[Senate Hearing 110-792]
[From the U.S. Government Publishing Office]
S. Hrg. 110-792
WATCH WHAT YOU EAT: FOOD MARKETING TO KIDS
=======================================================================
JOINT HEARING
before the
SUBCOMMITTEE ON LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND
RELATED AGENCIES
AND THE
SUBCOMMITTEE ON FINANCIAL SERVICES AND GENERAL GOVERNMENT
OF THE
COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
SPECIAL HEARING
SEPTEMBER 23, 2008--WASHINGTON, DC
__________
Printed for the use of the Committee on Appropriations
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
index.html
__________
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COMMITTEE ON APPROPRIATIONS
ROBERT C. BYRD, West Virginia, Chairman
DANIEL K. INOUYE, Hawaii THAD COCHRAN, Mississippi
PATRICK J. LEAHY, Vermont TED STEVENS, Alaska
TOM HARKIN, Iowa ARLEN SPECTER, Pennsylvania
BARBARA A. MIKULSKI, Maryland PETE V. DOMENICI, New Mexico
HERB KOHL, Wisconsin CHRISTOPHER S. BOND, Missouri
PATTY MURRAY, Washington MITCH McCONNELL, Kentucky
BYRON L. DORGAN, North Dakota RICHARD C. SHELBY, Alabama
DIANNE FEINSTEIN, California JUDD GREGG, New Hampshire
RICHARD J. DURBIN, Illinois ROBERT F. BENNETT, Utah
TIM JOHNSON, South Dakota LARRY CRAIG, Idaho
MARY L. LANDRIEU, Louisiana KAY BAILEY HUTCHISON, Texas
JACK REED, Rhode Island SAM BROWNBACK, Kansas
FRANK R. LAUTENBERG, New Jersey WAYNE ALLARD, Colorado
BEN NELSON, Nebraska LAMAR ALEXANDER, Tennessee
Charles Kieffer, Staff Director
Bruce Evans, Minority Staff Director
Subcommittee on Departments of Labor, Health and Human Services,
Education, and Related Agencies
TOM HARKIN, Iowa, Chairman
DANIEL K. INOUYE, Hawaii ARLEN SPECTER, Pennsylvania
HERB KOHL, Wisconsin THAD COCHRAN, Mississippi
PATTY MURRAY, Washington JUDD GREGG, New Hampshire
MARY L. LANDRIEU, Louisiana LARRY CRAIG, Idaho
RICHARD J. DURBIN, Illinois KAY BAILEY HUTCHISON, Texas
JACK REED, Rhode Island TED STEVENS, Alaska
FRANK R. LAUTENBERG, New Jersey RICHARD C. SHELBY, Alabama
ROBERT C. BYRD, West Virginia, (ex
officio)
Professional Staff
Ellen Murray
Erik Fatemi
Mark Laisch
Adrienne Hallett
Lisa Bernhardt
Bettilou Taylor (Minority)
Sudip Shrikant Parikh (Minority)
Administrative Support
Teri Curtin
Jeff Kratz (Minority)
------
Subcommittee on Financial Services and General Government
RICHARD J. DURBIN, Illinois, Chairman
PATTY MURRAY, Washington SAM BROWNBACK, Kansas
MARY L. LANDRIEU, Louisiana CHRISTOPHER S. BOND, Missouri
FRANK R. LAUTENBERG, New Jersey RICHARD C. SHELBY, Alabama
BEN NELSON, Nebraska WAYNE ALLARD, Colorado
ROBERT C. BYRD, West Virginia (ex THAD COCHRAN, Mississippi (ex
officio) officio)
Professional Staff
Marianne Upton
Diana Gourlay Hamilton
Mary Dietrich (Minority)
Rachel Jones (Minority)
Administrative Support
Michael Bain
LaShawnda Smith (Minority)
C O N T E N T S
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Page
Opening Statement of Senator Tom Harkin.......................... 1
Statement of Senator Sam Brownback............................... 3
Statement of Senator Richard J. Durbin........................... 5
Prepared Statement of........................................ 6
Statement of Julie Gerberding, M.D., M.P.H., Director, Centers
for Disease Control and Prevention, Department of Health and
Human Services................................................. 7
Prepared Statement of........................................ 9
Statement of Hon. Kevin J. Martin, Chairman, Federal
Communications Commission...................................... 14
Prepared Statement of........................................ 16
Statement of Hon. Jon D. Leibowitz, Commissioner, Federal Trade
Commission..................................................... 19
Prepared Statement of........................................ 20
FTC's Authority and History on Food Marketing to Children........ 21
The 2005 Workshop on Marketing, Self-Regulation, and Childhood
Obesity........................................................ 21
The 2007 Forum and Current Assessment of Industry Efforts........ 22
The 2008 Food Marketing Study and Report......................... 23
Health Systems Reports........................................... 29
Reducing Children's Television Viewing to Prevent Obesity........ 31
A Randomized Controlled Trial.................................... 31
Methods.......................................................... 32
Intervention..................................................... 32
Outcome Measurements............................................. 33
Statistical Analysis............................................. 34
Results.......................................................... 34
Participation in the Intervention................................ 35
Effects on Adiposity............................................. 35
Effects on Media Use, Diet, and Physical Activity................ 37
Comment.......................................................... 39
References....................................................... 40
A Randomized Trial of the Effects of Reducing Television Viewing
and Computer Use on Body Mass Index in Young Children.......... 42
Methods.......................................................... 44
Results.......................................................... 47
Comment.......................................................... 51
Physical Education in the Schools................................ 54
Statement of J. Michael McGinnis, M.D., MPP, Institute of
Medicine, Washington, DC....................................... 57
Prepared Statement of........................................ 59
Food Marketing to Children and Youth............................. 61
2008 Status of Recommendations in the 2005 IOM Report............ 61
Statement of Marc Firestone, Executive Vice President, Corporate
and Legal Affairs, and General Counsel, Kraft Foods,
Northfield, Illinois........................................... 64
Prepared Statement of........................................ 65
Statement of Marva Smalls, Executive Vice President and Chief of
Staff, MTV Network, IDS and Family Group (Nickelodeon), New
York,
New York....................................................... 67
Prepared Statement of........................................ 68
Childhood Obesity: A Multi-Dimensional Problem................... 69
Nickelodeon's Approach........................................... 69
Nickelodeon's Health & Wellness Initiatives...................... 70
Licensed Characters.............................................. 71
Collaboration with Advertisers and Food Companies................ 72
Statement of Patti Miller, Vice President, Children and the
Media, Children NOW............................................ 72
Prepared Statement of........................................ 73
WATCH WHAT YOU EAT: FOOD MARKETING TO KIDS
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TUESDAY, SEPTEMBER 23, 2008
U.S. Senate, Subcommittee on Labor, Health and
Human Services, Education, and Related
Agencies, and Subcommittee on Financial
Services and General Government, Committee on
Appropriations,
Washington, DC.
The subcommittees met at 10:35 a.m., in room SD-192,
Dirksen Senate Office Building, Hon. Tom Harkin (chairman of
the Labor-HHS Subcommittee) presiding.
Present: Senators Harkin, Durbin, and Brownback.
opening statement of senator tom harkin
Senator Harkin. Good morning, everyone. The two
subcommittees of the Appropriations Committee will come to
order.
This is the Subcommittee on Labor, Health, and Human
Services, Education, and Related Agencies, and the Subcommittee
on Financial Services and General Government, subcommittee of
the Committee on Appropriations.
I'd like to thank everyone for coming today to examine the
role of media and marketing food, beverages, and lifestyles to
children. I especially want to thank my ranking member, Senator
Arlen Specter, and also the Financial Services Subcommittee,
Senator Brownback, Senator Durbin, for working with us to have
this kind of a joint hearing. We don't often get to work across
jurisdictions, so I'm gratified that this epidemic of childhood
obesity has inspired this rare meeting of two subcommittees of
the Appropriations Committee.
I just want to say that, because of the number of
witnesses, we've had to shorten the statements; I'll get right
to the point. I'm convinced that the food and beverage industry
and the--and kids media industry, with all of their creativity
and resourcefulness, can be a powerful force for change and
doing good. Therefore, today's hearing is to discuss media and
marketing.
Now, I'm going to have other hearings on school nutrition
as we do the--as I wear my other hat, on agriculture, as we do
the reauthorization of the childhood--the Child Nutrition Act
for next year. But, I want to hear from you here today on how
media and advertising can be a part of the solution.
Senator Brownback and I have worked together on this a lot
in the past, and looking at the FCC and how we can try to get a
handle on this, with the help and assistance of the industry.
Now, I must say, in this regard, some within the food and
beverage industry, and several media companies, have really
tried to do the right thing. In the second panel, we're going
to hear from Kraft. Kraft Foods took the lead, back in 2005.
They announced that all TV, radio, and print advertising viewed
primarily by children ages 6 to 11 would feature only Kraft
products that meet specific nutrition criteria. And then, in
2006, Kraft extended this policy to their Web sites. So, I
personally want to applaud Kraft's work in this area, and hope
to hear, today, how we can build on those advancements.
Also, in November 2006, the Council of Better Business
Bureaus formed the Children's Food and Beverage Advertising
Initiative. Fifteen food companies have joined the initiative
and pledged to limit their marketing to children to foods that
meet company-developed nutrition standards. In addition,
several media companies, including Disney, Sesame Workshop, and
Cartoon Network, announced that they will only license their
characters on foods that meet their own nutrition standards.
Nickelodeon has also announced a licensed-character program
that relies on individual food company nutritional standards.
So, I look forward to learning more about these programs
from our second panel, and I'll be asking if all of Viacom's
characters are included.
You know, kids are powerfully influenced by these
characters. I mean, you know, to me, Nemo is a cartoon
character, but to kids, he's an authority figure. So, you know,
just the way you look at it.
Now, again, there are some great examples of how these
characters can assist in marketing good food to our kids. And
here, I have some props. What's good if you don't have a prop,
right? Here are mandarin oranges with Disney characters on it,
on the front of it. Yeah, Nemo. Thanks for telling me that.
Senator Harkin. Nemo's on the front of the mandarin
oranges. That's good. And here's--I never thought I'd live to
say the--they see this Mickey Mouse on a head of lettuce.
Now, to me, that's the direction we ought to be going.
So, again--it looks good. So, what's the problem? Well,
here are some of the problems. Studies have found that about 50
percent of commercial advertisements targeted to young people
during Saturday morning programming are for food and beverage
products, but few commercials are viewed for dairy products,
fruits, or vegetables. In 2007, a study published in Pediatrics
reviewed approximately 98,000 advertisements from a sample of
television programs that were top-rated among kids under 17,
found that nearly all of them--98 percent--viewed by the kids,
and 89 percent viewed by adolescents, were for products that
were high in fat, sugar, or sodium. That was in 2007, a year
after Kraft changed its guidelines, and after the creation of
the Better Business Bureau initiative.
A 2008 study by the Kaiser Family Foundation found that
little television airtime was devoted to the promotion of
healthy food choices. The study examined 1,680 hours of
television content on ten major broadcasting cable networks. It
reported that, across all of the ten networks, paid public
service announcements were shown for an average of 10 seconds
per hour, but none of them promoted good nutrition. Now, that's
28 minutes a week. Donated PSAs--public service announcements--
represented only one-half of 1 percent of all airtime, and,
within that, an average of 28 seconds per week was on promoting
good nutrition. Twenty-eight seconds per week on public service
announcements.
So, again, I think this is where the problem lies. Now,
again, I don't want to be misunderstood. It's television, but
now a lot of kids are now on the Internet and social networking
on the Internet. I thought I was doing pretty good, Sam, I've
got 1,500 friends on my Facebook.
Senator Brownback. Yeah, very good.
Senator Harkin. Yes, until I found out Obama had 8.1
million.
I've got 1,500. Okay? I've got 100 friends on my Facebook.
But--so, anyway, but more and more kids are doing that. So,
again, we need to think about that, also.
Expenditures for advertising on social-network Web sites
are expected to reach $1.8 billion by 2010. Markets such as
Wendy's, Burger King, and Pepsi have created profiles on My
Space, where visitors can interact with the brand, just as they
would with the profiles of their other friends. So, again, this
is the wave of the future. The question for us is, Will it just
be foods that are high in sugar, fat, and sodium, or will we,
kind of, redirect this towards other ways? Will the companies
do that?
So, again, these are the questions I think we need to be
exploring. I applaud what's happening on some of these things,
but we've got to think about what's happening both on
television and on the Internet, where kids are spending a lot
of their time and where they're getting a lot of influence.
So, I guess I look forward to hearing today from the
witnesses on how we can change the landscape of what our kids
see on TV, on the Internet, grocery items, and on and on. We're
going to be discussing, a lot in the next year or two,
healthcare. I don't care--well, maybe I do care who gets
elected President, but regardless who gets elected President,
this Congress and the next administration are going to be
working on healthcare reform. If all we're going to be doing is
talking about how we pay the bills, it's not going to get us
anywhere. We've got to get ahead of the curve with prevention
and wellness programs, and that starts with our kids, getting
our kids started off early in life, eating the right kind of
foods, enjoying the right kind of foods, developing the kind of
tastes for the right kind of foods, so that they won't be
developing diabetes and obesity, and the other things that are
plaguing our kids today. So, I see this as sort of the front
end, the most important part of what we're going to be doing in
healthcare reform in the next couple of years.
And I have talked way too long, and I would yield to my
good friend, Senator Brownback.
statement of senator sam brownback
Senator Brownback. Thank you very much. Mr. Chairman, I
couldn't agree more with your statement, and I really
appreciate working with you and with Chairman Martin.
We started a process about a 1\1/2\ years ago to try and
get some voluntary compliance with these issues. We didn't get
far enough, and that's the genesis of the hearing. I would like
to know what else we can do to move this process on forward.
We are on the verge of a nationwide crisis that threatens
to create, for the first time ever, a generation of kids who
will have a shorter life span than their parents. That's a
breathtaking statement. That's where we are today. And if we
don't start to do something about it, that's where we're going
to be, and that's why we have to get at these prevention
programs you mentioned.
You had some samples, I've got charts. They're dull, but
they do drive the point. The past 30 years, childhood obesity
rates have risen nearly 300 percent; from 5 percent in the mid-
1970s to over 17 percent of our children are obese in 2004. For
children, 2 to 5, it's gone from 5 to nearly 15 percent; for
adolescents, it's gone from 6\1/2\ to nearly 19 percent; for
teenagers, 17.4 percent. Wow. These are very, very troubling
figures.
While we all agree that there are myriad of different
factors that comprise childhood obesity, we cannot ignore that
our children live in a saturated media environment with
advertisers eager to make impressions on young minds. A 2004
Kaiser Family Foundation report found that children are exposed
to approximately 40,000 advertisements per year. And I want to
show that on this next chart.
A 2007 Kaiser Family report found that, in terms of
minutes, children ages 2 to 7 see an average of 17 minutes
worth of commercials per day; adolescents, 37 minutes;
teenagers, 35 minutes. Now, that same report, in the next
chart, also showed that, among all TV genres, children's shows
have the highest proportion of food ads--50 percent--versus
dramas, with 25 percent; sitcoms, with 23; and reality shows,
with 16 percent.
The recently released FTC report on marketing food to
children and adolescents, found that, in total, $1.6 billion
was spent on food and beverage advertising to children in 2006.
You can say, ``Well, okay, that maybe neither is good nor
bad,'' but, in the next chart, of that $1.6 billion, 34 percent
of the ads were for candy and snacks--here comes Halloween--28
percent were for cereals, and 10 percent were for fast foods.
We simply must do better, and we can do better.
We all know that there are serious long-term health
consequences to obesity, including an increased risk for
cardiovascular disease, high blood pressure, and type-2
diabetes. In fact--and this, I found just stunning--in July
2008 of this year, the American Academy of Pediatricians said
that more children, as young as 8, should be given cholesterol-
lowering drugs. As young as 8. According to the Centers for
Disease Control and Prevention--we'll hear from them today--
almost 60 percent of overweight children had at least one
cardiovascular disease risk factor, while 25 percent of
overweight children had two or more risk factors. American
Heart Association found that more than 6 million children in
the United States have nonalcoholic fatty liver disease
attributed to overweight or obesity. Six million. Already we
have pharmaceutical companies reformatting drugs for children
for such health conditions as type-2 diabetes, cardiovascular
disease, and hypertension.
Indeed, we have an enormous challenge before us, one I'm
hopeful we can address together an in expeditious way, when it
works with our spirit of a free society, but also places the
best interests of our Nation's children first.
And toward that end, Mr. Chairman, what I'm looking for,
from the testimony for the witnesses today, is, How do we
proceed forward with addressing this? This is an enormous
problem that's right on us, and we've got to do something about
it. And we can't just debate, in our healthcare policy, about
who's going to pay the bill, but how do we get out ahead of it?
And clearly this is a big one we've got to get out ahead of.
Thank you for holding the hearing.
Senator Harkin. Thank you, Senator Brownback, for working
with us and working together, and our staffs working together
on this. I think, again, this crosses party lines, crosses
regional lines. I mean, this is a national problem, and I look
forward to working with you on this as we move ahead, also. So,
I thank you very much.
And I yield to the chairman of the Financial Services and
General Government Subcommittee, Senator Durbin.
statement of senator richard j. durbin
Senator Durbin. Thank you very much.
I want to thank both Senators Harkin and Brownback for this
hearing and ask that my opening statement be placed in the
record in its entirety.
I also would like to make a note that we--we had a call to
arms on this issue in 2001. A fellow named Eric Schlosser wrote
a book called ``Fast Food Nation.'' And if you read it, you
couldn't help but realize how life had changed so dramatically,
in terms of the way we eat, the way we advertise for the food
that is purchased. And it means that generations, since the
1960s, have really been raised in a much different world than
some of us at this table. And their notion of what is healthy
and what is normal is a lot different than we had, growing up.
I tried to address one small part of this. I thought, well,
let's go after something the Federal Government has a special
responsibility for. How about school lunches? I started
visiting schools, and looking at what they serve, and listening
to the menus that are announced on a lot of radio shows back in
Iowa and Kansas and Illinois. It's disturbing. You know, choice
today is between corndogs and pizza, tater tots on the side,
you know, and you start thinking to yourself, ``Is this as good
as it gets?''
So, we started to try to work out a way to develop school
lunches that were healthy, that kids would actually eat. It
doesn't do us any good to put out the salad bar and watch the
kids go for the tater tots, so we had to figure out how to put
this food in front of kids at an age where they start choosing
the right thing, and choosing the right amount of the right
thing.
It's not easy. Any parent can tell you it's not easy. But
it works if you work at it. And we've had a dozen schools in
Chicago that have started with salad bars for kindergartners
and grade-school kids, and we've started trying to build this
appetite for the right kind of foods. We are doing this,
against this tidal wave of advertising, which says: supersize
carbos and salt and sugar. And it's tough.
But, if we're serious about it at the Federal level, we've
got to do more than just complain about advertising. Let's get
our own house in order. Let's make the school lunch program and
the school breakfast program a model for the Nation. Let's
prove that we can put nutritious foods in front of these kids
and they'll eat them. But, we're going to have to work at it.
One thing we found, for example, Mr. Chairman, was, milk
wasn't that appealing to these kids--they would go for those
sugar-filled juices, in a second--unless you put it in the
right container. Give them those little jugs, they grab them.
It's about packaging and marketing. And I hate to concede that
point, because it seems like an unnecessary expense and more
plastic in the environment, but, at the end of the day, it
worked.
prepared statement
So, we have to start thinking more sensibly about how we
move the Federal programs, whether it's the WIC program or the
school lunch program. Our feeding--we feed a lot of people in
this country through the Federal Government, and we can do a
much better job.
I'm glad we're having this hearing. Thank you.
[The statement follows:]
Prepared Statement of Senator Richard J. Durbin
Chairman Harkin, Senator Brownback, I am pleased to join you today
to discuss the important issue of childhood obesity. There's been
considerable upheaval in the world the last few days and weeks, but the
issue of children's health should always be a priority for us.
I welcome Chairman Martin of the FCC and Commissioner Leibowitz of
the FTC, two agencies under the jurisdiction of the Financial Services
and General Government Appropriations Subcommittee. I also welcome Dr.
Gerberding of the CDC and the witnesses on our second panel,
particularly Mark Firestone, Vice President of Illinois-based Kraft
Foods.
Childhood obesity in the Unites States has tripled in the last 40
years, putting children at unprecedented risk for lifetime struggles
with an array of chronic diseases. The problem of obesity in America
will not be solved overnight. But slowly, we're starting to see adults
and children making efforts to be more active and to eat healthier
foods.
For example, in 2003, I worked with Illinois schools to provide
healthier lunch choices for students. The schools used different
strategies to promote better food choices among students. The schools:
--Introduced healthier food choices,
--Changed packaging and pricing,
--Promoted fruits and vegetables, and
--Increased accessibility of school breakfast.
Before the changes, kids could choose between pizza and burgers for
lunch--too often their first meal of the day. After the changes,
students in 12 different Chicago-area schools had the option of a salad
bar with healthy fruits and vegetables or a warm breakfast to start
their day.
These small changes made a tremendous impact on kids' food choices.
With support from the Robert Wood Johnson Foundation and Action for
Healthy Kids, these changes made Illinois schools a model for other
schools. Since then, Action for Healthy Kids continues to help schools
in Illinois and nationwide to implement changes promoting healthier
eating.
It would be a mistake, though, to ignore the rest of the
environment kids are growing up in. The environment is a part of the
problem--but ultimately it can also be a part of the solution.
Marketing and advertising is inescapable in our day-to-day lives.
We're no longer just talking about commercial breaks between kid's
cartoons. We're seeing product placement in video games and movies,
Internet content flooded with commercial messages, and even ads on cell
phones.
The pervasiveness of advertising in America has a huge influence on
kids. They simply haven't developed the cognitive skills to tell the
difference between advertising and entertainment. As we all know, kids
are also are more easily persuaded by sophisticated ads, celebrity
endorsements, and flashy packaging.
Since the Surgeon General issued a health warning about smoking in
1964, the number of smokers in the United States has decreased by 50
percent. We have taken many steps in our fight against tobacco: looking
at what companies are doing, limiting advertisements, providing
cessation services, and educating families and communities. A similar
comprehensive approach may be useful in our fight against childhood
obesity. It is going to take the commitment of government, communities,
families, and industry to make a dent in this alarming trend.
Recent industry efforts are encouraging. Several companies have
come together with the Better Business Bureau to make commitments to
change the way they market food to children.
Kraft and McDonald's, two Illinois companies, have made promising
commitments under that initiative to limit advertising to children to
only the healthiest foods. I welcome Kraft here today as part of our
second panel. I think Kraft and other companies deserve recognition for
voluntarily changing the way they do business in the interest of
children's health.
Viacom, also a witness before us today, devotes air time to
encourage kids to be active. In fact, this Saturday Nickelodeon will
actually go completely off the air for 3 hours to encourage kids to get
outside and play. Let's all hope for good weather on Saturday!
These efforts are clearly a big step in the right direction. But
the question we're here to answer today is--will it be enough to make a
difference? How can we work together to make even stronger commitments
to limiting kids' exposure to unhealthy messages and promoting healthy
lifestyles?
I look forward to hearing our witnesses' testimony today and
hearing the views of my colleagues. Thank you.
Senator Harkin. I'm glad you mentioned the WIC program,
because, again, in our reauthorization bill next year, I can
tell you that there are forces at work to get white potatoes to
put into the WIC program. Be on guard.
Senator Durbin. Can I mention one? I forgot to mention the
Robert Wood Johnson Foundation and Action for Healthy Kids have
really been helpful on the school lunch program.
Senator Harkin. Yeah. Very good.
Well, thank you all very much. As you can see, there is a
great deal of interest on our committee and among others on
this issue. And I can tell you, just from talking to other
Senators and stuff, I know that their--the interest level and
the attention is going to be focused very high on this.
So, we have two panels. The first panel, we're honored to
have Dr. Julie Gerberding, the head of the Centers for Disease
Control and Prevention; Kevin Martin, the Chairman of the
Federal Communications Commission; and Mr. Jon Leibowitz,
Commissioner of the Federal Trade Commission.
We thank you all for being here. Again, your statements
will all be made a part of the record.
I will go in, just, the order I just announced here, so
we'll start with Dr. Gerberding, go to Mr. Martin, and then go
to Mr. Leibowitz.
And, Dr. Gerberding, welcome again to the subcommittee
here----
Dr. Gerberding. Thank you.
Senator Harkin [continuing]. Subcommittees, I should say.
STATEMENT OF JULIE GERBERDING, M.D., M.P.H., DIRECTOR,
CENTERS FOR DISEASE CONTROL AND PREVENTION,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Dr. Gerberding. Thank you. It is a privilege to appear in
front of both of these committees and to have a chance to
address an issue that's important. And I really thank you all
for making this visible, especially when there are so many
other important things on your agenda this week. And I
especially thank Senator Harkin for his fruits and vegetable
program on the desktops of children in school. You know, that's
one of our favorite projects.
As a CDC Director, I wake up every morning with one issue
on my mind, and that is, Why aren't we the healthiest Nation?
We spend the most money, but we're not the healthiest. We're
37th in the world in health, and we spend more than virtually
every other developed country to earn that pitifully poor
ranking.
One of the reasons why we're not the healthiest is because
our children are at high risk for chronic diseases, and they
are moving in a direction where, as Senator Brownback said, we
may see children whose life expectancies are shorter than our
own.
You've presented the statistics already, just showing the
percentage of our children who are obese over the past several
years. I also want to emphasize that this is not something that
affects all children equally. We see health disparities here--
significantly greater rates of obesity in children of Mexican-
American and African-American origin compared to white
children--but all children are affected by this problem.
We have lots of statistics, and we can describe this in
great detail, some horrifying statistics about the poor health
status of our children. But, I think it's important to think of
this as more than statistics; these are about individual
children, the children that I see when I visit schools, and the
children across America--12 million children, to be exact--who
are obese.
If you're an 8-year-old today, you have more than a 30-
percent chance of having diabetes in your life. If you are an
obese 8-year-old today, you have a 70 percent chance of having
a second risk factor for cardiovascular disease, and a 25-
percent chance of having a third risk factor for cardiovascular
disease. So, we are conditioning our children's health status
now at a point where they don't even have a chance to look
forward to a healthy life. And it a national catastrophe and a
major reason for our national health shortage.
So, children have poor health and poor health prognosis in
America, but what they don't have is the maturity and judgment
to make decisions about healthy foods, themselves. You've shown
this graphic that reveals the toxic food environment present on
our children's television viewing, but this is just a piece of
the picture. Children are exposed to these kinds of
advertisements on the Internet, and their parents are exposed
to them through a variety of channels and media; and, of
course, that influences food choices available in the home, as
well.
So, we've got our work cut out. And one of the things that
CDC is doing is to create a comprehensive approach to
children's health. We will be soon rolling out our Children's
Health Goal Plan, which lays out what we think are the
priorities for action. But, those actions do include, number
one, finding the evidence, understanding what is the
relationship between advertising choices and obesity; more
importantly, what is the effect of changing that and doing
something about it?
We also need standards and agreement across all of our
government agencies on what constitutes a healthy choice so
that we're all identifying and thinking about the same thing.
And we can use that consistently across industry and families.
We need regulation. Whether or not that's self-regulation
or imposed regulation, I understand, is the big debate and the
subject of this committee. But, there's clear indicators that
we've got to do more than we're doing, and we need to have
those apply not just to the television industry or the food and
beverage industry, but across a much broader swath, where
children are exposed. And, of course, if we do that, we have to
have a means of accountability and enforcement. And, I think,
most importantly, we need to have measures of success so that
we can see what's working, what isn't working, and act
effectively on behalf of our children.
PREPARED STATEMENT
So, from a CDC perspective, I'll just summarize by saying
this is job one for our Nation, this is our future. We owe it
to our children, and we've got to do a lot more than we've been
doing to get this problem under control.
[The statement follows:]
Prepared Statement of Dr. Julie L. Gerberding
Introduction
Distinguished Chairmen, Members of the Committees, thank you for
the opportunity to provide this statement for the record for today's
hearing on food marketing to youth. I am Dr. Julie Louise Gerberding,
Director of the Centers for Disease Control and Prevention (CDC), and
Administrator of the Agency for Toxic Substances and Disease Registry
(ATSDR), within the U.S. Department of Health and Human Services. My
statement provides you with an overview of the obesity epidemic
including updated surveillance data on youth overweight and obesity;
the role of a healthful diet in obtaining and maintaining healthy
weight; the effects of food marketing on youth dietary habits; and a
description of CDC's resources to combat the childhood obesity
epidemic.
Youth Obesity Epidemic
To understand the extent of the youth obesity epidemic, we need to
grasp the trend in youth weight gain over the past few decades.
National Health and Nutrition Examination Survey (NHANES) data revealed
that between 1976 and 1980 the prevalence of overweight among youth
aged 2-5 years was 5 percent, for youth 6-11 years it was 6.5 percent,
and for youth aged 12-19 year it was 5 percent. The most recent data
available from NHANES (2003-2006) show the prevalence of overweight
among America's youth to be 12.4 percent for 2-5 year olds, 17 percent
for 6-11 year olds and 17.6 percent for 12-19 year olds. These data
point to an alarming rate of obesity among youth in all age groups. To
determine whether a child was overweight CDC determined their body mass
index (BMI), which is a number calculated from a child's weight and
height.
BMI is an accepted screening tool for the initial assessment of
body fatness for children, but it is not a diagnostic measure. It is
also an acceptable tool to determine overweight status of children and
youth at the population level. If a child's BMI was at or above the
95th percentile the child was classified as overweight or at risk for
obesity. Recently, however, an expert Committee on Assessment,
Prevention and Treatment, of Child and Adolescent overweight and
Obesity \1\ has recommended classifying children whose BMI is at or
above the 95th percentile for age and gender on the CDC growth charts
as obese. This is only a change in the terminology.
---------------------------------------------------------------------------
\1\ The committee was supported by the American Medical
Association, the Health Resources and Service Administration and the
Centers for Disease Control and Prevention, to figure out solutions for
the growing number of children who are severely overweight. It included
representatives from 15 medical societies such as the American Academy
of Pediatrics and the National Medical Association.
---------------------------------------------------------------------------
Obesity among youth has emotional, social and physical consequences
and is associated with early onset of chronic diseases such as
arthritis, asthma, type 2 diabetes, and heart disease. In fact, 61
percent of obese children aged 5-10 years old have one or more risk
factors for heart disease and 27 percent have two or more risk factors
for heart disease. (Freedman DS et al. Pediatrics 1999;103:1175-8.)
Further, high childhood BMI is associated with an increased
likelihood of adult obesity. Adult overweight and obesity increases the
risk of many diseases and chronic health conditions, including coronary
heart disease, stroke, type 2 diabetes, and some cancers. In 2001
dollars, obesity-associated annual hospital costs among youth were
estimated to have more than tripled from $35 million in 1979-1981 to
$127 million in 1997-1999. (Wang G and Dietz WH. Economic Burden of
Obesity in Youths Aged 6 to 17 years: 1979-1999. Pediatrics.
2002;109;e81.) In 2000, the total direct and indirect healthcare costs
(which include medical costs and days lost because of illness,
disability, or premature death) from obesity for all ages was estimated
to be $117 billion. (Wolf, AM, Manson JE, Colditz GA. The Economic
Impact of Overweight, Obesity and Weight Loss. In: Eckel R, ed.
Obesity: Mechanisms and Clinical Management. Lippincott, Williams and
Wilkins; 2002)
One of the national Healthy People 2010 objectives is to ``reduce
the proportion of children and adolescents who are overweight or
obese'' to the target of 5 percent. Not since 1980 has the prevalence
of overweight and obesity among youth been at or near this target.
Obesity is often the result of an improper balance between energy/
calories consumed (poor diet) and energy expended (physical
inactivity). The increasing rate of obesity among the Nation's youth
demonstrates the necessity of engaging in a comprehensive approach
focused on policy and environmental changes that help make the healthy
choice the easy choice when it comes to nutrition and physical
activity. Appropriate policy and environmental changes can be effective
in increasing the consumption of fruits and vegetables, increasing
physical activity, increasing the initiation and duration of
breastfeeding, reducing television viewing, reducing the consumption of
sugar sweetened beverages, and reducing calorie dense-nutrient poor
food intake.
Role of Healthy Diet
Healthy eating in childhood and adolescence is important for
overall healthy growth and development and can prevent health problems
such as obesity, dental caries, and iron deficiency anemia as well as
positively affect mental acuity and academic performance. The diets of
most young people, however, do not meet the recommendations set forth
in the Dietary Guidelines for Americans. Of U.S youth aged 12-18, only
39.1 percent meet the total grain recommendation and only 3.4 percent
meet the recommendations for whole grain intake. (USDA, Grain
Consumptions by Americans, Nutrition Insights 32, August 2005.)
According to CDC's National Youth Risk Behavior Survey, in 2007, only
21.4 percent of high school students reported eating five or more
servings of fruits and vegetables (when fried potatoes and potato chips
are excluded) per day during the past 7 days. Only 14.1 percent drank
three or more glasses per day of milk (Morbidity and Mortality Weekly
Report 2006; 57 SS04; 1-131.)
CDC Efforts to Address Food Marketing to Youth and Childhood Obesity
In 2004, CDC commissioned IOM to conduct a study on food marketing
to children. One of the conclusions of the study was that, ``public
policy programs and incentives do not currently have the support or
authority to address many of the current and emerging marketing
practices that influence the diets of children and youth.'' CDC is
exploring options to identify and assess the feasibility of
implementing policy and environmental change strategies aimed at both
reducing television viewing as well as positively influencing those
products that are marketed to youth. CDC is working closely with the
Academy for Educational Development (AED) to develop a research plan
around marketing to children. Based on recommendations from the IOM
committee members, the plan will focus on 8-12 year olds and on
vegetables, in particular, because consumption of vegetables is lower
than consumption of fruits.
In 2005, CDC created the National Center for Health Marketing in
response to communication innovations to revolutionize the way people
receive and use health information and interventions to make healthy
decisions. To increase the reach and impact of health information by
understanding when, where, and how people need it, CDC is exploring the
potential for conducting health literacy and content analysis research
on food marketing to youth on television and through other
communication channels including the Web, social networks, and new
media.
In 2007, CDC and partners launched Fruits & Veggies--More
MattersTM, a marketing and communication strategy designed
to influence healthy dietary choices to replace high calorie dense
foods. The National Fruit and Vegetable Alliance, CDC and Produce for
Better Health Foundation (PBH) are leading Fruits & Veggies--More
MattersTM, which is a health initiative that consumers will
see in stores, online, at home, and on packaging. It replaces the
existing 5 A Day awareness program and will leverage the 5 A Day
heritage and success to further inspire and support consumers to eat
more fruits and vegetables, showcasing the unrivaled combination of
great taste, nutrition, abundant variety, and various product forms
(fresh, frozen, canned, dried, and 100 percent juice). It also will
build upon the body of science that indicates increased daily
consumption of fruits and vegetables may help prevent many chronic
diseases.
CDC's School Health Policies and Program Study is a national survey
conducted to assess school health policies and practices at the State,
district, school, and classroom levels. The 2006 study showed that many
schools are taking a leadership role in marketing healthy food options
to their students. A majority of the schools in the study gave menus to
their students to promote the school nutrition services program (95.6
percent), placed posters or other materials promoting healthy eating
practices in the cafeteria area (82.7 percent), included articles about
the school nutrition services program in their school publications
(68.0 percent), and included nutrition services topics during school-
wide announcements (53.3 percent). However, one third of all school
districts allowed soft drink companies to advertise soft drinks in
school buildings (35.8 percent) and almost half of all school districts
allowed soft drink companies to advertise on school grounds, including
on the outside of school buildings and on playing fields (46.6
percent). Additionally, less than 25 percent of school districts
prohibit schools from advertising for candy, fast food restaurants, or
soft drinks on school property.
In addition to these efforts, CDC has a number of initiatives and
programs under way to address childhood obesity. They include programs
in education, surveillance of youth nutrition behaviors and obesity
rates, surveillance of school policies and programs, translation and
promotion of effective intervention strategies, and policy and Web-
based tools for healthy eating, physical activity, and obesity.
CDC's National Coordinated School Health Program to Improve Physical
Activity, Nutrition, and Prevent Tobacco Use Among Youth
CDC provides funding for 22 State education agencies (average
award: $411,000) and 1 tribal government ($275,000) to help school
districts and schools implement a Coordinated School Health Program
(CSHP), and, through this approach, increase effectiveness of policies,
programs, and practices to promote physical activity, nutrition, and
tobacco-use prevention among students.
A CSHP is a planned, organized set of health-related programs,
policies, and services coordinated to meet the health and safety needs
of K-12 students at both the school district and individual school
building levels. CSHP is comprised of multiple components that can
influence health and learning. These include physical education; health
education; health services; nutrition services; counseling and
psychological services; a healthy school environment; family/community
involvement; and health promotion for staff. Active coordination is
needed to engage school staff, implement district/school priority
actions; assess programs and policies; create a plan based on data and
sound science; establish goals; and evaluate efforts.
CDC's National Nutrition and Physical Activity Program to Prevent
Obesity
CDC is funding 23 States (average award $750,000) to improve
healthful eating and physical activity to prevent and control obesity
and other chronic diseases by building and sustaining statewide
capacity and implementing population-based strategies and
interventions. Funded State programs develop strategies to leverage
resources and coordinate statewide efforts with multiple partners to
address all of the following principal target areas: increase physical
activity; increase the consumption of fruits and vegetables; increase
breastfeeding initiation, duration and exclusivity; reduce the
consumption of high energy dense foods; decrease the consumption of
sugar sweetened beverages; and decrease television viewing.
From individual behavior change to changes in public policy, State
efforts aim to engage multiple levels of society including individual,
family and community settings. Each State funded by the Nutrition and
Physical Activity Program to Prevent Obesity and Other Chronic Diseases
uses the Social-Ecological Model to more fully understand the obesity
problem in that State. This model serves as a reminder to look at all
levels of influence that can be addressed to support long-term,
healthful lifestyle choices. State efforts include making policy and
environmental changes to encourage access to healthy foods and places
to be active, and strengthening obesity prevention and control programs
in preschools, child care centers, work sites, and other community
settings. All funded States will continue to evaluate their
interventions to determine their effectiveness and to guide future
efforts.
Supporting Communities through the Steps Program
The Steps Program is a critical part of CDC's national efforts to
address the urgent realities of chronic disease and obesity. Since
2003, Steps has supported local communities to implement evidence-based
interventions in community-based settings including schools,
workplaces, community organizations, health care settings, and
municipal [city/county] planning, to achieve local changes necessary to
prevent chronic diseases and their risk factors. Special focus has been
directed toward populations with disproportionate burden of disease and
lack of preventive services. In fiscal year 2008, CDC is supporting 21
communities through cooperative agreements with three States (average
award $1.580 million), five local urban health departments (average
award $1.256 million), and two tribal organizations (average award
$747,000). In addition, CDC is supporting 14 communities through new
cooperative agreements with two States, two local urban health
departments, and two tribal organizations and 40 additional communities
through new cooperative agreements with national organizations.
As part of the new grant strategy, CDC will support 50 Steps
Community Grants in fiscal year 2009. Communities will receive funds to
spark local-level action, change community conditions to reduce risk
factors, establish and sustain state-of-the-art programs, test new
models of intervention, create models for replication, and help train
and mentor additional communities. Tools, resources, and training will
be provided to community leaders and public health professionals to
equip these entities to effectively confront the urgent realities of
the growing national crisis in obesity and other chronic diseases in
their communities.
CDC Surveillance Programs
CDC monitors the Nation's health through surveillance programs in
order to accomplish its mission to promote health and quality of life
by preventing and controlling disease, injury, and disability.
Through its ongoing National Health and Nutrition Examination
Survey, CDC produces nationally representative surveillance data on the
prevalence of overweight and obesity among children and adolescents
based on measured height and weight, as well as on their physical
activity and dietary behaviors. (Additional information available at
www.cdc.gov/nchs/nhanes.htm.)
In addition, CDC's biennial Youth Risk Behavior Survey provides
national, State, and city data on self-reported height and weight,
physical activity, physical education, and dietary behaviors among high
school students. (Additional information available at http://
www.cdc.gov/HealthyYouth/yrbs/)
CDC's School Health Policies and Program Study (SHPPS) is a
national survey periodically conducted to assess school health policies
and programs of State education agencies and of nationally
representative samples of school districts, schools, and physical
education and health education classrooms. SHPPS provides national data
on what schools are doing in relation to physical education, after
school physical activity programs, recess, nutrition education, school
food service, and vending machine policies and practices. (Additional
information available at http://www.cdc.gov/HealthyYouth/shpps/)
CDC's School Health Profiles survey, conducted every other year,
tells us about the extent to which schools are implementing physical
education, physical activity, and nutrition-related policies and
practices in different States and cities. (Additional information
available at http://www.cdc.gov/HealthyYouth/profiles/)
CDC's Pediatric Nutrition Surveillance System (PedNSS) is a child-
based public health surveillance system that describes the nutritional
status of low-income U.S. children who attend federally-funded maternal
and child health and nutrition programs. PedNSS provides data on the
prevalence and trends of nutrition-related indicators. (http://
www.cdc.gov/pednss/index.htm)
Tools to Help Schools and Community-based Organizations Promote Healthy
Eating
CDC has developed, and is continuing to develop, a variety of tools
that schools and community based organizations can use to implement
policies and practices. Examples include:
--The Guide to Community Preventative Services: Review of
Interventions that Support Healthy Weight, which is a
systematic review of the effectiveness of selected population-
based interventions aimed at supporting healthful weight among
children, adolescents, and adults; http://
www.thecommunityguide.org/obese/.
--Guidelines for School and Community Programs to Promote Lifelong
Healthy Eating Among Young People that identify the most
effective policies and practices schools can implement to help
young people adopt and maintain healthy eating habits; http://
www.cdc.gov/mmwr/preview/mmwrhtml/00042446.htm.
--CDC's School Health Index for Physical Activity and Healthy Eating,
a widely used self-assessment and planning tool, enables
schools to identify the strengths and weaknesses of their
health promotion policies and programs, develop an action plan
for improving student health, and involve teachers, parents,
students, and the community in improving school policies and
programs; http://apps.nccd.cdc.gov/shi/default.aspx.
--Fit Healthy and Ready to Learn, a school health policy guide,
developed by the National Association of State Boards of
Education with CDC support, that provides education
policymakers and administrators with sample physical activity
and nutrition policies and information to support the policies;
--Making It Happen--School Nutrition Success Stories (MIH), a joint
product of CDC and USDA, tells the stories of 32 schools and
school districts that have implemented innovative strategies to
improve the nutritional quality of foods and beverages offered
and sold on school campuses. The most consistent theme emerging
from these case studies is that students will buy and consume
healthful foods and beverages--and schools can make money from
healthful options; http://www.cdc.gov/healthyyouth/nutrition/
Making-It-Happen/about.htm.
--The Health Education Curriculum Analysis Tool which is a user-
friendly checklist designed by CDC to help schools select or
develop curricula based on the extent to which they have
characteristics that research has identified as being critical
for leading to positive effects on youth health behaviors. The
companion Healthy Eating Curriculum Analysis Tool will help
school districts promote healthy eating, sound nutrition, and
healthy dietary practices based on insights gained from
research and best practice, and; http://www.cdc.gov/
HealthyYouth/HECAT/index.htm.
--The CDC Program Technical Assistance Manual, was created to serve
CDC's State and community partners as they develop, implement,
and evaluate an array of nutrition and physical activity
initiatives that aim to prevent and control obesity and other
chronic diseases.
--We Can! (Ways to Enhance Children's Activity & Nutrition), a
national NIH-supported public education program for reaching
parents and caregivers of children ages 8-13 in home and
community settings--provides educational materials and
activities to encourage healthy eating, increase physical
activity, and reduce ``screen-time'' among youth. NIH and CDC
are working together to promote We Can! and CDC's school health
tools (e.g., the School Health Index) and resources to
partners; nongovernmental organizations; State departments of
education and departments of health; schools; and community
sites.
I have briefly described the efforts of CDC in this area; we are
but one of many programs within the Department of Health and Human
Services focusing on this epidemic. For example, CDC is an active
member in ``Healthy Youth for a Healthy Future,'' the Secretary's
Childhood Overweight and Obesity Prevention Initiative that is
spearheaded by the Acting Surgeon General, Rear Admiral Steven Galson.
Uniting programs from across the Department, the Childhood Overweight
and Obesity Prevention Council has implemented an action plan that
leverages and enhances programs that prevent childhood overweight and
obesity. The Council synergizes Department-wide prevention efforts,
including community interventions and evaluation, outreach and
services, and education and research. The Council's efforts have
broadened the reach of individual agency campaigns.
CDC also supports the Surgeon General's Outreach Tour under the
``Healthy Youth for a Healthy Future'' campaign which is traveling from
State to State, meeting with communities to recognize and bring
attention to effective prevention programs that motivate organizations
and families to work together on this issue. The tour focuses on three
themes: Help Children Stay Active, Encourage Health Eating Habits, and
Promote Healthy Choices. During the visits, the focus is not only about
the importance of childhood overweight and obesity prevention, but also
on model healthy behaviors for children of all ages realizing these are
significant teaching moments that will help them develop healthy habits
to last a lifetime.
Conclusion
No single cause or factor is to blame for the epidemic of obesity
among children and adolescents. Indeed, many factors have contributed
to the unfavorable trends in physical activity and nutrition that have
fueled the obesity epidemic.
We have learned a great deal about effective strategies for
promoting physical activity and healthy eating among young people. We
know that no one strategy alone will be sufficient to slow or reduce
the obesity epidemic. Our chances for success will be greater if we use
multiple strategies to address multiple factors that contribute to the
imbalance between calorie consumption and physical activity and if we
involve multiple sectors of society at the community, State, and
national levels.
CDC is committed to doing all that we can to help our young people
enjoy good health now and for a lifetime. I thank you for your interest
and the opportunity to share information about the childhood obesity
epidemic, the importance of good nutrition in combating the epidemic
and an overview of CDC's activities. I would be happy to answer your
questions.
Senator Harkin. Thank you very much, Dr. Gerberding, and I
look forward to working with you and the CDCP in the next
couple of years as we do this healthcare reform, and to make
sure that this is up front, a big part, an important part of
this healthcare reform that we're talking about.
Now we'll turn to Mr. Martin, the head of the--Chairman of
the Federal Communications Commission, the FCC, before we go to
the FTC.
Mr. Martin.
STATEMENT OF HON. KEVIN J. MARTIN, CHAIRMAN, FEDERAL
COMMUNICATIONS COMMISSION
Mr. Martin. Thank you. Good morning, Chairman Durbin,
Chairman Harkin, and Senator Brownback. I appreciate the
opportunity to speak to you today about this important issue
that is facing American families, the impact of media on the
rising rate of childhood obesity.
In recent years, the rate of childhood obesity has gone in
only one direction, and that is up. And, understandably, the
concerns of parents, medical experts, and public officials has
risen, as well.
Last September, the Institute of Medicine found that one-
third of American children are either obese or at risk for
obesity. And this is consistent with the Centers for Disease
Control's findings that, since 1980, the number of overweight
children ages 6 to 11 has doubled, and the number of overweight
adolescents has tripled. Childhood obesity has gone from a
national problem to a point of crisis.
Parents, of course, are the first line of defense, but we,
in the government and in the industry, must make sure that they
have the tools that they need to ensure their children's
welfare. As a parent, I already know the enormous influence
that media has on our children. Its impact really can't be
overstated.
According to Nielsen Media Research for the 2004-2005
season, an average American household has the television turned
on more than 8 hours a day, with children watching between 2
and 4 hours every day. And recent studies have found that even
the youngest children are exposed to a lot of television.
Almost one-half--43 percent--of children under the age of two
watch TV every day. According to Kaiser Family Foundation, by
the time a child enters the first grade, they will have spent
the equivalent of 3 school years in front of the television.
In the Children's Television Act, Congress recognized the
unique role television and the media can have on children.
Specifically, Congress noted that by the time the average child
is 18, he or she will have spent between 10,000 and 15,000
hours watching television and will have been exposed to more
than 200,000 commercials. Congress also noted that it is well
established by scientific research that children are uniquely
susceptible to the persuasive messages contained in television
advertising.
Given the enormous impact of the media--specifically,
television--on children, the Commission, along with Senator
Harkin and Senator Brownback, convened the Joint Task Force on
Media and Childhood Obesity. The task force sought to bring
together government officials, media companies, advertisers,
and the food and beverage industry to work on behalf of
America's children. I appreciate the leadership of Senators
Brownback and Harkin and all my colleagues on the Commission.
And I particularly want to recognize the hard work and many
hours volunteered by Gary Knell, of Sesame Workshop, who led
the task force efforts.
While the task force succeeded in producing some
significant voluntary commitments, ultimately it did not reach
an agreement on two key issues: one, a uniform standard for
what constitutes healthy versus unhealthy foods; and, two, the
willingness of most media companies to place any limit on the
advertising of unhealthy foods on children's programming.
Several good companies did make significant voluntary
commitments. For example, 15 of the largest food companies and
manufacturers--beverage manufacturers, including Kraft and
Kellogg--agreed to curtail advertising of ``unhealthy food'' to
children under age 12. As described in more detail by some of
the other witnesses, although the food and beverage industry
have made some significant steps in the right direction, there
is no uniform agreement among the companies as to the
definition of what constitutes ``healthy foods.''
On the media side, Disney and Ion have made the most
aggressive commitments. The Disney Company's Healthy Kids
Initiative set a new standard for the food served in the Disney
parks, they disallowed the licensing of Disney characters to
foods that do not meet strict nutritional standards, and they
disallowed the promotion of foods on the Disney Channel that do
not meet these same standards.
Ion media's Qubo was referred to as the ``gold standard''
by the children's advocates, for their leadership. Ion has
committed to licensing their characters for use with healthy
foods, and they agreed to no longer accept advertising for any
unhealthy foods targeted at children.
Unfortunately, not all of the participants in the Obesity
Task Force were as forthcoming in their effort to protect
American children. I was particularly disappointed at the media
companies who made no solid commitments in this area. For
example, some companies only agreed to limit character usage
while leaving a major loophole for special occasions. That
leads one to wonder, ``What is a special occasion?'' May a
character that endorses candy or cakes for birthdays,
President's Day, Valentine's Day, St. Patrick's Day, Easter,
Halloween, Thanksgiving, Christmas, and Hanukkah all be
exempted from their voluntary commitment?
Even more troubling was the majority of media companies'
refusal to agree to any kind of limit on advertising toward our
children. Patty Miller summarizes the majority of media
companies as being, quote, ``absent from any attempt to solve
this problem, and refusing to play a role in protecting
children from the advertising of unhealthy food.''
As a result, all of the public-health and child-advocacy
groups have asked Congress to adopt legislation mandating that
at least 50 percent of all food advertising to children on
broadcast and cable television be devoted to healthy food
products.
In the past, Congress has anticipated that children would
be particularly susceptible to advertising, and put certain
protections in place. Indeed, in the Children's Television Act,
Congress enacted specific limits on the amount of advertising
that could be shown during children's programming. The
Children's Television Act requires that commercial TV
broadcasters and cable operators limit the amount of
commercials in children's programming to no more than 10\1/2\
minutes per hour on weekends and 12 minutes per hour on
weekdays.
Finally, the lack of action by the media industry creates a
disincentive for those companies that have volunteered for such
limits, like Ion and Kraft. Without a broader commitment from
our media companies, these companies are actually put at a
competitive disadvantage.
While it was, and always is, my hope that we will not have
to resort to actual requirements--and I strongly encouraged the
media companies involved in the task force to propose some
voluntary limits on advertising targeted at our children--in
the end, no widespread voluntary commitment on behalf of the
media industry was forthcoming. On the voluntary side, I am
left to conclude that, sadly, no limit was even close to being
presented.
In reference to Senator Brownback's comments about wanting
to ask what the solution should be, I would highlight that I
think that there's one key ingredient: any remedy must be
targeted to both broadcast and cable outlets on the media side.
According to a recent Kaiser Family Foundation study, the three
ad-supported children's cable networks have 32 percent of their
advertising time dedicated towards advertising for food,
compared to only 13 percent of broadcast networks, and they
have twice as many ads--8.8 versus 4.8 ads--again, targeted for
foods per hour. So, I think that leaves us with the absolute
conclusion that any kind of a solution must be comprehensive as
you look forward to what the Congress should now be addressing.
PREPARED STATEMENT
Again, I want to thank you all for your leadership on these
efforts and your support for the Commission and its attempt on
the Childhood Obesity Task Force, and I look forward to working
with you all as you go forward to try to improve the health of
our children.
[The statement follows:]
Prepared Statement of Hon. Kevin J. Martin
Good morning, Chairman Durbin, Chairman Harkin, Ranking Member
Brownback, Ranking Member Specter, and Members of the Committee.
I appreciate the opportunity to speak to you today about an
important issue facing American families; the impact of the media on
the rising rate of childhood obesity.
I particularly want to thank Senator Harkin and Senator Brownback
for their leadership, support and dedication to these issues.
In recent years the rate of childhood obesity has gone in only one
direction--up. Understandably, the concern of parents, medical experts
and public officials has risen as well.
Last September, the Institute of Medicine found that one-third of
American children are either obese or at risk for obesity. This is
consistent with the Center for Disease Control's finding that since
1980 the number of overweight children ages 6-11 has doubled and the
number of overweight adolescents has tripled. To quote the American
Academy of Pediatrics, the trends of children becoming overweight and
inactive ``pose an unprecedented burden in terms of children's health
as well as present and future health care costs.'' Childhood Obesity
has gone from a national problem to a point of crisis.
Parents of course are the first line of defense. But we in
government and in industry must make sure they have the tools they need
to ensure their children's welfare.
A study in the Journal of the American Dietetic Association
recently outlined two important ways to reduce childhood obesity. The
first is that parents should become more aware of children's
nutritional needs. And the second, which goes to the heart of this
hearing today, is that parents should reduce the amount of time their
children spend watching television.
As a parent, I already know the enormous influence the media has on
our children. Its impact can't really be overstated. According to
Nielsen Media Research (for the 2004-2005 season), an average American
Household has the television turned on more than 8 hours a day, with
children watching between 2 and 4 hours every day.
And recent studies have found that even the youngest children are
exposed to a lot of television. Almost one-half (43 percent) of
children under the age of two watch TV every day. One-quarter (26
percent) of these youngest children even have a television in their
bedroom.
According to the Kaiser Family Foundation, by the time children
enter the first grade, they will have spent the equivalent of three
school years in front of the TV.
In the Children's Television Act, Congress recognized the unique
role television and the media can have on children. Specifically,
Congress noted that, by the time the average child is 18 years old, he
or she has spent between 10,000 to 15,000 hours watching television and
has been exposed to more than 200,000 commercials. Congress also noted
that it is well established by scientific research that children are
uniquely susceptible to the persuasive messages contained in television
advertising. Indeed, the Kaiser Family Foundation found that children
under 6 cannot distinguish between programming content and advertising.
In addition, these kids cannot distinguish between marketing messages
and their favorite show, especially when the ad campaigns feature
favorite TV characters like Sponge Bob. And a report by the Institute
of Medicine concluded that there is strong evidence that television
advertising influences short-term food consumption patterns in children
between the ages of 2 and 11.
Given the enormous impact of the media--specifically television on
children, the FCC along with Senators Harkin and Brownback convened the
Joint Task Force on Media and Childhood Obesity (the ``Task Force'').
The ``Task Force'' sought to bring together government officials, media
companies, advertisers and the food and beverage industry to work on
behalf of America's children.
I appreciate the leadership of Senators Brownback and Harkin and my
colleagues on the Commission, Commissioners Tate and Copps. I also want
to thank all of the Task Force participants for dedicating their time,
energy and efforts. In particular I want to recognize the hard work and
many hours volunteered by Gary Knell of Sesame Workshop who led the
Task Force's efforts.
We cannot hope to truly address this problem without the
participation of all those involved, the media, advertisers and the
food and beverage industry. Indeed, this task force was founded on the
notion that we all have a responsibility to promote and protect our
children's welfare.
While the Task Force succeeded in producing some significant
voluntary commitments aimed at reducing the negative impact of the
media on children's eating habits and increasing its positive influence
on their behavior, ultimately it did not reach an agreement on two key
issues: (1) a uniform standard of what constitutes healthy versus
unhealthy foods; and (2) the willingness of most media companies to
place any limit on the advertising of unhealthy foods on children's
programs.
Several food companies made significant voluntary commitments. For
example, fifteen of the Nation's largest food and beverage
manufacturers including Kraft Foods and Kellogg agreed to curtail
advertising of ``unhealthy food'' to children under age twelve and
others are reformulating current products. As described in more detail
by some other witnesses, although the food and beverage industry have
made some significant steps in the right direction there is no uniform
agreement among the companies as to the definition of ``healthy
foods.''
On the media side, Disney and Ion have made the most aggressive
commitments. The Disney company's Healthy Kids Initiative set new
standards for the food served in Disney's parks, disallowed the
licensing of Disney characters to foods that did not meet strict
nutritional standards and disallowed the promotion of foods on the
Disney Channel that do not meet those same standards.
Ion media's Qubo was referred to as the ``gold standard'' by
children's advocates for their leadership. Ion has committed to only
licensing their characters for use with healthy foods and they agreed
to no longer accept advertising for unhealthy food targeted at
children.
Several companies took significant steps to limit the licensing of
their characters for use to promote unhealthy foods. Companies like
Discovery Kids, Cartoon Network and Sesame Workshop announced
commitments to license characters only to promote food and beverages
that meet specific nutritional standards.
Other media companies agreed to telecast public service
announcements promoting healthy lifestyles. I applaud these
developments.
Unfortunately, not all participants in the Obesity Task Force were
as forthcoming in their efforts to protect American children. I am
particularly disappointed in those media companies who made no solid
commitments in these areas.
For example, some companies only agreed to limit character usage
while leaving a major loop hole for ``special occasions.'' That leads
one to wonder what is a special occasion? May a character then endorse
candy or cakes for birthdays, President's Day, Valentine's Day, Saint
Patrick's Day, Easter, Halloween, Thanksgiving, Christmas, and
Chanukah?
Even more troubling was the majority of media companies refused to
agree to any kind of limit on advertising targeted toward our children.
Patti Miller summarizes the majority of media companies as being
``absent from any attempt to solve this problem'' and ``refusing to
play a role in protecting children from the advertising of unhealthy
food. As a result, all of the public health and child advocacy groups
have asked Congress to adopt legislation mandating that at least 50
percent of all food advertising to children on broadcast and cable
television programming be devoted to healthy food products.
In the past, Congress has anticipated that children would be
particularly susceptible to advertising and thus put certain
protections in place. Indeed, in the Children's Television Act,
Congress enacted specific limits on the amount of advertising that
could be shown during children's programming. The Children's Television
Act requires that commercial TV broadcasters and cable operators limit
the amount of commercials in children's programs to no more than 10
minutes per hour on weekends and 12 minutes per hour on weekdays.
In the United Kingdom, Ofcom has gone a step further than we have
here in the United States. They recently implemented rules targeted at
reducing the impact of advertising of high fat, salt and sugar (HFSS)
food and beverages to children by banning such ads on children's
television channels. In recent weeks, there has been some question as
to whether children are still being exposed to these ads under the
existing restrictions. Ofcom is reviewing the rules and will be
releasing a report on how they might improve regulations to better
accomplish their goals of reducing unhealthy advertising towards
children.
Finally, the lack of action creates a disincentive for those
companies that have volunteered to such limits, like Ion and Kraft.
Without a broader commitment from our media companies, these companies
are actually put at a competitive disadvantage.
Conclusion
A study published in the Official Journal of the American Academy
of Pediatrics last year found that the overwhelming majority of food
product advertisements seen on television were of poor nutritional
content. The article stated that ``these findings will provide a
benchmark against which future research can evaluate the commitments by
food companies to change the nature of food advertising directed at
America's children.'' As a result we will be able to measure our
progress.
While it was--and always is--my hope that we will not have to
resort to actual requirements, and I strongly encouraged the media
companies to propose some voluntary limitations on advertising
targeting our children, in the end no widespread voluntary commitment
on behalf of the media industry was forthcoming. On the voluntary side,
I am left to conclude that, sadly, no limit was even close to being
presented.
Thank you again for your leadership on this issue. I look forward
to working with you to improve the health of our children.
Senator Harkin. Thank you very much, Mr. Martin, for a very
profound statement. I've got some things that I'll come back to
questioning you on some--very good. Really appreciate it very,
very much.
And now we turn to Mr. Leibowitz--Jon D. Leibowitz,
Commissioner, Federal Trade Commission.
Mr. Leibowitz.
STATEMENT OF HON. JON D. LEIBOWITZ, COMMISSIONER,
FEDERAL TRADE COMMISSION
Mr. Leibowitz. Thank you, Chairman Harkin, Chairman Durbin,
Ranking Member Brownback. I am pleased to be here to testify
today about childhood obesity and food marketing to children.
As you know, at your request we issued this comprehensive
report in July. It is called, ``Marketing Food to Children and
Adolescents: A Review of Industry Expenditures, Activities, and
Self-Regulation.'' It examines food marketing expenditures,
reviews new self-regulatory initiatives, and recommends
additional steps.
Simply put, whether or not food and beverage marketers are
part of the problem--and in my view, we all share some
responsibility--they have to be part of the solution. As you
pointed out, Senator Harkin, industry can play an instrumental
role in influencing children's food choices and helping to curb
the obesity epidemic.
To obtain data for our FTC report, we sent subpoenas to 44
major food, beverage, and fast-food companies. And, as you can
see from the charts that are going up, and from the chart that
Senator Brownback put up earlier, in 2006 these companies spent
approximately $1.6 billion to advertise to children and
adolescents, or almost $2 billion if we include the cost of
toys provided with fast-food children's meals.
Let me go to the second chart.
Our report details what foods were advertised and how they
were promoted in 2006, just as industry self-regulatory
initiatives were starting up, so it is going to serve as a
benchmark to measure future progress.
Perhaps most striking is the fully integrated, cross-
platform nature of the campaigns directed to children and
teens, and the cross-promotional marketing that links food,
drinks, and restaurants with popular entertainment.
Television advertising still dominates landscape, but it is
not like what you see in, say, Mad Men. Modern ad campaigns
carry over to product packaging, displays in supermarkets and
restaurants, Internet sites with online advergames, contests,
and e-cards to send to friends. New digital media is becoming a
major and a very efficient marketing tool.
Our report also assesses industry self-regulatory efforts.
In 2006, after we held the workshop with HHS, the Better
Business Bureau created the Children's Food and Beverage
Advertising Initiative. To date, 15 major food and beverage
companies, including one today, have joined and pledged to
restrict their child-directed TV, print, and Internet
advertising to healthy dietary choices, or to simply stop
advertising to children under 12.
In addition, the Alliance for a Healthier Generation
secured marketers agreements to stop selling high-calorie foods
and drinks in schools--and it sounds like you're making some
progress with nutritional lunches in schools in Illinois,
Senator Durbin.
Our report concludes with a list of recommendations. For
example, all food marketers should adopt meaningful, nutrition-
based standards for promoting their products to children under
12. Those standards should apply to all child-directed
marketing, not only to broadcast, print, and Internet
advertising, but also to product packaging and other
promotions. And media companies should develop their own
programs to impose nutritional standards for both the licensing
of characters--and, as Chairman Martin pointed out, they are
starting to do this--and the advertising placed on children's
programming.
PREPARED STATEMENT
Mr. Chairman, your hearing comes at a propitious moment in
the debate over self-regulation and how far it can take us. We
are encouraged that some industry members are stepping up to
the plate. Still, these promising first efforts need to be
expanded and replicated. To that end, we are committed to
monitoring industry progress and to issuing a followup report,
and we'll use our subpoena power to do that.
Hopefully, by working together, we can go a long way toward
ensuring the healthier future for our young people that all of
us want to see.
Thank you, and I'd be happy to answer questions.
[The statement follows:]
Prepared Statement of Jon D. Leibowitz
introduction
Chairman Durbin, Chairman Harkin, Ranking Member Brownback, Ranking
Member Specter, and Members of the Subcommittees, I am Jon Leibowitz,
Commissioner of the Federal Trade Commission (``FTC'' or
``Commission'').\1\ The Commission is pleased to have this opportunity
to provide testimony on our efforts to address childhood obesity.
Today, I would like to provide some context to the Commission's
efforts, describe the agency's various initiatives to advocate for
responsible marketing and enhanced self-regulation, and then turn more
specifically to a discussion of the Commission's July 2008 Report to
Congress: ``Marketing Food to Children and Adolescents: A Review of
Industry Expenditures, Activities, and Self- Regulation.'' \2\ The full
text of the Report has been submitted to the subcommittees for the
record.
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\1\ The written statement presents the views of the Federal Trade
Commission. My oral testimony and responses to questions reflect my
views, and do not necessarily reflect the views of the Commission or
any other Commissioner.
\2\ Federal Trade Commission, Marketing Food to Children and
Adolescents: A Review of Industry Expenditures, Activities, and Self-
Regulation (2008) (2008 Report), available at http://www.ftc.gov/os/
2008/07/P064504foodmktingreport.pdf. See also Concurring Statement of
Commissioner Jon Leibowitz, available at http://www.ftc.gov/speeches/
leibowitz/080729foodmarketingtochildren.pdf.
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The Commission believes that this Report will provide an important
benchmark for measuring the future progress of self-regulatory
initiatives. In addition to describing the state of food marketing to
children and adolescents in 2006 and analyzing industry initiatives to
date, the Report also sets forth a number of recommendations. For
example, the Commission recommends that all companies engaged in
marketing food to children limit such marketing to products that meet
meaningful, nutrition-based standards and that such standards apply to
all forms of advertising and promotion. A good first step would be for
all such companies to join the self-regulatory initiative established
by the Council of Better Business Bureaus.\3\ In addition, the
Commission recommends that the media and entertainment companies
develop their own self-regulatory program to impose meaningful
nutrition standards for both the licensing of characters and the
advertising placed on programming directed to children. After allowing
a reasonable time for response to these recommendations, the Commission
will issue a follow-up report assessing the extent to which the
recommendations have been implemented and identifying what, if any,
additional measures may be warranted.
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\3\ See pp. 6-7, infra.
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ftc's authority and history on food marketing to children
The Federal Trade Commission is the Nation's consumer protection
agency and has a broad mandate under Section 5 of the Federal Trade
Commission Act to stop deceptive or unfair acts and practices in
commerce.\4\ The Commission fulfills this mandate primarily through law
enforcement, but also engages in rulemaking, research, policy
development, consumer and business education, and promotion of industry
self-regulatory initiatives. Issues that relate to health and well-
being have always been a priority of our consumer protection mission,
and in recent years, the Commission has devoted substantial resources
to addressing childhood overweight and obesity.
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\4\ 15 U.S.C. Sec. 45(a).
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The prevalence and seriousness of this public health problem have
been well documented by the Centers for Disease Control and Prevention
(CDC).\5\ The causes of the problem are complex, and there is ongoing
vigorous debate over the social and economic factors that may
contribute to the problem. Poor city planning that makes it difficult
for children to walk or bike ride, cuts in school physical education
classes, increased television viewing, computer use, and video gaming,
fewer hours of sleep, and more frequent restaurant meals have all been
cited as factors. Much of the public attention has naturally focused on
what and how much children consume and what types of foods and
beverages they are encouraged to eat and drink by marketers.
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\5\ According to the CDC, the prevalence of overweight youth has
increased about three-fold over the last 25 or 30 years, with 19
percent of children ages 6 to 11 and 17 percent of teenagers 12 to 19
now overweight or obese. The long-term health consequences for these
children are serious and include increased risk of cardiovascular
disease and increased prevalence of type 2 diabetes. Centers for
Disease Control and Prevention, Obesity and Overweight: Childhood
Overweight, available at http://www.cdc.gov/nccdphp/dnpa/obesity/
childhood/index.htm.
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The Commission has concluded that, at this point, the most
effective means of addressing childhood obesity, and particularly the
food marketing issue, is through industry initiatives that include
vigorous self-regulation.\6\ Under the right circumstances, industry-
generated solutions have the potential to address a public health
problem of this magnitude quickly, creatively, and flexibly.
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\6\ In 1978, the Commission embarked on a rulemaking effort to
address concerns about marketing of sugary foods to children. In 1980,
Congress enacted restrictions that prohibited the Commission from
adopting any rule regarding children's advertising that relies on a
legal basis that the advertising is unfair under the FTC Act. FTC
Improvements Act of 1980, Public Law No. 96-252, Sections 11(a)(1),
11(a)(3), 94 Stat. 374 (1980) (current version codified at 15 U.S.C.
Sec. 57a(h)). For this and other reasons, the Commission ultimately
terminated the rulemaking proceeding. 46 Fed. Reg. 48,710 (Oct. 2,
1981). An effort by government to ban or restrict food marketing could
also face significant constitutional constraints. Any government
regulation of truthful commercial speech must pass three tests: (1)
there must be a substantial government interest to be achieved by
restricting the speech; (2) the regulation must directly advance that
interest; and (3) the restriction must be narrowly tailored. Cent.
Hudson Gas & Elec. Corp. v. Pub. Serv. Comm'n, 447 U.S. 557, 564
(1980).
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For these reasons, the Commission has focused its efforts in recent
years on encouraging, guiding, and pushing the private sector in the
right direction. We have explored how the food industry can contribute
to reversing obesity trends through product and packaging innovations
and responsible marketing practices that emphasize healthier food
choices for children. The Commission has also looked at ways that the
media and entertainment industries can use their considerable creative
know-how and strong appeal to children to encourage healthier diets and
lifestyles. The FTC has kept a close watch on industry progress and has
been candid in its assessments. We are encouraged by what we have seen
so far, but we are also recommending that industry take additional
steps.
the 2005 workshop on marketing, self-regulation, and childhood obesity
The Commission's push for industry solutions to childhood obesity
began in July 2005, when the FTC and the Department of Health and Human
Services (HHS) jointly convened a 2-day Workshop on Marketing, Self-
Regulation, and Childhood Obesity.\7\ This event brought together some
of the largest food manufacturers and entertainment companies, as well
as government officials, health experts, and consumer advocates. The
purpose of the workshop was neither to determine the causes of
childhood obesity nor to assess blame; rather, the goal was to focus
attention on positive initiatives that industry members and others
could take to encourage healthier eating and living by the Nation's
young people.
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\7\ Marketing, Self-Regulation, and Childhood Obesity: A Joint
Workshop of the Federal Trade Commission and the Department of Health
and Human Services (July 14-15, 2005). Agenda and transcript of
proceedings available at http://www.ftc.gov/bcp/workshops/
foodmarketingtokids/index.htm.
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The workshop yielded a number of important findings, which are
detailed in an April 2006 joint report of the FTC and HHS.\8\ The
report identified several steps that food and beverage companies were
already taking to respond to childhood obesity, including the
introduction of new, lower-calorie products and smaller-portion
packages; use of icons and seals to provide simple nutrition
information; and an increase in use of popular characters to deliver
nutrition and health messages to children.\9\ In addition, two
companies \10\ had committed to shift their children's advertising to
products meeting certain nutrition standards.
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\8\ Federal Trade Commission & Department of Health and Human
Services, Perspectives on Marketing, Self-Regulation, & Childhood
Obesity (2006) (2006 Report), available at http://www.ftc.gov/os/2006/
05/PerspectivesOnMarketingSelf-
Regulation&ChildhoodObesityFTCandHHSReportonJointWorkshop.pdf.
\9\ See id. at 11-23.
\10\ Kraft Foods, Inc. and PepsiCo, Inc.
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The 2006 Report included a series of specific recommendations for
the food and media industries. The FTC and HHS called on industry to
implement self-regulatory initiatives to change the way food is
marketed to children. The agencies also encouraged food marketers to:
create more nutritious food choices for children through product
innovation and reformulation; expand product packaging efforts to
control portion size and calories; explore labeling initiatives to help
consumers identify lower-calorie, more nutritious foods; improve the
nutritional profile of foods marketed to children; educate consumers
about nutrition and fitness; and improve the nutritional quality of
foods and beverages sold in schools outside of the meal program. In
addition, the 2006 Report recommended that media and entertainment
companies incorporate nutrition and fitness messages into programming
and revise their practices with respect to licensing popular children's
characters for use in food marketing.\11\
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\11\ See 2006 Report at 48-54.
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the 2007 forum and current assessment of industry efforts
In July 2007, the FTC and HHS conducted a follow-up forum to review
progress in the implementation of these self-regulatory and educational
initiatives.\12\ The agencies were encouraged to learn that the 2005
Workshop and 2006 Report had provided a stimulus for many individual
company efforts as well as broad industry programs. One notable program
is the Children's Food and Beverage Advertising Initiative, established
by the Council of Better Business Bureaus (CBBB) and the CBBB's
National Advertising Review Council.\13\ To date, 14 of the largest
food and beverage companies--estimated to represent more than two-
thirds of children's food and beverage television advertising
expenditures \14\--have joined the Initiative, making pledges that,
when fully implemented, will significantly improve the landscape of
food marketing to children. Most of these companies have committed
either not to direct television, radio, print, and Internet advertising
to children under 12 or to limit such advertising to foods that qualify
as ``healthy dietary choices'' by meeting specified nutritional
standards, such as limitations on calories, fat, sugar, and sodium and/
or providing certain nutritional benefits to children. In addition, the
companies have pledged to limit the use of licensed characters to
promote ``healthy dietary choices'' or healthy lifestyles, not to seek
product placements in child-directed media, not to advertise food or
beverages in elementary schools, and to use only their ``healthy
dietary choices'' in interactive games directed to children.
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\12\ FTC/HHS Forum on Marketing, Self-Regulation, and Childhood
Obesity (July 18, 2007). Agenda and transcript of proceedings available
at http://www.ftc.gov/bcp/workshops/childobesity/index.shtml.
\13\ See About the Initiative, available at www.us.bbb.org/
advertisers4healthykids.
\14\ That estimate was made with reference to the initial ten
program members. Four additional major companies subsequently
subscribed to the Initiative. See Press Release, Council of Better
Business Bureaus, New Food, Beverage Initiative to Focus Kids' Ads on
Healthy Choices; Revised Guidelines Strengthen CARU's Guidance to Food
Advertisers (Nov. 14, 2006), available at www.us.bbb.org/
advertisers4healthykids (More Information, item 7).
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The forum also highlighted another industry program directed
specifically at the sale of foods and beverages in schools. Created in
2006 under the auspices of the Alliance for a Healthier Generation, the
program brings together several food and beverage companies who have
committed to limit the sale of ``competitive foods''--those sold
outside of the school meal program--to lower-calorie, more nutritious
products.\15\ Although not yet fully implemented, the program has
already begun to have a significant impact, resulting in a 58 percent
decrease in total calories for beverages shipped to schools between
2004 and the 2007-08 school year.\16\
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\15\ See Competitive Foods Guidelines for K-12 Schools and Alliance
School Beverage Guidelines, Alliance for a Healthier Generation,
available at www.healthiergeneration.org. The Alliance is a partnership
of the American Heart Association and the William J. Clinton
Foundation.
\16\ See American Beverage Association, School Beverage Guidelines
Progress Report 2007-2008 (Sept. 2008), available at http://
www.schoolbeverages.com/download.aspx?id=111.
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the 2008 food marketing study and report
The Commission's 2008 Report assesses the industry's self-
regulatory initiatives undertaken since our last report and identifies
areas where we believe more needs to be done. In addition, this Report
provides the results of the agency's comprehensive study of food and
beverage industry marketing expenditures and activities directed to
children and adolescents.
Until now, research on food and beverage marketing to children has
consisted largely of studies of television advertising and, to a lesser
extent, other forms of traditional, measured media. The FTC's Bureau of
Economics, for example, issued a study in 2007 comparing children's
exposure to food advertising on television in 1977 with their exposure
in 2004. The study concluded that children's exposure to food ads had
fallen modestly from 6,100 ads seen by children ages 2-11 in 1977, to
5,500 ads in 2004. In 2004, however, children's ad exposure was more
concentrated on children's programming; about half of the food ads seen
by children were during programs in which they were at least 50 percent
of the audience, compared to about one quarter of the ads seen in
1977.\17\ Although children's exposure to food advertising on
television has remained fairly constant over the past 30 years,
marketing to children has become omnipresent, and promotional campaigns
have become more integrated because of the Internet, other new
electronic media, and the burgeoning of cross-promotions with products,
movies, and characters popular with children and teens. Previously,
however, there has been little information quantifying children's
exposure to these newer, more integrated marketing venues and
techniques.
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\17\ Children's Exposure to TV Advertising in 1977 and 2004:
Information for the Obesity Debate, FTC Bureau of Economics Staff
Report (June 2007), available at www.ftc.gov/os/2007/06/cabecolor.pdf.
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The FTC's new study, which was conducted at the request of
Congress,\18\ addresses not only marketing activities in traditional
measured media--television, radio, and print--but also analyzes the
Internet and other new media, as well as older, but mostly unmeasured,
forms of promotional activities directed to youth. This Report presents
a great deal of information not previously collected and not otherwise
available to the research community. Significantly, the study analyzes
data from 2006--a year just before, or very early in the inception of,
industry self-regulatory activities. The Commission believes,
therefore, that the study will serve as a benchmark for measuring the
future effects of voluntary efforts to reduce the amount or improve the
nutritional profile of food and beverage marketing to children.
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\18\ The Conference Report (H.R. Rep. No. 109-272 (2005)) for the
Commission's fiscal year 2006 appropriation legislation (Public Law No.
109-108) incorporated by reference language from the Senate Report
directing the FTC to submit a report to the Committee regarding:
marketing activities and expenditures of the food industry targeted
toward children and adolescents. The report should include an analysis
of commercial advertising time on television, radio, and in print
media; in-store marketing; direct payments for preferential shelf
placement; events; promotions on packaging; all Internet activities;
and product placements in television shows, movies, and video games. S.
Rep. No. 109-88, at 108 (2005).
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Study Design and Scope
The study analyzes data from both public and non-public sources to
provide a comprehensive picture of expenditures and activities directed
toward children and adolescents by 44 food and beverage producers,
marketers, and quick-service restaurants (QSRs) in the United States
during 2006. Those 44 companies, which provided data in response to
compulsory process issued by the Commission, were generally selected
based on their status as the top advertisers during children's
programming and as the companies with the largest sales shares for
selected food categories. The Commission sought information from these
companies for marketing of brands in 11 categories of food products
ranging from breakfast cereals, candy, and carbonated beverages, to
fruits and vegetables. Companies were required to report their
marketing expenditures across 20 categories of promotional activities
including traditional media like television, newer media like the
Internet and mobile phones, and other promotional techniques like
product placement, event sponsorship, character licensing, and in-
school marketing. In each category, spending was broken down between
activities targeted to children (ages 2-11) and adolescents (ages 12-
17). In addition to reporting spending, companies were also asked to
provide samples or descriptions of their marketing in various
categories.\19\
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\19\ Appendix A to the Report describes the research methods in
detail and identifies the specific companies, food categories, and
promotional activities that were included in the study.
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Although the study does not include the entire universe of
companies marketing food to children and adolescents, or the entire
range of foods promoted to them, the Commission believes that it covers
a substantial majority of such expenditures and activities for the
relevant time frame. It should provide an accurate picture of the scope
and variety of food marketing to American youth in 2006.
Key Findings
The Report provides a detailed breakdown of spending for both
children and teenagers for each type of marketing activity and across
each food category. It also provides examples and descriptions of the
various promotional techniques used by the companies. This testimony
will highlight only a few key findings.
Total spending on food and beverage marketing to children and teens
(together described as ``youth'') by the 44 reporting companies
slightly exceeded $1.6 billion, with approximately $870 million of that
spent on marketing directed to children under 12.\20\ Not surprisingly,
television advertising, one of the more expensive media, accounted for
nearly half (46 percent) of the total reported youth-directed marketing
expenditures. With a total of $745 million spent, television
advertising ranked at the top of promotional techniques. In-store
display materials and packaging ranked second in youth-directed
spending at 12 percent ($195 million), closely followed by in-school
marketing at 11 percent ($186 million).\21\ The Internet and other new
media and techniques, such as digital media and viral marketing,
represented a combined 5 percent of youth-directed expenditures ($77
million). Youth-directed premiums were reported as representing only 4
percent of total expenditures ($67 million).\22\
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\20\ 2008 Report, supra note 2, at 7. The cost of youth marketing
reported here is significantly lower than some previous estimates.
There are several reasons for this disparity. Other researchers have
not had access to the confidential company financial data obtained by
the Commission. Moreover, prior estimates have included advertising
directed to children for products other than food and also have
included price promotions, which generally are targeted to adults and
therefore were not included in the FTC data.
\21\ The FTC defined the in-school marketing category to include
the commissions paid to schools and school districts by beverage
companies and bottlers pursuant to vending machine contracts. Thus, the
majority of the expenditures reported in this category were not for
traditional advertising or marketing activities. The Commission
included these expenses because the payments afford the companies
access to young people in school. We recognize that many schools rely
on these payments to support athletic and other school programs.
\22\ 2008 Report at 8, 12-13.
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The low level of spending on premiums may seem surprising at first
glance. The figure, however, does not tell the whole story because it
excludes toys distributed by QSRs with children's meals--an expense
that is recouped by the cost of the meal and thus not reported as a
marketing expenditure by the companies. If the cost of QSR toys is
added to premium expenditures, this marketing technique jumps from $67
million to $427 million, ranking second only to television in youth-
directed expenditures.\23\
---------------------------------------------------------------------------
\23\ Id. at 8.
---------------------------------------------------------------------------
The foods most heavily marketed to all youth were carbonated
beverages, restaurant foods, and breakfast cereals, with these three
categories comprising 63 percent of all youth-directed spending.\24\
For children under 12, the top marketed food categories, ranked in
order, were breakfast cereals ($229 million), restaurant food ($161
million), and snack foods ($113 million).\25\ Again, this ranking
changes dramatically if the cost of toys included in QSR kids' meals is
added to expenditures for children under 12. With these toys included,
QSR food becomes the most heavily marketed category to children, at
$521 million--more than twice that spent in any other food and beverage
category.\26\
---------------------------------------------------------------------------
\24\ Id. at 10.
\25\ Id.
\26\ Id.
---------------------------------------------------------------------------
In addition to providing these figures, the Report describes the
various ways in which food is marketed to children. A principal finding
is that many marketing campaigns are fully integrated, weaving together
a sweeping net of repeated product exposure across multiple venues and
techniques. A typical campaign, for example, may begin with a child
seeing an ad on television. The child is then likely to encounter
promotional displays and product packaging at the grocery store or
restaurant and perhaps receive a toy or other premium upon purchase of
the product. Often, that toy or premium will be tied to a popular movie
release, for which there will be additional advertising exposure. The
child also might be directed to a website to enter a package UPC or
other code to participate in a sweepstakes or earn points toward
prizes. Once on the website, the child may interact with the brand
through online games or participate in viral marketing by sending an e-
card to a friend.
The extensive cross-promotion of food and beverage products with
popular movie releases illustrates the integration of marketing
methods. The PG-13-rated movie, Pirates of the Caribbean: Dead Man's
Chest, for example, was released in July 2006.\27\ Coinciding with the
release, food, beverage, and restaurant companies ran cross promotions
for QSR meals, frozen waffles, fruit snacks, breakfast cereals,
popcorn, lunch kits, candy, and fresh fruit. The food products tied to
Pirates were promoted by television ads, in-theater ads, Internet
``advergames,'' specially marked packaging, and in-store displays and
tags for pineapples and bananas. Limited edition line extensions were
created, including candy that turned gold in the mouth, fruit snacks in
treasure shapes, and frozen waffles stamped with movie images.
Promotions also included premiums and prizes like skull-shaped cereal
bowls, bandanas, and skull strobe light key chains.\28\ Pirates was
just one of approximately 80 films, television programs, and video
games used in cross promotion of food and beverages to children and
teens in 2006.\29\
---------------------------------------------------------------------------
\27\ In October 2006, the Walt Disney Company announced new food
guidelines stating that its name and characters would be used only for
food products that meet specific nutritional requirements, including
limits on calories, fat, and sugar. This and other initiatives by media
and entertainment companies are described in the 2008 Report at 78-79.
\28\ 2008 Report at 37-38.
\29\ Id. at 29-32.
---------------------------------------------------------------------------
The Report also provides illustrations of many other youth-directed
marketing techniques used by the industry. It describes, for example,
the variety of methods that the industry uses to market in schools--
vending machines, contests, team sponsorship, event advertising, and
others. The Report also describes the branding of clothing, toys, and
other children's merchandise with food, beverage, and QSR logos;
digital marketing that includes downloadable podcasts, ``webisodes,''
and ringtones; viral marketing; word-of-mouth marketing that recruits
youth as ``ambassadors'' to hand out product samples and promotional
items; event marketing; celebrity endorsements; product placement;
philanthropic activities, and more.
Key FTC Recommendations
Drawing from the findings of our study as well as from our
assessment of the industry's progress on self-regulation since our
first report, the 2008 Report concludes with several new and stronger
recommendations designed to further strengthen and expand on all
aspects of the industry's self-regulatory efforts and company
initiatives.
First, the Commission recommends that all food and beverage
companies adopt and adhere to meaningful nutrition-based standards for
marketing their products to children under 12. A useful first step
would be to join the CBBB Initiative. In other words, all companies
should take measures to limit their food and beverage promotions
directed to children to those for healthier products.
Second, given the integrated nature of most marketing campaigns,
the Commission also recommends that these nutrition-based standards be
extended beyond television, radio, print, and Internet advertising, to
cover the full spectrum of marketing activities to children, including
product packaging, advertising displays at the retail site, premium
distribution, celebrity endorsements, and other promotional activities.
Third, the Commission also recommends that all companies stop in-
school promotion of foods and beverages that do not meet meaningful
nutrition-based standards. In addition, all companies that sell
``competitive'' food or beverage products in schools (outside of the
school meal program) should join the Alliance for a Healthier
Generation or otherwise adopt and adhere to meaningful nutrition-based
standards for foods and beverages sold in schools, such as those
recommended by the Institute of Medicine.
Fourth, the Report contains many other specific recommendations for
the food industry, which address the nutritional profile of product
offerings, nutrition labeling, healthy messages, and marketing in
schools.
Finally, in light of the character licensing and extensive cross
promotion of foods with films and children's televison programs, the
Report also recommends actions by media and entertainment companies.
Included among these is a recommendation that media and entertainment
companies should consider instituting their own self-regulatory
initiative and working with the CBBB in this endeavor.\30\
---------------------------------------------------------------------------
\30\ The complete list of recommendations is set forth in the
Executive Summary. 2008 Report at ES-8-ES-11.
---------------------------------------------------------------------------
Conclusion
The Commission is hopeful that continued and expanded efforts by
all stakeholders will yield more progress in addressing the issue of
childhood obesity. Going forward, the Commission will continue to
monitor developments in this area. In particular, we will be looking at
the progress of the food and media industries' self-regulatory
initiatives and examining the impact on marketing to children. At an
appropriate point in the future, the Commission is committed to issuing
a follow-up report assessing the extent to which the recommendations in
the 2008 Report have--or have not--been implemented.
On behalf of the Commission, I would like to thank the
subcommittees for the opportunity to present testimony on this
important topic.
Senator Harkin. Thank you all very much for your
statements.
First, Mr. Leibowitz, let me start with you.
Mr. Leibowitz. Sure.
Senator Harkin. If you look at that chart that both Senator
Brownback had and, I think, that Dr. Gerberding had, where it
showed the increase in obesity rates among kids, it had a line
going up--there were three or four lines there.
Mr. Leibowitz. Uh-huh.
Senator Harkin. You notice those lines, like this one
here--it's odd, isn't it, that they all started a precipitous
increase right around 1980, 1981? Now, I remember, back in the
1970s, there was this proposal to regulate advertising to kids.
I was in the House at the time. I was on the Agriculture
Committee. We had a little bit of it. But, I remember, there
was a big hue and cry went up about nanny government and this
and that, and I remember those. But then, I kind of forgot
about it, because it kind of went away.
Well, what happened was, in 1981 the Congress--the Congress
passed a law that took away the authority of the Federal Trade
Commission to regulate children's advertising, in this way.
Right now, the FTC has the authority to regulate advertising to
adults on the basis of deception or unfairness.
Mr. Leibowitz. That is right. We usually do it with our
enforcement power by going after deceptive advertisements, but
that is exactly right.
Senator Harkin. But you have both of those----
Mr. Leibowitz. Right.
Senator Harkin [continuing]. For adults.
Mr. Leibowitz. We do have those, that's right.
Senator Harkin. But, for kids, only on deception. Now, why
is it the FTC has more authority to regulate advertising to me
than to my grandkids? Now, that's an interesting statement.
But, it is true, is it not, Mr. Leibowitz?
Mr. Leibowitz. It is absolutely correct.
Senator Harkin. So, therefore, taking it a step further,
since they took away--the Congress took away the power of the
FTC to regulate advertising to kids based on unfairness, they
can only do it on deception. Well, most ads are probably--
they're not deceptive, but I would propose this, that a--an ad
targeted to a child--and there have been studies that have
shown this, that they can't tell the difference between program
content and advertising content--that that kind of advertising
to children is inherently unfair. Inherently unfair, because
they can't distinguish. We have studies that show that. Yet,
the Federal Trade Commission, Mr. Leibowitz, if I'm right----
Mr. Leibowitz. You are right.
Senator Harkin [continuing]. Can't do anything about it.
Mr. Leibowitz. Well, I would say that was the motivation
for the rulemakings that we did in the Pertschuk Commission in
the late 1970s. It has also, I think, driven what some European
countries have done to ban food marketing to children. On the
other hand--that is also part of the reason why we have worked
so vigorously to use our bully pulpit at the FTC and to push
companies to do a better job using self-regulatory measures. We
think they have really improved.
You are absolutely right, as you described the history and
the restrictions that we are under now. The only other point I
would make is probably that even if you regulate in that area,
you still have First Amendment concerns, depending on what that
regulation is, as Chairman Martin knows. And so, you want to be
very, very careful, if you could regulate, about what you would
do. And we do think that one of the benefits of self-
regulation--and we have seen a lot of progress through the
Better Business Bureau initiative, and through the work that
the Clinton Foundation and the American Heart Association have
done in the schools on beverages. One of the advantages, I
would say, of the self-regulatory approach is that you avoid
litigation. And if you can get companies to do the right thing,
then they do it much more quickly.
But, yes, you described the history of the FTC and of our
rulemaking initiative very clearly.
Senator Harkin. I'd also make a note, also, that that
precipitous incline also started at about the time that we saw
the huge influx of vending machines in our schools. Go back and
look at it. That's when it--that's when--and I don't think it's
just coincidental, by the way, that the obesity rates and
everything else started and has gone up since both of those
things took place, this law that we passed and also the influx
of----
Mr. Leibowitz. Well, with vending machines----
Senator Harkin [continuing]. The vending----
Mr. Leibowitz [continuing]. In the schools, again, in the
last couple of years, particularly with the Clinton
Foundation's involvement, we have seen a lot of progress there
to have reduced-calorie juices and diet sodas in the schools,
replacing high-calorie drinks.
Senator Harkin. But, on a case-by-case basis, some--some
school districts have done magnificent jobs.
Mr. Leibowitz. That's right.
Senator Harkin. And others have done it.
Mr. Leibowitz. That's right.
Senator Harkin. So, it's sort of spotty. But then, from
what you said about self-regulation, that's where we've all
been headed, to try to get all these companies to do this.
But then, Mr. Martin, as you point out in your statement,
that some of these companies agreed to limit character usage,
leaving the loophole open for these special occasions that you
mentioned in your verbal statement. And then, as you point out
in your written statement, even more troubling was, the
majority of media companies refused to agree to any kind of
limit on advertising targeted toward our children. And then you
go on to say that, as a result, all of the public health and
child advocacy groups have asked Congress to adopt legislation
mandating that at least 50 percent of all food advertising to
children on broadcast and cable television programming be
devoted to healthy food products. So, you know, yes, as I said,
I applaud those companies that have done that.
Mr. Martin. Yes.
Senator Harkin. I mentioned Kraft. There are others. But, I
just singled them out because they really were moving ahead
and--but, the problem that I saw over the last few years with,
really, conscientious companies doing this--and I have examples
of this, of other companies coming in and trying to invade
their market share. So, the good companies basically are giving
up, maybe, some of their market share to those that don't much
care about this. As you say, they aren't adhering to this, and
so, they come in with, again, the high sugar, high salt, high
fat foods, advertising them to kids, to take away from the
companies that are doing good things. So, how do we get around
this problem?
Mr. Martin. Well, the same thing is true even on the media
company side, to the extent that any company--or in this case--
a company like Ion--that agreed to this kind of a commitment,
they're put at a competitive disadvantage in trying to get
advertising dollars----
Senator Harkin. Sure.
Mr. Martin [continuing]. So, it has a negative impact on
them, as well. So, that's why I would speak more from the media
company side of it, which is where the Commission ends up
having its regulatory authority, but I would say that I think
the voluntary efforts of trying to get them to put limits on
their advertising of unhealthy products has probably run its
course.
There was no question that over the last 1\1/2\year and a
half to 2 years we spent on the task force, the vast majority
of media companies were unwilling to place any kind of limit on
the advertising of unhealthy products to our children. And
that's why I think this is a significant problem, and I think
Congress should consider, what limits should be placed on them.
And, as I indicated in my testimony, I think that the solution
must be one that's comprehensive and involves all media
companies.
Senator Harkin. Well, I'd like to pursue that just a little
bit further, but----
Mr. Martin. Sure.
Senator Harkin [continuing]. My time's gone--run way over.
And, with that, I'd yield to Senator Brownback.
HEALTH SYSTEMS REPORTS
Senator Brownback. Thank you all, for being here.
Dr. Gerberding, you've mentioned that we're 37th on health,
and yet, we spend the most. What countries are doing the best
job, and what practices do you think we should import to help
us improve our health?
Dr. Gerberding. I can answer that generically, and I
appreciate what Senator Harkin said about healthcare reform.
But, I would like to ask that we think of this as ``health
system reform,'' because this kind of health isn't going to
happen in the healthcare delivery system, it's going to happen
in schools and communities and homes. And I know that's what
you mean, but we're trying to really emphasize ``health
system,'' not just ``healthcare system.''
What we can say, in comparison to the other developed
countries that are spending far less of their GDP on managing
their health, is that they put much more emphasis on things
going on in schools, on physical fitness and good nutrition, on
environments that support exercising and access to healthy
choices. I can't comment specifically on what they're doing
about advertising to children, so I would leave that to my
colleagues to address.
But, in general, their portfolio of health dollars is
invested much differently than ours is. We put our emphasis on
end-of-life care, in complex biomedical interventions, they're
more willing to spend upstream, where health really happens.
Senator Brownback. So, on school nutrition programs,
physical education in school----
Dr. Gerberding. Absolutely.
Senator Brownback [continuing]. Key items that you look
at----
Dr. Gerberding. Absolutely. They----
Senator Brownback [continuing]. When you look at this
chart, here, why the spike in 1980? Chairman Harkin mentioned a
couple of things that seem probable. I presume you guys have
studied this and you have several factors that you think are
likely.
Dr. Gerberding. Well, we can make correlations. That is the
same time at which television viewing increased. There are a
lot of things that happened along those same times. The decline
in school physical ed programs began in the 1980s as school
districts became less and less able to afford those activities.
So, there's a confluence of things. But, I think the sharp
change at 1981 is highly correlated with the policy change that
the Senator mentioned.
Senator Brownback. Either of the other gentlemen--Chairman
Martin, same question--are there practices in other countries
that would be very helpful if we would do?
Mr. Martin. In the United Kingdom, Ofcom has much more
direct regulations limiting the advertising of unhealthy
products during any children's programming. And they actually--
have instituted a series of rules and requirements and
regulations restricting that. And they're actually going
through a process of reviewing them and seeing if they need
even additional restrictions or regulations. But, they've been
the most aggressive of any country in trying to actually
restrict the advertising of unhealthy foods to children.
Senator Brownback. At up to a certain age, what's the age
that they target?
Mr. Martin. I think----
I'll have to get back to you, but I thought it was 16, but
I'll have to get back to you on the exact age.
Mr. Leibowitz. Yes, we can----
Senator Brownback. Mr. Leibowitz.
Mr. Leibowitz [continuing]. Find that, too.
[The information follows:]
Ofcom targets children under 16 (that is up to and including 15)
with respect to the regulations on food advertising. The restrictions
apply to ads for foods and drinks that are high in fat, salt, and sugar
(HFSS). HFSS ads are not permitted in or around programs made for
children and on dedicated children's channels. In addition, they are
not permitted in or around programs ``likely to be of particular appeal
to children aged 4-15.'' Whether a program has ``particular appeal'' to
those under 16 is determined by a statistical index. If the proportion
of children 4-15 watching a program is more than 20 percent higher than
their proportion of the general population, the program is defined as
having ``particular appeal'' to that age group. The regulations were
phased in and became fully effective January 1, 2009.
Mr. Leibowitz. The Europeans have gone much further than we
have in regulating the types of advertisements that children
can see, and particularly young children.
But, I would also say this, it is complicated, in the
United States, by the First Amendment. Under Central Hudson,
which is the major commercial speech case, there is a three-
part test, and you have to have substantial government
interest, and the regulation has to directly advance that
interest, and has to be narrowly tailored. So, it would
complicate rulemaking, and it would certainly complicate
legislating in this area. That doesn't mean it can't be done,
but you would have to be, very careful and cautious if you do
it. And, again, that is part of the reason why we have pushed
very hard for robust, strong, self-regulatory initiatives.
Senator Brownback. Dr. Gerberding----
Mr. Leibowitz. Plus, the ban.
Senator Brownback. What's that?
Mr. Leibowitz. As Chairman Harkin pointed out, we have a
ban on our rulemaking authority here.
Senator Brownback. Would these limitations in media
advertising get at the heart of the issue, in your estimation?
Or, are these useful, but we need to really get more at school
nutrition programs, the health system, physical education?
What's your thought?
Dr. Gerberding. I don't believe there'll be a simple fix.
This is going to take a comprehensive set of interventions that
involves schools and nutrition and activity. But, the Institute
of Medicine has specifically looked at the relationship between
advertisement and what children choose to eat, and there's no
question that the media influence is strong, that this exposure
to this toxic environment really does influence what kids want,
what they eat, what they won't eat, and that it is a major
influence.
What we don't know is, if we take that away, how much
weight change will occur. But, we've seen evidence that when
you do reduce exposure to advertisements, that children's
weight drops, even if they don't increase their physical
activity. So, that's some pretty direct evidence that there is
a logic model here that would suggest that removing this
influence would have beneficial health impact.
Senator Brownback. You have direct studies that show that.
Dr. Gerberding. If you remove the exposure, you see weight
loss.
Senator Brownback. Mr. Leibowitz, you're familiar with
these studies, as well, and agree with----
Mr. Leibowitz. I am aware of some of these studies. I mean,
I defer to the healthcare expert here, the director of CDC.
But, yes, we are aware of them.
Senator Brownback. Well, I think that's quite a strong and
clear statement. I'm hopeful, actually, that CDC can submit
that study, or the citation for those studies, to us so that we
can have that.
[The information follows:]
[From the Journal of the American Medical Association, October 27,
1999]
Reducing Children's Television Viewing to Prevent Obesity
(Thomas N. Robinson, MD, MPH)
[available on the web at: http://jama-ama-assn.org/cgi/reprint/282/16/
1561]
a randomized controlled trial
Context.--Some observational studies have found an association
between television viewing and child and adolescent adiposity.
Objective.--To assess the effects of reducing television,
videotape, and video game use on changes in adiposity, physical
activity, and dietary intake.
Design.--Randomized controlled school-based trial conducted from
September 1996 to April 1997.
Setting.--Two sociodemographically and scholastically matched
public elementary schools in San Jose, Calif.
Participants.--Of 198 third- and fourth-grade students, who were
given parental consent to participate, 192 students (mean age, 8.9
years) completed the study.
Intervention.--Children in 1 elementary school received an 18-
lesson, 6-month classroom curriculum to reduce television, videotape,
and video game use.
Main Outcome Measures.--Changes in measures of height, weight,
triceps skinfold thickness, waist and hip circumferences, and
cardiorespiratory fitness; self-reported media use, physical activity,
and dietary behaviors; and parental report of child and family
behaviors. The primary outcome measure was body mass index, calculated
as weight in kilograms divided by the square of height in meters.
Results.--Compared with controls, children in the intervention
group had statistically significant relative decreases in body mass
index (intervention vs control change: 18.38 to 18.67 kg/m\2\ vs 18.10
to 18.81 kg/m\2\, respectively; adjusted difference -0.45 kg/m\2\ [95%
confidence interval (CI), -0.73 to -0.17]; P=.002), triceps skinfold
thickness (intervention vs control change: 14.55 to 15.47 mm vs 13.97
to 16.46 mm, respectively; adjusted difference, -1.47 mm [95% CI, -2.41
to -0.54]; P=.002), waist circumference (intervention vs control
change: 60.48 to 63.57 cm vs 59.51 to 64.73 cm, respectively; adjusted
difference, -2.30 cm [95% CI, -3.27 to -1.33]; P<.001), and waist-to-
hip ratio (intervention vs control change: 0.83 to 0.83 vs 0.82 to
0.84, respectively; adjusted difference, -0.02 [95% CI, -0.03 to
-0.01]; P<.001). Relative to controls, intervention group changes were
accompanied by statistically significant decreases in children's
reported television viewing and meals eaten in front of the television.
There were no statistically significant differences between groups for
changes in high-fat food intake, moderate-to-vigorous physical
activity, and cardiorespiratory fitness.
Conclusions.--Reducing television, videotape, and video game use
may be a promising, population-based approach to prevent childhood
obesity.
introduction
The United States has experienced alarming increases in obesity
among children and adolescents. [1] However, most available treatments
for obese children have yielded only modest, unsustained effects. [2]
Consequently, prevention is considered to hold the greatest promise.
[3] Unfortunately, most prevention programs that specifically attempt
to reduce fat and energy intake and increase physical activity have
been ineffective at changing body fatness. [4] [5] As a result, there
is a need for innovative approaches to prevent obesity.
There is widespread speculation that television viewing is one of
the most easily modifiable causes of obesity among children. American
children spend more time watching television and videotapes and playing
video games than doing anything else except sleeping. [6] Two primary
mechanisms by which television viewing contributes to obesity have been
suggested: reduced energy expenditure from displacement of physical
activity and increased dietary energy intake, either during viewing or
as a result of food advertising.
Cross-sectional epidemiological studies have consistently found
relatively weak positive associations between television viewing and
child and adolescent adiposity. [7-21] Prospective studies are less
common and have produced mixed results. [7] [14] The consistently weak
associations found in epidemiological studies may be due to the
measurement error in self-reports of television viewing. As a result,
additional epidemiological studies would not be expected to clarify the
true nature of this relationship. [22]
A causal relationship can only be demonstrated in an experimental
trial, in which manipulation of the risk factor changes the outcome.
[23] Therefore, we conducted a randomized, controlled, school-based
trial of reducing third- and fourth-grade children's television,
videotape, and video game use to assess the effects on adiposity and
the hypothesized mechanisms of physical activity and dietary intake. We
hypothesized that compared with controls, children exposed to the
television reduction intervention would significantly decrease their
levels of adiposity.
methods
All third- and fourth-grade students in 2 public elementary schools
in a single school district in San Jose, Calif, were eligible to
participate. Schools were sociodemographically and scholastically
matched by district personnel. School principals and teachers agreed to
participate prior to randomization. Parents or guardians provided
signed written informed consent for their children to participate in
assessments and for their own participation in telephone interviews.
One school was randomly assigned to implement a program to reduce
television, videotape, and video game use. The other school was
assigned to be an assessments-only control. Participants and school
personnel, including classroom teachers, were informed of the nature of
the intervention but were unaware of the primary hypothesis. The study
was approved by the Stanford University Panel on Human Subjects in
Research, Palo Alto, Calif.
intervention
To test the specific role of television, videotape, and video game
use in the development of body fatness, as well as effects on dietary
intake and physical activity, it was necessary to design an
intervention that decreased media use alone without specifically
promoting more active behaviors as replacements. This was accomplished
by limiting access to television sets and budgeting use while
simultaneously becoming more selective viewers or players.
The intervention, which was based in Bandura's social cognitive
theory, [24] consisted of incorporating 18 lessons of 30 to 50 minutes
into the standard curriculum that was taught by the regular third- and
fourth-grade classroom teachers. The teachers were trained by the
research staff, and the majority of lessons were taught during the
first 2 months of the school year. Early lessons included self-
monitoring and self-reporting of television, videotape, and video game
use to motivate children to want to reduce the time they spent in these
activities. These lessons were followed by a television turnoff, [25]
during which children were challenged to watch no television or
videotapes and play no video games for 10 days. After the turnoff,
children were encouraged to follow a 7-hour per week budget. Additional
lessons taught children to become ``intelligent viewers'' by using
their viewing and video game time more selectively. Several final
lessons enlisted children as advocates for reducing media use. The
entire curriculum consisted of approximately 18 hours of classroom
time. Newsletters that were designed to motivate parents to help their
children stay within their time budgets and that suggested strategies
for limiting television, videotape, and video game use for the entire
family were distributed to parents.
To help with budgeting, each household also received an electronic
television time manager (TV Allowance, Mindmaster, Inc, Miami, Fla).
This device locks onto the power plug of the television set and
monitors and budgets viewing time for each member of the household
through use of personal identification codes. Because it controls power
to the television, it also controls video cassette recorder (VCR) and
video game use. Families could request additional units for every
television in their homes, at no cost.
outcome measurements
Assessments were performed by trained staff, blinded to the
experimental design, at baseline (September 1996) and after the
completion of the intervention (April 1997). At each time point, on the
same days in both schools, children completed self-report
questionnaires on 2 non-Monday weekdays. A research staff member read
each question out loud. Classroom teachers did not participate in the
assessments. Physical measures were performed during 2 physical
education periods at each time point, by the same staff in both
schools. Parents were interviewed by telephone at baseline and after
the intervention by trained interviewers following a standardized
protocol. Parents, children, and teachers were not aware that the
primary outcome was adiposity.
Body mass index (BMI), defined as the weight in kilograms divided
by the square of the height in meters, was the primary measure of
adiposity. [26] [27] Standing height was measured using a portable
direct-reading stadiometer and body weight was measured using a digital
scale, according to established guidelines. [28] [29] Test-retest
reliabilities were high (intraclass Spearman r>0.99 for height, r>0.99
for weight). Triceps skinfold thickness was included as a measure of
subcutaneous fat and was measured on the right arm, according to
established guidelines. [28] [29] Test-retest reliability was r>0.99
and skinfold thickness was highly correlated with BMI (r=0.82).
Waist and hip circumferences were measured with a nonelastic tape
at the level of the umbilicus and the maximal extension of the
buttocks, respectively, according to established guidelines.[28] [29]
Test-retest reliabilities were r>0.99. Waist and hip circumferences
were correlated with BMI (r=0.87, r=0.90, respectively) and triceps
skinfold thickness (r=0.72, r=0.78, respectively). The waist-to-hip
ratio was calculated as a measure of body fat distribution.
Children reported the time they spent ``watching television,''
``watching movies or videos on a VCR,'' and ``playing video games,''
separately for before school and after school, ``yesterday'' and ``last
Saturday'' on the first assessment day, and ``yesterday'' on the second
assessment day. Prior to reading these items, the research staff led
children through several participatory time-estimating exercises. This
instrument was adapted from a similar instrument previously used in
young adolescents with high test-retest reliability (r=0.94). [15]
Parents estimated the amount of time their child spent watching
television, watching videotapes on the VCR, and playing video games on
a typical school day and on a typical weekend day. Similar items have
produced accurate estimates compared with videotaped observation. [30]
There was moderate agreement between parent and child reports of
children's media use (Spearman r=0.31, P<.001 for television viewing;
r=0.17, P=.03 for videotape viewing; r=0.49, P<.001 for video game
playing). A previously validated 4-item instrument was used to assess
overall household television viewing. [31]
Children and parents also estimated the amount of time the child
spent in other sedentary behaviors, including, using a computer, doing
homework, reading, listening to music, playing a musical instrument,
doing artwork or crafts, talking with parents, playing quiet games
indoors, and at classes or clubs (parent-child agreement Spearman
r=0.16, P<.05).
On both days children reported their previous day's out-of-school
physical activities, using a previously validated activity checklist.
[32] Responses from the 2 days were averaged and weighted for levels of
intensity using standard energy expenditure estimates.[33] Parents
estimated the amount of time their child spent in organized physical
activities (such as teams or sports classes) and nonorganized physical
activities (such as playing sports, bicycling, rollerblading, etc)
(parent-child agreement Spearman r=0.16, P=.05).
On both days, children completed 1-day food frequency recalls for
60 foods in 26 food categories, based on instruments previously
validated in third- through sixth-grade children. [34] [35] High-fat
foods were those previously identified as the major contributors of fat
in the diets of children [35] and adults, [36] and were identified
through focus groups with children, parents, and school lunch
personnel. Highly advertised foods included 3 categories representing
sugary cereals, carbonated soft drinks, and foods from fast-food
restaurants.
Children also reported how often they ate breakfast and dinner in a
room with the television turned on during the past week, on 4-point
scales ranging from never to every day, and they reported the
proportion of time they were eating or drinking a snack (not including
meals) while watching television or videotapes or playing video games,
on a 3-point scale. Parents responded to the same questions about their
children, reporting the number of days in the last week for meals
(parent-child agreement Spearman r=0.24, P=.003) and the percentage of
time for snacking (parent-child agreement Spearman r=0.02, P>.05).
The maximal, multistage, 20-m, shuttle run test (20-MST) was used
to assess cardiorespiratory fitness. [37] The 20-MST has been found to
be reliable (test-retest r=0.73-0.93), [37] a valid measure of maximum
oxygen consumption as measured by treadmill testing (r=0.69-0.87), [38-
42] and sensitive to change &2] in children.
statistical analysis
Baseline comparability of intervention and control groups was
assessed using nonparametric Wilcoxon rank sum tests for scaled
variables and 2 tests for categorical variables. As a primary
prevention program, the intervention was designed to target the entire
sample. Effects were expected and intended to occur throughout the
entire distribution of adiposity in the sample-not just around a
defined threshold. Thus, for purposes of establishing the efficacy of
this intervention, it is most appropriate to compare the full
distributions of BMI between intervention and control groups.
Therefore, to test the primary hypothesis, accounting for the design
with school as the unit of randomization (adjusting for intraclass
correlation), a mixed-model analysis of covariance approach was used,
with postintervention BMI as the dependent variable; the intervention
group (intervention vs control) as the independent variable; and
baseline BMI, age, and sex as covariates (SAS MIXED procedure, SAS
version 6.12, SAS Institute Inc, Cary, NC). [43] The same analysis
approach was used for all secondary outcome variables, triceps skinfold
thickness, waist and hip circumferences, waist-to-hip ratio, and
measures of dietary intake and physical activity. Each outcome also was
tested for intervention by sex and intervention by age interactions.
All analyses were completed on an intention-to-treat basis, and all
tests of statistical significance were 2-tailed with =.05.
With an anticipated sample size of approximately 100 participants
per group and using the above analysis, the study was designed to have
80 percent power to detect an effect size of 0.20 or greater. This
corresponded to estimated differences between groups of about 0.75 BMI
units, 1.2 mm of triceps skinfold, 1.8 cm of waist circumference, and 2
hours per week of television, videotape, and video game use.
In children of this age, BMI, triceps skinfold thickness, waist
circumference, and hip circumference were all expected to increase over
the course of the experiment, as part of normal growth, in both the
intervention and control groups. Therefore, effect sizes are reported
as changes in the intervention group relative to changes in the
controls (relative differences). A negative difference is termed a
relative decrease in comparison with the controls, even if the actual
value increased as a result of normal growth and development.
results
The study design and participation are shown in Figure 1. Ninety-
two (86.8 percent) of 106 eligible children in the intervention school
and 100 (82.6 percent) of 121 eligible children in the control school
participated in baseline and postintervention assessments. Intervention
and control participants, respectively, were comparable in age (mean
[SD], 8.95 [0.64] vs 8.92 [0.70] years, P=.69), sex (44.6 percent vs
48.5 percent girls, P=.59), mean (SD) number of televisions in the home
(2.7 [1.3] vs 2.7 [1.1], P=.56), mean (SD) number of video game players
(systems) (1.5 [2.3] vs 1.2 [1.7], P=.49) and percentage of children
with a television in their bedroom (43.5 percent vs 42.7 percent,
P=.92). Physical measures but not self-reports were included in the
analysis for 11 children who were classified by their teachers as
having limited English proficiency or having a learning disability.
Baseline and postintervention telephone interviews were completed
by 68 (71.6 percent) and 75 (72.8 percent) of the parents of
participating children in the intervention and control schools,
respectively. Intervention school parents reported greater maximum
household education levels than participating control school parents
(45 percent vs 21 percent college graduates, P=.01) but did not differ
significantly in ethnicity (80 percent vs 70 percent white, P=.19), sex
of respondent (82 percent vs 88 percent female, P=.33) or marital
status (77 percent vs 67 percent married, P=.22).
Figure 1.--Study Design and Participant Flow
participation in the intervention
Teachers reported teaching all lessons, although we did not collect
detailed data determining whether the lessons were delivered as they
were intended. Ninety-five (90 percent) of 106 students in the
intervention school participated in at least some of the television
turnoff and 71 (67 percent) completed the entire 10 days without
watching television or videotapes or playing video games. During the
budgeting phase of the intervention, 58 (55 percent) of the students
turned in at least 1 signed parent confirmation that they had stayed
below their television and videotape viewing and video game playing
budget for the previous week. Forty-four parents (42 percent) returned
response cards reporting they had installed the TV Allowance and 29
families (27 percent) requested 1 or more additional TV Allowances.
effects on adiposity
Results of anthropometric measures are presented in Table 1. At
baseline, both groups were comparable (P>.10) on all baseline measures
of body composition. As expected for children of this age, BMI, triceps
skinfold thickness, waist circumference, and hip circumference all
increased in both intervention and control children during the course
of the school year. However, compared with controls, children in the
intervention group had statistically significant relative decreases in
BMI, triceps skinfold thickness, waist circumference, and waist-to-hip
ratio (Table 1). There were no significant interventions by sex or
intervention by age interactions for any of the body composition
outcomes. The results did not change when ethnicity and parent
education were included as additional covariates for children with
completed parent interviews.
TABLE 1.--CHILDREN'S ANTHROPOMETRIC MEASURES \1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
Baseline Postintervention
-------------------------------------------------------------------- Adjusted Change (95% CI) \2\ P Value
Intervention Control Intervention Control
--------------------------------------------------------------------------------------------------------------------------------------------------------
Body cross index, kg/m\2\........ 18.38 (3.67) 1810 (3.77) 18.67 (3.77) 18.81 (3.76) -0.45 (-0.73 to -0.17) .002
Triceps skinfold thickness, mm... 14.35 (6.06) 13.97 (5.43) 15.47 (5.95) 16.46 (5.27) -1.47 (-2.41 to -0.54) .002
Waist circumference, cm.......... 60.48 (9.91) 59.51 (8.91) 63.57 (8.96) 64.73 (8.91) -2.30 (-3.27 to -1.33) <.001
Hip circumference, cm............ 72.78 (8.91) 72.70 (8.78) 76.53 (7.94) 76.79 (8.37) -0.27 (-1.08 to 0.53) .50
Waist-to-hip ratio............... 0.83 (0.05) 0.82 (0.05) 0.83 (0.06) 0.84 (0.05) -0.02 (0.03 to -0.01) <.001
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Baseline and postintervention values are unadjusted mean (SD). At baseline, both groups were comparable (P>.10) on all measures of body composition.
\2\ Change estimates and 95 percent confidence intervals (CIs) are the differences between intervention group and control group after adjustment by
mixed-model analysis of covariance for the baseline value, age, and sex.
Although the sample size was insufficient to formally test for
effects within subgroups, it was desirable to further characterize the
effects of the intervention on participants with varying levels of
adiposity, with a descriptive analysis. Intervention and control group
changes were compared within strata defined by baseline levels of BMI,
triceps skinfold, waist circumference, and waist-to-hip ratio. For all
body composition measures, effects of the intervention occurred across
the entire distribution of baseline adiposity, with greater
intervention vs control differences evident among the middle and higher
strata of body fatness.
effects on media use, diet, and physical activity
Child measures are presented in Table 2 and parent measures are
presented in Table 3. Both groups were well matched at baseline,
although intervention group children reported eating significantly more
meals while watching television, and participating intervention group
parents reported significantly less overall household television use
and that their children spent significantly more time in other
sedentary behaviors at baseline.
TABLE 2.--CHILD MEASURES OF TELEVISION VIEWING. DIET AND PHYSICAL ACTIVITY AND FITNESS \1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
Baseline Postintervention
-------------------------------------------------------------------- Adjusted Change (95% CI) \2\ P Value
Intervention Control Intervention Control
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hours per week:
Television................... 15.35 (13.17) 15.46 (15.02) 8.80 (10.41) 14.46 (13.82) -5.53 (-8.64 to -2.42) <.001
Videotapes................... 4.74 (6.57) 5.52 (10.44) 3.46 (4.86) 5.21 (8.41) -1.53 (-3.39 to 0.33) .11
Video games.................. 2.57 (5.10) 3.85 (9.17) 1.32 (2.72) 4.24 (10.00) -2.54 (-4.48 to -0.60) .01
Meals in front of television, 0-3 2.38 (1.75) \3\ 1.84 (1.78) 1.70 (1.49) 1.99 (178) -0.54 (-0.98 to -0.12) .01
scale...........................
Frequency of snacking in front of 2.20 (0.56) 2.15 (0.61) 1.94 (0.51) 2.05 (0.59) -0.11 (-0.27 to 0.04) .16
the television. 1-3 scale.......
Daily servings of high-fat foods. 6.15 (3.63) 6.62 (5.85) 5.14 (3.50) 6.17 (4.88) -0.82 (-1.87 to 0.23) .12
Daily serving of highly 1.36 (0.96) 1.55 (1.20) 1.47 (1.10) 1.48 (1.06) 0.06 (-024 to 0.36) .71
advertised foods................
Other sedentary behaviors, h/d... 4.66 (3.81) 4.47 (6.37) 3.81 (2.66) 4.05 (4.53) -0.34 (-1.21 to 0.52) .44
Physical activity, metabolic 396.8 (367.8) 310.2 (250.7) 362.3 (235.2) 337.8 (277.3) -16.7 (-78.6 to 45.3) .60
equivalent-weighted, min/wk.....
20-m shuttle test, laps.......... 15.21 (9.60) 14.80 (8.56) 19.72 (11.40) 18.18 (10.72) 0.87 (-1.41 to 3.15) .45
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Baseline and postintervention values are unadjusted mean (SD).
\2\ Change estimates and 95 percent confidence intervals (CIs) are the differences between groups after adjustment by mixed-model analysis of covariance
for the baseline value, age, and sex.
\3\ Groups were significantly different (P<.05) at baseline by a nonparametraic Willcoxon rank sum test.
TABLE 3.--PARENT REPORTS OF CHILDREN'S TELEVISION VIEWING. DIET, AND PHYSICAL ACTIVITY \1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
Baseline Postintervention
-------------------------------------------------------------------- Adjusted Change (95% CI) \2\ P Value
Intervention Control Intervention Control
--------------------------------------------------------------------------------------------------------------------------------------------------------
Children's hours per week:
Television................... 12.43 (5.65) 14.90 (7.10) 8.86 (4.91) 14.75 (7.37) -4 29 (-5.89 to -2.70) .001
Videotapes................... (4.96) (4.21) 4.41 (3.72) 3.87 (2.87) 3.91 (3.21) -0.25 (-1.19 to 0.69) .60
Video games.................. 1.84 (2.73) 2.71 (3.78) 1.44 (1.96) 2.57 (4.41) -0.76 (-1.75 to 0.22) .13
Overall household television use, 7.09 (3.97) \3\ 8.60 (3.51) 6.09 (3.64) 7.76 (3.26) -0.77 (-1.69 to 0.14) .10
0-16 scale......................
No. of children's meals eaten in 3.18 (3.69) 3.53 (3.71) 2.19 (2.95) 3.43 (3.64) -1.07(-1.96 to 0.18) .02
front of the television, 0-14
meals...........................
Percentage of children's viewing 17.28 (20.91) 18.83 (41.24) 19.54 (22.43) 20.25 (22.70) -1.94 (-9.06 to 5.17) .59
when snacking...................
Children's other sedentary 44.89 (19.76) 39.79 (20.27) 41.31 (20.89) 43.37 (26.75) -4.88 (-11.69 to 1.93) .16
behaviors, h/wk................. \3\
Children's physical activity, h/ 11.19 (7.16) 9.19 (5.77) 16.08 (8.45) 17.21 (9.32) -2 00 (-4.58 to 0.59) .13
wk..............................
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Baseline and postintervention values are unadjusted mean (SD).
\2\ Change estimates and 95 percent confidence intervals (CIs) are the differences between groups after adjustment by mixed-model analysis on covariance
for the baseline value, age, and sex.
\3\ Groups were significantly different (P<.05) at baseline by a nonparametric Willcoxon rank sum test.
The intervention significantly decreased children's television
viewing, compared with controls, according to both child and parent
reports (relative reductions of about one third from baseline).
Intervention group children also reported significantly greater
reductions in video game use than controls. The intervention also
resulted in greater, but not statistically significant, decreases in
parent reports of children's video game use, parent and child reports
of videotape viewing, and parent reports of overall household
television viewing. There were no significant intervention by sex or
intervention by age interactions for any of the media use outcomes.
The intervention significantly reduced the frequency of children
eating meals in a room with the television turned on. Intervention
group children also reported relative reductions in servings of high-
fat foods compared with controls, although these differences were not
statistically significant. There were no significant intervention
effects on reports of children's physical activity levels or
performance on the 20-MST of physical fitness. There were no
significant intervention by sex or intervention by age interactions for
any of the diet or activity outcomes.
comment
This is the first experimental study to demonstrate a direct
association between television, videotape, and video game use and
increased adiposity. Because the intervention targeted reduction of
media use alone, without substituting alternative behaviors, a causal
inference might be made. [23] In one previous obesity treatment study,
obese children who were reinforced (ie, rewarded) for decreasing
sedentary activity (including television viewing and computer games, as
well as imaginative play, talking on the telephone, playing board
games, etc) along with following an energy-restricted diet lost
significantly more weight than obese children reinforced for increasing
physical activity or those reinforced for both. [44] Although that
study did not directly test the role of television, videotape, and
video game use, the similar findings support our results.
This experiment was designed to overcome the dependence of
epidemiological studies on error-prone measures of television viewing
behaviors by using BMI as the primary outcome. However, the
intervention did produce statistically significant decreases in
reported television viewing and video game use, compared with controls.
Previous studies of reducing children's television viewing have been
uncontrolled and limited to a small number of families. [45] [46] [47]
This study, therefore, also represents a promising model for studying
other hypothesized effects of television and videotape viewing and
video game use.
Because this study involved children in only 2 elementary schools,
the possibility that the results were due to differences in the groups
that were unrelated to the intervention cannot be ruled out completely.
This possibility is made less likely, however, because the schools were
in a single school district and participants were comparable at
baseline on almost all measured variables. In addition, the patterns of
the results strengthen the case for causal inference. The crossover
patterns of the changes in BMI, triceps skinfold thickness, waist
circumference, and waist-to-hip ratio lessen the likelihood of scaling
(a ``ceiling effect''), regression, and selection-maturation biases as
alternative interpretations of the results. [48] [49]
Effects of the intervention on diet and activity were less clear.
Compared with controls, children in the intervention group
significantly reduced the number of meals they reportedly ate in front
of the television set. There were no significant effects on reports of
snacking while watching television or intake of high-fat and highly
advertised foods. However, because snacking while watching television
was assessed as a proportion, even no change in this variable might
result in decreased energy intake as total viewing was decreased.
Epidemiological studies have found associations among hours of
television viewing and children's fat and energy intakes, [15] [50] and
experimental studies have shown that food advertising affects
children's snack choices and consumption. [51] [52]
Some epidemiological studies have found weak inverse associations
between hours of television viewing and physical activity [14] [18] and
fitness. [8] [16] Our intervention did not result in a significant
change in physical activity or cardiorespiratory fitness. However,
because only moderate- and vigorous-intensity activities were assessed,
it is also possible that reductions in television viewing resulted in
increased energy expenditure via more low-intensity activity. This is
consistent with the finding that reductions in television, videotape,
and video game use did not result in compensatory increases in other
sedentary pursuits. Larger experimental studies and improved measures
of diet and activity are needed to more definitively assess the
specific mechanisms that account for changes in adiposity in response
to reduced television, videotape, and video game use.
With a few exceptions, previous prevention interventions that have
attempted to increase physical activity and decrease dietary fat and
energy intake have been relatively ineffective at reducing body
fatness. [4] [5] In contrast, this intervention targeting only
television, videotape, and video game use produced statistically
significant and clinically significant relative changes in BMI, triceps
skinfold thickness, waist circumference, and waist-to-hip ratio over a
period of 7 months. These changes occurred over the entire sample,
shifting the entire distribution of adiposity downward. Even a small
shift downward in the population distribution of adiposity would be
expected to have large effects on obesity-related morbidity and
mortality. [53] Additional experimental studies with larger and more
sociodemographically diverse samples are needed to evaluate the
generalizability of these findings. However, this study indicates that
reducing television, videotape, and video game use may be a promising,
population-based approach to help prevent childhood obesity.
Funding/Support.--This work was funded by a grant from the American
Heart Association, California Affiliate, and by grant RO1 HL54102 from
the National Heart, Lung, and Blood Institute, Bethesda, Md. The study
was completed during the tenure of a Clinician-Scientist Award from the
American Heart Association.
Acknowledgment.--I thank Marta Luna Wilde, MA, Joel D. Killen, PhD,
Dina L. G. Borzekowski, EdD, K. Farish Haydel, Ann Varady, MS, Sally
McCarthy, and the students, teachers, and administrators who
participated in this project.
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[49] Cook TD, Campbell DT. Quasi-Experimentation: Design & Analysis
Issues for Field Settings. Boston, Mass: Houghton Mifflin Co; 1979.
[50] Taras HL, Sallis JF, Patterson TL, Nader PR, Nelson JA.
Television's influence on children's diet and physical activity. J Dev
Behav Pediatr. 1989;10:176-180.
[51] Gorn GJ, Goldberg ME. Behavioral evidence for the effects of
televised food messages on children. J Consumer Res. 1982;9:200-205.
[52] Jeffrey DB, McLellarn RW, Fox DT. The development of
children's eating habits: the role of television commercials. Health
Educ Q. 1982;9:78-93.
[53] Rose G. Strategies of prevention: the individual and the
population. In: Marmot M, Elliott P, eds. Coronary Heart Disease
Epidemiology: From Aetiology to Public Health. Oxford, England: Oxford
University Press; 1992.
______
[From the Archives of Pediatrics of Adolescent Medicine, Vol. 162 (No.
3), March 2008]
A Randomized Trial of the Effects of Reducing Television Viewing and
Computer Use on Body Mass Index in Young Children
(Leonard H. Epstein, PhD, James N. Roemmich, PhD, Jodie L. Robinson,
MA, MBA, Rocco A. Paluch, MA, Dana D. Winiewicz, Janene H. Fuerch, and
Thomas N. Robinson, MD, MPH)
[available on the web at: http://archpedi.ama-assn.org/content/vo1162/
issue3/index.dt1]
Objective.--To assess the effects of reducing television viewing
and computer use on children's body mass index (BMI) as a risk factor
for the development of overweight in young children.
Design.--Randomized controlled clinical trial.
Setting.--University children's hospital.
Participants.--Seventy children aged 4 to 7 years whose BMI was at
or above the 75th BMI percentile for age and sex.
Interventions.--Children were randomized to an intervention to
reduce their television viewing and computer use by 50 percent vs a
monitoring control group that did not reduce television viewing or
computer use.
Main Outcome Measures.--Age- and sex-standardized BMI (zBMI),
television viewing, energy intake, and physical activity were monitored
every 6 months during 2 years.
Results.--Children randomized to the intervention group showed
greater reductions in targeted sedentary behavior (P<.001), zBMI
(P<.05), and energy intake (P<.05) compared with the monitoring control
group. Socioeconomic status moderated zBMI change (P=.01), with the
experimental intervention working better among families of low
socioeconomic status. Changes in targeted sedentary behavior mediated
changes in zBMI (P<.05). The change in television viewing was related
to the change in energy intake (P<.001) but not to the change in
physical activity (P=.37).
Conclusions.--Reducing television viewing and computer use may have
an important role in preventing obesity and in lowering BMI in young
children, and these changes may be related more to changes in energy
intake than to changes in physical activity.
Trial Registration.--Clinical trials.gov Identifier: NCT00065052
introduction
Television viewing is cross-sectionally and prospectively related
to obesity in children.\1\ \2\ There is limited research assessing the
effect of reducing television viewing on the development of obesity.\3\
\4\ \5\ School-based interventions have shown that reducing television
viewing in third- and fourth-grade students slowed the increase in body
mass index (BMI) (calculated as weight in kilograms divided by height
in meters squared) \3\ and that reduction in television viewing was
related to success of a multicomponent obesity prevention program.\4\
Reducing television viewing in preschool children was associated with a
reduction in parent-reported television viewing, but no changes in BMI
were observed.\5\ Little research has involved children aged 4 to 7
years as they transition into their early school years.
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\1\ Dietz, WH, Jr; Gortmaker, SL. Do we fatten our children at the
television set? obesity and television viewing in children and
adolescents. Pediatrics. 1985;75(5):807-812.
\2\ Gortmaker, SL; Must, A; Sobol, AM; Peterson, K; Colditz, GA;
Dietz, WH. Television watching as a cause of increasing obesity among
children in the United States, 1986-1990. Arch Pediatr Adolesc Med.
1996;150(4):356-362.
\3\ Robinson, TN. Reducing children's television viewing to prevent
obesity: a randomized controlled trial. JAMA. 1999;282(16):1561-1567.
\4\ Gortmaker, SL; Peterson, K; Wiecha, J, et al. Reducing obesity
via a school-based interdisciplinary intervention among youth: Planet
Health. Arch Pediatr Adolesc Med. 1999;153(4):409-418.
\5\ Dennison, BA; Russo, TJ; Burdick, PA; Jenkins, PL. An
intervention to reduce television viewing by preschool children. Arch
Pediatr Adolesc Med. 2004;158(2):170-176.
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Reducing sedentary behavior could affect body weight by modifying
energy intake or energy expenditure in several ways. Television viewing
is related to consumption of fast food \6\ and foods and beverages that
are advertised on television.\7\ Viewing cartoons with embedded food
commercials can increase choice of the advertised item in
preschoolers,\8\ and television commercials may prompt eating.\9\ \10\
\11\ Television viewing or related sedentary behavior may prompt eating
by the association of these behaviors with eating, and television
viewing and related behavior may impair the development of satiety by
interfering with habituation to gustatory and olfactory cues.\12\ \13\
\14\ \15\ Reducing television viewing decreased energy and fat intake
in lean adolescents.\16\ Television viewing and related sedentary
behavior can compete with physical activity, lowering energy
expenditure.\11\ \17\ \18\ When sedentary behavior is reduced, children
may choose to engage in other sedentary behavior or to reallocate time
to be more physically active,\19\ \20\ \21\ \22\ although the
reallocation depends on child characteristics.\23\
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\6\ Taveras, EM; Sandora, TJ; Shih, MC; Ross-Degnan, D; Goldmann,
DA; Gillman, MW. The association of television and video viewing with
fast food intake by preschool-age children. Obesity (Silver Spring).
2006;14(11):2034-2041.
\7\ Utter, J; Scragg, R; Schaaf, D. Associations between television
viewing and consumption of commonly advertised foods among New Zealand
children and young adolescents. Public Health Nutr. 2006;9(5):606-612.
\8\ Borzekowski, DL; Robinson, TN. The 30-second effect: an
experiment revealing the impact of television commercials on food
preferences of preschoolers. J Am Diet Assoc. 2001;101(1):42-46.
\9\ Jeffrey, DB; McLellam, RW; Fox, DT. The development of
children's eating habits: the role of television commercials. Health
Educ Q. 1982;9(2-3):174-189.
\10\ Galst, JP. Television food commercials and pro-nutritional
public service announcements as determinants of young children's snack
choices. Child Dev. 1980;51(3):935-938.
\11\ Taras, HL; Sallis, JF; Patterson, PR; Nader, PR; Nelson, JA.
Television's influence on children's diet and physical activity. J Dev
Behav Pediatr. 1989;10(4):176-180.
\12\ Epstein, LH; Rodefer, JS; Wisniewski, L; Caggiula, AR.
Habituation and dishabituation of human salivary response. Physiol
Behav. 1992;51(5):945-950.
\13\ Epstein, LH; Paluch, R; Smith, JD; Sayette, M. Allocation of
attentional resources during habituation to food cues.
Psychophysiology. 1997;34(1):59-64.
\14\ Wisniewski, L; Epstein, LH; Caggiula, AR. Effect of food
change on consumption, hedonics, and salivation. Physiol Behav.
1992;52(1):21-26.
\15\ Temple, JL; Giacomelli, AM; Kent, KM; Roemmich, JN; Epstein,
LH. Television watching increases motivated responding and energy
intake in children. Am J Clin Nutr. 2007;85(2):355-361.
\16\ Epstein, LH; Roemmich, JN; Paluch, RA; Raynor, HA. The
influence of changes in sedentary behavior on energy and macronutrient
intake in youth. Am J Clin Nutr. 2005;81(2):361-366.
\17\ Buchowski, MS; Sun, M. Energy expenditure, television viewing
and obesity. Int J Obes Relat Metab Disord. 1996;20(3):236-244.
\18\ DuRant, RH; Baranowski, T; Johnson, M; Thompson, WO. The
relationship among television watching, physical activity, and body
composition of young children. Pediatrics. 1994;94(4 pt 1):449-455.
\19\ Epstein, LH; Valoski, AM; Vara, LS, et al. Effects of
decreasing sedentary behavior and increasing activity on weight change
in obese children. Health Psychol. 1995;14(2):109-115.
\20\ Epstein, LH; Saelens, BE; O'Brien, JG. Effects of reinforcing
increases in active behavior versus decreases in sedentary behavior for
obese children. Int J Behav Med. 1995;2(1):41-50.
\21\ Epstein, LH; Smith, JA; Vara, LS; Rodefer, JS. Behavioral
economic analysis of activity choice in obese children. Health Psychol.
1991;10(5):311-316.
\22\ Saelens, BE; Epstein, LH. The rate of sedentary activities
determines the reinforcing value of physical activity. Health Psychol.
1999;18(6):655-659.
\23\ Epstein, LH; Roemmich, JN; Paluch, RA; Raynor, HA. Physical
activity as a substitute for sedentary behavior in youth. Ann Behav
Med. 2005;29(3):200-209.
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The primary objective of this study was to determine the effects of
reducing television viewing and computer use on age- and sex-
standardized BMI (zBMI) changes in a sample of children aged 4 to 7
years who were at or above the 75th BMI percentile. Because BMI is
positively associated with chronic disease risk factors in children
\24\ and because childhood BMI predicts adult BMI,\25\ these young at-
risk children are an appropriate target group for prevention programs.
Secondary aims were to assess the effects of television viewing on
energy intake and on energy expenditure. The study was approved by the
Social and Behavioral Sciences Institutional Review Board at the State
University of New York at Buffalo.
---------------------------------------------------------------------------
\24\ Freedman, DS; Dietz, WH; Srinivasan, SR; Berenson, GS. The
relation of overweight to cardiovascular risk factors among children
and adolescents: the Bogalusa Heart Study. Pediatrics. 1999;103(6 pt
1):1175-1182.
\25\ Whitaker, RC; Wright, JA; Pepe, MS; Seidel, KD; Dietz, WH.
Predicting obesity in young adulthood from childhood and parental
obesity. N Engl J Med. 1997;337(13):869-873.
---------------------------------------------------------------------------
methods
Participants
Families were recruited through newspaper advertisements, flyers,
and direct mailings targeting families with children aged 4 to 7 years.
Inclusion criteria were a child aged 4 to 7 years at or above the 75th
BMI percentile for age and sex,\26\ participation in at least 14 hours
of television viewing and computer game playing per week in the primary
household, no medical conditions that prevented or interfered with
regular physical activity, unlimited access to television or
television-related sedentary activities, and family agreement to have
television monitoring devices (TV Allowance; Mindmaster Inc, Miami,
Florida) attached to every television and computer monitor in the home
for the duration of the study.
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\26\ Kuczmarski, RJ; Ogden, CL; Guo, SS, et al. 2000 CDC Growth
Charts for the United States: methods and development. Vital Health
Stat 11. 2002;246(246):1-90.
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Procedures
After completing a telephone screen, families attended an
orientation, and, if interested, parents read and signed the informed
consent and then completed a questionnaire that assessed the numbers of
televisions, television video game units, VCR and DVD players, and
computers in the home. Approximately 1 week later, a TV Allowance was
attached to each television and computer monitor in the home by a
research assistant (D.D.W. or J.H.F.), who recorded the numbers of
televisions and computers and their locations in the home. The TV
Allowance is an automated device that controls and monitors the use of
televisions or computer monitors, including television, video game
systems, DVD players, VCRs, and computers. The appliance was plugged
into the TV Allowance, the plug was locked in, and the device was
plugged into the wall. To turn on the television or computer monitor,
each family member used an individually selected 4-digit code. To
protect against the participating child watching television or playing
a computer game on other family members' time, the participating child
was not informed of the codes of other family members. If the child
learned the codes of another family member, these codes were changed.
The TV Allowance sums the minutes of use for each code to objectively
determine use of that device.
Baseline television and computer use was measured during a 3-week
period. Seventy families met eligibility criteria and were randomized
into intervention and control groups (Figure 1). Families were
recruited in cohorts, were stratified by child sex, and were randomized
by the study statistician (R.A.P.) in blocks of 2 without replacement
using a random number generator limited to 2 numbers. Group assignments
were provided to the project coordinator (J.L.R.).
Figure 1.--Overview of Study Flow
Study staff (D.D.W. and J.H.F.) set the weekly time budgets for
television viewing, computer use, and associated behaviors. Budgets
were reduced by 10 percent of their baseline amount per month for
children in the intervention group until the budget was reduced by 50
percent. When the budget was reached, the television or computer
monitor could not be turned on for the remainder of the week. Study
staff could set different amounts of time for each child in a
household, if desired, to reduce conflict if another child was not on
the program. Parents and non-participating family members could use
their code to watch television or to use computers without being on a
budget.
Children in the intervention group earned $.25 for each half hour
under budget, up to $2 per week. Parents were instructed to praise the
participating child for reducing television viewing and for engaging in
alternative behaviors. Decreases were also reinforced by a star chart.
At each home visit, a study staff member reviewed the star chart and
praised the child for the number of stickers earned. When the child
reached the 50 percent decrease at 6 months, the star charts were
discontinued, and changes were supported through monthly newsletters
and by parental praise for behavior change. The intervention group
received ideas for alternatives to sedentary behavior, a tailored
monthly newsletter with parenting tips to reduce sedentary behavior,
and information about how to rearrange the home environment to reduce
access to sedentary behavior. Children in the control group were
provided free access to television and computers and received $2 per
week for participating, independent of their behavior change. Control
families received a newsletter to provide parenting tips, sample praise
statements, and child-appropriate activities and recipes.
Measures
Television and computer time were measured using the TV Allowance.
Body mass index was calculated based on weight measured using a digital
or calibrated balance beam scale and height measured using a calibrated
stadiometer. The zBMI was calculated using age- (to the nearest month)
and gender-specific median, standard deviation, and power of the Box-
Cox transformation (LMS method).\26\ Physical activity was monitored
using an activity monitor (ActiGraph; ActiGraph, LLC, Pensacola,
Florida), a unidirectional accelerometer validated for children.\27\
\28\ \29\ Physical activity was recorded in 1-minute epochs on 3
randomly selected weekdays from after school until bedtime and all day
for 1 randomly selected weekend day. The mean counts per minute during
the 4 days was the measure of physical activity. Energy intake (in
kilocalories per day) was measured for the month before the assessment
using a validated \30\ 85-item food frequency questionnaire completed
by the participating parent. The numbers of televisions, computers, and
pieces of exercise equipment were measured by interviews with the
participating parent and child, as were the characteristics of the
neighborhood environment (including distance in miles to the nearest
park or playground, number of activities the child engaged in per week
in the neighborhood environment, and perceived safety of the
neighborhood on a scale of 1 to 5 [1, unsafe; 5, very safe]).
Socioeconomic status (SES) was measured using the Four Factor Index of
Social Status by Hollingshead,\31\ which provides a continuous measure
based on parental occupation and education.
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\27\ Pate, RR; Baranowski, T; Dowda, M; Trost, SG. Tracking of
physical activity in young children. Med Sci Sports Exerc.
1996;28(1):92-96.
\28\ Trost, SG; Ward, DS; Moorehead, SM; Watson, PD; Riner, W;
Burke, JR. Validity of the Computer Science and Applications (CSA)
activity monitor in children. Med Sci Sports Exerc. 1998;30(4):629-633.
\29\ Ekelund, U; Sjostrom M; Yngve, A, et al. Physical activity
assessed by activity monitor and doubly labeled water in children. Med
Sci Sports Exerc. 2001;33(2):275-281.
\30\ Blum, RE; Wei, EK; Rockett, HR, et al. Validation of a food
frequency questionnaire in Native American and Caucasian children 1 to
5 years of age. Matern Child Health J. 1999;3(3):167-172.
\31\ Hollingshead, AB. Four Factor Index of Social Status. New
Haven, CT: Yale University; 1975.
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Data Analysis Plan
t Tests and x \2\ tests were used to assess comparability of
groups. Mixed-effects regression models (MRMs) were used to assess
zBMI, television viewing, energy intake, and physical activity over
time. The MRMs do not assume compound symmetry but use separate
estimates of variance at each measurement, which is important because
variability often increases as follow-up is extended, and MRMs use all
available data.\32\ The models for targeted sedentary behavior, energy
intake, and physical activity included group, SES, and child age and
sex as time-invariant fixed effects, as well as a random intercept.
Child age and sex were excluded from the zBMI model because the zBMI
values were standardized for age and sex. The usual pattern of change
in behavioral studies is a decrease during the initial phases of
intervention, followed by maintenance of change or relapse. To capture
these patterns of change, linear (months) and quadratic (months
months) interactions with group were tested. Linear and quadratic
interactions with group were evaluated for improvement of fit for the
overall model by 2-tailed log likelihood tests using 2 df. If adding
the quadratic term did not improve the fit of the model, it was not
included to test the interaction of group months. Group months
interactions were explored by examining between-group differences from
baseline to 6, 12, 18, or 24 months.
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\32\ Hedeker, D; Gibbons, RD. Longitudinal Data Analysis. Hoboken,
NJ: John Wiley & Sons; 2006.
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Three families moved out of state during the 2-year measurement
period, so the primary analysis was based on 67 of 70 families (96
percent). Complete data were available for 66 of 67 families because 1
family withdrew before the 2-year follow-up, but all available data
were included in the MRM analysis. The primary analysis was based on
families who did not move because families who moved could not be
provided with the intervention, as it required implementation of the TV
Allowance and regular home monitoring. Intent-to-treat MRM analyses
were also completed, including the 3 families who moved.
The MRMs were used to evaluate moderators, mediators of outcome,
and nonspecific predictors.\33\ Moderators are baseline variables that
differentially predict outcomes of the groups and were evaluated by the
interaction of group potential moderator months (linear and
quadratic models as appropriate). Potential moderators included sex,
age, SES, energy intake, physical activity, baseline levels of targeted
sedentary behavior, and the numbers of televisions and computers in the
home and in the child's bedroom. Moderators were chosen to represent
baseline characteristics that could affect change but were not based on
specific theoretical hypotheses.
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\33\ Kraemer, HC; Wilson, GT; Fairburn, CG; Agras, WS. Mediators
and moderators of treatment effects in randomized clinical trials. Arch
Gen Psychiatry. 2002;59(10):877-883.
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Mediators are variables that differentially change between groups,
and the differential change is related to change in the dependent
variable. Only time-variant predictors that show between-group
differences can be considered mediators, and these were tested by the
interaction of group potential mediator months (linear and
quadratic models as appropriate).
Nonspecific predictors are baseline or time variant variables that
predict change in the dependent variable but do not interact with the
group. Nonspecific predictors included variables assessed as moderators
and mediators. The MRMs are particularly useful for studying mediators
or nonspecific predictors over time because the MRM allows for time-
variant (repeated) measures as independent and dependent variables.
The MRMs were used to estimate the elasticity between changes in
television viewing and physical activity or energy intake. Elasticity
is an economic construct that represents the relationships between
proportional changes in television viewing and physical activity or
energy intake. Elasticity coefficients are determined using log values
in the regression models.\34\ \35\ The finding of a statistically
significant positive relationship suggests that the 2 behaviors are
complements. For example, energy intake would be a complement to
television viewing and computer game playing if there was a
statistically significant positive relationship between the change in
television and computer use and energy intake. The finding of a
statistically significant negative relationship suggests that the 2
behaviors are substitutes. Physical activity would be considered a
substitute for watching television or playing computer games if
physical activity increased in association with a reduction in
television viewing and computer game playing.
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\34\ Epstein, LH; Raja, S; Gold, SS; Paluch, RA; Pak, Y; Roemmich,
JN. Reducing sedentary behavior: the relationship between park area and
the physical activity of youth. Psychol Sci. 2006;17(8):654-659.
\35\ Epstein, LH; Handley, EA; Dearing, KK, et al. Purchases of
food in youth: influence of price and income. Psychol Sci.
2006;17(1):82-89.
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Sample size estimates were based on research about the effects of
reducing sedentary behavior on BMI changes.\3\ We estimated that with
30 subjects per group we had 80 percent power to detect a standardized
effect size (Cohen d) of at least 0.23 at a 2-sided a level of .05 for
the primary outcome variable of zBMI using a repeated-measures analysis
of variance with 5 repeated measures (0, 6, 12, 18, and 24 months).
Analyses were performed using commercially available software (SYSTAT
11.0; Systat Software, Inc, Richmond, California).\36\
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\36\ Systat Software, Inc. SYSTAT 11.0. Richmond, CA: Systat
Software Inc; 2004.
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results
There were no statistically significant differences in baseline
characteristics among the participants (Table). Fifty-six of 70
children (80 percent) were above the 85th BMI percentile, and 31 of
them (44 percent) were above the 95th BMI percentile.
CHARACTERISTICS OF PARTICIPANTS
------------------------------------------------------------------------
Control Group Intervention
Characteristic (n=34) Group (n=36)
------------------------------------------------------------------------
Age, mean (SD), y....................... 6.1 (1.3) 5.8 (1.2)
Male to female ratio.................... 18:16 19:17
BMI (SD)................................ 19.1 (3.5) 19.3 (2.5)
Age- and sex-standardized BMI, mean (SD) 1.51 (0.57) 1.69 (0.58)
Television viewing and computer use, 26.1 (10.1) 24.2 (10.8)
mean (SD), h/wk........................
Physical acitivity counts per min, mean 783.5 (249.1) 757.0 (256.4)
(SD) \1\...............................
Energy intake per day, mean (SD), kcal.. 1,562.6 1,551.4
(474.0) (515.3)
Socioeconomic status, mean (SD) \2\..... 42.0 (13.0) 44.3 (10.6)
Minority race/ethnicity, No. (%) \3\.... 9/34 (27) 8/36 (22)
Home environment, No. (%):
Television.......................... 2.9 (1.4) 2.9 (1.2)
Computers........................... 1.0 (0.6) 1.1 (0.6)
Pieces of home exercise equipment, mean 1.4 (1.2) 1.8 (1.1)
(SD)...................................
Neighborhood environment, mean (SD):
Blocks to nearest park or playground 3.7 (2.8) 3.3 (2.2)
Activities per wk in the 6.6 (3.6) 6.4 (3.8)
neighborhood.......................
Perceived safety on a scale of 1 3.4 (1.5) 3.9 (1.2)
(safe) to 5 (dangerous)............
------------------------------------------------------------------------
Abbreviation: BMI, body mass index (calculated as weight in kilograms
divided by height in meters squared).
\1\ Based on accelerometer counts per minute.
\2\ Based on parental occupation and education.
\3\ Includes families of Hispanic, African American, Native American,
and multiple races/ethnicities.
In the control group, the mean (SEM) number of hours of television
viewing and computer games declined by -5.2 (11.1) hours per week at 24
months (Figure 2). In contrast, the mean (SEM) number of hours of
television viewing and computer games in the intervention group
declined by -17.5 (7.0) hours per week at 6 months and remained about
the same through 24 months (P<.001 for group months interaction).
Statistically significant between-group differences (P<.001) were
observed at 6 through 24 months.
Figure 2.--Reduction from baseline in targeted sedentary behavior
(television viewing and computer use) for the intervention and control
groups over time. A statistically significant difference in the rate of
change by group was observed (P<.001). Data are given as mean (SEM).
A statistically significant interaction of group x months was
observed for zBMI (P<.05), as zBMI decreased a mean (SEM) of -0.24
(0.32) at 24 months for the intervention group, while the control group
demonstrated a mean (SEM) zBMI increase of 0.05 (0.29) at 6 months, a
return to baseline at 12 months, and a gradual mean (SEM) zBMI decrease
of -0.13 (0.37) at 24 months after baseline (Figure 3). Statistically
significant between-group differences were observed from baseline to 6
months (P=.02) and 12 months (P=.03).
Figure 3.--Reduction in age- and sex-standardized body mass index
(zBMI) values relative to baseline for the intervention and control
groups over time. A statistically significant difference in the rate of
change in zBMI by group was observed (P<.05). Data are given as mean
(SEM).
Energy intake data showed a greater reduction for the intervention
group than for the control group (P<.05), with statistically
significant between-group differences from baseline to 18 months and 24
months (P=.047) (Figure 4). No statistically significant between-group
changes over time were observed for changes in physical activity, as
the control group demonstrated mean (SEM) changes in physical activity
counts per minute of 43.7 (302.2), 7.8 (316.9), -23.5 (262.4), and -
62.7 (189.7) at 6, 12, 18, and 24 months, respectively, while the
intervention group demonstrated mean (SEM) changes in physical activity
counts per minute of 36.2 (381.3), 63.7 (288.8), 111.8 (603.0), and
31.4 (275.4) at the same time points, respectively.
Figure 4.--Reduction in energy intake for the intervention and control
groups over time. A statistically significant difference in the rate of
change in energy intake by group was observed (P<.05). Data are given
as mean (SEM).
Socioeconomic status was a statistically significant moderator of
zBMI change (group xSES months; P=.01) (Figure 5). This effect was
explored by dividing the sample based on SES into 2 groups at the mean
SES and by examining changes in zBMI by group. For the low SES group,
statistically significant between-group differences were observed from
baseline to 6 months (P=.002), 12 months (P=.02), 18 months (P=.04),
and 24 months (P=.05), while no statistically significant between-group
differences in zBMI change were observed for the high SES group. Tele
vision and computer use mediated the effect of group on zBMI values
over time (group xtargeted sedentary behavior x months; P<.05).
Baseline zBMI was a nonspecific predictor of zBMI change (coefficient,
0.008; P<.001), with lower zBMI baseline values associated with greater
change. However, care should be used in interpreting the direction of
the relationship between baseline zBMI values and zBMI change over time
because of the distribution of zBMI values.\37\ Log changes in targeted
sedentary behavior were complemented by log changes in energy intake
(coefficient [SE], 0.10 [0.03]; P<.001), while physical activity was
not a substitute for targeted sedentary behavior (coefficient [SE], -
0.03 [0.03]; P=.37).
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\37\ Paluch, RA; Epstein, LH; Roemmich, JN. Comparison of methods
to evaluate changes in relative body mass index in pediatric weight
control. Am J Hum Biol. 2007;19(4):487-494.
Figure 5.--Change in age- and sex-standardized body mass index (zBMI)
values relative to baseline for the intervention and control groups
over time. A statistically significant difference in the rate of change
in zBMI by group for families divided into lower (A) and higher (B)
socioeconomic status (SES) was observed (P=.01). Data are given as mean
(SEM).
comment
This randomized controlled trial showed a statistically significant
and sustained reduction in television viewing and computer use that was
associated with decreases in zBMI for children whose BMI was at or
above the 75th percentile for age and sex. Results of the mediator
analyses suggest that zBMI changes were mediated by targeted sedentary
behavior changes. Our findings show that television viewing and
computer use can be modified in young children using behavioral
engineering technology that provides parental control over a child's
screen time budget while giving the child the opportunity to choose how
to spend this budget.
The trend for zBMI in the intervention group was a gradual
reduction during the 2 years of observation, while the control group
demonstrated an increase followed by gradual decreases. Differential
changes from baseline to 6 and 12 months were statistically
significant. The largest zBMI difference between groups was -0.19 at 6
months, which decreased to -0.13, -0.10, and -0.11 at 12, 18, and 24
months, respectively. Although the changes were modest, a small effect
of this simple and inexpensive intervention (approximately $100 for
each TV Allowance) magnified across the population may produce
important reductions in the prevalence of obesity and obesity-related
comorbidities.\38\
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\38\ Rose, G. Strategy of prevention: lessons from cardiovascular
disease. Br Med J (Clin Res Ed). 1981;282(6279):1847-1851.
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The changes in zBMI were moderated by child SES, with the
intervention working best for families of lower SES. Children from
families of higher SES showed reductions in zBMI whether they were in
the intervention group or the control group. Families of lower SES
showed large and sustained zBMI differences between the intervention
and control families throughout the 2 years of measurement of -0.17,
-0.20, -0.17 and -0.26 at 6, 12, 18 and 24 months, respectively. The
observation that the intervention worked better for families of lower
SES than of higher SES is important because children of low SES are at
greater risk of becoming obese adults than children of higher SES.\39\
\40\ Perhaps families of higher SES were more aware than families of
lower SES of information linking television viewing to weight in
children, and perhaps families of higher SES had the familial resources
and parenting skills needed to modify television viewing without use of
the TV Allowance. No differences in family characteristics between
groups of lower SES vs higher SES were found, including no differences
in the breakdown among families of minority races/ethnicities in the
lower (22.6 percent) and higher (22.2 percent) SES groups. Future re
search should explore differences between SES groups that may mediate
these effects.
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\39\ Parsons, TJ; Power, C; Logan, S; Summerbell, CD. Childhood
predictors of adult obesity: a systematic review. Int J Obes Relat
Metab Disord. 1999;23(suppl 8):S1-S107.
\40\ Janssen, I; Boyce, WF; Simpson, K; Pickett, W. Influence of
individual- and area-level measures of socioeconomic status on obesity,
unhealthy eating, and physical inactivity in Canadian adolescents. Am J
Clin Nutr. 2006;83(1):139-145.
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Changes in energy intake, but not changes in physical activity,
were differentially related to changes in the targeted sedentary
behavior. Reducing television viewing could affect energy intake by
minimizing cues to eat and by decreasing exposure to television
advertising.\6\ \7\ \8\ \9\ \10\ \11\ Patterns of change in energy
intake \16\ and physical activity \23\ were consistent with findings of
experimental research in which targeted sedentary behavior was modified
in older children. If the intervention works primarily by complementary
changes in energy intake, then youth who eat while watching television
would benefit more from the intervention. Previous research showed that
decreases in energy intake were not observed for youth who infrequently
ate in association with television viewing, while a decrease in energy
intake of more than 600 kcal was observed for youth who ate in
association with television viewing for at least 50 percent of their
eating episodes.\16\ Television viewing reduction technology can also
be used as part of a comprehensive obesity treatment program.\19\ \41\
The association of television viewing with eating supports the need to
explore the reduction of television advertising as a way to avoid
overeating and obesity in youth.\42\
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\41\ Epstein, LH; Paluch, RA; Gordy, CC; Dorn, J. Decreasing
sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc
Med. 2000;154(3):220-226.
\42\ Caraher, M; Landon, J; Dalmeny, K. Television advertising and
children: lessons from policy development. Public Health Nutr.
2006;9(5):596-605.
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The behavioral engineering technology of the TV Allowance may
simplify the modification of child television viewing. It is possible
that family rules regarding television viewing could have similar
effects, but there may be important differences in technology vs
parental control. Using technology to modify television viewing
eliminates parental vigilance needed to enforce family rules and
reduces the disciplinary action needed if a child exceeds his or her
sedentary behavior limits. Perhaps most important, the device puts the
choice of when to watch television in the child's control, as opposed
to a rule such as no television time until homework is completed.
Although the TV Allowance and family rules can reduce sedentary
behavior, there may be child differences in the perception of control
that may relate to intervention effectiveness.
The TV Allowance was placed on all televisions and computers in the
home. Without this technology, there would be additional parental
demands to monitor use, especially in the case of televisions in
children's bedrooms. Placement of a television in a child's bedroom may
increase the risk of obesity more than televisions in family spaces
\43\ and may make parental monitoring difficult.\44\
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\43\ Dennison, BA; Erb, TA; Jenkins, PL. Television viewing and
television in bedroom associated with overweight risk among low-income
preschool children. Pediatrics. 2002;109(6):1028-1035.
\44\ Robinson, JL; Winiewicz, DD; Fuerch, JH; Roemmich, JN;
Epstein, LH. Relationship between parental estimate and an objective
measure of child television watching. Int J Behav Nutr Phys Act. 2006.
[May 3, 2007]. p. e43. http://www.ijnpa.org/content/3/1/43.
---------------------------------------------------------------------------
The intervention used in children aged 4 to 7 years is applicable
to older children. It has previously been shown that the TV Allowance
can be used to reduce home television viewing and computer use among
older children and adolescents just as among younger children in the
present study.\3\ \16\ \45\ \46\ A major difference is that older
children may have more opportunities to visit friends and to accumulate
additional television viewing and computer use at friends' homes.
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\45\ Ford, BS; McDonald, TE; Owens, AS; Robinson, TN. Primary care
interventions to reduce television viewing in African-American
children. Am J Prev Med. 2002;22(2):106-109.
\46\ Robinson, TN; Killen, JD; Kraemer, HC, et al. Dance and
reducing television viewing to prevent weight gain in African-American
girls: the Stanford GEMS pilot study. Ethn Dis. 2003;13(1 suppl 1):S65-
S77.
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This study included children who were at or above the 75th BMI
percentile; therefore, the results cannot be generalized to the
prevention of at-risk children who were less overweight. Data on use of
the television and computer, such as to entertain children or for
educational purposes, may provide insight into how reducing television
and computer use moderated the effects of the intervention among
families of lower SES. There were limitations to the measurement of
television viewing and energy intake. The TV Allowance accumulates
television time until it is reset but does not provide downloadable
information about when the television is watched. Energy intake data
were collected using a food frequency questionnaire that assesses
eating during the past month. Food diaries would be more labor
intensive for subjects, but they would provide a detailed assessment of
how television viewing affects behaviors that influence energy balance
and body weight.
These results show that changes in the home environment may be
important targets for reducing BMI in children and that the home
environment as arranged by parents may contribute to the risk of
pediatric obesity.\47\ In addition to complementary changes in energy
intake that may accompany reductions in television viewing,\16\ an
environment in which parents provide easy access to fruits and
vegetables is related to children's fruit and vegetable
consumption,\48\ and parent and sibling models can maximize occasions
to teach healthy eating habits to young children.\49\ There may be
unique advantages to environmental manipulations that modify the shared
family environment, including television and computer use, in which
children develop positive behaviors that provide the basis for lifetime
good eating and physical activity habits and a healthy body weight.
---------------------------------------------------------------------------
\47\ Davison, KK; Birch, LL. Obesigenic families: parents' physical
activity and dietary intake patterns predict girls' risk of overweight.
Int J Obes Relat Metab Disord. 2002;26(9):1186-1193.
\48\ Baranowski, T; Cullen, KW; Baranowski, J. Psychosocial
correlates of dietary intake: advancing dietary intervention. Annu Rev
Nutr. 1999;19:17-40.
\49\ Harper, LV; Sanders, KM. The effect of adults' eating on young
children's acceptance of unfamiliar foods. J Exp Child Psychol.
1975;20(2):206-214.
---------------------------------------------------------------------------
Accepted for Publication. September 5, 2007.
Correspondence.--Leonard H. Epstein, PhD, Behavioral Medicine
Laboratory, Department of Pediatrics, School of Medicine and Biomedical
Sciences, State University of New York at Buffalo, Farber Hall, 3435
Main St, Room G56, Bldg 26, Buffalo, NY 14214-3000
([email protected]).
Author Contributions.--Study concept and design: Epstein, Roemmich,
and J. Robinson. Acquisition of data: Epstein, J. Robinson, Paluch,
Winiewicz, and Fuerch. Analysis and interpretation of data: Epstein, J.
Robinson, Paluch, and T. Robinson. Drafting of the manuscript: Epstein.
Critical revision of the manuscript for important intellectual content:
Epstein, Roemmich, J. Robinson, Paluch, Winiewicz, Fuerch, and T.
Robinson. Statistical analysis: Epstein and Paluch. Obtained funding:
Epstein and Roemmich. Administrative, technical, and material support:
Epstein, J. Robinson, Winiewicz, and Fuerch.
Financial Disclosure.--Dr. Epstein is a consultant to Kraft Foods.
Funding/Support.--This study was supported by grant DK63442 from
the National Institute of Diabetes and Digestive Diseases (Dr. Epstein)
and by the Behavioral Medicine Laboratory, Department of Pediatrics,
School of Medicine and Biomedical Sciences, State University of New
York at Buffalo (Dr. Roemmich).
Senator Brownback. One final question, and I'm not sure who
to ask this of, but if I'm recalling correctly on the
advertising area, the younger the person, the more susceptible
to being persuaded by the advertising. Therefore, there would
be some thought that you really want to guard the most the
youngest--that's six and under.
Mr. Martin. Sure.
Senator Brownback. Is that correct, Mr. Martin?
Mr. Martin. That's right. The Kaiser Family Foundation has
determined that children six and under are not really able to
distinguish between advertising and the programming itself. So,
they're obviously much more susceptible to the impact of
advertising.
And I would just add that, while, obviously, there are
always First Amendment concerns whenever you're talking about
any kind of restriction broadcasters are subject to a lesser
standard on First Amendment restrictions; it's only moderate
scrutiny instead of the strict scrutiny. And even for the paid
programming in the area of children's programming, the
Children's Television Act that Congress passed actually has
limits on paid programming. Children can be susceptible to
advertising and for this very reason, there is certainly a
compelling governmental interest to protect our children. I
think it could be narrowly tailored to address it. So, I'm not
convinced that there would be a prohibition on us taking
action.
Senator Brownback. Thank you.
Senator Harkin. Thank you very much.
Chairman Durbin.
PHYSICAL EDUCATION IN THE SCHOOLS
Senator Durbin. Dr. Gerberding, you talked a little bit
about physical activity, which is the other side of this
equation--nutrition, good food, and the amount of exercise and
activity that kids get. And I noticed, in your testimony, that
you have given grants to 23 States, $750,000 grants, to deal
with these issues of nutrition and physical activity. That
sounds like about $18 million, if I did my math correctly here.
And I noticed that, on the FTC proposal here, we find that
we're currently seeing expenditures of $185 million in schools
by these folks promoting food and such. So, it appears you're
being outgunned pretty dramatically here, 10 to 1, when it
comes to this, which I think puts you at a decided
disadvantage.
It reminds me, Chairman Harkin, of our battle against
tobacco, when we would put out a couple of public service
announcements, they would swamp us with Joe Camel.
But, let me ask you this. On the physical activity,
Illinois takes false pride in the fact that it's the only State
in the Nation that requires physical activity from kindergarten
through 12th grade. It's false pride, because I've seen it, and
it isn't what it should be. In high school, it's a joke. Two of
those years are driver's ed and driver's training, and high
school students, in 40-minute periods, are supposed to leave
the classroom, get into their tennis shoes or whatever it is,
exercise, and get back to the next class, all within 40
minutes. It doesn't work.
So, let me ask you about that aspect of it. Is there a
better way to approach this, in terms of encouraging physical
activity during the schoolday, that might be consistent with
all the testing that we're doing and all the other demands that
schools face?
Dr. Gerberding. Well, first of all, we need to learn more
about exactly how to do this well. And the school wellness
programs that were required in the agriculture bill have
required school districts to create plans for promoting fitness
and better nutrition in the schools. But, right now we don't
have any resource to evaluate where the best examples are and
how that really is playing out so that we can say, ``Here's the
best-case scenario. Do it this way and everyone will benefit.''
But, having said that, I think we have learned some best
practices. There's a wonderful Web site at CDC, where schools
can go. The problem is the competing priorities that the school
districts are experiencing. And when they put more money here,
it has to come out of some other part of their budget. And so,
the real strategy is, How can we do this efficiently at low
cost?
And some school districts have been able to figure this
out, with very little increase in the school budget. I visited
a school in Titusville, Pennsylvania, where every child in the
school has what I would consider to be an optimal exercise
program, and they were able to incorporate that by clever
changes in scheduling and rearranging the way students move
from one classroom to another, et cetera. So, it can be done,
but we've got to accelerate the pace. And I think we need to
require it.
Senator Durbin. One of the charter schools in Chicago has
what they call ``walking school buses,'' where they have some
parents who take on the responsibility of rounding up kids in a
neighborhood and walking to school, picking up other kids on
the way so that they actually do walk to school instead of send
the buses out. But, that--that works in a city, it wouldn't
work in a rural area in--necessarily, in Iowa or Illinois.
Dr. Gerberding. It doesn't work in January, either.
Senator Durbin. No, it--true. The weather can be a real
problem with that, as well.
Mr. Martin, what about this embedded product advertising--
Seinfeld's Junior Mints and things like that--what are we doing
about that, in terms of products that pop up in television
shows that kids are going to spot and obviously the advertisers
or the people making the product believe might be of some value
in marketing?
Mr. Martin. The Children's Television Act actually has
limits on the ability of embedding advertising in the program.
There is actually a requirement to have a bumper between the
programming and any commercials on children's programming. So,
on the children's side, actually that issue is addressed.
There is the issue of product placement that is occurring
in commercial programming, just in general, even as targeted
for adults, in large part because of the changes in the way the
media companies are selling their product. They no longer have
as much advertising revenue because of the way people are
recording their programs and then fast-forwarding through some
of the commercials. So, they are embedding more of those. We
have certain rules and requirements about the way that
advertising is supposed to be disclosed, so consumers are
aware, at the end of the program, that these certain products
were paid to be placed, although the Commission has been
investigating whether or not those companies are complying with
those rules and/or whether we need to update our rules, as that
is becoming more and more of a prevalent practice.
Senator Durbin. The chairman asked Mr. Leibowitz about FTC
rules and how they've changed when it came to advertising for
children. It seems to me that there are some real parallels
between our debate that's going on in another part of the
Capitol now, about regulation in the banking industry, and what
happened when we removed it and let the free market work its
will, and we find ourselves in a pretty dangerous situation
today. Do you feel that we've gone too far when it comes to
reducing the role of the Federal Communications Commission,
when it comes to program content and advertising on issues like
this?
Mr. Martin. I've certainly been concerned about many of the
different content issues as it relates to the role of
protecting our children, whether it is talking about indecent
content, violent content, or content that relates to healthy
foods. I worked with my colleagues, and we made a
recommendation to Congress, in part to respond to Senator
Rockefeller's concern, about violent programming about what
Congress could do to help restrict violent programming.
I think that we do need to be more concerned about that,
particularly in an environment in which families are asked to
contribute to, and pay for, these ever-larger and ever-
increasing packages of channels that have programming that they
may not want, but yet we are still forced to subsidize and pay
for. I think that if we really wanted to have a free-market
solution, we would allow people to pick and choose the channels
they wanted, and then their choices would have economic meaning
so that you could tell families, ``If you don't like what's
going on, on this particular children's programming, then you
should not subscribe to it any longer,'' and that would have an
impact on both their advertising and on their subscription
dollars.
Today, those are not meaningful choices, because you're
forced, as a family, to pay for those channels anyway. So,
without an implementation of a true market mechanism to allow
families to pick and choose the channels they want through an
a-la-carte system, to be able to opt out of channels that they
object to, then I do think there needs to be some kind of
standard that is applied to the channels that are included in
those packages.
Senator Durbin. And, just for the record, can you tell why
there's resistance to your idea?
Mr. Martin. Well, there is tremendous resistance to that
idea from all of the media companies, because of the
significant amount of money they receive, from their
subscription revenues. As I said, families are required to pay
for channels, even if they object to them. And as a result they
are not able to send an adequate market message. This is a
concern for families that are concerned about violence, that
are concerned about potentially indecent content, and also
about these unhealthy food products. So, I think that that
would be the market solution. But, in the absence of the
ability for families to make meaningful choices and have those
choices have economic meaning, then I think that there should
be some kind of standard.
Senator Durbin. Thanks.
Thanks, Mr. Chairman.
Senator Harkin. Thank you very much, Chairman Durbin.
And thank you all very much. I thank the first panel. We
have a vote coming up here at noon, so I'm going to have to
dismiss this panel and bring our second panel up. But, thank
you very much. Thanks, Dr. Gerberding.
All right, we'd call our second panel up, and that would be
J. Michael McGinnis, M.D., from the Institute of Medicine; Marc
Firestone, executive vice president, corporate and legal
affairs, general counsel, Kraft Foods; Marva Smalls, executive
vice president and chief of staff, MTV Network----
Again, I'm sorry, I was--the last person, I had not
introduced, was Patti Miller, vice president of the Children
and the Media, Children NOW. And, again, as I said to the first
panel, all of your statements will be made a part of the record
in their entirety, and I will start, as I did the list--first,
Dr. McGinnis, Mr. Firestone, Ms. Smalls, Ms. Miller--in that
order.
And if you could just give us a brief summary of your
testimony, I'd appreciate that.
And we'll start with Dr. McGinnis--thank you very much for
being here, Dr. McGinnis--from the Institute of Medicine.
STATEMENT OF J. MICHAEL McGINNIS, M.D., MPP, INSTITUTE
OF MEDICINE, WASHINGTON, DC
Dr. McGinnis. Thank you very much, Chairman Harkin. Thank
you very much, Senator Brownback.
And I'd like to begin with a note of thanks to the
committees for sponsoring the attention on this issue. It's
clearly an important question and challenge for the Nation, and
I'm pleased to be here to speak to you in my capacity as the
chair of the study committee that you initiated, the Study
Committee for the Institute of Medicine on Food and Marketing
and the Diets of Children and Youth.
This report, ``Food and Marketing, Children and Youth:
Threat or Opportunity,'' was issued as a result of that study
in December 2005, and I would like, briefly, to touch on just
three items and submit, as you suggested, the full text of the
testimony for the record.
First item is to review, quickly, the key elements of those
2005 report findings; secondly, to mention the many positive
developments, in brief, that have transpired since the release
of that report; and the third is to note the status, as of
September 2008, vis-a-vis the recommendations in that report.
On the first issue, the key elements of our report, we were
charged with reviewing, literally, the world's literature on
the relationship between food marketing and the diets of
children and youth, and the first lesson of our findings was
that marketing works. It clearly does. And I'll come back to
that in a second.
The second key element was that the dominant focus of
marketing to children is on foods that are high in calories and
low in nutrients.
And the third is that marketing itself is changing, and
changing rather dramatically. It is a moving target.
With respect to the first charge, we reviewed over 2,000
articles, and reviewed extensively, with a rigorous analytic
framework, the 123 that met our standards of evidence, and we
found, quite clearly, that there's a strong causal relationship
between marketing practices and the food preferences, purchase
requests, and short-term consumption of dietary food products.
There was, we found, a statistical association between
marketing and the prevalence of obesity, but not a causal
relationship, because the timeframe of the studies that we
assessed was too short to identify a causal relationship.
We also note that marketing works, not only with respect to
the relationship to adverse dietary patterns, but also that
marketing can work positively in a sustained social marketing
context.
With respect to the dominant focus of marketing of food
products on foods that are high in calories and low in
nutrients, we did an independent analysis, for example, of the
recent products, in the decade prior to the report, that were
introduced into the market, found the slope for those products
that were high in calories and low in fats targeted to children
to be much greater than for the rest of the food supply.
Thirdly, to emphasize the fact that marketing, itself, is
changing. With the notion of advergames, Internet, the combined
marketing strategies that Mr. Leibowitz mentioned, quite
clearly we have a very different and rapidly changing marketing
environment which requires ever more vigilance to its impact
and its strategies.
In essence, what we found was that the subtitle here,
``Threat or Opportunity,'' the answer is: both. It's both a
threat, but it is an opportunity, and it's the opportunity
piece that we need to focus on, I think, more extensively in
the time ahead.
To some extent there have been a number of positive actions
undertaken since the release of the report. Mr. Chairman, you
and Senator Brownback both mentioned some of those. The work of
the Council of Better Business Bureaus, several food company
initiatives, the American Beverage Association, some of the
cartoon character producers, both the FTC and the FCC
initiatives that you've heard about, HHS and USDA have had ad
hoc activities that are positive in this domain, and that
you've mentioned also; the Robert Wood Johnson Foundation
committed about half a billion dollars to the arena.
It is clear that there is interest and activity in this
domain, but the question is the extent to which the actions
have translated into progress, or when they will translate into
progress. And that gets me to the last point I want to
underscore, and that is, the assessment of the extent of
progress as of today. And our take on the ten recommendations
that were included in our report--and this is a matter of
personal opinion, because they--we have not subjected them to
systemic analysis, so I have to underscore, this is my personal
opinion--is that, for the most part, there has been relatively
limited progress; at best, the progress has been positive in
the general sense, but there are a few areas in which it's
actually reversed.
Just quickly, the ten areas of our recommendations ranged
from the policies of individual food and beverage companies,
the commercial meal establishments, the trade associations that
are crosscutting standards that are applied to food and
beverage products, and the media and entertainment industries.
Those are, sort of, half of the recommendations that focused on
industry practices. The remaining half focused on potential
government actions, including the potential establishment of a
sustained public/private social marketing effort, the policies
related to marketing in schools, the issues available--levers
available to government at all levels, such as the one that you
mentioned on fruits and vegetable promotion, as well as a
variety of other possible government actions; the research
capacity--expanding the research capacity to understand how
these marketing influences work; and finally, the monitoring
issue.
PREPARED STATEMENT
In the review of the progress--and I'll mention this in the
last 10 seconds--we found that much of the progress that's been
undertaken have been more in the category of individual
actions, actions that are, for the most part, ad hoc and
fragmented, and some of them even counterproductive in their
net effect. Without slighting the solid efforts of the Council
on Better Business Bureaus and those of individual companies,
or even the efforts of individual agencies in government, it's
very clear that as long as the efforts are as fragmented as
they are, as long as they are relatively unsupervised and they
aren't part of a broader strategy, we're going to fall short of
meeting that opportunity.
Thank you, Mr. Chairman.
[The statement follows:]
Prepared Statement of J. Michael McGinnis
Good morning, Chairman Harkin, Chairman Durbin, and members of the
subcommittees. I am Dr. Michael McGinnis, Senior Scholar and Executive
Director of the Roundtable on Evidence-Based Medicine at the Institute
of Medicine (IOM) of the National Academies in Washington, DC. Thank
you for your kind invitation to appear before this joint subcommittee
hearing.
First a word about the Institute of Medicine, which is my current
employer but my responsibilities lie outside this arena, and I am
appearing here as an individual expert to address issues related to my
prior responsibilities as an IOM committee chair. Established in 1970
under the Congressionally-granted Charter of the National Academy of
Sciences, the IOM provides independent, objective, evidence-based
advice to policymakers, health professionals, the private sector, and
the public. That advice is developed through committees comprised of
leading national and international experts from relevant fields
convened by the IOM to conduct rigorous reviews of problems at hand. I
join you today in the context a previous capacity, as Chair of the IOM
Committee on Food Marketing and the Diets of Children and Youth. Our
Committee produced the 2005 report, Food Marketing to Children and
Youth: Threat or Opportunity? I appreciate the opportunity to speak to
the findings of that report, the activities it has helped catalyze, and
the current state of play in the field. Most of my comments will be
oriented to matters of fact or interpretation of findings and
recommendations from the report, and I will be clear when opinions
expressed are personal and based solely on my individual expertise.
Against the backdrop of pressing public concern over the rapid and
widespread increase in the prevalence of childhood obesity, Congress,
in the fiscal year 2004 appropriation, directed the Centers for Disease
Control and Prevention (CDC) to undertake a study of the influence of
food and beverage marketing on the diets and health of children and
youth. The CDC requested that the IOM undertake the study, and the
Committee on Food Marketing and the Diets of Children and Youth was
formed. The committee charge included exploring what is known about
current food and beverage marketing to children and youth in the United
States, the scientific evidence on the relationship between these
marketing practices and the diets and health of children and youth, and
the strategies that have been, or could be, used to promote healthful
food and beverage choices among children and youth.
The committee's report on Food Marketing to Children and Youth was
released in December 2005 and published in 2006. It is one of several
recent IOM examinations of various aspects of childhood obesity
prevention, most notably Preventing Childhood Obesity: Health in the
Balance, Congressionally mandated and published in 2005, and Progress
in Preventing Childhood Obesity: How Do We Measure Up? published in
2007. Each highlights, from different perspectives, the urgent need for
attention to obesity in children and for multi-sectoral approaches to
addressing it.
Befitting the breadth of the topic, the food marketing committee
was comprised of experts of unusually varied disciplines, experience,
and perspective. The 16 members brought to the committee expertise not
only in child and adolescent development, epidemiology, public health,
and nutrition, but also in food production, marketing, children's
television, causal reasoning, constitutional law, and business ethics.
The Food Marketing report represented the most comprehensive review
undertaken of the scientific literature on the influence of marketing
on the diets of children at that time--and remains so today. In
conducting the study, the committee developed and applied a rigorous
analytic framework to the systematic review of the relevant scientific
literature. We also undertook an extensive review of the nutritional
status of and trends for children and youth, what is known about the
full range of factors that influence the dietary patterns of this
population, the broad and evolving food and beverage marketing
environment, and the policy measures that might improve the nutrition
of young people. Since our report was published, the continuing
improvement in identifying and understanding the influences of
marketing on diets of children and youth, is encouraging and a
reflection of the importance of this subject.
What did we find? In short, we found that marketing works. First,
we found that there is strong evidence that television advertising of
foods and beverages has a direct influence on what children choose to
eat. Second, the dominant focus of food and beverage marketing to
children and youth is for products high in calories and low in
nutrients, and this is sharply out of balance with healthful diets.
Third, marketing approaches have become multifaceted and sophisticated,
moving far beyond television advertising to include the Internet,
advergames, strategic product placement, and much more.
We also found that turning around the current trends in children's
diets and in marketing will require strong and active leadership and
cooperation, from both the public and private sectors. Industry
resources and creativity must be harnessed on behalf of healthier diets
for children. The food industry needs to be a substantial part of the
solution to a problem to which it has been a contributor. The committee
had limited access to proprietary marketing research, which might have
shed additional light on some of the research and marketing patterns
and strategies for child- and youth-oriented foods and beverages. Hence
the importance of the focus of today's hearing and the work of the
Federal Trade Commission.
The 2005 IOM Food Marketing report presented recommendations for
different segments of society to guide the development of effective
marketing strategies that promote healthier food, beverage, and meal
options to children and youth. Recommendations were also offered for
research necessary to chart the path of future improvements, and the
capacity to monitor and track improving in marketing practices that
have an influence on children's and youth's diets and diet-related
conditions.
With respect to strategy, one thing is very clear: the turnaround
required is so substantial, and the issues are so complex, that the
full involvement and leadership of food and beverage industries is
essential. The report identified a number of ways in which food,
beverage, and restaurant companies, food retailers, and advertising and
marketing firms can and should shift their child- and youth-oriented
product development and marketing. It also suggested ways they can and
should work with government, scientific, and public health groups to
develop and enforce marketing standards for healthful foods and for
marketing of products, to develop and implement an empirically tested
rating system and graphic representation for front of package labeling,
to develop a way to access propriety data, and to develop and implement
a sustained public-private cooperative social marketing effort aimed at
achieving better diets among our children. The report recommended that
Congress consider legislative mandates, should voluntary efforts fail
to shift the emphasis of television advertising to healthier products.
Since the release of our report, a number of interesting and
important developments have occurred which hold promise for progress in
improving the influence of marketing on children's diets. Several
individual food companies have committed to alter their marketing
practices in various ways to give greater emphasis to children's
products that are lower in calories and higher in nutrient density;
Disney, Nickelodeon, and the Cartoon Network all have announced some
limitations in licensing of their cartoon characters for use in
marketing to children; the soft drink industry announced cessation of
soda sales in elementary schools, with phased extension of that policy;
the industry-wide voluntary self-regulatory guidelines administered by
the Children's Food and Beverage Advertising Initiative were
strengthened and expanded; the American Academy of Pediatrics called
for rigorous standards on marketing food a beverages to children; in a
settlement with CSPI, Kellogg's agreed to stronger standards in
marketing healthier products; the Kaiser Family Foundation released the
most comprehensive survey to date of the magnitude and trends for food
advertising to children and youth; and the Federal Trade Commission
undertook its study on food marketing and industry practices, and
discussions here in Congress have included consideration of ways for
the FTC to engage standards for foods marketed to children. Outside of
the marketing arena, but important to overall progress is the pledge by
my former colleagues at the Robert Wood Johnson Foundation to commit
over $500 million in the coming years to combating childhood obesity.
These are all important developments. Still, as noted in the 2007 IOM
report Progress in Preventing Childhood Obesity: How Do We Measure Up?,
they are just beginnings and the fundamental gains for children are
still to be realized.
Challenges of the scope and potential national impact of obesity in
general, and childhood obesity in particular, require aggressive
government leadership, hence our Committee recommendations that
government explore the various incentives it has available to:
encourage and reward companies that develop and promote healthier
products for young people; use marketing resources in social marketing
for healthier lifestyles for children; and develop the type of
monitoring capacity required for a health challenge of this magnitude.
On the monitoring activity, we specifically recommended that the
Secretary of Health and Human Services, in consultation with other key
officials, designate an agency to monitor the progress of various
entities in doing their part to promote more healthful diets, and
report to Congress on the progress made and needed actions. To our
knowledge, that recommendation, among others, has yet to be addressed.
At the end of this statement is a list of our 10 Committee
recommendations \1\ with an informal status assessment. I emphasize
that this is my personal and preliminary view, offered without benefit
of the rigorous and regular scrutiny warranted for an issue of this
importance.
---------------------------------------------------------------------------
\1\ The recommendations are summarized at http://www.iom.edu/CMS/
3788/21939/31330/31337.aspx.
---------------------------------------------------------------------------
In summary, there is substantial and compelling concern about the
prospects for future health gains if the epidemic of obesity is not
reversed, beginning with its disturbing presence among children--our
Nation's future. This is a matter of truly compelling urgency, and
requires sustained and intense attention befitting any epidemic of
potentially widespread and generation-changing lethality. We thank you
for the attention and emphasis that you and your colleagues are drawing
to this issue, and hope that it will help catalyze the changes
necessary to transform the current threats into future opportunities.
That concludes my statement. Thank you again for the opportunity to
appear before you today, and for your leadership on this vital issue
for the health of Americans--now and in the years to come. I would be
happy to address any questions you may wish to ask.
food marketing to children and youth
2008 status of recommendations in the 2005 iom report
Food and beverage companies should use their creativity, resources,
and full range of marketing practices to promote and support more
healthful diets for children and youth.\2\
---------------------------------------------------------------------------
\2\ Note for emphasis: This status summary reflects personal and
preliminary opinion, offered without benefit of the rigorous, regular,
and formal scrutiny warranted for an issue of this importance. JMM.
---------------------------------------------------------------------------
--2008 Status.--Limited progress, initiatives beginning. The
components of this recommendation include shifting portfolio
balance toward more healthful products; reversing marketing
emphasis in child- and youth-oriented products so that
healthful products predominate; public-private collaboration to
develop industrywide rating system and graphic representation
for child- and youth-oriented products; and marshal marketing
capacity for broad promotion of healthier foods and beverages.
Activities such as those underway through the Council of Better
Business Bureaus (CBBB) pledge program represent incentives for
positive movement, and there may be some increase in
development and marketing more healthful products. But we are
far short of a reversal in the balance. The plethora of rating
systems and graphic representations continues, potentially
adding to consumer confusion. Despite ongoing discussion of the
issue through the Keystone dialogue process on common labeling
approaches to healthful products, the utility for children's
products is unclear and neither government nor industry has
specifically identified addressing this issue as a priority.
Full serve restaurant chains, family restaurants, and quick serve
restaurants should use their creativity, resources, and full range of
marketing practices to promote healthful meals for children and youth.
--2008 Status.--Very limited progress, growing interest and focus.
The components of this recommendation include expanding
healthier options for children and youth in commercial meal
establishments, and providing key nutrition information at the
point of choice and use. A number of national chains are
conducting research and experimenting with approaches, and
several States and localities have initiated legislative or
regulatory efforts on restaurant menu labeling, which may step
up the pace.
Food beverage, restaurant, retail and marketing industry trade
associations should assume transforming leadership roles in harnessing
industry creativity, resources, and marketing on behalf of healthful
diets for children and youth.
--2008 Status.--Very limited progress. The components of this
recommendation include trade association leadership and
technical assistance for the initiatives of individual
companies to develop creative approaches to healthful product
lines, marketing strategies, and public-private partnerships.
Although effects are still to be determined, the American
Beverage Association initiated certain member efforts to shift
sales and marketing efforts in schools. The Grocery
Manufacturers Association has been focused, appropriately, on
food safety issues, leaving leadership on healthful content
largely to the initiative of individual companies. And the
National Restaurant Association has opposed menu labeling
initiatives. To date, none has worked to spearhead the
collaborative development of the sort of sustained social
marketing effort noted in recommendation #6.
The food, beverage, restaurant, and marketing industries should
work with government, scientific, public health, and consumer groups to
establish and enforce the highest standards for the marketing of foods,
beverages, and meals to children and youth.
--2008 Status.--Some progress, pending assessment. The components of
this recommendation include work of the Children's Advertising
Review Unit (CARU) to strengthen self-regulatory guidelines;
eliminate of use of licensed cartoon characters for products
other than those that promote healthful diets; and FTC-CARU
cooperation on guideline monitoring and enforcement.
Advertising guidelines have been strengthened, and the joint
FTC/HHS conference and Better Business Bureau initiatives
report progress in reducing advertising to children. Impact on
broader marketing strategies is unclear. Other efforts, such as
the FCC-sponsored task force on food marketing to children have
not yet reported their progress. Announcement by Disney,
Nickelodeon, and the Cartoon Network to impose limitations of
their cartoon characters in marketing high calorie/low nutrient
foods to children represents progress that needs evaluation.
The media and entertainment industry should direct its extensive
power to promote healthful foods and beverages for children and youth.
--2008 Status.--No apparent progress. The components of this
recommendation include incorporation of promotion of healthful
foods through multiple media platforms, and close scrutiny and
reporting by news organizations of the activities of public and
private organizations on the level of effort in executing
responsibilities and engaging opportunities. Information is not
available on the trends on either dimension.
Government, in partnership with the private sector, should create a
long-term, multifaceted, and financially sustained social marketing
program supporting parents, caregivers and families in promoting
healthful diets for children and youth.
--2008 Status.--Some reversal of progress, with respect to the notion
of a sustained public-private effort. The components of this
recommendation include development of a mechanism for a
sustained public-private support stream for long-term social
marketing efforts to improve the diets and activity patterns of
children and youth; draw upon the marketing research and
expertise accumulated by industry to shape strategies; give
initial emphasis to skills building for parents and caregivers
of young children. Although there are notable ad hoc activities
under way (e.g. HHS and Advertising Council initiatives, Small
Steps obesity prevention campaign, America on the Move,
Alliance for a Healthier Generation, Action for Healthy Kids),
no government agency, company, association, or philanthropic
organization has taken the initiative to create the public-
private vehicle necessary for sustained conduct of the long-
term strategic social marketing necessary for progress against
the epidemic. In fact, public funding has ceased for the Verb
Campaign of the Centers for Disease Control and Prevention,
which showed some initial success in promoting physical
activity among young teens.
State and local educational authorities, with support from parents,
health authorities, and other stakeholders, should educate about and
promote healthful diets for children and youth in all aspects of the
school environment (e.g., commercial sponsorships, meals and snacks,
curriculum).
--2008 Status.--Some progress. The components of this recommendation
include implementation of nutrition standards for the school
environment; promotion of more healthful foods in schools; and
prominent leadership by all levels of public and private sector
influence over school environments. Amendments through Public
Law 108-265 to the Richard Russell National School Lunch Act
and the Child Nutrition Act of 1966 have established a basis
from which substantial changes can be made in the influence of
school meals and school centered initiatives on children's diet
and health, although effecting those changes has not received
the top to bottom emphasis necessary. A 2007 IOM report focused
on nutrition standards for food in schools, has been adopted
and used in several States, and both CDC and USDA are working
on related best practices for wider dissemination. Many
industry marketing practices in schools are undergoing
revision.
Government at all levels should marshal the full range of public
policy levers to foster the development and promotion of healthful
diets for children and youth.
--2008 Status.--Little apparent progress, despite some increase in ad
hoc public education campaigns (see #6). The components of this
recommendation include government incentives (e.g. subsidies,
tax policies, awards) to promote availability and family use of
fruits and vegetables; USDA use of school and other low-income
food programs to promote healthier meals, and Congressional
legislation on children's television advertising if industry-
led initiatives do not turn around the marketing emphasis.
Increased focus on school meals, as well as nutrition standards
for other USDA food programs, but little information available
on current status and trends; reliable updated information is
also not yet available on which Congress might base legislation
on children's broadcast and cable television advertising; and
economic incentive programs are not yet widely in place to
increase fruit and vegetable consumption.
The Nation's formidable research capacity should be substantially
better directed to sustained, multidisciplinary work on how marketing
influences the food and beverage choices of children and youth.
--2008 Status.--No apparent progress. The components of this
recommendation include expanded research capacity to learn more
about the ways marketing influences children's attitudes and
behaviors, especially related to new and emerging multifaceted
marketing strategies; and development of a means for commercial
marketing research to be made available as a publicly-available
resource for the design of broad social marketing strategies
targeting diet and activity patterns of children and youth.
Little research capacity has been developed to assess either
the broader impact of new media marketing strategies, or the
targeted impact on children's diets. No government agency,
company, association, or philanthropic organization has taken
the initiative to create the public-private vehicle necessary
for the receipt, mining, and application of insights of
commercial marketing research on behalf of strategies for pro-
social marketing on children's diets and activity patterns.
The Secretary of the U.S. Department of Health and Human Services
(HHS) should designate a responsible agency, with adequate and
appropriate resources, to formally monitor and report regularly on the
progress of the various entities and activities related to the
recommendations include in this report.
--2008 Status.--No apparent progress. The components of this
recommendation included consultation by the HHS Secretary with
counterparts from USDA, Education, FTC and FCC to develop
monitoring and reporting on progress on findings and
recommendations of the report, and issuance by December 2007 of
a report to Congress on the progress. Public knowledge is not
available to indicate that a formal collaborative effort of
this sort has been undertaken, nor has the report to Congress
been submitted.
Senator Harkin. Thank you very much, Dr. McGinnis.
I'm sorry the way--the seating arrangement--but the way
it's lined up here is, next we turn to Mr. Firestone, executive
vice president of corporate and legal affairs of Kraft Foods.
Then we'll go to Ms. Smalls and to Ms. Miller.
STATEMENT OF MARC FIRESTONE, EXECUTIVE VICE PRESIDENT,
CORPORATE AND LEGAL AFFAIRS, AND GENERAL
COUNSEL, KRAFT FOODS, NORTHFIELD, ILLINOIS
Mr. Firestone. Good morning, Mr. Chairman and Senator
Brownback. Thank you so much for the privilege to appear before
you today and to give me a chance to thank both of you
personally for the tremendous and engaging leadership you've
shown on behalf of the children of this country and their
health and well-being.
Childhood obesity is, indeed, a serious public health
issue, and it's one for which there's no simple answer. As
experts, including IOM, have emphasized, we need a national
effort that is comprehensive in scope, with active, coordinated
participation by government and communities, the food and
beverage industry, the entertainment and media industry,
schools, and parents.
The consistent recommendation by experts for action
specifically by food companies has been to change the mix of
advertising to children to emphasize better-for-you choices and
more physical activity. And, in that spirit, I'd like to share
examples of what Kraft has been doing.
In 2003, we announced a worldwide initiative that focused
on product nutrition, consumer information, marketing
practices, and public policy engagement. Then, in 2005, Kraft
took a bold step when it created what has become a model for
limiting children's advertising. We announced that we would no
longer advertise products that don't meet our better-for-you
nutrition criteria in mass media primarily directed to children
under the age of 12.
As a result, we stopped advertising many well-known, well-
loved products to kids. It wasn't an easy decision for the
company's management to take, but we heard, loud and clear from
policymakers and consumers alike, that among the dozen or so
actions that society should take to address this issue,
changing food advertising was the one most directly under our
control. Other food companies have since adopted a similar
approach under the auspices of the Council of Better Business
Bureaus. We were pleased to be a founding member of this
initiative, and applaud the progress that's taken place in the
last year and a half.
In addition, Kraft created the portion-controlled 100-
calorie packaging that is now common throughout the industry,
and we were the first to use dual-column nutrition labeling on
small packages with multiple servings.
The FTC's recent report on food marketing recommended
several important next steps, many of which Kraft already has
in place. For example, we don't engage in product placement in
children's media or in any in-school marketing.
Further, Kraft is participating with other food companies
in a Keystone Roundtable to develop uniform nutritional
criteria and labeling for better-for-you products.
To conclude, I'd like to share Kraft's perspective on the
overall effort to address youth marketing and childhood
obesity.
First, we view self-regulation as a means to an end, not an
end unto itself. Voluntary action by industry can, indeed, be
effective, and often is faster than regulation or legislation.
In all instances, though, we are looking for approaches that
make sense for our consumers, and therefore, our company and
our shareholders.
Second, Kraft has shown it's willing to lead, even if there
is a competitive disadvantage, but we certainly prefer a level
playing field, both for our business and for making a
difference socially. Fifteen major food companies have now
pledged to follow the BBB advertising principles, and we think
other companies that advertise food or beverages to children
should do the same.
PREPARED STATEMENT
Third, although food companies absolutely have major
contributions to make to this effort, we are only one part of
the equation. A nationwide approach that covers all areas, from
community intervention to food marketing to physical education
in schools, is critical. We value the leadership and the
encouragement--what we think of as the forceful encouragement--
that the Congress, the agencies, and other bodies can bring to
bear to ensure continued momentum in the right direction,
including over areas over which we, as a food company, have
little or no control.
Thank you, again, Senator Harkin and Senator Brownback. We
look forward to answering your questions.
[The statement follows:]
Prepared Statement of Marc S. Firestone
Good morning Mr. Chairman and members of the Appropriations
Committee. I am Marc Firestone, Executive Vice President of Kraft
Foods.\1\ It is a privilege to address you today on behalf of the more
than 100,000 people who work at Kraft, the country's largest food
company.
---------------------------------------------------------------------------
\1\ For more than a century, Kraft (www.kraft.com) has offered
delicious foods and beverages that fit the way consumers live,
including Kraft cheeses, dinners and dressings; Oscar Mayer meats;
Philadelphia cream cheese; Maxwell House coffee; Nabisco cookies and
crackers and its Oreo brand; Jacobs coffees; Milka chocolates; and LU
biscuits. The company's stock (NYSE: KFT) is included in the Dow Jones
Industrial Average and listed on the Standard & Poor's 100 and 500
indexes as well as the Dow Jones Sustainability Index and Ethibel
Sustainability Index.
---------------------------------------------------------------------------
Thank you for holding this hearing and for your leadership on
topics related to the well-being of children. You have set a tone that
encourages people to work together, to find pragmatic solutions and to
show real progress.
We recognize that childhood obesity is a serious public health
issue. For any one person, the key is to find the right balance between
calories in and calories out, but individual choices all take place
within a broader context. Unfortunately, there's no simple way to
improve diets and increase physical activity.
Economic conditions and access to nutritious foods; government
policies and food company practices; parental involvement and school
food programs; urban planning and building design: These and other
factors all influence obesity rates. Therefore, as the FTC, the IOM and
others have emphasized, we need a national effort that is comprehensive
in addressing each of those factors.
A national commitment takes national leadership, which is what I
believe you are providing through your encouragement--your forceful
encouragement--to all participants in pursuing opportunities and
addressing concerns within areas under their control. This includes
government, the food and beverage industry, the entertainment and media
industry, schools and parents. The consistent recommendation by experts
for action on the part of food companies has been to change the mix of
advertising to children to emphasize better-for-you choices and
physical activity.
What Kraft is Doing
In that spirit, I'd like to share examples of Kraft's leadership
within the food industry.
In response to concerns over obesity rates, we announced in 2003 an
11-point initiative. We focused on product nutrition, consumer
information, marketing practices and public policy engagement.
Then, in 2005, Kraft took a bold step when it created what has
become a model for limiting children's advertising. Kraft already had a
long-standing policy not to advertise our products in media primarily
directed to children under the age of six. In 2005, we voluntarily
adjusted our advertising practices globally, so that all TV, radio and
print advertising viewed primarily by children ages 6-11 would feature
only Kraft products that meet specific nutrition criteria. These
products are labeled with our Sensible Solution flag, so consumers can
easily identify the better-for-you options in our product line. In
2006, we extended this policy to our websites.
We phased out advertising primarily directed to children 6-11 for
products that do not meet the Sensible Solution criteria. As a result,
a number of well known, well loved Kraft products, including Oreo,
Chips Ahoy! and the original versions of Kool-Aid, are no longer
advertised to children.
It wasn't an easy decision for the company's management to take.
But we heard loud and clear from policy makers and consumers alike that
among the dozen or so actions that society should take, changing our
advertising was the one most directly under our control as a food
company.
Many of our competitors and other companies have since adopted a
similar approach to their advertising under the auspices of the Council
of Better Business Bureaus. We were pleased to be a founding member of
this initiative and applaud the progress that's taken place in the last
year and a half.
As part of the BBB initiative, most major food and beverage
companies have committed to advertise to children only those products
that meet specific nutrition standards. And advertising content
increasingly encourages active behaviors and aims to model appropriate
meals, eating behaviors and portion control.
In addition, we created the type of 100 calorie, portion-control
packaging that is now common throughout the industry. In most cases, we
didn't simply put the same product in a smaller package. We created
special recipes for making cookies, crackers and other items in a
single serving of 100 calories. This gives consumers another choice.
And we were the first to use dual-column nutrition labeling on
small packages with multiple servings. These labels do the math for
consumers by showing calories and other data both on a per-serving
basis, as FDA requires, and for the whole package. This helps consumers
make informed choices in managing their diets.
The FTC's recent report on food marketing has recommendations for
next steps, many of which Kraft already has in place. For example, we
don't engage in product placement in children's media or in-school
marketing. Further, consistent with the FTC's recommendations, Kraft is
participating with other food companies in the Keystone Roundtable to
develop more uniform nutritional criteria and labeling for ``better-
for-you'' products.
Conclusion
To conclude, I'd like to share Kraft's perspective on the overall
effort to address youth marketing and childhood obesity.
First, we view self-regulation as a means to an end, not an end
unto itself. Voluntary action by industry can indeed produce results,
often faster than regulation or legislation. The shift in food
advertising is a great example. From our perspective, the issue is less
about the means and more about the substance: We are looking for
approaches that make sense for our consumers and therefore for our
company and our shareholders.
Second, we remain eager to find common sense approaches. Kraft has
shown it's willing to lead, even if there's a competitive disadvantage,
but we certainly prefer a level playing field, both for our business
and for making an impact socially. Fourteen major food companies have
now pledged to follow the BBB advertising principles, which goes a long
way in that direction. We think other companies that advertise food or
beverages to children should do the same.
Third, enduring change comes when there is proportionally equal
effort by all those who can influence the calories in/calories out
equation. I believe that Kraft and other food companies have made major
contributions to the effort. But we're only one part of the equation. A
nationwide approach that covers all key areas, from community
intervention to food marketing to physical education in schools, and so
on, is critical. We value the leadership and forceful encouragement
that Members of Congress, the agencies and other bodies can bring to
bear to ensure continued momentum in the right direction, including in
areas over which we, as a food company, have little control.
In closing, I thank you again for inviting Kraft here today. We are
honored to be part of an effort that has shown progress is possible. I
look forward to answering your questions.
Senator Harkin. Thank you again, Mr. Firestone. And thank
you again, publicly, for Kraft working with us through the
years. I thought probably the boldest step of all was when
Kraft decided not to advertise Oreo cookies to kids. I mean,
whooo, that was quite a step----
Mr. Firestone. Thank you, sir.
Senator Harkin [continuing]. And we applaud you for it.
Now we turn to Ms. Smalls, executive vice president, public
affairs, chief of staff of Nickelodeon, MTV Network's Kids and
Family Group.
Ms. Smalls, welcome.
STATEMENT OF MARVA SMALLS, EXECUTIVE VICE PRESIDENT AND
CHIEF OF STAFF, MTV NETWORK, IDS AND FAMILY
GROUP (NICKELODEON), NEW YORK, NEW YORK
Ms. Smalls. Thank you. And thank you for holding this
hearing today, and for your leadership on this issue.
And let me just add, on a personal level, I've had a long-
time interest, in that I was chief of staff to Congress when
Robin Tallon, who chaired the House Subcommittee on Food,
Nutrition, and Marketing--we actually had the first hearing on
establishing the pyramid. But, at Nickelodeon our mantra has
always been, ``What is good for kids is good for business.''
And because of that, we were compelled to confront the
childhood issue on obesity, and our approach was to make
ourselves as smart as possible.
So, over the past 5 years, we've conducted research, we've
reached out to advocates, food industry CEOs, government
agencies, and academics. We've participated in public and
private forums. We've partnered with organizations like the
Boys and Girls Club, the Clinton Foundation, and the American
Heart Association. And, based on all that we've learned through
this around-the-world meeting with the stakeholders, we've
committed more than $30 million in annual resources and 10
percent of our airtime to balanced lifestyle messages. We've
given more than $2.5 million in grants in schools--to schools
and community-based organizations, direct cash, many in the
States you represent. We've launched the Let's Just Play
Campaign and our annual Worldwide Day of Play, when all of our
TV and Web sites go dark. And this year, the fifth annual
Worldwide Day of Play will take place on this upcoming
Saturday. We've pledged to limit the use of our licensed
character, and we've put--characters--and we've put more
resources into our long-form programming. And not to leave
parents behind, we've launched Nick at Night's Family Table,
encouraging families to share more quality meals together, and,
just in January, we launched the Kick One, Pick One Campaign,
asking families to exchange a bad habit for a good one on a
monthly basis.
So, in conclusion, we agree with the Institute of
Medicine's assessment that media can be an integral part of the
childhood obesity solution, but advertising and media are not
the only solution. Fighting obesity is a marathon, not a
sprint. And while we've made great strides toward empowering
kids and families with the tools they need to navigate this
issue, we are determined to go the distance to empower our
audience to make balanced choices.
I'd like to just roll a tape that briefly summarizes all of
the various programs we've done on air and off air, and then
I'll be happy to answer any questions.
Thank you.
Senator Harkin. How long is this?
Ms. Smalls. It's one minute.
[The statement follows:]
Prepared Statement of Marva Smalls
Good Morning. My name is Marva Smalls and I am the Executive Vice
President of Public Affairs and Chief of Staff at the Nickelodeon Kids
and Family Group.
At the outset, I want to thank Chairman Harkin, Chairman Durbin and
Senators Brownback and Specter for holding this hearing today. I'd also
like to acknowledge Senators Harkin and Brownback for leading the FCC
Media and Childhood Obesity Task Force, a forum in which Nickelodeon
was heavily engaged for more than a year and a half.
Nickelodeon's Kids and Family Group is comprised of four television
networks. The Kids and Family Group also includes online, digital,
consumer products and recreation businesses focused on children and
families. Nickelodeon was launched 30 years ago and it has been the #1
cable network for the past 14 years, reaching over 83 million viewers
per week. It is the most widely distributed channel in the world and
can be viewed in over 175 countries.
During my 15 year tenure at Nickelodeon, `what is good for kids is
good for business' has been a guiding principle of the company. Year
round, we work to ensure that our corporate responsibility and
engagement upholds and honors that core value. It extends not only to
the quality content we create for kids, but also to what we leave with
them when they turn the TV off, put down their magazine or log off the
internet.
As discussed in greater detail herein, Nickelodeon's ongoing
efforts to promote health and wellness and combat childhood obesity
demonstrate our commitment to kids, parents and families.
For kids:
--Let's Just Play, Nickelodeon's long-term, multimedia campaign
designed to help kids make healthy lifestyle choices.
--Nickelodeon's commitment to license its characters only on ``better
for you'' foods.
--The annual Worldwide Day of Play when Nickelodeon, Nicktoons,
Noggin, The N and their corresponding websites go off the air
and Nickelodeon partners with community-based organizations and
schools to encourage kids to get up, go outside and play here
in the United States and in ten countries around the world.
--Programming devoted to health and wellness like My Family's Got
GUTS, Lazytown and the Let's Just Play Go Healthy Challenge and
other short form content including PSAs.
--Partnerships with the American Heart Association and the W.J.
Clinton Foundation's Alliance for a Healthier Generation, the
NFL, the LeBron James Family Foundation and the Boys and Girls
Clubs of America, which reaches millions kids in diverse
communities and clubs.
--$2.5 million in grants to schools and communities to promote
physical fitness and nutrition education.
--Regular features in Nick Magazine highlighting healthy activities
and options for kids
For parents and families:
--Nick at Nite and TV Land's Family Table, an initiative to raise
awareness about the benefits of quality, uninterrupted family
time especially at meals.
--Nick at Nite's Kick One, Pick One, a new PSA campaign promoting
kids and parents joining together to eliminate one unhealthy
habit and choose a positive new one every 21 days.
--ParentsConnect.com, an on-line community for parents which features
experts and advice on all matters related to health, fitness
and good nutrition.
--Nicktrition, an effort with our fruit and vegetable licensing
partners to introduce families to the produce aisle in retail
stores and to provide healthy on-pack tips on packaged foods.
These commitments are ongoing, but they must be viewed in the
context of the larger, multi-dimensional problem of childhood obesity.
childhood obesity: a multi-dimensional problem
Nothing matters more than the health of kids. Good health is the
first key that opens the door to learning, to proper development, and a
happy childhood. Unfortunately, despite some evidence that the obesity
crisis has leveled off, far too many kids are getting too little
nutrition and consuming too many calories while burning too few. Making
matters worse, too many of these kids are African American, Latino, or
from low-income families, which adds good health to an already long
list of closed doors they face.
We all know the disturbing statistics about childhood obesity, so
there is no need to repeat them here. The point I want to make is this:
Childhood obesity is a challenge all of us must address because no
matter what we do for a living, all adults are collectively responsible
for the well-being of America's kids. Each of us must do our part. Each
of us must connect kids to an active, healthy life-style.
We know that obesity has many complex causes: poor nutrition at
home and at school, lack of access to safe recreational facilities,
confusion about what is a healthy food and what is not. It is foolish
to cite one factor and claim that changing it alone will solve the
problem. There is no magic bullet solution. Fighting obesity is a
process of evolution, not revolution. It is a marathon, not a sprint.
We wholeheartedly concur with the Institute of Medicine's
assessment that media can be an integral part of the obesity solution,
but advertising and media are not the only solution. We also know that
at the end of the day, it is a personal commitment and responsibility.
Anything we do must recognize that kids and parents need tools and
messages from all stakeholders to help them make the daily choices that
will change their lives.
nickelodeon's approach
It is helpful to understand Nickelodeon's approach to confronting
challenging social issues with our audience. When an issue becomes so
prevalent that it impacts the well-being of kids, our approach is to do
the necessary due diligence to ensure that our programming, initiatives
and messaging will help serve our audience. Kids need to have command
of information they can use and actions they can take so they are
empowered to control their lives.
The company's current commitment to health and wellness is in line
with its pro-social legacy. For example in the 1990s, we launched The
Big Help campaign, an initiative to inspire and equip the Nation's
youngest citizens to volunteer in their communities. The campaign moved
beyond the traditional mold of linear public service campaigns to build
a grassroots, in-community infrastructure in partnership with 28
national service organizations (e.g. Big Brothers/Big Sisters, National
4-H, Second Harvest, YMCA, the Boys & Girls Clubs of America, etc) to
give kids service projects on the local level. Over an 8 year span, 33
million kids pledged and fulfilled more than 383 million hours of
volunteering. Based on our success with The Big Help, the Centers for
Disease Control invited us to help craft the direction of the VERB
campaign in 2001.
Long before the media frenzy started about childhood obesity, we
were compelled to confront it. The results were beginning to have
disastrous implications especially for African American, Latino as well
as other challenged communities in urban areas and regions such as the
southern United States.
Our approach was to do what we've always done: to make ourselves as
smart as possible on the issue and collaborate with willing
stakeholders with the ultimate goal of empowering kids with
information. We could have opted out, but that would have violated
every principle that guides us. We opted in because that's how we
operate.
We met folks who market to kids and those who believe it is wrong
to do so. We did this to see and understand the whole picture because
what is at stake is too important for anything less. We wanted all the
facts and every opinion because everything was under review. We wanted
to act smartly and effectively. What we learned helped guide the
company in our health and wellness campaigns and craft content to help
kids lead the way.
Our outreach on childhood obesity included advocates, food industry
CEOs, government agencies and academics from Yale, New York University,
Tufts University, and the University of Colorado, all of which are
well-respected leaders in this field, to help formulate best practices
and create scalable change. We have sought out and willingly
participated in both public and private forums, sometimes in very
heated debate, including the Institute of Medicine, the Kaiser Family
Foundation, the Department of Health and Human Services, the Federal
Trade Commission and most recently the FCC Task Force on Media and
Childhood Obesity. As the issue has spread around the world, we have
worked with groups in other countries to discover more and more options
to address the issue.
In collaboration with a leading academic institution, we conducted
a national survey to identify kids and parents' attitudes and behaviors
on eating, food, media and marketing.
What did we learn? Perhaps most telling, our research found that
most parents feel overstressed and overscheduled. They are working
longer outside of the house than ever before, so they have less time to
spend with their kids and less time to prepare nutritious meals. This
impacts how they make decisions and how they take responsibility. They
are most likely to choose one of the following four options in orders
of preference.
--One, what makes their life easier?
--Two, what makes their kids happy?
--Three, what helps them raise their kids to be ``good'' people?
--And four, what stays within their financial means?
Anyone here who has school-aged kids can understand why this is the
case. For better or worse, these priorities are a natural outgrowth of
modern life. If letting Johnny eat a frosted donut or danish for
breakfast makes him happy, gets him off to school on time without fuss,
and makes mom and dad's lives simpler, that's a trade-off many parents
are understandably, if reluctantly, willing to make.
This reality speaks volumes about how stakeholders must work very
specifically to address how children and parents can take
responsibility. It is incumbent upon all stakeholders to acknowledge
the reality of this important family dynamic, and the role parental
responsibility must play, so that meaningful steps can be made.
Allow me to share with you in specific terms how we deliver on that
promise to promote health and wellness and combat childhood obesity.
nickelodeon's health & wellness initiatives
For the past 6 years, Nickelodeon has championed health and
wellness as its premier pro-social initiative. It represents a
commitment of more than $30 million in resources of the company. This
unprecedented campaign involves engaging a leading registered
dietitian/nutritionist and consulting with an advisory committee of
experts on child nutrition, exercise and fitness, psychology and civic
engagement. In addition, the company commits resources externally,
partnering to build a national grassroots infrastructure for kids to be
leaders in making healthy and balanced lifestyle choices in their
homes, schools and communities.
Let's Just Play
Let's Just Play has been Nickelodeon's long-term campaign to help
kids make healthy lifestyle choices. The Let's Just Play Go Healthy
Challenge, a television program and website challenging children to
make the changes necessary to lead healthier lives, launched the W.J.
Clinton Foundation and the American Heart Association's Alliance for a
Healthier Generation's outreach program to combat childhood obesity. In
2007, over 1 million kids signed up to take the Challenge and to follow
a nine month healthy living program mirroring two role model kids. Our
partnership with The Boys & Girls Clubs of America extends the reach of
the program to millions more in diverse communities and clubs.
The Go Healthy Challenge does not just talk about calories in and
energy out. It also helps kids understand the underlying causes of
overweight and obesity, such as lack of physical education in schools,
families not spending quality time together, regional demographic
challenges, and insufficient safe play-space in communities, to name a
few. By understanding the causes and giving them solutions to confront
the obstacles they encounter, we are connecting the dots between
information and action.
The campaign also offers a personal training game and tracking log
for kids online so that they can follow their progress and celebrate
their success. Nickelodeon delivers this and other Let's Just Play
content through all multi-media platforms including Nickelodeon
Magazine, www.nick.com, our broadband site www.TurboNick.com, wireless
phones, video on demand and iTunes. We provide standards-based
curriculum materials to teachers through our Cable in the Classroom
website for educators at www.teachers.nick.com.
Activation of community events and programs has been the
cornerstone of Nickelodeon's Let's Just Play campaign. Millions of kids
and families in all 50 states have participated in Let's Just Play
activities and community-wide events created with our partners as well
as the National Football League, the National PTA, schools, mayors, and
other community-based organizations. Nickelodeon provides tool-kits to
100,000 local organizers so that they can take advantage of
Nickelodeon's connection with kids to generate more attention and
support for their in-community health, nutrition and fitness programs.
The kits feature Let's Just Play Go Healthy Challenge and include how-
to information on organizing programs and events with kids, monthly
themes based on goal-setting and health, and health information for
parents. Additional resources, such as customizable banner, flyer and
poster art are offered online to local organizations.
Local Grants for Under-resourced Programs
Since 2005, Nickelodeon has given $2.5 million in local seed
funding for health, nutrition, physical education and other fitness
programs through the Let's Just Play Give-Away, a kid-driven grants
program. Kids partner with their school or community-based organization
to apply for the grants for much needed resources where physical
education and nutrition education are lacking. Over 450 communities in
all 50 states and the District of Columbia have benefited from these
resources, including Iowa ($45,000), Illinois ($45,000), Kansas
($42,000) and Pennsylvania ($85,000). Winners are announced on-air and
on-line, thereby raising awareness to kids about the lack of resources
in schools and communities for nutrition, fitness and physical
education programs.
Nickelodeon's Worldwide Day of Play serves as an annual culmination
for Let's Just Play, as well as Family Table and Kick One, Pick One,
our health and wellness initiatives on Nick at Nite and TV Land. In
addition to suspending programming and ``going dark'' on air and
online, Nickelodeon and its national and local partners generate
thousands of local events to celebrate the accomplishments of kids and
to hit home the powerful message of tuning out to play.
Make no mistake, this is not a one day effort or investment. This
programming is a constant part of our content throughout the year.
Let's Just Play daily messaging has included a growing library of
short-form PSAs and interstitials. In addition, our long-form
programming that features healthy messages include:
--My Family's Got GUTS,
--Nick News with Linda Ellerbee,
--The Let's Just Play Go Healthy Challenge,
--Lazy Town,
--Dance on Sunset, and
--The N's Student Body.
Initiatives to Engage Parents
What we have learned through our work on Let's Just Play is that
kids cannot succeed without positive encouragement from their parents
and others in their home. We launched Kick One, Pick One on Nick at
Nite to involve the whole family with humor, simplicity and no guilt.
This campaign is designed for kids and parents to write and sign a
family contract committing to eliminate a bad habit and to pick up a
newer healthier habit. In this way, kids and parents can support each
other and keep each other honest in the process. Families can track
their progress at www.nickatnite.com/kopo.
Kick One, Pick One is a natural extension of our 4 year effort with
Family Table on Nick at Nite and TV Land, which promotes uninterrupted
family dinner as a way for parents and children to discuss all sorts of
topics of importance in their lives like work, school, difficult
situations and healthy living.
Kick One, Pick One and Family Table messages are extended through
Nickelodeon's online outreach to parents. On ParentsConnect.com and
NickJr.com, you will find a host of resources for parents to find ways
that they can help their kids with good nutrition, fitness and overall
healthy living. ParentsConnect in particular is a community site where
parents openly share advice as well as challenges on keeping healthy.
licensed characters
In 2007, Nickelodeon announced that it will limit the use of its
licensed characters to food packaging that meets ``better for you''
criteria as established by our marketing partners in accordance with
governmental dietary guidelines. We will continue to allow characters
to be used on a limited number of seasonal treats, such as Halloween
candy. This policy will become effective with all new agreements
beginning in 2009.
This announcement follows more than three years of pro-active
efforts by Nickelodeon to seek and secure partners to license
Nickelodeon's most popular characters for ``better for you'' food
products. We've changed our licensing model so that we could establish
on-going programs with a growing list of fruit and vegetable partners
who otherwise would not have the financial means to market their
products. These now include, but are not limited to SpongeBob Carrots
and Spinach; SpongeBob and Dora clementines, mandarin oranges and
tangelos; Dora and Diego peaches, plums, and nectarines; SpongeBob and
Dora Frozen Edamame. All Nickelodeon licensed food products are
marketed with ``Nicktrition'' on-label food tips, which highlight
portion control, valuable nutrients and healthful preparations.
collaboration with advertisers and food companies
Nickelodeon actively engages its business partners to encourage
improvements in how they market to kids and parents. These
conversations have yielded changes in food labels, product re-
formulations involving fat, sugar and sodium content, and kid-friendly
portion sizes and information. These conversations have also led to the
introduction of healthy options in kids' meals offered by Nickelodeon's
quick service restaurant partners. In addition, all advertising must
adhere to the advertising guidelines established by the Children's
Advertising Review Unit (CARU).
Since last summer, 14 of the major food companies that market to
kids took the unprecedented step of launching a major new self-
regulatory initiative to complement the Children's Advertising Review
Unit (CARU) guidelines. It is important to note that companies that are
party to the agreement have announced pledges which exceed the
agreement to devote at least 50 percent of all advertising primarily
directed to children under 12 and to reduce use of third-party licensed
characters in advertising directed to children under 12. In addition,
most companies are well ahead of schedule in terms of full
implementation by January 1, 2009.
in conclusion
The media and food industries have demonstrated their commitment to
fighting childhood obesity. Now, the government must step in to address
the main causes of childhood obesity, including the lack of recess and
physical education in schools and proper nutrition in school lunches.
I am confident that a fair review over the past few years shows
that the children's media landscape has changed for the better. On its
own since 2002, Nickelodeon has made childhood obesity a filter by
which we review all our business initiatives, whether television,
online, digital, consumer products or recreation, and we will continue
to do so.
Senator Harkin. Thank you very much, Ms. Small.
Now we'll turn to our last witness, Patti Miller, vice
president of Children NOW.
STATEMENT OF PATTI MILLER, VICE PRESIDENT, CHILDREN AND
THE MEDIA, CHILDREN NOW
Ms. Miller. Thank you, Senator Harkin and Senator
Brownback, for holding this hearing today.
Our Nation's children face an unprecedented public health
crisis. While a confluence of factors contribute to this
crisis, food marketing is a significant one. In 2005, the
Institute of Medicine recommended that the industry voluntarily
shift marketing and advertising targeted to kids to products
that are lower in calories, fat, salt, and added sugars and
higher in nutrient content. If the industry was not able to
achieve significant reform, the IOM recommended that Congress
intervene.
More than 2 years have passed since the IOM's call to
action, and, unfortunately, voluntary industry action has
fallen considerably short of the goal. Industry leaders assert
that the Children's Food and Beverage Advertising Initiative
will address concerns about food advertising to children, yet
the initiative is insufficient, for three main reasons:
Number one, food and beverage companies participating in
the initiative lack a uniform nutrition standard for defining
healthy foods. This poses numerous problems. It's confusing to
parents. It creates situations where similar food products will
be classified as healthy by one company, but will be considered
unhealthy by another. This absence of a level playing field
allows companies to maneuver their product portfolios and their
definitions of ``better for you'' to best serve their own
economic interests. For any industry initiative to be
effective, there must be a uniform nutrition standard.
Number two, food and beverage companies have created a huge
loophole that allows non-nutritious foods to be categorized as
``better for you.'' They take products loaded with added sugar
and fat, and then label them as ``better for you'' because they
have a modest proportion of the unhealthy ingredients removed.
Yes, it's true that it's better for you to eat Fruit Loops or
Cocoa Puffs with less sugar than in the original formula, but
it's also true that these types of products remain non-
nutritious. We must close the ``better for you'' food loophole
and focus on shifting food advertising to children to actual
healthy products.
Number three, media companies that deliver children's
programming are absent from any attempt to solve this problem.
They point to the food and beverage companies, hoping they will
fix it. Yet, without media company participation, another
loophole is created. What do you do about the food and beverage
companies that refuse to participate in the industry
initiative? They will be allowed to continue to advertise junk
food to children. That's hardly a solution to this problem.
That's why media companies must play a critical gatekeeper
role by monitoring their advertising environments to ensure
that unhealthy food advertising is significantly reduced, while
healthy food advertising is enhanced.
PREPARED STATEMENT
Children NOW believes that media companies should be
required to devote either equivalent time or a majority of
their total time--advertising time--for the promotion of
healthy food products. To accomplish this, Congress should,
one, adopt legislation mandating that at least 50 percent of
all food advertising to children on broadcast and cable TV
programming be devoted to healthy food products, and, two,
delegate to appropriate agencies the task of devising criteria
for a uniform nutrition standard. It's essential that we
intervene on behalf of the Nation's children. The stakes are
too high to sell their needs short.
Thank you, Senators, for your leadership on this issue. We
look forward to working with you to improve the health of the
Nation's kids.
[The statement follows:]
Prepared Statement of Patti Miller
Children Now thanks Senators Harkin, Specter, Durbin and Brownback
for hosting this hearing today to address the influence of food
marketing on children's health. It could not come at a more critical
time.
Our Nation's children are facing an unprecedented public health
crisis. For the first time in modern history, we have a generation of
children whose life expectancy may be lower than that of their
parents.\1\ The U.S. Surgeon General has identified overweight and
obesity as ``the fastest growing cause of disease and death in
America.'' \2\
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\1\ S. Jay Olshanksy, et al, ``A Potential Decline in the Life
Expectancy in the United States in the 21st Century,'' New England
Journal of Medicine: 352: 11: 1138-1145.
\2\ Richard H. Carmona, ``The Obesity Crisis in America,''
Testimony of the United States Surgeon General before the Subcommittee
on Education Reform, Committee on Education and the Workforce, United
States House of Representatives, July 19, 2003. http://
www.surgeongeneral.gov/news/testimony/obesity07162003.html.
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While a confluence of factors contribute to childhood obesity,
advertising and marketing clearly are very significant ones. Children
are exposed to tens of thousands of ads each year on television alone,
the majority of which are for fast food, junk food and sugared
cereals.\3\
---------------------------------------------------------------------------
\3\ Kaiser Family Foundation, Food for Thought: Television Food
Advertising to Children in the United States, March 2007, http://
www.kff.org/entmedia/7618.cfm.
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In 2005, the Institute of Medicine released a report which found
compelling evidence that television advertising influences the food and
beverage preferences, purchase requests and consumption habits of
children. The IOM recommended that the food industry voluntarily shift
advertising and marketing targeted to kids to products and beverages
that are lower in calories, fat, salt and added sugars and higher in
nutrient content. If the industry was not able to achieve significant
reform, the IOM recommended that Congress intervene.\4\
---------------------------------------------------------------------------
\4\ Institute of Medicine, Food Marketing to Children and Youth:
Threat or Opportunity, National Academy of Sciences Press, December
2005, http://books.nap.edu/openbook.php?record_id=11514&page=1.
---------------------------------------------------------------------------
Children Now was hopeful that the industry--both the food/beverage
companies and the media companies--would respond to the IOM's call to
action. Yet more than two years have already passed and unfortunately,
voluntary industry action has fallen considerably short of the goal.
Industry leaders assert that the Children's Food and Beverage
Advertising Initiative, a voluntary self-regulatory program that
includes 14 food and beverage companies, has sufficiently addressed the
concerns about unhealthy food advertising to children. They tell
advocates to give the Initiative a chance to work. Yet the Initiative
is insufficient for three main reasons:
--The food/beverage companies participating in the Initiative say
they will advertise ``healthier products'' to children--but the
companies lack a uniform nutrition standard for defining
healthy foods. This poses numerous problems. It will be
confusing to parents. It creates situations where similar food
products will be classified as ``healthy'' for kids by one
company but will be considered ``unhealthy'' for kids by
another company's standards. This absence of a level playing
field allows companies to maneuver both their product
portfolios and their definitions of ``better for you'' food to
best serve their own economic interests. For the industry
initiative to effectively address the concerns about childhood
obesity, there must be a uniform nutrition standard for
defining healthy foods that food/beverage companies adopt.
--Food/beverage companies have created a huge loophole that allows
non-nutritious foods to be categorized as ``better for you''
for children. They take products loaded with added sugar and
fat, and then label the item as ``better for you'' because it
has a modest proportion of the unhealthy ingredients removed.
It's true that it is ``better for you'' to eat Fruit Loops or
Cocoa Puffs with less sugar than the original formula with all
of the added sugar. But it's also true that these types of
products remain non-nutritious and that regular consumption
poses a risk of obesity. ``Better for you'' foods are not the
same as ``healthy'' foods. We must close the ``better for you''
food loophole and focus on the goal of shifting food and
beverage advertising to children to actual healthy products.
--Media companies that deliver children's programming are absent from
any attempt to solve this problem. They refuse to take the
necessary steps to reduce unhealthy food advertising to
children. They simply point toward the food and beverage
companies, hoping they will fix it. Yet without the
participation of media companies, another loophole is created.
Food/beverage companies that do not participate in the industry
initiative will be allowed to continue to advertise junk food
to children. That's hardly a solution to the problem. Media
companies must play a critical gatekeeper role by monitoring
their advertising environments to ensure that unhealthy food
advertising is significantly reduced, while advertising for
healthy food products is enhanced.
Because there is no uniform nutrition standard;
Because unhealthy products creatively labeled as ``better for you''
are being passed off as healthy food for children;
And because the media companies refuse to play a role in protecting
children from the advertising of unhealthy food products, all of the
public health and child advocacy groups involved with the Joint Senate/
FCC Task Force have refused to accept the industry initiative as a
viable solution to the problem we face here.
Children Now believes that media companies (both broadcast and
cable) should be required to devote either equivalent time or a
majority of their total advertising time for the promotion of healthy
and nutritious food products, as judged by basic scientific standards.
To accomplish this, Congress should:
--Adopt legislation mandating that at least 50 percent of all food
advertising to children on broadcast and cable television
programming be devoted to healthy food products;
--Delegate to an appropriate agency or agencies the task of devising
criteria for a uniform nutrition standard that would identify
healthy, nutritious foods.
It is essential that we intervene on behalf of the Nation's
children. Industry is privileging their profits over the health and
nutrition concerns of the Nation's children. The stakes are too high to
sell children's needs short.
Thank you Senators Harkin, Brownback, Durbin and Specter for your
leadership on this issue. We look forward to working with you to
improve the health and well-being of our Nation's children.
Senator Harkin. Thank you very much, Ms. Miller.
I thank the panel for being here today.
Let me just start--first, I'll start with Ms. Smalls. I'm
thrilled you're here today to represent Nickelodeon. When we're
talking solutions, we must have Nickelodeon at the table. As
you state in your testimony, Nick reaches over 84 million
viewers per week. It's the number-one cable network. And so,
I'm very happy to learn about the many initiatives that your
network's been involved in over the last several years, and
your collaboration with leading academics and experts in the
field.
So, again--but, we have to take a realistic look at what's
happening. Now, I was--looked at a statement that just came out
for--the Center for Science and the Public Interest, that just
did a study of Nickelodeon. And it said here, ``In early 2008,
the Center for Science and the Public Interest undertook a
second assessment of Nickelodeon food marketing to children.
The 2008 assessment indicates that Nickelodeon continues to
market primarily foods of poor nutritional quality to children.
The vast majority--79 percent--of food ads, products, and meals
marketed to children by Nickelodeon are too high in fats,
salts, and sugars. This is just a little lower than in 2005,
when 88 percent were of poor nutritional quality.'' So, they're
saying that, really, not much has changed at Nickelodeon.
And it went on to point out that--and there's some data
here--they did 28 hours, on Friday and Saturday, of Nickelodeon
programming--they reviewed that--during which a total of 819
advertisements and PSAs and promos were shown. Of the 185 food
ads, 177 had nutrition information available; 138--78 percent--
of those ads were for foods of poor nutritional quality. Four--
out of all of this, four nutrition-related public service
announcements were observed, probably similar to what you just
showed, one for every 34 ads for foods high in fats, salts, and
sugar. So, you get 34 ads on Nickelodeon that are for foods
that are high in fats, salts, and sugar, and you get one public
service announcement.
And then they looked at the Nickelodeon magazine. Seven
issues--August 2007 to March 2008--of Nickelodeon were
reviewed. Of the 31 food ads, 24--or 77 percent--were for foods
of poor nutritional quality. And use of licensed characters on
food packages, nine food products containing Viacom marketing
were found at the Georgetown Safeway grocery store in
Washington, DC--7 or 78 percent--of the products were foods of
poor nutritional quality.
Last, they go to the promotional tie-ins between
Nickelodeon and fast-food restaurants. During the study period,
three restaurants featured Viacom tie-in promotions:
McDonald's, with the Spiderwick Chronicles; Subway, with the
Naked Brothers Band; and Chuck E. Cheese, with Bee Movie.
Listen to this. Of 24 Happy Meal combos at McDonald's using
this tie-in, 92 percent are of poor nutritional quality. Of 18
Fresh Fit Combos at Subway--much better--56 percent are of poor
nutritional quality; 89 percent of Chuck E. Cheese's menu items
are of poor nutritional quality.
So, with all of this, don't we think Nickelodeon has got a
ways to go?
Ms. Smalls. Well, sir, I'm very proud of the efforts
Nickelodeon has made, and I think what's missing from that
press release is the fine--footnotes and the fine print. For
example, I believe that press release--I saw it only briefly
before I sat down--was that 81 percent of our advertising is
covered by the CBBB food pledges. So, let me begin by saying
that only 20 percent of our advertising comes from food. The
majority of that advertise--food advertising is covered by the
CBBB pledges.
So, part of the issue here is not being sure what standards
that CSPI has used in analyzing the food criteria, because
we've attempted nutritional standards ourselves, and it is a
challenging and daunting task. We used it to engage on our on-
pack foods. But, for every one nutritionist or dietician we
spoke to, there is a different nutritionist or dietician who
had a different point of view. When we met with our individual
food and marketing partners--if you take the 15 that have
agreed to the pledge, they each have a different nutritional
standard, based on their foods.
So, what I'm saying is, our air is balanced. So, if 80---if
the majority--or if they--if we use their number, 81 percent of
our air is covered by better-for-you food advertising, we
believe we've closed the gap----
Senator Harkin. Well, Ms.----
Ms. Smalls [continuing]. A long way. And----
Senator Harkin. So, Ms. Smalls, what you're saying is,
you're relying upon the companies----
Ms. Smalls. No, I haven't----
Senator Harkin [continuing]. Themselves. That's--yeah.
Ms. Smalls. Sir, we are----
Senator Harkin. Eighty-one percent are covered by current
CFBI pledges, remaining ads not subject to any company
nutrition standards.
Ms. Smalls. We--again, Senator, we have to rely on the
experts, the people who are closest to the food product. We're
an entertaining and media company, we aren't in the business of
food. We could not begin, with any credibility, to develop
nutritional standards for food for the diversity of products or
manufacturers or the diversity of age groups that apply--that
they would apply to.
We have a very balanced air. Even the CBBB pledges
establish a 50-percent threshold. We give more than 30
percent--or, more than 10 percent of our airtime to balanced
messaging, $30 million in resources, direct grants, long-form
programming. We go dark on the air. We have engaged
stakeholders, up and down--excuse the pun--the food chain. But,
when the majority of our advertisers, who are closest to the
product, and they have the experts who know what the
nutritional standards makes most sense for their food, we've
learned--we've learned, by attempting to establish the food
standards, that we can't do it. We don't have the expertise to
be a gatekeeper on nutritional standards.
Senator Harkin. Well, there are standards that are out
there that are widely accepted. The Institute of Medicine has
come up with standards.
Dr. McGinnis.
Dr. McGinnis. We do have standards for nutrition products
in schools. But, the fact is that the sort of standard that--
across the board, as to what constitute a healthy food for
children has not been subjected to a consensus study of that
sort. It's doable, I think. The issues are very complex, but
it's doable. And this is a very important issue. There do need
to be--there needs to be a common understanding, across the
board, about the standards for the labels, and there needs to
be a more consistent approach, in terms of the graphics used to
portray the food content so that the consumer is aided and not
confused.
Ms. Smalls. And just----
Senator Harkin. See, that's the idea----
Ms. Smalls [continuing]. Just to follow up--if we----
Senator Harkin [continuing]. That if--that Nick will only
license their characters for foods that meet an individual food
company's nutritional standard. I don't know what that means.
What does Mars candy--I mean, what's their nutritional
standard?
Ms. Smalls. Well, Mars candy--well, let me back up. We said
we will only license our characters to healthier better-for-you
products, in keeping with the U.S. dietary guidelines, as
filtered through the individual company's better-for-you
standards. Again, the issue is, there is no uniform food
standard across the 15 companies who've accepted the pledge, or
even if you line up our--the other kids' networks in--who've
made commitments, and you lined up all of the standards that
they've committed to, none of them are uniform. In contrast, if
you look at what has been committed to in the United Kingdom by
our channel there, the government, Ofcom, took the initiative
and laid out uniform standards, and those are the standards we
used.
So, if--between USDA, HHS, whoever established the pyramid,
the dietary guidelines, or the industry themselves, if a
baseline of uniform food standards can be established--because,
as a media company--I assure you, it--we tried--it's a
challenging task. We don't have the expertise, nor would we be
credible in this space. But, if the industry or the government
or something similar to Ofcom came up with uniform standards by
which we could use to engage our advertising and marketing
partners, we would be there. But, we cannot credibly come up
with those standards to cover all of the food manufacturers and
their products----
Senator Harkin. Ms. Smalls----
Ms. Smalls [continuing]. Or the agents.
Senator Harkin [continuing]. Will Nick support uniform
standards if they are adopted?
Ms. Smalls. Sir, if uniform standards are adopted, and they
apply to all of the industries we deal with, absolutely, we
will use that as a filter for all of our----
Senator Harkin. And----
Ms. Smalls [continuing]. Marketing and advertising
relationships.
Senator Harkin. And in the meantime, could you do a better
job--when you have 34 ads for foods high in fats, salt, and
sugar, and only one for a public service announcement, that
does not seem to me to be a balanced approach.
Ms. Smalls. Again, sir, I don't know the statistics they
used, but what you saw in that tape is the diversity of our air
that our audience sees on a regular----
Senator Harkin. I don't know. All I can tell----
Ms. Smalls [continuing]. And consistent basis.
Senator Harkin. All I can tell is, this is what they said
of watching it over----
Ms. Smalls. And I would----
Senator Harkin [continuing]. A 2-day period----
Ms. Smalls [continuing]. And I will----
Senator Harkin [continuing]. Of time.
Ms. Smalls [continuing]. Be happy to provide you and your
staff more information----
Senator Harkin. Thank you.
[The information follows:]
The Center for Science in the Public Interest (CSPI) hastily
presented Nickelodeon with a report entitled ``Nickelodeon: Food
Marketing Little Improved between 2005 & 2008'' just moments before the
September 23 hearing. Although the two-page report was unscientific and
lacked substantiation, it nevertheless generated interest among Members
of the Committee. I feel compelled to set the record straight.
As an initial matter, the report actually undercuts the CSPI
premise that food marketing to children has not improved by noting that
just 20 percent of ads on Nickelodeon are for foods and ``[e]ighty-one
percent of the Nickelodeon food ads are covered by current [Children's
Food and Beverage Advertising Initiative (CFBAI)] pledges.'' The
balance of the report suffers serious flaws and should be rejected.
First, CSPI conducted its analysis in February 2008, almost a full
year before the CFBAI food advertising pledges went into effect on
January 1, 2009. CFBAI self-regulation must be given a chance to work,
particularly since even CSPI has praised the program as ``historic.''
\1\ For CSPI to ignore the pending implementation of the pledges is
disingenuous at best. Nickelodeon expects the landscape of food
advertising on Nickelodeon television and in Nickelodeon Magazine to be
very different in 2009 than it was in February 2008.\2\ As more food
and beverage marketers join the CFBAI pledge program, as Nestle did
last July, the scale of the change will be even more dramatic.
---------------------------------------------------------------------------
\1\ See http://www.cspinet.org/new/200707181.html.
\2\ In the absence of a uniform nutritional standard, the
qualitative measurement of food advertising is inherently subjective.
As a media company, Nickelodeon cannot and does not assess the
nutritional content of food and beverages featured in advertising.
Nevertheless, Nickelodeon expects a shift in the types of food
advertisements in all media after January 1, 2009.
---------------------------------------------------------------------------
Second, CSPI developed a unique and arbitrary standard for
``nutritionally poor'' foods in ads aired on Nickelodeon. In some
instances, the CSPI standards are stricter than industry and government
standards. In other instances, they are less strict or unclear, such as
in defining portion size. This lack of consistency, and the unhelpful
confusion it adds for parents, underscores the need for a uniform
nutritional standard.
The CSPI standard is one of at least 20 different non-governmental
guidelines for nutritional content in children's foods. In addition,
there are competing U.S governmental standards, including the U.S.
Department of Agriculture's MyPyramid and the Food and Drug
Administration's Dietary Guidelines for Americans. Using CSPI's unique
guidelines to measure food marketing on Nickelodeon makes little sense
if the goal is to evaluate the effectiveness of self-regulation. CSPI
should direct their apparent concern with the CFBAI food standards to
the food and beverage companies that created them.
It also makes little sense for Nickelodeon to add yet another set
of nutritional standards, as CSPI suggests. Setting aside the practical
difficulty in having a media company develop nutritional standards, how
would more than 20 sets of standards help kids and parents navigate
what is ``healthy'' and what is not? Plainly, it would not.
Finally, the CSPI report failed to provide proper perspective on
the children's media industry. Nickelodeon is the largest, but not the
only, children's media company. Time Warner Inc., The Walt Disney
Company and Discovery Communications Inc. each accept food advertising
and sponsorships directed to children. If CSPI had surveyed these
companies, they would have discovered similar food products and
promotions likewise not yet subject to fully implemented CFBAI pledges.
Ms. Smalls [continuing]. That counters that, sir.
Senator Harkin. Thank you.
Senator Brownback.
Senator Brownback. Thank you very much, Mr. Chairman.
Ms. Miller, you put forward a proposal to have half the
advertising time being put toward something healthy. If you're
going to advertise junk food, okay, but of 100 percent of your
budget, half of it has to go to some healthy product or
setting.
Dr. McGinnis, do you agree or like that proposal?
Dr. McGinnis. Yes. The committee that issued the report in
2005 recommended that the proportion of food products that are
marketed be reversed, in terms of the relative emphasis on
foods now that are high in calories and low in other nutrients,
toward a--marketing products that were more helpful. We didn't
set a specific percent, but, in fact, some of the members, as I
mentioned, were, in fact, focused on a reversal, which would be
a much greater proportion change.
Senator Brownback. Mr. Firestone, first, thank you guys for
what Kraft has done, and done voluntarily. And I'm sure that's
come at some market dislocation for some of your products.
And I'd note, just parenthetically, chairman, when I was
there to help present that BBB award. That was the last time I
saw Tim Russert. He was there at that award presentation, the
last time I saw him, was a strong proponent and supporter of
it, as well.
I sense, in what you're saying, though, that you're saying,
``Look, we've got to have a level playing field on this.'' Now,
what do you mean by that?
Mr. Firestone. Well, Senator, I'd say that I think--two
things I'd mention. One is that these are difficult commercial
decisions that we make, and will continue to make because of
the broader social policies. The question of 50 percent versus
100 percent, for example, is one that's come up, where
basically our rule is 100 percent. So, 100 percent of the
products we advertise meet the sensible-solutions standards,
and zero of the products that we advertise don't. So, we've
basically made it an all-or-nothing standard, as opposed to the
50 percent. And some other companies have started to come
along.
So, one would be a degree of uniformity and consistency in
the standards, including the nutritional criteria and the other
practices.
And then, second, and more broadly, as everybody has been
saying, this morning and in your July hearing, this whole issue
takes place in a broader ecosystem, of which marketing is a
hugely important part, and we want to do our part, but
community intervention, for example, is something that can be
very powerful.
So, ideally, what we, from the food companies, do, and the
others, all interrelate in the broader program. So, it's the
level playing field within our industry, and the integration of
what we're doing with what the other five or six components of
the ecosystem are doing.
Senator Brownback. Well, let me get sharper to the point,
then.
Mr. Firestone. Yes, sir.
Senator Brownback. Is it that you believe all food
companies should be required, 100 percent, to do what you're
doing, to level that playing field?
Mr. Firestone. Well, yes, Senator, as I said in my opening
remarks, we certainly hope that all of the food companies will
follow the BBB standards, along with us and the other 14
companies that have done so. So, yes, we would like to see the
entire industry following a similar approach.
Senator Brownback. And required to follow?
Mr. Firestone. Well, I think that what we've seen over the
last few years really is a huge change in the mix of
advertising, in a relatively short time. We announced, in 2005;
we're now 2008. There's been a huge change in the mix of
advertising. So, I think self-regulation has shown that it has
the advantage of speed, so--and, as Commissioner Leibowitz was
saying, it avoids questions of litigation. So, to the extent
that the pace remains as impressive as it's been, we would
certainly support, through your forceful encouragement and your
encouraging companies to participate, that--everybody to do so.
And I'd defer, to the broader question of whether, at this
point, there should be legislation. I think we've seen the
speed and the effectiveness of these voluntary measures that
has proven----
Senator Brownback. Well, and that's what I certainly
support. And I've started down this road--gosh, this has been a
couple of years ago. I think Kaiser Family Foundation had a
meeting I presented and said that where we need to do this on a
voluntary basis.
This is a problem. It's a big problem. It's well documented
that it's a problem. It is in a broader environment, as we
heard from Dr. Gerberding. But, this is a piece that can be
gotten at, and I think we've got to do our job on the school
nutrition and physical education, as well. There's no question
about it. But, here's one that you can get right at.
And as a parent of five children and two 10-year-olds, I've
witnessed the power of advertising, and I know it's very
strong.
And, Ms. Smalls, I think that's what the chairman's really
getting at with you, where you've got a powerful set of
characters in it, so that anything you can do would be helpful.
My 10-year-old son is a real fan of SpongeBob, which I didn't
know existed until he started watching him. And then you put
SpongeBob on a product of fruit-flavored snacks--now, I don't
know that he sees SpongeBob as an authority figure, but it
certainly is attractive to him.
And this was purchased yesterday. I don't think my next-
door neighbor, who's a dentist, would like these at all. They
really stick to the teeth, and the lead ingredient in this--
sugar, modified corn syrup, cornstarch, just a number of not
particularly healthy items. And we got this yesterday.
And I think that's what the chairman is pointing out, that
I'm concerned about, too, is that you do have a big impact in a
youngster's mind. And you know that. And you entertain them.
You spend a lot of time with them. In many cases, you spend
more time with them than most parents do, unfortunately, given
the way things have evolved in our society. And so we're really
saying to you, and pleading with you, that you've got to get it
better for us to be able to move this forward, given your
presence in their lives. And I'm sure you can appreciate that.
And I would just really press you that, to the degree you
can, that you go back to your company and you press within the
corporation, that we've got to do better, because we are at a
crisis stage on this. And self-regulation is the better route
to go. But, if it doesn't work then the other steps move on
forward. And you've heard the testimony here today, as well.
So, we'd really plead with you on that.
Ms. Smalls. Well, Senator, I was the one who engaged with
you, 2 years ago at the Kaiser study, and encouraged the
formulation of a task force, a safe-space kind of environment
that did take place with a task force. And since that time, we
have--the industry, most all, have agreed to limit the use of
licensed characters. Fifteen companies have signed the CBBB
pledges, all to take----
Senator Brownback. But, what about this guy?
Ms. Smalls [continuing]. Effect in January 2009. Our
agreements that are----
Senator Brownback. Not until 2009, this guy comes off?
Ms. Smalls. Well, we also have SpongeBob Dora on edamame
grapes, vegetables, Clementines----
Senator Brownback. When does he come off of this?
Ms. Smalls [continuing]. Oranges----
Ms. Smalls. He--effective January 2009, our licensed
characters will only be used on better-for-you products. In
addition to that, most of the food companies--15 of the major
food manufacturers have said they will only market their
better-for-you products to our core audience. So, I think, in
January--the pledges aren't fully in effect yet, and we've
already seen tremendous movement. I think that we're going to
continue to see even more movement when all of the pledges, by
both the food companies, the media companies, are fully loaded
in. But, we----
Senator Brownback. Okay.
Ms. Smalls [continuing]. Are also--created partnerships
with the Fresh Food and Marketing Association and Vegetable
Association. So, our characters on--are on a variety of
products. And, you know, but it is this whole intervention
across many platforms.
The other----
Senator Brownback. May I get to----
Ms. Smalls [continuing]. Thing you said----
Senator Brownback.--Ms. Miller, too, here? We've given you
quite a bit of time to respond, and we appreciate that.
Ms. Miller.
Ms. Miller. Yes. I just want to make sure everyone is clear
on the advocates and public health groups' position on this
issue. Better-for-you foods does not mean healthy foods. You
can take out a couple of grams of sugar, you can take out a
couple of, you know, parts of the salt; that does not mean--
then you're putting characters on something--that that, in
fact, is advertising a healthy food to kids.
Senator Brownback. That's where we've got to get the
standard----
Ms. Miller. That's what we----
Senator Brownback [continuing]. Developed----
Ms. Miller. That's why we need a standard here. You can
talk all about--you know, companies saying, ``We have 100
percent of better-for-you''--that doesn't work for us. We need
at least 50 percent of foods advertised to children to be
healthy. And that should be judged by a uniform nutrition
criteria that we all agree to accept, that can be devised, you
know, across agencies, across government agencies, that, you
know, people who have expertise in determining what good
nutrition criteria would be, sit down, and it's evidence-based,
that it's based on good scientific criteria.
But, better-for-you foods does not equal healthy foods, and
that's where the advocates and public health groups come down
on this issue. So, you can put characters on some products, and
that doesn't necessarily mean we're getting to the root of the
problem.
Senator Brownback. Thanks, chairman.
Senator Harkin. Thank you very much, Senator Brownback.
I thank the panel for being here today and for your
involvement in this issue. We are going to continue to,
obviously--both Senator Brownback and I have been working
together on this for a long time, we're going to continue to
work on this issue.
I would ask consent that the hearing record be left open
for 1 week, and for the addition of other statements to be
included in the record.
CONCLUSION OF HEARING
Senator Harkin. Thank you all very much. The subcommittees
will stand recessed.
[Whereupon, at 12:16 p.m., Tuesday, September 23, the
hearing was concluded, and the subcommittee was recessed, to
reconvene subject to the call of the Chair.]
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