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

Social Media and Children's and Adolescents' Diets: A Systematic Review of the Underlying Social and Physiological Mechanisms

The association between social media (SM) and children's and adolescents' diet is poorly understood. This systematic literature review aims to explore the role of SM in children's and adolescents' diets and related behaviors, considering also the underlying mechanisms. We searched Medline, Scopus, and CINAHL (2008-December 2021) for studies assessing the relation of SM exposure with food intake, food preference, dietary behaviors, and the underlying mechanisms (e.g., brain activation to digital food images-as proxy for SM food images) among healthy children and adolescents aged 2-18 y. A total of 35 articles were included. Of 4 studies, 1 found that exposure to peers' videos on healthy eating, but not SM influencers', increased vegetable intake. Most studies reported that SM was associated with skipping breakfast, increased intake of unhealthy snacks and sugar-sweetened beverages, and lower fruit and vegetable intake, independent of age. Children and adolescents exposed to unhealthy compared with healthy digital food images showed increased brain response in reward- and attention-related regions. The mechanisms underpinning the abovementioned associations were 1) physiological (appetitive state, increased neural response to portion size and energy density of food depicted) and 2) social (food advertising via SM influencers and peers). SM exposure leads to unfavorable eating patterns both in children and adolescents. The identified mechanisms may help tailor future health interventions. Downregulating SM advertising and limiting SM exposure to children and adolescents may improve food intake and subsequent health outcomes. The protocol of this review was registered in PROSPERO as CRD42020213977 (https://www.crd.york.ac.uk/prospero/).

Food choice in transition: adolescent autonomy, agency, and the food environment

Dietary intake during adolescence sets the foundation for a healthy life, but adolescents are diverse in their dietary patterns and in factors that influence food choice. More evidence to understand the key diet-related issues and the meaning and context of food choices for adolescents is needed to increase the potential for impactful actions. The aim of this second Series paper is to elevate the importance given to adolescent dietary intake and food choice, bringing a developmental perspective to inform policy and programmatic actions to improve diets. We describe patterns of dietary intake, then draw on existing literature to map how food choice can be influenced by unique features of adolescent development. Pooled qualitative data is then combined with evidence from the literature to explore ways in which adolescent development can interact with sociocultural context and the food environment to influence food choice. Irrespective of context, adolescents have a lot to say about why they eat what they eat, and insights into factors that might motivate them to change. Adolescents must be active partners in shaping local and global actions that support healthy eating patterns. Efforts to improve food environments and ultimately adolescent food choice should harness widely shared adolescent values beyond nutrition or health.

Nutritional Analysis of Foods and Beverages Posted in Social Media Accounts of Highly Followed Celebrities

IMPORTANCE

Celebrity social media posts engage millions of young followers daily, but the nutritional quality of foods and beverages in such posts, sponsored and unsponsored, is unknown.

OBJECTIVE

To quantify the nutritional quality of foods and beverages depicted in social media accounts of highly followed celebrities and assess whether nutritional quality is associated with post sponsorship, celebrity profession or gender, and followers' likes and comments.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study analyzed the content of food- and beverage-containing posts from Instagram (a photo- and video-sharing social media platform) accounts of 181 highly followed athletes, actors, actresses, television personalities, and music artists. Data were collected from May 2019 to March 2020.

MAIN OUTCOMES AND MEASURES

The nutritional quality of foods and beverages posted in celebrity social media accounts was rated using the Nutrient Profile Index (NPI) based on the sugar, sodium, energy, saturated fat, fiber, protein, and fruit and/or vegetable content per 100-g sample (a score of 0 indicated least healthy and 100, healthiest); foods with scores less than 64 and beverages with scores less than 70 were rated as "less healthy." Secondary outcomes were whether the nutritional quality of foods and beverages in social media posts was associated with post sponsorship, celebrity profession or gender, and followers' likes and comments. Mixed-effects regression models were used to estimate how outcomes differed across fixed effects.

RESULTS

The sample included social media accounts of 181 celebrities (66 actors, actresses, and television personalities [36.5%]; 64 music artists [35.4%]; and 51 athletes [28.2%]). A total of 102 celebrities (56.4%) were male, and the median age was 32 years (range, 17-73 years). Among 3065 social media posts containing 5180 total foods and beverages (2467 foods [47.6%]; 2713 beverages [52.4%]), snacks and sweets (920 [37.3%] of the foods) and alcoholic beverages (1375 [50.7%] of the beverages) were most common. Overall, 158 celebrity social media accounts (87.3%) earned a less healthy overall food nutrition score and 162 (89.5%) earned a less healthy overall beverage nutrition score, which would be unhealthy enough to fail legal youth advertising limits in the UK. For foods, social media posts with healthier nutrition scores were associated with significantly fewer likes (b, -0.003; 95% CI, -0.006 to 0.000; P = .04) and comments (b, -0.006; 95% CI, -0.009 to -0.003; P < .001) from followers. For beverages, nutrition scores were not significantly associated with likes (b, -0.010; 95% CI, -0.025 to 0.005; P = .18) or comments (b, -0.003; 95% CI, -0.022 to 0.016; P = .73). Only 147 food- or beverage-containing posts (4.8%) were sponsored by food- or beverage-relevant companies. Beverages in sponsored posts contained more than twice as much alcohol as those in nonsponsored posts (10.8 g [95% CI, 9.3 g to 12.3 g] per 100 g of beverage vs 5.3 g [95% CI, 4.7 g to 5.9 g] per 100 g of beverage).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, most highly followed celebrity social media accounts depicted an unhealthy profile of foods and beverages, primarily in nonsponsored posts. These results suggest that influential depictions of unhealthy food and beverage consumption on social media may be a sociocultural problem that extends beyond advertisements and sponsorships, reinforcing unhealthy consumption norms.

Promoting Fruit and Vegetable Consumption for Childhood Obesity Prevention

Currently, food marketing for unhealthy foods is omnipresent. Foods high in fat, salt, and sugar (HFSS) are advertised intensively on several media platforms, including digital platforms that are increasingly used by children, such as social media, and can be bought almost everywhere. This could contribute to the obesity epidemic that we are facing. As the majority of children and adolescents do not eat the recommended amount of fruits and vegetables (F&V), which leads to chronic diseases, we need to change the obesogenic environment to a healthogenic environment. Reducing the marketing of energy-dense snacks to children and increasing the promotion of healthier foods, such as fruits and vegetables, may be an effective and necessary instrument to improve the dietary intake of children and reduce the risk of their experiencing some chronic diseases later in life. With this focused narrative review, we provide an overview of how children and adolescents react to food promotions and how food promotional efforts might be a useful tool to increase the attractiveness of fruit and vegetables. This review therefore contributes to the question of how changing the advertising and media environment of children and adolescents could help create a world where the healthy choice is the easier choice, which would reduce childhood obesity and improve children’s health, as well as to make the food system more sustainable.

Rising to the challenge: Introducing protocols to monitor food marketing to children from the World Health Organization Regional Office for Europe

Unhealthy marketing has been unequivocally linked to children's food preferences, requests, purchases and eating behaviors and hence to childhood obesity. Regulating children's exposure to such marketing has been identified as a key challenge to which States must rise. Regulation mandates the need for monitoring and hence for credible data that are comparable between countries, regions and across time. However, there are major challenges presented by the complexity of the digital marketing ecosystem including the personalized targeting with persuasive, exploitative advertising to which children are subject. This narrative review identifies challenges faced by researchers in the digital ecosystem; reviews recent papers attempting to address these and specifies benefits and limitations; and introduces a set of WHO protocols with templates and guidance for studies of food marketing to children.

How Food Marketing on Instagram Shapes Adolescents' Food Preferences: Online Randomized Trial

Background

Worldwide obesity rates have prompted 16 countries to enact policies to reduce children’s exposure to unhealthy food marketing, but few policies address online advertising practices or protect adolescents from being targeted. Given adolescents spend so much time online, it is critical to understand how persuasive Instagram food advertisements (ads) are compared with traditional food ads. To strengthen online food marketing policies, more evidence is needed on whether social media ads are more persuasive than other types of ads in shaping adolescents’ preferences.

Objective

This study examined whether adolescents could identify food companies’ Instagram posts as ads, and the extent to which Instagram versus traditional food ads shape adolescents’ preferences.

Methods

In Part 1, participants aged 13-17 years (N=832) viewed 8 pairs of ads and were asked to identify which ads originated from Instagram. One ad in each pair was selected from traditional sources (eg, print; online banner ad), and the other ad was selected from Instagram, but we removed the Instagram frame—which includes the logo, comments, and “likes.” In Part 2, participants were randomized to rate food ads that ostensibly originated from (1) Instagram (ie, we photoshopped the Instagram frame onto ads); or (2) traditional sources. Unbeknownst to participants, half of the ads in their condition originated from Instagram and half originated from traditional sources.

Results

In Part 1, adolescents performed worse than chance when asked to identify Instagram ads (P<.001). In Part 2, there were no differences on 4 of 5 outcomes in the “labeled ad condition.” In the “unlabeled ad condition,” however, they preferred Instagram ads to traditional ads on 3 of 5 outcomes (ie, trendiness, P=.001; artistic appeal, P=.001; likeability, P=.001).

Conclusions

Adolescents incorrectly identified traditional ads as Instagram posts, suggesting the artistic appearance of social media ads may not be perceived as marketing. Further, the mere presence of Instagram features caused adolescents to rate food ads more positively than ads without Instagram features.

Social media's influence on adolescents' food choices: A mixed studies systematic literature review

Over 90% of adolescents have at least one social media account, and their presence on social media continues to grow. Food and beverage brands capitalize on this trend by marketing their products on social media to adolescents. Depending on the nutrition value of the products being marketed, social media advertisements' influence may contribute to the risk of developing unfavorable health outcomes such as obesity, hypertension, and type 2 diabetes. This review aimed to investigate social media's food and beverage advertisements' role in influencing adolescents' food choices by appraising published literature. A systematic literature review was conducted reporting on social media's role in adolescents' food choices. Articles were searched through CINAHL and PubMed from scholarly journals between 2015 and 2020, using the search terms: social media use, food advertisements, adolescents, and food choices. Eligible articles were selected based on inclusion criteria. PRISMA guidelines were followed, and study quality was assessed using the Mixed Methods Appraisal Tool. The analysis was conducted using narrative analysis to identify key findings. Of the 234 records, six articles met inclusion criteria. The studies revealed two major findings: adolescents were more likely to recall unhealthy food and celebrity influence was a common component of the advertisements. This review suggests that food and beverage companies use social media for marketing their products by targeting the adolescent population. The use of celebrities and influencers and the promotion of "unhealthy" products appear to be commonly used tactics. With these findings, healthcare professionals should consider screening adolescents routinely for social media use and current eating habits and educating the adolescents, parents, and families about health risk. Additionally, implementing legislation and policies may be beneficial in preventing this exposure.

Shaping Healthy Eating Habits in Children With Persuasive Strategies: Toward a Typology

There is an abundance of evidence that the presentation of unhealthy foods (UHFs) in different media has the power to shape eating habits in children. Compared to this rich body of work with regard to the effects of UHF presentations, studies testing the effects of healthy foods (HFs) are less conclusive. In particular, while the persuasive mechanisms behind HF presentations are well-understood, we lack insights about the role of messages factors, that is, how are (and should) HFs (be) presented in order to foster healthy eating habits in children. This paper tackles this research gap by suggesting the Persuasive Strategies Presenting Healthy Foods to Children (PSPHF) typology, classified along three pillars: (a) composition-related characteristics, (b) source-related characteristics, and (c) information-related characteristics. Against the background of the PSPHF typology, we review the available empirical evidence, outline pressing research gaps, and discuss implications for researchers, health promoters, and program planers.

#SupportLocal: how online food delivery services leveraged the COVID-19 pandemic to promote food and beverages on Instagram

Objective:

To explore the promotion of discretionary foods/beverages and marketing strategies employed by the top three online food delivery services’ (OFDS) Instagram accounts in three countries before and during the coronavirus disease 2019 (COVID-19) pandemic.

Design:

Publicly available data were extracted for the top three OFDS Instagram accounts for Australia, United Kingdom (UK) and the United States of America (USA) from March to May 2019 and 2020. Food/beverage items from posts were classified as ‘discretionary’ or from the five food groups (FFG) according to the Australian Dietary Guidelines. Marketing strategies were coded using an existing framework. Posts referring to COVID-19 were coded under four marketing strategies: (i) appropriating frontline workers; (ii) combatting the pandemic; (iii) selling social distancing; and (iv) accelerating digitalisation.

Results:

From 581 posts, 618 food/beverage items were shown, of which 69 % (427/618) were classified as discretionary. In 2019, the most used marketing strategies were product imagery (unbranded) (137/195, 70 %), links (111/195, 57 %) and sponsorships/partnerships (58/195, 30 %). In 2020, the most used were links (252/386, 68 %), product imagery (unbranded) (179/386, 49 %) and branding elements (175/386, 45 %). The most common COVID-19 marketing strategy was combatting the pandemic (76/123, 62 %) followed by selling social distancing (53/123, 43 %), appropriating frontline workers (34/123, 28 %) and accelerating digitalisation (32/123, 26 %).

Conclusions:

Following the COVID-19 pandemic, OFDS adapted their marketing, creating content with the theme of ‘combatting the pandemic’. Due to the growing number of discretionary foods/beverages promoted on Instagram, this highlights the need for policy action to counter the potential influence social media platforms have on dietary behaviours.

Effects of Advertising: A Qualitative Analysis of Young Adults' Engagement with Social Media About Food

Young adults are constantly exposed to energy-dense, nutrient-poor food and beverages, particularly through advertising. Exposure can influence poor food choices and negatively impact health. This study aimed to understand young adults' attitudes and experiences associated with food-related advertisements, particularly on social media. This qualitative analysis involved n = 166 Australian 18 to 24-year-olds who were involved in a four-week online conversation on different areas relating to health, social media, and eating. Inductive thematic analysis was utilised on two forums on the recall and perceptions of food-related advertisements. Young adults commonly mentioned aspects of the marketing mix (promotion, product, price, and place) in food advertisements. Participants were more readily able to recall energy-dense, nutrient-poor food advertisements compared to healthy food-related advertisements. Digital advertisements were often discussed alongside the use of ad-blockers and algorithms which tailored their social media viewing to what they like. Participants felt constant exposure to unhealthy food advertisements hindered their ability to realise healthy eating behaviours and created feelings of guilt. This current analysis highlights the need to provide an advertising environment that appropriately motivates healthy eating and a food environment that allows healthy food to be the affordable and convenient option.

Adolescent Peer Influence on Eating Behaviors via Social Media: Scoping Review

BACKGROUND

The influence of social media among adolescent peer groups can be a powerful change agent.

OBJECTIVE

Our scoping review aimed to elucidate the ways in which social media use among adolescent peers influences eating behaviors.

METHODS

A scoping review of the literature of articles published from journal inception to 2019 was performed by searching PubMed (ie, MEDLINE), Embase, CINAHL, PsycINFO, Web of Science, and other databases. The review was conducted in three steps: (1) identification of the research question and clarification of criteria using the population, intervention, comparison, and outcome (PICO) framework; (2) selection of articles from the literature using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines; and (3) charting and summarizing information from selected articles. PubMed's Medical Subject Headings (MeSH) and Embase's Emtree subject headings were reviewed along with specific keywords to construct a comprehensive search strategy. Subject headings and keywords were based on adolescent age groups, social media platforms, and eating behaviors. After screening 1387 peer-reviewed articles, 37 articles were assessed for eligibility. Participant age, gender, study location, social media channels utilized, user volume, and content themes related to findings were extracted from the articles.

RESULTS

Six articles met the final inclusion criteria. A final sample size of 1225 adolescents (aged 10 to 19 years) from the United States, the United Kingdom, Sweden, Norway, Denmark, Portugal, Brazil, and Australia were included in controlled and qualitative studies. Instagram and Facebook were among the most popular social media platforms that influenced healthful eating behaviors (ie, fruit and vegetable intake) as well as unhealthful eating behaviors related to fast food advertising. Online forums served as accessible channels for eating disorder relapse prevention among youth. Social media influence converged around four central themes: (1) visual appeal, (2) content dissemination, (3) socialized digital connections, and (4) adolescent marketer influencers.

CONCLUSIONS

Adolescent peer influence in social media environments spans the spectrum of healthy eating (ie, pathological) to eating disorders (ie, nonpathological). Strategic network-driven approaches should be considered for engaging adolescents in the promotion of positive dietary behaviors.

'Pizza every day - why?': A survey to evaluate the impact of COVID-19 guidelines on secondary school food provision in the UK

The nutritional requirements of adolescence and the reported poor UK eating behaviours of young people are a significant public health concern. Schools are recognised as an effective 'place' setting to enable improvement to nutrition outcomes. The COVID-19 pandemic resulted in UK school closures from March 2020. In re-opening in September 2020, schools were required to meet guidelines to ensure the minimised impact of COVID-19 on the population (DfE 2020). We aimed to evaluate the impact of COVID-19 school guidelines on secondary and post-16 (16-18 years) food provision. An online survey was posted on 8th October to 1st December 2020, targeted at young people, parents and staff of secondary/post-16 education establishments in the UK. Two hundred and fifty-two responses were received, of which 91% reported a change in their school food provision, 77% reported time for lunch was shortened and 44% indicated the provision was perceived as less healthy during September 2020 (post-lockdown school return) compared with March 2020 (pre-lockdown). Analyses demonstrated that time, limited choice and healthiness impacted negatively upon young people's school food experience. The COVID-19 pandemic has presented a huge challenge to the delivery of healthy school food to young people. Therefore, schools require more support in following national food standards and incorporating nutrition education and behaviour change strategies within current guidelines.

Does exposure to socially endorsed food images on social media influence food intake?

Social norms can influence the consumption of high and low energy-dense (HED/LED) snack foods. Such norms could be communicated via social media, however, there is little experimental research investigating this possibility. This laboratory study aimed to investigate the acute effect of socially endorsed social media posts on participants' eating behaviour. Healthy women students (n = 169; mean age = 20.9; mean BMI = 23.3) were assigned to either a HED, LED or control condition, where they viewed three types of images (HED foods, LED foods and interior design as control), but only one type was socially endorsed (e.g. in the control condition, only interior design images were socially endorsed). Participants completed questionnaires and were also provided a snack buffet of grapes and cookies. One-way ANOVA revealed a significant main effect of condition on participants' relative consumption of grapes (percentage of grapes consumed out of total food intake), for both grams and calories consumed (both ps < .05). Follow-up t-tests revealed that participants consumed a larger proportion of grapes (grams and calories) in the LED condition vs HED condition (all ps < .05), and a larger proportion of calories from grapes in the LED compared to control condition (p < .05). These findings suggest that exposure to socially endorsed images of LED food on social media could nudge people to consume more of, and derive more calories from these foods in place of HED foods. Further research is required to examine the potential application of these findings.

Twitch user perceptions, attitudes and behaviours in relation to food and beverage marketing on Twitch compared with YouTube

Influencer marketing may be amplified on livestreaming platforms (e.g., Twitch) compared with asynchronous social media (e.g., YouTube). However, food and beverage marketing on Twitch has not been evaluated at a user level. The present study aimed to compare users' self-reported exposure to food marketing and associated attitudes, consumption and purchasing behaviours on Twitch compared with YouTube. A survey administered via social media was completed by 621 Twitch users (90 % male, 64 % white, 69 % under 25 years old). Of respondents, 72 % recalled observing at least one food or beverage advertisement on Twitch. There were significant differences in the recall of specific brands advertised on Twitch (P < 0⋅01). After observing advertised products, 14 % reported craving the product and 8 % reported purchasing one. In chat rooms, 56 % observed conversations related to food and 25 % participated in such conversations. There were significant differences in the number of users who consumed various products while watching Twitch (P < 0⋅01). Of users who frequented YouTube (n 273), 65 % reported negative emotions when encountering advertising on YouTube compared with 40 % on Twitch (P < 0⋅01). A higher proportion felt Twitch's advertising primarily supported content creators (79 v. 54 %, P < 0⋅01), while a higher proportion felt that YouTube's advertising primarily supported the platform (49 v. 66 %, P < 0⋅01). The findings support that food marketing exposures on Twitch are noticeable, less bothersome to users and influence consumption and purchasing behaviours. Future studies are needed to examine how the livestreaming environment may enhance advertising effectiveness relative to asynchronous platforms.

Sugary drink advertising expenditure across Australian media channels 2016-2018

OBJECTIVE

The aim of this study was to describe advertising expenditure for sugary drinks compared with alternative cold non-alcoholic beverages (artificially sweetened beverages, plain water, plain milk) between 2016 and 2018 across Australian media channels.

METHODS

Monthly estimates of advertising expenditure for non-alcoholic beverages were obtained from Nielsen Media and aggregated by product type and media.

RESULTS

Total sugary drink advertising expenditure between 2016 and 2018 ($129.5M) significantly exceeded expenditure on artificially sweetened drinks ($23.26M), plain water ($14.27M), and plain milk ($31.30M). Television and out-of-home advertising accounted for the largest share of sugary drink advertising (45%, 35%). Expenditure on out-of-home advertising was more heavily dominated by sugary drinks (75%) than advertising in all media combined (65%). Sugary drink advertising peaked in warmer months and was lowest in August. Soft drinks (26%), flavoured milks (24%) and energy drinks (21%) accounted for the majority of sugary drink advertising.

CONCLUSIONS

Cold non-alcoholic beverage advertising in Australian media is dominated by the advertising of sugary drinks. Implications for public health: Restricting unhealthy beverage advertising on television and out-of-home media may be most effective initially. However, comprehensive restrictions capturing a broader range of media and settings would be optimal to prevent displacement and limit advertising reach and exposure.

Exploring the extent of digital food and beverage related content associated with a family-friendly event: a case study

Background

Exposure to unhealthy food and beverage content is a contributing factor to the obesity epidemic. Youth are susceptible to unhealthy digital food marketing including content shared by their peers, which can be as influential as commercial marketing. Current Canadian regulations do not consider the threat digital food marketing poses to health. No research to date has examined the prevalence of food related posts on social media surrounding family-friendly events. The aim of this study was to explore the frequency of food related content (including food marketing) and the marketing techniques employed in social media posts related to a family-friendly event in Canada.

Methods

In this case study, a content analysis of social media posts related to a family-friendly event on Facebook, Twitter, and Instagram was conducted between January to February 2019. Each post containing food related content was identified and categorized by source and food category using a coding manual. Marketing techniques found in each food related post were also assessed.

Results

A total of 732 food and beverage related posts were assessed. These posts were most commonly promoted through Instagram (n = 561, 76.6%) with significantly more individual users (61.5%; p < 0.05) generating food and beverage related content (n = 198, 27%) than other post sources. The top most featured food category was fast food (n = 328, 44.8%) followed by dine-in restaurants (n = 126, 17.2%). The most frequently observed marketing techniques included predominantly featuring a child in the post (n = 124, 16.9%; p < 0.0001), followed by products intended for children (n = 118, 16.1%; p < 0.05), and the presence of family (n = 57, 7.8%; p < 0.0001).

Conclusions

The present study highlights the proliferation of unhealthy food and beverage content by individuals at a family-friendly event as well as the presence of food marketing. Due to the unfettered advertising found in digital spaces, and that they are largely unregulated, it is important for future policies looking to combat childhood obesity to consider incorporating social media into their regulations to safeguard family-friendly events. General awareness on the implications of peer to peer sharing of unhealthy food and beverage posts should also be considered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10716-w.

The Timing, Nature and Extent of Social Media Marketing by Unhealthy Food and Drinks Brands During the COVID-19 Pandemic in New Zealand

Background: Concerns have been raised that health and societal causes surrounding the COVID-19 pandemic were misappropriated by companies to promote their unhealthy products to vulnerable populations during a time of increased stress and hardship (i.e., COVID-washing). Social media is a common medium for unhealthy foods and beverage marketing due to lack of regulation and low levels of monitoring. Purpose: This study aimed to investigate the timing, nature and extent of COVID-washing on public social media accounts by New Zealand's major food and drink brands in the initial stage of the pandemic after the first case was detected in New Zealand and when stay-at-home lockdown restrictions (Level 4 and 3 Alert levels) were in place. Methods: A content analysis of social media posts from February to May 2020 by the twenty largest confectionery, snacks, non-alcoholic beverages, and quick-service restaurant (fast-food) brands was undertaken. COVID-19 related posts were identified and classified to investigate the timing, themes and engagement with social media marketing campaigns, flagging those that may breach New Zealand's Advertising Standards. Results: 14 of 20 unhealthy food and drink brands referenced COVID-19 in posts during the 4-month period, peaking during nationwide lockdown restrictions. Over a quarter of all posts by the 14 brands (n = 372, 27.2%) were COVID-19 themed. Fast-food brands were most likely to use COVID-19 themed posts (n = 251/550 posts, 46%). Fast-food brands also had the highest number of posts overall during the pandemic and the highest engagement. The most commonly-used theme, present in 36% of all social media posts referring to COVID-19, was to draw on feelings of community support during this challenging time. Suggesting brand-related isolation activities was also common (23%), and the message that "consumption helps with coping" (22%). Six posts were found to potentially breach one of New Zealand's advertising standards codes by promoting excessive consumption or targeting children. Conclusion: COVID-washing was used by unhealthy food and drinks brands to increase brand loyalty and encourage consumption. The current Advertising Standards system is ineffective and must be replaced with a government-led approach to effectively regulate social media advertising to protect all New Zealanders, particularly in times of crisis.

Social media and unhealthy food nexus: Evidence from Saudi Arabia

This study assesses consumers' preference for food from social media on a sample of 510 respondents from the Eastern region of Saudi Arabia using the Best-Worst Scaling method. The findings of the study conclude that unhealthy and nutrient-poor food items are more preferred than healthy and nutrient-rich food items. The study recommends that the food and drug authority should intervene to increase consumers' awareness about the effect of unhealthy food items by creating social media accounts to warn consumers about the health outcomes of consuming certain unhealthy foods marketed through social media platforms.

Food Choice Determinants and Perceptions of a Healthy Diet among Italian Consumers

Healthy food choices are crucial for a healthy lifestyle. However, food choices are complex and affected by various factors. Understanding the determinant factors affecting food choices could aid policy-makers in designing better strategies to promote healthy food choices in the general public. This study aims to evaluate the food choice motivations and to segment consumer groups, according to their food choice motivations, in a sample of 531 Italian consumers (collected by convenience sampling), through offline and online survey platforms. K-means cluster analysis was applied to identify consumer groups using six food choice motivation categories (health, emotional, economic and availability, social and cultural, environmental and political, and marketing and commercial). The results suggest that the strongest determinants for the food choices of Italian consumers are Environmental factors and Health. Two consumer profiles were identified through the segmentation analysis: Emotional eating and Health-driven consumers. The respondents were found to have a good awareness of what comprises a healthy diet. There is a potential market for healthy and sustainable food products, especially products with minimal or environmentally friendly packages. Food labels and information strategies could be promoted as tools to assist consumers to make healthy food choices.

The Devil is in the Detail: Challenging the UK Department of Health's 2019 Impact Assessment of the Extent of Online Marketing of Unhealthy Foods to Children

Background: How much unhealthy marketing do children see on digital devices? Marketing of unhealthy food and beverages has long been identified as a factor in children’s preferences, purchase requests and consumption. Rising global obesity mandates States to craft environments that protect children and young people’s health, as recommended by the World Health Organization, among others. However, assessing the impact of marketing restrictions is particularly challenging: the complexity of digital advertising markets means that measurement challenges are profound. In 2019, the UK Department of Health published an Impact Assessment that applied a novel method aiming to calculate costs and benefits of restricting unhealthy food and beverage advertising on digital devices (planned for implementation by 2022). It estimated UK digital unhealthy marketing to children at 0.73 billion advertising impressions annually, compared to television impacts of 3.6 billion. Aim and Method: We assessed this conclusion by reviewing the UK Department of Health/Kantar Consulting’s Online Baseline Methodology (the “Government Model”). We examined the model’s underlying premise and specified the seven analytic steps undertaken. For each step, we reviewed industry and academic evidence to test its assumptions and the validity of data applied. Results: We found that, in each step, the Government Model’s assumptions, and the data sources selected, result in underestimates of the scale of digital advertising of unhealthy foods—at least tenfold, if not substantially more. The model’s underlying premise is also problematic, as digital advertising spend data relate poorly to digital advertising exposure, leading to further underestimation of market scale. Conclusion: We conclude that the Government Model very substantially underestimates the impact of digital unhealthy food advertising restrictions on health. This analysis has relevance for global policy and for the impact of regulation on children’s health and well-being.

#Healthy: smart digital food safety and nutrition communication strategies-a critical commentary

This paper explores how food safety and nutrition organisations can harness the power of search engines, games, apps, social media, and digital analytics tools to craft broad-reaching and engaging digital communications. We start with search engines, showing how organisations can identify popular food safety and nutrition queries, facilitating the creation of timely and in-demand content. To ensure this content is discoverable by search engines, we cover several non-technical aspects of search engine optimisation (SEO). We next explore the potential of games, apps, social media, and going viral for reaching and engaging the public, and how digital data-based tools can be used to optimise communications. Throughout, we draw on examples not only from Europe and North America, but also China. While we are enthusiastic about the benefits of digital communications, we recognise that they are not without their drawbacks and challenges. To help organisations evaluate whether a given digital approach is appropriate for their objectives, we end each section with a discussion of limitations. We conclude with a discussion of General Data Protection Regulation (GDPR) and the practical, philosophical, and policy challenges associated with communicating food safety and nutrition information digitally.

The Advertising Policies of Major Social Media Platforms Overlook the Imperative to Restrict the Exposure of Children and Adolescents to the Promotion of Unhealthy Foods and Beverages

There have been global calls to action to protect children (aged <18) from exposure to the marketing of unhealthy foods and beverages (‘unhealthy foods’). In this context, the rising popularity of social media, particularly amongst adolescents, represents an important focus area. This study aimed to examine the advertising policies of major global social media platforms related to the advertising of unhealthy foods, and to identify opportunities for social media platforms to take action. We conducted a desk-based review of the advertising policies of the 16 largest social media platforms globally. We examined their publicly available advertising policies related to food and obesity, as well as in relation to other areas impacting public health. The advertising policies for 12 of the selected social media platforms were located. None of these platforms adopted comprehensive restrictions on the advertising of unhealthy foods, with only two platforms having relevant (but very limited) policies in the area. In comparison, 11 of the 12 social media platforms had policies restricting the advertising of alcohol, tobacco, gambling, and/or weight loss. There is, therefore, an opportunity for major social media platforms to voluntarily restrict the exposure of children to the marketing of unhealthy foods, which can contribute to efforts to improve populations’ diets.