Food Marketing and Childhood Obesity — A Matter of Policy
N Engl J Med 2006; 354:2527-2529June 15, 2006DOI: 10.1056/NEJMp068014
Everyone knows that American children are becoming fatter, but not everyone agrees on the cause. Many of today's children routinely consume more calories than they expend in physical activity, but this imbalance results from many recent changes in home, school, and neighborhood environments. Concerned about the health and economic costs of childhood obesity, in 2004 Congress asked the Centers for Disease Control and Prevention to examine one potential cause — the marketing of foods directly to children. The result is a new Institute of Medicine (IOM) study, Food Marketing to Children and Youth: Threat or Opportunity, 1 that provides a chilling account of how this practice affects children's health. Food marketing, the IOM says, intentionally targets children who are too young to distinguish advertising from truth and induces them to eat high-calorie, low-nutrient (but highly profitable) “junk” foods; companies succeed so well in this effort that business-as-usual cannot be allowed to continue.
Since the late 1970s, obesity rates have more than doubled among children 6 to 11 years of age and more than tripled among those 12 to 19 years of age. As one consequence, type 2 diabetes mellitus is no longer rare in pediatric practice.2 The IOM states its first conclusion politely: the diets of American children are “in need of improvement.” As its report makes clear, this is a gross understatement: at least 30 percent of the calories in the average child's diet derive from sweets, soft drinks, salty snacks, and fast food. Soft drinks account for more than 10 percent of the caloric intake, representing a doubling since 1980. According to the U.S. Department of Agriculture, even babies consume measurable quantities of soft drinks, and pediatricians say it is not unusual for overweight children to consume 1200 to 2000 calories per day from soft drinks alone.
Is food marketing responsible? The IOM analyzes the results of 123 published, peer-reviewed studies addressing links between food marketing and children's preferences, requests, consumption, and adiposity. Despite Talmudic parsing of the limitations of the research, the IOM finds that the preponderance of evidence supports the links. Marketing strongly influences children's food preferences, requests, and consumption. The idea that some forms of marketing increase the risk of obesity, says the IOM, “cannot be rejected.”
The IOM conducted its study under a considerable handicap. Companies would not provide proprietary information, because the IOM is required to make public all documents it uses. The report reveals why companies insist on keeping such research private. It lists numerous firms that conduct marketing research focused even on preschool children, using methods — photography, ethnography, focus groups — in an Orwellian-sounding fashion to elucidate the psychological underpinnings of children's food choices, “kid archetypes,” the “psyche of mothers as the family gatekeeper,” and “parent–child dyads of information.” As the IOM documents, this enterprise is breathtaking in its comprehensive and unabashed effort to provide a research basis for exploiting the suggestibility of young children. Although marketers justify appeals to children as “training” in consumer culture, as free speech, and as good for business, they are not selling just any consumer product: they are selling junk foods to children who would be better off not eating them.
American children spend nearly $30 billion of their own money annually on such foods, and companies design products to tap this market. Since 1994, U.S. companies have introduced about 600 new children's food products; half of them have been candies or chewing gums, and another fourth are other types of sweets or salty snacks. Only one fourth are more healthful items, such as baby foods, bread products, and bottled waters. Companies support sales of “kids' foods,” with marketing budgets totaling an estimated $10 billion annually.1,3 Kellogg spent $22.2 million just on media advertising to promote 139.8 million dollars' worth of Cheez-It crackers in 2004, but these figures are dwarfed by McDonald's $528.8 million expenditure to support $24.4 billion in sales.
Marketing to children is hardly new, but recent methods are far more intense and pervasive. Television still predominates, but the balance is shifting to product placements in toys, games, educational materials, songs, and movies; character licensing and celebrity endorsements; and less visible “stealth” campaigns involving word of mouth, cellular-telephone text messages, and the Internet. All aim to teach children to recognize brands and pester their parents to buy them. The IOM notes that by two years of age, most children can recognize products in supermarkets and ask for them by name.
But the most insidious purpose of marketing is to persuade children to eat foods made “just for them” — not what adults are eating. Some campaigns aim to convince children that they know more about what they are “supposed to” eat than their parents do. Marketers explicitly attempt to undermine family decisions about food choices by convincing children that they, not adults, should control those choices.4 Indeed, children now routinely report that they, and not their parents, decide what to eat.
The IOM concludes that its data establish a “need and an opportunity [to] . . . turn food and beverage marketing forces toward better diets for American children and youth.” This will be no small task. Junk foods are major sources of revenue for food companies. In response to threats of lawsuits and legislation, companies are scrambling to support health and exercise programs, to announce policies renouncing advertising directed at children under certain ages, and to make their products appear more healthful. Hence: vitamin-enriched candy, whole-grain chocolate cereals, and trans fat–free salty snacks. Yet candies, soft drinks, and snack foods remain the most heavily promoted products.1
Companies, says the IOM, must do better. At the moment, their efforts — and those of government agencies — to promote more healthful foods “remain far short of their full potential.” If the industry does not change its practices voluntarily, “Congress should enact legislation mandating the shift.” Strong words, but the IOM can only advise. Others, however, can act. In January 2006, advocacy groups announced a Massachusetts lawsuit to enjoin Kellogg and Viacom, owner of the Nickelodeon television network, from promoting junk foods to children.5 Dozens of state legislatures have introduced bills to curb food marketing, and parent and advocacy groups are demanding bans on food marketing in schools.
Such efforts may push U.S. policies in the direction of those of at least 50 other countries that regulate television advertising aimed at children. Australia, for example, bans food advertisements meant for children younger than 14 years of age; the Netherlands bans advertisements for sweets to those younger than 12; and Sweden bans the use of cartoon characters to promote foods to children younger than 12. Although such actions have not eliminated childhood obesity — rates in these countries are increasing, although they remain lower than the U.S. rate — they may help to slow current trends. In contrast, U.S. regulations apply only to time: commercials may take up to 12 minutes per hour during weekdays but “only” 10.5 minutes per hour on weekends.
The IOM report provides plenty of evidence to support additional policy actions. Worth serious consideration, I believe, are restrictions or bans on the use of cartoon characters, celebrity endorsements, health claims on food packages, stealth marketing, and marketing in schools, along with federal actions that promote media literacy, better school meals, and consumption of fruits and vegetables. Without further changes in society, such actions may not be enough to prevent childhood obesity, but they should make it much easier for parents — and health care providers — to encourage children to eat more healthfully.
An interview with Dr. Nestle can be heard at www.nejm.org.
Dr. Nestle is a professor of nutrition, food studies, and public health at New York University, New York.
McGinnis JM, Gootman JA, Kraak VI, eds. Food marketing to children and youth: threat or opportunity? Washington, D.C.: National Academies Press, 2006.
Koplan JP, Liverman CT, Kraak VI, eds. Preventing childhood obesity: health in the balance. Washington, D.C.: National Academies Press, 2005.
California Pan-Ethnic Health Network, Consumers Union. Out of balance: marketing of soda, candy, snacks and fast foods drowns out healthful messages. San Francisco: Consumers Union, September 2005. (Accessed May 25, 2006, at http://www.consumersunion.org/pdf/OutofBalance.pdf.)
Pestering parents: how food companies market obesity to children. Washington, D.C.: Center for Science in the Public Interest, November 2003. (Accessed May 25, 2006, at http://www.cspinet.org/new/200311101.html.)
Parents and advocates will sue Viacom & Kellogg. Press release of the Center for Science in the Public Interest, Washington, D.C., January 18, 2006. (Accessed May 25, 2006, at http://www.cspinet.org/new/200601181_print.html.)
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J L Stevenson, S Krishnan, M A Stoner, Z Goktas, J A Cooper. (2013) Effects of exercise during the holiday season on changes in body weight, body composition and blood pressure. European Journal of Clinical Nutrition
Lisa A. Mandl. (2013) Determining who should be referred for total hip and knee replacements. Nature Reviews Rheumatology 9:6, 351-357
Gerdi Weidner. (2012) Sustainability in medicine: a case for the prevention of chronic non-communicable diseases. The Environmentalist 32:3, 353-359
Marie A Bragg, Peggy J Liu, Christina A Roberto, Vishnu Sarda, Jennifer L Harris, Kelly D Brownell. (2012) The use of sports references in marketing of food and beverage products in supermarkets. Public Health Nutrition1-5
Sarah Potter, Christy Szczech Moser, Eric Everson, Mike Lundstrom. (2012) Childhood Obesity. Journal of Occupational Therapy, Schools, & Early Intervention 5:3-4, 183-195
Wolfgang Weimer-Jehle, Jürgen Deuschle, Regine Rehaag. (2012) Familial and societal causes of juvenile obesity—a qualitative model on obesity development and prevention in socially disadvantaged children and adolescents. Journal of Public Health
Andrea Tanner, Christine E. Blake, James F. Thrasher. (2012) Tracking Beverage Nutrition Information in the News: An Evaluation of Beverage-Related Health Reports on Television News. Ecology of Food and Nutrition 51:1, 1-21
Jessica Aschemann-Witzel, Federico JA Perez-Cueto, Barbara Niedzwiedzka, Wim Verbeke, Tino Bech-Larsen. (2012) Lessons for public health campaigns from analysing commercial food marketing success factors: a case study. BMC Public Health 12:1, 139
Kerith Duncanson, Tracy Burrows, Clare Collins. (2012) Study protocol of a parent-focused child feeding and dietary intake intervention: the feeding healthy food to kids randomised controlled trial. BMC Public Health 12:1, 564
Amanda Hinebaugh, Christina Calamaro. (2011) The Clinical Nurse Leader: Playing an Integral Role in the Prevention and Treatment of Pediatric Overweight and Obesity. Bariatric Nursing and Surgical Patient Care 6:3, 145-150
Jean Adams, Rachel Tyrrell, Ashley J Adamson, Martin White. (2011) Socio-economic differences in exposure to television food advertisements in the UK: a cross-sectional study of advertisements broadcast in one television region. Public Health Nutrition1-8
Alison K Ventura, Julie A Mennella. (2011) Innate and learned preferences for sweet taste during childhood. Current Opinion in Clinical Nutrition and Metabolic Care 14:4, 379-384
Jean Adams, Ellie Ganiti, Martin White. (2011) Socio-economic differences in outdoor food advertising in a city in Northern England. Public Health Nutrition 14:06, 945-950
Jean Adams, Rachel Tyrrell, Martin White. (2011) Do television food advertisements portray advertised foods in a ‘healthy’ food context?. British Journal of Nutrition 105:06, 810-815
Nathalie Auger, Mark Daniel, Bärbel Knäuper, Marie-France Raynault, Barry Pless. (2011) Children and youth perceive smoking messages in an unbranded advertisement from a NIKE marketing campaign: a cluster randomised controlled trial. BMC Pediatrics 11:1, 26
Rachel Griffith, Martin O'Connell. (2010) Public Policy towards Food Consumption*. Fiscal Studies 31:4, 481-507
David L. Katz. (2010) It Does, Indeed, Take a Village: Schools, Families, and Beyond for Weight Control in Children. Childhood Obesity (Formerly Obesity and Weight Management) 6:4, 184-192
K. Morgan, R. Sonnino. (2010) The urban foodscape: world cities and the new food equation. Cambridge Journal of Regions, Economy and Society 3:2, 209-224
Deborah A. Cohen. Evidence on the Food Environment and Obesity. In: Preventing Childhood Obesity. Wiley-Blackwell, 2010:113-119.
Jennifer L. Pomeranz. (2010) Television Food Marketing to Children Revisited: The Federal Trade Commission Has the Constitutional and Statutory Authority to Regulate. The Journal of Law, Medicine & Ethics 38:1, 98-116
Julie Henderson, John Coveney, Paul Ward, Anne Taylor. (2009) Governing childhood obesity: Framing regulation of fast food advertising in the Australian print media. Social Science & Medicine 69:9, 1402-1408
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E. Ben-Sefer, M. Ben-Natan, M. Ehrenfeld. (2009) Childhood obesity: current literature, policy and implications for practice. International Nursing Review 56:2, 166-173
Maira Bes-Rastrollo, Miguel Angel Martinez-Gonzalez. (2009) Concerns about the Discretion of Sweetened Beverages. Journal of the American Dietetic Association 109:3, 404-405
Parke Wilde. (2009) Self-regulation and the response to concerns about food and beverage marketing to children in the United States. Nutrition Reviews 67:3, 155-166
Chantal Blouin, Mickey Chopra, Rolph van der Hoeven. (2009) Trade and social determinants of health. The Lancet 373:9662, 502-507
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María D. Torres, María A. Tormo, Carlos Campillo, María I. Carmona, Montaña Torres, Mercedes Reymundo, Purificación García, José E. Campillo. (2008) Factores etiológicos y de riesgo cardiovascular en niños extremeños con obesidad. Su relación con la resistencia a la insulina y la concentración plasmática de adipocitocinas. Revista Española de Cardiología 61:9, 923-929
Randy Page, Katie Montgomery, Andrea Ponder, Amanda Richard. (2008) Targeting Children in the Cereal Aisle. American Journal of Health Education 39:5, 272-282
Lorraine King, Andrew J. Hill. (2008) Magazine adverts for healthy and less healthy foods: Effects on recall but not hunger or food choice by pre-adolescent children. Appetite 51:1, 194-197
Maciej Witkos, Michelle Uttaburanont, Christopher D. Lang, Rohit Arora. (2008) Costs of and Reasons for Obesity. Journal of the CardioMetabolic Syndrome 3:3, 173-176
Schroeder , Steven A. , . (2007) We Can Do Better — Improving the Health of the American People. New England Journal of Medicine 357:12, 1221-1228
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