Television food advertising to children: nature, extent and potential consequences

Background: Experimental studies have shown that exposure to food advertising on television can affect children’s food preferences, choices and consumption in the short-term. However, little is known about the role of habitual television viewing (and therefore food advert exposure) and its potential relationship with brand awareness, brand requests, food preferences and weight status in children. The published research examining the UK television food advertising landscape also has a number of limitations that restrict its usefulness in assessing the potential influence of such food promotion on children’s diets. The current thesis used innovative methodologies to examine hypotheses arising from these issues in 6-13 year old children and on the UK television channels most popular with this age group. Key Findings: Effects of acute, experimental food advertising exposure (Chapter 3): Relative to toy advertisement exposure, food advertising exposure increased all children’s selection of branded and non-branded fat and carbohydrate items from food preference measures. No weight status differences in food preferences or response to advertising were found. Preferences for branded food items were particularly enhanced in high TV viewing children following food adverts suggesting that these children may have an increased susceptibility to these messages. However, all children were better able to recognise food adverts than toy adverts. Effects of habitual food advertising exposure (Chapters 3-5): Food preference differences between high and low TV viewers were evident in the absence of experimental television food advertising exposure in Chapters 4 and 5. All children were better able to correctly identify product names from brand character stimuli than vice versa. Higher habitual advertising exposure did not confer a greater ability to recognise food advertisements (Chapter 3) nor identify brand characters or products. Children with greater brand awareness did not display greater self-reported preferences for branded food items. The extent of food advertising on UK television (Chapter 6): Food advertising on television varied across channels, channel types, broadcast platforms, viewing times and recording periods (months of the year). The foods advertised on the channels most popular with young people were predominantly unhealthy items, even during periods when large numbers of children are watching, with promotions for healthy foods comprising less than a fifth of all food advertisements. The nature of food advertising on UK television (Chapter 6): Promotional characters (such as brand equity characters, licensed characters and celebrities) were often used to promote unhealthy foods to young people, although their use to promote healthier food items was greatest on dedicated children’s channels. Food adverts aimed at children principally rely on ‘fun’ as a key attribute of both the advertising experience and the use/consumption of the product. Food brand websites were most likely to be promoted during food adverts aimed at teenagers or adults. Implications: This thesis increases understanding of the effects of habitual food advertising exposure on food preferences and food preference responses to acute, experimental food advertising, in addition to providing a comprehensive assessment of the television food advertising landscape in the UK following regulatory reform

Evaluating implementation of the WHO set of recommendations on the marketing of foods and non-alcoholic beverages to children: Progress, challenges and guidance for next steps in the WHO European Region

This paper describes the status of the implementation of the WHO Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children (2010). The Set of Recommendations, adopted by the World Health Assembly, urges Member States to reduce the impact on children of the marketing of energy-dense, highly processed foods and beverages that are high in saturated fats, trans fats, free sugars and/or salt (HFSS). A growing body of independent monitoring and research indicates that existing policies and regulations are markedly insufficient to address the continuing challenges in this field. This report identifies loopholes, ongoing challenges, and factors that Member States need to consider to effectively limit the harmful impact that HFSS food marketing has on children, their health and their rights. Policies and regulations tend to use narrow definitions and criteria (they frequently apply to pre-digital media only, to younger children and not to adolescents, and to “child-directed” media, rather than those with the greatest child audiences), and they almost never address the complex challenges of crossborder marketing. This situation can be explained, in part, by the strong scrutiny and opposition that countries have faced from parts of the private sector, and by weak self-regulatory schemes. As a result, and in order to ensure that States uphold their legal obligations to protect the child’s right to health and related rights, the World Health Assembly requested that WHO provides additional technical support to Member States in implementing the Set of Recommendations. This report identifies challenges States need to address

The role of lipid and carbohydrate digestive enzyme inhibitors in the management of obesity: a review of current and emerging therapeutic agents

Obesity is a global epidemic associated with significant morbidity and mortality in adults and ill health in children. A proven successful approach in weight management has been the disruption of nutrient digestion, with orlistat having been used to treat obesity for the last 10 years. Although orlistat-induced weight loss remains modest, it produces meaningful reductions in risk factors for obesity-related conditions such as diabetes and cardiovascular disease. Moreover, this lipase inhibitor is free of the serious side effects that have dogged appetite-suppressing drugs. This success had driven investigation into new generation nutraceuticals, supplements and pharmaceutical agents that inhibit the breakdown of complex carbohydrates and fats within the gut. This review focuses on agents purported to inhibit intestinal enzymes responsible for macronutrient digestion. Except for some synthetic products, the majority of agents reviewed are either botanical extracts or bacterial products. Currently, carbohydrate digestion inhibitors are under development to improve glycemic control and these may also induce some weight loss. However, colonic fermentation induced side effects, such as excess gas production, remain an issue for these compounds. The α-glucosidase inhibitor acarbose, and the α-amylase inhibitor phaseolamine, have been used in humans with some promising results relating to weight loss. Nonetheless, few of these agents have made it into clinical studies and without any clinical proof of concept or proven efficacy it is unlikely any will enter the market soon

Towards effective restriction of unhealthy food marketing to children: unlocking the potential of artificial intelligence

The World Health Organization recommends that member states enact policies to limit unhealthy food marketing to children. Chile enacted relatively stringent laws that restrict unhealthy food marketing to children in two phases, beginning in 2016. Dillman-Carpentier and colleagues examined the incremental effectiveness of the first and second phases of Chile's policy in limiting children's exposure to unhealthy food marketing on television relative to pre-policy. Banning advertisements for all 'high-in' products (i.e., those that exceeded thresholds for energy, saturated fats, sugars and/or sodium) during the daytime (phase 2) was more effective in reducing children's exposure to unhealthy food marketing on television than only banning 'high-in' marketing during programs with large child audiences (phase 1). These findings underscore the importance of implementing comprehensive policies that reduce children's exposure to all marketing for unhealthy foods-not simply that which targets them directly-to better protect them from its negative impacts. However, although policies in Chile and other nations have reduced children's exposure to unhealthy food marketing in broadcast media, it is not clear whether such policies have meaningfully reduced children's overall food marketing exposures. This is partly due to the challenges of studying children's digital food marketing exposures, which are an increasingly important source of unhealthy food marketing. To address these methodologic gaps, several research teams are developing artificial intelligence (AI)-enabled systems to assess food marketing to children on digital media and support efforts to monitor compliance with policies that restrict this marketing. These and other AI systems will be essential to comprehensively and systematically study and monitor food marketing to children on digital media internationally and at scale

Tackling food marketing to children in a digital world: trans-disciplinary perspectives. Children’s rights, evidence of impact, methodological challenges, regulatory options and policy implications for the WHO European Region

There is unequivocal evidence that childhood obesity is influenced by marketing of foods and non-alcoholic beverages high in saturated fat, salt and/or free sugars (HFSS), and a core recommendation of the WHO Commission on Ending Childhood Obesity is to reduce children’s exposure to all such marketing. As a result, WHO has called on Member States to introduce restrictions on marketing of HFSS foods to children, covering all media, including digital, and to close any regulatory loopholes. This publication provides up-to-date information on the marketing of foods and non-alcoholic beverages to children and the changes that have occurred in recent years, focusing in particular on the major shift to digital marketing. It examines trends in media use among children, marketing methods in the new digital media landscape and children’s engagement with such marketing. It also considers the impact on children and their ability to counter marketing as well as the implications for children’s rights and digital privacy. Finally the report discusses the policy implications and some of the recent policy action by WHO European Member States

See, Like, Share, Remember: Adolescents’ Responses to Unhealthy-, Healthy- and Non-Food Advertising in Social Media

Media-saturated digital environments seek to influence social media users’ behaviour, including through marketing. The World Health Organization has identified food marketing, including advertising for unhealthy items, as detrimental to health, and in many countries, regulation restricts such marketing and advertising to younger children. Yet regulation rarely addresses adolescents and few studies have examined their responses to social media advertising. In two studies, we examined adolescents’ attention, memory and social responses to advertising posts, including interactions between product types and source of posts. We hypothesized adolescents would respond more positively to unhealthy food advertising compared to healthy food or non-food advertising, and more positively to ads shared by peers or celebrities than to ads shared by a brand. Outcomes measured were (1a) social responses (likelihood to ‘share’, attitude to peer); (1b) brand memory (recall, recognition) and (2) attention (eye-tracking fixation duration and count). Participants were 151 adolescent social media users (Study 1: n = 72; 13−14 years; M = 13.56 years, SD = 0.5; Study 2: n = 79, 13−17 years, M = 15.37 years, SD = 1.351). They viewed 36 fictitious Facebook profile feeds created to show age-typical content. In a 3 × 3 factorial design, each contained an advertising post that varied by content (healthy/unhealthy/non-food) and source (peer/celebrity/company). Generalised linear mixed models showed that advertisements for unhealthy food evoked significantly more positive responses, compared to non-food and healthy food, on 5 of 6 measures: adolescents were more likely to wish to ‘share’ unhealthy posts; rated peers more positively when they had unhealthy posts in their feeds; recalled and recognised a greater number of unhealthy food brands; and viewed unhealthy advertising posts for longer. Interactions with sources (peers, celebrities and companies) were more complex but also favoured unhealthy food advertising. Implications are that regulation of unhealthy food advertising should address adolescents and digital media

Beyond-brand effect of television food advertisements on food choice in children: The effects of weight status

Copyright © The Authors 2007.Objective - To investigate the effect of television food advertising on children’s food intake, specifically whether childhood obesity is related to a greater susceptibility to food promotion. Design - The study was a within-subject, counterbalanced design. The children were tested on two occasions separated by two weeks. One condition involved the children viewing food advertisements followed by a cartoon, in the other condition the children viewed non-food adverts followed by the same cartoon. Following the cartoon, their food intake and choice was assessed in a standard paradigm. Setting - The study was conducted in Liverpool, UK. Subjects - Fifty-nine children (32 male, 27 female) aged 9–11 years were recruited from a UK school to participate in the study. Thirty-three children were normal-weight (NW), 15 overweight (OW) and 11 obese (OB). Results - Exposure to food adverts produced substantial and significant increases in energy intake in all children (P < 0·001). The increase in intake was largest in the obese children (P = 0·04). All children increased their consumption of high-fat and/or sweet energy-dense snacks in response to the adverts (P < 0·001). In the food advert condition, total intake and the intake of these specific snack items correlated with the children’s modified age- and gender-specific body mass index score. Conclusions - These data suggest that obese and overweight children are indeed more responsive to food promotion, which specifically stimulates the intake of energy-dense snacks.University of Liverpoo

The impact of exposure to cartoons promoting healthy eating on children's food preferences and choices

Objective: This study explored whether a cartoon show with healthy eating messages positively affected children's food choices and food preferences.Design: Experimental between-subjects design.Setting: Four elementary schools in Portugal were investigated.Participants: Children (aged 4-8 years; n = 142) were randomly assigned to 1 of 2 groups: a comparison group (n = 73) was exposed to cartoons with no reference to food and an intervention group (n = 69) was exposed to cartoons with healthy eating messages. After viewing, each child was given the opportunity to eat ad libitum for 10 minutes from a small selection of snack foods.Main Outcome Measure: Number of healthy and unhealthy food items chosen. Food preferences were measured using an adapted version of the Leeds Food Preference Checklist.Analysis: Generalized linear models were used to test for differences between groups. Results were considered significant at P <= .05.Results: Children in the experimental group chose significantly more healthy food items than did those in the comparison group (B = -.600; SE = .19; P < .05).Conclusions and Implications: Future studies may address the effect of prolonged exposure to healthy eating cartoons. Cartoons can be used to promote healthy food choices and can be a part of health promotion campaigns.This research was partially supported by Fundacao para a Ciencia e Tecnologia through a European Union COMPETE program grant to Eva Conceicao (IF/01219/2014), and a postdoctoral scholarship (SFRH/BPD/94490/2013) to Ana Rita Vaz, cofinanced by FEDER under the PT2020 Partnership Agreement (UID/PSI/01662/2013) and the project PTDC/MHC-PCL/4974/2012. This research was supported, in part, by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology, and Higher Education through national funds and cofinanced by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). The authors would like to thank Nutri Ventures for adapting the episodes for the research purposes. They would also like to thank Ana Rito for her suggestions regarding the study protocol

A deep learning approach to identify unhealthy advertisements in street view images

While outdoor advertisements are common features within towns and cities, they may reinforce social inequalities in health. Vulnerable populations in deprived areas may have greater exposure to fast food, gambling and alcohol advertisements, which may encourage their consumption. Understanding who is exposed and evaluating potential policy restrictions requires a substantial manual data collection effort. To address this problem we develop a deep learning workflow to automatically extract and classify unhealthy advertisements from street-level images. We introduce the Liverpool 360 ∘ Street View (LIV360SV) dataset for evaluating our workflow. The dataset contains 25,349, 360 degree, street-level images collected via cycling with a GoPro Fusion camera, recorded Jan 14th–18th 2020. 10,106 advertisements were identified and classified as food (1335), alcohol (217), gambling (149) and other (8405). We find evidence of social inequalities with a larger proportion of food advertisements located within deprived areas and those frequented by students. Our project presents a novel implementation for the incidental classification of street view images for identifying unhealthy advertisements, providing a means through which to identify areas that can benefit from tougher advertisement restriction policies for tackling social inequalities. © 2021, The Author(s)

A deep learning approach to identify unhealthy advertisements in street view images

While outdoor advertisements are common features within towns and cities, they may reinforce social inequalities in health. Vulnerable populations in deprived areas may have greater exposure to fast food, gambling and alcohol advertisements encouraging their consumption. Understanding who is exposed and evaluating potential policy restrictions requires a substantial manual data collection effort. To address this problem we develop a deep learning workflow to automatically extract and classify unhealthy advertisements from street-level images. We introduce the Liverpool 360 degree Street View (LIV360SV) dataset for evaluating our workflow. The dataset contains 26,645, 360 degree, street-level images collected via cycling with a GoPro Fusion camera, recorded Jan 14th -- 18th 2020. 10,106 advertisements were identified and classified as food (1335), alcohol (217), gambling (149) and other (8405) (e.g., cars and broadband). We find evidence of social inequalities with a larger proportion of food advertisements located within deprived areas, and those frequented by students and children carrying excess weight. Our project presents a novel implementation for the incidental classification of street view images for identifying unhealthy advertisements, providing a means through which to identify areas that can benefit from tougher advertisement restriction policies for tackling social inequalities