Healthful

Advertising and its Effects on Childhood Overweight and

Physical Activity Status
Sasha Sheftel
NTRS 511
Final Proposal
Professor Hillstrom

Abstract
Incidence of childhood obesity is on the rise in the United States causing
children to face weight related problems at a young age. Children are heavily
influenced by culture and with less emphasis on being active, and more on
technology, children are loosing sight of what it means to play. With sedentary
lifestyles and a plentiful amount of screen time, children are direct targets of food
advertising. Children who watch television have a higher exposure to unhealthful
food advertising and tend to be overweight (Parvanta et al., 2010). Additionally, a
majority of the commercials children are exposed to during regular programming
are for high fat and sugar food products (Kim, Cheong, & Zheng, 2009). Research is
lacking for the effectiveness of healthful advertising. This randomized controlled
trial aims to study the effectiveness of healthy food and physical activity advertising
on body weight and activity levels in elementary and middle school students by
airing healthful advertisements during weekly movie screenings. The proposed trial
will be conducted in 8 Los Angeles Unified School District schools, 4 will be the
controls and 4 will be the interventions.

Background
The practice of advertising can be used to encourage the use of certain goods
or services. Advertising has been around for many years, changing styles in an
effort to keep up with popular culture in order to be the most influential way to
reach people (Food marketing to children: Threat or opportunity?, 2006). There are
many different forms of advertising that are targeted to audiences to promote

products and social roles. These advertising techniques vary in style and are meant
for certain ages and gender groups. A major area of concern is the age people can be
exposed to manipulation and solicitation through direct advertising. Specifically,
direct marketing to children is the subject of immense controversy because it
endorses certain products in addition to promoting socialized lifestyles and
behaviors (Campaign for a Commercial-Free, CCFC, Childhood, 2014).

Currently, the youth of America are experiencing drastically increasing levels

of childhood obesity in all age groups (Kim et al., 2009). With one-third of our youth
either obese, or at risk of obesity, this generation is the first which may have a
shorter life expectancy than their parents (Kelly et al., 2010). The food advertising
industry is playing an enormous role in food and lifestyle choices of children as
advertising has expanded from television to MP3 players, computer games, internet
sites, school buses, classrooms, and other media (CCFC, 2014). Additionally, studies
show a strong relationship between amount of time spent watching television and
an increase in calorie consumption, contributing to the rise of childhood overweight
or obesity (Wiecha, Peterson, & Ludwig, 2006).

Many studies have been conducted to find data that demonstrates a

relationship between food advertisement and food choices in order to understand

how influential food advertising can be. In a study done by Kelly et al., research in
Australia, Brazil, China, Germany, Greece, and other countries demonstrated food
advertisements typically used child-oriented persuasive techniques when
advertising unhealthy foods, which influenced food choices. This technique aims to
persuade different age groups to purchase and/or consume certain food products.

With a food advertisement exposure rate of 56-126 advertisements per week while
only watching 2 hours of television per day, it becomes easy to persuade children
and their easily moldable minds (Kelly et al., 2010).

Other research has directly demonstrated a link between branding and

advertising to food preferences, requests, and diet patterns (Food marketing to

children and youth: Threat or opportunity?, 2006). Additionally, there is much
evidence that depicts a strong relationship between youth-targeted advertisements
and their influence on behaviors, cultural values, and hobbies (Food marketing to
children: Threat or opportunity?, 2006). Many parents are advocating for
adaptation of advertisement policy to eliminate food advertising for popular
children programming (CCFC, 2014). However, with the knowledge of the impact of
direct-to-child advertising, there may be another solution to the problem.

After thorough review of current research, there is an apparent deficiency in

problem-solving research. Instead of advocating for a change of policy, the product

being advertised can be swapped for more healthful alternatives. With ample
research published that demonstrates advertisings influence on young minds, using
commercials as a tool to promote healthful lifestyles could prove beneficial. In order
to implement a change in products to be advertised, research will need to be
conducted on the effectiveness of this practice. This proposed study aims to
investigate the effects of healthful advertising on children ages 4-14. Healthful
advertising will include products, such as fruits and vegetables, and lifestyle choices,
such as physical activity. Weight and physical activity levels will be examined in
response to healthful advertising. With the success of direct-to-child advertising

seen in previous experimentation, the proposed experiment is favored to produce

positive results.
Hypothesis and Specific Aims
Children aged 4-17 will show a significant (p<.05) reduction in weight and
increase in physical activity when exposed to 15 physical activity and healthful food
commercials during the course of a 1.5-2 hour weekly movie screening when
compared those in the same age group exposed to unhealthful food advertisements
during a 1.5-2 hour movie over 1 school year.
The first specific aim of the proposed study is to examine the effect of direct-
to-children food advertising on overweight status and physical activity levels by
airing 15 healthful commercials during a weekly movie screening to 4 schools in
LAUSD. The second aim of research is to examine the impact of persistent healthy
food and lifestyle commercial exposure over a 1 school year period on food choices
contributing to a decrease in students average weight. Thirdly, this study aims to
compare the effects of food advertising exposure among a control group and an
intervention group at a variety of ages. Lastly, the proposed study intends to
understand impacts of food advertising on children in order to make adjustments in
advertising accordingly for the most healthful outcomes.
Research Design and Methods
Participant Selection
Subjects of the proposed experiment will be students of all Los Angeles
Unified School District (LAUSD) schools aged 4 to 15 (elementary and middle school
students). Participants will be exposed to experimentation through required in-

school screenings of movie broadcasts with healthful advertisements twice a month

for an entire school year. From 2011-2012, there were a total of 274,193 elementary
and middle school students, and this study aims to reach 5,000 (2%) of those
students (Los Angeles Unified School District, LAUSD, 2012). The screenings will be
hosted at a total of 8 schools, 4 elementary schools and 4 middle schools. The
specific school sites will be determined with LAUSD when seeking approval of the
proposed study. With the screenings being a curriculum requirement, there will not
be much opportunity for participants to drop out of the study. Students will be
given 10 extra minutes of recess time if they comply with all aspects of the proposed
study. This proposal will be submitted to the California State University, Los Angles
Institutional Review Board for approval. Each student is required to fill out an
assent form along with a parental consent form in order to participate.
Procedure

Participants will watch 1 movie in school each week. The movie will tie into

the students current curriculum. For the movies showed to the variable group,
during the movie screening, there will be a series of health promotion
advertisements aired. The control group will see regularly aired food commercials.
Fifteen advertisements will be aired throughout the course of the movie. The
healthful advertisements will endorse fruits and vegetables, and physical activity.
Prior to the screenings, the students will complete the School-Based Nutrition
Monitoring (SBNM) survey to assess current eating behavior and physical activity
habits (Hoelscher, Day, Kelder, & Ward, 2003). Additionally, a trained research
assistant will record students heights and weights. To track physical activity, each

participant will be administered a pedometer at the beginning of the intervention. A

trained research assistant will record the number of steps notated on the pedometer
at the end of each week to track physical activity changes. Once the screenings are
completed at the end of the school year, students will also fill out the SBNM survey.
The survey will then be administered again after 6 months to observe any changes
in nutrition and physical activity behaviors.
Research Design and Data Collection

The proposed research study design will be a blinded controlled trial.

Participants will be unaware they are being shown healthful advertisements to

influence their health behavior. Parents, however, will be informed in order to
obtain their consent. Health surveys will be administered before the proposed
experiment, immediately after the experiment has concluded, and as a 6-month
follow up. The data from the SBNM surveys will be recorded and analyzed to track
changes in nutrition and lifestyle behaviors. All students who attend the selected
elementary and middle schools in the LAUSD will be included in this study. If the
student is unable to complete the survey due to physical or mental disability, they
will be excluded from this study. In order to track physical activity levels, each
student will be given a pedometer to wear over the course of the school year to
count his or her steps. The number of steps will be recorded at the end of each
week.

All surveys will be administered, collected, and entered into a database by

trained personnel. All consent forms, assent forms, and data collected will be stored
on a secure computer to maintain participant privacy. A trained research assistant

will perform all privacy procedures. In order to analyze the data, a statistician will
be hired to calculate any statistical significance.
Outcomes Assessment

Anthropometric data, including height and weight, taken pre and post-

intervention will assess the outcomes of the proposed research study. Additionally,
at the end of each week, a trained research assistant will record each students steps
tracked with a pedometer that will be given to each participant at the start of the
study. Also, students will be administered a School-Based Nutrition Monitoring
(SNBM) questionnaire to complete pre and post-intervention. Six months after the
conclusion of the trial, students heights, weights, and SNBM will be collected for
comparison data.
Statistical Analysis

A statistician will be hired to conduct a thorough statistical analysis of the

data collected. In order to interpret the data, SPSS 22.0 t-test will be used to
calculate significances. This test will be calculated for the initial survey, completion
survey, and 6-month follow up survey. Additionally, a regression analysis will be
used to identify a possible relationship among the variables and conditions.
Strengths and Weaknesses

A major strength of the proposed research study is the ability to blind the

participants to the intervention in which they are partaking. Another strength of

this study is the ability to relate healthful advertising with its effects on children. A
third major strength of the current research proposal is the retention that will be
maintained due to the screenings being an in-school requirement.

A weakness of the proposed study is the need to get LAUSDs approval to

implement the movie screenings into their curriculum for the span of a school year.
Additionally, the students compliance to the use of the pedometers is vital for
tracking physical activity levels. Wearing a pedometer on a day-to-day basis for an
entire year is difficult to enforce, which could skew the physical activity levels data.
Timeline

Once the study has been submitted to the Institutional Review Board for

approval, preparation of the food commercials will begin and take 6 months to
complete. After the study is approved, training research assistants for 3 weeks will
begin. Participant assent and parental consent will take 2 weeks to obtain. Height,
weight, and survey data will take 2 weeks to obtain at the beginning of the study,
after the study has concluded, and at the 6 month follow up. Overall, the study will
take 2 years to complete in full.

References
Bauman, A., Phongsavan, P., Schoeppe, S., & Neville,. O. (2006). Physical activity
measurement-a primer for health promotion. International Union for Health
Promotion and Education, 8(2).
Campaign for a Commercial-Free Childhood. (2014). Food marketing and childhood
obesity. Retrieved from
[Link]
childhood-obesity
Certain, L. K., & Kahn, R. S. (2002). Prevalence, correlates, and trajectory of
television viewing among infants and toddlers. Pediatrics, 109(4), 634.
Retrieved from
[Link]
&site=ehost-live
Dietz Jr., W. H., & Gortmaker, S. L. (1985). Do we fatten our children at the television
set? obesity and television viewing in children and adolescents. Pediatrics,
75(5), 807. Retrieved from
[Link]
&site=ehost-live
Food marketing to children and youth: Threat or opportunity?(2006). Adolescence,
41(164), 772-773. Retrieved from
[Link]
Greenberg, B. S., Eastin, M., Hofschire, L., Lachlan, K., & Brownell, K. D. (2003).
Portrayals of overweight and obese individuals on commercial television.

American Journal of Public Health, 93(8), 1342-1348. Retrieved from

[Link]
99749-006&site=ehost-live
Hawkes, C. (2005). Self-regulation of food advertising: What it can, could and cannot
do to discourage unhealthy eating habits among children. Nutrition Bulletin,
30(4), 374-382. doi:10.1111/j.1467-3010.2005.00526.x
Henderson, V. R., & Kelly, B. (2005). Food advertising in the age of obesity: Content
analysis of food advertising on general market and african american
television. Journal of Nutrition Education and Behavior, 37(4), 191-196.
Retrieved from
[Link]
09215-003&site=ehost-live
Hoelscher, D. , Day, R. , Kelder, S. , & Ward, J. (2003). Reproducibility and validity of
(Kim et al., 2009)the secondary level school-based nutrition monitoring
student questionnaire. Journal of the American Dietetic Association, 103(2),
186-194.
Kelder, S., Hoelscher, D. M., Barroso, C. S., Walker, J. L., Cribb, P., & Hu, S. (2005). The
CATCH kids club: A pilot after-school study for improving elementary
students nutrition and physical activity. Public Health Nutrition, 8(02), 133-
140. doi:10.1079/PHN2004678
Kelly, B., Halford, J. C. G., Boyland, E. J., Chapman, K., Bautista-Castao, I., Berg, C., et
al. (2010). Television food advertising to children: A global perspective.
American Journal of Public Health, 100(9), 1730-1736. Retrieved from

[Link]
25205-018&site=ehost-live
Kent, M. P., Dubois, L., & Wanless, A. (2012). A nutritional comparison of foods and
beverages marketed to children in two advertising policy environments.
Obesity, 20(9), 1829-1837. Retrieved from
[Link]
23937-012&site=ehost-live
Kim, K., Cheong, Y., & Zheng, L. (2009). The current practices in food advertising:
The usage and effectiveness of different advertising claims. International
Journal of Advertising: The Quarterly Review of Marketing Communications,
28(3), 527-553. Retrieved from
[Link]
10798-005&site=ehost-live
Lioutas, E. D., & Tzimitra-Kalogianni, I. (2014). I saw santa drinking soda!?
advertising and children's food preferences. Child: Care, Health and
Development, , n/a-n/a. doi:10.1111/cch.12189
geles Unified School District. (2014). Guide to schools. Retrieved
from [Link]
Parvanta, S. A., Brown, J. D., Du, S., Zimmer, C. R., Zhao, X., & Zhai, F. (2010).
Television use and snacking behaviors among children and adolescents in
china. Journal of Adolescent Health, 46(4), 339-345.
doi:[Link]

Wiecha, J., Peterson, K., & Ludwig, D., (2006). When children eat what they watch:
impact of television viewing on dietary intake in youth. Archives of Pediatric
& Adolescent Medicine. 160(4), 436-442.