Feeds:
Posts
Comments

Archive for the ‘Diet’ Category

By Dr Jennifer Mindell, Reader in Public Health, Research Department of Epidemiology and Public Health, University College London

Today nearly a third of children aged two to 15 are overweight or obese (1, 2), and younger generations are becoming obese at earlier ages and staying obese for longer. Given the evidence that children and adults’ diet is influenced by advertising, summarised by Adams and colleagues (3), the World Health Organization (WHO) made 12 recommendations in 2010 about marketing food and non-alcoholic drinks to children (4).

However, industry spends 500 times as much on promoting high fat, salt or sugar (HFSS) foods as the WHO spends on promoting healthy diets. For example, food companies in the UK spend one billion pounds on marketing. Not surprisingly to a public health audience, there are marked differences in proportions between constituents of a healthy diet and food advertising (Figure). The ways that marketing can influence behaviour, as well as some examples, were available in the presentation given at the FPH 2017 annual conference session organised by the FPH Health Improvement Committee.

Disproportionate food advertising
Adapted from: www.foodcomm.org.uk/pdfs/Broadcasting_bad_health.pdf

In the UK, legal restrictions on television advertising of HFSS foods to children under 16 focused on preventing screening of such advertisements on children’s channels, and around or during programmes on general channels of particular appeal to children aged 4-15 years. As the Health Improvement Committee had predicted, this had no effect on children’s exposure overall (despite adherence to the restrictions) because of increased HFSS advertising around programmes aimed at a general audience, not covered by these regulations, screened before 9pm (4): larger numbers of children watch these general programmes than watch ‘children’s TV’. Similar restrictions were introduced on 1 July 2017 on advertising HFSS foods to children under 16 via non-broadcast media, including on children’s media and on media where children form more than 25% of the audience. However, the exclusions are many (see examples).

Discussions by about 25 people at the FPH conference session produced the following policy suggestions:
A. Gold standard: Ban advertising of all HFSS products (regardless of to whom, when, where).
B. Banning marketing aimed at or influencing children is a good place to start, if (A) isn’t (yet) politically acceptable. This should be a part safeguarding children.
C. We need to keep reiterating our point that the proportion of the audience who are children is irrelevant:

  • Far more children may watch a generally popular show (eg. X Factor) than children’s TV or TV programmes where children are 25%+ of the audience, so restrictions need to apply based on the number of children exposed as well as the percentage.
  • Advertising aimed overtly at adults also influences children through what adults buy for them, what adults do, and what adults see as the norm.

D. Online material is now more important than TV; even TV is mostly watched on-demand, so the timing of programmes is now largely irrelevant: Should we ignore the watershed?
E. Ban anything aimed at children or young people, eg. toys, cartoon characters, celebrities, that can increase desirability of the associated HFSS products or influence behaviour adversely. The Olympics should not be associated with MacDonalds, Coca Cola, etc.
F. Ban HFSS product displays and marketing at point of sale (PoS) eg. supermarket checkouts, newsagents.
G. Ban displays of HFSS products at children’s height (put on top shelves only?)
H. Ban HFSS displays or marketing posters in shop windows (seen by children as they pass).
I. Ban marketing that displays people eating except when sitting at a table for a meal The benefit of the Mediterranean diet may be partly because of eating slowly at a family meal while talking, etc, instead of eating ‘on the go’, as well as the actual diet itself.
J. Harness the opportunity of controlled environments to change the accepted norms (eg. rules for schools, workplaces, hospitals, prisons).
K. Recognise the time it takes to change social norms and to make regulation socially acceptable; balance this with the size of impact of HFSS products on health and health inequalities.
L. Need for a clear iteration of the harms of HFSS with agreement amongst influential public health bodies, to start influencing the debate.

Other ideas suggested were to ban price-based promotions of HFSS, given that fruit is often more expensive to buy than crisps or chocolate bars. Chile introduced health warnings and standardised packages for HFSS last year; we need to monitor what effects these have. Brexit may yield an opportunity to influence front-of-packaging labelling, for example by portion size rather than per 100g, if EU rules no longer apply. Given most children’s incessant exposure to marketing, schools should be encouraged to teach advertising literacy.

The main conclusions by those attending as that this is a societal responsibility, rather than individuals or their parents being to blame. Population-level initiatives are needed to control commercial activities that are costly to the country both in terms of poor health and regarding healthcare, social care, and economic costs of ill health.

References:

1. Fuller E, Mindell J, Prior G (Eds). Health Survey for England trend tables 2015. Leeds: NHS Digital, 2016.
2. Childhood obesity: a plan for action. London, 2017. https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action/childhood-obesity-a-plan-for-action
3. Adams J, Tyrrell R, Adamson AJ, White M. Effects of restrictions on television food advertising to children on exposure to advertisements for ‘less healthy’ foods: repeat cross-sectional study. Plos One. 2012;7(2):e31578.
4. World Health Organization. Set of recommendations on the foods and non-alcoholic beverages to children. Geneva: WHO, 2010.

Read Full Post »

By Sarah Payne

I have the privilege to be a Health Education England (HEE) academic fellow this year, taking up my fellowship just as summer was throwing us an extra few weeks of warm weather to take forward into the Autumn. My first weeks were a blur of getting my feet under the table in my new home, the Nuffield Department of Primary Care Health Sciences at Oxford University, meeting new colleagues and setting out my plan for the year ahead. I was then straight off to a week-long intensive course to learn the art of changing people’s behaviours – courtesy of Susan Michie and colleagues at the University College London Centre for Behaviour Change. And what a week it was! Not only was it a great course but it was a great way to kick off my fellowship year, providing lots of inspiration and a ‘to-do list’ as long as my arm to get stuck into when I returned to the office.

Developing a suitable research project and securing research funding for it was one of the aims of my HEE academic fellowship, so I was thrilled when I found out I had been successful in securing an award, from the British Heart Foundation, to fund my proposed research project – investigating ways to help people with high blood pressure reduce their salt intake. Cue a short but wild celebration – short because the funding was contingent on having ethics approval for all elements of the research in place before the award would be given. So, duly inspired from my behaviour change course and brimming with enthusiasm to delve into the literature to understand more about the target behaviour I hoped to change and effective behaviour-change techniques to do so, and to spend some quality time developing a behaviourally informed intervention… I was faced with ETHICS FORMS! Hmmm….not so inspiring, though of course a critical part of the process.

Thankfully, the HEE fellowship provides a perfect bridge to support the development phase of my work, allowing me to prepare detailed research protocols and all the associated documents that support an ethics application for my proposed research and to begin some of the training in research skills needed to carry out the research. As well as fulfilling the immediate requirement to secure my longer term PhD funding, the process of preparing ethics applications has forced me to consider the finer details of my research and really think through how I will deliver it. I’ve had great support from my supervisors and my department – including the opportunity to gather valuable statistics feedback from the regular department Stats Coven!

So, a slightly different focus for my first six months than I had planned, but it has so far been a fulfilling and interesting time, as well as suitably productive. I’ve attended a couple of other short courses, both of which have helped to keep my ‘inspiration and enthusiasm’ barometer high. I’ve attended various department seminars and workshops and had an opportunity to meet and network with other PhD students. Naturally, I’ve also learnt the ins and outs of the various ethics processes and undertaken some training in research integrity and good clinical practice!

So onward and upwards. I have submitted my ethics applications and I’m in the midst of the lengthy process of amendments and waiting… and waiting… Perhaps I will use some of this time to explore that behaviour change literature-base I’ve been waiting to get to. Maybe there are even the beginnings of a systematic review in sight…

Sarah Payne is a Health Education England Academic Fellow

Read Full Post »