The kids are not alright

-- Submitted by Heart & Stroke

Following is an abbreviated version of the Heart & Stroke 2017 Report on the Health of Canadians: The kids are not alright – How the food and beverage industry is marketing our children and youth to death.

To read the full report visit http://heartandstroke.ca/heartreport.

Call to action – everyone has a role to play

Federal legislation restricting food and beverage marketing is a critical component of a multi-pronged strategy to improve children’s nutrition, one that has proven successful elsewhere – including in Quebec. Parents should be supported and young children and adolescents need and deserve this protection if they are to develop into strong healthy adults.

In addition to federal action, there are plenty of ways that individual communities can make the healthy choices the easy choices and it will come as no surprise that Ontario’s public health community continues to play a leadership role in realizing this change:

  • The Association of Local Public Health Agencies (alPHa) unanimously ratified Heart & Stroke’s position statement calling for a levy on sugary drinks.
  • Toronto Public Health is a full member of the Stop Marketing to Kids Coalition and released “Stop Marketing to Kids: A Window of Opportunity.”
  • Windsor-Essex and Peterborough have both written letters to Canada’s Minister of Health in support of Bill S-228.
  • Sudbury District Health Unit has formally endorsed the Ottawa Principles (http://stopmarketingtokids.ca/the-ottawa-principles-2/) developed by the Stop Marketing to Kids Coalition.
  • Boards of Health in Ottawa and Middlesex-London have asked for staff to report back on the municipal recommendations in our 2017 Report on the Health of Canadians (see page 14 of full report).
  • Many other health units are also working hard to identify changes that they can recommend for their communities.

If you and/or your health unit would like to get involved or to learn more, please contact us at [email protected].

Losing our appetite for advertising

Marketing is big business and it is sophisticated. Millions of dollars are spent convincing our impressionable children and teens they want a whole range of products, including food and beverages that are having a devastating effect on their health. Children and youth are targeted through multiple channels and locations including movies and video games, websites, apps and social media. Marketing targets kids in their homes, at school, on the street, and in rec centres, stores, restaurants, and through celebrity endorsements. In short, it is anywhere and everywhere.

Marketing is preventing too many kids from developing healthy habits that would extend into adulthood. It’s not the only obstacle, but it is a significant one. Legislation restricting food and beverage marketing aimed at our youngest citizens is a critical component of a multi-pronged strategy to improve children’s nutrition – one that has proven successful, including in Quebec for several decades. Other elements of such a strategy include improved food labelling and information, better access to affordable healthy food, public awareness and skills building, and polices that support reduced sugar consumption, especially in liquid form. A good example with successful results exists in tobacco control. Smoking rates in Canada have been slashed over the last several decades from 50% to 18%, including fewer young people starting, thanks to a comprehensive strategy which included restrictions around how these harmful products could be marketed and sold.

Eat healthy early, eat healthy often

What we eat affects our health. It has become increasingly clear that the overall quality of our diets — including the types and amounts of food we eat — is one of the most important overall factors impacting our health. According to the World Health Organization, unhealthy diet is a major risk factor for non-communicable diseases; these risks start in childhood and build through life.

We know how important nutrition is and yet our children’s health is threatened; their risk factors for premature heart disease and stroke, high blood pressure and diabetes are at epidemic levels. Kids who eat an unhealthy diet enter adulthood predisposed to develop chronic disease. Since 1979, the number of Canadian children with obesity has tripled, with almost one in three children overweight or obese. Obesity puts children and adolescents at risk for many health problems, including heart disease, stroke, diabetes and depression.

Chronic disease treatment accounts for over two-thirds of health care spending, and costs are projected to grow. Heart disease and stroke cost the Canadian economy $21 billion each year. The economic burden of obesity in Canada due to direct healthcare costs and indirect costs from lost productivity is estimated to be between $4.6 billion and $7.1 billion annually.

Growing up surrounded by unhealthy choices

We live in an environment that does not help us eat well. We are surrounded by unhealthy, low cost food and beverages. The easiest, most accessible and heavily marketed choices are often energy-dense, nutrient-poor processed foods and sugary drinks.

The result is that over the past 70 years our consumption of processed and ultra-processed foods has doubled; these products are now 60% of the average family’s food purchases, up from 30%. Highly processed foods are generally high in calories, sugar, fat and sodium. Sugary drinks are the single largest contributor of sugar in our diets — one can of pop provides close to the recommended daily maximum. According to a report from the Public Health Agency of Canada, one-quarter of children ages 5 –19 say they consume sugary drinks every day.

Family food fights

Many factors influence our ability to eat a healthy, balanced diet: access, price, skills and knowledge all come into play. Another important aspect is marketing.

Research — and common sense — show that marketing affects kids’ food and beverage preferences and the kinds of products they pester their parents to buy. The World Health Organization (WHO) states that evidence shows that TV ads influence children’s food preferences, purchase requests and consumption patterns. It also points out that the evidence is unequivocal: childhood obesity is influenced by marketing of food and beverages high in fat, sodium or sugar. A recent systematic review out of McMaster University shows that kids’ extensive exposure to marketing for unhealthy food and beverages resulted in increased calories consumed and preference for junk food.

As much as 90% of food and beverages marketed to kids on TV and online are high in salt, fat or sugar. The average child watches about two hours of TV a day and see four to five food and beverage ads per hour. Canadian children and youth spend almost eight hours a day in front of screens.

Marketers understand the power that kids hold. Children to some extent, and teens to a greater degree, have purchasing power themselves, but more importantly they influence what their parents buy. Children and youth are also potential life-long customers.

Almost all junk, almost all the time

Dr. Monique Potvin Kent, an expert on food and beverage marketing and children’s nutrition, reviewed advertising on children’s and youths’ preferred websites for Heart & Stroke. Looking at a one-year period (June 2015 – May 2016), she reviewed the top ten most popular websites for children (ages 2 – 11) and adolescents (ages 12 – 17). She determined the volume of food and beverage advertising and carried out a nutritional analysis of the products using the Pan-American Health Organization (PAHO) Nutrient Profile Model.

Her research discovered that in one year children viewed over 25 million food and beverage ads on their favourite websites and that over 90% of food and beverage product ads online are for unhealthy foods — mostly processed foods and beverages which are high in fat, sodium, or sugar.

In the same year teens viewed over 2.5 million food and beverage ads on their favourite websites. Like the ads viewed by their younger counterparts, over 90 per cent are for unhealthy foods. The seemingly lower level of marketing for teens in her research is not because they actually see fewer ads, but likely that because teens look at a much larger number of diverse sites than younger children, each site receives a smaller share of the overall teen audience and the research only looked at the top 10 sites for each age group.

Advertising on the Internet is cheap, allowing food and beverage companies to place their ads on a host of sites that appeal to kids. These same companies can also create branded environments on their own websites that encourage user participation. For example, advergames are video games with embedded advertising, and kids can join sites and participate in contests.

The research revealed that the most frequently advertised product categories on children’s favourite websites are restaurants, cakes, cookies, ice cream and cereal. The most frequently advertised food and beverage product categories on teens’ favourite websites are cakes, cookies and ice cream, cereal, restaurants and sugar sweetened beverages.

The most frequently advertised products on children’s favourite websites are:

  • Kellogg’s Pop Tarts
  • Kellogg’s Frosted Flakes
  • McDonald’s Happy Meal
  • Red Bull Energy Drink
  • Kraft Lunchables.

The most frequently advertised food and beverage products on teens’ favourite websites are:

  • Kellogg’s Pop Tarts
  • Kellogg’s Froot Loops
  • Red Bull Energy Drink
  • Kellogg’s Frosted Flakes
  • Tim Hortons’ Roll Up the Rim to Win.

Industry should pick on someone its own age

Marketing works on everyone. It is well documented that before age five, most children cannot distinguish ads from unbiased programming; those under eight do not understand the intent of marketing messages and believe what they see. By age 10 to 12, children understand that ads are designed to sell products, but they are not always able to be critical of these ads.

Teens are also affected — more than might be expected. According to research from the Rudd Centre for Food Policy and Obesity at the University of Connecticut, teens are exposed to more ads than younger kids and they remember them better. They can critique ads when prompted, but on their own are likely to believe misleading claims.

Both young children and adolescents should be protected from food industry tactics. Young kids are particularly impressionable but teens are also susceptible. There are good examples of activities where age is a barrier to participating because a certain maturity is required to make appropriate decisions: driving, voting, and purchasing and consuming alcohol or tobacco.

Legislation means a fair fight for everyone

Legislation is about creating rules that protect society and are applied equally and enforced with meaningful penalties — for instance, seat belt laws and smoke-free legislation. These types of policies that apply to the entire population are also a cost-effective way to improve health outcomes. In particular, restrictions on food and beverage marketing to kids have been shown to be highly cost effective in preventing childhood obesity.

However, for the past 10 years the food and beverage industry has set its own standards and self-regulated its marketing through the Canadian Children’s Food and Beverage Advertising Initiative (CAI). Because the program is not mandatory, not all food and beverage companies participate. Those who do have either committed to advertise only products that meet the CAI’s nutrition criteria to children under 12, or they have committed to not advertise to them at all.

As long as regulation is optional, the playing field is not even. Even if the criteria were strong, companies who comply and put children’s health first would be at a competitive disadvantage, and industry’s priority is to maximize profits.  

Recent Canadian research into industry self-regulation has shown that there has been no reduction in children’s exposure to ads for unhealthy foods. In fact, children’s exposure to food and beverage advertising has actually increased.

The best example is in our own backyard

Far ahead of its time, Quebec banned commercial advertising of all goods and services to children under 13 starting in 1980. The result? A 2011 study concluded that the law is associated with a 13% reduction (compared with Ontario) in the likelihood to purchase fast food and that “the social-welfare impact of such a ban can be significant.” Quebec has the lowest obesity rate in Canada among children ages 6 to 11 and the highest rate of vegetable and fruit consumption — all this despite Quebec children having among the most sedentary lifestyles and existing loopholes and despite exceptions in the law that need to be addressed.

What in the world is going on?

The World Health Organization has called for national and international action to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars or salt. Restrictions should cover all media, including digital, and close any regulatory loopholes. Several countries have restricted food and beverage marketing to children.

In Canada

  • The Quebec Consumer Protection Act was implemented in 1980, banning advertising of all goods and services targeted to children under age 13. Quebec children have the highest vegetable and fruit intake and the lowest obesity rates (among 6 – 11 year-olds) in the country.
  • In his 2015 mandate letter to Health Minister Jane Philpott, Prime Minister Justin Trudeau instructed the minister to act on the government’s election platform commitment to restrict the marketing of unhealthy food and beverages to children.
  • In March 2016, the Senate of Canada’s Standing Committee on Social Affairs, Science and Technology issued a report recommending that the federal government conduct an assessment of the prohibition on advertising food to children in Quebec and design and implement a national prohibition on the advertising of food and beverages to children based on that assessment.
  • In September 2016 Senator Nancy Greene Raine introduced the Child Health Protection Act in the Senate to prohibit the marketing of food and beverages to children under the age of 13 years.
  • The federal government announced a Healthy Eating Strategy in October 2016 including the intention to restrict the commercial marketing of unhealthy food and beverages to kids.

Children should be protected from commercial food and beverage marketing and parents should be supported to teach their children healthy eating habits and food preferences. To make that a reality will take concerted effort from Canadians, governments, schools, communities and organizations.

Stop Marketing to Kids Coalition

The Stop Marketing to Kids (Stop M2K) Coalition was founded by Heart & Stroke in collaboration with the Childhood Obesity Foundation in 2014. The Stop M2K Coalition is made up of 11 non-governmental organizations with written endorsement from dozens of additional organizations and individuals. Our goal: to restrict all food and beverage marketing to children and youth 16 years and under.

The coalition has developed the Ottawa Principles, which outline the policy recommendation of restricting commercial marketing of food and beverages to children and youth 16 and under, with marketing being defined as any means of advertising or promoting products or services. The restrictions would not apply to non-commercial marketing for valid public health education or public awareness campaigns. The Ottawa Principles also include a set of definitions, scope, and principles to guide policy development.

Over 60 organizations and individuals have provided written endorsement of the Stop M2K Coalition’s recommendation to restrict food and beverage marketing to children and youth 16 and younger. For more information including the Ottawa Principles and the list of endorsers visit stopmarketingtokids.ca.

To read the full report visit http://heartandstroke.ca/heartreport. Also available are researcher videos, resources, articles for parents, and an opportunity to sign up to learn more about Heart & Stroke campaigns and take action.