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

Contemporary digital marketing techniques used in unhealthy food campaigns targeting young people

The digital marketing of unhealthy foods and non-alcoholic beverages has a detrimental impact on children's eating behaviours, leading to adverse diet-related health outcomes. To inform the development of evidence-based strategies to protect children online, this study aimed to describe contemporary digital marketing techniques and industry reported impacts from unhealthy food and beverage marketing campaigns aimed at young people aged 3-17. We conducted a qualitative conceptual content analysis of 111 industry reports detailing the nature and impact of unhealthy food and beverage marketing campaigns from around the world that directly or indirectly targeted children through digital channels. We categorised and narratively describe how food and beverage companies are using digital marketing techniques, across four conceptual groups: (i) leveraging data and technology to optimise marketing, (ii) profiling and segmenting audiences, (iii) targeting and personalisation, and (iv) generating participation and engagement. Industry reported impacts on young people as a result of campaigns included i) increased exposure to, and engagement with, unhealthy food marketing, ii) purchases and consumption of unhealthy foods and beverages iii) formation of emotional brand connections and enhanced future marketing through data collection. Our findings support and extend existing literature revealing how multinational food and beverage companies are using advanced digital marketing techniques, including artificial intelligence and new technologies, to shape children's food behaviours and influence their diets worldwide. Policy actions are needed to protect children from the sophisticated digital marketing techniques used by the food and beverage industry.

How Children's Experiences and Perceptions of Their School Food Environment Influence Their Food-Related Decisions In-School in Urban Ghana

School food environments play an important role in shaping children's food-related decisions, including where and what foods to acquire and consume on a school day. In Ghana, evidence indicates that food environments in and around schools may limit healthy food acquisition and consumption behaviour. This study aimed to understand how children's experiences and perceptions of their school food environment influence food acquisition and consumption decisions. Data from 18 focus group discussions with children (n = 157; aged 10-17 years) attending Public Basic Schools in the Greater Accra Region of Ghana were analysed, guided by the African urban food environment framework for creating healthy nutrition policies and interventions. Children's food decisions in school were found to be influenced by experiences and perceptions at multiple food environment levels: macro, physical and social levels in combination with individual-level factors. At the macro level, exposure to food advertisements on television emerged as an influence on food-related decisions. At the physical level, experiences and perceptions of environmental sanitation, food vendor hygiene practices, affordability, and food quality were consistently reported to influence decisions. Social-level experiences including influence from friends/peers, family (mostly caregivers/parents) and social qualities of food vendors also shaped food-related decisions. Caregiver/parental dietary advice was often linked to healthier acquisition and consumption decisions by children in school. The findings highlight the need for actions that work in synergy across multiple levels of the school food environment to create conditions that support children to acquire and consume healthier diets.

Evidence-Based Lessons From Two Decades of Implementation Research on Complementary Feeding Programmes

Child nutrition has serious long-term development implications. Evidence-based frameworks and models are urgently needed to reduce deficits in infants and young children's diets on a large scale. Our paper reviews 32 publications and five impact evaluations of programmes in Bangladesh, Ethiopia, Nepal, Nigeria and Vietnam to identify what worked and why; the quality of evidence, diversity of countries and multi-level interventions on a large scale were selection criteria. Key lessons are: the need for advocacy to prioritize complementary feeding; engagement of multiple stakeholders to reach national scale and to address diverse factors such as food access, harmful marketing of unhealthy foods and beverages, knowledge gaps, social norms and maternal self-efficacy. Applying a behavioural science lens, monitoring intervention coverage, targeting to reduce inequalities, engaging community leaders, motivating frontline workers and leveraging mass media to reach multiple audiences worked synergistically to produce impacts at scale. Despite different contexts and dietary diversity levels at baseline, rigorous evaluations documented substantial improvements attributable to the interventions in all five countries. The expenditures incurred varied by programme complexity and showed that they are manageable if the interventions focus on priority issues, are streamlined to fit existing platforms and reach large populations. With evidence of impact in diverse contexts, an evidence-based conceptual framework and tools for implementation, insights into how to adapt to country contexts and knowledge of what to budget, decision-makers can invest confidently in improving complementary feeding programmes.

Comprehending the Epidemiology and Aetiology of Childhood Obesity: Integrating Life Course Approaches for Prevention and Intervention

INTRODUCTION

Childhood obesity is defined as a medical condition characterised by abnormally high amounts of body fat relative to lean body mass, which increases the risk of adverse health outcomes among children and adolescents from birth to 18 years. The prevalence of childhood obesity, which has serious healthcare implications, is surging, together with its healthcare burden. In this review we explore the intricate interplay of hereditary, environmental, behavioural, cultural and metabolic factors contributing to the global increase in childhood obesity rates. We examine the influence of prenatal factors, genetic predispositions and epigenetic mechanisms on obesity susceptibility and treatment strategies, emphasising the importance of a multilevel life course framework to understand the multifactorial causes of obesity.

METHODS

This narrative review examines the epidemiology, burden, aetiology and impact of childhood obesity by focusing on published literature and the efficacy of multilevel interventions. Comprehensive algorithms are provided to illustrate the causes of childhood obesity through the lens of a multilevel life course framework, taking into consideration individual, family, community and societal factors.

RESULTS

Genetic predispositions, including inherited tendencies towards emotional eating, metabolic variations and body fat distribution, significantly influence a child's obesity risk. Environmental factors, such as limited access to nutritious food, sedentary behaviour, insufficient opportunities for physical activity and obesogenic environments, contribute to the increasing prevalence of childhood obesity. Prenatal influences, including maternal hyperglycaemia and nutritional exposures, lead to epigenetic alterations that predispose children to obesity and metabolic disorders. The social environment, including parental influences, cultural norms and peer dynamics, shapes children's dietary habits and physical activity levels. Additionally, the review highlights the importance of early detection of metabolic alterations associated with paediatric obesity and insulin resistance and the potential for epigenetic mechanisms as therapeutic targets. Recommendations are made for tailored medical nutrition therapy, screening for syndromic obesity and multilevel interventions targeting individual and societal factors.

CONCLUSIONS

This review underscores the necessity of a comprehensive, multilevel approach that integrates genetic, environmental, behavioural and cultural factors along with lifestyle modifications and public health initiatives to address the complex and multifaceted issue of childhood obesity effectively. Targeted interventions across the life course, policy reforms, community engagement and technological innovations are recommended to mitigate obesity risks and promote long-term health. An infographic is available for this article. INFOGRAPHIC.

Nutrition knowledge of primary schoolchildren in Poland from the parents' perspective based on qualitative studies

Unhealthy nutrition among schoolchildren causes different diseases during childhood and later life, and the nutrition habits created in this period will continue in the future life. The aim of this study was to estimate schoolchildren's food and nutrition knowledge based on parents' opinions collected during qualitative research conducted using the Focus Group Interview (FGI) technique among 49 parents of primary school pupils from the capital city of Poland-Warsaw. Based on these findings, it was concluded that nutrition education for school children is needed because of the current lack of appropriate knowledge in both children and their parents, especially in practical aspects. Nutrition education is necessary to change pupils' attitudes toward food and nutrition, especially their nutritional behavior and responsible food choices. For this purpose, traditional and modern IT and telecommunications tools can be used; however, it should be noted that they must be used under adult supervision to understand better the different aspects of proper nutrition and food choices and to distinguish advertising from nutrition knowledge. The results provide a theoretical basis for undertaking intervention measures based on the family and school. It is important to underline that nutrition education at home, the equal institution in terms of importance within formulating proper attitudes toward food and nutrition as well other kinds of social behavior as school, can be realized during everyday activities connected with meal preparations.

Changes in the food environment surrounding schools in four New Jersey school districts between school years 2012-13 and 2019-20

OBJECTIVES

While public health policies have mostly targeted the food environment within schools, recent research shows that the food environment surrounding schools is also related to children's diet and health outcomes. The goal of this paper was to examine the changes in the food environment around schools from school year 2012-13 to 2019-20 in four New Jersey school districts.

METHODS

We analyzed data from 152 kindergarten - 12th grade public schools in Camden, Newark, New Brunswick, and Trenton for 2012-13 to 2019-20. Food outlets within 0.25-mile buffers around schools were classified into convenience stores, limited-service restaurants, small grocery stores, and upgraded convenience stores. Multivariable Poisson and negative binomial regression models were used to evaluate trends in food outlet prevalence over the study period.

RESULTS

The number of convenience stores decreased by 6 % annually (exp(βi) = 0.94, 95 % CI: 0.91; 0.96), while the number of upgraded convenience stores (carrying a selection of healthier items) increased by 30 % annually (exp(βi) = 1.30, 95 % CI: 1.17; 1.44). Other outlet types, such as small grocery stores and limited-service restaurants, remained stable.

CONCLUSIONS

Although unhealthy outlets remained the most prevalent, there were improvements in the food environment around schools over the study period. Notably, these changes coincided with local policy initiatives aimed at improving healthy food offerings in convenience stores. Local policies can improve the food environment around schools by increasing access to healthier options. Policies aimed at improving the food environment around schools are crucial for supporting children's health and enhancing the effectiveness of school nutrition programs.

Age, socioeconomic status, and weight status as determinants of dietary patterns among German youth: findings from the LIFE child study

Background

Malnutrition and its consequences, such as obesity, are growing problems, especially in disadvantaged subpopulations. In order to pinpoint possible contributors to children's nutritional habits, we examined potential determinants as age, sex, socioeconomic status, and weight status of different dietary patterns (dp) in a large German research project.

Methods

The data was collected within a population-based longitudinal cohort study. We used the Food Frequency Questionnaire (FFQ) to assess food intake in 484 children and adolescents aged 5-18 years across 1,068 visits. Cluster analysis was used to identify food groups. Study participants who consumed food groups with a similar frequency were grouped together as dietary patterns. We applied logistic and linear regression to test for whether group membership in different food groups and dietary patterns was associated with age, sex, socioeconomic status (SES), or body mass index (BMI).

Results

Overall, food consumption frequency decreased with age, including healthy foods like fruits (β = -0.39, p < 0.001) and vegetables (β = -0.17, p = 0.020). Boys consumed more meat and carbohydrates, milk/egg products, and junk food than girls did, but dietary patterns showed no significant sex differences. There was a trend toward a healthier diet with increasing SES (OR = 1.33, p < 0.001). Children with overweight or obesity were less likely to follow an infrequent diet (OROW = 0.56, p = 0.075; OROB = 0.41, p < 0.001) and were not significantly underrepresented in the healthiest pattern but were more likely to follow a neutral diet (OROW = 4.14, p = 0.042; OROB = 1.47, p = 0.504).

Conclusion

Our study identified age and SES as key factors in children's and adolescents' nutrition, highlighting their importance for improvement measures. The findings on weight and diet suggest both the complexity of obesity aetiology and potential reporting bias in certain weight groups.

Adolescent Nutritional Patterns and Health Behaviors in Romania: A Cross-Sectional Analysis

Background: Adolescence is a pivotal developmental stage marked by physiological and behavioral changes that significantly influence dietary habits and long-term health outcomes. Objectives: This study aimed to examine the associations between socio-demographic characteristics, psychological factors, and dietary behaviors among school-aged children and adolescents in Romania. Methods: A cross-sectional study was conducted using a structured, self-administered questionnaire completed by 662 children and adolescents aged 6 to 18 years, enrolled in primary, middle, and high schools across urban and rural areas. The questionnaire evaluated nutritional intake, meal patterns, hydration habits, physical activity, screen time, and psychological factors such as fatigue, stress, and mood fluctuations. Body mass index (BMI) was calculated based on self-reported height and weight. Results: The analysis reveals significant gender differences in body mass index (BMI), weight-loss behaviors, and family structure. Female adolescents were more likely to be underweight (18.27%) compared to male adolescents (10.82%), while overweight prevalence was higher among male adolescents (18.66%) than female adolescents (11.68%) (χ2 = 11.457, p = 0.009). Dietary patterns varied significantly across age groups, with high-school-aged children demonstrating lower vegetable consumption and increased autonomy over food choices. Primary school children exhibited higher intake of carbonated beverages (OR = 0.185, p = 0.002 for high school; OR = 0.116, p < 0.001 for middle school), whereas teenagers showed a preference for structured meals and lower fast-food intake. Meat consumption frequency correlated with greater diversity in protein sources (χ2 = 48.77, p < 0.001), while chaotic eating behaviors were more prevalent among middle and high-school-aged children (OR = 2.291, p = 0.032 for middle school; OR = 2.225, p = 0.030 for high school). Hydration habits played an essential role in dietary quality, with school-age children consuming ≥ 3 L of water daily exhibiting healthier eating patterns (OR = 7.146, p = 0.001). Additionally, psychological factors such as fatigue and stress were significantly associated with unhealthy dietary choice. Conclusions: These findings highlight the need for targeted nutritional education, school-based interventions, and family-focused strategies to improve adolescent health behaviors.

Consumers acceptability of using screen capture methods to capture marketing strategies on online food delivery platforms: a qualitative study

OBJECTIVE

The use of online food delivery (OFD) platforms is on the rise, and currently, there are no public health policies that regulate what and how food is sold on these platforms. Research quantifying and describing the marketing strategies on OFD platforms is limited. Our study aimed to test the consumers' acceptability of using two screen capture methods to record their food purchasing behaviour on OFD platforms and describe consumers' exposure to, and engagement with, marketing strategies on OFD platforms in real time.

DESIGN

Semi-structured online interviews on the consumer acceptability of using the screen capture methods were analysed using thematic analysis. Screen recordings of OFD orders were analysed using content analysis, guided by the marketing mix framework (i.e. product, placement, price and promotion).

SETTINGS

Victoria, Australia.

PARTICIPANTS

Twenty adults using the OFD service at least once a month were recruited.

RESULTS

The mean age of the sample was 28 years. 75 % were females, over 80 % had completed higher education and 20 % lived with children < 18 years of age. Over half used OFD service two to five times per week. Participants expressed that both smartphone's in-built screen recording function and third-party screen recording application are easy-to-use and time-efficient with high levels of user satisfaction. A range of marketing strategies were observed on the OFD platform. These included the presence of, and strategic placement of selected food products, price discounts and promotion strategies. Participants appeared to engage with marketing strategies through multiple clicks to reduce the total cost of their OFD order.

CONCLUSIONS

Our study demonstrates that screen recording is an acceptable method for capturing and assessing consumers' real-time exposure to, and engagement with, a range of marketing strategies on the OFD platform. Studies with larger samples are needed to substantiate our findings.

Nutritional quality and on-package marketing of pre-packaged foods and non-alcoholic beverages for sale in Senegalese supermarkets

BACKGROUND

The high availability and marketing of unhealthy foods has contributed to unhealthy diets. Unhealthy diets are a major risk factor for a range of non-communicable diseases (NCDs). However, the availability and marketing of pre-packaged foods haven't been assessed in Senegal. Nutrient profiling models have been developed to identify less healthy foods that could be subject to marketing restrictions, particularly when targeted at children. The aim of this study was to assess the nutritional quality and on-pack promotion of pre-packaged food sold in major supermarkets in Senegal using the Nutrient Profile Model for the WHO African Region (NPM-WHO/AR), the Nutri-Score labelling system and the NOVA classification.

METHODS

A cross-sectional survey was conducted in two major supermarkets in Dakar between August and September 2021. Data were collected for all pre-packaged foods, with the exception of the fresh food and alcoholic beverages categories. Pre-packaged foods were classified into fifteen food categories and five beverage categories according to the NPM-WHO/AR, with the exception of the categories "fresh and frozen meat, fish and sea food" and "fresh and frozen fruits and vegetables, legumes and tubers". Nutritional information was extracted from product labels and products were evaluated using 3 classification systems: NPM-WHO/AR, Nova classification as an indicator of the degree of food processing and Nutri-Score, a nutritional labelling system based on a 5-colour scale from dark green to red, associated with letters ranging from A (high nutritional quality) to E (low nutritional quality), established according to nutritional value and fruits, vegetables and legumes content. Depending on the classification system used, foods were rated on the basis of the nutritional information declared as relevant for this rating. Thus, 5,542 products were evaluated for their nutritional composition, 5,280 products were evaluated according to the NPM-WHO/AR and 5,407 products were evaluated according to both the Nutri-Score and the Nova classification. A pre-packaged food was classified as "non-permitted" to be marketed to children if the content of defined nutrients exceeded the threshold set in the model for the corresponding product category. Data analysis was performed using RStudio.

RESULTS

Ultra-processed foods (71.1%) and processed foods (18.8%) were the most common in Senegalese supermarkets. According to the Nutri-Score, pre-packaged foods were most frequently classified as Nutri-Score D (24.4%) and Nutri-Score E (22.1%). Almost 63.3% of the products were classified as non-permitted to be marketed to children according to the NPM-WHO/AR. Of these foods, 12.5% had on-pack promotions. Non-permitted foods to be marketed to children with the highest number of on-pack promotions were "breakfast cereals" (50.0%), "chocolate and sugar confectionery" (31.3%), "milk and dairy based drinks" (28.1%) and "cakes, sweet biscuits and pastries" (17.7%). However, the comparison between the NPM-WHO/AR and the Nutri-Score showed that some NPM-WHO/AR prohibited foods were classified into Nutri-Score A and B.

CONCLUSIONS

This study shows that pre-packaged foods available in major supermarkets in Senegal are predominantly non-permitted to be marketed to children. In the context of increasing levels of obesity and diet-related NCDs, effective policies should be established to regulate the promotion of these foods.

Childhood Obesity: A Narrative Review

Obesity among children has emerged as a worldwide health issue due to childhood obesity becoming a pandemic, and it is often linked to various illnesses, fatal outcomes, and disability in adulthood. Obesity has become an epidemic issue in both developed and developing countries, particularly among youngsters. The most common factors contributing to non-communicable diseases (NCDs) are unhealthy eating habits, desk-bound games, avoidance of physical activity-requiring activities, smoking, alcohol usage, and other added items. All these factors increase NCDs, including obesity, resulting in various morbidities and early death. Additionally, childhood obesity has psychological, emotional, cognitive, societal, and communicative effects. For example, it raises the possibility of issues related to physical appearance, self-esteem, confidence level, feelings of isolation, social disengagement, stigma, depression, and a sense of inequality. Children who consume more energy-dense, high-fat, low-fiber-containing food than they need usually store the excess as body fat. Standardizing indicators and terminology for obesity-related metrics is critical for better understanding the comparability of obesity prevalence and program effectiveness within and between countries. The underlying variables must be altered to reduce or avoid harm to the target organ in children. As a result, reducing childhood obesity is a considerable public health goal for the benefit of society and the long-term well-being of individuals.

Public support for unhealthy food marketing policies in Australia: A cross-sectional analysis of the International Food Policy Study 2022

OBJECTIVE

This study aimed to explore public opinion towards food marketing policies.

METHODS

In 2022, a cross-sectional online survey was completed by 3,923 adults in Australia, including 1,152 caregivers of children aged <18 years. Concern about children's exposure to unhealthy food marketing was assessed among caregivers. Public support for seven policy options to restrict unhealthy food marketing in different media and settings (broadcast, online, outdoors, packaging and retail) was quantified. Multivariable regression analyses were conducted to examine sociodemographic differences.

RESULTS

Most caregivers (85%) reported some degree of concern about their child's exposure to unhealthy food marketing. Among all respondents, there was a high level of support or neutrality (>70%) for all policies aimed at restricting unhealthy food marketing. Respondents who were female, older, highly educated, who identified as Aboriginal and/or Torres Strait Islander, perceived their monthly income as adequate or had at least one child living in the household reported higher support/neutrality towards several of the assessed policies.

CONCLUSIONS

Most Australian adults were supportive or neutral towards policies restricting unhealthy food marketing. The level of support varied depending on the policy's target group and its setting.

IMPLICATIONS FOR PUBLIC HEALTH

Implementing unhealthy food marketing policies in Australia would most likely have broad public support and minimal opposition.

Down the Rabbit Hole: How Digital Media Shapes Public Perceptions of Food Science and Technology Research (And How We Can Safeguard Science Integrity and Credibility)

Professionals and practitioners in food science and technology navigate a minefield of challenges stemming from the convergence of science, scientific inquiry and research, and online mass and social media. Misinterpretations and politicized debates occur frequently in online media, where food- and diet-related topics have an avid following, and conflicting information or incomplete coverage may occasionally undermine public trust in the integrity of food science research from both academia and industry. Leveraging a broad landscape analysis of scientific and popular lay journal reports, we catalog a series of food science and technology topics that have been popularized in online forums, sometimes at the expense of scientific accuracy. Finally, we detail some guidelines and tools that may assist food science and technology academics, industry professionals, science publishers, and online journalists in rigorously safeguarding the integrity and credibility of research reports that reach the lay consumer through social and online media channels.

The use of social media to promote unhealthy food and beverage consumption among Indonesian children

BACKGROUND

Rates of childhood overweight and obesity are rising across most low and middle-income countries (LMICs), including Indonesia, the largest country in Southeast Asia. Marketing of unhealthy food and beverages to children is a key driver, yet evidence on digital marketing strategies used in LMICs remains scarce. This study examines the techniques used to advertise unhealthy food and beverages to children on social media in Indonesia.

METHODS

We retrieved 295 ads on three social media platforms (Facebook, Instagram, and Twitter) from 20 food brands with the highest market share in Indonesia across four food categories (snacks, processed foods, soft drinks, and fast food). Marketing techniques used in the ads were coded based on a pre-developed codebook outlining techniques often used to target children and assessed qualitatively through content analysis. The healthfulness of the products advertised was also evaluated, based on the WHO nutrient profile model for Southeast Asia.

RESULTS

The ads analysed employed frequently marketing techniques used to target children. The most common marketing techniques across the three platforms were the inclusion of social media features (21.3%), branded products (19.6%), emotional cues and appeal of fun (10.1%), images of children, teens, or adults (9.0%) and special offers (6.6%). Notably, 85% of the brands analysed promoted at least one food unsuitable for marketing to children based on the WHO model.

CONCLUSIONS

Food and beverage brands in Indonesia purposely and frequently employ various techniques on social media to target children with ads for food and beverages that, based international nutritional standards, are unsuitable for promotion to this age group. This represents a threat to the nutritional status, health, and well-being of Indonesian children, and calls for stricter regulations on the marketing of these products in the country.

A Narrative Review of Multifactorial Determinants of Childhood Eating Behaviors: Insights and Interventions Using the Social Ecological Model

Background/Objectives: Childhood eating behaviors result from a complex interplay of familial, social, and environmental factors, influenced by socioeconomic and cultural contexts. These behaviors impact dietary habits, nutritional status, and long-term health. Using the Social Ecological Model (SEM), this narrative review synthesizes evidence on key determinants of childhood eating behaviors and proposes a framework for multi-level interventions. Methods: A structured literature search was conducted across PubMed, PsycINFO, and CINAHL, focusing on studies published between January 2014 and September 2024. Keywords related to childhood eating behaviors, familial determinants, and social influences were used to identify relevant studies. Inclusion criteria centered on empirical research examining how social and familial factors impact childhood eating behaviors within the SEM framework. Results: The review highlights critical determinants, including parental feeding practices, home food environments, peer influences, screen time, school meal programs, and socioeconomic disparities. These factors interact across multiple levels, emphasizing the importance of holistic interventions that target both individual behaviors and broader systemic influences. Conclusions: Addressing childhood eating behaviors requires a multi-level approach that integrates caregiver education, peer-led interventions, improved food environments, and supportive policies. Healthcare providers and policymakers play a crucial role in implementing strategies that foster healthier dietary behaviors and mitigate childhood obesity risks.

Unhealthy food advertising on social media: policy lessons from the Australian Ad Observatory

The World Health Organization and public health experts are calling for urgent restrictions on the online marketing of unhealthy food. The harmful effects of exposure to advertising for 'unhealthy foods', including discretionary foods high in fat, salt or sugar, particularly for children, has prompted a proposed policy action in Australia to prohibit all online unhealthy food marketing. We used a novel data donation infrastructure, the Australian Ad Observatory, to create a dataset of 1703 ads promoting top-selling unhealthy food brands that had been placed by 141 different advertisers on 367 individual Australians' Facebook feeds. We used this dataset to identify any targeting of unhealthy food ads towards young people (18-24), investigate harmful marketing practices by four of the top advertisers (KFC, McDonald's, Cadbury and 7-Eleven); and demonstrate how online advertising may be made observable and accountable. We find indications that young people (18-24), especially young men, are being targeted by unhealthy food, especially fast food, ads. We also find that unhealthy food brands use potentially harmful marketing strategies to appeal to children, young people, parents and the broader community, including cartoon characters, and associations with popular sports and greenwashing. The policy implications of our findings are that a broad prohibition on all forms of unhealthy food advertising online is desirable to protect not only children but also young people and the broader community. Such a prohibition will go one step towards addressing the commercial and digital determinants of health caused by harmful industries' use of online automated advertising.

A Multi-Level Approach to Childhood Obesity Prevention and Management: Lessons from Japan and the United States

BACKGROUND

Childhood obesity is a pressing global public health challenge, marked by significant disparities in prevalence and management across countries. Japan and the United States offer contrasting approaches to addressing this issue, presenting a valuable opportunity for comparative analysis.

OBJECTIVE

This review examines the effectiveness of public health policies, cultural dietary habits, and lifestyle factors in combating childhood obesity in Japan and the United States. It aims to identify actionable insights to inform global strategies for obesity prevention.

RESULTS

Japan exhibits one of the lowest childhood obesity rates globally, attributed to prevention-focused policies such as the food education program, stringent school lunch standards, and culturally ingrained healthy eating practices. These efforts are complemented by active lifestyle promotion through urban planning and school-based physical education programs. In contrast, the United States faces higher obesity rates due to systemic challenges, including socioeconomic disparities, reliance on processed foods, sedentary lifestyles, and inconsistent implementation of federal programs like the National School Lunch Program (NSLP) and Supplemental Nutrition Assistance Program Education (SNAP-Ed).

CONCLUSIONS

This review highlights Japan's success in aligning public health initiatives with cultural norms to achieve sustainable outcomes. In the United States, systemic barriers and cultural disconnects hinder obesity prevention efforts. Recommendations include adopting integrated, prevention-focused policies, addressing socioeconomic inequities, redesigning urban environments to promote active living, and fostering global collaboration. This comparative analysis underscores the importance of culturally tailored, multidimensional strategies for addressing childhood obesity and improving public health outcomes worldwide.

Feasibility and Preliminary Efficacy of Co-Designed and Co-Created Healthy Lifestyle Social Media Intervention Programme the Daily Health Coach for Young Women: A Pilot Randomised Controlled Trial

BACKGROUND

Young women spend 50 min daily on social media (SM); thus, SM platforms are promising for health interventions. This study tested the feasibility and preliminary efficacy of the co-designed SM intervention the Daily Health Coach (DHC). The DHC is a 3-month healthy lifestyles intervention programme, targeting eating, physical activity, and social wellbeing behaviours in women aged 18-24, via the dissemination of health and nutrition content on social media platform Instagram.

METHODS

The programme was tested using an assessor-blinded, two-arm pilot randomised controlled trial with 46 participants over 12 weeks. Engagement was assessed via SM metrics; acceptability via post-programme questionnaires; and feasibility included retention, randomisation, recruitment, and data collection. Secondary outcomes-dietary quality, physical activity, social influence, disordered eating behaviours, body image, and digital health literacy-were assessed using validated surveys. Analyses included t-tests, chi-squared tests, and linear mixed models. The treatment effects were estimated by testing mean score differences from baseline to 3 months for intention-to-treat populations.

RESULTS

The DHC scored 83.6% for programme satisfaction. Over time, a significant decrease in body image disturbance was observed (p = 0.013). A significant group-by-time interaction for digital health literacy (p = 0.002) indicated increased ability to discern evidence-based nutrition information (p = 0.006). The waitlist control group showed increased social influence compared to the intervention group (p = 0.034). No other significant changes were observed.

CONCLUSION

The DHC is a feasible and acceptable method for disseminating nutrition information. Larger studies are needed to determine efficacy.

Extent and Nature of Television Food and Nonalcoholic Beverage Marketing in 9 Asian Countries: Cross-Sectional Study Using a Harmonized Approach

BACKGROUND

Rising childhood obesity rates in Asia are adding risk for the future adult burden of obesity and noncommunicable diseases. Weak policies across most Asian countries enable unrestricted marketing of obesogenic foods and beverages to children. Television is the common medium for food marketing to reach this audience.

OBJECTIVE

This study aimed to assess the extent and nature of television food and nonalcoholic beverage marketing in 9 Asian countries (Bangladesh, China, India, Malaysia, Mongolia, Nepal, the Philippines, Sri Lanka, and Vietnam) with capacity building support from the International Network for Food and Obesity/Non-Communicable Disease Research, Monitoring and Action Support, who enabled harmonization of data collection method and content analyses.

METHODS

Advertised foods were categorized as permitted or not permitted based on the nutrient profile models established by the World Health Organization regional offices for South-East Asia (SEARO) and the World Health Organization regional offices for Western Pacific (WPRO). Overall rates of food advertisements (advertisements per hour per channel) and persuasive strategy use were analyzed along with comparisons between children's peak viewing time (PVT) and non-PVT.

RESULTS

Cross-country comparisons, irrespective of country income level, indicated that not permitted food advertising dominated children's popular television channels, especially during PVT with rates as per WPRO or SEARO criteria ranging from 2.40/2.29 (Malaysia) to 9.70/9.41 advertisements per hour per channel (the Philippines). Persuasive strategy rates were also comparatively higher during PVT. Sugar-sweetened beverages, sugar-containing solid foods, and high salt- and fat-containing snacks and fast foods were frequently advertised. Evaluation of the application of WPRO and SEARO nutrient profile models identified inconsistencies due to regional taste and cuisine variations across Asia.

CONCLUSIONS

This study clearly showed that unhealthy food marketing through popular children's television channels is widely occurring in Asia and is a clear breach of child rights. Evidence outcomes will benefit advocacy toward stronger policy regulations to control unhealthy food marketing and strengthen strategies to promote a healthier food environment for Asia's children.

The relationship between youth's exposure to unhealthy digital food marketing and their dietary intake in Canada

There is limited evidence on how exposure to digital marketing of unhealthy foods affects youth's dietary behaviours. This study therefore aimed to examine the association between youth's self-reported digital food marketing exposure and dietary intakes, and explore predictors of frequent unhealthy food consumption. A survey was conducted among 1075 youth in Canada (aged 10-17 years) in April 2023. Proportional odds models examined associations between frequency of exposure to digital marketing of unhealthy foods and frequency of consumption of those foods, adjusted for sociodemographic characteristics and digital device usage. Compared with participants reporting no exposure to digital fast-food marketing in the past week, those exposed ≥4 times per week were more likely to consume fast food more frequently. Youth exposed to digital marketing of sugary drinks and salty/savoury snacks ≥1 time(s) in the previous week were more likely to consume these foods on a greater number of days, compared with those reporting no exposure to this marketing in the past week. Reporting exposure to digital marketing of desserts/sweet treats every day or more than once a day was associated with more frequent consumption of desserts/sweet treats. Province of residence (Ontario/Quebec) and total daily time spent online predicted more frequent consumption of fast food, sugary drinks, salty/savoury snacks, and desserts/sweet treats. Overall, more frequent self-reported exposure to digital marketing of unhealthy foods is associated with more frequent consumption of these foods by Canadian youth. Regulations are needed to help protect youth from digital food marketing, which may help reduce their unhealthy food consumption.

Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system

This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.

Navigating the Global Pandemic in Pediatric Overweight and Obesity: Emerging Challenges and Proposed Solutions

BACKGROUND

Since 1990, childhood overweight and obesity have been rising on every continent and have almost doubled worldwide. The deleterious consequences include hypertension, type 2 diabetes mellitus, and dyslipidemia leading to metabolic syndrome in childhood and myocardial infarction, stroke, cancer and other disabling conditions in adulthood.

PURPOSE

In Southern Europe, including Greece, Italy, and Spain, 10 to 15% of children are obese. Obesity in Eastern European countries is somewhat lower, but the rates of rise are very steep and will approach those in Southern Europe during the next few years. Worldwide, Asia accounts for nearly half of all overweight children under the age of 5, while Africa is home to one quarter of overweight children under 5. In Latin America, about 20% of children under 20 are overweight. Further, children living in poverty can suffer simultaneous overweight and obesity as well as malnutrition. In the US, the risk of being overweight in adolescence is several times higher when a younger child has a body mass index (BMI) in the 50th or greater percentile.

FINDINGS

If the clinical, non-clinical and public health communities ignore these challenges, such inaction will surely portend an unprecedented future pandemic of overweight and obesity in children and adolescents leading to future premature morbidity and mortality. All clinical, non-clinical and public health professionals should exert concerted efforts concerning their individual patients, their families, communities, and policymakers.

CONCLUSIONS

Such coordinated interdisciplinary efforts may curb these alarming trends and secure healthier futures for children and their families throughout the world.

The impact of exposure to sugary drink marketing on youth brand preference and recall: a cross-sectional and multi-country analysis

BACKGROUND

Consumption of sugary drinks (SD) among children and adolescents is a prevalent public health issue both within Canada and worldwide. This problem is exacerbated by the powerful marketing of such beverages to youth, which is known to influence a wide range of dietary behaviours.

METHODS

A cross-sectional, secondary analysis of the International Food Policy Survey Youth Wave 2019 was conducted to assess the relationship between self-reported exposure to SD marketing within the past 30 days or SD brand advertisements and brand preference and brand recall among youth aged 10-17 from Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. Ordinal, multinomial, and binary logistic regression were used as appropriate to examine these associations.

RESULTS

Youth brand preference and recall was positively associated with self-reported exposure to general and brand-specific SD marketing across all countries. No statistical interaction was observed between youth age and SD marketing overall or within countries. Soft drinks, sports drinks, and fruit juice brands were most commonly recalled by all youth.

CONCLUSION

Similar results were observed among children and adolescents within all countries. Global marketing policies should consider older children and adolescents to adequately protect and support child health.

Challenges and solutions to banning the advertisement of unhealthy products: a qualitative study

Unhealthy products (food, alcohol, tobacco) are among the main risk factors of non-communicable diseases. To discourage the consumption of these products, Iran has passed a law banning the advertisement of unhealthy products in all media and for all age groups. The purpose of the present study was to identify the challenges of this approach and provide evidence to facilitate the enforcement process and the participation of stakeholders. In this qualitative study participants were selected from the policymakers and experts involved in the banning of advertisements on unhealthy products in Iran. Semi-structured interviews were conducted with 24 specialists and experts. The participants were selected through purposive and snowball sampling. Identified challenges and solutions were divided into three categories and nine themes: external (political, social, and economic); interorganizational (mission and communication); and internal (planning, organization, leadership, and control). Banning the advertisement of unhealthy products involves many challenges due to the existence of key players with different roles and missions. If these challenges are not managed effectively, they will hinder the enforcement and success of this law. Therefore, it is necessary for policymakers and health system managers to take the necessary measures to remove these obstacles.

Associations between exposure to advertising of foods high in fats, salt and sugar and purchase of energy and nutrients: a cross-sectional study

OBJECTIVE

To assess associations between self-reported advertising exposure to foods high in fats, salt and sugar and household purchases of energy, nutrients and specific product categories.

DESIGN

A cross-sectional design was used. Advertising exposure data were gathered using a questionnaire administered to the main shopper of each household, and purchase data from supermarkets and other stores for these households were accessed for a 4-week period during February 2019.

SETTING

Households in London and the North of England.

PARTICIPANTS

Representative households (N 1289) from the Kantar Fast Moving Consumer Goods Panel. Main shoppers were predominantly female (71 %), with a mean age of 54 years (±13).

RESULTS

Linear regression models identified that exposure to foods high in fats, salt and sugar advertising through traditional mediums (including broadcast and print), but not digital, transport, recreational or functional mediums, was associated with greater purchases of energy (9779 kcal; 95 % CI 3515, 16 043), protein (416 g; 95 % CI 161, 671), carbohydrate (1164 g; 95 % CI 368, 1886) and sugar (514 g; 95 % CI 187, 841). Generalised linear models showed that individuals who reported exposure to sugary drink advertising were more likely to purchase sugary drinks (1·16; 95 % CI 2·94, 4·99) but did not purchase more energy or nutrients from sugary drinks. There was no evidence of associations between exposure to advertising for sugary cereals or sweet snacks and purchases from these categories.

CONCLUSIONS

There was a strong influence of traditional advertising and sugar-sweetened beverage advertising on household food and drink purchases, thus supporting the need for advertising restrictions across traditional formats and for sugary drinks specifically.

Assessment of foods for infants and toddlers in Australia against the World Health Organization's Nutrient and Promotion Profile Model for food products for infants and young children

OBJECTIVE

Global public health agencies have recommended stronger regulation of food marketing to protect children's diets. This study assessed commercial foods for infants and toddlers available in Australian supermarkets for compliance with the World Health Organization (WHO) Regional Office for Europe's Nutrient and Promotion Profile Model: supporting appropriate promotion of food products for infants and young children 6-36 months in the WHO European Region (NPPM).

DESIGN

Dietitians assessed a sample of commercial foods for infants and toddlers against the composition, labelling and promotion requirements of the NPPM.

SETTING

Australia.

PARTICIPANTS

Commercial foods for infants and toddlers (n 45) available in two major Australian supermarkets, purposely sampled across product categories and brands.

RESULTS

Fewer than one quarter (23 %) of the assessed products met all nutrient content requirements of the NPPM. No products met all of the labelling or promotional requirements. All products included at least one promotional marketing claim that was not permitted under the NPPM.

CONCLUSIONS

The NPPM is useful to assess and monitor the nutritional composition and prevalence of marketing claims on commercial foods for infants and toddlers. Findings of noncompliance with the NPPM recommendations indicate an urgent need for stronger government regulation of the composition, labelling and marketing of commercial foods for infants and toddlers in Australia.

Normalizing junk food: The frequency and reach of posts related to food and beverage brands on social media

Food and beverage marketing on social media contributes to poor diet quality and health outcomes for youth, given their vulnerability to marketing's effects and frequent use of social media. This study benchmarked the reach and frequency of earned and paid media posts, an understudied social media marketing strategy, of food brands frequently targeting Canadian youth. The 40 food brands with the highest brand shares in Canada between 2015 and 2020 from frequently marketed food categories were determined using Euromonitor data. Digital media engagement data from 2020 were licensed from Brandwatch, a social intelligence platform, to analyze the frequency and reach of brand-related posts on Twitter, Reddit, Tumblr, and YouTube. The 40 food brands were mentioned on Twitter, Reddit, Tumblr, and YouTube a total of 16.85M times, reaching an estimated 42.24B users in 2020. The food categories with the most posts and reach were fast food restaurants (60.5% of posts, 58.1% of total reach) and sugar sweetened beverages (29.3% of posts, 37.9% of total reach). More men mentioned (2.77M posts) and were reached (6.88B users) by the food brands compared to women (2.47M posts, 5.51B users reached). The food and beverage brands (anonymized), with the most posts were fast food restaurant 2 (26.5% of the total posts), soft drink 2 (10.4% of the total posts), and fast food restaurant 6 (10.1% of the total posts). In terms of reach, the top brands were fast food restaurant 2 (33.1% of the total reach), soft drink 1 (18.1% of the total reach), and fast food restaurant 6 (12.2% of the total reach). There is a high number of posts on social media related to food and beverage brands that are popular among children and adolescents, primarily for unhealthy food categories and certain brands. The conversations online surrounding these brands contribute to the normalization of unhealthy food and beverage intake. Given the popularity of social media use amongst of children and adolescents, policies aiming to protect these vulnerable groups need to include the digital food environment.

Is food and drink advertising across various settings associated with dietary behaviours and intake among Australian adolescents? Findings from a national cross-sectional survey

ISSUE ADDRESSED

The pervasive promotion of energy-dense, nutrient-poor food and drinks undermines efforts by adolescents and their parent/carers to maintain a nutritious diet during a crucial developmental period. This study examined the association between awareness of food and drink advertisements and adolescents' dietary behaviours and intake.

METHODS

A sample of Australian secondary students aged 12-17 years (N = 8763) self-reported their awareness of food and drink advertisements across seven settings, whether they had tried a new product or asked a parent/carer to purchase a product they had seen advertised, and their consumption of various unhealthy food and drink types. Analyses used multilevel mixed-effects generalised linear models adjusted for school-level clustering, socio-demographic factors and television viewing.

RESULTS

Students with higher advertising awareness were more likely to have tried a new product they had seen advertised (adjusted prevalence ratio [APR] = 1.62, 95% CI = 1.51-1.73, p < .001) and asked their parent/carer to buy an advertised product (APR = 1.62, 95% CI = 1.51-1.73, p < .001) at least once in the past month. As advertising awareness increased, so too did students' likelihood of reporting these dietary behaviours. A high unhealthy food intake was more commonly reported among students with higher advertising awareness (APR = 1.45, 95% CI = 1.32-1.58, p < .001), as was a high unhealthy drink intake (APR = 1.29, 95% CI = 1.18-1.42, p < .001).

CONCLUSIONS

Australian adolescents are vulnerable to the persuasive effects of food and drink marketing. SO WHAT?: Greater restrictions on the way the food and drink industry can market their products to adolescents are needed to better support them in developing and maintaining positive dietary behaviours.

The Role of Food and Beverage Environments in Child Health and Weight-Related Behaviors

This article explores how food and beverage environments influence child health and obesity risk and addresses institutional settings, retail environments, food assistance programs, and food and beverage industry marketing. It emphasizes social determinants of health, evidence-based interventions, and policy recommendations to promote healthier food options and reduce inequities. Pediatric health care providers play a critical role in addressing the need for systemic changes to eliminate inequities in food environments and the systems that support these inequities.

My feed is what I eat? A qualitative study on adolescents' awareness and appreciation of food marketing on social media

BACKGROUND

Adolescents spend much of their time online and hence are exposed to a lot of non-core (energy-dense, nutrient-poor) social media food marketing (SMFM). This may influence their dietary choices and health. This present study aimed to investigate adolescents' perceptions towards SMFM; that is, their recognition and appreciation of SMFM.

METHODS

Semi-structured one-on-one interviews were conducted with Dutch adolescents aged 13-16 years (n = 16), on Skype. Examples of food promotions on Instagram, Snapchat, TikTok and YouTube were discussed with adolescents.

RESULTS

Adolescents' reasons for recognising and appreciating or liking SMFM were often related to the level of product integration. Factors that determined participants' recognition of SMFM included product focus (e.g., brand or product prominence), sponsorship disclosure, type of content (paid, influencer and peer-generated content) and promotional strategy (e.g., discounts, promotional texts, layout). Participants' appreciation of SMFM was determined by the format of a post (image, video, text, pop-up), trustworthiness of the source (brand, celebrity, friend/peer), type of product promoted (core, non-core) and appearance or layout of a post (e.g., professionalism, appeal).

CONCLUSIONS

The present study contributes to the ongoing debate on how to increase adolescents' resilience to commercial messages that promote non-core foods. Adolescents mostly enjoy watching non-core video content from peers or influencers and do not perceive this as food marketing. It is recommended that future studies investigate the effects of earned social media marketing formats (i.e., unpaid peer and influencer endorsements) promoting non-core foods on adolescents' dietary intake, and how they can be made more critical towards such types of SMFM.

Mild hunger elicits attentional desensitization to visual food cues in healthy, non-obese individuals

Introduction

Food is a vital human need, and the human visual system is finely tuned to detect and respond to food cues in the environment. The omnipresence of food cues across various settings has been linked to the prevalence of obesity in susceptible populations. However, the influence of the post-prandial state on visual attention to food stimuli remains poorly understood. This study aimed to elucidate how a 12 hour fast affects visual attention to food and non-food stimuli in healthy, non-obese individuals.

Methods

Visual attention was assessed by measuring the total duration of visual fixations on stimuli presented on a computer screen, using a screen-based eye tracker (Tobii X2-60). Participants were divided into two groups: those who had fasted for 12 hours and those tested within two hours after consuming breakfast (satiated state). Additionally, performance on the Food Stroop task and electrodermal activity (EDA) responses were measured to evaluate attentional interference and physiological arousal, respectively. Salivary samples were also collected to assess levels of alpha-amylase and cortisol.

Results

Fasted participants exhibited a progressive decline in visual attention toward food stimuli compared to satiated individuals, reflecting a satiated state. This effect was independent of the palatability of the depicted food items and was not observed with stimuli representing non-food items. The Food Stroop task revealed no differences between fasting and satiated participants, indicating that the presence of food-related stimuli does not differentially impact attentional interference under varying hunger states. Moreover, no significant variations were observed in EDA responses across participant groups and stimulus types, suggesting that the modulation of visual attention to food cues by hunger is independent of physiological arousal. Interestingly, satiated subjects exhibited higher levels of salivary alpha-amylase, which was inversely related to their subjective hunger ratings. No differences in salivary cortisol levels were found between groups.

Discussion

The findings indicate a novel influence of mild hunger on the processing of visual food cues, independent of physiological arousal. The decline in visual attention to food stimuli in fasted individuals suggests that satiety modulates visual processing. The lack of differences in attentional interference and physiological arousal between fasting and satiated states further supports the notion that visual attention to food cues is primarily driven by hunger-related mechanisms rather than stress. Additionally, the inverse relationship between salivary alpha-amylase levels and hunger ratings implies that alpha-amylase may serve as a marker of satiety rather than stress.

Nigerian adolescents' exposure to fast food marketing via Instagram

OBJECTIVES

To explore the promotion of fast food to lower-income adolescents on Instagram with the specific aims of (i) identifying the marketing strategies used by fast food brands on Instagram to promote fast food to Nigerian adolescents and (ii) examining the influence of these strategies on user engagement.

DESIGN

A content analysis of posts from a 90-day period of the Instagram accounts of five fast-food brands in Nigeria was conducted. Overall, 576 posts were analysed, using a codebook developed based on the relevant literature, to identify adolescent-targeted strategies. User engagement was measured by number of likes each post received.

RESULTS

The observed brands frequently utilised adolescent-targeted marketing strategies, with the most popular strategies being emotional appeal, 'teen language' and product appeal. The results of Mann-Whitney U tests revealed significant associations between the use of these promotional strategies and user engagement. Adolescent-aimed strategies like product appeal and competitions resulted in higher user engagement with fast food promotional content.

CONCLUSION

Fast food companies heavily target lower income adolescents through the use of Instagram. This raises health concerns related to the consumption of unhealthy food that arises from regular advertising in that demographic. Further, this exposure increases ad interactions that could cause adolescents to view fast foods more positively. Overall, findings indicate the need for actions aiming to limit and reduce the effect of adolescents' exposure to fast food marketing on social media, to target the features of social media platforms which affords users the ability to interact with fast food advertisements.

Characterising Parent-Appeal Marketing on Foods for Children: A Scoping Review

PURPOSE OF REVIEW

This scoping review examines current evidence on parent-appeal marketing on the front-of-pack of food products for children and the impacts on parents' perceptions, intentions, and behaviours.

RECENT FINDINGS

Thirteen relevant studies were identified. Marketing features on packages of foods for children that appealed to parents include health claims, nutrition claims, non-nutrient claims such as 'natural', healthy-looking product images, images of healthy ingredients, and celebrity endorsements. At the same time, parents were wary of front-of-pack marketing and find it confusing, deceptive, and misleading. Child-appeal marketing features such as cartoon characters and bright colours gave parents the perception that products were unhealthy. Overall, this scoping review offers important insights into the types of front-of-pack marketing that appeal to parents and offers an inventory of parent-appeal marketing features. These findings support the design and implementation of policies that aim to reduce commercial influences on children's diets through stronger regulation of marketing of foods for children.

Examining the effects of brand and licensed characters on parents' perceptions of Children's breakfast cereals

Brand and licensed characters frequently appear on children's breakfast cereal boxes and are known to affect children's product perceptions, selection, and consumption. However, less is known about their impact on parents' perceptions of foods they purchase for their child. The present study assessed the impact of brand and licensed characters featured on three children's breakfast cereal packages on parents' intentions and perceptions in an online experiment. Parents of children aged 2-12 years (n = 1013) were randomized into one of two conditions: breakfast cereals containing brand and licensed characters or breakfast cereals without any characters. Within each condition, participants viewed three breakfast cereal brands in random order per their assigned condition and reported their purchase intentions, healthfulness perceptions, and perceptions of appeal to children using 5-point Likert scales. No significant differences in purchase intentions (p = 0.91), perceived healthfulness (p = 0.52) or perceived child appeal (p = 0.59) were observed between the experimental and control groups. However, exploratory moderation analyses revealed that educational attainment moderated the impact of experimental condition on purchase intentions (p for interaction = 0.002) such that participants with a bachelor's degree in the character condition reported 0.36 points lower purchase intentions compared to the control with no difference between conditions for those with an associate's degree/trade school or high school degree or less. This study did not find an impact of brand and licensed characters on children's breakfast cereals, suggesting that their primary appeal is directly to children. Parents with higher educational attainment may be skeptical of characters on cereal brands. Additional research on the impact of brand and licensed characters on other products, in real-world settings, is needed.

Understanding parents' perceptions of children's exposure to unhealthy food marketing in digital and retail environments

Unhealthy food and non-alcoholic beverage marketing (UFM) adversely impacts children's selection and intake of foods and beverages, undermining parents' efforts to promote healthy eating. Parents' support for restrictions on children's exposure to food marketing can catalyse government action, yet research describing parent concerns is limited for media other than television. We examined parents' perceptions of UFM and their views on potential policies to address UFM in supermarkets and on digital devices - two settings where children are highly exposed to UFM and where little recent research exists. We conducted in-depth interviews with sixteen parents of children aged 7-12 from Victoria, Australia, analysing the data thematically. Parents perceived UFM as ubiquitous and viewed exposure as having an immediate but temporary impact on children's food desires and pestering behaviours. Parents were concerned about UFM in supermarkets as they viewed it as leading their children to pester them to buy marketed products, undermining their efforts to instil healthy eating behaviours. Parents generally accepted UFM as an aspect of contemporary parenting. Concern for digital UFM was lower compared to supermarkets as it was not directly linked to pestering and parents had limited awareness of what their children saw online. Nevertheless, parents felt strongly that companies should not be allowed to target their children with UFM online and supported government intervention to protect their children. While parents supported government policy actions for healthier supermarket environments, their views towards restricting UFM in supermarkets varied as some parents felt it was their responsibility to mitigate supermarket marketing. These findings could be used to advocate for policy action in this area.

Unhealthy Food and Beverage Marketing to Children in the Digital Age: Global Research and Policy Challenges and Priorities

Food and nonalcoholic beverage marketing is implicated in poor diet and obesity in children. The rapid growth and proliferation of digital marketing has resulted in dramatic changes to advertising practices and children's exposure. The constantly evolving and data-driven nature of digital food marketing presents substantial challenges for researchers seeking to quantify the impact on children and for policymakers tasked with designing and implementing restrictive policies. We outline the latest evidence on children's experience of the contemporary digital food marketing ecosystem, conceptual frameworks guiding digital food marketing research, the impact of digital food marketing on dietary outcomes, and the methods used to determine impact, and we consider the key research and policy challenges and priorities for the field. Recent methodological and policy developments represent opportunities to apply novel and innovative solutions to address this complex issue, which could drive meaningful improvements in children's dietary health.

Philadelphia Beverage Tax's Impact on Beverage Ad Expenditures and Number of Ads Purchased

INTRODUCTION

On January 1, 2017, Philadelphia implemented a beverage excise tax. The study's objective was to determine whether beverage advertising expenditures and the number of beverage ads purchased changed in Philadelphia compared to Baltimore because of this tax.

METHODS

Monthly beverage ad expenditures and the number of beverage ads purchased by brand from January 2016 through December 2019 were obtained. Ads were coded as being for taxed or not taxed beverages and analyzed in 2023. The primary outcomes were quarterly taxed beverage ad expenditures and number of ads purchased. A controlled interrupted time series design on segmented linear regression models was used. Models (aggregated and stratified by internet, spot TV, and local radio) compared whether levels and trends in the outcomes changed from pre- to post-tax in Philadelphia compared to Baltimore.

RESULTS

There were no significant differences in taxed beverage advertising expenditures between Philadelphia and Baltimore for trends pretax, at implementation, or post-tax. There were 0.13 (95% CI: -0.25, -0.003) fewer quarterly taxed beverage ads purchased per 100 households in Philadelphia versus Baltimore at baseline. Among internet advertising, there were 0.42 (95% CI: -0.77, -0.06) fewer quarterly taxed beverage ads purchased per 100 households in Philadelphia versus Baltimore immediately post-tax. For spot TV ads, the percentage of taxed beverages ads purchased per quarter was greater at baseline in Philadelphia by 28.0 percentage points (95% CI: 1.9, 54.1).

CONCLUSIONS

This study found little evidence of changes in mass media advertising on the examined platforms between 2016 and 2019 due to the Philadelphia beverage tax.

Barriers to Care for Pediatric Patients with Obesity

This review article emphasizes the challenges pediatric patients face during obesity treatment. Prior research has been compartmentalized, acknowledging that stigma, the ability to implement lifestyle changes, social health determinants, and healthcare accessibility are considerable impediments for obese children. These issues emerge at various levels, including the individual or family, the community and school, and even national policy. This suggests the need for a more comprehensive, team-based approach to tackle pediatric obesity. Understanding these barriers is the first step toward creating effective strategies and solutions to overcome these challenges.

Examining school nutrition policies and their effect on the promotion of low-nutrient foods in the context of sports advertising

OBJECTIVES

Despite recommendations to implement nutrition standards in schools, low-nutrient foods and high-energy drinks are still some of the most important challenges for school management and students' purchasing and consumption behavior. In this regard, the aim of the present study is to examine school nutrition policies and their effect on the promotion of low-nutrient foods in the context of sports advertising.

METHODS

A partial least square technique with SmartPLS 3.0 and bootstrapping with 500 resamples was used to examine the effect of food marketing on school nutrition policies and students' nutritional involvement. Online surveys were done through The Iranian Educational Network of students and measured on a 5-point Likert scale. The survey questionnaire consisted of 3 scales to measure the following: school nutrition policies, advertising of low-nutrient foods, and student nutritional involvement.

RESULTS

Results from a sample of 382 Iranian high school students revealed that low-nutrient food advertising has a significant effect on student consumption, and the greatest overall effect on students' nutritional involvement. School nutrition policies were affected by media, endorsement, and the environmental advertising, whereas school financial capabilities had the greatest direct effect on students' nutritional involvement.

CONCLUSIONS

These findings suggest that advertising through sports media plays a mediating role in school nutrition policies and student nutritional involvement. Policy changes to restrict food marketing for young people must include both television and non-broadcast media.

Television Time, Especially During Meals, Is Associated With Less Healthy Dietary Practices in Toddlers

BACKGROUND

While several studies examine the relationship between screen time and dietary practices in children and teenagers, there is limited research in toddlers. This study evaluates the association between television (TV) exposure and dietary practices in 2-year-old children.

METHODS

We conducted a cross-sectional, secondary data analysis from the Greenlight Intervention Study. Toddlers' daily TV watching time, mealtime TV, and dietary practices were assessed by caregiver report at the 24-month well-child visit. Separate regression models were used and adjusted for sociodemographic/household characteristics and clinic site.

RESULTS

Five hundred and thirty-two toddlers were included (51% Latino; 30% non-Latino Black; 59% ≤$20,000 annual household income). Median daily TV watching time was 42 minutes (interquartile range: 25, 60); 25% reported the TV was "usually on" during mealtimes. After adjustment, toddlers who watched more TV daily had higher odds of consuming sugar-sweetened beverages, fast food, and more junk food; those watching less TV had higher odds of consuming more fruits/vegetables. Those with the TV "usually on" during mealtimes were more likely to consume sugar-sweetened beverages (aOR 3.72 [95% confidence interval {CI} 2.16-6.43]), fast food (aOR 2.83 [95%CI 1.54-5.20]), and more junk food (aOR 4.25 [95%CI 2.71-6.65]).

CONCLUSIONS

Among toddlers from primarily minoritized populations and of lower socioeconomic status, those who watched more TV daily and usually had the TV on during meals had significantly less healthy dietary practices, even after adjusting for known covariates. This study supports the current American Academy of Pediatrics screen time guidelines and underscores the importance of early counseling on general and mealtime TV.

Evaluation of the Consumption of Junk Food Products and Lifestyle among Teenagers and Young Population from Romania

BACKGROUND

The long-term consumption of junk food products can lead to nutritional and metabolic imbalances, especially when it is associated with a lack of physical activity and the consumption of alcohol or other high-calorie products.

METHODS

The evaluation of junk food consumption among teenagers and young people in Romania was carried out with the help of a cross-sectional study based on a questionnaire.

RESULTS

A total number of 1017 respondents participated in this study, comprising 470 males and 547 females aged between 16 and 25 years. Although the majority of young people fell into the normal-weight category (607 of them, p < 0.0001), some aspects can be noted that in the long term can produce a series of nutritional imbalances: an increased tendency toward sedentarism, with 553 (p = 0.613) of the respondents declaring that they performed sports rarely or not at all, and a tendency toward relatively high consumption of foods high in calories (fast food products and especially fried potatoes, hamburgers, shawarma, pastries, and snacks, along with sweetened drinks and even alcoholic beverages). The respondents participating in this study even indicated a perceived addiction to the consumption of certain products: coffee (50.48%), fried potatoes (38.9%), hamburgers (37.05%), shawarma (31.65%), and snacks (30.08%). Many of these products are rich in calories, saturated fat, and even trans fat.

CONCLUSIONS

This study highlights a series of aspects that can have long-term negative effects related to the excess weight associated with other imbalances: consumption preferences among young people for hypercaloric fast food products, sweetened drinks associated with reduced physical activity, and even the development of some forms of food addictions for a series of hypercaloric foods.

Development of a questionnaire for assessing the impact of children's food marketing exposure on diet-related outcomes

Introduction

The Government of Thailand has drafted legislation to protect children from the harmful impact of unhealthy food (including beverages) marketing. Local evidence on Thai children's exposure to, and the impact of, this marketing is necessary to, first, support the adoption of this Law and, second, to contribute to assessing policy implementation and effectiveness. This study aimed to develop and validate a questionnaire for examining Thai children's exposure to unhealthy food marketing and its impact on diet-related outcomes.

Materials and methods

To design the questionnaire, we first conceptualised the range of impacts of unhealthy food marketing on children's diet-related outcomes based on published frameworks. These outcomes related to food brand loyalty, preference, purchase and consumption. We conducted a literature review to gather related questions used in earlier surveys to assess these outcomes. Using these questions, we assessed content validity with five experts. Face validity and reliability were assessed for 32 children. Validity was assessed using Content Validity Index (CVI) and Kappa statistics. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients (ICC).

Results

We identified 15 survey questions that had been used to assess the outcomes of interest. The CVI of all questions was 1.0, indicating perfect agreement with each question's relevance by the experts. Most questions were perceived to be easy to read and comprehend, suggesting face validity. Cronbach's alpha and ICC of all questions were both 0.75, demonstrating internal consistency across responses to questions about, separately, brand loyalty, preferences, purchase and consumption.

Conclusion

The final 15-item questionnaire provides a valid and reliable survey instrument for measuring the impact of unhealthy food marketing on children's diet-related outcomes. This instrument will be useful for gathering local evidence on the need for policy reform to protect children from unhealthy food marketing in Thailand. The instrument also provides a cost-effective approach for generating evidence in other jurisdictions to propel policy actions. This is a pilot study and the validity and reliability needs further testing after a larger-scale roll-out.

The association between obesity severity and food reward in adolescents with obesity: a one-stage individual participant data meta-analysis

BACKGROUND

Food reward and cue reactivity have been linked prospectively to problematic eating behaviours and excess weight gain in adults and children. However, evidence to date in support of an association between degree of adiposity and food reward is tenuous. A non-linear relationship between reward sensitivity and obesity degree has been previously proposed, suggesting a peak is reached in mild obesity and decreases in more severe obesity in a quadratic fashion.

OBJECTIVE

To investigate and characterise in detail the relationship between obesity severity, body composition, and explicit and implicit food reward in adolescents with obesity.

METHODS

Data from seven clinical trials in adolescents with obesity were aggregated and analysed in an independent participant data meta-analysis. Linear and curvilinear relationships between the degree of obesity and explicit and implicit reward for sweet and high fat foods were tested in fasted and fed states with BMI-z score as a continuous and discrete predictor using clinically recognised partitions.

RESULTS

Although positive associations between obesity severity and preference for high-fat (i.e. energy dense) foods were observed when fasted, none reached significance in either analysis. Conversely, adiposity was reliably associated with lower reward for sweet, particularly when measured as implicit wanting (p = 0.012, ηp2 = 0.06), independent of metabolic state. However, this significant association was only observed in the linear model. Fat distribution was consistently associated with explicit and implicit preference for high-fat foods.

CONCLUSIONS

A limited relationship was demonstrated between obesity severity and food reward in adolescents, although a lower preference for sweet could be a signal of severe obesity in a linear trend. Obesity is likely a heterogenous condition associated with multiple potential phenotypes, which metrics of body composition may help define.

CLINICAL TRIAL REGISTRATIONS

NCT02925572: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT02925572 . NCT03807609: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT03807609 . NCT03742622: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT03742622 . NCT03967782: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT03967782 . NCT03968458: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT03968458 . NCT04739189: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT04739189 . NCT05365685: https://www.

CLINICALTRIALS

gov/study/NCT05365685?tab=history .

The rise and fall of the Queensland Government policy to restrict unhealthy food and alcohol advertising on publicly owned assets

OBJECTIVE

To examine the strategies employed by opponents of the Queensland Government's policy to restrict unhealthy food and alcohol advertising on publicly owned assets and identify which of the opposing arguments appeared to influence the policy outcomes.

METHODS

Retrospective qualitative policy analysis case study informed by the Policy Dystopia Model of corporate political activity. We used qualitative content analysis to examine data from stakeholder submissions to the 'Advertising content on Queensland Government advertising spaces' policies (v1 and 2), and Minister for Health's diaries.

RESULTS

Stakeholders from the food, beverage, alcohol and advertising industries and several not-for-profit health organisations opposed the policy. Industry actors used discursive strategies, coalition management (including co-option of not-for-profit health organisations), information management and direct involvement with policy makers to communicate their arguments against the policy. The second version of the policy was weaker regarding scope and key policy provisions, reflecting the arguments of industry actors.

CONCLUSIONS

Influence from industries with a clear conflict of interest should be minimised throughout policy development to ensure public health is prioritised over corporate gain.

IMPLICATIONS FOR PUBLIC HEALTH

Our findings can support other jurisdictions to prepare for industry opposition when designing policies to restrict unhealthy food and alcohol marketing.

Content analysis of food and beverage marketing in global esports: sponsorships of the premier events, leagues, teams and players

Background

Food marketing has been implicated as a driving force of the obesity epidemic. Electronic sports, or 'esports', garners billions of viewership hours and is a consolidation of two major marketing outlets, online social media and sporting events, making it a focal point for food marketers and policy-makers.

Methods

The top 10 esports events and leagues were identified using data scraped between 1 January 2021 and 15 December 2021. The 10 teams within each league (90 total teams) and up to 10 players from each team (451 total players) were identified. Of the top 10 events and leagues, 6 events and 2 leagues were held or located outside the USA, reflecting the global popularity of esports. Food and beverage brands associated with each event, league, team or player were systematically identified and extracted via official websites and social media accounts. The number of sponsorships was totalled for each brand. Brands were then categorised based on product type into the following categories: energy drinks, sugar-sweetened beverages, alcohol, candy/snacks, restaurants, food delivery and stores, and supplements. The total number of brand sponsorships was then calculated for each product category.

Results

90 unique food and beverage brands were identified. Across all brands, a total of 497 food brand sponsorships were identified. For product categories, energy drink brands had the most sponsorships (181 sponsorships, 36.4%), followed by restaurants (86 sponsorships, 17.3%) and candy/snacks (64 sponsorships, 12.8%). The individual brand with the most sponsorships was Monster Energy (47 sponsorships, 9.4%), followed by Jack Links (44 sponsorships, 8.8%) and Red Bull (42 sponsorships, 8.4%).

Conclusion

Despite its nascent character, the esports industry is already heavily saturated by food and beverage marketing. There is a need to consider policies to appropriately regulate food and beverage marketing within esports communities to safeguard the health of viewers.

Covert marketing of quick-service restaurants via news media in Australia: A content analysis

OBJECTIVE

To determine the extent and nature of news media coverage generated from press releases made by top-selling quick-service restaurants in Australia.

METHODS

We conducted a content analysis of press releases made between July 2021 and June 2022 by the five largest quick-service restaurant brands in Australia by brand share, including coding their main subject. We then conducted a content analysis of news media coverage related to the press releases, including coding its slant towards the brand.

RESULTS

Among 52 press releases, new food products (27% of press releases; all unhealthy foods) and corporate social responsibility activities (25%) were the most promoted subjects. For 62% of press releases, at least one news media item was identified. Among the 86 identified news media items, most related to press releases promoting new food products (45% of news media items) or corporate social responsibility activities (21%). News media items overwhelmingly had a slant favourable to the relevant brand (93%).

CONCLUSIONS

Press releases by top-selling quick-service restaurant brands in Australia commonly generate news media coverage that promotes such brands and their predominantly unhealthy products.

IMPLICATIONS FOR PUBLIC HEALTH

Policies restricting unhealthy food marketing should consider brand-generated news media coverage.

What Is the Nutritional Quality of Pre-Packed Foods Marketed to Children in Food Stores? A Survey in Switzerland

Food marketing targeting children influences their choices and dietary habits, and mainly promotes food high in fat, sugar, and salt as well as ultra-processed food. The aim of this study was to assess the nutritional quality of food and beverages marketed to children over the age of 3 and available on the Swiss market. Products with at least one marketing technique targeting children on the packaging were selected from five food store chains. Three criteria to assess nutritional quality were used: (1) nutritional composition (using the Nutri-Score), (2) degree of processing (NOVA classification), and (3) compliance with the World Health Organization (WHO) Nutrient Profile Model (NPM). A total of 735 products were found and analyzed. The most common marketing techniques used were childish names/fonts (46.9%), special characters (39.6%), and children's drawings (31.3%). Most products had a Nutri-Score of D or E (58.0%) and were ultra-processed (91.8%). Only 10.2% of products displayed the Nutri-Score. The least processed products generally had a better Nutri-Score (p < 0.001). Most products (92.8%) did not meet the criteria of the WHO NPM. Products that met the WHO NPM criteria, organic products, and products with a nutritional claim generally had a better Nutri-Score and were less processed (ps < 0.05). Pre-packaged foods and beverages marketed to children in the Swiss market were mostly of poor nutritional quality. Public health measures should be adopted to improve the nutritional quality of foods marketed to children in Switzerland and restrict the marketing of unhealthy foods to children.

Effects of Food Depictions in Entertainment Media on Children's Unhealthy Food Preferences: Content Analysis Linked With Panel Data

Background

Entertainment media content is often mentioned as one of the roots of children's unhealthy food consumption. This might be due to the high quantity of unhealthy foods presented in children's media environments. However, less is known about the role of the centrality of food placement, that is, whether foods are interacted with, consumed, verbally mentioned, or appear unobtrusively. We also lack longitudinal research measuring both children's unhealthy and healthy food consumption behaviors as outcomes.

Objective

The aim is to connect content analytical data based on children's actual media diet with panel data in order to explain children's food preferences. Moreover, this study not only focuses on the amount of healthy and unhealthy foods children are exposed to, but also on how these foods are presented (ie, centrally or not). Furthermore, we looked at the question of how parental coviewing can diminish (or enhance) the effects of unhealthy (or healthy) food depictions, and we measured healthy and unhealthy consumption as dependent variables.

Methods

We conducted a 2-wave panel study with children and one of their parents (of 2250 parents contacted, 829 responded, for a response rate of 36.84%; 648 valid cases, ie, parent-child pairs, were used for analysis), with 6 months between the 2 panel waves. We linked the 2-wave panel data for the children and their parents to content analytical data for movies (n=113) and TV series (n=134; 3 randomly chosen episodes per TV series were used) that children were exposed to over the course of 6 months.

Results

There was no significant relationship between exposure to unhealthy food presentation and unhealthy (b=0.008; P=.07) or healthy (b=-0.003; P=.57) food consumption over time. Also, healthy food presentation was unrelated to unhealthy (b=0.009; P=.18) or healthy (b=0.000; P=.99) food consumption over time. However, there was a significant, positive interaction between unhealthy food presentation and presentation centrality on unhealthy food consumption (b=0.000; P=.03), suggesting that the effects of unhealthy food presentation rise with increasing levels of centrality. There was no interaction between unhealthy food presentation and presentation centrality on the consumption of healthy foods (b=0.000; P=.10). Also, exposure to healthy food presentation interacted with centrality (b=-0.001; P=.003). That is, when a healthy product was presented at maximum centrality, it led to less unhealthy food consumption in children. Coviewing did not interact with exposure to unhealthy foods when explaining unhealthy (b=0.003; P=.08) or healthy (b=-0.001; P=.70) food consumption.

Conclusions

We conclude that simply presenting more healthy foods is not sufficient to combat children's unhealthy food preferences. Further regulations may be necessary with respect to representations of unhealthy foods in children's media.

More than a Nuisance: Implications of Food Marketing for Public Health Efforts to Curb Childhood Obesity

Fifteen years ago, public health experts urged industry, governments, and advocates to take action to dramatically improve the unhealthy food-marketing environment surrounding children in order to address the global childhood obesity crisis. Since then, research has confirmed that food marketing to children has far-reaching negative effects on their diets and health, takes advantage of adolescent vulnerabilities, and contributes to health disparities. In addition, digital marketing has profoundly changed young people's engagement with brands. Moreover, reliance on industry self-regulation as a solution has proven ineffective. Government-led policies have been more successful, but they remain limited in scope and challenging to adopt and implement. New approaches are necessary to increase public and policy maker awareness that food marketing is more than a nuisance, that it threatens the long-term health of children and adolescents worldwide, and that meaningful governmental action is urgently required to curtail industry's negative impact on young people's well-being.