Sugary Beverage Advertising to Black and Hispanic Youth in the United States: A Call for Action

Abstract

The obesity epidemic remains a major public health issue worldwide, and it is pronounced in the United States. As rates of obesity continue to increase, children now experience obesity at younger ages, which predisposes them to early-onset obesity-related diseases. Of note, Black and Hispanic children experience obesity at higher rates compared with their White counterparts. Although there are many factors that contribute to higher rates of obesity, the increased consumption of sugar-sweetened beverages is one such contributor. Despite the dire state of obesity in these populations, sugar-sweetened beverage companies continue to increase their advertisements to Black and Hispanic children, which can negatively influence the childhood obesity epidemic. This article discusses the effect that sugar-sweetened beverages and their advertisements have on children in underrepresented communities.

For decades, the childhood obesity epidemic has been a long-standing public health issue. Since 1999, rates of obesity have continued to steadily increase from 13.9% to 18.5% in 2015 to 2016.¹ Furthermore, according to the Centers for Disease Control and Prevention (CDC), 22% of Black children and 25.8% of Hispanic children were living with obesity compared with only 14.1% of White children and 11% of Asian children.² These rates show a clear racial disparity when it comes to childhood obesity rates in the United States.² Likewise, Hispanic and Black populations are more likely to suffer from heart disease, diabetes, and early mortality in adulthood—conditions that are related to increased rates of obesity.² Given this data, it is important to address factors contributing to increased weight gain, particularly during childhood. Although genetics and physical activity play a role in metabolism and weight status, diet and lifestyle may also contribute greatly to a child’s nutritional status.

The complex multifactorial disease of obesity has become increasingly important in pediatrics because of the potential lifelong sequelae of the disease and its effect on all organ systems. Children who have the disease of obesity are often subjected to considerable weight stigma, which compounds racial bias that is commonplace for people from racial and ethnic minority groups.³ Once the disease of obesity is present, children and adolescents from racial and ethnic minority groups may have a less potent response to the treatment of their obesity than majority groups.⁴ As such, we must investigate all strategies that might mitigate the disease of obesity in racial and ethnic minority communities.

Unfortunately, the food and drink industry has continued to grow at alarming rates and has contributed greatly to poor dietary habits for youth in the US. According to the CDC, “frequently drinking sugar-sweetened beverages is associated with weight gain/obesity, type 2 diabetes, heart disease, kidney diseases, nonalcoholic liver disease, tooth decay and cavities, and gout.”⁵ Despite these known risk factors, beverage companies spent more than $1 billion on sugary drink advertising in 2018.⁶ Furthermore, it appears that these beverage companies have targeted Hispanic and Black communities and those of lower socioeconomic status at higher rates than in less vulnerable communities.⁷

The Sugary Drinks FACTS 2020 report⁸ addressed several racial discrepancies related to beverage advertising during 2018. According to the report, “companies spent $84 million to advertise regular soda, sports drinks, and energy drinks on Spanish-language TV, an increase of 8% versus 2013 and 80% versus 2010.”⁸ The report also points out that sports drink brands had increased advertising on Spanish-language TV, with a larger proportion of advertisements dedicated to Spanish-language TV compared with all other sugary drinks.⁸ Furthermore, Black children and teenagers were found to view more than twice as many sugary drink advertisements than White children and teens.^6,8 These marketing tactics have been especially detrimental to these vulnerable youth as they are more likely to view these advertisements given their higher proportional use of television and media compared with White children.⁹ Studies have shown that Black and Hispanic children older than age 2 years are more likely to have a television in their room and consume more sugar-sweetened beverages on average compared with White children.⁹ Increased screen time can be harmful to children, as it promotes eating while viewing and “influences children’s preferences, purchase requests, [and] consumption habits.”⁹

Through the years, several steps have been taken to reduce the risk of obesity in Black and Hispanic youth; however, junk food and sugar-sweetened beverage marketing remains a significant obstacle to these efforts. For example, the lack of fresh fruits and vegetables in supermarkets within “food deserts” is known to contribute to poor diet quality. However, studies have shown that just increasing the number of supermarkets and access to healthy foods is not enough; eliminating food deserts requires limiting junk food marketing as well.¹⁰ Likewise, increasing the costs of sugar-sweetened beverages have been proposed to limit purchase of these items.¹¹ Still, efforts to impose taxes on sugar-sweetened beverages have been vehemently blocked by the sugary drink industry, and these companies continue to advertise low-priced sugar-sweetened beverages compared with healthier alternatives in stores at higher rates, particularly in lower socioeconomic neighborhoods that are majority Black and Hispanic.⁸ Decreasing screen time might also decrease childhood obesity rates, and, despite BIPOC (Black, Indigenous, People of Color) children consuming higher rates of television and media, there has been a steady decline by more than 50% of screen time for children of all races.⁶ However, even considering this decline, the Sugary Drinks FACTS 2020 report has shown that there has been an increase in advertisements for sugar-sweetened beverages compared with prior years.^6,8

Increased efforts to combat sugar-sweetened beverage companies’ advertising and influence on vulnerable youth are needed. For example, the Sugary Drinks FACTS 2020 report calls for increasing regulations on labeling of beverages with added sugar, as well as prohibiting the sale of energy drinks to children younger than age 18 years.^6,8 The American Academy of Pediatrics (AAP) recommends “[reducing] advertising of unhealthy foods and beverages to children and teenagers, particularly targeted advertising that exacerbates disparities when combined with structural sources of inequality (eg, healthy food scarcity and public underinvestment in opportunities for exercise or play).”¹² Furthermore, the AAP recommends imposing taxes on sugar-sweetened beverage companies and using the accumulated revenue to fund community programs that can reduce health disparities in all communities.³

The coronavirus disease 2019 (COVID-19) pandemic has elucidated racial and ethnic disparities in health care and delivery. Unfortunately, the heightened morbidity and mortality in BIPOC communities from COVID-19 has been closely linked with obesity.¹³ With COVID-19 as a priority focus, efforts should be made to reduce any contributors to obesity, particularly in those who have faced the highest burden for disease. Although it may be challenging to address the multifactorial nature of obesity, steps to reduce marketing to vulnerable communities are a step in the right direction to begin to tackle the most prevalent chronic disease in the pediatric and adult population—obesity.