Marketing and Consumer Perceptions of Sugar-Containing Beverages Positioned as Healthy or as Having Health-Related Benefits

Reducing population consumption of sugar-containing beverages is widely acknowledged as an important public health measure to address high population prevalence of overweight and obesity and related non-communicable diseases. In this thesis, I address marketing as a key driver of consumption and explore how advertising may function to negate increasing consumer concerns about sugar in beverages. My specific aims were to investigate how sugar-containing beverages are being marketed as healthy, or as having health-related benefits, and, how health-related marketing influences consumers’ perceptions of the healthfulness of these beverages. In study one, I conducted a cross-sectional audit of sugar-containing beverages sold in 17 Australian supermarkets during 2016. I analysed the content of 945 sugar-containing beverage labels to assess the extent and nature of explicit and implicit features that positioned them as healthy or better-for-you. I found that 88% of labels displayed advertising that positioned the beverage as healthy or better-for-you. Certain types of beverages were strongly positioned in this way. I also examined the use of the Health Star Rating System, a government-endorsed front-of-pack labelling scheme, in a sub-set analysis of 762 ready-to-drink sized beverages. I found that in its voluntary nature the system was preferentially displayed on high sugar products that scored a healthy rating, namely juices. In this way the system functioned more as tool for advertising juices than a comprehensive tool for informing consumers. In study two, I further explored the positioning of sugar-containing beverages as healthy or better-for-you in television advertisements. All advertisements on free-to-air television from one Australian major network were collected during 2016. I qualitatively analysed 37 unique advertisements from beverage manufacturers to examine health-related messaging in sugar-containing beverage television advertisements. I observed that beverages were positioned as contributing a functional role to promote and enhance physical, mental and social health and wellbeing. In this way, advertisements were situated in wider understandings and conceptualisations of health. In study three, I explored how young adults conceptualise the healthfulness of sugar-containing beverages. I conducted seven semi-structured focus groups with South Australians aged 18 to 25 years (n=32) to elicit information on perceptions regarding beverage healthfulness and how participants evaluated whether a beverage was healthy, or healthier than others. I found that conceptualisation of beverage healthfulness was a balancing act in which participants weighed up their perceptions of beverage ingredients and properties that they saw to be harmful to health, necessary for health, and beneficial to health. In beverages that are positioned as healthy, ingredients and properties perceived as health-promoting appeared to outweigh concern for sugar content. The studies provide insight into how sugar-containing beverages are being advertised within the current sugar-conscious era and how this positioning aligns with consumers’ understanding of health-promoting products. This body of work highlights the gaps in current advertising regulations that allow beverages high in sugar to be positioned as healthy or as having health-related benefits and makes recommendations for strengthening these regulations. Further, this body of work can be used to inform public health interventions which seek to counter misperceptions of beverage healthfulness.Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 202