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Challenges and Opportunities FOR CHANGE IN FOOD MARKETING TO CHILDREN AND YOUTH Workshop Summary Heather Breiner, Lynn Parker, and Steve Olson, Rapporteurs Standing Committee on Childhood Obesity Prevention Food and Nutrition Board INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

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THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. This project was supported by Contract/Grant No. 69449 between the National Academy of Sciences and the Robert Wood Johnson Foundation. The views pre- sented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for this project. International Standard Book Number-13:  978-0-309-26953-7 International Standard Book Number-10:  0-309-26953-9 Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Cover credit: Design by Casey Weeks. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2013. Challenges and opportunities for change in food marketing to children and youth: Workshop summary. Washing- ton, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE ON NEW CHALLENGES AND OPPORTUNITIES IN FOOD MARKETING TO CHILDREN AND YOUTH1 WILLIAM H. DIETZ (Chair), Retired Director, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia KELLY D. BROWNELL, Director, Rudd Center for Food Policy and Obesity, Yale University, New Haven, Connecticut THOMAS N. ROBINSON, Professor of Pediatrics and Medicine, Stanford Prevention Research Center, Stanford University, California MARY T. STORY, Senior Associate Dean and Professor, Division of Epidemiology and Community Health, University of Minnesota ELLEN WARTELLA, Al-Thani Professor of Communication, Professor of Psychology, and Professor of Human Development and Social Policy and Director of the Center on Median and Human Development, Northwestern University, Evanston, Illinois IOM Staff LYNN PARKER, Scholar HEATHER BREINER, Associate Program Officer SARAH SIEGEL, Senior Program Assistant SARAH ZIEGENHORN, Research Assistant ANTON L. BANDY, Financial Associate GERALDINE KENNEDO, Administrative Assistant LINDA D. MEYERS, Director, Food and Nutrition Board 1  Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

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Reviewers T his workshop summary has been reviewed in draft form by indi- viduals chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institu- tion in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: DAVID V. B. BRITT, Sesame Workshop (Retired) ELIZABETH CAMPBELL, Dr. Robert C. and Veronica Atkins Center for Weight & Health, University of California, Berkeley ELAINE D. KOLISH, Children’s Food and Beverage Advertising Initiative ROBIN McKINNON, National Cancer Institute Although the reviewers listed above provided many constructive com- ments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by HUGH H. TILSON, University of North Carolina at Chapel Hill. Appointed by the Institute of Medicine, he was responsible for making vii

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viii REVIEWERS certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the workshop rapporteurs and the institution.

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Contents 1 INTRODUCTION AND THEMES OF THE WORKSHOP 1 Purpose of the Workshop, 2 Themes of the Workshop, 3 2 PROGRESS SINCE FOOD MARKETING TO CHILDREN AND YOUTH: THREAT OR OPPORTUNITY? 5 Progress Toward Achieving the Recommendations of the IOM Report, 6 Overall Progress, 10 3 EMERGING ISSUES IN FOOD MARKETING 13 Integrated Marketing Communications, 14 Marketing to Adolescents, 17 Marketing Targeting Low-Income and Minority Communities, 20 4 INNOVATIONS AND FUTURE WORK IN INDUSTRY PRACTICES 23 Healthy Food Marketing Initiatives in Retail Chains, 23 Progress to Date and Future Directions for the Children’s Food and Beverage Advertising Initiative, 26 Changing Company-Wide Marketing Practices at The Walt Disney Company, 29 Monitoring and Evaluating Industry Innovations, 31 ix

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x CONTENTS 5 EMERGING POLICY INITIATIVES AND COMMUNICATION STRATEGIES 33 Parent-Led Communication Strategies, 33 Youth-Led Communication Strategies, 36 Lessons Learned from the truth® Antitobacco Campaign, 38 Legal and Policy Challenges and Opportunities, 40 International Developments, 45 6 DISCUSSIONS 49 Multiple Levels of Intervention, 49 The Age Cutoff, 50 Media Literacy, 51 Looking Toward the Future, 52 REFERENCES 55 APPENDIXES A WORKSHOP AGENDA 59 B WORKSHOP PARTICIPANTS 63 C ACRONYMS AND ABBREVIATIONS 67 D SPEAKER BIOGRAPHICAL SKETCHES 69