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Archive for the ‘Obesity’ Category

By Jennifer Mindell, FPH Fellow and Chair of the Health Improvement Committee

Public Health England (PHE) and Department of Health and Social Care yesterday unveiled plans to limit excessive calorie consumption as part of the Government’s strategy to cut childhood and adult obesity. The plans target both consumers and industry, challenging the latter to reduce calories in products consumed by families by 20% by 2024. If the 20% target is met within five years more than 35,000 premature deaths could be avoided. Yesterday also saw the launch of the latest One You campaign, which will encourage adults to use the 400-600-600 calorie guidance for breakfast, lunch and dinner.

This is a very welcome step forward. We know that there are many drivers of obesity, including our environment, our genes, our behaviour and our surrounding culture. This very complexity means that if we are to tackle and prevent obesity, we must mobilise all sectors of society to take action and bring workable solutions to the table, and we are hopeful that PHE’s package of targeted reforms and initiatives will do just that.

We particularly welcome the Government’s focus on solutions that will impact families rather than just individuals. More than a quarter of children aged two to 15 in England are currently overweight or obese and younger children are becoming obese at earlier ages and staying obese for longer. This burden falls disproportionately on children and adults from low-income backgrounds. There are few effective interventions in place at the moment to help children identified as overweight or obese, making the prevention of obesity in children all the more urgent.

At the Faculty of Public Health (FPH) we believe that actions to protect children from obesity must be prioritised. This is why the FPH Health Improvement Committee has been developing policy to protect children from exposure to the advertising of foods high in fat, sugar, and salt (HFSS). We know that marketing greatly influences the food and drink children consume. The promotion of unhealthy food and drink is a significant risk for childhood obesity and the development of diet-related diseases. This is widely recognised by the World Health Organization (WHO) and many other countries. Industry spends 500 times as much on promoting HFSS products as the WHO spends on promoting healthy diets.

We recognise that regulations on HFSS food and drinks in the UK are among the toughest in the world. We are proud that the UK was the first country in the world to introduce scheduling restrictions on food advertisements, when in 2007, the Government banned HFSS product advertisements during or adjacent to ‘children’s TV’ programming or those that are likely to be ‘of particular appeal’ to children aged 16 and under.

However, we think that now is the time for additional progress to reflect modern family life. Children do not just watch children’s TV programmes and their viewing time actually peaks from 6-9pm, during what is called ‘family viewing time’. ‘Children’s TV’ programming generally is not broadcast during family viewing time, meaning that current regulations banning HFSS products make no impact then.

We started developing our thinking on this issue at the FPH conference in June of last year, where delegates discussed and debated how we could implement policy to limit children’s exposure to junk food marketing and encourage healthier behaviours. Around 15 different policy solutions were debated, covering a wide range of interventions. We’ve since refined our thinking; we believe that to protect children and support parents, the Government should take forward the following three interventions as priorities:

1. Strengthen existing broadcast regulations to restrict children’s exposure to junk food marketing by introducing a pre-9pm watershed on all HFSS food and drink advertising
2. Take action to ensure online restrictions apply to all content watched by children
3. Extend regulations to cover sponsorship of sports and family attractions and marketing communications in schools.

We believe that voluntary calorie reduction initiatives and behaviour change campaigns – like the ones launched by PHE and DHSC yesterday — will have the best chance of success if they are complemented by other regulatory measures like the ones we have proposed above.

We continue to be heartened by the progress that the Childhood Obesity Action Plan has made and are hopeful that PHE’s calorie and sugar reduction initiatives will prove to be world-leaders in tackling obesity and its health-related consequences. We believe that action against junk food marketing to children will support those aims and be critical to their success. We look forward to continuing to engage FPH’s membership and other partners in the development of this policy.

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By Jamie Waterall, National Lead for Cardiovascular Disease Prevention and Associate Deputy Chief Nurse at Public Health England, and Honorary Associate Professor at the University of Nottingham

Over recent weeks, we’ve seen constant media reporting about the increased pressures our health and care system is experiencing.

There’s no disputing that the NHS is facing ever greater demands, often linked to our aging population and many more people living with long-term conditions such as heart disease, diabetes, dementia and certain cancers.

But it’s worrying that most of the news reports only focus on the need for more acute hospital beds and ambulances, rather than discussing the need for a radical upgrade in prevention to reduce demand on these services.

As public health professionals we know that there are no easy solutions to the pressure on our health and care system. These are complex problems, requiring a whole-systems response.

However, we also know that many of the health issues keeping our hospitals so busy are preventable. Having worked in acute medicine and cardiology for a number of years I witnessed the scores of patients I treated who were admitted to hospital with conditions that could have been delayed or avoided altogether.

And when working in the acute trust environment, I would have agreed that more beds and acute services was the answer to our problems. It was not until I was working in primary care as a nurse consultant that I became more aware of the need for an increased focus on prevention.

So I frequently ask myself; how can we better harness the skills of our trusted front-line professionals, ensuring we all get behind this radical upgrade.

Our research informs us that there’s real appetite to build more prevention into our daily practice, however it also shows us that there can be barriers and challenges.

Time and resource is of course an issue, but we’ve heard that some professionals can be apprehensive about talking to members of the public about their weight, for instance, or whether they smoke or keep active. We also know that there can be uncertainty about the availability of local lifestyle services to refer patients to.

With all this in mind, Public Health England has developed All Our Health, a framework which supports all health and care professions to get more involved in the upgrade in prevention. It provides tools and advice to support ‘health promoting practice’ with quick links to evidence and impact measures and top tips on what works.

Based on user research we’re making improvements to All Our Health as well as forging new links with universities and Health Education England, so we can build more prevention into the way we train our future professionals to practise in this different world with new expectations and opportunities.

We also hope All Our Health will help health and care professionals to engage with the local public health system, including getting involved in the development of prevention initiatives.

Surveys of the public constantly show that our frontline health staff are amongst the most trusted professionals in our communities. Just imagine the impact if our estimated two million health and care staff built more prevention into their practice. We could truly achieve the radical upgrade we so urgently need to see.

For further information and to read more about All Our Health, click here.

 

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By Linda Hindle, Deputy Chief AHP Officer, Public Health England, and James Gore, Director of Education & Standards, Faculty of Public Health

Three years ago the Allied Health Professions (AHPs) agreed a collective ambition to be recognised as an integral part of the public health workforce. Since then AHPs have developed their public health contribution and profile, and there have been some excellent examples of AHP public health initiatives.

We want to support AHPs to share and celebrate some of the fantastic work happening already, which is why Public Health England (PHE) and the Faculty of Public Health (FPH) are delighted to be co-sponsoring the public health award at next year’s Advancing Healthcare Awards.

Previous winners have commented on the opportunities applying for this award has created in terms of profile and recognition.

In this blog we want to showcase winners from the past four years and encourage AHPs to consider applying for this prestigious award.

Previous winners have so far included occupational therapists, dietitians, physiotherapists and paramedics, but we have had applications from members of most of the AHPs.

In 2014 Mary Jardine and Allison Black from NHS Ayrshire and Arran won the award for their ‘whole system approach for women’ which was developed to divert women from the criminal justice and court systems with the aim of reducing offending behaviour and targeting the reasons for offending. This project showed clear outcomes in terms of health and re-offending and involved partnership-working between statutory and voluntary organisations across health, criminal justice, social and community organisations

Winners in 2015 were Lisa De’Ath and her team from the Family Food First Programme in Luton. This programme aims to encourage families with young children to adopt healthy lifestyles in order to reduce the burden of disease such as obesity and tooth decay. The team work in early years settings, such as nurseries, pre-schools and children centres, to promote and adopt healthy-eating messages. This is an example of AHPs using their unique skills and working through other partners to support population-level outcomes.

In 2016 Emma Holmes and Katie Palmer lifted the trophy. Emma and Katie are dietitians from Cardiff whose innovative project used food facilities during the school holidays to provide meals and educational play for children in need. The project involved working with more than 20 partners from the public, private and third sector. As well as addressing health problems, they provided affordable childcare to support families during school holidays.

Last year’s winner was Gillian Rawlinson, a physiotherapist from Salford Royal Hospitals NHS Trust, whose project embedded health promotion within musculoskeletal physiotherapy services. This collaborative service redesign incorporated opportunistic health assessments, NHS Health Check and diabetes checks within routine physiotherapy assessments. This resulted in a holistic service for patients, improved assessment and an income generating a financial model. Gillian has blogged about her experience of winning this award.

Ruth Crabtree and Tom Hayward from Yorkshire Ambulance Service were highly commended for their pathway to support ambulance service staff to identify, support and signpost people who would benefit from support to reduce their alcohol intake. This example demonstrated how a making-every-contact-count approach can be adopted in a systematic way across a full service.

We know there are many other excellent projects like these.

Applying for an award can take time, but this is generally time well spent regardless of whether the project wins. The process of making an application helps to raise the profile of the work internally and externally. It is also a useful in supporting reflection on what has been successful with the project and where it can go next.

This year we hope to profile all of the shortlisted applicants because we know it is not just the winners who have undertaken excellent pieces of work, and we want to use this as an opportunity to share good practice as much as possible.

So what are the judges looking for and how do you apply?

We will particularly be looking for examples of AHPs which have shown leadership and partnership in working to deliver effective health improvement interventions across a population or with the potential to be broadened to a population level – with evidence of impact, value for money and sustainability.

You have until 19 January 2018 to apply, so don’t put it off; start thinking about your application today.

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By 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.

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By Claire Beynon MFPH

BACP Travelling Fellowship
Every two years the Faculty of Public Health (FPH) awards a BACP travelling fellowship to assist members of FPH in training to undertake educational travel. This fund was established in 1994, using funds donated by the British Association of Community Physicians (BACP) on its dissolution.

At the FPH Conference in Telford in June I was delighted to receive the travelling fellowship funding based on my application to travel to Japan to experience its culture and make observations about why its levels of childhood obesity were so much lower than those in the UK, and to present my public health work at a conference in Japan.

Observations on Childhood Obesity in Japan
Before I left for Japan I read many articles that explored the differences between childhood obesity rates in the USA and Japan. Their focus was on lifestyle factors including diet and physical activity.

Whilst in Japan I met with several academics who specialised in obesity, physical activity and diet. They were all most welcoming and shared their research and experiences readily.

The key points they raised were:

  • Younger children spend less time in school. As age increases so does the length of the school day. This gives more free time for outdoor play.
  • 90% of children walk to school daily.
  • Children do three hours of physical activity each week in school time.
  • There are no cleaners in Japanese schools; part of a child’s everyday activities includes cleaning their own school – children are active when cleaning.
  • Schools often have before-school sports clubs as well as after-school sports clubs.
  • Between each lesson there is a five-minute break to allow children to run around in the play area. This is in addition to morning break, lunch and afternoon break.
  • There are multiple opportunities in school for competitive sports, with regular competitions and celebrations. Children spend time practising for these with friends.
  • Children have three hot meals a day at breakfast, lunch time and in the evening.
  • Children serve each other a cooked meal at lunch time and sit and eat this hot meal together.

Further Observations
Whilst travelling in Japan I observed a number of additional environmental factors that tip the balance in favour of walking and cycling:

  • Priority is given to the pedestrian, then cyclist, then the motor vehicle. Encouraging walking and cycling. By giving priority to more vulnerable road users speed of motor vehicles is also decreased.
  • Cyclists and pedestrians share the pavement area, which is often separated from the road with a barrier and/or low-level bushes. This makes for a safer cycling experience than the UK where cycle lanes are often shared with buses.
  • There were a number of covered shopping areas, which were accessible only to cyclists and pedestrians and proved very popular thoroughfares.

    Shopping area in Japan

    Covered shopping area where pedestrians and cyclists share space

  • There was consistent and regular signage for cyclists and pedestrians, including details of directions and distances to the nearest public transport options.
Example of road, cycling and walking space in Tokyo

Example of road, cycling and walking space in Tokyo

• The number of employed people working on any urban street was much higher than the UK, with police highly visible, construction staff, cleaners, car park attendants and others all adding to the sense that the street was a safe place.

 

Policeman on the street in Japan

Presence on streets of local police make a space feel safe

• Public art installations make walking and cycling spaces more interesting and appealing.

Street art in Japan

Example of simple art installation

We know from the 2007 Foresight Report that obesity is a complex issue with multiple factors influencing obesity levels in adults and children. My own research looking at the risk factors for obesity in children in Wales using Welsh Health Survey data showed a reduced risk of obesity for children who met the one-hour physical activity guideline.

 

The new experiences and culture that I have experienced from this educational trip make me more determined than ever to tackle childhood obesity in Wales. I am looking forward to being involved in the drafting of an obesity strategy for Wales as part of my placement with the Welsh Government and will share my experiences with other registrars and colleagues at every opportunity.

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By Dr Nadeem Hasan

The importance of effective advocacy to achieving public health goals cannot be overstated.
Every day policies and regulations that affect health outcomes for better or worse are put on the agenda and kept off the agenda; discussed and debated; approved and rejected.

Many, if not most of these relate primarily to non-health sectors, such as food and beverages, energy and infrastructure, and alcohol and tobacco. But their impact on health outcomes is very real: all the stop-smoking programmes in the world can’t match the impact of the ban on advertising and smoking in public places on smoking prevalence; and there’s no amount of spending on childhood obesity programmes that can make up for the regulatory vacuum in this area.

Looking more broadly, policy decisions that affect income inequality, carbon emissions, and military action all have serious consequences for health across the world.

If we’re serious about prevention, we need to be serious about advocacy.
Where profits can be affected (almost everywhere), industry lobbyists seek to influence the regulatory environment in their favour. And they are very good at it. In principle, this is quite right – those affected by policy and regulatory shifts should indeed be able to make representations and provide additional evidence to support the decision-making process – and this includes relevant industry actors.
Representing the interests of everybody else is where advocacy organisations come in – acting as sort of ‘civil society lobbyists’ to balance out the discussion – advocating on behalf of the health, wellbeing, and broader concerns of the general population. Notably, this isn’t always an ‘us vs. them’ relationship: health insurance companies are routinely allies on advocating for lower drug prices; and renewable energy companies are more than happy to work with advocacy organisations on climate change regulation.

Put this way, it might sound like a fair playing field, with decision-makers receiving submissions from a range of groups and making balanced decisions to maximise the benefits to all parties. The reality of course is quite different, and much, much messier.
In 2014, there were an estimated 30,000 industry lobbyists in Brussels alone, falling just short of the 31,000 employees for the whole European Commission.

Civil society pockets are not deep enough to come close to matching this (or the salaries of lobbyists), and civil society advocacy and pressure groups are few and far between. Transparency falls short of the ideal, and the revolving door between policy-making and industry remains alive and well. Most recently the former President of the European Commission José Manuel Barroso was appointed Chairman of Goldman Sachs International, a move that has been widely criticised.
Advocacy organisations, then, have a difficult task – but one where even small successes can have far-reaching benefits for public health.
The European Public Health Alliance (EPHA), based in Brussels, is one such advocacy organisation. They bring together a range of health-related NGOs to advocate for better public health in Europe, working across five campaign areas: antimicrobial resistance; food, drink and agriculture; healthy economic policy; universal access and affordable medicines; and trade for health (and specifically the EU-US free trade agreement – TTIP – and the EU-Canada free trade agreement – CETA). Earlier this year, they hosted myself and another registrar in a pilot placement to understand health advocacy at the European level and to develop skills in this area.
So how to sum up the placement?
Invaluable. EPHA track the policy process for each one of their campaign areas and engage at every possible point. They attend every meeting at the European Parliament and the European Commission on these areas and make oral contributions at every opportunity; they submit comprehensive written responses to every relevant consultation; they engage on a daily basis with journalists to publicise their positions and build public support; they engage like-minded actors in the public, private, and not-for-profit sectors on a case-by-case basis to coordinate action; and they do all of this with just a handful of relatively young staff and interns.

They were very welcoming in bringing us into the whole process, allowing me to engage in every one of these steps – from writing position papers and consultation responses to making oral contributions at the European Commission and Parliament on their behalf.
Notably, EPHA also position themselves as an advocacy agency that actors from across the spectrum can engage with – in contrast to, for example, much more vocal organisations such as Greenpeace.

By way of example, the area that I was working on was TTIP. Whilst there are a raft of advocacy organisations across Europe (and the USA) that reject TTIP outright, EPHA’s

approach is to work through the whole agreement and advocate for the protection of public health on a section-by-section basis without rejecting the whole deal. With the European Commission politically committed to getting a deal, this makes EPHA one of the few organisations they can meaningfully engage with on this issue (though recent developments have called into question the likelihood of getting a deal in the near future).

This isn’t to say that their approach is ‘superior’ – every actor plays a particular role, with the more intransigent organisations key in shifting public opinion and providing the space for actors such as EPHA to engage in more balanced discussions. This means that they are invited to closed-door sessions with only a handful of actors, and have much more influence on the process than they otherwise would.
One of the challenges from a ‘public health professional’ perspective was that effective advocacy sometimes involves taking – shall we say – a less balanced view than we would normally as technical experts. From an ethical perspective, this raises a number of questions around whether the ends justify the means. I witnessed first-hand industry lobbyists making quite outrageous claims, including a rather undignified moment where I coughed up half my glass of water in a large auditorium at the European Commission when it was submitted that ‘alcohol is in no way an unhealthy commodity’ .

In a world where climate change denial is alive and well despite the most overwhelming evidence to the contrary, the ‘best’ approach to making our points is perhaps not so easy to discern.
And what of the relevance to the UK, particularly as we now start closing our doors to the EU in a bid to be a more open, global-facing country?
Whether or not the UK is a member, the EU remains a powerful actor that can influence policies related to public health both for its own citizens (which will still number ~450m after the UK leaves), and globally. As a close neighbour, EU regulations will have a strong bearing on public health in the UK too, and so engaging in advocacy at this level will continue to be an effective approach to improving UK public health.

This is true for everything from environmental regulations and air pollution, to pharmaceutical regulations and drug pricing and safety.
Within the UK, whilst it’s true that our policy-making process is not as amenable to advocacy as at the EU level (or remotely as civilised), effective advocacy still has huge potential to improve public health. We have not done well recently, with a watered-down childhood obesity strategy, no resistance to an unfunded ‘7-day’ NHS (that differs from the 7-day NHS that has existed since 1948 in some undefined way), and year-on-year increases in the use of food banks without any policy response (to name just three areas).

At the local level, there are a cornucopia of opportunities for advocacy to improve health, from influencing urban planning (fast food outlets close to schools, street design, cycling lanes) to advocacy around shifting public perceptions e.g. from opposing to welcoming refugees into local communities.
In this context, strengthening the advocacy skills of the UK public health workforce through engaging with and learning from experienced actors such as EPHA should be pursued with vigour – we can ill afford the alternative.

Dr Nadeem Hasan is a Specialty Registrar in Public Health

 

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  • Amy Smullen
  • Policy Officer
  • British Heart Foundation

The nation’s oversized waistline is putting our hearts under increasing strain.

We know that obesity puts people at a greater risk of coronary heart disease and having their lives shortened by a heart attack or stroke. But this isn’t just a problem of the here and now. It’s one that’s already waiting in the wings to devastate future generations as well.

junkfood_image

Watershed? why we need to ban some food adverts before 9pm

Around 30% of children in the UK are now classed as either overweight or obese. (1) Dietary surveys show that children are also eating too much saturated fat, salt and sugar. (2) Together, these factors put too many children at risk of carrying their excess weight and poor eating habits into adulthood, putting their hearts at risk.

That is why the British Heart Foundation (BHF), alongside many other organisations, such as the Faculty of Public Health want to see advertisements for food and drink that is high in saturated fat, salt and sugar (HFSS) banned before the 9pm watershed.

The BHF are acutely aware that obesity is a complex problem that requires action on lots of fronts. We don’t pretend banning junk food adverts is a magic bullet. But the sad reality is that our children are being bombarded with clever marketing encouraging them to eat products that have little nutritional value whether it’s walking to school, surfing the internet or watching TV at home. Banning these adverts before 9pm and tightening online regulation has to be part of the solution.

So why have we focused in on junk food adverts?

Firstly; because children aren’t like us adults. They cannot distinguish between what is harmless entertainment and what is persuasive advertising (3) and are they are therefore classed as a vulnerable group when it comes to advertising. Industry regulator Ofcom (4) states that ‘media literacy develops with age and … it isn’t until after 11 or 12 years of age that children can articulate a critical understanding of advertising.’

Second, research shows that food promotion, such as TV ads, can influence children’s food preferences and consumption. (5) Adverts also encourage general consumption, meaning that an advert for a specific chocolate bar won’t make you more likely to buy just that specific brand but any chocolate bar in general. (6)

And thirdly, on average our children are spending 27 hours either online or watching TV every week. That averages out at just under 4 hours per day. And it’s not just a few children skewing the average. Over 80% of children aged 5-15 watch the TV almost every day (7).

In 2007, the Government acknowledged that HFSS advertising was a problem, and banned any HFSS adverts during children’s programming. (8) But, while reducing the number they saw, this hasn’t stopped children seeing them.

That’s because adverts which are banned during children’s shows can be shown during family programming. Shows such as The Simpsons, X-Factor, and Britain’s Got Talent are technically classed as ‘family programmes’ despite high child audience levels. (The last two programmes made it into the top 20 programmes most watched by children in 2013.) (9) As such, marketeers are allowed to advertise any product they want. An audit by the University of Liverpool in 2013 showed that  almost one in four TV adverts shown between 8-9pm, when children’s viewing peaks, were for food products. (10)

Online, it’s even worse. It’s no secret that our children are online more than ever. Worryingly many of the techniques used to promote food and drinks online blur the lines between persuasion and entertainment, making it difficult for children to identify online marketing. (11)

Take, for example, advergames. These are online games that have a brand or marketing message integrated into them. Where a TV advert may only last for 30 seconds, research has shown that children spend longer engaging with the product message and engage with the brand at a deeper subconscious level. (12)

Adding to this the Committee of Advertising Practice Code, which governs marketing on advertisers own websites and their social media channels, doesn’t distinguish between healthy and unhealthy food.

The code states that “marketing communications should not condone or encourage poor nutritional habits or an unhealthy lifestyle in children’ – but what constitutes ‘condoning and encouraging’ or ‘poor habits’ is not defined.

But isn’t it all down to the parents? Shouldn’t they be policing their children more?

While we agree that parents are responsible for helping children eat a healthy balanced diet, these adverts undermine their efforts to do that. When we asked parents for their views, 70% of them told us that they had been pestered to buy HFSS products that their children had seen advertised on TV and 39% of parents said that these adverts were making it difficult for them to help their children eat a healthy diet. (13)

Over 30,000 people have already signed our petition, which calls on the Government to ban HFSS adverts before the 9pm watershed. Alongside the BHF and Faculty of Public Health the Academy of Medical Royal Colleges, the Royal College of Paediatrics and Child Health, Children’s Food Campaign, UK Health Forum, The Heart of Mersey, the British Dental Association, Family and Childcare Trust, the Association for the study of Obesity and the University of Liverpool also call for a 9pm watershed ban.

The demand for action is getting stronger and louder.

Help us stop these adverts by signing our petition to send a clear message to the Government that they must stop our children from being bombarded with HFSS adverts to protect their health.

1) British Heart Foundation (2013) ‘Children and Young People Statistics’ http://www.bhf.org.uk/publications/view-publication.aspx?ps=1002326
2) Department of Health (2014) ‘National Diet and Nutrition Survey: Headline Results from Years 1, 2 and 3 (combined) of the Rolling Programme 2008/09 – 2011/12.
3)  E.g. Young B (2003) ‘Does food advertising influence children’s food choices?’ International journal of Advertising 22: 441-459. Hastings et al (2003) ‘Review of the research on the effects of food promotion to children.’ Food Standards Agency
4)  Livingstone S (2004) Childhood Obesity – Food Advertising in Context.
5)  Ofcom (March 2006) ‘Television Advertising of Food and Drink products to Children: Options for new restrictions: A consultation’ (para 1.8).
6) Hastings et al (2003) ‘Review of the research on the effects of food promotion to children.’ Food Standards Agency.
7)  Ofcom (2014)
8) Ofcom (2007) ‘Television advertising of food and drink products to children – final statement.’
9) Ofcom (2014)
10) Boyland, E and Whalen E (2014) ‘Analysis of food adverts shown during a sample of primetime television.’
11)  A.Nairn (2009) ‘Changing the rules of the game: implicit persuasion and interactive children’s marketing.’ Berkley Media Studies Group
12) Nairn, A. (2012) ‘Advergames: It’s not child’s play.
13)  British Heart Foundation (2015) survey.

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