Picture warnings on fizzy drinks? A promising tool to fight childhood obesity
A study published in the journal PLOS Medicine is the first to examine whether pictorial health warnings on sugary drinks, like juice and fizzy drinks, influence whether or not parents purchase these types of beverages for their children.
The study’s results found that these warnings reduced parental purchases of sugary drinks for their children by 17%.
Researchers at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health ran the study in a unique laboratory by creating the “UNC Mini Mart”. This space was set up to mimic a convenience store and simulate a realistic setting for a shopping experience.
“We created this store because we saw a major need for research that tests the impact of policies in a food store setting that is much more realistic,” said senior author Lindsey Smith Taillie, PhD, assistant professor in the Department of Nutrition at the Gillings School and a member of UNC’s Carolina Population Center (CPC). “When people make choices about what food to buy, they are juggling dozens of factors like taste, cost, and advertising and are looking at many products at once. Showing that warnings can cut through the noise of everything else that’s happening in a food store is powerful evidence that they would help reduce sugary drink purchases in the real world.”
Taillie’s and her co-authors’ positive findings about the effects of image-based warning labels highlight a recent approach to combating the global struggle with obesity. Children in the United States and many other countries, including the UK, consume more than the recommended amount of sugary drinks, which increases their risk for obesity and other diet-related chronic diseases, including Type 2 diabetes.
Taillie has conducted research on warning labels and taxes on sugar-sweetened beverages and junk food in Chile, Mexico and South Africa. Marissa G. Hall, PhD, one of the study’s co-authors, researches the impact of warnings on tobacco and food as well as effectiveness of obesity prevention policies.
In their study, 326 parents of children between the ages of 2 to 12 years old participated in a randomised trial with 1) a pictorial warning arm (in which drink labels had images representing heart damage and Type 2 diabetes), and 2) a control arm (in which drinks labels displayed a barcode).
Participants were instructed to choose one drink and one snack for their child, along with one household good, the latter being added to the shopping list to potentially mask the purpose of the study. After shopping, participants completed a survey about their selections and left with their drink of choice and a cash incentive.
The picture warnings led to a 17% reduction in purchases of sugary drinks, with 45% of parents in the control arm buying a sugary drink for their child compared to 28% in the pictorial warning arm.
The warnings also reduced calories purchased from sugary drinks and led to parents feeling more in control of healthy eating decisions and thinking more about the harms of sugary drinks.
“We think the paper could be useful for policymakers in the U.S. and globally,” Hall says. “This evidence supports strong, front-of-package warnings to reduce sugary drink consumption in children.”
Read MoreChildhood Obesity: A Growing Pandemic
Reported in The Lancet, childhood obesity rates have increased substantially over the past year in the UK, according to a new report from the UK Government’s National Child Measurement Programme. The report details that this rise in prevalence is the largest single-year increase since the programme began 15 years ago and highlights a trend in obesity among children and adolescents not just in the UK, but worldwide. The trend now extends to both low-income and middle-income countries despite obesity once being seen as a problem mainly for high-income countries. Childhood obesity has long been a cause for concern, but the effects of the pandemic and national lockdowns has added to the issue, making childhood obesity an undeniable public health crisis and one that should be addressed imminently.
A different lifestyle brought about because of lockdown measures including school closures, restrictions on leaving the house, and limitations on meeting new people has meant children have seen a huge jump in screen time and have become more sedentary than they were previously. The CDC Morbidity and Mortality Weekly Report measured the effects of these lifestyle changes and it notes that the rate of BMI increase almost doubled in US children and adolescents aged 2–19 years during the pandemic compared to pre-pandemic. Children with overweight and obesity are more likely to become adults with obesity and to develop a host of non-communicable diseases including type 2 diabetes and cardiovascular disease, and have an increased risk of cancer, premature death, and disability later in life.
Read MoreHow does birth weight affect adult obesity in a low resource context?
South Africa is experiencing rapid increases in weight gain across the entirety of its population. Obesity is rising in both males and females, across all ages and socioeconomic groups. Like many other low-middle-income countries, it is experiencing a double burden of malnutrition alongside these high obesity rates. Malnutrition is present in one quarter of children under the age of three, resulting in stunting.
This stunting has been reported to be associated with adulthood disease risk, including obesity. Researchers thus far have not been able to look at this relationship in a low-middle-income country in the same participants by following them from birth into early adulthood. The authors of this study were able to do this for the first time using the Birth to Twenty Cohort which is a longitudinal study of children born in 1990 in South Africa.
Authors found that relative weight gain from birth into adulthood was positively related to fat mass, including both visceral and subcutaneous fat in adulthood. Being stunted at age two was inversely associated with fat-free soft tissue mass (i.e. lean body mass) in adulthood. This finding is analogous to trends that have been shown across Brazil, Guatemala and India.
Read MoreWhat is driving rates of obesity in Chinese boys?
Over recent decades, alongside economic development, China has undergone a rapid nutrition transition that has resulted in a dramatic acceleration of obesity. Unlike other countries across the world, like the USA and UK, where childhood obesity rates have stabilised, the prevalence in China continues to worsen.
This crisis in China is also unique in terms of how it presents between genders. Dissimilar to other countries, obesity is higher in boys than girls. Boys are almost twice as likely to have obesity. Up until now, there has been limited evidence explaining why these unique sex differences have emerged.
Using a cross-sectional national health survey, Wang and colleagues revealed, as would be expected, that adolescent boys were much more likely to have energy intakes exceeding expectations. Importantly however, it found significantly different self-perceptions by sex, with boys much more likely to underestimate their weight and be satisfied with their current health behaviours.
These weight perceptions were supported by mothers, who were more accurate in predicting their daughter’s weight vs those with a son. Clearly, weight-related beliefs in China have a role to play in the increasing – and widening – rates of obesity in children.
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