Positive Health Online

Worldwide, over 22 million children under five are severely overweight. In the UK there are around 1 million obese children under 16 years of age. These soaring rates in obesity have led to an increase in childhood type II diabetes, and will lead to more future cases of heart disease, osteoarthritis and some cancers. Estimates indicate that, if current trends continue, at least one fifth of boys and one third of girls will be obese by 2020.[1]

More than a quarter of children in English secondary schools are clinically obese, almost double the proportion a decade ago, and an official survey showed that girls were suffering more than boys from a crisp and chocolate-fuelled life of too much eating and too little exercise. Colin Waine, chairman of the National Obesity Forum, said that the figures showed a "public health time-bomb" in the making: children who were obese in their early teens were twice as likely to die by age 50, he said.[2]

Researchers measured the height and weight of 11-15 year olds, and found 26.7% of girls and 24.2% of boys qualified as obese - nearly double the rate in 1995. Among children aged 2-10, 12.8% of girls and 15.9% of boys weighed above the obesity threshold - also well up on 10 years before. The figures, based on 2,000 children, come from the National Health Survey for 2004, and have alarmed doctors as well as casting doubt on the government's ability to achieve its target to halt the rise in childhood obesity. The survey revealed that the increase in obesity accelerated sharply in 2004.[1] A report by the National Audit Office in February said that the government would fail to halt the rise in obesity without clearer leadership from the top. According to this report, the target of stopping the rise by 2010 had been set in 2004, but plans to change children's diet and exercise at school and home had hardly got off the starting blocks.[3]

The topic of children's eating habits and their contribution to obesity is regularly discussed in the media. One of the most influential exposures has been the Channel 4 series fronted by Jamie Oliver in March 2005, which revealed how little some schools spent on pupils' meals. In response to the general outcry generated by the programme, the government announced that would invest an extra £280m. While the discussion was ostensibly about school meals, the publicity serves to highlight the issue of children's eating habits in general.[2]

Weight gain is not just the result of the intake of calories, but also relates to the expenditure of energy. Thus the increasing weight gain of children is often related to their increasingly sedentary lifestyle. Many children these days spend a high proportion of their leisure time slumped in front of the television as well as increasing amounts of time on computers and on games consoles. There is also evidence to suggest that not only are children less active during their own free time, but they spend less time doing sport at school.[5]

In general, children and adolescents are eating more salt, sugar and saturated fats than is recommended, and not enough fruit and vegetables. Attention has also recently focused on adolescents' high consumption of fast food and soft drinks.[6] The problem is most acute for those who are born into low-income families, with inadequate income and inadequate access to healthy food, making it much more difficult to improve the diet. There is increasing evidence that adult susceptibility to disease is associated with nutrition in early childhood and adolescence, and therefore early intervention is vital.[7]

There is concern that children receive a huge amount of attention from food advertisers, with a marked discrepancy between the foods marketed at children and the nutritional quality of that food. The media has an important role to play in forming attitudes to nutrition and there is scope to harness this potential and further regulate its more harmful impact.[13]

With an explosion in recent years in media aimed directly at children, and the advertising that accompanies such media, the youngest members of our society are being exposed to more television and more advertisements than ever before.[2] Preschool-aged children are uniquely susceptible to advertising, because children in this age group have trouble distinguishing programs from commercials and often have difficulty discriminating between reality and what they see on television, even when programming is animated. Children are likely to view advertisements as objective statements of fact, that is, unbiased informational pieces designed to tell them about a toy or food product, and lack the ability to comprehend an advertisement's intent to sell.[12]

Hence, 'Junk' food adverts are to be banned from some of the most popular television programmes in an attempt to halt child obesity. The ban will come into effect before the end of January 2007. Shows watched by large numbers of children and young teenagers - from teatime programmes to Hollyoaks, The Simpsons and Friends - are to be subject to the new rules. Ofcom, the communications regulator, said that the advertising of products high in fat, salt and sugar would be banned in all children's programmes. The ban will extend to any show in which the proportion of children viewing is 20 per cent more than the average.[3]

However, there appears only limited evidence that junk food advertising has any impact on obesity. Commercials have only a 2 per cent influence on food preference, according to Ofcom's own statistics. But Ed Richards, chief executive of Ofcom, said that action was justified because "television has a meaningful indirect effect" on children's lifestyles. On the other hand, health professionals and anti-obesity campaigners argue, that the recommendations did not go far enough and continue to call for a ban on all junk food adverts shown before 9pm. Vivienne Nathanson, of the British Medical Association, questioned whether the health of our children is not more important than advertising revenues.[1]

However, Philip Cullum, deputy chief executive of the National Consumer Council, said that these proposals don't get to the heart of the problem. He mentioned that seventy per cent of children's viewing time is outside children's airtime, hence Ofcom's proposed ban, won't catch programmes that are very popular with under-16s. Ofcom originally considered a ban aimed at under-9s only, but extended it to under-16s, suddenly bringing MTV into the list of affected channels.[3]

The regulator produced figures to show that a total ban on all junk food advertising would cost ITV, Channel 4 and other commercial broadcasters £263 million in the first year, falling to £211 million thereafter. Under Ofcom's planned ban, the cost is £39 million in the first year, dropping to £23 million over time. If the ban works, under-16s would see 41 per cent fewer food and drink advertisements, and the under-9s 51 per cent fewer.[2]

The Food and Drink Federation (FDF) said it was "shocked" by the Ofcom proposed junk food adverts ban, targeted at under-16s, adding it feared that the planned regulations were "over the top", as this would cost broadcasters an estimated £39m in lost advertising revenue.[4]

The proposed changes, expected to be enforced from the end of January 2007, and phased over 24 months, are primarily due to the growing public debate about childhood obesity. Its decision to target youngsters below that age of 16 comes after two years of research and consultation. Originally, it had been widely expected to settle for a ban on adverts aimed at under-fives, but those fall short of affecting TV advertising before 9pm.[3]

The new rules mean any adverts for foods deemed as too high in fat, sugar and salt cannot be shown during pre-watershed adult shows that are popular with children. However, the Food and Drink Federation (FDF) director general Melanie Leech argued that the guidelines for which foods should be targeted by the ban were "scientifically flawed". She stressed that the debate around this important issue has been based on high emotions and subjective opinions rather than a sensible dialogue about how childhood obesity can be tackled.[8]

The Advertising Association gave a "mixed response", saying that said while it welcomed Ofcom's decision not to adopt a pre-watershed blanket ban, it was unhappy at the decision to widen the ban away from primary school children. It added the "draconian measure" could mean a difficult future for UK-produced children's programmes, as reduced advertising revenues would mean less money to plough back into shows.[9] 'Flextetch', which provides content for cable broadcaster NTL, including the youth channel 'Trouble', said Ofcom had gone "substantially further" than expected. Surprisingly, fast-food chain 'McDonald's' welcomed the recommendations, saying they had helped bring some clarity to the debate. Some food companies had already taken pre-emptive action ahead of the ban. The fast food chain 'Burger King' said it would voluntarily stop making and showing television adverts in the UK aimed at children from 22 December.[8]

However, there is sufficient empirical evidence to conclude that TV advertising has a modest, direct effect on children's food choices. While indirect effects are likely to be larger, there is insufficient evidence to determine the relative size of the effect of TV advertising on children's food choice, by comparison with other relevant factors.[10] This does not however mean that the indirect effects of television advertising are negligible. It is widely argued in the fields of social and developmental psychology and in consumer marketing research that substantial indirect effects occur. In the context of the multiplicity of influences of children's food choice, it is perhaps not surprising that the direct effect of TV advertising has been found to be 'modest'. While qualitative research found that TV plays an important role, quantitative research suggested that more important are, for example, the child's own taste preference, price, familiarity, peer pressure, healthiness and convenience.[11]

Analysis of children's viewing behaviour revealed that on average children aged 4-15 watch far more television in adult airtime than they do in children's airtime (12 hours vs 5 hours/week). Moreover, most of their viewing in commercial children's airtime (2.6 hours/week) is with non-terrestrial channels (1.9 hours/week). Children watch an average of 22 minutes a day of commercial children's TV. Most of the TV advertising products that children see is for confectionery, savoury snacks, soft drinks, fast food and pre-sugared breakfast cereals (the 'Big Five').[4]

Most parents believe that the rules about how the 'Big Five' are advertised on television need to be changed. Least support was registered for an outright ban on the advertising of those products on TV. Most support emerged for ensuring that there is accurate information in advertising (i.e. the provision of nutritional information; banning health claims if something else about the product is 'unhealthy'). There is also support for targeting the attractiveness of advertising to children (in general, not using celebrities or cartoon characters).[12] To date, little research has been done to evaluate the effectiveness of banning food advertising on TV, and where there has been research in other countries on the effectiveness of bans on food advertising in relation to obesity, the conclusions are at best both unclear and contested.[2]

Solutions to the problems of obesity/children's health need to be multi-faceted. While the research suggests that regulation of TV advertising has a role to play, changing the rules around the advertising of child food products alone as a single approach to combat obesity seems highly unlikely to succeed. Addressing how those products are advertised on television will need to be accompanied by comparable action in a number of other areas, for example.[9):

• Improved access to healthy foods in areas of multiple deprivation
• Improved food provision in schools
• Promotion of physical exercise
• Educational programmes to promote healthy eating
• Promotion of media and advertising literacy
• Food pricing
• Labelling of foods
• Regulation of other forms of promotion.

Professor Hasting's stressed at the Westminster Diet and Health Forum conference (2004) that the whole process has to be considered in order to make an intelligent impact. Professor Hastings thinks that banning TV advertising to children is going to be, at best, ineffective.[14]

In sum, it appears that there is much need to be more strategic in response to this problem. 'Unhealthy marketing' should be reduced by limiting the amount of promotion, product development, pricing and advantageous distribution, and 'healthy marketing' should be increased. Furthermore, a necessary prerequisite for any proportionate and targeted intervention would be a practical, actionable definition of what defines a 'unhealthy' product, and conversely, what constitutes a healthy food.

References

1. Market Intelligence Food and Drink, Market Intelligence: UK. Childhood Obesity. 2005. Available: http://reports.mintel.com/sinatra/reports/display/id=161544   [accessed 28.11.06].

2. British Medical Association (BMA) 2003. Adolescent health. London: BMA. 2003.

3. 3. BARB TV viewing data 2006. Survey Of Heritage Television Viewing 2005-06. Available:

www.English-heritage.org.uk/upload/pdf/eh_tvcounts_report_final.pdf   [accessed 29.11.06].

4. Speiser, P. & Rudolf, M.C.J. Consensus statement: childhood obesity. Journal of Clinical Endocrinology and Metabolism 9: 1871-87. 2005.

5. British Medical Association (BMA) Eating disorders, body image & the media. London: BMA. 2000.

6. Food Standard Agency (FSA) See Chief Medical Officer's Annual Report. Available: www.foodstandards.gov.uk/healthierearting/promotion/promofacts  [accessed 29.11.06]. 2000.

7. British Medical Association (BMA) Growing up in Britain: Ensuring a healthy future for our children. London: BMJ Books. 1999.

8. FDF (2006) FAU Conference  - Marketing Food and Health: A Changing Media Landscape. 2006. Available: www.fdf.org.uk/events/MLFAUConference8Nov2006.pdf   [accessed 30.11.06].

9. OFCOM  What is Ofcom's role in tackling childhood obesity? Available: 2006. www.ofcom.org.uk/media/mofaq/bdc/foodadsfaq  [accessed 30.11.06].

10. WHO. Young people's health in context. Health Behaviour in School-aged Children (HBSC) study: international report from the 2001/2002. 2004. Available: www.euro.who.int/Document/e82923.pdf   [accessed 27.11. 06].

11. Foulds, R. Food Promotion and Children. Qualitative Research on behalf of the Food Standards Agency. 2004. Available: www.food.gov.uk/multimedia/pdfs/report_qua.pdf#page=2 [accessed 29.11.06].

12. Livingstone, S. & Helsper, E. (2004) Advertising HFSS Foods to Children: Understanding Promotion In The Context Of Children's Daily Lives [online]. Available: www.unicef.org/magic/resources/ofcom_childhood_obesity_report.pdf9  [accessed 29.11.06]. 

13. Jason C.G. Halford, Jane Gillespie, Victoria Brown, Eleanor E. Pontin, Terence M. Dovey, Appetite 42. 221–225. 2004.

14. Taylor Nelson Sofres (TNS).  Young people's health in context. Available: http://stakeholders.ofcom.org.uk/binaries/consultations/foodads_new/statement/statement.pdf . 2004. [accessed 29.11.11].

Note

† Author for correspondence; E-mail: claudia.louch@phytoclinic.com