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Marketing of food to children
Professor Knut-Inge Klepp, Acting Deputy Director General
Norwegian Directorate of Health
The 8th Global Conference on Health Promotion, Helsinki, Finland, June 2013
| 2
Children: Dietary habits, health and
marketing of foods
• Diets high in energy, saturated
fat, free sugars, salt and low in
certain nutrients are putting
children at risk of overweight
and obesity and other diet-
related diseases
• The marketing of energy-dense
micronutrient-poor foods and
beverages to children is one
important contributing factor
| 3
Food and beverage marketing to children
is extensive and affects diets
• Evidence from systematic reviews on the extent,
nature and effects of food marketing to children
conclude that advertising is extensive and other
forms of food marketing to children are
widespread across the world
• The food products promoted represent a very
undesirable dietary profile, with heavy emphasis
on energy dense, high fat, high salt and high
sugar foods, and almost no promotion of foods
that public health evidence encourages greater
consumption of
• Such marketing influences children’s knowledge,
attitudes, and food choices
• Evidence also shows that television advertising
influences children’s food preferences, purchase
requests and consumption patterns
Publications WHO – Marketing foods to children
2004-2012
2006
2004
2007
2007
2009
2010
2012
WHO Set of recommendations on marketing of foods
and non-alcoholic beverages to children - 2010
• The recommendations were endorsed by
the World Health Assembly in May 2010
• The main purpose is to guide efforts by
Member States in designing new and/or
strengthening existing policies on food
marketing communications to children in
order to reduce the impact marketing of
foods with a high content of fat, sugar or
salt has on children.
• Consists of 12 recommendations
structured in 5 sections: Rational, policy
development, policy implementation,
policy monitoring and evaluation, and
research
WHO European Network on reducing
marketing pressure on children
Goal: To protect children’s health through
sharing experiences and best practices in
order to identify and implement specific
actions to reduce the extent and impact of
all marketing to children of unhealthy
foods and beverages
The network was established in 2008 in Oslo,
and it involve a diverse set of countries in
the WHO European Region:
Albania, Austria, Belgium, Bulgaria, Croatia,
Cyprus, Denmark, Estonia, Finland, France,
Greece, Latvia, Ireland, Israel, Macedonia,
Moldova, Montenegro, the Netherlands,
Norway, Poland, Portugal, Serbia, Slovenia,
Spain, Sweden, Switzerland, the United
Kingdom, Turkey and Uzbekistan
+ Observers such as WHO, EU, FAO, SCN, CI, IOTF
Applying the WHO set of recommendations
in Norway
2011
•MOH & ministry for consumer
affairs established a working
group to explore whether the
WHO recommendations were
met by current Norwegian law
and practice
2012
•Public consultation on a
proposal for new statutory
regulation, restricting
marketing to children under the
age of 18 years
2013
•Revised proposal for statutory
regulation submitted for public
consultation
•The food industry was invited to
submit a proposal for self-regulation
(that would be sufficiently effective)
•The Government decided last week to
test the voluntary industry code for a
two year period
•Future implementation of any
statutory regulation depends on the
evaluation of this self-regulation
| 7
Countries with restrictions on food
marketing to children
C Hawkes, WCRF, May 2013
Statutory - food
•South Korea
•Ireland
•United Kingdom
•(France = messaging)
Self-regulation
“approved” by
government
•Australia
•Canada
•Denmark
•EU
•Norway
•Portugal
•Spain
•USA
Statutory - children

Sweden

Quebec, Canada
Independent
voluntary pledges

Brazil

EU

India

Mexico

Peru

Philippines

Russia

Singapore

South Africa

Switzerland

Thailand

Turkey
• Peer-reviewed research papers show high levels of exposure
continue to be found in several countries worldwide
• The evidence provided in industry-sponsored reports indicates a
remarkably high adherence to voluntary codes
• Adherence to voluntary codes may not sufficiently reduce the
advertising of foods which undermine healthy diets, or reduce
children’s exposure to this advertising
Galbraith-Emami S, Lobstein T: Obesity Reviews, In press
Is self-regulation working?
A systematic review of children’s exposure to
marketing of foods and beverages 2008-2012
| 10
Conclusions and implications
The growth of marketing activities in emerging economies and
developing countries is of special concern and demonstrate the
global relevance of this issue
International action is essential to ensure an effective overall
approach
There is more convincing evidence to support restrictions on food
marketing relative to many other policies
Implementation of statutory action, government overseen self-
regulation and voluntary pledges are workable and enforceable
Restrictions have an effect, but are undermined
by migration to other channels
Consistent monitoring and nutrient profiling is
crucial

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Knut-Inge Klepp, Directorate of Health, Norway

  • 1. Marketing of food to children Professor Knut-Inge Klepp, Acting Deputy Director General Norwegian Directorate of Health The 8th Global Conference on Health Promotion, Helsinki, Finland, June 2013
  • 2. | 2 Children: Dietary habits, health and marketing of foods • Diets high in energy, saturated fat, free sugars, salt and low in certain nutrients are putting children at risk of overweight and obesity and other diet- related diseases • The marketing of energy-dense micronutrient-poor foods and beverages to children is one important contributing factor
  • 3. | 3 Food and beverage marketing to children is extensive and affects diets • Evidence from systematic reviews on the extent, nature and effects of food marketing to children conclude that advertising is extensive and other forms of food marketing to children are widespread across the world • The food products promoted represent a very undesirable dietary profile, with heavy emphasis on energy dense, high fat, high salt and high sugar foods, and almost no promotion of foods that public health evidence encourages greater consumption of • Such marketing influences children’s knowledge, attitudes, and food choices • Evidence also shows that television advertising influences children’s food preferences, purchase requests and consumption patterns
  • 4. Publications WHO – Marketing foods to children 2004-2012 2006 2004 2007 2007 2009 2010 2012
  • 5. WHO Set of recommendations on marketing of foods and non-alcoholic beverages to children - 2010 • The recommendations were endorsed by the World Health Assembly in May 2010 • The main purpose is to guide efforts by Member States in designing new and/or strengthening existing policies on food marketing communications to children in order to reduce the impact marketing of foods with a high content of fat, sugar or salt has on children. • Consists of 12 recommendations structured in 5 sections: Rational, policy development, policy implementation, policy monitoring and evaluation, and research
  • 6. WHO European Network on reducing marketing pressure on children Goal: To protect children’s health through sharing experiences and best practices in order to identify and implement specific actions to reduce the extent and impact of all marketing to children of unhealthy foods and beverages The network was established in 2008 in Oslo, and it involve a diverse set of countries in the WHO European Region: Albania, Austria, Belgium, Bulgaria, Croatia, Cyprus, Denmark, Estonia, Finland, France, Greece, Latvia, Ireland, Israel, Macedonia, Moldova, Montenegro, the Netherlands, Norway, Poland, Portugal, Serbia, Slovenia, Spain, Sweden, Switzerland, the United Kingdom, Turkey and Uzbekistan + Observers such as WHO, EU, FAO, SCN, CI, IOTF
  • 7. Applying the WHO set of recommendations in Norway 2011 •MOH & ministry for consumer affairs established a working group to explore whether the WHO recommendations were met by current Norwegian law and practice 2012 •Public consultation on a proposal for new statutory regulation, restricting marketing to children under the age of 18 years 2013 •Revised proposal for statutory regulation submitted for public consultation •The food industry was invited to submit a proposal for self-regulation (that would be sufficiently effective) •The Government decided last week to test the voluntary industry code for a two year period •Future implementation of any statutory regulation depends on the evaluation of this self-regulation | 7
  • 8. Countries with restrictions on food marketing to children C Hawkes, WCRF, May 2013 Statutory - food •South Korea •Ireland •United Kingdom •(France = messaging) Self-regulation “approved” by government •Australia •Canada •Denmark •EU •Norway •Portugal •Spain •USA Statutory - children  Sweden  Quebec, Canada Independent voluntary pledges  Brazil  EU  India  Mexico  Peru  Philippines  Russia  Singapore  South Africa  Switzerland  Thailand  Turkey
  • 9. • Peer-reviewed research papers show high levels of exposure continue to be found in several countries worldwide • The evidence provided in industry-sponsored reports indicates a remarkably high adherence to voluntary codes • Adherence to voluntary codes may not sufficiently reduce the advertising of foods which undermine healthy diets, or reduce children’s exposure to this advertising Galbraith-Emami S, Lobstein T: Obesity Reviews, In press Is self-regulation working? A systematic review of children’s exposure to marketing of foods and beverages 2008-2012
  • 10. | 10 Conclusions and implications The growth of marketing activities in emerging economies and developing countries is of special concern and demonstrate the global relevance of this issue International action is essential to ensure an effective overall approach There is more convincing evidence to support restrictions on food marketing relative to many other policies Implementation of statutory action, government overseen self- regulation and voluntary pledges are workable and enforceable Restrictions have an effect, but are undermined by migration to other channels Consistent monitoring and nutrient profiling is crucial

Editor's Notes

  1. Referanse: Marketing of food and non-alcoholic beverages to children. Report of a WHO Forum and Technical Meeting, Oslo, 2-5 May 2006: We know that diets high in energy, saturated fat, free sugars, salt and low in certain nutrients are putting children at risk of overweight and obesity and other diet-related diseases which are increasing public health problems worldwide The marketing of energy-dense micronutrient-poor foods and beverages to children has been identified as one of the many factors contributing to this in a series of expert consultations
  2. From WHO Set of recommendations, page 10: ” Evidence from systematic reviews on the extent, nature and effects of food marketing to children conclude that advertising is extensive and other forms of food marketing to children are widespread across the world (Ref: Hastings 2003, IOM, 2006 og Cairns G, Angus K, and Hastings G, 2009) Most of this marketing is for foods with a high content of fat, sugar or salt. Evidence also shows that television advertising influences children’s food preferences, purchase requests and consumption patterns”. Referanse: Marketing of food and non-alcoholic beverages to children. Report of a WHO Forum and Technical Meeting, Oslo, 2-5 May 2006 Scientific evidence shows that food and beverage marketing to children is extensive Most of this promotion is for products that are high in saturated fat, free sugars and low in micronutrients and fibre Such marketing influences children’s food choice The participants in the Technical meeting in Oslo in May 2006 concluded that there is a robust evidence base to support the fact that exposure to the commercial promotion of energy-dense, micronutrient-poor foods and beverages adversely affects children’s diets, and that a large body of literature supports this view, as summarized in the background paper by Hastings et al (2006) as well as the 2006 report of the Institute of Medicine in the United States. Fra Cairns, et al, 2009: The evidence reviewed confirms that the food products promoted continue to represent a very undesirable dietary profile, with heavy emphasis on energy dense, high fat, high salt and high sugar foods, and almost no promotion of foods that public health evidence encourages greater consumption of – for example fruit and vegetables.
  3. www.who.int/dietphysicalactivity/marketing/en
  4. The World Health Organisation (WHO) has developed a set of recommendations on marketing of foods and non-alcoholic beverages to children. The set of recommendations are one of the measures of the Non-Communicable Disease strategy which aims to counteract the obesity epidemic. The set of recommendations were presented to the World Health Assembly (WHA) in May 2010 RECOMMENDATION 1. The policy aim should be to reduce the impact on children of marketing of foods high in saturated fats, trans -fatty acids, free sugars, or salt. RECOMMENDATION 2. Given that the effectiveness of marketing is a function of exposure and power, the overall policy objective should be to reduce both the exposure of children to, and power of, marketing of foods high in saturated fats, trans -fatty acids, free sugars, or salt. RECOMMENDATION 3. To achieve the policy aim and objective, Member States should consider different approaches, i.e. stepwise or comprehensive, to reduce marketing of foods high in saturated fats, trans -fatty acids, free sugars, or salt, to children. RECOMMENDATION 4. Governments should set clear definitions for the key components of the policy, thereby allowing for a standard implementation process. The setting of clear definitions would facilitate uniform implementation, irrespective of the implementing body. When setting the key definitions Member States need to identify and address any specific national challenges so as to derive the maximal impact of the policy. RECOMMENDATION 5. Settings where children gather should be free from all forms of marketing of foods high in saturated fats, trans -fatty acids, free sugars, or salt. Such settings include, but are not limited to, nurseries, schools, school grounds and pre-school centres, playgrounds, family and child clinics and paediatric services and during any sporting and cultural activities that are held on these premises. RECOMMENDATION 6. Governments should be the key stakeholders in the development of policy and provide leadership, through a multi-stakeholder platform, for implementation, monitoring and evaluation. In setting the national policy framework, governments may choose to allocate defined roles to other stakeholders, while protecting the public interest and avoiding conflict of interest. RECOMMENDATION 7. Considering resources, benefits and burdens of all stakeholders involved, Member States should consider the most effective approach to reduce marketing to children of foods high in saturated fats, trans -fatty acids, free sugars, or salt. Any approach selected should be set within a framework developed to achieve the policy objective. RECOMMENDATION 8. Member States should cooperate to put in place the means necessary to reduce the impact of cross-border marketing (in-flowing and out-flowing) of foods high in saturated fats, trans -fatty acids, free sugars, or salt to children in order to achieve the highest possible impact of any national policy. RECOMMENDATION 9. The policy framework should specify enforcement mechanisms and establish systems for their implementation. In this respect, the framework should include clear definitions of sanctions and could include a system for reporting complaints. RECOMMENDATION 10. All policy frameworks should include a monitoring system to ensure compliance with the objectives set out in the national policy, using clearly defined indicators. RECOMMENDATION 11. The policy frameworks should also include a system to evaluate the impact and effectiveness of the policy on the overall aim, using clearly defined indicators. RECOMMENDATION 12. Member States are encouraged to identify existing information on the extent, nature and effects of food marketing to children in their country. They are also encouraged to support further research in this area, especially research focused on implementation and evaluation of policies to reduce the impact on children of marketing of foods high in saturated fats, trans -fatty acids, free sugars, or salt.
  5. The action network on marketing is a follow-up to the Resolution on the Prevention and Control of Noncommunicable Diseases (WHA 60.23) and the Second WHO European Action Plan for Food and Nutrition Policy. The network was established in close cooperation with the WHO Regional Office for Europe. The network was established January 2008 as a response to several calls for actions to reduce the marketing pressure on children of foods and non-alcoholic beverages The network was established during its first meeting in Oslo in January 2008. Network leader Knut-Inge Klepp, Director General of Division, Public Health, Norwegian Directorate of Health. Norwegian Directorate of Health is the network secretariat The WHO Regional Office for Europe facilitated setting up the network. 2 working groups were established during the first meeting in Oslo, one worked on the Content of regulations, such as regulatory approaches, marketing methods and channels and age limits etc and the other group worked on different ways of monitoring marketing regulation, exposure, content etc. The network has made a Network Code, and sweep protocols under development. Today the network currently consists of over 20 countries in the WHO European Region. In addition, there are observers from World Health Organization (WHO), Consumers International (CI), International Association for the Study of Obesity, International Obesity TaskForce (IASO – IOTF). New time frame decided on the last network meeting in May: 2013-2015.
  6. Working group jointly headed by the Ministry of Health and Care Services and The Ministry of Children, Equality and Social Inclusion – established in 2011 The working group consisted of representatives from the MoH, the Ministry of Children, Equality and Social Inclusion, the Norwegian Food Safety authority, Consumer Ombudsman and the Norwegian Directorate of Health
  7. Dr. Corinna Hawkes’ presentation at the WHO European Network meeting in Ankara, Turkey, May 2013: Key lessons from Dr. Hawkes’s presentation: There is more convincing evidence to support restrictions on food marketing relative to many other policies Implementation of statutory, government-oversight of self-regulation & voluntary pledges is workable &enforceable Restrictions have an effect – but are undermined by migration to other channels, so it is impossible to say what effect they are having on the objective of reducing total exposure of children to unhealthy food marketing Comprehensive approach is needed – but worth trying step-by-step restrictions if only political option Monitoring using consistent indicators is crucial