Food Marketing to Children and Youth
J. Michael McGinnis, MD, MPP
Institute of Medicine
The National Academies
Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
Subcommittee on Financial Services and General Government
Committee on Appropriations
United States Senate
September 23, 2008
Good morning, Chairman Harkin, Chairman Durbin, and members of the subcommittees. I am Dr. Michael McGinnis, Senior Scholar and Executive Director of the Roundtable on Evidence-Based Medicine at the Institute of Medicine (IOM) of the National Academies in Washington, DC. Thank you for your kind invitation to appear before this joint subcommittee hearing.
First a word about the Institute of Medicine, which is my current employer but my responsibilities lie outside this arena, and I am appearing here as an individual expert to address issues related to my prior responsibilities as an IOM committee chair. Established in 1970 under the Congressionally-granted Charter of the National Academy of Sciences, the IOM provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. That advice is developed through committees comprised of leading national and international experts from relevant fields convened by the IOM to conduct rigorous reviews of problems at hand. I join you today in the context of a previous capacity, as Chair of the IOM Committee on Food Marketing and the Diets of Children and Youth. Our Committee produced the 2005 report, Food Marketing to Children and Youth: Threat or Opportunity? I appreciate the opportunity to speak to the findings of that report, the activities it has helped catalyze, and the current state of play in the field. Most of my comments will be oriented to matters of fact or interpretation of findings and recommendations from the report, and I will be clear when opinions expressed are personal and based solely on my individual expertise.
Against the backdrop of pressing public concern over the rapid and widespread increase in the prevalence of childhood obesity, Congress, in the FY2004 appropriation, directed the Centers for Disease Control and Prevention (CDC) to undertake a study of the influence of food and beverage marketing on the diets and health of children and youth. The CDC requested that the IOM undertake the study, and the Committee on Food Marketing and the Diets of Children and Youth was formed. The committee charge included exploring what is known about current food and beverage marketing to children and youth in the United States, the scientific evidence on the relationship between these marketing practices and the diets and health of children and youth, and the strategies that have been, or could be, used to promote healthful food and beverage choices among children and youth.
The committee’s report on Food Marketing to Children and Youth was released in December of 2005 and published in 2006. It is one of several recent IOM examinations of various aspects of childhood obesity prevention, most notably Preventing Childhood Obesity: Health in the Balance, Congressionally mandated and published in 2005, and Progress in Preventing Childhood Obesity: How Do We Measure Up? published in 2007. Each highlights, from different perspectives, the urgent need for attention to obesity in children and for multi-sectoral approaches to addressing it.
Befitting the breadth of the topic, the food marketing committee was comprised of experts of unusually varied disciplines, experience, and perspective. The 16 members brought to the committee expertise not only in child and adolescent development, epidemiology, public health, and nutrition, but also in food production, marketing, children's television, causal reasoning, constitutional law, and business ethics.
The Food Marketing report represented the most comprehensive review undertaken of the scientific literature on the influence of marketing on the diets of children at that time—and remains so today. In conducting the study, the committee developed and applied a rigorous analytic framework to the systematic review of the relevant scientific literature. We also undertook an extensive review of the nutritional status of and trends for children and youth, what is known about the full range of factors that influence the dietary patterns of this population, the broad and evolving food and beverage marketing environment, and the policy measures that might improve the nutrition of young people. Since our report was published, the continuing improvement in identifying and understanding the influences of marketing on diets of children and youth, is encouraging and a reflection of the importance of this subject.
What did we find? In short, we found that marketing works. First, we found that there is strong evidence that television advertising of foods and beverages has a direct influence on what children choose to eat. Second, the dominant focus of food and beverage marketing to children and youth is for products high in calories and low in nutrients, and this is sharply out of balance with healthful diets. Third, marketing approaches have become multifaceted and sophisticated, moving far beyond television advertising to include the Internet, advergames, strategic product placement, and much more.
We also found that turning around the current trends in children's diets and in marketing will require strong and active leadership and cooperation, from both the public and private sectors. Industry resources and creativity must be harnessed on behalf of healthier diets for children. The food industry needs to be a substantial part of the solution to a problem to which it has been a contributor. The committee had limited access to proprietary marketing research, which might have shed additional light on some of the research and marketing patterns and strategies for child- and youth-oriented foods and beverages. Hence the importance of the focus of today’s hearing and the work of the Federal Trade Commission.
The 2005 IOM Food Marketing report presented recommendations for different segments of society to guide the development of effective marketing strategies that promote healthier food, beverage, and meal options to children and youth. Recommendations were also offered for research necessary to chart the path of future improvements, and the capacity to monitor and track improving in marketing practices that have an influence on children’s and youth’s diets and diet-related conditions.
With respect to strategy, one thing is very clear: the turnaround required is so substantial, and the issues are so complex, that the full involvement and leadership of food and beverage industries is essential. The report identified a number of ways in which food, beverage, and restaurant companies, food retailers, and advertising and marketing firms can and should shift their child- and youth-oriented product development and marketing. It also suggested ways they can and should work with government, scientific, and public health groups to develop and enforce marketing standards for healthful foods and for marketing of products, to develop and implement an empirically tested rating system and graphic representation for front of package labeling, to develop a way to access propriety data, and to develop and implement a sustained public-private cooperative social marketing effort aimed at achieving better diets among our children. The report recommended that Congress consider legislative mandates, should voluntary efforts fail to shift the emphasis of television advertising to healthier products.
Since the release of our report, a number of interesting and important developments have occurred which hold promise for progress in improving the influence of marketing on children’s diets. Several individual food companies have committed to alter their marketing practices in various ways to give greater emphasis to children’s products that are lower in calories and higher in nutrient density; Disney, Nickelodeon, and the Cartoon Network all have announced some limitations in licensing of their cartoon characters for use in marketing to children; the soft drink industry announced cessation of soda sales in elementary schools, with phased extension of that policy; the industry-wide voluntary self-regulatory guidelines administered by the Children’s Food and Beverage Advertising Initiative were strengthened and expanded; the American Academy of Pediatrics called for rigorous standards on marketing food a beverages to children; in a settlement with CSPI, Kellogg’s agreed to stronger standards in marketing healthier products; the Kaiser Family Foundation released the most comprehensive survey to date of the magnitude and trends for food advertising to children and youth; and the Federal Trade Commission undertook its study on food marketing and industry practices, and discussions here in Congress have included consideration of ways for the FTC to engage standards for foods marketed to children. Outside of the marketing arena, but important to overall progress is the pledge by my former colleagues at the Robert Wood Johnson Foundation to commit over $500 million in the coming years to combating childhood obesity. These are all important developments. Still, as noted in the 2007 IOM report Progress in Preventing Childhood Obesity: How Do We Measure Up?, they are just beginnings and the fundamental gains for children are still to be realized.
Challenges of the scope and potential national impact of obesity in general, and childhood obesity in particular, require aggressive government leadership, hence our Committee recommendations that government explore the various incentives it has available to: encourage and reward companies that develop and promote healthier products for young people; use marketing resources in social marketing for healthier lifestyles for children; and develop the type of monitoring capacity required for a health challenge of this magnitude. On the monitoring activity, we specifically recommended that the Secretary of Health and Human Services, in consultation with other key officials, designate an agency to monitor the progress of various entities in doing their part to promote more healthful diets, and report to Congress on the progress made and needed actions. To our knowledge, that recommendation, among others, has yet to be addressed. At the end of this statement is a list of our 10 Committee recommendations1 with an informal status assessment. I emphasize that this is my personal and preliminary view, offered without benefit of the rigorous and regular scrutiny warranted for an issue of this importance.
In summary, there is substantial and compelling concern about the prospects for future health gains if the epidemic of obesity is not reversed, beginning with its disturbing presence among children—our nation’s future. This is a matter of truly compelling urgency, and requires sustained and intense attention befitting any epidemic of potentially widespread and generation-changing lethality. We thank you for the attention and emphasis that you and your colleagues are drawing to this issue, and hope that it will help catalyze the changes necessary to transform the current threats into future opportunities.
That concludes my statement. Thank you again for the opportunity to appear before you today, and for your leadership on this vital issue for the health of Americans—now and in the years to come. I would be happy to address any questions you may wish to ask.
1. The recommendations are summarized at http://www.iom.edu/CMS/3788/21939/31330/31337.aspx.
Food Marketing to Children and Youth
2008 Status of Recommendations in the 2005 IOM Report*
1. Food and beverage companies should use their creativity, resources, and full range of marketing practices to promote and support more healthful diets for children and youth.
2008 Status: Limited progress, initiatives beginning. The components of this recommendation include shifting portfolio balance toward more healthful products; reversing marketing emphasis in child- and youth-oriented products so that healthful products predominate; public-private collaboration to develop industrywide rating system and graphic representation for child- and youth-oriented products; and marshal marketing capacity for broad promotion of healthier foods and beverages. Activities such as those underway through the Council of Better Business Bureaus (CBBB) pledge program represent incentives for positive movement, and there may be some increase in development and marketing more healthful products. But we are far short of a reversal in the balance. The plethora of rating systems and graphic representations continues, potentially adding to consumer confusion. Despite ongoing discussion of the issue through the Keystone dialogue process on common labeling approaches to healthful products, the utility for children’s products is unclear and neither government nor industry has specifically identified addressing this issue as a priority.
2. Full serve restaurant chains, family restaurants, and quick serve restaurants should use their creativity, resources, and full range of marketing practices to promote healthful meals for children and youth.
2008 Status: Very limited progress, growing interest and focus. The components of this recommendation include expanding healthier options for children and youth in commercial meal establishments, and providing key nutrition information at the point of choice and use. A number of national chains are conducting research and experimenting with approaches, and several states and localities have initiated legislative or regulatory efforts on restaurant menu labeling, which may step up the pace.
3. Food beverage, restaurant, retail and marketing industry trade associations should assume transforming leadership roles in harnessing industry creativity, resources, and marketing on behalf of healthful diets for children and youth.
2008 Status: Very limited progress. The components of this recommendation include trade association leadership and technical assistance for the initiatives of individual companies to develop creative approaches to healthful product lines, marketing strategies, and public-private partnerships. Although effects are still to be determined, the American Beverage Association initiated certain member efforts to shift sales and marketing efforts in schools. The Grocery Manufacturers Association has been focused, appropriately, on food safety issues, leaving leadership on healthful content largely to the initiative of individual companies. And the National Restaurant Association has opposed menu labeling initiatives. To date, none has worked to spearhead the collaborative development of the sort of sustained social marketing effort noted in recommendation #6.
4. The food, beverage, restaurant, and marketing industries should work with government, scientific, public health, and consumer groups to establish and enforce the highest standards for the marketing of foods, beverages, and meals to children and youth.
2008 Status: Some progress, pending assessment. The components of this recommendation include work of the Children’s Advertising Review Unit (CARU) to strengthen self-regulatory guidelines; eliminate of use of licensed cartoon characters for products other than those that promote healthful diets; and FTC-CARU cooperation on guideline monitoring and enforcement. Advertising guidelines have been strengthened, and the joint FTC/HHS conference and Better Business Bureau initiatives report progress in reducing advertising to children. Impact on broader marketing strategies is unclear. Other efforts, such as the FCC-sponsored task force on food marketing to children have not yet reported their progress. Announcement by Disney, Nickelodeon, and the Cartoon Network to impose limitations of their cartoon characters in marketing high calorie/low nutrient foods to children represents progress that needs evaluation.
5. The media and entertainment industry should direct its extensive power to promote healthful foods and beverages for children and youth.
2008 Status: No apparent progress. The components of this recommendation include incorporation of promotion of healthful foods through multiple media platforms, and close scrutiny and reporting by news organizations of the activities of public and private organizations on the level of effort in executing responsibilities and engaging opportunities. Information is not available on the trends on either dimension.
6. Government, in partnership with the private sector, should create a long-term, multifaceted, and financially sustained social marketing program supporting parents, caregivers and families in promoting healthful diets for children and youth.
2008 Status: Some reversal of progress, with respect to the notion of a sustained public-private effort. The components of this recommendation include development of a mechanism for a sustained public-private support stream for long-term social marketing efforts to improve the diets and activity patterns of children and youth; draw upon the marketing research and expertise accumulated by industry to shape strategies; give initial emphasis to skills building for parents and caregivers of young children. Although there are notable ad hoc activities under way (e.g. HHS and Advertising Council initiatives, Small Steps obesity prevention campaign, America on the Move, Alliance for a Healthier Generation, Action for Healthy Kids), no government agency, company, association, or philanthropic organization has taken the initiative to create the public-private vehicle necessary for sustained conduct of the long-term strategic social marketing necessary for progress against the epidemic. In fact, public funding has ceased for the Verb Campaign of the Centers for Disease Control and Prevention, which showed some initial success in promoting physical activity among young teens.
7. State and local educational authorities, with support from parents, health authorities, and other stakeholders, should educate about and promote healthful diets for children and youth in all aspects of the school environment (e.g., commercial sponsorships, meals and snacks, curriculum).
2008 Status: Some progress. The components of this recommendation include implementation of nutrition standards for the school environment; promotion of more healthful foods in schools; and prominent leadership by all levels of public and private sector influence over school environments. Amendments through PL 108-265 to the Richard Russell National School Lunch Act and the Child Nutrition Act of 1966 have established a basis from which substantial changes can be made in the influence of school meals and school centered initiatives on children’s diet and health, although effecting those changes has not received the top to bottom emphasis necessary. A 2007 IOM report focused on nutrition standards for food in schools, has been adopted and used in several states, and both CDC and USDA are working on related best practices for wider dissemination. Many industry marketing practices in schools are undergoing revision.
8. Government at all levels should marshal the full range of public policy levers to foster the development and promotion of healthful diets for children and youth.
2008 Status: Little apparent progress, despite some increase in ad hoc public education campaigns (see #6). The components of this recommendation include government incentives (e.g. subsidies, tax policies, awards) to promote availability and family use of fruits and vegetables; USDA use of school and other low-income food programs to promote healthier meals, and Congressional legislation on children’s television advertising if industry-led initiatives do not turn around the marketing emphasis. Increased focus on school meals, as well as nutrition standards for other USDA food programs, but little information available on current status and trends; reliable updated information is also not yet available on which Congress might base legislation on children’s broadcast and cable television advertising; and economic incentive programs are not yet widely in place to increase fruit and vegetable consumption.
9. The nation’s formidable research capacity should be substantially better directed to sustained, multidisciplinary work on how marketing influences the food and beverage choices of children and youth.
2008 Status: No apparent progress. The components of this recommendation include expanded research capacity to learn more about the ways marketing influences children’s attitudes and behaviors, especially related to new and emerging multifaceted marketing strategies; and development of a means for commercial marketing research to be made available as a publicly-available resource for the design of broad social marketing strategies targeting diet and activity patterns of children and youth. Little research capacity has been developed to assess either the broader impact of new media marketing strategies, or the targeted impact on children’s diets. No government agency, company, association, or philanthropic organization has taken the initiative to create the public-private vehicle necessary for the receipt, mining, and application of insights of commercial marketing research on behalf of strategies for pro-social marketing on children’s diets and activity patterns.
10. The Secretary of the U.S. Department of Health and Human Services (HHS) should designate a responsible agency, with adequate and appropriate resources, to formally monitor and report regularly on the progress of the various entities and activities related to the recommendations include in this report.
2008 Status: No apparent progress. The components of this recommendation included consultation by the HHS Secretary with counterparts from USDA, Education, FTC and FCC to develop monitoring and reporting on progress on findings and recommendations of the report, and issuance by December 2007 of a report to Congress on the progress. Public knowledge is not available to indicate that a formal collaborative effort of this sort has been undertaken, nor has the report to Congress been submitted.
*Note for emphasis: This status summary reflects personal and preliminary opinion, offered without benefit of the rigorous, regular, and formal scrutiny warranted for an issue of this importance. JMM
An archived transcript of the hearing can be found on the Government Printing Office's Web site.