The potential health impact of restricting less-healthy food and beverage advertising on UK television between 05.30 and 21.00 hours: A modelling study


Autoři: Oliver T. Mytton aff001;  Emma Boyland aff002;  Jean Adams aff001;  Brendan Collins aff003;  Martin O’Connell aff004;  Simon J. Russell aff005;  Kate Smith aff004;  Rebekah Stroud aff004;  Russell M. Viner aff005;  Linda J. Cobiac aff006
Působiště autorů: Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom aff001;  Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom aff002;  Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom aff003;  Institute for Fiscal Studies, London, United Kingdom aff004;  Great Ormond Street Institute of Child Health, University College London, London, United Kingdom aff005;  Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom aff006
Vyšlo v časopise: The potential health impact of restricting less-healthy food and beverage advertising on UK television between 05.30 and 21.00 hours: A modelling study. PLoS Med 17(10): e32767. doi:10.1371/journal.pmed.1003212
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003212

Souhrn

Background

Restrictions on the advertising of less-healthy foods and beverages is seen as one measure to tackle childhood obesity and is under active consideration by the UK government. Whilst evidence increasingly links this advertising to excess calorie intake, understanding of the potential impact of advertising restrictions on population health is limited.

Methods and findings

We used a proportional multi-state life table model to estimate the health impact of prohibiting the advertising of food and beverages high in fat, sugar, and salt (HFSS) from 05.30 hours to 21.00 hours (5:30 AM to 9:00 PM) on television in the UK. We used the following data to parameterise the model: children’s exposure to HFSS advertising from AC Nielsen and Broadcasters’ Audience Research Board (2015); effect of less-healthy food advertising on acute caloric intake in children from a published meta-analysis; population numbers and all-cause mortality rates from the Human Mortality Database for the UK (2015); body mass index distribution from the Health Survey for England (2016); disability weights for estimating disability-adjusted life years (DALYs) from the Global Burden of Disease Study; and healthcare costs from NHS England programme budgeting data. The main outcome measures were change in the percentage of the children (aged 5–17 years) with obesity defined using the International Obesity Task Force cut-points, and change in health status (DALYs). Monte Carlo analyses was used to estimate 95% uncertainty intervals (UIs). We estimate that if all HFSS advertising between 05.30 hours and 21.00 hours was withdrawn, UK children (n = 13,729,000), would see on average 1.5 fewer HFSS adverts per day and decrease caloric intake by 9.1 kcal (95% UI 0.5–17.7 kcal), which would reduce the number of children (aged 5–17 years) with obesity by 4.6% (95% UI 1.4%–9.5%) and with overweight (including obesity) by 3.6% (95% UI 1.1%–7.4%) This is equivalent to 40,000 (95% UI 12,000–81,000) fewer UK children with obesity, and 120,000 (95% UI 34,000–240,000) fewer with overweight. For children alive in 2015 (n = 13,729,000), this would avert 240,000 (95% UI 65,000–530,000) DALYs across their lifetime (i.e., followed from 2015 through to death), and result in a health-related net monetary benefit of £7.4 billion (95% UI £2.0 billion–£16 billion) to society. Under a scenario where all HFSS advertising is displaced to after 21.00 hours, rather than withdrawn, we estimate that the benefits would be reduced by around two-thirds. This is a modelling study and subject to uncertainty; we cannot fully and accurately account for all of the factors that would affect the impact of this policy if implemented. Whilst randomised trials show that children exposed to less-healthy food advertising consume more calories, there is uncertainty about the nature of the dose–response relationship between HFSS advertising and calorie intake.

Conclusions

Our results show that HFSS television advertising restrictions between 05.30 hours and 21.00 hours in the UK could make a meaningful contribution to reducing childhood obesity. We estimate that the impact on childhood obesity of this policy may be reduced by around two-thirds if adverts are displaced to after 21.00 hours rather than being withdrawn.

Klíčová slova:

Advertising – Body mass index – Body weight – Food – Childhood obesity – Children – Obesity – Overweight


Zdroje

1. Lobstein T, Brinsden HC. Atlas of childhood obesity. London: World Obesity Federation; 2019 [cited 2020 Sep 15]. Available from:http://s3-eu-west-1.amazonaws.com/wof-files/11996_Childhood_Obesity_Atlas_Report_ART_V2.pdf.

2. Brownell KD, Frieden TR. Ounces of prevention—the public policy case for taxes on sugared beverages. N Engl J Med. 2009;360:1805–8. doi: 10.1056/NEJMp0902392 19357400

3. Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD, et al. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Ther. 2016;7:125–46. doi: 10.2147/AHMT.S101631 27881930

4. Kelly B, West J, Yang TC, Mason D, Hasan T, Wright J. The association between body mass index, primary healthcare use and morbidity in early childhood: findings from the Born In Bradford cohort study. Public Health. 2019;167:21–7. doi: 10.1016/j.puhe.2018.10.019 30610958

5. Booth JN, Tomporowski PD, Boyle JME, Ness AR, Joinson C, Leary SD, et al. Obesity impairs academic attainment in adolescence: findings from ALSPAC, a UK cohort. Int J Obes. 2014;38:1335–42. doi: 10.1038/ijo.2014.40 24614099

6. Simmonds M, Llewellyn A, Owen CG, Woolacott N. Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obes Rev. 2016;17:95–107. doi: 10.1111/obr.12334 26696565

7. Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes. 2011;35:891–8. doi: 10.1038/ijo.2010.222 20975725

8. Llewellyn A, Simmonds M, Owen CG, Woolacott N. Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis. Obes Rev. 2016;17:56–67. doi: 10.1111/obr.12316 26440472

9. Department of Health and Social Care. Childhood obesity: a plan for action, chapter 2. London: Department of Health and Social Care; 2018 [cited 2020 Sep 15]. Available from: https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action-chapter-2.

10. Department of Health. Nutrient profiling technical guidance. London: Department of Health; 2011 [cited 2020 Sep 28]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216094/dh_123492.pdf.

11. Davies S. Time to solve childhood obesity: an independent report by the Chief Medical Officer. London: Department of Health and Social Care; 2019.

12. Health Select Committee. Childhood obesity: time for action. London: UK Parliament; 2018 [cited 2020 Sep 15]. Available from: https://publications.parliament.uk/pa/cm201719/cmselect/cmhealth/882/88202.htm.

13. Obesity Health Alliance. Written evidence submitted by Obesity Health Alliance (COY0009). London: UK Parliament; 2018 [cited 2020 Sep 15]. Available from: http://data.parliament.uk/WrittenEvidence/CommitteeEvidence.svc/EvidenceDocument/Health and Social Care/Childhood obesity/written/81099.html.

14. Ofcom. HFSS advertising restrictions—final review. London: Ofcom; 2010 [cited 2020 Sep 15]. Available from: https://www.ofcom.org.uk/__data/assets/pdf_file/0024/31857/hfss-review-final.pdf.

15. Adams J, Tyrrell R, Adamson AJ, White M. Effect of restrictions on television food advertising to children on exposure to advertisements for “less healthy” foods: repeat cross-sectional study. PLoS ONE. 2012;7:e31578. doi: 10.1371/journal.pone.0031578 22355376

16. Whalen R, Harrold J, Child S, Halford J, Boyland E. Children’s exposure to food advertising: the impact of statutory restrictions. Health Promot Int. 2019;34:227–35. doi: 10.1093/heapro/dax044 29092014

17. Griffith R, O’Connell M, Smith K, Stroud R. Children’s exposure to TV advertising of food and drink. London: Institute for Fiscal Studies; 2018.

18. Boyland EJ, Nolan S, Kelly B, Tudur-Smith C, Jones A, Halford JC, et al. Advertising as a cue to consume: a systematic review and meta-analysis of the effects of acute exposure to unhealthy food and nonalcoholic beverage advertising on intake in children and adults. Am J Clin Nutr. 2016;103:519–33. doi: 10.3945/ajcn.115.120022 26791177

19. Russell SJ, Croker H, Viner RM. The effect of screen advertising on children’s dietary intake: a systematic review and meta-analysis. Obes Rev. 2019;20:554–68. doi: 10.1111/obr.12812 30576057

20. Sadeghirad B, Duhaney T, Motaghipisheh S, Campbell NRC, Johnston BC. Influence of unhealthy food and beverage marketing on children’s dietary intake and preference: a systematic review and meta-analysis of randomized trials. Obes Rev. 2016;17:945–59. doi: 10.1111/obr.12445 27427474

21. Norman J, Kelly B, McMahon A-T, Boyland E, Baur LA, Chapman K, et al. Sustained impact of energy-dense TV and online food advertising on children’s dietary intake: a within-subject, randomised, crossover, counter-balanced trial. Int J Behav Nutr Phys Act. 2018;15:37. doi: 10.1186/s12966-018-0672-6 29650023

22. Cairns G, Angus K, Hastings G, Caraher M. Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary. Appetite. 2013;62:209–15. doi: 10.1016/j.appet.2012.04.017 22561190

23. Kelly B, King L, Chapman K, Boyland E, Bauman AE, Baur LA. A hierarchy of unhealthy food promotion effects: identifying methodological approaches and knowledge gaps. Am J Public Health. 2015;105:e86–95. doi: 10.2105/AJPH.2014.302476 25713968

24. Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review. Circulation. 2016;133:187–225. doi: 10.1161/CIRCULATIONAHA.115.018585 26746178

25. Adriouch S, Julia C, Kesse-Guyot E, Ducrot P, Péneau S, Méjean C, et al. Association between a dietary quality index based on the food standard agency nutrient profiling system and cardiovascular disease risk among French adults. Int J Cardiol. 2017;234:22–7. doi: 10.1016/j.ijcard.2017.02.092 28258849

26. Julia C, Ducrot P, Lassale C, Fézeu L, Méjean C, Péneau S, et al. Prospective associations between a dietary index based on the British Food Standard Agency nutrient profiling system and 13-year weight gain in the SU.VI.MAX cohort. Prev Med. 2015;81:189–94. doi: 10.1016/j.ypmed.2015.08.022 26348449

27. World Health Organization. Set of recommendations on the marketing of foods and non-alcoholic beverages to children. Geneva: World Health Organization; 2010.

28. Kovic Y, Noel JK, Ungemack JA, Burleson JA. The impact of junk food marketing regulations on food sales: an ecological study. Obes Rev. 2018;19761–9. doi: 10.1111/obr.12678 29521031

29. WHO Regional Office for Europe. Evaluating implementation of the WHO set of recommendation on the marketing of foods and non-alcoholic beverages to children. Copenhagen: WHO Regional Office for Europe; 2018.

30. Brown V, Ananthapavan J, Veerman L, Sacks G, Lal A, Peeters A, et al. The potential cost-effectiveness and equity impacts of restricting television advertising of unhealthy food and beverages to Australian children. Nutrients. 2018;10:622. doi: 10.3390/nu10050622 29762517

31. Advertising Association. 10 key facts about HFFS advertising in the UK. Advertising Association. 2018 May 7 [cited 2019 Mar 18]. Available from: https://www.adassoc.org.uk/policy-areas/10-key-facts-about-hfss-advertising-in-the-uk-2/.

32. Hills J. “We can compete”—ITV Chief Executive Carolyn McCall says television can challenge online opposition. ITV. 2018 Jul 25 [cited 2019 Mar 18]. Available from: https://www.itv.com/news/2018-07-25/future-of-itv-and-online-streaming/.

33. Cobiac LJ, Scarborough P, Kaur A, Rayner M, Shields E, Cobiac L. The Eatwell Guide: modelling the health implications of incorporating new sugar and fibre guidelines. PLoS ONE. 2016;11:e0167859. doi: 10.1371/journal.pone.0167859 27997546

34. Hall KD, Butte NF, Swinburn BA, Chow CC. Dynamics of childhood growth and obesity: development and validation of a quantitative mathematical model. Lancet Diabetes Endocrinol. 2013;1:97–105. doi: 10.1016/s2213-8587(13)70051-2 24349967

35. Broadcasters’ Audience Research Board. BARB explained: the central role of the BARB panel. London: Broadcasters’ Audience Research Board; 2019 [cited 2020 May 29]. Available from: https://www.barb.co.uk/barb-explained/the-central-role-of-the-barb-panel/.

36. Boyland EJ, Harrold JA, Kirkham TC, Halford JCG. The extent of food advertising to children on UK television in 2008. Int J Pediatr Obes. 2011;6:455–61. doi: 10.3109/17477166.2011.608801 21846176

37. Gordon-Larsen P, The NS, Adair LS. Longitudinal trends in obesity in the United States from adolescence to the third decade of life. Obes (Silver Spring). 2010;18:1801–4. doi: 10.1038/oby.2009.451 20035278

38. Singh AS, Mulder C, Twisk JWR, Van Mechelen W, Chinapaw MJM. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9:474–88. doi: 10.1111/j.1467-789X.2008.00475.x 18331423

39. Office for National Statistics. Health Survey for England, 2016. Leeds: Office for National Statistics; 2017 [cited 2020 Sep 15]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/health-survey-for-england-2016.

40. Cole TJ, Lobstein T. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes. 2012;7:284–94. doi: 10.1111/j.2047-6310.2012.00064.x 22715120

41. Adams J, Tyrrell R, Adamson AJ, White M. Socio-economic differences in exposure to television food advertisements in the UK: a cross-sectional study of advertisements broadcast in one television region. Public Health Nutr. 2012;15:487–94. doi: 10.1017/S1368980011001686 21806864

42. Office for National Statistics. DC6127EW—approximated social grade by household composition. Durham: Nomis; 2011 [cited 2019 Nov 24]. Available from: https://www.nomisweb.co.uk/census/2011/DC6127EW/view/2092957703?rows=household_composition&cols=c_scgpuk11.

43. Bann D, Johnson W, Li L, Kuh D, Hardy R. Socioeconomic inequalities in childhood and adolescent body-mass index, weight, and height from 1953 to 2015: an analysis of four longitudinal, observational, British birth cohort studies. Lancet Public Health. 2018;3:e194–203. doi: 10.1016/S2468-2667(18)30045-8 29571937

44. Barendregt JJ, Van Oortmarssen GJ, Van Hout BA, Van Den Bosch JM, Bonneux L. Coping with multiple morbidity in a life table. Math Popul Stud. 1998;7:29–49,109. doi: 10.1080/08898489809525445 12321476

45. Briggs ADM, Scarborough P, Wolstenholme J. Estimating comparable English healthcare costs for multiple diseases and unrelated future costs for use in health and public health economic modelling. PLoS ONE. 2018;13:e0197257. doi: 10.1371/journal.pone.0197257 29795586

46. The Human Mortality Database. 2019 [cited 2019 Mar 10]. Available from: https://www.mortality.org/.

47. HM Treasury. The green book: central government advice on appraisal and evaluation. London: HM Treasury; 2018 [cited 2020 Sep 15]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/685903/The_Green_Book.pdf.

48. Scarborough P, Harrington R, Mizdrak A, Zhou LM, Doherty A. The Preventable Risk Integrated ModEl and its use to estimate the health impact of public health policy scenarios. Scientifica (Cairo). 2014;2014:748750. doi: 10.1155/2014/748750 25328757

49. Brown V, Tan EJ, Hayes AJ, Petrou S, Moodie ML. Utility values for childhood obesity interventions: a systematic review and meta-analysis of the evidence for use in economic evaluation. Obes Rev. 2018;19:905–16. doi: 10.1111/obr.12672 29356315

50. Office for National Statistics. Gross domestic product per head: table P. Leeds: Office for National Statistics; 2018 [cited 2019 Dec 4]. Available from: https://www.ons.gov.uk/economy/grossdomesticproductgdp/datasets/gdpperheadtablep.

51. Robinson LA, Hammitt JK, Chang AY, Resch S. Understanding and improving the one and three times GDP per capita cost-effectiveness thresholds. Health Policy Plan. 2017;32:141–5. doi: 10.1093/heapol/czw096 27452949

52. Public Health England. Annex C: basis of the nutrient/food component and scoring for the UK NPM 2004/5 and the draft 2018 NPM. London: Public Health England; 2018 [cited 2020 Sep 15]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/692042/Annex_C_basis_of_the_nutrient_food_component_and_scoring_for_the_draft_2018_NPM.pdf.

53. Delfino LD, Dos Santos Silva DA, Tebar WR, Zanuto EF, Codogno JS, Fernandes RA, et al. Screen time by different devices in adolescents: association with physical inactivity domains and eating habits. J Sports Med Phys Fitness. 2018;58:318–25. doi: 10.23736/S0022-4707.17.06980-8 28462567

54. Pearson N, Biddle SJH, Griffiths P, Johnston JP, Haycraft E. Clustering and correlates of screen-time and eating behaviours among young children. BMC Public Health. 2018;18:753. doi: 10.1186/s12889-018-5698-9 29914455

55. Broadcasters’ Audience Research Board. Trends in television viewing. London: Broadcasters’ Audience Research Board; 2018 [cited 2020 Sep 15]. Available from: https://www.barb.co.uk/download/?file=/wp-content/uploads/2018/03/BARB-Trends-in-Television-Viewing-2017.pdf.

56. Department for Health and Social Care, Department for Digital, Culture, Media & Sport. Introducing further advertising restrictions on TV and online for products high in fat, sugar and salt (HFSS). London: Department for Health and Social Care; 2019 [cited 2020 Sep 15]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/795412/hfss-advertising-consultation-10-april-2019.pdf.

57. Azizpour Y, Delpisheh A, Montazeri Z, Sayehmiri K, Darabi B. Effect of childhood BMI on asthma: a systematic review and meta-analysis of case-control studies. BMC Pediatr. 2018;18:143. doi: 10.1186/s12887-018-1093-z 29699517

58. Paulis WD, Silva S, Koes BW, van Middelkoop M. Overweight and obesity are associated with musculoskeletal complaints as early as childhood: a systematic review. Obes Rev. 2014;15:52–67. doi: 10.1111/obr.12067 23941399

59. Smith SM, Sumar B, Dixon KA. Musculoskeletal pain in overweight and obese children. Int J Obes. 2014;38:11–5. doi: 10.1038/ijo.2013.187 24077005

60. Magnus A, Haby MM, Carter R, Swinburn B. The cost-effectiveness of removing television advertising of high-fat and/or high-sugar food and beverages to Australian children. Int J Obes. 2009;33:1094–102. doi: 10.1038/ijo.2009.156 19652656

61. Sonneville KR, Long MW, Ward ZJ, Resch SC, Wang YC, Pomeranz JL, et al. BMI and healthcare cost impact of eliminating tax subsidy for advertising unhealthy food to youth. Am J Prev Med. 2015;49:124–34. doi: 10.1016/j.amepre.2015.02.026 26094233

62. Goris JM, Petersen S, Stamatakis E, Lennert Veerman J. Television food advertising and the prevalence of childhood overweight and obesity: a multicountry comparison. Public Health Nutr. 2010;13:1003–12. doi: 10.1017/S1368980009992850 20018123

63. Veerman JL, Van Beeck EF, Barendregt JJ, Mackenbach JP. By how much would limiting TV food advertising reduce childhood obesity? Eur J Public Health. 2009;19:365–9. doi: 10.1093/eurpub/ckp039 19324935

64. Cecchini M, Sassi F, Lauer JA, Lee YY, Guajardo-Barron V, Chisholm D. Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Lancet. 2010;376:1775–84. doi: 10.1016/S0140-6736(10)61514-0 21074255


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2020 Číslo 10

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