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.

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.

Two recent studies conducted by researchers from the Global Food Research Program at UNC-Chapel Hill and the University of Chile have found that in the first phase of Chile’s Law of Food Labeling and Advertising, consumers’ beverage purchases contained less sugar and more non-nutritive sweeteners (e.g., Aspartame, Stevia, or Sucralose), but overall beverage sweetness stayed the same.

The requirement under Chile’s law for products high in calories or added sugar, salt, saturated fat to carry a front-of-package warning label has prompted the food and beverage industry to reformulate and introduce new products in order to avoid regulation. For example, companies have reduced the amount of added sugars in drinks to fall below the law’s sugar threshold, while replacing some of that sugar with non-nutritive sweeteners to maintain a similar taste. One study found that the share of beverages in Chile containing non-nutritive sweeteners increased by more than 10% after the law came into effect.

Taste test: beverage sweetness

In a study published in Frontiers in Nutrition in October 2022, researchers found that Chile’s policies were not associated with changes in overall sweetness taste of the beverages consumers bought, despite evidence of product reformulation to contain less sugars and more non-nutritive sweeteners (which can taste 10–20,000 times sweeter than sugars).

“We wanted to look at overall change in sweetness to understand what consumers were being exposed to, as a result of reformulation,” said Natalia Rebolledo, postdoctoral researcher at the Center for Research in Food Environments and Prevention of Nutrition-Related Chronic Diseases (CIAPEC) at the University of Chile and the study’s first author. “We focused on beverages because they are the main dietary source of added sugars and non-nutritive sweeteners in the Chilean diet.”

For this study, researchers analyzed the weekly grocery purchases of over 2,000 households before and after the labeling law began and evaluated the total sweetness of purchases. They did this by creating a “sweetness index” to measure and compare levels of non-nutritive sweeteners, total sugars, and total combined sweetness in each beverage purchased, taking into account the unique levels of sweetness tastes from non-nutritive sweeteners and sugars. The team used data from the Chilean Nutritional Facts Panel, which provided the actual amounts of total sugars and non-nutritive sweeteners included in the drinks purchased by study households.

Key findings during Phase 1 of the law:

This is the first study to analyze whether beverage sweetness changed based on the type of sweetener used (sugars and/or non-nutritive sweeteners) after the implementation of the Law of Food Labeling and Advertising in Chile.

Sweetener purchases

The team’s next study, published in Current Developments in Nutrition in December 2022, examined changes in purchases of foods and beverages sweetened with non-nutritive and caloric sweeteners after Phase 1 of the law.

Using the same dataset of weekly grocery purchases from over 2,000 households, researchers analyzed the sweetener content of purchased foods and beverages before and after the labeling and marketing law began. They created four product categories based on the types and combination of sweeteners used in each product purchased:

1. No added sweeteners used;
2. Caloric sweeteners used, but no non-nutritive sweeteners used;
3. Non-nutritive sweeteners used, but no caloric sweeteners used; and
4. Both caloric and non-nutritive sweeteners used.

Researchers then analyzed products purchased products in each category before and after the law.

Key findings during Phase 1 of the law:

This is the first study to analyze the change in purchases of sweeteners in food and beverages after the implementation of the Law of Food Labeling and Advertising in Chile.

Both of these studies add to previous research evaluating the impact of Chile’s Law of Food Labeling and Advertising on intake, including a study from the same research team finding that preschoolers increased their non-nutritive sweeteners intake by 14 percentage points in the first year of the law.

Rebolledo says of their findings, “It is positive that beverages did not get sweeter as a result of higher non-nutritive sweetener use. It appears that both the beverage industry and consumers are substituting caloric sweeteners with non-nutritive sweeteners, which could have long-term health impacts that we need to better understand. We need to continue monitoring the following phases of the law to see if Chileans changed their purchasing habits after the requirements for warning labels and marketing became stricter.”

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This research was funded by Bloomberg Philanthropies, National Institutes of Health, National Commission for Scientific and Technological Research (CONICYT), and Becas Chile Doctorado 2017.

AUTHORS

Natalia Rebolledo
Maxime Bercholz
Linda Adair
Camila Corvalán
Shu Wen Ng
Lindsey Smith Taillie

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What are non-nutritive sweeteners?

Non-nutritive sweeteners are sweeteners that have intensely sweet taste and typically do not contribute calories or are very low in calories. Non-nutritive sweeteners can be naturally occurring/derived from plants (e.g., sorbitol, xylitol, erythritol, stevia glycosides, monk fruit extract) or synthetic/”artificial” (e.g., aspartame, saccharin, sucralose, or acesulfame potassium).

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FACT SHEETS

Read more about the evidence for front-of-package labels and marketing restrictions.

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Learn more about Chile’s policies and our evaluation work there.

The Global Food Research Program recently contributed comments to the World Health Organization (WHO) draft guideline on policies to protect children from the harmful impact of food marketing.

Children worldwide are exposed every day to food marketing where they live, learn, and play — on TV, in and around their schools, at sporting events, in stores, at the movies, while watching videos and playing games online, and on social media. The vast majority of this marketing promotes calorie-dense, nutrient-poor, ultra-processed foods containing added sugar, saturated fat, and sodium well above recommended levels (e.g., sugary breakfast cereals, soft drinks, candies, salty and sugary snacks and baked goods, and fast foods).

The WHO and other health leaders worldwide point to children’s exposure to food marketing as a major risk factor for obesity. They have called for regulations to limit both the amount of marketing children are exposed to and the persuasive power of that marketing. To date, relatively few countries have implemented policies to restrict junk food marketing, and the food and beverage industry has successfully preempted mandatory policies in many countries by pledging to self-regulate their child-targeted promotional activities. Industry self-regulation has proved largely ineffective, underscoring the ongoing need for more and stronger governmental policies.

The WHO recently issued new draft guidelines for policies to protect children from the harmful impact of food marketing, updating previous recommendations based on more recent evidence and research. The Global Food Research Program was pleased to submit our comments to the public consultation, which closed July 31, 2022. Our key recommendations include:

• Advocating for a stronger focus on human rights and equity, in particular all children’s right to a healthy childhood that is free from economic exploitation, discrimination, and invasions of privacy, as guaranteed by The United Nations Convention on the Rights of the Child;
• Strengthening definitions of children, marketing, marketing exposure, and marketing power;
• Including marketing protection in school environments and mandated protection from targeting and tracking children in online environments; and
• Consideration of recent evidence from Chile, which was published after the latest WHO-commissioned systematic review. Chile has the most comprehensive policy to limit unhealthy food marketing to children to date. This was implemented alongside a ban on sales or promotion of regulated foods in schools and a front-of package warning label system. Evidence to date supports enacting mutually reinforcing policies as more effective than single policies. Chilean evaluations also highlight ways that industry might shift marketing strategies in response to regulation, which informs the need for more comprehensive restrictions.

We congratulate the WHO on their work thus far and appreciate the opportunity to contribute to development of the new guideline.

Read our full comments.

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RESOURCES

Learn more about the harms of food marketing and policy options to protect children.

View and compare national marketing regulations around the world.

Parents are more likely to choose a fruit drink with added sugar for their young child when the drink’s packaging includes nutrition-related claims, researchers with the Global Food Research Program found in a study published in the American Journal of Clinical Nutrition.

This study is among the first to look at how claims influence parents’ drink purchases for their young child (ages 1-5).

In their experiment, the research team invited parents to “shop” in a virtual convenience “store” (similar to a video game, right) on participants’ own computers. The study’s 2,219 participants were randomly assigned to view fruit drinks displaying one of three claims (“No artificial sweeteners,” “100% Vitamin C,” or “100% All Natural”) or no claim.

Findings

The research team found that healthful claims increased misperceptions about nutritional quality. Even though all drink labels also contained nutritional panel information, parents who viewed drinks with claims were more likely to incorrectly believe that the fruit drinks did not contain added sugar or were 100% juice.

“Parents who saw the claims were more likely to pick the sugary fruit drink instead of water, as well as choose the sugary fruit drink instead of 100% fruit juice,” said Marissa Hall, assistant professor at UNC-Chapel Hill’s Gillings School of Global Public Health and the study’s lead author. “The sugary fruit drinks had over 30 grams of added sugar, and that information was right there on the label. But still, the presence of a claim made parents more likely to think that the sugary fruit drinks did not have any added sugar. Also, the claims made parents think that the drinks were 100% fruit juice, which was not the case.”

These findings build on the authors’ research looking at how often nutrition-related claims appear on fruit drinks and how claims relate to drinks’ actual nutritional profile. They have also examined sociodemographic disparities between households that purchase fruit drinks with claims (under review). Key findings from these studies include:

• 

  Nutrition-related claims are ubiquitous: 97% of fruit drinks purchased had at least one and, on average, 3 to 4 nutrition-related claims on the front-of-package.
• Fruit drinks with claims related to vitamin C, juice or nectar, fruit or fruit flavor, and “natural” claims were higher in calories and sugar than fruit drinks without these claims.
• Less than a quarter of fruit drinks studied listed juice in their top two ingredients, but over half had juice, nectar, or fruit claims on the front of the package.
• U.S. households with infants and young children from socially disadvantaged groups were more likely to purchase fruit drinks.

Implications

Collectively, these studies’ findings suggest a need for stronger regulation of marketing claims on fruit drinks.

“Claims can make products seem healthier to parents than they really are,” said Lindsey Smith Taillie, PhD, senior author and assistant professor at Gillings School of Global Public Health. “This is problematic and important from a policy standpoint.”

“The FDA could consider requiring nutrient warning labels or disclaimers on the products to help inform consumers about the risk, or regulating use of certain claim types,” said Hall. “For example, the FDA could prohibit labeling a sugary fruit drink ‘all natural,’ if it contains above a certain amount of added sugar.”

Taillie notes that a precedent for such policies exists in other countries. “In Mexico, for example, beverages that are high in sugar are prohibited from carrying nutrition claims. This type of regulation could help make it easier for parents to be able to quickly and easily sort out the sugary drinks from the healthier options while grocery shopping.”

“The FDA has broad authority to combat deceptive labeling,” said Eva Greenthal, co-author and senior science policy associate at the public health advocacy group, Center for Science in the Public Interest. “The agency should consider requiring nutrient warnings on products that are high in added sugars, requiring more prominent ‘percent juice’ declarations on fruit drink labels, and prohibiting nutrient claims like ‘100% Vitamin C’ on beverages that are high in added sugars.”

Read more about these studies and their findings in our Fruit Drinks Study Series infographic fact sheet.

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This research was supported by grant #76337 from the Robert Wood Johnson Foundation’s Healthy Eating Research program.

AUTHORS:

Marissa G Hall
Allison J Lazard
Isabella CA Higgins
Jonathan L Blitstein
Emily W Duffy
Eva Greenthal
Sarah Sorscher
Lindsey Smith Taillie

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RESOURCES:

Learn more about the team’s findings on fruit drink claims in our fruit drinks fact sheet.

The latest evaluation of Chile’s Law of Food Labeling and Advertising finds that under Phase 1 of the law’s implementation, Chileans purchased significantly fewer calories, sugar, saturated fat, and sodium than would have been expected had the law and its regulations not gone into effect.

The study, published in the August issue of The Lancet Planetary Health, combined data on household food shopping from 2015–2017 (during Phase 1 of the law) with nutrition facts data for all the products purchased to examine changes in what groceries Chileans bought before/after the law took effect. 

Overall, purchased calories, sugar, saturated fat, and sodium declined significantly. Among “high-in” purchases (junk foods and sugary drinks that did not meet Phase 1 nutrition criteria), households bought 24% less calories, 27% less sugar, 16% less saturated fat, and 37% less sodium compared to what they were expected to buy, had the law not come into effect.

This evaluation builds on and confirms findings from the Global Food Research Program’s previous evaluation of changes in beverage purchases during Phase 1. In that study, authors observed a 24% drop in the volume of sugary drinks purchased and a 28% decline in calories purchased from sugary drinks, compared to expected purchases had the law not taken effect.

These results highlight the potential for multi-component policies to significantly impact people’s shopping and consumption habits. The GFRP team will continue working with colleagues in Chile and Mexico to evaluate changes following implementation of Phases 2 and 3 of the law, which have increasingly strict nutrition standards.

Read more about this research and its implications, according to the study authors.

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Funding for this study was provided by Bloomberg Philanthropies, the International Development Research Center, and the Carolina Population Center (P2C HD050924).