Anna Coates and Dr. Emma Boyland
Introduction
âObesogenic food environmentsâ are considered to be a key driver of increasing childhood obesity globally (Ng etal., 2014; Powell, Schermbeck, & Chaloupka, 2013; Swinburn etal., 2011; Wang & Lim, 2012). The promotional strategies used in the ubiquitous marketing of food and beverages high in fat, salt and/or sugar (hereafter referred to as âHFSS foodsâ) significantly contribute to these environments (WHO, 2010) and substantial evidence demonstrates the impact on younger childrenâs (12 years and under) dietary health (Boyland etal., 2016; Sadeghirad, Duhaney, Motaghipisheh, Campbell, & Johnston, 2016; WHO, 2016).
Children are viewed to be an important demographic target group by food marketers and are preferentially targeted to a greater extent than any other group (Linn, 2013; Montgomery, 2015). This is likely because children affect product sales in three ways (Story & French, 2004): (1) children have independent spending power (pocket money which is often spent on snacks and confectionery); (2) children influence family expenditure (parents who are accompanied by children to the supermarket are more likely to acquiesce to childrenâs demands, which are predominantly for branded HFSS products); and (3) children become adults, who are not only responsible for their own purchasing, but likely that of a complete family of their own. If brand loyalty is achieved during childhood, then a brand may benefit financially from that individual over the personâs full lifespan.
Young children have captured notable research interest due to concerns over their particular vulnerability to the effects of marketing (Ali, Blades, Oates, & Blumberg, 2009; Kelly, Vandevijvere, etal., 2015; Story & French, 2004). It is suggested that, unlike adults, young children are less cognitively able to understand the persuasive intent of advertising (Story & French, 2004), i.e. the knowledge that advertising presents the best attributes of a product (and withholds negative attributes) in order to encourage sales (Kunkel, 2001). Therefore, any advertising which is targeted towards children could be considered, on this basis, to be exploitative. Regulations tend to be designed to protect younger and not older children, but public health researchers have repeatedly called for government-led protection of all individuals as no one is immune to persuasive food marketing (WHO, 2018).
The World Health Organization (WHO) states that the impact of HFSS food marketing is a function of both the level of exposure (i.e. the reach and frequency of promotions) and the power (i.e. via the creative content of the message, e.g. design, execution and persuasive techniques) of that marketing to produce behavioural change (e.g. greater preference for the marketed product, increased consumption of unhealthy foods) (WHO, 2010). An overview of the evidence on the exposure, power and impact of broadcast marketing (i.e. television) and digital marketing (i.e. internet and social media) of HFSS foods to young children will be discussed.
In addition, traditional and contemporary psychological theories that may explain some of the observed behavioural effects will be explored, including Information Processing Approach (McGuire, 1976), Food Marketing Defense Model (Harris, Brownell, & Bargh, 2009) and Reactivity to Embedded Food Cues in Advertising Model (Folkvord, AnschĂŒtz, Boyland, Kelly, & Buijzen, 2016).
Television advertising of HFSS food
Exposure
Despite recent increases in childrenâs digital media consumption, television remains popular with children (Federal Trade Commission, 2012; Ofcom, 2016). In the UK, children (7â11 years) watch an average of 22 hours (12 hours commercial) of television per week (Boyland etal., 2018). A study that explored food advertising on UK television showed that children see an average rate of 3.5 food and beverage adverts per hour and that adverts for non-core food were shown most frequently (1.9 adverts per hour) (Whalen, Harrold, Child, Halford, & Boyland, 2017). This same study showed that the most heavily advertised foods were fast-food items (15.4%), followed by generic supermarket adverts (10.7%) and sugar-sweetened beverages (7.7%).
Childrenâs likely exposure to food advertising on television varies somewhat between countries (Kelly etal., 2010), but in any country is highly likely to involve exposure to a considerable amount of advertising of HFSS foods (Boyland, Harrold, Kirkham, & Halford, 2011; Kent & PauzĂ©, 2018; Royo-Bordonada etal., 2016). The most recent global study on television food advertising prevalence included data from Western Europe, North and South America, Asia and Australia (Kelly etal., 2010). Food adverts accounted for 11â29% of all adverts analysed. The majority (53â87%) of these adverts promoted HFSS foods and were predominantly shown during peak child viewing periods. In contrast, and inconsistent with national dietary recommendations, studies show a lack of, or complete absence of, adverts promoting fruit or vegetables (Powell etal., 2013; Whalen etal., 2017). This imbalance is reflected in the sizeable budgets of the food industry in comparison to health campaigns. For example, a total of ÂŁ143 million was spent by the largest HFSS product companies in the UK in 2017 (Obesity Health Alliance, 2017). This figure is 27 times larger than the amount that the UK Government spent on promoting healthy eating practices in the same year, estimated to be ÂŁ5 million (Obesity Health Alliance, 2017).
Power
Promotional techniques used in HFSS food advertising are based on extensive market research by the food and advertising industries and differ depending on the target market (Schor & Ford, 2007). For instance, toy giveaways and movie tie-ins are often used in fast-food television marketing aimed at young audiences (Bernhardt, Wilking, Gottlieb, Emond, & Sargent, 2014) but are less apparent in equivalent marketing targeted at adults (Bernhardt, Wilking, Adachi-Mejia, Bergamini, & Marijnissen, 2013). Frequently used techniques when marketing to children are premium offers (e.g. free gift, competitions and vouchers), promotional characters, celebrity endorsers, nutritional and health claims, and themes of âtasteâ and of âfunâ (Boyland, Harrold, Kirkham, & Halford, 2012; Jenkin, Madhvani, Signal, & Bowers, 2014).
Due to regulatory pressures, HFSS food manufacturers are increasingly engaging in a variety of health-promoting marketing initiatives (SĂŒtterlin & Siegrist, 2015), such as positioning HFSS products in the context of a âhealthy and balanced dietâ (Harris, Haraghey, Lodolce, & Semenza, 2018). One study identified foods featured in television advertisements as either âprimaryâ (the focus of the advert) or âincidentalâ and found that, when featured, incidental foods tended to be healthier than primary foods (Adams, Tyrrell, & White, 2011).
Another initiative is the use of health-related messaging. Implicit health claims (depiction of physical activity) and explicit health claims (health and nutritional messages), which one would expect to be used in promotion of healthy foods, were found most commonly in adverts promoting HFSS foods (Whalen, Harrold, Child, Halford, & Boyland, 2018). Marketers assert that depicting HFSS products in this way encourages children to maintain healthy lifestyles. However, research suggests they lead children to misinterpret foods (Bernhardt etal., 2014) and make poor judgements when making healthy food choices (Harris etal., 2018). For example, children who were shown a television advert for an HFSS breakfast cereal which depicted physical activity perceived the cereal as being healthier than children who were shown the same advert with no physical activity depicted (Castonguay, 2015). Also, children (7â10 years) exposed to adverts promoting âhealthyâ fast-food meal options (e.g. McDonaldâs Happy Meal with a fruit pack and mineral water) showed increased liking of fast food in general but did not choose healthier meal options from a fast-food menu (Boyland, Kavanagh-Safran, & Halford, 2015).
Impact
The impact of television HFSS food advertising on determinants of eating and childrenâs actual eating behaviour has been assessed using a multitude of behavioural measures. The range of outcomes of interest were conceptualised by Kelly etal. (2015) in the model shown in Figure 1.1; examples from many of these steps will be drawn for consideration in the current chapter.
Food, as a commodity, is one of the most highly branded items (Story & French, 2004). Food marketing often takes a brand-centred approach in order to build brand awareness and loyalty (Heath, 2009). From a very young age children display HFSS food brand awareness. An Australian study found that 76% of children (5â12 years) correctly matched at least one sport to the correct HFSS brand sports sponsor (Pettigrew, Rosenberg, Ferguson, Houghton, & Wood, 2013), which is concerning given that many sports events and teams are sponsored by fast-food companies. Brand awareness is an antecedent of brand preference, and children are shown to prefer the taste of foods served in branded packaging (McDonaldâs wrapping) in comparison with identical foods served in unbranded packaging (Robinson, Borzekowski, Matheson, & Kraemer, 2007). Children also prefer HFSS food brands that are endorsed by celebrities (Boyland etal., 2013; Smits, Vandebosch, Neyens, & Boyland, 2015) and have more positive attitudes towards foods featured in television adverts than those that are not (Boyland etal., 2016; Dixon, Scully, Wakefield, White, & Crawford, 2007; Sadeghirad etal., 2016).
A review of studies looking at the effect of HFSS food advertising on childrenâs product requests found that the majority showed exposure increased requests for advertised products (McDermott, OâSullivan, Stead, & Hastings, 2006). Importantly, a large-scale study using data from eight European countries linked childrenâs (2â9 years) requests for HFSS foods to overall diet and body weight (Huang etal., 2016). Specifically, children who âoftenâ requested these items were 31% more likely to have overweight (when weighed at a 2-year follow-up) than children who âneverâ requested products, suggesting that overweight children may be more susceptible to food advertising than normal-weight children (Russell, Croker, & Viner, 2018). Collectively these studies demonstrate how HFSS food advertising contributes to childrenâs poorer dietary health. Parents would support changes to the âobesogenic food environmentâ that could lessen in...