Evaluating the Canadian Packaged Food Supply Using Health Canada's Proposed Nutrient Criteria for Restricting Food and Beverage Marketing to Children

Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.

Systematic Review of Nutrient Profile Models Developed for Nutrition-Related Policies and Regulations Aimed at Noncommunicable Disease Prevention -An Update

Nutrient profiling (NP) models are useful for characterizing the healthfulness of foods and for underpinning various nutrition-related public health strategies. Recently, there has been a rapid increase in the number of NP models developed by different organizations worldwide. A systematic review (SR) summarizing the key characteristics of NP models with applications in government-led nutrition policies was carried out in 2016 and published by Labonté et al. [4]. Given the continuous proliferation of NP models, the current study aimed to update this SR. Systematic searches were performed in databases of both the peer-reviewed (n = 7) and grey (n = 1) literature to identify publications related to NP published between May 2016 and September 2020. The full text of relevant publications was assessed independently by 2 reviewers to build a list of potential models. Each model was classified as "already identified in the original SR" or as "newly identified." The eligibility of the "newly identified" models, and of some models excluded from the previous SR because their details were not known at that time, were then assessed independently by 2 reviewers based on pre-established criteria. A total of 151 potential NP models were assessed for eligibility, of which 93 were "newly identified," 28 were originally excluded from the previous SR, and 30 were identified from additional online searches during the eligibility assessment stage. Twenty-six models met the inclusion criteria. Their most frequent applications were food labeling (n = 17) and regulation of food marketing to children (n = 7). They all included nutrients to limit, with sodium, saturated fat, and total sugars being the most frequently considered. Content or face validity testing was conducted for 11 (42%) of the included models. As NP models are increasingly used worldwide to support public health strategies, having an up-to-date resource listing them and detailing their characteristics is crucial. PROSPERO #CRD42021259041.

Nutrient intakes and top food categories contributing to intakes of energy and nutrients-of-concern consumed by Canadian adults that would require a 'high-in' front-of-pack symbol according to Canadian labelling regulations

Canada recently mandated front-of-pack (FOP) labelling regulations, where foods meeting and/or exceeding recommended thresholds for nutrients-of-concern (i.e., saturated fat, sodium, and sugars) must display a 'high-in' FOP nutrition symbol. However, there is limited research on the amounts and sources of foods consumed by Canadians that would require a FOP symbol. The objective was to examine the intakes of nutrients-of-concern from foods that would display a FOP symbol and to identify the top food categories contributing to intakes for each nutrient-of-concern. Using the first day 24-hour dietary recall from the nationally representative 2015 Canadian Community Health Survey-Nutrition (CCHS), Canadian adults' intakes of nutrients-of-concern from foods that would display a FOP symbol was examined. Foods were assigned to 1 of 62 categories to identify the top food categories contributing to intakes of energy and nutrient-of-concern that would display a FOP symbol for each nutrient-of-concern. Canadian adults (n = 13,495) consumed approximately 24% of total calories from foods that would display a FOP symbol. Foods that would display a FOP symbol for exceeding thresholds for nutrients-of-concern accounted for 16% of saturated fat, 30% of sodium, 25% of total sugar, and 39% of free sugar intakes among Canadian adults. The top food category contributing intakes of each nutrient-of-concern that would display a FOP symbol were nutrient-specific: Processed meat and meat substitutes for saturated fat; Breads for sodium; and Fruit juices & drinks for total and free sugars. Our findings show that Canadian FOP labelling regulations have the potential to influence the intakes of nutrients-of-concern for Canadian adults. Using the findings as baseline data, future studies are warranted to evaluate the impact of FOP labelling regulations.

Child-appealing packaged food and beverage products in Canada-Prevalence, power, and nutritional quality

BACKGROUND

Children are frequently exposed to marketing on food packaging. This study evaluated the presence, type and power of child-appealing marketing and compared the nutritional quality of child-appealing vs. non-child-appealing Canadian packaged foods and examined the relationship between nutrient composition and marketing power.

METHODS

Child-relevant packaged foods (n = 5,850) were sampled from the Food Label Information Program 2017 database. The presence and power (# of techniques displayed) of child-appealing marketing were identified. Fisher's Exact test compared the proportion of products exceeding Health Canada's nutrient thresholds for advertising restrictions and Mann Whitney U tests compared nutrient composition between products with child- /non-child-appealing packaging. Pearson's correlation analyzed the relationship between nutrient composition and marketing power.

RESULTS

13% (746/5850) of products displayed child-appealing marketing; the techniques used, and the power of the marketing varied ([Formula: see text] 2.2 techniques; range: 0-11). More products with child-appealing packaging than with non-child appealing packaging exceeded Health Canada's thresholds (98% vs. 94%; p < .001). Products with child-appealing packaging (vs. non-child-appealing) were higher in total sugars (median: 14.7 vs. 9 g/RA; p < .001) and free sugars (11.5 vs. 6.2 g/RA; p < .001), but lower in all other nutrients. There was weak overall correlation between marketing power and nutrient levels. Results varied by nutrient and food category.

CONCLUSIONS

Unhealthy products with powerful child-appealing marketing displayed on package are prevalent in the food supply. Implementing marketing restrictions that protect children should be a priority.

Evaluating the potential implications of canadian front-of-pack labelling regulations in generic and branded food composition databases

Background

Canada proposed the implementation of mandatory front-of-pack (FOP) labelling regulations, whereby foods meeting or exceeding thresholds for nutrients-of-concern (i.e., total sugars, saturated fat, sodium) must display a ‘high-in’ FOP symbol (FOP). The objective of the study was to evaluate the potential implications of the proposed regulations using Canadian generic and branded food composition databases.

Methods

A generic food composition database of products consumed by Canadians, Canadian Nutrient File (CNF) 2015 (n = 3,677), and a branded food composition database of packaged foods and beverages, Food Label Information Program (FLIP) 2017 (n = 17,521), were used to evaluate the number and proportion of foods that would display a FOP symbol based on the details of the proposed FOP labelling regulations published in 2018.

Results

Overall, 35.5% (n = 1,306) of products in CNF 2015 and 63.9% (n = 11,193) of products in FLIP 2017 would display a FOP symbol for at least one nutrient-of-concern exceeding proposed thresholds. Soups, Combination Dishes, and Desserts categories in CNF 2015 and Combination dishes, Soups, and Meats categories in FLIP 2017 would have the highest proportion of products that would display a FOP symbol. Although displaying a FOP symbol for one nutrient was most common in both CNF 2015 (n = 992; 27.0%) and FLIP 2017 (n = 7,296, 41.6%), the number (i.e., 0–3) and type (i.e., saturated fat, sodium, total sugar) of nutrients displayed varied by food category.

Conclusion

While the generic database, containing both packaged and unpackaged foods, revealed a low prevalence of foods that would display a FOP symbol, the branded database showed that the proposed FOP labelling regulations would identify over 60% of packaged foods with excess contents of nutrients-of-concern. Considering the high prevalence of packaged foods in Canada that would meet or exceed the thresholds of nutrients-of-concern, the proposed FOP labelling regulations should be implemented in a timely manner to help consumers easily identify foods high in nutrients-of-concern and encourage manufacturer-driven product reformulations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14269-4.

Benchmarking unhealthy food marketing to children and adolescents in Canada: a scoping review

INTRODUCTION

Unhealthy food and beverage marketing in various media and settings contributes to children's poor dietary intake. In 2019, the Canadian federal government recommended the introduction of new restrictions on food marketing to children. This scoping review aimed to provide an up-to-date assessment of the frequency of food marketing to children and youth in Canada as well as children's exposure to this marketing in various media and settings in order to determine where gaps exist in the research.

METHODS

For this scoping review, detailed search strategies were used to identify relevant peer-reviewed and grey literature published between October 2016 and November 2021. Two reviewers screened all results.

RESULTS

A total of 32 relevant and unique articles were identified; 28 were peer reviewed and 4 were from the grey literature. The majority of the studies (n = 26) examined the frequency of food marketing while 6 examined actual exposure to food marketing. Most research focussed on children from Ontario and Quebec and television and digital media. There was little research exploring food marketing to children by age, geographical location, sex/gender, race/ethnicity and/or socioeconomic status.

CONCLUSION

Our synthesis suggests that unhealthy food marketing to children and adolescents is extensive and that current self-regulatory policies are insufficient at reducing the presence of such marketing. Research assessing the frequency of food marketing and preschooler, child and adolescent exposure to this marketing is needed across a variety of media and settings to inform future government policies.

The targeting of preschoolers, children, adolescents and adults by the Canadian food and beverage industry on television: a cross-sectional study

Unhealthy food advertising can negatively impact children's food preferences and nutritional health. In Canada, only companies participating in the self-regulatory Children's Food and Beverage Advertising Initiative (CAI) commit to limiting unhealthy food advertising to children. We analyzed food advertising from 182 Canadian television stations in 2018. A principal component analysis explored patterns of advertising by 497 food companies and their targeting of preschoolers, children, adolescents, and adults. Chi-square analyses tested differences in the volume of advertising between target age groups by heavily advertising food companies and by CAI-participating and non-participating companies. In 2018, Maple Leaf Foods, Boulangerie St-Méthode, Exceldor Foods, Goodfood Market and Sobeys advertised most frequently during preschooler-programming. General Mills, Kellogg's, the Topps Company, Parmalat and Post Foods advertised most frequently during child-programming, while Burger King, McDonald's, General Mills, Kellogg's and Wendy's advertised most frequently during adolescent-programming. CAI-participating companies were responsible for over half of the food advertising broadcast during programs targeted to children (55%), while they accounted for less than half of the food advertising aired during programs targeting preschoolers (24%), adolescents (41%) and adults (42%). Statutory food advertising restrictions are needed to limit food companies' targeting of young people on television in Canada. Novelty: Advertising from fast food restaurant chains dominated television programming targeted to adolescents in 2018. Advertising from breakfast cereal, candy, and snack manufacturers dominated television programming targeted at children in 2018. Over 100 Canadian and transnational companies contravened broadcast restrictions on advertising to preschoolers in 2018.

Relationship between Marketing to Children on Food Labeling and Critical Nutrient Content in Processed and Ultra-Processed Products Sold in Supermarkets in Lima, Peru

Consumption of ultra-processed foods has increased alarmingly, representing a risk to children’s health. Different techniques in marketing to kids (M2K) used on food labels are influencing the purchasing decisions of these products. This study aims to provide useful information about M2K found in labeling of food products sold in a supermarket chain in Lima, Peru and to determine its relationship with critical nutrient content. This was an observational, correlational, descriptive study. Data were collected by photographing the front-of-pack (FoP) of 2747 product labels sold in three supermarkets in Lima, but only those that met all the inclusion criteria were evaluated (n = 1092). A relationship was found between the use of techniques in marketing to kids and the level of critical nutrient regarding saturated fat (PR = 0.56; CI95%: 0.52–0.63), total sugar (PR = 1.70; CI95%: 1.64–1.77), and sodium (PR = 1.05; CI95%: 1.03–1.07). Particularly with sugar, the presence of M2K is a risk factor. New regulatory policies for the use of these food labeling techniques should be implemented to improve children’s health at the population level.

The Power of Packaging: A Scoping Review and Assessment of Child-Targeted Food Packaging

Child-targeted food marketing is a significant public health concern, prompting calls for its regulation. Product packaging is a powerful form of food marketing aimed at children, yet no published studies examine the range of literature on the topic or the “power” of its marketing techniques. This study attempts such a task. Providing a systematic scoping review of the literature on child-targeted food packaging, we assesses the nutritional profile of these foods, the types of foods examined, and the creative strategies used to attract children. Fifty-seven full text articles were reviewed. Results identify high level trends in methodological approaches (content analysis, 38%), outcomes measured (exposure, 44%) and with respect to age. Studies examining the nutritional profile of child-targeted packaged foods use various models, classifying from anywhere from 41% to 97% of products as unhealthy. Content analyses track the prevalence of child-targeted techniques (cartoon characters as the most frequently measured), while other studies assess their effectiveness. Overall, this scoping review offers important insights into the differences between techniques tracked and those measured for effectiveness in existing literature, and identifies gaps for future research around the question of persuasive power—particularly when it comes to children’s age and the specific types of techniques examined.