A new global review of school food policies published in Advances in Nutrition found that only 16% of countries worldwide have national policies restricting food marketing in schools, and only 25% have national policies restricting in-school sales of foods high in nutrients or ingredients of concern outside school meal programs. A mere 12% of countries have national policies restricting both.

Children around the world spend much of their days in schools, and many eat at least one meal a day there. This makes the school food environment a critical influence not only on what kids eat, but also potentially on their lifelong food preferences and dietary habits. To protect and enhance this environment, the World Health Organization and other public health leaders encourage policies to restrict children’s access and exposure to unhealthy foods and beverages in and around schools.

This scoping review study sought to assess the global landscape of national-level, mandatory policies related to food marketing and competitive food sales in in schools. To that end, researchers systematically searched all 193 United Nations countries for the presence of these national regulations:

• Restricting sales of competitive foods: “Competitive foods” are any foods or beverages sold in schools outside of a national school meal program. This includes foods sold in canteens, kiosks, tuck shops, vending machines, and from vendors coming onto school grounds.
• Restricting food marketing: Any oral, written, or graphic statements made to promote the sale of a food or beverage product. In schools, this can include featuring brand logos, spokes-characters, or product images on signs, scoreboards, vending machines, or other school equipment; branded sponsorship of incentive programs or school discount nights (e.g., at fast food restaurants), ads in school newspapers or yearbooks; fundraiser incentives; scholarships; and more.

“Decades of research clearly show that exposure to marketing for unhealthy foods and drinks harms children and adolescents and increases their risk for childhood obesity,” said first author Michelle Perry, MS, former Global Food Research Program research specialist and current doctoral student at Brown University School of Public Health. “This should be limited everywhere, but marketing especially has no place in schools. We expect the learning environment to foster knowledge and health, not entice food brand loyalty and eating behavior at odds with dietary guidelines.”

Researchers used a combination of global policy databases, peer-reviewed literature, official government websites, internet searches, and in-country experts to identify policies. For each policy, they gathered information on key features including how foods are nutritionally profiled, whether monitoring and enforcement language are included, and whether policies apply to the area around schools. They also examined trends in policy adoption by country income groups and found that over half of policies were found in high-income countries, and no low-income countries had either policy type.

“We may not have found these policies in low-income countries because of differences in food provision priorities, resources, or availability in schools,” said Barry Popkin, PhD, W.R. Kenan Jr. Distinguished Professor of Nutrition at the UNC Gillings Global School of Public Health, co-director of the Global Food Research Program, and the study’s senior author. “In these countries, the focus may be more on encouraging children to attend school and providing sufficient calories rather than restricting less-healthy foods, but given the double burden of under- and overnutrition in many low-income countries, these policy interventions should be considered to keep childhood obesity levels from worsening.”

Authors also suggest several possible reasons for the lack of greater policy adoption worldwide. For one, adoption could be limited by schools’ reliance on revenue generated by competitive food sales or vending agreements. There may also be a lack of awareness that food marketing is harmful or concern that the food industry could fight attempts at regulation based on rights to free speech/expression. Countries may have other, more pressing policy priorities or may not have the political will or enforcement infrastructure to enact such policies at this time.

“It’s clear that we have a big policy gap worldwide. More countries should consider adopting these policies, particularly in lower-income countries where ultra-processed foods haven’t taken over kids’ diets yet. These products absolutely should not be sold or marketed in schools.“

— DR. BARRY POPKIN

“It’s clear that we have a big policy gap worldwide,” said Popkin. “More countries should consider adopting these policies, particularly in lower-income countries where ultra-processed foods haven’t taken over kids’ diets yet. These products absolutely should not be sold or marketed in schools.”

The authors note a handful of limitations to this study, including the focus only on national-level policies. “We know that many places that have implemented some of these policies at the district, city, state, or province level,” said Emily Busey, MPH, RD, study co-author and research communications manager at the Global Food Research Program at UNC-Chapel Hill. “Given the global scope of this review, we chose to focus on national-level policies to make the search feasible for our team.”

The authors also acknowledge the challenge of finding and interpreting policies written in many different languages and the possibility that policies changed or were enacted after data collection concluded and may not be reflected in this review.

A second, companion scoping review examining national-level policies that restrict provision of categories, nutrients, or ingredients of concern in school meal programs is forthcoming.

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This research was funded by Bloomberg Philanthropies.

AUTHORS

Michelle Perry
Kayla Mardin
Grace Chamberlin
Emily Busey
Lindsey Smith Taillie
Francesca Dillman Carpentier
Barry Popkin

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Read the full study in Advances in Nutrition

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Learn more about school food environment policies.

In a new perspective piece in PLOS Medicine, Global Food Research Program researchers Barry Popkin and Francesca Dillman Carpentier and alum Fernanda Mediano Stoltze reflect on the recently released World Health Organization (WHO) guideline, “Policies to protect children from the harmful impact of food marketing.”

The authors highlight several strengths of the updated guidelines, which build on the WHO’s previous recommendations published in 2010. The new guidelines extend the organization’s recommendation to restrict marketing for high-fat, -salt, or -sugar foods and drinks, calling for policies that:

• Are mandatory;
• Protect children of all ages (up to 18 years old);
• Use a government-led nutrient profile model to classify foods for restriction;
• Are “sufficiently comprehensive to minimize the risk of migration of marketing to other media, to other spaces within the same medium, or to other age groups;” and
• That restrict the persuasive power of food marketing.

The authors highlight positive updates in the newer guidelines, including:

• Explicit, strong justification for protecting children based on their fundamental rights to health, privacy, and freedom from exploitation;
• Consideration of brand marketing — a strategy that can be used to promote a brand associated with ultra-processed foods high in nutrients of concern without highlighting any one particular product; and
• Caution against policies that focus too narrowly on certain media, places, or message types (e.g., only limiting marketing during children’s television programming or only prohibiting use of explicit child appeals like cartoon characters). Rather, the guideline’s definition of marketing covers all messages to which children are exposed, preempting marketers’ attempts to get around restrictions by shifting placement or content to get around restrictions and continue reaching children.

Drs. Dillman Carpentier, Mediano Stoltze, and Popkin also outline some key areas where they thought the new WHO guideline fall short. They recommend a stronger argument for policy comprehensiveness (i.e., focusing on eliminating rather than limiting exposure) and more consideration for increasing use of health marketing (e.g., greenwashing or social responsibility branding). They also outline flaws in how the guideline assessed available evidence on the effectiveness of marketing policies and how food marketing affects children, which limited the strength of policy recommendations.

Finally, the authors note that countries should consider limiting marketing for all ultra-processed products, in addition to nutritionally poor foods, to fully protect all children from unhealthy food marketing and its influence on their health trajectories.

While the WHO has been recommending regulations to limit food marketing and protect children from its harms for over a decade, countries have been slow to adopt such policies, and those that have been implemented are predominantly narrow in scope.¹ The new guidelines, in addition to evidence of early successes following Chile’s relatively comprehensive marketing laws,^2-4 support the imperative for bold, worldwide action to better protect children and population health through statutory regulation of food marketing.

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¹ Lindsey Smith Taillie, Emily Busey, Fernanda Mediano Stoltze, Francesca Renee Dillman Carpentier, Governmental policies to reduce unhealthy food marketing to children, Nutrition Reviews, Volume 77, Issue 11, November 2019, Pages 787–816, https://doi.org/10.1093/nutrit/nuz021

² Dillman Carpentier, F. R., Smith Taillie, L., Correa, T. (2023). “Chile’s Comprehensive Food Policy Offers Global Lesson in Tackling Unhealthy Foods.” from https://healthpolicy-watch.news/chiles-comprehensive-food-policy/.

³ Dillman Carpentier, F.R., Mediano Stoltze, F., Reyes, M. et al. Restricting child-directed ads is effective, but adding a time-based ban is better: evaluating a multi-phase regulation to protect children from unhealthy food marketing on television. International Journal of Behavioral Nutrition and Physical Activity 20, 62 (2023). https://doi.org/10.1186/s12966-023-01454-w

⁴ Mediano Stoltze, F., Barker, J., Kanter, R., Corvalán, C., Reyes, M., Taillie, L., & Dillman Carpentier, F. (2018). Prevalence of child-directed and general audience marketing strategies on the front of beverage packaging: The case of Chile. Public Health Nutrition, 21(3), 454-464. doi:10.1017/S1368980017002671

AUTHORS

Francesca Dillman Carpentier
W. Horace Carter Distinguished Professor, Hussman School of Journalism and Media, UNC-Chapel Hill

Fernanda Mediano Stoltze
Assistant professor, School of Psychology, Pontificia Universidad Catolica de Chile

Barry Popkin
W. R. Kenan Jr. Distinguished Professor, Department of Nutrition, UNC-Chapel Hill

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RESOURCES

Read more about the evidence for restricting marketing for non-essential foods and drinks high in sugar, salt, saturated or trans fats, or calorie density.

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Compare existing policies around the world aimed at restricting unhealthy food marketing to children.

Research from Colombia that examined food advertising and marketing tactics used on television (TV) has found that children were frequently exposed to advertising that used emotional appeals such as characters, cartoons, games, or suggestions of fun or excitement to promote unhealthy foods. Girls were more likely than boys to see these emotional appeals, as were children from households in lower-socioeconomic groups vs. higher-socioeconomic groups.

In the study, published this month in Public Health Nutrition, researchers from the University of Kansas, Pontificia Universidad Javeriana in Colombia, Universidad Nacional de Colombia, and the University of North Carolina at Chapel Hill analyzed over 500 top-viewed television advertisements (TV ads) for foods and beverages that aired on Colombian TV during 2017. For each ad, the researchers documented:

• The type of product(s) promoted;
• Each product’s nutritional quality;
• The size of the ad’s child audience using TV audience ratings data for children 4–11 years old (including the biological sex and household socio-economic level of each child exposed to the ad); and
• The type of marketing appeal(s) used in the ads, including rational appeals (e.g., highlighting the product’s cost, freshness, expert approval, or special ingredients) and emotional appeals (e.g., using cartoons, child actors, or other animations to attract children’s attention and associate the product with emotions like fun, excitement, or a sense of adventure).

They found that 78% of food ads were for products considered potentially harmful to health (i.e., products that were processed/ultra-processed, high in sugar, fats, or sodium, and/or contained non-caloric sweeteners). These are the nutrition standards used in Colombia’s new front-of-package warning label regulation, under which the products would currently be required to carry black, octagonal warning labels on their front-of-package. Of the ads for less-healthy products, 89% included an emotional appeal and 59% included a rational appeal, and over half (55%) used both rational and emotional appeals.

“The co-occurrence of both emotional and rational appeals in more than half of ads for products with lower nutritional quality is of special importance,” said the study’s first author Alcides Velasquez, associate professor of communication studies at the University of Kansas.“Combining emotional appeals, which can generate a positive association with the experience of consuming the product, with rational appeals that highlight products’ nutritional or health advantages might result in children associating positive emotions and consumption sensations with purported nutritional benefits of products that are actually less healthy.”  

Researchers also found differences in exposure that could contribute to health inequities: Girls and children from low-resource homes were exposed to significantly more appeals in TV ads than boys or children from higher-resource homes, respectively.

Key findings:

“The new WHO guideline on policies to protect children from the harmful impact of food marketing released this June pointed out the need for more research to examine inequities relating to food marketing, and this study shows clear inequities,” said senior author, Francesca Dillman Carpentier, W. Horace Carter Distinguished Professor at the UNC Hussman School of Journalism and Media. “The fact that we found these marked differences in marketing exposure based on socio-economic stratum and biological sex underscores the importance of developing comprehensive regulations that protect all children, not just a percentage of children, from unhealthy food marketing.”

In addition to being one of very few studies to examine differences in marketing exposure based on children’s socio-economic stratum and sex, this study establishes an important baseline measure of TV marketing and children’s exposure before Colombia implemented its front-of-package warning label law in December 2022 and ahead of its ultra-processed product taxes, which come into force in November 2023. While these policies do not include limits on marketing for foods and drinks that carry warning labels or will be taxed, changes to the Colombian food supply following the new regulations (i.e., reformulation of existing products or introduction of new, healthier alternatives) could lead to a smaller proportion of TV ads promoting foods and drinks that fail to meet nutritional standards.

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This research was funded by Bloomberg Philanthropies and the Clinical and Translational Science Award program of the Division of Research Resources, National Institutes of Health.

AUTHORS

Alcides Velasquez
University of Kansas, USA

Maria Fernanda Parra
Pontificia Universidad Javeriana, Colombia

Mercedes Mora-Plazas
Universidad Nacional de Colombia, Colombia

Luis Fernando Gómez
Pontificia Universidad Javeriana, Colombia

Lindsey S. Taillie
UNC-Chapel Hill, USA

Francesca R. Dillman Carpentier
UNC-Chapel Hill, USA

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RESOURCES

Read more about the evidence for restricting marketing for non-essential foods and drinks high in sugar, salt, saturated or trans fats, or calorie density.

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Compare existing policies around the world aimed at restricting unhealthy food marketing to children.

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MORE MARKETING RESEARCH FROM COLOMBIA:

Unhealthy food advertising disproportionately targets children in Colombia Read more…

The majority of breakfast cereals in South Africa feature child-directed marketing strategies on their packaging, according to a new study in Public Health Nutrition. In an analysis of over 200 breakfast cereals, researchers also found that breakfast cereals with child-directed marketing contained significantly more total sugar and less fiber than cereals without child-directed marketing.

South Africa faces high levels of obesity and other diet-related such as type 2 diabetes, hypertension, cardiovascular disease, and cancer. In April 2023, the National Department of Health released draft regulation R3337, which includes mandatory front-of-package warning labels and restrictions on marketing for products high in nutrients of concern that can cause or worsen NCDs when consumed in excess. Under this regulation, products with warning labels will be banned from making health or nutrition claims, featuring characters on packaging, and using other direct and indirect marketing strategies to appeal to children and their parents.

Research shows that marketing is a key factor in promoting consumption of ultra-processed products high in salt, sugar, saturated and trans fats, and calorie density. Children and adolescents are developmentally vulnerable to advertising and other marketing tactics and are highly targeted, often for food and beverage companies’ least-healthy products. Food and beverage advertising has remained unregulated even though children’s rights are guaranteed in the South African Constitution.

In this study, researchers assessed the nutritional composition of 222 breakfast cereals as well as the presence of direct child marketing strategies on packaging (e.g., illustrations, characters, fantasy, role models), and indirect marketing to children’s parents (nutritional claims and health claims). Breakfast cereals with direct child marketing strategies had lower levels of protein and fiber and higher total sugar and carbohydrate content than those without direct marketing strategies. 

Key findings:

This research was funded by Bloomberg Philanthropies.

AUTHORS

Alice S. Khan
Tamryn Frank
Rina Swart

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MORE RESEARCH FROM SOUTH AFRICA:

Nutrient warning labels work in South Africa: Results from a randomized controlled trial Read more…

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Beverage industry ad spend and airtimes in South Africa Read more…

Chilean policies aimed at reining in unhealthy food marketing are succeeding in protecting children from the onslaught of television advertisements (TV ads) for these products, according to new research. The country’s multi-phased regulations, which began in 2016, have led to a 73% drop in children’s exposure to TV ads for regulated foods and drinks (those that exceed legal thresholds for calories, sugar, salt or saturated fat) by 2019. During this time, the number of ads for unhealthy foods dropped 64% on all TV programs and 77% during children’s programming. Researchers also found that 67% fewer unhealthy food ads used child-directed creative content such as cartoons, characters, toys or contests, which are also prohibited under the country’s laws.

These and other findings from researchers at the University of Chile, Diego Portales University and the University of North Carolina at Chapel Hill underscore both the potential and need for strict rules around marketing to build healthier eating habits. The study also highlights the importance of a key policy addition contributing to the regulations’ success: The initial Law of Food Labeling and Advertising in 2016 limited child-directed creative content in any marketing and prohibited companies from placing TV ads for regulated products during programs attracting a child audience. In 2018, Chile extended this prohibition to a full “daytime” ban across all TV from 6 a.m. to 10 p.m. While researchers saw a decline in advertising for unhealthy foods during earlier phases of the law (in 2017 and early 2018), the significantly greater drop following the full daytime ban is noteworthy.

Key findings:

• Total TV advertising dropped 64% for unhealthy foods and drinks (i.e., those high in calories, sugar, salt and/or saturated fat) from 2016 (pre-regulation) to 2019, after the full 6 a.m. to 10 p.m. ban began.

• TV advertising for unhealthy products during children’s programming dropped 77%
  from 2016 to 2019.

• Children viewed 73% fewer TV ads for regulated products in 2019 compared to 2016.

• The number of TV ads for unhealthy foods and drinks that used prohibited child-directed content (e.g., cartoon characters, prizes, games) dropped 67% from 2016 to 2019.

• For all outcomes, impacts were significantly greater after the full 6 a.m. to 10 p.m. daytime advertising ban began in 2018 compared to earlier restrictions during children’s programming, only (in 2017 and early 2018).

“Focusing on child-directed ad content and child-directed programming to reduce children’s exposure to unhealthy food advertising does work to an extent, based on what we’ve seen in Chile, but children are simply exposed to much more than this,” said Francesca Dillman Carpentier, PhD, W. Horace Carter Distinguished Professor at the UNC Hussman School of Journalism and Media and the study’s first author. “To markedly reduce the amount of unhealthy food promotions children view, we see that it takes a bold move like Chile’s 6 a.m. to 10 p.m. ban to be effective. The number of unhealthy food ads on TV, as well as kids’ exposure to them, was greatly reduced after Chile added the daytime ban on these ads.”

This study’s findings underscores a weakness of nearly all governmental restrictions on TV advertising for unhealthy foods worldwide: Most focus on very narrow windows of time or programming, leaving children exposed most of the day and night to targeted ads for unhealthy foods and drinks. (See below.) This study provides evidence that countries could significantly strengthen existing policies by expanding TV restrictions to complete bans. Countries considering introducing policies to regulate food marketing can also learn from the Chilean experience to protect children more effectively from ad exposure.

Chile enacted marketing controls in 2016 as part of an ambitious, comprehensive policy package aimed at reducing childhood obesity and other health risks by creating a healthier food environment. The Law of Food Labeling and Advertising also mandated “stop sign” warning labels on packages for unhealthy foods and banned their sale or promotion in schools. This remains one of the most ambitious regulatory frameworks in the world aimed at tackling rising nutrition-related diseases and soaring health care costs, and many policymakers and public health advocates worldwide have been watching to gauge the policy package’s effectiveness.

Other studies evaluating the combined effects of Chile’s marketing restrictions, warning labels and school ban have yielded similarly promising results: A study of household grocery purchases found a 24% drop in calories purchased in the first year (during the most lax period of the law’s three-phased nutritional criteria) and a 37% reduction in sodium purchased. Focus groups indicate that parents are being encouraged by their children to avoid buying foods with warning labels. Students reduced their sugar, saturated fat and sodium intake in schools — albeit with some evidence of compensation outside of school settings. And marketing restrictions also led to the removal of child-directed marketing strategies from nearly half of all “high-in” breakfast cereals to just 15% in the first year of the law.

“The Chilean experience has shown us that rigorous food marketing regulations work to reduce kids’ exposure to TV food advertising,” said co-author Lindsey Smith Taillie, PhD, associate professor and associate chair of academics in the Department of Nutrition at UNC-Chapel Hill’s Gillings Global School of Public Health.

“Looking to the future, we need to figure out how to monitor and regulate the digital food marketing environment, as kids increasingly shift their attention to smartphones and other online content.”

Key messages:

This research was supported primarily by Bloomberg Philanthropies at part of the Food Policy Program, with additional support from INTA-UNC, INFORMAS, and CONICYT Fondecyt.

AUTHORS

Francesca R. Dillman Carpentier
Fernanda Mediano Stoltze
Marcela Reyes
Lindsey Smith Taillie
Camila Corvalán
Teresa Correa

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Read the study in the International Journal of Behavioral Nutrition and Physical Activity

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RESOURCES

Read more about the evidence for restricting marketing for non-essential foods and drinks high in sugar, salt, saturated or trans fats, or calorie density.

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Compare existing policies around the world aimed at restricting unhealthy food marketing to children.

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MORE RESEARCH FROM CHILE:

After Chile’s labeling and marketing law, drink purchases contained less sugar and more non-nutritive sweeteners, but overall sweetness stayed the same Read more…

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Study shows Chilean policy package led to declines in purchased calories, sugar, fat, and sodium Read more…

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Study finds no negative economic impact from Chilean food labeling and advertising law Read more…

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Sugary Drink purchases plunge following Chile’s new food law Read more…

A new study published in the Journal of Public Health Research has found that in South Africa, sugar-sweetened beverage manufacturers spent USD 191 million (ZAR 3.7 billion) advertising SSBs across different media from 2013 to 2019. The bulk of this was spent on television (TV) advertising, particularly during children’s and family viewing times.

Researchers from PRICELESS South Africa, the SAMRC Centre for Health Economics and Decision Science at the University of Witwatersrand, and UNC-Chapel Hill measured the number of sugary beverage advertisements in South Africa from January 2013 to April 2019. They used Nielsen data from the top 10 manufacturers in South Africa to assess advertising expenditures across different media, including TV, print newspapers and magazines, radio, and internet. They examined data by drink category and media type and analyzed the number of ads aired on TV during child and family peak viewing times (between 3 p.m. and 7 p.m. on weekdays).

Key findings:

South Africa faces high levels of diet-related diseases such as obesity, type 2 diabetes, hypertension, cardiovascular disease, and cancer. Drinking excess sugary drinks increases the risk of developing these diseases and their risk factors. Research shows that marketing and advertising is a key factor in promoting the consumption of sugary drinks and other ultra-processed products and that children and adolescents are highly susceptible to food marketing.

To lower consumption of sugary drinks as well as foods high in sugar, salt, saturated fat, South Africa implemented a sugary drink tax in 2018 that has already led to decreased purchases and intake of sugary drinks. The country also recently issued a draft regulation for mandatory front-of-package warning labels, which includes a stipulation that products with warning labels (i.e., high in salt, fat, sugar, or containing artificial sweeteners) may not use certain marketing techniques on their packages.

Thus far, however, the country has not enacted policies to restrict marketing of non-essential foods or drinks beyond the proposed packaging restrictions. This study suggests that the sweetened beverage industry is capitalizing on the child and family market, particularly via television advertising. The study also finds that industry’s voluntary pledges to curb marketing aimed at children have not worked, further underscoring the need for statutory action.

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This research was funded by Bloomberg Philanthropies and the South African Medical Research Council.

AUTHORS

Micheal Kofi Boachie
Susan Goldstein
Petronell Kruger
Shu Wen Ng
Karen J Hofman
Evelyn Thsehla

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FACT SHEETS

Read more about the evidence for restricting marketing for non-essential foods and drinks high in sugar, salt, saturated or trans fats, or calorie density.