Children and adolescents in the United States consume too many calories, including empty calories from foods and beverages high in sugar and saturated fat, placing themat risk for obesity and obesity-related diseases including type 2 diabetesmellitus, hypertension, and cancer.1-3 Yet food companies continue to directly target young people with marketing for products that contribute to poor health. They spend$1.8 billion annually in youth-targetedmarketing,with thepromotionof fast food, sugarydrinks, sugarybreakfast cereals, and candy accounting for 90% of these expenditures.4 Although companies have promised to market healthier choices to children younger than 12 years of age, there have been few improvements in the overall landscape of foodmarketed to children.5 In addition, companies continue to view children 12 years of age and older as an important targetmarketandoutside thescopeofcurrent self-regulatory initiatives.6 Marketing in schools is one tool in the foodcompanies’ diverse toolbox to encourage children and adolescents to consumetheirbrandsandrecruit lifelong loyal customers. In2009, food and beverage companies spent $149 million on inschool marketing. This amount represents 8% of total youthtargeted food marketing expenditures and the third-largest category of promotional activity behind television and premiums.4 Carbonated and other sugary beverages account for more than 90% of school-based marketing expenditures, followed by fast food. Snack foods, candy, and baked goods, as well as dairy products, also are marketed in schools. Most of these products are high in sugar, calories, and fat and are inconsistent with recommendations of the Dietary Guidelines for Americans.7 The school environment provides an optimal setting for companies to reach youth, but this marketing raises significant public health concerns. Students are “a captive audience,” exposed to school-based marketing messages multiple times over the almost 200 days per year they spend in school. Continuous exposure to brand logos directly increases long-term preferences for brands.8 Furthermore, school-based marketing occurs without parental interference. Even if parents are aware ofmarketing to their children in school, their ability to change these practices is limited. In addition, marketing in schools implies the school’s endorsement of the products.Howcan schools effectively teach good nutritionwhen theproducts they tell children to limit are featured in school halls, cafeterias, vending machines, and athletic fields? All too often school officials believe that corporate supportprovidesanacceptable solution toaddressbudget shortfalls. However, this short-term solution comes with the potential for long-term detriment to students’ health and well-being. In this month’s JAMA Pediatrics, Terry-McElrath and colleagues9 provide an important contribution to our understandingof theprevalenceandtypesof foodandbeveragemarketing in schools. To our knowledge, their article9 is the first toquantify foodmarketing in anational sampleof schools and to measure changes over a 6-year period. Many of the findings are surprising and disturbing. Almost two-thirds of elementary schools provide food coupons as student incentives (eg, Pizza Hut’s Book It program10 and Sonic Limeades for Learning11). In cafeterias, 10% of elementary schools and 30% of high schools serve branded fast food weekly; 19% of highschools serve it everyday.From2007 to2012, onlymiddle schools exhibited a significant reduction in food marketing, while 70% of elementaryand middle-school students continue to encounter some form of food-related marketing. Although incidence is low at 6%, posters or other ads for soft drinks, fast food, and candy increased steadily in elementary schools from 2008. Vending contracts remain prevalent but contributeminimal financial support: approximately $2 to $4 per studentannually.Not surprisingly,middleandhighschools with ahighpercentage of low-income students havemore exclusive vending beverage contracts than other schools. The school-based food and beverage marketing described in Terry-McElrath et al9 understates the overall picture. As documented by others,4,12-15 the full range of inschool marketing practices is even broader. Branded fundraising sponsoredby food companies is common, including direct sales of products (eg, David’s Cookies16 and Hershey’s candy17) and reward programs for families’ purchases (eg, General Mills’ Box Tops for Education18 andMy Coke Rewards for schools19). Ronald McDonald visits elementary schools to teach children abouthealthy eating,20 and fast food restaurants donate a percent of the night’s proceeds in return for in-school promotions.21 Soda and sports drink logos are commonly featured on donated school equipment such as scoreboards and beverage coolers.15 Food marketing also enters the classroom through display advertising on Internet search engines and educational websites such as coolmath-games.com22 and Channel One News.23 Across all demographic groups, two-thirdsof parents support regulations to limit advertising and sponsorships of unhealthy foods and beverages in schools, a higher level of support thanregulationsonfoodmarketing tochildren inanyother Related article page 234 Opinion
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Jan 1, 2015
Kevin M Guskiewicz + 1
Open Access