Reducing children’s exposure to unhealthy food marketing is crucial to combat childhood obesity. We aimed to estimate the reduction of children’s exposure to food marketing under different policy scenarios and assess exposure differences by socio-economic status.

Data on children’s exposure to unhealthy food marketing were compiled from a previous cross-sectional study in which children (n 168) wore wearable cameras and Global Positioning System (GPS) units for 4 consecutive days. For each exposure, we identified the setting, the marketing medium and food/beverage product category. We analysed the percentage reduction in food marketing exposure for ten policy scenarios and by socio-economic deprivation: (1) no product packaging, (2) no merchandise marketing, (3) no sugary drink marketing, (4) no confectionary marketing in schools, (5) no sugary drink marketing in schools, (6) no marketing in public spaces, (7) no marketing within 400 m of schools, (8) no marketing within 400 m of recreation venues, (9) no marketing within 400 m of bus stops and (10) no marketing within 400 m of major roads.

Wellington region of New Zealand.

168 children aged 11–14 years.

Exposure to food marketing varied by setting, marketing medium and product category. Among the ten policy scenarios, the largest reductions were for plain packaging (60·3 %), no sugary drink marketing (28·8 %) and no marketing in public spaces (22·2 %). There were no differences by socio-economic deprivation.

The results suggest that plain packaging would result in the greatest decrease in children’s exposure to food marketing. However, given that children are regularly exposed to unhealthy food marketing in multiple settings through a range of marketing mediums, comprehensive bans are needed to protect children’s health.

Food advertising is an important determinant of unhealthy eating. However, analysing a large number of advertisements (ads) to distinguish between food and non-food content is a challenging task. This study aims to develop a machine learning-based method to automatically identify and classify food and non-food ad videos.

Methodological study to develop an algorithm model that prioritises both accuracy and efficiency in monitoring and classifying advertising videos.

From a collection of Brazilian television (TV) ads data, we created a database and split it into three sub-databases (i.e. training, validation and test) by extracting frames from ads. Subsequently, the training database was classified using the EfficientNet neural network. The best models and data-balancing strategies were investigated using the validation database. Finally, the test database was used to apply the best model and strategy, and results were verified with field experts.

The study used 2124 recorded Brazilian TV programming hours from 2018 to 2020. It included 703 food ads and over 20 000 non-food ads, following the protocol developed by the INFORMAS network for monitoring food marketing on TV.

The results showed that the EfficientNet neural network associated with the balanced batches strategy achieved an overall accuracy of 90·5 % on the test database, which represents a reduction of 99·9 % of the time spent on identifying and classifying ads.

The method studied represents a promising approach for differentiating food and non-food-related video within monitoring food marketing, which has significant practical implications for researchers, public health policymakers, and regulatory bodies.

To establish the relationship between the marketing strategies and nutritional quality of foods and beverages promoted in television food advertisements (TV ads) seen by Colombian child audiences overall and based on child gender and socio-economic strata (SES).

A quantitative content analysis of marketing appeals was combined with nutritional data of the food products advertised and matched with TV audience ratings data for each food and beverage ads for Colombian children between 4 and 11 years.

All beverages and foods TV ads cable or over-the-air channels in Colombia in 2017.

N/A.

Compared with rational appeals (e.g. freshness, health or nutrition messages), emotional appeals (referencing or depicting human senses or emotions, e.g. using cartoons to suggest fun) were more frequently used in the TV ads most viewed by Colombian children. Female children and children in lower SES tended to be more exposed to emotional appeals in TV ads than their male or higher SES counterparts. Furthermore, TV ads using more emotional appeals tended to be for products high in problematic nutrients.

The findings of this study highlight the need to implement statutory measures to reduce the deleterious effect of food marketing on children.

To analyse food advertised on an online food delivery (OFD) platform during 16 weeks of the COVID-19 pandemic in Brazil.

Longitudinal study. We randomly selected foods advertised on the OFD app’s home page, classifying the food items into: water; natural juices and smoothies; vegetables; fruits; traditional meals and pasta; ultra-processed beverages; ice cream, candies, and salty packaged snacks; sandwiches; savoury snacks; and pizza. We also registered the marketing strategies used to promote the food items, such as photos, discounts, ‘combo deals’, and messages on healthiness, value for the money, tastiness, and pleasure.

Belo Horizonte, Minas Gerais, Brazil.

1593 food items.

In general, the OFD platform most commonly promoted traditional meals and pasta, ultra-processed beverages, and sandwiches – these food groups were offered 20–25 % of the time during the 16 weeks. There were no promotions for water during the whole period, and the least common promotions were those for natural juices and smoothies, vegetables, and fruits (< 5 %). The most common food promotion strategies were photos (> 80 %) and discounts (> 95 %), while approximately 30 % of the offers featured combo deals. Messages on tastiness, pleasure and value for the money varied from 15 % to 40 %.

Although the OFD platform offered traditional meals and pasta, most of the foods and beverages advertised were unhealthy and promoted with persuasive strategies. This finding highlights a growing public health concern: an increase in unhealthy eating patterns during the pandemic.

To investigate the advertising patterns on the posts of a fast-food chain in Brazil on three social media platforms in 2019.

An exploratory cross-sectional study.

Advertising strategies on the posts of a major fast-food chain on their official Facebook, Instagram and YouTube accounts. The strategies were investigated according to the INFORMAS protocol for food promotion monitoring. Principal component analysis (PCA) was employed to identify advertising patterns in each platform.

305 advertisements

Four advertising patterns were identified in the PCA of Facebook and Instagram. In both platforms, the components for kids and product exaltation were similar. On Facebook, a pattern corresponding to economic appeal was identified as price and discount, while on Instagram, this pattern also included a practical approach. On Facebook, the fourth component was named celebrity, while on Instagram it was celebrity/innovation since on this second social media the component also included the ‘new brand development’ variable. On YouTube, three advertising patterns were identified in PCA. Similar to the other platforms, the first and the second patterns were called for kids and price and discount, and the third component referred to both celebrity and commemorative dates.

The advertising patterns of the fast-food chain on three social media platforms were commonly directed to children and addressed price, discounts and the celebrities’ universe. The findings of this study corroborate other data in the literature regarding unhealthy food advertising on social media. This study discusses the urgency of regulating food advertising content on this medium.

To quantify food/beverage advertising on television in Montreal (Quebec), to estimate and characterise children’s exposure and to examine trends over time.

Television food advertising data were licensed for nineteen food categories and eighteen stations for May 2011, 2016 and 2019. The frequency of advertisements and the average number viewed per child aged 2–11 years overall, by food category and by station type (i.e. youth-appealing (n 3) and generalist (n 15) stations) were determined. The percent change in advertising frequency and exposure between May 2011 and 2019 was calculated.

Montreal, Quebec, Canada.

This study used media data and did not directly involve human participants.

The total number of television advertisements increased by 11 % between May 2011 (n 41 084) and May 2019 (n 45 406); however, exposure to food/beverage advertisements decreased by 53 %, going from 226 ads/child in May 2011 to 107 ads/child in May 2019. Overall, the most advertised food categories in both May 2011 and 2019 were fast food (29·8 % and 39·2 %, respectively) followed by chocolate (14·2 %) in 2011 and savory snacks (9·7 %) in 2019. In May 2019, children were predominantly exposed to unhealthy food categories such as fast food (41·3 % of exposure), savory snacks (7·5 %), chocolate (5·0 %) and regular soft drinks (4·5 %), and most (89·3 %) of their total exposure occurred on generalist television stations.

Despite Quebec’s restrictions on commercial advertising directed to children under 13 years, Quebecois children are still frequently exposed to unhealthy food advertising on television. Government should tighten restrictions to protect children from this exposure.

To examine children’s exposure to food and beverage advertising across a year of Colombian television based on whether products exceed Pan-American Health Organization (PAHO)-defined nutrient thresholds.

Nutritional information was obtained for all foods and beverages advertised and used to categorise each product according to the product category (e.g. beverage, snack food) and nutritional quality based on the PAHO model for identifying products in excess of free sugars, Na or saturated fat or containing non-caloric sweeteners or trans-fat. Television audience ratings data were used to derive the average child audience (unique child viewers) per ad and the number of times ads were seen by children in a single week (weekly impressions) based on product category and nutritional quality.

All food and beverage ads on cable and over-the-air TV in Colombia in 2017.

N/A.

Of all instances of TV ads, 89·3 % were of unhealthy products. A larger proportion of male and female children, as well as children from low (88·01 %), mid (89·10 %) and high (89·10 %) socio-economic status, are exposed to advertising of unhealthy products, but no significant difference was found between these proportions.

The majority of foods and beverages advertised to Colombian children are unhealthy. These findings highlight a need to implement statutory measures to reduce children’s exposure to unhealthy food advertising in Colombia, as obesity and overweight have been increasing among school-age children in Colombia, and exposure to television advertising of unhealthy foods is a known contributor to children’s food intake and obesity.

To examine the frequency of television (TV) food and beverage advertisements (F&B ads) to which children (4–11 years) are likely exposed and the nutrient profile of products advertised.

TV broadcasting between September and November 2016 was recorded (288 h of children’s programming; 288 h of family programming) resulting in 8980 advertisements, of which 1862 were F&B ads. Of those, 1473 could be classified into one of the seventeen food groups, and into permitted/non-permitted according to the WHO-EU nutrient profile model. Persuasive marketing techniques used were also identified.

TV programming was recorded for four weekdays and four weekend days, between 06.00 and 00.00 hours (576 total hours), for four channels (two national and two cable), in Costa Rica.

Mean (sd) number of F&B ads/h was greater in cable than national channels (3·7 (0·4) v. 2·8 (0·4), P < 0·05) and during children’s peak viewing hours (4·4 (0·4) v. 2·9 (0·3)). Of F&B ads classified with WHO-EU nutrient profile model (n 1473, 71·1 %), 91·1 % were non-permitted to be marketed to children. Categories most frequently advertised were ready-made/convenience foods (16 %), chocolates/confectionery/desserts (15 %), breakfast cereals (14 %), beverages (15 %), edible ices (9 %) and salty snacks (8 %). Non-permitted F&B ads were more likely to use promotional characters, brand benefit claims, and nutrition and health claims than permitted F&B ads.

Children watching popular TV channels in Costa Rica are exposed to a high number of unhealthy F&B ads daily. Our findings help justify the need for regulatory actions by national authorities.

In the light of Chile’s comprehensive new restriction on unhealthy food marketing, we analyse food advertising on Chilean television prior to the first and final phases of implementation of the restriction.

Content analysis of marketing strategies of 6976 advertisements, based on products’ nutritional quality. Statistical analysis of total and child audience reached using television ratings data.

Advertising from television aired between 06.00 and 00.00 hours during two random composite weeks across April–May 2016 from the four broadcast and four cable channels with the largest youth audiences.

Food ads represented 16 % of all advertising; 34 % of food ads featured a product high in energy, saturated fats, sugars and/or salt (HEFSS), as defined by the initial regulation. HEFSS ads were seen by more children and contained more child-directed marketing strategies than ads without HEFSS foods. If HEFSS advertising was restricted only in programmes where 20 % are children aged 4–12 years, 31 % of children’s and 8 % of the general audience’s HEFSS advertising exposure would be reduced. The newest 06.00–22.00 hours restriction captures 80 % of all audience exposure.

HEFSS advertising was seen by a large proportion of children before Chile’s regulation. Chile’s first implementation based on audience composition should reduce a third of this exposure and its second restriction across the television day should eliminate most of the exposure. The current study is a crucial first step in evaluating how Chile’s regulation efforts will impact children’s diets and obesity prevalence.

Food marketing is an important factor influencing children’s food preferences. In Slovenia the use of magazines is widespread among children. We investigated food advertising in children’s and teens’ magazines (CTM) in 2013 and 2017. The penetration of food advertising was compared with magazines targeting the adult population.

A repeated cross-sectional study. Magazines were searched for branded food references (BFR). All BFR were categorised and evaluated using the WHO Europe nutrient profile model.

Slovenia.

All issues of CTM and a selected sample of issues of adult-targeting magazines and newspapers published in Slovenia in 2013 and 2017.

One hundred and seventy-five issues of CTM (ninety-two in 2013, eighty-three in 2017) and 675 issues of adult-targeted magazines and newspapers were analysed (345 in 2013, 330 in 2017). In 2017, food advertising in CTM dropped notably but the opposite was found for adult-targeted magazines. Regular advertisements dominated in 2017 in CTM, while in 2013, 83 % of BFR types were games/puzzles, competitions and product placements. Chocolate and confectionery were the most advertised in CTM and food supplements in adults’ magazines. Most foods in CTM were classed as ‘not permitted’ in both years (98 % in 2013 and 100 % in 2017).

The advertisements in CTM still mostly refer to unhealthy foods. The extent of food advertising has dropped considerably since 2013. On the contrary, food advertising in printed media targeting adults has increased, chiefly referring to food supplements and foods that do not pass the WHO Europe nutrient profile model criteria.

To examine the nutritional quality of menu items promoted in four (US) fast-food restaurant chains (McDonald’s, Burger King, Wendy’s, Taco Bell) in 2010 and 2013.

Menu items pictured on signs and menu boards were recorded at 400 fast-food restaurants across the USA. The Nutrient Profile Index (NPI) was used to calculate overall nutrition scores for items (higher scores indicate greater nutritional quality) and was dichotomized to denote healthier v. less healthy items. Changes over time in NPI scores and energy of promoted foods and beverages were analysed using linear regression.

Four hundred fast-food restaurants (McDonald’s, Burger King, Wendy’s, Taco Bell; 100 locations per chain).

NPI of fast-food items marketed at fast-food restaurants.

Promoted foods and beverages on general menu boards and signs remained below the ‘healthier’ cut-off at both time points. On general menu boards, pictured items became modestly healthier from 2010 to 2013, increasing (mean (se)) by 3·08 (0·16) NPI score points (P<0·001) and decreasing (mean (se)) by 130 (15) kJ (31·1 (3·65) kcal; P<0·001). This pattern was evident in all chains except Taco Bell, where pictured items increased in energy. Foods and beverages pictured on the kids’ section showed the greatest nutritional improvements. Although promoted foods on general menu boards and signs improved in nutritional quality, beverages remained the same or became worse.

Foods, and to a lesser extent, beverages, promoted on menu boards and signs in fast-food restaurants showed limited improvements in nutritional quality in 2013 v. 2010.

To describe the number of processed and ultra-processed food (PUPF) advertisements (ads) targeted to children on Argentinean television (TV), to analyse the advertising techniques used and the nutritional quality of the foods advertised, and to determine the potential exposure of children to unhealthy food advertising in our country.

Five free-to-air channels and the three most popular children’s cable networks were recorded from 07.00 to 22.00 hours for 6 weeks. Ads were classified by target audience, type of product, advertised food categories and advertising strategies used. The NOVA system was used to classify food products according to industrial food processing level. Nutritional quality was analysed using the Pan American Health Organization’s nutrient profile model.

Buenos Aires, Argentina. Results are considered applicable to most of the country.

The study did not involve human subjects.

Of the sample of food ads, PUPF products were more frequently advertised during children’s programmes (98·9 %) v. programmes targeted to the general audience (93·7 %, χ2=45·92, P<0·01). The top five food categories were desserts, dairy products, non-alcoholic sugary beverages, fast-food restaurants, and salty snacks. Special promotions and the appearance of cartoon characters were much more frequent in ads targeting children. Argentinean children are estimated to be exposed to sixty-one ads for unhealthy PUPF products per week.

Our study showed that Argentinean children are exposed to a high number of unhealthy PUPF ads on TV. The Argentinean Government should build on this information to design and implement a comprehensive policy to reduce exposure to unhealthy food marketing that includes TV and other communication channels and places.

To determine whether food label information and advertisements for foods containing no fruit cause children to have a false impression of the foods’ fruit content.

In the food label condition, a trained researcher showed each child sixteen different food label photographs depicting front-of-food label packages that varied with regard to fruit content (i.e. real fruit v. sham fruit) and label elements. In the food advertisement condition, children viewed sixteen, 30 s television food advertisements with similar fruit content and label elements as in the food label condition. After viewing each food label and advertisement, children responded to the question ‘Did they use fruit to make this?’ with responses of yes, no or don’t know.

Schools, day-care centres, after-school programmes and other community groups.

Children aged 4–7 years.

In the food label condition, χ2 analysis of within fruit content variation differences indicated children (n 58; mean age 4·2 years) were significantly more accurate in identifying real fruit foods as the label’s informational load increased and were least accurate when neither a fruit name nor an image was on the label. Children (n 49; mean age 5·4 years) in the food advertisement condition were more likely to identify real fruit foods when advertisements had fruit images compared with when no image was included, while fruit images in advertisements for sham fruit foods significantly reduced accuracy of responses.

Findings suggest that labels and advertisements for sham fruit foods mislead children with regard to the food’s real fruit content.

The current study examined the impact of television and Internet food advertising on Australian parents and children.

Parents and their children aged 8 to 14 years were exposed to a television advertisement, an Internet advertisement or a control picture for four commonly advertised energy-dense, nutrient-poor foods.

Online web panel survey, Australia.

Parents (n 1302) and their children aged 8 to 14 years (n 1302).

After a single exposure to each advertisement, parent respondents in the two exposure conditions evaluated the products more favourably, had a greater desire to consume the products and thought the product could be consumed more frequently than those in the control condition. Similar trends were observed among children, although the differences were statistically significant only for the frequency of food consumption in the Internet advertisement condition and the evaluation of one product.

The results have implications for assumptions of adults’ immunity to advertising. This is of particular importance in efforts to address child obesity and the reliance on parents to mediate the effects of food advertising.

To examine whether the German food industry directs commercials for unhealthy products to children and whether self-administered voluntary restrictions on the promotion of less healthy foods (the EU Pledge) are effective to mitigate this exposure.

By analysing German data from television (TV) channels, advertised products were categorized and food products classified as core foods (healthy) and non-core foods (less healthy). Marketing techniques were documented. Food commercials were furthermore compared with commercials for toy products, and comparisons were made between advertising patterns before and after the EU Pledge.

Data for ten German TV channels were recorded for two weekdays and two weekend days from 06.00 to 22.00 hours in 2007 and 2008. A second sample containing one weekday and one weekend day of three German TV channels was recorded again in 2010 for comparison in the same time period.

In total 16 062 advertisements from 2007–2008 and 2657 from 2010 were analysed.

In 2007–2008 19·9 % of TV commercials were for food products, of which 73 % were for non-core foods, 21 % for core foods and 6 % not classified. In three specified channels widely viewed by children and youth, 14·5 % of commercials were for food products, of which 88·2 % were for non-core foods. Commercials for unhealthy foods were broadcast significantly more often during children's peak viewing and in children's programmes, with a higher use of promotional characters and premiums than found in commercials for non-food products. In 2010, analysis of the three specified channels found that 18·5 % of commercials were for food products, of which 98·2 % were for non-core foods. While the use of premiums decreased compared with other commercials, the use of promotional characters in non-core food commercials increased, especially during children's programmes.

Children in Germany are exposed to large numbers of food commercials. The exposure to commercials for non-core foods and the use of techniques attractive to children are widespread and appear to have remained unaffected by the announcement of the EU Pledge in December 2007. We conclude that the industry's voluntary agreement has failed to fulfil its declared purpose.

To describe ready-to-eat (RTE) cereal purchases in 2008 in the USA according to cereal nutritional quality and marketing strategy and household sociodemographic characteristics.

Cross-sectional study of purchases in one year. Each type of cereal was assigned to one of four nutrition quality categories (based on Nutrient Profile Index, NPI) and one of four advertising categories based on television exposure and analysis of packaging (child-targeted, family-targeted, adult-targeted and no television advertising). Medians and distributions of purchase indicators were calculated for the cereal categories and the distributions were compared across sociodemographic groups.

RTE cereals (n 249) with complete label and nutritional content.

RTE cereal purchases according to household sociodemographic characteristics obtained from Nielsen Homescan, a nationally representative panel of households.

Purchases of RTE cereals were highest in households with one or more child and lowest in African-American and Asian households, as well as those earning <$US 30 000 per annum. The lowest-quality products were purchased by four times as many households as the highest-quality cereals, but loyalty to these products was lower. Purchases of cereals by households with children and in African-American and Hispanic households increased as cereal nutritional quality declined. Compared with non-advertised products, advertised child-targeted cereals were purchased thirteen times more frequently; family-targeted brand purchases were ten times higher; and adult-targeted cereals were purchased four times more frequently.

Our findings suggest that improving the nutritional quality of RTE cereals with advertising targeted to children could also lead to increased consumption of healthier products by young people.

To evaluate the level of compliance with the PAOS Code (Publicidad, Actividad, Obesidad y Salud), which establishes standards for the self-regulation of food marketing aimed at minors, in television advertising by food and beverage companies that have agreed to abide by the Code.

The study sample consisted of food and beverage advertisements targeting children during 80 h of programming by four Spanish television networks. The level of compliance with each standard of the PAOS Code was classified into three categories: ‘compliance’, ‘non-compliance’ and ‘uncertain compliance’. Overall, an advertisement was considered compliant with the PAOS Code if it met all the standards; non-compliant if it contravened one or more standards; and uncertain in all other cases.

Of a total of 203 television advertisements from companies that agreed to the PAOS Code, the overall prevalence of non-compliance was 49·3 % (v. 50·8 % among those that did not agree to the code), with 20·7 % of advertisements considered of uncertain compliance. Non-compliance was more frequent on Saturdays, in longer advertisements, in advertisements containing promotions or dairy products, and for advertisements from companies of French or US origin.

Non-compliance with the PAOS Code was very high and was similar for companies that did and did not agree to the Code, casting doubt on the Code’s effectiveness and oversight system. It seems the time has come to commit to statutory regulations that reduce the negative impact of advertising on children’s diets, as demanded by public health experts and consumer associations.

To evaluate the feasibility of the UK Nutrient Profile (NP) model for identifying ‘unhealthy’ food advertisements using a case study of New Zealand television advertisements.

Four weeks of weekday television from 15.30 hours to 18.30 hours was videotaped from a state-owned (free-to-air) television channel popular with children. Food advertisements were identified and their nutritional information collected in accordance with the requirements of the NP model. Nutrient information was obtained from a variety of sources including food labels, company websites and a national nutritional database.

From the 60 h sample of weekday afternoon television, there were 1893 advertisements, of which 483 were for food products or retailers. After applying the NP model, 66 % of these were classified as advertising high-fat, high-salt and high-sugar (HFSS) foods; 28 % were classified as advertising non-HFSS foods; and the remaining 2 % were unclassifiable. More than half (53 %) of the HFSS food advertisements were for ‘mixed meal’ items promoted by major fast-food franchises. The advertising of non-HFSS food was sparse, covering a narrow range of food groups, with no advertisements for fresh fruit or vegetables.

Despite the NP model having some design limitations in classifying real-world televised food advertisements, it was easily applied to this sample and could clearly identify HFSS products. Policy makers who do not wish to completely restrict food advertising to children outright should consider using this NP model for regulating food advertising.

The aim of the present study was to describe the nature and extent of food marketing on popular children’s websites and food product websites in Australia.

Food product websites (n 119) and popular children’s websites (n 196) were selected based on website traffic data and previous research on frequently marketed food brands. Coding instruments were developed to capture food marketing techniques. All references to food on popular children’s websites were also classified as either branded or non-branded and according to food categories.

Websites contained a range of marketing features. On food product websites these marketing features included branded education (79·0 % of websites), competitions (33·6 %), promotional characters (35·3 %), downloadable items (35·3 %), branded games (28·6 %) and designated children’s sections (21·8 %). Food references on popular children’s websites were strongly skewed towards unhealthy foods (60·8 % v. 39·2 % healthy food references; P < 0·001), with three times more branded food references for unhealthy foods. Branded food references displayed similar marketing features to those identified on food product websites.

Internet food marketing uses a range of techniques to ensure that children are immersed in brand-related information and activities for extended periods, thereby increasing brand familiarity and exposure. The relatively unregulated marketing environment and increasing use of the Internet by children point to the potential increase in food marketing via this medium. Further research is required to investigate the impact of Internet food marketing on children’s food preferences and consumption, and regulatory options to protect children.