Globally, the prevalence of paediatric overweight and obesity has risen dramatically over the past 30 years and is now widely considered to qualify as an epidemic. In many countries, a third of young people suffer from excess adiposity, which is associated with a raft of medical comorbidities such as type 2 diabetes and some cancers, as well as a reduced quality of life and poorer socioeconomic outcomes.

This is a concern not only for the individuals and families involved, but also for society as a whole, as health services and employers struggle to cope with the financial implications of an overweight population. 

This article looks at the role of pervasive food advertising via television and other media in driving up the numbers of children worldwide who are at increased risk for type 2 diabetes and other non-communicable diseases. It also makes a call for intervention to prevent further related damage to health.

Obesogenic environment

As our genetic make-up has not changed significantly since the 1980s, the finger of blame for the recent rapid growth in overweight has been pointed at our increasingly ‘obesogenic’ environment – characterised by the constant availability of highly palatable, energy-dense foods, which are aggressively and relentlessly marketed to young people via an ever-increasing number of available avenues. 

Indeed, the frequency and intensity of children’s exposure to branding messages is unprecedented. Brands and their products can be promoted to children through traditional means, such as television advertising, but also through such diverse methods as event sponsorship, programme sponsorship, internet advertising (including ‘advergames’, where brand immersion is the primary aim), mobile phone advertising, point-of-sale promotions and even advertising in schools.

The child market – a lucrative target

As their access to income has risen markedly in recent years, children have developed an emerging role as independent consumers. Moreover, children are seen as the teenage and adult shoppers of the future; any brand loyalty that is fostered at a young age may reward a food or soft drinks company with a lifetime of sales. Importantly also, not only do they have independent spending power; children exert considerable influence over family purchases – food and drink purchases in particular.

It is logical to assume that food and drinks manufacturers spend extremely large sums of money on advertising campaigns because these are an effective means of increasing sales. This suggests that exposure to advertising has an effect on behaviour. 

For children and young people, this can be considered in terms of the actual purchasing behaviour mentioned above, but also behaviour that influences adult purchases – ‘pester power’. There is considerable evidence that food preferences, choices and requests are modified by branding and exposure to food advertising, resulting in purchasing behaviour or purchase-influencing behaviour being altered in favour of an advertised product.

During the 1970s, one of the earliest studies on this topic showed that children’s choice of foods reflected their exposure to television food advertisements.¹

Children in Canada who had viewed adverts for highly sugared foods were more likely to opt for sugared products (both those advertised and others not appearing in the adverts), whereas children who had viewed public-service announcements with a pro-nutrition message selected more fruit and vegetables.¹

A more recent UK study exposed nine-to-11-year-old children to food or non-food advertisements on two different occasions.² Following viewing, the children’s consumption of sweet and savoury, high- and low-fat snack foods was measured. Exposure to food advertising increased food intake in all of the children. 

Interestingly, a further study demonstrated that this increase in intake was largest in the obese children, suggesting that overweight and obese children are more responsive to food promotion.³ Furthermore, it has been demonstrated that the more television adverts a child watches, the more susceptible she or he is to the effects of television food advertising.⁴

Media literacy, vulnerability and the societal response

It has been suggested that younger children may be more susceptible to advertising than are older children, adolescents or adults because they lack the cognitive development required to be able to understand the persuasive intent of adverts. And if young children are not able to understand the persuasive intent of advertising, there are question marks over their ability to make a critical judgement on the messages. Therefore, some believe that children are being unfairly exploited by marketers.

The debate over the effects of food advertising on children’s diets has not been limited to the academic literature; scrutiny has also been applied by international advisory bodies such as the World Health Organization (WHO) and the Institute of Medicine, as well as special-interest groups, such as the Kaiser Family Foundation. A 2003 report by WHO and the UN Food and Agriculture Organization acknowledged that the promotion of energy-dense foods is a ‘probable’ cause of increasing prevalence of overweight and obesity in children worldwide.

However, it is also recognised that to attribute more than a ‘modest direct effect’ to food advertising is extremely difficult – identifying and eliminating all other possible variables is seemingly unfeasible. Carrying out studies in lifelike situations is virtually impossible; observational studies are complicated by numerous known and potential confounders. Nevertheless, the evidence base for this effect is sufficient for it to have been suggested that between one-in-seven and one-in-three obese children in the US might not have developed obesity had advertising for unhealthy foods been removed from television.

In response to growing pressure from academics, consumer groups, health advocacy groups and a concerned public, many countries have implemented regulations in an attempt to tackle the issue of food advertising to children on television. In the UK, such regulations are statutory but have been criticised for failing to reduce adequately children’s exposure to foods that are high in fat, sugar and/or salt. 

Indeed, a study conducted during the implementation of these regulations in 2008 demonstrated that unhealthy foods dominated advertising despite the legislation, with a majority of food advertisements promoting products such as fast food, high-sugar, low-fibre breakfast cereals and chocolate/confectionery.⁵ A similar pattern was found when food advertising was examined on a global scale by collaborating research groups across Australia, Asia, Western Europe and North and South America.⁶

Protect children now

Millions of children worldwide are overweight or obese. Numerous health consequences, including type 2 diabetes and fatty liver, were unheard of in young people before 1980, but are now occurring in approximately a third of obese children. A 2007 editorial in the New England Journal of Medicine warned that by 2050 ‘paediatric obesity may shorten life expectancy by two to five years’.⁷ It is essential that we develop ways to protect young people from pervasive messages that encourage children to consume foods and beverages that are detrimental to their health before that grim prediction is realised.

Emma Boyland is a research associate in the Biopsychology Research Group within the Department of Experimental Psychology at the University of Liverpool, UK

Reproduced with the kind permission of Diabetes Voice 2011; 56(2): 47-50. Original title: The impact of food advertising to children – why we must protect our most vulnerable citizens

References

1. Goldberg M E, Gorn GJ, Gibson W. TV Messages for Snack and Breakfast Foods: Do They Influence Children’s Preferences? J Consum Res 1978; 5: 73-81
2. Halford JCG, Gillespie J, Brown V, Pontin EE, Dovey TM. Effect of television advertisements for foods on food consumption in children. Appetite 2004; 42: 221-5
3. Halford JCG, Boyland EJ, Hughes GM, Stacey L, et al. Beyond-brand effect of television (TV) food advertisements on food choice in children: The effects of weight status. Public Health Nutr 2008; 11: 897-904
4. Boyland EJ, Harrold JA, Kirkham TC, Dovey TM, et al. Food commercials increase preference for energy-dense foods particularly in children who watch more television. Pediatrics 2011; 128: e93-e100
5. Boyland EJ, Harrold JA, Kirkham TC, Halford JCG. The extent of food advertising to children on UK television in 2008. International Journal of Pediatric Obesity (in press)
6. Kelly B, Halford JCG, Boyland EJ, Chapman K, et al. Television food advertising to children: a global perspective. Am J Public Health 2010; 100: 1730-6
7. Ludwig, DS. Childhood obesity: The shape of things to come. N Engl J Med 2007; 357: 2325-7