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Journal ArticleDOI

Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary

01 Mar 2013-Appetite (Academic Press)-Vol. 62, pp 209-215
TL;DR: The collective review evidence on marketing practice indicates little progress towards policy aims has been achieved during the period 2003-2012 and there is a gap in the evidence base on how substantive policy implementation can be achieved.
About: This article is published in Appetite.The article was published on 2013-03-01 and is currently open access. It has received 541 citations till now. The article focuses on the topics: Food marketing & Systematic review.

Summary (2 min read)

Jump to: [Introduction][Objectives][Methods][Discussion] and [Conclusions]

Introduction

  • A number of policy initiatives intended to ‘rebalance the food marketing landscape’ have been introduced during the last decade (Hawkes & Lobstein, 2011).
  • An important recent initiative to address the threat of current marketing practice to public health was the endorsement at the 63rd World Health Assembly’s of the World Health Organization (WHO) ‘Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children’ (WHO, 2010).
  • In 2011, promotion of the WHO Set of Marketing Recommendations was one of the actions cited in the Political Declaration adopted at the 66th session of United Nations General Assembly (UN, 2011).
  • The United Nations Resolution provides clear leadership for international action to tackle the rising prevalence of noncommunicable diseases (NCDs).
  • This high-level political commitment presents both challenges and opportunities for research aimed at informing the evidence-informed policy cycle.

Objectives

  • The research objectives of the SR was to review the international evidence base on (a) the nature and extent of food promotion and non-alcoholic beverages to children; and (b) the effects of child-oriented food and nonalcoholic beverage promotion on diet, dietary determinants and health.
  • The main purpose of the recommendations is to ‘guide efforts by Member States in designing new and/or strengthening existing policies on food marketing communications to children in order to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt’ (WHO, 2010: 7).

Methods

  • SR methodology aims to comprehensively identify and evaluate all relevant evidence available to answer pre-specified research questions using a fully documented methodology (Littell, Corcoran, & Pillai, 2008).
  • All data sources that met eligibility criteria for one or more research question were summarised in Data Extraction Tables, coded and thematically analysed.
  • Forty-six studies on the effects of food promotion on children’s diet, dietary determinants and health were assessed as capable of demonstrating causality and were therefore included in the evidence pool for Qs 6-8.
  • Eight studies reported small non-significant effect sizes and four reported inconclusive results.

Discussion

  • The first systematic review of evidence on the nature, extent and effects of marketing was published in 2003.
  • Subsequent SRs published in 2006 (Hastings, McDermott, Angus et al., 2006) and 2009 (Cairns, Angus, & Hastings, 2009) extended the geographic scope of the evidence base to include research conducted in low income countries.
  • A North American systematic review of evidence published in 2006 also concluded that food and beverage promotion to children is extensive, primarily promotes low nutrition foods and influences children’s food behaviours and dietrelated health (McGinnis, Gootman, & Kraak, 2006).
  • The relationship between research and policy is likely to be most effective if policy informs evidence as well as evidence informing policy.

Conclusions

  • This should include research on mapping what controls and interventions work in limiting the amount of advertising and marketing to children including the impact on health outcomes.
  • There is a need to move beyond debates over mapping the extent of the problem to exploring policy and public health solutions which are evidence based.
  • The authors are grateful to the World Health Organization for commissioning the 2006 and 2009 systematic reviews.
  • The authors would also like to thank Laura MacDonald and Diane Dixon for their help in checking records and data, and in preparation of the manuscript.

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Citations
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TL;DR: The commercial determinants of health are defined as “strategies and approaches used by the private sector to promote products and choices that are detrimental to health” and a single concept unites a number of others: at the micro level, these include consumer and health behaviour, individualisation, and choice; at the macro level, the global risk society, theglobal consumer society, and the political economy of globalisation.

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TL;DR: An essential contribution of this piece is to marry and integrate the nutrition transition literature with the literature on the economics of food system transformation.
Abstract: The Latin America and the Caribbean (LAC) region faces a major diet-related health problem accompanied by enormous economic and social costs. The shifts in diet are profound: major shifts in intake of less-healthful low-nutrient-density foods and sugary beverages, changes in away-from-home eating and snacking and rapid shifts towards very high levels of overweight and obesity among all ages along with, in some countries, high burdens of stunting. Diet changes have occurred in parallel to, and in two-way causality with, changes in the broad food system - the set of supply chains from farms, through midstream segments of processing, wholesale and logistics, to downstream segments of retail and food service (restaurants and fast food chains). An essential contribution of this piece is to marry and integrate the nutrition transition literature with the literature on the economics of food system transformation. These two literatures and debates have been to date largely 'two ships passing in the night'. This review documents in-depth the recent history of rapid growth and transformation of that broad food system in LAC, with the rapid rise of supermarkets, large processors, fast food chains and food logistics firms. The transformation is the story of a 'double-edged sword', showing its links to various negative diet side trends, e.g. the rise of consumption of fast food and highly processed food, as well as in parallel, to various positive trends, e.g. the reduction of the cost of food, de-seasonalization, increase of convenience of food preparation reducing women's time associated with that and increase of availability of some nutritious foods like meat and dairy. We view the transformation of the food system, as well as certain aspects of diet change linked to long-run changes in employment and demographics (e.g. the quest for convenience), as broad parameters that will endure for the next decades without truly major regulatory and fiscal changes. We then focus in on what are the steps that are being and can be taken to curb the negative effects on diet of these changes. We show that countries in LAC are already among the global leaders in initiating demand-related solutions via taxation and marketing controls. But we also show that this is only a small step forward. To shift LAC's food supply towards prices that incentivize consumption of healthier diets and demand away from the less healthy component is not simple and will not happen immediately. We must be cognizant that ultimately, food industry firms must be incentivized to market the components of healthy diets. This will primarily need to be via selective taxes and subsidies, marketing controls, as well as food quality regulations, consumer education and, in the medium term, consumers' desires to combine healthier foods with their ongoing quest for convenience in the face of busy lives. In the end, the food industry in LAC will orient itself towards profitable solutions, ie those demanded by the broad mass of consumers.

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Cites background from "Systematic reviews of the evidence ..."

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Related Papers (5)
Frequently Asked Questions (14)
Q1. What are the contributions in this paper?

In this paper, a summary of the public health evidence base that has informed policy development to date, and highlights evidence gaps pertinent to next steps in developing effective marketing control policies is provided. 

The authors recommend future research strategies build on the empirical evidence that unconstrained food marketing promotes low nutrition foods and that promotions influence children ’ s food behaviours and diet-related health. The WHO Set of Marketing Recommendations provides comprehensive, strategic direction for future research as well as policy. 

Purchase incentives such as competitions, giveaways, brand-based discounting, as well as the deployment of innovative digital technologymediated marketing are increasingly common. 

The most common categories of food products promoted to children are pre-sugared breakfast cereals, soft drinks, savoury snacks, confectionery and fast foods. 

Forty-six studies on the effects of food promotion on children’s diet, dietary determinants and health were assessed as capable of demonstrating causality and were therefore included in the evidence pool for Qs 6-8. 

The next most heavily promoted food categories were juice and non-carbonated beverages, snack foods and candy/frozen deserts which accounted for 25% of total expenditure (FTC, 2008). 

Food marketing in low-income countries aimed at children and families is using TV advertising, sports stars and celebrity endorsement, interactive digital technologies and11building of brand loyalty to promote the same types of micro-nutrient poor, energy-dense foods and beverages as in richer countries. 

A US Federal Trade Commission (FTC) survey of industry expenditure reported 63% of the marketing spend directed to children was for carbonated beverages, fast food and breakfast cereals. 

More serious health and nutrition appeals (with the exception of breakfast cereal promotions) and the use of disclaimers (qualifying statements on products’ contribution to consumer needs) are rarely deployed. 

Consumption behaviours: Fourteen of the 18 included studies demonstrated positive associations between food promotion and consumption behaviours such as increased snacking, higher energy intake and less healthful food choices. 

The collective evidence of the major reviews published to early 2012 capture nearly forty years of evidence on the effects of marketing. 

Two reviewers applied the causality and quality rating criteria to screen and grade studies eligible for inclusion to answer Qs 6-8. 

Study design was assessed using the Bradford Hill criteria7for determining if observed associations between variables may be inferred to be causal or simply correlational (Bradford-Hill, 1965)2. 

A study illustrating this (Gantz, Schwartz, Angelini, & Rideout, 2007), reported that 34% of TV food advertising targeting children used taste appeals, 18% used fun appeals and only 2% used nutrition or health appeals.