obesity reviews
doi: 10.1111/j.1467-789X.2007.00458.x
Agro-food industry growth and obesity in China: what
role for regulating food advertising and promotion and
nutrition labelling?
C. Hawkes
Food Consumption and Nutrition Division,
Summary
International Food Policy Research Institute
Taking a food supply chain approach, this paper examines the regulation of food
marketing and nutrition labelling as strategies to help combat obesity in China in
an era of rapid agro-food industry growth. China is the largest food producer and
consumer in the world. Since the early 1980s, the agro-food industry has undergone phenomenal expansion throughout the food supply chain, from agricultural
production to trade, agro-food processing to food retailing, and from food service
to advertising and promotion. This industry growth, alongside related socioeconomic changes and government policies, has encouraged a ‘nutrition transition’.
China’s population, especially in urban areas, is now consuming significantly
more energy from dietary fat, which is leading to higher rates of obesity. Regulation of food advertising and promotion and nutrition labelling has the potential
to help prevent the further growth of obesity in China and encourage the agrofood industry to supplier healthier foods. Government legislation and guidance, as
well as self-regulation and voluntary initiatives, are needed to reduce children’s
exposure to food advertising and promotion, and increase the effectiveness of
nutrition labelling. Policies on food marketing and nutrition labelling should be
adapted to the China context, and accompanied by further action throughout the
food supply chain. Given China’s unique characteristics and position in the world
today, there is an opportunity for the government and the agro-food industry to
lead the world by creating a balanced, health promoting model of complementary
legislation and industry action.
(IFPRI), Washington, DC, USA
Address of Correspondence: C Hawkes,
IFPRI, 2033 K Street NW, Washington DC
20006, USA. E-mail: [email protected]
Keywords: Advertising, food industry, labelling, nutrition transition.
obesity reviews (2008) 9 (Suppl. 1), 151–161
Introduction
Two policies frequently proposed to help address the global
obesity epidemic are the regulation of food marketing,
particularly to children and young people, and nutrition
labelling. Food marketing (advertising and other forms of
promotion) and nutrition labelling (labels on foods listing
nutritional information) are considered important, because
they both communicate information about food to the
public. They are a major means through which consumers
learn – and potentially make choices – about food.
Regulating food marketing and nutrition labelling were
both emphasized by the World Health Organization’s
Global Strategy on Diet, Physical Activity and Health
(2004) as potential strategies to address the growth of
obesity and diet-related chronic diseases (1). In many
western countries, policy development in these areas is
underway, but elsewhere, these strategies are still relatively
undeveloped as tools to help combat obesity (2,3).
In China, regulating food advertising and promotion
has hardly been discussed in an obesity prevention context, and nutrition labelling is at a relatively early stage of
© 2007 The Author
Journal compilation © 2007 The International Association for the Study of Obesity. obesity reviews 9 (Suppl. 1), 151–161
151
152
Food advertising and nutrition labelling
development. China presents quite a different context to
Europe or North America. Not only is the obesity epidemic
at an earlier stage (albeit, as documented in this special
issue, a worrying one), but the large-scale agro-food indus-
Examples of agro-food
industry growth
Meat
7.4% increase 1982-2002
Milk/Eggs
9.7 %increase 1982-2002
Sugar
5.6% increase 1982-2002
Veg
9.2% increase 1982-2002
Fruit
11% increase 1982-2002
Palm oil imports (Mt)
317,943 (1986/88)
4,181,185 (2003/05)
obesity reviews
C. Hawkes
Agro-food industry
supply chain
try is also at a different stage – less developed but characterized by phenomenal growth (Fig. 1).
This paper thus examines the regulation of food marketing to children and young people and labelling as strategies
Policy drivers
behind agro-food
industry growth
Regulation of food
marketing and
labelling as policies to
align food supply
chain with healthy
diets
(world 2.8%)
(world 1.4%)
(world 1.8%)
Agricultural production
(world 4.2%)
- Decentralization of the agricultural
production system (1981)
- Reduction of state food procurement from
agricultural producers and price controls for
non-staple foods (1984/85)
- Elimination of food rationing system
(1993)
(world 2.4%)
Soybean oil imports
(Mt)
250,334 (1986/88)
2,169,036 (2003/05)
Agricultural trade
Output value of agro-food processing
industry grew by 13.85% between 19811987
Agro-food processing
Foreign enterprises in the food processing
industry produced 20% of total output in
1997
China is world’s 7th largest retail market
Dominated by small stores (chains are 8% of
market), but tremendous hypermarket growth
in urban centers
Domestic chains and multinationals (latter
accounted for 23% of total sales in 2004, up
from 16% in 2003)
China’s “food-away-from-home” market 159
times larger than 1978
Yum! More than doubled outlets 2002-2006:
650 to 1908
McDonald’s: over 666 outlets and plans to
open up to 100 new outlets annually from
2006
Food retailing/eating outlets
Advertising grew at a rate of 40% per year n
the 1990s
Advertising generated total revenues of US$3.6
billion in 2006, representing a compound
annual growth rate of 24.2% during 2002-06
Food was fourth largest amount of advertising
revenues in 2006
Coca-Cola spends over $15 million per year
Huge growth of children’s television channels
Food advertising &
promotion
- Unilateral trade reforms (1990s).
- Accession to World Trade Organization
(2001).
- Regional and bilateral trade agreements
(2000s)
- Establishment of Special Economic
Zones to attract foreign direct investment
(late 1970s-80s)
- Policies to open up food sector to foreign
participation (early 1980s)
- Policy to open up China to foreign capital
(1992)
- Privatisation of food retail; state and
municipal government investment in
supermarket chains (1980s)
- Gradual relaxation of restrictions on
foreign investment in food retail (from 1991)
65% of foreign participation permitted in
joint retail ventures and liberalisation of
foreign investment in wholesale and
logistics services (2002)
- Complete liberalisation of retail sector
scheduled for December 2004 following
access to the World Trade Organisation.
- Active conversion of wet-markets into
supermarkets (2003)
- In line with World Trade Organization
agreements, foreign agencies permitted to
own up to 49% of joint media ventures
(2004).
- Government order for provincial level
television stations to launch more
children’s channels (2004)
Labelling foods with nutritional
information at point-of-sale
potentially encourages consumers
to make healthier food choices…
… and also affects industry
incentives to lower saturated fat,
trans fats etc in foods
Marketing of energy-dense,
nutrient-poor foods to children aims
to create demand for these foods and the habit to stay for life
… Reducing/eliminating it reduces
consumer incentives to purchase –
and food industry incentives to
produce these foods
Food purchase and
consumption
Figure 1 The growth of the agro-food industrial supply chain in China: policy drivers (sources: 4,5,7,8,10–12,14,15,17,19,56–59).
© 2007 The Author
Journal compilation © 2007 The International Association for the Study of Obesity. obesity reviews 9 (Suppl. 1), 151–161
obesity reviews
to help combat obesity in China in an era of rapid agrofood industry growth. Taking a food supply chain
approach, it first describes agro-food industry growth in
China and its drivers.
Agro-food industry growth in China: a supply
chain approach
Growth throughout the food supply chain
China is the largest food producer and consumer in the
world. Since the early 1980s, and particularly since the
1990s, the agro-food industry has been expanding at a
rapid rate. As shown by Fig. 1, all major components of
the agro-food supply chain are growing: agricultural
production and trade, agro-food processing, the food
retailing and food-away-from-home sectors (e.g. restaurants, fast food) and food marketing (advertising and
promotion).
Agricultural growth has been remarkable. According to
figures from the Food and Agricultural Organization of the
United Nations, production of agricultural commodities
have grown at over double (vegetables) to nearly seven
times higher (milk and eggs) than average world growth
rates since the 1980s (Fig. 1) (4,5). The structure of agricultural trade has also altered. China has emerged as a
major agricultural exporter, and while it remains selfsufficient in most food items, it has become a major
importer of soybeans and vegetable oils (6). Imports of
palm oil and soybean oil grew over eight and 13 times in
quantity, respectively, between 1986/1988 and 2003/2005
(7). In 2003, China’s soybean imports accounted for about
one-third of all world soybean imports (8).
Growth of the agro-food processing industry is also
impressive. The food manufacturing industry has grown
at double-digit rates in the past 5 years, with a notable
increase of private businesses at the expense of state
enterprises. Echoing global trends, foreign direct investment in food processing is also increasing (9). No data
are available specific to food processing, but between
1979 and 2000, China received $346.6bn in foreign
direct investment, comprising 5.5% of the world’s inward
flows. The greatest proportion was in manufacturing,
including food manufacturing (10). In 1997, although
foreign food companies accounted for just 6.2% of the
number of enterprises, they accounted for 20% of output
and 31% of gross profit (11). Food processing companies
from Europe and North America, such as Danone, CocaCola, Kraft, MasterFoods, Nestlé, PepsiCo and Tyson’s,
have invested in joint ventures in China.
Although the food retail market remains dominated by
small stores, both large-scale domestic and foreign supermarket chains (especially Carrefour and Wal-Mart) are
growing fast. The first supermarket in China opened in
Food advertising and nutrition labelling
C. Hawkes
153
1990 and, by 2002, there were over 53 000, representing
the fastest growth rate in the word (30–40% per year sales
growth) (12). It is widely predicted that supermarkets will
be the dominant food retailers in China’s urban areas in the
near future. China’s ‘food-away-from-home’ market has
also experienced phenomenal growth. It is now 159 times
larger than 1978 – the result of the growth of the domestic
restaurant industry, but also of foreign chains such as Yum!
Brands and McDonald’s (13).
The media has played an important role in the growth of
the agro-food industry. The advertising industry has grown
extremely rapidly in the past 15 years (Fig. 1). Retail and
food formed the third and fourth largest categories of the
value of advertising in 2006 (10.3% and 8.5%, respectively) (14). More than half of all advertising is on
television and in newspapers – there are thousands of newspapers and magazines in China, and hundreds of television
channels. In-store display and sales promotions, sponsorship of television programmes and service-orientated marketing are also proving very important channels. The aim is
to encourage consumers – especially younger consumers –
to adopt habits for life.
Drivers of agro-food industry growth
The growth of the agro-food industry has been driven by a
combination of socioeconomic (demand side) and policy
(supply side) drivers (12). The two major socioeconomic
drivers are income growth and urbanization. Income has
grown rapidly in China since the economic reform process
first started in 1978 and driven demand for more and
different foods. Between 1978 and 2004, per capita
nominal gross domestic product increased by 8–9% per
year (15). Income growth has been concentrated among
urban populations, which grew from 20% of China’s
population in 1980 to 40% in 2000 (12). Between 2000
and 2003, average per capita income for the wealthiest
10% of urban households grew at over 15%, relative to
4–5% among rural households; among poorest urban residents, income actually declined (6). Although the greatest
income growth has been concentrated among very wealthy
groups, it is predicted that a mass urban middle class will
continue to grow, creating a new spending force that will
further stimulate the growth of the agro-food industry (16).
Income has also grown among children and young people
in urban areas. It is estimated that in 1999, the approximately 60 million children aged 4–12 years in the largest
cities in China spent around $6.2bn of their own money,
and influenced the spending of their parents and grandparents of around $61bn, giving them a market potential of
around $67bn (17).
Policy drivers behind agro-food industry growth were
implemented following the economic reforms of the late
1970s. Policies in the realm of agriculture, trade, invest-
© 2007 The Author
Journal compilation © 2007 The International Association for the Study of Obesity. obesity reviews 9 (Suppl. 1), 151–161
154
Food advertising and nutrition labelling
C. Hawkes
ment, retailing and the media aimed to shift the food
market away from centralized planning towards a marketorientated economy. These policies stimulated the domestic
agro-food industry and encouraged integration of the
Chinese agro-food industry into the global market (i.e. the
process commonly termed ‘globalization’).
Specific policy drivers affecting each key component of
the food supply chain are described on Fig. 1. Agricultural
growth was directly stimulated by policies that decentralized and privatized agricultural production (15). Unilateral
trade reforms (e.g. reduction of import tariffs, elimination
of the state trading monopoly) enabled the rapid increase of
imports of soybeans and soybean oil in the mid-1990s (8).
Policies on foreign direct investment stimulated the agrofood processing industry both directly by increasing the
amount of investment, and indirectly by stimulating
domestic competition (11). Supermarket growth was carefully and deliberately planned through a series of government policies designed to encourage domestic and foreign
investment since the 1980s, shifts that have also affected
the food-away-from-home sector (12). Policy changes have
also stimulated foreign companies to form strategic partnerships in advertising and the media, including for children’s programming – an important potential advertising
vehicle (18). To compete, the Chinese government ordered
domestic stations to launch more children’s channels which
experts say is ‘potentially the biggest explosion of children’s
channels in any single market the world has ever seen’
(19).
Implications for food consumption
Income growth and urbanization have clearly stimulated
changes in food consumption patterns in China. In a ‘nutrition transition’, as incomes have grown, consumers have
begun to eat more meat, fish, vegetable oils and processed
foods, and fewer basic grains such as rice (6,20,21). This
has led to an increase in dietary energy obtained from fat –
a primary determinant of obesity risk in China (22). By
1997, over a third of all Chinese adults and 60.1% of those
in urban areas already consumed over 30% of their energy
from fat (the maximum level recommended by the World
Health Organization) (23). At a population level (adults),
the average proportion of dietary energy obtained from fat
increased from 9% to 28% between 1989 and 2004 (21).
Experts suggest that decreasing consumption of vegetable
oils and pork products will be critical to reducing dietary
fat intake (21).
Although, overall, per capita consumption of branded,
processed foods remains small in China (24), the creation
of a wealthy urban class and a generation of ‘little emperors
and empresses’ (single children in wealthy and middleclass urban families) has driven significant market growth
obesity reviews
(6,25,26), growth which is predicted to spread as the mass
urban middle class grows. Urban spending on food is predicted to grow by 6.7% annually during the next two
decades, making China one of the fastest-growing food
markets in the world (16). The same trends are likely with
eating out: away-from-home spending on food rose from
8% or urban household food expenditures in 1992 to
nearly 20% in 2004 (6).
Changing food consumption has not simply been a
function of income growth and urbanization. Policy
drivers and associated transformations in the food market
have also played a key role – an observation supported by
econometric analysis (15). Policy changes have directly
facilitated increased fat consumption. Calories available
for consumption from vegetable oils grew from 141 to
218 calories per capita per day between 1989/1991 and
2000/2002. This increase is almost entirely the result of
increased imports, which have been directly encouraged
through more liberal trade policies (27). Imported palm
oil is now used increasingly in partially hydrogenated
form (trans fatty acids) in processed foods. For pork – a
fatty meat widely consumed in China – the elimination of
state procurement quotas and price controls in 1985 led
to a sharp upturn in production, the amount sold in the
market (rather than kept for home consumption), and,
consequently, calorie availability (28,29). Consumption
of vegetable oils, meat and dairy are predicted to
further increase as a result of China’s membership of the
World Trade Organization because of lower prices
(30).
Processed food consumption has been stimulated by
investment in agro-food processing, food retailing and
advertising and promotion. It is notable that Coca-Cola
was the first foreign company to distribute products after
the country was opened to foreign investment, and PepsiCo
soon followed in 1982 (31). Whereas there are numerous
domestic food processors in China, foreign investors dominate the processed foods market (e.g. instant noodles, soft
drinks, snacks, sweet biscuits and fast foods) (11). Supermarkets also play a role by providing a greater variety
of processed foods and running in-store promotions to
encourage consumers to try new products. Advertising and
promotion are increasing the importance of brand loyalty
as a component of food choice in China. Given their spending power and greater tendency to adopt new habits, children and young people are a particular target (17). The
provision of facilities for birthday parties, play areas and
educational activities by fast food chains has encouraged
children to form a cultural identity with fast food (25).
Anecdotal evidence suggests that promotions can be effective. For example, when McDonald’s ran a sales promotion
in 2001 (customers had to buy six meals in order to purchase a toy), sales revenues grew by over RMB 2.3m (31).
Sales of a sour yoghurt drink promoted during the popular
© 2007 The Author
Journal compilation © 2007 The International Association for the Study of Obesity. obesity reviews 9 (Suppl. 1), 151–161
obesity reviews
Food advertising and nutrition labelling
Super Girl television show more than tripled during one
run of the show in 2005 (32).
Aligning the food supply chain with healthy diets
Although growth is very much still underway, the agrofood industry can be counted as one of China’s many
economic success stories. Still, as the agro-food supply
chain has grown, the Chinese consumer has begun to eat
excessive amounts of fat. High-calorie, nutrient-poor processed foods are also emerging as more important in the
urban diet. Combined with inadequate physical activity,
the result is the emergence of obesity as an expanding
health problem. Agro-food industry growth – and the policies that influence this growth – has not therefore been
adequately aligned with the growth of healthy diets. This
situation highlights the need for intervention to bring the
growth of the agro-food industry closer into step with the
development of healthy diets among all Chinese consumers.
The importance of aligning the food supply chain with
healthy diets has already been recognized by the Chinese
authorities. In the report which accompanied the release of
the Survey on the Status of Nutrition and Health of the
Chinese people (October 2004), the government stated that
there was a need to ‘enhance scientific guidance in the fields
of agriculture, food manufacturing, distribution and marketing to make them play more important roles in improving people’s nutrition and health status’ (33). This echoes
calls in the World Health Organizations Global Strategy on
Diet Physical Activity and Health which states that
‘National food and agricultural policies should be consistent with the protection and promotion of public health
. . .’, and that the food industry ‘could become partners
with governments & nongovernmental organizations in
implementing measures aimed at sending positive & consistent messages to . . . encourage healthy eating’ (1).
It is clear from the above analysis that policy changes in
China – and the associated growth of the agro-food indus-
C. Hawkes
155
try – have been a driver of changing food consumption
patterns. It therefore follows that policies could be used to
better align the food supply chain with the promotion of
healthier eating among the Chinese population.
Regulating food marketing and nutrition labelling are
policies that can help align the food supply chain with
healthier diets, and both can be achieved through either
government regulation and/or industry-led intervention.
Figure 1 describes how. First, as the marketing of highcalorie, nutrient-poor foods aims to create demand for
these foods – and create lifetime habits and brand loyalty –
reducing the amount would reduce consumer incentives to
purchase these foods and, importantly, agro-food industry
incentives to produce these foods. Labelling foods with
nutritional information at point-of-sale, meanwhile,
potentially encourages consumers to make healthier food
choices, thereby affecting industry incentives to change
food product composition, such as reducing fat. Such a
regulatory framework can in turn alter the direction of
influence (as depicted by the arrows on Fig. 1), so that the
agro-food industry has a greater incentive to produce and
market healthier foods, as well as consumers to choose
them. The next section analyses the policy options available
to regulate food marketing and nutrition labelling.
Policies to regulate food marketing and
nutrition labelling
Food advertising and promotion and nutrition labelling
can be regulated either by government or industry through
legislation/statutes or guidelines (government) or selfregulation or voluntary initiatives (industry). These are
described in Table 1.
Analysis of policy options for food marketing
to children
Table 2 shows the different policy options available to
regulate food marketing to children and young people. The
Table 1 General policy options to regulate food marketing and nutrition labelling
Authority
Type of regulation
Definition
Government
Statutory regulation
Industry
Government guidelines
Self-regulation
Texts enshrined in laws or statutes, or rules designed to fill in the details of the broad concepts
mandated by legislation
Guidelines issued or implemented by a government or mandated body with no legal backing
Regulation applying to whole industry sectors involving a code of practice and a process for the
establishment, review and application of the code of practice, usually in the form of a ‘self-regulatory
organization’; May be mandated by government framework legislation, but can also exist
independently of government regulation
Voluntary codes and schemes developed by individual food companies (distinct from self-regulation,
since they not industry-wide, and lack an independent process for the establishment, review and
application of the code of practice); may be directly encouraged by government or government
guidelines
Voluntary initiatives
© 2007 The Author
Journal compilation © 2007 The International Association for the Study of Obesity. obesity reviews 9 (Suppl. 1), 151–161
156
Food advertising and nutrition labelling
obesity reviews
C. Hawkes
aims of the policies range from encouraging non-deceptive,
responsible marketing (improving quality) to reducing
exposure to advertising among children (reducing quantity). The aim determines the regulatory strategy adopted,
such as banning the use of false claims, the use of words or
graphics that directly depict excessive consumption, or the
advertising of food altogether.
That these aims vary between different policy options is
clear from existing regulation. A review published by the
World Health Organization in 2004 showed that globally,
a majority of countries have some type of general, ethically
based regulation to prevent advertising from ‘exploiting the
credulity’ of children or ‘bringing them harm’ (i.e. deceptive, irresponsible advertising) (3). Although statutory and
self-regulations coexisted in around 50% of the countries
reviewed, the aim of reducing exposure to advertising was
found only in government-implemented legislation or statutes, usually in the form of a restriction on the time allocated to children’s advertising on television. In Sweden and
Quebec, Canada, where television advertising to children is
banned, and Norway, where advertising is restricted on
certain broadcasters, regulation is government-led.
The review also found that food was not directly affected
by child-specific advertising regulations unless there was a
regulation specific to food and an implementation mechanism. Although 22 countries had a clause on food within
statutory or self-regulations (not including claims made on
foods), these very generally stated that advertising should
not directly promote unhealthy diets, and in only one case
had a clear implementation mechanism. Even in this case –
in the United States – the use of self-regulation meant that
the aim of the regulation was not to reduce the exposure
among children, but to prevent deception and exploitation
of their credulity and limit the use of graphics and words
that directly encourage excessive consumption (34).
Since 2004, statutory and self-regulation have been
increasingly complemented by voluntary initiatives by the
food industry. These are food-specific and do include
measures that would reduce exposure to marketing among
children (35,36). For example, Coca-Cola, Kraft and MasterFoods – all active in China – have developed policies not
to advertise to children under the ages of 12, 6 and 12,
respectively, nor to promote products in primary schools
(36,37). These voluntary initiatives are intended to be
global and have some potential to reduce exposure to
marketing among young children. But they are inherently
limited if they only apply to (a minority) of individual food
companies, not the food industry as a whole, and are not
subject to independent monitoring or enforcement. Two
(disputed) assessments of voluntary initiatives by critics of
the food industry indicate that current industry policies
tend to only apply to younger children, seldom cover all
marketing tactics, and do not limit core marketing practices
to which children are exposed (38,39).
Overall, there has been a trend since 2004 towards
greater regulation of food marketing to children and young
people (40). For the most part, this comprises voluntary
initiatives and self-regulation. The advertising industry has
Table 2 Specific policy options to regulate food marketing to children and young people and aims
Authority
Type of regulation
Aim
Aspect of
marketing
Specific regulatory strategies
applicable to obesity prevention
Government
(i) Statutory regulation
Reduce deception and
exploitation of vulnerability
Comprehensively restrict
exposure on all or
specific medias
Reduce exposure
Quality
Ban false claims about degree of
healthiness of food products
Ban on food marketing across all
medias or any major medias such
as television
Limits in certain places (schools), during
certain times (e.g. during
children’s programming), using certain
techniques (e.g. product
placement), and in certain medias
(e.g. the Internet)
Limits on use of specific graphics or
words that directly encourage
excessive consumption and specific
techniques which children may not
understand (e.g. product placement;
or be particularly vulnerable to (e.g.
use of celebrities)
Combination of (ii) and (iii), but limited
because no clear implementation or
enforcement mechanism
Quantity
Government
and industry
(ii) Statutory regulation;
Self-regulation to a
limited extent
Industry
(iii) Self-regulation
Reduce deception and
exploitation of vulnerability
and encourage responsible
marketing
Quality
Industry
(iv) Voluntary
initiatives
Encourage responsible
marketing and reduce exposure
among young children
Quality and
intensity
Intensity
© 2007 The Author
Journal compilation © 2007 The International Association for the Study of Obesity. obesity reviews 9 (Suppl. 1), 151–161
obesity reviews
Food advertising and nutrition labelling
developed a united front in developing self-regulations specific to food advertising to children, following the Framework For Responsible Food And Beverage Marketing
Communication of the International Chamber of Commerce (2004, revised 2006) (41). As self-regulations, they
have more potential to affect quality than quantity
(Table 2) (34). Government-led statutory regulation to
reduce quantity has been slow to develop. An exception is
the UK, where the government’s communications regulator
(Ofcom) imposed some restrictions on food advertising to
young people in 2006 (42).
Analysis of policy options for nutrition labelling
Specific policies to regulate nutrition labelling and their
aims are listed in Table 3. International guidance in the
area comes from the Codex Alimentarius, the international
food code of the Food and Agricultural Organization of the
United Nations and the World Health Organization. The
Codex states that listing nutrients has to be mandatory only
on foods for which a nutrition claim is made, or if the
food is intended for a special dietary use. This guidance is
reflected in national regulations on nutrition labelling. A
review published by the World Health Organization in
2004 showed that 60% of countries mandated nutrient
labelling only on foods which have a nutrition claim or a
special dietary use (2). The aim of this form of labelling is
to provide information to support claims made on the
label.
Just 13% of countries went beyond Codex in mandating
a nutrient list on all packaged foods. Mandatory labelling
has the additional aim of providing an incentive for food
companies to change their product content (because they
want to avoid labelling high quantities of nutrients consumers would rather avoid). This is more relevant to
obesity prevention as it potentially affects the nutritional
content of foods consumed by the whole population. Mandatory labelling of trans fats provides an interesting
example. In 2006, the United States implemented new rules
requiring food companies to list trans fat content on the
C. Hawkes
157
nutrition label. As a result, the majority of food companies
have made efforts to eliminate or reduce the amount of
trans fatty acids in their foods. Likewise in Canada, mandatory trans fatty acid labelling was implemented in
December 2005; limited evidence suggests that the intake
of trans fats has declined since that time (43). In contrast to
this mandatory approach, voluntary labelling creates no
such incentive because food companies can decide which
foods they want and do not want to label and which
nutrients to list.
Nutrition labels, whether mandatory and voluntary,
have a key limitation from an obesity prevention perspective: they tend to be far more widely used by more educated
consumers already aware of nutritional concerns (2).
Moreover, research conducted in Europe and the United
States suggests that while many people read and value
nutrition labels, consumers often find the numerical information provided difficult to interpret, especially people
with poor literacy and numerical skills (44,45).
One proposed solution that explicitly aims to directly
encourage consumers to choose healthier foods is so-called
‘front-of-pack’ nutrition labelling, in which the numerical
information on the back of the food package is interpreted
graphically on the front with an easy-to-understand
symbol. Front-of-pack schemes, which can be implemented
through government legislation, government guidelines or
voluntary industry initiatives, are becoming more widespread in Europe, North America and Australia and New
Zealand (46). For example, the United Kingdom’s government food regulator (the Food Standards Agency) now
recommends that food manufacturers and retailers adopt
a ‘traffic light’ scheme to help consumers easily identify
foods high in fat, sugar and salt (47). Companies have also
responded with voluntary initiatives. Kraft and PepsiCo
have developed voluntary labelling initiatives (‘Sensible
Solutions’ and ‘Smart Spot’) to help guide consumers to
‘better-for-you’ foods. The supermarket Carrefour – an
important market player in China – has also developed a
nutrition labelling scheme for its own-brand products in
France. This represents a shift away from the aim of nutri-
Table 3 Specific policy options to regulate nutrition labelling and aims
Authority
Policy type
Specific regulation
Aim
Government
Legislation/statute
Mandatory nutrient list on foods with
nutrient claims or with special dietary uses
Mandatory labelling on all packaged foods
Industry
Legislation/statute or
government guidelines
Voluntary initiatives
Graphic front-of-pack
nutrition symbols
Nutrient list on selected foods
Graphic front-of-pack nutrition symbols
Provision of information to back up claims made and
to assist people with special dietary needs
Provision of information and incentive for food
industry to amend products
To directly encourage consumers to choose
healthier foods
Provision of information
To directly encourage consumers to choose
healthier foods
© 2007 The Author
Journal compilation © 2007 The International Association for the Study of Obesity. obesity reviews 9 (Suppl. 1), 151–161
158
Food advertising and nutrition labelling
obesity reviews
C. Hawkes
tion labelling only as a provider of information, towards
the aim of actively promoting healthier food choices. A key
question concerning this policy option is whether government action or voluntary industry initiatives are more
appropriate. While government guidance may stifle innovation, the use of different symbols by different food companies (backed up by different nutritional criteria) could
well confuse consumers.
Policy options for China
Regulating food marketing and nutrition labelling are policies that can potentially help realign the Chinese food
supply chain towards healthier diets. But which options
could or should be applied in China?
As always, there are many considerations that need to be
taken into account when evaluating policy options. Four
considerations are particularly important in the China
context. First is the phenomenal growth of the agro-food
industry. The agro-food industry is growing through both
demand and supply side drivers to provide more food to
more people. This is counter to one of the aims of regulating food marketing and labelling: to encourage consumers
to eat less of certain foods (in this case, high-fat foods). As
found in the United States, dietary guidance to ‘eat less’
tends to be politically unpopular with the agro-food industry (48). But the fact that the industry, and the mass market
for processed foods, are still growing, indicates that taking
action now will be more effective than waiting until later
for the tide to turn completely.
Second is the consideration of the culture of regulation.
China is a country that, despite its shift to a market
economy, has a tradition of government-led regulation and
is still strongly guided by state intervention. Third is consideration of the existing regulatory environment on food
marketing to children and young people and nutrition
labelling. Current regulations in China are described in
Box 1; none are specifically targeted at obesity prevention.
Concern about advertising targeted at children does,
however, appear to be on the rise. A survey carried out in
2001/2002 of 1665 parents in three major Chinese cities
indicated that parents are dissatisfied with child-targeted
advertising on the basis that it is biased and does not tell the
truth (17). In March 2006, a delegate to the National
People’s Congress tabled a bill before the Chinese parliament which would ban the use of children under the age of
12 years from appearing in advertising and would restrict
advertising directed at children under the age of 13 years
(49). There is also a reported increase interest in nutrition
labelling.
Fourth is a consideration applicable in any country: the
nature of the policy options themselves (Tables 2 and 3).
Analysis in this paper shows that only some of the options
are likely to be effective for obesity prevention, i.e. market-
Box 1
Current regulation of food advertising and nutrition
labelling in China
Food advertising
Advertising is regulated through the Advertising Law
(1994, implemented 1995), which states that ‘advertisements shall not impair the physical and mental health of
minors’ (52). The law is monitored and enforced by the
State Administration of Industry and Commerce.
Beyond this, there are no regulations specific to children
or diet.
There have been many cases of illegal advertisements in
China, including false claims made in food advertising
targeted at children (17). In part to help reduce this
problem, the State Food and Drug Administration
(SFDA) issued Interim Rules for Health Food Advertisement Reviewing (2005) which imposes stricter rules on
the advertisements of health foods, e.g. they must not
indicate that they have curative effects (53). There are
also laws restricting specific advertising techniques (e.g.
comparative advertising and news-format advertising),
and on advertising socially sensitive products, including
tobacco and alcohol (54).
Self-regulation does exist in nominal form through the
China Advertising Association, an organization linked
with the state which has some self-regulatory guidelines
stating that children’s advertising should be beneficial to
their mental and physical health (17).
Nutrition labelling
Nutrition labelling in China is regulated through an
adaptation of the Codex standard: the National Standard for Special Nutrient Food Labelling (GB134322003), which requires nutrients to be listed on foods
with a nutrient claim or with special dietary uses (55).
No further mandatory labelling is required.
ing regulations specific to food that aim to reduce exposure
among children and young people rather just simply reducing deception and improving quality and nutrition labelling
that actively aims to promote healthier diets rather than
simply provide information. It also shows that government
legislation and guidance is needed in order to stimulate
effective, industry-wide change, but there is space for selfregulation and voluntary initiatives to achieve complementary aims.
These considerations lead to key policy implications.
First, action is needed now to regulate food marketing to
children and young people and nutrition labelling. Second,
© 2007 The Author
Journal compilation © 2007 The International Association for the Study of Obesity. obesity reviews 9 (Suppl. 1), 151–161
obesity reviews
this action should aim to actively promote healthier diets
and reduce exposure to negative dietary influences, rather
than just prevent deception or provide information. Third,
government needs to spearhead this action by developing
legislation and regulations and providing strong incentives
for self-regulation and voluntary initiatives by the industry.
The culture of regulation in China implies that government
is in a position to take a strong hand, especially given
their past and ongoing action to regulate the advertising
sector (Box 1). Fourth, threat of government action and the
declining popularity of marketing methods among parents
create an incentive for the agro-food industry to adopt
voluntary initiatives which can complement government
action. Both government regulation and self-regulatory and
voluntary industry initiatives are needed to align the food
supply chain more closely with healthier diets.
Conclusion
To conclude, the time is ripe for China to join the global
trend towards greater regulation of food marketing to children and young people and nutrition labelling to tackle
obesity. These policies have their limitations. Most notably
in the Chinese context, products high in fat, such as pork
and vegetable oils, are unlikely to be significantly affected
by policies that dominantly affect processed foods. Thus, to
align the agro-food supply chain with healthier diets, regulating food marketing and nutrition labelling would need to
be accompanied by actions throughout agro-food industry
supply chain.
Policies would also need to be carefully designed for
the China context. For example, research conducted in
Taiwan, China suggests that adolescents do not understand
the information provided on nutrition labels and seldom
read them (50). Thus, action on nutrition labelling would
need to be accompanied by an education campaign to
promote their use and understanding. Another study found
that consumption of processed potatoes (e.g. French fries
and crisps) was not influenced by television advertising, but
in-store displays promotions were likely to have played a
role (51). Thus regulation of marketing should focus on the
retail industry as well as the advertising industry.
Overall, government intervention is needed now to
create a framework for positive industry action and better
align the growing agro-food supply chain with healthy diets
to help tackle growing obesity in China. Lack of earlier
action in Europe and North America is a warning of what
will happen if action is not taken soon. China also has the
benefit of being able to learn from the experience of the
different policy options implemented elsewhere in selecting
effective strategies to regulate food marketing and nutrition
labelling. Given China’s unique characteristics and position
in the world today, there is an opportunity for the government and the agro-food industry to lead the world by
Food advertising and nutrition labelling
C. Hawkes
159
creating a balanced, health-promoting model of complementary legislation and industry action.
Acknowledgements
The author would like to thank Madam Chunming Chen
and Professor Philip James for inviting her to Beijing to
present this paper.
Conflict of Interest Statement
C.H. declares no conflict of interest.
References
1. WHO. Global Strategy on Diet, Physical Activity and Health.
World Health Organization: Geneva, 2004.
2. Hawkes C. Nutrition Labels and Health Claims: The Global
Regulatory Environment. WHO: Geneva, 2004.
3. Hawkes C. Marketing Food to Children: the Global Regulatory
Environment. WHO: Geneva, 2004.
4. FAOSTAT. Data Archives > Production > Livestock Primary.
[WWW document]. URL http://faostatfaoorg/site/410/defaultaspx
(accessed August 2005).
5. FAOSTAT. Data Archives > Production > Crops Primary.
[WWW document]. URL http://faostatfaoorg/site/408/defaultaspx
(accessed August 2005).
6. Gale F, Huang K. Demand for Food Quantity and Quality in
China. Economic Research Service Report Number 32. United
States Department of Agriculture: Washington DC, 2007.
7. FAOSTAT. TradeSTAT Detailed Trade Data. [WWW document]. URL http://faostatfaoorg/site/534/defaultaspx (accessed
April 2007).
8. Tuan FC, Fang C, Cao Z. China’s Soybean Imports Expected to
Grow Despite Short-Term Disruptions: Outlook Report OCS2004-04J-01. United States Department of Agriculture, Washington DC, 2004.
9. Hawkes C. The role of foreign direct investment in the nutrition
transition. Public Health Nutr 2005; 8: 357–365.
10. van Tongeren F, Huang J. China’s Food Economy in the Early
21st Century. Agricultural Economics Research Institute (LEI):
The Hague, 2004.
11. Wei A, Cacho K. Competition among foreign and Chinese
agro-food enterprises in the process of globalization. Int Food
Agribusiness Manage Review 1999; 2: 437–451.
12. Hu D, Reardon T, Rozelle S, Timmer PWH. The emergence of
supermarkets with Chinese characteristics: challenges and opportunities for China’s agricultural development. Dev Policy Rev
2004; 22: 557–586.
13. Mei Y. China, Peoples Republic of HRI Food Service Sector.
Mainland China HRI sector Annual Report 2006. GAIN Report
Number: CH6402. United States Department of Agriculture
Foreign Agricultural Service: Washington DC, 2006.
14. Datamonitor. Advertising in China: Industry Profile. Datamonitor: London, 2006.
15. Dong F, Fuller F. Changing Diets in China’s Cities: Empirical
Fact or Urban Legend? Working Paper 06-WP 437. Center
for Agricultural and Rural Development (CARD), Iowa State
University: Ames, IA, 2006.
16. Farrell D, Gersch UA, Stephenson E. The Value of China’s
Emerging Middle Class. McKinsey Quarterly. 2006 Special
Edition.
© 2007 The Author
Journal compilation © 2007 The International Association for the Study of Obesity. obesity reviews 9 (Suppl. 1), 151–161
160
Food advertising and nutrition labelling
C. Hawkes
17. Chan K, McNeal JU. Parental concern about television
viewing and children’s advertising in China. Int J Public Opin Res
2003; 15: 151–166.
18. Anon. Foreign media firms allowed one production venture.
Business Daily Update [18 April 2005] 2005; Accessed through
Lexis-Nexis.
19. Harney A, Wang F. Beijing calls for more cartoons and children’s shows on TV. Financial Times (London) Asia Edition 1 [13
August 2005 ] 2005; Accessed through Lexis-Nexis.
20. Du S, Mroz TA, Zhai F, Pop Popkin BM. Rapid income growth
adversely affects diet quality in China – particularly for the poor!
Social Science and Medicine. 2004; 59: 1505–1515.
21. Zhai F, Wang H, Du S, He Y, Ge K, Popkin BM. Lifespan
nutrition and changing socio-economic conditions in China. Asia
Pac J Clin Nutr 2007; 16: 374–382.
22. Chen C, Zhao W, Yang Z, Zhai Y, Wu Y, Kong L. The role of
dietary factors in chronic disease control in China. Chin J Epidemiol 2006; 27: 739–743.
23. Du S, Lu B, Zhai F, Popkin BM. A new stage of the nutrition
transition in China. Public Health Nutr 2002; 5: 169–174.
24. Adair LS, Popkin BM. Are child eating patterns being transformed globally? Obes Res 2005; 13: 1281–1299.
25. Watson JL. Golden Arches East: Mcdonald’s in East Asia.
Stanford University Press: Stanford, CA, 1997.
26. Lozado EP. Globalized childhood? Kentucky Fried Chicken in
Beijing. In: Jun J. (ed.). Feeding China’s Little Emperors. Stanford
University Press: California, 2000, pp. 114–134.
27. Hawkes C. Uneven dietary development: linking the policies
and processes of globalization with the nutrition transition, obesity
and diet-related chronic diseases. Global Health 2006; 2: 4.
28. Fang C, Fuller F. Feed-Grain Consumption by Traditional
Pork-Producing Households in China: Working Paper 98-WP
203. Center for Agricultural and Rural Development, Iowa State
University: Ames, IA, 1998.
29. Hawkes C. Promoting Healthy Diets and Tackling Obesity
and Diet-Related Chronic Diseases: What are the agricultural
policy levers? Food Nutr Bull 2007; 28(Suppl.): 312–322.
30. Fuller F, Beghin J, De Cara S, Fabiosa J, Fang C, Matthey H.
China’s accession to the WTO: what is at stake for agricultural
markets? Rev Agric Econ 2003; 25: 399–414.
31. Hawkes C. Marketing activities of global soft drink and fast
food companies in emerging markets: a review. In: Globalization,
Diets and Noncommunicable Diseases. WHO: Geneva, 2002.
[WWW document]. URL Whqlibdoc.Who.Int/Publications/
9241590416.Pdf. (accessed August 2006).
32. St-Maurice I, Wu C. Understanding China’s Teen Consumers.
McKinsey Quarterly. Special Edition.
33. State Council Information Office. Material for the Press Conference of the State Council Information Office. The Nutrition and
Health Status of the Chinese People 12-10-2004, 2004.
34. Hawkes C. Self-regulation of food advertising: what it can,
could and cannot do to discourage unhealthy eating habits among
children. Nutr Bull 2005; 30: 374–382.
35. Lang T, Rayner G, Kaelin E. The Food Industry, Diet, Physical Activity and Health: A Review of Reported Commitments and
Practice of 25 of the World’s Largest Food Companies. City University: London. [WWW document]. URL http://www.city.ac.uk/
press/The%20Food%20Industry%20Diet%20Physical%20
Activity%20and%20Health.pdf (accessed August 2006).
36. CIAA. CIAA Commitments for 2006 to drive action within
the framework of the EU Platform for action on Diet, Physical
Activity and Health. [WWW document]. URL http://www.ciaa.be/
documents/positions/CIAA_Commitments_EU_Platform_Diet_
Physical_Activity_Health.pdf (accessed March 2006).
obesity reviews
37. Wiggins J. Mars to axe child-targeted adverts. Financial Times
(London), 5 February 2007, p. 1.
38. Which? Food Fables: Exploding Industry Myths on Responsible Food Marketing to Kids. Which?: London, 2006.
39. Lewin A, Lindstrom L, Nestle M. Food industry promises to
address childhood obesity: preliminary evaluation. J Public Health
Policy 2006; 27: 327–348.
40. Hawkes C. Regulating food marketing to young people worldwide: trends and policy drivers. Am J Public Health 2007; 97:
1962–1973.
41. International Chamber of Commerce. ICC Framework for
Responsible Food and Beverage Marketing Communication.
[WWW document]. URL http://www.iccwboorg/uploadedFiles/
ICC/Policy_pages/332%20FINAL_Framework_Food_and_
Beveragepdf (accessed January 2006).
42. Ofcom. Television Advertising of Food and Drink Products to
Children: Statement and Further Consultation. Ofcom: London.
[WWW document]. URL http://www.ofcom.org.uk/consult/
condocs/foodads_new/foodads3.pdf
(accessed
November
2006).
43. Friesen R, Innis SM. Transfatty acids in human milk in
Canada declined with the introduction of trans fat food labelling.
J Nutr 2006; 136: 2558–2561.
44. Cowburn G, Stockley L. Consumer understanding and use of
nutrition labelling: a systematic review. Public Health Nutr 2005;
8: 21–28.
45. Rothman RL, Housman R, Weiss H, Davis D, Gregory R,
Gebretsadik T, Shintani A, Elasy TA. Patient understanding of
food labels: the role of literacy and numeracy. Am J Prev Med
2006; 31: 391–398.
46. Stockley L. Review of ‘front of pack’ nutrition schemes. European Heart Network: Brussels, 2006.
47. Food Standards Agency. Board agrees principles for front
of pack labelling [News Release March 9 2006]. [WWW document]. URL http://www.food.gov.uk/news/newsarchive/2006/mar/
signpostnewsmarch (accessed April 2007).
48. Nestle M. Food lobbies, the food pyramid, and U.S. nutrition
policy. Int J Health Serv 1993; 23: 483–496.
49. World Federation of Advertisers. Chinese bill tabled to
ban use of children in ads and to restrict advertising to children.
[News release March 6 2006]. [WWW document]. URL http://
www.fanet.org/news/article_detailasp?Lib_ID=1679
(accessed
April 2007).
50. Wei L, ChingHua L. Food and nutrition labeling, attitudes,
and related purchasing practices of Taiwanese adolescents. Nutr
Sci J 2005; 31: 43–53.
51. Curtis KR, McCluskey JJ, Wahl TI. Westernization in China:
a case study in processed potatoes. WCC-101 Agribusiness and
Food Marketing in China. Proceedings of WCC-101, April 17–18,
2003, Portland, Orgeon Washington State University: Seattle,
2003, pp 81–96.
52. Advertisement Law of The People’s Republic of China.
[WWW document]. URL http://www.novexcn.com/advert_law_
95.html (accessed April 2007).
53. China to ban uncensored food ads [news report 13 June
2005]. Xinhua Economic News Service. Accessed through LexisNexis.
54. Gao Z. Harmonious regional advertising regulation: a comparative examination of government advertising regulation in
China, Hong Kong and Taiwan. J Adv 2005; 34: 75–87.
55. Branson A, Bugang W. China, Peoples Republic of FAIRS
Product Specific. GB13432-2003 Special Nutrient Food Labeling
G/TBT/N/CHN/34 2004. GAIN Report Number: CH4027. Washington DC. [WWW document]. URL http://www.fas.usda.gov/
© 2007 The Author
Journal compilation © 2007 The International Association for the Study of Obesity. obesity reviews 9 (Suppl. 1), 151–161
obesity reviews
gainfiles/200502/146118826.pdf. (accessed April 2007). United
States Department of Agriculture Foreign Agricultural Service,
2004.
56. Bean R. China, Peoples Republic of Retail Food Sector. All
China Retail Annual Report 2006. GAIN Report Number:
CH6804. United States Department of Agriculture Foreign Agricultural Service: Washington DC, 2006.
57. Mai L. FDI in China’s agro-processing sector. The Agro-Food
Processing sector in China: Developments and Policy Challenges.
Food advertising and nutrition labelling
C. Hawkes
161
Organisation for Economic Co-Operation and Development:
Paris, 2000, pp. 99–109.
58. Bolling C, Somwaru A, Crook FUS. Foreign direct investment
in China’s processed food industry. WCC-101 Chinese Agriculture
and the WTO: Proceedings of WCC-101, December 2–3 1999.
Washington State University: Seattle, 1999, pp. 78–87.
59. Anonymous. China’s media open for investment. Sunday
Business Post [5 December 2004] 2004; Accessed through
Lexis-Nexis.
© 2007 The Author
Journal compilation © 2007 The International Association for the Study of Obesity. obesity reviews 9 (Suppl. 1), 151–161