Children's exposure to food advertising on free-to-air television: an Asia-Pacific perspective

High consumption of unhealthy commercial foods and beverages tracks across the complementary feeding period in rural/peri-urban Cambodia

Consumption of unhealthy commercial foods and beverages (UCFB) is common among infants and young children living in low- and middle-income countries. Such foods can displace other nutritious foods, however, there is limited evidence on how this consumption tracks across time. This study assessed and tracked UCFB consumption of children living in rural/peri-urban Cambodia during the complementary feeding period, identified UCFB consumption patterns of these children, and explored the association between UCFB consumption and growth. A 6-month longitudinal cohort study was implemented among 567 caregivers of children aged 10-14 months at recruitment. UCFB consumption was estimated each month via a telephone-administered 7-day food frequency questionnaire, and UCFB consumption patterns were identified based on changes in this frequency of consumption over time. The majority of children either maintained (45.7%, n = 246) or developed (43.5%, n = 234) an unhealthy consumption pattern and only 10.8% (n = 58) of children maintained/transitioned into a healthy consumption pattern. High consumers of UCFB at 10-14 months had a 4.7 (CI: 4.7 [3.1-7.2]) times odds of being high consumers of UCFB at 15-19 months (p < 0.001). There was a trend of lower length-for-age z-scores (LAZ) among children maintaining or developing an unhealthy consumption pattern (~-0. SD LAZ) compared to children maintaining/transitioning into a healthy consumption pattern, however, this association was not statistically significant. Findings indicate that high UCFB consumption begins during infancy and tracks into early childhood. National policies and programmes centred on early interventions addressing the use of UCFB for infant and young child feeding are needed.

Strategies used by the soft drink industry to grow and sustain sales: a case-study of The Coca-Cola Company in East Asia

BACKGROUND

The market and non-market activities of the food and beverage industry contribute to unhealthy and unsustainable dietary patterns, increasingly in low-income and middle-income countries (LMICs). We aimed to describe how The Coca-Cola Company (TCCC), as the world market leader in the sugar-sweetened beverage sector, operationalises their activities in LMICs in East Asia, among the world's most highly populated yet under-researched countries, to illustrate the ways in which these activities may negatively influence health outcomes.

METHODS

We adopted a theoretically-guided qualitative research design and documentary analysis method. Data sources included: industry documents and web pages, marketing case studies obtained from the World Advertising Research Centre, media reports, global trade summaries and websites of industry associations. To guide data analysis, we synthesised a conceptual framework from existing commercial determinants of health literature, to describe ways in which the market and non-market activities of TCCC influence health.

RESULTS

TCCC leverages subsidiary companies and investments in international networks to expand its supply chains. The company engages in frequent political activities to minimise the implementation of nutrition policies that may impact profits. The company markets products, particularly on digital and mobile devices, often targeting children, adolescents and mothers, and undertakes public relations activities related to human rights, environmental sustainability and community and economic supports, and these public relations activities are often integrated into marketing campaigns. The identified activities of TCCC are frequently in direct contrast to efforts to improve the healthfulness of population diets in East Asia LMICs.

CONCLUSIONS

A public health analysis of the market and non-market activities of corporations active in unhealthy commodity industries needs to be broad in scope to cover the diverse set of strategies used to increase their market power and influence. Governments should consider a suite of policy options to attenuate these commercial determinants of unhealthy diets.

The extent and nature of television food and non-alcoholic beverage advertising to children during chinese New Year in Beijing, China

Background

Exposure to food and non-alcoholic beverage advertisements (F&B ads) on television, which can affect children’s nutrition knowledge, food consumption, diet quality, and purchasing preferences, is one aspect of the obesogenic environment. This aspect has been well-studied and assessed in many countries. In China, however, only few studies have been done in earlier years and all of them were focus on regular days. This study aimed to assess the extent and nature of F&B ads on television (TV) during the public holiday directed towards children aged 4–14 years in Beijing.

Method

Top 3 channels viewed by children aged 4–14 years in Beijing were selected by TV viewership data, survey, and expert consultation. Each channel was recorded for 7 days (24 h) during the public holiday of the Chinese New Year in 2019. F&B ads were coded and analyzed following the adapted food promotion module of INFORMAS protocol. Three nutrient profile models were used to classify F&B ads as healthy or unhealthy F&B ads.

Results

Of the 10,082 ads in 504-hour recorded programs, 42.9% were F&B ads. The hourly average ads and F&B ads per channel were 19.8 (SD 15.32) and 8.6 (SD 9.84), while that was higher on the national children’s channel (17.15, SD 12.25) than other channels (p < 0.05). Of F&B ads classified with the three nutrient profile models, more than 55% were unhealthy for children. The categories most frequently advertised were savory snacks, milk drinks, nonpermitted milk drinks, cakes/sweet biscuits, and beverages. Unhealthy F&B ads were more likely to use promotional characters, brand benefit claims, and health claims than permitted F&B ads (p < 0.05).

Conclusions

Children in Beijing were exposed to a high proportion of unhealthy F&B ads during the Chinese New Year holiday. Our findings support the need to assess and regulate TV F&B ads marketing for children.

The nutrition transition, food retail transformations, and policy responses to overnutrition in the East Asia region: A descriptive review

BACKGROUND

The East Asia region is facing an increasing burden of overweight, obesity and related noncommunicable diseases, resulting from an ongoing nutrition transition. This study aimed to document the growing burden of overweight and obesity, and the accompanying dietary shifts, in the East Asia region and describe the policy responses to this.

METHODS

We present noncommunicable disease risk factor collaboration data on trends in the burden of malnutrition, and Euromonitor International data on trends in dietary purchases, in the East Asia region. We searched the NOURISHING and GINA databases to identify food and nutrition policies implemented in these countries.

RESULTS

There is an ongoing nutrition transition in the East Asia region, notably in upper-middle and lower-middle income countries. The prevalence of overweight, obesity, and accompanying health conditions, purchases of ultra-processed foods and beverages, and purchasing from supermarkets, fast-food and takeaway outlets, and other convenience retailers, are increasing. The policy response to this nutrition transition is limited, with the majority of policies implemented in higher-income countries.

CONCLUSIONS

East Asian countries are facing a growing burden of malnutrition, due in part to the dietary shifts occurring here. An ecological approach to policy intervention is needed to drive transformative food systems change.

Barriers and opportunities to restricting marketing of unhealthy foods and beverages to children in Nepal: a policy analysis

BACKGROUND

Marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt ("unhealthy foods") to children is contributing to increasing child obesity. However, many countries have not implemented WHO recommendations to restrict marketing of unhealthy foods to children. We sought to understand the absence of marketing restrictions and identify potential strategic actions to develop and implement such restrictions in Nepal.

METHODS

Eighteen semi-structured interviews were conducted. Thematic analysis was based on Baker et al.'s 18 factor-framework for understanding what drives political commitment to nutrition, organised by five categories: Actors; Institutions; Political and societal contexts; Knowledge, evidence and framing; Capacities and resources.

RESULTS

All factors in Baker et al.'s framework were reported to be acting largely as barriers to Nepal developing and implementing marketing restrictions. Six factors were identified by the highest number of respondents: the threat of private sector interference in policy-making; lack of international actor support; absence of well-designed and enacted policies and legislation; lack of political commitment to regulate; insufficient mobilisation of existing evidence to spur action and lack of national evidence to guide regulatory design; and weak implementation capacity. Opportunities for progress were identified as Nepal's ability to combat private sector interference - as previously demonstrated in tobacco control.

CONCLUSIONS

This is the first study conducted in Nepal examining the lack of restrictions on marketing unhealthy foods to children. Our findings reflect the manifestation of power in the policy process. The absence of civil society and a multi-stakeholder coalition demanding change on marketing of unhealthy food to children, the threat of private sector interference in introducing marketing restrictions, the promotion of norms and narratives around modernity, consumption and the primary role of the individual in regulating diet - all have helped create a policy vacuum on marketing restrictions. We propose that stakeholders focus on five strategic actions, including: developing a multi-stakeholder coalition to put and keep marketing restrictions on the health agenda; framing the need for marketing restrictions as critical to protect child rights and government regulation as the solution; and increasing support, particularly through developing more robust global policy guidance.

Advertising Unhealthy Food to Children: on the Importance of Regulations, Parenting Styles, and Media Literacy

Purpose of Review

Childhood obesity is a global health concern. And a number of studies have indicated that food promotions affect children’s food attitudes, preferences, and food choices for foods high in fat and sugar, which potentially impacts children’s body weight development. This review showcases how children are affected by food promotions, why companies even target children with their promotional efforts, and what makes children so susceptible to promotion of unhealthy food. In addition, this review discusses how regulations, parental styles, and individual media literacy skills can help to contain the potential detrimental effects of food promotions on children’s health.

Recent Findings

The recent findings indicate that children are affected by food promotions in their preference for unhealthy food and beverages in selection tasks shortly conducted after exposure. Furthermore, results indicate significant effects of food marketing, including enhanced attitudes, preferences, and increased consumption of marketed (predominantly unhealthy) foods connected with a wide range of marketing strategies. Children are particularly vulnerable to promotional efforts and react to it strongly due to their still developing cognitive and social skills as well as their lack in inhibitory control.

Summary

This review proposes an applied focus that discusses pathways for regulators, parents, and educators. In the light of the discussed results, a large number of studies on food promotion indicate that there is need to react. In all these measures, however, it is of relevance to consider children’s developmental stages to effectively counteract and respond to the potential detrimental effects of food promotions on children’s long-term weight development.

Are the Italian Children Exposed to Advertisements of Nutritionally Appropriate Foods?

Unhealthy eating habits are one of the main risk factors for overweight/obesity, and food marketing plays a major role in their development. The aim of this study was to monitor the amount and the characteristics of food marketing directed to Italian children broadcasted on television (TV). The WHO tool to assess food and beverage multimedia marketing aimed at children was used to analyze TV recordings. Type of product branded, viewing time, channel’s target, and broadcasting company were the exposure variables analyzed. The power of persuasive techniques was also assessed. Food products were categorized as either core or non-core products on the basis of their nutritional profile. A total of 320 h of TV broadcasting was analyzed, including 51.7 h of commercials. Food and beverages were the second most frequently advertised products, with an average of 6 food advertisements per hour during peak viewing time. A total of 23.8% of food advertisements were recorded during the time slot of 3:00 p.m. Considering food and beverage commercials, “humor” was the most frequently used primary persuasive technique, while the “image of the product/packaging” was the most commonly used secondary persuasive technique. Products specifically targeted to children were 94.3% non-core. Our findings indicate that core foods are highly underrepresented in TV commercials, especially during children TV programs and peak viewing time.

Nutritional quality of foods and non-alcoholic beverages advertised on Brazilian free-to-air television: a cross-sectional study

BACKGROUND

Evidence shows that foods marketed on television are often low-nutrient-dense foods associated with poor nutritional diet quality, obesity and non-communicable diseases. However, little research has been undertaken in Brazil around this issue. This study assessed the nutritional profile of foods and non-alcoholic beverages advertised on Brazilian television by applying the Pan American Health Organization (PAHO) and the World Health Organization (WHO/Europe) nutrient profiling models.

METHODS

Cross-sectional study based on the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) protocol. A total of 432 h on the three major Brazilian free-to-air TV channels was recorded from April 1st to 30th 2018. Recordings were done for eight non-consecutive and randomly selected days from 6 am to 12 am (midnight). All food-related ads were coded using a systematic approach and classified according to the PAHO and the WHO/Europe nutrient profile models as "eligible"/"not eligible" for marketing restrictions. Absolute and relative frequencies were used to describe absolute numbers and proportions of food and beverage advertisements. The nutritional profile of foods was compared by day, time of the day and types of TV program. For each advertisement, the parent company of promoted food products, supermarkets and restaurants was identified.

RESULTS

A total of 1610 food and beverage ads were broadcast, representing 18.1% of the total ads shown on selected channels. Over 80.0% of all foods and beverages advertised on Brazilian TV channels did not meet the PAHO and the WHO/Europe nutritional quality standards and were considered eligible for marketing restrictions. The proportion of unhealthy food ads was significantly higher on weekends, in the afternoon, and during soap operas programming. Altogether, 10 transnational and local food and beverage companies, two large international fast food chains and two of Brazil's largest supermarket retailers accounted for almost 90% of all unhealthy food ads shown.

CONCLUSIONS

The findings of the present study indicate a high exposure of the Brazilian population to unhealthy food marketing and an inefficient enforcement of existing regulations. Further research to monitor population exposure to unhealthy food marketing and understand the policy inertia that is preventing policy progress, is highly recommended.

High proportions of children under 3 years of age consume commercially produced snack foods and sugar-sweetened beverages in Bandung City, Indonesia

Child undernutrition continues to be a national concern in Indonesia, whereas childhood overweight/obesity rises. Economic development has led to wide availability of highly processed foods and beverages, with growing evidence that children are consuming commercial snack products during the critical complementary feeding period. This study assessed the prevalence and patterns of consumption of commercially produced snack foods and sugar‐sweetened beverages among Indonesian children. A cross‐sectional survey was conducted with 495 mothers of children aged 6–35 months living in Bandung City, Indonesia. Among all children, 81.6% consumed a commercial snack food and 40.0% consumed a sugar‐sweetened beverage in the day preceding the interview. At 6–11 months, 46.5% of children consumed a snack food and 2.0% consumed a sugar‐sweetened beverage. Snack foods were consumed 3 or more times a day by 60.0% of children 24–35 months of age. Sweet biscuits and savory snacks were the most commonly consumed snack foods; sweetened milks and sweetened teas were the most common beverages. Maternal education, child age, and consumption of a commercially produced complementary food were associated with snack food consumption. Factors associated with sugar‐sweetened beverage consumption were child age and consumption of a commercially produced complementary food or breastmilk substitute. These findings reflect a high presence of processed, high‐sugar/salt commercial snack products in the diets of children 6–35 months. National attention should focus on interventions to reduce reliance on processed snack products and increase consumption of nutrient‐rich, locally available foods during the complementary feeding period.

Improved Understanding of Interactions between Risk Factors for Child Obesity May Lead to Better Designed Prevention Policies and Programs in Indonesia

The nutrition transition in low-middle income countries is marked by rising intakes of highly caloric, low nutrient-dense (junk) foods, decreasing intakes of fruits and vegetables, and sedentary behavior. The objective of this study was to explore interactions among fruit-and-vegetable intake, junk food energy intake, sedentary behavior, and obesity in Indonesian children. We conducted this school-based, case-control study in 2013 in Yogyakarta Special Province, Indonesia. The cases were 244 obese children aged 7–12 years having a BMI ≥95th percentile of an age- and sex-specific distribution from the Centers for Disease Control and Prevention. The controls (n = 244) were classroom-matched children with a BMI <85th percentile. Using conditional logistic regression, the relative odds (95% confidence intervals; OR: 95% CI) of obesity given reported frequent fruit-and-vegetable intake (≥3 servings/day), low junk food energy (≤1050 kcal/day) intake and low sedentary behavior (<5 h/day) was 0.46 (0.30–0.69), 0.61 (0.37–0.98), and 0.18 (0.12–0.28), respectively. Effect sizes were dose-responsive and appeared additive. For example, children with low sedentary behavior and frequent fruit-and-vegetable intake were 92% less likely (OR = 0.08; 0.04–0.15) to be obese than children not exceeding either of these thresholds. Similarly, children frequently eating fruits and vegetables and reporting a low junk food energy intake were 70% less likely (OR = 0.30; 0.15–0.59) to be obese. The findings were unchanged after adjusting for child, maternal, and household covariates. Preventive interventions for child obesity need multiple components to improve diets and raise levels of physical activity rather than just addressing one of the three types of assessed behaviors.

Global benchmarking of children's exposure to television advertising of unhealthy foods and beverages across 22 countries

Restricting children's exposures to marketing of unhealthy foods and beverages is a global obesity prevention priority. Monitoring marketing exposures supports informed policymaking. This study presents a global overview of children's television advertising exposure to healthy and unhealthy products. Twenty-two countries contributed data, captured between 2008 and 2017. Advertisements were coded for the nature of foods and beverages, using the 2015 World Health Organization (WHO) Europe Nutrient Profile Model (should be permitted/not-permitted to be advertised). Peak viewing times were defined as the top five hour timeslots for children. On average, there were four times more advertisements for foods/beverages that should not be permitted than for permitted foods/beverages. The frequency of food/beverages advertisements that should not be permitted per hour was higher during peak viewing times compared with other times (P < 0.001). During peak viewing times, food and beverage advertisements that should not be permitted were higher in countries with industry self-regulatory programmes for responsible advertising compared with countries with no policies. Globally, children are exposed to a large volume of television advertisements for unhealthy foods and beverages, despite the implementation of food industry programmes. Governments should enact regulation to protect children from television advertising of unhealthy products that undermine their health.

The extent, nature, and nutritional quality of foods advertised to children in Lebanon: the first study to use the WHO nutrient profile model for the Eastern Mediterranean Region

Objective

Exposure to food marketing may influence children’s food preferences and consumption patterns and may increase the risk of childhood obesity. The WHO Office for the Eastern Mediterranean Region (EMR) has recently released a regional nutrient profile model (WHO EMR) for the purpose of regulating the marketing of food and beverages to children. This study aimed at 1) analyzing the frequency and types of food and drink advertisements during children’s viewing time in Lebanon; 2) examining the nutritional content of the advertised food products in reference to the nutrient thresholds specified by the WHO EMR model; and 3) assessing the proportion of food advertisements that included health messages.

Design

This study consisted of a cross-sectional content analysis of food advertisements on local TV channels, during children’s viewing time.

Setting

Three local Lebanese channels with the highest viewership among 4- to 14-year-olds were selected. Recorded broadcasts (September 2016 through January 2017) were analyzed between 3 pm and 10 pm on weekdays and between 8 am and 10 pm on weekend days.

Results

Approximately 31% of advertisements were for foods or drinks. The proportion of food advertisements was the highest during children’s programs (43%) compared to general viewing (32%) and parental guidance (29%) programs. Approximately 8 out of 10 food advertisements were for products that did not meet the standards of the WHO EMR model. Of concern was the heavy advertisement of alcoholic beverages during programs for general audiences. The majority of the advertisements that comprised a health claim were for foods that did not meet the WHO EMR’s nutritional standards (79%).

Conclusions

The findings of this study, which is the first to utilize the new WHO EMR profile model, should be viewed as a foundation for the development of food marketing policies aimed at reducing children’s exposure to TV food advertisements in Lebanon, a country that harbors a high burden of childhood obesity.

Unhealthy food and non-alcoholic beverage advertising on children's, youth and family free-to-air and digital television programmes in Thailand

Background

Food advertising is a key factor which influences children’s food preferences. This study assessed the rates, nutritional quality and contents of food and beverage advertising in children’s, youth and family television programmes in Thailand.

Methods

Free TV was recorded for two weeks in March 2014 from six to ten am and three to eight pm on weekends and three to eight pm on weekdays across all four channels; a total of 344 h recorded. Digital TV was recorded across three channels for one week for 24 h per day in October 2014; a total 504 h recorded.

Results

For Free TV, 1359 food advertisements were identified, with on average 2.9 non-core food advertisements per hour per channel. The most frequently advertised food products on free TV were sugar-sweetened drinks. The rates of advertisements containing promotional characters and premium offers were significantly higher for non-core than core foods, 1.2 versus 0.03 and 0.6 versus 0.0 per hour respectively. For Digital TV, 693 food advertisements were identified, with an average of one non-core food advertisement per hour per channel. The most frequently advertised food products on digital TV were baby and toddler milk formulae.

Conclusions

Food and beverage advertising on Thai television is predominantly unhealthy. Therefore, the Government and related agencies should introduce and enforce policies to address this issue. Current regulations should be adapted to control both the frequency and nature of unhealthy on-air food marketing to protect the health of Thai children.

Why Food System Transformation Is Essential and How Nutrition Scientists Can Contribute

BACKGROUND

The International Union of Nutritional Sciences held its 21st International Congress of Nutrition in October 2017 in Buenos Aires, Argentina under the theme - From Sciences to Nutrition Security. In addition to multiple sessions on food systems and their links to diet, nutrition and health, the Congress closing lecture focused on the need to transform food systems so as to increase their capacity to provide healthy diets, making a call for greater involvement of nutrition scientists.

SUMMARY

This article presents the main messages of that lecture, providing (i) an overview of global nutrition trends and their links to diets, food environments and food systems, (ii) a synopsis of the current global momentum for food system transformation and (iii) the need for nutrition scientists to leverage this momentum in terms of increased evidence generation and policy advocacy. Key Messages: Poor quality diets are increasingly leading to the compromising of human health as never before; the prevalence of undernutrition persists and remains acute in vulnerable regions, and hunger is increasing concomitantly with an unprecedented rise in overweight, obesity and nutrition-related non-communicable diseases. Increasing access to healthy diets through faster, stronger implementation of supply and demand-side strategies that address the underlying drivers of today's faulty food systems is imperative to solve these problems, as well as to address related environmental and economic costs. The global momentum for such action is increasing, but the evidence base needed to galvanize governments and hold stakeholders accountable remains yet a fledgling. To date, inputs from nutrition scientists to this reform agenda have been weak, especially given the unique contributions the field can make in terms of rigorous analysis and technical advice. Strengthened participation will require innovations in metrics and methodologies, combined with new thinking on what constitutes viable evidence and a greater willingness to engage with private sector agri-food actors.

Development of the Adolescent Preoccupation with Screens Scale

BACKGROUND

Although public health concerns have been raised regarding the detrimental health effects of increasing rates of electronic screen use among adolescents, such effects have been small. Instruments currently available tend to be lengthy, have a clinical research focus, and assess young people's screen use on specific screen-based activities (e.g., TV, computer, or internet). None appear to address screen use across a broad range of screens, including mobile devices and screen-based activities. The objective was to develop a new and short self-report scale for investigating adolescents' screen use across all screens and screen-based activities in non-clinical settings.

METHODS

The Adolescent Preoccupation with Screens Scale (APSS) was developed over a three stage process. First, a review of the current literature and existing instruments was undertaken and suitable items identified. Second, the draft APSS was piloted with adolescents and item affectivity and discrimination indices were calculated. Third, a cross sectional school based online survey of 1967 Australian adolescents in grades 5 (10 years old), 7 (13 years) and 9 (15 years) from 25 randomly selected schools was conducted.

RESULTS

Factor Analysis on a sub-sample of the data (n = 782) and Confirmatory Factor Analysis on the remaining sub-sample (n = 1185), supported a two-factor model. The first factor reflects adolescents' mood management with screen use, and the second reflects a behavioural preoccupation. The measure demonstrated strong invariance across sex and across Grades 5, 7, and 9. Both factors displayed good internal consistency (α = .91 and .87, respectively). Sex and grade differences on both scales were investigated and boys in Grade 5 reported higher levels of both mood management and behavioural preoccupation with screens. There were no sex differences on mood management in Grades 7 and 9, but girls reported higher behavioural preoccupation in both these later grades.

CONCLUSION

The APSS provides researchers with a new, brief and robust measure of potentially problematic screen use across a wide array of screens, including mobile devices, so readily accessed during adolescence.

The extent and nature of television food advertising to children in Xi'an, China

Background

To explore the extent and nature of television food advertising especially unhealthy food advertising to primary school children in Xi’an, China.

Methods

Television data were recorded for 2 weekdays and 2 weekend days between 6:00 and 22:00 during May and June in 2012 from a total of five television channels most popular with children in Xi’an. Pearson χ² tests and logistic regression were applied to determine differences in the proportion of healthy food, unhealthy food and miscellaneous food advertisements for different channels, programs, dates, viewing periods and the use of persuasive marketing tactics.

Results

Of the 5527 advertisements transcribed, 25.5 % were for food, among which 48.1 % were considered to be unhealthy. The frequency of food advertisements was 6 per hour per channel, including 3 unhealthy food advertisements. Compared with healthy and miscellaneous food advertisements, more unhealthy food advertisements were shown during afternoon, weekends and children’s non-peak viewing times as well as on children’s television channels, central television channels and non-children’s programmes. Unhealthy foods contributed the highest proportion of all food advertisements containing promotional characters (51.7 %) and premium offers (59.1 %). Both promotional characters and premium offers appeared more on non-children’s television channels.

Conclusions

The majority of food advertisements were for unhealthy food. More unhealthy food ads were shown in children’s non-peak time and afternoon as well as non-children’s channels. More children-oriented persuasive marketing tactics were used in unhealthy food ads especially in non-children’s channels. Therefore, intervening in the entrance of unhealthy foods into the market and establishing regulations related to food advertising especially unhealthy food advertisements are important strategies to prevent children’s exposure to unhealthy food and childhood obesity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3468-0) contains supplementary material, which is available to authorized users.

Cardiovascular diseases in mega-countries: the challenges of the nutrition, physical activity and epidemiologic transitions, and the double burden of disease

PURPOSE OF REVIEW

There are today 11 mega-countries with more than 100 million inhabitants. Together these countries represent more than 60% of the world's population. All are facing noncommunicable chronic disease (NCD) epidemic where high cholesterol, obesity, diabetes, and cardiovascular diseases are becoming the main public health concerns. Most of these countries are facing the double burden of malnutrition where undernutrition and obesity coexist, increasing the complexity for policy design and implementation. The purpose of this study is to describe diverse sociodemographic characteristics of these countries and the challenges for prevention and control in the context of the nutrition transition.

RECENT FINDINGS

Mega-countries are mostly low or middle-income and are facing important epidemiologic, nutrition, and physical activity transitions because of changes in food systems and unhealthy lifestyles. NCDs are responsible of two-thirds of the 57 million global deaths annually. Approximately, 80% of these are in low and middle-income countries. Only developed countries have been able to reduce mortality rates attributable to recognized risk factors for NCDs, in particular high cholesterol and blood pressure.

SUMMARY

Mega-countries share common characteristics such as complex bureaucracies, internal ethnic, cultural and socioeconomic heterogeneity, and complexities to implement effective health promotion and education policies across population. Priorities for action must be identified and successful lessons and experiences should be carefully analyzed and replicated.

Reading the mind of children in response to food advertising: a cross-sectional study of Malaysian schoolchildren's attitudes towards food and beverages advertising on television

BACKGROUND

Television food advertising (TVFA) is the most dominant medium in the obesogenic environment promoting unhealthy food choices in children.

METHODS

This cross-sectional study investigated children's attitudes towards TVFA by examining four well-cited induction factors namely advertisement recognition, favourite advertisement, purchase request, and product preference. Malaysian urban schoolchildren (7 to 12 years) of equal ethnic distribution were voluntarily recruited (n = 402). Questionnaire administration was facilitated using a food album of 24 advertised food products.

RESULTS

Majority of children were older (66.2 %), girls (56.7 %) with one-third either overweight or obese. TV viewing time for weekend was greater than weekdays (4.77 ± 2.60 vs 2.35 ± 1.40 h/day) and Malay children spent more time watching TV compared to Chinese (p < 0.001) and Indian (p < 0.05) children. Chinese children spent significantly more time surfing the internet compared to either Malay or Indian (p < 0.01). Median score trend was advertisement recognition > favourite advertisement and product preference > purchase request, and significantly greater (p < 0.001) for non-core than core food advertisements. TV viewing time and ethnicity significantly influenced all induction factors for non-core foods. After correcting for all influencing factors, 'favourite advertisement' (IRRfinal adj: 1.06; 95 % CI: 1.04 to 1.08), 'purchase request' (IRRfinal adj: 1.06; 95 % CI: 1.04 to 1.08) and 'product preference' (IRRfinal adj: 1.04; 95 % CI: 1.02 to 1.07) still were significantly associated with TV viewing time. For every additional hour of TV viewing, the incidence rates increased significantly by 1.04 to 1.06 for 'favourite advertisement', 'purchase request' and 'product preference' related to non-core foods amongst Malay and Indian children. However, Chinese children only demonstrated a significant association between TV viewing time and 'favourite advertisement' (IRRadj: 1.06; 95 % CI: 1.01 to 1.10).

CONCLUSION

This study highlights TVFA as a powerful medium predisposing the mind of children to non-core foods through appealing TV commercials, promoting purchase request and generating unhealthy food preferences in early childhood.

Obesogenic television food advertising to children in Malaysia: sociocultural variations

BACKGROUND

Food advertising on television (TV) is well known to influence children's purchasing requests and models negative food habits in Western countries. Advertising of unhealthy foods is a contributor to the obesogenic environment that is a key driver of rising rates of childhood obesity. Children in developing countries are more at risk of being targeted by such advertising, as there is a huge potential for market growth of unhealthy foods concomitant with poor regulatory infrastructure. Further, in developing countries with multi-ethnic societies, information is scarce on the nature of TV advertising targeting children.

OBJECTIVES

To measure exposure and power of TV food marketing to children on popular multi-ethnic TV stations in Malaysia.

DESIGN

Ethnic-specific popular TV channels were identified using industry data. TV transmissions were recorded for each channel from November 2012 to August 2013 (16 hr/day) for randomly selected weekdays and weekend days during normal days and repeated during school holidays (n=88 days). Coded food/beverage advertisements were grouped into core (healthy), non-core (non-healthy), or miscellaneous (unclassified) food categories. Peak viewing time (PVT) and persuasive marketing techniques were identified.

RESULTS

Non-core foods were predominant in TV food advertising, and rates were greater during school holidays compared to normal days (3.51 vs 1.93 food ads/hr/channel, p<0.001). During normal days' PVT, the ratio of non-core to core food advertising was higher (3.25 food ads/hr/channel), and this more than trebled during school holidays to 10.25 food ads/hr/channel. Popular channels for Indian children had the lowest rate of food advertising relative to other ethnic groups. However, sugary drinks remained a popular non-core product advertised across all broadcast periods and channels. Notably, promotional characters doubled for non-core foods during school holidays compared to normal days (1.91 vs 0.93 food ads/hr/channel, p<0.001).

CONCLUSIONS

This study highlights non-core food advertising, and predominantly sugary drinks are commonly screened on Malaysian TV channels. The majority of these sugary drinks were advertised by multinational companies, and this observation warrants regulatory attention.