Main

K. J. Chapman, R. M. Fairchild and M. Z. Morgan British Dental Journal 2014; 217: E20

Editor's summary

Public Health England has just released the results of a survey of 3-year-olds which shows that 12% are affected by tooth decay. Eighty-two percent of children read comics or magazines and there is no doubt that advertising is a major influence on media users. These two facts alone make this BDJ article significant.

One questions the extent to which adults under the influence of advertising have free will, not to mind children. Otherwise why would manufacturers spend so much money on it (£17.9 billion in the UK alone in 2014)? In this article Maria Morgan and colleagues have determined that over two thirds of food references within children's magazines concerned products with high sugar or acid content. In addition, 97.7% of the magazines investigated had free gifts and over a third of these were sweets. So not only is the mention of sugary or acidic foods in editorial, advertorial and advertising content an issue, this medium can actually deliver sugar to children!

This article comes at a good time in view of the current upsurge in awareness about the problems associated with sugar consumption. It has long been known by the dental profession that high levels of sugar intake are the main cause of dental caries. So now is the time to fight the sugar lobby; considering that the weight of the medical profession, media and general public is starting to move with the dental profession at last.

Five things we can do right now:

  1. 1

    Advise patients to download the free UK Foodswitch App. This allows you to scan barcodes to search a database for similar but healthier alternative products if necessary: www.foodswitch.co.uk

  2. 2

    Write directly to local outlets of supermarkets, cinemas etc. asking them to act responsibly when marketing food and drink, as part of the BDA's Make a meal of it campaign: www.bda.org

  3. 3

    Sign the petition on the British Heart Foundation website which calls on the UK Government to close down loopholes that allow adverts for unhealthy food and drinks on TV before 9 pm: http://extras.bhf.org.uk/junkfood/

  4. 4

    Post photographs of unacceptable marketing at the checkout on the Children's Food Campaign's (childrensfood.org.uk) 'Wall of Shame'

  5. 5

    Finally, talk to your patients about the findings in this paper so they know to be aware of the problem of sweet giveaways and sugary/acidic food marketing in children's magazines.

The full paper can be accessed from the BDJ website ( www.bdj.co.uk ), under 'Research' in the table of contents for Volume 217 issue 10.

Ruth Doherty

Managing Editor

Author questions and answers

1. Why did you undertake this research?

Children's magazines are popular in the United Kingdom, but their content is poorly regulated. Consequently food and beverages high in fat, salt and sugar (HFSS), detrimental to wider and oral health, make unrestricted appearances in the form of product advertisements, editorial and general content. Our goal was to assess the amount of HFSS food and drink children are exposed to whilst reading magazines; with particular focus on foods containing free sugars due to their known cariogenic properties.

2. What would you like to do next in this area to follow on from this work?

We would like to repeat our study to cover a wider range of magazines encompassing younger children and other socio-demographic groups. We would also like expand the research by investigating websites and other forms of non-broadcast media aimed at children. We need to disseminate our findings to health professionals working in dentistry, nutrition and public health – magazines might be viewed as an innocuous alternative treat to confectionery and colleagues need to know about the sugar-loaded messages contained within children's magazines.

Commentary

There is currently much interest in the unacceptably high levels of free sugars being consumed, particularly by children, because of concern about rising rates of obesity and diabetes. A notable feature of the discussions about sugars and health is that the dental consequences of sugars are hardly mentioned, despite overwhelming scientific evidence that free sugars cause caries. That reflects the little emphasis given to sugars by the dental profession and a failure of dentists to collaborate with others concerned with non-communcable diseases in strategies to reduce free sugars consumption.

The WHO's Nutrition Guidance Expert Advisory Group (NUGAG) recently issued guidelines on halving current levels of free sugars consumption, as have the Scientific Advisory Committee on Nutrition (SACN) that advises Public Health England and other government agencies and departments on nutrition. Ironically, their recommendations are mainly based on the very good evidence on the dose-response relationship between sugars and caries. To achieve the recommended reductions will require concerted efforts by all health professionals. In particular, dentists, in their role as advocates, should put pressure on government, decision makers, and the media to reduce sugar levels.

One important source of misinformation that should be targeted because of its influence on sugars consumption, is children's magazines. As Chapman, Fairchild and Morgan conclude in their interesting study 'Food references within children's magazines are biased towards unhealthy foods especially those detrimental to oral health; these permeate throughout the general and editorial content and are not restricted to direct advertisements.' Seventy-four percent of references to foods in the children's magazines they reviewed were for foods detrimental to oral health owing to their high sugar and/or acid content. That should be a warning bell for dentists. A point of interest to oral health advocates is that direct advertisements for foods and drinks accounted for less than 10% of the food references. Therefore, publishers and food writers, as well as advertisers, need to be targeted and challenged about recommending and providing misleading information on foods and drinks that are harmful to health and oral health. The unabated increase in dental caries shows that such approaches are badly needed.