Confused health and nutrition claims in food marketing to children could adversely affect food choice and increase risk of obesity

TLDR: In this paper, the authors investigated the nutritional quality of foods marketed to children in the UK and explored the use of health and nutrition claims, including cartoon characters (91.6%), nutrition claims (41.6%) and health claims (19.6%).

Abstract: Objectives To investigate the nutritional quality of foods marketed to children in the UK and to explore the use of health and nutrition claims. Design This cross-sectional study was carried out in a wide range of UK food retailers. Products marketed to children above the age of 1 year containing any of a range of child friendly themes (i.e. cartoons, toys and promotions), and terms suggesting a nutritious or healthy attribute such as ‘one of 5-a-day’, on product packaging were identified both in stores and online. Information on sugar, salt and fat content, as well as health and nutrition claims, was recorded. The Ofcom nutrient profiling model (NPM) was used to assess if products were healthy. Results Three hundred and thirty-two products, including breakfast cereals, fruit snacks, fruit-based drinks, dairy products and ready meals, were sampled. The use of cartoon characters (91.6%), nutrition claims (41.6%) and health claims (19.6%) was a common marketing technique. The one of 5-a-day claim was also common (41.6%), but 75.4% (103) of products which made this claim were made up of less than 80 g of fruit and vegetables. Sugar content (mean±SD per 100 g) was high in fruit snacks (48.4±16.2 g), cereal bars (28.9±7.5 g) and cereals (22.9±8.0 g). Overall, 41.0% of the products were classified as less healthy according to the Ofcom NPM. Conclusion A large proportion of products marketed to children through product packaging are less healthy, and claims used on product packaging are confusing. Uniform guidance would avoid confusion on nutritional quality of many popular foods.

Figures

Table 1: Nutrient content (mean ± SD) of different foods marketed to children (n=332)

Table 3: Association between claims made on foods marketed to children and Ofcom nutrient profiling model % (n)

Table 2: Description of food products sampled according to marketing strategies, use of processed food as an ingredient, claims, and nutrient profiling classification %(n)

Full text

García, A. L., Morillo-Santander, G., Parrett, A. and Mutoro, A. N. (2019) Confused
health and nutrition claims in food marketing to children could adversely affect food
choice and increase risk of obesity. Archives of Disease in Childhood,
(doi:10.1136/archdischild-2018-315870).
There may be differences between this version and the published version. You are
advised to consult the publisher’s version if you wish to cite from it.
http://eprints.gla.ac.uk/172178/
Deposited on: 29 October 2018
Enlighten – Research publications by members of the University of Glasgow
http://eprints.gla.ac.uk

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Misrepresentation of health and nutrition claims in food marketing to
children could adversely affect food choice and increase risk of obesity
Ada Lizbeth Garcia, Gabriela Morillo-Santander, Alison Parrett, Antonina N Mutoro
Affiliations for all authors
Human Nutrition School of Medicine, College of Medical, Veterinary & Life Sciences
University of Glasgow, Glasgow, UK
*Corresponding author
Ada L Garcia
Human Nutrition, School of Medicine, College of Medical, Veterinary & Life Sciences,
University of Glasgow
New Lister Building, Glasgow Royal Infirmary,
10-16 Alexandra Parade, Glasgow, G31 2ER, UK
Tel +44(0)141 201 8687
Email: Ada.Garcia@glasgow.ac.uk
Word count: 2796
Key words: sugar, food labelling, nutrition claims, 5-a-day, child-oriented foods

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Abstract
Objective: To investigate the nutritional quality of foods marketed to children in the United
Kingdom, to explore the use of health and nutrition claims and to assess their healthiness.
Design: This cross-sectional study was carried out in seven UK supermarkets, Tesco, Aldi,
Sainsbury’s, Morrisons, Asda, Lidl and Waitrose. Products marketed as healthy to children
above the age of 1 year containing child oriented imagery including cartoon characters and
terms such as ‘one of 5-a-day’ on product packaging were identified both in stores and
online. Information on the sugar, salt and fat content, as well as health and nutrition claims
was recorded. The Ofcom Nutrient Profiling Model (NPM) was used to assess if products
were healthy.
Results: Three hundred and thirty-two products, including breakfast cereals, fruit snacks,
fruit-based drinks, dairy products and ready meals were sampled. The use of cartoon
characters (91.6%), nutrition (41.6%) and health (19.6%) claims were common marketing
techniques. The one of 5-a-day claim was also common (41.6%), but 75.4% (103) products
which made this claim were made up of less than 80g of fruit and vegetables. Sugar content
(mean ± SD per 100g) was high in fruit snacks (48.4g ±16.2g), cereal bars (28.9g ±7.5g) and
cereals (22.9g ±8.0g). Overall, 41.0% of the products were classified as less healthy
according to the Ofcom NPM.
Conclusion: A large proportion of products marketed to children through product packaging
are less healthy and claims used on product packaging are misrepresentative. Strict
regulations on food labelling and product composition are required.

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Introduction
The burden of childhood obesity is associated with increased availability, widespread
targeted marketing and increased consumption of unhealthy obesogenic foods that are high in
sugar, saturated fats, and salt (1, 2) . Child-focused marketing techniques which create an
emotional appeal of fun by using cartoon characters, toys, games and promotions have been
long used for advertising (3-5) while the use of health and nutrition claims is a more recent
trend (6, 7). These marketing techniques have been shown to create a cognitive bias which
occurs when a claim about a single health quality of a product creates a positive impression
of the food also known as the “health halo effect” (8, 9).
In the UK, regulations such as control of food television advertising targeting children (10)
taxation (11, 12) and removal of food products from public institutions (13) have been
implemented to mitigate the marketing of “less healthy foods” such as confectionary and
sugar sweetened beverages to children. Marketing of regular foods considered “healthy”
through packaging in stores and online has not received much attention. This is important
given the UK government’s commitment to reduce childhood obesity (2, 14).
We aimed to investigate the nutritional quality of foods marketed to children in terms of their
energy, fat, sugar and salt content. We also explored the use of health and nutrition claims
such as 5-a-day claims on the packaging of these products and determined whether they were
“healthy” or “less healthy” using a nutrient profiling model.

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Methods
This cross-sectional survey sampled nutritional information on food packages at point-of-sale
(in store) and online from foods marketed to children. Seven UK supermarkets: Tesco, Aldi,
Sainsbury’s, Morrisons, Asda, Lidl and Waitrose; were selected because they have a large
market share, 89.6%, in the U.K (15). Data was surveyed between May and July 2016 and
November and December 2017. Further corroboration of data entry was done in June 2018.
Overall, three different researchers checked the database for accuracy.
The selection and inclusion criteria was adapted from previous studies on child food
advertising (16, 17). Foods were identified and included if they contained any of the
following in their food packaging: cartoon imagery (licenced or unlicensed), child friendly
images, puzzles, games, toys and activities or promotions appealing to children (i.e.
collecting cards, amusement park vouchers), as well as terms such as ‘children’, ‘child’,
‘kids’, or ‘little/young ones’ and references to ‘lunch box’ or ‘growing up’ Products were
then further selected if they were promoted as ‘healthy’ or “good” for children Foods such
as cereals, yoghurts, ready meals and fruit juices that are regularly consumed as part of a
healthy diet, were included. An online search was also carried out on the same supermarket
websites using child related terms but in combination with words such as yoghurts, meals,
cereals and fruit juices, this was done to ensure all products were considered,
Exclusion criteria were: 1) foods marketed to children under 12 months of age because of
differences in nutrition composition requirements and regulations 2) cakes, biscuits
confectionary items, crisps and soft drinks because they are high in fat, sugar and salt and are
considered less ‘healthy’, 3) fresh and unpacked foods (i.e. fruit and vegetables).
Data Extraction

Frequently asked questions

Q1. What have the authors contributed in "Misrepresentation of health and nutrition claims in food marketing to children could adversely affect food choice and increase risk of obesity" ?

This paper investigated the nutritional quality of foods marketed to children in terms of their energy, fat, sugar and salt content and explored the use of health and nutrition claims such as 5-a-day claims on the packaging of these products. 

Q2. what is the nutrient profile of yogurt in children?

Yogurt consumption is associated with higher nutrient intake, diet quality and favourable metabolic profile in children: a cross-sectional analysis using data from years 1-4 of the National diet and Nutrition Survey, UK. 

Q3. What are the main sources of free sugars for children in the UK?

While cereals are the main source of free sugars for most children in the UK, they are also a source of fibre and micronutrients (28, 32-34). 

Q4. What is the main reason why processed fruits have been classified as free sugars?

Processed fruits are perceived by the public as a healthy natural alternative to added sugars, but because of the breakdown of the cellular structure, they potentially have the same negative effect on weight gain as other forms of sugar, which is why they have recently been classified as free sugars in the UK (38-40). 

Q5. How many supermarkets are selected for this study?

Seven UK supermarkets: Tesco, Aldi, Sainsbury’s, Morrisons, Asda, Lidl and Waitrose; were selected because they have a large market share, 89.6%, in the U.K (15). 

Q6. Why was the recommended adult portion size used to assess the validity of 5-a-day claims?

Due to lack of unified recommendations for fruit and vegetables in children, 40g, the amount most children in the UK eat, was also used to assess validity of 5-a-day claims (20). 

Q7. What is the main reason why yoghurts were classified as less healthy?

Diary products are a good source of protein and calcium for children (37), but in this study, a large proportion of yoghurts were classified as less healthy because of their high saturated fatand low fibre content. 

Q8. What were the nutritional information on foods that were marketed to children?

Nutrition information on energy (kcal and joules), saturated fat (g), fat (g), carbohydrates (g), total sugars (g), protein (g), fibre (g), and salt (g) were recorded per 100g. 

Q9. What are the requirements for strict regulations on product composition, food labelling and marketing?

Strict regulations on product composition, food labelling and marketing techniques are required to discourage the promotion of foods which might be considered obesogenic . 

Q10. What was the likely reason for the higher health classification of fruit and vegetables?

Based on child portions of fruit and vegetables, products which contained less than 40g of fruit and vegetables were more likely to be classified healthy, this is due to low salt, saturated fats and sugar content (Table 3). 

Q11. What is the need to regulate the sugar content of breakfast cereals and yoghurts?

Considering the potential benefits of breakfast cereals and yoghurts, there is a need to regulate their sugar, salt and fat content as well as the use of misrepresenting nutrition and health claims. 

Q12. What were the common claims made about fruit and vegetables?

Nearly a quarter of the products made “no added sugars” claims most of which were fruit-based beverages and fruit snacks (Table 2). 

Q13. What were the criteria for the selection of foods?

Products were then further selected if they were promoted as ‘healthy’ or “good” for children Foods such as cereals, yoghurts, ready meals and fruit juices that are regularly consumed as part of a healthy diet, were included. 

Q14. What were the common words used to describe the portion sizes of fruit and vegetables?

Words such as “crushed”, “pressed”, “mashed” were used to describeFigure 1: Proportion of products which made no added sugar claim (n=80) but contain concentrated fruit juice and fruit puree as an ingredientprocessed fruit without specifying whether fruit juice or fruit puree was used 3.6% . 

Q15. What were the criteria used to determine whether a food was considered healthy?

An online search was also carried out on the same supermarket websites using child related terms but in combination with words such as yoghurts, meals, cereals and fruit juices, this was done to ensure all products were considered,Exclusion criteria were: 1) foods marketed to children under 12 months of age because of differences in nutrition composition requirements and regulations 2) cakes, biscuits confectionary items, crisps and soft drinks because they are high in fat, sugar and salt and are considered less ‘healthy’, 3) fresh and unpacked foods (i.e. fruit and vegetables). 

Q16. What is the need for stricter regulations on product composition and marketing?

Use of cartoons and health claims to market less healthy foods are potentiallymisrepresenting, as they increase the consumption Strict regulations on product composition and product marketing through packagingare required A large proportion of foods that are marketed as healthy for children in the UnitedKingdom are less healthy Health and nutrition claims used on product packaging are misrepresenting. 

Q17. What was the common claim made about fruit and vegetables?

Most of these products claimed to have one portion size of fruit and vegetables, 81.9% (113) and a few, 14.5 % (20) claimed to have more than one portion size of fruit and vegetables, but all of these were made up of less than 80g of fruits and vegetables. 

Q18. What was the percentage of cereals that had a high sugar content?

A large proportion of cereals, had a high sugar content and were more likely to be classified as less healthy compared to those with low sugar content (Table 3).