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Tiktok influence on people's diets and fast food consumption

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Tiktok influence on people's diets and fast food consumption

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Study reveals TikTok’s influence on people’s diets and fast food consumption | Newshub

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Evidence Review of Nutrition Social Marketing

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Evidence Review of Nutrition Social Marketing

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Critical review of food advertising in NZ

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Critical review of food advertising in NZ

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Nutrients. 2020 May; 12(5): 1278.

New Zealand has the second highest overweight and obese child population in the Organisation for Economic Co-operation and Development (OECD). This paper evaluates whether New Zealand's self-regulatory controls on the advertising of unhealthy food and beverages to children and young people adequately protects children from the exposure to, and power of, such marketing in order to limit its impact on children's food and beverage preferences. First, an analysis of the relevant New Zealand Advertising Standards Authority (ASA) Codes was conducted, including the ASA Complaints Board and Appeals Board decisions from 2017-2019 to determine the application of the Codes in practice. Second, a public health law framework was applied to the self-regulatory system. Of the 16 complaints assessed, 12 were not upheld, and only one was upheld under the Children and Young People's Advertising Code (CYPA Code). Three complaints were upheld under the Advertising Standards Code (ASC) but not the CYPA Code. An analysis of the Codes and their interpretation by the Complaints Board found that many facets of the public health law framework were not met. The self-regulatory system does not adequately protect children from the exposure to, and power of, unhealthy food and beverage marketing, and government-led, comprehensive, and enforceable marketing restrictions are required.

Keywords: advertising, self-regulation, children, food

Substantive terms and conditions.

3. The enforcement of standards:

Enforcement.

3.1. Summary of Decisions

Sixteen complaints and two appeals met the criteria for analysis between 2017 and 2019. Eight were brought under the CYPA Code solely, six under both the CYPA Code and the ASC, and two under the CYPA Code and other Codes (Advertising Code of Ethics and Code for Advertising Food (the predecessor to the ASC)). Table 1 provides a summary of the complaints and decisions. The advertising mediums included a mix of television advertisements, online advertisements (Facebook, websites, Instagram), outdoor advertisements (outside shops, street signage, bus shelters-otherwise known as 'out of home' advertisements), and print advertisements. The marketing techniques used included using famous sports stars, children, digital techniques, such as emojis or characters like Santa Claus, and advertising limited edition offers, major food and beverage industry-sponsored events, or advertising the 'healthful' nature of the products (i.e., a healthy burger or pizza options). Other advertisements suggested ways children could consume products, such as cookies for breakfast cereal, chocolate eggs 'made for kids', or biscuit packets in lunch boxes. Radio is an uncommon medium for advertising to children and there were no complaints about advertisements on radio.

Table 1

Complaints

Grounds for Complaint

Medium/Technique

Decision

1. Frucor, Pepsi Max, Out of Home (12/09/17)

CYPA-Principles 1; Rule 1(a), 1(g), 1(h), 1(i), 1(j), 1(l), Principle 3, Rule 3(a), 3(b)

Bus shelter

Limited edition product with emojis and famous sports people

Settled as ad removed

2. Frucor, Pepsi Max, Facebook (12/09/17)

ASC-Rule 1(a), (g), (h), Rule 3 (a) and (b)
CYPA-Principle 1, Rule 1(a), 1(g), 1(h), Principle 3, Rule 3(a), 3(b)

Online advertisement-Facebook

Limited edition product with emojis and famous sports people

Not Upheld-ASC
Rule 1(a), (g), (h), Rule 3 (a) and (b)
CYPA-Principle 1, Rule 1(a), 1(g), 1(h), Principle 3, Rule 3(a), 3(b)

3. Coca-Cola Oceania (13/02/18) Digital and Print media

CYPA-Principle 1 Rule 1(a), 1(i), 1(j), Principle 2, Principle 3, Rule 3(a), 3(b)
Advertising Code of Ethics-basic Principle 4

Digital, billboard, bus shelter and print advertisements of Coca Cola sponsored Christmas event using Santa Claus. Sponsored Event itself

Not upheld-CYPA
Principle 1-Rule 1(a), 1(i), 1(j), Principle 2, Principle 3, Rule 3(a), 3(b)
Advertising Code of Ethics-basic Principle 4

4. Coca Cola Oceania, Out of Home, Poster, (13/02/18) 17/454

CYPA-Principle 1, Rule 1(h), 1(i), 1(j), Rule 3(a)

Billboard advertising using Santa Claus

Upheld-CYPA
Principle 1, Rule 1(i), Rule 3a
Not upheld-CYPA
Rule 1(h), 1(j)

5. McDonalds Restaurants NZ, Television (08/05/18) 18/107

CYPA-Principle 1, Rule1(i), 1(j)

TV advertisement using children

Not upheld-CYPA
Principle 1, Rule1(i), 1(j)

6. Kinder Chocolate TV advertisement (12/06/18)

CYPA-Principle 1, Rule 1(j), 1(k), Principle 2
Code for Advertising Food
CFAF-Principle 1, Principle 2 Guidelines 2(a)2(b)

TV advertisement

Not upheld-CYPA
Principle 1, Rule1(i), Rule1 (j)
CFAF Principle 1, Principle 2, Guidelines 2(a)2(b)

7. Kinder Chocolate TV online advertisement (30/10/18)

CYPA-Principle 1, Principle 2 and Rules 1(i) and 2(f)

TV and online advertisement

Not upheld -Principle 1, Principle 2 and Rules 1(i) and 2(f)

8. Cookie Time Limited Facebook and Instagram (9/04/19, 30/04/19)

CYPA-Principle 1, Rule 1(e), 1(j)
ASC-Principle 1, Rule 1(h)

Digital advertisement and billboard advertising (bus shelter)

Upheld-ASC Principle 1, Rule 1(h)
Not upheld
CYPA Principle 1, Rule 1(e),1(j)

9. Arnott's Tiny Teddy bus shelter and website (13/08/19)

CYPA-Principle 1, Rule 1(e), Principle 2
ASC-Principle 1, Rule 1(h)

Bus shelter using school aged child

Digital advertising (website) using school aged child

Upheld-Bus shelter-ASC Principle 1 and Rule 1(h)
CYPA-bus shelter-Principle 1, Principle 2, Rule 1(e)
Not upheld
Website-CYPA and ASC

Appeal Decision 1-Arnott's Tiny Teddy bus shelter and website-appeal (9/12/19)

Bus shelter-de novo

Bus shelter

Not upheld -CYPA-bus shelter-Principle 1, Principle 2, Rule 1(e)

10. BurgerFuel Instagram and website advertisement (13/08/19)

CYPA-Principle 1Rule 1(i), Rule 2(f)
ASC-Principle 1, Rule 1(h), 2(g)

Digital advertising (Instagram and website)

Settled in part
Upheld
Instagram ASC
Website-ASC Principle 1 Rule 1(h), 2(g)
Not upheld
Instagram-CYPA
Website-CYPA

11. Red Bull Digital Marketing Facebook, Instagram, Website (10/07/18)

CYPA-Principle 1, Principle 2, Rule 1(h), 1(i), 1(j)

Digital advertising using famous person
Sponsorship

Not upheld
CYPA-Principle 1, Principle 2, Rule 1(h), 1(i), 1(j)

12. Wilson Consumer Products Out of Home (15/11/18)

CYPA-Principle 1, Rule 1(i)
Principle 3, Rule 3(a)

Banners advertising confectionary at school aged sports event

Settled -as ad removed

13. Hell Pizza, Digital Marketing (11/12/18)

CYPA-Principle 1, Rule 1(i)

Digital advertising using children

Not upheld
CYPA-Principle 1, Rule 1(i)

14. KFC's television advertisement (08/04/19)

ASC-Principle 1, Rule 1(h), Principle 2, Rule 2(g)
CYPA Code-Principle 1, Rule 1(h),1(i),1(j)

TV advertising using famous sports people

Not upheld
ASC-Principle 1, Rule 1(h), Principle 2, Rule 2(g)
CYPA Code-Principle 1, Rule 1(h),1(i),1(j)

15. Griffins Food Company-Toffee pops (10/07/18)

CYPA-Principle 1, Rule 1(c) Rule 1(i)

TV advertisement using famous sports people

Not upheld
CYPA-Principle 1, Rule 1(c) Rule 1(i)

16. Unilever Australasia (24/09/19)

ASC-Principle 1 and Rule 1(h);
CYPA-Principle 1; Rule 1(i) and Principle 2

Ice cream advertisement outside food store

Upheld
ASC-Principle 1 and Rule 1(h)
Not upheld
CYPA-Principle 1; Rule 1(i) and Principle 2

Appeal Decision 2 E Fowler-Unilever Australasia (25/11/19)

ASC-Principle 1 and Rule 1(h);
CYPA-Principle 1; Rule 1(i) and Principle 2

Ice cream advertisement outside food store

Not upheld
ASC-Principle 1 and Rule 1(h);
CYPA-Principle 1; Rule 1(i) and Principle 2

Two complaints were upheld under the CYPA Code; however, one was appealed and the decision reversed. Four complaints were upheld under the ASC; however, one was appealed and the decision reversed. Two further complaints were "settled", and one complaint was partially settled, meaning that the advertiser removed the advertisement before the Complaints Board adjudicated on the complaint, therefore no decision was given. Thus, of the 16 complaints under the CYPA Code, 12 were not upheld, and only one was fully upheld.

The analysis of how the Codes were interpreted by the Complaints Board to reach the final decisions provides additional context about how the regulatory system performs in practice.

3.2. Application of Public Health Law Framework to the ASA System

3.2.1. Evaluating the Substantive Terms and Conditions of the Regulatory System

Regulatory Purpose: CYPA Code

An effective marketing regulation should have a stated objective of reducing children's exposure to, and the persuasive power of, marketing of unhealthy products to provide an important standard to measure the performance of the system [ 3, 13, 39]. Regulatory systems are weaker if they have vague objectives that are not aligned with reducing exposure and power of marketing practices [ 39].

The stated purpose of the CYPA Code is to recognise the need to protect children under the United Nations Convention on the Rights of the Child (UNCROC); it is a commendable objective; however, there is no mention of reducing exposure or power of marketing. In order to fulfil the UNCROC, a strong regulatory system that effectively reduces the exposure of children to harmful marketing practices, is required [ 20]. This analysis of complaints demonstrates that the ASA system is not fulfilling that objective.

Substantive Terms and Conditions: CYPA Code

A robust regulatory system that effectively restricts exposure and power of marketing to children would address the following key components [ 13, 19, 39]:

Accurately capture the full extent of advertising that children are exposed to in the scope of the regulation;

Use a definition of children that protects children up to 18 years;

Capture the full range of mediums and techniques used to advertise to children and

Use a comprehensive nutrient profiling system to define which food and beverages are subject to the regulatory system.

Accurately Capture the Full Extent of Advertising that Children are Exposed to in the Scope of the Regulation

The CYPA Code applies to all advertisements that target children, whether contained in children's or young people's media or otherwise. Of the 16 complaints adjudicated on by the Complaints Board under the CYPA Code, only one advertisement was deemed to be "targeting children". For an advertisement to be classified as "targeting children or young people", the context of the advertisement needs to be analysed, as well as the relationship between the following three criteria:

Nature and intended purpose of the product or service being promoted is principally or generally appealing to children or young people;

Presentation of the advertisement content (e.g., theme, images, colors, wording, music, and language used) is appealing to children or young people;

Expected average audience at the time or place the advertisement appears includes a significant proportion of children or young people.

In practice, the Complaints Board requires all three criteria to be met, and even where the product and presentation of a product is appealing to children or young people, the Complaints Board considers the harm can be mitigated by the placement of the advertisement.

The most common ground given by the Complaints Board for not upholding a complaint is that the expected average audience of the advertisement would not include a "significant proportion of children or young people", which is deemed to be 25% or more of the expected audience. This definition was derived from advertisements on television, but the flaw of having adult viewership included in the denominator means that more adults in the audience will reduce the percentage of children watching but not the total number of children watching. Therefore, the restrictions may not limit children's actual exposure to unhealthy food marketing, leaving unprotected the many children who watch mixed-audience programming or online activity and outdoor advertising [ 9, 12, 14].

The Complaints Board did not uphold certain complaints claiming that the intended audience for the advertisements were parents not children. An appeal decision (Appeal Decision 1) found that an advertisement with a school boy promoting a small biscuit packet of teddy bear biscuits in a child's lunchbox advertised in bus shelters was targeting adult shoppers and not children because the nature and intent of the product and the presentation of the product was aimed at parent shoppers not children.

The Definition of Children

The Reeve and Magnusson framework defines a robust regulatory system as one that protects children up to 18 years old, in line with the UNCROC and other international recommendations [ 13, 14, 39].

While the CYPA Code does include young people aged 14 and up to 18 years old in its scope, it affords the age group different protections. While Rule 1 (i) states that advertisements of occasional foods must not target children, Rule 1 (j) states that young people can be targeted, but a "special duty of care" must be applied, a vague and less stringent rule. The guidelines state that advertisements must not state or imply that such products are suitable for frequent or daily consumption and, where possible, healthy or better-for-you options should be promoted. Other guidelines state that, where occasional food and beverages are advertised to young people, they should not be portrayed in any way that suggests they are beneficial to health. While sponsorship advertisements must not target children, "a special duty of care" must be taken for young people and must not show an occasional food or beverage product, such a product's packaging, or depict the consumption of an occasional product.

None of the complaints made regarding young people have been upheld by the Complaints Board and the interpretation of a "special duty of care" has not been articulated expressly by the Complaints Board beyond accepting that advertisers put age limits on who sees the advertising campaign online (for example, Complaint Decision 11).

Capture the Full range of Mediums and Techniques Used to Advertise to Children

The CYPA Code defines "Advertising and Advertisements" as "any message, the content of which is controlled directly or indirectly by the advertiser, expressed in any language, and communicated in any medium with the intent to influence the choice, opinion, or behavior of those to whom it is addressed".

While the definition of advertising is broad, when analysing the Complaints Board's decisions, it is apparent that the scope of the advertising mediums and techniques that are restricted by the self-regulatory system is limited. Various advertising mediums and techniques have been the subject of the complaints made to date, but only one complaint, regarding outdoor advertising using Santa Claus (Complaint Decision 4), has been upheld under the CYPA Code.

In nearly all the decisions, marketing techniques, such as the use of famous sports stars, popular children's characters, such as Santa Claus, the use of other children in the advertisements, limited edition offers, and the use of emojis, were considered to be appealing to children. However, the mediums they were communicated on that included TV advertising, online advertising (websites, Instagram, and Facebook), and outdoor advertisements were judged not to meet the criteria for targeting children or young people. The narrow interpretation of "targeting children" or "targeting young people" reduces the scope of the mediums and techniques covered by the CYPA Code.

Use a Comprehensive Nutrient Profiling System to Define Which Food and Beverages are Subject to the Regulatory System

The CYPA Code uses the New Zealand FBCS to determine which food and beverages are considered occasional and therefore subject to the restrictions. However, this classification system was not designed for advertising standards, but rather for classifying the type and portion size of food and beverages that should be sold in New Zealand schools. In addition, the FBCS has been retired by the Ministry of Health of New Zealand, and a new classification system for education settings is under development. This means the FBCS will no longer be a Government endorsed system, making it obsolete [ 40].

The WHO Regional Offices have designed nutrient profile models that are specifically intended for governments to use when restricting marketing to children, which would be more robust and appropriate classification systems to use, but are not used in the ASA system [ 41, 42, 43]. Under these models, foods are unable to be marketed to children if they include nutrients of concern that exceed the prescribed threshold based on per 100g only, not per serve. Under the WHO Western Pacific Regional Model, any form of cakes or biscuits are prohibited from being marketed to children, regardless of their nutritional composition, i.e., no thresholds are provided [ 43].

The FBCS system uses both a per 100g ratio and a per serve ratio as its thresholds, depending on the product category. For example, a small packet of children's mini biscuits could be considered a "sometimes" food rather than an "occasional" food because the quantity of the product is under the prescribed serving size threshold. Using a serving size metric for products such as "sweet snacks" (biscuits, cakes, pastries) that are high in fat, sugar, or salt is inadequate, as the nutritional composition of the product should be the chosen metric of whether the food can be marketed to children not the quantity in the serving size. Such products should be prohibited from being marketed to children, as is the case in the WHO nutrient profile models.

In a comparison study conducted to ascertain which nutrient profiling systems to classify foods would best protect New Zealand children from exposure to the marketing of unhealthy food and beverages, it was found that the WHO Regional Office of Europe model would permit marketing of 29% of the products in scope, while the FBCS system would permit 39% of products. The FBCS system was found to permit marketing of a number of food products of concern, particularly high-sugar breakfast cereals, fruit juices, and ready meals [ 44].

Regulatory Purpose: ASC

The ASC states as its purpose that all advertising must be legal, decent, honest, and truthful and respect the principles of fair competition, so that the public can have confidence in advertising. This is a general regulatory purpose that does not specifically mention reducing exposure or power of advertising to children but is in line with the general purpose of the ASC.

Substantive Terms and Conditions: ASC

The ASC does not have comparable terms and conditions in relation to the components of targeting children with advertising. However, given that more complaints have been upheld under the ASC and not the CYPA Code, an exploration of the substantive terms and conditions and the ASA's interpretation of the ASC is important.

Of the relevant complaints made under the ASC (n = 6), all contained a complaint under Principle 1 (Advertisements must be prepared and placed with a due sense of social responsibility to consumers and to society), in particular, Rule 1(h) (Advertisements must not undermine the health and well-being of individuals). Two complaints were also made under Rule 2(g), which states that Food and Beverage claims must be factual and able to be substantiated and must not be misleading.

The ASC provisions protect the general public: Children or young people are not uniquely protected and, as such, the advertising in question does not need to meet the same "targeting" criteria as the CYPA Code. The definition of advertising is the same as the CYPA Code and "foods high in salt, fat, and sugar" are the subject of the provisions, with no thresholds provided for what is considered "high in".

The Complaints Board upheld four complaint under Rule 1(h) finding that the advertisements in question were socially irresponsible or undermined health and wellbeing (or both) (Complaint Decisions 8-10 and 16). The complaints that were upheld consisted of a mixed range of mediums such as bus shelter advertisements, Instagram, or website advertisements, and usually involved children in the advertisements. One complaint was upheld under Rule 2(g) as the advertisement was found to give false information about the nutritional value of the food product in question (Complaint Decision 10).

Multiple complaints were upheld under the ASC but not under the CYPA Code (Complaint Decisions 8-10 and 16). For example, the biscuit advertisement in a child's lunchbox advertised at a bus shelter was determined to be socially irresponsible and undermining health and wellbeing, whereas it was not considered to be "targeting children" under the CYPA Code (Complaint Decision 9) [ 45].

3.2.2. Evaluating the Regulatory Process Governing the Regulatory System

Rule Development and Scheme Design

The public health law framework stipulates that regulatory processes governing a regulatory system should include transparency and accountability mechanisms from their commencement, including when developing substantive regulatory rules and in determining scheme design. For example, working groups consisting of government agencies, public health organisations, and consumer advocates can be involved in the drafting of the regulations or external stakeholders could be consulted with [ 39].

As is typical for a self-regulatory system, the ASA Codes and Complaints system was designed by the ASA, which is made up of advertising industry stakeholders, but an external public advisory board consisting of different stakeholders, including public health, did advise the process.

The ASA did consult the public on the amendment of the CYPA Code and received submissions from various stakeholders, including public health stakeholders, on how the system could be improved. Some of the recommendations within the submissions were incorporated, but more substantial recommendations were not [ 42].

Administration and Monitoring of Performance and Compliance and Independent Review of Restrictions

The public health law framework states that an independent body should administer the regulatory system including monitoring and enforcing the system [ 39]. The independent body can organise a regular and structured external review of the system's performance against its objectives [ 39]. The review should include baseline and follow-up data and timeframes for evaluation and should be conducted by independent third parties [ 39].

As is typical of a self-regulatory system, the ASA administers the New Zealand regulatory system. It is not an independent body with no conflicts of interest. The ASA states that the Codes will be reviewed every 5 years, or earlier if the need arises, and the CYPA Code is due for review in 2022. It is unclear what a review entails, but there is no provision in the ASA governing rules for an external review of the performance of the system by an arm's length party, nor collection of baseline data, outcome indicators, stakeholder's compliance with the Codes beyond the complaints process, or the scheme's success in meeting its stated objectives.

3.2.3. Evaluating Enforcement of Regulatory Standards for Food Advertising

Complaints Handling Mechanisms

The public health law framework states a complaint-handling scheme should be independent and credible so that the public feel confident using it and so that any amendments can be made to improve the system. Publishing the decisions on each complaint ensures the system is transparent and that a series of precedents can be developed to help understand the regulatory schemes' terms and conditions [ 39].

The ASA complaints system is self-managed by the ASA through a Complaints Board and is therefore not independent. The Complaints Board is made up of a Chairperson, four public members, and four industry members. While the public members have no connection with the media or advertising industry, the ASA appoints the members.

The Complaints Board adjudicate on each complaint, including the advertiser's response to the complaint, and publish the decision on the ASA website. The complainant and the advertiser can appeal the decision to the Appeals Board, who also publish the final decision online. Evidence shows that parents are either unaware of the ASA system or feel they are powerless in the complaints process, relative to the food industry [ 46]. Filing a complaint takes skill and time, which creates barriers for participation in the process. A complainant must include the time, date, and channel information when the advertisement was viewed, which the general public may not have access to, whereas the advertiser will hold this information. The complainant must also ascertain whether the product in question meets the nutritional criteria of "occasional" food under the FBCS, including the per serve metric for certain unhealthy food product categories.

In some cases, advertisers voluntarily removed the advertisement before a decision was issued, effectively "settling" the case. For example, Frucor removed an advertisement before the Complaints Board could adjudicate on the case, resulting in no decision being given (Complaint decision 1) [ 47]. This meant that the opportunity of developing a precedent for the Complaints Board to use in later decisions and for other advertising practices to follow was lost. This practice also has the effect of taking removed advertisements outside of the scope of the Codes, even when they have breached the Codes.

Enforcement

The public health law framework states that a range of enforcement mechanisms including incentives to encourage compliance, less strict measures like persuasion and more strict measures such as fines should be utilised to increase compliance [ 39].

The ASA system relies on the public reporting breaches of the ASA system, placing the onus of monitoring and enforcing the Codes on the general public, not the industry being regulated or an independent governing body.

If a complaint is upheld under the CYPA Code, the sole penalty is to remove the offending advertisement. The Complaints Board only considers the advertisement seen by the complainant, for example, one advertisement at one bus stop, instead of applying the decision to the whole advertising campaign. As a complaint regarding a broadcast advertisement has not been upheld, it is unclear whether an advertisement at a certain time period would be removed, but the whole campaign could continue on broadcast. Under the ASC, an advertiser is required to remove the offending advertising campaign across the whole medium (i.e., Instagram), but not the whole mixed media campaign if other elements of the campaign were found not to be in breach or were not raised by the complainant. This results in the wider advertising campaign continuing to impact children and provides very little incentive to advertisers to adhere to the Codes.

The decisions of the Complaints Board are sent to the media and posted on the news section of the ASA website. There is no financial repercussion or a limited name and shame element to a decision being upheld by both common enforcement mechanisms in other similar systems [ 48].

17. World Cancer Research Fund International NOURISHING Database-Restrict Food Marketing. [(accessed on 15 March 2020)]; Available online: http://www.wcrf.org/nourishing

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51. Garde A., Byrne S., Gokani N., Murphy B. For a Children's Rights Approach to Obesity Prevention: The Key Role of an Effective Implementation of the WHO Recommendations. Eur. J. Risk Regul. 2017:327-341. doi: 10.1017/err.2017.26. [[ CrossRef] Google Scholar]

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Food Advertising to Children in New Zealand: A Critical Review of the Performance of a Self-Regulatory Complaints System Using a Public Health Law Framework

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Nutrients. 2020 May; 12(5): 1278. New Zealand has the second highest overweight and obese child population in the Organisation for Economic Co-operation and Development (OECD). This paper evaluates whether New Zealand's self-regulatory controls on the advertising of unhealthy food and beverages to children and young people adequately protects children from the exposure to, and power of, such marketing in order to limit its impact on children's food and beverage preferences.

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Impact of voluntary industry code for advertising food to children

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Impact of voluntary industry code for advertising food to children

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New Zealand has the second highest child obesity prevalence of all forty-one countries in the Organisation for Economic Co-operation and Development and European Union (behind the USA). The most recent New Zealand Health Survey in 2019/2020 revealed the obesity prevalence for children aged 2-14 years was 9·4 % (79 000 children). The same survey reported a greater prevalence of childhood obesity for Pacific (29·1 %) and Māori (indigenous population; 13·2 %) children, compared with 7·2 % of European/Other children. Obesity is a form of malnutrition and the consequences of childhood obesity can extend into adulthood, with the development of life-limiting co-morbidities such as diabetes, osteoarthritis, CVD and cancers(Reference Ng, Fleming and Robinson3,4) .

Several systematic reviews have affirmed unhealthy food advertising as a risk factor for childhood obesity, observed through children's food intake and increased positive attitudes towards advertised foods(Reference Boyland, Nolan and Kelly5-Reference Qutteina, De Backer and Smits7), and these early unhealthy eating patterns are likely to continue into adulthood(Reference Lipsky, Haynie and Liu8). In 2010 at the 63rd World Health Assembly, the WHO introduced a Set of Recommendations for the Marketing of Foods and Non-alcoholic Beverages to Children. The twelve recommendations relate to forming policies to restrict marketing of unhealthy foods to children, and their implementation was highlighted in the 2016 WHO Ending Childhood Obesity report. In 2018, the WHO policy recommendations were also recognised in a document developed by the United Nations Convention on the Rights of the Child to promote child rights-based approaches to protect children from harmful content, including unhealthy food marketing(Reference Garde, Byrne and Gokani10).

Governments and food and marketing organisations from several countries have responded with policies to reduce and regulate children's exposure to unhealthy food marketing(11-Reference Powell, Gheera and Foster13), usually taking one of three forms: mandatory (the policy is passed by the government (legislation) and must be followed by all food companies), self-regulatory (the policy is managed by the food and marketing industry and company participation is voluntary) and co-regulatory (the policy is a combination of government and self-regulatory initiatives). Previous systematic reviews(Reference Galbraith-Emami and Lobstein15-Reference Chambers, Freeman and Anderson17) suggest mandatory policies are marginally more successful than self-regulatory policies, and countries such as Chile where mandatory controls are in place have seen a reduction in children's exposure to unhealthy food advertising(Reference Dillman Carpentier, Correa and Reyes18,Reference Jensen, Carpentier and Adair19) .

In New Zealand, the industry-led Advertising Standards Authority (ASA) oversees a self-regulatory code to protect children from unhealthy food advertising in all virtual (e.g. television, websites, apps) and physical settings that target children or young people (except product packaging, and within news and broadcast programmes). In October 2017, a revised Children and Young People's Advertising Code came into effect after recommendations from an independent review, replacing two previous codes related to food advertising to children . The revision was informed by consultation with the public and public health stakeholders to reflect the goal of adequately protecting children (under 14 years) and young people (14-18 years) from unhealthy food advertisements. Changes to the code are outlined in Table 1. In summary, a definition was added for 'targeting children' (advertisements intended for, or appealing to children), the Ministry of Health Food and Beverage Classification System from 2013 was added to define an occasional (unhealthy) food or beverage, and 'children as a significant proportion of the audience (25 % of the total audience), and 'special duty of care' (to ensure advertising is not likely to result in physical, mental or moral harm) were defined .

After the announcement of the code changes in 2017, over seventy New Zealand public health professionals published a letter stating that the proposed changes were unlikely to make a significant impact on reducing children's exposure to unhealthy food marketing(Reference Swinburn, Vandevijvere and Woodward23).

A study assessed unhealthy food advertising on New Zealand television before the code update in 2017. The study found that the previous self-regulatory code failed to protect children from unhealthy food advertising as most unhealthy food advertisements were shown when the greatest number of children was watching television(Reference Kelly, Vandevijvere and Ng16,Reference Vandevijvere, Soupen and Swinburn24) . Two different nutrient profiling models (WHO-Europe nutrient profiling model (WHO-EU) and the Ministry of Health Food and Beverage Classification System from 2007 (MoH 2007)) were used to categorise unhealthy food advertisements on New Zealand television in 2015, finding children were exposed on average to 9·1 unhealthy food advertisements per hour (under WHO-EU). WHO-EU was the strictest nutrient profiling model and classified more food advertisements overall as unhealthy compared with MoH 2007 (68·5 % v. 50·5 %, respectively)(Reference Vandevijvere, Soupen and Swinburn24).

However, there have been no studies to determine the effectiveness of the 2017 revised ASA code. The aim of this study was to evaluate the impact of the 2017 ASA code update on the number of unhealthy food advertisements on New Zealand television and children's exposure to such advertisements using television and child audience data before (2015) and after (2018) the code update.

Methods

Methods were informed by the 2015 evaluation of the New Zealand ASA code by Vandevijvere et al.(Reference Vandevijvere, Soupen and Swinburn24) and to align with the protocol for such analyses published by the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) group. The primary outcome was to compare the number of children exposed to unhealthy food advertisements on television before and after the New Zealand ASA code update. Other outcomes were the mean rate and percentage of food advertisements that were unhealthy, and children as a proportion of total audience watching television in 2018. We also assessed whether the definition of children's peak viewing times in the revised code (when 25 % of the audience are children) corresponded to when most children were watching television.

Results

Discussion

This study was the first to assess the impact of the revised ASA industry code, a self-regulatory code to reduce unhealthy food advertising to New Zealand children. Between 2015 and 2018, the total number of unhealthy food advertisements overall decreased. This may have been due to a shift of unhealthy food advertisements to online marketing such as Facebook, where 98 % of food advertisements exposed to young people in New Zealand were unhealthy(Reference Kidd, Mackay and Swinburn32). However, the proportion of all food advertisements on television that were unhealthy remained high. This suggests that the impact of the revised code is minimal as unhealthy foods continue to make up most food advertising on New Zealand television.

The results also highlight that television viewing decreased for children and young people between 2015 and 2018. Despite free-to-air television viewership decreasing, New Zealand's overall screen time appears to be increasing due to the shift to other forms of media. This has been confirmed by other reports on audience behaviour which showed a decrease of television audiences from 83 to 66 % and increase of video streaming (from 6 to 37 %) and online video such as YouTube and Facebook (30-52 %) between 2014 and 2018.

The current ASA code definition of children's peak viewing time (25 % of the total viewing audience consisting of children up to 14 years) is an arbitrary threshold and in 2018 the percentage of child television viewers never came close to reaching the ASA definition. The proportions of children watching in New Zealand were similar to those in a South Australian report that found no more than 17 % of 0-14 years viewed television on weekdays, while a peak percentage of 0-14-year-old viewers (over 25 %) lasted for 3·5 h on weekend mornings(Reference Brindal, Corsini and Hendrie34).

The evening times when children aged 5-13 years were the lowest percentage of the audience were also when the greatest absolute number of children and young people was watching television and the greatest number of unhealthy food advertisements was shown. Thus, the current ASA definition of peak viewing time does not reflect when the greatest number of children is watching, and exposed to, unhealthy food advertising on television.

The UK government recently responded with a ban on high fat, sugar and salt foods shown on live television and on-demand programmes (free-to-air and paid) before 21.00 and for paid-for advertising online from 2022(Reference Powell, Gheera and Foster13). Results from a modelling study estimated that the impact of banning high fat, sugar and salt foods from 05.30 to 21.00 on UK television would result in children viewing 1·5 fewer high fat, sugar and salt advertisements per day and reduce overweight and obesity by 3·6 %(Reference Mytton, Boyland and Adams35). According to our New Zealand television analysis, a watershed period would be relevant until 22.00, when there are still at least 50 000 children and young people watching television.

Public health professionals have advocated for the use of the WHO-EU nutrient profiling model in New Zealand as it was specifically designed to restrict marketing of unhealthy food to children and was shown to be more sensitive than the Ministry of Health Food and Beverage Classification systems currently used by the ASA code. The latter was developed for classifying the healthiness of foods sold in schools(Reference Swinburn, Vandevijvere and Woodward23).

In 2020, the World Cancer Research Fund International released a report on the effectiveness of international policies to restrict inappropriate food advertising to children. According to thirty-eight studies from eleven countries, which all used television data to assess impact, improvements to reduce unhealthy food advertising to children were seen in less than one quarter of the studies (8/38 studies). From this, 6/12 evaluations looked at mandatory policies (in Canada (Quebec), Chile, South Korea and the UK), which was more promising than the 2/26 evaluations of self-regulatory policies (in Australia and the USA). Similarly, three global systematic reviews also looked at both mandatory and self-regulatory policies and showed greater reductions in unhealthy food advertising and marketing from mandatory policies compared with self-regulatory policies(Reference Galbraith-Emami and Lobstein15,Reference Chambers, Freeman and Anderson17,Reference Ronit and Jensen37) .

While mandatory policies are recommended by international public health agencies, most countries appear to be adopting self-regulatory policies due to food industry pressure and opposition(Reference Swinburn and Wood38). But when assessed against a public health law framework(Reference Reeve and Magnusson39), the ASA code did not meet the benchmark for best regulatory practice and was deemed an ineffective policy to support a healthier food marketing environment(Reference Sing, Mackay and Culpin40). Public health stakeholders are calling for movement towards mandatory government regulation to prevent further deviation from a children's rights-based approach(Reference Garde, Byrne and Gokani10,Reference Mackay, Sing and Gerritsen41,Reference Backholer and Sing42) . Other recommendations include involving multiple stakeholders during the policy development, separation of implementation and evaluation stages, and involving industry, government, civil society groups, public health officials and academics. Stronger and more precise definitions are emphasised, for instance, to apply the definition of 'children' in the code to include up to 18 year olds in accordance with the United Nations Convention on the Rights of the Child .

Currently, very few countries have regular practices to monitor and evaluate the effectiveness of policies to restrict unhealthy food and drink advertisements on television or other media over time, despite a recommendation from the WHO(11,44,Reference Tatlow-Golden, Jewell and Zhiteneva45) . It is worthwhile to conduct research independently of the food and advertising industry to provide a universal benchmark for research when globally assessing policies over time(Reference Kelly, Vandevijvere and Ng16,Reference Kelly26) . The results from this study and subsequent monitoring of the impact from the 2017 ASA code update will further inform the changes needed to be made under the next review of the ASA code in 2022 to increase its impact(Reference Truebridge46).

A strength of this study was that it was the first to use objective television programming and viewing data to assess the impact of changes to the New Zealand ASA code in 2017. It also compares data from before (2015) and after (2018) the code, which provides an indication of changes over time. Data from the two years were collected and analysed using the same protocol guided by INFORMAS, to ensure a consistent and validated methodology. A further strength is that the data on the number of children and young people watching television from both 2015 and 2018 were purchased from Nielsen. These were comprehensive datasets collected from representative samples of New Zealanders.

A limitation of this study was that it only looked at television data from a small number of free-to-air channels and did not include incidental television exposure, pay-to-view platforms, internet or social media, which are growing rapidly in popularity in New Zealand and globally. The most recent Children's Media Use Survey commissioned by NZ On Air and the Broadcasting Standards Authority in 2020 revealed that 35 % of children watched free-to-air television, compared with 73 % of children who watched video using overseas sites such as YouTube. A further limitation was that, due to lack of sufficient audience viewing data, the study did not analyse Māori and Pacific audience data separately, which is important due to the disproportionately higher prevalence of childhood obesity in these groups. As a result, the study could not examine whether viewing numbers and thus the impact of the code would be equal for different population groups.

The study also compared the different time periods in 2015 (July-August) and 2018 (October-December) which could have potentially different seasonal patterns. However, when comparing the audience rating data, daily trends did not seem to significantly differ, with peaks still taking place during the same times of the day.

As the ASA code applies to all advertising settings, future research should continue to monitor the New Zealand food advertising environment on all platforms to ensure the ASA code is a credible tool. The greatest challenge is creating a reliable methodology to measure the nature and extent of advertising exposure to children on web-based and social media platforms. Unlike television, internet and social media content is always accessible which inherently makes all children vulnerable to advertising at any time of the day. Barriers to monitoring include the ethical challenges of collecting personal data from social media users, and personalised tailoring of advertisements depending on individual use of media(44,Reference Tatlow-Golden, Jewell and Zhiteneva45,48) . Options could be to use a browser extension to monitor advertisements seen online(Reference Kidd, Mackay and Swinburn49) or to utilise a 2019 comprehensive monitoring framework developed by WHO(Reference Tatlow-Golden, Jewell and Zhiteneva45).

A final limitation was that there was no television audience data for children 0-5 years, an age group that is increasingly exposed to screens, as reported in the Growing Up in New Zealand study(Reference Stewart, Duncan and Walker50). The data from this study indicated that at 2 years old, New Zealand children spend approximately 1·5 h each day on screens (including television and electronic media such as computer, laptop, tablets, smart phones and electronic gaming devices). This increases to 2 h per day at 3·75 years old(Reference Stewart, Duncan and Walker50).

Conclusion

We explored change over time in the number of unhealthy food advertisements New Zealand children were exposed to on television following the ASA code update in 2017. Since adoption of the revised ASA code, there has been a small reduction in unhealthy food advertisements on free-to-air television channels and fewer children and young people watching free-to-air television. However, two-thirds of food advertisements are still classified as unhealthy and children never make up 25 % of the total viewing audience, making the ASA definition of peak viewing time ineffectual. Our findings indicate the need for stronger regulation, increasing the code's coverage to include children and young people up to 18 years, redefining 'peak viewing time' using an absolute number of children and young people rather than the arbitrary percentage of 25 % and the need to adopt a more stringent nutrient profiling model to define foods that are appropriate/not appropriate for marketing to children (WHO-Europe nutrient profiling model). Ultimately, government regulation and rigorous, independent monitoring of compliance across all media (including web-based and social media platforms) should be implemented to ensure protection of New Zealand children from unhealthy food marketing.

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Impact of a voluntary industry code for advertising food to children and young people: an analysis of New Zealand television data | Public Health Nutrition | Cambridge Core

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New Zealand has the second highest child obesity prevalence of all forty-one countries in the Organisation for Economic Co-operation and Development and European Union (behind the USA). The most recent New Zealand Health Survey in 2019/2020 revealed the obesity prevalence for children aged 2-14 years was 9·4 % (79 000 children).

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New Zealand's rates of childhood obesity are unacceptably high. According to the 2014/2015 New Zealand Health Survey, a third of New Zealand children aged 2-14 years are obese (11 %) or overweight (22 %), the third highest rates among countries belonging to the Organisation for Economic Co-operation and Development(). Furthermore, 30 % of Pacific children and 15 % of Māori children are classified as obese, and children living in the most deprived areas of New Zealand are five times more likely to be obese than those in the least deprived areas(). Children who are overweight or obese are more likely to become obese adults and to develop non-communicable diseases like diabetes and CVD earlier in life().

One of the key recommendations in the recent final report of the WHO's Commission on Ending Childhood Obesity, chaired by the Chief Science Advisor to the Prime Minister in New Zealand, has been to implement comprehensive restrictions on the marketing of unhealthy foods and non-alcoholic beverages (hereafter 'unhealthy food marketing') to children, including the monitoring and evaluation of these marketing efforts(). Previous research, including several systematic reviews, has shown that exposure to food marketing influences children's brand recognition, purchasing requests and food preferences(Reference Boyland, Nolan and Kelly 3-Reference Cairns, Angus and Hastings 6). In May 2010, 192 Member States endorsed Resolution WHA63.14 to restrict the marketing of unhealthy foods to children and adolescents globally, but progress by governments and food companies in implementing such restrictions has been very patchy to date(Reference Kraak, Vandevijvere and Sacks 7).

In New Zealand, food advertising to children is self-regulated by the industry, involving several bodies including the Commercial Approvals Bureau (CAB), the Advertising Standards Authority (ASA), individual broadcasters and food and beverage companies. Television and radio advertisements for both food and non-food products have to be screened by the CAB before being aired. The screening process for airing food advertisements during designated children's programming times (defined by individual broadcasters and not the CAB) is governed by two codes of practice developed by the ASA. These are the Children's Code for Advertising Food() and the Code for Advertising to Children, which only apply to children between 0 and 13 years of age. To be aired during designated children's programming times, it is recommended that foods advertised meet the New Zealand Ministry of Health criteria for an 'everyday' or 'sometimes' food(,).

'Everyday' foods are foods from the four core food groups (breads, rice and cereals, fruits and vegetables, meat, fish and poultry and dairy), while 'sometimes' foods are higher in fat, sugar and salt and should not dominate children's diets(). Under the codes, 'occasional' foods ('junk' foods high in fat, salt and sugar, low in nutritional value and suitable for occasional consumption only) can only be advertised during children's programming times under the assessment of independent nutritionists(). Previous research suggests that this system has been ineffective, with previous studies across several media platforms reporting that the majority of food marketing in New Zealand is for unhealthy or occasional foods(Reference Vandevijvere and Swinburn 11). In addition, internationally, it has been shown that industry self-regulation has been ineffective to date to reduce exposure of children to unhealthy food marketing(Reference Galbraith-Emami and Lobstein 12).

Several major weaknesses exist in New Zealand's current self-regulatory system, such as the lack of provisions to reduce the total volume of unhealthy food advertising seen by children and the definition of 'children's viewing times', which includes children's programmes but not children's peak viewing times. Recently the ASA codes have undergone a review and a new draft code has been proposed(), including the following new provision: 'Occasional Food and Beverage Product advertisements must not be screened, broadcast, published or displayed in any media or setting where more than 25 % of the expected audience are children.'

Previous studies on television food advertising in New Zealand are old and investigated only selected hours during the day(Reference Jenkin, Wilson and Hermanson 14-Reference Wilson, Signal and Nicholls 16). The aims of the present study were to comprehensively assess the extent, nature and impact of unhealthy food advertising targeted to children on New Zealand television and to derive key policy implications. Impact refers to the number of children viewing an advertisement, where one impact is equivalent to one child viewing one showing of an advertisement.

Methods

The methods follow the recommendations by the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) for monitoring unhealthy food marketing to children(Reference Kelly, King and Baur 17).

Results

Discussion

The findings of the present study suggest that children are exposed to a food marketing environment on television that is largely unhealthy and persuasive(Reference Kraak and Story 23,Reference Jenkin, Madhvani and Signal 24) (i.e. advertisements frequently incorporating promotional characters or premium offers). The majority of food advertising across all channels was found to be unhealthy. TV2, the channel sampled with the largest child audience, had the highest rate of unhealthy food advertising and food advertising overall. In addition, more than 80 % of unhealthy food advertisements were shown during children's peak viewing times and a third of unhealthy food advertisements used either promotional strategies or premium offers that might appeal to children. A recent study found that children who watched just twenty television adverts per week for sugary breakfast cereals eat about 30 % more of them than children who see none(Reference Longacre, Drake and Titus 25).

The volume and nature of the advertising to which children are exposed on television suggest that industry self-regulation has not been effective in New Zealand. When roughly compared with the previous studies done in New Zealand, which included only selected hours during the day, the rate and proportion of unhealthy food advertising on television have not decreased over time(Reference Jenkin, Wilson and Hermanson 14-Reference Wilson, Signal and Nicholls 16). One potential reason for this ineffectiveness is that the times where advertising is permitted or limited under self-regulation (during children's programmes) do not match children's actual viewing patterns. The findings of the present study suggest that this is the case, as child audience ratings data from A.C. Nielsen show that children's viewing reaches its highest peak in the evenings where no channel restrictions are in place. This means that there is no protection for children in place when they are most likely to be watching television and most likely to view unhealthy food advertisements.

Improved regulations are needed in order to reduce the exposure of children to unhealthy food advertising in New Zealand, especially during their peak viewing times. The revised self-regulation code for advertising to children() proposes a small improvement in that it now includes a nutrient profiling system (the Ministry of Health Food and Beverage Classification System), but not the most appropriate one, which is the WHO-EU nutrient profiling model(), as shown in the current study.

This WHO-EU model has previously been recommended as the best to restrict unhealthy food advertising to children in New Zealand based on a comparison of three nutrient profile models applied on a database of more than 13000 packaged food products in New Zealand(Reference Mhurchu, Mackenzie and Vandevijvere 20). The new code() includes a provision to limit unhealthy food advertising during programming times when children comprise at least 25 % of the total audience. This is not a logical definition to use because adult viewership is in the denominator (total audience); having more adults in the audience will reduce the percentage of children watching but not the total number or percentage of children watching. It would be recommended to define peak viewing times using audience ratings for children only. The present study has shown that a substantial reduction in impact could be achieved if unhealthy food advertisements would be restricted during times when at least 25 % of total New Zealand children are watching television.

In order to assess compliance with the new draft code, once implemented, and to measure progress on reducing exposure of unhealthy food advertising to children, regular monitoring by the government or an independent agency, using similar processes as used in the current study, is needed. In addition, sanctions for companies that breach regulations could be applied, similar to policies in Quebec (Canada) and the UK. Tools used in these countries include issuing warnings and fines, removing the advertisement from air and publicly naming companies that breach regulations. The current complaints-based system in New Zealand focuses on whether the content of individual advertisements is offensive socially or morally. There are no publicly available materials aimed at informing television watchers that they can also complain about the placement, frequency or nutritional content of food advertisements, which is a likely reason for the low complaint levels around these issues.

Conclusions

Responding effectively to childhood obesity is a major challenge facing decision makers in New Zealand and around the world. Ensuring that unhealthy foods are not marketed to children is one of the WHO's major policy recommendations for tackling unhealthy diets and contributing to the prevention of obesity and non-communicable diseases. The present study shows that the majority of food advertising on television in New Zealand is unhealthy and that most unhealthy food advertisements are specifically targeted at children. Current self-regulation is ineffective in protecting children from exposure to unhealthy food advertising. The WHO-EU nutrient profiling system needs to be used to restrict unhealthy food advertising to children on television, especially during their peak viewing times. In addition, a co-regulatory approach with independent monitoring could be implemented. To achieve this, efforts and consultations beyond the ASA's recent review of the advertising codes will be needed.

Acknowledgements

Financial support: This study was supported by the Health Research Council of New Zealand. The funder had no role in design, conduct, analysis, interpretation and write-up of the findings. Conflict of interest: S.V. is a Deputy Editor for Public Health Nutrition; the remaining authors report no conflict of interest. Authorship: S.V. and B.S. designed the study, A.S. collected the data, A.S. and S.V. analysed the data and wrote the manuscript, all authors critically revised draft versions of the manuscript. Ethics of human subject participation: This study was approved by the Human Participants Ethical Committee of the University of Auckland. However, no human subjects were involved in this study.

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Unhealthy food advertising directed to children on New Zealand television: extent, nature, impact and policy implications | Public Health Nutrition | Cambridge Core

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New Zealand's rates of childhood obesity are unacceptably high. According to the 2014/2015 New Zealand Health Survey, a third of New Zealand children aged 2-14 years are obese (11 %) or overweight (22 %), the third highest rates among countries belonging to the Organisation for Economic Co-operation and Development( ).

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NZ worrying food trends - supersize this?

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NZ worrying food trends - supersize this?

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Dr Helen Eyles Faculty of Medical and Health Sciences

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Supersize this? New Zealand’s worrying fast food trends - The University of Auckland

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The serving size, energy and sodium levels of New Zealand fast food have increased significantly over the past five years, according to University of Auckland research.

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INFORMAS Food Environments 201B Full Report

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Public Health Reports and Research - NZ Nutrition Foundation

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Pacific Islands Food and Nutrition Action Group

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Adult obesity statistics

The New Zealand Health Survey 2019/20 found that:

around 1 in 3 adults (aged 15 years and over) were obese (30.9%)

the prevalence of obesity among adults differed by ethnicity, with 63.4% of Pacific, 47.9% of Māori, 29.3% of European/Other and 15.9% of Asian adults obese

adults living in the most socioeconomically deprived areas were 1.8 times as likely to be obese as adults living in the least deprived areas*

the overall prevalence has remained relatively stable since 2012/13, however there was an increase between 2011/12 and 2019/20 for adults aged 45-54 years and 55-64 years.

Child obesity statistics

The New Zealand Health Survey 2019/20 found that:

around 1 in 10 children (aged 2-14 years) were obese (9.4%)

the prevalence of obesity among children differed by ethnicity, with 29.1% of Pacific and 13.2% of Māori obese, followed by 3.4% of Asian and 7.2% of European/Other children

children living in the most socioeconomically deprived areas were 2.7 times as likely to be obese as children living in the least deprived areas*

the child obesity rate has decreased since 2018/19, and while this has decreased since last year, it is too early to report a trend.

For more information refer to the Tier 1 statistics 2019/20: New Zealand Health Survey.

* Adjusted for differences in age, sex and ethnicity.

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The New Zealand Health Survey 2019/20 found that: around 1 in 3 adults (aged 15 years and over) were obese (30.9%) the prevalence of obesity among adults differed by ethnicity, with 63.4% of Pacific, 47.9% of Māori, 29.3% of European/Other and 15.9% of Asian adults obese adults living in the most socioeconomically deprived areas were 1.8 times as likely to be obese as adults living in the least deprived areas* the overall prevalence has remained relatively stable since 2012/13, however there was an increase between 2011/12 and 2019/20 for adults aged 45-54 years and 55-64 years.

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Health Washing - health claims made on packaging

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Health Washing - health claims made on packaging

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As a savvy consumer, you're probably on the look out for 'greenwashing,' the pop-culture term Greenpeace defines as 'the act of misleading consumers regarding the environmental practices of a company or the environmental benefits of a product or service.' But have you heard of 'healthwashing'?

This new term has been popping up online to describe when a product (typically food) is marketed as healthier than it actually is, with references in advertisements and on packaging to health-boosting ingredients, such as vitamins, antioxidants and probiotics.

Dr. Joe Schwarcz, the director of McGill University's Office for Science and Society, which demystifies science for the public, refers to healthwashing as the 'nutraceutical' trend (a mash-up of the words nutrition and pharmaceutical). 'It's the idea that a food can be a quasi drug and address health concerns,' he says.

While foods that suggest they can boost immunity or lower your risk of illness seem to be support a healthy lifestyle, some of the companies that produce them have gotten into trouble for making these claims.

In 2009, Coca-Cola was sued over language the company used to market its VitaminWater product line, including words such as "endurance," "rescue" and "energy." The drinks contain 33 grams of sugar and synthetic vitamins.

In 2010, Dannon settled a lawsuit that accused the company of falsely advertising that the products DanActive and Activia yogurts were 'clinically' and 'scientifically' proven to regulate digestion and boost the immune system. A judge ordered the company to repay customers because the company had made claims they had not proven.

And bothPom Wonderfuland General Mills, the makers of Cheerios, were also sent warning letters from the FDA to change packaging claims that their products reduce blood pressure and lower cholesterol.

Healthwashing in action

Fortified foods seem to be multiplying on the grocery-store shelves: Plant sterols are the newest additive to dairy products, probiotics have moved from yogurt to bread and orange juice comes fortified with calcium.

The influx of these products means consumers are buying them in droves. What makes these products so appealing? ' We see the labels and we want to believe it because the work of eating healthy and balanced is done for us. But remember there are no labels on whole foods, such as oranges or broccoli,' says Meghan Telpner, a Toronto-based certified nutritionist and holistic lifestyle consultant. It's always better to eat the whole food than a product that contains a synthetic version of a beneficial nutrient, she adds.

How are health claims regulated?

While Dannon was warned about its marketing in the U.S., Dannon in Canada uses some different language on its product packaging. The DanActive website states that the product 'contains probiotic that contributes to healthy gut flora,' which is a claim approved by the government.

Under Health Canada regulations, companies are allowed to make three types of health claims: The first type is functional claims, such as 'promotes regularity.' The second type is general claims, which provide dietary guidance such as 'include one serving a day as part of a healthy diet.' The third is disease reduction, such as 'lowers cholesterol.'

When a health claim brings the food under Health Canada's definition of a drug (that is, if a company claims a product treats or prevents a disease, for example), the company making it must submit proof to Health Canada in the form of human clinical trials that demonstrate a statistically significant positive effect. A food cannot be marketed with the health claim until the government gives approval.

Health claims that do not make the food a drug in Health Canada's eyes'such as the wording on DanActive's packaging'don't require pre-market approval. The expectation is that those claims must be truthful and not misleading, and manufacturers are expected to have evidence substantiating the health claim on hand in case the government questions them.

Why tune into healthwashing?

Purchasing a product because of a health claim made on its packaging may lighten your pocket book' some foods labelled with health claims can cost more money than their competitors. For example, Activia yogurt can be as much as 21 percent more expensive than other brands.

But healthwashing can also be harmful to your health, Telpner says. 'These claims lead some consumers to believe that a high-fiber cereal bar has as the same health benefits'like extra fibre or blood-sugar regulation'as a bowl of steel cut oats. But that's simply not true,' she asserts. When eat a prepackaged cereal bar, will certainly get some fibre, but you will also consume extra sugar, salt and other additives, which can contribute to health problems. 'People think they are making a good choice to benefit their health [when they eat these packaged foods], but they are not and would be better off with unprocessed food,' Telpner says.

Schwarcz says he believes healthwashing wrongly encourages consumers to focus on so-called miracle foods and nutrition in general as the path to perfect health. 'It's seductive to think you can dramatically change your health with eating alone. While food is an important contributor to our health and one that we control, we must not ignore the role of genetics, lifestyle, environment, sleep and stress,' he stresses. No one superfood can replace the benefits of a healthy lifestyle combined with a balanced diet.

In defense of health claims

Anne-Julie Maltais, the external communication manager at Danone Canada says health claims on foods are a good thing. 'We believe that these messages help consumers make the right choices and we intend to continue working with researchers and regulatory bodies to advance the understanding of foods that support human health and well-being,' she explains. When it comes to whole foods versus packaged options, she says that in certain cases you would need to eat an unrealistic amount of a whole food to get a significant nutritional benefit. Foods with added supplements can help you reach daily-suggested minimums for vitamins and minerals, she says.

Shop smart

Confused about the myriad health claims made by food products? Your key to clarity may be to cut back on the packaged foods you buy. 'It becomes a lot simpler when you're not trying to decipher if what the box says is true,' says Telpner.

But if you are interested in purchasing these foods, Schwarcz says there are certain health claims that should be ignored because they don't mean anything. These include 'made with' or 'made from,' 'now with less' and 'natural.' For other claims, visit the Canadian Food Inspection Agency's Guide to Food Labelling and Advertising to learn what companies need to prove in order to put phrases like 'reducing cholesterol,' 'lowering cancer risk,' or 'boosting immunity,' on your food.

Health Canada suggests that you always refer to a product's nutrition facts table when deciding if a food is a healthy choice for you or not. 'Remember that there are no 'miracle' foods or beverages out there. What matters is your overall diet,' says Schwarcz.

Don't miss out! Sign up for our free weekly newsletters and get nutritious recipes, healthy weight-loss tips, easy ways to stay in shape and all the health news you need, delivered straight to your inbox.

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As a savvy consumer, you're probably on the look out for 'greenwashing,' the pop-culture term Greenpeace defines as 'the act of misleading consumers regarding the environmental practices of a company or the environmental benefits of a product or service.' But have you heard of 'healthwashing'?

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Consider the following. One in ten New Zealanders is going (mostly) meat free. By some estimates, 70 percent of millennials are cutting back on meat in their diet. Millennials, those born between 1981 and 1996, make up an increasingly dominant percentage of the global population, and more than half the populations in Asia.

But in 2018, New Zealand's beef exports earned more than $3 billion. About 47 percent of New Zealand's beef goes to the United States where most of it gets turned into meat patties. In the US, 100 million hamburgers are consumed each day.

The often contradictory messages from demographics, consumer behaviour, export dollars and influencer comment tell different stories, but they are all about the future of food.

Dr Rosie Bosworth, a University of Auckland alumna who featured in the 40 Under 40 in 2017, is a future of foods strategist. Rosie is adamant that it is time for New Zealand to "stop polishing the wrong paradigm". The future of food comes down to what people choose to eat and she says global population shifts mean the immediate future will be dominated by millennials, estimated by Ernst Young to make up 75 percent of the global workforce by 2025.

She says the relationship that millennials have with their food has three big drivers: health, ethics and environment.

"When it comes to animal agriculture, New Zealand has a better system than most of the developed world but, even so, agriculture has a huge impact on our environment. Millennials and, to a lesser degree, baby boomers, are very conscious of the role of animal protein in our health.

"At the same time we're seeing the rise of conscious consumers who are after ethical, sustainable and healthy options for protein, often with impactful meaning. This is what millennials want and they've moved beyond the commodity play of just buying food, they want their food to be a values-driven experience," says Rosie.

Hot on the heels of the millennials are Generation Z, those born since 1997. They are estimated to surpass millennials as the dominant societal cohort by 2030.

"Gen Z are saying there are new ways to produce food that don't have the environmental, ethical and sustainability baggage," says Rosie.

"Why would you choose animals when there is a yummy, nutritious alternative that has the same sensory experience, that's produced in your own country and exacts no cost to a living animal?"

The University of Auckland's Professor Boyd Swinburn, co-chair of the Lancet Commission on Obesity, says New Zealand can help lead the change in diet and environmental sustainability.

"Food systems are central to our wellbeing as New Zealanders. They are by far the biggest contributor to our diseases and premature death and they are our biggest source of environmental damage.

"At the same time they contribute enormously to our national wealth and diverse cultures. New Zealand can and, I think, should, become a world leader in developing healthy, sustainable, equitable and prosperous food systems."

Global food giants are hedging their bets. Tyson, the biggest meat producer in the US, has created an alternative protein nugget and a blended patty that combines beef with pea protein. At a branch in Atlanta, the fast-food giant KFC recently decided to trial a new line of nuggets and wings made from plant protein. Cars and queues blocked streets. The meatless nuggets and wings sold out in less than a day.

French dairy and drinks giant Danone has made a decisive shift towards plant-based products. Chief executive Emmanuel Faber told the Globe and Mail this year, "There is a huge trend of people moving to less animal protein and more vegetable protein. We believe this flexibility in diets is fundamental for the future, for the health of the people and also for the health of the planet."

We're seeing the rise of conscious consumers who are after ethical, sustainable and healthy options for protein.

Dr Rosie Bosworth, future of foods strategist

The Intergovernmental Panel on Climate Change recently released its Climate Change and Land report that covers food production and security. The report is decidedly big picture, with mind-boggling estimates of environmental loss. Agriculture utilises about 70 percent of the world's fresh water. Soil on tilled fields is being lost at 100 times the rate it is being formed.

About 25 to 30 percent of food production is lost or wasted. Meanwhile, two billion adults are overweight or obese and 821 million are undernourished.

The report's big takeaway is that the window is open to reduce climate change by diversifying food production systems and what we eat. It says: "Balanced diets featuring plant-based foods ... and animal-sourced food produced in resilient, sustainable and low greenhouse gas emission systems present major opportunities ... while generating significant co-benefits in terms of human health."

The EAT-Lancet Commission on Food, Planet and Health was published in January. Food in the Anthropocene: The EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems is the work of 37 world-leading scientists from 16 countries. It distils a large body of research on the environmental impact of various diets and outlines a preferred future of food as one with far less meat. It says: "Most studies conclude that a diet rich in plant-based foods and with fewer animal- source foods confers both improved health and environmental benefits."

The report comes up with a "planetary health plate", the best diet for human health and environmental sustainability. Half the plate would be vegetables and fruits, the other half would be food made from whole grains, plant protein and unsaturated plant oils. Completely optional are modest amounts of animal protein.

The EAT-Lancet report concludes that business as usual for food production and diet is not an option. "Without action, the world risks failing to meet the UN Sustainable Development Goals (SDGs) and the Paris Agreement, and today's children will inherit a planet that has been severely degraded and where much of the population will increasingly suffer from malnutrition and preventable disease."

New Zealand's red-meat interests have not been sitting on their hands. Beef and Lamb NZ commissioned Antedote, a San Francisco innovation consultancy, to look at how our red meat sector should respond to the rise of alternative proteins. The Future of Meat is an engaging overview of the threats and opportunities.

The report acknowledges how consumers increasingly want food that is healthy, sustainable and ethical, a trend driven by the backlash against "broken food systems, e.g. factory farming and big food". There is the common echo about the influence of millennials and those who influence them directly via social media feeds. For example, the tennis powerhouse Williams sisters, Serena and Venus, promote a vegan diet in training to boost performance. The altmeat supporters include billionaire influencer Bill Gates, who has said: "The future of meat is vegan."
'Real' red meat
The report does find a silver lining in the otherwise gloomy scenario it paints for the meat industry. The authors argue: "The same considerations that are leading consumers to consider alternative proteins are the ones that give us confidence that there is a strong opportunity for New Zealand red meat. There is a desire for better food at all levels, which supports a strong future for 'real' red meat."

Take this counterfactual: in our biggest beef market, the US, and second-biggest market, China, consumers are happily chomping down quality red meat, with sales of grass-fed beef from New Zealand doubling every year since 2012 to the US, with China on a similar trajectory.

If the future of food is more accurately framed as the clash of proteins, alt protein versus meat, a glimpse of the future for New Zealand comes with the lesson that not all of our beef is created equal and it doesn't have to be consigned to the fast-food hamburger chains of the US. Firstlight Foods has pioneered the development of a Wagyu-cross beef with a network of Kiwi farmers. The cattle are raised on pasture to create quality beef cuts that have collected international awards.

The twist is that grass-fed Wagyu cuts also deliver a bounty of complex lipids and healthy omega-3 fatty acids, the so-called 'good fats' that help prevent heart disease.

Another company looking at the future of food is a2 Milk™ which, on the basis of a different protein in its milk, has grown into our biggest listed company. A clinical trial at the University of Auckland's Liggins Institute in 2018 found that a2 Milk™ was at least as effective as lactose-free milk at preventing or easing some symptoms of lactose intolerance.

Firstlight Foods and a2 Milk™ are examples of New Zealand businesses to benefit from research funding from High-Value Nutrition (HVN), one of two National Science Challenges (NSCs) hosted by the University of Auckland. In 2014, 11 National Science Challenges, each a nationwide research collaboration, were established to tackle the biggest science-based issues and opportunities facing this country. HVN's job is to deliver the research required to switch us from being a largely commodity food producer to one that exports high-value premium foods for health and wellbeing.

The University also hosts A Better Start, the NSC seeking to lift the health and life outcomes for children.

The idea to "let food be thy medicine", attributed to Hippocrates, has been updated for the 21st century as the prime research driver for HVN and over ten years it will have invested $69m in top food and nutrition scientists. HVN's focus is on foods for affluent consumers in China, where eating specific foods for health reasons is commonplace. So it has invested in research at the Malaghan Institute in Wellington, led by Dr Olivier Gasser, to look at the impact of diet on lung health. The aim is to create foods to help the good people of Shanghai breathe a little easier in pollution-shrouded winters.

A second major programme, Digestive Health, is led by Dr Nicole Roy at Massey University. Her team is looking at the links between diet, metabolism and the microbiome to understand irritable bowel syndrome which affects around one in three people worldwide.

Another strand is Metabolic Health. Professor Sally Poppitt, director of the Human Nutrition Unit at the University of Auckland, leads a team looking for early predictive markers of Type 2 diabetes in a common Chinese body shape, known as ToFi, 'Thin on the outside, Fat on the inside'. Despite a low body mass index, many people of Chinese heritage store unhealthy fat and face a high risk of diabetes. The estimate is that more than 300 million people in Asia have Type 2 diabetes. Early predictive markers for diabetes would be valuable intellectual property for future foods from New Zealand.

The fourth main strand of research, Infant Health, led by Associate Professor Clare Wall of the Faculty of Medicine and Health Sciences, is looking at ways to determine how complementary foods could boost the microbiome of infants to improve immunity and reduce infection.
Challenges for China
China has 17 cities with a GDP higher than $US140 billion, while New Zealand's national GDP is about $US205 billion.

China's big problem is that it needs to feed a fifth of the world's population and has only one tenth of its farmland. About 57 percent of its population now live in cities and their affluence is rising. As it rises, their diet now resembles what has become the bane of Western countries, much more processed food, a dramatic rise in consumption of pork, red meat and dairy and, with that, an epidemic of obesity and diabetes.

Little of this looks sustainable, which is why High-Value Nutrition supports food businesses that tread more lightly on the environment. "Sustainability is very much part of the mix we want in every business we work with," says Joanne Todd, director of HVN. As part of the criteria for funding, a business must provide evidence of how it responds to the UN's SDGs.

This includes working with innovative Maori businesses to ensure that Vision Matauranga, or unleashing the science and innovation of Maori knowledge and resources, is part of the future of food. A recent investment is in karengo (seaweed) with Ngai Tahu and Wakatu Incorporation, the Cawthron Institute, AgResearch, the Malaghan Institute and Hokkaido University.

Traditional sources of nori ( Pyropia spp) are in short supply because of reduced harvests in the Northern Hemisphere through climate change. One day the partners want to harvest, process and export karengo, an indigenous seaweed, as a premium and sustainable food with evidencebased health benefits. HVN has adopted a wait-and-see approach to alternative plant proteins that mimic animal meat. "We're not going down that road, because we need to look at what New Zealand can do at scale and efficiently."

Joanne agrees that the trend towards alternative proteins in the US is driven by millennial behaviour, but also by factors New Zealand lacks.

"They can do it because they have the money to do it and the land to grow it."

Even if the Canterbury Plains could grow peas to turn into Beyond Burger patties, any harvest would be dwarfed by production from the American Midwest. It is not in HVN's brief to invest in commodity foods either. As well as the karengo, HVN has looked at hemp seed, a rich source of protein when made into flour.

"We're definitely open to looking at emerging protein sources, but they have to be ones that New Zealand can grow sustainably."

Speaking as a nutritionist, Joanne urges consumers to think hard about their food choices. Plant-based "meat" is derived largely from imported pea protein and so comes with food miles. The Impossible Burger, showcased by Air New Zealand, comes with a long ingredient list of additives. She says the need to know where our food comes from works both ways. "On one hand you have a beautiful, tasty beef burger you know is grown on grass and on the other hand you have ... what exactly?"

We need to look at what New Zealand can do at scale and efficiently.

Joanne Todd, director of High-Value Nutrition, Liggins Institute
Monitoring consumer behaviour
The question of how millennial and Gen Z behaviour will shape the future of food is not clearcut, say researchers from the Department of Marketing at the Faculty of Business and Economics at the University.

Dr Jenny Young researches consumer behaviour, including decision-making for food, and works with Dr Joya Kemper, who has a special interest in the marketing of social and environmental issues and the rise of ethical consumption.

"Millennial and Gen Z generations are definitely driving changes regarding sustainability and animal rights issues," says Jenny.

"They are the 'loud voices', linked by their experience of technology, but they are also diverse groups who are fluid, hard to define and fragmented to reach. Within these cohorts, there are the socially aspirational, but many also simultaneously hold personal aspirations, seek convenience and are open to temptations."

They are embracing vegetarianism, veganism or 'vegan-ish' diets, and see lab-grown meats as appropriate for fast-food industries and to feed those who don't think about where meats come from. At the same time, Jenny says, deciding what to eat is complex, so it's difficult to generalise.

"Let's not forget the older generations with buying power who are now living longer and will continue to have a strong influence on the market well into the 2030s," she says.

"Among the baby boomers there have always been ethical and pro-sustainability consumers. Many mature consumers are following healthier eating patterns as they age, embracing plantbased diets or cutting back on red meat." But she says our attachment to meat remains strong because of taste, tradition and nutritional benefits. For some, there might be conflict between their desire for meat and concern over animal rights. Other consumers are divorced from this and believe they are entitled to eat meat because we're omnivores and that it is irreplaceable.

In the face of bombardment from the media and social networks with often contradictory information about the latest trending diet, dilemmas on what to eat will continue.

"We also need to consider how changes filter down to consumers who may not be as involved. Food decision-making is often done in a low involvement state, but it has an immediacy day to day," says Jenny.

Unfortunately, unhealthy packaged foods still proliferate, with nearly 70 percent of supermarket foods classified as ultra-processed by the University of Auckland's inaugural "State of the Food Supply".

Jenny has interviewed people before they enter a supermarket about their beliefs and views on the environment and desire for sustainability. When they leave, the contents of their trolley clearly contrast with what they have said. Consumer behaviourists call this the "attitude behaviour gap".

"People might have great intentions but convenience beckons and those intentions, don't translate to behaviour," she says.

Joya suggests that widespread changes in diet, such as reducing red meat consumption as advocated by the EAT-Lancet report, would require a complex mix of initiatives, from information campaigns to change social norms, to a regulatory framework. Germany, Brazil and Sweden have established guidelines for sustainable food consumption to give legitimacy to those wanting to change behaviour.

Alongside this, policymakers can consider limits on marketing and advertising, to taxes on unhealthy foods as part of national strategies to reduce obesity.

However, she says, New Zealanders value personal responsibility highly and any such strategy risks being dubbed an initiative of the nanny state.The push and pull between consumers and markets, the battle between good intention and habit, the ethical and sustainability struggle between alt protein and animal meat will all shape the future of food. How should New Zealand react to this menu of possibles and probables?

The Future of Meat report's advice: "This is a wake-up call to ensure we understand what is important to premium consumers, that we protect our natural food production systems and products, and do more to ensure that our customers and consumers recognise that New Zealand's red-meat farmers are in the natural foods business."

HVN's Joanne Todd says for New Zealand farmers to forget about animal protein would take a generational shift. For her, the future is for New Zealand to be a country that produces a wide range of premium foods in a pristine and sustainable environment for affluent consumers. In the meantime, innovation is needed and that's where work being done at the Liggins Institute comes in.

"At High-Value Nutrition, we hope to change the culture of the food and beverage industry to really show the value and necessity of investing in research and development," she says.

Rosie Bosworth sees alternative protein as a disrupter as potent as the internet. She says New Zealand needs to get behind more research and development, foster more start-ups and generate support for those who want change.

"We have five to ten years in this market, so let's use the cash cow to fund the new paradigm. Your first reaction is to defend, but we need to be more far-sighted than that. We need to find a new identity. Holding on to the old one means economic suicide."

Jenny Young sees the continuing fragmentation of food markets with tradition and innovation both driving the way we will eat. "There are vastly different segments - polarised values - so consumer-centric insights are crucial. Being a leader on sustainability, respectful marketing and ethical farming is the best position for New Zealand for the wild ride ahead."
This feature first appeared in the Spring 2019 issue of Ingenio. Contact Ingenio.

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Gilbert Wong looks at the forces shaping the future of food and how the University's research is contributing to what's likely to be on our plates in 2030.

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More policy action on NZ food environment

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More policy action on NZ food environment

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A new report reveals the troubling state of New Zealand's food environment due to inaction from successive Governments and calls for this to change. Food environments influence the food we buy and eat, so are a key intervention area for improving population nutrition and diet-related health conditions. Food policies can improve food environments by making healthier foods and drinks more available, affordable, accessible and widely promoted, so have the potential to address inequities in health.
INFORMAS (the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support), based at the University of Auckland, has been monitoring NZ's food environments since 2014. Our first comprehensive assessment from 2014 to 2017 1 concluded that the food environment in NZ is largely unhealthy. Since then, there have been a few government and food company policies, commitments and actions aimed towards improvement of NZ diets. But have these made an impact on the food environment? Our second assessment from 2018 to 2021 2 shows these had minimal impact on the food environment, though a few government initiatives have the potential for long-term improvements. We call for an overarching Food and Nutrition Strategy for Aotearoa, and recommend that policies be mandatory for substantial and enduring change to food environments. Many other countries are implementing innovative food policy with NZ is falling behind. In this blog we discuss the healthiness of the NZ food environment according to the INFORMAS framework. Methods and detailed results are outlined here. This latest INFORMAS assessment rated the implementation of healthy food polices by government, the impact of the Advertising Standards Authority (ASA) Children and Young People's Advertising (CYPA) Code on exposure to marketing, and food industry commitments.

The extent of Public sector policies and actions were rated by public health expert panels in 2014, 2017 and 2020 3 against international benchmarks. Over the last nine years most of the 47 measures have not improved at all and it is worrying that each government, left or right, is doing so little about obesity and healthy eating. Though NZ does do well with labelling and health claims and some infrastructure support strategies like the NZ Health Survey. One positive recent initiative is Ka Ora Ka Ako, which provides free healthy school lunches for over 200,000 school children.

University of Auckland researchers analysed the composition of our food supply using the comprehensive Nutritrack database, an annual survey of the packaged food supply in NZ supermarkets. In 2018, we found over two-thirds (69%) of packaged foods were ultra-processed and only two-fifths (41%) of products would qualify for a Health Star Rating of 3.5 or more 4. A deep-dive into the availability of single-serve beverages found four out of five (79%) drinks were sugar-sweetened despite more sugar-free/low sugar beverages on the market 5. A recent study of the fast-food supply found what we all expected; a lot of products were high in energy and sodium 6. What surprised us was just how unhealthy some of the meal combos were, with some providing more calories and sodium than recommended for a whole day.

Front of pack food labelling can assist consumers to choose healthier options. But in 2019, only one-quarter of packaged foods displayed the Health Star Rating, and in 2018 the HSR was more likely to be displayed on healthier products. We were impressed that almost all supermarket private label products displayed a HSR regardless of product healthiness 7. And some good news for those shopping on a budget - our analysis of supermarket branded products (private labels) compared to similar branded label products found that there was little difference in sodium and sugar content and that for most food categories the private labels were cheaper.

Food marketing in NZ is governed by the industry-led ASA CYPA Code, effective since October 2017. Our studies found children were regularly exposed to unhealthy food and beverage marketing in many different mediums, both before and after the code came into effect. An in-depth study of complaints made to the ASA 8 shows it is not an effective, transparent or accountable regulatory system, with vague definitions that create loopholes. A coalition of public health organisations and experts are so concerned about the lack of control on junk food marketing that we formed an alliance to advocate for legislation in this area which you can sign up to add support. We looked at the commitments and marketing practices of the top 26 packaged foods and beverage companies, supermarkets and quick-service restaurants. Children are still exposed to the marketing of these companies even when companies commit to the ASA CYPA Code.

The implementation of policies requires support, and in the Food Retail domain we found that the introduction of Food and Drinks Guidelines to Auckland Council-owned centres in 2016 was more effective when centres were supported by local health promotion organisations.

Small changes to the in-store supermarket environment have the potential to reach most New Zealanders. Supermarkets have been working hard to improve their supermarket brand labelling and products as mentioned above and have mostly met their commitments to display fresh food on the cover pages of their flyers. Supermarkets could go further by reducing the prominence of junk food displayed in store. Only two in five end-of-aisle promotions and island bins were free of junk food, and one in three supermarkets did not even have one checkout that was free of junk food.

What still needs to be done to improve food environments?

The public health expert panels emphasised the need for mandatory policies related to restricting food marketing, a substantial tax on sugary drinks, mandatory health star ratings and food reformulation targets. Self-regulation of nutrition policies is shown to be ineffective 9. More than 50 countries have introduced a levy on sugar-sweetened beverages, and it is so common and backed by solid evidence, that it is hard to imagine why New Zealand would not do the same 10. Recent research from our team found 45 countries now have mandatory regulation to restrict marketing to children. While countries have been slow to adopt mandatory front-of-pack labelling and food reformulation targets 11,12, these are effective in some countries in steering consumers toward healthier choices, and encouraging product reformulation 13. Action needs to be informed by a comprehensive food systems and nutrition strategy and supported by infrastructure actions. Some good news - planning is underway to develop the methodology for an updated national nutrition survey, though funding still needs to be secured for the data collection and analysis.
Actions prioritised by the expert panel for implementation by the New Zealand Government to improve the healthiness of New Zealand food environments
Additionally, the Government needs to ensure regular monitoring of food environments. At the moment this only happens when researchers receive funding from ad hoc grants. Thank you to the Heart Foundation of NZ and Health Research Council for funding the INFORMAS food environment surveys to date.

*Author details: All authors are with the School of Population Health, The University of Auckland

Acknowledgements: The authors thank Prof Boyd Swinburn for reviewing this blog.
References

Vandevijvere, S., Mackay, S., D'Souza, E., & Swinburn, B. (2019). The first INFORMAS national food environments and policies survey in New Zealand: A blueprint country profile for measuring progress on creating healthy food environments. Obesity Reviews, 20(52), 141-160.

Mackay, S., Garton, K., Gerritsen, S., Sing, F., Swinburn, B. 2021 How healthy are Aotearoa New Zealand's food environments? Assessing the impact of recent food policies 2018-2021., Auckland: The University of Auckland, 2021

Swinburn B, Kraak V, Allender S, Atkins V, Baker P, Bogard J, et al. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission Report. London; 2019. Available from: https://www.thelancet.com/commissions/global-syndemic

Obesity Evidence Hub 2022. Countries that have taxes on sugar-sweetened beverages (SSBs) https://www.obesityevidencehub.org.au/collections/prevention/countries-that-have-implemented-taxes-on-sugar-sweetened-beverages-ssbs. Accessed 17.02.2022.

Kelly B, Jewell J. What is the evidence on the policy specifications, development processes and effectiveness of existing front-of-pack food labelling policies in the WHO European region? Health Evidence Network synthesis report 61. Copenhagen: WHO Regional Office for Europe, 2018. Available from: https://www.euro.who.int/en/publications/abstracts/what-is-the-evidence-on-the-policy-specifications,-development-processes-and-effectiveness-of-existing-front-of-pack-food-labelling-policies-in-the-who-european-region-2018

World Cancer Fund International. Building momentum: lessons on implementing a robust front-of-pack label. London, UK, 2019. Available from: https://www.wcrf.org/policy/our-publications/building-momentum-series/lessons-implementing-robust-front-of-pack-food-label/

Roberto, C., Ng, S., Ganderats-Fuentes, M. et al (2021). The influence of front-of-package nutrition labelling on consumer behavior and product reformulation. Annual Review of Nutrition, 41: 529-550. https://doi.org/10.1146/annurev-nutr-111120-094932

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Aotearoa New Zealand's unhealthy food environment needs more policy action

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A new report reveals the troubling state of New Zealand's food environment due to inaction from successive Governments and calls for this to change. Food environments influence the food we buy and eat, so are a key intervention area for improving population nutrition and diet-related health conditions.

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Some download links around protecting kids from marketing junk food

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Some download links around protecting kids from marketing junk food

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Aotearoa New Zealand children experience excessive levels of unhealthy food and drink marketing every day. It affects their eating behaviour, leading children to become well above a healthy weight and setting them up for a lifetime of adverse health-related and social consequences. We must put our children before food industry profits and act now to protect their health and wellbeing.

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Aotearoa New Zealand children experience excessive levels of unhealthy food and drink marketing every day. It affects their eating behaviour, leading children to become well above a healthy weight and setting them up for a lifetime of adverse health-related and social consequences.

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Which companies dominate the packaged food supply in NZ

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Which companies dominate the packaged food supply in NZ

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Sally Mackay,

Helen Eyles,

Teresa Gontijo de Castro,

Leanne Young,

Cliona Ni Mhurchu,

Boyd Swinburn

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Abstract

Improvement of national food supplies are an opportunity to improve a country's health. Our aim was to identify the major food companies manufacturing packaged foods and non-alcoholic beverages available in New Zealand supermarkets in 2018; to assess the healthiness of products using (1) the Health Star Rating (HSR) system, (2) Australian Dietary Guidelines classification (core/discretionary), and (3) by level of processing; to compare the healthiness of products displaying and not displaying the HSR and; to assess potential for food reformulation within selected food sub-categories. Information on packaged foods was obtained from the Nutritrack supermarket database. Companies that manufactured each food and brand were identified using company websites and the New Zealand companies register. In total, 13,506 packaged products were mapped to 1,767 brands and 1,214 companies. Based on market share of products available for sale (Euromonitor data), there were 22 dominating companies producing 31% of products and 17% of brands. Fifty-nine percent of products were classified as unhealthy (HSR <3.5/5 stars), 53% as discretionary, and 69% as ultra-processed. Products displaying the HSR on the package had a higher mean HSR ±SD than if the HSR was not displayed (3.2±1.3 versus 2.5±1.4, p = 0.000). Efforts to improve the healthiness of products should be directed to the 22 food companies dominating this market share, particularly in the core foods groups which are currently less likely to meet Heart Foundation reformulation targets (bread, breakfast cereals, cheese, canned baked beans, yoghurt). The New Zealand supermarket packaged food supply included in the Nutritrack database is dominated by a small number of companies and is mostly unhealthy. Government leadership is required to improve the healthiness of the packaged food supply and provide adequate information to consumers. This includes interventions setting reformulation targets for core food groups, setting population nutrient intake targets and mandating that the HSR is displayed on all products.

Citation: Mackay S, Eyles H, Gontijo de Castro T, Young L, Ni Mhurchu C, Swinburn B (2021) Which companies dominate the packaged food supply of New Zealand and how healthy are their products? PLoS ONE 16(1): e0245225. https://doi.org/10.1371/journal.pone.0245225

Editor: Zhifeng Gao, University of Florida, UNITED STATES

Received: June 9, 2020; Accepted: December 27, 2020; Published: January 26, 2021

Copyright: © 2021 Mackay et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Because of the commercial and legal restrictions to the use of copyrighted material it is not possible to share data openly which reveal the product or company names but unredacted versions of the dataset are available with a licensed agreement that they will be restricted to non-commercial use. For access to Nutritrack, please contact the National Institute for Health Innovation at the University of Auckland at enquiries@nihi.auckland.ac.nz.

Funding: This research was supported by the National Health and Medical Research Council (NHMRC) funded Centre of Research Excellence in Reducing Salt Intake using Food Policy Interventions (APP1117300). The opinions, analysis and conclusions in this paper are those of the authors and should not be attributed to the NHMRC. The Nutritrack data collections and database are funded by a Health Research Council of New Zealand programme grant (18/672. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The burden of disease attributable to dietary factors among adults aged 25 years or older is 11 million deaths and 255 million disability adjusted-life years (DALYs) [ 1, 2]. High intake of sodium and low intakes of whole grains and fruit accounted for more than half of all diet-related deaths and two-thirds of diet-related DALYs [ 2]. In New Zealand (NZ), the average population diet for both adults and children is low in fruit, vegetables, whole grains, legumes, nuts and seeds with an excess intake of foods high in sodium and sugar [ 2]. Similar to other high income countries, poor diet is a leading cause of deaths in NZ, accounting for nearly 20% of total deaths in 2017 [ 2].

Unhealthy food environments contribute to unhealthy diets [ 3]. Most foods consumed in high income countries are processed or pre-prepared by the food industry [ 4- 7], and associations between adverse health outcomes and high intake of processed foods have been reported [ 7- 10]. Globalization of food production has also led to market domination by companies that produce mainly highly palatable processed foods [ 11] with low production costs, a long shelf-life, and a high retail value [ 12]. The packaged food and non-alcoholic beverage industry (referred to from hereon as the packaged food supply) is the world's leading fast-moving consumer goods industry [ 13], growing 25% between 2011 and 2016, faster than world population growth [ 14]. In NZ, the packaged food industry is experiencing steady moderate sales growth [ 13] with many New Zealanders considering price and convenience the most important factors when making decisions around food [ 15]. Therefore, the packaged food industry has an important role to play in improving population diets and preventing non-communicable chronic diseases [ 16].

In the United Kingdom [ 17] and Australia [ 18], a relatively small number of companies own the majority of brands and products. In NZ in 2018, the five packaged food companies with the highest market share accounted for one-fifth of sales and have maintained steady growth in the local market [ 13], with numerous brand acquisitions [ 19], particularly from overseas investors. In contrast to several companies in the NZ packaged food market, the non-alcoholic beverage market is dominated by just two major companies [ 13]. Therefore, policies targeted to the national packaged food and beverage supply and its contributing companies are an opportunity to improve health.

A recent 2020 assessment of Government food environment policies and infrastructure support [ 20] concluded that New Zealand is lagging behind other nations in implementing several major policies to improve food environments. NZ lacks clear government leadership and has no guiding strategy. Although New Zealand has a regulatory system for labelling of health and nutrient claims [ 21] and the New Zealand and Australian governments have implemented a voluntary front-of-pack labelling system (the Australasian Health Star Rating system based on a nutrient profiling model and implemented in 2014) [ 22], there are no Government-led targets for nutrients of concern for either packaged food or out-of-home meals. However, the Heart Foundation implemented a voluntary food reformulation programme in 2007 [ 23], funded by the Ministry of Health. The Heart Foundation programme involves working with industry to set and achieve voluntary reformulation targets. To date, forty-eight targets for sodium, saturated fat and/or total sugar have been set across twenty food categories. Nutrient profiling is used to rank the healthiness of individual foods [ 24]. The Health Star Rating (HSR) is the most commonly used front-of-pack labelling system in NZ and Australia. The frequency of consumption of foods can also be recommended by a country's dietary guidelines, such as the Australian 'Discretionary Food List' [ 25]. Finally, a more recent classification system is NOVA, which classifies foods and beverages by degree of processing [ 26]. Ultra-processed foods have been associated with an increased risk of negative diet-related health outcomes [ 7- 9] including excess weight gain [ 10]. However, there has been some criticism of NOVA for inconsistency in classification of products and inconsistent associations between consumption and diet-related health outcomes in national surveys [ 27].

This cross-sectional study represents a comprehensive assessment of major packaged foods and beverages in the NZ food supply. Using data collected from four NZ supermarkets (from four individual brands) in 2018 we aimed to: a) identify and describe the companies that manufactured the packaged food and non-alcoholic beverage products available for sale; b) identify the companies dominating the packaged food supply (making available the majority of products); c) assess the healthiness of all products available for sale and of products sold by dominant companies' by applying three food classification systems: the Australasian HSR front-of-pack nutrition labelling system [ 28], the Australian Dietary Guidelines core/discretionary classification [ 25], and the NOVA classification of level of processing [ 26]; d) compare the number of stars allocated to products which do and do not display the HSR on the front-of-pack and; e) use the findings from b) to c) to assess the potential for food reformulation within selected food sub-categories. This study sought to provide useful information to encourage government to act to improve the packaged food supply and encourage manufacturers to make changes to improve the healthiness of their product portfolios.

Materials and methods

NZ supermarkets packaged foods database

The major source of information for this study was Nutritrack, a NZ branded food-composition database developed by the National Institute for Health Innovation at The University of Auckland [ 29]. Nutritrack is part of an international collaborative approach for collation and sharing of data for packaged and processed foods to enable monitoring of their nutrient composition to support government and food industry efforts to improve the healthfulness of products [ 30]. Nutritrack is an annual inventory of packaged foods and non-alcoholic beverages available in major NZ supermarkets (herein referred to as packaged foods). The distribution of packaged food in NZ is dominated by supermarkets, accounting for 75% of all purchases [ 13]. Supermarkets are dominated by two retailers, Woolworths NZ Ltd and Foodstuffs NZ Ltd, which own the four store brands from which Nutritrack data are collected [ 13]. The database contains information on front-of-pack labels, nutrition and ingredient information as displayed on the package at one point in time each year [ 29]. The annual surveys are conducted by trained field workers who collect data using a customised smart phone application to take photographs and record barcodes for each food product. All unique products displaying a nutrition information panel [NIP] are included in the surveys. Different pack sizes of the same product have unique barcodes, and each product pack variant is included [ 29]. Information on products without a NIP, such as unpackaged fruits and vegetables, and fresh meat and alcohol, is not collected, nor is information on vitamins and supplements or seasonal foods. Nutritrack data quality is checked annually and the error rate in 2018 across key fields was <1%. All products sourced are classified in a hierarchical structure of 15 food groups (e.g. bread and bakery products), 66 categories (e.g. biscuits), 201 sub-categories (e.g. sweet filled biscuits) and 443 smaller sub-categories (e.g. chocolate biscuits) [ 31].

This observational study used information from the Nutritrack 2018 data collection, which was sourced from four NZ supermarket brands (one large store each) between February and April in 2018: New World, Four Square, Countdown and PAKn'SAVE. In total, Nutritrack contained information on 15,192 food products in 2018. Data from all available products in these supermarkets were collected and no sampling process was applied. All collected data were included in the analyses, except for the removal of products with multiple serving sizes or incomplete data (as described below). These methods are similar to those previously used to assess the healthiness of the food supply in the US [ 32] and Australia [ 33].

Information on packaged food companies

Information about food companies (types, names and brands of products produced) that manufactured the packaged food and beverage products registered for all products in Nutritrack in 2018 was gathered from the product labels, through website searches, by a trade-mark search of the NZ Intellectual Property Office trademarks website [ 34] or the NZ companies' register [ 35].

To identify the companies that dominated (sold the majority of) the packaged food and non-alcoholic beverages in the NZ market in 2018, information on market share (% retail value) was retrieved from the Euromonitor International Passport Global Market Information Database [ 13]. The dominant food companies in the NZ market were defined as those with a share of 1% or more in 2018. The major supermarket retailers in NZ (Foodstuffs, Woolworths NZ) were included within the packaged food manufacturers and their market share referred only to the own-brand labels of their respective supermarkets.

Products inclusion and exclusion criteria

Analyses were conducted for all products in Nutritrack 2018 together, and separately for products manufactured by each of the food companies identified as dominant. The initial Nutritrack 2018 database included 15,192 products. To avoid skewing results, where multiple packs of identical products existed, the product with the smallest pack size only was included in the analysis. After exclusion of multiple pack sizes (n = 744; 4.9%) products from food categories that do not contribute significantly to nutrient intake or are not required to display NIPs were excluded (i.e. baking powders, chewing gum, cough lollies, herbs and spices, plain teas and coffees, yeasts and gelatins, n = 723, 4.8%) ( S1 Table). Products with missing NIP information (n = 219; 1.4%) were excluded with the following exceptions: products with no saturated fat data that had ≤ 1g fat per 100g, (assigned '0' for saturated fat); products with no sugar value that contain no carbohydrate (assigned '0' for sugar); and plain water (assigned '0' for nutrients). After the exclusion criteria were applied, 2.8% of the products had missing information for HSR value and were then, excluded from analysis assessing the healthiness of products by this classification system. Fig 1 illustrates the exclusion criteria of products including the number of products analyzed in Nutritrack and within the major food companies according to the three metrics of food healthiness.

Assessment of product healthiness

There is no international, universally accepted method to classify foods as healthy (or not), with classification systems and nutrient profiling models developed for different purposes and contexts [ 36]. Therefore, the healthiness of the companies' product portfolios was assessed using three methods or systems, each which classifies foods using a different definition and criteria of healthy:

Health Star Rating.

Food products were assigned a rating between 0.5 (least healthy) and 5.0 stars (most healthy) in half-star increments based on the nutritional content of the product. This voluntary front-of-pack nutrition labelling system used in NZ and Australia determines healthiness based on a balance of energy, saturated fat, total sugar and sodium per 100g (mandatory to display on the nutrition information panel (NIP)), and with dietary fibre, protein and percentage of fruit, vegetables, nuts and legumes (FVNL) [ 28]. For products displaying the HSR value on the pack, the declared HSR value was used. For products not displaying the HSR on the pack, HSR was calculated using the HSR algorithm and nutritional information provided on the product`s NIP [ 28]. For some products, information was not available for fibre and FVNL (these are not mandatory to display on the pack of NZ food products [ 21]); in such cases points for fibre were estimated based on the median value for other products within the category and points for FVNL were assigned per category based on the percentage of FVNL of a sample of products from the category. Estimation of HSR value was not possible for single ingredients products (e.g. vinegar) and for products belonging to food categories with an insufficient number of products with fibre values (<20%) in order to reasonably impute fibre content. Products were classified as 'healthy' if the product had an HSR ≥ 3.5 based on prior research demonstrating that this threshold discriminates between healthy and unhealthy products [ 37].

Core/discretionary.

Foods were classified as core or discretionary based on definitions in the 2013 Australian Dietary Guidelines [ 25]. As the Australian and NZ food supplies and dietary guidelines [ 21] are similar, it was considered appropriate to use this measure.

NOVA.

The level of industrial food processing was assigned at a category level where possible according to the NOVA classification framework [ 26]. Foods and beverages were classified as 'unprocessed or minimally processed foods', 'processed culinary ingredients', 'processed foods' or 'ultra-processed'. Where possible, a level of processing was assigned at the Nutritrack sub-category level. If less than 70% of products in a sub-category were of the same degree of processing, or if the category included minimally processed and ultra-processed products [ 26], the product was assigned a level of processing at the individual level. Due to heterogeneity of the level of food processing in some food categories, among the 13,506 products with information for NOVA classification, 918 products (6.8%) were classified manually at the individual level using the ingredient list displayed on the label. Principles were developed to guide decisions ( S2 Table), particularly regarding the type of ingredients added (such as preservatives, stabilisers) based on a published, comprehensive description of each level of processing from Monteiro et al. [ 26].

Potential for food reformulation within specific food sub-categories

The potential for food reformulation was assessed within selected food sub-categories which are considered part of a healthy eating pattern by the NZ Eating and Activity Guidelines [ 38] and using the NZ Heart Foundation reformulation targets [ 23]. The rationale to limit this assessment at the level of food-subcategories instead of at the level of food groups was to be able to compare similar products. At the food group level there is a heterogeneous mix of products and level of healthiness. The selected food sub-categories were breads, breakfast cereals, cheese, yoghurt, margarines, and canned baked beans. For each of these food sub-categories the proportion of products meeting the NZ Heart Foundation reformulation targets for sodium and/or sugar [ 23] was assessed, within the Nutritrack dataset and according to dominant food companies that had products within the selected food sub-category amongst their portfolios.

Data analysis and statistics

Descriptive statistics of numbers, proportions, means, standard deviations (SD) and ranges were used to summarize the findings of this observational study. For all products in Nutritrack in 2018 and within products from dominant companies, the mean (SD) HSR and the proportion of products with HSR ≥3.5; discretionary and ultra-processed products was calculated. Statistically significant differences in mean HSR and products with HSR ≥3.5 for products displaying and not displaying the HSR front-of-pack label was assessed for all products in Nutritrack and for products from the dominant companies. T-tests for independent samples were applied to examine statistically significant differences in mean values and Pearson-chi-square tests were used to examine proportions. Analyses were performed using SPSS software (version 25, IBM SPSS Statistics), and all tests were two-sided at 5% significance level.

Results

Number and types of food companies

In total, the 13,506 products from Nutritrack database were matched to 1,767 brands and 1,214 companies. The total number of products per company ranged from one to 992 and the mean number of products per company was 12.5 (+ 50.9). Among the 545 NZ registered companies (almost half of companies represented in Nutritrack), most were NZ Limited companies (n = 375, 30.9% of all companies in Nutritrack) ( Table 1). NZ companies with an ultimate holding company (UHC) from another country which has control over all subsidiary companies represented 3.2% of all companies. The three top companies with the most products in descending order were: NZ Limited Company with UHC in another country (not NZ or Australia), NZ Limited Company with Australian UHC, and NZ Limited Company with NZ UHC. Despite representing 55% of the companies in Nutritrack, companies registered in Australia or other countries tended to have fewer products per company with a mean of 9.3 and 4.1 products, respectively ( Table 1).

Twenty-two food companies dominated the packaged food market in 2018. Nineteen packaged food companies and three non-alcoholic beverage companies held, respectively, 67% and 75% of the NZ market share but just 37% of products within the dataset. Twelve (55%) of the dominant companies were NZ Limited companies with an UHC in a country other than NZ or Australia, six (27%) were NZ Limited companies, a co-operative or a charity, and the remaining four (18%) were Australian linked (NZ Limited company with Australian UHC or an Australian company). The number of brands per company ranged from two (Dairyworks) to 37 (Goodman Fielder). Supermarket retailers had the highest number of products per company with their own-brand private labels (Foodstuffs, n = 904, and Woolworths NZ n = 851) (data not presented in table).

Health Star Rating, Australian Dietary Guidelines and NOVA classification

Across all products in Nutritrack, 41% were classified as 'healthy' (HSR ≥3.5), 53% were classified as discretionary and 69% as ultra-processed. This was similar for the 22 dominant companies, with 44% of products classified as 'healthy', 50% as discretionary and 74% as ultra-processed.

Table 2 presents the healthiness of the portfolios of the 22 dominant food companies using the three classification systems. The healthiness of product portfolios varied considerably among manufacturers. The range in mean HSR (±SD) was 1.0 +0.8 (Mondelēz) to 4.1 ±0.7 (Sanitarium), and the percentage of products classified with an HSR ≥3.5 ranged from 2.7% (Mondelēz) to 95.5% (Sealord). The top three companies with the highest mean HSR were Sanitarium, McCain Foods, and Sealord, with portfolios of at least 69.8% of products with an HSR ≥3.5; over two-thirds of their products were classified as core. Of note was that McCain Foods had 13% of products missing information for HSR, and thus there is a higher potential for overestimation of the mean HSR and proportion of products with HSR ≥3.5 in this company's portfolio.

All non-alcoholic beverage companies (Coca-Cola, Frucor Suntory, The Better Drinks Co) had a low mean HSR with at least 70% of their products with an HSR <3.5 and at least 83% of their products classified as ultra-processed ( Table 2). Among these three companies Cola-Cola performed worst (mean HSR 1.8; HSR ≥3.5 = 8.0%; discretionary products = 78.4%; ultra-processed products = 96.3%).

The proportion of discretionary foods in the product portfolio of the dominant companies ranged from 1.1% (Sealord) to 100% (Bluebird Foods)). Sixteen companies (72.7%) had product portfolios that contained at least 30% of discretionary products. The range of variation of ultra-processed products within companies`portfolios was 11% (Dairyworks) to 100% (Arnott's, Griffin's Foods and Bluebird Foods). Half of the companies (n = 11) had portfolios that contained more than 90% of ultra-processed products and 18 companies (81.8%) had product portfolios with more than 70% of products ultra-processed ( Table 2). Healthiness by manufacturer is highly dependent on product portfolio and differences in products available for sale within sub-categories can lead to large differences in relative healthiness. Both George Weston Foods and Griffin's Foods predominantly sell bread and bakery products but 86% of George Weston Food's products in this food group are bread and all of Griffins Foods products in this food group are biscuits. Hence the differences in overall HSR are considerable (mean 3.4, 67% ≥3.5; mean 1.9, 14.9% ≥3.5 respectively).

Companies that have a wide portfolio of food categories tended to have a low mean HSR and a high proportion of products classified as discretionary foods and ultra-processed. For example, Nestlé NZ (mean HSR 2.5, 72.4% discretionary, 93.4% ultra-processed), and Unilever NZ (2.4, 58.8%, 96.1%), Mars (2.2, 78.5%, 82.2%). The products of the two supermarket retailers, Woolworths NZ and Foodstuffs, were their own-brand products, which also span a wide range of food categories. In contrast, the product portfolios of the retailers performed better than the brand leaders named above with diverse portfolios, shown by higher mean HSRs (both retailers mean of 3.0) and a lower proportion of products that were discretionary (both retailers 46%) or ultra-processed products (59% and 60% respectively).

Health Star Rating displayed/not displayed on front of pack

Across all Nutritrack products, almost eight in 10 (79%) did not display the HSR label on the pack and the mean HSR (SD) of products displaying the HSR label was higher than the mean HSR of products not displaying the HSR label on pack (3.2+ 1.3 versus 2.5+ 1.4, t = 23.818; p = 0.000). There was also a higher proportion of products with an HSR ≥3.5 among products displaying the HSR in relation to products not displaying the HSR label (58.6% versus 36.2%, chi-square = 454.732; p = 0.000). Similar findings were observed for products sold by the dominant food companies, where products displaying HSR had a mean HSR of 3.1 (+1.4) and products not displaying HSR had a mean HSR of 2.7 (+1.3) (t = 10.577; p = 0.000). Fifty-five percent of products displaying HSR had an HSR ≥3.5 compared to 41% of products not displaying the HSR label (chi square = 87.743; p = 0.000) (data not presented in table).

Dominant companies with the highest percentage of products that displayed the HSR on front-of-pack were: Sanitarium (90%), Kellogg's (73%) and Foodstuffs (own-brand) (73%). The dominant companies with the lowest percentage of products displaying the HSR label were Goodman Fielder (3%), Hellers (3%) and George Weston Foods (6%). Six companies did not display the HSR on any products (Mars, Dairyworks, The Better Drinks Co, Griffin's Foods, Bluebird Foods, and Mondelēz).

Fig 2 visually displays the proportion of products within each HSR increment that did, or did not, display the HSR on the label. Patterns of HSR display differ across companies. Foodstuffs and Woolworths display the HSR on products across the range of HSR values while companies like Fonterra and Heinz Watties and Nestlé NZ display the HSR mainly on products with a higher HSR.

Potential for reformulation within selected food sub-categories

Table 3 indicates the proportion of products meeting Heart Foundation sodium and sugar targets for selected food sub-categories, both within Nutritrack and for individual dominant companies. Within all products from Nutritrack, the Heart Foundation targets for sodium were met by the majority of products in three of the five sub-categories assessed; breakfast cereals (92% of products) margarine (90%), and cheese (72%). For the remaining two categories (bread, baked beans), less than half of products met the Heart Foundation sodium targets. Among products from the portfolios of the dominant food companies displayed in Table 3, 36% of products from dominant companies met the sodium target for bread compared to 43% of all companies, and for baked beans 21% of products from the dominant companies met the target compared to 33% of all companies. One of the major bread manufacturers had 28% of products meeting the target and one of the baked beans manufacturers had no products meeting the sodium target.

For sugar, the Heart Foundation targets were met by the majority of products in one of the three sub-categories assessed: breakfast cereals (77% of products). For the remaining two categories (yoghurt and baked beans), less than half of products met the Heart Foundation sugar targets. One-third (33%) of products of the dominant companies met the sugar target for baked beans compared to 40% to all products in Nutritrack. For yoghurt, 40% of the products of the dominant companies met the target compared to 47% of all products in Nutritrack. These findings clearly demonstrate that it would be feasible to reduce sugar and sodium of the selected sub-categories across all food company portfolios.

Discussion

Main findings compared with other studies

The packaged food supply in NZ supermarkets is generally unhealthy with products receiving a mean HSR of 2.7 out of 5.0, 53% considered discretionary and 69% of products considered ultra-processed. These findings are similar to recent cross-sectional studies of the Australian [ 32] and the US [ 33] packaged food supplies using similar methodology, measures of healthfulness and level of processing. Although the Health Star Rating system is only present on foods in Australasia, this system was used in the US study as the system underpinning it is the basis for several similar systems used globally [ 33], including the UK Food Standards Agency Nutrient Profiling Model [ 39]. Results have been reported for NZ in detail along with mean energy, saturated fat, sodium and total sugar per company [ 40]. The authors of these previous studies concluded that the respective food supplies were dominated by highly processed packaged food and beverage products, and the mean (SD) HSR was similar to NZ 2.7 (1.4) compared with the US 2.7 (1.4) and Australia 2.8 (1.4). A similar number of products was classified as ultra-processed in NZ (69%) and the US (71%) with a lower proportion in Australia (61%). This is of concern as diet-related risk factors (including high salt intake, high saturated fat intake) and excess energy account for 28.6% of health loss in NZ [ 41]. Though there are over 15,000 unique packaged food and beverage items with NIPs for sale in major NZ supermarkets, there are also a considerable number of healthier options available such as fresh fruit and vegetables.

The HSR was only displayed on 21% of all products in Nutritrack and 39% of products produced by the dominant companies. Some companies (Sanitarium, Foodstuffs, Kellogg's) had the HSR displayed on the majority of products while others did not display the HSR on any products. For some companies the HSR was displayed on products across the range of HSR values (for example, Woolworths NZ, Foodstuffs) but for other companies (for example, Heinz Wattie's and Nestlé NZ) the HSR appeared selectively displayed on healthier products, such as packaged fruit and vegetables and hot cereals. The mean HSR of products displaying the HSR was higher than products not displaying the HSR, across all products in Nutritrack and within the products of the dominant companies. Similarly, an analysis using NZ Nutritrack data conducted in 2016 found 84% of products that displayed the HSR had higher (healthier) ratings of 3.0 to 5.0 stars [ 42]. If the HSR was to be made mandatory, then all relevant products would display the nutrition label enabling consumers to make better-informed choices when selecting packaged food and beverages.

There is a proliferation of packaged foods and brands in the NZ market with steady growth [ 13], though market share is dominated by a relatively small number of companies, especially in the non-alcoholic beverage retail market, which is heavily dominated by two major companies (Coca-Cola and Frucor Suntory). Most of the companies with the highest market share are not NZ owned (16 of the major 22 companies) which can make it more challenging for policy-makers and public health advocates to influence decisions on product portfolio, reformulation and promotion.

There are differences in the classification of healthiness by indicator so using multiple systems to monitor healthiness is a strength of this study. This analysis used three systems to classify food as healthy, each with a different principle of defining healthy food thus providing a comprehensive picture of the NZ packaged food supply. The HSR considers the actual amounts of six nutrients and positive food components, the proportion of discretionary foods is guided by the food group recommendations of the Australian Dietary Guidelines, and the proportion of ultra-processed products depends on the degree and method of processing along with added ingredients. Therefore, some manufacturers can have a high mean HSR, a low proportion of discretionary foods, and yet a high proportion of ultra-processed foods; for example, Sanitarium (breakfast cereals), and George Weston Foods (bread). Conversely, most of the products of Dairyworks are core and not ultra-processed yet only two-fifths have an HSR ≥3.5 due to the saturated fat content of many hard cheeses.

Within categories of commonly consumed foods, such as bread, breakfast cereals and dairy, there are many companies, brands and products in the NZ market but only a few dominant players despite the breadth of manufacturers. Efforts to improve the healthiness of products, and promotion of healthier options should be directed at dominant companies because of their high market share. However, most of the dominant companies are overseas owned due to globalization of food production [ 11], indicating there is considerable overlap among manufacturers who sell foods globally, therefore potential exists for healthier products to be manufactured and sold widely to make a large difference to global population intakes, particularly for sodium. Though products may differ between countries according to local regulations and preferences, ongoing monitoring of the global food supply by individual countries using similar methodology and assessment tools could assist policymakers to prioritise policy actions for improving the food supply to reduce the impact of diet-related ill-health [ 30].

Implications

To maximise adherence to national dietary guidelines, consumers need a food environment that enables them to follow an eating pattern based mostly on whole foods and less processed foods that are low in added sugar and sodium and leads to improved health outcomes [ 1, 7- 10]. While many of the packaged foods and beverages available in NZ are excessively energy dense and high in sodium, saturated fat and sugar [ 40] some companies do provide healthier and less processed products. A range of solutions is required to ensure the food supply is acceptable, affordable and accessible to reduce the exposure and availability of unhealthy foods and encourage consumers to choose the healthier items on offer. Such solutions include the setting of government-led reformulation targets for processed foods, monitoring population intake targets for nutrients of concern such as sodium and sugar, mandatory front-of-pack labelling and a substantial tax on sugary drinks. These are all actions that were prioritised by a public health expert panel that assessed Government progress on food environment policies and prioritised actions in NZ [ 20]. For reformulation, the Panel recommended a two-tier system for reducing sodium and added sugar in key food categories i.e. (1) setting mandatory maximum levels, similar to the voluntary Heart Foundation targets, to remove the products with the highest levels of sodium and added sugar in product categories, and (2) setting and monitoring targets for voluntary reductions in sales-weighted averages in key food groups as a collective target with the aim of reducing the average sodium or sugar content in a category.

Front-of-pack labelling, such as the Health Star Rating system in Australia and New Zealand can encourage reformulation [ 42]. However, uptake has been slow with the HSR on only one-fifth of products in New Zealand since its introduction in 2014 and with the HSR selectively displayed on products with a higher HSR, therefore public health experts recommend it should now be mandatory. However, a recommendation from a recent five year review was for the HSR system to continue as a voluntary system with the addition of industry uptake targets [ 43].

Reformulation can contribute to healthier eating by improving the healthiness of packaged foods, particularly by reducing the amount of sodium added. While the NZ government has not established population intake targets, or food reformulation targets for sodium and sugar, the Heart Foundation [ 23] has voluntary reformulation targets for twenty food categories, with sodium targets for seventeen categories, and total sugar targets for nine. This programme was developed in 2007 initially to reduce sodium levels across packaged foods with a focus on lower cost and higher volume products. While for some categories, a high proportion of products made by the dominant companies met Heart Foundation targets for sodium and/or sugar (margarine, breakfast cereals, cheese), there is a great deal of room for improvement in other categories, particularly bread, baked beans and yoghurt.

The results of this study could stimulate modelling studies such as assessing the impact of reducing the availability of highly processed foods on the health of populations. Ideally, future assessments of the packaged food supply would be complemented with sales data to provide useful information on consumer purchasing patterns in relation to the healthiness of the food supply. A comparison of estimates of nutrient exposure from a store survey of packaged foods with those from household panel food purchases in NZ found that store survey data provided a reasonable estimate of average population exposure to key nutrients from packaged foods [ 44].

Strengths and limitations

This study is the first in New Zealand to assess the healthiness of the packaged food supply by company. A strength of the study is that the packaged food data in Nutritrack are collected annually using a standardised approach since 2013, with a large range of products captured. The data are representative of what is on the shelves of the sampled stores during the survey period, though do not represent every packaged food and beverage available in every store throughout the year [ 29]. It is estimated that 75% of unique products are represented [ 13]. Further, supermarkets are where most NZ households (87%) purchase foods and drinks weekly or more often [ 45]. Nutritrack data collection and analysis are independent of interested parties, the food industry.

However, this study is limited by the changing food supply and dependence on the accuracy of the information provided on food packaging. The analyses rely upon the accuracy of data reported on pack by manufacturers, such as nutrient content, and since some manufacturers use the government-supplied food calculator [ 28] the true composition of foods may differ from that reported on the product label. For packaged products that did not display the HSR, imputation of some metrics was required for the calculation of the HSR, such as percentage of fruit, vegetable, nut and legume content. Therefore, the HSR may be over or underestimated for a small number of products.

Conclusions

In 2018, packaged foods and beverages available in NZ supermarkets included in the Nutritrack database were dominated by discretionary products (53%), products with HSR <3.5 (59%) and ultra-processed products (69%). In addition, 79% of products available for sale did not display the HSR, with the HSR being selectively displayed on healthier products i.e. those with higher HSR values (≥3.5). In contrast, some companies had a high proportion of products with an HSR of at least 3.5, commonly displayed the HSR and had committed to reformulation. Dietary guidelines emphasize the importance of whole foods for health, but as packaged foods are prolific in the food supply there is a need to change the proportion of less healthy options available within product portfolios. Another option is reformulation of products and this paper shows that, based on the analysis of five specific food sub-categories, reformulation to reduce sodium and salt is feasible, at least for some products. Efforts to improve the healthiness of products should be directed to the 22 food companies dominating this market share, particularly in the core foods groups which are currently less likely to meet Heart Foundation targets (bread, breakfast cereals, cheese, canned baked beans, yoghurt). Currently, there is no government-led structured reformulation programme in NZ and the front-of-pack labelling system is voluntary. Therefore, government leadership is required to make substantive gains across the food supply and address sub-optimal nutrient intake by setting reformulation targets for core food groups and by mandating the HSR on products. Regular monitoring of the healthiness of the food supply is required to monitor changes in food company policy and product portfolios.

References

2. GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease. Lancet. 2017;393:1958-72.

12. Stuckler D, Nestle M. Big food, food systems, and global health. PLoS Med. 2012;9:e1001242. Available from: https://doi.org/10.1371/journal.pmed.1001242 pmid:22723746

26. Monteiro C, Cannon G, Levy R, NOVA Al. E.. The star shines bright. World Nutr. 2016;7:28-38.

# data[].attributes.attachment_link.title
Which companies dominate the packaged food supply of New Zealand and how healthy are their products?

# data[].attributes.attachment_link.description
Improvement of national food supplies are an opportunity to improve a country's health. Our aim was to identify the major food companies manufacturing packaged foods and non-alcoholic beverages available in New Zealand supermarkets in 2018; to assess the healthiness of products using (1) the Health Star Rating (HSR) system, (2) Australian Dietary Guidelines classification (core/discretionary), and (3) by level of processing; to compare the healthiness of products displaying and not displaying the HSR and; to assess potential for food reformulation within selected food sub-categories.