A holistic food labelling strategy for preventing obesity and dental caries

Obesity and dental caries in childhood are among the major public health concerns described as a global pandemic because of their global distribution and severe consequences. A consensus has developed as to a recently emerging and alarming common risk factor that leads to the double burden of dental caries and obesity; energy-dense foods (sugar-coated cereals, high-sugar yogurt, soft drinks) are becoming very popular among children because of their dense marketing, cheaper price, increased supply and variety. Implementation of health-promoting and -supporting marketing strategies for healthy food can be one initial cornerstone for successful application of the common risk factor approach in prevention of obesity and dental caries, as also suggested by World Health Organization. Labelling healthy food with a 'health-friendly' logo, illustrating that the teeth and the heart are both parts of the whole body (standing side by side supporting each other as close friends), both happy and protected because of consumption of healthy food for the whole body, can promote the foods that are friendly to health of the whole body, implementing the common risk factor approach under a single theme. Labelling healthy food as 'health-friendly' based on an international consensus will provide a clear and uniform picture of what is healthy to eat and result in an international integrated programme for prevention of obesity and caries.     

A systematic review of persuasive marketing techniques to promote food to children on television

The ubiquitous marketing of energy‐dense, nutrient‐poor food and beverages is a key modifiable influence on childhood dietary patterns and obesity. Much of the research on television food advertising is focused on identifying and quantifying unhealthy food marketing with comparatively few studies examining persuasive marketing techniques to promote unhealthy food to children. This review identifies the most frequently documented persuasive marketing techniques to promote food to children via television. A systematic search of eight online databases using key search terms identified 267 unique articles. Thirty‐eight articles met the inclusion criteria. A narrative synthesis of the reviewed studies revealed the most commonly reported persuasive techniques used on television to promote food to children. These were the use of premium offers, promotional characters, nutrition and health‐related claims, the theme of taste, and the emotional appeal of fun. Identifying and documenting these commonly reported persuasive marketing techniques to promote food to children on television is critical for the monitoring and evaluation of advertising codes and industry pledges and the development of further regulation in this area. This has a strong potential to curbing the international obesity epidemic besieging children throughout the world.     

Influence of food companies' brand mascots and entertainment companies' cartoon media characters on children's diet and health: a systematic review and research needs

Reducing the extent and persuasive power of marketing unhealthy foods to children worldwide are important obesity prevention goals. Research is limited to understand how brand mascots and cartoon media characters influence children's diet. We conducted a systematic review of five electronic databases (2000–2014) to identify experimental studies that measured how food companies' mascots and entertainment companies' media characters influence up to 12 diet‐related cognitive, behavioural and health outcomes for children under 12 years. Eleven studies met the inclusion criteria. Studies used 21 unique popular media characters, but no brand mascots. Results suggest that cartoon media character branding can positively increase children's fruit or vegetable intake compared with no character branding. However, familiar media character branding is a more powerful influence on children's food preferences, choices and intake, especially for energy‐dense and nutrient‐poor foods (e.g. cookies, candy or chocolate) compared with fruits or vegetables. Future research should use a theoretically grounded conceptual model and larger and more diverse samples across settings to produce stronger findings for mediating and moderating factors. Future research can be used to inform the deliberations of policymakers, practitioners and advocates regarding how media character marketing should be used to support healthy food environments for children.     

Prevention of obesity: the role of the food industry

The food industry is a critical factor in any potentially successful long-term strategy to prevent obesity. By producing new products low in energy density and improving the nutritional quality (and reducing the energy content) of existing products, as well as through advances in responsible marketing and labeling, the food industry can provide foods that enable consumers to achieve lower energy intakes without going short of essential nutrients. The food industry is not the sole factor and government policies regarding agriculture, prices and subsidies are equally essential. Caterers and retailers are yet another important cog in the wheel for progress in obesity prevention. Intensive collaboration between all these players will only be attained if obesity prevention is given the priority it deserves in future public health planning.     

Preventive strategies against weight gain and obesity

A well‐resourced, comprehensive, population‐based set of strategiesis needed to attenuate and eventually reverse the current trendsof increasing obesity prevalence now apparent in most countries.The Epidemiological Triad (host, vector, environment) has provento be a robust model for other epidemics and is applied to obesity. Host‐based strategies are primarily educational and these tend to bemost effective among people with higher incomes and higher educational attainment.The main vectors for a high‐energy intake are energy‐dense foodsand drinks and large portion sizes and, for low energy expenditure,machines that promote physical inactivity. Vector‐based strategiesthat alter food formulation can have a significant impact, particularlythrough influencing common, high‐volume foods. The increasingly ‘obesogenic’ environmentsare probably the main driving forces for the obesity epidemic. Thereare many environmental strategies that can influence the physical,economic, policy or socio‐cultural environments, but the evidencebase for these potentially powerful interventions is small. ­Childrenshould be the priority population for interventions, and improvingthe general socio‐economic conditions for disadvantaged, marginalizedor poor population sectors is also a central strategy for obesityprevention. The key settings for interventions are schools, homes,neighbourhoods, primary health care services and communities. Thekey macroenvironments for interventions are the transport and infrastructuresector, the media and the food sector.     

Childhood obesity: are we missing the big picture?

Childhood obesity is increasing worldwide, raising alarm about future trends of cardiovascular disease, diabetes and cancer. This article discusses what may underlie our failure to respond effectively to the obesity epidemic, and presents a wider perspective for future research and public health agendas. So far targeting individual-level determinants and clinical aspects of childhood obesity has produced limited success. There is growing interest in understanding the wider determinants of obesity such as the built environment (e.g. walkability), social interactions, food marketing and prices, but much needs to be learned. Particularly, we need to identify distal modifiable factors with multiple potential that would make them attractive for people and policymakers alike. For example, walking-biking-friendly cities can reduce obesity as well as energy consumption, air pollution and traffic delays. Such agenda needs to be driven by strong evidence from research involving multi-level influences on behaviour, as well as the study of wider politico-economic trends affecting people's choices. This article highlights available evidence and arguments for research and policy needed to curb the obesity epidemic. The upstream approach underlying these arguments aims to make healthy choices not only the most rational, but also the most feasible and affordable.     

Obesity prevention at the point of purchase

The point of purchase is when people may make poor and impulsive decisions about what and how much to buy and consume. Because point of purchase strategies frequently work through non‐cognitive processes, people are often unable to recognize and resist them. Because people lack insight into how marketing practices interfere with their ability to routinely eat healthy, balanced diets, public health entities should protect consumers from potentially harmful point of purchase strategies. We describe four point of purchase policy options including standardized portion sizes; standards for meals that are sold as a bundle, e.g. ‘combo meals’; placement and marketing restrictions on highly processed low‐nutrient foods; and explicit warning labels. Adoption of such policies could contribute significantly to the prevention of obesity and diet‐related chronic diseases. We also discuss how the policies could be implemented, along with who might favour or oppose them. Many of the policies can be implemented locally, while preserving consumer choice. © 2016 World Obesity     

Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness

The obesity epidemic is spreading to low-income and middle-income countries as a result of new dietary habits and sedentary ways of life, fuelling chronic diseases and premature mortality. In this report we present an assessment of public health strategies designed to tackle behavioural risk factors for chronic diseases that are closely linked with obesity, including aspects of diet and physical inactivity, in Brazil, China, India, Mexico, Russia, and South Africa. England was included for comparative purposes. Several population-based prevention policies can be expected to generate substantial health gains while entirely or largely paying for themselves through future reductions of health-care expenditures. These strategies include health information and communication strategies that improve population awareness about the benefits of healthy eating and physical activity; fiscal measures that increase the price of unhealthy food content or reduce the cost of healthy foods rich in fibre; and regulatory measures that improve nutritional information or restrict the marketing of unhealthy foods to children. A package of measures for the prevention of chronic diseases would deliver substantial health gains, with a very favourable cost-effectiveness profile.     

Can food be addictive? Public health and policy implications

Aims Data suggest that hyperpalatable foods may be capable of triggering an addictive process. Although the addictive potential of foods continues to be debated, important lessons learned in reducing the health and economic consequences of drug addiction may be especially useful in combating food‐related problems. Methods In the current paper, we review the potential application of policy and public health approaches that have been effective in reducing the impact of addictive substances to food‐related problems. Results Corporate responsibility, public health approaches, environmental change and global efforts all warrant strong consideration in reducing obesity and diet‐related disease. Conclusions Although there exist important differences between foods and addictive drugs, ignoring analogous neural and behavioral effects of foods and drugs of abuse may result in increased food‐related disease and associated social and economic burdens. Public health interventions that have been effective in reducing the impact of addictive drugs may have a role in targeting obesity and related diseases.     

A review of the nutritional value of legumes and their effects on obesity and its related co‐morbidities

Since the 1970s, the proportion of overweight and obese people in the United States has grown at an alarming rate. An awareness of the consequences of obesity on the health and well‐being of individuals is evident in the plethora of strategic plans at the local and national levels, most of which have largely fallen short of their goals. If interventions continue to be unsuccessful, it is estimated that approximately three of four Americans will be overweight or obese by 2020. Prevention of excess weight gain can be accomplished with relatively small changes in lifestyle behaviours to control body weight. Small sustainable changes are perhaps better than efforts to achieve larger changes that cannot be sustained. Legumes can be a valuable food by which the needs of the undernourished or under‐served populations could be met. They can be incorporated into meat products, such as sausages and burgers, to lower the energy density of these foods while providing important nutrients. Replacing energy‐dense foods with legumes has been shown to have beneficial effects on the prevention and management of obesity and related disorders, such as cardiovascular disease, diabetes and the metabolic syndrome. This review explores the nutritional value and obesity‐related health benefits of legume consumption while focusing on pulses.     

Symposium report: the prevention of obesity and NCDs: challenges and opportunities for governments

This paper is written as a briefing document with the aim of providing support to policy‐makers and government officials tackling obesity and related non‐communicable diseases. It is based on a symposium Obesity and non‐communicable diseases: Learning from international experiences ¹ convened by the International Association for the Study of Obesity (now the World Obesity Federation) and its policy section, the International Obesity TaskForce (now World Obesity – Policy and Prevention). The symposium discussed a wide range of proposals to tackle the consumption of unhealthy food products, including interventions in the market through fiscal policies and marketing restrictions, measures to strengthen public health legislation and measures to limit agri‐food company lobbying activities. It recognized the need for government leadership and action in order to reduce preventable deaths while improving economic performance and identified a need for governments to take a systems wide approach to tackling obesity and to work with civil society, especially to monitor the drivers of disease and to hold all stakeholders accountable for progress.     

Effects of socioeconomic status on the obesity knowledge of adolescents from six Latin American cities

OBJECTIVE: To examine the effects of socioeconomic status (SES) on the obesity knowledge of adolescents in six Latin American cities. DESIGN: Data were collected using an anonymous, self-administered questionnaire consisting of demographic questions and a 25-item multiple-choice obesity knowledge test. Test items were clustered under five topics: the fat and calorie content of foods and beverages; weight loss methods; energy expenditure; food preparation methods; and the relationship between obesity and health. SUBJECTS: A total of 1272 ninth grade students from higher and lower SES families were recruited at schools in Buenos Aires, Argentina (n=195); Guatemala City, Guatemala (n=212); Havana, Cuba (n=213); Lima, Peru (n=218); Panama City, Panama (n=195); and Santiago, Chile (n=239). RESULTS: Mean test scores reflected a low level of obesity knowledge among adolescents from higher and lower SES groups in all six cities. Nevertheless, a trend for higher scores emerged in favor of adolescents from wealthier families. This income effect persisted after controlling for gender and weight status. The weakest knowledge areas among youth from the higher SES groups were food preparation methods and the relationship between obesity and health while those for adolescents from the lower SES groups were the fat and calorie content of foods and beverages and the relationship between obesity and health. Classroom instruction about obesity was generally more available to students from the higher SES groups. The majority of adolescents from both SES groups were interested in learning more about weight loss methods, energy expenditure, and the fat and calorie content of foods and beverages. The topic of least interest was the relationship between obesity and health. CONCLUSION: These preliminary findings suggest a need for more obesity education programs for adolescents, especially for those living in poverty.     

A scoping review on economic globalization in relation to the obesity epidemic

This study reviewed evidence linking economic globalization to the obesity epidemic. Keyword/reference search was performed in PubMed, Web of Science, Cochrane Library, Scopus, EconLit, Google Scholar, and BMC Globalization and Health. A total of 16 studies were identified, in which six adopted a cross‐sectional study design, nine adopted a longitudinal study design, and the remaining one adopted a case‐control study design. Thirteen studies assessed the relationship between economic globalization and obesity at the country level, whereas the remaining three analyzed individual‐level data. Fourteen studies found at least one aspect and/or measure of economic globalization to be positively associated with overweight/obesity, one found an inverse association, and the remaining one reported a null finding. Through market deregulation, tariff reduction, and investment liberalization, economic globalization tends to accelerate the market entry of modern food manufacturers, supermarket chains, and fast‐food restaurants, resulting in substantially increased supply of high‐sugar/fat energy‐dense foods with enhanced variety and accessibility and reduced price. The potential impact of economic globalization on obesity through the adoption of modern workplace and domestic technologies and motorized transportation and through changes in social norms and culture were hypothesized in the literature but not empirically examined, which warrants future data‐driven research.     

Structural responses to the obesity and non‐communicable diseases epidemic: Update on the Chilean law of food labelling and advertising

Chile approved the law of food labelling and advertising in 2012; this law aims to address the obesity epidemic, particularly in children. The implementation details were published in 2015, and the law was implemented finally in 2016, as described in the current article. Regulated foods were defined based on a specially developed nutrient profiling, which considered natural foods as gold standard. For liquid foods, amounts of energy, sugars, saturated fats, and sodium in 100 mL of cow's milk were used as cut‐offs. For solid foods, values within the 90th ‐ 99th percentile range for energy and critical nutrients were selected as cut‐off within a list of natural foods. A stop sign stating “High in <nutrient>” was chosen as warning label for packaged regulated foods. Regulated foods were also forbidden to be sold or offered for free at kiosks, cafeterias, and feeding programme at schools and nurseries. Besides, regulated foods cannot be promoted to children under 14 years. A staggered implementation of the regulation was decided, with nutrients cut‐offs becoming increasingly stricter over a 3‐year period. These regulatory efforts are in the right direction but will have to be sustained and complemented with other actions to achieve their ultimate impact of halting the obesity epidemic.     

New directions in the use of virtual reality for food shopping: marketing and education perspectives

Virtual reality is used in marketing research to shape food selection and purchase decisions. Could it be used to counteract the marketing of less-nutritious foods and teach healthier food selection? This article presents interviews with Raymond Burke, Ph.D., of Indiana University Bloomington, and Rachel Jones, M.P.H., of the University of Utah College of Health. Topics covered include new marketing research technologies, including virtual reality simulations; retailing and shopper behavior; and the use of virtual grocery stores to help students explore quality of diet and food/nutrient relationships. The interviewees discuss how the technologies they have developed fit into research and behavior change related to obesity and diabetes.     

Childhood obesity: a societal problem to solve

In contrast to other threats to American children's health, the treatment and prevention of childhood obesity are considered the responsibility of individual children and their parents. This pressure exists in the context of the societal stigmatization of overweight children and the powerful environmental inducements aimed directly at children to eat nutritionally poor foods. Parents of overweight children are left in the difficult position of fearing the social and health consequences of their child's obesity, and fighting a losing battle against the omnipotent presence of the media and constant exposure to unhealthy foods. This paper brings together several literatures to provide a comprehensive examination of the major challenges facing obese children and their families. In particular, this paper documents the extent of stigmatization towards overweight children and reviews evidence of the conflicting advice given to parents about how to help children develop healthful eating in the face of biological and learned food preferences. We conclude with a call for a shift in thinking about the role of our society in the aetiology, treatment and prevention of childhood obesity.     

Influence of unhealthy food and beverage marketing on children's dietary intake and preference: a systematic review and meta‐analysis of randomized trials

Marketing of foods and beverages high in fat, sugar and salt are suggested to contribute to poor dietary behaviours in children and diet‐related diseases later in life. This systematic review and meta‐analysis of randomized trials aimed to assess the effects of unhealthy food and beverage marketing on dietary intake (grams or kilocalories) and dietary preference (preference score or percentage of participants who selected specific foods/beverages) among children 2 to 18 years of age. We searched MEDLINE, EMBASE and PsycINFO up to January 2015 for terms related to advertising, unhealthy foods or beverages among children. Randomized trials that assessed the effects of unhealthy food and beverage marketing compared with non‐dietary advertisement or no advertisement in children were considered eligible. Two authors independently extracted information on study characteristics and outcomes of interest and assessed risk of bias and the overall quality of evidence using grade methodology. Meta‐analysis was conducted separately for dietary intake and preference using a random‐effects model. We identified 29 eligible studies, of which 17 studies were included for meta‐analysis of dietary preference and nine for meta‐analysis of dietary intake. Almost half of the studies were at high risk of bias. Our meta‐analysis showed that in children exposed to unhealthy dietary marketing, dietary intake significantly increased (mean difference [MD] = 30.4 kcal, 95% confidence interval [CI] 2.9 to 57.9, and MD = 4.8 g, 95%CI 0.8 to 8.8) during or shortly after exposure to advertisements. Similarly, children exposed to the unhealthy dietary marketing had a higher risk of selecting the advertised foods or beverages (relative risk = 1.1, 95%CI 1.0 to 1.2; P = 0.052). The evidence indicates that unhealthy food and beverage marketing increases dietary intake (moderate quality evidence) and preference (moderate to low quality evidence) for energy‐dense, low‐nutrition food and beverage. Unhealthy food and beverage marketing increased dietary intake and influenced dietary preference in children during or shortly after exposure to advertisements. © 2016 World Obesity     

Prevalence of obesity in India: A systematic review

Recent studies have reported that globally, more than 1.9 billion adults are overweight and 650 million are obese. Approximately 2.8 million deaths are reported as a result of being overweight or obese. Due to the consumption of energy dense food (i.e. unhealthy food habits), sedentary life style, lack of health care services and financial support, the developing countries are facing high risk of obesity and their adverse consequences (i.e. diabetes, ischemic heart disease, etc). In India, more than 135 million individuals were affected by obesity. The prevalence of obesity in India varies due to age, gender, geographical environment, socio-economic status, etc. According to ICMR-INDIAB study 2015, prevalence rate of obesity and central obesity are varies from 11.8% to 31.3% and 16.9%–36.3% respectively. In India, abdominal obesity is one of the major risk factors for cardiovascular disease (CVDs). Various studies have shown that the prevalence of obesity among women were significantly higher as compared to men. Obesity is one of the main medical and financial burdens for the government. This problem of obesity can be preventable by spreading public awareness about obesity and its health consequences. Governmental agencies should promote the benefits of healthy life style, food habits and physical activity. The aim of this article is to report the prevalence of obesity in different regions of India and highlight the problem areas.     

Global benchmarking of children's exposure to television advertising of unhealthy foods and beverages across 22 countries

Restricting children's exposures to marketing of unhealthy foods and beverages is a global obesity prevention priority. Monitoring marketing exposures supports informed policymaking. This study presents a global overview of children's television advertising exposure to healthy and unhealthy products. Twenty‐two countries contributed data, captured between 2008 and 2017. Advertisements were coded for the nature of foods and beverages, using the 2015 World Health Organization (WHO) Europe Nutrient Profile Model (should be permitted/not‐permitted to be advertised). Peak viewing times were defined as the top five hour timeslots for children. On average, there were four times more advertisements for foods/beverages that should not be permitted than for permitted foods/beverages. The frequency of food/beverages advertisements that should not be permitted per hour was higher during peak viewing times compared with other times (P < 0.001). During peak viewing times, food and beverage advertisements that should not be permitted were higher in countries with industry self‐regulatory programmes for responsible advertising compared with countries with no policies. Globally, children are exposed to a large volume of television advertisements for unhealthy foods and beverages, despite the implementation of food industry programmes. Governments should enact regulation to protect children from television advertising of unhealthy products that undermine their health.