Systematic review of the effect of policies to restrict the marketing of foods and non‐alcoholic beverages to which children are exposed

Abstract

Summary This systematic review examined the effectiveness of policies restricting the marketing of foods and/or non‐alcoholic beverages to children to inform updated World Health Organization (WHO) guidelines. Databases were searched to March 2020. Inclusion criteria were primary studies of any design assessing implemented policies to restrict food marketing to children (0–19 years). Critical outcomes were exposure to and power of marketing, dietary intake, choice, preference, and purchasing. Important outcomes were purchase requests, dental caries, body weight, diet‐related noncommunicable diseases, product change, and unintended consequences. Forty‐four observational studies met inclusion criteria; most were moderate quality. Pooling was conducted using vote counting by direction of effect, and GRADE was used to judge evidence certainty. Evidence suggests food marketing policies may result in reduced purchases of unhealthy foods and in unintended consequences favorable for public health. Desirable or potentially desirable (for public health) effects of policies on food marketing exposure and power were also found. Evidence on diet and product change was very limited. The certainty of evidence was very low for four outcomes (exposure, power, dietary intake, and product change) and low for two (purchasing and unintended consequences). Policies can effectively limit food marketing to children; policymakers should prioritize mandatory approaches aligned with WHO recommendations.

User engagement with a popular food brand before, during and after a multi-day interactive marketing campaign on a popular live streaming platform

“…Policies limiting the marketing of food and non-alcoholic beverages, particularly to children, may reduce engagement with energy-dense, nutrient-poor food brands and the purchases of such foods. (35) Further, reduced purchasing of energy-dense, nutrient-poor foods would likely reduce consumption, and thus reduce the negative post-consumption effects, such as weight gain and diet-related diseases. (36) However, there are many challenges to implementing digital marketing regulations.…”

Unhealthy food and beverage marketing to children on digital platforms in Aotearoa, New Zealand

“…Regulatory marketing restrictions should therefore include comprehensive and detailed definition of marketing content that has appeal to children of all ages. However, it is increasingly recognised that regulatory focus should be on reducing children’s exposure to UFB marketing, as opposed to simply controlling a set of defined ‘child-directed’ marketing techniques and child-focused media and settings [ 69 , 73 , 74 ]. Therefore, restrictions should apply to any UFB marketing in settings/media to which children are exposed.…”

“…Results from this study and others suggest that mandatory regulation (i.e. legislation) is required to ensure compliance and actually reduce children's exposure to UFB marketing [20,34,[67][68][69]. Expert consensus from the World Health Organization (WHO) and academic literature highlights the following characteristics for bestpractice: protecting children up to the age of 18, considering all marketing (rather than simply advertising), having a comprehensive definition of child-appealing elements, and restricting not only child-directed content but all children's exposure.…”

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

“…Over recent decades, the food environment has become increasingly obesogenic [ 5 ]. Exposure to advertising is an important strategy to influence awareness, attitudes and preferences, purchase intent, purchase requests, purchase, and consumption [ 6 ], including advertising targeted at children [ 7 ]. Outdoor advertisement spaces including bus stops, billboards and transport facilities are highly visible locations for advertisement and an integral part of the total exposure for residents.…”