Download Nutritional Imbalance Endorsed by Televised Food Advertisements

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
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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
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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-
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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.
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