Food and beverage marketing targeted to children ages 12 and under leads them to request and consume high-calorie, low-nutrient products, says a new report from the Institute of Medicine of the National Academies. The report offers the most comprehensive review to date of the scientific evidence on the influence of food marketing on diets of children and youth.

Because dietary preferences and eating patterns form early in life and set the stage for an individual's long-term health prospects, significant changes are needed to reshape children's awareness of healthy dietary choices, the report says. Manufacturers and restaurants should direct more of their resources to developing and marketing child- and youth-oriented foods, drinks and meals higher in nutrients and lower in calories, fat, salt and added sugars.

Noting that many factors shape children's dietary habits and that leadership from both the public and the private sectors will be needed to redirect the nation's focus toward healthier products, the committee also called on the government to enhance nutritional standards, incentives and public policies to promote the marketing of healthier foods and beverages. In addition, schools, parents and the media “should work with government and industry to pursue initiatives that support healthful diets for children and youth. If voluntary efforts by industry fail to successfully shift the emphasis of television advertising during children's programming away from high-calorie, low-nutrient products to healthier fare, Congress should enact legislation to mandate this change on both broadcast and cable television.”

Concern has focused on food and beverage marketing practices because of the increase in new products targeted specifically to children and youth over the past decade and the media's increasing role in socializing young people. Companies spent an estimated $10 billion to market foods, beverages and meals to U.S. children and youth in 2004, and four of the top 10 items that children ages 8 to 12 say they can buy without parental permission are either foods or beverages.

"Current food and beverage marketing practices put kids' long-term health at risk," said committee chair J. Michael McGinnis, senior scholar, Institute of Medicine. "If America's children and youth are to develop eating habits that help them avoid early onset of diet-related chronic diseases, they have to reduce their intake of high-calorie, low-nutrient snacks, fast foods and sweetened drinks, which make up a high proportion of the products marketed to kids. And this is an 'all hands on deck' issue. Parents have a central role in the turnaround required, but so do the food, beverage and restaurant industries."

FINDINGS ABOUT MARKETING'S INFLUENCE The committee assessed hundreds of relevant studies and rigorously reviewed evidence from more than 120 of the best designed to determine what effects marketing may have on children's diets and health. Most of these studies focused only on television advertising, a shortcoming that should be addressed in future research, given that marketing strategies are rapidly evolving and now employ many tactics beyond television advertising, including Internet marketing, mobile phone ads, and product placements in video games and other media. For the most part, the committee did not have access to the substantial body of proprietary market research data held by marketing firms and food, beverage and restaurant companies.

The committee found strong evidence that television advertising influences the food and beverage preferences and purchase requests of children ages 2 through 11 years old and affects their consumption habits, at least over the short term. Most advertising geared toward children promotes high-calorie, low-nutrient foods, beverages and meals which, the committee concluded, influences children to request and choose these products. There is not enough evidence to determine the extent to which marketing influences the preferences and consumption habits of 12- to 18-year-olds; too few studies have focused on teens, the report notes.

The evidence on whether television advertising directly affects children's long-term dietary patterns is limited and less conclusive. However, nutrition studies show that America's children and youth are consuming too many calories and too much added sugar, fat and salt, the report finds. Moreover, they are consuming less-than-recommended amounts of many key nutrients, including calcium, vitamin E and fiber.

Available studies are too limited to determine whether television advertising is a direct cause of obesity among children. However, the statistical association between ad viewing and obesity is strong. Even a small influence would amount to a substantial impact when spread across the entire population, the report suggests.

RECOMMENDATIONS TO PROMOTE HEALTHIER DIETS Some companies and restaurants have taken steps recently to develop and promote healthier offerings, but overall, the report finds the food, beverage and restaurant industries spend the majority of their resources on products that contain high amounts of added sugar, fat and salt and that lack essential nutrients. “These industries should shift their creativity and resources to develop a wider array of products that are nutritious, appealing and affordable.”

Food, beverage and restaurant companies, as well as the entertainment and marketing industries, should expand, strengthen and enforce their standards for marketing practices. “For example, licensed characters, such as popular cartoon characters, should be used only to promote products that support healthful diets,” the committee said. “The industries should work with health officials and consumer groups to develop an industry-wide rating system and labeling that convey the nutritional quality of foods and beverages in a consistent and effective fashion. The Children's Advertising Review Unit -- a group created and financed by the industry to monitor advertising directed toward children -- should expand and apply its voluntary guidelines to newer forms of marketing, such as Internet and wireless phone advertising and product placement. The media and entertainment industries should incorporate storylines that promote healthful eating into programs, films and games. The government should consider the use of awards and tax incentives that encourage companies to develop and promote healthier products for young people.

“A long-term, multifaceted national campaign should be initiated by the government in partnership with the private sector to educate families and children about making healthy food and beverage choices. This campaign should employ the full range of promotional and marketing tools and should be supported by both public funds and contributions from the food, beverage and restaurant industries.”

The committee called for governments and schools to develop and apply nutritional standards for all foods and beverages sold in schools that compete with federally reimbursed meals, including products sold in school stores and vending machines or for fundraising. School-based promotional efforts should focus on products that support healthful diets, the committee said.

The U.S. Department of Health and Human Services (HHS), in consultation with other federal agencies, should designate an agency to monitor the nation's progress in promoting more healthful diets, the report states. The HHS secretary should report to Congress within two years on the progress that has been made and additional actions that are needed.

The study was requested by Congress, in particular Sen. Tom Harkin and the House and Senate appropriations committees, and sponsored by the U.S. Centers for Disease Control and Prevention. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences.