A scoping review of outdoor food marketing: exposure, power and impacts on eating behaviour and health

Abstract

Background There is convincing evidence that unhealthy food marketing is extensive on television and in digital media, uses powerful persuasive techniques, and impacts dietary choices and consumption, particularly in children. It is less clear whether this is also the case for outdoor food marketing. This review (i) identifies common criteria used to define outdoor food marketing, (ii) summarises research methodologies used, (iii) identifies available evidence on the exposure, power (i.e. persuasive creative strategies within marketing) and impact of outdoor food marketing on behaviour and health and (iv) identifies knowledge gaps and directions for future research. Methods A systematic search was conducted of Medline (Ovid), Scopus, Science Direct, Proquest, PsycINFO, CINAHL, PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and a number of grey literature sources. Titles and abstracts were screened by one researcher. Relevant full texts were independently checked by two researchers against eligibility criteria. Results Fifty-three studies were conducted across twenty-one countries. The majority of studies (n = 39) were conducted in high-income countries. All measured the extent of exposure to outdoor food marketing, twelve also assessed power and three measured impact on behavioural or health outcomes. Criteria used to define outdoor food marketing and methodologies adopted were highly variable across studies. Almost a quarter of advertisements across all studies were for food (mean of 22.1%) and the majority of advertised foods were unhealthy (mean of 63%). The evidence on differences in exposure by SES is heterogenous, which makes it difficult to draw conclusions, however the research suggests that ethnic minority groups have a higher likelihood of exposure to food marketing outdoors. The most frequent persuasive creative strategies were premium offers and use of characters. There was limited evidence on the relationship between exposure to outdoor food marketing and eating behaviour or health outcomes. Conclusions This review highlights the extent of unhealthy outdoor food marketing globally and the powerful methods used within this marketing. There is a need for consistency in defining and measuring outdoor food marketing to enable comparison across time and place. Future research should attempt to measure direct impacts on behaviour and health.

Ultra‐processed food and non‐communicable diseases in the United Kingdom: A narrative review and thematic synthesis of literature

“…35 Again, the issues of access to nutritious food are amplified by socioeconomic status, with people living in more deprived areas often having to commute via multiple public transport lines to reach the nearest supermarket, necessitating a taxi journey home due to carrying shopping bags, resulting in an extra expense 36 and further exposure to UPF food marketing in outdoor settings. 37 Significant research attention has been paid to the detrimental impact of UPFs on health in Latin American nations, namely Brazil, where the NOVA system originated. 9 This has culminated in the Brazilian government advising citizens to avoid UPFs completely.…”

“…Clustering and co‐location of fast‐food outlets and other harmful commodities in areas of deprivation has been observed 35 . Again, the issues of access to nutritious food are amplified by socioeconomic status, with people living in more deprived areas often having to commute via multiple public transport lines to reach the nearest supermarket, necessitating a taxi journey home due to carrying shopping bags, resulting in an extra expense 36 and further exposure to UPF food marketing in outdoor settings 37 …”

Assessing exposure to outdoor advertisement for products high in fat, salt and sugar (HFSS); is self-reported exposure a useful exposure metric?

“…In 2021, the UK outdoor advertising industry generated more than £900 million in revenue [ 8 ]. However, its impact on public health is relatively under-studied [ 9 , 10 ]. Data from Scotland suggest that HFSS products totalled about 33% of all “out-of-home” advertisements, 4% on alcohol and 0.4% on gambling [ 11 ].…”

Food and non‐alcoholic beverage marketing in children and adults: A systematic review and activation likelihood estimation meta‐analysis of functional magnetic resonance imaging studies

“…The extensive marketing of unhealthy foods and non‐alcoholic beverages (hereafter referred to as food) is a critical characteristic of the current obesogenic food environment 1 and has been strongly implicated in rising levels of obesity globally, particularly in children 2,3 . Numerous systematic reviews and meta‐analyses have demonstrated the significant detrimental impacts of unhealthy food marketing exposure on eating and health‐related outcomes in children, 4–6 with some evidence that minority and socioeconomically disadvantaged groups are disproportionately exposed 7,8 . Some mandatory government policies have been shown to be effective in reducing children's exposure to food marketing, the persuasive power of that marketing, and purchasing of unhealthy foods by or on behalf of children 9,10 .…”

“…exposure on eating and health-related outcomes in children, [4][5][6] with some evidence that minority and socioeconomically disadvantaged groups are disproportionately exposed. 7,8 Some mandatory government policies have been shown to be effective in reducing children's exposure to food marketing, the persuasive power of that marketing, and purchasing of unhealthy foods by or on behalf of children. 9,10 However, many countries continue to rely on ineffective industry self-regulatory policies 9 despite the numerous best-practice recommendations including greater restrictions that have been issued by United Nations organizations and other authoritative bodies.…”