Awareness of marketing for high fat, salt or sugar foods, and the association with higher weekly consumption among adolescents: a rejoinder to the UK government's consultations on marketing regulation

Objective: Exposure to marketing for foods high in fat, salt, or sugar (HFSS) reportedly influences consumption, nutritional knowledge, and diet-related health among adolescents. In 2018/2019, the United Kingdom (UK) Government held two consultations about introducing new restrictions on marketing for HFSS foods. To reinforce why these restrictions are needed, we examined adolescents’ awareness of marketing for HFSS foods, and the association between past-month awareness and weekly HFSS food consumption. Design: Cross-sectional survey that measured past-month awareness of 10 marketing activities for HFSS foods (1=Everyday–6=Not in last month). Frequencies were converted into aggregate past-month awareness across marketing activities and grouped into three categories (low/medium/high). Consumption was self-reported for 15 foods (12 HFSS) (1=Few times per day–9=Never). For each, frequency was divided into higher/lower weekly consumption. Setting: UK. Participants: 11-19 year olds (n=3,348). Results: Most adolescents (90.8%) reported awareness of a least one marketing activity for HFSS foods, and at least half reported seeing >70 instances in the past month. Television, social media, and price offers were the activities most frequently reported. Awareness was associated with higher weekly consumption for 10 of the 12 HFSS foods. For example, those reporting medium awareness were 1.5 times more likely to report higher weekly consumption of cakes/biscuits versus low awareness (Odds Ratio=1.54, p=0.012). Likelihood of higher weekly HFSS food consumption increased relative to level of marketing awareness. Conclusion: Assuming there is a causal relationship between marketing awareness and consumption, the restrictions proposed by the UK Government are likely to help reduce HFSS consumption