Abstract
BackgroundUltra-processed food consumption is a risk factor for obesity and has a negative environmental impact. Food companies spend billions of dollars on advertisements each year to increase the consumption of ultra-processed food. In Australia, USA, and New Zealand, most food advertisements around schools and in train stations promote ultra-processed food, but no similar studies have been conducted in Sweden. The aim of this study was to explore the proportion of ultra-processed food advertisements in two districts of Stockholm, Sweden with low vs. high socioeconomic status (SES).MethodsTwo independent researchers (per area) mapped all advertisements, including storefronts, in two Stockholm districts. During consecutive days, all advertisements were photographed in Skärholmen (low SES district), and Östermalmstorg (high SES district), on the streets inside and outside the subway stations, as well as inside and outside of local shopping malls. Advertisements promoting food products were identified and a trained dietician categorized whether they promoted ultra-processed foods. Chi-Square test was conducted to test for differences in the proportion of ultra-processed food advertisements between the two study areas.ResultsIn total, 4092 advertisements were photographed in Skärholmen (n = 1935) and Östermalm (n = 2157). 32.8% of all advertisements promoted food, while 65.4% of food advertisements promoted ultra-processed foods. A significantly higher proportion of ultra-processed food advertisements out of total food advertisements was identified in the low SES area, irrespective of the researcher taking the pictures (74.6% vs. 61.8%, p < 0.001 and 70.4% vs. 54.8%, p = 0.001). There was no significant difference in the proportion of food advertisements out of total advertisements between the two areas.ConclusionsThis study provides initial evidence about the scale and the differences in exposure to food advertisements across areas in Stockholm. The observed high proportion of ultra-processed food advertisements is concerning and is in sharp contrast to the Swedish dietary guidelines that recommend reduced consumption of such foods. Based on our results, residents in low SES areas might be more exposed to ultra-processed food advertisements than those in high SES areas in Stockholm. If such findings are confirmed in additional areas, they should be considered during the deployment of food advertisement regulatory actions.
Highlights
Today, obesity is one of the greatest public health threats in the world
Out of the ads included in the final dataset, 1341 pictures (32.8% of total ads) were ads promoting food products (33.1% in Skärholmen vs. 32.5% in Östermalm), while 877 pictures (65.4% of all food ads) were of ads promoting ultra-processed food products
Our study reveals that two districts of low vs high socioeconomic status in Stockholm municipality are being exposed to a high proportion of ultra-processed food advertisements out of total food ads
Summary
Obesity is one of the greatest public health threats in the world. obesity is associated with early death [1], type 2 diabetes [2], coronary artery disease [2], cancer [3] and depression [4], while the global economic burden of obesity has been estimated to be equivalent to that of smoking or armed violence, war, and terrorism added together [5]. The public health threat of obesity is growing, as its global prevalence has been steadily increasing from 3.2 and 6.4% in 1975, among men and women respectively, to 10.8 and 14.9% in 2014 [6]. This observation indicates that the problem might further worsen in the coming decades, if the trend continues. A food type that has been shown to promote overconsumption of energy and subsequent weight gain is ultraprocessed foods (i.e. fast foods such as sugary drinks, junk foods and convenience foods). Recent epidemiological studies have linked ultra-processed foods to both weight gain and increased obesity prevalence [9]. The aim of this study was to explore the proportion of ultra-processed food advertisements in two districts of Stockholm, Sweden with low vs. high socioeconomic status (SES)
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