A School-based Brand Marketing Program’s Adherence to Federal Nutrition Criteria

Abstract

Introduction

The Healthy, Hunger-Free Kids Act of 2010 gave the U.S. Department of Agriculture authority to regulate school wellness policies, which include nutritional standards for foods advertised in schools. Brand marketing programs, which encourage students to purchase a company’s products in exchange for money or rewards, were not explicitly prohibited. This study assesses the nutritional quality of products participating in “Box Tops for Education” (“Box Tops”), one of the largest national brand marketing programs in schools.

Methods

Participating foods and beverages were obtained from the Box Tops product list and matched to nutrient information and ingredients from manufacturer websites in 2016 (N=949). Products were categorized as beverages (n=13), entrees (n=171), snacks (n=677), or fruits and vegetables exempt from the Smart Snacks in School Standards (“Smart Snacks” standards) (n=88) to assess the percentage that met the Smart Snacks standards.

Results

Of the foods participating in the Box Tops program, 69% of beverages, 26% of entrees, and 23% of snacks met the Smart Snacks standards. Most foods met the standards for trans fats (98%), calories (90%), and sugar (89%), but fewer met the requirements for sodium (60%). Noncompliant snacks contained more than twice the recommended sodium (mean=420mg, SD=191mg) and percent calories from saturated fat (mean=22%, SD=13%).

Conclusions

Fewer than one third of Box Tops foods met the Smart Snacks standards. Schools should consider whether the benefit of participation outweighs the harm of exposing kids to unhealthful marketing. Alternatively, schools could opt not to participate unless companies limit redeemable products to household items or healthful options meeting the Smart Snacks standards.

INTRODUCTION

Food and beverage companies heavily market their products to youth.¹ In 2009, $1.8 billion was spent on youth-targeted food marketing, with the majority going towards nutrient-poor foods and beverages.² Greater exposure to unhealthy food advertising increases intake and preference for nutritionally poor foods, which increase risk of weight gain and diabetes among school-aged children.^3–7 Thus, reducing youth exposure to food marketing is a promising strategy for improving dietary behaviors and health.^8–10

The Healthy, Hunger-Free Kids Act of 2010 sought to limit youth exposure to unhealthy food marketing by authorizing the U.S. Department of Agriculture (USDA) to revise regulations for school wellness policies.¹¹ Issued in 2016, the USDA’s final rule required schools participating in the National School Lunch Program to implement policies that promote wellness, in part by prohibiting the sale or advertising of foods or beverages failing to meet federal nutrition standards (the “Smart Snacks” standards).¹² Smart Snacks closely aligns with The National Academies of Sciences, Engineering, and Medicine recommendations,¹³ and is more health-driven than many previous state and local policies.¹⁴ School-based brand marketing programs, which often require the purchase, promotion, or sale of a company’s products in exchange for rewards, were not prohibited in the final rule, despite many commenters advocating for the inclusion of such programs.¹⁵

The purpose of this research is to assess the extent to which products sold under school-based brand marketing programs meet the Smart Snacks standards by examining the nutritional quality of products sold through Box Tops for Education (“Box Tops”). Box Tops was launched by General Mills in 1996 and is one of the largest incentive-based brand marketing programs, with more than 90,000 schools participating (www.boxtops4education.com).¹⁶ Schools earn money by collecting box tops from participating General Mills products. To date, no studies have assessed the healthfulness of products included in Box Tops or similar programs.

METHODS

The Box Tops product list was obtained from the General Mills website in July 2016 (www.boxtops4education.com/earn/participating-products). From July 2016 to December 2016, the authors recorded information from manufacturers’ websites for each product on the list. For foods, information about gram weight per serving, calories (kcal), total fat (g), saturated fat (g), trans fat (g), sodium (mg), sugar (g), food group of the first listed ingredient (i.e., meat/meat alternate, dairy, fruit, vegetable, or whole grain), and presence of multiple food groups in the product was recorded. Products with identical descriptions in different packaging (e.g., frozen versus canned), were recorded as distinct items, but identical products in different sizes (e.g., twin packs) were recorded once for the smallest package size. Percent calories from fat was calculated using the Atwater general factors, by multiplying grams of fat/serving by 9 kilocalories, dividing by total kilocalories/serving, and multiplying by 100.¹⁷ Percent sugar by weight was calculated by dividing grams of sugar/serving by gram weight/serving and multiplying by 100. For beverages, information about calories, portion size, presence of added sweeteners, and whether or not the beverage was 100% juice was collected. Condiments (n=45), variety packs (n=7), and items for which nutrient information or ingredients were not found on the manufacturer’s website (n=26) were excluded.

Products were grouped into four mutually exclusive categories: beverages, snacks, entrees, and fruits and vegetables exempt from the Smart Snacks standards. Fruits and vegetables were exempt if they were: (1) fresh or frozen, with no added ingredients except water, (2) canned fruits packed in 100% juice or light syrup, or (3) canned vegetables (no salt added or low sodium), with no added fats.¹⁶ Products that could feasibly be consumed as a main dish were classified as entrées if they contained a combination of: (1) meat/meat alternate and whole grain-rich food; (2) vegetable and meat/meat alternate; (3) fruit and meat/meat alternate; or (4) meat/meat alternate alone, except for meat snacks, yogurt, cheese, nuts, seeds, and nut or seed butters.¹⁸ Although the Smart Snacks standards are per item, many foods were intended for sharing, so the authors compared nutrients per serving to the Smart Snacks standards to determine the proportion of items meeting the standards.¹⁸ For foods not meeting each standard, the authors calculated mean calories, total fat (% calories), saturated fat (% calories), trans fat (g), sodium (mg), and sugar (% weight) per serving. Data were analyzed using Stata, version 13.1.

RESULTS

Of 949 Box Tops items, 88 (9%) were fruits and vegetables exempt from Smart Snacks. Of 13 beverages, nine (69%) met the Smart Snacks standards. Among 848 non-exempt foods, 24% met the Smart Snacks standards, with more entrees (26%) than snacks (23%) complying (Figure 1). All entrees met standards for sugar and most (99%) met standards for trans fat, but less than half complied with standards for sodium (45%) or for listing a whole food as the first ingredient (47%). Most snacks met the standard for trans fat (98%), calories (88%), and sugar (87%), but fewer complied with guidelines for sodium (64%) or listing a whole food as the first ingredient (59%). Entrees not meeting the sodium standard contained, on average, 680 mg (SD=89.7 mg) of sodium per serving, and snacks contained 420 mg (SD=190.5 mg) (Table 1). Snacks not meeting the fat and saturated fat standards contained 51% (SD=13.4%) and 22% (SD=12.7%) of calories from fat and saturated fat, respectively.

Figure 1.

Proportion of foods participating in Box Tops for Education that meet the Smart Snacks in School standards.

Notes: Figure shows the proportion of all items, snacks, and entrees meeting all standards (“All standards”) and each individual guideline: (1) “First ingredient” – have a whole grain, fruit, vegetable, dairy product, or protein food as the first ingredient;^a (2) “Calories” – contain <200 calories (snack) or <350 calories (entrée); (3) “Sodium” – contain <200 mg sodium (snack) or <480 mg sodium (entrée); (4) “Total fat” – contain <35% of calories from total fat; (5) “Saturated fat” – contain <10% of calories from saturated fat; (6) “Trans fat” – contain <0.5 g trans fat; (7) “Sugar” – contain <35% sugar by weight. Reduced fat cheese, nuts, seeds, and nut/seed butters were exempt from the total fat and saturated fat standards. Mixes of only dried fruits and nuts and/or seeds, with no added sugars or fats, were exempt from the total fat, saturated fat, and sugar standards.

^aThe Smart Snacks in School Standards also allow products containing at least 0.25 cup fruit or vegetable, which could not be assessed in this study. Given the small serving sizes of these items, it is unlikely that a food would contain enough fruit or vegetable if not listed as the first ingredient. Thus, we classified foods as not meeting the “first ingredient” standard if the food did not list a whole grain, fruit, vegetable, dairy, or protein food as the first ingredient.

Table 1.

Mean (SD) Nutrient Content of Box Tops for Education Products That Do Not Comply With Each of the Smart Snacks in School Standards

Product	Calories (kcals)	Total fat (% kcals)	Saturated fat (% kcals)	Trans fat (g)	Sodium (mg)	Sugar (% weight)
Snacks	242 (25.5)	51 (13.4)	22 (12.7)	1 (0.2)	420 (190.5)	44 (7.0)
Entrees	360 (0.0)	44 (7.4)	13 (2.8)	1 (0.0)	680 (89.7)	--

DISCUSSION

This study assessed the nutritional quality of nearly 1,000 Box Tops foods and beverages and found that less than one third met the Smart Snacks standards. Though participating products generally met the guidelines for calories, sugar, and trans fat, many foods were high in sodium and lacked healthful ingredients. These results have implications for parents, teachers, and staff involved in designing and enforcing local school wellness policies. Box Tops is just one of many brand marketing programs that use schools as a venue to advertise products to kids. School-based marketing programs like Labels for Education (www.labelsforeducation.com), McTeacher’s Night, Pizza Hut Book It (www.bookitprogram.com), and Sunny D Book Spree have all encouraged parents, teachers, and students to purchase, consume, or otherwise promote products in exchange for cash or other educational rewards.^19,20 Because the USDA does not prohibit schools from participating in brand marketing programs, wellness committee members and other stakeholders must decide if the financial benefits of participation outweigh the potential harm of marketing unhealthful foods to kids. On average, Box Tops has contributed less than $7,000 per school over the life of the program.¹⁶ The effort of promoting and collecting Box Tops products, along with the potential lasting detrimental effects of children linking these brands with rewards, may not be worth the benefit.²¹

Limitations

Because foods were evaluated per serving rather than per package, and serving sizes reported on the package often underestimate portions consumed, these results likely overestimate the nutritional quality of Box Tops products.²²

CONCLUSIONS

The majority of Box Tops products do not meet the Smart Snacks standards, and schools should carefully consider whether the financial benefit of participation outweighs the potential harm. As an alternative, food companies could enhance their public image by modifying these programs. Box Tops could expand the number of household items, like garbage bags, that are eligible for rewards. Alternatively, Box Tops could limit rewards to only healthful foods and beverages. The program already includes just over 300 items, like frozen vegetables, meeting the Smart Snacks standards, and General Mills sells other healthful foods, like frozen fruit, that could be added to the program. Limiting redeemable products to healthful items would not only reduce the negative impact of food marketing to kids, but may have a positive influence on children’s food preferences and dietary intake while still raising money for education.