When discussing food and beverage
marketing and advertising to children, it is important to distinguish between these terms. In this context, the World Health Organization ( WHO 2012) has defined marketing as 'any form of commercial communication or message that is designed to, or has the effect of, increasing the recognition, appeal and/ or consumption of particular products and services. It comprises anything that acts to advertise or otherwise promote a product or service'. Advertising, on the other hand is the 'paid public presentation and promotion of ideas, goods, or services by a sponsor that is intended to bring a product to the attention of consumers through a variety of media channels such as broadcast and cable television (TV), radio, print, billboards, the Internet, or personal contact', according to the definition ( Principles of Marketing 2008) adopted by the WHO (WHO 2012) and the Institute of Medicine (IoM) of the United States National Academy of Sciences, Engineering and Medicine ( IoM 2006). Advertising therefore is only one form of marketing. Integrated marketing campaigns employ a range of techniques across different media platforms, designed to assure that all activities produce a unified and customer-focused promotion message. This may include sponsorship, product placement and branding, direct marketing, product design and packaging, and point-of sale promotions. An example of an integrated marketing strategy would be a food brand with an on-pack promotion of a multi-platform (PC, mobile phone) brand-promoting game ( advergame), accompanied by a YouTube video that promotes the branded game and opportunities to share game scores on Facebook and Twitter ( WHO 2013a).
As far as the term
children is concerned, the United Nations Convention on the Rights of the Child ( UN 1989) defines children as 'every human being below the age of eighteen years unless, under the law applicable to the child, majority is attained earlier'. More specific to marketing though, WHO ( WHO 2012) recommends that policy-makers consider local policy in defining the age of children, and that the impact of marketing is not limited to only young children who do not recognise its persuasive or selling intent.
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Examples of marketing strategies used in food and beverage product marketing can be seen in Table 1. A marketing communication is based on two main elements: i. the communication channels, which influence the exposure to a specific marketing message, in turn dependent on its reach and its frequency, and ii. the content of the communication message, including the creative strategies used, which influences the power ( WHO 2012) of the marketing communication. As a result, the effectiveness of a marketing communication depends on both its exposure and power; these are also the main elements targeted by the various policy recommendations and implemented policies designed to address the issue of food marketing to children.
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There have been few published reports from international organisations and authoritative institutions in recents years quantifying the exposure of children and adolescents to marketing, especially in the EU. Reports
IoM 2006, WHO 2013a, FSA 2003, WHO 2007a, WHO 2009, OfCom 2004, OfCom 2006, EHN 2005 (from 2003 to 2013) from both the EU and the US indicate that: i) the majority of food marketing targeted at children and teenagers (via TV and online channels) referred to advertisement of high-calorie, low-nutrient quality foods, high in fats, sugar and salt (HFSS), with under-representation or absence of advertisement for fruits and vegetables; ii) most food advertising referred to sugary breakfast cereals, confectionary, high fat savoury snacks, soft drinks and quick service restaurants; and iii) the advertised foods are at odds with those recommended for a healthy diet.
According to the 2013 WHO report (
WHO 2013a), TV advertising still remained the main medium for food marketing in the EU, although a decline in TV advertising expenditures with a parallel significant increase in internet and digital marketing was observed. Reduced expenditure on TV advertising does not automatically mean reduced exposure however, since for example digital applications can give access to a large number of customers with relatively less monetary investment ( WHO 2013a).
Mirroring the EU marketing trends, the 2012 US Federal Trade Committee (FTC)
report found reduced (approx. 20%) TV advertising expenditure and increased (approx. 50%) advertising expenses in online mobile and viral marketing media between 2006 and 2009 ( a FTC 2012). US$1.79 billion was spent on food and non-alcoholic beverage advertising to children and teenagers in 2009, 72% of which was for the advertisement of quick-service restaurants, carbonated beverages and breakfast cereals. Data from 2014 showed that fast-food and other restaurants, candy, snacks, and carbonated beverages were still the top advertised food categories seen by children and adolescents, amounting to 60% and 66% of all food advertisements, respectively. The ratio of fruit and vegetable to fast-food and candy advertisements was 1:13 and 1:14 ( Yale Rudd Center 2014).
Children interact increasingly with social media, including platforms that are not child-specific, and although data is limited, studies confirm that children are reached by and interact with food and non-alcoholic beverage marketing in social media (
WHO 2016). A worrying trend has also been observed; parents are largely unaware of the amount of HFSS food marketing that children and adolescents are exposed to online.
Beyond TV and online media, children and adolescents are also exposed to marketing techniques in other settings. As an example, recent findings (
Velazquez C.E. et al 2017) suggest that children in the US, and to some extent in Canada and Europe, are exposed at schools to a significant amount of marketing of foods and beverages, which are at odds with those recommended for a healthy diet. The US Federal Trade Committee is responsible for engaging stakeholders and encouraging effective self-regulatory initiatives in food marketing. The FTC can obtain food-marketing related data (e.g. expenditures) from the private industry via compulsory process orders. a
Power, in the context of specific content creative strategies used, is critical to the impact that marketing communications can have. For example, reports that have examined how the age of a child relates to their susceptibility to marketing techniques consistently identify that children <8 yrs have limited ability to recognise the persuasive intent of advertising in commercial communications, making food marketing targeted at them to be particularly effective (
IoM 2006, WHO 2008, CAP 2014, WHO/FAO 2003). Additionally, children ≤ 4 yrs. cannot discriminate between advertising and other content of TV programmes; however, it was not possible to conclude whether this alters the way that food and beverage marketing can influence children ( IoM 2006).
In TV-advertisement, the most commonly reported persuasive techniques to promote food to children were use of premium offers, promotional characters, nutrition and health-related claims, themes of taste and the emotional appeal of fun (
Jenkin G. et al 2014). Marketing techniques such as brand mascots and cartoon media characters are broadly used to sell food products aimed at children. Findings suggest that cartoon media character branding can increase children's fruit or vegetable intake, when compared with no character branding. However, branding with characters familiar to children also appears to be a more powerful influence on children preferences, choices and intake of less healthy foods, when compared with fruits and vegetables ( Kraak V. I. et al 2015).
Digital marketing may augment the effects of traditional marketing practices by 'identifying and targeting more vulnerable populations with sophisticated analytics and creating engaging, emotion-focused, entertaining ways to reach children', and this has been found to occur with brands featuring HFSS products (
Millennial children appear more likely to have a better understanding of online marketing content, potentially buffering negative online food marketing effects, according to more recent data (
). However, it has also been noted that children’s understanding of the persuasive intent behind online marketing may develop at a later age, compared with other forms of marketing, perhaps due to its integrated nature (
). Nonetheless, even if the persuasive intent of advertising is recognised, this does not necessarily grant immunity to its influence, even in older children and adults. For example, adolescents, appear to be incapable to defend effectively against the immediate appeal of advertising (
Yale Rudd Center 2015
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Impact of food marketing refers to the effect that marketing has on people, in terms of changes to food knowledge, attitudes and behaviour, and to nutrition and health outcomes. A number of national and international institutions have examined the impact of food marketing on children. Most adopted a tiered approach and questioned whether food marketing could affect i) nutritional knowledge and food preferences, ii) effects on short food consumption and longer-term diet, and iii) impacts on health. Their findings, summarised in Table 2, illustrate that food marketing can influence children's food preferences, diet and health, albeit with different magnitude and strength of supporting evidence. Less data is available for adolescents, or on the effects of internet and digital technologies-based marketing.
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Given the potential impacts of food marketing to children, WHO has stated the importance of discouraging marketing practices that promote unhealthy dietary practices, urging national governments to develop multi-sectorial approaches to achieve this (
WHO 2004, WHO 2007b). Additionaly, policies to reduce the impact of food and non-alcoholic beverages high in saturated fats, trans fatty acids, free sugars, or salt, is one of the 25 indicators in the WHO Global NCD Action Plan 2013-2020 ( WHO 2013b).
In 2010, the WHO proposed a set of specific recommendations (
WHO 2010) aimed at reducing marketing (exposure and power) of HFSS foods to children, followed up in 2012 by a specific implementation framework ( WHO 2012).The WHO framework addresses policy development, implementation, monitoring and evaluation.
For policy development, WHO recommends that responsible ministries of health or other designated bodies establish a working group on food marketing to children and include representatives from multiple governmental departments, agencies and bodies. This government-led working group should also dialogue with a broader stakeholder group, e.g. civic society, academia, legislators, the private sector and the advertising/media industry, while protecting public interest and avoiding conflicts of interest. Policy development should thoroughly analyse the marketing environment, and clearly specify policy targets such as age groups, communication channels, marketing techniques etc. Selecting the appropriate approach is key for policy development; a comprehensive approach for example would aim at limiting all forms of marketing of HFSS foods, or limiting marketing of any foods or even marketing of any product to children. A stepwise approach on the other hand could set specific limits on marketing (e.g. target population, media involved, and times of programme transmission) and/or restrict specific marketing techniques (e.g. licensed characters). The choice of a comprehensive or stepwise approach is dependent on national circumstances and resources.
On policy implementation, WHO recommends considering a range of available options, e.g. using statutory regulation, focusing on government led or approved self-regulation of industry, or other options, such as a combination of legislation and self-regulation or non-binding state guidelines. Another important issue to consider is cross-border marketing, and the co-operation between governments as well as global actors that will be required to reduce its impacts. Other WHO recommendations on policy implementation address the need to clearly define stakeholder roles, and how to effectively monitor and if necessary enforce the policy.
Concerning digital marketing in particular, and given the borderless nature of the internet and the resulting jurisdictional and regulatory challenges, WHO recommends coordinated regulation across countries and supra-national bodies such as the EU, by introducing cross-border restrictions, (e.g. on advertising, promotion, sponsorships), irrespectively of whether the target audience of the marketing message is in the same country as the source of the marketing message (
WHO 2016). Additionaly, WHO suggests a range of policy specifications addressing HFSS digital marketing to children. For example, regulation of digital HFSS marketing to children should be independent of HFSS producers and the advertising or media industries, offline protection mechanisms should be extended online, define a legal age for digital HFSS marketing (e.g. minimum age of 16), compel internet platforms to remove marketing of HFSS foods etc. Finally, among recommendations for further research and action, WHO calls on food companies to disclose marketing spending activities for HFSS foods, including expenditure on social media, online videos and mobile campaigns ( WHO 2016).
Apart from WHO various other scientific and public health organisations have issued recommendations, primarily to introduce statutory regulation, for policy makers aiming to reduce the negative effect of food advertising to children (Table 3). In the EU, the European Commission’s White Paper on a strategy for Europe on Nutrition, Overweight and Obesity related health issues, recognised the power of marketing on consumer behaviour, diet and health (
COM 2007). The White Paper highlighted the various Member-State level approaches and the importance of self-regulatory voluntary efforts by the food industry at an EU level. These approaches are strengthened and complemented by a code of conduct for advertising of HFSS foods by the Audiovisual Media Services Directive (see Table 4). Table 3. Examples of policy recommendations addressing food and non-alcoholic beverage marketing to children and adolescents
In addition to the WHO ones described in the text.
Restrict or eliminate marketing of certain foods a Adopt an international code on marketing of foods and non-alcoholic beverages. No marketing to children of HFSS foods and associated brands. Categorise HFSS foods based on nutrient profiling in line with FAO/WHO Report ( WHO/FAO 2003). Restrictions should include, but not limited to, all advertisements between 06:00 and 21:00. Restrict indirect advertisement of energy dense, nutrient poor HFSS foods to adults responsible for children. Introduce legislation to limit the marketing and advertising of low-nutrient, high calorie foods and beverages. Only allow advertisement of 'healthy' foods (fruit, 100% fruit juice, vegetables, low-fat dairy and whole grain) that meet AHA criteria for CVD risk. b Allow licensed characters only for 'healthy' food advertising. Discourage product placement of low-nutrient, high calorie food brands in multiple media. No partnerships between toy and fast-food companies. Exclude advertising, marketing and brand awareness strategies from school environments.
Promote health diets a Advertising should include positive messages for 'good' nutrition. Food manufacturers and restaurants should use their creativity, resources, and full range of marketing practices to promote and support more healthful diets. Media and entertainment industry should promote healthful foods and beverages. Educational authorities and stakeholders should promote healthful diets in all aspects of school environment.
Provide information a Develop new standards in nutritional content, food labelling. Regulate nutritional labelling and health claims.
Monitor a Government should designate a responsible agency with necessary resources to formally monitor progress of recommendations Based on the Nuffield intervention ladder as described in Public Health: ethical issues from the Nuffield Council on Bioethics Nov 2007 a The adjective 'healthy' or 'unhealthy' to characterize a specific food or a food category is reported here as used in the original source of information and could have different meanings. WHO states that unhealthy foods can be defined in various ways, such as using national food-based dietary guidelines, or as identified in expert reports such as b Diet, Nutrition and the Prevention of Chronic Diseases, WHO Technical Report 916.
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Countries around the world have adopted different measures (Table 4) to limit the effects of food marketing to children and adolescents, from legally binding obligations to industry self-regulation and stakeholder co-operation platforms.
Most national legislation relates to advertising restrictions of HFSS foods to children or adolescents in broadcast or non-broadcast media, as well as restriction of food advertising in schools. Some countries expand mandatory restrictions to advertising across any kind of media and marketing techniques such as product placement, sponsorship and the use of licensed characters.
Most of the industry self-regulatory initiatives apply mainly to advertising via broadcast media (TV, radio), but some also expand to cover printed media, company websites or 3
party internet resources, and often address marketing in the school environment. rd