Regulation of food marketing to children: are statutory or industry self-governed systems effective?

Extensive marketing of foods and drinks that are high in fat, sugar and sodium (HFSS) directly targeted to young people has contributed to the rapid rise in youth with obesity and increased lifetime risk for diseases such as diabetes, hypertension and cancer. Yet real progress towards tackling this problem has been slow and questions remain over the most appropriate and efficacious measures. This discussion often focuses on the relative merits of industry-initiated improvements v. statutory restrictions. However, research has demonstrated limitations to both approaches, with similar types of loopholes that allow food marketers to continue to surround children with highly effective messages promoting HFSS products, including fast-food restaurants, sugary drinks, candy, snacks and sugary cereals. Transnational industry stakeholders (e.g. food and beverage manufacturers) have acknowledged the potential harm of unhealthy food marketing and their role in addressing childhood obesity by enacting self-regulatory actions in major markets worldwide, typically in the form of multi-company pledges to advertise only nutritious options directly to children. In most countries, governments have ceded the responsibility for improving marketing to children to these self-regulatory programmes. Although industry self-regulation could, in principle, help decrease children’s exposure, independent evaluations have demonstrated limited improvements in the nutritional quality of foods and beverages marketed to children or reductions in children’s exposure to marketing of HFSS foods following implementation of food industry self-regulation. For example, the Children’s Food and Beverage Advertising Initiative (CFBAI) was launched in the USA in 2006. As of 2016, eighteen of the largest food and beverage manufacturers and fast-food restaurants have pledged to ‘encourage healthier dietary choices’ in advertising directed to children under 12 years of age. However, children in 2015 saw just 3% fewer food ads on television than they had in 2007, the first year that children’s exposure to food ads was lower than it had been before the CFBAI was implemented. Furthermore, 86% of food ads viewed by children promoted HFSS products in 2009 compared with 94% before companies enacted their CFBAI pledges. In addition, the nutritional quality of products advertised on children’s television remains worse than those advertised during programming for older audiences. As a result, improvements in food marketing to children associated with industry self-regulation have been small and slow. In addition, there are obvious limitations to relying on industry to voluntarily make substantial changes to successful business models. Accordingly, public health experts have argued that government regulatory or legislative statutory actions will be the only effective solution. The WHO has given a mandate to act, via Resolution WHA63.14 (endorsed in May 2010), and has provided specific policy and technical guidance. In 2007, the UK was the first country to introduce statutory legislation specifically addressing food marketing to children, with the stated aim of ‘limiting the exposure of children to HFSS (foods high in fat, sugar, and/or salt) advertising on television, as a means of reducing opportunities to persuade children to demand and consume HFSS products’ (p. 3). HFSS advertising (determined by nutrient profiling) was banned in and around programmes of particular appeal to children under 16 years of age, with additional ‘content rules’ prohibiting the use of some promotional characters among other components. Although the UK broadcast regulator reported that children saw 34% less HFSS advertising following the regulations, academic evaluations suggest that reductions in exposure are likely limited to dedicated children’s programming or have not occurred at all – indeed, increases in relative exposure to HFSS advertising were found. Furthermore, fast-food restaurants have increased marketing of ‘healthier’ options that meet the nutrition criteria but allow restaurants to continue to market their brand to children. It remains to be seen whether brand advertising (ads that do not depict foods at all) for other types of products has also increased over this period, another potential loophole for circumventing the regulations. Few other statutory approaches have been evaluated. The Mexican Government introduced regulations in 2015 to limit unhealthy food advertising to children on television. However, these regulations are not expected to lead to substantial improvements in children’s exposure to unhealthy food advertising in Mexico due to two significant limitations. The nutrition quality standards in the Mexican regulations are weaker than the UK standards and the regulations do not address advertising for HFSS foods during the majority of television programming that children view.