Implicit Messages Regarding Unhealthy Foodstuffs in Chinese Television Advertisements: Increasing the Risk of Obesity

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.

Effect of changes in body mass index and waist-to-height ratio on blood pressure in 11- to 13-year-old children: a prospective population study

BACKGROUND

Existing evidence about associations between change in body mass index (BMI) and waist-to-height ratio (WHtR) change and high blood pressure are relatively limited.

AIMS

We aimed to investigate the associations of general overweight (based on BMI) and abdominal obesity (based on WHtR) change with high blood pressure in Chinese children.

SUBJECTS AND METHODS

A school-based cohort study in Ningbo region (China) was conducted among children with baseline evaluations in October 2016 with follow-up two years later. A total of 1432 children aged 11-13 years participated in this study.

RESULTS

Our results showed that a change from normal BMI or WHtR to overweight or abdominal obesity in children was associated with high blood pressure (adjusted odds ratio (AOR), 2.62; p<0.05 or AOR, 2.79; p<0.05, respectively). In addition, an increased risk of high blood pressure was observed in children who maintained overweight or abdominal obesity (AOR, 1.67; p<0.05 or AOR, 1.69; p<0.05, respectively), but not in children who experienced remission to non-excess weight. Interestingly, children who increased BMI or WHtR had greater impact on SBP than on DBP.

CONCLUSION

The 2-year longitudinal study indicated that general overweight or abdominal obesity can predict the risk factor of high blood pressure in children. However, children who remitted to non-excess weight did not exhibit an increased risk of high blood pressure.

Are Foods from the COVID-19 Pandemic Lockdown Low in Nutrients? An Analysis of Chinese Psychological Distress Effects

Background: The city-wide COVID-19 lockdown has resulted in psychological anguish, which may have an impact on dietary consumption. This study’s dual goals are to show how Chinese food consumption was altered before and after the lockdown, and to examine the nutrient density for the psychologically affected group. Methods: A cross-sectional study involving 652 people from Mainland China, Taiwan, and Macao was conducted with the aid of a web-based questionnaire. Sociodemographic characteristics, related environmental factors, nutrient consumption, food recommendations, and psychological distress were all measured. 516 trustworthy data revealed that two nutrient-poor foods were consumed less frequently during the lockdown than they were before to the COVID-19 outbreak (i.e., salty snacks and alcoholic beverages). People who endured high levels of psychological distress in particular tended to consume more. Particularly, those who experienced high levels of psychological distress had a tendency to consume far more alcohol than people who only experienced low levels of stress. Comparing the time before the COVID-19 to the present, there has statistically been an increase in the frequency of family members recommending diets. According to research, by food advice, individuals who experience psychological distress should consume more nutrient-dense foods (78.7%) than nutrient-poor ones (61.9%). Thus, food advice plays a role in mediating the relationship between psychological distress and dietary decisions for nutrient-rich (b = 0.186, p < 0.001) or nutrient-poor (b = 0.187, p < 0.001) food groups. This study provides insights for lowering psychological distress through dietary consumption, where the exact mechanisms underlying these connections have not been thoroughly elucidated. It encourages nutrition research by recommending practical nutrition education from family and environmental activities. Chronic psychological anguish may have a crucial relationship to secure access to food and a balanced diet. Along with nutrition instruction, it is critical to develop skills in interventions such as food procurement and culinary knowledge.

Impacts of Self-Efficacy on Food and Dietary Choices during the First COVID-19 Lockdown in China

The COVID-19 pandemic has caused a global public health emergency, increasing the prevalence of emotional distress, and potentially leading to altered diet behavior. Self-efficacy measures various aspects of perceiving and understanding emotions. The present study was carried out with the objective of understanding the effect of emotional self-efficacy on dietary behavior and quality. It also shed light on which elements contributed to the link between food-related behavior and perceived dietary quality during the first lockdown of the COVID-19 pandemic. Based on the factor analysis of nineteen food groups, choices, consumption, and socioeconomic status were examined in a sample of 441 Chinese participants. Multiple linear regression examined the association between food consumption, dietary quality, and self-efficacy. Contrary to prior research, the intake of salty snacks and alcoholic beverages dropped by 3.3% and 2.8%, respectively, during the first lockdown. Emotional self-efficacy negatively mediated the relationship between socioeconomic status and dietary quality. In conclusion, emotional self-efficacy is a well-established tool for evaluating how Chinese people cope with negative emotions. As an individual’s dietary quality was affected during the imposed lockdown, the present study offers valuable insight into psychosocial factors that may contribute to health disparities by advocating for organized nutritional support in future epidemic-related quarantines.

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.

Influence of the request and purchase of television advertised foods on dietary intake and obesity among children in China

Background

This study aims to examine the effects of the request and purchase of Television (TV) advertised foods on children’s dietary intake, overweight and obesity in China.

Methods

Data from 1417 children (aged 6–17 years) in the 2011 China Health and Nutrition Survey were analysed. The request and purchase of TV advertised foods were assessed through the frequency of children’s requests to purchase TV advertised foods and the frequency of parents’ purchases of these advertised foods, as well as the frequency of children’s purchases of TV advertised foods. The height and weight of children were measured. Logistic regression models were used to identify the associations between the request and purchase of TV advertised foods and overweight/obesity of children.

Results

The request and purchase of TV advertised foods were positively associated with children’s dietary intake of energy, protein, fat and carbohydrates. After adjusting for potential confounding factors, children’s request and purchase of TV advertised foods and parent’s purchase of TV advertised foods were positively associated with children’s overweight/obesity: odds ratio (OR) and 95% confidence interval (CI) for overweight/obesity were: 1.46 (1.01–2.11) for children purchasing advertised foods ≥1 time/week, 1.59 (1.15–2.18) for parents purchasing advertised foods for their children ≥1 time/week and 1.39 (1.00–1.95) for children requesting advertised foods ≥1 time/week.

Conclusions

The request and purchase of TV advertised foods are associated with children’s dietary intake. Moreover, the request and purchase of TV advertised foods can increase the risk of overweight and obesity of children. Health education involving children’s request and purchase of TV advertised foods and parents’ purchase of TV advertised foods should be considered in China.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11191-z.

Unhealthy aging? Featuring older people in television food commercials in China

Objectives

Advertising messages can affect the public as a risk or protective factor for socially disadvantaged groups, and they may reflect how characters reflect perceptions are perceived in a society. This study aimed to investigate how older people are portrayed in televised food commercials from the approach of a healthy aging perspective in contemporary Chinese society.

Methods

All televised advertising in the Ad Topic archive were screened against inclusion and exclusion criteria, and a total of 164 commercials from the years of 2016–2019 that portrayed Chinese older people were sampled. The association between the main older characters with the product categories, healthy vs. unhealthy foods, use of health claims, sex, type of spokesperson, companions, and tones and manners were included in the analysis.

Results

Older people more frequently appeared in unhealthy food products than in healthy food products. Health claims involving older adults were portrayed adequately, whereas nursing professions as companions of older adults were overlooked. Positive advertising that delivered happy, caring, or warm tones was overwhelmingly represented. Thus, the advertising messages circulated in China represent a binary stereotype model of images of older adults’ characteristics that reflect ageist and the so-called agelessism, referring to the new application of the look from the approach of social psychology and marketing field.

Conclusions

This study examined aging discrimination reflected in advertisements. Studies exploring the impact of a crisis remain limited. Research is needed to improve the accuracy of advertised healthy older adults and normal aging.

Development of a Teen-Informed Coding Tool to Measure the Power of Food Advertisements

The food-related information environment, comprised of food and beverage advertising within one’s surroundings, is a growing concern for adolescent health given that food marketing disproportionately targets adolescents. Despite strong public interest concerning the effects of food marketing on child health, there is limited evidence focused on outdoor food advertising in relation to teenage diets, food purchasing, and perceptions. Further, limited research has considered both the exposure to and influence of such advertisements. This study used a novel multi-method approach to identify and quantify the features of outdoor food and beverage advertisements that are most effective at drawing teenagers into retail food establishments. An environmental audit of outdoor advertisements and consultations with youth were used to: (1) identify teen-directed food marketing techniques; (2) validate and weigh the power of individual advertising elements; and, (3) develop a teen-informed coding tool to measure the power of food-related advertisements. Results indicate that marketing power is a function of the presence and size of teen-directed advertisement features, and the relative nature of each feature is an important consideration. This study offers a quantitative measurement tool for food environment research and urges policymakers to consider teen-directed marketing when creating healthy communities.