The impact of food advertising on childhood obesity

The childhood obesity epidemic is a serious public health problem that increases morbidity, mortality, and has substantial long term economic and social costs. The rates of obesity in America’s children and youth have almost tripled in the last quarter century. Approximately 20% of our youth are now overweight with obesity rates in preschool age children increasing at alarming speed. According to the Centers for Disease Control and Prevention, the prevalence of obesity has more than doubled among children ages 2 to 5 (5.0% to 12.4%) and ages 6 to 11 (6.5% to 17.0%). In teens ages 12 to 19, prevalence rates have tripled (5.0% to 17.6%). Obesity in childhood places children and youth at risk for becoming obese as adults and associated poor health such as diabetes, cardiovascular disease, and some forms of cancer. Prevention efforts must focus on reducing excess weight gain as children grow up.

Today’s children, ages 8 to 18, consume multiple types of media (often simultaneously) and spend more time (44.5 hours per week) in front of computer, television, and game screens than any other activity in their lives except sleeping. Research has found strong associations between increases in advertising for non-nutritious foods and rates of childhood obesity. Most children under age 6 cannot distinguish between programming and advertising and children under age 8 do not understand the persuasive intent of advertising. Advertising directed at children this young is by its very nature exploitative. Children have a remarkable ability to recall content from the ads to which they have been exposed. Product preference has been shown to occur with as little as a single commercial exposure and to strengthen with repeated exposures. Product preferences affect children's product purchase requests and these requests influence parents' purchasing decisions.

Sources:

American Psychological Association (2004). Report of the APA task force on advertising and children. Washington, DC: Author. Retrieved from http://www.apa.org/pi/families/resources/advertising-children.pdf.

American Psychological Association (2009). Resolution on promotion of healthy active lifestyles and prevention of obesity and unhealthy weight control behaviors in children and youth. Washington, DC: Author. Retrieved from http://www.apa.org/about/governance/council/policy/chapter-12b.aspx#active-lifestyle.

Centers for Disease Control and Prevention (2006). NHANES data on the prevalence of overweight among children and adolescents: United States, 2003–2006. Atlanta, GA: CDC National Center for Health Statistics, Health E-Stat.

Kaiser Family Foundation (2004). The role of media in childhood obesity. Washington, DC: Author. Retrieved from http://www.kff.org/entmedia/upload/The-Role-Of-Media-in-Childhood-Obesity.pdf.

Kaiser Family Foundation (2005). Generation M: Media in the lives of eight to eighteen year olds. Washington, DC: Author. Retrieved from http://www.kff.org/entmedia/entmedia030905pkg.cfm.

Koplan, J. P., Liverman, C. T., & Kraak, V. A., (Eds.) (2005). Preventing childhood obesity: Health in the balance. Washington, DC: Committee on Prevention of Obesity in Children and Youth, Food and Nutrition Board, Institute of Medicine of the National Academies. Retrieved from http://www.nap.edu/catalog.php?record_id=11015.

Ogden, C. L., Carroll, M. D., & Flegal, K. M. (2008) High body mass index for age among U.S. children and adolescents, 2003–2006. Journal of the American Medical Association, 299, 2401–2405.

Pratt, C. A., Stevens, J., & Daniels, S. (2008). Childhood obesity prevention and treatment recommendations for future research. American Journal of Preventive Medicine, 35, 249-252.

Serdula, M. K. D., Ivery, R. J., Coates, D. S., Freedman, D. F., Williamson, D. F., & Byers, T. (1993). Do obese children become obese adults?: A review of the literature. Preventive Medicine, 22, 167-177.

Whitaker, R. C., Wright, J. A., Pepe, M. S., Seidel, K. D., & Deitz, W. H. (1997). Predicting obesity in young adulthood from childhood and parental obesity. New England Journal of Medicine, 37, 869-873.

 

• Food industry advertising that targets children and youth has been linked to the increase of childhood obesity.
• Advertising by other industries often objectifies girls and women, contributing to body dissatisfaction, eating disorders, low self-esteem and depression.
• Many adolescents, particularly teenage girls, have body image concerns and engage in unhealthy weight control behaviors.
• Unhealthy weight control behaviors (e.g., fasting, skipping meals, eating very little food, vomiting and using diet pills, laxatives or diuretics) have been found to co-occur with obesity.
• Weight bias may marginalize children and youth considered obese by their peers and teachers and place them at risk for teasing and bullying.
• Body dissatisfaction and weight-related concerns extend across all ethnic groups and weight-related stigma has been found to co-occur with depression, low self esteem and suicidal thought.

Sources:

Ackard, D. M., Neumark-Sztainer, D., Story, M., & Perry, C. (2003). Overeating among adolescents: Prevalence and associations with weight-related characteristics and psychological health. Pediatrics, 111, 67-74.

American Psychological Association (2004). Report of the APA task force on advertising and children. Washington, D.C.: Author. Retrieved from http://www.apa.org/pi/families/resources/advertising-children.pdf (PDF, 617.6KB)

American Psychological Association (2009). Resolution on promotion of healthy active lifestyles and prevention of obesity and unhealthy weight control behaviors in children and youth. Washington, D.C.: Author. Retrieved from http://www.apa.org/about/governance/council/policy/chapter-12b.aspx#active-lifestyle.

Davison, K. K., & Birch, L. L. (2002). Processes linking weight status and self concept among girls form ages 5 to 7 years. Developmental Psychology^®, 38, 735-748.

Neumark-Sztainer, D., Croll, J., Story, M., Hannan, P. J., French, S. A., & Perry, C. (2002). Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys: Findings from Project EAT. Journal of Psychosomatic Research, 53, 963-974.

Puhl, R. M., & Latner, J. D. (2007). Stigma, obesity, and the health of the nation's children. Psychological Bulletin^®, 133, 557-580.

• Obesity in children increases the more hours they watch television.
  
• Children’s exposure to TV ads for unhealthy food products (i.e., high-calorie, low-nutrient snacks, fast foods and sweetened drinks) are a significant risk factor for obesity.
  
• In very young children, research has found that for every one-hour increase in TV viewing per day, there are higher intakes of sugar-sweetened beverages, fast food, red and processed meat, and overall calories (48.7 kcal/day). Excess weight can be gained by the addition of only 150 calories a day.
  
• Other research has found that children who watch more than three hours of television a day are 50 per cent more likely to be obese than children who watch fewer than two hours.
  
• Food and beverage advertising targeted at children influences their product preferences, requests and diet.
  
• The food and beverage industry has resolved to self-regulate their marketing to children, but this has not resulted in significant improvement in the marketing of healthier food (i.e., fruits, vegetables, whole grains, low-fat or non-fat milk or dairy products, lean meats, poultry, fish and beans) to children. Almost three out of every four foods advertised to children falls into the unhealthy categories that contribute to the obesity epidemic.
  
• Food ads on television make up 50 percent of all the ad time on children’s shows. These ads are almost completely dominated by unhealthy food products (34 percent for candy and snacks, 28 percent for cereal, 10 percent for fast food, 4 percent for dairy products, 1 percent for fruit juices, and 0 percent for fruits or vegetables). Children are rarely exposed to public service announcements or advertising for healthier foods.
  
• Children’s level of exposure to these ads by age can be found in the table below.
  

  Ages	No. of ads per day	Hrs of ads per year	No. of ads per year	Exposure to PSAs
  2-7	12	29:31	4,427	1 every 2-3 days
  8-12	21	50:48	7,609	1 every 2-3 days
  13-17	17	40:50	6,098	<1 every week

  (Source is Kaiser Family Foundation, 2007)
• Clearly, children between ages 8-12 are receiving the highest rates of ad exposure. They are entering a critical stage of development where they are establishing food habits, making more of their own food choices and have their own money to spend on the types of food they enjoy.

Sources:

American Psychological Association (2004). Report of the APA task force on advertising and children. Washington, D.C.: Author. Retrieved from http://www.apa.org/pi/families/resources/advertising-children.pdf (PDF, 618KB).

American Psychological Association (2009). Resolution on promotion of healthy active lifestyles and prevention of obesity and unhealthy weight control behaviors in children and youth. Washington, D.C.: Author. Retrieved from http://www.apa.org/about/governance/council/policy/chapter-12b.aspx#active-lifestyle.

Centers for Disease Control and Prevention (2009). Tips for parents – Ideas to help children maintain a healthy weight. Atlanta, GA: Author. Retrieved from http://www.cdc.gov/healthyweight/children/index.html.

Children Now (2009). Advertising and childhood obesity: An established connection. Oakland, CA: Author. Retrieved from http://www.childrennow.org/index.php/learn/advertising_obesity.

Crespo, C. J., Smit, E., Troiano, R. P., Bartlett, S. J., Macera, C. A., & Andersen, R. E. (2001). Television watching, energy intake, and obesity in U.S. children. Archives of Pediatric and Adolescent Medicine, 155, 360-365.

Kaiser Family Foundation (2007). Food for thought: Television food advertising to children in the United States. Washington, D.C.: Author. Retrieved from http://kff.org/other/food-for-thought-television-food-advertising-to/ .

Koplan, J. P., Liverman, C. T., & Kraak, V. A., (Eds.) (2005). Preventing childhood obesity: Health in the balance. Washington, D.C.: Committee on Prevention of Obesity in Children and Youth, Food and Nutrition Board, Institute of Medicine of the National Academies. Retrieved from http://www.nap.edu/catalog.php?record_id=11015.

Miller , S. A., Taveras , E. M. Rifas-Shiman, S. L., & Gillman, M. W. (2008). Association between television viewing and poor diet quality in young children. International Journal of Pediatric Obesity, 3(3), 168-176. DOI 10.1080/17477160801915935

Tremblay, M.S., & Willms, J.D. (2003). Is the Canadian child obesity epidemic related to physical inactivity? International Journal of Obesity, 27 , 1100-1105.

• Marketing of food to children on the internet is even more complex since the boundaries between content and pure advertising is often less clear than on television. Only a minority of advertisers include reminders distinguishing content from pure advertising.
• One study has shown that children find it harder to recognize advertisements on websites than they do on television; 6 year olds only recognized a quarter of the ads, 8 year olds recognized half of the ads, and 10 and 12 year olds recognized about three quarters of the ads.
• The majority of food brands advertised to children on TV is also promoted on the internet and often includes online games which are heavily branded, i.e. “advergames”.
• Advergames can provide a more highly involving and entertaining brand experience than what is possible with conventional media.
• Websites also contain other brand-related content such as television commercials, media tie-ins, promotions, viral marketing and website membership opportunities.
• Viral marketing is used to encourage children to talk to one another about a brand’s website by emailing friends in the form of an e-greeting or invitation and inviting them to visit the site.
• Marketers also often provide brand-related items that can be downloaded or printed and saved (e.g., brand-related screensavers and wallpaper).
• The continual branding through these sites reinforces and amplifies the product message to children, who have a remarkable ability to recall content from ads to which they are exposed.

Sources:

Ali, M., Blades, M., Oates, C., & Blumberg, F. (2009). Young children's ability to recognize advertisements in web page designs. British Journal of Developmental Psychology, 27(1), 71-83.

Kaiser Family Foundation (2006). It’s child’s play: Advergaming and the online marketing of food to children. Washington, DC: Author. Retrieved from http://www.kff.org/entmedia/upload/7536.pdf

• There is also a creeping commercialism of America’s schools.
• Children spend a considerable amount of their time in school settings, where compulsory attendance makes it difficult to avoid exposure to commercial content.
• Commercial content delivered in schools may be assumed to have the tacit endorsement of respected teachers and school officials, thereby enhancing the effectiveness of the advertising.
• Advertising and marketing in schools takes several forms:
  • Direct advertising in school classrooms (via advertiser-sponsored video or audio programming)
  • Indirect advertising (via corporate-sponsored educational materials)
  • Product sales contracts (with soda and snack food companies), and
  • School-based corporate-sponsored marketing research.
• Ads are now appearing on school buses, in gymnasiums, on book covers, and even in bathroom stalls.
• School advertising also appears under the guise of educational TV. For instance, Channel One, which is available in 12,000 schools, provides programming consisting of 10 minutes of current-events and 2 minutes of commercials. Advertisers pay $200,000 for advertising time and the opportunity to target 40% of the nation’s teenagers for 30 seconds.

Sources:

American Academy of Pediatrics (2006). Policy statement: Children, adolescents, and advertising. Pediatrics, 118, 2563-2569.

American Psychological Association (2004). Report of the APA task force on advertising and children. Washington, DC: Author. Retrieved from http://www.apa.org/pi/families/resources/advertising-children.pdf.

Richards, J. I., Wartella, E. A., Morton, C., & Thompson, L. (1998). The growing commercialization of schools: Issues and practices. Annals of the American Academy of Political and Social Science, 557, 148–167.

Wartella, E. A. & Jennings, N. (2001). Hazards and possibilities of commercial TV in the schools. In D. G. Singer & J. L. Singer (Eds.), Handbook of children and the media. Thousand Oaks, CA: Sage, 557–570.

• Active healthy lifestyles for children and adolescents include moderate television viewing, regular family mealtimes, and regular exercise.
• Limit excessive time spent watching TV, video, gaming, or surfing the web.
• Monitor the media that your children consume, particularly if they are under age 8.
• Encourage healthy eating habits (i.e., greater consumption of fruits, vegetables, whole grains, low-fat or non-fat milk or dairy products, lean meats, poultry, fish, and beans) and promote physical activity.
• Eat with your kids and take pleasure in your mealtimes together.
• Lead by example by eating healthy foods and engaging in physical activity yourself. Remember you can have the greatest influence on your children’s health.

Sources:

American Psychological Association (2009). Resolution on promotion of healthy active lifestyles and prevention of obesity and unhealthy weight control behaviors in children and youth. Washington, DC: Author. Retrieved from http://www.apa.org/about/governance/council/policy/chapter-12b.aspx#active-lifestyle.

Centers for Disease Control and Prevention (2009). Tips for parents – Ideas to help children maintain a healthy weight. Atlanta, GA: Author. Retrieved from http://www.cdc.gov/healthyweight/children/index.html

Ekeland, E., Heian, F., & Hagen, K. B. (2005). Can exercise improve self esteem in children and young people? A systematic review of randomized controlled trials. British Journal Sports Medicine, 39, 792-798.

Fulkerson, J. A., Strauss, J., Neumark-Sztainer, D., Story, M., & Boutelle, K. (2007). Correlates of psychosocial well-being among overweight adolescents: The role of the family. Journal of Consulting and Clinical Psychology, 75, 181-186.

Gable, S., Chang, Y., & Krull, J. (2007). Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of school-aged children. Journal of American Dietetics Association, 107, 53-61.