In the context of NCD prevention, reformulation means reducing the salt, sugar, fat, or overall calorie content of processed foods. Reformulation has the potential to be a powerful public health intervention, because it involves making changes to unhealthy foods upstream in the food supply: improving population diets without individual consumers needing to change their behaviour. However, questions remain as to which regulatory approaches will be most effective at spurring the food industry to reformulate. The prevailing view has been that governments should persuade and encourage companies to reformulate ‘voluntarily’. However, there is emerging evidence that the most effective voluntary reformulation schemes are those with a high degree of government involvement, monitoring and oversight. This suggests that mandatory reformulation — ie, the highest degree of government involvement, through legislated mandatory nutrient limits — may well be a promising approach. While voluntary reformulation has wide support, it is criticised for being weak, ineffective and open to regulatory capture. Mandatory reformulation offers the possibility of a stronger regulatory approach and a level playing field for industry, but critics are wary of its impact on free choice. Mandatory nutrient limits may also constitute technical barriers to trade. This article considers food reformulation as a policy goal, before exploring these regulatory options and the criticisms of each. 

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