2

Progress Since
Food Marketing to Children and Youth:
Threat or Opportunity?

Ellen Wartella, Al-Thani Professor of Communication and director of the Center on Media and Human Development in the School of Communication at Northwestern University, reviewed progress made since the Institute of Medicine (IOM) released its landmark report on food marketing and its relationship to children’s diets (IOM, 2006). The charge to the expert committee that produced the report was to review the evidence for the influence of food and beverage marketing practices on the diets of children and adolescents and to recommend strategies for promoting healthful diets among this population. The 16 committee members were drawn from industry, government, academia, nutrition science, psychology, and other disciplines.

The committee conducted a systematic review of the relevant published scientific, peer-reviewed literature available at the time on the relationship between food marketing and children’s food preferences, purchase requests, and diets. Of the approximately 200 articles examined, 123 met the committee’s standards of evidence review. Almost all were on television advertising.

The committee found strong evidence for the effects of advertising on food and beverage preferences, purchase requests, and short-term consumption among children aged 2-11, and moderate evidence for effects on food and beverage beliefs and dietary intake among those aged 2-5. The committee found insufficient evidence to establish a causal relationship between television advertising and adiposity, especially for teens. It did find correlational data between exposure to television advertising and adiposity



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2 Progress Since Food Marketing to Children and Youth: Threat or Opportunity? E llen Wartella, Al-Thani Professor of Communication and director of the Center on Media and Human Development in the School of Communication at Northwestern University, reviewed progress made since the Institute of Medicine (IOM) released its landmark report on food marketing and its relationship to children’s diets (IOM, 2006). The charge to the expert committee that produced the report was to review the evi- dence for the influence of food and beverage marketing practices on the diets of children and adolescents and to recommend strategies for promot- ing healthful diets among this population. The 16 committee members were drawn from industry, government, academia, nutrition science, psychology, and other disciplines. The committee conducted a systematic review of the relevant published scientific, peer-reviewed literature available at the time on the relation- ship between food marketing and children’s food preferences, purchase requests, and diets. Of the approximately 200 articles examined, 123 met the committee’s standards of evidence review. Almost all were on television advertising. The committee found strong evidence for the effects of advertising on food and beverage preferences, purchase requests, and short-term con- sumption among children aged 2-11, and moderate evidence for effects on food and beverage beliefs and dietary intake among those aged 2-5. The committee found insufficient evidence to establish a causal relationship between television advertising and adiposity, especially for teens. It did find correlational data between exposure to television advertising and adiposity 5

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6 CHANGE IN FOOD MARKETING TO CHILDREN AND YOUTH in children and teens, but observed that more studies would be needed to draw a stronger relationship. The committee concluded that food and beverage marketing influences the diets and health of children and adolescents and that current market- ing practices are out of balance with healthful diets. It also concluded that companies and marketers have underutilized the potential to devote creativ- ity and resources to developing and promoting foods, beverages, and meals that support healthful diets. According to the report, achieving healthful diets will require sustained multisectoral and integrated efforts that include industry leadership and initiative. The report also notes that public policy programs and incentives lack the support and authority to address many of the current and emerging marketing practices that influence the diets of children and youth. PROGRESS TOWARD ACHIEVING THE RECOMMENDATIONS OF THE IOM REPORT The IOM report includes recommendations in nine broad areas related to food marketing and children’s diets. Drawing on two recent articles reviewing progress since the report was released (Kraak et al., 2011, 2012), Wartella reviewed these recommendations and assessed the changes they have inspired. Products and Promotion The IOM report recommends that food and beverage companies use creativity, resources, and marketing practices to promote and support more healthful diets and meals for children and youth. This recommendation has led to some product reformulations and new product development, Wartella said. Television advertising for unhealthy products also has been reduced in some areas. Wartella pointed out that questions have been raised, however, about whether product reformulations have led to changes in what is mar- keted to children and youth. In addition, restaurants have made limited progress in expanding and promoting healthier meals and providing nutrition information at the point of choice and consumption. A study examining the meal choices of children and adolescents at the 12 largest restaurants in terms of sales and market- ing to youth found that only 12 and 15, respectively, of 3,039 possible meal combinations met established nutrition standards for preschoolers and older children (Harris et al., 2010). Meals purchased by adolescents provided an average of 800 to 1,200 calories, 30 percent or more of which came from sugar and saturated fat, and healthy side dishes rarely were offered as a default choice (Harris et al., 2010).

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PROGRESS SINCE FOOD MARKETING TO CHILDREN AND YOUTH 7 Industry Trade Associations The IOM report recommends that food, beverage, restaurant, retail, and marketing industry trade associations assume leadership roles in har- nessing industry creativity, resources, and marketing on behalf of healthful diets for children and youth. This recommendation, too, has led to some progress, Wartella said. In 2011, for example, the Grocery Manufacturers Association announced the new Facts Up Front program for front-of- package nutrition information to help consumers identify healthy products. This approach has not been widely adopted, however, and an associated education campaign has not yet started. Wartella also cited the involvement of some trade associations in a separate campaign, the Healthy Weight Commitment Foundation. The Healthy Weight Commitment Foundation is an obesity reduction coalition that targets retailers, food and beverage manufacturers, restaurants, sporting goods and insurance companies, trade associations and nongovernmental organizations, and professional sports organizations. Coalition members have pledged to “reduce 1.5 trillion calories annually by the end of 2015 through new lower-calorie options, reduced calorie content of current products and reduced portion sizes of existing single-serving products.”1 Marketing Practice Standards The IOM report recommends that the food, beverage, restaurant, and marketing industries establish and enforce the highest standards for the mar- keting of foods, beverages, and meals to children and youth. It recommends that these industries use licensed characters only to promote foods and beverages that support healthful diets for children and youth; work through the Children’s Advertising Review Unit (CARU) to revise, expand, apply, enforce, and evaluate explicit industry self-regulatory guidelines beyond traditional advertising; and help CARU and the Federal Trade Commission (FTC) evaluate and enforce the expanded self-regulatory guidelines. The most important response to this recommendation was the estab- lishment, a few months after the report’s release, of the Children’s Food and Beverage Advertising Initiative (CFBAI), a self-regulatory body designed to promote food and beverage marketing to children that supports healthier dietary choices and lifestyles (see the detailed discussion of the initiative in Chapter 4). When CFBAI was established, food and beverage marketing guidelines were inconsistent from one company to the next. Today CFBAI includes 16 companies, covers about 80 percent of foods marketed to chil- dren and youth, and has helped achieve much more consistent standards. 1  See http://www.healthyweightcommit.org.

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8 CHANGE IN FOOD MARKETING TO CHILDREN AND YOUTH CFBAI announced that as of 2011, four companies—Cadbury Adams, Coca-Cola, the Hershey Company, and Mars—had committed to directing no advertising to children under 12. Thirteen companies pledged to adver- tise only foods that meet the Dietary Guidelines for Americans and Food and Drug Administration (FDA) standards for healthy foods. The pledges cover all media platforms, including radio, print, the Internet, advertising on video and computer games, and push advertising to cell phones. The Media and Entertainment Industry The IOM report recommends that the media and entertainment indus- try leverage its extensive power to promote healthful foods and beverages for children and youth by incorporating into multiple media platforms foods, beverages, and storylines that promote healthful diets and by serv- ing as accurate interpreters and reporters of findings, claims, and practices related to the diets of children and youth. Limited progress had been made on this recommendation by 2011, Wartella said. Nutrition information is being provided in some television programs and online, and media cover- age of the issue has been trending upward. A 2010 report found, how- ever, that only about a quarter of entertainment companies had a clear policy on food marketing to children, and marketing policies that were in place covered fewer types of marketing approaches (CSPI, 2010). Existing policies most likely addressed the use of licensed characters, and they were weaker or did not exist for broadcast, print, company websites, and digital media. For example, the Cartoon Network developed policies on nutrition standards for its licensed characters but not for its television advertising or website. Only a few companies, such as Walt Disney and Sesame Workshop, reported limiting children’s marketing to products meeting specific nutrition standards. The School Environment The IOM report recommends that state and local education authorities educate about and promote healthful diets for children and youth in all aspects of the school environment. It recommends that they develop and implement nutrition standards for competitive foods and beverages2 sold or served in the school environment and adopt policies and best practices promoting the availability and marketing of foods and beverages that sup- 2  Competitive foods are foods and beverages offered at schools other than meals and snacks served through the federally reimbursed school lunch, breakfast, and after-school snack programs. Competitive foods include food and beverages items sold through à la carte lines, snack bars, student stores, vending machines, and school fundraisers.

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PROGRESS SINCE FOOD MARKETING TO CHILDREN AND YOUTH 9 port healthful diets. In addition, public and civic leaders at all levels should provide visible leadership on this issue. Education leaders, school districts, and local schools have been seeking to create healthier eating environments for students, said Wartella. In general, moderate progress has occurred in this area to date. A Government–Private Sector Partnership The IOM report recommends that a government–private sector part- nership create a long-term social marketing program that supports parents, caregivers, and families in promoting healthful diets for children and youth. This program should be directed at parents of young children through marketing and widespread educational and community-based efforts, it should provide reliable and sustained support for these efforts through publicly appropriated funds and cooperative support, and it should have a mechanism for making proprietary marketing data available to inform the social marketing program. According to Wartella, this has been one of the most disappointing areas for progress on the report’s recommenda- tions. In particular, the social marketing program to encourage the parents of young children to launch them on a lifelong healthy diet and exercise routine has not materialized. Public Policy The IOM report recommends that federal and local governments marshal the full range of public policy levers to foster the development and promotion of healthful diets for children and youth. Specifically, gov- ernments should consider implementing industry incentives to this end, the U.S. Department of Agriculture (USDA) should develop and test new strategies for promoting healthier and more appealing school meals, and governments should draft legislation for broadcast and cable television if voluntary efforts are unsuccessful in shifting the emphasis of advertising to healthier products. Limited progress has been made in this area, Wartella reported. First Lady Michelle Obama’s Let’s Move campaign and the Partnership for a Healthier America have been successful public-private partnerships, but the government has not taken action in a number of other areas. For example, the federal Interagency Working Group on Food Marketed to Children rec- ommended voluntary nutrition and marketing standards to guide industry self-regulatory efforts to improve the nutritional profile of foods marketed to children, but those standards have not been finalized, even though they were to be voluntary.

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10 CHANGE IN FOOD MARKETING TO CHILDREN AND YOUTH Research The IOM report recommends that research capacity be better directed to review how marketing influences the food and beverage choices of chil- dren and youth. Research should illuminate ways in which marketing influ- ences children’s attitudes and behaviors; study newer promotion techniques and venues, healthier foods and beverages, portion sizes, and product availability; and examine the impact of television advertising on diet and diet-related health. Limited progress has occurred in this area to date, said Wartella. The National Institutes of Health (NIH) and USDA have sup- ported some of this research, but the Robert Wood Johnson Foundation remains the largest funder of research on food and beverage marketing to children and adolescents. Monitoring The IOM report recommends that the secretary of the Department of Health and Human Services (HHS) designate an agency responsible for formally monitoring and making regular reports on progress on the rec- ommendations included in the report. The secretary should consult with other relevant cabinet officers and agency heads to develop and implement required monitoring and reporting and report to Congress within 2 years on progress made and any necessary additional actions. A report to Congress was made in fall 2008. However, no progress has been made in identifying a responsible agency to monitor the IOM report’s recommendations (FTC, 2008). OVERALL PROGRESS Overall, concluded Wartella, progress on the recommendations of the IOM report has varied from limited to moderate. A more recent IOM report on accelerating progress on obesity prevention, which includes mar- keting goals, contains recommendations similar to those of the 2006 report, including the following (IOM, 2012): • Reduce overconsumption of sugar-sweetened beverages. • Increase the availability of lower-calorie and healthier food and beverage options for children in restaurants. • Implement common nutrition standards for marketing of foods and beverages to children and adolescents. • Ensure consistent nutrition labeling for front-of-pack, store shelves, and menus.

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PROGRESS SINCE FOOD MARKETING TO CHILDREN AND YOUTH 11 Another recent IOM report, Front-of-Package Nutrition Rating Sys- tems and Symbols: Promoting Healthier Choices, suggests a front-of-pack nutrition labeling and symbol system, but no action has been taken in response (IOM, 2011). In addition, some movement has occurred at the local level, such as New York City’s proposed limit on the size of sugary drinks. Given the many new marketing techniques being used to reach children and youth, much remains to be learned, and much remains to be done, concluded Wartella. “Since 2006 . . . there has been a proliferation of new venues and vehicles, particularly the rise of digital media.” —Ellen Wartella

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