisms through which food industry actors shape responsibility narratives across domains, using methods such as interviews with citizens, media professionals and commercial sector representatives to better understand these dynamics. This review is a precursor to a future primary qualitative study on public perceptions. Systems mapping with local and national authorities could identify intervention points addressing commercial determinants influencing food practices. Also, implementation studies should examine whether strategic communication approaches can effectively shift public understanding towards greater recognition of societal factors and whether they can build support for structural policies that address the root causes of poor diets(Reference Reynolds, Vasiljevic and Pilling99).
Study strengths and limitations
This scoping review makes several novel contributions to understanding responsibility framing for poor diets. First, it provides the first systematic synthesis of responsibility framing across multiple domains (public perceptions, mass media and policy) in the UK context. This complete picture demonstrates cross-domain consistency in responsibility framing patterns (revealing consistent individual responsibility emphasis despite evidence of societal drivers) that may help explain barriers to evidence-based policy implementation. Second, it demonstrates a methodological approach for systematically analysing implied responsibility attributions from studies examining multiple factors influencing food choices, thereby broadening the scope of evidence that can inform responsibility framing research. Third, it identifies significant gaps in the representation of disadvantaged groups in this research area, despite their disproportionate burden of diet-related disease.
This review has some limitations. First, it included only peer-reviewed literature, omitting perspectives of non-government or civil society organisations that actively advocate for stronger government policy to curb unhealthy commercial practices. Second, all included articles were UK-based. Including research from countries with similar food environments, such as the USA, could have provided further insights. Third, excluding other stakeholder groups (e.g. healthcare professionals, policymakers) may have missed relevant information. Fourth, our search may have missed studies using alternative terminology for responsibility framing, such as ‘blame’, ‘attribution’, ‘accountability’, ‘culpability’ or ‘agency’. Fifth, our analysis of mass media was limited to newspapers, potentially missing important framing perspectives from non-print media, which are increasingly central to public discourse but appear underrepresented in peer-reviewed literature examining responsibility framing for poor diets. Sixth, a significant limitation of this study relates to our interpretive approach to responsibility attribution. While some included studies directly examined responsibility for poor diets, others investigated factors influencing food choices without explicitly addressing responsibility. For these studies, we applied an interpretive framework to infer responsibility attributions from how factors were framed (e.g. interpreting high food costs as indicating societal responsibility). However, this approach has three key limitations: participants or authors may describe barriers without assigning blame; when external factors are identified, the target of responsibility attribution may vary (e.g. food industry, government policies or economic systems more broadly) in ways that our analysis did not capture; and therefore, our interpretive judgments may not accurately reflect the actual responsibility attributions. Despite these limitations, this review provides a valuable synthesis of evidence on responsibility framing for poor diets in the UK. Future research should incorporate a wider range of sources (e.g. the content of web pages of professional bodies and charities related to obesity and policy databases), expand the geographical scope and explore the perspectives of other stakeholders.
Conclusions
This scoping review reveals that across the domains of the public, mass media (press) and government policies, poor diet and obesity are almost consistently framed as being an individual responsibility in the UK. While the social and environmental determinants of food choices are acknowledged to some extent, narratives persistently centre on individual responsibility, obscuring the powerful influence of food manufacturers and retailers and the role of government in providing safe, healthy environments for all. There is an urgent need to challenge and reframe this narrative on individual responsibility. The public health nutrition community can and should collectively work towards forcing a radical shift in public, media and policy framing to incite strong regulatory action by governments. Effectively addressing the root causes of diet-related health inequalities will require policymakers to abandon their neoliberal ideology and implement mandatory regulatory frameworks that set standards for commercial practices. Such action would prioritise the health and well-being of all members of society, particularly those most impacted by the burden of poor diets and diet-related diseases.
Supplementary material
The supplementary material for this article can be found at https://doi.org/10.1017/S1368980025101079
Acknowledgements
We want to thank Paula Sands, Research Engagement Librarian for the Faculty of Medicine of the University of Southampton, for her support to design the literature search strategy.
Financial support
This work is funded by the National Institute for Health Research Applied Research Collaboration Wessex.
Competing interests
There are no conflicts of interest.
Authorship
N.S-F. contributed to the conception, design and planning of the article; undertook the literature search, screening, extraction and synthesis of data; interpreted the findings; drafted the original article; and was responsible for the final manuscript. L.E. collaborated closely with N.S-F. on the conceptualisation, design, planning and time management at the project’s outset and also assisted in the overall conception of the article, contributed to maintaining methodological rigour and enhancing the clarity and coherence of the manuscript, revised the work critically for important intellectual content and edited the article. C.V. provided subject matter expertise; assisted in the conception, design and planning of the research; contributed to maintaining methodological rigour and enhancing the clarity and coherence of the manuscript; revised the work critically for important intellectual content; and edited a significant part of the article. J.B. provided subject matter expertise; assisted in the conception, design and planning of the research; contributed to maintaining methodological rigour and enhancing the clarity and coherence of the manuscript; revised the work critically for important intellectual content; and edited the article. N.T. contributed to the screening process, contributed to maintaining methodological rigour and enhancing the clarity and coherence of the manuscript and edited the article. M.C.P. assisted in the conception, design and planning of the research, contributed to maintaining methodological rigour and enhancing the clarity and coherence of the manuscript, revised the work critically for important intellectual content and edited the article. All authors gave final approval of the version to be published.
Ethics of human subject participation
Not applicable.
Open access
