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Issue Poor nutrition is a leading contributor to ill health worldwide. WHO recommends restrictions on the marketing of unhealthy food to children to reduce intakes of energy-dense, nutrient-poor foods. In Canada, the government made this a mandate commitment. This provides an opportunity for other countries pursuing public health nutrition policy to better understand and overcome commercial interests when trying to advance public health. Background Heart &amp; Stroke Foundation (H&amp;S) advocated for over a decade (2008-2019) to secure government policies to restrict food marketing to youth in Canada. The inclusion of such policy in the government's 2015 mandate was promising and the associated bill was one of the strongest in the world - well received by public health advocates worldwide, positioning Canada as global leader. However, the commercial interests of various stakeholders including food and marketing industries created concerns among policy makers. Public health advocates underestimated the influence, power and opposition of industry. Results In order to counter industry opposition, the public health community worked in coalitions and employed a range of innovative tactics to mitigate policy concerns. This included public engagement on social media, evidence generation, celebrity endorsement, as well as calling out industry practices and political blockers. Despite the innovative and collaborative approach of public health, the policy failed to be adopted. Lessons Food industry will use a range of concerns including economic, environmental, and health issues to generate skepticism among policy makers. Public health advocates working in nutrition need to be proactive and prepared with insightful counter arguments and evidence to dispel myths and re-frame the issue. Key messages Public health progress on nutrition policy is at an early stage and we need to learn lessons from successes and failures. There is a strong amount of food industry opposition to public health nutrition policy.

The kids are not alright: Lessons from the advocacy pursuit of restrictions on food marketing