The effectiveness of the food and beverage industry's self-established uniform nutrition criteria at improving the healthfulness of food advertising viewed by Canadian children on television

Background: Food and beverage marketing has been identified as an environmental determinant of childhood obesity. The purpose of this study is to assess whether the Uniform Nutrition Criteria established and implemented by companies participating in the self-regulatory Canadian Children's Food and Beverage Advertising Initiative (CAI) had an impact on the healthfulness of food and beverage advertising during television programming with a high share of children in the viewing audience. Methods: Data on food advertising were licensed from Numeris for 27 television stations for Toronto for May 2013 and May 2016 (i.e. before and after the implementation of the nutrition criteria). First, television programs that had a child audience share of >= 35% (when the nutrition criteria applied) were identified. Ten percent of these programs were randomly selected and included in the study. After identifying the food and beverage ads that aired during these programs, the nutritional information of advertised products was collected and their healthfulness was assessed using the Pan-American Health Organization (PAHO) and UK Nutrient Profile Models (NPM). The healthfulness of CAI products advertised in May 2013 and 2016 was compared using Chi-square tests. Results: Although in May 2016, products advertised by CAI companies were more likely to be categorized as healthier by the UK NPM (21.5% versus 6.7%, x(2)(1) = 12.1,p = 000) compared to those advertised in May 2013, the frequency of advertised products considered less healthy in May 2016 remained very high (78.5%) and comparable to that of products advertised by companies not participating in the CAI (80.0% categorized as less healthy). Furthermore, in both May 2013 and May 2016, 99-100% of CAI advertisements featured products deemed excessive in either fat (total, saturated, trans), sodium or free sugars according to the PAHO NPM. Conclusions: Despite modest improvements noted after the implementation of the CAI's Uniform Nutrition Criteria, the healthfulness of most products advertised during programs with a high share of children in the viewing audience remains poor. Mandatory regulations are needed.