* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Nutritional Imbalance Endorsed by Televised Food Advertisements
Survey
Document related concepts
Malnutrition wikipedia , lookup
Hunger in the United States wikipedia , lookup
Academy of Nutrition and Dietetics wikipedia , lookup
Food safety wikipedia , lookup
Overeaters Anonymous wikipedia , lookup
Human nutrition wikipedia , lookup
Obesity and the environment wikipedia , lookup
Food studies wikipedia , lookup
Food coloring wikipedia , lookup
Food politics wikipedia , lookup
Childhood obesity in Australia wikipedia , lookup
Transcript
RESEARCH Research and Practice Innovations Nutritional Imbalance Endorsed by Televised Food Advertisements MICHAEL MINK, PhD; ALEXANDRA EVANS, PhD; CHARITY G. MOORE, PhD; KRISTINE S. CALDERON, PhD, CHES; SHANNON DEGER, MPH, CHES ABSTRACT The ubiquity of television in American culture makes it a potential contributor to the obesogenic (obesity-causing) environment. Televised food advertisements, which encourage viewers to eat the foods promoted for sale, constitute a de facto set of dietary endorsements. The purpose of this study was to compare the nutritional content of food choices endorsed on television to nutritional guidelines. Using a cross-sectional design, food advertisements were observed during 84 hours of primetime and 12 hours of Saturday-morning televised broadcast during the fall of 2004. One-sample t tests were used to compare the food group servings of observed food items to the recommended daily servings and to compare the nutrient content of observed food items to the Daily Values. Results suggest that a diet consisting of observed food items would provide 2,560% of the recommended daily servings for sugars, 2,080% of the recommended daily servings for fat, 40% of the recommended daily servings for vegetables, 32% of the recommended daily servings for dairy, and 27% of the recommended daily servings for fruits. The same diet would substantially oversupply protein, total fat, saturated fat, cholesterol, and sodium, while substantially undersupplying carbohydrates, fiber, vitamins A, E, and D, pantothenic acid, iron, phosphorous, calcium, magnesium, copper, and potassium. Overall, the food choices endorsed on television fail to meet nutrition guidelines and encourage nutritional imbalance. J Am Diet Assoc. 2010;110:904-910. M. Mink is an assistant professor and MPH program coordinator, Armstrong Atlantic State University, Savannah, GA. A. Evans is associate professor, University of Texas School of Public Health, Austin. C. G. Moore is associate professor of medicine, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA. K. S. Calderon is director of collaborative grants, MedXcel, Tampa, FL. S. Deger is a DrPH student, University of Hawaii, Honolulu. Address correspondence to: Michael Mink, PhD, Armstrong Atlantic State University, 11935 Abercorn St, Savannah, GA 31419. E-mail: [email protected] Manuscript accepted: September 11, 2009. Copyright © 2010 by the American Dietetic Association. 0002-8223/$36.00 doi: 10.1016/j.jada.2010.03.020 904 Journal of the AMERICAN DIETETIC ASSOCIATION T he critical influence of environment on eating behaviors has become well recognized (1). Dr Kelly Brownell (2) has led the charge against what he calls the “toxic” food and physical activity environment in America, arguing “that genetic susceptibility, no matter how strong, will rarely create obesity in the absence of a bad environment” (2). Media messages function as one of the major variables of the environment that influence health behavior (3). In fact, mass media may be one of the most important environmental influences on health behavior because of their ubiquity and role as the primary source of public information about health (4). Television reaches more people each day than any other medium, in almost every major demographic market segment (5). By age 65, the average person will have seen about 2 million advertisements on television (6), of which a large proportion will be for foods. In 2004, annual expenditures on food-related advertisements totaled $11.26 billion (7), while the US Department of Agriculture spent a mere 2% of that amount ($268 million) on all nutrition education (8). A joint report by the California Pan-Ethnic Health Network and the Consumers Union states “the overwhelming presence of food and beverage advertising in American life is a powerful part of the context that cannot be ignored in a discussion of eating and obesity trends in the United States” (8). Five recent studies found that the nutrient content of advertised foods directly contradicts dietary guidelines (9-13), and eight additional studies found food advertisements on television to be biased toward foods that are high in fat, sugars, and salt (14-22). Despite the growing evidence suggesting a bias toward marketing unhealthy foods, methodological issues in previous studies limit the application of these results. First, some studies used the number of advertisements instead of servings as the unit of analysis (14,15,17,18,20). Because consumption is measured by servings, counting advertisements cannot accurately reflect the endorsed intake amounts. Second, some studies created an “unhealthy” food group based on the oversupply of salt, sugars, or fat and compared the number of unhealthy foods to the number of healthy foods (10,15,17,19-22). These groupings ignored other nutrient imbalances and precluded measuring the degree of nutritional imbalance in observed foods. Third, most of these studies failed to use statistical analysis to compare observed foods to serving guidelines, and the few that did use statistical procedures employed nonstandard food groups (12,16,19,22,23). Finally, although several studies compared observed foods to recommended food group servings, none of them com- © 2010 by the American Dietetic Association pared nutrient content in observed foods to dietary reference intakes. Therefore, the purpose of this study was to use improved methods to critically assess the nutritional quality of food choices endorsed on American television by comparing advertised foods to nutrition guidelines. Based on previous research, the authors hypothesized that observed food advertisements would endorse a set of food choices that contradicts nutrition guidelines and promotes nutritional imbalances. METHODS Study Design This study used a nonexperimental, cross-sectional design that involved both qualitative and quantitative methods to analyze the nutritional content of foods advertised on American television. The design of this study included the following innovations: focusing exclusively on advertisements because they are specifically constructed to influence purchasing behavior; using serving sizes instead of food items as the unit of analysis; limiting serving categories to the food groups of the Food Guide Pyramid (24); adding a second set of analyses to compare the nutrient content of observed foods to established nutrient intake goals; and using statistical analysis to compare observations to guidelines. Sample Selection Eighty-four hours of primetime and 12 hours of Saturdaymorning broadcast were observed during 28 consecutive days during the fall of 2004. Observations were limited to the four major broadcast television networks (ie, ABC, CBS, FOX, and NBC) because 99% of all American households have access to these stations, compared to only 56% with cable service (9). Primetime shows were selected because they air the highest proportion of nationwide advertisements. Observations rotated through the four sample networks on a daily basis in order to get a complete profile of each network across every day of the week. The Saturday-morning cartoon segment (from 8:00 AM to 11:00 AM) was included to capture the food advertisements marketed primarily to children. Content Observation All 96 hours of observations were videotaped and reviewed later to identify food advertisements and specific food items being promoted for sale. Only food items that were clearly promoted for sale during an advertisement were recorded. Foods displayed as background to other featured foods were not included in the sample because these foods were not clearly being promoted for sale. In fact, many background foods were not even available for sale from the advertisement sponsor. Nutrition Data Collection Each food item observed was entered into Nutritionist Pro software program to obtain a nutritional profile (Nutritionist Pro 2.5.1, 2003, Axxya Systems, Stafford, TX). Each nutritional profile identified the number of servings provided in each food group and the amount of every essential nutrient contained in the observed food item. Whenever possible, brand-specific nutrient profiles were used in the final dataset. Otherwise, generic food-item profiles were used. In rare instances (⬍1% of food items), substitute brand-specific profiles were used, but only when the original brand was not available in Nutritionist Pro and the substitute food had highly similar ingredients. This method provided a more complete profile than using the data from nutrition labels or product Web sites. Data in each food-item’s profile were based on the portion sizes promoted in the respective advertisements. When a distinct item (eg, an apple or a hamburger) was promoted, that single item was used as the portion size. When the portion size for one person was clearly identified (eg, a large soft drink), the endorsed portion was used to calculate the servings in Nutritionist Pro. When the portion size for a single person was not identifiable in the advertisement (eg, a large pizza or a pasta bar), the single serving defined in Nutritionist Pro was used as the default portion. Data Analysis Food Group Comparisons. One-sample t tests were conducted using SPSS (SPSS 12.0, 2003, Apache Software Foundation, Forest Hill, MD) to compare the number of servings in the observed food items to the recommended daily servings of the Food Guide Pyramid (24). (Because the data were observed in the fall of 2004, this comparison was made to the version of the Food Guide Pyramid that was most current at that time.) This comparison was problematic for two reasons. First, the recommended daily servings are stated in terms of a range of servings per day (eg, six to 11 servings of grains), while the servings provided by food items are expressed as specific point values (eg, three servings of grains). Second, the recommended daily servings reflect a daily intake amount, while a single food item contains a fraction of daily intake. Therefore, this comparison required converting the recommended daily servings into per-food-item values. This conversion required two steps. First, the recommended daily servings for each food group were converted from a daily intake range into a daily point value by simply finding the midpoint of each range. For example, the midpoint value of the recommended daily servings for vegetables (3 to 5 servings) is 4 servings. Second, the daily point value for each recommended daily servings was converted to a per-food-item value by dividing the daily point value by the number of observed food items needed to meet daily calorie needs of 2,000 kcal. This daily calorie intake target was selected because it is the standard of daily intake used on food labels (25). Because the average observed food item provided one eighth of the daily requirement for calories (258 kcal/2,000 kcal), eating eight observed foods would meet daily calorie needs. Dividing each midpoint value by eight provided an estimate of the recommended daily servings for individual food items. This calculation elicited the following perfood-item recommended daily servings values: 0.06 servings of sugars, 0.06 servings of fat, 0.31 servings of meat, 0.31 servings of dairy, 0.5 servings of vegetables, 0.38 servings of fruits, and 1.06 servings of grains. (Note that in 2004, the Food Guide Pyramid grouped sugars and fat together into a single food group. Because Nutritionist June 2010 ● Journal of the AMERICAN DIETETIC ASSOCIATION 905 Pro software separated serving data from these two groups, this study treated these two groups separately to increase specificity.) This conversion calculation was based on the logic that, in order to be balanced, a diet providing 100% of a day’s supply of calories should also supply roughly 100% of the recommended daily servings in each food group. Nutrient Content Comparisons. One-sample t tests were used to compare the amount of calories, macronutrients, vitamins, and minerals to the respective Daily Values used for nutritional labeling. The Daily Values were chosen for this analysis because these are the nutrition guidelines used on food labels, which makes them highly accessible to the public, and because they provide a single set of daily guidelines for all people older than the age of 4 years (25). To conduct the t tests, all nutrient values were converted into percentages of their respective daily values. For example, a food item with 200 calories would be divided by the Daily Value of 2,000 calories to get 10% Daily Value for calories. Expressing the nutrient amounts as a percent of the Daily Value allowed meaningful comparisons across different nutrients. Because the average observed food item provided 13% of the daily requirement for calories (258 kcal/2,000 kcal), the expected value used for each t test was 13%. As with the food group comparisons, this expected value was based on the logic that, in order to be balanced, any group of foods that supplies 100% of the Daily Value of calories should also supply roughly 100% of each nutrient’s Daily Value. RESULTS Summary Statistics During the 28 consecutive days, 96 hours of television broadcast were recorded on videotape. Two of the 96 hours were taped improperly and 4.5 were free of advertisements (presidential and vice-presidential debates), leaving 89.5 hours for viewing. Reviews of the videotapes identified 3,584 total advertisements, 614 food advertisements (17% of total), and 831 food-item endorsements. There were no nutritional data available in Nutritionist Pro for 56 (7%) of the 831 observed foods, leaving 775 nutrient profiles for the analyses. Of the 116 public service announcements observed during the 96-hour observation period, none addressed nutrition education. Some of the advertisements for breakfast cereals did state that the featured product should be eaten “as part of a complete breakfast.” However, this warning did not define a “complete breakfast” or identify what other food additions would make a breakfast complete. To monitor the accuracy of observation data in this study, an additional rater watched a random sample of 12.5% of the total broadcast hours using the same observation protocol as the first observer. For the inter-observer reliability test, agreement between the two observers was calculated by dividing the number of recorded items that were identical in both sets of observations by the total number of nonduplicated recorded items. This yielded 94% agreement on both identified advertisements (471 of 500) and featured food items (117 of 124). This high degree of inter-observer reliability helps support the 906 June 2010 Volume 110 Number 6 integrity of the nutrition data that were based on television observations. Food-Group Serving Analysis Of the 775 observed foods with nutrient profiles, 67 did not provide any food-group servings. These foods, which included vitamin supplements, artificial sweeteners, black coffee, unsweetened tea, diet soda, bottled water, and alcoholic beverages, were therefore not included in the food-group analysis. Of the remaining 708 nutrient profiles, 677 (96%) contained food-group serving data. Results from the one-sample t tests suggest that the observed food items fail to comply with Food Guide Pyramid recommendations in every food group except grains. When compared to the per-food-item recommended daily servings values (see “Food Group Comparisons” in the Methods section for an explanation of per-food-item recommended daily servings values), the average observed food item contained excessive servings of sugars (1.62 servings vs 0.06 servings; P⬍0.001), fat (1.27 servings vs 0.06 servings; P⬍0.001), and meat (0.43 servings vs 0.31 servings; P⬍0.001), and inadequate servings of dairy (0.11 servings vs 0.31 servings; P⬍0.001), fruit (0.06 servings vs 0.38 servings; P⬍0.001), and vegetables (0.18 servings vs 0.50 servings; P⬍0.001). Nutrient Analysis Although Nutritionist Pro provided nutrient content information for 775 of the observed food items, not every available nutrient profile was complete. The following nutrients were omitted from the analysis, because the corresponding data were available in ⬍30% of the observed food items: vitamin K, iodine, biotin, chromium, molybdenum, and fluoride. Data on the remaining 27 essential nutrients were used for this analysis. As explained in the Methods section, the observed foods were expected to provide 13% of the Daily Value for every essential nutrient. Results of comparisons to this expected value found that observed foods oversupplied eight nutrients: protein (22.8%; P⬍0.001), selenium (20.8%; P⬍0.001), sodium (20.3%; P⬍0.001), niacin (18.0%; P⬍0.001), total fat (17.8%; P⬍0.001), saturated fat (17.1%; P⬍0.001), thiamin (16.4%; P⫽0.001), and cholesterol (15.2%; P⫽0.018). These same foods undersupplied 12 nutrients: iron (10.7%; P⬍0.001), phosphorus (10.3%; P⬍0.001), vitamin A (9.9%; P⫽0.001), carbohydrates (9.1%; P⬍0.001), calcium (6.9%; P⬍0.001), vitamin E (6.3%; P⬍0.001), magnesium (6.2%; P⬍0.001), copper (6.1%; P⬍0.001), potassium (5.7%; P⬍0.001), pantothenic acid (5.7%; P⬍0.001), fiber (5.4%; P⬍0.001), and vitamin D (4.4%; P⬍0.001). DISCUSSION The purpose of this study was to compare the nutritional content of food choices endorsed on television to established nutrition guidelines. Findings suggest that a diet of foods advertised on American television would fail to comply with recommendations of both the Food Guide Pyramid and Daily Values. The average food item in this study provided too many servings of sugars, fat, and meat, and too few servings of dairy, fruits, and vegeta- Figure 1. Food group servings provided by a daily diet of advertised foods as compared to Food Guide Pyramid recommendations. *Deviates significantly from recommendations; P⬍0.001. Figure 2. Nutrients that would be significantly oversupplied by a 2,000-calorie diet of advertised foods. bles. These foods also oversupplied eight essential nutrients while undersupplying 12 essential nutrients. A 2,000-calorie diet consisting entirely of advertised foods would contain 25 times the recommended servings of sugars and 20 times the recommended servings of fat, but less than half of the recommended servings of vegetables, dairy, and fruits (see Figure 1). In fact, the excess of servings in sugars and fat is so large that, on average, eating just one of the observed food items would provide more than three times the recommended daily servings for sugars and two and a half times the recommended daily servings for fat for the entire day. This suggests that advertised foods would have to be consumed infrequently to maintain a balanced diet. And although these endorsements did appear to contain the recommended servings of grains, the extremely low fiber content of the endorsed foods (only 5.4% of Daily Value per food item) suggests that these grain servings are of poor quality. The same 2,000-calorie diet would provide ⬎150% of the Daily Value for protein, selenium, and sodium, and ⬎120% of the Daily Value for total fat, saturated fat, and cholesterol (see Figure 2), but only about half of the Daily Value for calcium, vitamin E, and magnesium, and less than half of the Daily Value for copper, potassium, pantothenic acid, fiber, and vitamin D (see Figure 3). Although some of these imbalances are not likely to be harmful, such as slight overages of water-soluble B vitamins, others could contribute to chronic illnesses. June 2010 ● Journal of the AMERICAN DIETETIC ASSOCIATION 907 Figure 3. Nutrients that would be significantly undersupplied by a 2,000-calorie diet of advertised foods. The pattern of nutritional imbalance found in advertised foods mimics the pattern of imbalance in the common American diet. According to the 2005 Dietary Guidelines for Americans, Americans consume too much saturated fat, cholesterol, sodium, and added sugars (26), all of which were oversupplied in advertised foods, and too little calcium, potassium, fiber, magnesium, vitamin A, and vitamin E (26), all of which were undersupplied in advertised foods. This similarity suggests that exposure to television could be a contributor to the nutritional imbalances commonly found in the American diet. Food-related advertisements accounted for about 17% of all advertisements in this study, for an average of three food advertisements every 30 minutes of broadcast; yet no nutrition-related public service announcements occurred during the observation period. Because Americans watch or listen to 6.75 hours of television per day (6), the average American is exposed to ⬎14,780 nutrition messages each year that are biased toward nutritionally imbalanced foods, without any nutrition-related public service announcements to help counter this misinformation. Limitations The observation period of 28 consecutive days is representative of the fall 2004 broadcast season, but may not represent the advertising content of other broadcast seasons. Although there is no reason to assume that the observation period was unusual in its advertising content, there is no guarantee that the observed content will remain consistent across other seasons. Additional re- 908 June 2010 Volume 110 Number 6 search should compare the content of several seasons to assess any changes in advertising content across time. Omission of 7% of the observed foods that did not have nutrient profiles available in Nutritionist Pro could have skewed the data slightly. Because most of these omitted foods were very new, processed foods, the effect of their exclusion may have caused the results to slightly underestimate deviation from nutrition guidelines. Missing nutritional data could not be found on product Web sites and the data on their respective nutrition labels were inadequate for this analysis. It is important to note that this study did not intend to measure eating habits that might result from exposure to television food advertising. Because this study has established strong evidence to suggest that foods endorsed by television advertisements deviate considerably from nutrition guidelines, future research should explore the degree to which these endorsements influence viewers’ actual food choices and eating behaviors. CONCLUSION The results of this study suggest the foods advertised on television tend to oversupply nutrients associated with chronic illness (eg, saturated fat, cholesterol, and sodium) and undersupply nutrients that help protect against illness (eg, fiber, vitamins A, E, and D, calcium, and potassium). Although this study did not attempt to assess appropriate response to this bias for advertising unhealthful food selections, the authors recommend inves- tigating health-promotion strategies that target consumers, the food industry, public media, and regulation. Consumer-based strategies should focus on three parts. First, the public should be informed about the nature and extent of the bias in televised food advertisements. Educational efforts should identify the specific nutrients that tend to be oversupplied and undersupplied in advertised foods and should specify the single food items that surpass an entire day’s worth of sugar and fat servings. Second, educational efforts should also provide consumers with skills for distinguishing balanced food selections from imbalanced food selections. For example, interactive Web sites could be developed that test a participant’s ability to identify imbalanced food selections from a list of options. This type of game-based approach would likely appeal to youths and adults. Third, the public should be directed to established nutrition guidelines and other credible resources for making healthful food choices. Food industry strategies should focus on education and coalition building. First, food producers and retailers should be educated about the nutritional imbalance of the foods they elect to advertise. There is no evidence to suggest that this collective bias was intentional and food advertisers might welcome an opportunity to promote their more nutrient-balanced products. Second, health professionals should partner with consumers and the food industry to find mutually beneficial ways to eliminate the advertising bias toward unhealthful foods. Food marketing can be used to support, instead of impede, public health nutrition efforts. As an example, dietary fat consumption in the United States did not decrease after years of public awareness efforts, until fat-related health claims were included in televised advertisements for specific foods (27). Connecting consumers with food industry representatives could be the critical component that leads to a voluntary shift in advertising strategies toward more healthful food offerings. Public media strategies should focus on education and policy change. Television broadcasters could be encouraged by a variety of incentives to air more public service announcements and to ensure that a certain proportion provide nutrition education. To help this process, health professionals can make a concerted effort to submit more public service announcements to their local media outlets on a regular basis. This effort would help public media fulfill their community service obligations. Finally, government policies should couple increased educational opportunities with increased regulation. For example, new policies should be considered to require a minimum number of nutrition-related public service announcements during primetime programming. However, education by itself will be inadequate. Regulatory policies should also be endorsed to limit or require mandatory disclaimers in advertisements for high-fat, high-sugar, and low-nutrient-density foods, especially for single food items that surpass daily intake limits of sugar and fat servings. Models for such regulation can be found in countries that have restricted food advertisements (eg, France, Thailand, China, Denmark, Finland, Malaysia, Korea, Romania, and the Philippines), as well as countries that have banned, to varying degrees, advertisements of unhealthy foods to children (eg, Norway, Sweden, and the United Kingdom) (28). Much like current restrictions on direct-to-consumer drug advertisements found in the United States, nutritional warnings for imbalanced foods could provide consumers with much needed information about health effects of food choices and help reallocate some of the burden of identifying healthful food options from consumers to food producers and retailers. STATEMENT OF POTENTIAL CONFLICT OF INTEREST: No potential conflict of interest was reported by the authors. FUNDING/SUPPORT: The authors received no funding to conduct this work from any source. References 1. Boyle MA. Community Nutrition in Action. 3rd ed. Belmont, CA: Thomson Wadsworth; 2003. 2. Brownell KD. The environment and obesity. In: Fairburn CG, Brownell KD, eds. Eating Disorders and Obesity: A Comprehensive Handbook. 2nd ed. New York, NY: The Guilford Press; 2002:467472. 3. Cohen DA, Scribner RA, Farley TA. A structural model of health behavior: A pragmatic approach to explain and influence health behaviors at the populations level. Prev Med. 2000;30:146-154. 4. Finnegan JR Jr, Viswanath K. Communication theory and health behavior change: The media studies framework. In: Glanz K, Rimer BK, Lewis FM, eds. Health Behavior and Health Education. 3rd ed. San Francisco, CA: Jossey-Bass; 2002:361-388. 5. Media Comparisons Study. Television Bureau of Advertising Web site. http://www.tvb.org/nav/build_frameset.aspx. Accessed November 3, 2008. 6. Herr N. Television Statistics. The Sourcebook for Teaching Science Web site. http://www.csun.edu/science/health/docs/tv&health.html. Accessed June 8, 2004. 7. California Pan-Ethnic Health Network and Consumers Union. Out of balance: Marketing soda, candy, snacks and fast foods drowns out healthful messages. http://www.consumersunion.org/pdf/OutofBalance. pdf. Accessed March 1, 2006. 8. Frost A, Walker K. Food Stamp Nutrition Education: Promoting Healthy Eating and Active Lifestyles. http://www.nal.usda.gov/foodstamp/ Training/October.ppt. Posted November 2, 2006. Accessed March 16, 2009. 9. Dickinson R. Food and eating on television: Impacts and influences. Nutr Food Sci. 2000;30:24-29. 10. Gamble M, Cotugna N. A quarter century of TV food advertising targeted at children. Am J Health Behav. 1999;23:261-267. 11. Kotz K, Story M. Food advertisements during children’s Saturday morning television programming: Are they consistent with dietary recommendations? J Am Diet Assoc. 1994;94:1296-1300. 12. Ostbye T, Pomerleau J, White M, Coolich M, McWhinney J. Food and nutrition in Canadian “prime time” television commercials. Can J Public Health. 1993;84:370-374. 13. Zuppa JA, Morton H, Mehta KP. Television food advertising: Counterproductive to children’s health? A content analysis using the Australian Guide to Healthy Eating. Nutr Diet J Diet Assoc Austral. 2003;60:78-84. 14. Arnas YA. The effects of television food advertisement on children’s food purchasing requests. Pediatr Int. 2006;48:138-145. 15. Byrd-Bredbenner C, Grasso D. Trends in US prime-time television food advertising across three decades. Nutr Food Sci. 2000;30:59-66. 16. Harrison K, Marske AL. Nutritional content of foods advertised during the television programs children watch most. Am J Public Health. 2005;95:1568-1574. 17. Kuribayashi A, Roberts MC, Johnson RJ. Actual nutritional information of products advertised to children and adults on Saturday. Child Health Care. 2001;30:309-322. 18. Maryam A, Mehdi M-R, Masood K, Mosoomeh G, Nasrin O, Yadollah M. Food advertising on Iranian children’s television: A content analysis and an experimental study with junior high school students. Ecol Food Nutr. 2005;44:123-133. 19. Powell LM, Szczypka G, Chaloupka FJ, Braunschweig CL. Nutritional content of television food advertisements seen by children June 2010 ● Journal of the AMERICAN DIETETIC ASSOCIATION 909 20. 21. 22. 23. 24. 910 and adolescents in the United States. Pediatrics. 2007;120: 576-583. Story M, Faulkner P. The prime-time diet: A content analysis of eating behavior and food messages in television program content and commercials. Am J Public Health. 1990;80:738-740. Taras HL, Sallis JF, Patterson TL, Nader PR, Nelson JA. Television’s influence on children’s diet and physical activity. J Dev Behav Pediatr. 1995;10:176-180. Wilson N, Quigley R, Mansoor O. Food ads on TV: A health hazard for children? Aust N Z J Public Health. 1999;23:647-650. Powers M. Prime-time nutrition. Hum Ecol Forum. 1996;24:8-11. US Center for Nutrition Policy and Promotion, Food and Drug Administration. Food Guide Pyramid. http://www.mypyramid.gov/. Accessed January 12, 2006. June 2010 Volume 110 Number 6 25. Center for Food Safety and Applied Nutrition, US Food and Drug Administration. A food labeling guide: Reference values for nutritional labeling. http://www.cfsan.fda.gov/⬃dms/flg-7a.html. Accessed January 12, 2006. 26. US Department of Health and Human Services and US Department of Agriculture. 2005 Dietary Guidelines for Americans. http://www. health.gov/dietaryguidelines/dga2005/document/default.htm. Posted January 2005. Accessed August 28, 2009. 27. Ippolito PM, Mathios AD. Information and advertising: The case of fat consumption in the United States. Inform Educ Market Health Care. 1995;85:91-95. 28. Darwin D. Advertising obesity: Can the US follow the lead of the UK in limiting television marketing of unhealthy foods to children? Vanderbilt J Transnatl Law. 2009;42:317-350.