8: No. 5, September 2011
Jennifer L. Harris, PhD, MBA; Samantha K. Graff, JD
Suggested citation for this article: Harris JL, Graff SK. Protecting
children from harmful food marketing: options for local government to make a
difference. Prev Chronic Dis 2011;8(5):A92.
http://www.cdc.gov/pcd/issues/2011/sep/10_0272.htm. Accessed [date].
The obesity epidemic cannot be reversed without substantial improvements in
the food marketing environment that surrounds children. Food marketing targeted
to children almost exclusively promotes calorie-dense, nutrient-poor foods and
takes advantage of children’s vulnerability to persuasive messages. Increasing
scientific evidence reveals potentially profound effects of food marketing on
children’s lifelong eating behaviors and health. Much of this marketing occurs
in nationwide media (eg, television, the Internet), but companies also directly
target children in their own communities through the use of billboards and
through local environments such as stores, restaurants, and schools. Given the
harmful effect of this marketing environment on children’s health and the
industry’s reluctance to make necessary changes to its food marketing
practices, government at all levels has an obligation to act. This article
focuses on policy options for municipalities that are seeking ways to limit
harmful food marketing at the community level.
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The prevalence of childhood obesity in the United States imposes a major
burden on society in health care costs and children’s physical and mental health
(1). Meanwhile, the food industry spends massive amounts of money marketing
calorie-dense, nutrient-poor foods, and its marketing specifically targets
children (2). The obesity crisis cannot be solved without dramatic changes to
the obesogenic marketing environment that surrounds children (3).
The White House Task Force on Childhood Obesity has called for immediate
action: “Key actors — from food and beverage companies, to restaurants, food
retailers, trade associations, the media, government and others — all have an
important role to play in creating a food marketing environment that supports,
rather than undermines, the efforts of parents and other caregivers to encourage
healthy eating among children and prevent obesity” (4). Given government’s
fundamental obligation to advance public health, lawmakers at all levels must
take the lead to change this toxic environment and shield children from exposure
to marketing of food products that contribute to the obesity crisis (3).
Although the federal government has jurisdiction to regulate national media and
the First Amendment to the US Constitution limits what government at any level
can do to restrict advertising, municipalities do have constitutionally viable
options to protect children from the harmful food marketing that permeates their
In this article, we describe ways in which food companies market
calorie-dense, nutrient-poor foods directly to children in national media and
local communities. We present evidence that this marketing negatively affects
children’s diets, increases children’s risk for obesity and obesity-related illness,
and takes advantage of youths’ unique vulnerabilities. We then discuss
limitations in food industry self-regulatory initiatives that address these
concerns. Next, we present the legal doctrine that balances government’s
obligation to promote public health against the liberty interests of individual
citizens and organizations. Finally, we highlight potentially viable local
policy options to restrict the marketing of obesogenic food to children.
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Food Marketing Targeting Children
In 2006, the food industry spent more than $1.6 billion on marketing to
youth, including $900 million in marketing aimed directly at children younger
than 12 years and designed specifically to increase positive attitudes and
preferences for its products (2). Approximately half ($514 million) was spent
on television advertising and other forms of national media, including the
Internet, print, and radio. Children’s exposure to these advertisements is
considerable. For example, the average child aged 6 to 11 years views 13
television food advertisements daily (5). Approximately 400,000 children spent
more than 60 minutes per month playing games and viewing branded content
promoting high-sugar cereals on General Mills’s millsberry.com, which was
closed down in April 2011 as a result of pressure from public health advocates
Companies also spend considerable sums to reach children directly in their
local communities, in stores, restaurants, schools, and almost anywhere children
spend their time. These locally based food marketing practices include product
packaging, signs, and promotions in stores that appeal specifically to children
($106 million spent in the United States in 2006), marketing to children in
schools ($73 million), and local child-focused events ($30 million) (2).
Additionally, food companies spend $127 million on premiums, cross-promotion
licenses, athletic sponsorships, celebrity fees, and philanthropic tie-ins.
These programs increase products’ appeal to children by associating foods with
popular cartoon characters, sports, and entertainment celebrities and events,
and even charities (eg, Girl Scouts [Girl Scouts of the USA, New York, New
York]) (7). Similarly, fast-food restaurants spent $360 million in the United
States in 2006 on toy giveaways (2). In 2009, the average child viewed 262
television advertisements (5 per week) that encouraged them to visit their local
fast-food restaurant for the toy or other promotion in children’s meals (8).
Locally based marketing practices are more difficult to measure
quantitatively because they vary widely by location; however, reports document
the extent of child-targeted marketing in communities and schools. For example,
in supermarkets, high-sugar cereals marketed directly to children are more
likely to be placed on lower and middle shelves (ie, children’s eye level) and
be featured in special store displays and price promotions (6). Products
featuring youth-oriented cross-promotions on packaging in the supermarket
increased by 78% during 2006-2008 (7). In schools, where children provide a
captive market for advertisers, examples of food marketing include sponsored
incentives (eg, rewarding children with free pizza for reading books);
fundraising programs in which schools receive funds when families purchase food
products and give proof of purchase to the school; branded food items served in
school cafeterias, stores, and vending machines; corporate logos on scoreboards,
book covers, and team jerseys; and sponsored curricula with branded content (9).
Although less overt than traditional media advertising, school-based marketing
practices are designed specifically to increase children’s affinity and desire
for companies’ products by increasing familiarity and positive associations with
the brands (10).
Food companies expend these prolific marketing efforts almost exclusively
to promote foods that children should consume only occasionally and in limited
quantities. On television, 98% of food advertisements watched by children
promote products high in fat, sugar, or sodium (11). In all forms of
marketing targeted to children, calorie-dense, nutrient-poor foods predominate
(3). Breakfast cereals are most frequently marketed directly to
children, representing 25% of all child-targeted food marketing in 2006 (2).
Moreover, cereal companies choose to market products to children that contain
85% more sugar, 60% more sodium, and 65% less fiber than the products they
market to adults (6). Restaurants are the second most frequent food category
marketed to children (2). In 2007, fast-food restaurants represented 22% of all
television food advertisements viewed by children, an increase of 12% from 2003
(5). Child-targeted spending to market beverages — including carbonated
beverages, fruit drinks, and juices — sweets and baked goods, and snack foods
totaled $376 million in 2006 (2). In contrast, only 4% of all child-targeted
food marketing ($38 million) promoted fruits, vegetables, and dairy products.
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Harmful Effects of Food Marketing
Food companies have traditionally argued that their advertising simply
encourages children to prefer one brand over another and thus does not
contribute to childhood obesity (3). Most research on the effects of television
food advertising to children confirms that it increases children’s preferences
for advertised brands, choices of specific foods after advertisement exposure,
and requests to parents for advertised foods (12). More recent research has
demonstrated, however, that food marketing also has potentially profound effects
on children’s overall diet and health. For example, television food advertising
increases consumption of any available snack foods during and immediately after
exposure, and exposure to commercial television is associated with increased
overall calorie consumption, higher body mass index, and reduced fruit and
vegetable consumption 5 years later (10). Research has also demonstrated an
association between exposure to soft drink advertising and consumption of all
sugar-sweetened beverages (13). Marketing can even affect how much children like
the taste of advertised foods: preschoolers indicated that snack foods presented
in packages with licensed characters tasted better than the same foods in plain
Research on the harmful effects of food marketing on broader health-related
outcomes (beyond brand preference and attitudes) is in its early stages;
however, potentially far-reaching and dangerous effects have been hypothesized
(10). Because of its ubiquity, food marketing likely affects children’s
normative beliefs about the types of foods that are acceptable to eat regularly
without adverse consequences, may affect how much children like the taste of
advertised foods, and may automatically prime other unrelated goals and
behaviors, including children’s motivation to engage in unhealthful behaviors.
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Children’s Unique Vulnerability
Child advocates also question the ethics of marketing practices targeted to
children who cannot yet defend against their influence (3). Research
consistently demonstrates that until the age of 8 years, most children do not
possess the necessary cognitive skills to understand that advertising is not
just another source of information and presents a biased point of view (12).
Although older children and adolescents understand the intent of advertising,
they do not regularly act on that knowledge nor do they attempt to counteract
its influence. Resisting advertisements for the highly tempting products
commonly promoted also requires the ability to weigh long-term health
consequences of consumption against short-term rewards, an ability that is not
fully developed until the early 20s (15). Finally, marketing practices that
persuade indirectly (eg, through logo placements, associations with popular
characters and movies, and Internet games) are designed to create lifelong
customers by imprinting brand meaning into the minds of young children (10).
Before children know better, they have learned to love the products they
encounter most frequently and associate with positive experiences.
Evidence also exists that food companies disproportionately target
advertising for high-calorie, nutrient-poor foods to black and Hispanic
communities, where youth are most vulnerable to obesity and obesity-related
disease (16). For example, billboards for fast-food and sugar-sweetened
beverages appear substantially more often in low-income black and Hispanic
neighborhoods (17), and fast-food outlets in low-income black communities are
more likely to promote less healthful menu items (18).
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Food Industry Initiatives to Address These Public
The food industry appears to have heard concerns raised by the public health
community about child-targeted marketing practices. In 2006, the Children’s Food
and Beverage Advertising Initiative (CFBAI), an industry-sponsored program
purportedly designed to improve food-marketing practices, was launched (19).
Sixteen of the largest food companies that market to children have joined CFBAI
and implemented pledges to market only “better-for-you” foods in child-targeted
media. However, exclusions and limitations demonstrate that these pledges are
unlikely to produce substantial changes to existing marketing practices. For
example, participating companies have created their own definitions of
“better-for-you” foods that include products dietitians may regard as
unhealthful, including high-sugar cereals, juice drinks made of 10% fruit juice
with 16 grams of sugar per 6-ounce serving, and even certain flavors of toaster
pastries. Similarly, participating companies have declared that widely used
forms of marketing designed specifically to appeal to children are not
child-targeted advertising and thus not subject to limitations, including
product packaging and other types of marketing to children that occur in stores
or restaurants, advertising on prime-time television shows popular with children
but also viewed by a broader audience, and food and beverage displays in
Recent evaluations of the effects of the CFBAI pledges on the volume and
types of foods advertised to children demonstrate limited changes in the foods
advertised to children (6,8,20). Public health professionals have suggested that
industry self-regulatory efforts (eg, CFBAI) provide more public relations
benefit to the food industry than real health benefits for children and that
overreliance on such efforts could exacerbate the childhood obesity crisis
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Government’s Role in Advancing Public Health
Because the food marketing environment contributes to the health crisis
facing our nation’s children and because members of the food industry appear
unlikely to voluntarily make the considerable changes required to improve this
environment, government at all levels has an obligation to intervene where it
can. In our constitutional democracy, a core responsibility of government is to
protect and promote public health — especially among vulnerable populations,
including children. Public health is essential to civil society because it
provides the general population with basic security and welfare that can be
achieved only through collective action (24).
A common refrain among opponents of public health regulations is that
government should not impede individual liberty to benefit the general public.
The US Constitution addresses this concern: provisions of the Bill of Rights and
the Fourteenth Amendment — including those regarding free speech, due process,
equal protection, and property ownership — mandate that a balance be struck
between the government’s obligation to serve the general welfare and the
interest of individual citizens and organizations in freedom, fairness, and
self-determination (25). Therefore, when the government regulates food marketing
to children, it must achieve a balance between public and private interests.
Congress and federal agencies (eg, the Federal Trade Commission, the Federal
Communications Commission) have purview over media that cross state lines,
including television, radio, the Internet, and other digital media.
Consequently, policy efforts to limit food advertising in the national media
must be initiated at the federal level. However, states and localities have
power to take a regulatory stand against many forms of marketing for obesogenic
food to youth that occur in their communities, including marketing in retail
establishments, restaurants, and schools. In fact, states and their subdivisions
have always borne primary responsibility for public health. In the
constitutional compact, each state retains police power — the inherent authority
to act in the interest of the public’s health, safety, and welfare (24). Most
states grant their localities a form of home rule, or the ability to legislate
on the basis of the police power (26). Because regulating public health is a
fundamental police power function, states and home-rule localities have the
presumptive authority to pass public health laws as long as the laws do not
overstep constitutional bounds and are not preempted (ie, trumped) by the law of
a higher jurisdiction.
Accordingly, public health advocates have identified multiple policy
proposals that localities can consider to reduce marketing of unhealthful
food to children in stores, restaurants, schools, and elsewhere in the community
(Table). A limited number of the policies listed have been tested in court, but
in light of case law on analogous policies, these all have a reasonable chance
of withstanding constitutional scrutiny. A community interested in pursuing any
of these policies should involve government attorneys early in the process to
ensure the proposal is legally sound in the jurisdiction.
An important role of local government is to serve as a testing ground for new
and promising public health initiatives. One of the special features of our
constitutional system is that, to paraphrase Justice Louis Brandeis, our states
and localities serve as laboratories of democracy, testing new social and
economic experiments that can be studied, adapted, and honed to benefit other
jurisdictions. Given the recent attention to food marketing as a significant
contributor to childhood obesity, many of the policies listed in the Table are
untried or just starting to be tried. Therefore, we do not yet know which will
be most effective at limiting marketing of unhealthful foods and ultimately
improving children’s health. As local governments develop and implement policies
to address the marketing of unhealthful foods in their communities, it is
critical that they form partnerships to conduct research and generate knowledge
about the effectiveness of their policies and to transfer that knowledge to
other municipalities (27). Protecting children from the harmful effects of food
marketing requires a range of policy interventions at all levels of government —
and ultimately a change in social norms of acceptable behavior.
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Action must be taken to change the obesogenic environment that surrounds
children, and food marketing is a key contributor to that environment. Initial
actions by the food industry do not reflect a genuine commitment to reversing
the effects of persistent and prolific marketing programs directly targeted to
children, which continually reinforce the rewards of consuming nutrient-poor,
calorie-dense foods. Accordingly, both the federal and local governments have an
obligation to act. Municipalities can play a critical role in developing,
implementing, and evaluating policies to improve the marketing environment for
children in their own communities and across the country.
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This work was supported by grants from the Robert Wood Johnson Foundation
through the National Policy and Legal Analysis Network to Prevent Childhood
Obesity, a project of Public Health Law & Policy, and the Rudd Center for Food
Policy and Obesity, and by the Rudd Foundation. The authors thank Professor Mark
Aaronson for his insights on framing the manuscript. This article highlights ideas generated and conclusions reached at the Symposium on Ethical Issues in Interventions for Childhood Obesity, sponsored by the Robert Wood Johnson Foundation and Data for Solutions, Inc.
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Corresponding Author: Jennifer L. Harris, PhD, MBA, Rudd Center for Food
Policy and Obesity, Yale University, PO Box 208369, New Haven, CT 06520-8369.
Telephone: 203-432-4613. E-mail:
Author Affiliation: Samantha K. Graff, Public Health Law & Policy, Oakland,
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