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© 2005 American Public Health Association
DOI: 10.2105/AJPH.2004.048058
RESEARCH AND PRACTICE |
Kristen Harrison is with the University of Illinois, Urbana-Champaign. At the time of the study, Amy L Marske was a student in the Department of Speech Communication at the University of Illinois, Urbana-Champaign.
Correspondence: Requests for reprints should be sent to Kristen Harrison, Department of Speech Communication, University of Illinois, 244 Lincoln Hall, 702 South Wright Street, Urbana IL 61801 (e-mail: krishar{at}uiuc.edu).
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONTHE NUTRITION FACTS LABELMETHODSRESULTSReferences |
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Objectives. We sought to code food (nutritional content and food type and eating occasion) and character (cartoon and live action) attributes of food advertisements airing during television programs heavily viewed by children, and to represent and evaluate the nutritional content of advertised foods in terms of the nutrition facts label.
Methods. Food advertisements (n=426) aimed at general and child audiences were coded for food and character attributes. "Nutrition Facts" label data for advertised foods (n=275) were then analyzed.
Results. Convenience/fast foods and sweets comprised 83% of advertised foods. Snacktime eating was depicted more often than breakfast, lunch, and dinner combined. Apparent character body size was unrelated to eating behavior. A 2000-calorie diet of foods in the general-audience advertisements would exceed recommended daily values (RDVs) of total fat, saturated fat, and sodium. A similar diet of foods in the child-audience advertisements would exceed the sodium RDV and provide 171 g (nearly 1 cup) of added sugar.
Conclusions. Snack, convenience, and fast foods and sweets continue to dominate food advertisements viewed by children. Advertised foods exceed RDVs of fat, saturated fat, and sodium, yet fail to provide RDVs of fiber and certain vitamins and minerals.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONTHE NUTRITION FACTS LABELMETHODSRESULTSReferences |
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According to the Healthy People 2010 report, childhood obesity attributable to an unhealthy diet is increasing in prevalence worldwide.1 The Centers for Disease Control and Prevention and the World Health Organization have labeled this increase an epidemic.2,3 About 1 in 7 White children and 1 in 4 African-American and Latino children in the United States are currently overweight or obese.4 The spread of childhood obesity has been linked to the spread of modernization,5 one component of which is television advertising. The average child views over 40000 commercials per year,6 mostly for toys, cereals, candies, and fast foods.7 As early as 1985, children’s television consumption was linked with an increased risk for obesity,8 and this link continues to receive support in recent reports,9–12 including research reporting an association between childhood television viewing and adult obesity—a correlation that remained robust despite demographic controls.13
Although parents are typically responsible for the contents of the family pantry, television advertising does influence children’s food purchases and purchase requests.14,15 Children aged 14 years and younger purchase an estimated $14 billion in goods annually and influence the purchase of $190 billion in family goods.16 Moreover, parents’ food purchases are directly influenced by children’s requests.17 High-fat, high-sugar, and low-fiber foods are frequently advertised on television,18–23 especially on children’s television.24–27 Still, advertisements for even nutrient-poor items often feature messages implying that the advertised products are beneficial.28 The implication that such foods possess health benefits, although not technically false (e.g., one company’s claim that its chocolate syrup is a fat-free food is legitimate), may nonetheless confuse children and their parents about what makes a food "healthy."29,30 Research on the effects of television viewing suggests that food portrayals affect children’s understanding of nutrition,30–32 their choice of types and amounts of foods to eat,15,33,34 and even their ability to resist temptation when presented with low-nutrition treats.35 Furthermore, it has been argued that the trend toward corporate licensing agreements associating beloved media characters with food products marketed to children could make resistance even more difficult.36
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THE NUTRITION FACTS LABEL |
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TOPABSTRACTINTRODUCTIONTHE NUTRITION FACTS LABELMETHODSRESULTSReferences |
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To help consumers understand the nutritional content of their food and its health implications, the Nutrition Labeling and Education Act (NLEA), passed in 1990, introduced a standardized food-labeling system, the use of which was mandated on eligible foods starting May 8, 1994.37,38 The purpose of the system is to help consumers construct diets in line with the Dietary Guidelines for Americans presented by the US Department of Agriculture (USDA) and US Department of Health and Human Services (USDHHS).39 These guidelines include limiting fat, saturated fat, cholesterol, sodium, and sugar, and increasing fiber. Most foods packaged and sold in supermarkets and fast-food chains are eligible for labeling, exemptions include certain foods prepared for immediate consumption; medical foods; nonnutritive foods, such as tea and spices; and foods produced by small businesses, such as nonfranchised restaurants.38 The majority of foods advertised on television are therefore subject to labeling.
More than a decade after its introduction, the label bearing the heading Nutrition Facts should be familiar to consumers. This label lists information about the serving size and the number of servings per package, plus calories per serving and calories from fat, which is relevant to individuals aged 4 years and older. Also listed are quantities in grams and percent of recommended daily values (RDVs) of total fat, saturated fat, cholesterol, sodium, carbohydrates, fiber, vitamin A, vitamin C, calcium, and iron. The bottom of the label features RDVs so that consumers can compare a food’s nutritional content to a government health standard. For a diet of 2000 calories, the label indicates that total fat should be limited to 65 g or 30% of calories, 20 g of saturated fat or 10% of calories, 300 mg of cholesterol, 2400 mg of sodium, 300 g of total carbohydrates or 60% of calories, and that dietary fiber should be at least 25 g.
The label features no RDVs for protein or sugars, but nutritional guidelines made available to the public by the US Food and Drug Administration reference a minimum of 10% of calories from protein, equivalent to 50 g for a 2000-calorie diet for people over the age of 4 years who are not athletes, pregnant, or breastfeeding.38 Humans obtain natural sugars from fruits, vegetables, dairy products, whole grains, and legumes. Thus, the USDA and USDHHS dietary guidelines recommend limiting refined sugar because it adds calories without adding nutrients.39 The American Heart Association issued a statement warning that diets containing more than 20% calories from sugar (sucrose) could be problematic for this same reason.40,41
Research points to the poor nutritional status of foods advertised during television programs viewed by children, even quantifying this status in terms of the USDA Food Guide Pyramid;42–44 however, a decade after the introduction of the Nutrition Facts label, no study has specifically quantified the nutritional profile of television-advertised foods in terms of this label. Given that the label is both understood and used by consumers when shopping for family food products,42 it is useful to represent television advertising’s nutritional landscape in terms of this label. As such, we build upon existing research by first analyzing features of food advertisements, such as eating occasion and location, health-related messages, and character attributes, and then presenting facsimiles of Nutrition Facts labels representing the average nutritional profile of advertised foods. Because advertisements targeted at children are particularly likely to feature high-sugar foods,19,44 for comparative purposes we distinguish between commercials targeting a general audience and those targeting children and teens specifically.
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METHODS |
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TOPABSTRACTINTRODUCTIONTHE NUTRITION FACTS LABELMETHODSRESULTSReferences |
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To obtain a sample of food advertisements viewed by children, we taped 40 hours of television programming airing in north-central Illinois over a 5-week period in spring 2003. The selected programs, a list of which was purchased directly from Nielsen Media Research, had been rated as most popular nationwide among viewers aged 6–11 years in fall 2002 and spring 2003. This age group possesses money and freedom to purchase food (e.g., from school vending machines), along with the linguistic skills to persuade parents to buy foods advertised on television. Moreover, about 16% of American children in this group are overweight.45 The sample consisted of the 10 most viewed hours from each of 4 sources: network Saturday, network prime time, syndication, and cable. We included multiple sources because modern children’s viewing is no longer limited to Saturday morning programming.44,46,47 Episodes that appeared more than once during the sampling period were sampled randomly. Programs, a list of which is available upon request, ranged from
hour to 2 hours in length and were broadcast between 7:00 AM and 10:00 PM, when children are likely to be viewing. The sample yielded 1424 advertisements, 29.9% (n=426) for food products. For each advertisement, the first 4 food products (e.g., Big Mac, french fries, apple pie, and a Coke) and the first 4 human characters appearing on-screen were coded, yielding a total sample of 1194 characters and 725 foods. We limited analyses to four products and four characters because relatively few advertisements featured more of either, with the exception of the occasional crowd of characters. We opted to retain repeat advertisements because they represent multiple attempts to persuade viewers to consume the advertised food(s), and initial resistance to temptation does not guarantee future resistance. We observed 275 unique foods, a list of which is available upon request.
The first part of analysis involved coding the advertisements. Four independent coders were trained to code along various dimensions. First, each advertisement was coded as being aimed at a child audience (n=201) or a general audience (n=225). A "child audience" designation was made on the basis of visual and auditory cues, including the presence of child/adolescent actors or narrators, verbal appeals to a child/adolescent audience (e.g., references to school), and the presence of products marketed specifically to children or adolescents (e.g., Kid Cuisine). The absence of these cues resulted in a "general audience" designation. Target audience was determined at the advertisement level rather than the program level because children pay more visual attention to content featuring child actors and animation than to adults and live action,48 regardless of the broader programming context. In the second coding step, advertised foods were coded by type as breads/cereals, fruits/vegetables, dairy products, meats/poultry/fish, candy/sweets/soft drinks, alcohol, or convenience/fast foods (e.g., Big Mac, pizza, Lunchables). The separate grouping of convenience and fast foods is appropriate for analyses of television’s food advertising landscape19 because convenience/fast foods are usually composed of multiple food types (e.g., hamburgers are both breads/cereals and meats/ poultry/fish). In the third coding step, verbal or visual health-related messages in the advertisements were coded as low fat, fiber or bran, vitamins or minerals, low in sodium, partially or completely nonartificial or natural, low in calories, or other (e.g., "Makes you feel great!").
Human characters were coded for apparent gender, age, race, eating behavior (shown eating or not), and body size. When characters were shown eating, the eating locale was coded as home, in a restaurant, in a car, outside, or elsewhere. The eating occasion was coded as breakfast, lunch, dinner, snack, or nondiscernible. If multiple eating locales or occasions were depicted, the primary one (i.e., the one on-screen the longest) was recorded. Finally, the apparent body size of each character was coded using a figure drawing scale, ranging from very underweight to very overweight.49 To test the degree of variability between coders, each of whom coded a unique portion of the sample, a fifth independent coder coded a random 10% (n=44) of the total advertisements sampled in order to obtain intercoder reliability indices for all variables using a 
statistic. Reliability values ranged from .71 to .92.
The second part of our analysis targeted the nutritional breakdown of the advertised foods using data obtained from Nutrition Facts labels by visiting grocery stores, company websites, and restaurants, and by calling company consumer relations departments. Variables included serving size (g or mL), servings per container, calories (kcal), calories from fat, total fat (g ), saturated fat (g ), cholesterol (mg), sodium (mg ), carbohydrate (g ), fiber (g ), sugar (g ), protein (g ); percent RDVs for fat, saturated fat, cholesterol, sodium, carbohydrate, fiber; vitamin A, vitamin C, calcium, and iron.
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RESULTS |
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Features of Advertisements
Counts and percentages for variables coded at the advertisement level appear in Table 1
. For the entire sample, the 7 food type categories were unequally distributed across advertisements (
26, n = 725 =1331.33, P <.001). Candy, sweets, soft drinks, and convenience/fast foods were advertised most frequently, followed distantly by breads and cereals. There was little representation of fruits and vegetables, dairy foods, meats, poultry, fish, and alcohol. We observed a similar pattern of unequal distribution in the general-audience subsample, but here the dominant category was convenience/fast foods. For the child-audience subsample, the dominant category was candy/sweets/soft drinks. Most advertisements featured no health-related messages (25, n = 725 =2867.35, P <.001). Of the few health-related messages in the sample, most common was the message that advertised foods contained some natural ingredients and (for the general-audience advertisements only) that they were low in calories. For the entire sample, advertised foods were eaten mostly as snacks (24, n = 413 =96.47, P <.001). This pattern held for the general-audience and child-audience subsamples. In the child-audience advertisements, foods were consumed at snack time more frequently than at breakfast, lunch, and dinner combined. Because of the relatively high representation of food products in the breads/cereals category, breakfast was also fairly well represented in the child-audience subsample. Primary eating locale, another indicator of snacktime eating, was unequally distributed in the sample (24, n = 411 =52.61, P <.001), with a similar pattern in both subsamples. Home and restaurant locales typically indicate mealtime eating. If these two categories are combined, we see that less than half of all eating is depicted in traditional mealtime locales, whereas more than half is depicted in locations rarely associated with mealtime eating, such as cars, outdoors, or elsewhere.
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Because of the coding scheme distinguishing general-audience from child-audience advertisements, adult characters dominated the general-audience advertisements (
25, n = 559 = 433.36, P <.001), whereas child characters dominated the child-audience advertisements (25, n = 635 =585.00, P <.001). Table 1
presents additional data for character attributes. Males were overrepresented in the overall sample (22, n = 1194 =1315.27, P <.001) and both subsamples. In the child-audience sub-sample, 36% of male characters were depicted eating, compared with 24% of female characters (two-tailed t609 =3.03, P <.01). For both general-audience (24, n = 559 =1179.26, P < .001) and child-audience (24, n = 635 = 1166.66, P <.001) advertisements, White characters occupied the majority of roles, appearing about three times as often as all non-White characters combined. Although average-weight characters occupied over 75% of all roles, there were gender differences in apparent body size. In the child-audience sub-sample, overweight male characters appeared more frequently than underweight male characters, whereas underweight female characters appeared more frequently than overweight female characters. Where there was deviation from the average-size norm, for males it tended toward overweight whereas for females it tended toward underweight. For the entire sample, there was a correlation between maleness and body size (r =.12, P <.001). There was, however, no correlation between characters’ apparent body size and their tendency to be shown eating.
Nutritional Content of Advertised Foods
The average serving size for all foods in the sample was 140 g/mL (range, 0.6–960), with an average of 229 calories (kcal)/serving (range, 0–1650). If the foods in the sample could be combined into a single composite food, Figures 1 (general-audience foods) and 2 (child-audience foods) show what this food’s Nutrition Facts label would look like. To facilitate comparison, nutritional data for a 200-calorie serving size are presented in both figures, and values are rounded to adhere to the whole-number format of the Nutrition Facts label. The general-audience composite food is particularly high in fat and sodium, whereas the child-audience composite food is especially high in sugar. At 17 g per 200-calorie serving, this food gets 34% of its calories from sugar, well in excess of the 20% limit recommended by the American Heart Association.40
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A 2000-cal/day diet composed entirely of these foods would undersupply some nutrients and oversupply others.38 As presented in Table 2
, an individual eating a 2000-calorie diet composed of the general-audience foods would consume considerably more than the RDVs of fat, saturated fat, and sodium, while ingesting only a fraction of the RDVs of fiber, vitamin C, calcium, and iron. In contrast, an individual consuming 2000 calories/day of the child-audience foods would not exceed RDVs of fat, saturated fat, or cholesterol, but his/her daily intake of fiber, vitamin A, calcium, and iron would be inadequate. Moreover, that individual would ingest 171 g (684 cal) of sugar, which amounts to almost 1 cup. In summary, consumers of the general-audience diet would ingest considerably more total fat, saturated fat, and sodium, and less fiber, vitamin C, calcium, and iron than recommended. Consumers of the child-audience diet would exceed limits for sodium and sugar, and fail to obtain adequate fiber, vitamin A, calcium, and iron. Consumers of both types of diets, as shown in the "All Advertisements" column of Table 2, would exceed RDVs of total fat, saturated fat, and sodium, and fall short of RDVs of fiber, vitamin A, vitamin C, calcium, and iron.
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Comment
Given an average in our sample of 10.65 food advertisements per hour and a television viewing average among preteens approaching 3 hours/day,50 the typical child aged 6–11 years would be exposed to approximately 11000 food advertisements each year. In spite of the widespread adoption of the Nutrition Facts label, foods advertised during the television programs children watch most remain nutritionally unbalanced. Nutrient-poor, high-sugar foods were especially prevalent in advertisements aimed at children. If these advertisements influence children’s food purchase requests to their parents,14,15 the same advertisements probably influence the choices children make when buying foods themselves. In our sample, sweets, candy, soft drinks, and convenience/fast foods were much more prominent than whole, less processed foods, and most foods were consumed as snacks. There were few health-related messages, possibly because advertisers expect children to be more concerned with a food’s flavors and colors than its disease-fighting properties. The most common health-related message in our sample was that the advertised product contains some natural ingredients. This is easily verified by consumers, who can use this information to decide whether the product meets their own dietary standards. The recent trend toward "low-carb" messages in food advertisements (none of which appeared in our sample) is an example of how advertisers may confine their health-related messages to ingredients breakdowns and allow consumers to make their own conclusions regarding health benefits.
Attributes of characters in our sample conveyed subtle messages about food and eating. Males were more likely than females to be shown eating in child-audience advertisements—a finding that is consistent with previous research.51 That there were almost twice as many male as female characters also suggests that food consumption is more appropriately linked with masculinity. Also, although we oppose stereotypical portrayals of fat characters stuffing themselves with food, the lack of any correlation between body size and eating behavior suggests, erroneously, that eating and body weight are not related. The prevalence of average-sized and thin characters in our sample also suggests that anyone can eat a diet low in fiber and high in fat and salt and still remain slender.18
In terms of the nutrients on the Nutrition Facts label, the foods in our sample were satisfactory on some counts and unsatisfactory on others. One notable finding was the amount of sugar in the child-audience foods. Because sugar has no vitamins, minerals, or fiber, a child eating this diet would be forced to rely on the rest of his/her food to provide these nutrients. Over time, it is argued, widespread adherence to such a diet could increase the number of children who are poorly nourished yet obese.52 The items in our sample consisted of breakfast, lunch, snack, and dinner foods. It is therefore possible to build an entire diet consisting of nothing but these foods. Moreover, the nutrient amounts listed in Table 2 represent a conservative estimate of what some American children and adolescents are consuming. We used the 2000-calorie standard that appears on the Nutrition Facts label, but many children and teenagers consume considerably more. A governmental report on dietary adherence to the USDA’s Food Guide Pyramid by more than 18000 individuals showed that boys aged 6–11 years consumed an average of 1985 kcal/ day, but boys aged 12–19 years consumed 2716 kcal/day.53 Using our Nutrition Facts facsimile labels, it is possible to calculate that, if the older boys consumed a diet consisting of the foods in our study, they would ingest 122 g (188% RDV) of fat per day from a diet of the general-audience foods, and 231 g (1.2 cups) of sugar per day from a diet of the child-audience foods.
Our study represents an analysis of the foods advertised during the programs most popular among, and therefore most likely to be viewed by, children aged 6–11 years during a 5-week period in the spring of 2003. Our purpose was to represent television’s food landscape from a child viewer’s eye, but we have revealed only a portion of that landscape. More extensive and exhaustive content analyses are needed to obtain a complete picture of the diet being advertised to children and their coviewing family members. Further, the Nutrition Facts label omits some nutritional information of considerable importance to consumer health (e.g., amount of trans fatty acids), so more comprehensive nutritional analyses of advertised foods are warranted. Though dietary experts might maintain that none of the food products in our sample are inherently bad, and all may have a place in a healthy diet if eaten in moderation,39 a diet in which these foods feature prominently, with few whole, unrefined foods to balance them, would be—as our calculations indicate—quite problematic. Given the food industry’s heavy marketing of convenience/fast foods and other refined, high-calorie products, it is becoming increasingly difficult for parents to maintain the moderation necessary to preserve their children’s health.10,36
In spite of this difficulty, parental involvement remains the most important factor in the determination of the family diet. Parents can work to maintain the integrity of the family pantry not only through selective shopping, but also through efforts to instruct their children about food and nutrition. Indeed, research suggests that parental mediation may help reduce the effects of television advertising on children’s purchase requests.54 On the other hand, parents obtain information about food and nutrition from television advertisements just as children do. Moreover, research demonstrates a connection between television viewing and obesity for adults as well as for children.10 Critics of the food industry assert that it has taken few steps to remedy this situation despite claims that it has children’s nutritional interests at heart.36 One possible solution to this problem is for parents to limit their children’s (and their own) television viewing. Another is for further restrictions on advertising to children—a position advocated by the American Psychological Association.9 Still another is for physicians, nutritionists, and other public health professionals to continue interviewing parents and children about their awareness of dietary options and providing them with additional guidance if this awareness seems limited to television-advertised foods. In collaboration with parental efforts, the continued investment of the medical and public health communities will be needed if parents are to be successful in helping their children resist the influence of commercial food advertising.
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Acknowledgments |
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This study was funded in part by a 2002 William T. Grant Foundation Scholars Award to the first author.
The authors thank Susana Vazquez for taping the sample of commercials, Nicole Martins for data entry and coding, and Michelle Hals and Ally Bibart for additional coding to help establish intercoder agreement.
Note. The William T. Grant Foundation did not provide any input on the design or execution of the study, nor on the collection, analysis, or interpretation of data, nor on the preparation, review, or approval of the manuscript. The views herein are those of the authors and not necessarily those of the William T. Grant Foundation.
Human Participant Protection
No human participants were involved in this study.
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Footnotes |
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Peer Reviewed
Contributors
K. Harrison obtained funding, originated the study concept and design, gathered nutritional data, conducted all analyses, wrote the article, and supervised all other aspects of the study. A.L. Marske helped refine the coding scheme, coded data, gathered nutritional data, and prepared data for analysis. Both authors worked to conceptualize ideas and review drafts of the article.
Accepted for publication September 19, 2004.
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