KFM Report Summary

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National Academy of Science/Institute of
Medicine CommitteeOctober 2005 December, 2006
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Trends Childrens Obesity
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Food Marketing Quiz

• How much per year is spent on food beverage
  marketing directed to children youth?
• 500 million
• 1 billion
• 5 billion
• 10 billion

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Food Marketing Quiz

• At what age can children differentiate
  advertising from program content on television?
• 2 years
• 4 years
• 6 years
• 8 years

• At what age do children understand the persuasive
  intent of advertising?
• 4 years
• 6 years
• 8 years
• 10 years

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Growth in New Food Products Targeted to U.S.
Children and Youth 1994 to 2004
New products targeted to total market
New products targeted to children youth
Source Williams J. 2005b. Product
Proliferation Analysis for New Food and Beverage
Products Targeted to
Children, 19942004. University of Texas at
Austin Working Paper.
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Policy History

• Tobacco
• Surgeon Generals Report -1964
• Labels and Warnings within weeks
• TV Radio Advertising Banned by Law in 1970
• 1971 FTC (Sweets and Cavities)
• Rules proposed to ban ads for children lt8
• Congress intervenes to hold back FTC
• CARU formed 1974
• 1990s
• Alarming rise in Obesity

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Committee Timeline
2004 Spring Summer Fall 2005 Winter
Spring Summer Fall 2006 Winter
Spring Summer Fall 2007
2008

• - Congress asks CDC to study Food Marketing and
  Childrens Diets
• - CDC commissions National Academy of
  Science/Institute of Medicine
• - IOM Committee Formed
• - Committee Works Tirelessly (for FREE!)
• - Press Release
• - Book in Print
• - 2,000,000,000 lawsuit
• - Policy? E.g., Law, Monitoring body, etc.??

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Main Committee Charge

• Comprehensive evidence based review of what is
  known about
• The causal influence of food and beverage
  marketing on the diets and diet-related health
  outcomes of children and youth

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Committee Work

• 15 Committee members
• 2 - ½ time IOM staff members
• 4 (2 ½ day) Meetings
• Subgroups
• Diet
• Marketing
• Ecological Model
• Evidence Review
• Public Policy
• 6 months almost weekly conference calls

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Systematic Evidence Review

• explicit criteria for study inclusion
• explicit criteria for study relevance, ratings,
  etc.
• replicable

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Study Inclusion

• Only Peer-reviewed, published research
• English
• Any country
• Any date
• Only original research, no review articles
• Only research that reports a quantitative
  relationship between a variable involving
  marketing, and a variable involving either a
  pre-cursor to diet, diet, or diet-related health

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Dimensions for Study Evaluation

• Sample size, year published, population studied
• Cause variable, effect variable
• Research Method
• Statistically significant association between
  cause variable and effect variable?
• Strength of evidence for causation (Causal
  Inference Validity)
• Quality of Measures
• Generalizability (Ecological Validity)

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Causal Framework Used for the Systematic Evidence
Review
Marketing
Mediators/Precursors
Food Beverage
Product, Place,
Preferences, Beliefs,
Price, Promotion
Purchase Requests
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Cause Variable, Effect Variable

• Cause variable, e.g.
• TV ad exposure
• Product Placement in Film
• Print Ad exposure
• Radio Ad exposure
• Effect variable, e.g.,
• Food Preferences
• Food Purchase requests
• Short-term consumption
• Adiposity

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Research Method

• CS (cross-sectional)
• Exp (randomized trial)
• Exp-N (natural experiment)
• L-Pnl (longitudinal study panel)
• L-Trnd (longitudinal study trend)

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Statistical Significance

• Cause __ Effect Measured Covariates

E.g., in a regression BMI 21.7
.52TVhours/day - .64Mothers Education P-value
.0074
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Strength of Evidence for Causation

• Experimental studies
• Observational studies

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Strength of Evidence for CausationExperimental
studies

• Randomized Assignment of Treatment
• High Quality Measures
• If dropout - not associated with treatment

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Strength of Evidence for CausationExperimental
studies
Evidence Causeset __ Effect
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Strength of Evidence for CausationObservational
studies

• Quality Measures
• All potential confounders measured (well) and
  appropriately controlled for statistically,
• Reverse causation can be eliminated, perhaps by
  time-order

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Strength of Evidence for CausationObservational
studies
Evidence Cause __ Effect Measured
Confounders
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Strength of Evidence for CausationObservational
studies
Cause __ Effect Measured Confounders
Good Evidence for causation if

• All confounders measured well

• Effect not prior to cause

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Measurement

• Validity measure directly and accurately
  measures what it is intended to measure
• Reliability same measurement technique applied
  repeatedly, yields same outcome
• Precision fineness vs. coarseness of measure

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Ecological Validity
Generalizability Similarity of observational
conditions to real-life. E.g., - after-school
lab study vs. survey
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Results

• Tabular Overview of Evidence Base
• Marketing ? Precursors
• Marketing ? Diet
• Marketing ? Health

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Example Results Summary
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Example Results Summary
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Results

• Tabular Overview of Evidence Base
• Marketing ? Precursors
• Marketing ? Diet
• Marketing ? Health

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Results Pre-cursors

• Precursors
• Preferences
• Food Purchase Requests
• Beliefs about Food

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Results TV Ads and Food Preferences
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TV Ads and Purchase Requests

• (Young 2-5) Strong evidence for causation
• (OC 6-11) Moderate evidence for causation
• (Teens 12-18) Weak/Insufficient for causation

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Results Summary of Pre-cursors
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Results

• Tabular Overview of Evidence Base
• Marketing ? Precursors
• Marketing ? Diet
• Marketing ? Health

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Results Short-term Consumption

• (Young 2-5) Strong evidence for causation
• (OC 6-11) Strong evidence for causation
• (Teens 12-18) No evidence

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Results Usual Dietary Consumption

• (Young 2-5) Moderate evidence for causation
• (OC 6-11) Weak evidence for causation
• (Teens 12-18) Weak/Insufficient against causation
• (not including French, et al., study on vending
  machine price

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Results

• Tabular Overview of Evidence Base
• Marketing ? Precursors
• Marketing ? Diet
• Marketing ? Health

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Marketing ? Health
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Results Summary

• TV Ads ? Precursors (esp. for young children)
• TV Ads ? Short-term consumption (esp. for YC)
• TV Ads ? Usual Diet (???)
• Moderate evidence for YC
• Weak for OC
• Weak against for teens
• Marketing ? Health (???)
• TV Ads __ Obesity strong evidence
• TV Ads ? Obesity insufficient evidence

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Results

• ONLY TV Ads studied marketing much broader
• Only effects of ads for high-calorie, low
  nutrition foods studied
• Effects of ads for healthy foods virtually
  unstudied!

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Lawsuit

• Center for Science in the Public Interest (CSPI)
• vs. Viacom, Kellog
• Charge Unfair and deceptive advertising and
  marketing to children under 8
• Request 1 billion each

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Committee on Food Marketing and the Diets of
Children and Youth

• J. Michael McGinnis (Chair), Institute of
  Medicine
• Daniel Anderson, University of Massachusetts,
  Amherst
• J. Howard Beales III, George Washington
  University
• David Britt, Sesame Workshop (retired)
• Sandra Calvert, Georgetown University
• Keith Darcy, Ethics Officer Association
• Aimee Dorr, University of California, Los Angeles
• Lloyd Kolbe, University of Indiana

• Dale Kunkel, University of Arizona
• Paul Kurnit, Kurnit Communications KidShop
• Robert Post, Yale Law School
• Richard Scheines, Carnegie Mellon University
• Frances Seligson, Pennsylvania State University
• Mary Story, University of Minnesota, Minneapolis
• Ellen Wartella, University of California,
  Riverside
• Jerome Williams, University of Texas, Austin
• Co-study Directors Jennifer Gootman and Vivica
  Kraak

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For more information. . .

• Read about the project and download fact sheets
• at www.iom.edu
• The book is available at www.nap.edu
• Download the executive summary free . . .