Research ReviewSystematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary☆
Highlights
• Food and beverage marketing to children is international, pervasive and pluralistic. • The evidence confirms marketing can influence children’s diet, dietary determinants and health. • Most commercial marketing is for products high in fats, sugars and salt. • Global action is needed to reduce the impact of current marketing practice. • We recommend future research on how and what policy actions can effectively protect children.
Introduction
A number of policy initiatives intended to ‘rebalance the food marketing landscape’ have been introduced during the last decade (Hawkes & Lobstein, 2011). Policies have been informed by substantial and consistent evidence that the promotion of low nutrition foods is a modifiable risk factor for non-communicable disease and is linked to the international obesity crisis (Harris et al., 2009, Hastings et al., 2006, Hastings et al., 2003, McGinnis et al., 2006, WHO, 2004, WHO, 2010).
An important recent initiative to address the threat of current marketing practice to public health was the endorsement at the 63rd World Health Assembly of the World Health Organization (WHO) ‘Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children’ (WHO, 2010). In 2011, promotion of the WHO Set of Marketing Recommendations was one of the actions cited in the Political Declaration adopted at the 66th session of United Nations General Assembly (UN, 2011). The United Nations Resolution provides clear leadership for international action to tackle the rising prevalence of non-communicable diseases (NCDs).
This high-level political commitment presents both challenges and opportunities for research aimed at informing the evidence-informed policy cycle. Policy planning can and should provide strategic direction to policy research as much as research evidence can and should inform policy design, development and evaluation. This paper therefore has two purposes. It provides a summary of the public health evidence base that has informed policy development to date, and highlights evidence gaps pertinent to next steps in developing effective marketing control policies.
Section snippets
Objectives
A 2009 systematic review (SR) of evidence on commercial food promotion to children was commissioned by the World Health Organization to inform the development of a set of recommendations on food marketing to children. The research objectives of the SR were to review the international evidence base on (a) the nature and extent of food promotion and non-alcoholic beverages to children; and (b) the effects of child-oriented food and non-alcoholic beverage promotion on diet, dietary determinants
Methods
SR methodology aims to comprehensively identify and evaluate all relevant evidence available to answer pre-specified research questions using a fully documented methodology (Littell, Corcoran, & Pillai, 2008). The methods are intended to be transparent and therefore replicable, and to minimise selection bias. Systematic review is increasingly used to inform the development of policy and identify gaps in the research literature (Bambra, 2011, Dobbins et al., 2007).
The 2006 and 2009 SRs were
Overall results of search and screening
A total of ninety-nine primary studies and 16 review articles met inclusion criteria for questions on nature and extent of food promotion to children in the 2009 SR. Some studies contributed evidence to more than one question. Cross-sectional content analysis was the principal study design (over 75%) followed by reviews and other methods of content analysis. North America was the most common source of evidence (more than 50% by fieldwork and/or authorship provenance) followed by Europe,
Discussion
The first systematic review of evidence on the nature, extent and effects of marketing was published in 2003. It examined more than 30 years of evidence on marketing practice and its effects in developed economies (Hastings et al., 2003). Subsequent SRs published in 2006 (Hastings et al., 2006) and 2009 (Cairns et al., 2009) extended the geographic scope of the evidence base to include research conducted in low income countries. A North American systematic review of evidence published in 2006
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Acknowledgements: The authors are grateful to the World Health Organization for commissioning the 2006 and 2009 systematic reviews. We also gratefully acknowledge the valuable contributions of Christine Godfrey, Alasdair Forsyth, Anne Marie MacKintosh, Laura McDermott, Mike Rayner, Martine Stead and Stephen Thomson as authors of the earlier (2003 and 2006) systematic reviews, and the UK Food Standards Agency for commissioning the initial systematic review (2003). We would also like to thank Laura MacDonald and Diane Dixon for their help in checking records and data, and in preparation of the manuscript.