Objective: To estimate the contribution of television (TV) food advertising to the prevalence of obesity among 6-11-year-old children in Australia, Great Britain (England and Scotland only), Italy, The Netherlands, Sweden and the United States. Design: Data from contemporary representative studies on the prevalence of childhood obesity and on TV food advertising exposure in the above countries were entered into a mathematical simulation model. Two different effect estimators were used to calculate the reduction in prevalence of overweight and obesity in the absence of TV food advertising in each country; one based on literature and one based on experts' estimates. Setting: Six-to eleven-year-old children in six Western countries. Results: Estimates of the average exposure of children to TV food advertising range from 1?8 min/d in The Netherlands to 11?5 min/d in the United States. Its contribution to the prevalence of childhood obesity is estimated at 16 %-40 % in the United States, 10 %-28 % in Australia and Italy and 4 %-18 % in Great Britain, Sweden and The Netherlands. Conclusions: The contribution of TV advertising of foods and drinks to the prevalence of childhood obesity differs distinctly by country and is likely to be significant in some countries.
KeywordsChild Overweight Obesity Advertising Comparison Childhood overweight and obesity is an increasing public health problem (1)(2)(3) . Often persisting into adulthood, childhood obesity increases the risk of suffering from a range of diseases, including diabetes mellitus and CVD, which can lead to poor quality of life and a shortened lifespan (3)(4)(5) . Overweight among children is related to many factors at the individual, family and environmental levels.Cross-sectional and longitudinal studies have shown a positive association between time spent watching television (TV) and an increase in the prevalence of childhood overweight and obesity (6)(7)(8)(9) ; whereas the results of published studies indicate a positive relationship between TV viewing and overweight (10)(11)(12) , mechanisms driving this are not clear. Two primary mechanisms by which TV viewing contributes to weight gain in children have been suggested: reduced physical activity or increased energy intake or a combination of both. Weak-to-modest inverse associations between TV viewing and physical activity have been found (9,13) . There is also evidence that at least part of the relationship between TV viewing and overweight in children can be linked to energy intake; that is, TV watching is associated with an increase in consumption of fast food and energy-dense snacks (6,7,12) . The present study focuses on the latter mechanism and will explore the potential effect of TV food advertising on childhood obesity.There is substantial evidence that exposure to TV food advertising significantly influences children's food preferences, choices, purchase requests and food intake, but the strength of the evidence decreases with the length of the putative causal chain from advertising to obesi...