New Studies Show Social Media Food Advertising of Unhealthy Foods and Fast Food Portion Size Increase Health Risks

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Two recent articles show how food company practices contribute to unhealthy eating and  high rates of obesity and diet-related diseases.  The firs article  in Pediatrics conducted an experiment to examine the impact of social media influencer marketing of healthy and unhealthy foods on children’s food intake.  

The study found that children after viewing social media influencers consuming unhealthy snacks , children significantly increased overall intake of calories and of unhealthy snacks specifically compared with children who viewed influencers with nonfood products. Viewing influencers with healthy snacks did not significantly affect intake.

The authors conclude that popular social media influencer promotion of food affects children’s food intake. Influencer marketing of unhealthy foods increased children’s immediate food intake, whereas the equivalent marketing of healthy foods had no effect. Increasing the promotion of healthy foods on social media may not be an effective strategy to encourage healthy dietary behaviors in children.

A forthcoming article in the Journal of the Academy of Nutrition and Dietetics compared changes over time across menu categories such as entrées, sides, and desserts in fast-food menu items over 30 years.  US national survey data shows fast food accounted for 11% of daily caloric intake in 2007-2010. Fast-food entrées, sides, and dessert menu item data for 1986, 1991, and 2016 were compiled from primary and secondary sources for 10 popular fast-food restaurants.

The authors found that from 1986 to 2016, the number of entrées, sides, and desserts for all restaurants combined increased by 226%. Portion sizes of entrées and desserts, but not sides, increased significantly, and the energy and sodium of items in all three menu categories increased significantly. Desserts showed the largest increase in energy, and entrées had the largest increase in sodium. Calcium increased significantly in entrées and to a greater extent in desserts, but not sides, and iron increased significantly only in desserts.

The authors concluded that these results demonstrate broadly detrimental changes in fast-food restaurant offerings over a 30-year span including increasing variety, portion size, energy, and sodium content. Research is needed to identify effective strategies that may help consumers reduce energy intake from fast-food restaurants as part of measures to improve dietary-related health issues in the United States.

Citations:  Coates AE, Hardman CA, Halford JCG, Christiansen P, Boyland EJ.  Social Media Influencer Marketing and Children’s Food Intake: A Randomized TrialPediatrics. 2019 Mar 4. pii: e20182554.

McCrory MA, Harbaugh AG, Appeadu S, Roberts SB. Fast-Food Offerings in the United States in 1986, 1991, and 2016 Show Large Increases in Food Variety, Portion Size, Dietary Energy, and Selected Micronutrients. Journal of the Academy of Nutrition and DieteticsDOI: https://doi.org/10.1016/j.jand.2018.12.004

Increasing disparities in unhealthy food advertising targeted to Hispanic and Black youth

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Unhealthy food marketing aimed at youth under age 18 is a significant contributor to poor diets and diet-related diseases. Therefore, greater exposure to this marketing by Hispanic and Black children and teens, both in the media and in their communities, likely contributes to diet-related health disparities affecting communities of color, including obesity, diabetes, and heart disease. A new report on targeted food marketing by the Rudd Center for Food Policy & Obesity University of Connecticut,  the Council on Black Health , and Salud America! assessed whether the 10 companies with the most targeted advertising spending documented in the Rudd Center’s 2015 report have made changes in their targeted advertising.

By collecting  data on advertising expenditures on Spanish-language and Black-targeted TV programming by company, brand and product category, the study identified  television advertising targeted to Hispanic and Black consumers.

From 2013 to 2017, the total amount that companies spent to advertise restaurants, food, and beverages on all types of TV programming declined by just 4% (from $11.4 billion to $10.9 billion). However, greatly reduced TV viewing by children and teens resulted in large reductions in exposure to food-related TV ads: -28% for children and -43% for teens overall.

Despite this decline, on average children and teens continued to view approximately 10 food-related TV ads per day in 2017. Total food-related advertising spending on Spanish-language TV also declined by 4% over the past five years (from $817 million in 2013 to $787 million in 2017), and reductions in TV viewing and food-related ads viewed by Hispanic youth mirrored declines for all youth. In contrast, total food-related advertising spending on Black-targeted TV increased by more than 50% from 2013 to 2017 ($217 million to $333 million). Disparities between Black and White youth in exposure to all food-related TV ads also increased. In 2013, Black children and teens viewed 70% more food ads than their White peers viewed.

In 2017, these disparities grew to 86% more ads viewed by Black children compared to White children and 119% more ads viewed by Black teens than by White teens. On average in 2017, Black children and teens saw 16.4 and 17.1 food-related TV ads-per-day, respectively. This increased disparity in ads viewed resulted from increased food-related spending on Black-targeted TV advertising as well as greater declines in TV watching among white than Black children.

The authors of the report call on food manufacturers to market healthy products to Black and Hispanic consumers and for fast-food, candy, sugary drink, and unhealthy snack food brands to stop disproportionately targeting their advertising in Spanish-language and Black-targeted media. Public health advocacy campaigns should also focus on improving marketing practices of companies that disproportionately target Hispanic and Black youth and explore opportunities to engage youth of color in campaigns to address targeted food marketing as a social justice issue.

Read the full report.

Soda industry influence on obesity science and policy in China

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A new report by Susan Greenhalgh in the Journal of Public Health Policy found that soda industry efforts to manipulate obesity science and policy in the US are well documented, yet little is known about whether the industry has pursued similar efforts abroad. In-depth research in China—analyses of interviews with prominent Chinese obesity experts, and of trends in obesity-related activities documented in newsletters of China’s lead organization on obesity, a branch of the International Life Sciences Institute (ILSI), a US-based, corporate-funded, global nonprofit strongly influenced by the Coca-Cola Company—showed that from 1999 to 2015, China’s obesity science and policy shifted markedly toward physical activity as Coca-Cola’s influence in China increased. This shift aligned with Coca-Cola’s message that it is activity, not diet, that matters—a claim few public health scholars accept. These changes correlated with the growing importance of Coca-Cola’s funding, ideas, and affiliated researchers via ILSI-China. In putting its massive resources behind only one side of the science, and with no other parties sufficiently resourced to champion more balanced solutions that included regulation of the food industry, the company, working through ILSI, re-directed China’s chronic disease science, potentially compromising the public’s health.

The Capital NCD-Nexus: The Commercial Determinants of Health and Global Capital Flows

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Cross-border Merger and Acquisitions  purchases in food, beverages, and tobacco. Source: World Investment Report 2018, Table 10 (Annex); calculations and illustrations by CPC Analytics. Note: The average M&A value in the sectors food, beverages, and tobacco between 2000 – 2009 is calculated by excluding the two crisis years. Credit

In the past, the role of global capital flows for health has not been considered in the debate about key risk factors of Noncommunicable Diseases (NCDs). This is a blind spot in public health. A significant share of the global food and beverage industry is owned by institutional investors. Cross-border mergers and acquisition volumes in the food, beverage, and tobacco industries have substantially increased. Progress on preventing and controlling NCDs requires the public health community to engage in a forward-looking discussion to address investors’ responsibility in relation to global health in general and the tsunami of NCDs in particular.

Citation: Franz C, Kickbusch I. The Capital NCD-Nexus: The Commercial Determinants of Health and Global Capital Flows  Eurohealth 2018;24(3): 21-25.

Reducing Harmful Corporate Influences on Diet-Related Non-Communicable Diseases

Cross-posted from CUNY Urban Food Policy Institute

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Seven years ago, the first United Nations High Level Meeting on Non-Communicable Diseases (NCDs — the public health term for chronic diseases) met to discuss the growing health, social and economic burdens NCDs were imposing on high, middle- and low-income countries around the world. A World Health Organization report prepared for the UN meeting concluded that four risk factors — tobacco use, unhealthy diets, alcohol use and physical inactivity accounted for the vast majority of the rising prevalence of premature deaths and preventable illnesses from conditions like cardiovascular disease, diabetes, stroke, hypertension and some forms of cancer. Later, the UN and WHO set the goal of reducing premature deaths — those before age 70 — by 25% by 2025, a goal that has proved elusive. Here in the United States and New York City and around the world, NCDs are a leading cause of persistent inequities in health between the better off and the poor and in the US between Blacks and other people of color and whites. 

In seeking to achieve these reductions, the public health community has launched three different — although sometimes intersecting — strategies. The first seeks to change individual behavior through education, counseling and support. These strategies encourage and support people to quit or not start smoking, eat healthier diets, stop or reduce alcohol consumption and become more physically active. This approach is an essential foundation for reducing NCDs but by itself it has shown disappointing results in bringing about population level change.

The second strategy is to change the behavior and practices of health care systems– provide more people with access, emphasize clinical and community prevention, and ensure that every health care worker applies what is known about prevention and early intervention for NCDs. This too is an essential foundation for reducing the burden of NCDs. But as public health researchers deepen our understanding of the profound influence of what are called social determinants of health and the challenge of transforming health care systems that have mostly focused on treatment rather than prevention, the limits of this strategy of changing health care to reduce NCDs have also been recognized.

The third strategy, the focus of the CUNY Urban Food Policy Institute’s Forum on Reducing Harmful Corporate Influences on Diet-Related Non-Communicable Diseases on September 26, 2018, seeks to change the behavior of the corporations that have played such a powerful role in promoting the behaviors that contribute to NCDs. This approach examines the business practices of food, alcohol, tobacco and pharmaceutical corporations — their marketing, product design, pricing and retail practices — to identify opportunities for changing practices that contribute to NCDs. It also puts the spotlight on corporation’s political practices such as lobbying, campaign contributions, sponsored science and philanthropy to illuminate their influence in weakening or strengthening public health protection. By limiting corporate political practices that undermine public health, we can prevent disease and perhaps strengthen democracy.

To explore these topics, three speakers summarized some of what we have learned in the last seven years.

Jeff Collin, Professor of Global Health Policy at the University of Edinburgh discussed Limiting Corporate Interference in Health Policy: Lessons from across Tobacco, Alcohol and FoodView his presentation here.

Paula Johns, General Director, ACT Health Promotion – Brazil spoke on The Role of Global and National Civil Society Groups in Reducing Harmful Corporate Influences on Food Policy.

Neena Prasad, Director of Obesity Prevention Program, Bloomberg Philanthropies, described  Lessons from the Obesity Prevention Program, a multi-year effort to support public health policies aimed at improving the food environment in Mexico, Brazil, Colombia, the Caribbean and South Africa.

Nicholas Freudenberg, Distinguished Professor of Public Health at the CUNY Graduate School of Public Health and Health Policy and Director of the CUNY Urban Food Policy Institute moderated the discussion.

To view the resources the speakers suggested for those who want more information, click here.

To view the video of the forum on September 26, 2018, click here.

People’s Health Movement: A Call to Action on Nutrition, Food Security and Food Sovereignty

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In a commentary, in World Nutrition,  David Sanders, Claudio Schuftan, and Vandana Prasad write, “There are common roots underlying both under and ‘over-nutrition’ in our globalized world. These pertain to the impact on food systems of current practices related to food production, processing, manufacture, distribution, trade and commerce, as well as to the power differentials between those who are most affected by and those who benefit most from the current food system.

The unregulated penetration of food and beverage companies and the aggressive marketing of processed and ultra-processed foods have been severely compounding the problem of malnutrition and the underlying food insecurity.  This process is driven by mega agribusiness conglomerates and transnational food and beverage corporations through the employment of technologies and practices that are energy intensive and ecologically unsustainable, and that are also implicated in environmental degradation and climate change… In sum, malnutrition in all its forms, food insecurity and the erosion of food sovereignty are all socially and politically determined.  It is inadequate to acknowledge the continuing crisis of malnutrition and the inequalities it engenders without addressing their political roots and the conditions that perpetuate this.”

Four Recent Books on the Political Economy of Global Health

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Four recent books dealing with the political economy of global health are reviewed in a recent issue of Critical Public Health.  Drawing on the material covered in these sources, the reviewer argues that the concepts of capitalism, imperialism and class (at the national and global levels) are fundamental to a critical public health in the present era of economic globalization.

Analysis of corporate political activity strategies of the food industry: evidence from France

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A new study in  Public Health Nutrition  analyzed the corporate political activity (CPA) of major food industry actors in France. The  analysis shows that the main practices used by Coca-Cola and McDonald’s were the framing of diet and public health issues in ways favorable to the company, and their involvement in the community. The French National Association of Agribusiness Industries primarily used the ‘information and messaging’ strategy (e.g. by promoting deregulation and shaping the evidence base on diet- and public health-related issues), as well as the ‘policy substitution’ strategy. Nestlé framed diet and public health issues and shaped the evidence based on diet- and public health-related issues. Carrefour particularly sought involvement in the community. The authors found that, in 2015, the food industry in France was using CPA practices that were also used by other industries in the past, such as the tobacco and alcohol industries. Because most, if not all, of these practices proved detrimental to public health when used by the tobacco industry, we propose that the precautionary principle should guide decisions when engaging or interacting with the food industry.

Public Procurement of Food in Canada

Unhealthy foods are widely available in public settings across Canada, contributing to diet-related chronic diseases, such as obesity and diet-related diseases especially among vulnerable groups, including children and seniors. Healthy food procurement policies, which support procuring, distributing, selling, and serving healthier foods, have recently emerged as a promising strategy to counter this public health issue by increasing access to healthier foods. Although numerous Canadian health and scientific organizations have recommended such policies, they have not yet been broadly implemented in Canada.  To inform further policy action on healthy food procurement in a Canadian context, the authors conducted an evidence synthesis to assess the impact of healthy food procurement policies on health outcomes and sales, intake, and availability of healthier food. Based on this review, they recommend policies and practices for governments, publicly funded institutions, decision-makers and professionals, citizens, and researchers. They conclude that implementation of healthy food procurement policies can increase Canadians’ access to healthier foods as part of a broader vision for food policy in Canada.

Citation: Raine KD, Atkey K, Olstad DL,  et al. Healthy food procurement and nutrition standards in public facilities: evidence synthesis and consensus policy recommendations. Health Promot Chronic Dis Prev Can. 2018 ;38(1):6-17.