By Susan Blumenthal, M.D. and Oliver Tang
Obesity is an unrelenting public health problem in the United States today: over 68% of American adults are overweight or obese. A recent study published in the Journal of the American Medical Association found that the prevalence of obesity was 37.7% among adults and 17% among children and adolescents. Food marketing of unhealthy products to the public has been identified as a significant factor fueling this public health epidemic, especially among children. A recent study, Popular Music Endorsements in Food and Nonalcoholic Beverage Marketing, published in the scientific journal Pediatrics, reveals concerning trends in food advertisements using celebrities. The findings from this research have important implications for addressing childhood obesity and food insecurity in America. Using an American advertising industry database to examine all celebrity food product endorsements between 2000 and 2014, the authors identified 65 music celebrities who endorsed 57 food or beverage products manufactured by 38 companies. The study employed the United Kingdom’s Nutrition Profile Model — a database commonly used for evaluating marketing to children — to quantify the nutritional value of products. Alarmingly, the celebrity food and drink endorsements were overwhelmingly for unhealthy products: 81% of endorsed foods were nutrient poor and 71% of endorsed beverages were sugar-sweetened. Not one of the celebrities endorsed fruits or vegetables and only a single celebrity endorsed a food product, a pistachio snack, which had received a healthy score. When the researchers analyzed YouTube commercials for foods and beverages, ads endorsing a specific soft drink brand comprised 160 million of the 312 million views.
Eric Schlosser, the author of Fast Food Nation: The Dark Side of an American Meal, explains the power of food marketing that targets children: “People form their eating habits as children so [companies] try to nurture clients as youngsters.” As the study notes, marketing through music celebrities is especially effective at influencing children because kids are large consumers of music. For example, a study published in the Journal of Child Health Care found that 54% of fast food advertisements and 34% of all food advertisements used “emotional appeals of social enhancement and peer acceptance.” The study points out how this approach appeals to children, especially adolescents, who can be “highly impulsive with their purchases.” The American Psychological Association also reports that young children often do not understand the persuasive intent of advertising and can’t distinguish advertising from programming, making it easy for ads to influence their purchase requests and subsequently their parents’ purchasing decisions. These factors collectively help explain why food marketers view music celebrities as the best messengers and children as the best audience for their products’ ads.
The Pediatrics study is not alone in describing the impact of food marketing. A 2005 review published in the Journal of the American Dietetic Association found that 90% of food ads aired during Saturday morning children’s TV programming were for unhealthy and low-nutritional foods. A 2010 study by researchers at the University of Pennsylvania found that the amount of fast food advertising steadily increased across all age groups of children from 2003 to 2007 and is now the most frequently seen type of food ad. A 2009 Yale study entitled Priming Effects of Television Food Advertising on Eating Behavior describes the impact: children consumed 45% more food when exposed to food advertising. Another study from the same year published in the International Journal of Behavioral Nutrition and Physical Activity alarmingly found that exposure to unhealthy food ads was a strong predictor for “a lower intake of fruits, vegetables, whole grain and calcium-rich foods, and a higher intake of trans-fat, fried foods, fast food menu items, snack products, and sugar-sweetened beverages” as long as five years after the child viewed the ad.
The good news is that there are ways to rectify this situation and strategies to promote healthy nutritional habits. The authors of the Pediatrics study explain that while most foods and beverages endorsed by music celebrities are for unhealthy products such as fast foods and sugar-sweetened beverages, the companies also manufacture healthier alternative food products. The researchers hope as a result of their study that the celebrity community resolves to use their powerful voices and leverage “their influence to promote more healthful messages and encourage consumption of healthy foods.” Corporate pledges to self-regulate televised food advertising have helped in the past, but the Pediatrics study recommends that these voluntary corporate pledges go much further, arguing that many companies’ promises to reduce food marketing to children under the age of twelve is minimal compared to the federal regulations that were placed on the tobacco industry prohibiting marketing to young people under the age of eighteen. The University of Pennsylvania study also revealed that other business practices such as each company creating its own standards for advertising limits the effectiveness of corporate pledges. Opportunities for improvement are possible, but current food marketing practices including the use of celebrities to promote unhealthy products continues to create an environment that promotes poor nutritional choices among youth.
However, just as marketing strategies are being used to promote unhealthy food and nutritional choices, advertising also has great potential to encourage healthy nutritional choices. First Lady Michelle Obama discusses this in a recent editorial, Marketing Can Make America Healthier, posted in Adweek magazine. Mrs. Obama discusses the success of marketing initiatives targeting millennials such as the Partnership for America’s FNV (fruits and vegetables) educational campaign. While many music celebrities may endorse unhealthy foods, she writes that there are also celebrities such as Steph Curry, the first unanimous National Basketball Association Most Valuable Player, who have “chosen fruits, vegetables, and water as [their] primary product endorsements.” Nevertheless, healthy options still face a number of obstacles when it comes to marketing: less than 1% of the $2 billion spent annually marketing food to Americans is spent on fruits and vegetables. The solution must be smarter and more effective marketing of healthy products. The First Lady gives the example of how MyPlate, an easier-to-understand guide to illustrate healthy food choices for Americans, replaced the food pyramid. The Let’s Move! initiative established by the First Lady works with a wide range of organizations to encourage physical activity: for example, the campaign has partnered with Team USA to coordinate athletic programming for 1.7 million children, with the Department of Defense (DOD) to provide $4.65 million in food sent to military troops and their families, and with 157 hospitals to improve the nutritional quality of food served in these facilities.
The Let’s Move! initiative illustrates the importance of engaging in marketing campaigns using public-private partnerships to improve the health of youth nationwide. However, this is not the only way policymakers and the government can harness food marketing as a force for good. Large-scale change could be achieved with public health marketing programs incorporated into one of America’s largest government program, the Supplemental Nutrition Assistance Program (SNAP) that serves 45 million people, 70% of whom are families with children. This is a program where healthy food marketing messages could make an important difference, especially because it serves America’s most vulnerable and food-insecure, populations who are at risk for obesity. SNAP (formerly known as the Food Stamp Program) is the nation’s largest anti-hunger program: in 2015, SNAP spent more than $74 billion to provide food benefits for 1 out of 7 Americans. SNAP’s mission is to reduce hunger and food insecurity, and includes an initiative to educate participants about healthy nutrition. Just like Let’s Move!, SNAP needs now to incorporate fresh approaches to encourage healthy food choices. A report directed by Susan Blumenthal, M.D., Snap to Health: A Fresh Approach to Improving Nutrition in the Supplemental Nutrition Assistance Program, emphasizes that a social-ecological approach to strengthen nutrition in this program, one that combines “environmental, policy, and systems changes as well as education and social marketing,” could help fight obesity among low-income Americans participating in SNAP. This approach has produced some positive effects in Philadelphia, Pennsylvania; Somerville, Massachusetts; and cities within California. Such programs are implemented through SNAP-Education (SNAP-Ed), established in 1981 as a state option. Amidst growing national concern about poor nutrition in America, all 50 states adopted SNAP-Ed by 2004. SNAP-Ed is a program that engages in its own form of food marketing, promoting healthy food choices through nutritional messages, especially for families with children. SNAP-Ed does have success stories: some states have used SNAP-Ed to create “large-scale social marketing campaigns.” However, as the SNAP to Health report importantly qualifies, the program as a whole still faces critical hurdles and there are many opportunities for improvement.
First, the paradigm for SNAP must change from not only ensuring food security of low income Americans, but also placing a real emphasis on health and nutrition. A major step forward would be increasing funding for the SNAP-Ed program. While SNAP-Ed is the main source for nutrition education in this Federal food assistance program, it received less than 0.5% of the program’s funding in 2012. Increased resources for SNAP-Ed would allow states to strengthen their education and public health marketing initiatives. With current spending for food marketing by companies heavily skewed against healthy food choices, every dollar matters in mitigating the impact of marketing that promotes consumption of unhealthy food and beverage products.
Second, policy restrictions on what can be included in SNAP-Ed’s educational messages limit the program’s effectiveness at promoting healthy nutritional choices. For example, while offering discounts on healthy foods could help families to make healthier nutritional choices, the 2012 SNAP-Ed Plan Guidance report prohibited using literature to “influence a store’s pricing policy.” SNAP-Ed programs were also prohibited from using “nutrition education messages which convey negative messages” or discourage specific food/beverage products, even if such products were unhealthy. The latest 2016 SNAP-Ed Guidance report has begun to rectify some of these limitations: it supports the promotion of nutritional messages aligned with the U.S. Department of Agriculture’s (USDA) MyPlate guidance. However, these recommendations are currently just “allowable activities” and need extend beyond guidance into providing strategies for incentivizing healthy food choices and marketing practices. Furthermore, more tangible actions, such as the ability to influence store-pricing policies to make healthy foods more affordable to low-income families, must be allowed to ensure that nutritional education has the maximum potential to beneficially influence healthy nutritional choices.
Third, the SNAP to Health report recommends that SNAP-Ed could engage in more extensive partnerships with community stakeholders, such as farmers’ markets, childcare programs, and wellness initiatives. A positive development has been the U.S. Department of Agriculture (USDA) recently publishing the Healthy Corner Stores Guide providing guidance on how these markets that often sell nutritionally poor foods could increase the availability of healthy products. This change could have a powerful positive effect in low-income neighborhoods.
Fourth, SNAP would benefit from data collection about what products are being purchased with program benefits. The SNAP to Health Report underscores that a major benefit of data collection about purchases is the ability to “evaluate the impact of system improvements, including nutrition education and marketing.” Because SNAP distributes benefits to families through an Electronic Benefit Transfer (EBT) card, technological innovations could potentially be leveraged to improve data collection in the program by transforming this debit card into a “smart” card that not only collects aggregate information on product purchases but provides nutritional feedback to program participants. This fresh approach could help compare the effectiveness of interventions such as SNAP-Ed on improving nutrition for program participants. A collaborative project is currently underway between New America, MIT and the Harvard School of Public Health to develop a smart EBT card for use in the Women, Infant and Children’s Federal Nutrition Program (WIC) to do just this and someday if proven effective, this technology innovation might be incorporated into the SNAP program as well.
In summary, obesity and food insecurity are two co-existing problems that are taking a tremendous toll on the health of Americans. Individual-level behavioral changes related to nutrition are difficult to achieve, in part, because of the presence of an unhealthy food environment and other societal factors. It is troubling today that food and beverage marketing by companies is playing such a powerful role in driving poor nutritional choices among children and adults, but it is also heartening to know that smart public health marketing strategies could be employed to promote healthier food choices for Americans in the future. Innovative approaches mobilizing the skills, ingenuity, and resources of the public and private sectors to achieve this goal are needed now!
Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of The Huffington Post. She is a Senior Fellow in Health Policy at New America and a Clinical Professor at Tufts and Georgetown University Schools of Medicine. Dr. Blumenthal served for more than 20 years in senior health leadership positions in the federal government in the Administrations of four U.S. presidents including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women’s Health, and as Senior Global Health Advisor in the U.S. Department of Health and Human Services. She also served as a White House advisor on health. Prior to these positions, Dr. Blumenthal was Chief of the Behavioral Medicine and Basic Prevention Research Branch, Head of the Suicide Research Unit, and Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health. She has chaired many national and global commissions and conferences and is the author of many scientific publications. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal was named the Health Leader of the Year by the Commissioned Officers Association and as a Rock Star of Science by the Geoffrey Beene Foundation.
Oliver Tang is a Health Policy Intern at New America in Washington D.C. He is a rising sophomore at Brown University where he plans to major in Neuroscience and attend medical school in the future.
An earlier version of this article was published on the SNAP to Health website on June 10, 2016.