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.

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.