ABSTRACT

OBJECTIVE

To document the evidence about marketing of ultra-processed foods and “non-alcoholic” beverages in Latin America.

METHODS

We performed a structured search of quantitative and qualitative studies in PubMed, SciELO and LILACS, published between January 2000 and May 2017 and conducted in Latin America. We conducted a quality assessment following a standardized tool and a thematic analysis to identify key typologies of marketing across studies

RESULTS

Out of 521 studies screened by title and abstract, we included 36 in this review; 27 of them analyzed television advertisement. Other marketing channels studied were food packaging, point of sale and outdoor advertisement. Studies found television advertises foods and beverages that are mostly ultraprocessed foods and have low nutritional value, particularly those promoted during children’s programming. We also observed children have a literal interpretation of images printed on food packaging, so this can be deceiving. Several studies also found proximity to unhealthy foods may increase their consumption. Finally, the thematic analysis identified the following typologies of food marketing: a) television advertisement, b) food packaging marketing, c) marketing strategies at points of sale and d) other marketing strategies. We found almost no advertisements for unprocessed or minimally processed foods such as fruits and vegetables. We did not find any studies on digital marketing conducted in the region.

CONCLUSIONS

This review found that the main channel of food marketing was television advertising. This synthesis provides insights to the challenges unhealthy eating represents to the public health of Latin America and identifies knowledge gaps to guide future research.

INTRODUCTION

According to the Global Burden of Disease Study, unhealthy dietary patterns have become the third risk factor associated with disability-adjusted life years and the second risk factor associated with mortality in Latin America and Caribbean¹1. University of Washington, Institute for Health Metrics and Evaluation. Global Burden of Disease Study. Seattle: IHME; 2017 [cited 2018 April 17]. Available from:. Evidence shows the consumption of ultra-processed foods, including sweetened beverages, is associated with obesity and type 2 diabetes²2. Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ. 2013;346:e7492. https://doi.org/10.1136/bmj.e7492
https://doi.org/10.1136/bmj.e7492... . Changes in eating patterns and the growing consumption of ultra-processed foods and beverages⁵5. Monteiro CA, Levy RB, Claro RM, Castro IR, Cannon G. Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil. Public Health Nutr. 2010;14(1):5-13. https://doi.org/10.1017/S1368980010003241
https://doi.org/10.1017/S136898001000324... characterize Latin America’s rapid nutrition transition_. For instance, a study conducted in Brazil showed an increase of 4.8% in the energy value of ultra-processed foods between 2002-2003 and 2008-2009⁶6. Martins APB, Levy RB, Claro RM, Moubarac JC, Monteiro CA. Increased contribution of ultra-processed food products in the Brazilian diet (1987-2009). Rev Saude Publica. 2013;47(4):656-65. https://doi.org/10.1590/S0034-8910.2013047004968
https://doi.org/10.1590/S0034-8910.20130... . Another Mexican study found the calories from beverages frequently marketed to children increased from 161 kcal in 1999 to 310 kcal in 2006⁷7. Rivera JA, Barquera S, González-Cossío T, Olaiz G, Sepúlveda J. Nutrition transition in Mexico and in other Latin American countries. Nutr Rev. 2004;62 Suppl 2:S149-57..

Marketing plays an important role in this transition process as it allows to modify and reinforce social norms that dictate the type of foods to be eaten and the manner and time to eat them. Marketing often depicts foods being consumed in situations other than mealtimes, away from the table and in unlimited quantities⁸8. Harris JL, Pomeranz JL, Lobstein T, Brownell KD. A crisis in the marketplace: how food marketing contributes to childhood obesity and what can be done. Annu Rev Public Health. 2009;30:211-25. https://doi.org/10.1146/annurev.publhealth.031308.100304
https://doi.org/10.1146/annurev.publheal... ,⁹9. Harris JL, Brownell KD, Bargh JA. The food marketing defense model: integrating psychological research to protect youth and inform public policy. Soc Issues Policy Rev. 2009;3(1):211-71. https://doi.org/10.1111/j.1751-2409.2009.01015.x
https://doi.org/10.1111/j.1751-2409.2009... . The food and beverage industries spend billions of dollars every year on advertising¹⁰10. Cairns G, Angus K, Hastings G, Caraher M. Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary. Appetite. 2013;62:209-15. https://doi.org/10.1016/j.appet.2012.04.017
https://doi.org/10.1016/j.appet.2012.04.... , and the vast majority of promoted products are energy-dense and nutrient-poor¹¹11. Palmer E, Carpenter C. Food and beverage marketing to children and youth: trends and issues. Media Psychol. 2006;8(2):165-90..

Children are extremely vulnerable to food marketing. They are highly impressionable, cannot recognize advertising intent, lack nutritional knowledge, and are motivated by immediate gratifications.¹²12. McGinnis JM, Gootman JA, Kraak VI, editors. Food marketing to children and youth: threat or opportunity? Washington, DC: National Academies Press; 2006,¹⁵15. Story M, French S. Food advertising and marketing directed at children and adolescents in the US. Int J Behav Nutr Phys Act. 2004;1(1):3. https://doi.org/
https://doi.org/... ,¹⁶16. Singh AS, Mulder C, Twisk JW, Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9(5):474-88. https://doi.org/10.1111/j.1467-789X.2008.00475.x
https://doi.org/10.1111/j.1467-789X.2008... . Moreover, food companies target children for they have a strong influence in what families buy and establish brand loyalty at an early age, which has long-term effects on eating preferences and behaviors.⁹9. Harris JL, Brownell KD, Bargh JA. The food marketing defense model: integrating psychological research to protect youth and inform public policy. Soc Issues Policy Rev. 2009;3(1):211-71. https://doi.org/10.1111/j.1751-2409.2009.01015.x
https://doi.org/10.1111/j.1751-2409.2009... ,¹¹11. Palmer E, Carpenter C. Food and beverage marketing to children and youth: trends and issues. Media Psychol. 2006;8(2):165-90.,¹⁶16. Singh AS, Mulder C, Twisk JW, Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9(5):474-88. https://doi.org/10.1111/j.1467-789X.2008.00475.x
https://doi.org/10.1111/j.1467-789X.2008... . For example, the risk of becoming an overweight adult is twice as much for an overweight child compared with a normal weight child¹⁷17. Peters MDJ, Godfrey CM, McInerney P, Soares CB, Khalil H, Parker D. TheJoanna Briggs Institute reviewers’ manual 2015: methodology for JBI Sscoping reviews. Adelaide (AUS): The Joanna Briggs Institute; 2015..

Several studies on food and beverage marketing have been conducted in Latin America; however, no recent syntheses summarize the main results from the available literature. Therefore, we performed a scoping review¹⁹19. PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Ottawa (CAN); 2015 [cited 2018 April 10]. Available from: http://www.prisma-statement.org/
http://www.prisma-statement.org/... of studies that analyzed marketing of food and nonalcoholic beverages conducted in Latin America, in terms of exposure, marketing strategy, and nutritional value, using both qualitative and quantitative methods.

METHODS

We conducted a scoping review following the Joanna Briggs Institute guidelines¹⁸18. Colquhoun HL, Levac D, O’Brien KK, Straus S, Tricco AC, Perrier L, et al. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014;67(12):1291-4. https://doi.org/10.1016/j.jclinepi.2014.03.013
https://doi.org/10.1016/j.jclinepi.2014.... , which is the criteria recommended by Colquhoun et al.¹⁹19. PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Ottawa (CAN); 2015 [cited 2018 April 10]. Available from: http://www.prisma-statement.org/
http://www.prisma-statement.org/... and used PRISMA guidelines to design the protocol and report the results²⁰20. World Health Organization. A framework for implementing the set of recommendations on the marketing of foods and non-alcoholic beverages to children. Geneva: WHO; 2012.. We documented the study objectives, methods, inclusion criteria and quality assessment in a study protocol. This form of knowledge synthesis enabled systematically searching, selecting, and synthesizing the existing evidence in this area of study¹⁹19. PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Ottawa (CAN); 2015 [cited 2018 April 10]. Available from: http://www.prisma-statement.org/
http://www.prisma-statement.org/... . The research questions were: What is the evidence regarding the marketing of food and nonalcoholic beverages conducted in Latin America? And, what are the key typologies of marketing across studies?

Data Sources and Search Strategy

We took the evidence documented in this scoping review from original quantitative and qualitative studies in the area of food and beverage marketing, which were conducted in Latin and Central American countries and the Greater Antilles (Cuba, Hispaniola; Haiti and the Dominican Republic, Puerto Rico and Jamaica). In this review, marketing was assumed as “any form of commercial communication or message that is designed to, or has the effect of, increasee the recognition, appeal and/or consumption of particular products and services. It comprises anything that acts to advertise or otherwise promote a product or service” (WHO, p. 9)²¹21. Sonntag D, Schneider S, Mdege N, Ali S, Schmidt B. Beyond food promotion: a systematic review on the influence of the food industry on obesity-related dietary behaviour among children. Nutrients. 2015;7(10):8565-76. https://doi.org/10.3390/nu7105414
https://doi.org/10.3390/nu7105414... .

After clearly identifying the research question, scoping reviews need to identify relevant studies. To ensure the comprehensiveness and range of our search, we investigated studies in the following electronic databases: PubMed, SciELO and LILACS. To further ensure the desired level of breadth, we included studies published in Spanish, Portuguese, French and English. The time frame of publication was from January 2000 to May 2017. The search included the following free terms, using the Boolean operator “OR”: “marketing”, “advertisement”, “publicity”, “promotion”, and “ad”. Moreover, the terms “food” and “beverage” were added to the query using the operator “AND” (Appendix I). This search strategy was defined to support sensitivity and reduce the risk of omitting relevant studies. In addition, we conducted a manual search to include relevant articles cited in the studies found, following recommendations of scoping reviews experts¹⁹19. PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Ottawa (CAN); 2015 [cited 2018 April 10]. Available from: http://www.prisma-statement.org/
http://www.prisma-statement.org/... . Finally, we contacted Latin American researchers and public health advocates members of the Coalición Latinoamérica Saludable (Healthy Latin America Coalition), to verify gray literature sources. We carried out the search until May 31, 2017.

Study Selection and Inclusion Criteria

Two of the authors undertook the study selection process, which can be seen in the PRISMA flow diagram (Figure 1) based on the content of titles and abstracts and in a second step based on the review of the manuscript text. In case of discrepancies, a third author reviewed the manuscript, and an agreement was obtained using a deliberative process. Studies that were not directly connected with health, nutrition and or food marketing were not included in this review.

Data Extraction and Quality Assessment

For each study inclusion, two authors independently extracted the data, based on titles and abstracts. Subsequently, these two reviewers extracted the basic information from the manuscript texts and assessed the quality of each study. In case of disagreement, a third author was consulted. The following information was obtained and summarized from each study: authors, publication date, country, year in which the study was conducted, study design and objectives, study population, sample size, prevalence, and sociodemographic correlates.

A quality assessment was performed on both quantitative and qualitative articles following a standardized tool that has been used by authors in similar situations and that enables the application to several research methods²²22. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101.. Five items were assessed: a) Is there a clear and focused research question? b) Did the authors establish a theoretical framework? c) Was the methodology used appropriate for the objectives of the study? d) Did the authors recognize and describe the limitations of their study? and e) Did the authors clearly describe their results? The studies were classified for each of these criteria as “meeting the criteria”; 20 points, “partially meeting the criteria”; 10 points, and “not meeting the criteria”; 0 points. Finally, a percentage of criteria met were calculated and studies were labeled as being of poor quality (< 60%), fair quality (60%–90%), and good quality (> 90%).

Analytical Approach

Two methods of analysis were used. Firstly, we briefly described the objective, study design, setting and main results of the studies. The second was a thematic analysis that was used to identify key typologies of marketing across studies²³23. Almeida SS, Nascimento PCBD, Quaioti TCB. [Amount and quality of food advertisement on Brazilian television]. Rev Saude Publica. 2002;36(3):353-5. Portuguese.. The authors reviewed, refined and named these typologies during several meetings, considering the terminology proposed by the World Health Organization²²22. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101.. Since some studies addressed several topics of marketing, their findings might be included in several typologies.

RESULTS

We identified 558 studies in our database search in PubMed, Scielo and LILACS and four additional studies were found by a manual search of cited articles and by contact with public health researchers, for a total of 562 studies. After adjusting for duplicates, 521 studies remained. Out of these, 432 were discarded based on title and abstract and 89 studies were selected for full text assessment. Among these, 53 articles did not meet the inclusion criteria and were discarded; 36 studies were included (Figure 1).

The Table 1 shows a general description of the main characteristics and findings of the 36 studies included in the review²⁴24. Olivares S, Yáñez R, Díaz N. Publicidad de alimentos y conductas alimentarias en escolares de 5º a 8º básico. Rev Chil Nutr. 2003;30(1):36-42.

25. Fiates GMR, Amboni RDMC, Teixeira E. Television use and food choices of children: qualitative approach. Appetite. 2008;50(1):12-8.

26. Ramírez-Ley K, De Lira-García C, Souto-Gallardo ML, Tejeda-López MF, Castañeda-González LM, Bacardí-Gascón M, et al. Food-related advertising geared toward Mexican children. J Public Health (Oxf). 2009;31(3):383-8. https://doi.org/10.1093/pubmed/fdp058
https://doi.org/10.1093/pubmed/fdp058...

27. Pérez-Salgado D, Rivera-Márquez JA, Ortiz-Hernández L. Publicidad de alimentos en la programación de la televisión mexicana: ¿los niños están más expuestos? Salud Publica Mex. 2010;52(2):119-26. https://doi.org/10.1590/S0036-36342010000200003
https://doi.org/10.1590/S0036-3634201000...

28. Crovetto-M M, Durán-T M, Guzmán-R M, Miranda-H C. Estudio descriptivo de la frecuencia y duración de la publicidad alimentaria emitida en la programación de canales de televisión asociados a ANATEL. Rev Chil Nutr. 2011;38(3):290-9.

29. Olivares-C S, Lera-M L, Mardones-H MA, Araneda-F J, Bustos-Z N, Olivares-C MA, et al. Promoción de alimentos y preferencias alimentarias en escolares chilenos de diferente nivel socioeconómico. Arch Latinoam Nutr. 2011;61(2):163-71.

30. Santos CC, Stuchi RAG, Arreguy-Sena C, Pinto NAVD. [Television’s influence on eating habits, practices and behavior]. Cogitare Enferm. 2012;17(1):65-71. Portuguese. h

31. Rodrigues VM, Fiates GMR. [Children’s eating habits and consumer behavior: influence of household income and television viewing habits. Rev Nutr. 2012;25(3):353-62. Portuguese. https://doi.org/10.1590/S1415-52732012000300005
https://doi.org/10.1590/S1415-5273201200...

32. Costa SMM, Horta PM, Santos LC. Food advertising and television exposure: influence on eating behavior and nutritional status of children and adolescents. Arch Latinoam Nutr. 2012;62(1):53-9.

33. Bacardí-Gascón M, Díaz-Ramírez G, Cruz López B, López Zuñiga E, Jiménez-Cruz A. TV food advertisements’ effect on food consumption and adiposity among women and children in México. Nutr Hosp. 2013;28(6):1900-4. https://doi.org;10.3305/nutr hosp.v28in06.6966
https://doi.org;10.3305/nutr hosp.v28in0...

34. Chacon V, Letona P, Barnoya J. Child-oriented marketing techniques in snack food packages in Guatemala. BMC Public Health. 2013;13:967. https://doi.org/10.1186/1471-2458-13-967
https://doi.org/10.1186/1471-2458-13-967...

35. Díaz-Ramírez G, Jiménez-Cruz A, Souto-Gallardo MC, Bacardí-Gascón M. Effect of the exposure to TV food advertisements on the consumption of foods by mothers and children. J Pediatr Gastroenterol Nutr. 2013;56(1):86-8. https://doi.org/10.1097/MPG.0b013e3182638d13
https://doi.org/10.1097/MPG.0b013e318263...

36. Costa SM, Horta PM, Santos LC. Analysis of television food advertising on children’s programming on “free-to-air” broadcast stations in Brazil. Rev Bras Epidemiol. 2013;16(4):976-83.

37. Rojas-Huayllani EC, Delgado-Pérez DH. [Influence of Peruvian television advertising in unhealthy food consumption in 4th to 6th grade elementary scholars]. An Fac Med. 2013;74(1):21-26. Spanish

38. Busse P, Díaz R. What are the television viewing and eating habits of children in Peru? Glob Health Promot. 2016;23(1):50-60. https://doi.org/10.1177/1757975914547923
https://doi.org/10.1177/1757975914547923...

39. Gunderson MD, Clements D, Benjamin Neelon SE. Nutritional quality of foods marketed to children in Honduras. Appetite. 2014;73:1-6. https://doi.org/10.1016/j.appet.2013.10.009
https://doi.org/10.1016/j.appet.2013.10....

40. Letona P, Chacon V, Roberto C, Barnoya J. A qualitative study of children’s snack food packaging perceptions and preferences. BMC Public Health. 2014;14:1274. https://doi.org/10.1186/1471-2458-14-1274
https://doi.org/10.1186/1471-2458-14-127...

41. Mazzonetto AC, Fiates GMR. Perceptions and choices of Brazilian children as consumers of food products. Appetite. 2014;78:179-84. https://doi.org/10.1016/j.appet.2014.03.028
https://doi.org/10.1016/j.appet.2014.03....

42. Mejía-Díaz D, Carmona Garcés IC, Giraldo-López P, González-Zapata L. Contenido nutricional de alimentos y bebidas publicitados en la franja infantil de la televisión colombiana. Nutr Hosp. 2014;29(4):858-64.

43. Amanzadeh B, Sokal-Gutierrez K, Barker JC. An interpretive study of food, snack and beverage advertisements in rural and urban El Salvador. BMC Public Health. 2015;15:521. https://doi.org/10.1186/s12889-015-1836-9
https://doi.org/10.1186/s12889-015-1836-...

44. Bridle-Fitzpatrick S. Food deserts or food swamps? A mixed-methods study of local food environments in a Mexican city. Soc Sci Med. 2015;142:202-13. https://doi.org/10.1016/j.socscimed.2015.08.010
https://doi.org/10.1016/j.socscimed.2015...

45. Cárdenas MK, Benziger CP, Pillay TD, Miranda JJ. The effect of changes in visibility and price on fruit purchasing at a university cafeteria in Lima, Peru. Public Health Nutr. 2015;18(15):2742-9. https://doi.org/10.1017/S1368980014002730
https://doi.org/10.1017/S136898001400273...

46. Chacon V, Letona P, Villamor E, Barnoya J. Snack food advertising in stores around public schools in Guatemala. Crit Public Health. 2015;25(3):291-8. https://doi.org/10.1080/09581596.2014.953035
https://doi.org/10.1080/09581596.2014.95...

47. Ortiz-Pérez H, Molina-Frechero N, Martínez-Barbabosa I, Córdova-Moreno R. Contenido nutricional de los alimentos promovidos por el Canal 5 de la televisión mexicana dirigidos a la población infantil. Rev Chil Nutr. 2015;42(3):260-6.

48. Soo J, Letona P, Chacon V, Barnoya J, Roberto CA. Nutritional quality and child-oriented marketing of breakfast cereals in Guatemala. Int J Obes (Lond). 2016;40(1):39-44. https://doi.org/10.1038/ijo.2015.161
https://doi.org/10.1038/ijo.2015.161...

49. Viacava KR, Weydmann GJ, Vasconcelos MF, Jaboinski J, Batista GD, Almeida RM, et al. It is pleasant and heavy: convergence of visual contents in tobacco, alcohol and food marketing in Brazil. Health Promot Int. 2016;31(3):674-83. https://doi.org/10.1093/heapro/dav057
https://doi.org/10.1093/heapro/dav057...

50. Britto SR, Viebig RF, Morimoto JM. Analysis of food advertisements on cable television directed to children based on the food guide for the Brazilian population and current legislation. Rev Nutr. 2016;29(5):721-9.

51. Busse P. Food content of TV shows seen by children in Peru: a double dose of food messages? Int J Commun. 2016;10:1194-211.

52. Castronuovo L, Gutkowski P, Tiscornia V, Allemandi L. Las madres y la publicidad de alimentos dirigida a niños y niñas: percepciones y experiencias. Salud Colectiva. 2016;19;12(4):537-50.

53. Mazariegos S, Chacón V, Cole A, Barnoya J. Nutritional quality and marketing strategies of fast food children’s combo meals in Guatemala. BMC Obesity. 2016;3:52.

54. Patiño SRG, Tolentino-Mayo L, Flores Monterrubio EA, Harris JL, Vandevijvere S, Rivera JA, et al. Nutritional quality of foods and non-alcoholic beverages advertised on Mexican television according to three nutrient profile models. BMC Public Health. 2016;16:733. https://doi.org/10.1186/s12889-016-3298-0
https://doi.org/10.1186/s12889-016-3298-...

55. Théodore FL, Tolentino-Mayo L, Hernández-Zenil E, Bahena L, Velasco A, Popkin B, et al. Pitfalls of the self-regulation of advertisements directed at children on Mexican television. Pediatr Obes. 2017;12(4):312-9. https://doi.org/10.1111/ijpo.12144
https://doi.org/10.1111/ijpo.12144...

56. Zucchi ND, Fiates GMR. Analysis of the presence of nutrient claims on labels of ultra-processed foods directed at children and of the perception of kids on such claims. Rev Nutri. 2016;29(6):821-32.

57. Rovirosa A, Zapata ME, Gómez P, Gotthelf S, Ferrante D. Food and beverage advertising on children’s TV channels in Argentina: frequency, duration, and nutritional quality. Arch Argent Pediatr. 2017;115(1):28-34. https://doi.org/10.5546/aap.2017.eng.28
https://doi.org/10.5546/aap.2017.eng.28...

58. Allemandi L, Castronuovo L, Tiscornia MV, Ponce M, Schoj V. Food advertising on Argentinean television: are ultra-processed foods in the lead? Public Health Nutr. 2018;21(1);238-46. https://doi.org/10.1017/S1368980017001446
https://doi.org/10.1017/S136898001700144... -⁵⁹59. Corvalán C, Reyes M, Garmendia ML, Uauy R. Structural responses to the obesity and non-communicable diseases epidemic: update on the Chilean law of food labelling and advertising. Obes Rev. 2019;20(3):367-74. https://doi.org/10.1111/obr.12802
https://doi.org/10.1111/obr.12802... . Ten studies were conducted in Brazil, eight in México, and five in Guatemala. The other studies were from Peru (n = 4), Argentina (n = 3), Chile (n = 3), Honduras (n = 1), El Salvador (n = 1), and Colombia (n = 1). In total, 27 studies were quantitative, six were qualitative and three used mixed method approaches.

Appendix II shows the results of the quality assessment, in which zero studies were judged as being poor quality, 21 had fair quality and 16 had good quality.

The thematic analysis identified the following typologies: a) television advertisement, b) food packaging marketing, c) marketing strategies at points of sale and d) other marketing strategies. Figure 2 shows the main findings of the review based on these typologies.

Twenty-five studies inquired several topics related with television advertisement. Fourteen of them found that food and nonalcoholic beverage advertisements represented between 5.6% and 36.4% of all television ads²⁴24. Olivares S, Yáñez R, Díaz N. Publicidad de alimentos y conductas alimentarias en escolares de 5º a 8º básico. Rev Chil Nutr. 2003;30(1):36-42.,²⁷27. Pérez-Salgado D, Rivera-Márquez JA, Ortiz-Hernández L. Publicidad de alimentos en la programación de la televisión mexicana: ¿los niños están más expuestos? Salud Publica Mex. 2010;52(2):119-26. https://doi.org/10.1590/S0036-36342010000200003
https://doi.org/10.1590/S0036-3634201000...

28. Crovetto-M M, Durán-T M, Guzmán-R M, Miranda-H C. Estudio descriptivo de la frecuencia y duración de la publicidad alimentaria emitida en la programación de canales de televisión asociados a ANATEL. Rev Chil Nutr. 2011;38(3):290-9.-²⁹29. Olivares-C S, Lera-M L, Mardones-H MA, Araneda-F J, Bustos-Z N, Olivares-C MA, et al. Promoción de alimentos y preferencias alimentarias en escolares chilenos de diferente nivel socioeconómico. Arch Latinoam Nutr. 2011;61(2):163-71.,³⁴34. Chacon V, Letona P, Barnoya J. Child-oriented marketing techniques in snack food packages in Guatemala. BMC Public Health. 2013;13:967. https://doi.org/10.1186/1471-2458-13-967
https://doi.org/10.1186/1471-2458-13-967... ,³⁶36. Costa SM, Horta PM, Santos LC. Analysis of television food advertising on children’s programming on “free-to-air” broadcast stations in Brazil. Rev Bras Epidemiol. 2013;16(4):976-83.,³⁷37. Rojas-Huayllani EC, Delgado-Pérez DH. [Influence of Peruvian television advertising in unhealthy food consumption in 4th to 6th grade elementary scholars]. An Fac Med. 2013;74(1):21-26. Spanish,⁴⁰40. Letona P, Chacon V, Roberto C, Barnoya J. A qualitative study of children’s snack food packaging perceptions and preferences. BMC Public Health. 2014;14:1274. https://doi.org/10.1186/1471-2458-14-1274
https://doi.org/10.1186/1471-2458-14-127... ,⁴³43. Amanzadeh B, Sokal-Gutierrez K, Barker JC. An interpretive study of food, snack and beverage advertisements in rural and urban El Salvador. BMC Public Health. 2015;15:521. https://doi.org/10.1186/s12889-015-1836-9
https://doi.org/10.1186/s12889-015-1836-... ,⁴⁹49. Viacava KR, Weydmann GJ, Vasconcelos MF, Jaboinski J, Batista GD, Almeida RM, et al. It is pleasant and heavy: convergence of visual contents in tobacco, alcohol and food marketing in Brazil. Health Promot Int. 2016;31(3):674-83. https://doi.org/10.1093/heapro/dav057
https://doi.org/10.1093/heapro/dav057... ,⁵²52. Castronuovo L, Gutkowski P, Tiscornia V, Allemandi L. Las madres y la publicidad de alimentos dirigida a niños y niñas: percepciones y experiencias. Salud Colectiva. 2016;19;12(4):537-50.,⁵³53. Mazariegos S, Chacón V, Cole A, Barnoya J. Nutritional quality and marketing strategies of fast food children’s combo meals in Guatemala. BMC Obesity. 2016;3:52.,⁵⁶56. Zucchi ND, Fiates GMR. Analysis of the presence of nutrient claims on labels of ultra-processed foods directed at children and of the perception of kids on such claims. Rev Nutri. 2016;29(6):821-32.,⁵⁹59. Corvalán C, Reyes M, Garmendia ML, Uauy R. Structural responses to the obesity and non-communicable diseases epidemic: update on the Chilean law of food labelling and advertising. Obes Rev. 2019;20(3):367-74. https://doi.org/10.1111/obr.12802
https://doi.org/10.1111/obr.12802... .

Seventeen studies found the most frequently advertised food products were ultra-processed foods, whereas almost no advertisements were found for unprocessed foods such as fruits and vegetables²⁴24. Olivares S, Yáñez R, Díaz N. Publicidad de alimentos y conductas alimentarias en escolares de 5º a 8º básico. Rev Chil Nutr. 2003;30(1):36-42.,²⁷27. Pérez-Salgado D, Rivera-Márquez JA, Ortiz-Hernández L. Publicidad de alimentos en la programación de la televisión mexicana: ¿los niños están más expuestos? Salud Publica Mex. 2010;52(2):119-26. https://doi.org/10.1590/S0036-36342010000200003
https://doi.org/10.1590/S0036-3634201000... ,²⁹29. Olivares-C S, Lera-M L, Mardones-H MA, Araneda-F J, Bustos-Z N, Olivares-C MA, et al. Promoción de alimentos y preferencias alimentarias en escolares chilenos de diferente nivel socioeconómico. Arch Latinoam Nutr. 2011;61(2):163-71.,³¹31. Rodrigues VM, Fiates GMR. [Children’s eating habits and consumer behavior: influence of household income and television viewing habits. Rev Nutr. 2012;25(3):353-62. Portuguese. https://doi.org/10.1590/S1415-52732012000300005
https://doi.org/10.1590/S1415-5273201200... ,³⁴34. Chacon V, Letona P, Barnoya J. Child-oriented marketing techniques in snack food packages in Guatemala. BMC Public Health. 2013;13:967. https://doi.org/10.1186/1471-2458-13-967
https://doi.org/10.1186/1471-2458-13-967... ,³⁶36. Costa SM, Horta PM, Santos LC. Analysis of television food advertising on children’s programming on “free-to-air” broadcast stations in Brazil. Rev Bras Epidemiol. 2013;16(4):976-83.

37. Rojas-Huayllani EC, Delgado-Pérez DH. [Influence of Peruvian television advertising in unhealthy food consumption in 4th to 6th grade elementary scholars]. An Fac Med. 2013;74(1):21-26. Spanish-³⁸38. Busse P, Díaz R. What are the television viewing and eating habits of children in Peru? Glob Health Promot. 2016;23(1):50-60. https://doi.org/10.1177/1757975914547923
https://doi.org/10.1177/1757975914547923... ,⁴⁰40. Letona P, Chacon V, Roberto C, Barnoya J. A qualitative study of children’s snack food packaging perceptions and preferences. BMC Public Health. 2014;14:1274. https://doi.org/10.1186/1471-2458-14-1274
https://doi.org/10.1186/1471-2458-14-127... ,⁴³43. Amanzadeh B, Sokal-Gutierrez K, Barker JC. An interpretive study of food, snack and beverage advertisements in rural and urban El Salvador. BMC Public Health. 2015;15:521. https://doi.org/10.1186/s12889-015-1836-9
https://doi.org/10.1186/s12889-015-1836-... ,⁴⁹49. Viacava KR, Weydmann GJ, Vasconcelos MF, Jaboinski J, Batista GD, Almeida RM, et al. It is pleasant and heavy: convergence of visual contents in tobacco, alcohol and food marketing in Brazil. Health Promot Int. 2016;31(3):674-83. https://doi.org/10.1093/heapro/dav057
https://doi.org/10.1093/heapro/dav057... ,⁵²52. Castronuovo L, Gutkowski P, Tiscornia V, Allemandi L. Las madres y la publicidad de alimentos dirigida a niños y niñas: percepciones y experiencias. Salud Colectiva. 2016;19;12(4):537-50.,⁵³53. Mazariegos S, Chacón V, Cole A, Barnoya J. Nutritional quality and marketing strategies of fast food children’s combo meals in Guatemala. BMC Obesity. 2016;3:52.,⁵⁶56. Zucchi ND, Fiates GMR. Analysis of the presence of nutrient claims on labels of ultra-processed foods directed at children and of the perception of kids on such claims. Rev Nutri. 2016;29(6):821-32.,⁵⁷57. Rovirosa A, Zapata ME, Gómez P, Gotthelf S, Ferrante D. Food and beverage advertising on children’s TV channels in Argentina: frequency, duration, and nutritional quality. Arch Argent Pediatr. 2017;115(1):28-34. https://doi.org/10.5546/aap.2017.eng.28
https://doi.org/10.5546/aap.2017.eng.28... ,⁵⁹59. Corvalán C, Reyes M, Garmendia ML, Uauy R. Structural responses to the obesity and non-communicable diseases epidemic: update on the Chilean law of food labelling and advertising. Obes Rev. 2019;20(3):367-74. https://doi.org/10.1111/obr.12802
https://doi.org/10.1111/obr.12802... ,⁶⁰60. Ministerio da Saúde (BR), Secretaría de Atenção à Saúde, Departamento de Atenção Básica. Guia alimentar para a população brasileira: relatório final da consulta pública. Brasília, DF; 2015 [cited 2018 April 17]. Available from:

Several studies also found that more food advertisements appear during children’s programming compared with general audience programming and that child-oriented advertisements had less nutritional quality compared with general audience advertisements²⁴24. Olivares S, Yáñez R, Díaz N. Publicidad de alimentos y conductas alimentarias en escolares de 5º a 8º básico. Rev Chil Nutr. 2003;30(1):36-42.,²⁸28. Crovetto-M M, Durán-T M, Guzmán-R M, Miranda-H C. Estudio descriptivo de la frecuencia y duración de la publicidad alimentaria emitida en la programación de canales de televisión asociados a ANATEL. Rev Chil Nutr. 2011;38(3):290-9.,⁴⁰40. Letona P, Chacon V, Roberto C, Barnoya J. A qualitative study of children’s snack food packaging perceptions and preferences. BMC Public Health. 2014;14:1274. https://doi.org/10.1186/1471-2458-14-1274
https://doi.org/10.1186/1471-2458-14-127... ,⁴³43. Amanzadeh B, Sokal-Gutierrez K, Barker JC. An interpretive study of food, snack and beverage advertisements in rural and urban El Salvador. BMC Public Health. 2015;15:521. https://doi.org/10.1186/s12889-015-1836-9
https://doi.org/10.1186/s12889-015-1836-... ,⁵²52. Castronuovo L, Gutkowski P, Tiscornia V, Allemandi L. Las madres y la publicidad de alimentos dirigida a niños y niñas: percepciones y experiencias. Salud Colectiva. 2016;19;12(4):537-50.,⁵⁶56. Zucchi ND, Fiates GMR. Analysis of the presence of nutrient claims on labels of ultra-processed foods directed at children and of the perception of kids on such claims. Rev Nutri. 2016;29(6):821-32.,⁵⁷57. Rovirosa A, Zapata ME, Gómez P, Gotthelf S, Ferrante D. Food and beverage advertising on children’s TV channels in Argentina: frequency, duration, and nutritional quality. Arch Argent Pediatr. 2017;115(1):28-34. https://doi.org/10.5546/aap.2017.eng.28
https://doi.org/10.5546/aap.2017.eng.28... .

Ten studies found most children enjoyed television food advertisements and are enticed by these ads to try new foods²⁵25. Fiates GMR, Amboni RDMC, Teixeira E. Television use and food choices of children: qualitative approach. Appetite. 2008;50(1):12-8.,²⁶26. Ramírez-Ley K, De Lira-García C, Souto-Gallardo ML, Tejeda-López MF, Castañeda-González LM, Bacardí-Gascón M, et al. Food-related advertising geared toward Mexican children. J Public Health (Oxf). 2009;31(3):383-8. https://doi.org/10.1093/pubmed/fdp058
https://doi.org/10.1093/pubmed/fdp058... ,³⁰30. Santos CC, Stuchi RAG, Arreguy-Sena C, Pinto NAVD. [Television’s influence on eating habits, practices and behavior]. Cogitare Enferm. 2012;17(1):65-71. Portuguese. h,³²32. Costa SMM, Horta PM, Santos LC. Food advertising and television exposure: influence on eating behavior and nutritional status of children and adolescents. Arch Latinoam Nutr. 2012;62(1):53-9.

33. Bacardí-Gascón M, Díaz-Ramírez G, Cruz López B, López Zuñiga E, Jiménez-Cruz A. TV food advertisements’ effect on food consumption and adiposity among women and children in México. Nutr Hosp. 2013;28(6):1900-4. https://doi.org;10.3305/nutr hosp.v28in06.6966
https://doi.org;10.3305/nutr hosp.v28in0... -³⁴34. Chacon V, Letona P, Barnoya J. Child-oriented marketing techniques in snack food packages in Guatemala. BMC Public Health. 2013;13:967. https://doi.org/10.1186/1471-2458-13-967
https://doi.org/10.1186/1471-2458-13-967... ,³⁸38. Busse P, Díaz R. What are the television viewing and eating habits of children in Peru? Glob Health Promot. 2016;23(1):50-60. https://doi.org/10.1177/1757975914547923
https://doi.org/10.1177/1757975914547923... ,³⁹39. Gunderson MD, Clements D, Benjamin Neelon SE. Nutritional quality of foods marketed to children in Honduras. Appetite. 2014;73:1-6. https://doi.org/10.1016/j.appet.2013.10.009
https://doi.org/10.1016/j.appet.2013.10.... ,⁴²42. Mejía-Díaz D, Carmona Garcés IC, Giraldo-López P, González-Zapata L. Contenido nutricional de alimentos y bebidas publicitados en la franja infantil de la televisión colombiana. Nutr Hosp. 2014;29(4):858-64.,⁵⁴54. Patiño SRG, Tolentino-Mayo L, Flores Monterrubio EA, Harris JL, Vandevijvere S, Rivera JA, et al. Nutritional quality of foods and non-alcoholic beverages advertised on Mexican television according to three nutrient profile models. BMC Public Health. 2016;16:733. https://doi.org/10.1186/s12889-016-3298-0
https://doi.org/10.1186/s12889-016-3298-... .

A Mexican study assessed the self-regulation agreement implemented by the industry in that country in 2012. The authors found that 93% of the advertisements, from companies that had signed the self-regulation agreements, promoted unhealthy food and beverages⁵⁷57. Rovirosa A, Zapata ME, Gómez P, Gotthelf S, Ferrante D. Food and beverage advertising on children’s TV channels in Argentina: frequency, duration, and nutritional quality. Arch Argent Pediatr. 2017;115(1):28-34. https://doi.org/10.5546/aap.2017.eng.28
https://doi.org/10.5546/aap.2017.eng.28... .

Three studies found the most common marketing technique used on food packages was licensed characters — especially in child-oriented products — followed by the presence of health claims³⁵35. Díaz-Ramírez G, Jiménez-Cruz A, Souto-Gallardo MC, Bacardí-Gascón M. Effect of the exposure to TV food advertisements on the consumption of foods by mothers and children. J Pediatr Gastroenterol Nutr. 2013;56(1):86-8. https://doi.org/10.1097/MPG.0b013e3182638d13
https://doi.org/10.1097/MPG.0b013e318263... ,⁵⁰50. Britto SR, Viebig RF, Morimoto JM. Analysis of food advertisements on cable television directed to children based on the food guide for the Brazilian population and current legislation. Rev Nutr. 2016;29(5):721-9.,⁵⁸58. Allemandi L, Castronuovo L, Tiscornia MV, Ponce M, Schoj V. Food advertising on Argentinean television: are ultra-processed foods in the lead? Public Health Nutr. 2018;21(1);238-46. https://doi.org/10.1017/S1368980017001446
https://doi.org/10.1017/S136898001700144... .

A Guatemalan study found children had a literal interpretation of food packaging, which leads to a misunderstanding about the nutritional value and the ingredients of products; children believe, for example, that the food drawn on the packaging represents the ingredient of the product inside.⁴¹41. Mazzonetto AC, Fiates GMR. Perceptions and choices of Brazilian children as consumers of food products. Appetite. 2014;78:179-84. https://doi.org/10.1016/j.appet.2014.03.028
https://doi.org/10.1016/j.appet.2014.03.... Another study, which assessed snack foods available in stores near schools, found that almost all child-oriented products were considered unhealthy according to the UK Food Agency standards.³⁵35. Díaz-Ramírez G, Jiménez-Cruz A, Souto-Gallardo MC, Bacardí-Gascón M. Effect of the exposure to TV food advertisements on the consumption of foods by mothers and children. J Pediatr Gastroenterol Nutr. 2013;56(1):86-8. https://doi.org/10.1097/MPG.0b013e3182638d13
https://doi.org/10.1097/MPG.0b013e318263... A third study, which gathered breakfast cereals available in supermarkets in Guatemala City, observed cereals marketed to children had higher sugar content compared with cereals marketed to other age groups.⁵⁰50. Britto SR, Viebig RF, Morimoto JM. Analysis of food advertisements on cable television directed to children based on the food guide for the Brazilian population and current legislation. Rev Nutr. 2016;29(5):721-9.

Another study conducted in Guatemala analyzed the point of sale marketing strategies in stores located around schools to determine the relation between food advertising and proximity to schools. This study found many child-oriented products with a proportional relation between them and the distance to the school. The most common products found were sweetened beverages and soft drinks⁴⁸48. Soo J, Letona P, Chacon V, Barnoya J, Roberto CA. Nutritional quality and child-oriented marketing of breakfast cereals in Guatemala. Int J Obes (Lond). 2016;40(1):39-44. https://doi.org/10.1038/ijo.2015.161
https://doi.org/10.1038/ijo.2015.161... .

Also in Guatemala, a study exploring point of sale marketing in fast food restaurants observed that only five children’s combo meals out of 19 had nutrition information, and all of them were classified as “less healthy” according to the UK Nutrient Profiling Model. On average, combo meals were less expensive than children’s meal items individually. All restaurants offered a soft drink as the first drink option and all combo meals included a toy giveaway⁵⁵55. Théodore FL, Tolentino-Mayo L, Hernández-Zenil E, Bahena L, Velasco A, Popkin B, et al. Pitfalls of the self-regulation of advertisements directed at children on Mexican television. Pediatr Obes. 2017;12(4):312-9. https://doi.org/10.1111/ijpo.12144
https://doi.org/10.1111/ijpo.12144... .

Advertisements on billboards and posters promote products by appealing to people’s desire for modern and cost-effective foods vs traditional foods⁴⁵45. Cárdenas MK, Benziger CP, Pillay TD, Miranda JJ. The effect of changes in visibility and price on fruit purchasing at a university cafeteria in Lima, Peru. Public Health Nutr. 2015;18(15):2742-9. https://doi.org/10.1017/S1368980014002730
https://doi.org/10.1017/S136898001400273... .

Access to unhealthy snacks in stores near students’ houses affects their perceptions of consumption of processed foods. Students who were asked to record the food they had access to, observing that, if unhealthy foods were available, they felt tempted to consume them⁴⁶46. Chacon V, Letona P, Villamor E, Barnoya J. Snack food advertising in stores around public schools in Guatemala. Crit Public Health. 2015;25(3):291-8. https://doi.org/10.1080/09581596.2014.953035
https://doi.org/10.1080/09581596.2014.95... .

DISCUSSION

This scoping review synthesizes the evidence about the marketing of foods and beverages in Latin American countries in the last 15 years and provides insights about the challenges this issue represents to global and public health. This study also shows the different ways in which marketing companies interact with children when promoting ultra-processed foods and beverages in this region. Finally, it allows the identification of knowledge gaps that can guide the future research agenda in this area.

The main findings of this review can be described as follows: a) most foods and beverages advertised in television are ultra-processed foods and have low nutritional value²⁴24. Olivares S, Yáñez R, Díaz N. Publicidad de alimentos y conductas alimentarias en escolares de 5º a 8º básico. Rev Chil Nutr. 2003;30(1):36-42.,²⁷27. Pérez-Salgado D, Rivera-Márquez JA, Ortiz-Hernández L. Publicidad de alimentos en la programación de la televisión mexicana: ¿los niños están más expuestos? Salud Publica Mex. 2010;52(2):119-26. https://doi.org/10.1590/S0036-36342010000200003
https://doi.org/10.1590/S0036-3634201000... ,²⁹29. Olivares-C S, Lera-M L, Mardones-H MA, Araneda-F J, Bustos-Z N, Olivares-C MA, et al. Promoción de alimentos y preferencias alimentarias en escolares chilenos de diferente nivel socioeconómico. Arch Latinoam Nutr. 2011;61(2):163-71.,³¹31. Rodrigues VM, Fiates GMR. [Children’s eating habits and consumer behavior: influence of household income and television viewing habits. Rev Nutr. 2012;25(3):353-62. Portuguese. https://doi.org/10.1590/S1415-52732012000300005
https://doi.org/10.1590/S1415-5273201200... ,³⁴34. Chacon V, Letona P, Barnoya J. Child-oriented marketing techniques in snack food packages in Guatemala. BMC Public Health. 2013;13:967. https://doi.org/10.1186/1471-2458-13-967
https://doi.org/10.1186/1471-2458-13-967... ,³⁶36. Costa SM, Horta PM, Santos LC. Analysis of television food advertising on children’s programming on “free-to-air” broadcast stations in Brazil. Rev Bras Epidemiol. 2013;16(4):976-83.

37. Rojas-Huayllani EC, Delgado-Pérez DH. [Influence of Peruvian television advertising in unhealthy food consumption in 4th to 6th grade elementary scholars]. An Fac Med. 2013;74(1):21-26. Spanish-³⁸38. Busse P, Díaz R. What are the television viewing and eating habits of children in Peru? Glob Health Promot. 2016;23(1):50-60. https://doi.org/10.1177/1757975914547923
https://doi.org/10.1177/1757975914547923... ,⁴⁰40. Letona P, Chacon V, Roberto C, Barnoya J. A qualitative study of children’s snack food packaging perceptions and preferences. BMC Public Health. 2014;14:1274. https://doi.org/10.1186/1471-2458-14-1274
https://doi.org/10.1186/1471-2458-14-127... ,⁴³43. Amanzadeh B, Sokal-Gutierrez K, Barker JC. An interpretive study of food, snack and beverage advertisements in rural and urban El Salvador. BMC Public Health. 2015;15:521. https://doi.org/10.1186/s12889-015-1836-9
https://doi.org/10.1186/s12889-015-1836-... ,⁴⁹49. Viacava KR, Weydmann GJ, Vasconcelos MF, Jaboinski J, Batista GD, Almeida RM, et al. It is pleasant and heavy: convergence of visual contents in tobacco, alcohol and food marketing in Brazil. Health Promot Int. 2016;31(3):674-83. https://doi.org/10.1093/heapro/dav057
https://doi.org/10.1093/heapro/dav057... ,⁵²52. Castronuovo L, Gutkowski P, Tiscornia V, Allemandi L. Las madres y la publicidad de alimentos dirigida a niños y niñas: percepciones y experiencias. Salud Colectiva. 2016;19;12(4):537-50.,⁵³53. Mazariegos S, Chacón V, Cole A, Barnoya J. Nutritional quality and marketing strategies of fast food children’s combo meals in Guatemala. BMC Obesity. 2016;3:52.,⁵⁶56. Zucchi ND, Fiates GMR. Analysis of the presence of nutrient claims on labels of ultra-processed foods directed at children and of the perception of kids on such claims. Rev Nutri. 2016;29(6):821-32.,⁵⁷57. Rovirosa A, Zapata ME, Gómez P, Gotthelf S, Ferrante D. Food and beverage advertising on children’s TV channels in Argentina: frequency, duration, and nutritional quality. Arch Argent Pediatr. 2017;115(1):28-34. https://doi.org/10.5546/aap.2017.eng.28
https://doi.org/10.5546/aap.2017.eng.28... ,⁵⁹59. Corvalán C, Reyes M, Garmendia ML, Uauy R. Structural responses to the obesity and non-communicable diseases epidemic: update on the Chilean law of food labelling and advertising. Obes Rev. 2019;20(3):367-74. https://doi.org/10.1111/obr.12802
https://doi.org/10.1111/obr.12802... ; b) children’s television programming contains several food advertisements and many studies found advertisements for this demographic group had a lower nutritional value compared with general audience programming²⁴24. Olivares S, Yáñez R, Díaz N. Publicidad de alimentos y conductas alimentarias en escolares de 5º a 8º básico. Rev Chil Nutr. 2003;30(1):36-42.,²⁸28. Crovetto-M M, Durán-T M, Guzmán-R M, Miranda-H C. Estudio descriptivo de la frecuencia y duración de la publicidad alimentaria emitida en la programación de canales de televisión asociados a ANATEL. Rev Chil Nutr. 2011;38(3):290-9.,⁴⁰40. Letona P, Chacon V, Roberto C, Barnoya J. A qualitative study of children’s snack food packaging perceptions and preferences. BMC Public Health. 2014;14:1274. https://doi.org/10.1186/1471-2458-14-1274
https://doi.org/10.1186/1471-2458-14-127... ,⁴³43. Amanzadeh B, Sokal-Gutierrez K, Barker JC. An interpretive study of food, snack and beverage advertisements in rural and urban El Salvador. BMC Public Health. 2015;15:521. https://doi.org/10.1186/s12889-015-1836-9
https://doi.org/10.1186/s12889-015-1836-... ,⁵²52. Castronuovo L, Gutkowski P, Tiscornia V, Allemandi L. Las madres y la publicidad de alimentos dirigida a niños y niñas: percepciones y experiencias. Salud Colectiva. 2016;19;12(4):537-50.,⁵⁶56. Zucchi ND, Fiates GMR. Analysis of the presence of nutrient claims on labels of ultra-processed foods directed at children and of the perception of kids on such claims. Rev Nutri. 2016;29(6):821-32.,⁵⁷57. Rovirosa A, Zapata ME, Gómez P, Gotthelf S, Ferrante D. Food and beverage advertising on children’s TV channels in Argentina: frequency, duration, and nutritional quality. Arch Argent Pediatr. 2017;115(1):28-34. https://doi.org/10.5546/aap.2017.eng.28
https://doi.org/10.5546/aap.2017.eng.28... ; c) food packages can be deceiving especially to children who have a literal interpretation of what is printed on the packaging³⁵35. Díaz-Ramírez G, Jiménez-Cruz A, Souto-Gallardo MC, Bacardí-Gascón M. Effect of the exposure to TV food advertisements on the consumption of foods by mothers and children. J Pediatr Gastroenterol Nutr. 2013;56(1):86-8. https://doi.org/10.1097/MPG.0b013e3182638d13
https://doi.org/10.1097/MPG.0b013e318263... ,⁵⁰50. Britto SR, Viebig RF, Morimoto JM. Analysis of food advertisements on cable television directed to children based on the food guide for the Brazilian population and current legislation. Rev Nutr. 2016;29(5):721-9.,⁵⁸58. Allemandi L, Castronuovo L, Tiscornia MV, Ponce M, Schoj V. Food advertising on Argentinean television: are ultra-processed foods in the lead? Public Health Nutr. 2018;21(1);238-46. https://doi.org/10.1017/S1368980017001446
https://doi.org/10.1017/S136898001700144... ; d) proximity to unhealthy foods may increase the consumption of these foods²⁵25. Fiates GMR, Amboni RDMC, Teixeira E. Television use and food choices of children: qualitative approach. Appetite. 2008;50(1):12-8.,²⁶26. Ramírez-Ley K, De Lira-García C, Souto-Gallardo ML, Tejeda-López MF, Castañeda-González LM, Bacardí-Gascón M, et al. Food-related advertising geared toward Mexican children. J Public Health (Oxf). 2009;31(3):383-8. https://doi.org/10.1093/pubmed/fdp058
https://doi.org/10.1093/pubmed/fdp058... ,³⁰30. Santos CC, Stuchi RAG, Arreguy-Sena C, Pinto NAVD. [Television’s influence on eating habits, practices and behavior]. Cogitare Enferm. 2012;17(1):65-71. Portuguese. h,³²32. Costa SMM, Horta PM, Santos LC. Food advertising and television exposure: influence on eating behavior and nutritional status of children and adolescents. Arch Latinoam Nutr. 2012;62(1):53-9.,³⁴34. Chacon V, Letona P, Barnoya J. Child-oriented marketing techniques in snack food packages in Guatemala. BMC Public Health. 2013;13:967. https://doi.org/10.1186/1471-2458-13-967
https://doi.org/10.1186/1471-2458-13-967... ,³⁸38. Busse P, Díaz R. What are the television viewing and eating habits of children in Peru? Glob Health Promot. 2016;23(1):50-60. https://doi.org/10.1177/1757975914547923
https://doi.org/10.1177/1757975914547923... ,⁴²42. Mejía-Díaz D, Carmona Garcés IC, Giraldo-López P, González-Zapata L. Contenido nutricional de alimentos y bebidas publicitados en la franja infantil de la televisión colombiana. Nutr Hosp. 2014;29(4):858-64.,⁴⁴44. Bridle-Fitzpatrick S. Food deserts or food swamps? A mixed-methods study of local food environments in a Mexican city. Soc Sci Med. 2015;142:202-13. https://doi.org/10.1016/j.socscimed.2015.08.010
https://doi.org/10.1016/j.socscimed.2015... ,⁴⁶46. Chacon V, Letona P, Villamor E, Barnoya J. Snack food advertising in stores around public schools in Guatemala. Crit Public Health. 2015;25(3):291-8. https://doi.org/10.1080/09581596.2014.953035
https://doi.org/10.1080/09581596.2014.95... ,⁵⁴54. Patiño SRG, Tolentino-Mayo L, Flores Monterrubio EA, Harris JL, Vandevijvere S, Rivera JA, et al. Nutritional quality of foods and non-alcoholic beverages advertised on Mexican television according to three nutrient profile models. BMC Public Health. 2016;16:733. https://doi.org/10.1186/s12889-016-3298-0
https://doi.org/10.1186/s12889-016-3298-... . These findings enhance the necessity of implementing statutory policies covering all marketing channels and robust nutritional standards as the case of the Chilean regulations approved in 2012⁶⁰60. Ministerio da Saúde (BR), Secretaría de Atenção à Saúde, Departamento de Atenção Básica. Guia alimentar para a população brasileira: relatório final da consulta pública. Brasília, DF; 2015 [cited 2018 April 17]. Available from:. Similarly, the Brazilian food dietary guidelines and the Uruguayan food guidelines emphasized on encouraging and increasing consumption of natural and minimally processed foods while making recommendations for marketing⁶¹61. Ministerio de Salud (URY). Guía alimentaria para la población uruguaya: para una alimentación saludable, compartida y placentera. Montevideo; 2016.,⁶²62. Cairns G, Angus K, Hastings G. The extent, nature and effects of food promotion to children: a review of the evidence to December 2008. Geneva: WHO; 2009?.

Television is one of the main channels used to advertise food products⁶³63. Powell LM, Szczypka G, Chaloupka FJ. Exposure to food advertising on television among US children. Arch Pediatr Adolesc Med. 2007;161(6):553-60. https://doi.org/10.1001/archpedi.161.6.553
https://doi.org/10.1001/archpedi.161.6.5... and more than half of the 37 studies included in this review focused on television advertising. The frequency of food advertisements was between 5.6% and 36.4% with a median of 21.35%²⁴24. Olivares S, Yáñez R, Díaz N. Publicidad de alimentos y conductas alimentarias en escolares de 5º a 8º básico. Rev Chil Nutr. 2003;30(1):36-42.,²⁷27. Pérez-Salgado D, Rivera-Márquez JA, Ortiz-Hernández L. Publicidad de alimentos en la programación de la televisión mexicana: ¿los niños están más expuestos? Salud Publica Mex. 2010;52(2):119-26. https://doi.org/10.1590/S0036-36342010000200003
https://doi.org/10.1590/S0036-3634201000...

28. Crovetto-M M, Durán-T M, Guzmán-R M, Miranda-H C. Estudio descriptivo de la frecuencia y duración de la publicidad alimentaria emitida en la programación de canales de televisión asociados a ANATEL. Rev Chil Nutr. 2011;38(3):290-9.-²⁹29. Olivares-C S, Lera-M L, Mardones-H MA, Araneda-F J, Bustos-Z N, Olivares-C MA, et al. Promoción de alimentos y preferencias alimentarias en escolares chilenos de diferente nivel socioeconómico. Arch Latinoam Nutr. 2011;61(2):163-71.,³⁴34. Chacon V, Letona P, Barnoya J. Child-oriented marketing techniques in snack food packages in Guatemala. BMC Public Health. 2013;13:967. https://doi.org/10.1186/1471-2458-13-967
https://doi.org/10.1186/1471-2458-13-967... ,³⁶36. Costa SM, Horta PM, Santos LC. Analysis of television food advertising on children’s programming on “free-to-air” broadcast stations in Brazil. Rev Bras Epidemiol. 2013;16(4):976-83.,³⁷37. Rojas-Huayllani EC, Delgado-Pérez DH. [Influence of Peruvian television advertising in unhealthy food consumption in 4th to 6th grade elementary scholars]. An Fac Med. 2013;74(1):21-26. Spanish,⁴⁰40. Letona P, Chacon V, Roberto C, Barnoya J. A qualitative study of children’s snack food packaging perceptions and preferences. BMC Public Health. 2014;14:1274. https://doi.org/10.1186/1471-2458-14-1274
https://doi.org/10.1186/1471-2458-14-127... ,⁴³43. Amanzadeh B, Sokal-Gutierrez K, Barker JC. An interpretive study of food, snack and beverage advertisements in rural and urban El Salvador. BMC Public Health. 2015;15:521. https://doi.org/10.1186/s12889-015-1836-9
https://doi.org/10.1186/s12889-015-1836-... ,⁴⁹49. Viacava KR, Weydmann GJ, Vasconcelos MF, Jaboinski J, Batista GD, Almeida RM, et al. It is pleasant and heavy: convergence of visual contents in tobacco, alcohol and food marketing in Brazil. Health Promot Int. 2016;31(3):674-83. https://doi.org/10.1093/heapro/dav057
https://doi.org/10.1093/heapro/dav057... ,⁵²52. Castronuovo L, Gutkowski P, Tiscornia V, Allemandi L. Las madres y la publicidad de alimentos dirigida a niños y niñas: percepciones y experiencias. Salud Colectiva. 2016;19;12(4):537-50.,⁵³53. Mazariegos S, Chacón V, Cole A, Barnoya J. Nutritional quality and marketing strategies of fast food children’s combo meals in Guatemala. BMC Obesity. 2016;3:52.,⁵⁶56. Zucchi ND, Fiates GMR. Analysis of the presence of nutrient claims on labels of ultra-processed foods directed at children and of the perception of kids on such claims. Rev Nutri. 2016;29(6):821-32.. These results agree with those found by other studies worldwide. In the United States, a study by Powell et al⁶⁴64. Powell LM, Szczypka G, Chaloupka FJ. Trends in exposure to television food advertisements among children and adolescents in the United States. Arch Pediatr Adolesc Med. 2010;164(9):794-802. https://doi.org/10.1001/archpediatrics.2010.139
https://doi.org/10.1001/archpediatrics.2... found 36.4% of television advertising corresponded to food promotions, a study also by Powell⁶⁵65. Whalen R, Harrold J, Child S, Halford J, Boyland E. Children’s exposure to food advertising: the impact of statutory restrictions. Health Promot Int. 2019;34 (2):227-35. https://doi.org/10.1093/heapro/dax044
https://doi.org/10.1093/heapro/dax044... comparing television food advertisements seen by children in 2003 and 2007 saw a slight reduction from 13.1%-13.6% of ads watched by children in 2003 to 11.5%-13.6% in 2007. In the United Kingdom, Whalen et al.⁶⁶66. Li D, Wang T, Cheng Y, Zhang M, Yang X, Zhu Z, et al. The extent and nature of television food advertising to children in Xi’an, China. BMC Public Health. 2016;16(1):770. https://doi.org/10.1186/s12889-016-3468-0
https://doi.org/10.1186/s12889-016-3468-... studied food promotions aired on television after statutory restrictions; food and drink ads were the third most advertised product with a frequency of 11.9%. In China, a recent study by Danyong et al.⁶⁷67. Boyland EJ, Harrold JA, Kirkham TC, Halford JCG. The extent of food advertising to children on UK television in 2008. Int J Pediatr Obes. 2011;6(5-6):455-61. https://doi.org/10.3109/17477166.2011.608801
https://doi.org/10.3109/17477166.2011.60... reports that food advertisements constitute 25.5% of television ads and in a comparative study conducted in 2010 by research groups in Australia, Asia, Europe, North America and South America, food items represented 18% of all television advertisements and represented the second most advertised product¹⁷17. Peters MDJ, Godfrey CM, McInerney P, Soares CB, Khalil H, Parker D. TheJoanna Briggs Institute reviewers’ manual 2015: methodology for JBI Sscoping reviews. Adelaide (AUS): The Joanna Briggs Institute; 2015..

The most frequently advertised foods on television were ultra-processed foods and sweetened beverages, with few advertisements for healthier options such as fruits and vegetables²⁴24. Olivares S, Yáñez R, Díaz N. Publicidad de alimentos y conductas alimentarias en escolares de 5º a 8º básico. Rev Chil Nutr. 2003;30(1):36-42.,²⁷27. Pérez-Salgado D, Rivera-Márquez JA, Ortiz-Hernández L. Publicidad de alimentos en la programación de la televisión mexicana: ¿los niños están más expuestos? Salud Publica Mex. 2010;52(2):119-26. https://doi.org/10.1590/S0036-36342010000200003
https://doi.org/10.1590/S0036-3634201000... ,²⁹29. Olivares-C S, Lera-M L, Mardones-H MA, Araneda-F J, Bustos-Z N, Olivares-C MA, et al. Promoción de alimentos y preferencias alimentarias en escolares chilenos de diferente nivel socioeconómico. Arch Latinoam Nutr. 2011;61(2):163-71.,³¹31. Rodrigues VM, Fiates GMR. [Children’s eating habits and consumer behavior: influence of household income and television viewing habits. Rev Nutr. 2012;25(3):353-62. Portuguese. https://doi.org/10.1590/S1415-52732012000300005
https://doi.org/10.1590/S1415-5273201200... ,³⁴34. Chacon V, Letona P, Barnoya J. Child-oriented marketing techniques in snack food packages in Guatemala. BMC Public Health. 2013;13:967. https://doi.org/10.1186/1471-2458-13-967
https://doi.org/10.1186/1471-2458-13-967... ,³⁶36. Costa SM, Horta PM, Santos LC. Analysis of television food advertising on children’s programming on “free-to-air” broadcast stations in Brazil. Rev Bras Epidemiol. 2013;16(4):976-83.

37. Rojas-Huayllani EC, Delgado-Pérez DH. [Influence of Peruvian television advertising in unhealthy food consumption in 4th to 6th grade elementary scholars]. An Fac Med. 2013;74(1):21-26. Spanish-³⁸38. Busse P, Díaz R. What are the television viewing and eating habits of children in Peru? Glob Health Promot. 2016;23(1):50-60. https://doi.org/10.1177/1757975914547923
https://doi.org/10.1177/1757975914547923... ,⁴⁰40. Letona P, Chacon V, Roberto C, Barnoya J. A qualitative study of children’s snack food packaging perceptions and preferences. BMC Public Health. 2014;14:1274. https://doi.org/10.1186/1471-2458-14-1274
https://doi.org/10.1186/1471-2458-14-127... ,⁴³43. Amanzadeh B, Sokal-Gutierrez K, Barker JC. An interpretive study of food, snack and beverage advertisements in rural and urban El Salvador. BMC Public Health. 2015;15:521. https://doi.org/10.1186/s12889-015-1836-9
https://doi.org/10.1186/s12889-015-1836-... ,⁴⁹49. Viacava KR, Weydmann GJ, Vasconcelos MF, Jaboinski J, Batista GD, Almeida RM, et al. It is pleasant and heavy: convergence of visual contents in tobacco, alcohol and food marketing in Brazil. Health Promot Int. 2016;31(3):674-83. https://doi.org/10.1093/heapro/dav057
https://doi.org/10.1093/heapro/dav057... ,⁵²52. Castronuovo L, Gutkowski P, Tiscornia V, Allemandi L. Las madres y la publicidad de alimentos dirigida a niños y niñas: percepciones y experiencias. Salud Colectiva. 2016;19;12(4):537-50.,⁵³53. Mazariegos S, Chacón V, Cole A, Barnoya J. Nutritional quality and marketing strategies of fast food children’s combo meals in Guatemala. BMC Obesity. 2016;3:52.,⁵⁶56. Zucchi ND, Fiates GMR. Analysis of the presence of nutrient claims on labels of ultra-processed foods directed at children and of the perception of kids on such claims. Rev Nutri. 2016;29(6):821-32.,⁵⁷57. Rovirosa A, Zapata ME, Gómez P, Gotthelf S, Ferrante D. Food and beverage advertising on children’s TV channels in Argentina: frequency, duration, and nutritional quality. Arch Argent Pediatr. 2017;115(1):28-34. https://doi.org/10.5546/aap.2017.eng.28
https://doi.org/10.5546/aap.2017.eng.28... ,⁵⁹59. Corvalán C, Reyes M, Garmendia ML, Uauy R. Structural responses to the obesity and non-communicable diseases epidemic: update on the Chilean law of food labelling and advertising. Obes Rev. 2019;20(3):367-74. https://doi.org/10.1111/obr.12802
https://doi.org/10.1111/obr.12802... . Researchers in developed countries have been repeatedly making this observation ⁶⁵65. Whalen R, Harrold J, Child S, Halford J, Boyland E. Children’s exposure to food advertising: the impact of statutory restrictions. Health Promot Int. 2019;34 (2):227-35. https://doi.org/10.1093/heapro/dax044
https://doi.org/10.1093/heapro/dax044... ,⁶⁸68. Powell LM, Szczypka G, Chaloupka FJ, Braunschweig CL. Nutritional content of television food advertisements seen by children and adolescents in the United States. Pediatrics. 2007;120(3):576-83. https://doi.org/10.1542/peds.2006-3595
https://doi.org/10.1542/peds.2006-3595... . For example, in 2007, Powel et al.⁶⁹69. Mink M, Evans A, Moore CG, Calderon KS, Deger S. Nutritional imbalance endorsed by televised food advertisements. J Am Diet Assoc. 2010;110(6):904-10. https://doi.org/10.1016/j.jada.2010.03.020
https://doi.org/10.1016/j.jada.2010.03.0... found almost all food products advertised to children and adolescents in US television were high in fat, sugar or sodium. Another study also conducted in the US observed foods advertised on television contained in general too much sugar, fat and protein and too few servings of dairy, fruits and vegetables⁷⁰70. Sadeghirad B, Duhaney T, Motaghipisheh S, Campbell NR, Johnston BC. Influence of unhealthy food and beverage marketing on children’s dietary intake and preference: a systematic review and meta-analysis of randomized trials. Obes Rev. 2016;17(10):945-59. https://doi.org/10.1111/obr.12445
https://doi.org/10.1111/obr.12445... .

Several of the studies included in this review also observed that children were heavily targeted by marketing and that foods marketed to them had a lower nutritional value compared with food advertised to adults²⁴24. Olivares S, Yáñez R, Díaz N. Publicidad de alimentos y conductas alimentarias en escolares de 5º a 8º básico. Rev Chil Nutr. 2003;30(1):36-42.,²⁸28. Crovetto-M M, Durán-T M, Guzmán-R M, Miranda-H C. Estudio descriptivo de la frecuencia y duración de la publicidad alimentaria emitida en la programación de canales de televisión asociados a ANATEL. Rev Chil Nutr. 2011;38(3):290-9.,⁴⁰40. Letona P, Chacon V, Roberto C, Barnoya J. A qualitative study of children’s snack food packaging perceptions and preferences. BMC Public Health. 2014;14:1274. https://doi.org/10.1186/1471-2458-14-1274
https://doi.org/10.1186/1471-2458-14-127... ,⁴³43. Amanzadeh B, Sokal-Gutierrez K, Barker JC. An interpretive study of food, snack and beverage advertisements in rural and urban El Salvador. BMC Public Health. 2015;15:521. https://doi.org/10.1186/s12889-015-1836-9
https://doi.org/10.1186/s12889-015-1836-... ,⁵²52. Castronuovo L, Gutkowski P, Tiscornia V, Allemandi L. Las madres y la publicidad de alimentos dirigida a niños y niñas: percepciones y experiencias. Salud Colectiva. 2016;19;12(4):537-50.,⁵⁶56. Zucchi ND, Fiates GMR. Analysis of the presence of nutrient claims on labels of ultra-processed foods directed at children and of the perception of kids on such claims. Rev Nutri. 2016;29(6):821-32.,⁵⁷57. Rovirosa A, Zapata ME, Gómez P, Gotthelf S, Ferrante D. Food and beverage advertising on children’s TV channels in Argentina: frequency, duration, and nutritional quality. Arch Argent Pediatr. 2017;115(1):28-34. https://doi.org/10.5546/aap.2017.eng.28
https://doi.org/10.5546/aap.2017.eng.28... . In 2008, WHO published a review of the evidence regarding food marketing to children, including 14 studies that compared television advertising to both populations, which found a larger proportion of food advertisements for children vs. adults⁶³63. Powell LM, Szczypka G, Chaloupka FJ. Exposure to food advertising on television among US children. Arch Pediatr Adolesc Med. 2007;161(6):553-60. https://doi.org/10.1001/archpedi.161.6.553
https://doi.org/10.1001/archpedi.161.6.5... .

This is especially troubling since children’s exposure to marketing of unhealthy foods has been connected to an increased energy intake and childhood obesity⁷¹71. Andreyeva T, Kelly IR, Harris JL. Exposure to food advertising on television: associations with children’s fast food and soft drink consumption and obesity. Econ Hum Biol. 2011;9(3):221-33. https://doi.org/10.1016/j.ehb.2011.02.004
https://doi.org/10.1016/j.ehb.2011.02.00... ,⁷²72. Corvalán C, Garmendia ML, Jones-Smith J, Lutter CK, Miranda JJ, Pedraza LS, et al. Nutrition status of children in Latin America. Obes Rev. 2017;18 Suppl 2:7-18. https://doi.org/10.1111/obr.12571
https://doi.org/10.1111/obr.12571... . Latin America is experiencing a rapid increase in obesity and other associated non-communicable diseases in children and young adults⁷³73. Rivera JA, Cossio TG, Pedraza LS, Aburto TC, Sánchez TG, Martorell R. Childhood and adolescent overweight and obesity in Latin America: a systematic review. Lancet Diabetes Endocrinol. 2014;2(4):321-32., and in 2014 a systematic review by Rivera et al. found that from 20 to 25% of the population were already obese⁷⁴74. Goris JM, Petersen S, Stamatakis E, Veerman JL Television food advertising and the prevalence of childhood overweight and obesity: a multicountry comparison. Public Health Nutr. 2010:13(7):1003-12. https://doi.org/10.1017/S1368980009992850
https://doi.org/10.1017/S136898000999285... . We still have no knowledge of a study that analyzes the relation between television food advertising and childhood obesity rates in Latin America. According to a recent international comparison, the magnitude of the television advertising effect on overweight and obesity in children varies by country⁷⁵75. Weber K, Story M, Harnack L. Internet food marketing strategies aimed at children and adolescents: a content analysis of food and beverage brand websites. J Am Diet Assoc. 2006;106(9):1463-6., highlighting the necessity for evidence-based studies in Latin America illustrating this effect.

While numerous studies have focused on the nature of the food advertised on television, little can be said about the nature of other above-the-line advertising such as printed media. We found only one study that investigated advertisements printed on billboards, which were found to be all for fast food chains⁴⁵45. Cárdenas MK, Benziger CP, Pillay TD, Miranda JJ. The effect of changes in visibility and price on fruit purchasing at a university cafeteria in Lima, Peru. Public Health Nutr. 2015;18(15):2742-9. https://doi.org/10.1017/S1368980014002730
https://doi.org/10.1017/S136898001400273... .

This review did not find studies about the use of digital marketing. Adults and children across the world have increasing access to digital media, especially with the widespread availability of cellphones and, as such, digital marketing is becoming more significant⁷⁶76. World Health Organization, Regional Office for Europe. Tackling food marketing to children in a digital world: trans-disciplinary perspectives. Copenhagen (DNK); 2016.,⁷⁷77. Kelly N. How marketing is evolving in Latin America. Harvard Bus Rev. 2015 Jun 1 [cited 2018 April 17]. Available from:; it allows brands to emit widely amplifying advertising messages, achieving high levels of recall and brand awareness⁷⁷77. Kelly N. How marketing is evolving in Latin America. Harvard Bus Rev. 2015 Jun 1 [cited 2018 April 17]. Available from:. Additionally, digital marketing benefits from the personal information collected about the user and how this fact might affect consumers is still unknown. Latin America is a growing market for digital advertising with more than half of its population connected to the Internet, and as of 2015, it is the fourth largest mobile device market in the world⁷⁸78. Bruijzen M, Valkenburg PM. Parental mediation of undesired advertising effects. J Broadcast Electron Media. 2005;49(2):153-65.. As youth become increasingly and permanently connected through mobile media, new research in this region is needed to understand the prevalence and effects of digital marketing on children’s health and consumption behaviors.

Below-the-line promotional techniques such as product packaging and product placement inside stores, as well as sponsorship of food items in movies or television programs, toy giveaways, free samples, and loyalty programs are also under-researched. We found nine studies that focused on food packaging and point of sale advertising. The results are similar to those of television advertising with most of the child-oriented products being ultra-processed foods and sweetened beverages. Studies found that children have a literal interpretation of food packaging and tend to believe the images and health claims printed on the packages⁴¹41. Mazzonetto AC, Fiates GMR. Perceptions and choices of Brazilian children as consumers of food products. Appetite. 2014;78:179-84. https://doi.org/10.1016/j.appet.2014.03.028
https://doi.org/10.1016/j.appet.2014.03.... ,⁵⁰50. Britto SR, Viebig RF, Morimoto JM. Analysis of food advertisements on cable television directed to children based on the food guide for the Brazilian population and current legislation. Rev Nutr. 2016;29(5):721-9.. Children also reported that easy access to unhealthy foods such as having stores inside and around schools and in the vicinity of their houses affected their consumption⁴⁶46. Chacon V, Letona P, Villamor E, Barnoya J. Snack food advertising in stores around public schools in Guatemala. Crit Public Health. 2015;25(3):291-8. https://doi.org/10.1080/09581596.2014.953035
https://doi.org/10.1080/09581596.2014.95... . These findings place children in a particularly vulnerable situation when confronting purchasing decisions made with pocket money and are the development to an unhealthy diet in adult life.

Therefore, new research examining the effects of external factors (amplifying and attenuating) such as school environment, family communication styles and parental advertising mediation is needed. Family communication styles and parental advertising mediation has been found to moderate the effect of television ads geared towards children⁷⁹79. Buijzen M. The effectiveness of parental communication in modifying the relation between food advertising and children’s consumption behaviour. Br J Dev Psychol. 2009;27(1):105-21., including food television advertising⁸⁰80. Lapierre MA. Advertising literacy and executive function: testing their influence on children’s consumer behavior. Media Psychol. 2019;22(1):35-59.. Other studies have analyzed how cognitive development and other psychological factors help children cope with advertising messages. Findings in these studies suggest children’s executive function and advertising literacy directly affect children’s consumer behavior when exposed to advertising⁸¹81. Livingstone S, Helsper EJ. Does advertising literacy mediate the effects of advertising on children? A critical examination of two linked research literatures in relation to obesity and food choice. J Commun. 2006;56(3):560-84.,82 and can help to moderate the effect.

Several limitations can be identified in this review. Firstly, despite the exhaustive search used in this review, we have the probability of having excluded thesis or dissertations conducted in the area that were not published in indexed journals. Secondly, we did not find studies conducted in countries such as Venezuela, Bolivia, Paraguay, and Panama, which limits the reach of conclusions of this review. Thirdly, the exploratory scope of this review does not enable conclusions and recommendations about specific topics of food marketing to be made. In consequence, this study should be considered as a preliminary approximation to this topic.

Despite these limitations, the results of this study may provide insights to guide policy actions to prevent the growing public health problem of obesity and non-communicable diseases. Furthermore, it can contribute to identifying knowledge gaps to lead the future research agenda in the area.

CONCLUSIONS

This review synthesizes the evidence published in the last 15 years on marketing of food and beverages in Latin American countries. The main advertising medium explored by these studies was television advertising, and while studies focusing on digital advertising were not found, it is also gaining strength, especially among youths. These media transcend national borders and, as such, it is necessary to view the panorama of the region as a whole. This review provides insights about the challenges unhealthy eating represents to the public health of Latin America and identifies knowledge gaps to guide future research.

Acknowledgments

We thank Lindsey Smith Taillie and Barry Popkin for their support and leadership. We thank Yersika Caro y Maria Fernanda Carreño for their support in the data synthesis.

REFERENCES

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