Exposure and power of TV food advertising during the COVID-19 pandemic in Brazil: a content analysis.

BACKGROUND: With the COVID-19 pandemic and the restrictions imposed to contain the spread of SARS-CoV-2, the Brazilian population has increased the time spent at home and watching television (TV). Since food advertising exposure is a key driver of food choices, this study described the content of food advertisements (ads) on Brazilian TV during the COVID-19 pandemic. METHODS: This is an exploratory study. A total of 684 h of TV programming comprised of three free-to-air channels and two pay-per-view channels was recorded from 06 a.m. to 12 a.m. for eight non-consecutive days in June 2020. A content analysis of all the food-related ads was carried out. The data collection process followed INFORMAS Protocol for TV food advertising monitoring. RESULTS: The sample was composed of 7,083 ads, 752 (10.6%) of which were food-related and 487 (6.9%) were promoting ultra-processed foods. The content analysis indicated seven thematic categories, all of them with reference to the COVID-19 pandemic: brand and product differentials (79.8%); visual and sound effects (70.2%); thematic campaigns (56.0%); digitization (22.9%); convenience (16.5%); economic benefits (11.9%); and commensality and social interaction (6.1%). Ads content varied according to the day of the week, the time of the day, the length of the ad, and the channel type. CONCLUSIONS: The thematic of food advertising on Brazilian TV during the COVID-19 pandemic is aligned with the country's health crisis context and varied during the programming.

Revolutionising food advertising monitoring: a machine learning-based method for automated classification of food videos.

OBJECTIVE: Food advertising is an important determinant of unhealthy eating. However, analysing a large number of advertisements (ads) to distinguish between food and non-food content is a challenging task. This study aims to develop a machine learning-based method to automatically identify and classify food and non-food ad videos. DESIGN: Methodological study to develop an algorithm model that prioritises both accuracy and efficiency in monitoring and classifying advertising videos. SETTING: From a collection of Brazilian television (TV) ads data, we created a database and split it into three sub-databases (i.e. training, validation and test) by extracting frames from ads. Subsequently, the training database was classified using the EfficientNet neural network. The best models and data-balancing strategies were investigated using the validation database. Finally, the test database was used to apply the best model and strategy, and results were verified with field experts. PARTICIPANTS: The study used 2124 recorded Brazilian TV programming hours from 2018 to 2020. It included 703 food ads and over 20 000 non-food ads, following the protocol developed by the INFORMAS network for monitoring food marketing on TV. RESULTS: The results showed that the EfficientNet neural network associated with the balanced batches strategy achieved an overall accuracy of 90·5 % on the test database, which represents a reduction of 99·9 % of the time spent on identifying and classifying ads. CONCLUSIONS: The method studied represents a promising approach for differentiating food and non-food-related video within monitoring food marketing, which has significant practical implications for researchers, public health policymakers, and regulatory bodies.

Sugary drinks taxation: industry's lobbying strategies, practices and arguments in the Brazilian Legislature.

OBJECTIVE: To assess the strategies, practices and arguments used by the industry to lobby legislators against sugary drinks taxation in Brazil. DESIGN: We performed a content analysis of arguments put forward by sugary drink and sugar industries against sugary drinks taxation, using the framework developed by the International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support to assess corporate political activity of the food industry. SETTING: Two public hearings held in 2017 and 2018 in the Brazilian Legislature. PARTICIPANTS: Representatives from two prominent industry associations - one representing Big Soda and the other representing the main sugar, ethanol and bioelectricity producers. RESULTS: The 'Information and messaging' and 'Policy substitution' strategies were identified. Five practices were identified in the 'Information and messaging' strategy (four described in the original framework and an additional practice, 'Stress the environmental importance of the industry'). Mechanisms not included in the original framework identified were 'Stress the reduction of CO2 emissions promoted by the industry'; 'Question the effectiveness of regulation'; 'Suggest public-private partnerships'; 'Shift the blame away from the product' and 'Question sugary drinks taxation as a public health recommendation'. No new practices or mechanisms to the original framework emerged in the 'Policy substitution' strategy. CONCLUSIONS: The strategies and practices are used collectively and complement each other. Arguments herein identified are in line with those reported in other countries under different contexts and using different methodologies. Future research should address whether and under what conditions lobbying from this industry sector is effective in the Brazilian Legislature.

Electoral campaign contributions: an obstacle to sugary drink industry regulation in Brazil?

OBJECTIVE: To assess corporate electoral campaign contributions from industries related to sugary drinks production and the characteristics of the elected officials financed by the sector. DESIGN: Cross-sectional analysis of electoral campaign contributions from corporations related to sugary drinks production (sugary drink industries and sugary drink input industries) to candidates to the Chamber of Deputies, Brazil. SETTING: Elections to the 55th Congress (2015-2019), held in October 2014. PARTICIPANTS: Candidates to the Chamber of Deputies, Brazil. RESULTS: Forty-nine companies or corporate groups that produce sugary drinks and fifty-two corporations that produce inputs for sugary drinks manufacturing contributed to electoral campaigns of candidates in the 2014 Election. Contributions from this industry sector represented 7·3 % of all corporate contributions and helped finance 11·7 % of the candidates and 46·2 % of the elected officials. The transnationals Ambev and Coca-Cola were the first and second biggest donors, respectively. Revenues mediated by political parties, from sugary drink industries and from corporate members of some industry associations (Abir, Unica and CitrusBR), were more prevalent. Among elected officials, a significant association was found between being financed by the sector and representing the south-east region, having higher education level and referring themselves as being professional politicians. In the multivariate model, financed candidates were 27 % more likely to be elected. CONCLUSIONS: Corporations related to sugary drinks production have contributed to the electoral campaigns of almost half of the Federal Deputies in Brazil in 2014. This possibly facilitates access to decision-makers and could help buy influence on legislative proposals, including health-related food policies.

Ultra-processed food industry regulation for tackling obesity and diet-related non-communicable diseases in the Brazilian legislature: many proposals, no enactments.

OBJECTIVE: To assess efforts of the Brazilian legislature to regulate ultra-processed food industry practices related to obesity and diet-related non-communicable diseases during the first 4 years of the United Nations' Decade of Action on Nutrition. DESIGN: We searched the Chamber of Deputies and Federal Senate internal databases to identify bills under consideration between 2016 and December 2019. Keywords related to the main recommendations of international organisations regarding the regulation of food industry practices were used. Descriptive and content analysis of the bills were carried out. SETTING: Brazilian legislature (Chamber of Deputies and Federal Senate). PARTICIPANTS: None. RESULTS: Eighty-four bills were identified. The most frequently addressed topics were: nutrition labelling (38·1 %), marketing of unhealthy products (30·9 %), availability of unhealthy products (26·2 %) and critical nutrients content (14·3 %). Only 9·5 % of bills have proposed taxation on unhealthy products. No bill was passed during that period; 2·4 % were rejected and 10·7 % archived. Among the bills still under consideration, 52·4 % have not been passed in any Committee. CONCLUSIONS: Although many bills have been introduced, no regulation of ultra-processed food industry practices has been enacted by the Brazilian legislature by 2020. It is likely that no positive impact on population nutrition in Brazil will be achieved by the end of the United Nation's Decade of Action on Nutrition, in 2025 - especially regarding those goals set by the Brazilian government which were supposed to have been achieved by 2019.

UN Food System Summit Fails to Address Real Healthy and Sustainable Diets Challenges.

Evidence of the impacts of corporate food systems on people's health raised concerns about the multiple outcomes of malnutrition and climate change, including commodities production and high consumption of ultra-processed food products. The COVID-19 pandemic overwhelms this scenario, highlighting the urgency for improvements in governance spaces and regulatory measures that can tackle the advance of large corporations, which act exclusively based on their private interests.

Association between the price of ultra-processed foods and obesity in Brazil.

BACKGROUND AND AIMS: To estimate the relationship between the price of ultra-processed foods and prevalence of obesity in Brazil and examine whether the relationship differed according to socioeconomic status. METHODS AND RESULTS: Data from the national Household Budget Survey from 2008/09 (n = 55 570 households, divided in 550 strata) were used. Weight and height of all individuals were used. Weight was measured by using portable electronic scales (maximum capacity of 150 kg). Height (or length) was measured using portable stadiometers (maximum capacity: 200 cm long) or infant anthropometers (maximum capacity: 105 cm long). Multivariate regression models (log-log) were used to estimate price elasticity. An inverse association was found between the price of ultra-processed foods (per kg) and the prevalence of overweight (Body mass index (BMI) ≥25 kg/m2) and obesity (BMI ≥30 kg/m2) in Brazil. The price elasticity for ultra-processed foods was -0.33 (95% CI: -0.46; -0.20) for overweight and -0.59 (95% CI: -0.83; -0.36) for obesity. This indicated that a 1.00% increase in the price of ultra-processed foods would lead to a decrease in the prevalence of overweight and obesity of 0.33% and 0.59%, respectively. For the lower income group, the price elasticity for price of ultra-processed foods was -0.34 (95% CI: -0.50; -0.18) for overweight and -0.63 (95% CI: -0.91; -0.36) for obesity. CONCLUSION: The price of ultra-processed foods was inversely associated with the prevalence of overweight and obesity in Brazil, mainly in the lowest socioeconomic status population. Therefore, the taxation of ultra-processed foods emerges as a prominent tool in the control of obesity.

Ultra-processed food and beverage advertising on Brazilian television by International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support benchmark.

OBJECTIVE: To analyse the extent and nature of food and beverage advertising on the three major Brazilian free-to-air television (TV) channels. DESIGN: Cross-sectional study. A protocol developed for the International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support was applied for data collection. A total of 432 h of TV programming was recorded from 06.00 to 24.00 hours, for eight non-consecutive and randomly selected days, in April 2018. All TV advertisements (ads) were analysed, and food-related ads were classified according to the NOVA classification system. Descriptive analyses were used to describe the number and type of ads, food categories and the distribution of ads throughout the day and time of the day. SETTING: The three most popular free-to-air channels on Brazilian TV. PARTICIPANTS: The study did not involve human subjects. RESULTS: In total, 14·2 % (n 1156 out of 7991) of ads were food related (858 were specific food items). Approximately 91 % of food items ads included ultra-processed food (UPF) products. The top three most promoted products were soft drinks, alcoholic beverages and fast-food meals. Alcoholic beverage ads were more frequently broadcast in the evening. CONCLUSION: The high risk of exposure of the Brazilian population to UPF ads should be considered a public health concern given the impact of unhealthy food advertising on people's food choices and health.

Nutritional quality of foods and non-alcoholic beverages advertised on Brazilian free-to-air television: a cross-sectional study.

BACKGROUND: Evidence shows that foods marketed on television are often low-nutrient-dense foods associated with poor nutritional diet quality, obesity and non-communicable diseases. However, little research has been undertaken in Brazil around this issue. This study assessed the nutritional profile of foods and non-alcoholic beverages advertised on Brazilian television by applying the Pan American Health Organization (PAHO) and the World Health Organization (WHO/Europe) nutrient profiling models. METHODS: Cross-sectional study based on the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) protocol. A total of 432 h on the three major Brazilian free-to-air TV channels was recorded from April 1st to 30th 2018. Recordings were done for eight non-consecutive and randomly selected days from 6 am to 12 am (midnight). All food-related ads were coded using a systematic approach and classified according to the PAHO and the WHO/Europe nutrient profile models as "eligible"/"not eligible" for marketing restrictions. Absolute and relative frequencies were used to describe absolute numbers and proportions of food and beverage advertisements. The nutritional profile of foods was compared by day, time of the day and types of TV program. For each advertisement, the parent company of promoted food products, supermarkets and restaurants was identified. RESULTS: A total of 1610 food and beverage ads were broadcast, representing 18.1% of the total ads shown on selected channels. Over 80.0% of all foods and beverages advertised on Brazilian TV channels did not meet the PAHO and the WHO/Europe nutritional quality standards and were considered eligible for marketing restrictions. The proportion of unhealthy food ads was significantly higher on weekends, in the afternoon, and during soap operas programming. Altogether, 10 transnational and local food and beverage companies, two large international fast food chains and two of Brazil's largest supermarket retailers accounted for almost 90% of all unhealthy food ads shown. CONCLUSIONS: The findings of the present study indicate a high exposure of the Brazilian population to unhealthy food marketing and an inefficient enforcement of existing regulations. Further research to monitor population exposure to unhealthy food marketing and understand the policy inertia that is preventing policy progress, is highly recommended.

Is food store type associated with the consumption of ultra-processed food and drink products in Brazil?

OBJECTIVE: To analyse the association between food store type and the consumption of ultra-processed products in Brazil. DESIGN: Data from the 2008-2009 Household Budget Survey involving a probabilistic sample of 55 970 Brazilian households. Food stores were grouped into nine categories. Foods and drinks were grouped according to characteristics of food processing. The contribution of each food store type to the total energy acquired from each food processing group, and according to quintiles of consumption of ultra-processed products, was estimated. Exploratory factor analysis was conducted to identify a pattern of food store usage. Linear regression models were performed to estimate the relationship between the purchase pattern and the consumption of ultra-processed products. RESULTS: In line with their larger market share, supermarkets accounted for 59 % of total energy and participated most in acquisition for three food groups, with emphasis on ultra-processed products (60·4 % of energy). The participation of supermarkets in total purchase tended to increase in populations with higher consumption of ultra-processed products, while the participation of small markets and small producers tended to decrease. The purchase pattern characterized by use of traditional retail (street fairs and vendors, small markets, small farmers, butcheries) was associated with a smaller consumption of ultra-processed products. CONCLUSIONS: Food policies and interventions aiming to reduce the consumption of ultra-processed products should consider the influence of supermarkets on the consumption of these products. A purchase pattern based on traditional retail constitutes an important tool for promoting healthy eating in Brazil.

Needed Improvements in Diabetes Prevention and Management in Brazil.

INTRODUCTION: Diabetes mellitus is one of the most common chronic diseases worldwide and its prevalence continues to increase. Adherence to good health behaviors provides better control of the disease. This study analyzed trends in the prevalence of diabetes among Brazilian adults between 2006 and 2016 and compared the frequency of key health behaviors between people with and without diabetes. METHODS: We analyzed data from 572,437 Brazilian adults interviewed between 2006 and 2016 by using the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel). We used regression models to investigate significant trends in the prevalence of diabetes and differences in adherence to health behaviors between people with and without diabetes. RESULTS: The prevalence of diabetes increased significantly from 5.5% to 8.9% (P <.001), being higher among women, older adults, and those with less than a high school education. The greatest increase was observed among these groups with higher prevalence. People with diabetes had a lower frequency of risk behaviors and a higher frequency of protective behaviors when compared to people without diabetes. The greatest differences were observed in the consumption of soft drinks and sugar-sweetened beverages (9.5% vs 25.0%) and alcoholic beverages (9.0% vs 17.9%), and the smallest differences were related to regular consumption of fruits and vegetables (40.7% vs 34.0%) and meats with excess fat (24.3% vs 32.2%). People with diabetes reported less leisure-time physical activity (PRa, 0.92 [P < .001]) and less transport-related physical activity (PRa, 0.84 [P <.001]) than those without diabetes. CONCLUSION: Diabetes prevalence increased between 2006 and 2016. People with diabetes had better dietary habits than those without diabetes, but still had risk behaviors such as insufficient physical activity.

Impact of the Bolsa Família program on food availability of low-income Brazilian families: a quasi experimental study.

BACKGROUND: The Bolsa Família Program was created in Brazil in 2003, by the joint of different social programs aimed at poor or very poor families with focus on income transfer to promote immediate poverty relief, conditionalities and complementary programs. Given the contributions of conditional cash transfer programs to poverty alleviation and their potential effects on nutrition and health, the objective of this study was to assess the impact of the Bolsa Família Program on food purchases of low-income households in Brazil. METHODS: Representative data from the Household Budget Survey conducted in 2008-2009 were studied, with probabilistic sample of 55,970 households. 11,282 households were eligible for this study and 48.5 % were beneficiaries of the BFP. Food availability indicators were compared among paired blocks of households (n = 100), beneficiaries or non-beneficiaries of the Bolsa Família Program, with monthly per capita income up to R$ 210.00. Blocks of households were created based on the propensity score of each household to have beneficiaries and were homogeneous regarding potential confounding variables. The food availability indicators were weekly per capita expenditure and daily energy consumption, both calculated considering all food items and four food groups based on the extent and purpose of the industrial food processing. The comparisons between the beneficiaries and non-beneficiaries blocks of households were conducted through paired 't' tests. RESULTS: Compared to non-beneficiaries, the beneficiaries households had 6 % higher food expenditure (p = 0.015) and 9.4 % higher total energy availability (p = 0.010). It was found a 7.3 % higher expenditure on in natura or minimally processed foods and 10.4 % higher expenditure on culinary ingredients among the Bolsa Família Program families. No statistically significant differences were found regarding the expenditure and the availability of processed and ultra-processed food and drink products. In the in natura or minimally processed foods group, the expenditure and the availability of meat, tubers and vegetables were higher among the Bolsa Família Program beneficiaries. CONCLUSION: The Bolsa Família Program impact on food availability among low-income families was higher food expenditure, higher availability of fresh foods and culinary ingredients, including those foods that increase diet's quality and diversity.

Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults.

OBJECTIVES: The aim of this study was to evaluate the relationship between the consumption of ultra-processed foods and obesity indicators among Brazilian adults and adolescents. METHODS: We used cross-sectional data on 30,243 individuals aged ≥10 years from the 2008-2009 Brazilian Dietary Survey. Food consumption data were collected through 24-h food records. We classified food items according to characteristics of food processing. Ultra-processed foods were defined as formulations made by the food industry mostly from substances extracted from foods or obtained with the further processing of constituents of foods or through chemical synthesis, with little if any whole food. Examples included candies, cookies, sugar-sweetened beverages, and ready-to-eat dishes. Regression models were fitted to evaluate the association of the consumption of ultra-processed foods (% of energy intake) with body-mass-index, excess weight, and obesity status, controlling for socio-demographic characteristics, smoking, and physical activity. RESULTS: Ultra-processed foods represented 30% of the total energy intake. Those in the highest quintile of consumption of ultra-processed foods had significantly higher body-mass-index (0.94 kg/m(2); 95% CI: 0.42,1.47) and higher odds of being obese (OR=1.98; 95% CI: 1.26,3.12) and excess weight (OR=1.26; 95% CI: 0.95,1.69) compared with those in the lowest quintile of consumption. CONCLUSION: Our findings support the role of ultra-processed foods in the obesity epidemic in Brazil.

Dietary guidelines to nourish humanity and the planet in the twenty-first century. A blueprint from Brazil.

OBJECTIVE: To present and discuss the dietary guidelines issued by the Brazilian government in 2014. DESIGN: The present paper describes the aims of the guidelines, their shaping principles and the approach used in the development of recommendations. The main recommendations are outlined, their significance for the cultural, socio-economic and environmental aspects of sustainability is discussed, and their application to other countries is considered. SETTING: Brazil in the twenty-first century. SUBJECTS: All people in Brazil, now and in future. RESULTS: The food- and meal-based Brazilian Dietary Guidelines address dietary patterns as a whole and so are different from nutrient-based guidelines, even those with some recommendations on specific foods or food groups. The guidelines are based on explicit principles. They take mental and emotional well-being into account, as well as physical health and disease prevention. They identify diet as having cultural, socio-economic and environmental as well as biological and behavioural dimensions. They emphasize the benefits of dietary patterns based on a variety of natural or minimally processed foods, mostly plants, and freshly prepared meals eaten in company, for health, well-being and all relevant aspects of sustainability, as well as the multiple negative effects of ready-to-consume ultra-processed food and drink products. CONCLUSIONS: The guidelines' recommendations are designed to be sustainable personally, culturally, socially, economically and environmentally, and thus fit to face this century. They are for foods, meals and dietary patterns of types that are already established in Brazil, which can be adapted to suit the climate, terrain and customs of all countries.

Dietary sources of fiber intake in Brazil.

The objective of this study was to estimate the household availability of fibers in Brazil and to identify the dietary sources of this nutrient. Data from the 2008-2009 Household Budget Survey were used to estimate national household availability and density of fibers and also according to stratifications defined by income level, five regions and area (rural or urban). The contribution of the different food groups, classified by the nature, extent and purpose of processing, to total fibers available in Brazilian households was also determined. The mean density of per capita fibers was 7.6 g/1000 kcal. Higher availability and density of fibers was observed in households situated in rural areas and among low-income families. The main dietary sources of fiber were beans, bread, rice, fruit, vegetables and manioc flour. Fiber intake was found to be insufficient. Therefore, actions promoting a healthy diet are needed to improve the dietary quality of the Brazilian population.

Processed and ultra-processed food products: consumption trends in Canada from 1938 to 2011.

PURPOSE: A classification of foods based on the nature, extent, and purpose of industrial food processing was used to assess changes in household food expenditures and dietary energy availability between 1938 and 2011 in Canada. METHODS: Food acquisitions from six household food budget surveys (1938/1939 , 1953, 1969, 1984, 2001, and 2011) were classified into unprocessed or minimally processed foods, processed culinary ingredients, and ready-to-consume processed or ultra-processed products. Contributions of each group to household food expenditures, and to dietary energy availability (kcal per capita) were calculated. RESULTS: During the period studied, household expenditures and dietary energy availability fell for both unprocessed or minimally processed foods and culinary ingredients, and rose for ready-to-consume products. The caloric share of foods fell from 34.3% to 25.6% and from 37% to 12.7% for culinary ingredients. The share of ready-to-consume products rose from 28.7% to 61.7%, and the increase was especially noteworthy for those that were ultra-processed. CONCLUSIONS: The most important factor that has driven changes in Canadian dietary patterns between 1938 and 2011 is the replacement of unprocessed or minimally processed foods and culinary ingredients used in the preparation of dishes and meals; these have been displaced by ready-to-consume ultra-processed products. Nutrition research and practice should incorporate information about food processing into dietary assessments.

Consumption of ultra-processed foods and likely impact on human health. Evidence from Canada.

OBJECTIVE: To investigate consumption of ultra-processed products in Canada and to assess their association with dietary quality. DESIGN: Application of a classification of foodstuffs based on the nature, extent and purpose of food processing to data from a national household food budget survey. Foods are classified as unprocessed/minimally processed foods (Group 1), processed culinary ingredients (Group 2) or ultra-processed products (Group 3). SETTING: All provinces and territories of Canada, 2001. SUBJECTS: Households (n 5643). RESULTS: Food purchases provided a mean per capita energy availability of 8908 (se 81) kJ/d (2129 (se 19) kcal/d). Over 61·7 % of dietary energy came from ultra-processed products (Group 3), 25·6 % from Group 1 and 12·7 % from Group 2. The overall diet exceeded WHO upper limits for fat, saturated fat, free sugars and Na density, with less fibre than recommended. It also exceeded the average energy density target of the World Cancer Research Fund/American Institute for Cancer Research. Group 3 products taken together are more fatty, sugary, salty and energy-dense than a combination of Group 1 and Group 2 items. Only the 20 % lowest consumers of ultra-processed products (who consumed 33·2 % of energy from these products) were anywhere near reaching all nutrient goals for the prevention of obesity and chronic non-communicable diseases. CONCLUSIONS: The 2001 Canadian diet was dominated by ultra-processed products. As a group, these products are unhealthy. The present analysis indicates that any substantial improvement of the diet would involve much lower consumption of ultra-processed products and much higher consumption of meals and dishes prepared from minimally processed foods and processed culinary ingredients.

Information on food additives on food labels in Brazil: a critical analysis.

Questions about the safety of food additives and their consumption have been raised in recent years. The increased exposure to these substances, either by intake of ultra-processed foods or by the broad use and combination of various categories of additives, may be related to higher risks to consumer health. This article comments on the results of a study that quantified and characterized food additives found on the labels of 9,856 packaged foods and beverages available in Brazilian supermarkets. The study adopted a field diary method to record and analyze nonconformities in the lists of ingredients. The objective of this article is to discuss the use of additives identified on the labels and the limitations of Brazilian legislation, which should guarantee the right to information and health.