Major sticking points have been the inclusion of advice that countries recommend limits on sugar intake and a reference in the strategy document that taxes and subsidies are, and could be, used to encourage healthier eating and exercise habits.
A mention that food and agricultural policies should be consistent with the protection and promotion of public health has also raised concerns for some countries.
A senior Brazilian official confirmed that Brazil plans to propose changes to the strategy document's language that address sugar limits and agricultural policies, but said the intention was to finesse the wording so that other developing countries become more comfortable with it. They seek approval of the strategy, not to derail it, said the official, speaking on condition of anonymity.
However, health advocates fear that the suggested changes will reopen the entire document to discussion and that the ministers will opt for more in-depth analysis of the text and its resolution will be stalled.
"It seems to me that the strategy is unraveling," said Dr. Philip James, head of the International Obesity Task Force, a coalition of obesity scientists and advocates pushing for the adoption of the global strategy. "If this doesn't go through, the world will be a lot worse off."
Speaking on the fringes of the annual meeting of the governing body of the World Health Organization, James said the heads of several delegations have shared their concerns with him.
"Many of the developing country ministers believe that the problem of diabetes and heart disease and so on is not really an issue for them compared with the agonies of malnutrition and HIV," said James.
"They also think that this strategy has been developed by the Western world and that the sugar component has been inserted in such a way that the countries that are going to be most damaged are the poorest countries and that one of their major sources of income is going to be taken away from them."
"We are seeing that there are blocs forming, with the Latin American bloc being led by Cuba and Brazil. The Sub-Saharan African countries are being dominated by the southern Africa groups that are extremely concerned about malnutrition.
Brazil, one of the world's largest sugar producers, is coordinator of the Group of 77 developing countries.
"My guess is that there's going to be enormous chaos with the African, Caribbean and sugar-producing Latin American countries opposing, with Asia being fractured in its support," James said.
Meanwhile, two influential industry groups weighed in Tuesday with their support for the adoption of the strategy.
The Grocery Manufacturers of America and the Confederation of the Food and Drink Industries of the European Union, called it an important step forward in improving nutrition, promoting physical activity and combating obesity worldwide.
James said it was early complaints by the United States that set off the current objections.
The United States submitted comments to the WHO executive board in January arguing that the science underpinning the strategy was flawed and should be thrown out and that personal responsibility for health was the way to address the issue.
"They may have been testing the waters," said Dr. Derek Yach, who spearheaded the development of the strategy at the WHO. "I think they had a try, saw that it didn't have the support of their major partners — the EU, the Canadians, the Australians _" and have since backed off and declared their support for the strategy.
The U.S. delegation on Tuesday called the strategy, as now drafted, a "sound blueprint for action for all of us."