Creating an Environment in Which Youths Are

Encouraged to Eat a Healthier Diet

Marvin E. Goldberg and Kunter Gunasti

More than one-third of young people in the United States are either obese or at risk of becoming
obese. The authors consider how food marketers have contributed to this problem and how they might
help resolve it. The article organizes the marketing activities of food-related companies around the
classic four Ps. The authors first discuss product, price, and promotion in terms of past, present, and
potential future industry actions. They then discuss place as a function of four key commercial end
points in the food channel: (1) supermarkets, (2) convenience stores, (3) restaurants, and (4) schools.
The authors consider government actions in terms of how they affect the actions of both the food
industry and consumers. Throughout the article, the authors consider how extant research can be
extended in an effort to better understand and address the youth obesity problem.

besity rates among adolescents in the United States diet and exercise were not significantly related to larger

O have tripled since 1963. More than one-third (33.6%)

of U.S. children and adolescents are either obese or at
risk of becoming obese (Ogden et al. 2006), with significant
effect sizes. Programs with adolescents were somewhat
more successful than were those with younger children.

variations across ethnic and socioeconomic groups.1 Over- A Case Study

weight children have a 70% chance of being overweight or
obese as adults and an 80% chance if one or more parent is
overweight or obese. Obesity increases various health-
related risks both in childhood and into adulthood (Ameri-
can Heart Association 2005). It is estimated that at current
rates, the lifetime risk of type 2 diabetes (and many related
health problems) is 30% for boys and 40% for girls
(McGinnis, Gootman, and Kraak 2006). Other associated
health problems for which obesity increases the risk include
high cholesterol, high blood pressure, asthma, and general
poor health (Koplan, Liverman, and Kraak 2005).
A meta-analysis of 64 intensive obesity-prevention pro-
grams (Stice, Shaw, and Marti 2006) found that only 21%
of efforts worked in the short run and only 5% had effects
that lasted for any significant time beyond the programs
termination. It is not surprising that programs with self-
selected participants tended to be more effective. Moreover,
the meta-analysis found that mandated improvements in
1Among female adolescents, both Mexican Americans and African
Americans are more likely to be obese or at risk for obesity than white
Americans. Among male adolescents, Mexican Americans but not African
Americans are significantly more likely to be obese or at risk for obesity
than white Americans (Ogden 2006). Although families socioeconomic
status is inversely related to the prevalence of adolescent obesity for white
Americans, the same is not true for African Americans or Mexican Ameri-
cans (Ogden, Carroll, and Flegal 2003; Troinano and Flegal 1998).
Marvin E. Goldberg is Irving & Irene Bard Professor of Marketing
(e-mail: mgold@psu.edu), and Kunter Gunasti is a doctoral student
(e-mail: kunter@psu.edu), Department of Marketing, Pennsylvania
State University. The authors thank Gerry Gorn, Bill Dietz, Betsy
Moore, Joel Cohen, and the three anonymous JPP&M reviewers for
their valuable insights.
2007, American Marketing Association
ISSN: 0743-9156 (print), 1547-7207 (electronic)
A recent case demonstrates the challenges that lie ahead in
addressing the increasingly serious problem of obesity. The
case involved an intense effort of a single school in Osceola
County, Fla., to improve what children ate for breakfast and
lunch at the school (Belkin 2006). The U.S. Census data for
2004 indicate that the county had a population of slightly
less than 232,000. Personal per-capita income was $20,811,
compared with $31,469 for the entire state. In terms of race
and ethnicity, 77.2% of the county residents are white;
29.4%, Hispanic; 7.4%, African American; 2.2%, Asian;
and 13.2%, other (U.S. Census Bureau 2004).
In the Florida school effort, it was expected that the chil-
dren would be reluctant to try new (and strange) foods.
Program administrators realized early on that they could not
just place the new foods out in the cafeteriathey needed
to explain and promote the foods. Several other factors,
however, did take the program administrators by surprise.
Costs of healthier food ingredients were significantly higher
than the ingredients the schools typically received from the
U.S. Department of Agriculture (USDA) or other large-
scale food providers (e.g., lower-fat cheese slices cost $.04
more per slice than the regular higher-fat version). As a
result of limited government subsidies for meals, the price
differentials are highly significant.
The program administrators also failed to anticipate fully
that parents and teachers would be as reluctant as the chil-
dren to support the changes. The school administrators and
staff reported disliking at least some of the new foods them-
selves. At least by their physical appearance, many, if not
most, of the teachers did not seem to represent positive role
models for good nutrition and exercise. Many teachers did
not use the program-provided educational materials,
explaining that they did not have time or that they involved
too much work. State requirements posed a challenge as
162 Vol. 26 (2) Fall 2007, 162181

well. Many of the teachers said that they would not use the
educational materials because they needed to focus on get-
ting their students to pass the mandated state tests.
Although some of these difficulties are limited to the
school environment, many others are associated with the
broader culture. The program clearly represented a threat to
many of the parents. Some complained about their children
being put on a diet. Others worried that the children would
like the food so much that they would be reluctant to eat the
food at home. Despite the program, parents continued to
raise money for the parentteacher organization by selling
fast food in the parking lot once a week.
The broader culture is such that children have learned to
associate fast food with rewards. In the Florida school,
honor-roll students receive a coupon for a meal at McDon-
alds once per grading period. The lure of foods such as
pizza and nachos (termed la carte foods) in the school
cafeteria is so strong that the program administrators
acknowledged that it was impossible to do away with them.
Moreover, given the need to show improvements in the
childrens health as a concrete outcome, the program
administrators quickly recognized that the myriad compet-
ing influences operating on the childrenhome, friends,
fast food, television, video games, and so onmay limit
their success.
Key Downstream, Midstream, and
Upstream Actors in the Food Marketing
System
The Florida school case emphasizes the complexity of both
trying to improve childrens dietary patterns and identifying
which actors need to be won over in the process. It provides
some understanding of how each actor must be convinced
that the benefits of the dietary changes being pursued out-
weigh the costs to them personally and to their institution
(beyond the benefits to the children; for a discussion of this
perspective, see Andreasen 2006). We model the network
of actors involved using an upstreamdownstream
metaphor that we derived from the work of Wallack and
colleagues (1993) and adapted for our purposes. The
metaphor helps position the actors and institutions in the
food-marketing system. Wallack and colleagues begin by
describing how most change efforts have focused on the
downstream victims of the social/health problem in ques-
tion and point to efforts to try to save them from drowning
(i.e., by using direct persuasive change efforts).
Downstream Actors
Although much of this article focuses on what is done or
what might be done further upstream, ultimately it is the
young people themselves and their eating behaviors that
must change. Children and adolescents control considerable
amounts of discretionary monies. More than one-third
(36%) of teenagers shop for at least a portion of their fam-
ilys food, and close to three-quarters (72%) help at least
once a week with meal preparation (Lempert 2004). The
U.S. Census Bureau estimated that in 2005, 5- to 11-year-
olds would spend between $17 billion and $23 billion them-
selves, spending 30% of that, or $5.8 billion, on food and
beverages (as cited in Lempert 2004).
Journal of Public Policy & Marketing 163
Although we do not focus on physical activity in this arti-
cle, one-third of adolescents do not partake in the recom-
mended levels of moderate or vigorous activity. Ten per-
cent of adolescents are completely inactive, and levels of
physical activity drop as adolescents age (Institute of Medi-
cine [IOM] 2004). Moreover, the data, based on self-
reports, may represent overestimates (Pate et al. 2002). It is
evident that encouraging youths to engage in increased lev-
els of physical activity and providing opportunities for them
to do so is a critical part of the goal of improved health and
fewer cases of obesity.
As downstream targets of the food industry, parents must
also change their behavior. Many of the issues we discuss
herein, such as the impact of food labeling and the general
availability of healthier foods at supermarkets than at
convenience stores, affect parents more directly than chil-
dren. The foods that parents provide for their children and
the example they set by virtue of what they themselves eat
are likely critical factors (Hanson et al. 2005; Neumark-
Sztainer et al. 2003). Some researchers have even noted sig-
nificant correlations between not only parent and child
snack intake but also eating motivations and levels of body
dissatisfaction (Brown and Ogden 2004).
The more frequently families eat together, the healthier
are the childrens dietary habits (Gillman et al. 2000). Par-
ents fruit and vegetable consumption is the best predictor
of young childrens fruit and vegetable consumption
(Cooke et al. 2003; Wardle, Carnell, and Cooke 2005). The
same is true for soft drink consumption (Grimm, Harnack,
and Story 2004). Modeling behavior (Bandura 1977) and
parents simply providing access to particular foods seem to
be effective strategies. In contrast, when parents restrict
access to specific foods, apply pressure for children to eat
specific foods, or reward children for eating a disliked food,
the strategy backfires and children are less likely to follow
their parents preferences or dictates (Birch 1999).
Six in ten mothers of preschoolers and three in four
mothers of 6- to 17-year-olds are in the labor force. More
than 70% of such mothers work full-time (U.S. Department
of Health and Human Services [USDHHS] 2003). The
more hours that women work outside the home, the more
likely their children are to be obese. This effect is most
pronounced in children from upper-income households
(Anderson, Butcher, and Levine 2003). The trends associ-
ated with full-time working mothers and dual-career fami-
lies that are hypothesized to be related to the increase in
childhood obesity include fewer family meals; more eating
out, particularly at fast-food restaurants; and increased
demand for convenience and prepared foods (McGinnis,
Gootman, and Kraak 2006).
Wallack and colleagues (1993) metaphor implies that
though everything possible must be done to save drowning
victims downstream, it may be worthwhile to move
upstream to see how and why they got into the riverinto
the predicamentto begin with. Somewhat further
upstream (or, in our terminology, midstream), Wallack and
colleagues identify many actors in the system, including, in
our case, the various people and institutions in the food-
marketing system whose actions are in many ways respon-
sible for the fate of those drowning downstream. The per-
spective of Wallack and colleagues is that saving the
164 Creating an Environment in Which to Eat a Healthier Diet
drowning victims by influencing the actions of upstream
actors is far more important and effective than is focusing
on (and, in some cases, blaming) the downstream victims.
Midstream Actors
In the food-marketing system, the key participants operat-
ing at midstream include, most directly, food growers and
food-processing firms and their distributors and advertisers;
outside-the-home food purveyors, including restaurants,
fast-food chains and otherwise, convenience stores, grocery
stores, and supermarkets; schools; and the media. We sub-
sequently consider how each of these actors contributes to
shaping the environment in which children and their parents
make food choices. Andreasen (2006) suggests that market-
ing can be used to motivate key individuals in each of these
institutions to work toward a desired social goal, such as
addressing youth obesity.
Upstream Actors
Still further upstream, Wallack and colleagues (1993)
locate broader background societal problems (e.g.,
poverty), which they describe as the root causes of the
downstream problem. We view government as situated at
this most-upstream level. Government (i.e., politicians and
the legislature) operates upstream and, by setting public
policy, helps shape the environment in which midstream or
downstream actors must operate (Andreasen 2006; Wallack
et al. 1993). Laws, including those that structure economic
incentives and disincentives, provide a framework within
which the food industry, the media, and schools conduct
themselves. Regulatory bodies such as the Food and Drug
Administration (FDA) and the Federal Trade Commission
(FTC) give structure to legislation by virtue of their regula-
tory actions. Marketing can inform these steps to make
them more effective.
Upstream Versus Downstream Flows of
Influence
Influence can flow upstream as well. Customer preferences
guide industry actions. Parents and teachers associations
influence school actions. Constituents (especially at elec-
tion time) and industry lobbyists influence legislators. Mar-
keting can be effective in shaping the agenda or priorities of
both legislators and regulators by encouraging them to take
steps that result in healthier diets for children (for a discus-
sion of the related media advocacy strategy, see Wallack et
al. 1993).
Furthermore, upstream and downstream marketing
efforts need not be mutually exclusive (Andreasen 2002;
Goldberg 1995; Rothschild 1999). For example, down-
stream, at the individual level, improving childrens media
literacy may enhance their ability to evaluate advertising
messages critically so that they are more vigilant in pro-
cessing them. At the same time, at midstream, the media
environment itself might change so that the nature and bal-
ance of the food messages to which children are exposed
favor healthier options. Upstream actions by the govern-
ment, such as either constraining the advertising of less
healthful food or encouraging the development of messages
promoting healthier foods and healthful eating, may also
promote the balance.
Midstream and Upstream Actors and the Four
Ps
We next use marketings classic four Ps to describe how the
food-marketing system has contributed to the problem of
youth obesity and how it can contribute to the solution. We
draw on a wide body of recent research to establish both
what is understood at this point and what research needs to
be done to help address the youth obesity problem (see
Figure 1).
As with the marketing of other products, the marketing of
food centers on the basics of marketing, the four Psprod-
uct, price, promotion, and placeas midstream companies
attempt to shape their offerings to reach parents and chil-
dren, their downstream consumers, more effectively. We
first consider a basic aspect of the product: taste. We then
review additional product-related issues, particularly pack-
aging, with a focus on mandatory package labels. It is not
surprising that price is a key dimension. We review the
somewhat-sparse data on price elasticity and sensitivity for
food, particularly as it regards youths. We consider the
impact of the farm bill subsidies on food costs. In addition
to focusing on price in a separate section, we find that price
is also a critical factor in issues such as the type of stores
located in lower-income areas and their relative prices for
healthier foods. In discussing food promotion, we begin by
exploring the degree to which food advertising affects
youths dietary choices and patterns. We also anticipate
how alternative messages for healthier foods might be cre-
atedby whom and creativelyby tapping into youth
motives.
Finally, we focus on the commercial end points of the
food channelthe place where foods are sold: supermar-
kets; smaller grocery stores and convenience stores; restau-
rants, fast-food chains, and full-service restaurants; and
schools. We pay particular attention to what occurs in the
schools, given how central they are to childrens and ado-
lescents day. Children and adolescents not only spend a
good part of their day in school but also eat one and often
two meals there. Moreover, schools can educate students
about the link between nutrition and health and promote its
importance.
Note that some of the marketing functions, such as price,
are relatively unidimensional and/or are covered in a less
extensive body of research, particularly as they relate to
food and youths; thus, they receive a briefer discussion.
Others, such as promotion, are relatively multidimensional
and have more extensive research, which calls for a broader
discussion. In addition, at each point, we consider the pre-
sent and potential role of government and governmental
regulations.
Product
The Paramount Importance of Taste
Researchers have noted that the taste of food products is the
most important factor that guides the food preferences and
choices of children, adolescents, and adults, both in general
and specifically for fruits and vegetables (French et al.
1999; Neumark-Sztainer et al. 2003). Taste is the number-
one factor that children cite as influencing their restaurant

Figure 1. Midstream/Upstream: Marketing and Public Policy Influences on Parents and Youths Food Choices and Dietary
Habits
choice (really important by 84% of children; Strottman
International 2004).
If taste is critical in motivating food choices, the question
becomes, How does one enhance the perceived taste of
fruits and vegetables? No doubt a strawberry dipped in
chocolate appeals a lot more to children (and adults) than a
plain strawberry. To the extent that food producers and
processors view such compromises as likely to help sell a
particular food, and to the extent that nutritionists view
them as acceptable in terms of health, such compromises
may be an effective strategy. It should be relatively straight-
forward for companies to determine, for example, which
(low-fat) dips are tasty enough that they help sell vegetables
to children and adolescents.
Along these lines, McDonalds sells sliced apples, but
with a caramel sauce to enhance their appeal. Kraft Foods
has run commercials for salad dressing that feature vegeta-
bles displayed prominently and attractively with the dress-
ing poured over them. Nestl has launched what it labels a
better-tasting nutrition bar, something that tastes more like
a candy bar (Thompson 2005, p. 3). Inevitably, the balance
that some of the new offerings strike will be controversial.
Marss Kid-Didits snacks (including chocolate cookies and
pretzels) are an example of what critics have labeled green-
washingthe effort by food companies to present less
healthful foods in a more positive light (Thompson 2007).
Packaging: The Value of Convenience
Can making it as convenient to eat fresh produce as it is to
open a bag of chips (Munoz 2005, p. B1) lead children to
eat more fruits and vegetables? Simple experimental
Journal of Public Policy & Marketing 165
designs could be structured to determine whether children
evaluate the same fruits and vegetables more positively and
select them more often if they are dressed in more inter-
esting and more helpful packaging. Examples of this strat-
egy include Sunkist Growers Fun Fruitsliced oranges
kept fresh in special plastic packagingDel Montes precut
melons and bagged grapes, and Mann Packings 2-ounce
salad snack packs in a bag. A significant drawback is that
the added processing of such products substantially
increases prices.
Packaging: The Challenge of Developing
Effective Product Labeling
The National Labeling and Education Act
What is the most effective way to use package labeling to
guide the consumer to healthier foods? One approach is the
federal governments 1990 National Labeling and Educa-
tion Act (NLEA 1990), an effort to specify exactly what
can and cannot be stated about nutrient content as well as
nutrient and health claims on package labels. Given con-
sumers penchant for processing information using simpli-
fying heuristics, which we discuss subsequently, the
approach has had limited success. Acknowledging this ten-
dency, PepsiCo has developed a simple green symbol called
Smart Spot, which now appears on the packages of more
than 100 of the companys products that its blue-ribbon
panel identifies as healthier (see http://www.pepsico.com).
In guiding the consumer to healthier products, Smart Spot is
intended to remove the consumers need to study the more
detailed nutrient information on the label. Researchers need
166 Creating an Environment in Which to Eat a Healthier Diet
to assess the extent to which the ability to use this simplify-
ing heuristic will attract the consumer and to what extent it
is effective in improving consumer health.
The NLEA mandates the prominent display of nutrient
information in a label format that includes the percentage of
the daily values that each nutrient represents. It also regu-
lates stated serving sizes to those that realistically reflect
what people eat. In addition, the NLEA regulates health
claims (e.g., Diets low in sodium can help blood pres-
sure) and descriptive nutrient-content claims (e.g., low fat,
high fiber) with restrictions on exactly what can be said and
under what circumstances (FDA 1994). Broadly, the intent
of the NLEA was to provide consumers with more accurate
health information so that they could make better, healthier
choices and to encourage the development and promotion
of more, healthier food products. Despite the NLEAs
ambitious aims, researchers have found that the govern-
ments goals for the NLEA have, in general, not been ful-
filled as intended.
Confirming the idea of consumers as cognitive misers
(Fiske and Taylor 1991), researchers have found that con-
sumers tend to use simplifying heuristics in the processing
of food labels. For example, they rely on easy-to-digest
health claims and descriptive nutrient-content claims rather
than on the more comprehensive and complex Nutrition
Facts panel (Balasubramanian and Cole 2002). Consumers
are likely to focus on negative nutrition attributes (e.g., fat)
and ignore positive ones (e.g., calcium). Consumers also
tend to focus on information related to fat and to ignore or
misperceive other nutrients (e.g., sodium) (Garretson and
Burton 2000). In another study, consumer judgments as to
the overall healthiness of a product were unrelated to sys-
tematic variation in the percentage of daily values of the
nutrients in the food (Barone et al. 1996).
Researchers have suggested that labels with simplified
information motivate more use of information and are more
effective (e.g., Burton, Biswas, and Netemeyer 1994;
Moorman 1996; Viswanathan and Hastak 2002). Innovative
proposals in this regard include providing average nutrient
values for a product category to serve as a reference point
(Barone et al. 1996) and incorporating the USDAs (2005a)
Healthy Eating Index. Although such proposals have limita-
tions, preliminary tests of consumer response to each have
been positive (Barone et al. 1996; Garretson and Burton
2000).
The range of products typically studied to date has been
limited, and much of the data were collected more than a
decade ago, when the NLEA first took effect. As a result, it
remains important to assess how consumers process labels
today, now that they have gained considerable experience
with them. Furthermore, research has not traced the poten-
tial links between information processing of the labels in
stores and ultimate purchases and between purchase pat-
terns and related health outcomes. For example, did the
NLEA restrictions reduce or eliminate misleading claims
with product categories such as oils and cookies? If so, did
this result in improved health (Caswell et al. 2003; Ippolito
2003)?
Although consumers have not responded to the NLEA as
legislators and the FDA might have hoped, the law appears
also to have failed in its goal to encourage food-processing
firms to develop, produce, and promote more, healthier
foods. Would food-processing companies and produce
growers generate more competition and do more to promote
their products if restrictions on health claims and compara-
tive labeling statements were loosened? For example, if
they were permitted to tout smaller reductions in calories
and carbohydrate content associated with their foods (which
they are currently not able to do), would new product devel-
opment and competition on these dimensions increase with
commensurate contributions to public health (Ippolito
2003)? It would be useful to assess the early responses of
food-processing firm executives to the various proposed
forms of reduced restrictions.
Labeling and Youths
Although the research we reviewed with regard to labeling
has focused on adults, it is also important to assess the
extent to which youths process food labels and how the
information on the labels influences their food choices.
There is a broadly held view that childrens long-term,
heavy exposure to television over the past several decades
has resulted in their shorter attention spans and lesser moti-
vation to expend energy in processing the printed word.
Thus, it might be anticipated that youths are less likely than
adults to pay attention to and be influenced by the NLEA-
based labels. However, the attention span hypothesis has
not been substantiated (Anderson et al. 2001).
Labeling and Packaging Innovations in the
Private Sector
Several companies, including Procter & Gamble, Kraft,
Pepperidge Farm, General Mills, Frito-Lay, and Coca-Cola,
have addressed one aspect of the calorie issue by devel-
oping 100-calorie portion control packages for products
such as Pringles, Oreos, Chips Ahoy, Wheat Thins, Gold-
fish Crackers, Doritos, Cheetos, and Coca-Cola (many of
these have been on the market long enough to register con-
siderable success; Horovitz 2006; Warner 2005b). The
underlying reason for this innovation was the confusion that
can be generated by the fact that packages and containers
are currently permitted to offer servings that range from
half to double the standard actual serving size. The immedi-
ate impetus for the development of the 100-calorie pack-
ages may be that the FDA is considering an initiative that
would mandate full-package information, including more
realistic information on the number of servings and total
calories per package, to supplement the current per-serving
information (Seiders and Petty 2004). As with Smart Spot,
the underlying hypothesis with regard to the 100-calorie
portion-control packaging is that the ability to use the sim-
plifying heuristic will attract the consumer.
Price
In this section, we explore the issues of both price elas-
ticities for foods and the relative costs of healthier versus
less healthful foods. We consider food costs in terms of the
structure of the food industry, farm bill subsidies, and tax
(dis)incentives.
Price Elasticities
With limited data available, price elasticities for foods need
to be assessed in a more detailed way, particularly for

youths and for different demographic segments. A study
focusing on high school students found that fruit and veg-
etable consumption was lower in zip codes where prices
were higher or where the price of fast food was lower (Pow-
ell et al. 2007). Some more demographically specific data
are available for adults, in which researchers have found
that consumers in supermarkets in upscale areas of Chicago
were less price sensitive and that African Americans and
Hispanics were more price sensitive (Hoch et al. 1995). A
review of five quasi-experimental studies (including two in
schools, which we discuss later in this article) also provides
evidence that people respond positively to lowered prices
for fruits, vegetables, and low-fat snacks. However, the
review also concluded that the effect may be limited to
choices made at the particular place where the lower-cost
foods were available and may not carry over to other set-
tings (Faith et al. 2007).
Industry Structure and Costs for Healthier Foods
Healthier foods such as lean meats, fish, and fresh vegeta-
bles and fruit cost considerably more than calorie-dense
foods (those high in refined grains, sugar, and fat;
Drewnowski 2004; see also Meltzer 2006). The structure
and size of food-related firms may determine, in part, the
relative costs of healthier foods. Because many fruit and
vegetable growers are fairly small, they do not typically
gain the same economies of scale as food-processing firms.
(Adding to the fragmentation in the marketplace, many of
the fruits and vegetables consumed are imported.) A resul-
tant hypothesis is that the relative advantage food proces-
sors have with regard to economies of scale likely con-
tributes to a favorable price differential for their products.
Several cooperative associations have been established to
represent growers, such as Produce for Better Health Foun-
dation (www.5aday.com) and the California Tree and
Grape League (www.cgtfl.com); however, with limited
budgets for promotion and often representing a wide variety
of different kinds of produce, such associations are likely to
provide only a limited remedy. Supportive government sub-
sidies may help, but to date, the bulk of the considerable
subsidies from the federal farm subsidy program (i.e., the
farm bill) have gone predominantly to grain growers (par-
ticularly corn growers) rather than to produce growers
(Philpott 2006). It is only recently (under pressure from
cheaper imports) that the many independent fruit and pro-
duce growers have developed a lobbying group to seek out
federal subsidies in a revision of the farm bill (Barrionuevo
2006). At the time of this writing, the House version of the
farm bill provides greatly expanded assistance to fruit and
vegetable growers (Rogers 2007).
Financial and Tax (Dis)incentives
Can positive and/or negative financial incentives influence
market structure and product demand? A Danish economet-
ric model found mixed results for a combination of negative
and positive tax incentives, with greater effects likely in
combination with promotional efforts (Smed, Jensen, and
Denver 2005). A parallel effort to simulate the effects of
positive incentives in the U.S. economy would be useful.
Some negative incentives are currently in place: In 2000, 18
U.S. states taxed unhealthful foods such as candy and soft
Journal of Public Policy & Marketing 167
drinks. However, given the strenuous opposition to the
taxes, the degree to which this strategy might be success-
fully extended is an open question (Brownell and Horgen
2004; Jacobson and Brownell 2000).
Can the private sector create effective financial incen-
tives to motivate people to eat healthier foods? A few pri-
vate incentive programs have been developed; for example,
the Phoenix Insurance Company offers discounts of up to
20% on life insurance policies to customers whose body
mass index (BMI) is verified to be relatively low, between
19 and 25. Premiums drop by 5% for every five years that a
policyholder maintains a healthy BMI ratio, up to a maxi-
mum of 20% after 20 years (Associated Press 2007). How
effective this program is and whether any of the effect trick-
les down to the children of the adults involved remains
unclear.
Promotion
As we noted previously, there are multiple dimensions of
food advertising and promotion to consider. Here, we con-
sider (1) the impact of food advertising on youths, (2) how
restricting existing advertising or creating alternative mes-
sages for healthier foods might redress the balance between
advertising for healthful and unhealthful foods, and (3)
what institutions might create these messages and what
themes or youth motives they might draw on most
effectively.
The Nature of Food Advertising Directed to
Children
Children are exposed to high levels of advertising for foods,
and the most recent estimates range from more than 4400
food commercials per year for 2- to 7-year-olds to 7600 for
8- to 12-year-olds and 6000 for 12- to 17-year-olds. Of
these food commercials, 34% are for candy and snacks,
28% are for cereal, and 10% are for fast food (Gantz et al.
2007; see also FTC 2006). The assessment of the impact of
food advertising on children has been highly controversial
(see, e.g., Ashton 2004). As we note subsequently, the con-
sensus perspective is that food advertising influences young
peoples food choices. However, several issues have been
raised regarding this conclusion. For example, critics argue
that the studies relied on are primarily more than 20 years
old and are heavily focused on television advertising (Ash-
ton 2004).2
To be sure, todays media environment is a different one
from that of 20 years ago, and targeted childrens television
channels (including Nickelodeon, the Cartoon Network, the
Disney Channel, Fox Kids, and others) vastly expand the
television offerings that expose children to food commer-
cials. This implies that there is a potentially greater effect of
food advertising on young people today than there was
2Although the age of many of the studies cited is an issue, the basic
process associated with a child exposed to a set of commercials is not itself
likely to have changed much over time. For example, a more recent study
that paralleled previous ones found that preschoolers exposed in the short
run to embedded commercials for certain foods were more likely to prefer
such foods than were their classmates who were not so exposed
(Borzekowski and Robinson 2001).
168 Creating an Environment in Which to Eat a Healthier Diet
decades ago. Similarly, there is a considerable array of
newer alternative advertising vehicles, including video
games (Moore 2006; Stanley 2006), corporate Web sites
(Moore 2006), cell phones (Cuneo 2006; Yuan 2006),
in-store television networks (Frazier 2005a, b; Hays 2005),
and the expanded placement of branded products in televi-
sion and films (Linn 2004; Vranica and Steinberg 2004). It
is likely that advertising in these rapidly growing media
adds to the impact of television advertising on youths; thus,
the need for research to assess such effects is evident. In
contrast, some have speculated that children have become
more cynical in processing commercials than they were
several decades ago; thus, children may be less vulnerable
to advertising and promotional influences. However, evi-
dence from neuroscience concludes otherwise. Adoles-
cents reasoning and judgment under cold cognition situa-
tions may be almost the equivalent to that of adults.
However, in more emotional or volatile hot cognition situa-
tions, in which youths often perceive themselves as operat-
ing, the development of the brain leaves them at a distinct
processing and judgmental disadvantage through the
teenage years (Pechmann et al. 2005).
Advertisings Impact on Youths Food Intake
Previous questions aside, recent comprehensive and critical
analyses of the available data have attempted to provide a
more solid footing for the overall conclusions that have
been drawn regarding advertisings effects on youths (Hast-
ings et al. 2003; McGinnis, Gootman, and Kraak 2006).
Relying in particular on the work of Hastings and col-
leagues (2003), the U.K. Office of Communications
(Ofcom) concluded that advertising has a modest direct
effect on childrens food choices (Ofcom 2004, p. 23).
Drawing on the work of both Hastings and colleagues and
its own more comprehensive analysis, the IOM (McGinnis,
Gootman, and Kraak 2006) concluded that for children
aged 2 to 11 (but not adolescents aged 12 to 18), there is
considerable evidence that television advertising influences
their food and beverage preferences, purchase requests, and
short-term consumption patterns.
To some extent, the multiple studies that Hastings and
colleagues and IOM review allow for an assessment of the
degree of convergence or triangulation (Webb et al. 1966)
in the findings across divergent methodologies, particularly
in correlational and controlled experimental studies. It is, in
part, this sense of convergence that has led both the IOM
(McGinnis, Gootman, and Kraak 2006) and Ofcom (2004)
to conclude that there is a valid causal relationship between
youths exposure to food advertising and their food choices
and short-term eating patterns. In contrast, evidence on the
impact of television advertising on usual dietary intake
and level of obesity is far more tentative. The typical
reliance on correlational studies linking levels of exposure
to television advertising and obesity makes it impossible to
rule out alternative explanations (e.g., increased sedentary
behavior associated with television viewing). Moreover,
given the covariation between levels of television viewing
and sedentary behavior, any experimental effort to manipu-
late one without affecting the other would be difficult, if not
impossible.
Achieving a Balance: The Advertising of
Healthful and Unhealthful Foods
If exposure to food advertising leads youths to select less
healthful foods, altering the balance of food messages to
which they are exposed may be a useful strategy. This
could be achieved either by restricting advertising for
unhealthful foods or by enhancing the level of advertising
for healthier foods. Seiders and Petty (2004) argue that
efforts in the 1970s to use regulatory actions to limit adver-
tising to children failed and likely would fail again. More-
over, given First Amendment issues, the constitutionality of
such measures is also difficult to predict (McGinnis, Goot-
man, and Kraak 2006). Nevertheless, given the rapidly
changing U.S. political climate, it is difficult to predict the
odds of efforts to regulate food advertising to children.
Recently, the FTC subpoenaed 44 major food, beverage,
and chain restaurant firms to request their marketing plans
for targeting children. The data are intended as input for a
report to the Senate (Edwards 2007; Teinowitz 2007).
The Alliance for American Advertising, representing
food advertisers, the Grocery Manufacturers Association,
the American Association of Advertising Agencies, and the
Association of National Advertisers, strenuously opposes
efforts to restrict their current promotional efforts legally.
In the lead are the three leading advertisers of packaged
food to children, General Mills, Kellogg, and Kraft Foods
(Ellison 2005a, b).
Instead, 11 leading food companies, which account for
more than two-thirds of all food and beverage television
advertising (including Kraft Foods, PepsiCo, McDonalds,
Coca-Cola, and Kellogg), have moved forward with volun-
tary restrictions. They have pledged to devote at least half
of their television, radio, print, and Internet advertising
directed at children to promoting healthier products and
healthier lifestyles. In addition, they have agreed to stop
advertising products that do not meet certain nutritional
standards to children under 12 (Barnes 2007; Better Busi-
ness Bureau 2006; McKay and Adamy 2006). Both Kraft
and Kellogg have withdrawn their commercials from Chan-
nel One, the commercial venture that provides ten minutes
of television news each school day to middle and high
school students in schools across the country, with paid
commercial messages directed to the youths embedded in
the newscast (Atkinson 2005).
Can voluntary restrictions result in significant changes in
the advertising environment to positively affect the health
outcomes for youths? The IOM in the United States has
taken a wait-and-see stance on the degree to which signifi-
cant voluntary restraints are forthcoming and the extent to
which they have a meaningful impact before engaging in
efforts to develop restrictive governmental regulations
(Koplan, Liverman, and Kraak 2005).
Evidence to date of the effects of efforts to restrict or ban
food advertising is mixed. For example, in the Canadian
province of Quebec, which banned all advertising directed
to children, one study found that those most affected by the
law reported having fewer childrens sugared cereals in
their homes (Goldberg 1990). However, as are most bans,
the Quebec ban was far from hermetic, and as a result, get-
ting youths to make healthier choices as a function of their

exposure to fewer advertisements for unhealthful foods may
be difficult. Indeed, much of the television that children
watch is at a time when adults are watching; as a result,
children are likely to be exposed to a considerable amount
of food advertisements, regardless of any child-focused
television advertising ban (McGinnis, Gootman, and Kraak
2006). This is a reason we consider the value of teaching
children media literacy with the goal of increasing their
vigilance in processing advertising.
Developing Alternative Food Messages
As we noted previously, a way to alter the balance of
healthful to unhealthful food advertising seen by youths is
to encourage the development of positive food messages
either for specific foods or for eating more healthfully in
general. In turn, this may have a positive effect on youths
food choices. This strategy may prove useful because the
heavy advertising for sugared snacks, sweetened beverages,
and fast-food restaurants (Gantz et al. 2007) may lead to the
perception that such foods are consumed even more fre-
quently than is the case. Such a perceived norm could serve
to validate these foods and beverages in youths eyes and foods. Many in the food industry maintain that there are no
encourage them to gravitate toward such choices. Although
it remains for research to determine the extent to which this
process is operative with foods, there is some parallel evi-
dence that the process is operative with heavy cigarette
advertising and its effects on adolescents smoking initia-
tion (Botvin et al. 1993; Chassin, Presson, and Sherman
1984; Leventhal, Glynn, and Fleming 1987).
Several institutions are working to develop messages that
promote the value of eating healthier foods, including the
Ad Council, which coordinates its Healthy Lifestyles
public-service campaign with the USDHHS Small Steps
campaign (Ad Council 2007), and the William J. Clinton
Foundation and American Heart Associations Alliance for
a Healthy Generation, which has teamed previously with
Nickelodeon and more recently with Channel One to pro-
duce and air positive nutritional messages (Clinton Founda-
tion 2007). It is important to evaluate the impact of the
efforts on young viewers food-related attitudes and behav-
iors. (Although Channel One no longer carries food-related
advertising, about one-quarter of Nickelodeons advertising
is for food, with the majority of the advertisements
88%deemed to be for foods of poor nutritional quality; incentives.
Batada and Wootan 2007.)
A considerably more ambitious approach is to develop a
center with a mandate to develop national advertising cam-
paigns that promote youths healthier eating. Legislation in
France could provide the model for funding such an institu-
tion. Under a law passed in France in 2004 and put into
effect by spring 2007, for television and radio advertise-
ments that deal with food or beverages (other than water),
marketers can either add a government-proscribed health
message to the advertisement or pay a tax equivalent of
1.5% of their annual advertising budget to the French
national institute created to promote healthier eating (Jar-
dine and Wentz 2005). The French center is to be an
autonomous, free-standing institution funded by industry
and, in that sense, resembles another possible model, the
American Legacy Foundation, the Washington, D.C.based
Journal of Public Policy & Marketing 169
institution that is responsible for an ongoing, nationwide
antitobacco campaign targeting youths. The tobacco indus-
try has funded the antitobacco campaign as a function of the
tobacco settlement of 1998 between the industry and the
attorneys general of 46 states (National Association of
Attorneys General 1998).
If the French experience is any example, it is highly
likely that the food industry will object strenuously to this
approach; however, it may be politically less unpalatable
than restrictive regulations of the type that now govern the
advertising of foods in the United Kingdom. As of January
2007, all U.K. advertisements for junk foods during televi-
sion programs targeted at children younger than 16 are
banned. Junk foods are understood to mean calorie-dense
foods, including those that are high in refined grains, fat,
and sugar. The ban also includes advertisements during
childrens programs on childrens channels as well as dur-
ing adult programs that a large number of children watch.
The measures include all cable and satellite childrens chan-
nels as well as broadcast channels (BBC News 2006).
Among the difficulties in putting these regulations into
effect is the challenge of operationally defining unhealthful
unhealthful foods, only the overconsumption of food. How-
ever, of late, some industry players such as Kraft have been
able to identify foods that are less healthful and to market
them differently. Although the measure may not be perfect,
nutritionists appear to be comfortable determining the calo-
rie or energy density of foods per gram, with foods such as
chocolate, potato chips, and doughnuts measuring quite
high (Drewnowski 2004).
A rationale for an approach that bolsters the presentation
of healthier foods in the media is apparent in the compara-
tive advantage of food-processing firms over food growers
or their distributors. This advantage is a function, at least in
part, of the ability of food-processing firms to more readily
package, store, and distribute their products nationally and
for long periods. This ability provides the opportunity to
develop national branding and, with it, large-scale national
advertising and promotion. For these reasons, any large-
scale effort to expose consumers (including youths) to a
wider, more health-oriented portfolio of fruits and veg-
etables (that may be branded) will likely need some sort of
government intervention, by way of subsidies or tax
Alternative Food Messages: Education Versus
Motivation
A potential goal for a national center charged with develop-
ing messages for healthier foods and for eating more health-
fully is to promote research to identify underlying motives
that could be used effectively in the messages. Intuitively,
the motives most directly implicated are the desire for foods
that taste good and for those that are nutritious.
Ellen, Bone, and Stuart (1998) suggest that educating
young people about the importance of eating nutritional,
healthier foods is unlikely to change their behavior. Never-
theless, given the noncontroversial nature of such messages,
they are likely to continue being developed (Seiders and
Petty 2004). A primary educational vehicle for communi-
170 Creating an Environment in Which to Eat a Healthier Diet
cating nutrition information has been the USDAs (2005b)
food pyramid, which it recently amended to allow for more
flexible, individual guidance. However, the new version has
been criticized for its ambiguity (Pivonka 2006). Another
highly salient educational vehicle promoting healthful eat-
ing, the 5 a Day Campaign is also to be changed in favor of
Fruits & VeggiesMore Matters, with the hypothesis used to promote less healthful, junk foods (The New York
that it is simpler, more understandable, and, as a result,
more compelling (Harvester Online 2006). Given the uncer-
tainty about the effectiveness of these types of educational
change efforts and given that there will likely be consider-
able investment in disseminating both new messages, it is
important to assess responses to them by both youths and
their parents. With various levels of cognitive processing
abilities, children of different ages likely will respond dif-
ferently to the new change efforts.
Data that point to the relatively low salience of nutri-
tional information for youths underscore the degree to
which relying on such information may be an uphill battle.
As we noted previously, taste is critical in motivating
restaurant and food choices. Only 27% of students report
that health motivates them in making food choices (Shan-
non et al. 2002), and only 17% of students indicated that the
food being healthy was really important in their selec- rebels, and edgy (Evans and Wasserman 2001); and who
tion of a restaurantthe lowest of 13 factors presented to
them (Strottman International 2004). Indeed, both children
and adolescents tend to believe that taste and the nutritional
value of foods are inversely related (Baranowski et al.
1993).
Educational materials about the value of eating healthful
foods may represent a necessary but not sufficient element
in persuading young people to eat more healthfully. If this
is the case, it is important to consider developing messages
that combine such information with a strategy that links
healthful foods to key youth motives, including (1) the
desire to grow up or be older (using the concept of social
modeling; Bandura 1977); (2) youths desire to make their
own decisions, free of pressure from (food) advertisers; (3)
fitting in and being accepted by peers (using conformity
concepts; Berndt 1979); (4) having fun (using the hedonic
concept; Holbrook and Hirschman 1982); (5) saving time
(using the concepts of speed and convenienceespecially
for teens at breakfast; Neumark-Sztainer et al. 1999; Story
and Resnick 1986); and (6) a developing concern for others,
particularly their families (using the concept of empathy;
Steinberg 1993).
Such efforts would do well to model on promotional
examples that the food industry provides. For example, the
promotional effort for Marss Kid-Didits makes the snacks
feel fun and cool for kids and [they] dont say healthy been suggested that, given the volume of soft drinks adoles-
directly which by default implies it tastes terrible (Thomp-
son 2007, p. 4). The goal is to empower kids using achieve-
ment and aspiration themes. In this regard, it is encouraging
to note the Disney Corporations decision to license and
link its fun characters only to nutritious products
(Thomas 2006). Targeting childrens lack of exercise,
DreamWorks Animation SKG, the studio that produced the
Shrek movies, has developed public-service announcements
with the Shrek character entertainingly urging kids to get
out and exercise. Initial efforts involved PepsiCo and Mac-
Donalds backing the effort with point-of-sales displays and
tray liners (Marr 2007). More recently, McDonalds has
extended this program, putting Shrek logos on jugs of low-
fat milk, developing healthier Shrek Happy Meals, and
even creating a Shrek Web site on which children can play
Shrek games and win various prizes (Adamy 2007). How-
ever, the use of Shrek to promote healthier foods is not
without controversy, given that the Shrek character is also
Times 2007).
The Potential of Counteradvertising
Tobacco Counteradvertising as a Model
Although youth obesity and underage smoking are not anal-
ogous problems, at least some lessons may be learned from
the American Legacy Foundations effective antitobacco
Truth campaign (Farrelly et al. 2005). The campaign
eschews the typical health- and risk-oriented themes and
instead focuses on key youth motivators, including inde-
pendence and rebellion. The campaign goal is to create an
attractive brand identity, Truth, in which teens are
encouraged to identify with youths who are not opposed to
experimenting with tobacco; who are risk takers, dreamers,
reject smoking. Thus, a nonsmoking lifestyle is cast as
socially desirable and linked to the attractive images typi-
cally associated with smokers (Evans et al. 2004).
The campaign portrays the tobacco industry as manipula-
tively seeking to get teens to smoke and, in so doing, rob-
bing them of their independence. The intent is to tap into a
reactance motivation (Brehm and Brehm 1981), thus
heightening the youths desire for personal control and
independence from the tobacco industry. The thematic
goals of the Truth campaign have been empirically sup-
ported in a study using two-stage structural equation model-
ing. When known confounders were controlled for, expo-
sure to the campaign was correlated with both the desire to
make independent decisions regarding tobacco and positive
social imagery about not smoking. In turn, these outcomes
were correlated with the likelihood of smoking uptake
(Evans et al. 2004). Portraying appealing youths as making
their own decisions independently and being drawn to
healthful foods is an evident way to parallel the Truth cam-
paign approach.
Soft Drinks as a Potential Target
Given the many types of unhealthful foods produced by a
highly diverse industry, it is difficult for counteradvertising
with such a broad focus to be effective. However, it has
cents consume, the category could and should be the focus
of any counteradvertising campaign (Marchione 2006).
Almost three-quarters (73%) of adolescent boys and 62% of
adolescent girls reported that they consumed carbonated
soft drinks (primarily regular/sugared) on any given day.
Those who consume soft drinks obtain 10% to 11% of their
total energy intake from such drinks (French, Lin, and
Guthri 2003).
A meta-analysis of 88 studies found a clear association
between soft drink consumption and increased energy
intake and body weight. Experimental studies controlling
for various extraneous variables yielded the strongest rela-

tionship between soft drink intake and body weight, with a
moderate effect size (r = .24; Vartanian, Schwartz, and
Brownell 2007). For example, a recent 25-week experiment
provided diet sodas to half a set of teens for them to substi-
tute for sugared sodas or beverages. Those who received the
diet sodas reduced their consumption of sugared drinks by
82%. The heaviest among the teens (those in the top one-
third of BMI scores) experienced significant reductions in
their BMI (Ebbeling et al. 2006). Although the evidence
linking consumption of soft drinks and youth obesity is
growing, the sponsorship of any campaign targeting soft
drinks would be an issue, likely limited to advocacy groups.
Place
The ready availability of tasty, healthful foods at a reason-
able price is critical in the effort to address obesity. In this
section, we consider the retail providers of food, from
supermarkets with their wide offerings but uneven geo-
graphic distribution to omnipresent convenience stores that
particularly attract youths. We also consider restaurants,
both fast food and full service, and schools, in which youths
consume a considerable portion of their caloric intake.
Supermarkets
To date, public health efforts focusing on supermarkets
have typically involved generic campaigns both in the
media and at the front of stores with broad appeals to buy
healthier foods. The most extensive of these, the California
5 a Dayfor Better Health! statewide campaign, lasted
three years and resulted in no significant increase in fruit
and vegetable consumption (Foerster et al. 1995). Given the
aisle-by-aisle, product-by-product nature of consumer deci-
sion making in supermarkets, campaigns should perhaps
mirror this pattern. Such campaigns would require heavy,
product-focused industry support.
In comparison with smaller grocery and convenience
stores, supermarkets tend to offer a greater variety of
healthier foods (Horowitz et al. 2004) at lower cost (Chung
and Myers 1999; Mantovani et al. 1997). As such, it is
problematic that supermarkets are less prevalent in low-
income neighborhoods (Morland, Wing, and Roux 2002;
Morland et al. 2002). A recent study documented the extent
of this imbalance using the Dun & Bradstreet MarketPlace
(2005) database. The software, which incorporates Standard
Industrial Classification data associated with 28,050 zip
codes, was used to generate the list and location of super-
markets nationwide. Income and racial/ethnic data were
drawn from the 2000 census data and linked to the Market-
Place data. Low-income neighborhoods had only 75% as
many chain supermarkets as middle-income neighborhoods.
Even after income and other covariates were controlled for,
African American neighborhoods had only 52% as many
chain supermarkets as white neighborhoods, and Hispanic
neighborhoods had only 32% as many chain supermarkets
as non-Hispanic neighborhoods (Powell et al. 2007).
By providing tax incentives to induce supermarkets into
lower-income neighborhoods, the government could help
provide lower-income consumers with more, healthier food
options at lower prices. Various state and municipal gov-
ernment programs now target certain lower-income urban
areas and provide various incentives for industry to invest
Journal of Public Policy & Marketing 171
in those areas (e.g., the New York State Empire Zones Pro-
gram; New York State Department of Labor 2006). The
Robert Wood Johnson Foundation has contributed to the
Food Trust to persuade supermarket operators to return to
poor neighborhoods (Strom 2007). Wal-Mart is a company
with a food chain that has taken advantage of such incen-
tives. Although many support this policy, others have criti-
cized it, in part because it tends to displace family-owned
groceries already in the neighborhood (Leroy 2005).
Convenience Stores
Nationally, three of four teenagers shop at a convenience
store at least once a week, staying an average of ten minutes
per visit, or twice as long as adults; one-third of teenagers
stop in at least two or three times a week (Chanil 2002). A
healthier array of snack foods made prominently available
in convenience stores might influence young peoples diets
for the better. Efforts are afoot to place single-serving pre-
cut and bagged fruits and vegetables in convenience stores.
This provides an opportunity to systematically assess the
potential for these products, supported by effective in-store
placement and promotion, to lead to healthier food choices
by youths. Given the centrality of convenience stores for
adolescents, this could be a very valuable strategy.
A study of unplanned or impulse purchases as a percent-
age of total sales for selected categories at convenience
stores (by both adults and youths) indicated that sweet
snacks (52%), candy/gum/mints (40%), and salty snacks
(38%) were the three highest categories (Point of Purchase
Advertising International [POPAI] 2002a, b). Convenience
stores are the heaviest users of in-store point-of-purchase
promotions (POPAI, n.d.). Such in-store programs, together
with the prominent positioning of products such as sodas,
sweets, and candy, likely have much to do with the pro-
grams level of success in convenience stores.
Last, although no national picture is available, two stud-
ies, one in New York City and the other in Los Angeles and
Sacramento, indicate that the limited number of healthful
foods typically available in convenience stores and smaller
groceries may be even more limited in lower-income neigh-
borhoods (Horowitz et al. 2004; Jetter and Cassady 2006).
Restaurants
Portion size contributes to obesity. Restaurants have widely
used super-sizing (i.e., increasing the size of food items
such as french fries and soft drinks for a partial price
increase) as a competitive strategy, which has been well
received (Hayes and Huffman 1995; Jeitschko and Pec-
chenino 2006). Because such super-sized foods tend to
load consumers up with unnecessary levels of fats, choles-
terol, and calories, consumer groups have pressured for
their termination, and a few chains, such as McDonalds,
have complied (Center for Science in the Public Interest
2004).
Initial research shows that it is important to persuade
restaurants to use smaller containers and plates. Whatever
consumers may know cognitively with regard to appropri-
ate food portions, they tend to eat what is on a plate (or to
fill the plate and then eat what is on it). This tendency
begins as early as five years of age (Rolls, Engell, and Birch
2000). A recent field experiment found that providing
172 Creating an Environment in Which to Eat a Healthier Diet
people with a larger (rather than smaller) bowl or serving
spoon induced them to unknowingly serve themselves rela-
tively more ice cream (Wansink, van Ittersum, and Painter
2006; see also Wansink 2006). The subtle suggestiveness of
this process appears to make it critical to educate people as
to its operation. Unfortunately, the results of one study sug-
gested that even warning people of this bias was not suc-
cessful (Wansink, van Ittersum, and Painter 2005). The
researchers concluded that it is more effective to adopt the
concrete step of using smaller plates and utensils. The chal-
lenge remains to convince restaurants to adopt smaller serv-
ing sizes and to educate consumers about the serving-size
effect. Relatedly, and more cognitively, countering the
sometimes-subtle but sometimes-not-so-subtle idea of
more (food) for your money is a challenge as well.
These concerns have become more critical, as out-of-
home eating has become an increasingly prevalent phenom-
enon, with Americans spending almost half (47%) of their
food dollars on meals and snacks outside the home (Stewart
et al. 2004). From the 1970s to the 1990s, children and ado-
lescents increased their intake of calories from fast food
from 2% to 10% (Guthrie, Lin, and Frazao 2002). A study
in the Chicago area that documented a disproportionate
number of fast-food outlets near schools suggests the need
to assess this factor more broadly (S. Bryn Austin et al.
2005).
Introduction of Healthier Foods
Changing the portfolio of products the fast-food industry
sells so that it offers more, healthier foods appears to call
for both upstream and downstream marketing efforts. Such
efforts would involve upstream encouragement of fast-food
chains (and other restaurants) to improve the nutritional
quality of their foods and to promote the healthier choices.
Efforts to date have been mixed, as some fast-food chains
have pursued this path more aggressively and/or success-
fully than others (Gray 2006; MacArthur 2005a, b). Efforts
should also involve downstream encouragement and per-
suasion of youths and parents to opt for the healthier offer-
ings more often. Without this positive consumer reaction,
efforts to encourage a wider, healthier array of food offer-
ings in restaurants would have difficulty succeeding.
Changing food choices in fast-food restaurants is an
important goal. Although correlational data need to be
interpreted with caution, the frequency of adolescents eat-
ing at fast-food restaurants is positively associated with the
total number of calories they consume, the percentage of
calories they consume from fat, and the number of daily
servings of sodas and french fries they eat and is negatively
correlated with their consumption of fruits, vegetables, and
milk (French, Story, et al. 2001).
In-Restaurant Promotion and Signage
Simply introducing healthier foods is unlikely to be suffi-
cient; restaurants must promote them as heavily as they do
their less healthful menu items. The extent to which promo-
tion is effective in expanding the market for healthier food
options, either in its own right or in interaction with other
factors, needs to be tested. Signage and menu descriptors
are critical because what consumers actually taste is, at
least in part, a function of how products are labeled and
advertised. In one experiment with adults, the same lunch
meals were sold in a cafeteria but labeled differently on dif-
ferent days. For example, on some days, one such meal was
identified as Succulent Italian Seafood Filet, but on other
days, it was labeled merely as Seafood Filet. Those who
bought and ate the foods when they were described in an
embellished way reported that the foods were more appeal-
ing to the eye and tasted significantly better and that after
eating the meal, they felt more comfortably full and satis-
fied (Wansink, van Ittersum, and Painter 2005). This strat-
egy bears testing with youths.
At present, the FDA does not have regulatory authority to
require nutritional displays in restaurants (Mathews and
Leung 2003). The pending Federal Menu Education and
Labeling Bill would require restaurant chains with 20 or
more outlets to display calorie, fat, and sodium information.
Concerned about costs, full-service restaurants have lobbied
against the bill, as they routinely change their menus and
the recipes for given items on the menu (Gray and Brat
2005). New York and Seattle have mandated the prominent
display of nutrient and calorie information for all restau-
rants in the city that serve standardized meals and have pub-
lished their calorie contentprimarily fast-food outlets
(Adamy 2006a, b). Washington, D.C., and other cities may
follow suit (Squires 2007a). Perhaps hoping to avoid this
type of public policy move on a broader scale, McDonalds
is to provide extensive nutrition information on the packag-
ing of most food items in its stores worldwide. Although
some critics consider the move inadequate, it is a useful
experiment (Warner 2005a).
Schools
As a unique channel in the food-distribution system, we
consider schools in some detail, examining the influence of
in-school product, price, and promotion factors on chil-
drens food choices. The subsequent evidence suggests that
altering the array of foods presented to children in schools
can have a significant effect on their choices. The passage
of the Child Nutrition and WIC Reauthorization Act has
required school districts that participate in the federal meal
programs structure to meet increased wellness guidelines by
the 20062007 school year (Government Accountability
Office [GAO] 2005). The guidelines target the array of
foods provided by school breakfast and lunch programs and
those in vending machines, as well as the level of physical
activity in which the children engage. Researchers will need
to assess (1) the extent to which the new law succeeds in
altering the array of foods in the school so that more,
healthier options are made available; (2) the effects of such
an altered array on young peoples food choices; and (3) the
effects on observed levels of obesity.
The opportunity and challenge is considerable: Most
schools offer the federally funded National School Lunch
Program and School Breakfast Program. On an average
school day, approximately 60% of children in such schools
participate in the lunch program and approximately 37%
participate in the breakfast program (Fox et al. 2004).
Twenty percent of middle schools and high schools have
contracts with fast-food restaurants (Wechsler et al. 2001).
Two-thirds of elementary schools and approximately nine
in ten middle and high schools have la carte foods for sale

(GAO 2005). Given that most la carte foods are relatively
high in fat and/or sugar and low in nutritional value, it is not
surprising that in one research study, the availability of la
carte items was negatively related to students consumption
of fruits and vegetables and positively associated with total
fat and saturated fat intake (French et al. 2003; Kubik et al.
2003).
Product Assortment and Quality
Two government pilot programs have been introduced with
the goal of increasing the availability of fruits and vegeta-
bles in schools. The 2002 farm bill provided $6 million for
the Fruit and Vegetable Pilot Program to distribute fresh
and dried fruits and fresh vegetables to elementary and sec-
ondary schools. The Department of Defenses Fresh Pro-
duce Program has the same goal. The schools themselves
have also begun to incorporate produce from school gar-
dens and farmers markets to improve the array of fruits and
vegetables available to students at lunchtime (McGinnis,
Gootman, and Kraak 2006; Waters 2006).
The strategy of placing more fruits and vegetables in
salient locations in the cafeteria and in vending machines is,
at least in theory, a relatively simple one and deserves
extensive testing. There is conflicting preliminary evidence
as to how well the strategy works. In one study, increasing
the availability of a broader range of healthier la carte
foods for high school students (supported by student-led
schoolwide promotions) led to significant increases in sales
of the targeted foods (French et al. 2004). However, a sec-
ond study increasing the availability of fruits, juice, and
vegetables as part of schools meals for elementary school
students showed only marginal increases in the selection of
fruit and none for vegetables or juice (Perry et al. 2004). A
possible reason for the differences in outcomes between the
two studies is that, in the latter study, the produce came not
unbundled, as in French and colleagues (2004) study, but
as a package with the school meal (French 2007).
The taste of the healthier foods offered is a critical factor
as schools struggle to implement the requirements of the
Child Nutrition and WIC Reauthorization Act. With that in
mind, efforts are afoot to work with school-based food pre-
parers to help them improve the nutritional quality, appear-
ance, and taste of school meals (Center for Advancing
Nutrition and Activity 2006).
Over time, pressure has been building for stricter regula-
tion of soft drinks and high-fat and sweetened snacks in the
schools. This has led major beverage firms to agree to halt
sales of sugared sodas in schools and to limit the size and
calorie content of other beverages sold (McKay 2006). This
is a good example of the effectiveness of influence from (1)
downstream to upstream units and (2) alliances operating
horizontally. Downstream, parents are key among those
pressuring the schools for change, whereas the midstream-
operating Clinton Foundation and American Heart Associa-
tion made arrangements with the beverage companies
(McKay 2006).
These changes will need to be traced to determine
whether they have the intended effect or whether youths
find alternative channels (e.g., nearby convenience stores)
to maintain their pattern of beverage choices. The potential
for change is considerable, given that in 20032004, almost
Journal of Public Policy & Marketing 173
half of elementary schools and approximately nine in ten
middle and high schools had vending machines; in addition,
30% of elementary schools, 65% of middle schools, and
almost 75% of high schools had exclusive beverage con-
tracts (GAO 2005).
Price
With limited discretionary spending, it might be anticipated
that youths are fairly price sensitive in their food purchases
in school. Preliminary evidence suggests that lowering the
cost for fruits in schools increases student demand, but less
so for vegetables. When the price of fresh fruit, baby car-
rots, and salads in two high schools was reduced by 50%,
sales of fruit increased fourfold and carrot sales increased
by about twofold; there was no significant change in the
sales of salads (French et al. 1997). Similarly, when
researchers manipulated the price of low-fat snacks in vend-
ing machines over two years in 12 high schools and 12
worksites, price reductions were associated with increases
in low-fat snack sales (French, Jeffrey, et al. 2001).
Promotion Through In-Class Curricula: Media Literacy
Although schools do not necessarily view themselves as
involved in promotion, they do engage in change efforts.
The most prevalent of these efforts have used health educa-
tion and prevention-based curricula but have not been very
successful (French and Stables 2003). Media literacy is a
different approach. As we noted previously, efforts to
shield youths from advertising for high-fat and sugared
foods and beverages, whether through voluntary restrictions
or regulations, are likely to be partial at best. As such, there
has been a growing sense that if youths can be made more
media literate, their increased vigilance in processing the
food and beverage commercials to which they are exposed
would protect them. School educators appear to be recep-
tive to the concept (Gonzales et al. 2004; Sallis 1993), and
at least on the basis of preliminary tests, the approach
seems to hold some promise. Three experimental interven-
tions, two that focused on tobacco advertising (Erica W.
Austin et al. 2005; Gonzales et al. 2004) and another on
alcohol advertising (Goldberg et al. 2006), suggest that this
approach may be effective.
Conclusions
Thanks in part to analyses by Nestle (2002) and Brownell
and Horgen (2004), as well as several reports by the IOM
and government agencies, youth obesity is now viewed as a
major societal and, indeed, worldwide health problem
(World Health Organization 2005). It is understood that the
problem has been shaped in some measure by the marketing
efforts of the food industry and that the help of this same
industry is needed to ameliorate the problem. The focus on
the problem appears to be ongoing, with a consistent stream
of new initiatives introduced by government, industry, and
nongovernmental organizations. Only recently did the
Robert Wood Johnson Foundation announce a $500 million
commitment over the next five years to fight child obesity
(Strom 2007). The 2007 USDA farm bill is unusual in its
focus on the same issue, with a proposal to spend $500 mil-
lion over ten years or $50 million per year for the purchase
174 Creating an Environment in Which to Eat a Healthier Diet
of additional fresh fruits and vegetables for use in the fed-
eral school lunch and breakfast programs (USDA 2007).
Prioritizing Private and Public Actions in
Addressing Youth Obesity
We subsequently use Hoyer and MacInniss (2004) motiva-
tion, ability, opportunity framework to help prioritize
actions in both the private and the public sectors that are
being undertaken or that might be undertaken to address the
problem of youth obesity.
Opportunity: Availability of and Access to Healthful Foods
To succeed in changing youths diets, the availability of
healthier foods is a key first step. The opportunity for adults
or children to choose healthier foods is plainly limited if the
foods are not available. Without access, generating the
motivation or ability to seek out healthful foods is relatively
pointless (and frustrating). Research shows that simply
making foods (healthful or unhealthful) available in the
home is a strong predictor of what children will eat. Simi-
larly, in schools, making fruits, vegetables, and other
appealing healthier foods available and prominently placed
(on the cafeteria line or in vending machines) encourages
youths to choose them.
The Child Nutrition and WIC Reauthorization Act has
mandated that schools provide healthier foods. The
USDAs (2007) farm bill proposes that schools be required
to bring their menus into compliance with USDA dietary
guidelines (Squires 2007b). Putting real teeth to the Child
Nutrition Act seems to be critical. As we noted previously,
both the Department of Defense and the USDA have cur-
rent programs to increase the supply of fruits and vegeta-
bles to schools. The 2007 farm bill proposes substantial
increases in funding support for this initiative. The success-
ful growth of such programs could prove helpful. Evaluat-
ing their effectiveness in improving childrens diets will be
useful.
As we discussed previously, the opportunity for residents
of lower-income neighborhoods to find fruits and vegeta-
bles at reasonable prices is constrained because of the
reduced numbers of supermarkets in their neighborhoods.
However, there exist state investment incentives that
attempt to interest industry, including supermarkets, to
enter such neighborhoods, and the Robert Wood Johnson
Foundation has contributed to this effort. Should such
incentives succeed, it will be important to assess how much
of a change in purchase and eating habits occurs in lower-
income neighborhoods when they manage to secure a
supermarket.
Motivation
Efforts to increase the consumers motivation to seek out
healthful foods cannot lag far behind efforts to make the
foods more available. Healthier food options that go beg-
ging on school cafeteria lines, in restaurants, and in super-
markets would soon be scaled back or terminated. How best
should motivation be generated? For an answer, it is worth-
while to look to the themes employed by food companies,
in which the profit motive demands a relatively immediate
and positive response by consumers. The motives typically
tapped are those that are central to youths: Foods are por-
trayed as fun and are shown vividly and as tasting good
(Gantz et al. 2007); given that nutrition is perceived to be
negatively correlated with taste, relatively little is said
about it. In comparison, the current Small Steps campaign,
sponsored by the USDHHS and the Ad Council, features
appealing children but static and relatively unappealing por-
trayals of the focal foods.
Tapping into a different motivation, the teaching of
media literacy is intended not simply to give children an
understanding of how media and advertising operate but,
more important, to motivate them to be more vigilant in
regard to the advertising targeted at them. Because youths
are likely to remain exposed to messages for less healthful
foods, schools should be encouraged to develop appropriate
media literacy programs. These efforts can build on pro-
grams that have successfully focused on alcohol and
tobacco advertising. This field is a relatively new one, and
monitoring the effectiveness of various approaches would
be valuable.
Promotions that motivate healthful food choices are
equally important in venues such as restaurantssimply
increasing availability is likely not enough. It is a challenge
for food-processing firms and restaurants to consider
whether they can produce and provide healthier foods at a
profit. However, part of the problem involves stimulating
demand for the products. For restaurant chains, this means
not only placing healthful options on the menu but also
actively promoting them both on the premises and in the
media. A recent flyer for McDonalds had two-for-one
coupons for sandwich items but not salads. (It would be
interesting to assess the degree to which sales of apple
slices at McDonalds would jump if customers encountered
the smell of apples rather than fries as they entered the
restaurants.)
Although promotions are likely to increase customers
interests in healthful foods made available in restaurants, in
the home, parents exhortations or other forms of promoting
healthier foods tend to backfire. The most successful moti-
vator is the parents modeling behavior and the accessibility
of the healthier foods.
The nutrient and calorie labeling now on packaging as a
result of the NLEA is a good example of the need to gener-
ate consumer motivation and not just provide the opportu-
nity or access to information. The evidence suggests that
most consumers tend not to process these labels or, if they
do, tend to use simplifying heuristics. As cognitive misers,
they find the information overly complex. Recognizing this,
food companies have been successful in offering consumers
simplifying solutions, including PepsiCos Smart Spot and
Krafts, General Millss and others 100-calorie snack
packages. Government efforts to adapt the current NLEA
labels will need to recognize these dynamics. Suggestions
such as including the average nutrient values for the rele-
vant product category or incorporating the USDA Healthy
Eating Index could increase the use of nutrient and calorie
labeling and should be assessed.
New York City and Seattle are requiring restaurants to
give customers the ability to evaluate the caloric and nutri-
tional values associated with the foods they order in a
prominent and timely manner. To the extent that other

major cities follow suit, this could be an important step
nationally. Much as with the calorie and nutrient labels on
packages, research needs to be conducted to help determine
the best way to provide restaurant patrons with this infor-
mation so that they will be motivated to process it and use it
in guiding their food choices.
Ability
Ability refers to the necessary resources, including money,
time, and product knowledge, that consumers need to pur-
sue positive, healthful eating habits. To what extent can the
prices of fruits and vegetables be lowered to enable more
low- and middle-income consumers to buy them? In the
2007 farm bill, the USDA proposes a significant shift in its
commodity support programlargely from its historical
support for grains to vastly increased support for produce
growers (Squires 2007b). Although this may be politically
difficult to achieve, should increased support for produce
growers be forthcoming, to what extent would subsidies
trickle down to consumers in the form of more affordable
produce? Research that provides a greater understanding of
the economic structure of the food industry and the resul-
tant cost structure for food would be useful.
Time, or the lack of it, is another critical resource that
contributes to problematic dietary choices. That working
mothers and dual-career families have less time for in-home
food preparation is an important factor that has led Ameri-
cans to consume almost half of all foods outside the home.
These foods, especially in fast-food outlets, tend to be less
nutritious. Any remedy that ignores this critical time con-
straint is bound to fail. One such failed effort was a USDA
guide that was intended to help mothers choose and prepare
low-cost healthful foods in the home. Unfortunately, the
preparation time for the meals presented as part of this plan
was estimated at an average of 16 hours per week, whereas
the estimated time that a working mother realistically has to
prepare meals was just 6 hours (Rose 2004). In retrospect,
any effort to engage working mothers with the goal of
increasing the number of meals prepared inside the home
must acknowledge severe time limitations.
The same time limitations on working mothers and dual-
career families may encourage the food industry to use the
successful upscale Lean Cuisine or Healthy Choice lines of
frozen foods as a model to appeal to working-class con-
sumers. However, developing a healthful and appealing
product line to serve a working-class family of five at a fea-
sible price point that still leaves the company with a reason-
able profit margin may prove a fairly tall order. Motivating
consumers to purchase the product is a remaining issue.
Finally, although some may argue that most people know
that fruits and vegetables are healthful choices, how these
foods fit into an overall diet is less clear to many. To that
end, the educational approach inherent in the (new) food
pyramid, developed by the USDA and typically reviewed in
schools, can be considered a necessary, if limited, step to
enable young people to understand how to construct a
healthful diet. Although the new food pyramid has the flexi-
bility to be individually tailored, the argument that this
comes at the expense of increasing its ambiguity deserves
testing. Furthermore, determining how the pyramid (as a
necessary but not sufficient instrument) might be used most
Journal of Public Policy & Marketing 175
effectively in conjunction with other change efforts would
be an important research contribution.
Conflicting Goals
Although various actors and institutions are now taking
innovative steps, there are many conflicting goals that rep-
resent serious constraints. For example, although the USDA
has developed programs that underscore the value of eating
fruits and vegetables, as we have noted, farm bill subsidies
in general have not supported this goal.
Schools face a financial challenge on the cafeteria lines
because students are attracted to the less healthful but prof-
itable la carte foods; in 2004, 30% of high schools gener-
ated more than $125,000 through la carte and vending
machine sales (GAO 2005). Paradoxically, schools use the
la carte revenues in part to help pay to improve the nutri-
tional quality of government-mandated meals, given the
level of funding for the latter (GAO 2005).
A goal of the NLEA was to stimulate the promotion of
healthier fruits and vegetables, which is miniscule com-
pared with promotion for less healthful processed foods.
However, it is argued that the strictures the law has placed
on food advertisers have had the opposite effect. Post-
NLEA, there has been a significant reduction in the amount
of advertising for fruits and vegetables, and orange juice
advertisements are practically the only place where health
claims are still seen (Ippolito 2003).
Although the major beverage firms have agreed to move
sweetened carbonated drinks out of schools, many substi-
tutes (e.g., sport drinks, orange juice, diet soda) do not meet
nutritional purists goals. Both the beverage firms and the
school administrators, fearing a loss of revenues, are eager
to induce children to expend the same amount of money on
these somewhat-healthier options. The question of modera-
tion, balance, and incremental change is an inherent part of
the discussion. In this regard, the most recent IOM report
requested by Congress concluded that federally reim-
bursable school nutrition programs should be the main
source of nutrition at school (Stallings and Yaktine 2007).
Access to la carte foods in school vending machines and
cafeterias should be strictly limited; furthermore, la carte
foods that are made available should be limited to nutritious
fruits, vegetables, whole grains, and nonfat or low-fat milk
and dairy products, as consistent with the USDAs 2005
Dietary Guidelines for Americans. High-fat and high-sugar
foods such as potato chips and ice cream would be elimi-
nated. In high schools, after-school access to pretzels and
caffeine-free diet sodas would be permitted but not to sport
drinks (see also Zhang 2007).
For restaurant chains such as McDonalds, although the
relative profitability of healthier offerings such as salads
may be questioned, another perspective involves how
McDonalds or others define profit. As Andreasen (2006)
points out, longer-term definitions of corporate profitability
often involve some investment in corporate responsibility.
Healthier foods may be more readily defined as profitable
to the extent that their value to the firm lies partially in pro-
tecting its long-term position. Salads help McDonalds sell
the proposition that it offers the potential of a healthy bal-
anced diet over time, if not at every meal, thus protecting its
long-term position in the marketplace in the face of the cur-
176 Creating an Environment in Which to Eat a Healthier Diet
rent pressure for healthier foods (the validity of this argu-
ment remains to be tested).
The federal government is still more likely to produce
nutrition education programs than truly promotional cam-
paigns that tap into key youth motives, but the latter would
represent a useful contribution. The partnership between the
USDA and the Ad Council to produce messages touting
healthful foods for youths is a positive step in this regard.
The creation of the National Center for Health Marketing
within the Centers for Disease Control and Prevention
(CDC; 2005) represents a significant opportunity for the
federal governments health programs, including efforts to
combat obesity, to incorporate the marketing perspective.
Finally, the partnerships between the nongovernmental
organization Alliance for a Healthy Generation and the
private-sector Nickelodeon and Channel One offers another
opportunity to encourage the effective use of the media in
promoting healthier diets for children.
This article calls attention to the complexity and multiple
determinants of childrens and adolescents dietary patterns,
which, together with parallel issues related to inadequate
levels of physical activity, contribute to the current prob-
lematic levels of obesity. As the Florida school case dis-
cussed initially shows, improving childrens dietary intake
is fraught with difficulties, and potential failure lurks
around every corner. Many are now addressing the prob-
lem, and no doubt, the free market system and innovative
players in that system will contribute to the solution. How-
ever, there are many pieces to the puzzle, and some stand in
conflict with one another. In such circumstances, there is a
need for coordination and oversight so that no critical piece
falls between the cracks.
For all its possible negative connotations, a food czar
charged with oversight, coordination, and consideration of
conflicting goals may help with the solution. Given that the
USDA, the FDA, and the CDC all have jurisdiction over
food, comprehensive oversight calls for the role or office to
be superordinate to these and other agencies. Because youth
obesity is a pressing issue of national concern, the office
might be housed in the executive office of the president, as
is the Office of National Drug Control Policy, headed by
the national drug czar.
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