Policy and System Changes in Marketing Foods to Children

In the October issue of Childhood Obesity , David Katz called for action on so-called “kid” food and proposed a day of national boycott to focus attention on this issue and bring about change. ¹ This roundtable brings together experts in policy, nutrition, and pediatrics to discuss the availability of kid food and the marketing of unhealthy food to children. The panel presents strategies and ideas on advocacy efforts and policy and system change to accelerate progress in regulating food marketing and reducing advertising of unhealthy foods to children.

David L. Katz: Is the current marketing of “kid food” in the US acceptable?

Marlene B. Schwartz: The current marketing of kid food in the US is not acceptable on two fronts. One is that the sheer volume of marketing is a huge problem because kids are being exposed to multiple messages a day to eat foods that their parents may not want them to eat. The second reason that it is unacceptable is because the research has shown, very clearly, that the foods marketed to kids are the least healthy foods in that category. ² Even companies that make some healthier products tend to not choose to market those to kids; they tend to choose their less-healthy options.

David L. Katz: With regard to your second point, Marlene, why is that the case? Is it because that is where the profit margin is: the popular items are the least healthy items? Are they popular because they are marketed or are they marketed because they are popular?

Marlene B. Schwartz: I will use cereal as an example because that is where we have done a lot of our research at the Yale Rudd Center for Food and Policy. The cereals that are marketed to kids tend to be higher in sugar and sodium and lower in fiber. When we ask the cereal companies why they choose to market those products, they say that kids will not eat the healthier cereals.

Now, our research would suggest that is not really what is going on; it is that kids actually overeat these very-high-sugar cereals. ³ So, if your business is selling cereal, you are better off marketing a highly palatable product that children will ask for and then will overeat so that their parents have to buy another box.

David L. Katz: So there is an intersect between the marketing of foods and ideas about food engineering and the inability to stop eating that Michael Moss discusses in his book, Salt Sugar Fat . ⁴ Margo, what are your thoughts?

Margo G. Wootan: A lot of companies and opponents of food marketing regulation try to position marketing as merely a matter of leaving parents to do their jobs, that companies are just doing their job and it is up to parents to say “no.” However, marketing is much more than a matter of occasionally having your kids nag you. Marketing helps to define what kids want to eat. It helps to define the social norm of eating for kids, what kids think of as food.

As Marlene said, unfortunately it helps to define a diet that is mostly unhealthy and it affects what kids are willing to eat not only at home, but also in restaurants, in child care, in after-school programs, and at school. Marketing is one of the key reasons why pizza, hamburgers, chicken nuggets, and fries dominate school lunch menus. Those are the foods that all kids are familiar with, because of marketing strategies, and have become the foods that are easiest to get children to eat.

David L. Katz: It is a good point. Marion Nestle coauthored an article with Michael Jacobson and among the salient items that I recall was that familiarity is a potent driver of dietary preference. ⁵ I imagine that cultivating that familiarity is one of the goals of marketing.

Francine R. Kaufman: It all merges into this type of adverse lifestyle that we have developed in the US—with branding, comarketing, and watching TV, where there are familiar items that we are encouraged to buy. This has somehow become the accepted mode for childhood. You wake up and have your fruity cereal with the fun images on the front of the box and all the characters that you know. Then you see it in your toy store, you see it on your TV. This marketing does not promote the kind of nutrition and healthy lifestyle that we want our kids to have—the physical and educational activities and the more-exploratory learning we would like for them. It is all intertwined into an adverse system we set up for children. It starts when they are so young and continues throughout their lives.

David L. Katz: It sounds as if we all agree that this is a problem. You are actually raising the bar in some sense in saying we have a bigger cultural problem—an adverse attitude about health in general.

Tracy Fox: The way I approach this is that it is not really marketing of kid food, per se, that is the issue, but the marketing of junk food to kids and the huge amount of funding invested in the marketing of junk food. It is very prominent in our culture. It could not be more obvious that companies are overemphasizing the foods that the Dietary Guidelines for Americans say not to encourage. The Federal Trade Commission report that highlighted the money companies spend to market food shows this to be true. ⁶ Less than one half of one percent of marketing dollars goes toward the promotion of fruits and vegetables. The money goes primarily to fast-food restaurant foods, carbonated beverages, and cereals. As Marlene said, the predominant food groups that are marketed to children are very high in sugar. I do not think that there could be much question as to whether or not the marketing of junk foods to kids is out of balance, because it is.

David L. Katz: Do we have, in your opinion, Tracy, an adequate, consistent operational definition of junk food? It is one of those things that everybody talks about, everybody feels as if they know what it is, but there is not really an agreed-upon definition. Is that an impediment to progress?

Tracy Fox: It is a good question. The $64 million dollar question always is: How do you define healthy or unhealthy food? The self-regulatory program that is operated by the Children's Food and Beverage Advertising Initiative (CFBAI) has recently updated its nutrition standards for companies to abide by when marketing to kids under 12. Most would say they are definitely an improvement over the patchwork of existing standards developed by the companies. So, at least there is one set of standards, which will go into effect in January 2014. However, there are still loopholes, and experts have identified where those loopholes are.

In general, we do have enough information. By referring to the dietary guidelines, we know what foods to encourage: fruits; vegetables; whole grains; and low-fat milk. There is not a lot of question around those items. However, we are so out of kilter with even that basic definition of healthy food and we have a long way to go.

David L. Katz: There has been a lot of recent discussion about food marketing. The First Lady has been talking about it. Other countries regulate it. But, it is oxymoronic, in a sense, to make food for a particular audience and not market it to them. So, is this really a problem with food marketing or is it the food supply? Should we be making multi-colored marshmallows and calling that part of a complete breakfast in the first place? I do not know that we can expect food companies to make a product and not market it. So, are we saying they should stop making certain foods altogether?

Margo G. Wootan: The products themselves are marketing. The Center for Science in the Public Interest (CSPI) is not only trying to reduce ads for unhealthy foods, but also to get companies to reformulate their products. Policies can lead to reformulation. When CSPI worked to require trans fats be listed on food labels, it was not only to educate consumers, but also to provide a reason, an incentive for companies to reformulate.

As a result, trans fat labeling has resulted in a decrease in trans fat in the food supply by upwards of 75%. With caloric content labeled on menus, we are seeing an effect on restaurants and they are changing foods themselves—adding healthier menu items and reformulating existing items. From food marketing policies that companies have adopted, we are already seeing that the companies themselves have been reformulating the products. It is slow going, but there is reformulation happening.

David L. Katz: I have had similar experience in our work with nutrition profiling through the NuVal^® system. We have had many reports of companies reformulating because they get a low score and, relative to something else, their sales decline. Fran, what are your thoughts on this? If we have the right focus on marketing, does it fix the products?

Francine R. Kaufman: In basic terms, if there was not the level of marketing that exists currently, there would be decreased demand and some of the products would go away.

David L. Katz: Do you think the focus on marketing can help make that happen?

Francine R. Kaufman: Yes, I do. We probably all tried to do the right thing with our own kids. I remember the first time one of my kids, my oldest son, went to McDonald's. He had seen it; he did not know what it was. He was about 5 years old, at a friend's house, and they took him to McDonald's. He called me immediately because he did not know that I knew what it was. He wanted to tell me, “It was so great!” He got a toy. I said, “What did you eat?” and he replied, “I did not eat any of it, Mom. I just got all the toys.” But he loved it and he wanted to go back.

David L. Katz: That reminds me of the comment made on The Daily Show with Jon Stewart when San Francisco set nutrition standards for the kids' meals that can be sold with toys: “The toy is the healthiest thing in the meal.” The implication was that they should keep the toy and ban everything else. It sounds like your son settled on that very solution.

Francine R. Kaufman: But, after a while, he wanted the toys and he started eating the food. If you get rid of some enticements that catch their eye, there is a chance the interest in these items might diminish.

David L. Katz: Tracy, what are your thoughts on whether we can limit the sale of these products by focusing on the marketing rather than directly saying these products have to go and no kids should be eating these foods?

Tracy Fox: That is a good way to frame it in terms of how much we could do on the front end to try to create a system where we are encouraging marketing of healthy foods directly and aggressively and discouraging the marketing of unhealthy foods. In this political environment, it is going to be hard to do anything from a real policy standpoint with Congress or the Federal Trade Commission. Advocates, Congress, and the agencies involved in the Interagency Working Group on Food Marketed to Children tried that and it did not work.

There is still hope that it will work in the future, but in the meantime, there are efforts underway to monitor, work with, and reprimand companies for their practices. If they are doing good things and marketing products responsibly, then call that out. If they are not, then call that out, too.

At the same time, we need to be working with some of the self-regulatory initiatives to see if we can strengthen the nutrition standards and answer the question: What really is a healthy food and how do you define it? We need to work with them on expanding their definition of food marketing to ensure it is not just TV focused, but also includes what is on packages, in stores, and on mobile devices. We can actually start to move the needle by looking at some of those systemic infrastructure issues.

Marlene B. Schwartz: I would like to get back to the philosophical question of whether companies should be developing and marketing a particular type or brand of food that is just for kids.

I look at it from the parents' perspective and I feel as if parents are being given extremely mixed messages. On one hand, they are told that they are responsible for feeding their child and that they need to be a role model in terms of how they eat in front of their child. They are told to have family meals and have everyone sit down and eat the meal together. All of those things suggest to me that the child should be eating the same thing that the parent is eating and that it does not make sense to buy different types of yogurt, for example, for different family members.

I do feel that there has been a shift in our willingness to let the companies define who should be eating a particular food and we just accept it. What parents really need is more confidence in their ability to feed their children well. It can be especially worrisome for parents of young children.

One of the things parents worry about the most when they have a baby is, “Is my baby getting enough to eat?” That thought seems to persist as the child gets older. Parents sometimes panic so much that their child is not eating that they then think, “They should at least have something in their belly. If I give them this food, I know for sure that they will accept it.”

We need a whole shift in terms of giving the power back to the parents and supporting parents; giving them more of a sense of self-confidence and self-efficacy, that they are capable of feeding their children and that it is perfectly fine to feed your child the same types of food that you feed yourself. The companies really capitalize on parents' fear that their child is not getting enough vitamins and minerals and manipulate them, in a way, to buy these products by making them feel insecure about their abilities.

Margo G. Wootan: I agree that the goal at home should be to move toward cooking just one meal for the family. I am one of 11 children and my mom was not a short-order cook. There was one meal and that is what you had for dinner, but there were some reasonable accommodations. Most moms do make accommodations for kids, like adding a little less hot sauce to food for younger kids or cutting the meat or vegetables into smaller pieces, so that a smaller child can eat it, or offering an alternative vegetable in the place of salad for a 2-year-old.

We all probably agree that there are some differences when feeding young children. First, infants need to be breastfed and then they transition to solids, which requires different foods, foods that are easier to chew and that are not a choking hazard. Then you have to help kids get over neophobia. Some lack front teeth, when they are younger, so you have to cut up an apple; you cannot just give them a whole apple with an elementary school lunch.

We recognize that kids need to be fed a little differently. They need fewer calories so they need nutrient-dense choices that are lower in calories and served in reasonable portion sizes. The problem is that companies are not designing food that is appropriate for kids. They are designing food that they think will be especially desirable to kids, so that kid food has become synonymous with hamburgers, pizza, macaroni and cheese, and a side of French fries. Kids' food has become synonymous with junk, when it should be just the opposite. Kid food should be the best food. It should be nutritionally superior.

The idea of kid food itself is something that we all do as parents. We do make adaptations for kids and their unique nutritional needs or their stage of development. However, what the food industry has done is a perversion of that and turned kid food into junk food.

Marlene B. Schwartz: I agree, Margo. Parents do make accommodations, but we sure do not need the industry helping with that. The things that you are talking about, leaving the sauce off the pasta or cutting things into small pieces, those are all things that parents can do without the help of General Mills and Kellogg's. It is really about teaching parents and giving them that confidence.

Frankly, people make adaptations for their spouses, too. It is not just kids for whom you make adaptations. It is about giving the parent, or whoever is cooking the meal, confidence that they can make those small changes, but it certainly does not involve buying an entirely different product, that has a picture of SpongeBob on it, at the store.

Margo G. Wootan: However, making food fun for children is not a bad thing. When my daughter was little, I bought her special plates, forks, and cups that had animals on them or chose colors that she liked or different pictures that would appeal to her. Making food fun and appealing for children is not a bad thing. The problem is that companies have put their focus on making unhealthy foods the fun foods, the appealing foods.

Marlene B. Schwartz: I get a little bit concerned when we are telling parents, “You need to make sure your child reads and does their homework and then you need to feed them healthy foods but, that is not enough, you need to make food fun also.” I feel that it puts more pressure on already-stressed-out parents that they are not good enough if they just provide healthy foods. They have to cut up the cucumber and make it look like a caterpillar as well.

I have three kids and I cannot put all that extra time into it. It should be fun enough just to sit down as a family and talk about your day.

David L. Katz: I want to expand the discussion. I am missing Brian [Wansink] now because some of his work is on how to make healthier foods appealing and maybe that is turning carrots into caterpillars.

We are well into the discussion of whether we really need kids' food and, if so, under what circumstances. What are your thoughts on when we need kid food and when we do not?

Francine R. Kaufman: I am a pediatrician. I deal with children with special healthcare needs—mainly diabetes and other metabolic issues. Even for the children with diabetes, however young they are, the goal is to get them to eat foods that the family eats, to have the family understand how to take the best foods, fruits, and vegetables that are available and incorporate them in their diet.

The goal that most pediatricians have is to go for a very short transition period from processed foods, so the child does not choke, to the child eating the same food that the family eats. Of course, taking into account the safety issues of size and texture of the food items and the risk of choking.

There has been a lot of emphasis in pediatrics on mealtime as a time for the family to spend together. Families, even with varying ages of children, should be eating the same healthy foods all together. That should be the goal. I do not think we need a section of food for people with diabetes, and, in the same way, we do not need food that is specifically for children.

Tracy Fox: No one is going to disagree that kids are physically and developmentally different. So, along the stages of growth and development, there needs to be some kind of accommodation. I do not think anybody would dispute that.

The problem is we have a system that really overemphasizes junk food without encouraging what we know is best for kids—fruits, vegetables, whole grains, and low-fat dairy. It gets back to the idea that companies are only going to market what they can reasonably get away with and make money on. The fruit and vegetable structure that we have in this country is not conducive to fruit and vegetable companies putting a lot of money into marketing because that is just not the structure of how their funding and their profit margin works. That is the underlying problem.

In terms of making healthy food fun for kids, I am sure every one of us has cut up the apple and made a face on the plate or put a little peanut butter in the celery stick and put raisins on top. However, to Marlene's point, you do not want to make a masquerade of every food by making it fun and enjoyable. Some of that is okay, but overemphasizing the fun part and making it a game every time you are trying to get the child to eat an apple is probably not the best strategy.

Margo G. Wootan: Making food fun for kids does not have to be something that is done all the time. Every once in a while a parent wants to give their child a treat. You can make healthy foods more of a treat by putting them on a special plate or cutting them up in a fun shape.

You certainly do not need to have food manufacturers making special foods for kids, but if they are going to do that, they should make sure that those foods are especially nutritious, instead of the situation that we have now where kids' food is almost all unhealthy.

Tracy Fox: It is a matter of what is the norm as well. When my kids were in elementary school, they would come home and announce that there was going to be a party. We, as parents, had to sign up to bring something. My daughter, even before she would show me the form, would say, “Mom, don't worry. I already added grapes on here. They didn't have those on the list, but I knew that was what I was going to bring anyway.” She was always happy to do that. In fact, the grapes were the first thing to go because kids were really thirsty after eating potato chips and Fritos and they were happy to get grapes or cut up green peppers, for example.

It is also about having the kids recognize that healthy food can be an important part of a celebration. Soda and junk food should not be synonymous with a party.

Francine R. Kaufman: “Fun” for most kids is participating in preparing the family meal. In the context of childhood obesity, food needs to be put back into a normal perspective. It is very important to place food back in the right perspective in our lives and our society.

David L. Katz: We have been talking about things as broad as culture and society and we moved from food marketing to attitudes about food and health. What actually inspired my editorial was thinking of us as a species and part of all of nature. ¹

I have five kids. My son is the youngest and we particularly like watching Planet Earth and Life together. It occurred to me one day, watching one of these programs, that the majority of this programming is images of beautiful places we are in the process of destroying. However, many of the programs focus on adult animals teaching their young how to eat. So much of life in nature is about acquiring the skills to sustain yourself for a lifetime.

Of course, no other species says, “Hey, you are just cubs, eat this junk. We will eat the stuff that lions are supposed to eat and you go over here and eat junk.” In fact, it is a dedicated focus on, “This is what will keep you alive. This is what will sustain you. This is the food you are adapted to eat for your lifetime.” It just seems to be absolutely indelible.

We have addressed the idea that what we share with our kids imparts lessons about what food ought to be. We have suggested, in this discussion, that if we get the marketing under control, the products might go away, but maybe we want a lightning rod. Maybe we want to say that, throughout nature, creatures teach their young how to eat for a lifetime and we are messing this up. Tracy, you said that what we call kid food is junk food. Should we think about a national day of boycott of kid food, meaning junk food, and might that shine a spotlight on this issue that the long discussions about marketing are not solving?

Tracy Fox: First, I would like to discuss the issue of all species teaching their kids what to eat for a lifetime. I will shake things up now because I would disagree with that. While certainly many animals, probably all animals, teach their young how to find food, they do not necessarily teach them what to eat.

The main difference with humans is that, unlike other mammals, we have the ability to reason and make choices. That is where the problem lies with food marketing. A lion cub in the woods is not going to have the option of fresh fruits and vegetables and whole grains. That is not what they eat. They eat other animals. It is not a choice; that is just what they do.

I would beg to differ about the analogy between humans and mammals. We give birth to live young, we drink milk at the very beginning, and we all have a little bit of hair on us. After those three, the similarities end because of our ability to reason and choose.

In terms of a national day of boycott, I like the idea as an advocate of stirring up the pot. However, I do not know that a national day of boycott would really work. I would much rather see an advocacy effort. If there is going to be a national day of something, I would like to see a more targeted focus where people are asked to boycott something specific. I would love to see a national day of “weigh-in with Nickelodeon” where viewers are given the opportunity to say they do not like marketing of junk food on their television shows. There could be weigh-ins with many different companies. I would much rather see people being activated to do something specific that triggers them to realize that there is a problem with the existing system in place.

To answer: Do we want a boycott day? I would probably say not so much. Could we use it as an opportunity to really inspire more people to advocate for changes in a specific way and recognize that the marketing system in place now is pretty bad? Yes.

David L. Katz: We mostly agree about food and policy issues, but I think we disagree about animals. A lot of animals do really need to teach their young what to eat. Certainly, herbivores have a wide array of choices and some potential food choices are toxic and some are not, so I think there is an educational component. You could argue that all animals in any given environment have access to all the same foods, but they do not all eat the same foods. There actually is an education. It is modeling, it is do as I do. So, it is experiential learning.

Marlene B. Schwartz: The idea of a boycott appeals to me because it will bring attention to the issue, but people might find a positive message more acceptable. One idea is to have a day for “One Family, One Meal.” It is about everybody sitting down as a family and eating the same thing. You could talk directly about the idea that there should not be kids' food and that what we really need is foods for the whole family and focus on that positive message. That is the approach I would take.

Margo G. Wootan: Rather than boycotting kid food, I would prefer to see a focus on improving food marketing to kids and mobilizing parents around a specific campaign, a specific company. For example, the Food Marketing Workgroup's campaigns to try to get Nickelodeon to adopt a policy on food marketing to kids, improve the nutritional quality of kids' meals in restaurants, pass state and local policies, and urge a range of companies to do better. We really need public pressure, state and local policies, litigation, and other sustained approaches to improve food marketing to kids.

I would like to go back to what was said about food being just food and we should eat for nourishment and calories. I am a nutritionist and have dedicated much of my life and time to helping people eat better. However, I reject the notion that food is only for nutrition. Food plays a very important role in our culture. It can be fun, it should be fun. It should taste good. It is a part of celebration and tradition.

If we look at food as merely nutrients and calories, we will fail in helping people to eat better. We have to recognize and acknowledge food as a part of culture and help people find ways to incorporate and use food in ways that are healthier.

David L. Katz: I totally agree with that last comment. The position I would defend is loving food that loves us back. Food is one of life's great pleasures. Ultimately, our arguments about eating better are about health, but health really is for living. Health is a currency you spend on having a better life, and, frankly, eating well is something that makes life better, too. Ideally, if we reshape the prevailing palate, something like the Mediterranean diet is not exactly a hardship. We could eat a lot better and enjoy it. I do agree that is certainly what we are aiming for, but we have a long way to go.

I am actually a little surprised, Margo, that you do not support the idea of a boycott, since CSPI often does some fairly provocative things to draw attention to an issue and it often works quite well.

Margo G. Wootan: Yes, I just think that boycotting kid food is a little off topic. I do not think the problem is that companies are making food fun for kids. The problem is they are making unhealthy food fun for kids and they are encouraging kids to eat a diet that contributes to obesity.

Francine R. Kaufman: I agree, food has a huge role in our culture, but we have to promote healthy food and put it in the proper perspective within our culture.

David L. Katz: My concern is it seems we are talking about strategies that we have already been using. What could we do differently? Are we really just saying, “Let us keep doing what we have been doing?” If so, those of you who have been in the trenches, is it enough? Are we going to win? Is it just a matter of staying the course and making the argument again and again and again that the junkiest food is being marketed to kids and that is wrong?

Marlene B. Schwartz: I wish that it would work. I wish that the food industry would respond in such a way that they started helping parents by marketing the very same foods that parents are really trying to promote and want their children to eat. At the Rudd Center, we have been working on it for about 6 years. Other people have been at it a lot longer than that, and there has not been very much progress. There have been tiny increases in healthier foods being marketed, but there have been bigger increases in unhealthy foods being marketed.

I am worried that we will keep using the same approach and industry will keep inching its way along trying to reformulate a little bit so that it can squeeze in under some sort of nutrition standard, but it is really missing the point. The basic foods that are on my plate, the ones that do not come in a box, those are the foods that we should be promoting. It might be a losing battle trying to convince the industry to change that much.

Margo G. Wootan: I have been working on food marketing to kids for about 15 years. There has been measurable progress on food marketing to kids, but certainly our work is far from done. The percentage of food ads that are for unhealthy food during children's programming has gone down. On Nickelodeon, the absolute number of junk food ads has gone down by 60% since 2005. ⁷ Now, granted, the majority of ads are for unhealthy foods still, but this is the first decrease in unhealthy food marketing that has ever been measured.

We are starting to have an effect. It is just not happening fast enough. As the First Lady said, companies need to do more and they need to do it faster. If companies adopt stronger nutrition standards, cover all their media approaches, and participate in self-regulation, we can continue to make progress and continue to see declines in unhealthy food marketing to kids.

David L. Katz: To refer back to this notion that we are part of a natural system in which adults teach their young how to eat, I wrote a commentary on that initially for US News and World Report and I think it was the most viewed, most-commented-on piece that they had ever published. ⁸ There seemed to be a lot of traction. The value in it might be the potential to attract new attention, even if, ultimately, the solutions we want are the same.

Tracy Fox: In terms of whether or not we are really seeing progress, Marlene is right, it has been incremental, but it has been moving in the right direction. This is where the pragmatic part of me comes in, in terms of living and working in Washington for over 25 years on policy issues and seeing different Congresses come and go.

Taking this approach, as advocates and nutrition professionals and other experts, like you David, we have to recognize the need to work within the political environment, and times are tough. We have to maneuver in a political environment that is not conducive to big-hammer-coming-down types of approaches. Not that anybody is specifically recommending that, but we need to continue to collect the data, monitor where we are, and continue to hold companies responsible. Honestly, at this point, inching toward the ultimate goal is about all we can reasonably do.

Trying to get more people activated and understanding this issue—not necessarily through a boycott—is key to helping create leverage and momentum.