The hidden hand in retail: a qualitative analysis of how ultra-processed food companies shape consumer purchasing

BACKGROUND: Ultra-processed foods (UPFs) are increasingly recognized for their health harms, yet consumer selection of UPFs is strongly shaped by retail marketing strategies. Despite widespread acknowledgment of these tactics, detailed understanding of their implementation has been limited by restricted access to industry insider information. This study aimed to obtain direct, industry-based insights into the implementation of retail marketing strategies designed to influence consumer purchasing of UPFs. METHODS: We conducted 49 interviews with 27 sales representatives and distributors of major UPF companies and 22 managers of chain and independent stores. Participants provided marketing agreements, planograms, and other business files (n = 46). Using reflexive thematic analysis, we coded and analyzed the 95 documents and identified key themes. RESULTS: Findings reveal UPF manufacturers and retailers deliberately orchestrate the 4Ps-product, placement, price, and promotion-to condition predictable UPF customer selection responses. Strategies included leveraging precise sales data, embedding scripted marketing tactics in contracts, monitoring retailer compliance, refreshing store layouts to create an illusion of choice and innovation, and integrating all 4Ps simultaneously while prioritizing placement. These strategies were organized into six sub-themes across two overarching themes: Guiding Principles of 4Ps Implementation (Simultaneous use of the 4Ps, Placement as a top priority, and Keeping things fresh) and Governance and Surveillance Mechanisms to Best Execute the 4Ps (Monitoring every move, Contracts dictate the 4Ps, and Maintaining store compliance). CONCLUSIONS: Overall, UPF companies exert extensive and deliberate control over retail spaces, challenging the narrative that food and beverage purchases reflect consumer choice. Enhanced regulation of the 4Ps and counter-marketing campaigns that reveal overlooked marketing practices may mitigate UPF companies' influence on customer purchases and thus reduce their related health harms.