The effectiveness of the food and beverage industry's self-established uniform nutrition criteria at improving the healthfulness of food advertising viewed by Canadian children on television

The effectiveness, cost-effectiveness and policy processes of regulatory, voluntary and partnership policies to improve food environments: an evidence synthesis

Background

Dietary factors are among the largest and costliest drivers of chronic diseases in England. As a response, the government implements a range of population interventions to promote healthy diets by targeting food environments.

Objectives

This study aimed to conduct a systematic review of the effectiveness, cost-effectiveness and policy process of real-world evaluations of national and state policies on improving food environments, with a focus on whether they were regulatory, voluntary or partnership approaches.

Data sources

Fourteen relevant English-language databases were searched in November 2020 for studies published between 2010 and 2020.

Methods

Six separate evidence reviews were conducted to assess the evidence of effectiveness, cost-effectiveness and policy processes of policies to improve food environments.

Results

A total of 483 primary research evaluations and 14 evidence syntheses were included. The study reveals considerable geographic, methodological and other imbalances across the literature, with, for example, 81% of publications focusing only on 12 countries. The systematic reviews also reveal the effectiveness and cost-effectiveness of reviewed regulatory approaches designed to improve health, consumer behaviour and food environment outcomes while public-private partnerships and voluntary approaches to improve diets via reformulation, advertising and promotion restrictions or other changes to the environment were limited in their effectiveness and cost-effectiveness. The study also revealed key enabling and impeding factors across regulatory, voluntary and public-private partnership approaches.

Conclusion

From the available evidence reviewed, this study finds that regulatory approaches appear most effective at improving the food environment, and voluntary agreements and partnerships have limited effectiveness. These findings should be carefully considered in future public health policy development, as should the findings of geographic imbalance in the evidence and inadequate representation of equity dimensions across the policy evaluations. We find that food policies are at times driven by factors other than the evidence and shaped by compromise and pragmatism. Food policy should be first and foremost designed and driven by the evidence of greatest effectiveness to improve food environments for healthier diets.

Limitations

This was a complex evidence synthesis due to its scope and some policy evaluations may have been missed as the literature searches did not include specific policy names. The literature was limited to studies published in English from 2010 to 2020, potentially missing studies of interest.

Future work

Priorities include the need for guidance for appraising risk of bias and quality of non-clinical studies, for reporting policy characteristics in evaluations, for supporting evaluations of real-world policies equitably across geographic regions, for capturing equity dimensions in policy evaluations, and for guideline development for quality and risk of bias of policy evaluations.

Study registration

This study is registered as PROSPERO CRD42020170963.

Funding

This award project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128607) and is published in full in Public Health Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information.

Nutritional quality and level of processing of food items broadcasted on Italian television in advertisements targeted to children

This study evaluates the nutritional quality and level of processing of food and beverage products advertised on television channels most watched by children, in Italy. Data were collected over 20 non-consecutive days from the five top channels in Italy. A total of 209 food items were analysed using the Nutri-Score and the NOVA classification. Additionally, compliance with nutritional criteria established by the World Health Organisation (WHO) and the EU-PLEDGE was assessed. Results indicate a high proportion of energy-dense and low nutritional quality foods, with 68% falling into less favourable Nutri-Score categories (C, D, and E), and 61% classified as ultra-processed by NOVA classification. When applying WHO and PLEDGE criteria, 71% and 56% of products, respectively, did not meet nutritional standards. This study underscores the low prevalence of nutritionally adequate products in food advertisements targeting children on Italian television, despite differences found based on methodological variations.

Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.

The relationship between parent's self-reported exposure to food marketing and child and parental purchasing and consumption outcomes in five countries: findings from the International Food Policy Study

Food and beverage marketing influences children's food preferences and dietary intake. Children's diets are also heavily influenced by their family environment. The aim of this study was to assess the relationship between parent's self-reported exposure to unhealthy food marketing and a range of outcomes related to children's desire for and intake of unhealthy foods and beverages. The study also sought to examine whether these outcomes varied across different countries. The analysed data are from the International Food Policy Study and were collected in 2018 using an online survey. The sample included 5764 parents of children under 18, living in Australia, Canada, Mexico, the United Kingdom, or the United States. Binary logistic regressions assessed the link between the number of parental exposure locations and children's requests for and parental purchases of unhealthy foods. Generalized ordinal regression gauged the relationship between the number of exposure locations and children's consumption of such items. Interaction terms tested if these associations varied by country. Parental exposure to unhealthy food marketing was positively associated with parents reporting child purchase requests and purchase outcomes; and differed by country. Increased parental exposure to unhealthy food marketing was associated with slightly lower odds of children's weekly consumption of unhealthy foods, and this association varied by country. In conclusion, parental report of a greater range of food marketing exposure was associated with a range of outcomes that would increase children's exposure to unhealthy food products or their marketing. Governments should consider developing more comprehensive restrictions on the marketing of unhealthy foods.

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.

The extent of energy drink marketing on Canadian social media

BACKGROUND

Caffeinated energy drink (CED) consumption among children and adolescents is a growing global public health concern due to its potential to produce adverse effects. CED marketing viewed by children and adolescents contributes to this problem as it increases consumption and favourable attitudes towards these high-caffeine and high-sugar products. This study aimed to describe the social media marketing of CEDs by estimating the frequency of user-generated and company-generated CED marketing and analyzing the marketing techniques used by Canadian CED brands on social media.

METHODS

CED products and brands were identified using the list of CEDs that received a Temporary Marketing Authorization from Health Canada in June 2021. The data on the frequency, reach and engagement of CED-related posts created by users and Canadian CED brands on Facebook, Instagram, Twitter, Reddit, Tumblr, and YouTube were licensed from Brandwatch for 2020-2021. A content analysis was conducted to assess the marketing techniques used in Canadian CED company-generated posts using a coding manual.

RESULTS

A total of 72 Canadian CED products were identified. Overall, there were 222,119 user-level mentions of CED products in total and the mentions reached an estimated total of 351,707,901 users across platforms. The most popular product accounted for 64.8% of the total user-level mentions. Canadian social media company-owned accounts were found for 27 CED brands. Two CED brands posted the most frequently on Twitter and accounted for the greatest reach, together making up 73.9% of the total company-level posts and reaching 62.5% of the total users in 2020. On Instagram/Facebook, the most popular brand accounted for 23.5% of the company-level posts and 81.3% of the reach between July and September 2021. The most popular marketing techniques used by Canadian CED brands were the use of viral marketing strategies (82.3% of Twitter posts and 92.5% of Instagram/Facebook posts) and the presence of teen themes (73.2% of Twitter posts and 39.4% of Instagram/Facebook posts).

CONCLUSION

CED companies are extensively promoting their products across social media platforms using viral marketing strategies and themes that may appeal to adolescents. These findings may inform CED regulatory decision-making. Continued monitoring is warranted.

Advertising expenditures across media on food and beverage products heavily advertised on youth-appealing television stations in Canada

This research estimated and characterized advertising expenditures on food products heavily advertised on youth-appealing television stations in Canada in 2019 overall, by media, by food category, and compared expenditures in two policy environments (Quebec and the rest of Canada, excluding the territories) and on "healthier" versus "less healthy" products. Advertising expenditure estimates for 57 selected food categories promoted on television, radio, out-of-home media, print media, and popular websites were licensed from Numerator. Sixty-one products or brands were identified as heavily advertised on youth-appealing stations and classified as "healthier" or "less healthy" based on a nutrient profile model proposed by Health Canada. Total expenditures and expenditures per adolescent capita were calculated. Approximately, $110.9 million was spent advertising food products heavily advertised to adolescents in Canada in 2019, with television accounting for 77% of total expenditures and fast food restaurants accounting for 51%. Most expenditures (77%; $80.6 million) were devoted to advertising "less healthy" products. In Quebec, advertising expenditures on examined products were 23% lower per capita ($45.15/capita) compared to the rest of Canada ($58.44/capita). Advertising expenditures in Quebec were lower for energy drinks (-47%; -$0.80/capita) and candy and chocolate (-41%; -$1.00/capita) and higher for yogurt (+85%; +$1.22/capita) and portable snacks (+25%; +$0.15/capita). Quebec's restriction of commercial advertising directed to children under 13 may explain lower per capita advertising expenditures on some "less healthy" foods heavily advertised to adolescents in Quebec. Nevertheless, this spending remains high in Quebec and nationally. Continued monitoring of these expenditures is warranted.

Broadcast Television Is Not Dead: Exposure of Children to Unhealthy Food and Beverage Advertising on Television in Two Policy Environments (Ontario and Quebec). An Observational Study

BACKGROUND

Food marketing can influence children's dietary behaviors. In Canada, Quebec banned commercial advertising to children under the age of 13 y in 1980, whereas advertising to children is self-regulated by industry in the rest of the country.

OBJECTIVES

The objective of this study was to compare the extent and power of food and beverage advertising on television to children (age: 2-11 y) in two different policy environments (Ontario and Quebec).

METHODS

Advertising data for 57 selected food and beverage categories were licensed from Numerator for Toronto and Montreal (English and French markets) from January to December 2019. The 10 most popular stations for children (age: 2-11 y) and a subset of child-appealing stations were examined. Exposure to food advertisements (ads) was based on gross rating points. A content analysis of food ads was conducted, and the healthfulness of ads was assessed using Health Canada's proposed nutrient profile model. Descriptive statistics were tabulated for the frequency of and exposure to ads.

RESULTS

On average, children were exposed to 3.7 to 4.4 food and beverage ads per day, exposure to fast-food advertising was highest (670.7-550.6 ads per year), advertising techniques were used frequently, and the majority (>90%) of advertised products were classified as unhealthy. On the top 10 stations, French children in Montreal were most exposed to unhealthy food and beverage advertising (712.3 ads per year), although they were exposed to fewer child-appealing advertising techniques compared with those in other markets. On the child-appealing stations, French children in Montreal were least exposed to food and beverage advertising (43.6 ads per year per station) and child-appealing advertising techniques compared with the other groups.

CONCLUSIONS

The Consumer Protection Act appears to positively impact exposure to child-appealing stations; yet, it does not sufficiently protect all children in Quebec and requires strengthening. Federal-level regulations restricting unhealthy advertising are needed to protect children across Canada.

Children's measured exposure to food and beverage advertising on television in Toronto (Canada), May 2011-May 2019

OBJECTIVE

Exposure to unhealthy food advertising is a known determinant of children's poor dietary behaviours. The purpose of this study was to quantify and characterize Canadian children's exposure to food advertising on broadcast television and examine trends over time.

METHODS

Objectively measured advertising exposure data for 19 food categories airing on 30 stations broadcast in Toronto were licenced for May 2011 and May 2019. Using ad ratings data, the average number of food advertisements viewed by children aged 2-11 years, overall, by food category and by type of television station (child-appealing, adolescent-appealing and generalist stations), was estimated per time period.

RESULTS

In May 2019, children viewed an average of 136 food advertisements on television, 20% fewer than in May 2011. More than half of advertisements viewed in May 2019 promoted unhealthy food categories such as fast food (43% of exposure), candy (6%), chocolate (6%) and regular soft drinks (5%) and only 17% of their total exposure occurred on child-appealing stations. Between May 2011 and May 2019, children's exposure increased the most, in absolute terms, for savory snack foods (+7.2 ad exposures/child), fast food (+5.4) and regular soft drinks (+5.3) with most of these increases occurring on generalist stations.

CONCLUSION

Canadian children are still exposed to advertisements promoting unhealthy food categories on television despite voluntary restrictions adopted by some food companies. Statutory restrictions should be adopted and designed such that children are effectively protected from unhealthy food advertising on both stations intended for general audiences and those appealing to younger audiences.

Commercial use of evidence in public health policy: a critical assessment of food industry submissions to global-level consultations on non-communicable disease prevention

BACKGROUND

Ultra-processed food industry (UPFI) actors have consistently opposed statutory regulation in health policy debates, including at the WHO. They do so most commonly with claims that regulatory policies do not work, will have negative consequences or that alternatives such as self-regulation work well or better. Underlying this are often assertions that industry is aligned with principles of evidence-based policymaking. In this study, we interrogate if this holds true by exploring the extent and quality of the evidence UPFI respondents employed to support claims around regulatory policy, and how they did this.

METHODS

First, we identified all submissions from organisations who overtly represent UPFI companies to consultations held by the WHO on non-communicable disease policy between 2016 and 2018. Second, we extracted all relevant factual claims made in these submissions and noted if any evidence was referenced in support. Third, we assessed the quality of evidence using independence from UPFI, nature, and publication route as indicators. Lastly, where peer-reviewed research was cited, we examined if the claims made could be justified by the source cited.

RESULTS

Across 26 included consultation responses, factual claims around regulation were made in 18, although only 10 referenced any evidence at all. Of all 114 claims made, 39 pieces of identifiable evidence were cited in support of 56 claims. Of the 39 distinct pieces of evidence, two-thirds were industry-funded or industry-linked, with only 16 externally peer-reviewed. Over half of industry-funded or industry-linked academic articles failed to declare a conflict of interest (COI). Overall, of only six claims which drew on peer-reviewed and independent research, none appropriately represented the source.

DISCUSSION

UPFI respondents made far-reaching claims which were rarely supported by high-quality, independent evidence. This indicates that there may be few, if any, benefits from consulting actors with such a clear COI.

In-store food environment for adults and children in Nova Scotia, Canada

OBJECTIVES

This paper examines the retail food environment in grocery and convenience stores across Nova Scotia with specific attention to prominence and promotion of foods and beverages, as well as in-store promotion of foods and beverages to children.

METHODS

A descriptive cross-sectional analysis of data on the availability, price, prominence, and promotion of foods and beverages classified as "healthier" and "less healthy" was undertaken as a part of a Nova Scotia Consumer Food Environment (NS-CFE) project. Data were collected in a random stratified sample of 47 grocery stores and 59 convenience stores by trained research assistants working in pairs using adapted Nutrition Environment Measures Survey Toronto grocery store (NEMS-S) and NEMS Corner Store (NEMS-CS) tools.

RESULTS

"Less healthy" snack foods and sugar-sweetened beverages were more prominently displayed than "healthier" options with an exception of cereal, at both grocery and convenience stores (all p < 0.001). Coke™ and fruit juice were more expensive than water in both grocery and convenience stores (both p ≤ 0.05). Significantly more child-specific strategies were used to promote "less healthy" compared with "healthier" options in both grocery and convenience stores (both p < 0.001).

CONCLUSION

Results of this study demonstrate that "less healthy" options are significantly more prominently displayed and more heavily marketed to all Nova Scotians, including children, in the retail food environment compared with items classified as "healthier". These findings indicate that there is a need for comprehensive structural changes to the retail food environment in Nova Scotia, to support population health.

Creating supportive eating places: a systematic review of food service initiatives

Obesity and diet-related health problems are complex, multi-factorial issues. Individual food choices are shaped by the wider context, and food environment level change is needed to support individual behaviour change. The food service sector can play an integral role, changing aspects of the food environment and contributing to improved consumer health. This systematic review aimed to analyse food service schemes that aimed to improve consumer health. Ten electronic databases were systematically searched to identify articles, supplemented with checking of reference lists from similar reviews and forward and backward searches to identify articles describing food service sector schemes. Sixteen schemes were identified, documented in 36 articles/reports. The schemes aimed to improve consumer health through one of three approaches-informing, enabling or engineering. In this order, these approaches involved increasing levels of effort from food services, corresponding with decreasing levels of effort for consumers. Half the schemes were informing, relying on an informed consumer to make a healthy choice. Most informing schemes had been evaluated to determine their impact on consumer choice and/or health, the evidence showed these schemes were generally ineffective. The effect of the enabling or engineering schemes on consumer choice and health had not been measured. Instead, evaluations focussed on process or business engagement rather than behavioural change assessments. This review indicates the food sector has the potential to contribute to consumer health through enabling and engineering; however, detailed outcome assessments are needed to draw definitive conclusions.

Defining unhealthy food for regulating marketing to children-What are Australia's options?

AIM

To compare six nutrient profiling models for suitability in food marketing to children regulation.

METHODS

Products (n = 220) advertised at transport hubs were classified as eligible/ineligible to be advertised to children using an Australian government developed guide (Council of Australian Governments), the Health Star Rating system before and after the modifications made in 2020, World Health Organization Western Pacific Region and Europe nutrient profile criterion and the NOVA food classification system. Agreement between models was determined using Cohen's Kappa.

RESULTS

The Council of Australian Governments' guide was able to classify more products than the other models (n = 210) and was easy to use as it did not require nutrition information. It agreed most closely with NOVA (moderate agreement). The proportion of foods classified as eligible to be marketed (most strict) was lowest for NOVA (10%), similar for Council of Australian Governments and the World Health Organisation models (16%-17%) and highest for Health Star Rating models (26%-28%).

CONCLUSIONS

The Council of Australian Governments' guide provides simple, easy to use profiling criteria aligned with Australian dietary advice. Political will is now required to incorporate a profiling model within government-endorsed food marketing regulation.

The targeting of preschoolers, children, adolescents and adults by the Canadian food and beverage industry on television: a cross-sectional study

Unhealthy food advertising can negatively impact children's food preferences and nutritional health. In Canada, only companies participating in the self-regulatory Children's Food and Beverage Advertising Initiative (CAI) commit to limiting unhealthy food advertising to children. We analyzed food advertising from 182 Canadian television stations in 2018. A principal component analysis explored patterns of advertising by 497 food companies and their targeting of preschoolers, children, adolescents, and adults. Chi-square analyses tested differences in the volume of advertising between target age groups by heavily advertising food companies and by CAI-participating and non-participating companies. In 2018, Maple Leaf Foods, Boulangerie St-Méthode, Exceldor Foods, Goodfood Market and Sobeys advertised most frequently during preschooler-programming. General Mills, Kellogg's, the Topps Company, Parmalat and Post Foods advertised most frequently during child-programming, while Burger King, McDonald's, General Mills, Kellogg's and Wendy's advertised most frequently during adolescent-programming. CAI-participating companies were responsible for over half of the food advertising broadcast during programs targeted to children (55%), while they accounted for less than half of the food advertising aired during programs targeting preschoolers (24%), adolescents (41%) and adults (42%). Statutory food advertising restrictions are needed to limit food companies' targeting of young people on television in Canada. Novelty: Advertising from fast food restaurant chains dominated television programming targeted to adolescents in 2018. Advertising from breakfast cereal, candy, and snack manufacturers dominated television programming targeted at children in 2018. Over 100 Canadian and transnational companies contravened broadcast restrictions on advertising to preschoolers in 2018.

The physical activity and nutrition-related corporate social responsibility initiatives of food and beverage companies in Canada and implications for public health

Background

As diet-related diseases have increased over the past decades, large food companies have come under scrutiny for contributing to this public health crisis. In response, the food industry has implemented Corporate Social Responsibility (CSR) initiatives related to nutrition and physical activity to emphasize their concern for consumers. This study sought to describe the nature and targeted demographic of physical activity and nutrition-related CSR initiatives of large food companies in Canada and to compare companies who participate in the Canadian Children’s Food and Beverage Advertising Initiative (CAI), a self-regulatory initiative aimed at reducing unhealthy food advertising to children, with non-participating companies.

Methods

A cross-sectional study was conducted in 2016. Thirty-nine large food companies, including 18 participating in the CAI, were included in the study. The webpages, Facebook pages and corporate reports of these companies were surveyed to identify CSR initiatives related to nutrition and physical activity. Initiatives were then classified by type (as either philanthropic, education-oriented, research-oriented or other) and by targeted demographic (i.e. targeted at children under 18 years or the general population). Differences between CAI and non-CAI companies were tested using chi-square and Mann-Whitney U tests.

Results

Overall, 63 CSR initiatives were identified; 39 were nutrition-related while 24 were physical activity-related. Most (70%) initiatives were considered philanthropic activities, followed by education-oriented (20%), research-oriented (8%) and other (2%). Almost half (47%; n = 29) of initiatives targeted children. Examples of child-targeted initiatives included support of school milk programs (n = 2), the sponsorship of children’s sports programs (n = 2) and the development of educational resources for teachers (n = 1). There were no statistically significant differences in the number of CSR initiatives per company (CAI: Mdn = 1, IQR = 3; non-CAI: Mdn = 0, IQR = 2; p = .183) or the proportion of child-targeted initiatives (CAI: 42%; non-CAI: 54%; p = .343) between CAI and non-CAI companies.

Conclusion

Food companies, including many that largely sell and market unhealthy products, are heavily involved in physical activity and nutrition-related initiatives in Canada, many of which are targeted to children. Government policies aimed at protecting children from unhealthy food marketing should consider including CSR initiatives that expose children to food company branding.

The Frequency and Healthfulness of Food and Beverage Advertising in Movie Theatres: A Pilot Study Conducted in the United States and Canada

The marketing of unhealthy foods and beverages contributes to childhood obesity. In Canada and the United States, these promotions are self-regulated by industry. However, these regulations do not apply to movie theatres, which are frequently visited by children. This pilot study examined the frequency and healthfulness of food advertising in movie theatres in the United States and Canada. A convenience sample of seven movie theatres in both Virginia (US) and Ontario (Canada) were visited once per month for a four-month period. Each month, ads in the movie theatre environment and before the screening of children's movies were assessed. Food ads were categorized as permissible or not permissible for marketing to children using the World Health Organization's European Nutrient Profile Model. There were 1999 food ads in the movie theatre environment in Ontario and 43 food ads identified in the movie theatre environment in Virginia. On average, 8.6 (SD = 3.3) and 2.2 (SD = 0.9) food ads were displayed before children's movies in Ontario and Virginia, respectively. Most or all (97%-100%) food ads identified in Virginia and Ontario were considered not permissible for marketing to children. The results suggest that movie theatre environments should be considered for inclusion in statutory food marketing restrictions in order to protect children's health.

Food and Beverage Advertising to Children and Adolescents on Television: A Baseline Study

The progressive rise in Canadian child obesity has paralleled trends in unhealthy food consumption. Industry has contributed to these trends through aggressive food and beverage marketing in various media and child settings. This study aimed to assess the extent of food and beverage advertising on television in Canada and compare the frequency of food advertising broadcasted during programs targeted to preschoolers, children, adolescents and adults. Annual advertising from 2018 was drawn from publicly available television program logs. Food and beverage advertisement rates and frequencies were compared by, target age group, television station, month and food category, using linear regression modelling and chi-square tests, in SAS version 9.4. Rates of food and beverage advertising differed significantly between the four target age groups, and varied significantly by television station and time of the year, in 2018. The proportion of advertisements for food and beverage products was significantly greater during preschooler-, child-, and adult-programming [5432 (54%), 142,451 (74%) and 2,886,628 (48%), respectively; p < 0.0001] compared to adolescent-programming [27,268 (42%)]. The proportion of advertisements promoting fast food was significantly greater among adolescent-programming [33,475 (51%), p < 0.0001] compared to other age groups. Legislation restricting food and beverage advertising is needed in Canada as current self-regulatory practices are failing to protect young people from unhealthy food advertising and its potential negative health effects.

Exposure to Food and Beverage Advertising on Television among Canadian Adolescents, 2011 to 2016

Adolescents represent a key audience for food advertisers, however there is little evidence of adolescent exposure to food marketing in Canada. This study examined trends in Canadian adolescents’ exposure to food advertising on television. To do so, data on 19 food categories were licensed from Nielsen Media Research for May 2011, 2013, and 2016 for the broadcasting market of Toronto, Canada. The average number of advertisements viewed by adolescents aged 12–17 years on 31 television stations during the month of May each year was estimated using television ratings data. Findings revealed that between May 2011 and May 2016, the total number of food advertisements aired on all television stations increased by 4%, while adolescents’ average exposure to food advertising decreased by 31%, going from 221 ads in May 2011 to 154 in May 2016. In May 2016, the advertising of fast food and sugary drinks dominated, relative to other categories, accounting for 42% and 11% of all exposures, respectively. The findings demonstrate a declining trend in exposure to television food advertising among Canadian adolescents, which may be due to shifts in media consumption. These data may serve as a benchmark for monitoring and evaluating future food marketing policies in Canada.

Strategies used by the Canadian food and beverage industry to influence food and nutrition policies

BACKGROUND

Unhealthy food environments contribute to the rising rates of obesity and diet-related diseases. To improve the Canadian nutritional landscape, Health Canada launched the Healthy Eating Strategy in October 2016 which involved several initiatives including the restriction of unhealthy food marketing to children, the reduction of sodium in the food supply and the introduction of front-of-package labelling. Subsequently, various stakeholders engaged in discussions with Health Canada. This study sought to describe the interactions between Health Canada and industry and non-industry stakeholders and to identify the strategies used by industry to influence food and nutrition policy in Canada.

METHODS

Documents such as correspondences and presentations exchanged in interactions between Health Canada and stakeholders regarding the Healthy Eating Strategy were obtained from Health Canada's Openness and Transparency website. The participating stakeholders of each interaction and the topics discussed were determined and described quantitatively. A directed content analysis was then conducted to identify the strategies employed by industry to influence policy. This was guided by a previously developed coding framework that was adapted during analysis.

RESULTS

A total of 208 interactions concerning the Healthy Eating Strategy occurred between October 2016 and June 2018. Of the interactions for which documents were received (n = 202), 56% involved industry stakeholders, 42% involved non-industry stakeholders and 2% involved both. Industry stakeholders were more likely to initiate interactions with Health Canada (94% of their interactions) than non-industry stakeholders (49%). Front-of-package labelling was the most frequently discussed topic by industry stakeholders (discussed in 49% interactions involving industry) while non-industry stakeholders most frequently discussed the Healthy Eating Strategy as a whole (discussed in 37% of interactions involving non-industry). A wide variety of strategies were used by industry in their attempts to influence policy. Those most frequently identified included: "framing the debate on diet- and public health-related issues", "promoting deregulation", "shaping the evidence base", "stressing the economic importance of industry", and "developing and promoting alternatives to proposed policies".

CONCLUSION

Industry stakeholders are highly active in their attempts to influence Canadian nutritional policies. Policymakers and public health advocates should be aware of these strategies so that balanced and effective food and nutrition policies can be developed.

Development of a Responsible Policy Index to Improve Statutory and Self-Regulatory Policies that Protect Children's Diet and Health in the America's Region

In 2010, 193 Member States of the World Health Organization (WHO) endorsed World Health Assembly Resolution WHA63.14 to restrict the marketing of food and beverage products high in fat, sugar and salt (HFSS) to children to prevent obesity and non-communicable diseases (NCDs). No study has examined HFSS marketing policies across the WHO regional office countries in the Americas. Between 2018 and 2019, a transdisciplinary team examined policies to restrict HFSS food and beverage product marketing to children to develop a responsible policy index (RESPI) that provides a quality score based on policy characteristics and marketing techniques. After designing the RESPI, we conducted a comprehensive literature review through October 2019 to examine policies in 14 countries in the WHO Americans Region. We categorized policies (n = 38) as either self-regulatory or statutory and calculated the RESPI scores, ranked from 0 (lowest) to 10 (highest). Results showed Brazil, Canada, Chile, and Uruguay had the highest RESPI scores associated with statutory policies that restricted point of sale, cartoon, licensed media characters and celebrities; and HFSS products in schools and child care settings, and broadcast and print media. Policymakers can use the RESPI tool to evaluate marketing policies within and across geopolitical boundaries to protect children's diet and health.

The effectiveness of voluntary policies and commitments in restricting unhealthy food marketing to Canadian children on food company websites

Marketing unhealthy foods and beverages to children (M2K) fosters poor dietary patterns, increasing obesity and noncommunicable disease risk. Federal restrictions on M2K have been under development in Canada since 2016; however, at present, M2K is mostly self-regulated by food companies. This study aimed to compare M2K on Canadian websites of food companies with and without voluntary policies or commitments in this area. A systematic content analysis of company websites was conducted in spring/summer 2017 for major packaged food (n = 16), beverage (n = 12), and restaurant chain (n = 13) companies in Canada. M2K policies were sourced from company websites and published corporate documents. Sixteen companies (43%) reported national and/or global M2K policies, while 21 companies (57%) had no published policies. The websites of Canadian companies (n = 154) were scanned for child-directed products and marketing; type and frequency of marketing techniques were recorded. Child-directed marketing appeared on 19 websites of 12 companies (32%), including 9 companies with M2K policies. Websites featured products with unconventional flavours, colours, shapes, or child-oriented packaging, and used promotional characters, contests, games, activities, or lettering and graphics appealing to children. The nutritional quality of products marketed to children was evaluated using a nutrient profile model developed by Health Canada for proposed M2K regulations. Of the 217 products marketed to children, 97% exceeded Health Canada's proposed ∼5% Daily Value threshold for saturated fat, sodium, and/or sugars, 73% of which were products from 9 companies with policies. These findings highlight the limitations of self-regulation in restricting M2K on food company websites, reinforcing the need for government regulations.