Ms. Wilking provides legal technical assistance to public health officials and public health researchers working to reduce sugar-sweetened beverage consumption and to increase access to drinking water. She also conducts research into the role of state consumer protection laws to limit unfair, deceptive and misleading food marketing aimed at children. Ms. Wilking was a Northeastern University School of Law Public Interest Law Scholar.
Breastfeeding protects against overweight and obesity, asthma, eczema, and type-II diabetes, and has long-term health benefits for women. The health benefits of breastfeeding are so valuable that in 1981, the World Health Organization established the International Code of Marketing of Breast-Milk Substitutes (WHO Code) that prohibits marketing infant formula to the public. The U.S. has not adopted the WHO Code and currently has few protections from most digital marketing to adults. As a result, the vast amount of consumer data expectant parents and infant caregivers generate as they navigate daily life can be used to target them with digital advertising for infant formula.
This report explores the policy frameworks and self-regulatory bodies that govern the use of sensitive consumer information about pregnancy and infant feeding used to market infant formula. It addresses the following questions:
How do marketers identify expectant parents and infant caregivers?
What digital marketing tactics are used to promote infant formula?
What laws and policies govern the collection and use of consumers’ pregnancy and infant-feeding-related information?
What role do company privacy policies and user agreements play?
How can self-regulation be used to limit infant formula marketing?
The report contains recommendations for how to better protect the public from infant formula marketing by the infant formula industry and through third-party retailers and digital platforms like Facebook and Google. Issue briefs on the topics of Consumer Privacy, Self-Regulation and Recommendations for Action summarize key findings from the full report.
Access to safe and appealing drinking water in child care centers and schools is a key strategy to build healthy habits that children will use for life to maintain a healthy body weight and to support overall health.
This study sought to identify and summarize state-level policies in twenty states for drinking water quality and access in public schools and licensed child care centers. This information was then used to generate individual state profiles and general policy recommendations to achieve increased drinking water consumption by children and to ensure drinking water is safe and appealing.
The guiding principles behind these policy recommendations are to ensure that safe, potable drinking water is made available at no cost to children throughout the day. The state profiles and policy recommendations can be used to assess current policies for drinking water access and quality and to determine which policy recommendations are relevant to the needs of a particular state’s schools and child care centers. The state profiles and policy recommendations also can be used as points of comparison and sources of ideas during the policymaking process.
For years, the month of February has been the kick-off of the Coca-Cola Company’s sponsorship of the National Heart Lung and Blood Institute’s (NHLBI) Heart Truth campaign. Heart Truth began in 2002, with the goal of raising awareness that heart disease is the number one killer of women. The campaign fits within the general mission of NHLBI to collaborate with a range of stakeholders to promote the prevention and treatment of heart, lung, and blood diseases. As part of the Department of Health and Human Services (HHS), NHLBI provides research funding and conducts outreach with the public to improve the public health. As a federal agency, NHLBI is subject to legal limits on its use of funds and HHS’s ethical guidelines for co-sponsorship of events. These guidelines are meant to guard against conflicts of interest that would undermine the primary mission of NHLBI. Coke’s corporate funding disclosures in the Fall of 2015 indicate that as public pressure on NHLBI built, Coke shifted the bulk of its heart health giving to a tight circle of non-governmental heart health organizations consisting of the American College of Cardiology, the Preventive Cardiovascular Nurses Association, the American Dietetic Association, and Brigham and Women’s Hospital in Boston, MA.
Coke’s Heart Health Campaign
From 2008 to 2014, The Coca-Cola Company, under its Diet Coke brand, was the Heart Truth campaign’s most visible co-sponsor: Despite the fact that HHS’s ethical guidelines place a particular emphasis on avoiding the appearance of product endorsement, Heart Truth logos were printed on billions of Diet Coke cans, heart health-themed Diet Coke ads ran during the Olympic Games, Coke enlisted high-profile celebrities like Heidi Klum to appear at Heart Truth events, and Diet Coke beverages were distributed at community heart health screenings.
NHLBI’s partnership with Coke drew ire from the public health community because it seemed untenable to partner with a company that also sells sugary drinks linked to obesity and heart disease. The fact that the partnership focused on Diet Coke was particularly problematic because it closely followed the release of the NHBLI-funded Framingham Heart Study’s findings that consumption of diet soft drinks appeared to be linked to increased risk factors for heart disease.
In 2010, the Center for Science in the Public Interest (“CSPI”) called on the government agency to sever its ties with Coke, but NHLBI publicly refused to do so. The primary rationale NHLBI gave for keeping Coke as a corporate sponsor was that the company allowed the agency to extend its reach to get out the message that heart disease is an important health concern for women. CSPI’s challenge to the program led to a public debate about the role of Coke in NHLBI’s educational activities.
Coke’s Heart Truth Contracts with NHLBI
In 2010, PHAI requested Coke’s contracts with the NHLBI pursuant to the Freedom of Information Act (FOIA) and received copies of contracts the company entered into with Ogilvy Public Relations Worldwide on behalf of the NHLBI from 2007, 2008, 2009 and 2010:
At the time, the dollar amounts in these contracts were redacted as proprietary information.
Coke’s recent funding disclosures date back to 2010, and show that in 2010 the company paid NHLBI $440,000 in support of a fashion show to promote heart health awareness. Through its contracts with NHLBI for the 2010 Heart Truth Fashion Show, Coke was granted:
-Exclusivity as the only carbonated beverage category event sponsor
-Full use of the NHLBI Heart Truth logo in any Coke marketing, advertising and or promotional materials or activities
-Assistance from NHLBI’s agent, Ogilvy, in the “development of heart health content and messages” for its use
-“Access to heart health experts and spokespeople to serve on Coca-Cola’s behalf including at Coca-Cola luncheons, ambassador program, opinion shaper and other customer/VIP events”
-Highlighted attention to Coca-Cola’s partnership activities on the Heart Truth webpage
-Soundbites from NHLBI representatives at Heart Truth events for use by Coca-Cola
-The right to provide free samples of Coca-Cola products at the fashion show
-The right to feature Coca-Cola advertising in essentially all aspects of the event
-Pre-approval of “all [NHLBI] creative materials, press releases, collateral materials, signage and other items using” Coca-Cola’s trademarks
The breadth of the rights granted to Coca-Cola is in keeping with a typical private arrangement for event sponsorship, but seems startling in the context of a government run educational campaign. Ogilvy Public Relations Worldwide was awarded multi-year government contracts from the NHLBI totaling $11.9 million to execute the Heart Truth campaign on its behalf. Organizers of complex, national educational campaigns must work with sponsors to ensure events run smoothly. The contracts Ogilvy entered into on NHLBI’s behalf with Coke, however, reveal a situation where it appears that NHLBI was granting Coke rights to advance the company’s commercial agenda.
Coke Abruptly Shifts Its Heart Health Spending
In March of 2010, PHAI wrote a detailed letter to the Associate General Counsel for Health and Human Services (HHS), asking that it review NHLBI’s relationship with Coke pursuant to the agency’s written ethical guidelines for co-sponsorships of events. In its reply, HHS cited a general provision of the Public Health Service Act granting NHLBI the authority to conduct health promotion campaigns and deferred decision-making about the appropriateness of Coke’s co-sponsorship of the Heart Truth campaign to NHBLI. Despite NHLBI’s public defense of Coke in response to CSPI’s letter and apparent agency inaction after PHAI’s request to review the relationship, after 2011 Coca-Cola shifted its support for Heart Truth and other heart health activities sharply away from the NHLBI.
According to Coke’s initial funding disclosures in the Fall of 2015, between 2010 and 2015, Coke’s total funding of heart health-related organizations and educational activities was approximately $8 million (click here for a detailed description). $7.8 million of these funds went to just five organizations: NHLBI (via Ogilvy and the Foundation for the National Institutes of Health), the American College of Cardiology, the Preventive Cardiovascular Nurses Association, the American Dietetic Association, and Brigham and Women’s Hospital in Boston, MA. NHLBI-related funding of the Heart Truth totaled $1.9 million with Coke’s contributions peaking at $1 mil in 2011. Starting in 2012, Coke sharply reduced its direct NHLBI support and shifted its gifts to private organizations not subject to FOIA requests.
Coke’s Heart Truth Spending to Key Partners (2010-2015)
Brigham and Women’s Hospital Cardiologists Associated with Millions in Coke Money
Coke’s Heart Truth partnership with NHLBI was created under the leadership of then NHLBI Director Elizabeth (Betsy) Nabel, MD. Dr. Nabel is a cardiologist who left public service in 2010 to become President of Brigham and Women’s Hospital (BWH) in Boston, MA. Dr. Nabel traveled to Canada to be an official 2010 Olympic Games Torchbearer for Coke and spoke glowingly about her relationship with Coke.
It turned out that Dr. Nabel was not the only Coke heart health partner at BWH. She was joined by Dr. JoAnne Foody, MD, the Medical Director of BWH’s Pollin Cardiovascular Wellness Center. Dr. Foody is featured as a heart health expert in continuing education presentations produced by Coca-Cola’s Beverage Institute for Health, and in 2011 was selected to serve as the Editor-In-Chief of the American College of Cardiology’s (ACC) CardioSmart initiative. ACC received $2.6 million in Coke funding for CardioSmart and community screenings between 2010 and 2015. CardioSmart is described as “a patient education site committed to providing accurate, un-biased heart health information in an advertising-free environment.”
Coke clearly valued its relationship with Dr. Foody. As was reported in 2012, she was included in an email sent from Coca-Cola executive Helen Tarleton to a list of “partners” in various health organizations sharing the company’s position on a proposed New York City ordinance to limit soda portions. The email asked Dr. Foody to disseminate a Coke infographic downplaying the role of sugary drinks in the obesity epidemic. Coke’s direct request to advance a policy position potentially at odds with CardioSmart’s mission to educate heart health patients is a striking example of the depth of the relationships it formed with its public health “partners.”
In 2013 and 2014, Dr. Nabel and Dr. Foody leveraged their relationship with Coke into $1.2 million dollars of funding for a BWH cardiovascular health initiative called ClimbCorps to promote stair climbing for heart health and provide heart health education. Dr. Foody served as the ClimbCorps’ Medical Director. In 2013, Coca-Cola executive Helen Tarleton personally attended a ClimbCorps event with Dr. Nabel and Dr. Foody. The program no longer has an active website and all links to ClimbCorps redirect to the BWH general website. The program’s emphasis on physical activity fit well within Coke’s overall obesity strategy to focus on physical activity as opposed to diet.
Coke Exits the Heart Health Picture
Coke’s funding disclosures paint a more complete picture of how it operated and who it turned to when it needed to shift its giving from a highly scrutinized government agency to private organizations. In response to public pressure, Coke has since bowed out of the heart health initiatives it funded over the past five years:
Coke ended its role as a corporate sponsor of NHLBI’s Heart Truth Campaign in 2014
After being called out by the New York Times for funding junk science promoted by Coke and researchers it funded that focused on what it calls “energy balance science” (which claims that there is no established link between soda consumption and obesity and promotes exercise as the most effective way of compensating for the extra calories derived from soda consumption), Coke announced in September 2015 that it would no longer fund the American College of Cardiology including the CardioSmart program
ClimbCorps is no longer an active program of BWH
In the process, millions of dollars were spent in ways that Coke itself now admits were not adequately transparent, and were inappropriate given the company’s overwhelming commercial interests in the health issues addressed.
There is no question that funds are desperately needed for programs to address crucial diet-related public health issues like cardiovascular disease in women. Coke spent $8 million on heart health education in five years (not including the in-kind contributions it made via specially printed product packages, Heart Truth dedicated websites and television commercials), while the federal government spent just $17 million on the Heart Truth campaign over ten years. The problem with Coke’s heart health spending is that its primary goal has been to downplay the role of sugary drinks in the obesity epidemic and to position diet beverages as healthy alternatives. Neither of these positions is fully supported by actual evidence and, as such, are in conflict with the mission of truly unbiased cardiovascular health initiatives.
There remain many unanswered questions about Coke’s heart health “partnerships.” To what extent did Coke’s initial participation with NHBLI’s Heart Truth campaign give the company legitimacy through what appeared to have been the government’s imprimatur and grant it access to the private organizations it subsequently partnered with? What other requests for political support did the company make of the heart health organizations it funded? How did Coke’s funding impact the heart health activities of the organizations it funded in terms of dietary recommendations to the public or support for public health policies at odds with Coke’s agenda? The most important question left in the wake of Coke’s co-optation of the Heart Truth campaign is this: Moving forward, how can the United States create and sustain unbiased funding mechanisms for the crucial public health issues of our time?
The Coca-Cola Company’s pouring of millions of dollars into the Global Energy Balance Network (GEBN), a front group focused on exercise as opposed to diet to combat obesity, has crystallized an issue that the public health community has long been concerned about: the role of industry funding to research and develop solutions to public health threats. A New York Times story exposing this funding arrangement has led to a public relations nightmare that finally culminated in a formal statement from Coke’s Chairman and CEO, Muhtar Kent. Mr. Kent stated that the accusation that the company is deceiving the public about its support for scientific research “does not reflect our intent or our values,” and promised more transparency. He promised to make available a list of the funding it supports, and to convene expert panels to assist with future “investments in academic research.”
Coke’s funding of GEBN is part of a well-articulated company strategy it calls “Balancing the Debate.” Coca-Cola’s chief scientific officer, Rhona S. Applebaum , PhD, laid out the Balancing the Debate strategy at a 2012 conference for the sugar industry. (CLICK HERE FOR THE FULL PRESENTATION) The strategy seeks to discredit what the company calls “detractors” in the scientific community like Kelly Brownell, Dean of the Sanford School of Public Policy at Duke University (formerly of Yale University), and public health organizations like Center for Science in the Public Interest.
At that 2012 industry conference, Ms. Applebaum told participants that she had come with a “plea from Coca-Cola” that “we all have to work together and use science.”
To that end, Ms. Applebaum, shared Coke’s strategy to “Balance the Debate” by using three interdependent steps: “Cultivate Relationships,” “Collaborate Research,” and “Communicate Results.” These steps, if properly taken, will result in a balanced debate that will “Address the Negative” and “Advance the Positive” for the food industry.
Ms. Applebaum, was clear that cultivating relationships and research collaborations comes down to dollars and cents. She outlined how to use research funding for “defensive and offensive science and research” to address the issues faced by the food industry.
The GEBN seems to have been tailor-made for the offensive and defensive research Coke had in mind, and it amplifies and expands the mission and capabilities of Coke’s Beverage Institute for Health and Wellness, which is run by Ms. Applebaum. On a slide entitled “What Experts Tell Us,” Ms. Applebaum gave insight into the company’s research agenda to “Shift energy balance,” “Inspire/Motivate consumer behavior change,” and “Bring opportunities (on energy in/out).”
To add a gloss of legitimacy to Coke’s vision for funding science to serve its agenda, its chief scientific officer, Ms. Applebaum, co-authored two papers: one in 2009 with guiding principles for industry funding of food science and nutrition research, and one in 2012 with guiding principles for establishing panels of scientific advisers. With respect to funding food science and nutrition research like that conducted by GEBN, Ms. Applebaum co-wrote the following guiding principles:
In the conduct of public/private research relationships, all relevant parties shall:
1) conduct or sponsor research that is factual, transparent, and designed objectively; according to accepted principles of scientific inquiry, the research design will generate an appropriately phrased hypothesis and the research will answer the appropriate questions, rather than favor a particular outcome;
2) require control of both study design and research itself to remain with scientific investigators;
3) not offer or accept remuneration geared to the outcome of a research project;
4) prior to the commencement of studies, ensure that there is a written agreement that the investigative team has the freedom and obligation to attempt to publish the findings within some specified time frame;
5) require, in publications and conference presentations, fully signed disclosure of all financial interests;
6) not participate in undisclosed paid authorship arrangements in industry-sponsored publications or presentations;
7) guarantee accessibility to all data and control of statistical analysis by investigators and appropriate auditors/reviewers; and
8) require that academic researchers, when they work in contract research organizations or act as contract researchers, make clear statements of their affiliation; require that such researchers publish only under the auspices of the contract research organizations. (emphasis added).
These guiding principles clearly were not adequately followed in the case of Coke’s funding of the GEBN, and it remains to be seen what other research it has been cultivating as part of its effort to “balance the debate.” Moreover, the whole concept of funding “defensive and offensive science and research” is completely at odds with the principles of objective research design contained in the guiding principles.
Coke has had a concerted effort to fund science in its favor pursuant to a specific plan laid out by its chief scientist in 2012, and it failed to adequately follow the ethical guidelines its chief scientist helped to write in 2009. The remedies CEO Kent now promises are to disclose who the company has funded (something, according to their chief scientist, the company should have already been doing), and enlisting more experts to help sort things out. For Coke’s CEO to say that the criticism of actions that were clearly in line with a well-articulated Coca-Cola Company strategic plan and failed to comply with basic ethical principles co-written by its chief scientific officer “does not reflect” the company’s “intent” or “values” is partly right and partly wrong. It clearly reflects Coke’s intent to fund science to serve its interests. It does not, however, reflect the purported values of the company with respect to working with scientific researchers.
Researchers at the University of Vermont in Burlington (UVM) published a paper describing the impact of a campus bottled water ban that was paired with a healthy beverage requirement. The study found that removing bottled water from campus had no impact on the number of plastic bottles shipped to the campus, and resulted in higher consumption of unhealthy beverages. These results do not support the sustainability or public health goals of the bottled water ban: it failed to reduce plastic trash and carbon emissions or improve the nutrition profile of beverages consumed by students, faculty and staff on the UVM campus.
The study puts a fine point on a very practical tension that exists between two highly organized movements: the obesity and oral health prevention movements with a primary focus on shifting the public from caloric beverages to non-caloric beverages like water–for the most part regardless of how they are packaged; and a segment of the sustainability movement that has honed in on bottled water as a unique source of plastic trash, carbon emissions from its transportation, and a burden on communities from where it is extracted for packaging. The public health community regards bottled water as a healthy alternative to other drinks when consumers are choosing a beverage to buy, and the environmental community considers bottled water to be a needless source of pollution. The UVM study findings call out for solutions that meet the goals of both groups, and that combine their forces for a greater collective impact.
A constructive path forward is for both movements to work together to reduce access points for all packaged beverages. A key to the bottled beverage industry’s success has been to insert itself into every aspect of daily life. Vending machines are found in parks, schools, college campuses, recreation centers, etc. And coolers selling bottled beverages are placed at the end-caps of retail check-out lines, and fill the walls of convenience stores all over the country—including in places like college campuses. These access points haven’t always been there. They’ve been inserted via private contracts over time—these are contracts that are not required to be renewed and can be radically altered to support the environment and the public health.
A strategic focus on reducing total access points for packaged beverages benefits the environment through:
Reduction in total number of plastic bottles used
Reduction in carbon emissions from transport of bottled beverages
Increase in awareness of and local support for public water systems
And benefits the public health through:
Reduction of total packaged beverages consumed, many of which contribute to diet-related chronic disease and poor oral health
Increase in investment and maintenance of plumbed drinking water access points
Increase in awareness of and local support for community water systems
A focus on a total reduction of packaged beverages is timely because demand for sugary drinks is on the decline. This new path will require both movements to expand their thinking on their respective issues and entails political risks on both sides. The obesity prevention movement will have to move beyond efforts to change the product mix in existing vending machines and other retail sales outlets and embrace phase-outs of beverage vending machines and cooler equipment. A focus on an overall total reduction in sales of bottled beverages will not be cost-neutral in terms of revenues from bottled beverage sales. This will undoubtedly raise great opposition from the beverage industry and firms and institutions that profit from packaged beverage sales.
The environmental movement will have to expand its definition of bottled water to include water that has been carbonated, sweetened, flavored or brewed and packaged in plastic. A focus on bottled water alone has strategic benefits, especially on a college campus, because plain water can be accessed via drinking fountains. Moreover, allowing other packaged beverages to remain quells critics by providing choices beyond the drinking fountain. There, however, seem to be few discernible differences between bottled water and other bottled beverages: all have water as the primary ingredient, both may have been bottled at the same factory, both are placed in plastic containers, trucked in a vehicle, refrigerated in a machine, tossed into a trash or recycling receptacle, or not properly disposed of at all.
Both movements have built momentum and achieved many accomplishments. Imagine how much more progress can be made if they join forces.
Today, the Public Health Advocacy Institute at Northeastern University School of Law, is releasing the issue brief Copycat Snacks in Schoolson the food industry’s recent push to market popular junk food brands in schools. As noted in today’s New York Times story by Michael Moss entitled “The Domino’s Smart Slice Goes To School,” PHAI has called upon the USDA to address branded junk food marketing in schools. Starting July 1, 2014, all foods sold outside of the National School Lunch Program, such as food from vending machines and school stores, will have to meet United States Department of Agriculture “Smart Snacks” nutrition criteria. Not wanting to lose an in-school marketing opportunity, major food companies like PepsiCo are producing reformulated versions of popular junk foods like Cheetos® and Doritos® that meet the Smart Snacks criteria, but use the same brand names, logos and spokescharacters as are used to market traditional junk food.
For example, PepsiCo produces and markets to school food service directors a product called Cheetos®Flamin’ Hot Puffs Reduced Fat. This product meets the USDA Smart Snack guidelines, but it is not widely available for retail purchase outside of schools. Instead, PepsiCo offers Cheetos®Flamin’ Hot Puffs to the broader public. As you can see below, the product packaging is almost identical.
Copycat snacks like reduced fat versions of Cheetos® products are not widely available for purchase outside of schools and are clearly designed to co-market traditional junk food to children in school. The issue brief describes copycat snacks, how they undermine nutrition education efforts, and what can be done to stop the sale and marketing of these products in schools.
Since 2008, national advertising for McDonald’s Happy Meals has not depicted soda as per a self-regulatory pledge made to the Children’s Food and Beverage Advertising Initiative (CFBAI). In a recent pledge with the Clinton Global Initiative (CGI) and the Alliance for a Healthier Generation, McDonald’s stated that it will not display soda company logos in the children’s section of its restaurant menu boards or otherwise promote or feature soda, but soda will remain on the children’s menu. This seems to be a huge public admission that McDonald’s has no plans to actually take soda off of its children’s menu. Almost five years after McDonald’s began implementation of its CFBAI pledge its in-store children’s menu offerings still do not match the Happy Meal combinations it advertises to the public.
In July of 2011, I wrote about the fact that McDonald’s CFBAI pledge had not translated into its healthier options becoming its most popular or commonly sold options (a fact later confirmed by McDonald’s). At that time, meal combinations with french fries and a 12 oz. soda were the most popular Happy Meal combinations. Two years later, soda is still on the children’s menu. In order to truly improve the nutritional profile of the meals it actually sells, McDonald’s needs to do the same thing with beverages that it did with its french fries. Change the default. When a parent orders a Happy Meal the clerk should ask, “milk, apple juice or water.” Its CGI pledge does not accomplish that and evinces a potentially huge disconnect between what McDonald’s advertises and what it is actually selling to children and their parents.
In response to a recent study finding that nationally televised fast food television advertisements to children by McDonald’s and Burger King from 2009-2010 focused primarily on toys, movie tie-ins and branding, CARU Director Wayne Keeley stated that “[b]oth companies have always respected CARU’s recommendations by discontinuing the challenged ads, and pledged to take into account CARU’s recommendations in their future advertising,” and went on to note that there haven’t been any recent cases involving either of the two companies.
A look at CARU case reports tells a different story. Since 2005, McDonald’s Corporation has been cited by CARU six times for violations of its premium guideline. Just one of these cases, from Sept 2012, was decided in McDonald’s favor. The most recent CARU case against the company in December 2012 found the premium guideline had been violated. Each time McDonald’s pledged to take CARU guidelines into consideration in future advertisements. Burger King also was found to have violated CARU’s premium guideline in 2011.
A list of CARU case reports. Click on the image above to view a larger version.
Fast-food companies emphasize toy giveaways and movie tie-ins rather than food products when marketing to kids on television, which suggests that industry is not abiding by its self-regulatory pledges for child-directed marketing, according to a study co-authored by the Geisel School of Medicine at Dartmouth and the Public Health Advocacy Institute at Northeastern University School of Law. The study, “How Television Fast Food Marketing Aimed at Children Compares with Adult Advertisements,” is published in PLOS ONE and found that among ads for children’s meals, toy giveaways appeared in 69 percent of ads and movie tie-ins were used in 55 percent of ads.
“Fast-food companies use free toys and popular movies to appeal to kids and their ads are much more focused on promotions, brands, and logos—not on the food,” said James Sargent, Professor of Pediatrics at the Geisel School of Medicine at Dartmouth and the lead author of the study. “These are techniques that the companies’ own self-regulatory body calls potentially misleading and it’s a clear sign that they’re not living up to their pledges about marketing to kids.”
Sargent and his colleagues examined all nationally televised ads for children’s meals by leading fast-food restaurants for one year, from July 1, 2009 to June 30, 2010. They compared ads for kids with ads for adults from the same companies to assess whether self-regulatory pledges for food marketing to children had been implemented.
Key findings include:
Nearly all (99%) of the ads that aired during the study period were attributable to McDonald’s (70%) and Burger King (29%).
McDonald’s had the strongest emphasis on the children’s market, with 40% of its 44,062 ads aimed at kids, compared to 21% of 37,210 aired ads for Burger King.
Seventy-nine percent of the fast-food ads aimed at kids aired on only four channels: Cartoon Network (32.3%), Nickelodeon (18.3%), Disney XD (16.2%), and Nicktoons (12.4%).
Compared with fast food ads for adults, kids ads emphasized branding and the food images were smaller. For example:
Images of food packaging were present in 88 percent of ads directed at kids and 23 percent of ads for adults.
A street view of the restaurant appeared in 41 percent of ads directed at kids and 12 percent of ads for adults.
Food images averaged 20 percent of the screen diagonal in kids’ ads, but 45 percent of the screen diagonal in adult ads.
Leaders of the food and beverage industry have publicly recognized the need to reform marketing practices targeting children. In 2006, the Council of Better Business Bureaus launched the Children’s Food and Beverage Advertising Initiative (CFBAI), a voluntary pledge by major U.S. food manufacturers to advertise only healthier products to young children. McDonald’s and Burger King participate in the CFBAI. Both companies also have pledged to abide by marketing guidelines set by the Children’s Advertising Review Unit, which include a provision stating that food—not toys or other promotions—should be the primary focus of ads directed at kids.
“This study adds to a growing body of research suggesting that there’s a big gap between what industry has promised and what they’re actually doing when it comes to marketing to kids,” said Cara Wilking, J.D. of the Public Advocacy Institute at Northeastern University School of Law. “There comes a point when intervention by a regulatory body like the Federal Trade Commission or state Attorneys General is needed to address self-regulatory failures. These findings suggest we’ve reached it with respect to fast food marketing to kids.”
A recent report by the Federal Trade Commission found that among all U.S. food and beverage companies, fast-food companies spent the most on marketing directed at youths ages 2 to 17—more than $714 million in 2009. The report also found that fast-food companies have dramatically increased their spending on television ads and new media targeting kids ages 2 to 11. Further analysis of that report shows while some fast-food restaurants slightly improved the nutritional quality of kids’ meals, the number of child-directed television ads for other higher-calorie meals and menu items more than doubled from 2006 to 2009.
Cheeseburger Bills or Common Sense Consumption Acts (CCAs) were spearheaded by the National Restaurant Association as well as the American Legislative Exchange Council (ALEC) and have been enacted in 26 states. Media coverage and legislative debates about CCAs were dominated by themes of personal responsibility and the need for tort reform to protect businesses from frivolous litigation. A recent study just published in the Food and Drug Law Journal by PHAI’s Cara Wilking, J.D. and Richard A. Daynard, J.D., Ph.D. analyzes the
The majority of CCAs (16 states) may be interpreted to confer broad civil immunity for claims seeking to recover for health harms stemming from long-term consumption of food.
The CCAs enacted in nine states (Alabama, Colorado, Georgia, Idaho, Illinois, Michigan, Missouri, Oklahoma and Tennessee) impose a limitation on the kinds of cases government attorneys can bring by specifically referencing governmental entities when defining the reach of the statute.
Six states (Alabama, Georgia, Kentucky, Texas, Oregon and Washington) explicitly protect the authority of governmental entities to enforce certain food-related laws.
Thirteen states impose substantial procedural barriers such as heightened pleading requirements and stays of discovery for covered obesity-related claims.
All states had laws to guard against frivolous litigation in place prior to the enactment of CCAs.
The health harms of tobacco are well-known and linked to corporate misconduct. In the late 1990’s, tobacco litigation brought by State Attorneys General resulted in individual settlements by four states to recover smoking-related Medicaid costs. Forty-six states and territories negotiated the Master Settlement Agreement securing annual payments of several billion dollars in perpetuity as repayment for smoking-related healthcare costs.
Between 2008 and 2010, adult obesity rates increased in a total of 16 U.S. states, 11 of which are CCA states. The CCA states of Alabama, Louisiana and Tennessee are among the top five states with the highest rates of obesity, diabetes and hypertension. The current medical cost of adult obesity in the U.S. is estimated at $147-$210 billion per year, $61.8 billion of which is paid for by Medicare and Medicaid (Levi et al. 2012). The twenty-sixth CCA was passed in North Carolina in 2013 and they continue to be introduced in state legislatures. “A close analysis of CCAs reveals that the real point of the CCA proponents was not to prevent frivolous litigation, from which industry already had plentiful protection, but rather to limit legally and factually sound tobacco-style litigation, which might eventually have harmed industry’s bottom line and forced it to change its practices,” said Cara Wilking, J.D.
This research was supported by award #2R01CA087571 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.
ottled water to be a needless source of pollution. The UVM study findings call out for solutions that meet the goals of both groups, and that combine their forces for a greater collective impact.
