Marketing to children: implications for obesity
Dr. Pamela Mason, Nutrition Researcher, The Rectory, Gwernesney, Usk, Monmouthshire NP15 1HF, UK. E-mail: email@example.com
University College London 7 June 2011
On 7 June 2011, the Association for the Study of Obesity held a conference at the University College London on marketing to children and the implications for obesity
Introducing the conference, Dr Jason Halford (Director of the Kissileff Laboratory for the Study of Human Ingestive Behaviour, University of Liverpool) said that the conference topic of marketing to children was timely given the Public Health Responsibility Deal and the general changes to health outlined in the Public Health White Paper, Healthy Lives, Healthy People. The regulatory environment is being considered globally with even more activity outside of the UK than within. For example, in 2010, the World Health Organization (WHO) produced a set of recommendations on the marketing of foods and non-alcoholic beverages to children (WHO 2010). According to Dr Halford, the UK Ofcom regulation introduced in 2009 is considered to be the ‘gold standard’ in this area, but has not been effective at reducing the promotion of high-fat, sugar and salt (HFSS) foods during children's peak viewing times.
Children's understanding of advertisements
The first presentation was given by Dr Mark Blades (Department of Psychology, University of Sheffield) on the topic of children's understanding of advertisements. Children are an important and significant market for the food industry. In the United States, Dr Blades' figures suggest that children under the age of 12 spend $30 billion a year in direct food purchases and influence $250 billion in family spending. Children have been found to spend their money on a narrow range of products, including food and drinks and also games and associated hardware. Advertising is a multi-billion dollar industry, indicating effective marketing. However, advertising to children raises a number of concerns, especially advertising that advocates unhealthy lifestyles.
Marketing may be aimed at children who, depending on their age, might not understand the basis of advertising. It could be argued that it is unethical to advertise to those who are unaware of the meaning of advertising. The number of television advertisements seen by an average child in the UK is estimated to be around 18 000 per child per year, compared with 40 000 in the United States and 16 000 in China. Children's ability to understand advertisements is often described in two stages: first is the ability to distinguish advertisements from non-advertisements, second is the understanding that the advertisement has a persuasive intent. Research conducted in the United States nearly 30 years ago (Levin et al. 1982) and repeated more recently by Dr Blades (in press) showed that children can distinguish television advertisements from television programmes by about the age of 6 years. However, at this age, children have no awareness that advertisements are trying to sell them a product. It is only after about 8 years of age that children become aware that the purpose of advertisements is to sell a product, i.e. that advertisements have a persuasive intent. These ages have generally been agreed in the research literature. However, the existing research has been based almost entirely on assessing children's understanding of television advertising and it may be that this understanding has been overestimated in two ways. Firstly, even with regard to traditional media such as television, children may remain naïve and trusting about the nature of such advertising for many years after the age of 8. Secondly, advertising in newer media (e.g. the Internet) has received little attention from researchers and almost nothing is known about how children's understanding of advertising in new media develops. Identifying what is and what is not an advertisement is the first step in realising that an advertisement is a marketing message.
Dr Blades went on to say that little research has been carried out with regard to advertisements in other media, even though new media, especially the Internet, has become an important channel of marketing to children. In two experiments, a total of 401 children, aged 6, 8, 10 and 12 years of age, from the UK and Indonesia, were shown printed copies of invented web pages that included advertisements. Six-year-olds recognised a quarter of the advertisements, 8-year-olds recognised half the advertisements, and the 10- and 12-year-olds recognised about three-quarters. Only the 10- and 12-year-olds were more likely to identify an advertisement when it included a price (Ali et al. 2009). Blades suggested that these findings infer that children may be poorer at recognising advertising on the Internet in comparison with television advertising. Web marketing blurs the distinction between advertisements and non-advertisements. Web advertisements are difficult to separate from web content, with advergames (advertising combined with games) being very similar to computer games and including brand names, as well as product placement, viral marketing and sponsorship. No research to date has examined when children may be able to identify advertising of this type.
Dr Blades went on to discuss interventions that might help children to better understand the nature of advertising and the limitations of such interventions. Marketers emphasise the right to advertise, but research has shown that parents are generally negative about advertising to children mainly because of pressure on the parent to buy things (Young et al. 2003). This suggests that parents may be motivated to help children understand advertising, but the difficulty is that parents may not know what their children are watching. Parents also seem to overestimate their children's abilities to understand advertisements so they do not tend to intervene. Parents may therefore need to be better educated, and media literacy programmes designed specifically for children might help to create a better awareness of advertising amongst young people.
Implicit processing of brand images
The second presentation given by Professor Charlie Lewis (Department of Psychology, University of Lancaster) continued to look at children's understanding of advertising, particularly in new media. Professor Lewis asked why attempts to promote healthy eating among children are less successful than those used to promote less-healthy food. In addition to the differences in the amount of money spent on advertising of healthy compared to less-healthy food, differences exist in the way each type of advertisement attempts to change consumer behaviour. Department of Health campaigns like Change4Life and 5 A DAY promote explicit awareness of the benefits of consuming healthy foods, but most UK children still fail to consume sufficient fruit and vegetables and childhood obesity continues to rise. In contrast, marketers often target children with unhealthy food products using covert interactive techniques, particularly advergames and in-game brand placement.
By embedding brands within entertainment, these strategies exert a powerful implicit influence on children's memory and choices, typically without explicit awareness of advertising exposure. Professor Lewis went on to describe some of his own studies that have examined the implicit vs. explicit influence of product placement in films and video games on children. In one study, children of two different age groups (6–7 years and 11–12 years) were exposed to a brief film in the classroom. They were asked to describe as much as possible about what they had seen. Half of each class was shown a clip of Home Alone in which Pepsi was spilled and the other a similar clip with no branded products. All the children were invited to help themselves to Pepsi or Coca-Cola before being interviewed. Those who had seen the branded clip made a significantly different choice of drink being more likely to select Pepsi over Coca-Cola. The responses to the interviews suggested that it is not simply exposure to the film, but rather previous exposure together with a reminder in the form of recent exposure that affects choice. Age did not appear to be a mediating factor affecting choice, as mere exposure seems to be more important than explicit recall (Auty & Lewis 2004).
These findings reveal implicit influences of advertising on children's food and other product choices, often without explicitly recalling exposure to an advertisement. Professor Lewis concluded by saying that models serving to increase explicit awareness of good nutrition may thus prove ineffective, unless they use the same marketing techniques.
Influence of the extent of TV exposure on eating behaviour
Dr Emma Boyland (Kissileff Laboratory for the Study of Human Ingestive Behaviour, University of Liverpool) discussed the relationship between television viewing and dietary habits among children. She said that recent data suggests that this relationship is mediated by the commercial content of television viewing.
She described a series of within-subjects, counterbalanced design studies used to investigate the effects of television food advertising on food preference and intake in children. In the most recent of these studies (Boyland et al. 2011a), the aim was to determine if levels of television viewing (a proxy measure for habitual commercial exposure) affect children's food preference responses to television food commercials. A total of 281 children aged 6-to-13-years from north west England viewed toy or food television commercials followed by a cartoon on two separate occasions; they then completed three food preference measures, a commercial recognition task and a television viewing questionnaire. After viewing the food commercials, all children selected more branded and non-branded fat-rich and carbohydrate-rich items from food preference checklists compared with after viewing the toy commercials. The food preferences of children with higher habitual levels of television viewing were more affected by food commercial exposure than those of low habitual television viewers. After viewing food commercials, children who were high television viewers selected a greater number of branded food items than after watching the toy commercials and selected more branded items compared with children who were low television viewers. Both children with high and low television viewing correctly recognised more food commercials than toy commercials.
Another study by a research group in Liverpool (Halford et al. 2008), set out to investigate the effect of television food advertising on children's food intake, specifically whether childhood obesity is related to a greater susceptibility to food promotion. Fifty-nine children, of whom, 33 were normal weight, 15 were overweight and 11 obese, took part. The children were tested on two occasions separated by 2 weeks. One condition involved the children viewing food advertisements followed by a cartoon; in the other condition, the children viewed non-food adverts followed by the same cartoon. Exposure to food adverts produced substantial and significant increases in energy intake in all children (P < 0.001). The increase in intake was found to be largest in the obese children (P = 0.04). All children increased their consumption of high-fat and/or sweet energy-dense snacks in response to the adverts (P < 0.001). In the food advert condition, total intake and the intake of these specific snack items correlated with the children's modified age- and gender-specific Body Mass Index (BMI) score. These findings suggest that obese and overweight children may be more susceptible to food promotion, which specifically stimulates the intake of energy-dense snacks.
In another recent study, the same group in Liverpool examined the nature and extent of food advertising appearing on UK television in 2008 following implementation of the new regulations intended to limit children's exposure to the promotion of products high in fat, sugar and/or salt (Boyland et al., 2011b) There were 147 672 adverts appearing in 2008 overall, of which, 18 888 (12.8%) were for food. Food was the third most advertised category behind channel promotions and toys. Of the food advertisements, the most frequently broadcast were advertisements for supermarkets (12.3%), fast food (11.9%) and high-sugar breakfast cereals (9.4%). A greater proportion of the advertisements during peak times were for food, compared to non-peak times (P < 0.001) and the proportion of non-core foods (such as biscuits, crisps, chocolate and other snacks) advertised (56%) was greater than that of core foods (18.1%, P < 0.01). Data from this study indicate that advertising during both children's and family TV schedules remains largely for ‘unhealthier’ foods and this is no better than non-peak viewing (i.e. there is little evidence of children being specifically protected). The adverts for children and adults differed in theme rather than the nutritional value of the products promoted. Further analysis reveals that these products and restaurant experiences were marketed to children on themes of fun and taste. Large year-long multi-channel datasets such as this Liverpool 2008 data provide a unique resource that can be used to model the impact of nutrient profiling and regulatory frameworks. To date, no objective monitoring system has been sanctioned, but these data indicate that such monitoring is necessary to enable the tracking of changing marketing practices in response to increasing scrutiny and to determine compliance with regulation.
Quantification of the impact of food advertising on diet and health
Dr Georgina Cairns (Senior Lecturer, Stirling Management School, University of Stirling) gave a presentation on the impact of food advertising on diet and health. Policy in relation to advertising needs to be informed by evidence, though it is difficult for evidence to keep up with promotional activity. Food marketing is a prominent, ubiquitous feature in children's lives with food promotions tending to be predominantly for energy-dense foods with a relatively low micronutrient content (Cairns et al. 2009). Food marketing affects preference, understanding and purchasing habits as well as consumption (Hastings et al. 2003; Hastings et al. 2006; McGinnis et al. 2006; Cairns et al. 2009). A correlation between marketing and health outcomes has also been confirmed (McGinnis et al. 2006). The weight of evidence is strongest for short-term effects and for the effects of marketing on the most proximal outcomes, particularly purchasing habits.
Mediation analysis has demonstrated that the variables influencing food choices and behaviours are multiple, complex and interlinked and outcomes are manifested over prolonged timelines (Glanz et al. 2005; Livingstone 2005; Moore & Rideout 2007). A better understanding of the effects of food marketing on long-term outcomes and direct effects, such as food norms, heuristic food choices and food behaviours is needed, as is more insight into how the effects of marketing are mediated. New and innovative marketing methods, channels and strategies evolve quickly. Interactive digital marketing, for example, is rapidly overtaking broadcast media as the dominant promotional media. Empirical research on the impact of marketing lags behind current practice. Most published research to date has measured direct effects of marketing only and tested the effects of TV advertising, with only a few studies examining new channels and strategies, such as interactive digital promotions.
Effective and proportionate policy development with regards to health, the food supply chain and marketing requires relevant contemporary evidence. The Government's Foresight Report on Obesity suggests that much of this information must be derived from practice rather than from empirical research (Egger & Swinburn 1997; Go-Science, 2008; Cairns 2009). The methodology used in other policy areas offers insights into how this might be achieved and is already being used to support and inform obesity prevention policy to a limited degree. For this to be adopted more widely, it needs the commercial sector and the academic sector to develop concrete actions including appropriate research methodologies, new forms of data sharing and a willingness to engage within a framework of validated objectives and performance indicators.
NGO perspectives on food marketing to children in the UK
Jane London, Deputy Chief Executive of the National Heart Forum, discussed the perspective of non-governmental organisations (NGOs) on food and drink marketing to children. Key issues for NGOs active in this area include freedoms and fairness, protecting children, supporting parents and defending broader initiatives to promote health and wellbeing. Health, child welfare and consumer groups also have a role in building the evidence base, raising awareness, reflecting public opinion, developing advocacy goals and shaping policy on the marketing of foods to children.
Non-governmental organisation engagement with this issue is motivated on the one hand by concerns about the adverse dietary health impacts of promoting HFSS foods, and on the other hand, by the need to protect the rights of vulnerable consumers, including children and their parents. Many NGOs see the control of HFSS food and drink marketing as a crucial part of a wider campaign to improve children's dietary health and wellbeing that also includes improving school food, cooking skills, food labelling and education about healthy eating.
Ms London went on to explain that recent NGO activity has focused around four key types of food marketing to children: television advertising, non-broadcast marketing in digital media, packaging (including the use of licensed characters and cartoons) and nutrition claims and sponsorship (including branding and sports events).
Firstly, with regards to television advertising, NGO analyses of the nature and frequency of TV adverts for HFSS foods dates back to the early 1990s. A broad consensus exists among public interest organisations that food and drink advertising should be restricted during programmes popular with children. In the UK, this is advocated as a restriction on HFSS food and drink advertising before the 9:00 p.m. watershed. Non-governmental organisations were actively involved in the process leading up to the development of the Ofcom rules on TV advertising, backing the use of the Food Standards Agency's nutrient profiling model to differentiate HFSS foods from non-HFSS foods and successfully arguing for restrictions to apply to children up to the age of 16 years.
Secondly, considering digital media, restrictions on food marketing in regulated media have shifted marketing effort into less-regulated media. There has been significant growth in marketing via website advergames and social networking sites, such as Facebook. New rules introduced in 2011 extend the UK self-regulatory advertising rules to these media but NGOs have identified definitional limitations, which mean that many of the marketing examples seen in digital media are not covered by the new rules.
Thirdly, when it comes to packaging, brands which seek to appeal to children rely heavily on the creation of fun characters, cartoon imagery and associations with films or music on the product packaging. Non-governmental organisations have highlighted the gaps in the regulatory regimes, which mean that what appears on the packaging is not controlled by relevant rules on advertising. Non-governmental organisation surveys have shown that this gives rise to a situation where almost exclusively HFSS products are marketed to children with cartoon characters. Non-governmental organisations have also been instrumental in challenging misleading claims on packaging to promote nutritional or health benefits of children's products to parents.
Fourthly, sponsorship is another largely unregulated area of food and drink marketing, including the use of brand sponsorship of sports or cultural events. Major sporting events such as the Olympics reinforce the association between sport and HFSS foods and drinks. Non-governmental organisation surveys have found that there is public support for breaking the link between sport and unhealthy brands and there have been NGO initiatives to develop principles and guidance for schools and public sector organisations to avoid inappropriate associations between HFSS brands and sporting events popular with children.
Marketing to children: principles, policy and practice
Dr Tim Lobstein, Director of Policy, International Association for the Study of Obesity (IASO), discussed the range of marketing techniques being used by food and beverage companies to attract children's attention with a consideration of the last 10 years of action to bring this marketing under control. The drive for change has come largely from NGOs concerned with health and consumer rights, and the issues have been given an extra impetus by the dramatic rise in obesity among children in virtually all developed economies and increasingly in emerging and underdeveloped economies as well.
The policy response can be summarised as ranging from ‘do nothing’ through industry self-regulation and government-led voluntary measures to statutory law. A review of international regulations carried out as part of the PolMark (POLicies on MARKeting foods and beverages to children) project suggested that successful regulation requires government-led guidelines with timelines and clear objectives (IASO 2010). However, stakeholders do not agree with this view – some prefer to continue with industry-led voluntary measures, while others see the need for tougher statutory measures.
The industry response in the last few years has often been to offer a series of pledges around their marketing activities directed at children. The terms are ambiguous and the success of their pledges in reducing children's exposure questionable. Dr Lobstein went on to describe the set of principles developed in the recent European Union-funded STANdards for MARKeting foods and beverages to children (StanMark) project (IASO 2011). These entail the following:
- • a risk-based approach, allowing the promotion of fruit and vegetables, but prohibiting the marketing of foods and beverages high in saturated fat, trans fat, sugars and salt;
- • risk reduction, reducing the exposure and the power of marketing messages for such foods received by children;
- • children are persons who have not yet reached an age when they are legally considered to be competent to protect their own welfare;
- • foods to be promoted are those which conform to national and international dietary guidelines, supporting the WHO Global Strategy to prevent obesity and chronic diseases;
- • marketing media are those which carry marketing messages, including packaging materials and, product formulation, presentation and sponsorship at sports events;
- • marketing techniques include all techniques with appeal to children and adolescents;
- • non-specific brand promotion should be assumed to be prohibited unless the message is specifically and only for permitted products;
- • marketing locations include retail and catering outlets and settings where children may be exposed – that is, where children gather (schools, play areas);
- • accountable bodies are those with a duty of care in the marketing process, including media distributors, web hosts and Internet service providers.
Research presented during the conference showed that young children may not be able to identify advertising, particularly in new media (e.g. on web pages and social networking sites), but they are influenced by it and advertising can shift attentional bias to food. Attempts have been made during the last decade, largely by NGOs, to control the marketing of food and beverages to children. The different policy proposals for restricting marketing to children need to be scientifically assessed, as does the policy-making process itself. This may provide exciting opportunities for further research.