Ultra-processed products are usurping healthier, minimally processed foods in much of the world. Breakfasts are too often pre-packaged and sugar-laden, while lunches are loaded with sodium and wrapped in plastic – products that have been transformed using industrial processes and filled with additives to make them highly palatable.

The widespread consumption of these foods and drinks, high in salt, sugar and saturated fat, is responsible for an estimated 11 million preventable deaths each year.

Intense, pervasive marketing by food and beverage companies is central to profit-driven strategies to increase the intake of ultra-processed foods, and children are the most vulnerable targets. While multiple countries have implemented strategies to thwart the food industry, including marketing restrictions, warning labels and taxes, Chile’s comprehensive approach to food policy stands out.

 Chile passed legislation in 2016 that went a step beyond the incremental, single-issue food policies seen globally, such as front-of-package labeling or sugary drink taxes. Chile’s law combines these approaches with exacting restrictions on marketing unhealthy foods and beverages to children and banning the sales of these products in schools. 

Chile’s comprehensive law covers not only what children are eating and drinking, but how they are exposed to ultra-processed products through all forms of media.

These policies have clearly moved the needle in the fight against the harms inflicted by ultra-processed foods and drinks on children in Chile. The world would be wise to learn from Chile’s example.

 Sweeping food policy reforms

In 2016, close to half of all children in Chile were overweight or obese. That same year, Chile passed food policy reforms under one sweeping new law.

 The Law of Food Labeling and Advertising addresses unhealthy diets in three ways. First, it mandates black, octagonal warning labels on products high in sugar, calories, sodium and/ or saturated fat.

Secondly, it bans the advertising of these products during child-focused TV and digital media, at cinemas and in locations that attract a high proportion of children. Sponsorships are also banned.

Thirdly, food and beverage companies are prohibited from intentionally using child-directed advertising methods, such as cartoon characters or mascots (for example, Tony the Tiger is no longer a visible Frosted Flakes mascot).

In 2018, a total TV advertising blackout on unhealthy products between 6 am and 10 pm was put in place. Finally, the government banned the sale or free distribution of ultra-processed products at schools and nurseries.

 Crucially, the bill required the Ministry of Health to implement the new regulations within a year and created strict penalties for violators. The stringent nutrient thresholds were phased in over a three-year period as a minor concession to food companies

 Seven years after Chile’s policies were first adopted, there is a growing body of evidence that they have worked as intended. The law provides proof-of-concept for comprehensive global healthy food policies and offers a path forward for public health advocates grappling with the increase in ultra-processed food consumption and associated health harms.

The numbers don’t lie

 To date, only a handful of prospective studies have examined the association between comprehensive food policies and a lessened burden of obesity and disease, especially in children. While it takes time to see changes in obesity rates, very few existing policies have been associated with significant impacts on diets or industry behavior due to either falling short of Chile’s wide-ranging approach or weak enforcement mechanisms.

 But when a law is as airtight as Chile’s and rigorously upheld, it’s possible to assess the short-term results of implementation. This allows researchers and advocates to reasonably extrapolate how this suite of policies will save lives and prove cost-effective.

New research published in the International Journal of Behavioral Nutrition and Physical Activity by researchers from the University of North Carolina, the University of Chile and Diego Portales University found that the Chilean law has significantly reduced children’s exposure to unhealthy food marketing.

Since the law went into effect in 2016, there has been a 73% drop in Chilean children’s exposure to TV ads for regulated foods and drinks. In addition, TV advertising for unhealthy foods and drinks had dropped 64% by 2019, and the number of TV ads for unhealthy foods and drinks that used prohibited child-directed content (such as cartoon characters) dropped 67% in the same period.

These findings add to a growing evidence base demonstrating a steep overall decline in Chileans’ purchases of foods containing “nutrients of concern” in response to the 2016 law, according to a 2021 study in The Lancet.

The considerable decline seen after 2016 was greater than those following earlier laws in Chile solely focused on sugary drink consumption. Across the country, overall calories purchased declined by 3.5%, purchased sugar declined by 10.2%, saturated fat declined by 3.9% and the sodium content of overall purchases declined by 4.7%.

Crucially, the decline in unhealthy food purchases was even more pronounced for the unhealthiest products highest in nutrients of concern. Additional research also observed important decreases in the nutrients themselves (i.e., sugar and sodium) in packaged foods as the industry began to reformulate products to comply with the new policies in Chile.

The challenge of changing media landscape

While the effectiveness of marketing restrictions has been demonstrated in Chile, especially when implemented in tandem with clear front-of-package warning labels and sugary drinks taxes, it is early days and there are still challenges to overcome.

 Time-phased restrictions on TV and traditional direct-to-consumer advertising have been successful at reducing children’s exposure, but these policies must be able to reach all forms of media that children encounter – a challenging proposition in our quickly transforming media landscape.

Regulations need to consider how often children watch television outside of “child-directed” programming. The recent WHO guideline on policies to protect children from the harmful impact of food marketing notes the importance of moving beyond limiting marketing on the very narrow subset of television directed at children to all channels that children may view.

While it may seem like a small language change, moving beyond only regulating marketing on shows for children would be a meaningful, more comprehensive next step for these policies.

Advocates and many policymakers also understand the need to address the huge growth in food marketing across digital and social media platforms. Industry won’t go away quietly, particularly as visible consequences for violating government policies are handed down. 

Child-directed ads have already adapted and migrated to video games and platforms like TikTok, YouTube and Twitter. Although Chile’s regulation policies cover digital media, the term “child-directed” only covers a small portion of what children see online, particularly when it comes to social media.

 Future marketing restrictions may benefit from scrutinizing existing legislation restricting other industries from influencing young people, such as tobacco. The industry playbook is recycled, repackaged and rarely changes. Public health experts and policymakers can avoid being overrun by the same schemes by being proactive and learning from efforts in other industries.

Public health policymaking should be led by public health experts and governments, not muddied by commercial interests. Where we’ve seen similar policies in other countries that allow industry to dictate and enforce their own marketing regulations, the result has been weakened policy and inferior evidence of efficacy.

Following in Chile’s footsteps, other governments need to continue this momentum and implement effective policies based on evidence-informed regulations with clear penalties to confront the challenges ahead.

Francesca R Dillman Carpentier, PhD, is the W. Horace Carter Distinguished Professor at the Hussman School of Journalism and Media at the University of North Carolina, Chapel Hill, US. She conducts research on mass media effects, the psychology of media audiences, and the analysis of media content.

Lindsey Smith Taillie, PhD, is an associate professor in the Department of Nutrition at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill. She is a nutrition epidemiologist focused on designing and evaluating healthy food policies.

Teresa Correa, PhD, is a full professor in the School of Communication at Diego Portales University, Chile, director of the Research Center in Communication, Literature and Social Observation (CICLOS) and alternate director of the Millennium Nucleus on Digital Inequalities and Opportunities (NUDOS in Spanish). She conducts research on media and inequality, particularly in the digital sphere.

Image Credits: UNC Chapel Hill.