packaging health: examining "better-for-you" foods targeted at children

Canadian Public Policy

Packaging Health: Examining "Better-for-You" Foods Targeted at ChildrenAuthor(s): Charlene ElliottSource: Canadian Public Policy / Analyse de Politiques, Vol. 38, No. 2 (June/juin 2012), pp.265-281Published by: University of Toronto Press on behalf of Canadian Public PolicyStable URL: http://www.jstor.org/stable/41756757 .

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Packaging Health:

Examining "Better-for-You"

Foods Targeted at Children

Charlene Elliott

Faculty of Arts and Faculty of Kinesiology University of Calgary, Alberta

Les préoccupations de nombreux consommateurs en ce qui a trait à la santé et à l'obésité ont conduit des entreprises à mettre sur le marché une gamme de produits présentés comme étant « meilleurs pour la santé ». Dans cet article, j'examine 354 produits vendus dans les supermarchés et qui ciblent les jeunes, et j'évalue leur qualité nutritionnelle et la façon de présenter différents aspects de certains produits dits « meilleurs pour la santé », en comparaison avec des produits « réguliers ». Résultat : si les produits dits « meilleurs pour la santé » offrent certains avantages du point de vue nutritionnel (en particulier en ce qui concerne les quantités de matières grasses et de sodium), le sucre est présent à des degrés élevés dans les deux types de produits. Je fais ensuite quelques remarques importantes sur 1'« auréole santé » et l'aspect « amusant » que l'on associe à certains produits alimentaires. Enfin, je conclus que toutes ces données indiquent que les produits mis en marché pour les jeunes et présentés comme « meilleurs pour la santé » sont tout autant une affaire de marketing qu'une question de nutrition.

Mots clés : obésité chez les jeunes, mise en marché des produits alimentaires, santé, emballages, étiquetage, supermarchés, jeunes

Concerns over health and obesity have led to a range of "better-for-you" food products targeted at consumers. This analysis examines 354 supermarket foods targeted at children in Canada, assessing the nutritional quality and types of appeals of "better-for-you" packaged foods compared to "regular" fare. While "better- for-you" products fared better nutritionally (particularly for fat or sodium), high levels of sugar are evident in both categories. This analysis further examines some important considerations regarding both "health halos" and the promotion of food as "fun." Overall, it reveals that products marketed to children as "better- for-you" are as much about marketing as they are about nutrition.

Keywords: childhood obesity, food marketing, health, packaging, labeling, supermarket, children

Introduction

Concerns range of "better-for-you" over health and

food obesity

products have

targeted led to a

range of "better-for-you" food products targeted at consumers. Three years ago, the global market research firm Mintel observed the rise of new products "being developed against a backdrop of movement

towards generally healthier, more natural and wholesome food and drink for children" (Scott-Thomas 2009). Mintel tagged the "claim of naturalness" as a strong and profitable trend, affirming that "the message that a food or food component is naturally and intrinsically healthy is one of the most appealing to consumers in all cultures" (Stones 2009).

Canadian Public Policy - Analyse de politiques, vol. xxxviii, no. 22012



266 Charlene Elliott

This trend toward health is now a commonplace. Foods marketed as "natural" and "healthful" have moved beyond the specialty aisles in supermarkets (Scott-Thomas 2010). When considering trends in consumer packaged goods, "natural" claims of all types "have grown in importance in all regions, and across all categories" (Mintel 2010). Indeed, not only did PepsiCo's Chief Executive Officer announce her intent to expand the company's "good- for-you" brands, growing the nutrition portfolio from $10 billion to $30 billion by 2020 (Bauerlein 2010), but health claims on packaged foods have also become ubiquitous. As Nestle and Ludwig observe in The Journal of the American Medical Association , "[at] no point in US history have food products displayed so many symbols and state- ments proclaiming nutrition and health benefits" (2010, 771).

The problem, however, is that appeals to health do not necessarily translate into nutritious products. Examples of so-called "better-for-you" products that transgress common sense understandings of health are manifold. For example, the industry-created (and now defunct) Smart Choices program saw green check marks placed on products of dubious nutritional value, including Froot Loops, Fudgsicle bars, and Kid Cuisine cheeseburgers. Smart Choices was followed by a new front-of-package (FOP) program called Nutrition Keys, announced by the Grocery Manufacturers of America and the Food Marketing Institute - perhaps in a preemptive move to circumvent recommendations on front-of-package criteria being developed by the Institute of Medi- cine (IOM) and the Food and Drug Administration (FDA). Moreover, a spate of lawsuits has further underscored the questionable nature of so-called "good-choices." In January 2011, the UK Adver- tising Standards Authority (ASA 2011) ruled that Coca-Cola ads for Vitamin Water were misleading, because they promoted the beverage as "delicious and nutritious," when in fact a 500 ml bottle contains 23 grams of sugar - and the average consumer would not expect a "nutritious" drink to contain

four to five teaspoons of added sugar. Nutella, a chocolate hazelnut spread advertised as part of a nutritious breakfast for children, is the target of a similar consumer class action lawsuit filed in San Diego. The case avers that Nutella - which contains about 70 percent saturated fat and processed sugars by weight - is "not part of a nutritionally 'balanced' breakfast for consumption by children," as claimed ( Hohenberg v. Ferrero 2011, 3). And the Kellogg Company, in November 2010, settled a class action lawsuit worth US $2.75 million for falsely advertising (on product packages, as well as in a television, print and Internet campaign) that Frosted Mini-Wheats were "clinically shown to improve kids' attentiveness by nearly 20 percent" (Starling 2010). (The FTC also ruled against Kel- logg's "improved attentiveness" marketing in 2009, as well as against Kellogg's Rice Krispies in 2010, for making unsupported claims that Rice Krispies "helps support your child's immunity" (FTC 2010).)

This trend toward health in packaged food products is also set against a backdrop of wide- sweeping policy and regulatory concerns over food marketing to children. In May 2010, the World Health Assembly (WHA) unanimously endorsed recommendations by the World Health Organization (WHO) to reduce "the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt" (WHA 2010; WHO 2009). The 2010 Dietary Guidelines for Americans, released by the US Department of Agriculture (USDA), equally called for "effective policies to limit food and beverage marketing to children," while emphasizing the importance of consuming "nutrient dense food and beverages" (2010, 59, 62).

In Canada, recommendations from the feder- ally formed Sodium Working Group, released July 2010, encouraged all levels of government to "work to identify improvements that can be made to the current marketing environment for children, in order to further protect children from the marketing of foods and beverages high in fat, sugar and /

Canadian Public Policy - Analyse de politiques, vol. xxxviii, no. 2 2012



Packaging Health : Examining "Better-for-You " Foods Targeted at Children 267

or salt" (Hutchinson et al. 2010, 31). This idea of improving the food environment for children was echoed by Canada's ministers of health in their 2010 document Curbing Childhood Obesity : A Federal- Provincial-Territorial Framework for Action to Promote Healthy Weights (PHAC 2010). Noted as a strategy within their "action framework" is to make the healthy choice "an available and easily recognizable option" (2010, 4). In short, a strong push exists to ensure that the foods marketed to children promote - or at the very least, do not undermine - the health of our children.

In light of this interest in healthy packaged foods, this study seeks to assess the nutritional quality of the "better-for-you" food products targeted at children in the Canadian supermarket. The study is unique because, while hundreds of child-friendly packaged food products exist, to date there is no published research showing how "better-for-you" products compare nutritionally to the other child- targeted foods/"fun foods" in the marketplace.

"Fun foods" are specifically designed to appeal to children through the use of cartoon iconography, cross-merchandising, and claims to "fun" (including "fun" shapes or colours, or references to the entertainment factor of the food). Analyses have revealed that these child-targeted supermarket foods are not always healthy choices (Elliott 2008a); the very products aimed at our youngest consumers can be lacking in nutritional quality (Elliott 201 la; Elliott 2011b; Harris et al. 2009; Harris, Schwartz, and Brownell 2010). And yet, a range of "better-for-you" products and product lines exists within the category of "fun foods" found in the supermarket. Overall, the number of these "better-for-you" choices is increasing, as per the broader trend toward health in packaged foods (as detailed above).

This study examines the nutritional quality of "better-for-you" products compared to the vast array of child-targeted foods available. Given the increasing interest in packaging health, this study

finds that products marketed to children as "better for you" are as much about marketing as they are about nutrition. This in turn points to the need to reconsider the exemption of packaging, labels and wrapping as a form of "media" under the Canadian Code of Advertising Standards, and to also consider whether these types of appeals should be regulated.

Methods

Content analysis was used to create a profile of the food products targeted at children in the Canadian supermarket. Data collection and analysis was done over a 12-month period in 2009 in Calgary, Alberta. Researchers visited two major grocery store chains, purchasing "fun foods" for analysis. Duplicate products were not included in the study. Products were photographed, stored and subsequently coded for analysis.

The Real Canadian Superstore and Safeway were selected as the site/supermarkets for food coding. Loblaw Companies Limited (parent to The Real Canadian Superstore) is Canada's largest food distributor, both in terms of revenue and number of stores. Canada Safeway Limited is a main competi- tor. Selecting products from these two stores makes the study comprehensive, but also generalizable: since most stores carry the same national brands, the products in one grocery store are typically consistent with those found in another.

Selections of "fun food" were made according to very specific criteria. The study focuses on the "regular" foods (within the dry goods, dairy, produce and frozen food categories) that have been repackaged to appeal to children; the study expressly excludes products in the obvious category of "junk food" (including confectioneries, soft drinks, sodas, potato chips, etc.). Food products/packages selected had to uniquely target children through the use of cartoon images, direct appeals to fun or play, the foregrounding of unusual shapes, colours or tastes,




268 Char lene Elliott

and/or tie-ins with children's television programs, films or toys.

Specific indicators and criteria of children's food and "fun food" include the following:

1 . Brands that specifically reference children in the name, or are marketed as designed specifically for children (e.g., EnviroKidz, Safeway's Eating Right Kids, or President's Choice Mini Chefs); or

2. Products that have at least one of the following aspects: • Direct claims or allusions to "fun'Vplay on the

package; • Cartoon iconography pointedly directed to

children; • Tie-ins with children's television programs,

merchandise or films; • The foregrounding of strange shapes, unusual

colours or unconventional tastes; • Puzzles or games targeted at children.

A total of 354 products were purchased for coding, and 37 variables were recorded for each product (including the brand, product name, food category, food type, and price - as well as variables specific to the package itself, such as the use of cartoons/ cross merchandising appeals, nutrition claims, and verbal claims). Nutrition information was recorded for all products.

Since the goal was to assess how "better-for-you" products compare nutritionally with other children's foods, the researchers needed to identify the "better- for-you" products within the dataset comprised of 354 child-targeted foods. The mere presence of a front-of-package health claim, mark, seal or nutrient claim did not suffice to characterize the product as "better-for-you," as such marks are ubiquitous (present on everything from boxes of Marshmallow Pebbles and Pop Tarts to fruit snacks, packaged meals, and yogurts). Front-of-package claims were therefore removed from consideration when it came

to selecting "healthier" products. Instead, products were deemed "better-for-you" when the brand line or specific product was explicitly labeled (or foregrounded as part of a marketing campaign) as "healthier for you." This would include, for example, Safeway's Eating Right Kids brand launched in 2009 and promoted as a "new brand of great tasting foods" with "better-for-kids nutritional benefits" (Safeway 201 1). It also includes Loblaw's PC Mini Chefs brand, a line of healthy-choice products for children that debuted in 2004, as well as the child- targeted brands of Healthy Times, Healthy Handfuls, BOBOKIDS,1 Annie's Homegrown (Totally Natur- al)2 and Florida's Natural. Since the term "organic" is strongly associated with the concept of "healthy" for consumers (Schuldt and Schwartz 2010), brands that touted organic or environmental names - such as Na- ture's Path EnviroKidz line-up of products, Earth's Best Organic, and Eco-Planet were also included. As Schuldt and Schwartz attest, "strong associations exist between the concepts 'organic' and 'healthy' in contemporary America, associations that are promoted by marketers and reflected in survey data in which most Americans endorse organics as healthier" (2010, 144). Furthermore, "natural foods ... tend to be seen as inherently good and healthy ... further supporting associations between organic production and healthy attributes" (2010, 144). Certain product extensions such as Yoplait Minigo immuni+ Jr. were also included, because Minigo immuni+ Jr. was marketed as "specially designed for parents who want to protect their child's health and help them develop a strong immune system" (Yoplait 2008). Note that products typically presumed to be "better-for-you" (such as yogurt, stringable cheese or unsweetened applesauce) did not automatically get classified as "better-for-you" based on some presupposed notion of health. The brand or product name needed to deal explicitly with the concepts of "healthy," "eating right," "natural," "organic," etc., to be selected as "better-for-you." (For instance, Yoplait Minigo immuni* Jr. was categorized as "better-for-you," but

Yoplait Minigo - which does not foreground a claim to health - was not.)




Packaging Health : Examining "Better-for-You" Foods Targeted at Children 269

Nutritional Criteria Building on previous research (CSPI 2006; Elliott 2008a; Sims et al. 2011) we defined foods as being of Poor Nutritional Quality (PNQ) if they met one or more of the following criteria with respect to fat, sodium or sugar. Note that these criteria are extremely liberal when it comes to sodium levels in processed foods - particularly in light of the Insti- tute of Medicine's recommended Adequate Intake (AI) levels of 1,200 mg/day for children aged four to eight, and 1 ,500 mg/day for children aged nine to 13 (IOM 2005). For fat and sodium, PNQ products have one of the following:

• >35 percent of total calories from fat, excluding nuts, seeds, and peanut or other nut butters;

• >230 mg sodium per serving for chips, crackers, cheeses, baked goods, french fries, other snacks, and meats;

• >600 mg sodium for pizza, sandwiches, and main dishes;

• >770 mg sodium for meals (CSPI 2006).

To evaluate sugar, the study drew from Amer- ican Heart Association (AHA) recommendations (Gidding et al. 2005), as well as previous research (Elliott 2008a, 201 lb; Harrison and Marske 2005), which suggest that foods are of poor nutritional quality if more than 20 percent of their calories derive from sugar. This criterion was selected because it assesses the percentage of sugars (rather than an absolute cut-off regardless of portion size), and therefore allows for a more nuanced analysis. Al- though current recommendations for sugar pertain to added sugars - not naturally occurring sugars found in fruit or milk - product labels do not distinguish between the two, which means that the Nutrition Facts table must be read at face value. As such, with the exception of certain products (detailed below), the amount of total sugars displayed on the label was used to assess the nutritional quality. Relying

on the Nutrition Facts table, it should be noted, is something that consumers must also do.

Exceptions to the Criteria for Sugar One obvious challenge arises from evaluating packaged foods strictly according to the threshold of 20 percent of calories coming from sugar. In certain cases, products containing only naturally occurring sugars, such as plain cut-up fruit, might be erroneously classified as "poorly nutritious" due to high levels of naturally occurring sugars noted on the label. To avoid this misclassification, child- targeted products that were simply plain cut-up fruit, unsweetened fruit cups or unsweetened applesauce were left in the sample set, but were not classified as high in sugar (or "poorly nutritious"), regardless of the sugar levels indicated on the label.3

Analysis and Results

Univariate analyses in the form of frequencies (or counts) were conducted to describe the nature of variables used in this study, comparing levels of sugar, fat, and sodium across various product categories and subcategories. In certain instances contingency tables and statistical tests (Pearson's chi-square and Fisher's exact test) were used to verify independence between the "better-for-you" and "regular" foods and nutritional quality. In such cases the null hypothesis is that there is no difference between the "better-for-you" and "regular" foods; the alternate hypothesis is that there is a statistically significant difference.

Of the 354 children's foods purchased, 82 products (roughly 23 percent of the sample) were classified as "better-for-you" due to the brand's (or the individual product's) emphasis on being "healthy," "natural," "organic" or "environmental." As would be expected, the "better-for-you" products fared much better nutritionally than the "regular" child-targeted foods. While 91 percent of the "regular" child-oriented foods had high levels of




270 Charle ne Elliott

sugar, fat or sodium, only 65 percent of the "better" products were high in fat, salt or sugar (HFSS).4 "Regular" fun foods, were almost three times as likely to have high levels of sodium as the "better" products (14.3 percent vs. 5 percent),5 and twice as likely to have high levels of fat (18 percent vs. 8.5 percent).6 High levels of sugar were evident in both the "better-for-you" and "regular" foods aimed at children - with 55 percent of the "better" and 74 percent of the "regular" products containing high sugar levels (Table 1).

Collectively, the most dominant representation of child-targeted foods is found in the dry goods category (221 products; approximately 63 percent of the sample). Dairy came second (59 products; 17 percent); and refrigerated and frozen foods, third (28 products; 14 percent). Substantially under- represented was the fruits and vegetables category, which comprised merely 1 percent of the sample and was represented by two brands. Consistent with what was observed in a 2008 analysis of "fun food" (Elliott 2008b), and despite the broader trend toward health (described above), only small apples and baby carrots comprise children's fare when it comes to produce. No other unprocessed fruits and vegetables were specifically targeted at children (2008a, 263).

Dry Goods Within the dry goods category (as shown in Table 2), high levels of sugar were evident. Over 87 percent of the 166 "regular" child-targeted foods in this category had over 20 percent of the calories coming from sugar, whereas this was the case in only 62 percent of the 60 "better-for-you" products.7 While the "better-for-you" products were, in the specific case of cookies and biscuits, better (with 69 percent containing high levels of sugar compared to 93 percent of "regular" fun foods),8 overall, this is a difference of degree, not kind. Cereals, fruit snacks, granola/cereal bars and drink boxes in both groups were consistently high in sugar. Ninety percent of "better-for-you" cereals had high sugar content (versus 100 percent of "regular" cereals) making it difficult to recommend either option. The same holds true for granola/cereal bars (all high in sugar) and drink boxes (100 percent of "better-for-you" fun-food drinks were high in sugar versus 92 percent of "regular" child-targeted drinks).

The remaining food categories - dairy, refrigerated and frozen foods, meat/seafood, and frozen desserts - had a very low number of items positioned as "better-for-you" (five products or fewer), and so will not be outlined in depth. Suffice it to say that both

Table 1 Nutritional Quality within the Whole Sample

"Better-for-You" Fun Foods "Regular" Fun Foods High Level (%) High Level (%)

Sugar (45) 54.9% (200) 73.5% Total fat (7) 8.5% (49)18.0% Sodium (4) 4.9% (39)14.3%

High levels in one or more of the above (53) 64.6% (247) 90.8% None of the above (low level of sugar, fat, and sodium (29) 35.4% (25) 9.2%

Note: Numbers in brackets indicate number of individual products (individual product counts). Source: Author's calculations.




Packaging Health: Examining "Better-for-You" Foods Targeted at Children 271

Table 2 Nutritional Quality within Dry Goods

Over 35% of Calories High Sodium Over 20% of Calories Coming from Fat Coming from Sugar

Type of Food " Better-for-You " "Regular" Fun " Better-for-You " "Regular" Fun "Better-for-You" "Regular" Fun Fun Foods Foods Fun Foods Foods Fun Foods Foods

Cereal - (9) 90.0 (21)100.0 Crackers (3)42.9 (3)50.0 (2) 28.6 (1) 16.7 Cookies/biscuits (1) 7.7 (6)20.0 - - (9)69.2 (28)93.3 Fruit snacks/applesauce - - - (6) 42.9 (30) 90.9 Granóla bars/snacks/cereal bars - - - (5)100.0 (16)100.0 Pasta (box/canned) soups - (13)100.0 (1) 25.0 (10) 76.9 Drinks/drink boxes - - (6)100.0 (12) 92.3 Drink syrups/crystals - (22) 1 00.0 Puddings/gelatin desserts - - - - - (5)100.0 Dressings/sauces/condiments - - - (1)100.0 Peanut butters/jams/spreads - - - - _ (1) 14.3

Total (4) 6.7 (9) 5.4 (2) 3.3 (14) 8.4 (37) 61.7 (145) 87.3

Note: Numbers in brackets are the number of individual products. Dashes indicate that no products were observed in that category and classification.

Source: Author's calculations.

yogurts in the "better-for-you" lineup contained over 20 percent of calories coming from sugar; the "all natural" fries targeted at children were high in both fat and sodium; and the "better-for-you" ice cream/ ice cream bars were high in either sugar or fat. Since sugar is the typical reason "better-for-you" products were classified as of poor nutritional quality, Table 3 details the percentage of calories coming from sugar in four main food categories: dry goods, dairy, refrigerated and frozen foods, and frozen desserts. This table reveals that, on average, the percentage of calories coming from sugar in the refrigerated and frozen foods category is comparable between the "better-for-you" and "regular" child-targeted foods (12 percent vs. 13 percent), and that the "regular" child-targeted foods in the dairy category had, on average, a lower percentage of calories coming from sugar than the "better-for-you" products (39.9 percent

vs. 41.5 percent). It is important to underscore that the products ranking highest for sugar in the "better- for-you" category- such as Eating Right Kids Fruit Punch flavoured juice blend (with 98 percent of calories coming from sugar), and Sun-Rype Funbites Fruit-to-Go fruit snacks (with 93 percent) - contain no added sugar. Sugars in these products are naturally occurring fruit sugars, although products further down the list, such as "better-for-you" sundae cups (64 percent of calories from sugar) and fudge pops (54 percent of calories from sugar), did have added sugar. EnviroKidz Koala Crisp cereal - containing 40 percent calories from sugar - has a higher percentage of calories from sugar than Kellogg's Pop Tarts (36 percent). In fact, Koala Crisp has the same percentage of sugar calories found in marshmallow Lucky Charms (40 percent) and a level not dissimilar to Froot Loops (44 percent).9





Table 3 Percentage of Calories from Sugar

Average Percentage of Calories from Sugar

Healthy Line Regular

Dry goods Cereal (10) 26.6% (21) 35.5% Crackers (7) 10.1% (6) 5.9% Cookies/biscuits (13) 22.6% (30) 38.6% Fruit snacks/applesauce (14) 71.0% (33) 65.1% Granóla bars/snacks/cereal bars (5) 26.4% (16) 32.8% Pasta (boxed/canned) soups (4) 1 0.5% (1 3) 1 8.3% Drinks/drink boxes (6) 81 .2% (1 3) 82.0% Drink syrups/drink crystals/powders (22) 94.5% Puddings/gelatin desserts (5) 61 .8% Peanut butters/jams/spreads (7) 1 6.9% Dressings/sauces/condiments (1 ) 35.0%

Total dry goods (60) 38.7% (1 66) 50.7%

Dairy Milk (16) 61.7% Yogurt (2)43.6% (13)48.8% Milk/yogurt based drinks (1 ) 66.7% Cheese (3)40.0% (17)11.0%

Total dairy (5) 41 .5% (47) 39.9%

Refrigerated and frozen foods Frozen dinners/meals (2) 13.3% (3) 14.5% Pizza pops/pogos (2) 8.3% (14) 5.6% Fries/potatoes (1) 9.1% (2) 2.6% Packaged lunches (2) 1 3.1 % (1 3) 24.3% Frozen breakfast foods (2)14.3% (7) 9.8%

Total refrigerated and frozen foods (9) 1 1 .9% (39) 1 3.1 %

Frozen desserts Frozen ices/popsicles (13)77.3% Icecream (3)48.4% (2)24.9%

Total frozen desserts (3) 48.4% (15) 70.3%

All of sample (82) 36.1% (272) 43.9%

Note: Numbers in brackets indicate the number of individual products. Source: Author's calculations.





Not surprisingly, conducting the statistical test of the null hypothesis of no difference in proportions of food products of poor nutritional quality using the proportions in Table 3 results in a loss of statistical significance compared to the same test of the proportions in Table 1 . That is, accounting for the fixed-effects of the dry goods subcategories (Cereal, Crackers, Cookies/biscuits, etc.) that have both better-for-you" and "regular" products produces a lower significance level than when all subcategories are considered pooled together: p-value=0. 1 1 4 is not enough to reject the null hypothesis that there is no difference between the proportions of "better-for- you" and "regular" foods that are of poor nutritional quality. While the difference in proportions of products of poor nutritional quality is qualitatively the expected direction if "better-for-you" foods are healthier, the lack of statistical significance of the differences suggests that a food shopper is statistically no better off choosing a "better-for-you" product than a regular product within a given food category. In the case of dry goods, this would suggest that "better- for-you" claims on packages, wrappers, and labels are very much about advertising, with few important benefits in terms of identifying healthier food choices.

Nutritional Quality and Nutrition Claims As poted above, the use of front-of-package labeling to signal a product's "healthful qualities" is

particularly robust in today's marketplace. This is patently the case with "better-for-you" products: 96 percent of products analyzed (79 out of 82) made one or more nutrition claims on the front of the box (see Table 4). Products claimed to have no artificial flavours, colours, or trans fats; to be low in fat; or to be a source of particular vitamins (e.g., vitamin D or C) or minerals (e.g., calcium or iron). Products may also have a Health Check or nutrition mark/ seal. In fact, compared to "regular" child-targeted food packages, "better-for-you" products had a substantially higher percentage of FOP claims - 96 percent versus 41 percent. Remarkably, 96 percent of "better-for-you" products classified as being of poor nutritional quality due to high levels of fat, sodium, or sugar also had a front-of-package claim. Every one of the seven "better-for-you" products with over 35 percent of calories coming from fat displayed one or more FOP claims (compared to only 28.6 percent of "regular" child-targeted packaged food) (see Table 5). Likewise, all four of the "better-for-you" products flagged for high levels of sodium displayed FOP claims - whereas only 41 percent of high sodium "regular" child-targeted foods did so. In the case of sugar, 96 percent of high sugar products in the "better-for-you" line-up (43 products) had one or more FOP claims. Popular claims included "No Trans Fat," "Source of Fibre," "Whole Grain," "Source of Vitamin C," and "No

Table 4 Nutrition Claims on "Better-for-You" Products

Front-of-Box Claim Not Poor Nutrition PNQ Due to Fat, Sodium, or Sugar Total Frequency /% Frequency /%

No specific claim (1) 3.4 (2) 3.8 (3) Some sort of claim (28) 96.6 (51)96.2 (79)

Total (29) (53) (82)

Notes: PNQ = poor nutritional quality. Numbers in brackets indicate the number of individual products. Source: Author's calculations.





Table 5 Nutrition Claims on Child-Targeted Products Assessed for Fat, Sodium, and Sugar

Front-of-Box Claim " Better-for-You " Fun Foods " Regular " Fun Foods

Not Poor Nutrition Over 35% of Calories Not Poor Nutrition Over 35% of Calories Coming from Fat Coming from Fat

No specific claim (3) 4.0% - (73) 32.7% (35)71.4% Some sort of claim (72) 96.0% (7)100.0% (150) 67.2% (14)28.6% Total (75) (7) (223) (49)

Not Poor Nutrition High Sodium Not Poor Nutrition High Sodium

No specific claim (3) 3.8% - (85) 36.5% (23)59.0% Some sort of claim (75) 96.2% (4) 1 00.0% (1 48) 63.5% (1 6) 41 .0% Total (78) (4) (233) (39)

Not Poor Nutrition Over 20% of Calories Not Poor Nutrition Over 20% of Calories Coming from Sugar Coming from Sugar

No specific claim (1) 2.7% (2) 4.4% (38)52.8% (70) 35.0% Some sort of claim (36)97.3% (43) 95.6% (34) 47.2% (130) 65.0% Total (37) (45) (72) (200)

Note: Numbers in brackets are the number of individual products. Source: Author's calculations.

Artificial Flavours/Colours" (see Table 6). In com- parison, only about two-thirds of "regular" products identified as high in sugar also had nutrition claims on the front of the package. "Better-for-you" products, across all food categories, made consistent use of FOP claims - even when the products contained high levels of sugar, fat, or sodium.

Package Appeals and Product Nutrition Child-targeted supermarket food is designed to interest children through various appeals to "fun" and play - whether through the use of cartoon images, cross-merchandising or direct claims to "fun." Almost 70 percent of the products analyzed (69.3 percent of the whole sample) prominently displayed a cartoon image on the front of the package - and 22

percent of these child-targeted products specifically articulated the "fun" aspect of the edible. Products claimed to be "fun to eat" or to come in "fun shapes" or "assorted fun colours." Sometimes the names of the products themselves communicated fun, as with Black Diamond's FunCheez or Eggo's FunPix waffles. In both of these cases, the packaging further reinforces such fun claims - explicitly describing the food itself as "fun to eat" or correlating the product with fun by directing children to a website "for more Eggo fun." Squeezable fruit spread, another example, claims to "add great flavour and fun to your food and snacks!" while squeezable yogurt tubes proclaim "a lot of fun, with no artificial col- our!" Kool-Aid's drink mix further instructs children to "mix up some fun!"




Packaging Health: Examining " Better-for-You

" Foods Targeted at Children 275

Table 6 Specific Nutrition Claims on "Better-For-You" Products Analysed for Sugar

Low Sugar High Sugar Claim on Front of Package Frequency Frequency

No specific claim 1 2 No artificial flavours/colours 1 1 5 Low fat 2 4 Low sugar 1 6 Whole grain/fibre 7 8 Source of iron 7 4 Source of calcium 7 6 Non-hydrogenated oil - 1 No trans-fat 10 9 Organic 8 16 No preservatives 1 2 Essential nutrients 2 Nutritionist-endorsed - 1 Made with real fruit juice 1 6 Peanut free 3 1 Source of vitamin D - 3 Source of vitamine 8 6 Health check - 0 Other 7 22

Source: Author's calculations.

Yet it is worth noting that the "better-for-you" foods had higher percentage of products that directly reference "fun" somewhere on the package. Dole Squish'ems! squeezeable fruit snack promises "100% real fruit fun!" Earth's Best Organic Let- ter of the Day Cookies claim to "help your child make healthy habits an important and FUN part of everyday life!" (The box additionally instructs that Letter of the Day Cookies have an educational component - being "a nutritious and great tasting way for kids to learn their ABC's.") EnviroKidz Animal Cookies, likewise, emphasize their "fun to eat" nature. And the Eating Right Kids brand tagline - found on everything from bug-shaped pasta to mini-sized pink waffles - affirms that the brand (along with the Looney Tunes characters found on every package) "help[s] you and your kids make choosing better-for-you meals and snacks

fast, easy ... and fun!" (emphasis on package). Ap- proximately 29 percent of "better-for-you" products make a direct statement about "fun" somewhere on the package, compared to 23 percent of "regular" products. "Better-for-you" products that are also high in sugar or fat or sodium are also more likely to reference "fun" directly than "regular" products of poor nutrition; however, they are less likely to directly reference "fun" on the front of the box (see Table 7).

As with many "regular" child-targeted products, fun in the "better-for-you" line-up is often re- inforced by unique product names, flavours and/ or features. Both Squish'ems! and Smooshies squeezable fruit snacks underscore the interactive and entertaining nature of the food through the use of onomatopoeia. Earth's Best Organic Yummy





Table 7 Reference to "Fun" on Package and Poor Nutritional Quality

Claim on Package "Better-for-You" Fun Foods "Regular" Fun Foods

Not Poor Nutrition PNQ Due to Sugar, Not Poor Nutrition PNQ Due to Sugar, Sodium, or Fat Sodium, or Fat

Fun food theme on package (anywhere) (9)31.0% (13)24.5% (3)12.0% (53)21.5% No reference to fun (20) 69.0% (40) 75.5% (22) 88.0% (1 94) 78.5%

Total (29) (53) (25) (247)

Note: PNQ = poor nutritional quality. Numbers in brackets are the number of individual products. Source: Author's calculations.

Tummy Oatmeal or On-the-Go O's Cereal and Mini Chefs Cha-cha-Cheesy Macaroni & Cheese Dinner accomplish this through alliteration. BOBOKIDS Organic Secret Agent Kids Pancake Mix and Secret Agent Stew lend a mysterious air to banana chocolate chip pancakes and prepared stew. (The "secret" here is targeted to parents, however. The package reveals that it contains "Undercover Veggies" along with a "Sherlock" cartoon image under the phrase, " Shhhh ... veggies sneaked in .")

Discussion

Examining "better-for-you" products targeted at children reveals a number of considerations and opportunities when it comes to "packaging health." Not surprisingly, the study reveals that, when examining the two "sets" of products as overall categories ("better-for-you" and "regular"), the "better-for-you" child-targeted foods (overall) present a stronger nutritional profile than "regular" child-targeted foods: 91 percent of the "regular" child-oriented products have high levels of sugar, fat, or sodium, whereas 65 percent of the "better-for- you products" are HFSS. "Better-for-you" products are indeed "better." Yet it remains significant that the 65 percent of the products specifically designed

to communicate "healthy" to consumers still have high levels of sugar, fat, and/or sodium. This scen- ario does not make the healthy choice the "easily recognizable option," as recommended by Canada's Ministers of Health (PHAC 2010, 4).

Food manufacturers are clearly responding to the increased consumer interest in health by providing more wholesome packaged food options for children. However "better-for-you" products cannot be consumed with impunity. High levels of sugar are evident in both "better-for-you" and "regular" supermarket foods aimed at children. In fact, certain "health-oriented" products have an equal percentage of calories - or even more calories - coming from sugar than their "junkier" counterparts (e.g., Enviro- Kidz Koala Crisp cereal compared to marshmallow Lucky Charms and Pop Tarts).

Given this fact, "better-for-you" marketing can also be misleading - particularly if claims such as "organic," "natural" or "eating right" prompt consumers to extend a health halo to the product as a whole. Consumers strongly associate the term "organic" with both "healthy" and "lower calorie" (Schuldt and Schwartz 2010); if they don't carefully scrutinize the Nutrition Facts table, it is reasonable to assume that this health halo will be triggered.





Even though studies suggest that consumers in general are "fairly sophisticated in their ability to use information provided by the Nutrition Facts panel to formulate appropriate conclusions" (Kozup, Creyer, and Burton 2003, 25), their actual use of this information during food purchase is less certain (Cowburn and Stockley 2004). Some studies suggest that most consumers simply look at the "information available and mov[e] on, without processing it further, even when seeking 'healthy versions' of foods" (Higginson et al. 2002, 151).

Front-of-package claims, used to augment the "healthy" attributes of packaged foods, also fail to provide a reliable indicator of nutrition. This study found that 96 percent of the "better-for-you" products analyzed had some sort of FOP claim. Virtually all the "better-for-you" products classified as being of poor nutritional quality due to high levels of sugar, sodium, or fat also had a FOP claim. To reiterate, when examined unconditionally, statistically, "better-for-you" products were indeed better nutritionally than "regular" child-targeted foods - although "healthier" is not synonymous with "healthy." This study's finding is consistent with that of a recent US review that specifically examines FOP labels on supermarket foods targeted at children. Sims et al. report that 84 percent of the 58 packaged foods they analyzed were unhealthful because the products "did not meet one or more nutrient criteria for total sugars, fat, saturated fat, sodium or fiber" (201 1, 8). Sims et al. also observe that 95 percent of their study products contained added sugar, while 93 percent of the cereals they examined, along with 90 percent of the snack foods, were high in sugar. This prompts the authors to "call into question the nutritional value of products containing manufacturer-developed front-of-package labels" (201 1, 8). In fact, it seems that researchers are not the only ones calling FOP labels into question. The US Government Accountability Office (GAO) observed that "consumers find it difficult to distinguish among the many different types of claims on food labels," including health claims, qualified health claims, and structure/function

claims (GAO 2011). And in Canada, a nationwide poll reported that nearly half of Canadians do not believe health claims on food products (Schmidt 2011, A 13). Front-of-package labels, like health claims, are increasingly being regarded for what they fundamentally are: a marketing strategy.10

Most intriguing in this study is the fact that the "better-for-you" foods were more likely than the "regular" child-targeted products to directly reference "fun" somewhere on the package. Like FOP labels, the notion that food must be fun to be desirable is also a marketing strategy - although one unique to children's foods (Elliott 2010). The implications of marketing food to children as entertainment have been discussed elsewhere (Elliott 2008a, 2010, 2011a; Schor 2007); suffice it to say that the proliferation of this marketing technique not only encourages eating for the wrong reasons (i.e., for entertainment and distraction), but also powerfully communicates that children should be served "special" foods made uniquely for them. Children's fare, according to its marketing, should be more playful, colourful and interactive than other edibles. Fun is promised on the package, designed into the food, and made central to the eating experi- ence. And because the promotion of such products typically emphasizes the fun, cool, or "oppositional" aspects of kids'food (Schor 2007), children do not associate children's packaged food with "healthy" food (Elliott 2009, 201 la). Perhaps this is why one third of the "better-for-you" products make a point of referencing their "fun" qualities. Reasonably, one might question whether the theme of fun is a sensible one to yoke to food: promoting food on the basis of its "eatertainment" is a fairly recent development (Kessler 2009), and it is notable that the "fun" qualities consistently override claims to health in children's products. For children's supermarket fare, health is secondary to fun. In assessing "better-for- you" products targeted at children, then, one needs to consider not merely the nutritional quality (which is, overall, "better-for-you"). Equally significant are the ways that consumers might presume that "healthier" means "healthy" - and the ways that




2 78 Charlene Elliott

such products frame fun as a vital criterion for evaluating the desirability of foods.

Contributions and Policy Considerations Supermarket food, and its marketing, raise a number of policy considerations that can work to promote, rather than undermine, the health of our children. It is indisputable that both fun food and its packaging communicate powerful messages about eating and about what should be valued when it comes to food. At base, one must seriously consider the long- term consequences of such a marketing strategy. Foregrounding fun has nothing to do with health or nutrition; promoting "eatertainment" can contribute to over-eating and problematic relationships with food. While this analysis examined two distinct categories of packaged products targeted at children (i.e., "better-for-you" and "regular" products), both categories essentially present the same problem in terms of promoting fun through food to children, which is an unsettling technique for evaluating the desirability of food. (By extension, are unprocessed fruits and vegetables dull?).

A key policy consideration arising from this point pertains to what counts as marketing in the current food environment. Currently packaging, wrappers, and labels are exempted from regulation under the Canadian Code of Advertising Standards. Yet there is real purchase in recognizing that packaging is, in fact, a type of advertising that targets both children and parents (who make purchases for their children, and with them in mind). 1 1 Considering packaging as advertising means that any voluntary commitment the food industry makes to promote "healthier" for you products to children (as can be found in initia- tives such as the Canadian Children's Food and Beverage Advertising Initiative) would extend to packaged products. Secondly, for the products that do pivot on "better-for-you" appeals, implementing standardized criteria (and cut-offs) for sugar, fat, and sodium within product categories would help to ensure that products promoted as a "better-for-you" choices are, in fact, healthier. This is particularly significant given that front-of-package claims and

health claims are marketing strategies, and not simply about communicating health.

Notes

Funding for this research was generously provided by the Canadian Institutes of Health Research. The author would like to thank Shelley for her excellent work in coding, and the anonymous reviewers for their suggestions. Special thanks are owed to Dr. Conlon for his thoughtful advice, feedback, and ongoing support.

1 BOBOKIDS is described as a "healthy alternative" to the "ready-made options for kids' food." The company's founder describes her philosophy as "No Junk - Just Good Eating!" (Bobobaby, Inc. 2011).

2 Annie's brand emphasizes the organic, natural and sus- tainable aspect of its product line: "We nourish communities by providing healthy food promoting sustainability and supporting organizations motivated by our same intrinsic purpose" (Annie's Homegrown, Inc. 2011).

3 Note that juices were not included in this exception. There is considerable debate over sugar levels in juices, unsweetened or not. For example, Eating Right Kids markets a 100 percent juice blend - but the ingredients are all juices from concentrate. The USDA recommendations (2005) observe that "juice concentrate" is a synonym for sugar. In light of this, the unsweetened juices are not treated the same way as plain cut-up fruit, fruit cups, unsweetened applesauce, etc. Orange juice is certainly not poorly nutritious, although it does have a high level of naturally occurring sugars (and lacks the fiber of, for example, a whole orange, which works to mitigate insulin spikes).

4 Pearson's x2=3 1 .3973, d.o.f.= 1 , p-value=2. 1 03 x 1 0"8; Fisher's exact test (two-sided) p-value =8.53 lxlO"8.

5 Pearson's %2= 1 9.0933, d.o.f.= 1 , p-value= 1 .245 x 1 0"5; Fisher's exact test (two-sided) p-value=3.528><10"6.

6 Pearson's x2= 19.3687, d.o.f.=l,p-value=1.078xl0"5; Fisher's exact test (two-sided) p-value=4.89xl0"6.

7 Pearson's %2= 16.93 88, d.o.f.=l, p-value=3.860xl0"5; Fisher's exact test (two-sided) p-value=4.509xl0"5.

8 Pearson's x2= 2.6105, d.o.f.= l, p-value=0.1062; Fisher's exact test (two-sided) p-value= 0.05763.





9 As per the data in Table 3, doing a fixed-effects analysis on the dry goods subcategories (cereal, crackers, cookies/biscuits, etc.) that have both "better-for-you" and "regular" products produces a lower significance level than when all subcategories are considered; p-value=0. 1 14 is not enough to reject the null hypothesis that there is no difference between "better-for-you" and "regular" foods. This supports the argument just made under the dry goods subhead, which affirms that the difference between the "better-for-you" and "regular" products is a "difference in degree, not kind" - and therefore it is "difficult to recommend either option." Stated differ- ently, while the difference in proportions of products of poor nutritional quality is qualitatively the expected direction if "better-for-you" foods are healthier, the lack of statistical significance of the differences suggests that a food shopper is statistically no better off choosing a "better for you" product than a regular product within a given food category.

10 But it is a marketing strategy with consequences. Such appeals to health reinforce what Scrinis labels the ideology of nutritionism: the tendency to evaluate food in terms of its nutrient and biochemical composition instead of more holistically. Instead of encouraging consumers to eat whole foods the assumption "is that a calorie is a calorie, a vitamin a vitamin and a protein a protein regardless of the particular food it comes packaged in" (Scrinis 2008, 41). Nutritionism is a paradigm that has been advocated by nutrition scientists, dieticians, and public health au- thorities, but has increasingly "been co-opted by the food industry and has become a powerful means of marketing their products" (2008, 39). The value of nutritionism for marketers is that it allows processed foods to be reconfig- ured into "healthier": choices: a bowl of oats is a source of whole grain, but so (as the package declares) is Lucky Charms. As this study shows, one current challenge is that even the products promoted as "healthier" lie on a spectrum in terms of nutritional quality.

Note that in June 2011 the US Interagency Working Group on Food Marketed to Children completed its public consultation on a set of Preliminary Proposed Nutrition Principles to Guide Industry Self Regulatory Efforts (IWG, 2011). Section three of the proposed Principles explicitly includes packaging and point-of-purchase displays as part of the definition of marketing targeted to children" (2011, 16).

11 Note that in June 201 1, the US Interagency Working Group (IWG) on Food Marketed to Children completed

its public consultation on a set of Preliminary Proposed Nutrition Principles to Guide Industry Self Regulatory Efforts (IWG, 201 1). Section three of the proposed principles explicitly includes packaging and point-of-purchase displays as part of the definition of marketing targeted to children" (2011, 16).

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