Nine out of 10 food advertisements shown during Saturday morning children's television programming are for foods high in fat, sodium, or added sugars, or low in nutrients

Revisiting 42 Years of literature on food marketing to children: A morphological analysis

Despite the preventive measures taken by the WHO, childhood obesity is still on the rise and is expected to increase by 100% between 2020 and 2035. Food marketing continues to permeate children's environments in numerous ways and influence the food behaviour of children, thus significantly contributing to the rise of obesity. Studies suggest that the literature on the effects of food marketing on children is complex and multidimensional. To fully understand these effects, a comprehensive and systematic approach is required. Nonetheless, existing reviews have focused only on specific aspects and have not comprehensively covered the literature on food marketing to children. Therefore, this review aims to navigate potential research gaps in the existing literature through a comprehensive examination of the literature by using morphological analysis (MA) methodology, the first time in this domain. Using PRISMA, 202 papers were considered eligible for inclusion and further analysed using MA. The articles were categorised into three dimensions to develop the MA framework: Stimuli (Food well-being), Organism, and Response, and 34 variants. The review has presented future research prospects by identifying at least 218 research gaps. With these findings, researchers can further explore the gaps and develop new research questions that could foster an understanding of the multifarious literature. Moreover, these findings can also provide marketers and practitioners with a better comprehension of the current state of the literature and develop more effective strategies for responsible marketing practices and policies.

Cross-sectional and prospective associations between household socioeconomic resources, appetite traits, and body size among Samoan infants

In high-income countries, household socioeconomic resources (as measured by education, occupation, income, and/or household assets) and childhood obesity risk tend to be negatively associated. This association may arise in part because children from households with fewer resources are exposed to obesogenic environments that shape appetite trait development. In contrast, many low- and middle-income countries (LMICs) exhibit a positive association between socioeconomic resources and child body size. There is less evidence from LMIC settings about when during development this association emerges and whether appetite traits play a mediatory role. To explore these questions, we examined cross-sectional and longitudinal associations between socioeconomic resources, appetite traits, and body size among infants in Samoa, an LMIC in Oceania. Data were from the Foafoaga O le Ola prospective birth cohort of 160 mother-infant dyads. Appetite traits were characterized using the Baby and Child Eating Behavior Questionnaires and household socioeconomic resources were quantified using an asset-based measure. While infant body size and household socioeconomic resources were positively associated in both cross-sectional and prospective analyses, we found no evidence that appetite traits mediate this relationship. These results suggest that other aspects of the food environment, such as food security and feeding style, may explain the positive association between socioeconomic resources and body size observed in many LMICs.

Exposure to Food Marketing via Social Media and Obesity among University Students in Saudi Arabia

This study investigated the associations between obesity and unhealthy food/drink intake with both the frequency of social media platform usage and food/drink marketing exposure on social media. Data were obtained from 316 university students aged 18−29 years at two universities in Jeddah, Saudi Arabia. These participants completed online questionnaires with sections on demographics, anthropometric measurements, social media platform usage, food marketing exposure via social media, and unhealthy food consumption. All of the participants, 20.3% and 13.6% were overweight and obese, respectively. Snapchat was the most popular application (85.8%), followed by Instagram (75%), YouTube (61%), Twitter (51%), and TikTok (50%). The obese participants were more likely to purchase foods/drinks after watching relevant social media advertisements than their non-obese counterparts (p < 0.04). Moreover, those who purchased foods/drinks more frequently after watching such advertisements consumed higher amounts of potato chips (p < 0.01) and fast foods (p < 0.03). Finally, those who used Snapchat, TikTok, and Instagram tended to have higher consumption rates for potato chips (p < 0.02), fast foods (p < 0.01), sweets (p < 0.02), and sugary drinks (p < 0.04). Public health policymakers in Saudi Arabia should consider regulating unhealthy food and drink advertisements on social media platforms, especially those targeted at younger generations.

Nutritional Analysis of Foods and Beverages Posted in Social Media Accounts of Highly Followed Celebrities

IMPORTANCE

Celebrity social media posts engage millions of young followers daily, but the nutritional quality of foods and beverages in such posts, sponsored and unsponsored, is unknown.

OBJECTIVE

To quantify the nutritional quality of foods and beverages depicted in social media accounts of highly followed celebrities and assess whether nutritional quality is associated with post sponsorship, celebrity profession or gender, and followers' likes and comments.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study analyzed the content of food- and beverage-containing posts from Instagram (a photo- and video-sharing social media platform) accounts of 181 highly followed athletes, actors, actresses, television personalities, and music artists. Data were collected from May 2019 to March 2020.

MAIN OUTCOMES AND MEASURES

The nutritional quality of foods and beverages posted in celebrity social media accounts was rated using the Nutrient Profile Index (NPI) based on the sugar, sodium, energy, saturated fat, fiber, protein, and fruit and/or vegetable content per 100-g sample (a score of 0 indicated least healthy and 100, healthiest); foods with scores less than 64 and beverages with scores less than 70 were rated as "less healthy." Secondary outcomes were whether the nutritional quality of foods and beverages in social media posts was associated with post sponsorship, celebrity profession or gender, and followers' likes and comments. Mixed-effects regression models were used to estimate how outcomes differed across fixed effects.

RESULTS

The sample included social media accounts of 181 celebrities (66 actors, actresses, and television personalities [36.5%]; 64 music artists [35.4%]; and 51 athletes [28.2%]). A total of 102 celebrities (56.4%) were male, and the median age was 32 years (range, 17-73 years). Among 3065 social media posts containing 5180 total foods and beverages (2467 foods [47.6%]; 2713 beverages [52.4%]), snacks and sweets (920 [37.3%] of the foods) and alcoholic beverages (1375 [50.7%] of the beverages) were most common. Overall, 158 celebrity social media accounts (87.3%) earned a less healthy overall food nutrition score and 162 (89.5%) earned a less healthy overall beverage nutrition score, which would be unhealthy enough to fail legal youth advertising limits in the UK. For foods, social media posts with healthier nutrition scores were associated with significantly fewer likes (b, -0.003; 95% CI, -0.006 to 0.000; P = .04) and comments (b, -0.006; 95% CI, -0.009 to -0.003; P < .001) from followers. For beverages, nutrition scores were not significantly associated with likes (b, -0.010; 95% CI, -0.025 to 0.005; P = .18) or comments (b, -0.003; 95% CI, -0.022 to 0.016; P = .73). Only 147 food- or beverage-containing posts (4.8%) were sponsored by food- or beverage-relevant companies. Beverages in sponsored posts contained more than twice as much alcohol as those in nonsponsored posts (10.8 g [95% CI, 9.3 g to 12.3 g] per 100 g of beverage vs 5.3 g [95% CI, 4.7 g to 5.9 g] per 100 g of beverage).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, most highly followed celebrity social media accounts depicted an unhealthy profile of foods and beverages, primarily in nonsponsored posts. These results suggest that influential depictions of unhealthy food and beverage consumption on social media may be a sociocultural problem that extends beyond advertisements and sponsorships, reinforcing unhealthy consumption norms.

A deep learning approach to identify unhealthy advertisements in street view images

While outdoor advertisements are common features within towns and cities, they may reinforce social inequalities in health. Vulnerable populations in deprived areas may have greater exposure to fast food, gambling and alcohol advertisements, which may encourage their consumption. Understanding who is exposed and evaluating potential policy restrictions requires a substantial manual data collection effort. To address this problem we develop a deep learning workflow to automatically extract and classify unhealthy advertisements from street-level images. We introduce the Liverpool [Formula: see text] Street View (LIV360SV) dataset for evaluating our workflow. The dataset contains 25,349, 360 degree, street-level images collected via cycling with a GoPro Fusion camera, recorded Jan 14th-18th 2020. 10,106 advertisements were identified and classified as food (1335), alcohol (217), gambling (149) and other (8405). We find evidence of social inequalities with a larger proportion of food advertisements located within deprived areas and those frequented by students. Our project presents a novel implementation for the incidental classification of street view images for identifying unhealthy advertisements, providing a means through which to identify areas that can benefit from tougher advertisement restriction policies for tackling social inequalities.

Governmental policies to reduce unhealthy food marketing to children

Reducing children's exposure to food marketing is an important obesity prevention strategy. This narrative review describes current statutory regulations that restrict food marketing; reviews available evidence on the effects of these regulations; and compares policy design elements in Chile and the United Kingdom. Currently, 16 countries have statutory regulations on unhealthy food marketing to children. Restrictions on television advertising, primarily during children's programming, are most common. Schools are also a common setting for restrictions. Regulations on media such as cinema, mobile phone applications, print, packaging, and the internet are uncommon. Eleven evaluations of policies in 4 jurisdictions found small or no policy-related reductions in unhealthy food advertising, in part because marketing shifted to other programs or venues; however, not all policies have been evaluated. Compared with the United Kingdom, Chile restricts marketing on more products, across a wider range of media, using more marketing techniques. Future research should examine which elements of food marketing policy design are most effective at reducing children's exposure to unhealthy food marketing.

Precision nutrition: hype or hope for public health interventions to reduce obesity?

High-income countries are experiencing an obesity epidemic that follows a socioeconomic gradient, affecting groups of lower socioeconomic status disproportionately. Recent clinical findings have suggested new perspectives for the prevention and treatment of obesity, using personalized dietary approaches. Precision nutrition (PN), also called personalized nutrition, has been developed to deliver more preventive and practical dietary advice than ‘one-size-fits-all’ guidelines. With interventions becoming increasingly plausible at a large scale thanks to artificial intelligence and smartphone applications, some have begun to view PN as a novel way to deliver the right dietary intervention to the right population. We argue that large-scale PN, if taken alone, might be of limited interest from a public health perspective. Building on Geoffrey Rose’s theory regarding the differences in individual and population causes of disease, we show that large-scale PN can only address some individual causes of obesity (causes of cases). This individual-centred approach is likely to have a small impact on the distribution of obesity at a population level because it ignores the population causes of obesity (causes of incidence). The latter are embedded in the populations’ social, cultural, economic and political contexts that make environments obesogenic. Additionally, the most socially privileged groups in the population are the most likely to respond to large-scale PN interventions. This could have the undesirable effect of widening social inequalities in obesity. We caution public health actors that interventions based only on large-scale PN are unlikely, despite current expectations, to improve dietary intake or reduce obesity at a population level.

Food as an eye-catcher. An eye-tracking study on Children's attention to healthy and unhealthy food presentations as well as non-edible objects in audiovisual media

BACKGROUND

Food presentations within media content are often made responsible for todays' obesity epidemic. This assessment is based on the assumption that food presentations create cue reactivity, which in turn affects the amount of food intake.

OBJECTIVE

This study investigates children's implicit reactions (cue reactivity) toward healthy, unhealthy, and non-ediblel objects.

METHODS

We conducted an experimental eye-tracking study comparing children's cue reactivity assessed with visual attention toward healthy and unhealthy food presentations, as well as non-edible objects. We controlled for the role of children's hunger, body mass index (BMI), and age.

RESULTS

Results indicated no difference between healthy and unhealthy food presentations, yet food generally aroused more visual attention in children compared to non-edible objects. Explicit memory for the embedded foods or objects was mediated through visual attention. However, unhealthy food presentations also directly affected children's explicit memory.

CONCLUSIONS

Compared to non-edible objects, food presentations seem to be eye-catchers that immediately grab children's attention and they are also able to maintain this attention. Yet, for unhealthy food presentations, memory seems to be less dependent on visual attention. That is, compared to healthy products or non-edible objects, unhealthy food presentations do not require the same amount of visual attention in order to be remembered.

Effects of Family-Centered Media Literacy Training on Family Nutrition Outcomes

Parents frustrated about food marketing influences need media management skills to challenge marketing messages and interpret factual content. We tested a media literacy-based, family-centered intervention to reduce effects of appealing, but unrealistic, food marketing. We hypothesized that participation would facilitate family discussion that improves the home dietary environment and increases youth consumption of fruits and vegetables. Parent-child (age 9-14) dyads (N = 189) participated in a matched-group, pretest/posttest field experiment testing a 6-week media literacy-based curriculum. Hypothesis testing employed multiple analysis of covariance and Bayesian multigroup structural equation modeling (MGSEM). Improved nutrition outcomes for parents included talk with youth about food nutrition labels (d = 0.343) and ratio of healthy to unhealthy food in home (d = 0.232); youth improved talk with parent about food nutrition labels (d = 0.211), vegetables eaten yesterday (d = 0.264), and fruit eaten yesterday (d = 1.386). Bayesian MGSEM revealed that in the intervention group, 12 of 17 tested paths were significant (p < .05), compared with only 4 in the control group, with average effect size magnitudes of 0.236 and 0.113, respectively. Media literacy education can empower parents and improve youths' critical thinking to reduce negative effects of food marketing on families and improve use of media to obtain nutrition information that aids dietary choices. This approach reduces the risk for reactance from youth who like media and resist limiting media use, while helping families use media together to make better nutrition decisions.

Snacking characteristics and patterns and their associations with diet quality and BMI in the Childhood Obesity Prevention and Treatment Research Consortium

OBJECTIVE

To describe snacking characteristics and patterns in children and examine associations with diet quality and BMI.

DESIGN

Children's weight and height were measured. Participants/adult proxies completed multiple 24 h dietary recalls. Snack occasions were self-identified. Snack patterns were derived for each sample using exploratory factor analysis. Associations of snacking characteristics and patterns with Healthy Eating Index-2010 (HEI-2010) score and BMI were examined using multivariable linear regression models.

SETTING

Childhood Obesity Prevention and Treatment Research (COPTR) Consortium, USA: NET-Works, GROW, GOALS and IMPACT studies.

PARTICIPANTS

Predominantly low-income, racial/ethnic minorities: NET-Works (n 534, 2-4-year-olds); GROW (n 610, 3-5-year-olds); GOALS (n 241, 7-11-year-olds); IMPACT (n 360, 10-13-year-olds).

RESULTS

Two snack patterns were derived for three studies: a meal-like pattern and a beverage pattern. The IMPACT study had a similar meal-like pattern and a dairy/grains pattern. A positive association was observed between meal-like pattern adherence and HEI-2010 score (P for trend < 0⋅01) and snack occasion frequency and HEI-2010 score (β coefficient (95 % CI): NET-Works, 0⋅14 (0⋅04, 0⋅23); GROW, 0⋅12 (0⋅02, 0⋅21)) among younger children. A preference for snacking while using a screen was inversely associated with HEI-2010 score in all studies except IMPACT (β coefficient (95 % CI): NET-Works, -3⋅15 (-5⋅37, -0⋅92); GROW, -2⋅44 (-4⋅27, -0⋅61); GOALS, -5⋅80 (-8⋅74, -2⋅86)). Associations with BMI were almost all null.

CONCLUSIONS

Meal-like and beverage patterns described most children's snack intake, although patterns for non-Hispanic Blacks or adolescents may differ. Diets of 2-5-year-olds may benefit from frequent meal-like pattern snack consumption and diets of all children may benefit from decreasing screen use during eating occasions.

The extent, nature, and nutritional quality of foods advertised to children in Lebanon: the first study to use the WHO nutrient profile model for the Eastern Mediterranean Region

Objective

Exposure to food marketing may influence children’s food preferences and consumption patterns and may increase the risk of childhood obesity. The WHO Office for the Eastern Mediterranean Region (EMR) has recently released a regional nutrient profile model (WHO EMR) for the purpose of regulating the marketing of food and beverages to children. This study aimed at 1) analyzing the frequency and types of food and drink advertisements during children’s viewing time in Lebanon; 2) examining the nutritional content of the advertised food products in reference to the nutrient thresholds specified by the WHO EMR model; and 3) assessing the proportion of food advertisements that included health messages.

Design

This study consisted of a cross-sectional content analysis of food advertisements on local TV channels, during children’s viewing time.

Setting

Three local Lebanese channels with the highest viewership among 4- to 14-year-olds were selected. Recorded broadcasts (September 2016 through January 2017) were analyzed between 3 pm and 10 pm on weekdays and between 8 am and 10 pm on weekend days.

Results

Approximately 31% of advertisements were for foods or drinks. The proportion of food advertisements was the highest during children’s programs (43%) compared to general viewing (32%) and parental guidance (29%) programs. Approximately 8 out of 10 food advertisements were for products that did not meet the standards of the WHO EMR model. Of concern was the heavy advertisement of alcoholic beverages during programs for general audiences. The majority of the advertisements that comprised a health claim were for foods that did not meet the WHO EMR’s nutritional standards (79%).

Conclusions

The findings of this study, which is the first to utilize the new WHO EMR profile model, should be viewed as a foundation for the development of food marketing policies aimed at reducing children’s exposure to TV food advertisements in Lebanon, a country that harbors a high burden of childhood obesity.

Association between parental consumer attitudes with their children's sensory taste preferences as well as their food choice

Background

We investigated the association between the consumer attitudes of European parents and their children’s taste preferences and food choice. Furthermore, we studied whether the parental consumer attitudes were related to education level.

Methods

This analysis included 1,407 IDEFICS study children aged 6.0 to 11.8 years and from 7 European countries, who participated in the sensory taste perception module between 2007 and 2010. Parental consumer attitude was operationalized as ‘trusting in foods known from advertisements’ (trusting advertisements) and as ‘not avoiding additives in food’ (not avoiding additives). Parents reported their educational attainment and completed a food frequency questionnaire for their children. Consumption frequencies of sweet, fatty and processed foods as well as a healthy diet adherence score were calculated. Children performed fat, sweet and umami taste preference tests. Multivariable logistic models were used to analyse the association between parental consumer attitudes and their children’s taste preference frequencies as well as parental education. Linear regression models were used to analyse the association between parental consumer attitudes and their children’s food consumption.

Results

Parental consumer attitudes were not associated with children’s fat, sweet and umami taste preferences. Children of parents trusting advertisements consumed more frequently processed foods (β = 1.21, 95% CI: 0.49; 1.93). Children of parents not avoiding additives consumed more often sweet, fatty and processed foods and had a lower healthy diet adherence score (β = 2.37, 95% CI: 1.03; 3.70; β = 2.27, 95% CI: 1.12; 3.43; β = 0.91, 95% CI: 0.22; 1.59; β = -2.87, 95% CI: -3.89; -1.85, respectively). Unfavourable parental consumer attitudes were associated with a lower parental education level across Europe (Compared to high education: Odds Ratio (OR) of trusting advertisements with medium education: 1.04, 95% CI: 0.77; 1.40; OR with low education: 2.01, 95% CI: 1.15; 3.54; OR of not avoiding additives with medium education: 1.91, 95% CI: 1.44; 2.54; OR with low education: 1.76, 95% CI: 0.96; 3.24).

Conclusions

Across Europe, unfavourable parental consumer attitudes are associated with a lower diet quality of their children. Parental consumer attitudes in turn were associated with their own level of education. This has implications for policy makers, interventions and health promotion programmes that aim to promote healthy eating.

Evaluating the Nutritional Content of Children's Breakfast Cereals in Australia

Breakfast is an important contributor to the daily dietary intake of children. This study investigated the nutritional composition of ready to eat (RTE) children’s breakfast cereals, which display fictional cartoon characters and themes, compared to other cereals available in Australia. Nutrient content claims on packaging were also examined. Data were collected from RTE breakfast cereal packages (N = 347) from four major supermarkets in Sydney. Cereals were classified based on product type and promotional information displayed. Overall, 46% of children’s cereals were classified as “less healthy” as per nutrient profiling score criteria. Children’s cereals had a similar energy and sodium content per 100 g compared to other cereals but contained significantly higher levels of total sugar and lower levels of protein and dietary fibre compared to other varieties. Children’s cereals with nutrient content claims had improved (lower) nutrient profiling scores than those that did not (2 vs. 13, p = 0.021), but total sugar per 100 g was similar: 25 g (interquartile range (IQR) 14 g) vs. 32 g (IQR 19 g). In conclusion, RTE children’s breakfast cereals were found to be less healthy compared to other cereals on the market and the use of nutrient content claims on children’s cereals may mislead consumers regarding their overall nutrient profile.

Television advertising of food during children's programming in Nepal

OBJECTIVE

The World Health Organization has recommended that advertising of unhealthy food to children decrease in quantity (exposure) and efficacy (power). The degree to which marketing practices align with these recommendations varies across countries. The purpose of this study is to describe the television food marketing landscape that children experience in the South Asian country of Nepal.

RESEARCH METHODS & PROCEDURES

Commercials from 57hours of television were recorded from three channels during hours that children's programming was played. In a content analysis of 1,203 food commercials, researchers coded commercials for nutrition content, product category and marketing appeal type.

RESULTS

Principal findings of this study were that nearly 21% of airtime during children's programming was dedicated to commercials, and 55% of that was dedicated to foods. Over 70% of food commercials aired advertised foods with excessive amounts of saturated fat, sugar, and/or sodium; nearly half of the commercials (47.7%) featured products that contained excess sugar. The most prevalent food types shown were ice cream and popsicles (20.7%), energy/nutritional supplements (20.6%), and candy (14.7%). Additionally, the three most commonly occurring marketing appeals featured highly-efficacious strategies for persuading children-animated effects (83.2%), movie, cartoon, animated, or costumed characters (36.8%), and television/movie tie-ins (16.5%).

CONCLUSION(S)

Results from this study suggest that many television commercials shown in Nepal do not meet WHO recommendations for advertising foods to children. This is likely to negatively impact the diet and health of the next generation of Nepalis.

Adoptable Interventions, Human Health, and Food Safety Considerations for Reducing Sodium Content of Processed Food Products

Although vital for maintaining health when consumed in moderation, various epidemiological studies in recent years have shown a strong association between excess dietary sodium with an array of health complications. These associations are robust and clinically significant for development of hypertension and prehypertension, two of the leading causes of preventable mortality worldwide, in adults with a high-sodium diet. Data from developed nations and transition economies show worldwide sodium intake of higher than recommended amounts in various nations. While natural foods typically contain a moderate amount of sodium, manufactured food products are the main contributor to dietary sodium intake, up to 75% of sodium in diet of American adults, as an example. Lower cost in formulation, positive effects on organoleptic properties of food products, effects on food quality during shelf-life, and microbiological food safety, make sodium chloride a notable candidate and an indispensable part of formulation of various products. Although low-sodium formulation of each product possesses a unique set of challenges, review of literature shows an abundance of successful experiences for products of many categories. The current study discusses adoptable interventions for product development and reformulation of products to achieve a modest amount of final sodium content while maintaining taste, quality, shelf-stability, and microbiological food safety.

The healthfulness and prominence of sugar in child-targeted breakfast cereals in Canada

INTRODUCTION

The objective of this study was to compare the nutritional content and healthfulness of child-targeted and "not child-targeted" breakfast cereals and to assess the predominance of added sugar in these products.

METHODS

We collected data on the nutritional content of 262 unique breakfast cereals found in the five largest grocery store chains in Ottawa (Ontario) and Gatineau (Quebec). We noted the first five ingredients and the number of added sugars present in each cereal from the ingredients list. The various cereal brands were then classified as either "healthier" or "less healthy" using the UK Nutrient Profile Model. We assessed each cereal to determine if it was child-targeted or not, based on set criteria. Statistical comparisons were made between child and not child-targeted cereals.

RESULTS

19.8% of all breakfast cereals were child-targeted, and these were significantly lower in total and saturated fat. Child-targeted cereals were significantly higher in sodium and sugar and lower in fibre and protein, and were three times more likely to be classified as "less healthy" compared to not child-targeted cereals. No child-targeted cereals were sugar-free, and sugar was the second most common ingredient in 75% of cereals. Six breakfast cereal companies had child-targeted product lines that consisted entirely of "less healthy" cereals.

CONCLUSION

There is a need for regulations that restrict food marketing to children and youth under the age of 17 on packaging to reduce their appeal to this age group. Children's breakfast cereals also need to be reformulated through government-set targets, or through regulation should compliance be deemed unacceptable.

Children's purchase behavior in the snack market: Can branding or lower prices motivate healthier choices?

BACKGROUND

Children's dietary-related diseases and their associated costs have expanded dramatically in many countries, making children's food choice a policy issue of increasing relevance. As children spend a considerable amount of money on energy-dense, nutrient-poor (EDNP) products, a better understanding of the main drivers of children's independent food purchase decisions is crucial to move this behavior toward healthier options.

OBJECTIVE

The objective of the study is to investigate the role of branding and price in motivating children to choose healthier snack options.

METHODS

The study investigates snack choices of children ages 8 to 11, using a survey and a purchase experiment. The research took place in after-school programs of selected schools in the Boston area. Participants included 116 children. Products in the choice experiment differed on three factors: product type, brand, and price. Data were analyzed using aggregated and mixed logit models.

RESULTS

Children's purchase decisions are primarily determined by product type (Importance Value (IV) 56.6%), while brand (IV 22.8%) and price (IV 20.6%) prove to be of less relevance. Only those children who state that they like the familiar brand reveal a preference for the branded product in their purchase decision. Price is a significant predictor of choice when controlling for whether or not children obtain an allowance.

CONCLUSION

It is not simple brand awareness but a child's liking of the brand that determines whether a brand is successful in motivating a child to choose a product. The extent of children's experience with money influences their price responsiveness. To the extent that children who receive an allowance are primarily the ones buying food snacks, higher prices for EDNP snacks could be successful in motivating children to choose a healthier option.

Fast foods perception among adolescents by gender and weight status

BACKGROUND

Fast food restaurants have become widespread in both developed and developing countries due to nutritional and economic transitions. The frequency of fast food intake is relatively high among adolescents; however, fast food consumption is positively associated with total energy intake and obesity in adolescents.

OBJECTIVE

This study aimed to examine the perception of Jordanian adolescents towards fast foods relative to gender and obesity.

METHODS

A cross-sectional survey was conducted on 400 boys and 395 girls, aged 15-18 years. The adolescents completed a validated questionnaire to measure the perception of adolescents towards fast foods during the year 2013-2014. Weight and height were measured. Numbers who were non-overweight, overweight, and obese were calculated for each age and sex using the International Obesity Task Force (IOTF) standard.

RESULTS

The majority of participants perceived foods which are eaten as sandwiches as fast foods. A significant difference between boy and girl adolescents was reported regarding perception of French fries ( p < 0.012), fried chicken ( p < 0.001), fattayer ( p < 0.001), foul (boiled broad beans) sandwich ( p < 0.001), falafel sandwich ( p < 0.044) and fried eggs sandwich ( p < 0.001) as fast foods. Girls were significantly more enthusiastic than boys to consider cuscusi plate ( p < 0.001), rice dishes ( p < 0.002), Chinese foods ( p < 0.001), Indian foods ( p < 0.010), Mexican foods ( p < 0.011), and Italian foods ( p < 0.004) as non-fast foods. The difference between obese and non-obese regarding the perception of fast foods was only significant among boy participants. Western or non-Arab foods, food prepared fast and eaten fast in self-service outlets, and food rich in calories were significantly perceived as fast food by Jordanian adolescents ( p < 0.05).

CONCLUSIONS

The perception of foods as fast foods or non-fast foods was significantly different between both genders as well as in obese and non-obese male Jordanian adolescents.

Responsiveness to healthy advertisements in adults: An experiment assessing beyond brand snack selection and the impact of restrained eating

The objective of this study was to explore the impact of different advertising messages on adults' snack choice. Eighty participants (18-24 years old) were offered the choice between two snack packs following exposure to one of three advertising conditions. The snack packs contained either healthy or high fat, sugar or salt (HFSS) foods. Participants were exposed to commercials containing either non-food products, healthy food products or HFSS food products and their subsequent choice of snack pack was recorded. The Dutch Eating Behaviour Questionnaire (DEBQ) was used to assess the impact of external, restrained and emotional eating behaviour on snack pack selection following exposure to advertisements. The majority of unrestrained participants preferentially choose the HFSS snack pack irrespective of advertisement condition. In contrast, high restrained individuals exposed to the healthy eating advertisement condition preferentially selected the healthy snack pack while those in other advertisement conditions refused to take either snack pack. The healthy eating message, when distributed through mass media, resonated with restrained eaters only. Exposure to healthy food adverts provoked restrained eaters into choosing a snack pack; while exposure to other messages results in restrained eaters refusing to take any foods.

Are Food Advertisements Promoting More Unhealthy Foods and Beverages over Time? Evidence from Three Swedish Food Magazines, 1995-2014

Unhealthy food in advertising has been suggested as a mediator for the increase in diet-related illness. This study quantitatively investigates changes in food advertising between 1995 and 2014 in terms of food categories promoted, macronutrient content, and percentage of foods classified as heathy or unhealthy from a sample of 7,199 ads from three Swedish food magazines. With the exception of increased alcoholic beverage and decreased carbohydrate-rich-food promotion, no monotonic trends of increasingly unhealthy food advertisement are found. From these findings, it is argued that food magazine advertising is not a mediator of the adverse dietary trend.

Perinatal, sociodemographic and lifestyle correlates of increased total and visceral fat mass levels in schoolchildren in Greece: the Healthy Growth Study

Objective

To identify possibly independent associations of perinatal, sociodemographic and lifestyle factors with childhood total and visceral body fat.

Design

A representative sample of 2655 schoolchildren (9–13 years) participated in the Healthy Growth Study, a cross-sectional epidemiological study.

Setting

Seventy-seven primary schools in four large regions in Greece.

Subjects

A sample of 1228 children having full data on total and visceral fat mass levels, as well as on anthropometric, dietary, physical activity, physical examination, socio-economic and perinatal indices, was examined.

Results

Maternal (OR=3·03 and 1·77) and paternal obesity (OR=1·62 and 1·78), maternal smoking during pregnancy (OR=1·72 and 1·93) and rapid infant weight gain (OR=1·42 and 1·96) were significantly and positively associated with children’s increased total and visceral fat mass levels, respectively. Children’s television watching for >2 h/d (OR=1·40) and maternal pre-pregnancy obesity (OR=2·46) were associated with children’s increased total and visceral fat mass level, respectively. Furthermore, increased children’s physical activity (OR=0·66 and 0·47) were significantly and negatively associated with children’s total and visceral fat mass levels, respectively. Lastly, both father’s age >46 years (OR=0·57) and higher maternal educational level (OR=0·45) were associated with children’s increased total visceral fat mass level.

Conclusions

Parental sociodemographic characteristics, perinatal indices and pre-adolescent lifestyle behaviours were associated with children’s abnormal levels of total and visceral fat mass. Any future programme for childhood prevention either from the perinatal age or at late childhood should take these indices into consideration.

Child-targeted TV advertising and preschoolers' consumption of high-sugar breakfast cereals

Breakfast cereals represent the most highly advertised packaged food on child-targeted television, and most ads are for cereals high in sugar. This study examined whether children's TV exposure to child-targeted, high-sugar breakfast cereal (SBC) ads was associated with their consumption of those SBC brands. Parents of 3- to 5-year-old children were recruited from pediatric and Women, Infants, and Children (WIC) clinics in Southern New Hampshire, USA, and completed a cross-sectional survey between April-December 2013. Parents reported their child's consumption of SBC brands; whether their child had watched any of 11 kids' channels in the past week; their child's TV viewing time; and socio-demographics. Children's exposure to child-targeted SBC TV ads was calculated by combining TV channel and viewing time with advertising data for SBC ads aired on kids' TV channels during the same timeframe. Five hundred forty-eight parents completed surveys; 52.7% had an annual household income of $50,000 or less. Children's mean age was 4.4 years, 51.6% were female, and 72.5% were non-Hispanic white. In the past week, 56.9% (N = 312) of children ate SBCs advertised on kids' channels. Overall, 40.6% of children were exposed to child-targeted SBC TV ads in the past week. In fully adjusted analyses, the number of SBC brands children consumed was positively associated with their exposure to child-targeted SBC ads. Children consumed 14% (RR = 1.14, 95% CI: 1.02, 1.27) more SBC brands for every 10 SBC ads seen in the past 7 days. Exposure to child-targeted SBC TV advertising is positively associated with SBC brand consumption among preschool-aged children. These findings support recommendations to limit the marketing of high-sugar foods to young children.

Trust and doubt: An examination of children's decision to believe what they are told about food

The domain of food is one that is highly relevant and vital to the everyday lives of children. However, children's reasoning about this domain is poorly understood within the field of developmental psychology. Because children's learning about food, including its evaluative components (e.g., health, taste) is so heavily dependent on information conveyed by other people, a major developmental challenge that children face is determining who to distrust regarding food. In three studies, this investigation examined how 3- and 4-year-olds and adults (N=312) use different cues to determine when to ignore informant information (i.e., distrust what an informant tells them by choosing an alternative) in food- and non-food-specific scenarios. The results of Study 1 indicated that by age 4 years, children are less trusting of inaccurate sources of information compared with sources that have not demonstrated previous inaccuracy. Study 2 revealed that these results are applicable across the domain of objects. The results of Study 3 indicated that by age 4, children trust benevolent sources more often than malevolent ones. Thus, when reasoning about the evaluative components of food, by age 4, children appraise other people's untrustworthiness by paying attention to their inaccuracy and malevolence.

Content Analysis of Food and Beverages Advertisements Targeting Children and Adults on Television in Sri Lanka

INTRODUCTION

Food marketing is one of the main factors in the increase in childhood obesity. The objective is to compare the strategies used for promotion of food and beverages advertisements on Sri Lankan television for children and adults.

METHOD

Among 16 analog television channels in Sri Lanka, 50% of the channels were selected randomly after stratifying according to language. Recording was during weekdays and weekends. In total, 95 different food and beverages advertisements were analyzed irrespective of the channel.

RESULTS

Among all food and beverages-related advertisements, 78% were child focused, and among these 74% claimed health benefits. A statistically significant difference was found in terms of implications related to nutrition or health (P < .05). None of the advertisements contained disclaimers.

CONCLUSION AND RECOMMENDATIONS

The Ministry of Health needs to pursue all food and beverages-focused advertisements for policy formulation and implementation.

An accountability evaluation for the industry's responsible use of brand mascots and licensed media characters to market a healthy diet to American children

Corporate strategies that target children are controversial given the link between food marketing and childhood obesity. This case study explored diverse stakeholders' accountability expectations and actions for industry policies and practices that used popular cartoon brand mascots and media characters to promote food products to American children. We reviewed five electronic databases and Internet sources between January 2000 and January 2015. Evidence (n = 90) was selected based upon the Institute of Medicine's LEAD principles (i.e. locate, evaluate, assemble evidence to inform decisions) and organized into two tables: peer-reviewed articles, books and grey-literature reports (n = 34); and media stories, news releases and public testimony (n = 56). A four-step accountability framework was used to evaluate accountability structures. The results showed that moderate progress was achieved by stakeholders to take and share the account, limited progress to hold industry and government to account, and limited progress to strengthen accountability structures. Between 2006 and 2015, the U.S. Children's Food and Beverage Advertising Initiative lacked clear policies for companies to use brand mascots and media characters on food packages, in merchandising, and as toy giveaways and premiums. Government, industry and civil society can substantially strengthen their accountability for these food marketing practices to ensure healthy food environments for children.

The association of parent's outcome expectations for child TV viewing with parenting practices and child TV viewing: an examination using path analysis

Background

Television (TV) viewing has been associated with many undesirable outcomes for children, such as increased risk of obesity, but TV viewing can also have benefits. Although restrictive parenting practices are effective in reducing children’s TV viewing, not all parents use them and it is currently unclear why. The current study examined parenting practices related to TV viewing in the context of social- cognitive theory. Specifically, we hypothesized that positive and negative Parental Outcome Expectations for child’s TV Viewing (POETV) would be associated with social co-viewing and restrictive parenting practices, and that POETV and parenting practices influence the amount of TV viewed by child.

Method

Data were collected from an internet survey of 287 multi-ethnic parents and their 6–12 year old children on participants’ sociodemographic information, parenting practices related to TV use, POETV, and parent and child TV viewing. Path analysis was used to examine the relationship amongst variables in separate models for weekday and weekend TV viewing. controlling for child age, household education, and parental TV viewing.

Results

The results provided partial support for the hypotheses, with notable differences between weekday and weekend viewing. The models explained 13.6 % and 23.4 % of the variance in children’s TV viewing on weekdays and weekends respectively. Neither positive nor negative POETV were associated with restrictive TV parenting in either model. One subscale each from positive and negative POETV were associated with social co-viewing parenting on both weekends and weekdays in the expected direction. Restrictive parenting practices were directly negatively associated with children’s TV viewing on weekdays, but not weekends. Social co-viewing parenting was directly positively associated with children’s TV viewing on weekends, but not weekdays. The strongest influence on children’s TV viewing was having a TV in the child’s bedroom. Negative POETV was weakly associated with having a TV in the child’s room.

Conclusions

These findings suggest that POETV and parenting may have a greater impact on weekend TV viewing, when children tend to watch more TV, than weekday. The models suggest that POETV, parenting and especially removing the TV from children’s rooms may be promising targets for interventions.

Fruit-related terms and images on food packages and advertisements affect children's perceptions of foods' fruit content

OBJECTIVE

To determine whether food label information and advertisements for foods containing no fruit cause children to have a false impression of the foods' fruit content.

DESIGN

In the food label condition, a trained researcher showed each child sixteen different food label photographs depicting front-of-food label packages that varied with regard to fruit content (i.e. real fruit v. sham fruit) and label elements. In the food advertisement condition, children viewed sixteen, 30 s television food advertisements with similar fruit content and label elements as in the food label condition. After viewing each food label and advertisement, children responded to the question 'Did they use fruit to make this?' with responses of yes, no or don't know.

SETTING

Schools, day-care centres, after-school programmes and other community groups.

SUBJECTS

Children aged 4-7 years.

RESULTS

In the food label condition, χ 2 analysis of within fruit content variation differences indicated children (n 58; mean age 4·2 years) were significantly more accurate in identifying real fruit foods as the label's informational load increased and were least accurate when neither a fruit name nor an image was on the label. Children (n 49; mean age 5·4 years) in the food advertisement condition were more likely to identify real fruit foods when advertisements had fruit images compared with when no image was included, while fruit images in advertisements for sham fruit foods significantly reduced accuracy of responses.

CONCLUSIONS

Findings suggest that labels and advertisements for sham fruit foods mislead children with regard to the food's real fruit content.

Do weight status and television viewing influence children's subsequent dietary changes? A National Longitudinal Study in the United States

Objective

It is unknown how children’s dietary changes would vary by overweight/obese status and length of TV-viewing. This study examined whether US children’s weight status and TV-viewing duration influenced their subsequent dietary behavioral changes.

Methods

A national representative sample of the Early Childhood Longitudinal Study – Kindergarten Cohort were followed between 5^th and 8^th grades during 2004–2007 (N=7,720). Children’s daily TV-viewing hour and weight status were measured at 5^th grade. Children reported their dietary behaviors at the 5^th and 8^th grades, including fruit/vegetable consumption ≥5 times/day (five-a-day), daily fast food and soft drink consumption. Logistic models were used to estimate the odds ratio (OR) of dietary behavioral changes by children’s baseline weight status and TV-viewing duration. Gender and race/ethnicity differences in the ORs were examined. Sampling weight and design effect were considered for the analysis.

Results

Among those without five-a-day at 5^th grade, overweight/obese children were more likely to develop the five-a-day behavior at 8^th grade than normal weight children (for overweight: OR=1.65, 95% CI=1.14-2.39; obese: OR=1.35, 95% CI=0.81-2.23). Among girls, overweight group was more likely to develop eating vegetable ≥3 times/day than normal weight group, but 1 more hour/day of TV-viewing at baseline was associated with lower odds of developing eating vegetable ≥3 times/day. Overweight/obese black and Hispanic children were significantly more likely to develop five-a-day than their normal weight counterparts. TV-viewing did not show modification effect on the association between weight status and subsequent dietary changes.

Conclusions

Overweight/obese children were more likely to improve their subsequent FV consumption than normal weight children, but TV-viewing’s independent relationship with dietary changes may counteract the weight status-associated dietary improvement.

Strategic nutrition: a vision for the twenty-first century

It is now widely accepted that poor nutrition plays a major role in the epidemic of various diseases, including obesity, type 2 diabetes and CVD. There has also been much research regarding the role of related factors such as advertising and food prices. Many intervention studies have been carried out where attempts have been made to persuade people to modify their behaviour, such as by making dietary changes, in order to enhance health (health promotion). There has also been much debate on the potential of government policy as a tool for achieving these goals. Various proposals have been made, such as a tax on sugary drinks, the redirection of food subsidies and how the salt content of food can be reduced. However, the great majority of previous papers have considered only single aspects of the topics discussed here. The present paper reviews strategies for improving public health, both health promotion interventions and the use of government policy approaches. Topics discussed include providing advice for the general population and the design of food guides and food labels. This leads to the conclusion that we need an overall strategy that integrates this diverse body of information and formulates a comprehensive action plan. I propose the term ‘strategic nutrition’. The implementation of this plan opens up a path to a major advance in public health.

Legal action against health claims on foods and beverages marketed to youth

The prevalence of obesity among US children raises numerous health concerns. One pathway to reduce childhood obesity is by decreasing energy intake through the ingestion of fewer calories. Yet, food and beverage manufacturers often promote energy-dense items for children via varied health claims. Deceptive health claims are prohibited, and may be addressed through litigation or governmental regulatory efforts. While the amount of legal action against these potentially deceptive claims has increased, no comprehensive assessment has been conducted. This article, which analyzes litigation and governmental regulatory activities, considers key factors that may influence decisions to take legal action against potentially deceptive health claims on foods and beverages, including scientific support, forum selection, selection of plaintiffs, and potential public health impact.

Longitudinal relations of television, electronic games, and digital versatile discs with changes in diet in adolescents

BACKGROUND

Youth spend more time with screens than any activity except sleeping. Screen time is a risk factor for obesity, possibly because of the influence of food and beverage advertising on diet.

OBJECTIVE

We sought to assess longitudinal relations of screen time [ie, television, electronic games, digital versatile discs (DVDs)/videos, and total screen time] with the 2-y changes in consumption of foods of low nutritional quality (FLNQ) that are commonly advertised on screens [ie, sugar-sweetened beverages, fast food, sweets, salty snacks, and the sum of these foods (total FLNQ)] and fruit and vegetables.

DESIGN

With the use of 2004, 2006, and 2008 waves of the Growing Up Today Study II, which consisted of a cohort of 6002 female and 4917 male adolescents aged 9-16 y in 2004, we assessed screen time (change and baseline) in relation to the 2-y dietary changes. Regression models included 4604 girls and 3668 boys with complete screen time and diet data on ≥2 consecutive questionnaires.

RESULTS

Each hour-per-day increase in television, electronic games, and DVDs/videos was associated with increased intake of total FLNQ (range: 0.10-0.28 servings/d; P < 0.05). Each hour-per-day increase in total screen time predicted increased intakes of sugar-sweetened beverages, fast food, sweets, and salty snacks (range: 0.02-0.06 servings/d; P < 0.001) and decreased intakes of fruit and vegetables (range: -0.05 to -0.02 servings/d; P < 0.05). Greater screen time at baseline (except electronic games in boys) was associated with subsequent increased intake of total FLNQ, and greater screen time at baseline (except DVDs/videos) was associated with decreased intake of fruit and vegetables (P < 0.05). Across sex and food groups and in sensitivity analyses, television was most consistently associated with dietary changes.

CONCLUSIONS

Increases in screen time were associated with increased consumption of foods and beverages of low nutritional quality and decreased consumption of fruit and vegetables. Our results caution against excessive use of screen media, especially television, in youth.

Snack food advertising in stores around public schools in Guatemala

Obesity in school-age children is emerging as a public heath concern. Food marketing influences preferences and increases children's requests for food. This study sought to describe the type of snack foods advertised to children in stores in and around public schools and assess if there is an association between child-oriented snack food advertising and proximity to schools. All food stores located inside and within a 200 square meter radius from two preschools and two primary schools were surveyed. We assessed store type, number and type of snack food advertisements including those child-oriented inside and outside stores. We surveyed 55 stores and found 321 snack food advertisements. Most were on sweetened beverages (37%) and soft drinks (30%). Ninety-two (29%) were child-oriented. Atoles (100.0%), cereals (94.1%), and ice cream and frozen desserts (71.4%) had the greatest proportion of child-oriented advertising. We found more child-oriented advertisements in stores that were closer (<170 m) to schools compared to those farther away. In conclusion, the food industry is flooding the market, taking advantage of the lack of strict regulation in Guatemala. Child-oriented advertisements are available in almost all stores within a short walking distance from schools, exposing children to an obesogenic environment.

The effects of food advertising and cognitive load on food choices

Background

Advertising has been implicated in the declining quality of the American diet, but much of the research has been conducted with children rather than adults. This study tested the effects of televised food advertising on adult food choice.

Methods

Participants (N = 351) were randomized into one of 4 experimental conditions: exposure to food advertising vs. exposure to non-food advertising, and within each of these groups, exposure to a task that was either cognitively demanding or not cognitively demanding. The number of unhealthy snacks chosen was subsequently measured, along with total calories of the snacks chosen.

Results

Those exposed to food advertising chose 28% more unhealthy snacks than those exposed to non-food-advertising (95% CI: 7% - 53%), with a total caloric value that was 65 kcal higher (95% CI: 10-121). The effect of advertising was not significant among those assigned to the low-cognitive-load group, but was large and significant among those assigned to the high-cognitive-load group: 43% more unhealthy snacks (95% CI: 11% - 85%) and 94 more total calories (95% CI: 19-169).

Conclusions

Televised food advertising has strong effects on individual food choice, and these effects are magnified when individuals are cognitively occupied by other tasks.

Publicidade de alimentos e escolhas alimentares de crianças

O efeito de vídeos de desenhos com publicidade de alimentos saudáveis e não saudáveis versus vídeos neutros sobre as escolhas alimentares foi avaliado em 24 crianças de escola pública. Os vídeos foram apresentados em cinco sessões, sendo cada grupo exposto a uma sequência específica de publicidade. Após a exposição, a criança escolhia figuras de alimentos para as refeições do dia. Análises intra e entre sujeitos, por meio da Ancova de medidas repetidas, demonstraram que, com a mudança de vídeo, as crianças alteraram em até 13% a escolha de alimentos saudáveis ou não. O aumento da exibição de publicidade de alimentos saudáveis e a diminuição da publicidade de alimentos não saudáveis pode contribuir para a alimentação e peso saudáveis.

Adiposity and different types of screen time

OBJECTIVE

Few prospective studies have examined separate forms of screen time in relation to adiposity. Our objective was to assess independent relations of television, electronic games (video/computer), and digital versatile disc (DVD)/videos and total screen time with change in adolescent BMI.

METHODS

Using data from the 2004, 2006, and 2008 waves of the ongoing Growing up Today Study II, we assessed baseline and 2-year change in reported screen time in relation to concurrent change in BMI among 4287 girls and 3505 boys aged 9 to 16 years in 2004. Gender-specific models adjusted for previous BMI, age, race/ethnicity, growth/development, months between questionnaires, and physical activity.

RESULTS

Among girls and boys, each hour per day increase in reported television viewing was associated with a 0.09 increase in BMI (Ps < .001), and each hour per day increase in total screen time was associated with a 0.07 increase among girls and 0.05 increase among boys (Ps < .001). Among girls only, greater baseline television, games, and total screen time and change in DVDs/videos were associated with gains in BMI (Ps < .05). BMI gains associated with change in television and total screen time were stronger among overweight girls than lean girls (Ps-heterogeneity < .001).

CONCLUSIONS

Television, which remains the steadiest source of food advertising, was most consistently associated with BMI gains. Among girls, electronic games and DVDs/videos were also related to increased BMI, possibly due to influences of product placements and advergames on diet and/or distracted eating. Adolescents, especially overweight adolescents, may benefit from reduced time with multiple types of media.

Healthy characters? An investigation of marketing practices in children's food advertising

OBJECTIVE

To determine the nutritional quality of foods advertised with familiar children's characters and health-related messages.

DESIGN

Children's programming aired on the most popular broadcast and cable channels during 2011 was sampled to form a composite weekday and weekend day. All food advertisements (ads) included in this programming were content analyzed.

PARTICIPANTS

Five hundred seventy-seven food ads.

VARIABLES MEASURED

Familiar characters promoting products were either trade or licensed characters. A product's nutritional quality was determined using the United States Department of Health and Human Services' categorizations, based on the frequency foods should be consumed. Health cues were present when a food was claimed to be healthy, physical activity was depicted, or the product was associated with fruit.

ANALYSIS

Frequencies and chi square analyses were conducted; P < .05.

RESULTS

Nearly three quarters (73%) of food ads targeting children use a familiar character. The majority of these ads (72%) promote foods of low nutritional quality, yet 53% employ a health-related message.

CONCLUSIONS AND IMPLICATIONS

Familiar characters proliferate in food advertising to children, yet marketers do not adhere to recommendations that characters promote strictly healthy foods. Future research is needed to investigate effects and inform policy decisions in this realm.

Characteristics of screen media use associated with higher BMI in young adolescents

OBJECTIVES

This study investigates how characteristics of young adolescents' screen media use are associated with their BMI. By examining relationships between BMI and both time spent using each of 3 screen media and level of attention allocated to use, we sought to contribute to the understanding of mechanisms linking media use and obesity.

METHODS

We measured heights and weights of 91 13- to 15-year-olds and calculated their BMIs. Over 1 week, participants completed a weekday and a Saturday 24-hour time-use diary in which they reported the amount of time they spent using TV, computers, and video games. Participants carried handheld computers and responded to 4 to 7 random signals per day by completing onscreen questionnaires reporting activities to which they were paying primary, secondary, and tertiary attention.

RESULTS

Higher proportions of primary attention to TV were positively associated with higher BMI. The difference between 25th and 75th percentiles of attention to TV corresponded to an estimated +2.4 BMI points. Time spent watching television was unrelated to BMI. Neither duration of use nor extent of attention paid to video games or computers was associated with BMI.

CONCLUSIONS

These findings support the notion that attention to TV is a key element of the increased obesity risk associated with TV viewing. Mechanisms may include the influence of TV commercials on preferences for energy-dense, nutritionally questionable foods and/or eating while distracted by TV. Interventions that interrupt these processes may be effective in decreasing obesity among screen media users.

Association of symptoms of attention-deficit/hyperactivity disorder with physical activity, media time, and food intake in children and adolescents

Introduction

The aim of the study was to assess the association between attention deficit/hyperactivity disorder (ADHD) symptoms and potentially obesogenic behaviors.

Methods

Data of 11,676 German children and adolescents (6–17 years) were analyzed. Television/video exposure, physical activity, food frequency and portion size were assessed using questionnaires. A dietary quality index, energy density and volumes of consumed food, and total energy intake were calculated. The parent-rated hyperactivity/inattention subscale of the Strengths and Difficulties Questionnaire (SDQ-HI) was used as a continuous measure of ADHD symptoms. Associations were analyzed with general linear models adjusting for sex, age, socioeconomic status, migrant status, parental BMI, and parental smoking.

Results

SDQ-HI scores correlated positively with physical activity, average energy density of food, volume of beverages, total energy intake, and television exposure and negatively with the nutritional quality score (HuSKY) even after adjustment for parental variables (BMI, smoking, socioeconomic status, migrant status), age, sex, as well as the other SDQ subscales. The adjusted association of the SDQ-HI scores with the nutritional quality score was stronger in girls and the associations with food volume, food energy, and total energy intake was significant only in girls.

Conclusions

Poor nutritional quality, high energy intake and television exposure appear to be independently associated with ADHD symptoms. The relationship between food energy intake and ADHD symptoms was especially pronounced in girls and this may help to explain the reported association of ADHD symptoms with overweight in adolescent girls.

Does food marketing need to make us fat? A review and solutions

Food marketing is often singled out as the leading cause of the obesity epidemic. The present review examines current food marketing practices to determine how exactly they may be influencing food intake, and how food marketers could meet their business objectives while helping people eat healthier. Particular attention is paid to the insights provided by recently published studies in the areas of marketing and consumer research, and those insights are integrated with findings from studies in nutrition and related disciplines. The review begins with an examination of the multiple ways in which 1) food pricing strategies and 2) marketing communication (including branding and food claims) bias food consumption. It then describes the effects of newer and less conspicuous marketing actions, focusing on 3) packaging (including the effects of package design and package-based claims) and 4) the eating environment (including the availability, salience, and convenience of food). Throughout, this review underscores the promising opportunities that food manufacturers and retailers have to make profitable "win-win" adjustments to help consumers eat better.

A nutritional comparison of foods and beverages marketed to children in two advertising policy environments

Childhood obesity is associated with children's exposure to food/beverage marketing. Policy options in this area are being sought in order to reduce childhood obesity rates on a population-level. We examined the nutritional quality of foods advertised to children during their preferred television viewing in Ontario (Canada), where advertising is self-regulated by industry, and in Quebec (Canada), where a child-directed advertising ban exists. A total of 428 children aged 10-12 years completed television viewing diaries for 7 days. Thirty-two television stations were recorded simultaneously between 6 AM and midnight. A content analysis of 90 h of English Ontario, French Quebec, and English Quebec children's preferred viewing was then undertaken. A total of 429 food and beverage advertisements were analyzed and their nutritional quality was assessed. Food advertisements in the Quebec French sample were statistically significantly higher in total fat, saturated fat and protein, and lower in carbohydrates and sugar per 100 g, and as a percentage of energy than food ads in the two English samples. A statistically significantly lower percentage of the Quebec French food advertisements were classified as either high fat, sugar or sodium and a smaller proportion of food ads were classified as "less healthy" compared to the Ontario and Quebec English samples. These results suggest that the Quebec advertising ban is influencing the macronutrient profile of advertised foods viewed by French Quebec children during their preferred viewing and that their promotions are marginally healthier than that viewed by the English samples.

Evaluation of food and beverage television advertising during children's viewing time in Spain using the UK nutrient profile model

OBJECTIVE

To evaluate the nutritional quality of products advertised on television (TV) during children’s viewing time in Spain, applying the UK nutrient profile model (UKNPM).

DESIGN

We recorded 80 h of four general TV station broadcasts during children’s time in May and June 2008, and identified all advertisements for foods and beverages. Nutritional information was obtained from the product labels or websites and from food composition tables. Each product was classified as healthy (e.g. gazpacho, a vegetable juice) or less healthy (e.g. potato crisp snacks) according to the UKNPM criteria.

SETTING

Four free-of-charge TV channels in Spain: two national channels and two regional ones.

SUBJECTS

TV commercials of food and beverages.

RESULTS

A total of 486 commercials were broadcast for ninety-six different products, with a mean frequency of 5?1 advertisements per product. Some 61?5% of the ninety-six products were less healthy, and the percentage was higher for foods (74?1 %). All (100 %) of the breakfast cereals and 80% of the non-alcoholic drinks and soft drinks were less healthy. Of the total sample of commercials, 59?7% were for less healthy products, a percentage that rose to 71?2% during children’s reinforced protection viewing time.

CONCLUSIONS

Over half the commercials were for less healthy products, a proportion that rose to over two-thirds during the hours of special protection for children. This suggests that applying the UKNPM to regulate food advertising during this slot would entail the withdrawal of most food commercials in Spain. TV advertising of products with low nutritional quality should be restricted.