7
Findings, Recommendations, Next Steps

Food and beverage marketing to children and youth has become ubiquitous on the American landscape. Although recent public announcements by some companies suggest an interest in change, the preponderance of the foods and beverages introduced and marketed to children and youth have been high in total calories, added sugars, salt, fat, and low in nutrients.

Multiple influences interact to shape the food preferences and choices, eating behaviors, total calorie intake, diet quality, and health outcomes of children and youth. There is evidence that commercial advertising and marketing of foods and beverages to children and youth through a growing variety of channels and media outlets—including the mass media, schools, child-care settings, grocery stores, shopping malls, theaters, sporting events, and even airports—are notable contributors to the environments in which the nutritional patterns of children and youth evolve.

This report has summarized the status and trends in the health, diet, and eating patterns of children and youth; reviewed the various factors that influence the food and beverage consumption habits of children and youth; described how food and beverages are developed and marketed to children and youth; systematically reviewed the evidence on the influence of food and beverage marketing on the diets and diet-related health of children and youth; and described the policy instruments that may be combined to enhance availability and access to healthful foods and to support healthful food and beverage choices and marketing practices affecting children and youth. This chapter summarizes the findings included throughout the report and offers recommendations on ways in which various sectors could help improve the diets and health of children and youth.



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Food Marketing to Children and Youth: Threat or Opportunity? 7 Findings, Recommendations, Next Steps Food and beverage marketing to children and youth has become ubiquitous on the American landscape. Although recent public announcements by some companies suggest an interest in change, the preponderance of the foods and beverages introduced and marketed to children and youth have been high in total calories, added sugars, salt, fat, and low in nutrients. Multiple influences interact to shape the food preferences and choices, eating behaviors, total calorie intake, diet quality, and health outcomes of children and youth. There is evidence that commercial advertising and marketing of foods and beverages to children and youth through a growing variety of channels and media outlets—including the mass media, schools, child-care settings, grocery stores, shopping malls, theaters, sporting events, and even airports—are notable contributors to the environments in which the nutritional patterns of children and youth evolve. This report has summarized the status and trends in the health, diet, and eating patterns of children and youth; reviewed the various factors that influence the food and beverage consumption habits of children and youth; described how food and beverages are developed and marketed to children and youth; systematically reviewed the evidence on the influence of food and beverage marketing on the diets and diet-related health of children and youth; and described the policy instruments that may be combined to enhance availability and access to healthful foods and to support healthful food and beverage choices and marketing practices affecting children and youth. This chapter summarizes the findings included throughout the report and offers recommendations on ways in which various sectors could help improve the diets and health of children and youth.

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Food Marketing to Children and Youth: Threat or Opportunity? BOX 7-1 Broad Conclusions Along with many other intersecting factors, food and beverage marketing influences the diets and health prospects of children and youth. Food and beverage marketing practices geared to children and youth are out of balance with healthful diets, and contribute to an environment that puts their health at risk. Food and beverage companies, restaurants, and marketers have underutilized potential to devote creativity and resources to develop and promote food, beverages, and meals that support healthful diets for children and youth. Achieving healthful diets for children and youth will require sustained, multisectoral, and integrated efforts that include industry leadership and initiative. Public policy programs and incentives do not currently have the support or authority to address many of the current and emerging marketing practices that influence the diets of children and youth. Overall, the committee identified five broad conclusions (Box 7-1), derived from the individual findings. These serve as the basis for the committee’s recommendations. HEALTH, DIET, AND EATING PATTERNS OF CHILDREN AND YOUTH Health-related behaviors such as eating habits and physical activity patterns develop early in life and often extend into adulthood. A healthful and balanced diet provides recommended amounts of nutrients and other food components to promote normal growth and development, reduce chronic disease risk, and foster appropriate energy balance and a healthy weight. In order to develop eating habits that will have health-promoting benefits that carry them into adulthood, children and adolescents need to consume more fruits, vegetables, whole grains, and dairy products, and moderate their intakes of high-calorie and low-nutrient foods and beverages. The committee’s review in Chapter 2 of the health, diet, and eating patterns of children and youth identified several issues and trends. More certain determinations of nutritional requirements for children and adolescents await the development of better techniques and data sets.

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Food Marketing to Children and Youth: Threat or Opportunity? More accurate methods are needed to assess the dietary intakes of children and youth, including calorie intakes and expenditures. Total calorie intake appears to have increased substantially over the past 25 years for preschool children and adolescent boys and girls, with more modest changes for children ages 6–11 years. Children and youth consume a large proportion of their total calories from foods and beverages that are of high-calorie and low-nutrient content. Carbohydrate intake has increased substantially among children and youth over approximately the past two decades. Total fat and saturated fat intakes among children and youth remain at levels that exceed dietary recommendations. Most preschool children consume added sugars well above suggested limits, and older children and adolescents consume about double the suggested limit of added sugars in their diet. Mean sodium intake of children and youth has increased over the past 35 years, and the majority of children and adolescents are consuming sodium in greater amounts than recommended levels. Over the past decade, most children and youth have not met the daily recommended servings for vegetables, fruits, or whole grains. Sweetened beverage consumption (e.g., carbonated soft drinks and fruit drinks) by children and adolescents has increased considerably over the past 35 years and is now a leading source of added sugars, especially in adolescents’ diets. The consumption of milk, a major source of dietary calcium, has decreased among children and adolescents over the same period, and most have calcium intakes below the recommended adequate intake level. Breakfast consumption by children and adolescents has decreased considerably over the past 40 years and the occurrence of breakfast consumption declines with age. The frequency of breakfast consumption is predictive of lower body mass index (BMI) levels in children and adolescents. The prevalence of snacking and number of snacking occasions by children and youth have increased steadily over the past 25 years. There has been a steady increase in the proportion of calories that children and youth have received from away-from-home foods over the past 20 years. Approximately one-third or more of their calories are derived from foods purchased outside of the home, nearly one-half of which is obtained at restaurants and quick serve restaurants that contain higher fat content than food consumed at home. Calorie intake by infants and toddlers substantially exceeds their estimated requirements, although validation is needed on the reliability of food intake reporting by parents and caregivers, as well as on body weight estimates.

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Food Marketing to Children and Youth: Threat or Opportunity? Infants and toddlers are consuming diets disproportionately high in sweetened foods and beverages and fried potatoes, and disproportionately low in green leafy vegetables. Certain subgroups, such as low-income and minority children and adolescent girls, have inadequate dietary intakes of specific micronutrients (e.g., vitamins D and B6, folate, iron, zinc, and magnesium). FACTORS SHAPING FOOD AND BEVERAGE CONSUMPTION OF CHILDREN AND YOUTH Children’s dietary patterns and related health prospects are shaped by the interplay of many factors—genetics and biology, culture and values, economic status, physical and social environments, and commercial and media environments—all of which, apart from genetic predispositions, have undergone significant transformations over the past three decades. Interactions within and among these contexts affect behavior. The committee took an ecological perspective in assessing the processes and context of the influences shaping children’s eating behaviors, identifying in Chapter 3 several broad issues relevant to child and adolescent eating behaviors and food and beverage choices. Food preferences develop as early as 2–3 years of age and are shaped by a child’s early experiences, positive or negative conditioning, exposure to foods, and a biological predisposition to prefer sweet, high-fat, and salty foods. The availability and marketing of foods and beverages of larger portion sizes has increased steadily over the past three decades in many venues. Children are aware of food brands as young as 2–3 years of age and preschoolers demonstrate brand recognition when cued by spokescharacters and colored packages. The majority of children’s food requests are for branded products. Brand loyalty is highest in teens for carbonated soft drinks and quick serve restaurants. FOOD AND BEVERAGE MARKETING TO CHILDREN AND YOUTH In multiple forms, media influences have assumed a central socializing role for children and youth. As media pervasiveness has grown in influence, so has its use for the marketing of branded food and beverage products. The substantial investment in commercial advertising and marketing of foods and beverages directed to children and youth over the past several decades has spawned a sizable and sophisticated marketing research enter-

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Food Marketing to Children and Youth: Threat or Opportunity? prise to help companies translate desires and preferences into branded products and purchases for and by children and youth, making them a primary focus of food and beverage marketing initiatives. Last year an estimated more than $10 billion per year was spent for all types of food and beverage marketing to children and youth in America. The committee’s review of food and beverage marketing to children and youth in Chapter 4 identified several key findings. Marketing research can provide important insights about how marketing techniques might help improve the diets of children and youth. Yet, much of the relevant marketing research on the profile and impact of food and beverage marketing to children and youth is currently unavailable to the public, including for use in designing and targeting efforts to improve the diets of children and youth. Children and youth ages 4–17 years have increasing discretionary income and purchasing capacity, are being targeted more directly by marketers, and frequently spend their discretionary income on high-calorie and low-nutrient foods and beverages. Child-targeted food and beverage products have steadily increased over the past decade, and are typically high in total calories, sugars, salt, fat, and low in nutrients. Television is the primary promotional medium for measured media marketing of food and beverage products to children and youth, but a notable shift is occurring toward unmeasured sales promotion (e.g., product placement, character licensing, in-school marketing, special event marketing). The use of child-oriented licensed cartoon and other fictional or real-life spokescharacters has been a prevalent practice used to promote low-nutrient and high-calorie food and beverage products. Use of such characters to promote more healthful foods, particularly for preschoolers, is relatively recent. Children are exposed to extensive advertising for high-calorie and low-nutrient foods and beverages and very limited advertising of healthful foods and beverages during their daily television viewing. The competitive multifaceted marketing of high-calorie and low-nutrient food and beverage products in school settings is widely prevalent and appears to have increased steadily over the past decade. Food and beverage marketing is increasingly delivered through integrated vehicles other than the traditional television advertising (e.g., Internet, event sponsorships, outdoor media, kid’s clubs, video games, advergames, product placement, music, and schools) that are especially appealing to children and youth.

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Food Marketing to Children and Youth: Threat or Opportunity? Efforts by the Children’s Advertising Review Unit (CARU)—the children’s arm of the advertising industry’s self-regulation program for child-directed advertising and promotion in media—have influenced certain elements of traditional advertising within its designated purview, but these standards do not address the impact of the volume of advertising, the appeal of its association with other elements of the popular culture for children and youth, or the influences of rapidly increasing marketing approaches. Furthermore, there is a need for a more formal evaluation of the effectiveness of CARU’s impact and enforcement capacity. The consistency, accuracy, and effectiveness of the proprietary logos or icons introduced by several food companies as positive steps to communicate the nutritional qualities of some of their branded products to consumers have not been evaluated. Without an empirically validated industrywide rating system and approach, efforts to use such graphic portrayals on food labels may fall short of their potential as guides to better food and beverage choices by children, youth, and their parents. Certain food and beverage companies and quick serve restaurants with products prominently consumed by children are actively exploring more balanced and health-promoting product development and marketing strategies. Prevailing industry practices, guidelines, and efforts remain limited. The food retail sector has taken some steps to promote healthful products to young consumers and their families, but there are abundant opportunities to do more to promote child-oriented foods and beverages that are healthful, visually accessible, and economically affordable. INFLUENCE OF FOOD AND BEVERAGE MARKETING ON THE DIETS AND DIET-RELATED HEALTH OF CHILDREN AND YOUTH The prevalence of obesity in children and youth has occurred in parallel with significant changes in the U.S. media and marketing environments. This relationship has prompted the committee’s primary inquiry about the influence of food and beverage marketing on the diets and health of American children and youth. The committee’s review of the published, peer-reviewed literature in Chapter 5 indicates that, among many factors, food and beverage marketing influences the preferences and purchase requests of children, influences consumption at least in the short term, is a likely contributor to less healthful diets, and may contribute to negative diet-related health outcomes and risks among children and youth. The literature indicates a relationship among marketing, dietary precursors, diets, diet-related health, and, in particular, adiposity (body fatness). Specifically, the committee’s systematic evidence review found that:

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Food Marketing to Children and Youth: Threat or Opportunity? With respect to dietary precursors, food and beverage advertising on television has some influence on the preferences and purchase requests of children and youth: There is strong evidence that television advertising influences the food and beverage preferences of children ages 2–11 years. There is insufficient evidence about its influence on the preferences of teens ages 12–18 years. There is strong evidence that television advertising influences the food and beverage purchase requests of children ages 2–11 years. There is insufficient evidence about its influence on the purchase requests of teens ages 12–18 years. There is moderate evidence that television advertising influences the food and beverage beliefs of children ages 2–11 years. There is insufficient evidence about its influence on the beliefs of teens ages 12–18 years. Given the findings from the systematic evidence review of the influence of marketing on the precursors of diet, and given the evidence from content analyses that the preponderance of television food and beverage advertising relevant to children and youth promotes high-calorie and low-nutrient products, it can be concluded that television advertising influences children to prefer and request high-calorie and low-nutrient foods and beverages. With respect to diets, food and beverage advertising on television has some influence on the dietary intake of children and youth: There is strong evidence that television advertising influences the short-term consumption of children ages 2–11 years. There is insufficient evidence about its influence on the short-term consumption of teens ages 12–18 years. There is moderate evidence that television advertising influences the usual dietary intake of younger children ages 2–5 years and weak evidence that it influences the usual dietary intake of older children ages 6–11 years. There is also weak evidence that it does not influence the usual dietary intake of teens ages 12–18 years. With respect to diet-related health, food and beverage advertising on television is associated with the adiposity (body fatness) of children and youth: Statistically, there is strong evidence that exposure to television advertising is associated with adiposity in children ages 2–11 years and teens ages 12–18 years. The association between adiposity and exposure to television advertising remains after taking alternative explanations into account, but the research does not convincingly rule out other possible explanations for the association; therefore, the current evidence is not sufficient to arrive at

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Food Marketing to Children and Youth: Threat or Opportunity? any finding about a causal relationship from television advertising to adiposity. It is important to note that even a small influence, aggregated over the entire population of American children and youth, would be consequential in impact. Most children ages 8 years and under do not effectively comprehend the persuasive intent of marketing messages, and most children ages 4 years and under cannot consistently discriminate between television advertising and programming. The evidence is currently insufficient to determine whether or not this meaningfully alters the ways in which food and beverage marketing messages influence children. New research is needed on food and beverage marketing and its impact on diet and diet-related health and on improving measurement strategies for factors involved centrally in this research. Much of this research must be interdisciplinary and fairly large-scale in nature, although some highly-focused small-scale research is also desirable. Among the specific research needed are studies of newer promotion techniques, newer venues, and healthier products and portion sizes. PUBLIC POLICY ISSUES IN FOOD AND BEVERAGE MARKETING TO CHILDREN AND YOUTH Various public policies and actions at the federal, state, and local levels have been considered, implemented, or are in process to help improve the diets of children and youth. The committee reviewed efforts by government at the federal, state, and local levels to improve education and information to better inform the nutritional choices for children and youth; initiatives to enhance the influence that schools have on the nutritional status of students and their families; and the potential of social marketing as a means of improving dietary patterns and practices. It also surveyed the legal context for policies and regulations related to advertising and marketing. This review in Chapter 6 found a number of opportunities for improvement. A number of positive steps have been taken by the Food and Drug Administration to improve food and beverage labeling as a means of conveying helpful information to enable healthier choices, including exploration of ways to expand the provision of such information on menus and packaging in quick serve and full serve family restaurants. Still, the reach and effectiveness of such efforts—by the U.S. Food and Drug Administration (FDA), industry, and the two together—are far short of what they could or should be to provide children, youth, and their parents with the information they need, using consistent standards and graphics that are easily understood and engaging.

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Food Marketing to Children and Youth: Threat or Opportunity? National standards do not exist for the use or marketing of competitive foods and beverages in school settings or after-school venues such as in child-care settings. Cooperative initiative by the U.S. Department of Agriculture and the Department of Education has been limited in shaping policies and approaches related to healthier food and beverage promotion in schools. Evidence for the effectiveness of social marketing programs to promote healthful behaviors is promising but mixed. Programs with the most positive results have had higher funding, been more sustained, been shaped by formative research, deployed an integrated marketing approach, and used ongoing monitoring and evaluation. These characteristics are the likely requirements for achievement of successful social marketing programs to improve the diets of children and youth. Regulations for those who advertise and market food and beverage products to children will need to evolve as the food industry develops new techniques for promoting its products. How current law will be applied to rapidly changing areas like the Internet cannot currently be predicted with confidence. However, future regulatory interventions should certainly be taken on the basis of reliable data concerning the impacts on children of the marketing and advertising of food and beverage products. Currently, neither the Federal Trade Commission, nor any other responsible federal agency, collects or maintains such data. Comprehensive evaluations are not available to assess the effect on children’s diets of countrywide bans on child-directed television advertising. Limited evidence suggests that national borders may not serve as effective barriers to children’s broadcast media and advertising where it is common to receive broadcasts from outside the receiving countries. RECOMMENDATIONS Reflective of the responsibilities of multiple sectors, the committee’s recommendations address actions related to food and beverage production, processing, packaging, and sales; marketing practice standards; media initiatives; parents, caregivers, and families; school environments; and public policy. Recommendations are also offered for research activities necessary to chart the path of future improvements, and the monitoring capacity to track improvements in marketing practices and their influence on children’s and youths’ diets and health. These recommendations reflect the current context and information in a rapidly changing environment, and should be implemented together as a package to support and complement one another.

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Food Marketing to Children and Youth: Threat or Opportunity? Food and Beverage Production and Promotion Central to making progress toward more healthful diets for children and youth will be carefully designed and sustained commitments by the food, beverage, and quick serve restaurant industries to promote the availability, accessibility, affordability, and appeal of nutritious foods and beverages. Recommendation 1: Food and beverage companies should use their creativity, resources, and full range of marketing practices to promote and support more healthful diets for children and youth. To implement this recommendation, companies should Shift their product portfolios in a direction that promotes new and reformulated child- and youth-oriented foods and beverages that are substantially lower in total calories, lower in fats, salt, and added sugars, and higher in nutrient content. Shift their advertising and marketing emphasis to child- and youth-oriented foods and beverages that are substantially lower in total calories, lower in fats, salt, and added sugars, and higher in nutrient content (see later recommendations on public policy and monitoring). Work with government, scientific, public health, and consumer groups to develop and implement labels and advertising for an empirically validated industrywide rating system and graphic representation that is appealing to children and youth to convey the nutritional quality of foods and beverages marketed to them and their families. Engage the full range of their marketing vehicles and venues to develop and promote healthier appealing and affordable foods and beverages for children and youth. Recommendation 2: Full serve restaurant chains, family restaurants, and quick serve restaurants should use their creativity, resources, and full range of marketing practices to promote healthful meals for children and youth. To implement this recommendation, restaurants should Expand and actively promote healthier food, beverage, and meal options for children and youth. Provide calorie content and other key nutrition information, as possible, on menus and packaging that is prominently visible at the point of choice and use.

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Food Marketing to Children and Youth: Threat or Opportunity? Recommendation 3: Food, beverage, restaurant, retail, and marketing industry trade associations should assume transforming leadership roles in harnessing industry creativity, resources, and marketing on behalf of healthful diets for children and youth. To implement this recommendation, trade associations should Encourage member initiatives and compliance to develop, apply, and enforce industrywide food and beverage marketing practice standards that support healthful diets for children and youth. Provide technical assistance, encouragement, and support for members’ efforts to emphasize the development and marketing of healthier foods, beverages, and meals for children and youth. Exercise leadership in working with their members to improve the availability and selection of healthful foods and beverages accessible at eye level and reach for children, youth, and their parents in grocery stores and other food retail environments. Work to foster collaboration and support with public-sector initiatives promoting healthful diets for children and youth. Marketing Practice Standards A reliable barometer of the commitment of the members of the food, beverage, and restaurant industries to promote the nutritional health of children and youth will be the rigor of the standards they set and enforce for their own marketing practices. Recommendation 4: The food, beverage, restaurant, and marketing industries should work with government, scientific, public health, and consumer groups to establish and enforce the highest standards for the marketing of foods, beverages, and meals to children and youth. To implement this recommendation, the cooperative efforts should Work through the Children’s Advertising Review Unit (CARU) to revise, expand, apply, enforce, and evaluate explicit industry self-regulatory guidelines beyond traditional advertising to include evolving vehicles and venues for marketing communication (e.g., the Internet, advergames, branded product placement across multiple media). Assure that licensed characters are used only for the promotion of foods and beverages that support healthful diets for children and youth. Foster cooperation between CARU and the Federal Trade Commission in evaluating and enforcing the effectiveness of the expanded self-regulatory guidelines.

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Food Marketing to Children and Youth: Threat or Opportunity? Media and Entertainment Initiatives Because no element of the lives of Americans has a broader reach than the media and entertainment industry, their opportunities and responsibilities are great to depict and promote healthful diets and eating habits among children and youth. Recommendation 5: The media and entertainment industry should direct its extensive power to promote healthful foods and beverages for children and youth. To implement this recommendation, media, and the entertainment industry should Incorporate into multiple media platforms (e.g., print, broadcast, cable, Internet, and wireless-based programming) foods, beverages, and storylines that promote healthful diets. Strengthen their capacity to serve as accurate interpreters and reporters to the public on findings, claims, and practices related to the diets of children and youth. Parents, Caregivers, and Families Parents and families remain the central influence on children’s attitudes and behaviors, and social marketing efforts that aim to improve children’s and youths’ diets therefore must be tied directly to that influence. Recommendation 6: Government, in partnership with the private sector, should create a long-term, multifaceted, and financially sustained social marketing program supporting parents, caregivers, and families in promoting healthful diets for children and youth. To implement this recommendation Elements should include the full range of evolving and integrated marketing tools and widespread educational and community-based efforts, including use of children and youth as change agents. Special emphasis should be directed to parents of children ages birth to 4 years and other caregivers (e.g., child-care settings, schools, after-school programs) to build skills to wisely select and prepare healthful and affordable foods and beverages for children and youth. The social marketing program should have a reliable and sustained support stream, through public-appropriated funds and counterpart cooperative support from businesses marketing foods, beverages, and meals to children and youth.

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Food Marketing to Children and Youth: Threat or Opportunity? School Environments If schools and parents are to remain the strongest allies working to promote and advance the interests of American children and youth, the school environment must be fully devoted to preparing students for healthful lifelong dietary patterns. Recommendation 7: State and local educational authorities, with support from parents, health authorities, and other stakeholders, should educate about and promote healthful diets for children and youth in all aspects of the school environment (e.g., commercial sponsorships, meals and snacks, curriculum). To implement this recommendation, companies should Develop and implement nutrition standards for competitive foods and beverages sold or served in the school environment. Adopt policies and best practices that promote the availability and marketing of foods and beverages that support healthful diets. Provide visible leadership in this effort by public and civic leaders at all levels such as the National Governors Association, the state and local Boards of Education, and the National Parent Teacher Association, as well as trade associations representing private-sector businesses such as distributors, bottlers, and vending machine companies that directly interface with the school administration. Public Policy A first obligation of public policy is to protect the vulnerable and a second is to create the conditions for a desirable future. Both call for the careful use of policy initiatives to foster healthy prospects for children and youth. Recommendation 8: Government at all levels should marshal the full range of public policy levers to foster the development and promotion of healthful diets for children and youth. To implement this recommendation Government should consider incentives (e.g., recognition, performance awards, tax incentives) that encourage and reward food, beverage, and restaurant companies that develop, provide, and promote healthier foods and beverages for children and youth in settings where they typically consume them (e.g., restaurants, schools, amusement parks, sports venues, movie theaters, malls, and airports).

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Food Marketing to Children and Youth: Threat or Opportunity? Government should explore combining the full range of possible approaches (e.g., agricultural subsidies, taxes, legislation, regulation, federal nutrition programs) for making fruits and vegetables readily available and accessible to all children, youth, and families. The U.S. Department of Agriculture should develop and test new strategies for promoting healthier, appealing school meals provided through the School Breakfast Program and the National School Lunch Program as well as other federal programs designed for after-school settings (Special Milk Program) and child-care settings (Child and Adult Care Food Program). If voluntary efforts related to advertising during children’s television programming are unsuccessful in shifting the emphasis away from high-calorie and low-nutrient foods and beverages to the advertising of healthful foods and beverages, Congress should enact legislation mandating the shift on both broadcast and cable television.* Research Knowledge is the bedrock of effective action and progress, yet current resources are scant to expand the knowledge base, from all sources, on the changing ways in which marketing influences the diets and health of children and youth. Recommendation 9: The nation’s formidable research capacity should be substantially better directed to sustained, multidisciplinary work on how marketing influences the food and beverage choices of children and youth. To implement this recommendation The federal research capacity, in particular supported by the agencies of the U.S. Department of Health and Human Services (e.g., National Institutes of Health, Centers for Disease Control and Prevention, Food and Drug Administration), the U.S. Department of Agriculture, the National Science Foundation, and the Federal Trade Commission should be expanded to illuminate the ways in which marketing influences children’s attitudes and behaviors. Of particular importance are studies related to newer promotion techniques and venues, healthier foods and beverages and portion sizes, product availability, the impact of television advertising on diet and diet-related health, diverse research methods that systematically control for alternative explana- *   See text at pages 349 and 262.

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Food Marketing to Children and Youth: Threat or Opportunity? tions, stronger measurement, and methods with high relevance to every day life. A means should be developed for commercial marketing data to be made available, if possible as a publicly accessible resource, for better understanding the dynamics that shape the health and nutrition attitudes and behaviors of children and youth at different ages and in different circumstances, and for informing the multifaceted social marketing program targeting parents, caregivers, and families to promote healthful diets for children and youth. Monitoring Progress The saying goes that “what gets measured gets done.” Yet no single public body exists with responsibility or authority to track the influences of marketing on the dietary practices and health status of children and youth in the United States. Recommendation 10: The Secretary of the U.S. Department of Health and Human Services (DHHS) should designate a responsible agency, with adequate and appropriate resources, to formally monitor and report regularly on the progress of the various entities and activities related to the recommendations included in this report. To implement this recommendation The Secretary should consult with other relevant cabinet officers and agency heads (e.g., U.S. Department of Agriculture, U.S. Department of Education, Federal Trade Commission, Federal Communications Commission) in developing and implementing the required monitoring and reporting. Within 2 years, the Secretary should report to Congress on the progress and on additional actions necessary to accelerate progress. CLOSING THOUGHTS The review and recommendations presented in this report are anchored in the presentation and interpretation of the evidence. This was the central charge to the committee, and the effort represents the most comprehensive and rigorous review of existing scientific literature done to date. It is important to point out that the committee was not charged with, nor did it engage in addressing some of the broader philosophical, social, and political issues related to food and beverage marketing to children and youth. Perspectives about basic responsibilities to shepherd the welfare of those most vulnerable or impressionable, conjecture about insights from studies not yet done

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Food Marketing to Children and Youth: Threat or Opportunity? or information not available on the strength of relationships between marketing and behavior of children and youth, and social urgency prompted by the rapidly increasing prevalence of childhood obesity, all are legitimate and important matters for public discussion. But they were not central features of the committee’s charge or work. Neither was the related, but vital, matter of physical activity, which is so inextricably a part of the challenge of childhood obesity. What the committee can contribute to the ongoing and imperative public policy questions raised by this challenge is to conclude, based upon a thorough and impartial review of existing scientific data, that the dietary patterns of our children and youth put their health at risk, that the patterns have been reinforced if not encouraged by prevailing marketing practices, and that the turnaround required will depend upon aggressive and sustained leadership from all sectors, including the food and beverage industries. This is a public health priority of the highest order.