The extent, nature, and nutritional quality of foods advertised to children in Lebanon: the first study to use the WHO nutrient profile model for the Eastern Mediterranean Region

  • Lara Nasreddine
  • Mandy Taktouk
  • Massar Dabbous
  • Jad Melki
Keywords: food marketing, children, Lebanon, nutrient profiling, Eastern Mediterranean Region, media literacy


Objective: Exposure to food marketing may influence children’s food preferences and consumption patterns and may increase the risk of childhood obesity. The WHO Office for the Eastern Mediterranean Region (EMR) has recently released a regional nutrient profile model (WHO EMR) for the purpose of regulating the marketing of food and beverages to children. This study aimed at 1) analyzing the frequency and types of food and drink advertisements during children’s viewing time in Lebanon; 2) examining the nutritional content of the advertised food products in reference to the nutrient thresholds specified by the WHO EMR model; and 3) assessing the proportion of food advertisements that included health messages.

Design: This study consisted of a cross-sectional content analysis of food advertisements on local TV channels, during children’s viewing time. Setting: Three local Lebanese channels with the highest viewership among 4- to 14-year-olds were selected. Recorded broadcasts (September 2016 through January 2017) were analyzed between 3 pm and 10 pm on weekdays and between 8 am and 10 pm on weekend days.

Results: Approximately 31% of advertisements were for foods or drinks. The proportion of food advertisements was the highest during children’s programs (43%) compared to general viewing (32%) and parental guidance (29%) programs. Approximately 8 out of 10 food advertisements were for products that did not meet the standards of the WHO EMR model. Of concern was the heavy advertisement of alcoholic beverages during programs for general audiences. The majority of the advertisements that comprised a health claim were for foods that did not meet the WHO EMR’s nutritional standards (79%).

Conclusions: The findings of this study, which is the first to utilize the new WHO EMR profile model, should be viewed as a foundation for the development of food marketing policies aimed at reducing children’s exposure to TV food advertisements in Lebanon, a country that harbors a high burden of childhood obesity.


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  1. World Health Organization. Global status report on non-communicable diseases. 2014. Available from: [cited 10 December 2018].

  2. World Health Organization. Roadmap of WHO’s work for the Eastern Mediterranean Region 2017–2021: September 2017. 2017. Available from: [cited 10 December 2018].

  3. World Health Organization Regional Office for the Eastern Mediterranean. Nutrient profile model for the marketing of food and non-alcoholic beverages to children in the WHO Eastern Mediterranean Region. Cairo; 2017. Available from: [cited 30 May 2017].

  4. Afshin A, Micha R, Khatibzadeh S, Fahimi S, Shi P, Powles J, et al. The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis. BMJ Open 2015; 5(5): e006385. doi: 10.1136/bmjopen-2014-006385.

  5. Cecchini M, Sassi F, Lauer JA, Lee YY, Guajardo-Barron V, Chisholm D. Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Lancet 2010; 376(9754): 1775–84. doi: 10.1016/S0140-6736(10)61514-0.

  6. Nasreddine L, Naja F, Akl C, Chamieh MC, Karam S, Sibai A-M, et al. Dietary, lifestyle and socio-economic correlates of overweight, obesity and central adiposity in Lebanese children and adolescents. Nutrients 2014; 6(3): 1038–62. doi: 10.3390/nu6031038.

  7. Collison KS, Zaidi MZ, Subhani SN, Al-Rubeaan K, Shoukri M, Al-Mohanna FA. Sugar-sweetened carbonated beverage consumption correlates with BMI, waist circumference, and poor dietary choices in school children. BMC Public Health 2010; 10(1): 234. doi: 10.1186/1471-2458-10-234.

  8. Ali HI, Ng SW, Zaghloul S, Harrison GG, Qazaq HS, El Sadig M, et al. High proportion of 6 to 18-year-old children and adolescents in the United Arab Emirates are not meeting dietary recommendations. Nutr Res 2013; 33(6): 447–56. doi: 10.1016/j.nutres.2013.03.008.

  9. Sayegh A, Dini E, Holt R, Bedi R. Food and drink consumption, sociodemographic factors and dental caries in 4–5-year-old children in Amman, Jordan. Br Dent J 2002; 193(1): 37–42. doi: 10.1038/sj.bdj.4801478a.

  10. Al-Rewashdeh A. Assessment of the nutritional status for preschool children in Jordan. Bull Faculty Agriculture Cairo Univ 2009; 60(4): 423–32.

  11. De Onis M, Blössner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 2010; 92(5): 1257–64. doi 10.3945/ajcn.2010.29786.

  12. Abarca-Gómez L, Abdeen ZA, Hamid ZA, Abu-Rmeileh NM, Acosta-Cazares B, Acuin C, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128 9 million children, adolescents, and adults. Lancet 2017; 390(10113): 2627–42. doi: 10.1016/S0140-6736(17)32129-3.

  13. Batada A, Seitz MD, Wootan MG, Story M. Nine out of 10 food advertisements shown during Saturday morning children’s television programming are for foods high in fat, sodium, or added sugars, or low in nutrients. J Am Diet Assoc 2008; 108(4): 673–8. doi: 10.1016/j.jada.2008.01.015.

  14. World Health Organization Regional Office for Europe. Marketing of foods high in fat, salt and sugar to children: update 2012-2013. 2013. Available from: [cited 31 May 2017].

  15. Institute of Medicine. Food marketing to children and youth: threat or opportunity? Washington, DC: National Academies Press; 2006.

  16. Hobbs M, Pearson N, Foster PJ, Biddle SJ. Sedentary behaviour and diet across the lifespan: an updated systematic review. Br J Sports Med 2014; 49(18): 1179–88. doi: 10.1136/bjsports-2014-093754.

  17. Sadeghirad B, Duhaney T, Motaghipisheh S, Campbell N, Johnston B. 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. doi: 10.1111/obr.12445.

  18. Melki J. Media habits of MENA youth: a three-country survey. 2010. Available from: [cited 3 July 2017].

  19. Jari M, Qorbani M, Motlagh ME, Heshmat R, Ardalan G, Kelishadi R. A nationwide survey on the daily screen time of Iranian children and adolescents: the CASPIAN-IV study. Int J Prev Med 2014; 5(2): 224.

  20. World Health Organization. Set of recommendations on the marketing of foods and non-alcoholic beverages to children. 2010; Available from: [cited 23 May 2017].

  21. World Health Organization Regional Office for the Eastern Mediterranean. Framework for action to implement the United Nations Political Declaration on Noncommunicable Diseases, including indicators to assess country progress by 2018. 2015. Available from: [cited 23 May 2017].

  22. World Health Organization Regional Office for Europe. WHO Regional Office for Europe Nutrient Profile Model. Denmark: WHO; 2015. Available from: [cited 4 May 2017].

  23. World Health Organization. Guiding principles and framework manual for the development or adaptation of nutrient profile models (in press).

  24. World Health Organization Regional Office for Europe. Vienna declaration on nutrition and noncommunicable diseases in the context of health 2020. 2013. Available from: [cited 5 May 2017].

  25. IPSOS. IPSOS: global market and opinion research specialists; 2017. Available from: [cited 6 September 2016].

  26. IPSOS. Reference document and financial report. 2017. Available from: [cited 19 December 2018].

  27. Zuppa JA, Morton H, Mehta KP. Television food advertising: counterproductive to children’s health? A content analysis using the Australian Guide to Healthy Eating. Nutr Diet 2003; 60(2): 78–85.

  28. Romero-Fernandez MM, Royo-Bordonada MA, Rodríguez-Artalejo F. Evaluation of food and beverage television advertising during children’s viewing time in Spain using the UK nutrient profile model. Public Health Nutr 2013; 16(7): 1314–20. doi: 10.1017/S1368980012003503.

  29. Pellet PL, Shadarevian S. Food composition tables for use in the Middle East. 3rd ed. Beirut, Lebanon: American University of Beirut; 2013.

  30. United States Department of Agriculture. USDA food composition databases. 2017. Available from: [cited 5 June 2017].

  31. The European Parliament and the Council of the European Union. REGULATION (EC) No 1924/2006 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 20 December 2006 on nutrition and health claims made on foods. 2006. Available from: [cited 20 December 2018].

  32. The European Commission. COMMISSION REGULATION (EU) No 1047/2012 of 8 November 2012 amending Regulation (EC) No 1924/2006 with regard to the list of nutrition claims. 2012. Available from: [cited 20 December 2018].

  33. Prathapan S, Wijewardena K, Low WY. Content analysis of food and beverages advertisements targeting children and adults on television in Sri Lanka. Asia Pac J Public Health 2016; 28(1_suppl): 86S–92S. doi: 10.1177/1010539515620481.

  34. Calvert SL, Kotler JA. Lessons from children’s television: the impact of the Children’s Television Act on children’s learning. J Appl Dev Psychol 2003; 24(3): 275–335. doi: 10.1016/S0193-3973(03)00060-1.

  35. Corfield J. Network vs. Netflix: a comparative content analysis of demographics across prime-time television and Netflix Original Programming. Master’s thesis. South Carolina, United States of America: University of South Carolina; 2017.

  36. Royo-Bordonada M, León-Flández K, Damián J, Bosqued-Estefanía M, Moya-Geromini M, López-Jurado L. The extent and nature of food advertising to children on Spanish television in 2012 using an international food-based coding system and the UK nutrient profiling model. Public Health 2016; 137: 88–94. doi: 10.1016/j.puhe.2016.03.001.

  37. Jenkin G, Wilson N, Hermanson N. Identifying ‘unhealthy’ food advertising on television: a case study applying the UK Nutrient Profile model. Public Health Nutr 2009; 12(5): 614–23. doi: 10.1017/S1368980008003029.

  38. Adams J, Tyrrell R, Adamson AJ, White M. Effect of restrictions on television food advertising to children on exposure to advertisements for ‘less healthy’foods: repeat cross-sectional study. PLoS One 2012; 7(2): e31578. doi: 10.1371/journal.pone.0031578.

  39. Bugge AB. Food advertising towards children and young people in Norway. Appetite 2016; 98: 12–18. doi: 10.1016/j.appet.2015.12.008.

  40. World Health Organization Regional Office for Europe. Evaluating implementation of the WHO set of recommendations on the marketing of foods and non-alcoholic beverages to children: progress, challenges and guidance for next steps in the WHO European Region. 2018. Available from: [cited 18 December 2018].

  41. PAOS Code. Code of co-regulation of advertising of food products and beverages directed to children, prevention of obesity and health. 2012. Available from: [cited 18 December 2018].

  42. Advertising Standards Authority-New Zealand. ARCHIVE: children’s code for advertising food; 2017. Available from: [cited 18 December 2018].

  43. Office of Communications-UK. Television advertising of food and drink products to children: final statement. 2007. Available from: [cited 18 December 2018].

  44. Amini M, Omidvar N, Yeatman H, Shariat-Jafari S, Eslami-Amirabadi M, Zahedirad M. Content analysis of food advertising in Iranian children’s television programs. Int J Prev Med 2014; 5(10): 1337–42.

  45. Guran T, Turan S, Akcay T, Degirmenci F, Avci O, Asan A, et al. Content analysis of food advertising in Turkish television. J Paediatr Child Health 2010; 46(7–8): 427–30. doi: 10.1111/j.1440-1754.2010.01753.x.

  46. World Cancer Research Fund International. Nourishing framework. Restrict food advertising and other forms of commercial promotion. 2018. Available from: [cited 18 December 2018].

  47. International Food and Beverages Alliance (IFBA). Turkey pledge. 2012. Available from: [cited 18 December 2018].

  48. Turkish Radio and Television Supreme Council. New regulation on commercial communication of food products that are not recommended for excessive consumption; 2018. Available from: [cited 18 December 2018].

  49. Australian Communications and Media Authority. Children’s television standards 2009. 2009. Available from: [cited 18 December 2018].

  50. Gupta S, Kalra S, Kaushik JS, Gupta P. Content of food advertising for young adolescents on television. Indian J Community Med 2017; 42(1): 43. doi: 10.4103/0970-0218.199800.

  51. 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. doi:10.1542/peds.2006-3595.

  52. Kelly B, Chapman K, King L, Hebden L. Trends in food advertising to children on free-to-air television in Australia. Aust N Z J Public Health 2011; 35(2): 131–4. doi: 10.1111/j.1753-6405.2011.00612.x.

  53. 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. doi: 10.1016/j.appet.2012.04.017.

  54. Boyland EJ, Harrold JA, Kirkham TC, Halford JC. The extent of food advertising to children on UK television in 2008. Int J Pediatr Obes 2011; 6(5–6): 455–61. doi: 10.3109/17477166.2011.608801.

  55. Akl C. Prevalence and determinants of overweight and obesity in a nationally representative sample of Lebanese children 5 to 12 years old. Master’s thesis, American University of Beirut, Beirut, Lebanon.

  56. Kelly B, Hebden L, King L, Xiao Y, Yu Y, He G, et al. Children’s exposure to food advertising on free-to-air television: an Asia-Pacific perspective. Health Promot Int 2014; 31(1): 144–52. doi: 10.1093/heapro/dau055.

  57. Center for Science in the Public Interest. Guidelines for responsible food marketing to children. Washington, DC.; 2005. Available from: [cited 17 December 2018].

  58. National Alliance for Nutrition and Activity. Local school wellness policy. Available from: [cited 17 December 2018].

  59. US Department of Health and Human Services. Dietary guidelines for Americans. 2005. Available from: [cited 17 Dec 2018].

  60. Adams J, Hennessy-Priest K, Ingimarsdóttir S, Sheeshka J, Østbye T, White M. Food advertising during children’s television in Canada and the UK. Arch Dis Child 2009; 94(9): 658–62. doi: 10.1136/adc.2008.151019.

  61. Lovdata. Law on control of marketing and contract terms, etc. (Marketing Act); 2009. Available from: [cited 6 July 2017].

  62. Vijayapushpam T, Maheshwar M, Rao DR. A comparative analysis of television food advertisements aimed at adults and children in India. Int J Innov Res Sci Eng 2014; 2(6): 476–83.

  63. Kim H, Lee D, Hong Y, Ahn J, Lee KY. A content analysis of television food advertising to children: comparing low and general-nutrition food. Int J Consum Stud 2016; 40(2): 201–10. doi: 10.1111/ijcs.12243.

  64. Warren R, Wicks RH, Wicks JL, Fosu I, Chung D. Food and beverage advertising on U.S. television: a comparison of child-targeted versus general audience commercials. J Broadcast Electron Media 2008; 52(2): 231–46. doi: 10.1080/08838150801992037.

  65. Outley CW, Taddese A. A content analysis of health and physical activity messages marketed to African American children during after-school television programming. Arch Pediatr Adolesc Med 2006; 160(4): 432–5. doi: 10.1001/archpedi.160.4.432.

  66. Ashton D. Food advertising and childhood obesity. J R Soc Med 2004; 97(2): 51–2.

  67. Büttner OB, Florack A, Serfas BG. A dual-step and dual-process model of advertising effects: implications for reducing the negative impact of advertising on children’s consumption behaviour. J Consum Policy 2014; 37(2): 161–82. doi: 10.1007/s10603-013-9250-0.

  68. Anderson P, De Bruijn A, Angus K, Gordon R, Hastings G. Impact of alcohol advertising and media exposure on adolescent alcohol use: a systematic review of longitudinal studies. Alcohol Alcohol 2009; 44(3): 229–43. doi: 10.1093/alcalc/agn115.

  69. Morgenstern M, Li Z, Li Z, Sargent JD. The party effect: prediction of future alcohol use based on exposure to specific alcohol advertising content. Addiction 2017; 112(1): 63–70. doi: 10.1111/add.13509.

  70. Marshall EJ. Adolescent alcohol use: risks and consequences. Alcohol Alcohol 2014; 49(2): 160–4. doi: 10.1093/alcalc/agt180.

  71. McCambridge J, McAlaney J, Rowe R. Adult consequences of late adolescent alcohol consumption: a systematic review of cohort studies. PLoS Med 2011; 8(2): e1000413. doi: 10.1371/journal.pmed.1000413.

  72. Popovici I, French MT. Binge drinking and sleep problems among young adults. Drug Alcohol Depend 2013; 132(1): 207–15. doi: 10.1016/j.drugalcdep.2013.02.001.

  73. Richards G, Smith A. Caffeine consumption and self-assessed stress, anxiety, and depression in secondary school children. J Psychopharmacol 2015; 29(12): 1236–47. doi: 10.1177/0269881115612404.

  74. Cairns G, Angus K, Hastings G. The extent, nature and effects of food promotion to children: a review of the evidence. Geneva; 2009. Available from: [cited 6 July 2017].

  75. Wiecha JL, Peterson KE, Ludwig DS, Kim J, Sobol A, Gortmaker SL. When children eat what they watch: impact of television viewing on dietary intake in youth. Arch Pediatr Adolesc Med 2006; 160(4): 436–42. doi: 10.1001/archpedi.160.4.436.

  76. Baird J, Jacob C, Barker M, Fall CH, Hanson M, Harvey NC, et al. Developmental origins of health and disease: a lifecourse approach to the prevention of non-communicable diseases. Healthc 2017; 5(1): 14. doi: 10.3390/healthcare5010014.

  77. Naja F, Hwalla N, Itani L, Karam S, Sibai AM, Nasreddine L. A Western dietary pattern is associated with overweight and obesity in a national sample of Lebanese adolescents (13–19 years): a cross-sectional study. Br J Nutr 2015; 114(11): 1909–19. doi: 10.1017/S0007114515003657.

  78. Nasreddine L, Naja F, Chamieh MC, Adra N, Sibai A-M, Hwalla N. Trends in overweight and obesity in Lebanon: evidence from two national cross-sectional surveys (1997 and 2009). BMC Public Health 2012; 12(1): 798. doi: 10.1186/1471-2458-12-798.

  79. Nasreddine L, Naja F, Tabet M, Habbal MZ, El-Aily A, Haikal C, et al. Obesity is associated with insulin resistance and components of the metabolic syndrome in Lebanese adolescents. Ann Hum Biol 2012; 39(2): 122–8. doi: 10.3109/03014460.2012.655776.

  80. Hachem D. Determining body mass index, waist-to-height ratio, percent body fat, and conicity index cut-off values associated with metabolic abnormalities in Lebanese children and adolescents. Master’s thesis, American University of Beirut, Beirut, Lebanon, 2013.

  81. Sidani SI. Body fat and its relationship with metabolic syndrome indicators in overweight children and adolescents in Lebanon. Master’s thesis, American University of Beirut, Beirut, Lebanon, 2007.

  82. Magnus A, Haby M, Carter R, Swinburn B. The cost-effectiveness of removing television advertising of high-fat and/or high-sugar food and beverages to Australian children. Int J Obes 2009; 33(10): 1094–102. doi: 10.1038/ijo.2009.156.

  83. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. Geneva; 2000. Available from: [cited 29 May 2017].

  84. Office of Communications. HFSS advertising restrictions. Final review. London: Ofcom; 2010 Available from: [cited 10 July 2017].

  85. Silva A, Higgins LM, Hussein M. An evaluation of the effect of child-directed television food advertising regulation in the United Kingdom. Can J Agr Econ 2015; 63(4): 583–600. doi: 10.1111/cjag.12078.

  86. BankMed Market and Economic Research Division. Analysis of Lebanon’s media and advertising sector-May 2014. 2014. Available from: [cited 3 July 2017].

  87. Melki J, Maaliki L. Maneuvering entrenched structures of Arab education systems: the agency of Arab media literacy educators and activists. J Media Lit 2017; 64: 56–60.

  88. Melki J, Maaliki L. Helping Arab digital and media literacy blossom: three years of the Media and Digital Literacy Academy of Beirut (MDLAB). University of Gothenburg, Sweden: The International Clearinghouse on Children Youth and Media; 2016.

  89. World Health Organization. Guideline: sugars intake for adults and children. 2015. Available from: [cited 30 May 2017].

How to Cite
Nasreddine L., Taktouk M., Dabbous M., & Melki J. (2019). The extent, nature, and nutritional quality of foods advertised to children in Lebanon: the first study to use the WHO nutrient profile model for the Eastern Mediterranean Region. Food & Nutrition Research, 63. Retrieved from
Original Articles