Increasing rates of overweight, obesity, and related metabolic diseases documented among refugee communities across the United States necessitate greater attention to how processes of integration impact refugee health. These nutritional health trends (e.g., increasing rates of obesity) suggest potential disconnects between refugees' past environments and their conditions after re-settlement, which may contribute to adverse changes in energy balance (diet and exercise). While Bhutanese refugees were among the largest refugee groups entering the US during the five years leading up to this research, very few studies have examined how they have responded to integration and the impact of this transition on their health. Grounded in human adaptability and political economic theories, and adopting a biocultural approach, this dissertation investigates how Bhutanese refugees in “Prospect City” (pseudonym) negotiate changing and unfamiliar structural and sociocultural conditions after resettlement and the consequences for energy balance and nutritional status. The results reveal high rates of overweight and obesity compared to US averages. Age and caste related differences in nutritional status were also found. High rates of overweight and obesity corresponded with an energy imbalance due to over consumption of energy dense traditional foods and limited understanding of the importance of regular exercise. Over consumption of energy dense traditional foods stemmed from several interrelated factors: the abundance of foods in the US, prior experiences with food deprivation, a history of political exile that reinforced desires to preserve cultural food preferences, and joint family efforts to accommodate work-related time constraints by increasing food production and availability. Decreases in exercise appeared to stem from more sedentary lifestyles in the US as a result of work environments and available transportation, coupled with a lack of health knowledge regarding health benefits of physical activity. This dissertation’s findings are being reported to Prospect City’s Bhutanese Community Organization to help develop strategies for improving nutritional health in the community.

The thesis aims to present a case for a rethinking of the paradigmatic frames underpinning food marketing control policy and research. In support of its contention, it reports on the methodological strategies, evidence outcomes and knowledge translation contributions of a series of research projects. The projects were commissioned by national and international policy makers during the period 2009-2015 in support of responsible food marketing policy development. They were conceptualised, developed and interpreted through participatory and iterative research planning processes. The research drew on theories and constructs from multiple disciplines. Public health, marketing and policy science contributed most, but information economics and management theories also informed research design and analysis and interpretation of findings. Its key generalizable findings can be summarised as follows: • The identification of a fragmented but convergent pool of evidence indicating contemporary food and beverage marketing is an interactive, dynamic phenomenon. • The identification of a fragmented but convergent pool of evidence demonstrating it significantly impacts sociocultural determinants of food behaviours. • The generation of evidence demonstrating a gap between the strategic aims of responsible marketing policy regimes and the inherent capacity of implemented interventions to constrain marketing’s food environment impacts. • The generation of evidence demonstrating that critical re-appraisal of food marketing policy research assumptions and preconceptions is a strategy supportive of policy innovation. • The generation of evidence that research intended to support real world multi-stakeholder policy development processes requires additional skills to those established and recognised as central to high quality research. These include the ability to engage with dynamic and politicised policy processes and their public communications challenges. • The generation of evidence that can inform future independent benchmark standard for responsible marketing development initiatives. • The generation of evidence that can inform future research on designing and developing policy that is ‘future proof’ and targets marketing’s sociocultural food environment impacts. Its most significant knowledge translation contributions have been: • Support for the WHO Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children (subsequently endorsed at the 2010 World Health Assembly and the 2011 United Nations General Assembly). • Participatory research contributions to the Scottish Government’s responsible marketing standard development initiative (PAS2500). • Supporting the planning and development of the Scottish Government’s Supporting Healthy Choices Policy initiative. • Knowledge exchange with policy makers and stakeholders engaged in a scoping and prioritisation initiative commissioned by the United Kingdom’s Department of Health (An analysis of the regulatory and voluntary landscape concerning the marketing and promotion of food and drink to children). • Supporting responsible marketing policy agendas targeted to the engagement of a broad mix of stakeholders in innovative policy development processes. • Supporting policy makers’ efforts to increase popular support for stronger, more effective responsible marketing policy controls. The thesis therefore aims to present evidence that the programme of research presented here has made useful and original contributions to evidence and knowledge on contemporary food marketing and its impacts on food behaviours and the food environment. It aims to build on this by demonstrating how this evidence informed and supported policy development. Through this the thesis aims to support its case that a rethinking of food marketing policy research assumptions and conceptions can expand and enrich the evidence base as well as real world policy innovation.