Environmental risk factors for obesity

Excess body weight affects more than a quarter of all children in developed economies¹, and is now appearing at a dramatic rate in less developed economies among children experiencing rapid urbanisation and exposure to western forms of food supply^2,3.

Successful interventions to tackle childhood obesity have proved elusive, prompting an increased focus on environmental influences. The ‘heavy marketing of energy dense foods and fast food outlets’ is a ‘probable risk factor’ for obesity⁴. The European Commission’s 2007 White Paper Strategy on Overweight and Obesity urged industry to take voluntary action on this issue, with a plan to reassess this position in 2010-2011⁵.

The PolMark (POLicies on MARKeting of foods and beverages to children) project is designed to strengthen the evidence base available to policy-makers.

Analysis of the European environment

An updated review of current controls and regulations on marketing to children in all 27 European Union member states, last undertaken by the World Health Organization in 2005-6, was conducted for almost all European countries (as defined by the WHO European Region of 53 countries).

Leading representatives of the food industry, advertising agencies, media, government departments, public health bodies, consumer group, children’s groups and researchers were interviewed in 11 EU member states, for a total of 169 interviews. Interview questions assessed stakeholders’ views on marketing food and beverages to children, and the likely opportunities and barriers which exist in developing policies in this area.

A health impact assessment was conducted using stakeholder estimates of the effects of exposure to marketing messages (a proxy for exposure to health risk) on food choices and food consumption behaviour (a proxy for impact on health). Responses were analysed in the context of other stakeholder responses to map the relationship across dimensions of stakeholder interest (i.e. pro-commerce, neutral or pro-child) and power (as defined by annual turnover, head office employees, media department budget, number of media staff, and advocacy and lobbying budget).

Emergence of statutory approaches

Two thirds of WHO European countries now have statements on marketing to children in their national health policies or strategies, or proposals for action. While voluntary and self-regulation lead the policy response in many countries, statutory approaches are emerging.

Interviews revealed that two-thirds of stakeholders believed current controls in their country were not sufficient. Statutory regulations were preferred across all stakeholder groups with the exception of government officials, the food industry and advertising agencies.

Stakeholder views are prone to bias according to their organisation’s interests and power to influence policies. Stakeholders from high-power organisations with commercial interests were more moderate in their estimation of effects of various marketing techniques on purchase and consumption compared to stakeholders from lower-power organisations and those with health and consumer-focused interests. Stakeholders from organisations with less power tended to perceive current regulations on risk exposure as being weaker than needed, while stakeholders from more powerful organisations tended to perceive current levels of regulation as adequate.

Pressure to act

If governments wish to reduce children’s exposure to unhealthy food marketing, they need to maintain pressure for action on industry and on the more resistant parts of government. Whether the controls are statutory or self-regulatory, governments need to specify the policy objectives, define the indicators that demonstrate achievement and hold relevant stakeholders accountable for making progress. Companies are competitive and will use opportunities to market their products to children using traditional and modern media; the latter allowing them to access children without parental control. The opportunities for finding common ground – e.g., finding standards for co-regulation across the food industry and across European borders – need to be increased. By definition, less powerful organisations do not have the institutional resources to influence policy-makers which more powerful organisations can command, resulting in a potential imbalance in the democratic process which policy-makers should be aware of.