Effect of television advertisements for foods on food consumption in children

Food Marketing Influences Children's Attitudes, Preferences and Consumption: A Systematic Critical Review

Exposure to the marketing of unhealthy foods and beverages is a widely acknowledged risk factor for the development of childhood obesity and noncommunicable diseases. Food marketing involves the use of numerous persuasive techniques to influence children's food attitudes, preferences and consumption. This systematic review provides a comprehensive contemporary account of the impact of these marketing techniques on children aged 0-18 years and critically evaluates the methodologies used. Five electronic academic databases were searched using key terms for primary studies (both quantitative and qualitative) published up to September 2018; 71 eligible articles were identified. Significant detrimental effects of food marketing, including enhanced attitudes, preferences and increased consumption of marketed foods were documented for a wide range of marketing techniques, particularly those used in television/movies and product packaging. Together, these studies contribute strong evidence to support the restriction of food marketing to children. However, the review also signposted distinct gaps: Firstly, there is a lack of use of qualitative and physiological methodologies. Secondly, contemporary and sophisticated marketing techniques used in new media warrant increased research attention. Finally, more research is needed to evaluate the longer-term effects of food marketing on children's weight.

The effect of screen advertising on children's dietary intake: A systematic review and meta-analysis

Evidence indicates that screen advertising for unhealthy food results in significant increases in dietary intake among children. This review was undertaken with the main aim of estimating the quantitative effect of screen advertising in experimental and nonexperimental conditions on children's dietary intake. Systematic searches were undertaken of interdisciplinary databases. Studies from 1980 to April 2018, all geography and languages, were included; participants were children and adolescents aged between 2 and 18 years; the intervention was screen advertising; and the outcome was dietary intake. Meta-analyses were conducted for measured and nonmeasured outcomes. Food advertising was found to increase dietary intake among children (age range 2-14, mean 8.8 years) in experimental conditions for television (TV) advertising and advergames. Meta-analysis revealed that children exposed to food advertising on TV (11 studies) and advergames (five studies) respectively consumed an average 60.0 kcal (95% confidence interval [CI], 3.1-116.9) and 53.2 kcal (95% CI, 31.5-74.9) more than children exposed to nonfood advertising. There was also an effect by body mass index (BMI). Findings from nonexperimental studies revealed that exposure to TV food advertising was positively associated with and predictive of dietary intake in children. Short-term exposure to unhealthy food advertising on TV and advergames increases immediate calorie consumption in children.

Social Media Influencer Marketing and Children's Food Intake: A Randomized Trial

OBJECTIVES

To examine the impact of social media influencer marketing of foods (healthy and unhealthy) on children's food intake.

METHODS

In a between-subjects design, 176 children (9-11 years, mean 10.5 ± 0.7 years) were randomly assigned to view mock Instagram profiles of 2 popular YouTube video bloggers (influencers). Profiles featured images of the influencers with unhealthy snacks (participants: n = 58), healthy snacks (n = 59), or nonfood products (n = 59). Subsequently, participants' ad libitum intake of unhealthy snacks, healthy snacks, and overall intake (combined intake of healthy and unhealthy snacks) were measured.

RESULTS

Children who viewed influencers with unhealthy snacks had significantly increased overall intake (448.3 kilocalories [kcals]; P = .001), and significantly increased intake of unhealthy snacks specifically (388.8 kcals; P = .001), compared with children who viewed influencers with nonfood products (357.1 and 292.2 kcals, respectively). Viewing influencers with healthy snacks did not significantly affect intake.

CONCLUSIONS

Popular social media influencer promotion of food affects children's food intake. Influencer marketing of unhealthy foods increased children's immediate food intake, whereas the equivalent marketing of healthy foods had no effect. Increasing the promotion of healthy foods on social media may not be an effective strategy to encourage healthy dietary behaviors in children. More research is needed to understand the impact of digital food marketing and inform appropriate policy action.

Food consumption and related messages in animated comic series addressed to children and adolescents

Objective

To analyse the food content in animated comic series addressed to young audiences both in terms of the kinds of foods presented and the cues accompanying them.

Design

One hundred episodes of ten animated cartoon series with high television audience viewing (based on Average Minute Rating %) were reviewed and food items were classified into ten categories. In each episode, food cues (i.e. every mention of food, visual, oral or referring to foods consumed) was noted down and characterized as positive, negative or neutral. The rate of overall consumption and the food categories shown to be consumed were also recorded.

Setting

Greece.

Results

In ninety-four episodes one or more food cues were recorded; the total number of cues was 361, of which 209 referred to cues where food was shown or discussed and 152 referred to food items consumed. Out of the positive cues measured, almost half referred to sweets and snacks (sixty-one out of 125). Nevertheless, the majority of cues were of neutral character (n 213). Snacks, sweets and soft drinks were seen to be consumed in more episodes compared with other food categories. Moreover, in episodes where a higher frequency of food consumption was recorded, then consumption of sweets, snacks and soft drinks was significantly higher, with consumption of soft drinks often occurring in conjunction with that of snacks.

Conclusions

Food cues are present in children’s series, with an emphasis on sweets and snacks, which are projected in an attractive way, whether depicted, discussed or consumed, between cartoon characters.

Review: Trends, Safety, and Recommendations for Caffeine Use in Children and Adolescents

OBJECTIVE

Caffeine use is common in children and adolescents, but the recommendations for safe consumption are based on decades-old data collected exclusively in adults. Increased availability of caffeine-containing products and a concerted marketing effort aimed at children and adolescents, has increased interest in understanding the physiological, behavioral, and psychological effects of caffeine within this population. This manuscript provides a review of the literature concerning trends and safety of ingested caffeine in children and adolescents.

METHOD

A search of the National Library of Medicine database was conducted using the terms caffeine, children, adolescents, and safety, in addition to tailored searches on specific topics using combinations of search terms such as energy drinks, cardiovascular, mood, cognitive, mental health, sleep, and regulations.

RESULTS

The majority of the literature reviewed here suggests that typical, moderate caffeine consumption in children and adolescents is relatively safe, but that higher doses of caffeine consumption (>400 mg) can cause physiological, psychological, and behavioral harm, in particular in subgroups of children, such as those with psychiatric or cardiac conditions. More attention is being paid to the potential adverse effects of both acute and chronic caffeine use, and additional regulations surrounding the sale and marketing of highly caffeinated beverages are now being considered.

CONCLUSION

More research is needed to fill in gaps in our knowledge, including understanding the relationship between caffeine use and initiation of other substances, such as cigarettes, alcohol, or marijuana, identifying individuals at risk for caffeine toxicity, and developing harm-reduction strategies.

The prevalence and audience reach of food and beverage advertising on Chilean television according to marketing tactics and nutritional quality of products

OBJECTIVE

In the light of Chile's comprehensive new restriction on unhealthy food marketing, we analyse food advertising on Chilean television prior to the first and final phases of implementation of the restriction.

DESIGN

Content analysis of marketing strategies of 6976 advertisements, based on products' nutritional quality. Statistical analysis of total and child audience reached using television ratings data.

SETTING

Advertising from television aired between 06.00 and 00.00 hours during two random composite weeks across April-May 2016 from the four broadcast and four cable channels with the largest youth audiences.

RESULTS

Food ads represented 16 % of all advertising; 34 % of food ads featured a product high in energy, saturated fats, sugars and/or salt (HEFSS), as defined by the initial regulation. HEFSS ads were seen by more children and contained more child-directed marketing strategies than ads without HEFSS foods. If HEFSS advertising was restricted only in programmes where 20 % are children aged 4-12 years, 31 % of children's and 8 % of the general audience's HEFSS advertising exposure would be reduced. The newest 06.00-22.00 hours restriction captures 80 % of all audience exposure.

CONCLUSIONS

HEFSS advertising was seen by a large proportion of children before Chile's regulation. Chile's first implementation based on audience composition should reduce a third of this exposure and its second restriction across the television day should eliminate most of the exposure. The current study is a crucial first step in evaluating how Chile's regulation efforts will impact children's diets and obesity prevalence.

Food commercials do not affect energy intake in a laboratory meal but do alter brain responses to visual food cues in children

Food commercials promote snack intake and alter food decision-making, yet the influence of exposure to food commercials on subsequent neural processing of food cues and intake at a meal is unclear. This study tested whether exposing children to food or toy commercials altered subsequent brain response to high- and low-energy dense food cues and influenced laboratory intake at a multi-item, ad libitum meal. Forty-one 7-9-year-old children (25 healthy weight; 16 with overweight/obesity) completed five visits as part of a within-subjects design where they consumed multi-item test-meals under three conditions: no exposure, food commercial exposure, and toy commercial exposure. On the fourth and fifth visits, functional magnetic resonance imaging (fMRI) was performed while children viewed low- and high-energy dense food images following exposure to either food or toy commercials. Linear mixed models tested for differences in meal energy intake by commercial condition. A whole-brain analysis was conducted to compare differences in response by commercial condition and child weight status. Meal intake did not differ by commercial condition (p = 0.40). Relative to toy commercials, food commercials reduced brain response to high-energy food stimuli in cognitive control regions, including bilateral superior temporal gyri, middle temporal gyrus, and inferior frontal gyrus. Commercial condition * weight status interactions were observed in orbitofrontal cortex, fusiform gyrus, and supramarginal gyrus. Children with overweight/obesity showed increased response in these regions to high-energy stimuli following food commercials. Food commercial exposure affected children's subsequent processing of food cues by reducing engagement of the prefrontal cortex, a region implicated in cognitive control. Even though food commercial exposure did not increase intake at a meal, the effect of reduced prefrontal cortical engagement on a broader range of consumption patterns warrants investigation.

Changes in the nutritional quality of fast-food items marketed at restaurants, 2010 v. 2013

OBJECTIVE

To examine the nutritional quality of menu items promoted in four (US) fast-food restaurant chains (McDonald's, Burger King, Wendy's, Taco Bell) in 2010 and 2013.

DESIGN

Menu items pictured on signs and menu boards were recorded at 400 fast-food restaurants across the USA. The Nutrient Profile Index (NPI) was used to calculate overall nutrition scores for items (higher scores indicate greater nutritional quality) and was dichotomized to denote healthier v. less healthy items. Changes over time in NPI scores and energy of promoted foods and beverages were analysed using linear regression.

SETTING

Four hundred fast-food restaurants (McDonald's, Burger King, Wendy's, Taco Bell; 100 locations per chain).

SUBJECTS

NPI of fast-food items marketed at fast-food restaurants.

RESULTS

Promoted foods and beverages on general menu boards and signs remained below the 'healthier' cut-off at both time points. On general menu boards, pictured items became modestly healthier from 2010 to 2013, increasing (mean (se)) by 3·08 (0·16) NPI score points (P<0·001) and decreasing (mean (se)) by 130 (15) kJ (31·1 (3·65) kcal; P<0·001). This pattern was evident in all chains except Taco Bell, where pictured items increased in energy. Foods and beverages pictured on the kids' section showed the greatest nutritional improvements. Although promoted foods on general menu boards and signs improved in nutritional quality, beverages remained the same or became worse.

CONCLUSIONS

Foods, and to a lesser extent, beverages, promoted on menu boards and signs in fast-food restaurants showed limited improvements in nutritional quality in 2013 v. 2010.

Objectively-Measured Physical Activity and Sedentary Time are Differentially Related to Dietary Fat and Carbohydrate Intake in Children

Background: Research on the clustering of physical activity, sedentary, and dietary intake behaviors in children has relied on retrospective and parent-report measures, which may obscure true associations. The current study combined objectively-measured moderate-to-vigorous intensity physical activity (MVPA) and sedentary time (ST) data from waist-worn accelerometers, with multiple child-report 24-h dietary recalls to assess specific components of dietary intake (i.e., dietary fat, carbohydrates, protein; glycemic load, fruits and vegetables) in children.

Methods: Participants (n = 136, ages 8–12 years) wore an accelerometer for 7 days. On two of those days, children completed 24-h recall phone interviews to assess dietary intake.

Results: After adjusting for child age, sex, ethnicity, annual household income, and body mass index (BMI) percentile; ST was positively associated with percent dietary fat intake, and negatively associated with percent dietary carbohydrate intake and glycemic load (p's < 0.01). MVPA was positively associated with percent dietary carbohydrate intake and daily glycemic load, and negatively associated with percent dietary fat intake (p's < 0.05).

Conclusion: Despite its direct health benefits, physical activity may be associated with consuming greater proportion of total intake from carbohydrates, especially those with a higher glycemic index. Further research is needed to understand the differential implications of these unique behavioral interrelations for diabetes, cardiovascular, and obesity risk.

Adolescent Consumption of Sports Drinks

BACKGROUND

Sports drinks are aggressively marketed to teenagers to replenish fluids and/or electrolytes. According to the American Academy of Pediatrics, typical adolescent physical activity does not require sports drink rehydration. Given US obesity rates and that sugar-sweetened sports drinks add superfluous calories to the diet, it is important to assess adolescent sports drink consumption and changes over time.

METHODS

Researchers in the 2015 Youth Risk Behavior Survey and 2010 National Youth Physical Activity and Nutrition Survey collected nationally representative samples of US high school students about sports drink consumption. Respondent characteristics and health behaviors were examined relative to sports drink consumption by using multivariable survey logistic regression. χ² tests were used to compare the 2 samples and examine changes over time.

RESULTS

The 2015 Youth Risk Behavior Survey and 2010 National Youth Physical Activity and Nutrition Survey had national samples of 15 624 and 11 458 respondents, respectively. Sports drink consumption in the previous week increased from 56% (2010) to 57.6% (2015; P = .0002). However, comparisons of daily sports drink consumption revealed reductions for all age groups, sexes, race and/or ethnicity categories, and levels of physical activity. The greatest reductions were for non-Hispanic African Americans and for children with overweight. Daily sports drink consumption did not decrease for children with obesity and increased for children who watched >2 hours per day of television. In 2015, boys, non-Hispanic African Americans, Hispanics, and tobacco users exhibited higher odds of consuming sports drinks daily.

CONCLUSIONS

Although daily consumption of sports drinks has decreased overall, sugar-sweetened sports drinks remain popular, with the majority of high school students drinking them at least weekly. Of concern, daily consumption increased among teenagers watching television >2 hours per day. Pediatricians should counsel adolescents about the American Academy of Pediatrics' recommendations regarding sports drinks.

Relationships between parents' academic backgrounds and incomes and building students' healthy eating habits

BACKGROUND

Building healthy eating habit is essential for all people. School and family are the prime institutions to instill this habit during early age. This study is aimed at understanding the impact of family such as parents' educations and incomes on building students' healthy eating habits.

METHODS

A survey on building students' eating habits was conducted among primary school students of grade 4 (11 years) and 5 (12 years) from Kulim district, Malaysia. Data from 318 respondents were analysed. Descriptive statistics were used to find the present scenario of their knowledge, attitude and practices towards their eating habits while one-way ANOVA and independent sample t-test were used to find the differences between their practices based on students' gender, parents' educations and incomes.

RESULTS

The study finds that the students have a good knowledge of types of healthy food but yet their preferences are towards the unhealthy food. Though the students' gender and parents' educations are not found significantly related to students' knowledge, attitude and practices towards healthy eating habits, parents' incomes have significant influence on promoting the healthy eating habit.

DISCUSSION

Findings of this study can be useful to guide parents in healthy food choices and suggest them to be models to their children in building healthy eating habits.

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.

Sustained impact of energy-dense TV and online food advertising on children's dietary intake: a within-subject, randomised, crossover, counter-balanced trial

Background

Policies restricting children’s exposure to unhealthy food marketing have been impeded by the lack of evidence showing a direct link between food advertising exposure and children’s energy intake and body weight. Food advertising exposure increases children’s immediate food consumption, but whether this increased intake is compensated for at later eating occasions is not known; consequently the sustained effect on diets remains unclear.

Methods

We conducted a within-subject, randomised, crossover, counterbalanced study across four, six-day holiday camps in New South Wales, Australia between April 2016 and January 2017. Children (7–12 years, n = 160) were recruited via local schools, email networks and social media. Two gender- and age-balanced groups were formed for each camp (n = 20), randomised to either a multiple- or single- media condition and exposed to food and non-food advertising in an online game and/or a television cartoon. Children’s food consumption (kilojoules) was measured at a snack immediately after exposure and then at lunch later in the day. Linear mixed models were conducted to examine relationships between food advertising exposure and dietary intake, taking into account gender, age and weight status.

Results

All children in the multiple-media condition ate more at a snack after exposure to food advertising compared with non-food advertising; this was not compensated for at lunch, leading to additional daily food intake of 194 kJ (95% CI 80–308, p = 0.001, d = 0.2). Exposure to multiple-media food advertising compared with a single-media source increased the effect on snack intake by a difference of 182 kJ (95% CI 46–317, p = 0.009, d = 0.4). Food advertising had an increased effect among children with heavier weight status in both media groups.

Conclusion

Online (‘advergame’) advertising combined with TV advertising exerted a stronger influence on children’s food consumption than TV advertising alone. The lack of compensation at lunch for children’s increased snack intake after food advertising exposure suggests that unhealthy food advertising exposure contributes to a positive energy-gap, which could cumulatively lead to the development of overweight.

Trial registration

Australian New Zealand Clinical Trials Registry, number ACTRN12617001230347 (Retrospectively registered).

Sports Sponsorships of Food and Nonalcoholic Beverages

BACKGROUND

Food and nonalcoholic beverage companies spend millions of dollars on professional sports sponsorships, yet this form of marketing is understudied. These sponsorships are valuable marketing tools but prompt concerns when unhealthy products are associated with popular sports organizations, especially those viewed by youth.

METHODS

This descriptive study used Nielsen audience data to select 10 sports organizations with the most 2-17 year old viewers of 2015 televised events. Sponsors of these organizations were identified and assigned to product categories. We identified advertisements promoting food and/or nonalcoholic beverage sponsorships on television, YouTube, and sports organization Web sites from 2006 to 2016, and the number of YouTube advertisement views. The nutritional quality of advertised products was assessed.

RESULTS

Youth watched telecasts associated with these sports organizations over 412 million times. These organizations had 44 food and/or nonalcoholic beverage sponsors (18.8% of sponsors), second to automotive sponsors (n = 46). The National Football League had the most food and/or nonalcoholic beverage sponsors (n = 10), followed by the National Hockey League (n = 7) and Little League (n = 7). We identified 273 advertisements that featured food and/or nonalcoholic beverage products 328 times and product logos 83 times (some advertisements showed multiple products). Seventy-six percent (n = 132) of foods had unhealthy nutrition scores, and 52.4% (n = 111) of nonalcoholic beverages were sugar-sweetened. YouTube sponsorship advertisements totaled 195.6 million views.

CONCLUSIONS

Sports sponsorships are commonly used to market unhealthy food and nonalcoholic beverages, exposing millions of consumers to these advertisements.

Children's self-regulation of eating provides no defense against television and online food marketing

Exposure to unhealthy food marketing stimulates children's food consumption. A child's responsiveness is influenced by individual factors, resulting in an increased vulnerability to advertising effects among some children. Whether these differential responses may be altered by different parental feeding behaviours is unclear. The purpose of this study was to determine the relationship between parental feeding practices and children's food intake responses to food advertising exposure. A randomised, crossover, counterbalanced, within subject trial was conducted across four, six-day holiday camps in New South Wales, Australia between April 2016 and January 2017 with 160 children (7-12 years, n = 40/camp). Children were randomised to either a multiple media (TV and Internet) or single media (TV) condition and exposed to food (3 days) and non-food (3 days) advertising in an online game and/or a cartoon. Children's food consumption (kilojoules (kJ)) was measured at a snack immediately after advertising exposure and then at lunch later in the day. Parents completed the Child Feeding Questionnaire, and 'restriction' and 'pressure to eat' subscale scores were calculated. While food advertising affected all children in the multiple media condition, there was an increased effect on snack intake among children whose parents reported pressuring them to eat, with children consuming an additional 356 kJ after food advertising compared with non-food advertising. This was 209 kJ more than children whose parents did not pressure them to eat. In the single media condition, only children whose parents reported restrictive feeding practices ate more at lunch on food advertising days than non-food advertising days (240 kJ). These data highlight an increased susceptibility to food advertising among children whose parents report controlling feeding practices.

Contributions of Pavlovian incentive motivation to cue-potentiated feeding

Cues signaling the availability of palatable food acquire the ability to potentiate food seeking and consumption. The current study employed a combination of behavioral, pharmacological, and analytical techniques to probe the role of Pavlovian incentive motivation in cue-potentiated feeding. We show that a cue paired with sucrose solution (CS+) can transfer its control over feeding to stimulate sucrose consumption at a new receptacle, and that this effect depends on activation of D1 dopamine receptors, which is known to modulate other forms of cue-motivated behavior but not taste palatability. Microstructural analyses of sucrose-licking behavior revealed that the CS+ tended to increase the frequency with which rats engaged in active bouts of licking behavior without having a reliable effect on the duration of those licking bouts, a measure that was instead associated with sucrose palatability. Furthermore, we found that individual differences in CS+ elicited increases in bout frequency were associated with total sucrose intake at test, supporting the view that this process was related to meaningful dysregulation of eating behavior. The current study, therefore, (1) demonstrates that a dopamine-dependent Pavlovian incentive motivational process can mediate cue-potentiated feeding, and (2) lays out an experimental and analytical approach for parsing this aspect of behavior.

Parental feeding practice is associated with child’s body mass index in Thai school-aged children

Purpose

Parental feeding practice (PFP) plays an important role in child’s eating behavior and weight status, but less information is available about its role in the Thai family setting. The purpose of this paper is to examine the influence of PFP on child’s gender and body mass index (BMI).

Design/methodology/approach

Participants included 227 parents-child dyads from the suburban area of Nakhon Pathom province, Thailand. Children aged 9-12 years and parents who were either child’s mother, father or grandfather/grandmother were enrolled in the study. Body weight, height, waist circumference and body fat were measured in all children. Eating behavior of each child was assessed by using child’s eating questionnaire. Parents also provided their feeding practices in child feeding questionnaires. Information on household food security was also obtained from children’s parents.

Findings

There was significant difference in eating behaviors and home environment between child’s genders. For child’s eating behavior, mean total eating scores of girls were significantly greater (p=0.002) than that of boys and that the inappropriate home environment was more found in families of boys than girls. Regarding feeding practice, parents used more food restriction (p=0.008) and monitoring on child’s eating (p=0.042) in girls than boys. Parents put more pressure to eat on the normal weight than obese children (p=0.001). Regression analysis revealed that, apart from parental BMI and household income, PFPs have a significant impact (15.6 percent explained variance) on child’s BMI.

Originality/value

This study highlights the importance of being aware of child’s gender and weight status when feeding practices were provided to them. Nutrition education for parents should take account for parents’ perceptions and concerns as well as the modification of feeding practices to improve children’s eating behaviors.

Can attentional bias modification inoculate people to withstand exposure to real-world food cues?

Two experiments investigated whether attentional bias modification can inoculate people to withstand exposure to real-world appetitive food cues, namely television advertisements for chocolate products. Using a modified dot probe task, undergraduate women were trained to direct their attention toward (attend) or away from (avoid) chocolate pictures. Experiment 1 (N = 178) consisted of one training session; Experiment 2 (N = 161) included 5 weekly sessions. Following training, participants viewed television advertisements of chocolate or control products. They then took part in a so-called taste test as a measure of chocolate consumption. Attentional bias for chocolate was measured before training and after viewing the advertisements, and in Experiment 2 also at 24-h and 1-week follow-up. In Experiment 2, but not Experiment 1, participants in the avoid condition showed a significant reduction in attentional bias for chocolate, regardless of whether they had been exposed to advertisements for chocolate or control products. However, this inoculation effect on attentional bias did not generalise to chocolate intake. Future research involving more extensive attentional re-training may be needed to ascertain whether the inoculation effect on attentional bias can extend to consumption, and thus help people withstand exposure to real-world palatable food cues.

Marketing Food and Beverages to Youth Through Sports

Food and beverage marketing has been identified as a major driver of obesity yet sports sponsorship remains common practice and represents millions of dollars in advertising expenditures. Research shows that food and beverage products associated with sports (e.g., M&M's with National Association for Stock Car Auto Racing logo) generate positive feelings, excitement, and a positive self-image among adults and children. Despite this, self-regulatory pledges made by food companies to limit exposure of unhealthy products to children have not improved the nutritional quality of foods marketed to children. We reviewed the literature about sports-related food marketing, including food and beverage companies' use of sports sponsorships, athlete endorsements, and sports video games. This review demonstrates that sports sponsorships with food and beverage companies often promote energy-dense, nutrient-poor products and while many of these promotions do not explicitly target youth, sports-related marketing affects food perceptions and preferences among youth. Furthermore, endorsement of unhealthy products by professional athletes sends mixed messages; although athletes may promote physical activity, they simultaneously encourage consumption of unhealthy products that can lead to negative health outcomes. We argue that more athletes and sports organizations should stop promoting unhealthy foods and beverages and work with health experts to encourage healthy eating habits among youth.

Hippocampus ghrelin receptor signaling promotes socially-mediated learned food preference

Social cues are potent regulators of feeding behavior, yet the neurobiological mechanisms through which social cues influence food intake are poorly understood. Here we investigate the hypothesis that the appetite-promoting gut-derived hormone, ghrelin, signals in the hippocampus to promote learned social aspects of feeding behavior. We utilized a procedure known as 'social transmission of food preference' (STFP) in which rats ('Observers') experience a social interaction with another rat ('Demonstrators') that recently consumed flavored/scented chow. STFP learning in Observer rats is indicated by a significant preference for the Demonstrator paired flavor of chow vs. a novel unpaired flavor of chow in a subsequent consumption choice test. Our results show that relative to vehicle treatment, ghrelin targeted to the ventral CA1 subregion of the hippocampus (vHP) enhanced STFP learning in rats. Additionally, STFP was impaired following peripheral injections of l-cysteine that reduce circulating ghrelin levels, suggesting that vHP ghrelin-mediated effects on STFP require peripheral ghrelin release. Finally, the endogenous relevance of vHP ghrelin receptor (GHSR-1A) signaling in STFP is supported by our data showing that STFP learning was eliminated following targeted viral vector RNA interference-mediated knockdown of vHP GHSR-1A mRNA. Control experiments indicate that vHP ghrelin-mediated STFP effects are not secondary to altered social exploration and food intake, nor to altered food preference learning based on nonsocial olfactory cues. Overall these data reveal a novel neurobiological system that promotes conditioned, social aspects of feeding behavior.

Non-Conscious Effect of Food Odors on Children's Food Choices Varies by Weight Status

Objective

Food cues are omnipresent in the daily environment and may influence eating behavior even non-consciously. An increased reactivity to food cues, such as food odors, has been shown to be correlated with obesity in children. The objective of this study is to investigate whether the non-conscious influence of food odors on children’s food choices varies by their weight status.

Methods

Seventy-four children, of whom 29 were obese, took part in this study. The children performed a food choice intention task presented as a computer game in which 30 pairs of food images (a fatty-sweet food picture vs. a fruit picture) successively appeared on the screen. The children had to choose the item “they most wanted to eat at the present moment” for each pair. While performing this task, the children wore a headset in which the microphone foam was odorized with a fruity odor, a fatty-sweet odor or no odor. They performed the intention task three times, one time for each olfactory condition. The odors were non-attentively perceived, i.e., none of the children were aware of the odorization of the microphone foams. The modeled probability is the probability to choose a fruit.

Results

In children with obesity, the fruity odor increased the likelihood of a fruit to be chosen compared to the no-odor condition [OR (95% CL) = 1.42 (1.13–1.78), P = 0.0028], while the fatty-sweet odor had no effect on food choice [OR (95% CL) = 1.07 (0.85–1.36), P = 0.55]. In children without obesity, both the fruity and the fatty-sweet odors decreased the likelihood to choose a fruit compared to the no-odor condition [OR (95% CL) = 0.76 (0.64–0.90), P = 0.0015, for the fruity odor and OR (95% CL) = 0.79 (0.66–0.93), P = 0.0062, for the fatty-sweet odor].

Conclusion

The different patterns of results obtained in both groups of children suggest differences in the mental representations activated by non-attentively perceived olfactory cues based on weight status.

Influence of product placement in children's movies on children's snack choices

BACKGROUND

Media exposure affects health, including obesity risk. Children's movies often contain food placements-frequently unhealthy foods. However, it is not known if these cues influence children's food choices or consumption after viewing. We explored whether children's snack choices or consumption differs based on: 1) recent exposure to movies with high versus low product placement of unhealthy foods; and 2) children's weight status.

METHODS

Children ages 9-11 were assigned to watch a high ("Alvin and the Chipmunks," n = 54) or low ("Stuart Little," n = 60) product-placement movie. After viewing, participants selected a snack choice from each of five categories, several of which were specifically featured in "Alvin." Uneaten snacks from each participant were weighed upon completion. Snack choice and amount consumed by movie were compared by t-tests, and differences in snack choices by movie were tested with logistic regression.

RESULTS

Participants consumed an average of 800.8 kcal; mean kcal eaten did not vary by movie watched. Participants who watched the high product-placement movie had 3.1 times the odds (95% CI 1.3-7.2) of choosing cheese balls (most featured snack) compared to participants who watched the low product-placement movie. Children who were overweight or obese consumed a mean of 857 kcal (95% CI: 789-925) compared to 783 kcal (95% CI: 742-823, p = 0.09) for children who were underweight or healthy weight. Children's weight status did not significantly affect their choice of snack.

CONCLUSIONS

Branding and obesogenic messaging in children's movies influenced some choices that children made about snack foods immediately following viewing, especially food with greatest exposure time in the film, but did not affect total calories consumed. Future studies should examine how the accumulation of these messages affects children's long-term food choices.

Association between screen time and snack consumption in children and adolescents: The CASPIAN-IV study

BACKGROUND

The relationship between screen time (ST) and the frequency of snack consumption in a national sample of Iranian children and adolescents was assessed. The present nationwide survey was conducted on 14,880 school students living in urban and rural areas of 30 provinces in Iran. Trained healthcare providers conducted the physical examination and completed the questionnaire of the World Health Organization - Global School-Based Student Health Survey (WHO-GSHS).

METHODS

The association between ST (total time spent watching TV and using a computer in leisure time) and the frequency of snack consumption was determined using ordinal logistic regression analysis. The subjects were 13,486 students out of the 14,880 invited including 50.8% boys. The mean (SD) age of participants was 12.47 (3.36) years.

RESULTS

In multivariate models, for students who had prolonged ST (more than 4 h/day), the odds of daily consumption of sweets (odds ratio, OR 1.25; 95% CI 1.14-1.4), salty snacks (OR 1.6; 95% CI 1.5-1.76), soft drinks (OR 1.52; 95% CI 1.4-1.7), canned fruit juice (OR 1.3; 95% CI 1.2-1.4), and fast food (OR 1.53; 95% CI 1.4-1.7) were higher compared to those with low ST. Furthermore, the odds of daily consumption of milk in students who had prolonged ST (more than 4 h/day) were lower compared to those with low ST (OR 0.9; 95% CI 0.8-0.99).

CONCLUSIONS

Prolonged time spent watching TV and using a computer during leisure time might be associated with unhealthy dietary habits. Moreover, inactivity induced by prolonged ST may also lead to unhealthy dietary habits and in turn excess weight in children and adolescents.

Responsiveness to healthy advertisements in adults: An experiment assessing beyond brand snack selection and the impact of restrained eating

The objective of this study was to explore the impact of different advertising messages on adults' snack choice. Eighty participants (18-24 years old) were offered the choice between two snack packs following exposure to one of three advertising conditions. The snack packs contained either healthy or high fat, sugar or salt (HFSS) foods. Participants were exposed to commercials containing either non-food products, healthy food products or HFSS food products and their subsequent choice of snack pack was recorded. The Dutch Eating Behaviour Questionnaire (DEBQ) was used to assess the impact of external, restrained and emotional eating behaviour on snack pack selection following exposure to advertisements. The majority of unrestrained participants preferentially choose the HFSS snack pack irrespective of advertisement condition. In contrast, high restrained individuals exposed to the healthy eating advertisement condition preferentially selected the healthy snack pack while those in other advertisement conditions refused to take either snack pack. The healthy eating message, when distributed through mass media, resonated with restrained eaters only. Exposure to healthy food adverts provoked restrained eaters into choosing a snack pack; while exposure to other messages results in restrained eaters refusing to take any foods.

Television food advertisement exposure and FTO rs9939609 genotype in relation to excess consumption in children

BACKGROUND/OBJECTIVE

Exposure to food advertisements may cue overeating among children, especially among those genetically predisposed to respond to food cues. We aimed to assess how television food advertisements affect eating in the absence of hunger among children in a randomized trial. We hypothesized that the fat mass and obesity-associated gene (FTO) rs9939609 single-nucleotide polymorphism would modify the effect of food advertisements.

SUBJECTS/METHODS

In this randomized experiment, 200 children aged 9-10 years were served a standardized lunch and then shown a 34-min television show embedded with either food or toy advertisements. Children were provided with snack food to consume ad libitum while watching the show and we measured caloric intake. Children were genotyped for rs9939609 and analyses were conducted in the overall sample and stratified by genotype. A formal test for interaction of the food advertisement effect on consumption by rs9939609 was conducted.

RESULTS

About 172 unrelated participants were included in this analysis. Children consumed on average 453 (s.d.=185) kcals during lunch and 482 (s.d.=274) kcals during the experimental exposure. Children who viewed food advertisements consumed an average of 48 kcals (95% confidence interval: 10, 85; P=0.01) more of a recently advertised food than those who viewed toy advertisements. There was a statistically significant interaction between genotype and food advertisement condition (P for interaction=0.02), where the difference in consumption of a recently advertised food related to food advertisement exposure increased linearly with each additional FTO risk allele, even after controlling for body mass index percentile.

CONCLUSIONS

Food advertisement exposure was associated with greater caloric consumption of a recently advertised food, and this effect was modified by an FTO genotype. Future research is needed to understand the neurological mechanism underlying these associations.

Contexts Paired with Junk Food Impair Goal-Directed Behavior in Rats: Implications for Decision Making in Obesogenic Environments

The high prevalence of obesity and related metabolic diseases calls for greater understanding of the factors that drive excess energy intake. Calorie-dense palatable foods are readily available and often are paired with highly salient environmental cues. These cues can trigger food-seeking and consumption in the absence of hunger. Here we examined the effects of palatable food-paired environmental cues on control of instrumental food-seeking behavior. In Experiment 1, adult male rats received exposures to one context containing three “junk” foods (JFs context) and another containing chow (Chow context). Next, rats were food-deprived and trained to perform instrumental responses (lever-press) for two novel food rewards in a third, distinct context. Contextual influences on flexible control of food-seeking behavior were then assessed by outcome devaluation tests held in the JF, chow and training contexts. Devaluation was achieved using specific satiety and test order was counterbalanced. Rats exhibited goal-directed control over behavior when tested in the training and chow-paired contexts. Notably, performance was habitual (insensitive to devaluation) when tested in the JF context. In Experiment 2 we tested whether the impairment found in the JF context could be ameliorated by the presentation of a discrete auditory cue paired with the chow context, relative to a second cue paired with the JF context. Consistent with the results of Experiment 1, the devaluation effect was not significant when rats were tested in the JF context with the JF cue. However, presenting the chow cue increased the impact of the devaluation treatment leading to a robust devaluation effect. Further tests confirmed that performance in the chow context was goal-directed and that sensory-specific satiety in the JF context was intact. These results show that environments paired with palatable foods can impair goal-directed control over food-seeking behavior, but that this deficit was improved by a cue paired with chow. This has promising implications for assisting individuals in controlling their eating behavior in environments designed to dysregulate it.

Adolescent Maturational Transitions in the Prefrontal Cortex and Dopamine Signaling as a Risk Factor for the Development of Obesity and High Fat/High Sugar Diet Induced Cognitive Deficits

Adolescence poses as both a transitional period in neurodevelopment and lifestyle practices. In particular, the developmental trajectory of the prefrontal cortex (PFC), a critical region for behavioral control and self-regulation, is enduring, not reaching functional maturity until the early 20 s in humans. Furthermore, the neurotransmitter dopamine is particularly abundant during adolescence, tuning the brain to rapidly learn about rewards and regulating aspects of neuroplasticity. Thus, adolescence is proposed to represent a period of vulnerability towards reward-driven behaviors such as the consumption of palatable high fat and high sugar diets. This is reflected in the increasing prevalence of obesity in children and adolescents as they are the greatest consumers of “junk foods”. Excessive consumption of diets laden in saturated fat and refined sugars not only leads to weight gain and the development of obesity, but experimental studies with rodents indicate they evoke cognitive deficits in learning and memory process by disrupting neuroplasticity and altering reward processing neurocircuitry. Consumption of these high fat and high sugar diets have been reported to have a particularly pronounced impact on cognition when consumed during adolescence, demonstrating a susceptibility of the adolescent brain to enduring cognitive deficits. The adolescent brain, with heightened reward sensitivity and diminished behavioral control compared to the mature adult brain, appears to be a risk for aberrant eating behaviors that may underpin the development of obesity. This review explores the neurodevelopmental changes in the PFC and mesocortical dopamine signaling that occur during adolescence, and how these potentially underpin the overconsumption of palatable food and development of obesogenic diet-induced cognitive deficits.

The Influence of Televised Food Commercials on Children's Food Choices: Evidence from Ventromedial Prefrontal Cortex Activations

OBJECTIVE

To investigate how food commercials influence children's food choices.

STUDY DESIGN

Twenty-three children ages 8-14 years provided taste and health ratings for 60 food items. Subsequently, these children were scanned with the use of functional magnetic resonance imaging while making food choices (ie, "eat" or "not eat") after watching food and nonfood television commercials.

RESULTS

Our results show that watching food commercials changes the way children consider the importance of taste when making food choices. Children did not use health values for their food choices, indicating children's decisions were largely driven by hedonic, immediate rewards (ie, "tastiness"); however, children placed significantly more importance on taste after watching food commercials compared with nonfood commercials. This change was accompanied by faster decision times during food commercial trials. The ventromedial prefrontal cortex, a reward valuation brain region, showed increased activity during food choices after watching food commercials compared with after watching nonfood commercials.

CONCLUSION

Overall, our results suggest watching food commercials before making food choices may bias children's decisions based solely on taste, and that food marketing may systematically alter the psychological and neurobiologic mechanisms of children's food decisions.

The mediating role of energy intake on the relationship between screen time behaviour and body mass index in adolescents with obesity: The HEARTY study

Adolescents spend up to 6-8 h/day in sedentary screen behaviour and screen time is an independent risk factor for obesity. However, the mechanisms by which screen time confers obesity risk remain unclear. Via community level recruitment this study examined whether the relationship between screen time behaviours and body mass index (BMI: kg/m²) was mediated by total energy intake or macronutrient consumption. In a cross-sectional study of post-pubertal adolescents (N = 283: 86M, 197F) with overweight or obesity at baseline of an intervention for weight control, we examined self-reported total energy intake (mean Calories from 3 day food diary), macronutrient intake (grams/day of carbohydrate, fat, protein) and total screen time (aggregate of hours/day watching TV, playing seated video games, and recreational computer use). BMI was objectively measured and converted to standardized scores (z-BMI). Simple and multiple mediation analyses were conducted using the bootstrapping approach described by Preacher and Hayes. Covariates included age, sex, ethnicity, parental education, Tanner stage, and self-reported physical activity. The relationship between screen time and z-BMI was significantly mediated by energy intake. Higher levels of carbohydrate intake, but not fat or protein intake, significantly mediated the relationship between screen time and z-BMI (95% bias-corrected and accelerated confidence interval [0.0004, 0.0074]). Higher carbohydrate intake mediated the relationship between TV viewing and z-BMI, and video gaming and z-BMI. In conclusion, the relationship between screen time and BMI appears to be mediated by increased energy intake, primarily in the form of higher carbohydrate intake. It is possible that reducing time spent watching TV and playing video games may reduce food intake and help promote dietary adherence needed for weight management in obese adolescents.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT00195858.

Strengthening Children's Advertising Defenses: The Effects of Forewarning of Commercial and Manipulative Intent

This study investigated whether a forewarning of advertising's intent can increase children's (N = 159, 8-10 years old) defenses against television commercials to lower their desire for advertised products. Two different forewarnings were tested, one for advertising's commercial intent or warning for the promotional nature, and one for advertising's manipulative intent or warning for the deceptive nature. Results showed that only the warning of manipulative intent prior to advertising exposure was successful in increasing children's advertising defenses. This forewarning activated children's attitudinal advertising literacy (i.e., skepticism toward the commercial), which in turn led to lower advertised product desire. The forewarning of commercial intent was not effective in strengthening children's advertising defenses. These findings have important implications for interventions that aim to lower children's desire for (unhealthy) advertised products by activating their advertising literacy.

Incubation of food craving is independent of macronutrient composition

Cues previously paired with rewarding stimuli induce a time-dependent increase in the motivational craving state (incubation of craving). Whether there is an increase in craving for high-fat (HF) food over time, which may contribute to overeating and obesity, has not been determined. We hypothesized that cues paired with HF pellets would elicit a greater incubation of craving effect than those paired with standard chow (SC) pellets. Rats exposed to cues associated with either HF or SC pellets demonstrated equivalent levels of craving over an abstinence period of 30 days. Diet preference tests between SC pellets and LabDiet revealed that SC pellets were preferred over LabDiet. Rats reared on SC pellets exclusively, did not display incubation of craving for SC pellets, suggesting that prior history with the food plays an important role in cue-induced seeking behavior. Results identified cues previously associated with food undergo a comparable magnitude of incubation of craving. When ingestive behavior was measured after 30 days of abstinence, rats significantly increased their consumption of HF pellets. Our results indicate that food cues gain importance over time, trigger increased approach behaviors, and increased consumption of HF food following abstinence. This may contribute to overeating and the development of obesity.

Popular Music Celebrity Endorsements in Food and Nonalcoholic Beverage Marketing

BACKGROUND

Food and beverage marketing has been associated with childhood obesity. We quantified the number and type of food or beverage brands promoted by music celebrities, assessed the nutritional quality of the products, and examined Teen Choice Award data to assess the celebrities' popularity among adolescents.

METHODS

This was a descriptive study. A list of music celebrities associated with the 2013 and 2014 Billboard Hot 100 Chart, which ranks songs according to sales and radio impressions, was compiled. Data on celebrity endorsements were gathered from official company Web sites, YouTube commercials, an advertising database, and media reports. Nutritional quality of foods was assessed according to the Nutrient Profile Index, whereas nonalcoholic beverages were evaluated based on calories from added sugar. Teen Choice Award nominations were used to measure the celebrities' popularity among adolescents.

RESULTS

Of the 590 endorsements made by the 163 celebrities in the sample, consumer goods (eg, fragrances, makeup) represented the largest endorsement category (26%), followed by food and beverage (18%) and retail (11%). Sixty-five celebrities were collectively associated with 57 different food and beverage brands owned by 38 parent companies. Of these 65 celebrities, 53 (81.5%) had ≥1 Teen Choice Award nomination. Forty-nine (71%) of the 69 nonalcoholic beverage references promoted sugar-sweetened beverages. Twenty-one (80.8%) of the 26 endorsed foods were energy dense and nutrient poor. Baauer, will.i.am, Justin Timberlake, Maroon 5, and Britney Spears had the most food and beverage endorsements.

CONCLUSIONS

This study demonstrates that music celebrities who are popular among adolescents endorse energy-dense, nutrient-poor products.

The short-term effects of television advertisements of cariogenic foods on children's dietary choices

OBJECTIVE

To investigate the short-term influence of the advertising of cariogenic foods on children's dietary preferences, and the possible moderating effect of several factors on this influence.

METHODS

One-hundred and eighty-three children, 11-12 years of age, were exposed to advertisements showing sugary food and non-food items, in a within-subject counterbalanced design. Their preferences for unhealthy and healthy foods, and their ability to recall or recognise the advertisements, were measured following both sessions. Information on their dietary habits, leisure activities and sociodemographic details were obtained through a questionnaire completed by their parents. Their decayed, missing and filled teeth (DMFT) index, body weight and height were also recorded. A generalised linear mixed model was used to examine the differences in food preferences between experimental conditions, and the associations between children's preferences and the other factors assessed.

RESULTS

Exposure to food advertisements significantly decreased the selection of healthy foods. Children with a higher DMFT index chose a higher percentage of unhealthy foods, and children who spent more time watching television chose an increased number of healthy foods, after their exposure to food advertisements. Regardless of condition, girls selected fewer foods than boys. Children with a higher DMFT index selected more unhealthy foods than children with a lower DMFT index. Obese children chose an increased number of healthy foods than those who were overweight and normal weight.

CONCLUSIONS

Food advertisements can divert, for a short time, children's preference over healthy food choices, and could lead to changes in their eating habits, which may put them at higher risk of dental diseases and obesity.

Ghrelin: A link between memory and ingestive behavior

Feeding is a highly complex behavior that is influenced by learned associations between external and internal cues. The type of excessive feeding behavior contributing to obesity onset and metabolic deficit may be based, in part, on conditioned appetitive and ingestive behaviors that occur in response to environmental and/or interoceptive cues associated with palatable food. Therefore, there is a critical need to understand the neurobiology underlying learned aspects of feeding behavior. The stomach-derived "hunger" hormone, ghrelin, stimulates appetite and food intake and may function as an important biological substrate linking mnemonic processes with feeding control. The current review highlights data supporting a role for ghrelin in mediating the cognitive and neurobiological mechanisms that underlie conditioned feeding behavior. We discuss the role of learning and memory on food intake control (with a particular focus on hippocampal-dependent memory processes) and provide an overview of conditioned cephalic endocrine responses. A neurobiological framework is provided through which conditioned cephalic ghrelin secretion signals in neurons in the hippocampus, which then engage orexigenic neural circuitry in the lateral hypothalamus to express learned feeding behavior.

The Presence of Real Food Usurps Hypothetical Health Value Judgment in Overweight People

To develop more ecologically valid models of the neurobiology of obesity, it is critical to determine how the neural processes involved in food-related decision-making translate into real-world eating behaviors. We examined the relationship between goal-directed valuations of food images in the MRI scanner and food consumption at a subsequent ad libitum buffet meal. We observed that 23 lean and 40 overweight human participants showed similar patterns of value-based neural responses to health and taste attributes of foods. In both groups, these value-based responses in the ventromedial PFC were predictive of subsequent consumption at the buffet. However, overweight participants consumed a greater proportion of unhealthy foods. This was not predicted by in-scanner choices or neural response. Moreover, in overweight participants alone, impulsivity scores predicted greater consumption of unhealthy foods. Overall, our findings suggest that, while the hypothetical valuation of the health of foods is predictive of eating behavior in both lean and overweight people, it is only the real-world food choices that clearly distinguish them.

Advertising as a cue to consume: a systematic review and meta-analysis of the effects of acute exposure to unhealthy food and nonalcoholic beverage advertising on intake in children and adults

BACKGROUND

Several studies have assessed the effects of food and nonalcoholic beverage (hereafter collectively referred to as food) advertising on food consumption, but the results of these studies have been mixed. This lack of clarity may be impeding policy action.

OBJECTIVE

We examined the evidence for a relation between acute exposure to experimental unhealthy food advertising and food consumption.

DESIGN

The study was a systematic review and meta-analysis of published studies in which advertising exposure (television or Internet) was experimentally manipulated, and food intake was measured. Five electronic databases were searched for relevant publications (SCOPUS, PsycINFO, MEDLINE, Emerald Insight, and JSTOR). An inverse variance meta-analysis was used whereby the standardized mean difference (SMD) in food intake was calculated between unhealthy food advertising and control conditions.

RESULTS

Twenty-two articles were eligible for inclusion. Data were available for 18 articles to be included in the meta-analysis (which provided 20 comparisons). With all available data included, the analysis indicated a small-to-moderate effect size for advertising on food consumption with participants eating more after exposure to food advertising than after control conditions (SMD: 0.37; 95% CI: 0.09; 0.65; I(2) = 98%). Subgroup analyses showed that the experiments with adult participants provided no evidence of an effect of advertising on intake (SMD: 0.00; P = 1.00; 95% CI: -0.08, 0.08; I(2) = 8%), but a significant effect of moderate size was shown for children, whereby food advertising exposure was associated with greater food intake (SMD: 0.56; P = 0.003; 95% CI: 0.18, 0.94; I(2) = 98%).

CONCLUSIONS

Evidence to date shows that acute exposure to food advertising increases food intake in children but not in adults. These data support public health policy action that seeks to reduce children's exposure to unhealthy food advertising.

Food cue reactivity and craving predict eating and weight gain: a meta-analytic review

According to learning-based models of behavior, food cue reactivity and craving are conditioned responses that lead to increased eating and subsequent weight gain. However, evidence supporting this relationship has been mixed. We conducted a quantitative meta-analysis to assess the predictive effects of food cue reactivity and craving on eating and weight-related outcomes. Across 69 reported statistics from 45 published reports representing 3,292 participants, we found an overall medium effect of food cue reactivity and craving on outcomes (r = 0.33, p < 0.001; approximately 11% of variance), suggesting that cue exposure and the experience of craving significantly influence and contribute to eating behavior and weight gain. Follow-up tests revealed a medium effect size for the effect of both tonic and cue-induced craving on eating behavior (r = 0.33). We did not find significant differences in effect sizes based on body mass index, age, or dietary restraint. However, we did find that visual food cues (e.g. pictures and videos) were associated with a similar effect size to real food exposure and a stronger effect size than olfactory cues. Overall, the present findings suggest that food cue reactivity, cue-induced craving and tonic craving systematically and prospectively predict food-related outcomes. These results have theoretical, methodological, public health and clinical implications.