Food and drink high in fat, sugar and salt - out of home advertising restrictions: rapid evidence review

Executive Summary

Out of Home (OOH) advertising of food and drink high in fat, sugar, and salt (HFSS) is one form of advertising that may contribute to Scotland’s high levels of obesity^[1] and health inequalities^[2]. The Advertising Standards Authority (ASA) advises that advertising of HFSS products should not be aimed at children under the age of 16 and advertisements should not appear where 25% of the audience consists of under 16s^[3]. Many advertisers in the UK aim to adhere to this rule by not advertising HFSS products within 100 or 200 metres of schools^[4]. However, in Scotland, there are no Scottish Government policies in place that restrict outdoor advertising of HFSS products, despite evidence showing strong links between exposure to advertising of HFSS products and energy consumption^{[5] [6]}.

Across England, local governments have implemented policies restricting the advertising of HFSS products,^[7] the first being the Transport for London (TfL) network,^[8] which encompasses the London underground, rail network, buses, taxis, and TfL operated outdoor spaces. However, no evidence review has been conducted examining the scope and impact of these advertising restrictions. This report gathered the existing evidence on policy implementation in the UK by incorporating information gained from published peer-reviewed and grey literature up to June 2024, interviews with local government representatives, and conversations with industry and advocacy groups between June and September 2024. The following key points emerged from the research:

• Independent academic research has shown that restricting OOH advertising of HFSS products may be effective. In 2019, the Transport for London (TfL) network introduced restrictions on advertising HFSS products which were associated with a reduction in purchasing of HFSS products^[9].
• Subsequent academic research estimated that, after 12 months, the TfL restrictions could reduce the number of people with obesity by 4.8% and overweight by 1.8% in the Greater London Authority (GLA). In addition, the policy could save £218 million in the costs of health care over the lifetime of the current Greater London population^[10].
• Implementation of similar policies has had a snowball effect across England, with at least 14 local authorities confirmed as having an implemented or forthcoming policy. However, engagement with the policy is significantly more widespread than this, with up to 150 additional local authorities in England in the planning/consulting stages.
• Policies have been implemented relatively consistently, with all local authorities utilising the Nutrient Profiling Model (NPM; 2004/2005) to help advertising companies differentiate between HFSS and non-HFSS products. Local authorities have worked with the third-sector organisation, Sustain, to develop and implement the policy.
• Several factors facilitated policy implementation across local authorities, including support from smaller businesses, charities and the media. Prioritising health outcomes in the lead up to policy implementation was also an important facilitator, as was the ‘progressive’ culture of certain areas^{[11] [12] [13]} .
• Several challenges were also identified, including difficulty with operationalising the concept of ‘junk food’ and the policy differentially impacting food companies, some of whom have a narrow portfolio range. Opposition to the policy came from the food and advertising industry, primarily multi-national companies.
• Local government policy only applies to local government-owned advertising sites, of which there are often few. This is the case particularly in smaller regions, relative to larger numbers of privately owned sites, which may restrict the impact and reach of the policy.
• Evaluating the effectiveness and/or success of an implemented policy is also an ongoing challenge. One method may be to look at a reduction in advertising exposure, rather than change in energy consumption, obesity, or financial outcomes, which are difficult to measure and may be slow to change.