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My view of the fast food industry and obesity is that the Fast Food Industry affects the health of all Canadians. Consumers should be educated enough to know what products to buy, producers are not to blame. Producers in the fast food industry make inexpensive and unhealthy food with almost no nutrients this creates a large market with much to profit from, as consumers we are aware in current society what is put in these foods and how they are harmful to us. People cannot put the blame the fast food industry but only blame themselves for unhealthy choices.
Attached is the paper outline and the topic you need to write on.
Attached also are 4 PDF documents about obesity and will need to refrence the articles in the research paper and use them to exlpain your position toward the fast food industry and state that its the consumers to blame, not to fast food producers.
A good resource to also keep in mind (if you have seent he movie) Super Size me, to give a better understanding of the health defects these foods cause.
MLA Formatting
The research paper should be a persuasive, logical, and well-organized argument, using quotations and examples from the text to support your claims and incorporating secondary sources. From one of the topics that are listed, you will need to develop an original and focused thesis statement.
The process approach to this paper (choosing a topic, having a prospectus and annotated bibliography, and doing two rounds of peer editing) not only gives you extra in-class grades for work you’ll have to do in writing the paper anyway, but it also ensures that you have plenty of time for revision and plenty of help in preparing the paper. This process should ensure you submit your best writing on the topic. During this time, you can also consult with your instructor or get help from librarians and other resources at Grant MacEwan University.
Instructions
Due: November 28th
1. The research paper should be 1250–1750 typed words (approx. 5–7 pages, double-spaced) in length, excluding the works cited page, and the endnotes page (if you choose to have one), and should follow MLA format.
2. You must cite
at least four sources in your paper. Your argument should not repeat the argument in any one of these sources, but should instead use particular points these critics make, either as support for points in your argument or to contradict what they say. (To find at least four sources you can use, you will likely need to look up many more than four in the library since some may be of limited value or not have material related to your topic). Of the sources you use, at least two must be authoritative (from a journal article or scholarly book as opposed to a magazine article or web site). You can use sources we looked at in class, but you must have also at least three that we did not look at in class. The point of this paper is for you to engage in the critical debate already going on about the topic so the more authoritative sources you can incorporate, the better.
Topic:
Topic 3
Develop your ideas about the fast food industry into a focused thesis statement and argue to support that thesis. Your viewpoint on the topic may change and develop as you do research. Here are just a couple of examples (among many possibilities) of ways you could choose to focus your topic:
· The fast food industry should/should not be held legally responsible for the health problems of its patrons.
· The government should make policy changes to protect people from the detrimental effects of fast food, including…
The topic I am choosing for MWA 4 is the Fast Food Industry and how it affects the health of all Canadians and if the producers or the consumers are truly to blame. Producers in the fast food industry make inexpensive and unhealthy food with almost no nutrients this creates a large market with much to profit from. Fast food companies profit from parents of young children, people who have no time to cook, or a consumer only being able to afford fast food. People cannot put the blame the fast food industry but only blame themselves for unhealthy choices. Parents with children suffering with obesity from feeding them fast food products should be knowledgeable enough what they are feeding their kids and if it has the nutritional standards for a growing child. Adults are able to make their own choices when it comes to what they consume on a daily basis. They are many inexpensive ways to cook a healthy meal which may take a little more time to prep compared to going through a quick drive through. Today’s people use lack of time as an excuse of why they are eating these toxic foods which lead to health problems in the future. People don’t want to blame themselves for being overweight or unhealthy so they directly go to the source; the fast food company. These fast food producers are not forcing anyone to eat their products. Yes, they use enabling advertisement but as an individual you must realize there are not positive outcomes from eating these sorts of foods and to make healthy choices instead.
Annotated Bibliography
Bakir, A. “The Ethics of Food Advertising Targeted toward Children: Parental Viewpoint” Journal of Business Ethics , Vol. 91, No. 2 (Jan., 2010), pp. 299-311
This source will help the better understanding of advertisement targeted toward children and as to why parents should teach their children healthy ways as they are they eyes for the child or teach them portion control to prevent childhood obesity.
Raghunathan , R. “The Unhealthy = Tasty Intuition and Its Effects on Taste Inferences, Enjoyment, and Choice of Food Products.” Journal of Marketing, Vol. 70, No. 4 (Oct., 2006), pp. 170-184
People have a predisposed assumption in their minds that healthy food does not and cannot taste good. These assumptions come from lack of education in the food industry and what’s out there for alternative that might seem very minuscule but yet can have a great long term effect on a person’s health. It’s the concept of mind over matter. When it comes to taking your time to do research you will benefit and find what health conscious is and what’s not. Producers want their consumers to be lazy and just take the easy way out which long term wont be the easy way back to your healthy self.
Robinson, M. “Combating Obesity in the Courts: Will Lawsuits against McDonald’s Work?” Journal of Public Policy & Marketing , Vol. 24, No. 2 (Fall, 2005), pp. 299-306
This source will help bring my point across that if we are aware of these fast food industries putting harmful foods on their menus it’s our decision to consume these products or not. These companies are out to make addicting food to make a profit not to purposely make the waist line of society rise. Everyone is their own judge and shouldn’t have to put blame on these companies.
Sallis, J. “Physical Activity and Food Environments: Solutions to the Obesity Epidemic”
The Milbank Quarterly , Vol. 87, No. 1 (Mar., 2009), pp. 123-154
Consumers can be diligent and stay away from fast foods if they do not like the health consequences that come from ingesting it. Also physical activity is one aspect that people need to pay more attention too, not only is it important to eat healthy on a regular basis but to stay physical active. Keeping in shape will help your body digest fast foods if one does consume them once in a while. The epidemic between obesity and food is focused on while physical activity and obesity are over looked and is likely more important to help with obesity.
The Ethics of Food Advertising Targeted
Toward Children: Parental Viewpoint
Aysen Bakir
Scott J. Vitell
ABSTRACT. The children’s market has become signif-
icantly more important to marketers in recent years. They
have been spending increasing amounts on advertising,
particularly of food and beverages, to reach this segment.
At the same time, there is a critical debate among parents,
government agencies, and industry experts as to the ethics
of food advertising practices aimed toward chil
dren.
The present study examines parents’ ethical views of
food advertising targeting children. Findings indicate that
parents’ beliefs concerning at least some dimensions of
moral intensity are significantly related to their ethical
judgments and behavioral intentions of food advertis
ing
targeting children as well as the perceived moral intensity
of the situation.
KEY WORDS: parents, children, ethics, food advertis-
ing
The children’s market has become significantly
important to marketers (McNeal, 1998). Many mar-
keters spend millions of dollars on advertising to reach
this growing segment (Jardine and Wentz,
2005).
More specifically, food and beverage companies in the
USA spend an estimated US $10–12 billion targeting
children and adolescents (McKay, 2005). According
to the Kaiser Family Foundation, children are exposed
to more than 7,600 commercials on candy, cereal, and
fast food in any given year (Kotz, 2007).
The effects of advertising on children have been
highly debated among various groups, including par-
ents, researchers, industry experts, and government
agencies. One of the primary debates has been the
potential impact of food advertising directed at chil-
dren. A variety of institutions are involved in this
debate. Some of these organizations such as public
advocacy groups criticize the food companies and
television networks concerning the increased amounts
spent as well as the types of promotional efforts targeted
at children (York, 2007). Furthermore, statistics pro-
vide substantial concern about obesity, showing that
approximately 50% of elementary-school children and
80% of teenagers will battle obesity during their life-
time.
There is also debate among practitioners on
advertising practices directed at children, with even
marketing professionals indicating concern about
advertising targeted at children. When interviewed,
35% of them consider the general ethical and moral
standards in the industry to be ‘‘lower than in the
past,’’ with 40% believing that these standards are
about the same (Grimm, 2004). Thus, only 25%
believe the standards are improved.
Some companies have already started taking
actions to deal with criticisms and even with gov-
ernment warning. In Europe, soft-drink companies
have developed self-regulatory measures to stop
advertising junk food and to help tackle child
obesity. To avoid stricter laws, soft-drink companies
have pledged to stop marketing towards
children
under 12 years old. The companies also have
pledged to limit soft-drink sales at schools (Wentz,
2005). Other countries in Europe, however, have
been taking an even stricter stance on regulations;
for example, starting in 2005, Ireland introduced a
ban on celebrities who appear in food and bever-
ages targeted at children (Jardine
and Wentz, 2004).
Furthermore, some companies have also responded
to government calls by promoting active lifestyles
when targeting children in food ads. McDonald’s, in
the UK, ran a campaign that featured Ronald
McDonald and used animated fruit and vegetable
characters which were called Yums. These characters
urged children to eat right and stay active (Jardine
and Wentz, 2004).
Given all these statistics showing the potential
impact of food advertising targeting children, parents
Journal of Business Ethics (2010) 91:299–311 � Springer 2009
DOI 10.1007/s10551-009-0084-2
are concerned over whether or not marketers have
been conducting ethical practices in promoting their
products. However, this issue has not received sig-
nificant attention in the marketing literature. This
paper attempts to fill this apparent gap by examining
parents’ ethical views of food advertising targeted at
children. In doing so, it also examines the potential
impact of parents’ attitudes toward food advertising
and toward the use of nutrition information on their
ethical judgments and behavioral intentions.
Marketing ethics and advertising
to children
Advertising to children has long been one of the most
controversial areas of marketing. The debate ranges
from whether or not it is even ethical to advertise to
children and includes the types of advertising practices
that might be considered ethical. At the center of this
debate is food advertising targeted at children. The
impact of advertising to children has been shown in
previous studies (Goldberg and Gorn, 1974; Gorn and
Goldberg, 1977). Findings include the fact that
low-income children exposed to a commercial just
once had favorable attitudes towards the advertised
product (Gorn and Goldberg, 1977). Furthermore,
these authors found that exposure to television ads
among 5- and 6-year-old children directly influenced
breakfast food and snack preferences (Goldberg et al.,
1978). Finally, exposure to advertisements has also
been shown to influence the frequency of snacking
among children (Bolton, 1983).
Advertising has been criticized for promoting
materialism, persuading individuals to buy things
they do not need, and providing false or misleading
information (Pollay and Mittal, 1993). Parents’
concerns toward the impact of advertising directed at
children have risen significantly in the last decade
(Hudson et al., 2008). These concerns have also
been expressed by academicians (Moore, 2004).
However, only a limited number of studies have
examined ethical issues aimed at the children’s seg-
ment (Ahuja et al., 2001; Hudson et al., 2008).
Despite these increased concerns and the ensuing
debate, parents’ ethical views of food advertising
targeting children have not been examined in the
marketing literature.
Ethical judgments and behavioral intentions
Understanding how parents view and make deci-
sions about ethical issues targeted at children is
important to marketers. Several factors might influ-
ence ethical decision-making, including situational
factors (Hunt and Vitell, 1986) and individual dif-
ferences (Hunt and Vitellm, 1986; Jones, 1991).
Ethical (or unethical) behavior is influenced directly
by the ethical judgments and behavioral intentions of
the individuals. An individual’s ethical judgment is
defined as ‘‘the degree to which he or she considers a
particular behavior morally acceptable’’ (Bass et al.,
1999, p. 189). Ethical judgments have been con-
sidered a central construct in several ethical decision-
making models (Dubinsky and Loken, 1989; Hunt
and Vitell, 1986; Jones, 1991).
These decision-making theories provide an
understanding of how an individual’s behavioral
intentions and ethical judgments are relevant to
making decisions in situations involving ethical
issues; for example, the theory of reasoned action
suggests that individuals act in a manner consistent
with their attitudes. On the other hand, other fac-
tors might cause individuals to develop behavioral
intentions that might be inconsistent with their
attitudes (Fishbein and Ajzen, 1975). Past research
has also shown that individuals are more likely to
state their behavioral intentions if they perceive the
situation as ethical (Bass et al., 1999). Furthermore,
Hunt and Vitell (1986, p. 9) defined behavioral
intentions as ‘‘the likelihood that any particular
alternative will be chosen.’’ The authors also suggest
that ethical judgments would impact the
individual
behavior through behavioral intentions. Overall,
ethical judgments and behavioral intentions are
important constructs to gain insights regarding
advertising directed at
children.
Attitude toward food advertising
As noted, research examining parents’ attitudes
toward advertising, particularly to food advertising,
directed at children is limited. Past studies examined
the relationship between family communication
patterns and parental reactions toward advertising
(Rose et al., 1998), and parental involvement
300 Aysen Bakir and Scott J. Vitell
and authoritative parenting and attitude toward
advertising (Carlson and Grossbart, 1988). Only one
study examined the relationship between attitude
toward food advertising and parental styles (Crosby
and Grossbart, 1984). The authors found differences
regarding attitudes toward food advertising based
upon parental styles, with more authoritative parents
being more concerned about children’s food adver-
tising as compared with more permissive parents.
Governments and health advocates in different
countries are trying to introduce stricter regulations
on food advertising targeting children since they
blame marketers for increased levels of childhood
obesity. In France, food marketers are faced with
choosing between paying a 1.5% tax on their ad
budgets to fund healthy-eating messages or else
adding a health message to commercials. In Canada,
one-third of children between 2 and 11 years old
are overweight and some marketers are promoting
healthy lifestyles for children. Given the different
proportions of childhood obesity problems from
one county to the next, multinational food mar-
keters such as McDonald’s now have differing
strategies in each country based on how they must
undertake this global challenge (Jardine and Wentz,
2005).
Clearly, advertisers have been questioned about
their ethical standards. Although there is increased
discussion among parents regarding the potential
impact of advertising and concern about how
ethical (or unethical) advertising practices are
towards children, this issue has not been ade-
quately researched. Since the relationship
between parents’ attitude toward food advertising
and ethical judgments and behavioral intentions
of the advertising tactics targeted at children has
not been examined in the marketing literature,
this study focuses on those parental perspectives.
Therefore, based upon the previous discussion, it
is hypothesized that:
H1: Parents’ attitude toward food advertising will
be positively related to their ethical judg-
ments of the food advertising targeted at
children.
H2: Parents’ attitude toward food advertising will
be positively related to their behavioral inten-
tions of the food advertising targeted at chil-
dren.
Attitude toward use of nutrition information
Concerns about children’s nutrition include multiple
factors. Some of these concerns are centered on
nutrition deficiencies in children’s diets due to
economic factors, poor eating habits, and inadequate
nutritional knowledge of parents. The government
has taken several steps to deal with children’s
nutrition problems by being involved in school
lunch programs, regulation of children’s advertising,
and nutrition education in schools (Crosby et al.,
1982). Research has also shown the positive impact
of parental influence and nutrition education
(Grossbart et al., 1982).
Parents’ attitudes toward the use of nutrition vary
from one parent to the other. Furthermore, parents,
particularly mothers, wield a significant impact on
children’s consumption of a balanced diet and
exposure to a variety of foods. Previous research has
shown that mothers who endorsed nutrition infor-
mation had more positive attitudes toward nutrition
and expressed more concerns about food advertising
targeted at children (Crosby et al., 1982). Therefore,
it is further hypothesized that:
H3:
Parents’ attitude toward the use of nutrition
information will be positively related to their
ethical judgments of the food advertising tar-
geted at children.
H4: Parents’ attitude toward the use of nutrition
information will be positively related to their
behavioral intentions of the food advertising
targeted at children.
Moral intensity
Jones (1991) defines moral intensity as ‘‘the extent
of issue-related moral imperative in a situation’’
(p. 372). Furthermore, he suggests that ethics-related
contexts vary with their level of moral intensity.
Jones (1991) identified six categories (magnitude
of consequences, probability of effect, temporal
immediacy, concentration of effect, proximity, and
social consensus) of the moral intensity construct.
The first four items refer to the various dimensions
of harm the action might cause. More specifically,
magnitude of consequences refers to the cumulative
The Ethics of Food Advertising Targeted Toward Children 301
harm (or lack thereof) the action might cause.
Probability of effect refers to the likelihood that the
action will cause harm (or lack thereof). Temporal
immediacy refers to ‘‘the length of time between the
present and the onset of consequences of the moral
act in question (shorter length of time implies greater
immediacy)’’ (Jones, 1991, p. 376). The concentra-
tion of effect refers to the number of people who
would believe that the action would cause harm (or
lack thereof). Proximity is the ‘‘feeling of nearness
(social, cultural, psychological, or physical)’’ (Jones,
1991, p. 376) that the individual has for those
affected by the action in question. Finally, social
consensus is the extent of the feeling that action
taken is good (or not).
Moral intensity is a multidimensional construct
that measures the moral intensity of the situation.
Ethical decision-making process must be influenced
by the perception that the potential action has a
moral or ethical facet that needs to be evaluated
(Barnett, 2001). For marketing practitioners, studies
have shown that perceived moral intensity affects the
perception of ethical problems in various situations
(Singhapakdi et al., 1996a; Singhapakdi et al., 1999).
Furthermore, past studies also have shown that moral
intensity influences behavioral intentions of the
individuals in ethics-related situations (Robin et al.,
1996; Singhapakdi et al., 1996a). Also, Hunt and
Vitell (1986) suggest a theoretical link between
intentions and ethical judgments. Therefore, moral
intensity would also be expected to influence ethical
judgments. The relationship between moral intensity
and ethical judgments and behavioral intentions has
also been empirically shown (Barnett, 2001; Vitell
et al., 2003). Thus, it is hypothesized that:
H5: Parents’ attitude toward moral intensity will be
positively related to their ethical judgments of
the food advertising targeted at children.
H6: Parents’ attitude toward moral intensity will be
positively related to their behavioral intentions
of the food advertising targeted at children.
Idealism and relativism
Idealism and relativism have been used to measure
moral philosophies in various marketing-related
contexts (e.g., Singhapakdi et al., 1996c; Sing-
hapakdi et al., 1999). Forsyth (1980) suggests that
idealism and relativism can be considered as indi-
vidual differences that might impact individuals’
judgments of moral issues. Idealism measures an
individual’s acceptance of universal moral absolutes.
This construct focuses on the assumption that, if
right actions are taken, this will lead to desired
outcomes. On the other hand, relativism measures
individual’s rejection of universal moral tenets
(Forsyth, 1980). Therefore, the conceptualization of
these constructs might suggest that individuals who
are more idealistic would be more likely to have
higher ethical judgments and behavioral intentions.
Previous research provides some support for these
relationships (Singhapakdi et al., 1996c).
Relativism is defined as a belief that moral stan-
dards are relative to one’s culture or society. Forsyth
(1992) also indicates that relativistic individuals might
formulate their decisions based on skepticism and
evaluate situations based on other than ethical prin-
ciples. Furthermore, relativistic individuals evaluate
what is right or wrong based on the specifics of the
situation (Park, 2005). Forsyth (1992) also indicates
that idealism and relativism are not contrary con-
cepts, but rather independent of each other; for
example, an individual might have high scores both
on idealism and relativism, which indicates that the
person might simultaneously accept absolute moral
rules and yet also evaluate the alternatives available
based upon the specific situation and its possible
consequences. Therefore, parents would evaluate
each of the advertising tactics directed at their chil-
dren on a situation-by-situation basis. Since food
advertising directed at children has received signifi-
cant attention recently due to the health concerns of
children and increased obesity rates (York, 2007),
specific types of advertising tactics such as potentially
developing unhealthy eating habits might be received
more negatively due to their apparent impact on
children. Therefore, it is hypothesized that:
H7: Parents’ idealism will be related to their ethical
judgments of the food advertising targeted at
children.
H8: Parents’ idealism will be related to their
behavioral intentions of the food advertising
targeted at children.
302 Aysen Bakir and Scott J. Vitell
H9: Parents’ relativism will be related to their
ethical judgments of the food advertising tar-
geted at children.
H10: Parents’ relativism will be related to their
behavioral intentions of the food advertising
targeted at children.
Method
Sample
The survey was sent to parents at several schools
located in the Midwest. The researchers contacted
the schools and got permission to send the survey to
parents at the schools that agreed to participate in the
study. The number of schools that participated in the
study provided significant diversity in terms of
economic background. The majority of the sample
included educated and employed middle-income
families. Of the 1,020 surveys sent, 189 surveys
were completed, for a response rate of 18.52%. Of
the 189 surveys, 28 surveys had missing data for
individual questions. Among the respondents, 78%
were mothers and the rest of were fathers. Table I
displays the complete demographics of the respon-
dents.
Procedure
Once the school principals gave permission, the
researchers contacted the teachers from kindergarten
to eighth grade. The teachers in each grade sent the
questionnaires home to parents with the children.
Once the parents filled out the questionnaires, the
children returned the completed questionnaire to
the schools.
Measures and reliability
The dependent variables were behavioral intentions
and ethical judgments. The independent variables
were moral intensity, idealism, relativism, attitude
toward food advertising aimed at children, and
attitude toward the parents’ use of nutrition infor-
mation.
Moral intensity
This scale measures parents’ attitude toward moral
intensity in a given situation. This construct
was developed by Jones (1991) and includes six
dimensions. However, the scale used to measure
the construct was developed by Singhapakdi et al.
(1996b). Responses were measured by a seven-point
Likert-type scale, ranging from 1 (strongly disagree)
to 7 (strongly agree). The harm dimension included
three variables: magnitude of consequences, tem-
poral immediacy, and concentration of effect. The
other two items were proximity and social consen-
sus. The reliability of the harm scale was 0.85 for the
TABLE I
Demographics of the respondents
Variable %
Parent
Mother 78.1
Father 21.9
Age of the parent
29 years old or under 4.8
30–39 years old 48.9
40–49 years old 39.8
50–59 years old 6.5
Education level of the parent
High-school degree 5.4
Some college degree 19.4
College graduate 38.7
Some graduate study 5.4
Graduate degree 31.2
Household income (US $)
<30k 12.2
30–50k 14.5
50–75k 26.6
75–100k 23.9
>100k 22.8
Work status of the parent
Working full time 67.9
Working part time 17.1
Not working 15
No. of children
One child 18.7
Two children 42.2
Three children 27.3
Four children 7.5
More than four children 4.3
The Ethics of Food Advertising Targeted Toward Children 303
first scenario, 0.91 for the second scenario, and 0.86
for the third scenario.
Idealism and relativism
This scale measures the extent of individual’s
acceptance of moral absolutes, whereas the relativism
scale measures the extent of individual’s rejection of
universal moral principles. The two scales were
developed by Forsyth (1980). The ten items for each
scale were measured utilizing a seven-point Likert-
type scales, ranging from 1 (strongly disagree) to 7
(strongly agree). The reliability of the scale was 0.83
for idealism and 0.84 for relativism.
Attitude toward food advertising
This scale measures parents’ attitudes toward food
advertising directed at children. The scale is adapted
from a Carlson and Grossbart (1988) study and
includes six items. The parents’ extent of agreement
was measured by a five-point Likert-type scale,
ranging from 1 (strongly disagree) to 5 (strongly
agree). The reliability of the scale was 0.80.
Attitude toward use of nutritional information
This scale measures parents’ use of nutritional infor-
mation. The scale was originally developed by Moor-
man (1998) and includes four items. The parents’
extent of agreement toward the use of nutritional
information were measured by a five-point Likert-type
scale, ranging from 1 (strongly disagree) to 5 (strongly
agree). The reliability of the scale was 0.82.
Scenarios
This study utilized three scenarios to measure par-
ents’ behavioral intentions and ethical judgments
relative to specific situations. Ethical judgments and
behavioral intentions were then measured by using a
seven-point Likert scale asking the respondents
the extent they agree/disagree with the questions.
For measuring ethical judgments, the following
statement was used, ‘‘I consider the action taken to
be very ethical,’’ whereas for measuring behavioral
intentions, the following statement was used,
‘‘I would be likely to take the same action in this
situation.’’ Therefore, a greater degree of agreement
with the action taken indicates that the respondents
had higher ethical levels of behavioral intentions and
ethical judgments. At the end of each scenario, the
action taken by an advertiser was presented.
The scenarios focused on addressing some of the
current advertising practices used to target children.
The first scenario addresses the use of ‘‘advergames’’
targeting children. Children are playing these games
on the Internet in a branded context. The games
provide product-related information and even ask
children to contact their friends. The second sce-
nario focused on some of the highly debated
advertising practices at schools. A food company
sponsors programs at schools and child care centers.
During visits, the company provides entertainment
with well-known characters and exposes children to
samples of their potentially unhealthy food products.
The third scenario centers on a candy and cereal
company who is considering selling books that
spotlight the client’s brand. Children can play and
learn counting by using sugar-filled sweets and
cereals. The books use the company’s brand as an
example in their plays and counting.
The scenarios were pretested. The results indi-
cated that most respondents believed that the
actions
taken by the advertisers in all of the scenarios were
unethical. The majority of the respondents also
indicated that they disagreed with the actions taken
in the three scenarios.
Data analysis and results
The hypotheses were tested separately for each of
the three scenarios. Analysis of variance (ANOVA)
was used to test the hypotheses. H1 measured
whe
ther parents’ attitude toward food advertising is
positively related to their ethical judgments of the
food advertising targeted at children. The three
scenarios tested did not indicate significant differ-
ences. The ANOVA results were: scenario 1: F(7, 152) =
26.836, p< 0.926; scenario 2: F(7, 158) = 11.334, p<
0.933; and scenario 3: F(7, 160) = 21.468, p<0.724.
Thus, parents’ attitude toward food advertising was
not related to their ethical judgments of the food
advertising targeted at children. H2 measured whe-
ther parents’ attitude toward food advertising is
positively related to their behavioral intentions of the
food advertising targeted at children. Again, none of
the three scenarios resulted in significant differences.
304 Aysen Bakir and Scott J. Vitell
The ANOVA results were: scenario 1: F(7, 153) =
18.707, p < 0.854; scenario 2: F(7, 157) = 17.721,
p<0.643; and scenario 3: F(7, 160) = 16.315, p<0.554.
Thus parents’ attitude toward food advertising was
not related to their behavioral intentions relative to
the food advertising targeted at children. Tables II
and III display these findings.
H3 measured whether parents’ attitude toward the
use of nutrition information is positively related to
their ethical judgments of the food advertising tar-
geted at children. The three scenarios tested did
not indicate significant differences. The ANOVA
results were: scenario 1: F(7, 152) = 26.835, p < 0.093;
scenario 2: F(7, 158) = 11.334, p < 0.822; and sce-
nario 3: F(7, 160) = 21.468, p < 0.127. H4 measured
whether parents’ attitude toward the use of nutrition
information is positively related to their behavioral
intentions relative to the food advertising targeted
at children. There were no significant differences
regarding the first two scenarios, but there were sig-
nificant differences on the third scenario among par-
ents’ attitude toward the use of nutrition information
and its relation to their behavioral intentions of the
food advertising targeted at children. The ANOVA
results were: scenario 1: F(7, 153) = 18.707, p < 0.223;
scenario 2: F(7, 157) = 17.721, p < 0.116; and sce-
nario 3: F(7, 160) = 16.315, p < 0.004.
H5 measured whether parents’ attitude concern-
ing moral intensity is positively related to their
ethical judgments of the food advertising targeted
at children. Moral intensity was measured by
three separate dimensions: harm, social consensus,
and proximity. There were significant differences on
the harm construct among three scenarios. The
ANOVA results were: scenario 1: F(7, 152) = 26.836,
p < 0.000; scenario 2: F(7, 158) = 11.334, p < 0.000;
TABLE II
ANOVA analysis: scenarios 1, 2, and 3, dependent variable: ethical judgments
Variable Scenario 1 Scenario 2
Scenario 3
p Value p Value p Value
Moral intensity: harm 0.000 0.000 0.000
Moral intensity: consensus 0.095 0.037 0.000
Moral intensity: proximity 0.288 0.772 0.255
Idealism 0.206 0.166 0.633
Relativism 0.200 0.006 0.060
Attitude toward food advertising 0.926 0.933 0.724
Attitude toward use of nutrition 0.093 0.822 0.127
F(7, 152) = 26.835 F(7, 158) = 11.334 F(7, 160) = 21.468
TABLE III
ANOVA analysis: scenarios 1, 2, and 3, dependent variable: behavioral intentions
Variable Scenario 1 Scenario 2 Scenario 3
p Value p Value p Value
Moral intensity: harm 0.000 0.000 0.000
Moral intensity: consensus 0.000 0.002 0.005
Moral intensity: proximity 0.091 0.539 0.809
Idealism 0.732 0.186 0.567
Relativism 0.162 0.036 0.081
Attitude toward food advertising 0.854 0.643 0.554
Attitude toward use of nutrition 0.223 0.116 0.004
F(7, 153) = 18.707 F(7, 157) = 17.721 F(7, 160) = 16.315
The Ethics of Food Advertising Targeted Toward Children 305
and scenario 3: F(7, 160) = 21.468, p < 0.000. Fur-
thermore, there were significant differences on the
social consensus construct for the second and third
scenarios. The ANOVA results were: scenario 1:
F(7, 152) = 26.836, p < 0.095; scenario 2: F(7, 158) =
11.334, p < 0.037; and scenario 3: F(7, 160) = 21.468,
p < 0.000. Finally, there were no significant differ-
ences on proximity among three scenarios. The
ANOVA results were: scenario 1: F(7, 152) = 26.836,
p < 0.288; scenario 2: F(7, 158) = 11.334, p < 0.772;
and scenario 3: F(7, 160) = 21.468, p < 0.255. Thus,
overall H5 was at least partially supported.
H6 measured whether parents’ attitude concern-
ing moral intensity is positively related to their
behavioral intentions relative to the food advertis-
ing targeted at children. Parents’ attitude toward
the harm and social consensus dimensions indi-
cated significant differences among three scenarios.
The ANOVA results for harm were: scenario 1:
F(7, 153) = 18.707, p < 0.000; scenario 2: F(7, 157) =
17.721, p < 0.000; and scenario 3: F(7, 160) =
16.315, p < 0.000. The ANOVA results for social
consensus were: scenario 1: F(7, 153) = 18.707,
p < 0.000; scenario 2: F(7, 157) = 17.721, p < 0.002;
and scenario 3: F(7, 160) = 16.315, p < 0.005. On
the other hand, parents’ attitude toward proximity
did not indicate any significant differences among
three scenarios. The ANOVA results for proximity
were: scenario 1: F(7, 153) = 18.707, p < 0.091;
scenario 2: F(7, 157) = 17.721, p < 0.539; and sce-
nario 3: F(7, 160) = 16.315, p < 0.809.
H7 measured whether parents’ idealistic moral
philosophy is related to their ethical judgments of
the food advertising targeted at children. Parents’
idealism was not significantly related to their ethical
judgments. The ANOVA results for idealism were:
scenario 1: F(7, 152) = 26.835, p < 0.206; scenario 2:
F(7, 158) = 11.334, p<0.166; and scenario 3: F(7, 160) =
21.468, p < 0.633.
H8 measured whether parents’ idealistic moral
philosophy is related to their behavioral intentions of
the food advertising targeted at children. Again
the results were not significant. The ANOVA results
for idealism were: scenario 1: F(7, 153) = 18.707,
p < 0.732; scenario 2: F(7, 157) = 17.721, p < 0.186;
and scenario 3: F(7, 160) = 16.315, p < 0.567.
H9 measured whether parents’ relativistic moral
philosophy is related to their ethical judgments of
the food advertising targeted at children. H10 mea-
sured whether parents’ relativistic moral philosophy
is related to their behavioral intentions of the food
advertising targeted at children. H9 and H10 were
partially supported. Parents’ relativism was signifi-
cantly related to ethical judgments and intentions
for the second scenario. The ANOVA results
for idealism were: scenario 1: F(7, 152) = 26.835,
p < 0.200; scenario 2: F(7, 158) = 11.334, p < 0.006;
and scenario 3: F(7, 160) = 21.468, p < 0.060. There
were no significant differences among parents’ rela-
tivism regarding the behavioral intentions for
the first and the third scenarios. The ANOVA results
for relativism were: scenario 1: F(7, 153) = 18.707,
p < 0.7162; scenario 2: F(7, 157) = 17.721, p < 0.036;
and scenario 3: F(7, 160) = 16.315, p < 0.081.
Discussion
This paper examined parents’ views of the ethics of
food advertising targeted at children. The marketing
literature, surprisingly, has not examined this topic.
This study attempts to fill this gap by examining
how parents view various types of food advertising
directed at children. Children as consumers have
become significantly more important to marketers in
the last decade. Marketers have heavily promoted
their products to this segment and spent millions of
dollars on advertising to reach this segment (Jardine
and Wentz, 2005). Food advertising represents a
significant portion of all advertising spending for
marketers while food advertising targeted at children
has received significant criticism from both parents
and public policy-makers.
The findings of the study provide interesting
insights. Parents were asked to respond to three
different scenarios outlining various food advertising
strategies directed at children. Furthermore, parents’
ethical judgments and behavioral intentions were
measured for the three scenarios. One of the inde-
pendent variables was parents’ attitude toward food
advertising. The findings indicated that parents’
attitude toward food advertising did not affect their
ethical judgments and behavioral intentions con-
cerning specific food advertising directed at their
children. One of the reasons for not finding a sig-
nificant relationship might be due to the measure-
ment of other food advertising practices targeted at
children in the scenarios that was not included in the
306 Aysen Bakir and Scott J. Vitell
scale measuring attitudes toward food advertising.
This finding provides important implications for
marketers which might indicate that parents evaluate
specific food advertising targeted at children inde-
pendently of their potential views on general food
advertising directed at children. Thus, marketers
who are cognizant of the potential harm of adver-
tising to children might still be highly regarded by
consumers even if the consumer, in general, has
negative or skeptical views of advertising to children.
Parents’ attitude toward the use of nutrition
information displayed interesting findings. The third
scenario, in particular, focused on specific implica-
tions of a food product that might have unhealthy
eating implications for children. Parents’ attitude
toward the use of nutritional information for this
scenario was related to their behavioral intentions.
On the other hand, there were no significant rela-
tionships between an attitude toward the use of
nutrition and ethical judgments of food advertising
targeted at children for any of the scenarios,
including scenario 3. Parents might have not per-
ceived using well-known characters to distribute
food company products at schools and child care
facilities to have any potential harm.
The lack of a relationship between an attitude
toward the use of nutritional information and ethical
judgments of food advertising targeted at children
should be considered on a scenario-by-scenario
basis; for example, for the first scenario, it might be
that parents did not really think the advergames
and the use of well-known characters to distribute
food company products at schools and child care
facilities presented any potential unethical practices.
Particularly, advergames are new promotional tools
used on the Web to attract adults and children
within a branded context. Advergames are some-
where between advertising and computer games and
include product-related information from the com-
panies with the use of games or part of a game
(Nelson, 2002; Mallinckrodt and Mizerski, 2007).
Past studies also suggest that advergames might be
more persuasive for young children than traditional
advertising (Oanh Ha, 2004). Parental awareness of
advergames targeting children needs further inves-
tigation in future research. Future research should
also examine how parents use nutritional informa-
tion in their food purchase decisions to have a better
understanding of the relationship between attitude
toward use of nutrition information and ethical
perspectives regarding food advertising.
Moral intensity significantly affected parents’
ethical judgments and behavioral intentions. This
finding offers significant implications for marketers
and public policy-makers. Parents indicated con-
cerns regarding the potential harm of various food
advertising targeting children in the three scenarios.
It is important that marketers should be more
careful when they create their advertising tactics
targeting children. It might also be that more
regulations might be needed to address parental
concerns regarding the potential effects of food
advertising. The moral intensity measure of prox-
imity was not significantly related to the ethical
judgments and behavioral intentions of parents.
Proximity measures the ‘‘feeling of nearness (social,
cultural, psychological, or physical)’’ (Jones, 1991,
p. 376) that the individual has for those affected by
the action in question. It might be that parents
considered the action taken unethical whether the
results affected their friends/relatives or not. The
findings relative to social consensus and its effect on
their ethical judgments and behavioral intentions
were significant, in most instances. Thus, parents
did consider what others might think about a
specific situation when forming their ethical judg-
ments and intentions.
The ethical perspectives of idealism and relativism
also provide some insights regarding parents’ ethical
judgments and behavioral intentions. Findings indi-
cated that there is no significant relationship between
parents’ attitude toward idealism and their ethical
judgments and behavioral intentions. Parents, in this
study, may not have perceived the scenarios as situ-
ations that should carry universal moral absolutes.
On the other hand, parents’ attitude toward relativ-
ism significantly affected their ethical judgments and
behavioral intentions but only for the second
scenario. Relativism might be more likely to influ-
ence opinions on a situation-by-situation basis. The
second scenario in particular expressed potential
unhealthy effects on children. Therefore, parents
might have perceived this scenario as involving
questionable ethical practices.
Our study has some limitations. Although parents
were instructed to fill out the questionnaire individu-
ally or as a couple, we could not verify whether or not
they communicated with each other. This raises the
The Ethics of Food Advertising Targeted Toward Children 307
possibility of a potential demand artifact. Secondly,
although survey methods provide important informa-
tion on individuals’ perceptions and beliefs, qualitative
methods would bestow more detailed information on
parents’ perceptions and attitudes. Future research
should focus on more qualitative techniques to have a
deeper understanding of perceptions and attitudes.
Third, our findings provide insights only from parents
in the Midwestern USA. These findings are not yet
generalizable to other cultures or subcultures.
Understanding parents’ perspectives on advertis-
ing directed at children is important. Future research
should focus on a more detailed parental perspective
to uncover how parents make judgments on whe-
ther advertising directed at children is ethical or not.
Qualitative studies might provide more in-depth
understanding. Uncovering these issues might
minimize the discrepancy between parents and
marketers.
The debate on the effects of food advertising tar-
geted at children has intensified in the last several years
among academicians, public policy-makers, and
marketers. Companies need to respond better to the
food-related debates in society, particularly to those
related to healthy eating and ethical food marketing.
In conclusion, our findings assist both research
and theory in the children’s advertising field. With
the increasing prominence of ethics in business/
marketing research, this study presents important
findings that advance our understanding of the po-
tential antecedents to the ethical decision-making
process for parents in situations involving advertising
directed toward their children. We trust that the
results generated by this research can be successfully
used to guide future ethics research projects in this
growing field.
Appendix A: scenarios
Scenario 1
A food company whose products are, in part,
targeted at children is planning to use ‘‘adver-
games’’ (online games in which a company’s
product or brand characters are featured). It is also
considering encouraging children to contact their
friends about a specific product or brand as part
of their new advertising campaign. The company
is considering using the internet, rather than
more traditional media such as television, due to
the highly debated relationship between aggres-
sive food advertising and increased obesity among
children.
Action: The company decided to use Internet
advertising for their new campaign.
Scenario 2
An advertising agency recommended that their cli-
ent sponsor programs at schools and visit child care
centers. These sponsored programs would make a
financial contribution to each school and child care
center. During these visits the company would
provide entertainment with the company’s well-
known characters and provide a sample of the
company’s food products to children. If they do this,
children who are less than 5 years old would be
introduced to a range of products that might be
considered ‘‘unhealthy.’’
Action: The sponsor decided to conduct these
visits to the child care centers/schools and provide a
sample of their products.
Scenario 3
A candy and cereal company is considering sell-
ing books that spotlight the client’s brand. These
children’s books provide content on ‘‘counting and
playing.’’ Children can play checkers with various
fruit-flavored candies and can learn to count using
various forms of calorie and sugar-filled sweets and
cereals. The books use the company’s brand as an
example for the ‘‘counting and playing’’ content.
Action: The candy and cereal company decided to
sell these books to children.
308 Aysen Bakir and Scott J. Vitell
Appendix B: scale items
Idealism
1. A person should make certain that their actions never
intentionally harm another even to a small degree
2. Risks to another should never be tolerated,
irrespective of how small the risks might be
3. The existence of potential harm to others is always
wrong, irrespective of the benefits gained
4. One should never psychologically or physically harm
another person
5. One should not perform an action which might in
anyway threaten the dignity and welfare of another
individual
6. If an action could harm an innocent other, then it
should not be done
7. Deciding whether or not to perform an act by bal-
ancing the positive consequences of the act against
the negative consequences of the act is immoral
8. The dignity and welfare of people should be the most
important concern of any society
9. It is never necessary to sacrifice the welfare of others
10. Moral actions are those which closely match ideals of
the most ‘‘perfect’’ action
Attitude toward food advertising
1. There is too much food advertising directed at
children
2. Advertisers use tricks and gimmicks to get chil-
dren to buy their products
3. Advertising to children makes false claims about
nutrition content of food products
4. There is too much sugar in the foods advertised
to children
5. Advertising teaches children bad eating habits
6. Advertising directed at children leads to family
conflict
Attitude toward use of nutritional information
1. I usually pay attention to nutrition information
when I see it in an ad or elsewhere
2. I use nutrition information on the label when
making most of food selections
3. I don’t spend much time in the supermarket
reading nutrition information
4. I read about nutrition in magazines or books
Moral intensity
Harm 1 The overall harm (if any) done as a result
of the action would be very small
Harm 2 The action will harm very few people, if any
Harm 3 The action will not cause any harm in the
immediate future
Proximity If one were a personal friend of the person(s)
harmed, the action would be
wrong
Social
consensus
Most people would agree that the action is
wrong
Relativism
1. There are no ethical principles that are so important
that they should be part of any code of ethics
2. What is ethical varies from one situation and society
to another
3. Moral standards should be seen as being individu-
alistic; what one person considers to be moral may
be judged to be immoral by another person
APPENDIX B
continued
4. Different types of moralities cannot be compared as
to ‘‘rightness’’
5. Questions of what is ethical for everyone can never
be resolved since what is moral or immoral is up to
the individual
6. Moral standards are simply personal rules which
indicate how a person should behave, and are not to
be applied in making judgments of others
7. Ethical considerations in interpersonal relations are
so complex that individuals should be allowed to
formulate their own individual codes
8. Rigidly codifying an ethical position that prevents
certain types of actions could stand in the way of
better human relations and adjustment
9. No rule concerning lying can be formulated;
whether a lie is permissible or not permissible
totally depends upon the situation
10. Whether a lie is judged to be moral or immoral
depends upon the circumstances surrounding the
actions
The Ethics of Food Advertising Targeted Toward Children 309
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Aysen Bakir
Department of Marketing,
Illinois State University,
Campus Box 5590,
Normal, IL 61790-5590, U.S.A.
E-mail: abakir2@ilstu.edu
Scott J. Vitell
School of Business Administration,
The University of Mississippi,
University, MS 38677, U.S.A.
E-mail: svitell@bus.olemiss.edu
The Ethics of Food Advertising Targeted Toward Children 311
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The Unhealthy = Tasty Intuition and Its Effects on Taste Inferences, Enjoyment, and Choice
of Food Products
Author(s): Rajagopal Raghunathan, Rebecca Walker Naylor and Wayne D. Hoyer
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Source: Journal of Marketing, Vol. 70, No. 4 (Oct., 2006), pp. 170-184
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Rajagopal Raghunathan, Rebecca Walker Naylor, & Wayne D. Hoyer
The Unhealthy = Tasty Intuition and
Its Effects on Taste Inferences,
Enjoyment, and Choice of Food
Products
Across four experiments, the authors find that when information pertaining to the assessment of the healthiness of
food items is provided, the less healthy the item is portrayed to be, (1) the better is its inferred taste, (2) the more
it is enjoyed during actual consumption, and (3) the greater is the preference for it in choice tasks when a hedonic
goal is more (versus less) salient. The authors obtain these effects both among consumers who report that they
believe that healthiness and tastiness are negatively correlated and, to a lesser degree, among those who do not
report such a belief. The authors also provide evidence that the association between the concepts of “unhealthy”
and “tasty” operates at an implicit level. The authors discuss possibilities for controlling the effect of the unhealthy =
tasty intuition (and its potential for causing negative health consequences), including controlling the volume of
unhealthy but tasty food eaten, changing unhealthy foods to make them less unhealthy but still tasty, and providing
consumers with better information about what constitutes “healthy.”
Assessing the health consequences of food consump-
tion habits has emerged as an important topic of
inquiry in recent years (Oakes 2005; Oakes and
Slotterback 2005; Seiders and Petty 2004; Verbeke 2006;
Wansink 2004a, b; Wansink and Huckabee 2005). From an
evolutionary perspective, the easy availability of food pre-
sents a unique quandary for developed countries and
societies. On the one hand, it has virtually obliterated prob-
lems resulting from malnourishment. On the other hand, it
has generated problems stemming from the overconsump-
tion of food. For example, obesity is growing at an unprece-
dented rate, not just in the United States, where nearly two-
thirds of the population are overweight or obese, but in
other developing nations as well (Seiders and Petty 2004).
To many consumers and consumer activists, organiza-
tions (e.g., lobbyists for grocery manufacturers) and restau-
rants (e.g., McDonald’s, Hardee’s) that are interested in pro-
moting unhealthy eating habits are to blame for consumers’
propensity to overconsume (Brownell and Horgen 2003;
Rajagopal Raghunathan is Assistant Professor of Marketing (e-mail:
Raj.Raghunathan@mccombs.utexas.edu), and Wayne D. Hoyer is The
James L. Bayless/William S. Farish Fund Chair for Free Enterprises and
Professor of Marketing (e-mail: wayne.hoyer@mccombs.utexas.edu),
McCombs School of Business, University of Texas at Austin. Rebecca
Walker Naylor is Assistant Professor of Marketing, Moore School of Busi-
ness, University of South Carolina (e-mail: rnaylor@moore.sc.edu). The
authors thank Susan Broniarczyk, Kristin Diehl, Julie Irwin, Andrew
Gershoff, Jonathan Levav, and attendees at the 2005 Marketing Young
Scholars Conference for their helpful suggestions on the article.
To read or contribute to reader and author dialogue on this article, visit
http://www marketingpower. com/jmblog.
0 2006, American Marketing Association
ISSN: 0022-2429 (print), 1547-7185 (electronic)
Nestle 2003). Consequently, lawsuits have been filed
against fast-food companies such as McDonald’s (Parloff
2003). Attorneys representing these companies have argued
that consumers are aware of the ingredients in their offer-
ings and that they understand the weight and health conse-
quences of overconsumption. In their view, consumers are
ultimately responsible for the negative consequences of
their own actions.l
The objective of this research is to examine the role of a
subtle (and currently unrecognized) factor in the overcon-
sumption of food that is perceived as unhealthy. What if
people consume food that is considered unhealthy not
despite its perceived unhealthiness but rather because of it?
That is, what if part of the attractiveness of food lies in its
perceived unhealthiness? This can happen if consumers
intuitively believe that the unhealthier the food, the tastier it
is. The operation of such a belief would increase the
chances that people will overconsume food portrayed as
less (versus more) healthy because they expect that such
food will taste better. Consistent with this idea, we propose
that the perceived unhealthiness of food has the ironic effect
of enhancing its attractiveness. Consequently, under cir-
cumstances in which a hedonic (e.g., enjoyment) goal is
more (versus less) salient, people will choose options they
perceived as unhealthier, even if no information about their
tastiness relative to other options is available. Across the
experiments we conduct in this research, we obtain support
for this proposition.
1The fast-food chains appear to be winning the battle, at least
for now. In October 2005, the U.S. House of Representatives
passed a bill to block lawsuits blaming restaurants and food com-
panies for causing obesity or weight gain (Zhang 2005).
Journal of Marketing
170 Vol. 70 (October 2006,170-184
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Our research generates two theoretically interesting and
substantively meaningful insights. First, from a theoretical
standpoint, we document both direct and indirect support
for our main thesis, namely, that people subscribe to the
unhealthy = tasty intuition and that this intuition affects
inferences about food choice, actual enjoyment of foods,
and choice of food products. These notions are particularly
intriguing because there is little rigorous evidence that
healthiness and tastiness are indeed inversely related to
each other. Second, our research suggests that the influence
of the unhealthy = tasty intuition can be implicit; as such,
even people who may not report believing that unhealthy
food is tastier make judgments and choices as if they sub-
scribed to such a view.
We structure the rest of the article as follows: We begin
by briefly commenting on the potential sources for the
unhealthy = tasty intuition. Then, we derive predictions of
how the intuition affects three variables of theoretical and
substantive interest; (1) taste inferences of food products
when information pertaining to their healthiness is pro-
vided, (2) differences in enjoyment of the same food prod-
uct when it is presented as being more versus less healthy,
and (3) choice between two snack options as a function of
differences in the propensity to pursue a hedonic goal. We
report results from four controlled experiments that test
these hypotheses and conclude with a discussion of the
implications of our findings.
Theory
Sources of the Unhealthy =
Tasty Intuition
Intuitions or lay beliefs and theories may be generated
internally, through personal experience and self-observation
(Ross and Nisbett 1991), or externally, from environmental
cues (Morris, Menon, and Ames 2001). We posit that both
types of sources underlie the unhealthy = tasty intuition.
Internal source. We posit that the unhealthy = tasty intu-
ition is generated internally on the basis of a belief in a
compensatory relationship between the “wholesomeness”
of stimuli and their “hedonic potential.” That is, we believe
that the unhealthy = tasty intuition is a specific manifesta-
tion of a more general principle, according to which there is
an inverse relationship between things that are “healthy,”
“nourishing,” and “good for you” and those that are “enjoy-
able,” “fun,” and “exciting.” Evidence for an assumed com-
pensatory relationship between the wholesomeness and
hedonic potential of stimuli emerged across a separate
series of experiments we conducted. For example, the
results from one such experiment revealed that compared
with an automobile portrayed as attractive and fun to drive,
one that was portrayed as unattractive and less enjoyable to
drive was inferred to be safer, even though the more attrac-
tive automobile was objectively safer (as per the Insurance
Institute of Highway Safety). We speculate that a belief in
the more general unwholesome = fun intuition is rooted in
religious messages, such as the Protestant work ethic,
according to which a person is morally obligated to accord
greater priority to necessities over luxuries (e.g., Berry
1994; Weber 1998; see also Maslow 1962). Implicit in this
view are the ideas that comfort and luxury do not come eas-
ily and that a person needs to work hard to earn the right to
indulge (e.g., Kivetz and Simonson 2002). Thus, the Protes-
tant work ethic makes a clear distinction between stimuli or
activities that are of a “serious,” “worthy,” and “work-
oriented” nature and those that are of a “trivial,” “frivolous,”
and “fun-related” nature and suggests that stimuli/activities
fall neatly into one or the other category but rarely into
both. In the context of food, this translates into a belief that
healthy food is less tasty.
External source. Operating in concert with the internal
source for the unhealthy = tasty intuition is an external one.
Through the mass media or personal communication,
people are constantly exposed to views that are compatible
with the intuition. Several recent articles in popular maga-
zines (e.g., “Is Fat the Next Tobacco?” which appeared in
Fortune [Parloff 2003]), popular books (e.g., Fast Food
Nation, by Eric Schlosser [2001]), and movies (e.g., Mor-
gan Spurlock’s Super Size Me, which appeared in theaters
nationwide in 2004) explicitly or implicitly suggest an
inverse relationship between healthiness and tastiness. Con-
sumers are also likely to have been exposed to the
unhealthy = tasty view through personal communication.
For example, parents and guardians appear to find value in
propagating such a message because it encourages children
to consume hedonically unpleasant food that is perceived as
salubrious (e.g., eating broccoli) and discourages them from
overconsuming hedonically appealing fare that is poten-
tially harmful (e.g., candy).
In summary, we propose that the unhealthy = tasty intu-
ition is generated internally through its consistency with the
more general unwholesome = fun intuition and/or exter-
nally through repeated exposure to views that are compati-
ble with it.2 We believe that these sources help generate the
hypothesis that unhealthiness is inversely related to tasti-
ness. After this association has been generated, psychologi-
cal mechanisms help perpetuate it, as we discuss next.
Influence of the Unhealthy – Tasty Intuition on
Decision Making
Figure 1 depicts the influence of the unhealthy = tasty intu-
ition on three conceptually separate stages of the decision-
2It is worthwhile to mention an alternative source for the intu-
ition: direct experience. A person may arrive at the intuition
through lay inferencing (Kelly and Thibaut 1969), a process that
involves personal observation that unhealthier food is tastier.
There are two reasons we do not believe that this is a valid source
for the intuition. First, lay inferencing presupposes objectivity on
the part of the inference maker. However, we know that because of
the prevalence of external messages consistent with the
unhealthy = tasty intuition, consumers are unlikely to be objective
judges of the correlation between healthiness and tastiness. Sec-
ond, to assess accurately the true correlation between healthiness
and tastiness, it is first necessary to assign relatively stable health-
mess and tastiness ratings to various types of food. However, rele-
vant findings indicate that ratings of the healthiness and tastiness
of food likely depend heavily on contextual factors (Drewnowski
1997; Oakes 2005).
The Unhealthy = Tasty Intuition 1171
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making process. Research has shown that consumers gener-
ate inferences about missing product attributes on the basis
of lay theories, that is, beliefs and intuitions about the world
(Broniarczyk and Alba 1994; Sujan and Dekleva 1987).
Indeed, inferences about missing product attributes are dri-
ven by intuitions even in the face of contradictory cues. For
example, in a study in which participants were asked to
make inferences about a camera’s durability, the partici-
pants relied more heavily on the intuition that durability and
warranty are positively correlated than on the actual corre-
lation (in the presented data) between durability and shutter
speed, an association that is not supported by intuition (Bro-
niarczyk and Alba 1994).
Influence of intuition on taste inferences. Consistent
with these findings, we predict that as a consequence of
belief in the unhealthy = tasty intuition (see Figure 1, Stage
1),
H1: The healthier a food item is perceived to be, the lower is
its inferred tastiness.
Influence of intuition on enjoyment. Inferences about
missing attributes are likely to act as hypotheses that can
bias judgments about these attributes (Deighton 1984; Hoch
and Ha 1986; Shiv, Carmon, and Ariely 2005). The opera-
tion of this hypothesis confirmation bias was captured in
Shiv, Carmon, and Ariely’s (2005) experiments, which were
designed to demonstrate the placebo effects of marketing
actions. For example, in their first experiment, they find that
consumers who pay a discounted price for an energy drink
that purportedly increases mental acuity derive less benefit
from the drink (measured in terms of number of mental
puzzles solved) than do participants who pay full price.
Consistent with the operation of the hypothesis confirma-
tion bias, the discounted price serves as a hypothesis about
the (lack of) effectiveness of the drink, which is confirmed
on consumption of the drink (and reflected in the subse-
quent puzzle-solving task). In the context of the current
research, we expect that consumers will judge the same
food product as more tasty when it is portrayed as less
healthy. We state this prediction more formally as follows
(see Figure 1, Stage 2):
Hz: When actual tastiness of a food product is controlled for,
the healthier the food is portrayed to be, the lower is its
judged tastiness.
Influence of intuition on choice. Product choice is often
a function of consumption goals (Bettman, Luce, and Payne
1998). In the context of food choice, researchers have sug-
gested that, in general, the hedonic goal of enjoyment is
salient and important (Dhar and Simonson 1999; Food Mar-
keting Institute 1996; Shiv and Fedorikhin 1999; Tepper
and Trail 1998). For example, Shiv and Fedorikhin’s (1999)
experiments examine how a person’s mood can influence
how he or she resolves the trade-off between the enjoyment
and the health benefits of food offerings. Likewise, Dhar
and Simonson’s (1999) experiments examine conditions
that lead to “highlighting” (a focus on either an enjoyment
FIGURE 1
Model of the Influence of the Unhealthy = Tasty Intuition on Judgments and Decisions
172 / Journal of Marketing, October 2006
Stage 1
Stage 3
Choice
Salience of
hedonic goal
Stage 2
Actual
enjoyment
Belief in the
unhealthy =
tasty intuition
Taste
inferences
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or a health goal in choosing an entree and a dessert) versus
“balancing” (a focus on both goals). Given that enjoyment
is likely to be a significant goal when people choose food
products, the unhealthy = tasty intuition suggests that con-
sumers with a more (versus less) salient hedonic goal will
have a relatively greater preference for options they per-
ceived as unhealthy (see Figure 1, Stage 3).
H3: Given a choice between two food products that vary in
healthiness, people with a more (versus less) salient
enjoyment goal will choose the less healthy option.
Implicit and explicit influence of intuition. Thus far, we
have suggested that consumers’ taste inferences, the judged
tastiness of food, and product choice will be influenced in a
manner consistent with the unhealthy = tasty intuition.
Here, we explore whether explicitness of belief in the intu-
ition moderates this general pattern. If we find that even
consumers who do not explicitly report a belief in the intu-
ition make decisions as if they did, important theoretical
and substantive implications would emerge. From a theo-
retical standpoint, such a finding would suggest that the
influence of the intuition can occur outside the awareness of
consumers making consumption decisions in the context of
food. From a substantive standpoint, the finding would
point to the difficulty of controlling the influence of the
intuition.
The possibility that even people who do not report a
belief in the intuition will make decisions as if they believed
in it is consistent with the mechanism of hidden covariation
detection (e.g., Lewicki 1986; Lewicki and Hill 1989;
Lewicki, Hill, and Czyzewska 1997). Lewicki and col-
leagues find that people can learn the relationship between
variables implicitly, that is, without being able to articulate
their learning. In one experiment (Lewicki 1986, Experi-
ment la), participants were exposed to information about
some traits (e.g., kindness, capability) of women such that
these traits covaried with their hair length. Later, the same
participants were asked to assess these traits in another set
of women with long and short hair. Participants’ judgments
of these targets were consistent with the covariations
between hair lengths and traits in the initial stimuli. Impor-
tantly, even participants who were unable to articulate these
covariations explicitly made judgments as if they had
learned them. Thus, people are able to acquire information
nonconsciously about covariations in a data set without
being able to report such learning explicitly (Lewicki and
Hill 1989, p. 240).
Consistent with Lewicki and colleagues’ (e.g., Lewicki
1986; Lewicki and Hill 1989; Lewicki, Hill, and Czyzewska
1997) work, we expect that as a result of exposure to the
many external sources that suggest a negative correlation
between healthiness and tastiness, consumers will have
implicitly learned to associate unhealthiness with tastiness.
Thus, we expect that even consumers who do not explicitly
report believing that unhealthier food is tastier will make
judgments and decisions as if they did. However, because
there is evidence that explicitly (versus implicitly) learned
and articulated relationships are likely to have significantly
stronger influences on judgments (Allen and Janiszewski
1989), we expect that the influence of the unhealthy = tasty
intuition will be stronger among people who report explicit
belief in it. Thus:
H4: The pattern of results we predict in H1 -H3 holds for both
people who report an explicit belief in the unhealthy =
tasty intuition and those who do not, but it is stronger
among the former group.
Experiment 1: Implicitness of Belief in Intuition
We designed Experiment 1 to establish that people implic-
itly subscribe to the unhealthy = tasty intuition. To address
this objective, we used the implicit association test (IAT;
Greenwald, McGhee, and Schwartz 1998; Greenwald,
Nosek, and Banaji 2003), an established tool for demon-
strating the type of implicit association we wish to
demonstrate.
Participants and Procedure
One hundred thirty-eight undergraduate students partici-
pated in this experiment (which we conducted using IBM
computers and the Direct RT software) for course extra
credit. Participants were told that their task was to catego-
rize correctly stimuli shown on the middle of their screens.
We selected stimuli from one of the following four cate-
gories (see the Appendix) for the categorization tasks: (1)
pictures of unhealthy foods, (2) pictures of healthy foods,
(3) words associated with the tastiness or enjoyment of food
(e.g., tasty, delicious), and (4) words associated with the
lack of taste or enjoyment (e.g., flavorless, unpalatable). In
line with established protocol (Greenwald, McGhee, and
Schwartz 1998), participants completed seven blocks of tri-
als, five of which were practice blocks designed to familiar-
ize participants with the target stimuli and the categoriza-
tion labels. The critical blocks for analysis were Block 4, in
which the category labels were “Healthy Foods/Enjoyable”
versus “Unhealthy Foods/Not Enjoyable,” and Block 7, in
which the category labels were “Unhealthy Foods/
Enjoyable” and “Healthy Foods/Not Enjoyable” (see Table
1).
Stimuli from all four categories (healthy food images,
unhealthy food images, enjoyment words, and lack of
enjoyment words) were presented for classification in the
critical blocks for 48 trials across both blocks. An implicit
belief in the intuition that unhealthy foods are tastier (and
that healthier foods are less tasty) would be reflected in
faster responses when stimuli were to be categorized in the
condition in which the classification task was congruent
with the intuition (i.e., when participants paired unhealthy
foods with words associated with tastiness and enjoyment)
than in the incongruent condition (i.e., when participants
paired healthy foods with words associated with tastiness
and enjoyment). Explicit measures of belief in the
unhealthy = tasty intuition were collected (using paper-and-
pencil measures) before the IAT procedure to compare par-
ticipants’ explicit and implicit attitudes. We assessed explic-
itness of participants’ beliefs in the intuition by eliciting
their agreement with the following two items (1= “strongly
disagree,” 9 = “strongly agree”): (1) “Things that are good
The Unhealthy . Tasty Intuition 1173
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TABLE 1
Experiment 1: Sequence of Trial Blocks in IAT
Number of Items Assigned to Left-Key Items Assigned to Right-Key
Block Trials Function Response Response
1 20 Practice Healthy food images Unhealthy food images
2 28 Practice Good taste/enjoyment words Bad taste/lack of enjoyment words
3 24 Practice Healthy food images + good Unhealthy food images + bad
taste/enjoyment words taste/lack of enjoyment words
4 48 Critical test block Healthy food images + good Unhealthy food images + bad
taste/enjoyment words taste/lack of enjoyment words
5 40 Practice Unhealthy food images Healthy food images
6 24 Practice Unhealthy food images + good Healthy food images + bad
taste/enjoyment words taste/lack of enjoyment words
7 48 Critical test block Unhealthy food images + good Healthy food images + bad
taste/enjoyment words taste/lack of enjoyment words
for me rarely taste good,” and (2) “There is no way to make
food healthier without sacrificing taste.”
Data Preparation
Following the revised IAT scoring algorithm (Greenwald,
Nosek, and Banaji 2003), we subjected all data to the fol-
lowing criteria: (1) We eliminated trial response latencies
greater than 10,000 milliseconds (of the 13,248 trials in the
critical blocks, 2 were above this threshold and thus were
eliminated); (2) we excluded participants whose response
times were less than 300 milliseconds on more than 10% of
the critical trials (we discarded 2 of the participants, result-
ing in a final sample of 136 participants); (3) we included
all response latencies, even those for false responses; and
(4) we computed a difference score between the two critical
blocks of trials ([congruent: unhealthy food + enjoyable and
healthy foods + not enjoyable] – [incongruent: healthy
foods + enjoyable and unhealthy foods + not enjoyable]
divided by the pooled standard deviation of response laten-
cies across both blocks). The resultant measure is the IAT D
effect (Greenwald, Nosek, and Banaji 2003).
Results and Discussion
Response latencies were significantly lower when the stim-
uli were presented in the congruent (versus incongruent)
condition. Mean response time when participants were
asked to classify stimuli into the congruent categories (pair-
ing unhealthiness with enjoyment) was 767.76 millisec-
onds, compared with 1137.91 milliseconds when partici-
pants were asked to classify stimuli into the incongruent
categories (pairing healthiness with enjoyment); this differ-
ence in response time was significant (D = .648, SD = .497,
t(135) = 17.19, p < .0001, d =1.42). That participants were
able to respond significantly faster when asked to group
unhealthy foods with words describing tastiness and enjoy-
ment than with words describing lack of taste and lack of
enjoyment suggests that participants have a stronger
implicit association between unhealthiness and tastiness
than they do between healthiness and tastiness.
To test whether the unhealthy = tasty intuition influ-
ences the response times of even the participants who did
not report explicit belief in the intuition, we first averaged
the items used to measure explicitness of belief to form an
explicitness-of-belief index. We then assessed the mean dif-
ference in response time for the congruent versus incongru-
ent condition at each level of reported explicitness of belief
in the intuition (see Irwin and McClelland 2001). The
results revealed that this difference was significant at every
level of belief. That is, at all reported levels of explicit dis-
agreement and agreement with the intuition, the difference
in response latencies when participants were asked to pair
healthiness with enjoyment versus when they were asked to
pair unhealthiness with enjoyment was significantly differ-
ent from zero (all is > 3.23, all ps < .01). Participants at all
levels of belief were able to classify unhealthiness with
enjoyment more quickly than they were able to classify
healthiness with enjoyment.
Thus, the results of Experiment 1 are consistent with
our hypothesis that consumers implicitly subscribe to the
view that healthiness and tastiness are inversely related to
each other, regardless of their level of explicit belief in this
relationship. As such, we expect that even consumers who
do not report agreeing that healthiness and tastiness are
inversely related to each other will make judgments and
decisions as if they did; we tested this hypothesis in the next
three experiments.
Experiment 2: Taste Inferences of
Crackers
The results from Experiment 1 demonstrated that people
implicitly associate unhealthiness with tastiness. Thus, we
expect that the influence of the unhealthy = tasty intuition
on decision making can take place outside of awareness
such that even participants who do not report believing that
healthiness and tastiness are inversely related to each other
make decisions as if they believe in such a relationship. In
general, the objective of Experiment 2 was to test this pre-
174 I Journal of Marketing, October 2006
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diction in the context of inference making. Specifically, the
objective of this experiment was twofold: First, we wanted
to assess whether a food product portrayed as unhealthy
would be inferred to taste better (H1) than one portrayed as
healthy. Second, we wanted to assess whether such an infer-
ence is made both by people who explicitly report believing
that tastiness is inversely related to healthiness and, to a
lesser degree, by those who do not (H4).
Participants, Stimuli, and Procedure
One hundred ten undergraduate students (51 men and 59
women) took part in this experiment for course extra credit.
Participants were told that the purpose of the experiment
was to assess consumers’ taste perceptions of three new
brands of cheddar-flavored snack crackers. To lend credibil-
ity to the cover story, participants were told that a national
cracker manufacturer was interested in introducing these
brands of crackers into the local market. The brands were
portrayed as varying in terms of unhealthiness. After being
exposed to nutritional information for the cracker versions,
participants were asked to infer the tastiness of the three
versions.
Unhealthiness manipulation. The most natural way to
manipulate unhealthiness perceptions is to portray offerings
as differing in the content of an ingredient (e.g., fat) that is
generally accepted as being unhealthy. However, altering
the content of fat (or any other ingredient) can alter taste
perceptions directly (i.e., without altering perceptions of
unhealthiness). As a result, varying content of a specific
ingredient would confound our prediction with the compet-
ing possibility that the ingredient may independently
enhance inferred tastiness of the crackers. To overcome this
problem, we chose to manipulate perceptions of unhealthi-
ness by varying the purported content of “bad” versus
“good” fat, while controlling for the crackers’ total fat con-
tent. This allowed us to manipulate the perceived unhealthi-
ness of the crackers selectively while controlling for any
(potential) effects due to a direct association of fat content
with taste.
The unhealthiness manipulation unfolded as follows:
Before seeing the nutritional information for each cracker
version, participants were presented with the following
information about the characteristics of bad (saturated) and
good (unsaturated) fat:
Medical opinion suggests that consuming unsaturated fat
(good fat) can raise the level of high-density lipoproteins
(HDL), which carry cholesterol from the heart to the liver
and thereby eliminate excess cholesterol; in contrast, con-
suming saturated fat (bad fat) can raise the level of low-
density lipoproteins (LDL), which carry cholesterol from
the liver to the rest of the body and thereby lead to
blocked coronary arteries. (adapted from Harvard School
of Public Health Nutrition Source 2004)
Then, participants were told that each of the three new
brands of crackers contained 13 grams of total fat per serv-
ing. One brand (the healthy alternative) was portrayed as
containing 11 grams of good fat and 2 grams of bad fat, and
another (the unhealthy alternative) was portrayed as con-
taining 2 grams of good fat and 11 grams of bad fat. A third,
“control” version was portrayed as containing 6.5 grams of
both types of fat. All participants were exposed to informa-
tion about all three versions of the crackers in a counterbal-
anced manner.
Dependent and other variables. After exposure to infor-
mation about the fat content of the three cracker versions,
participants were asked to rate “How tasty do you think
these crackers would be?” and “How much do you think you
would enjoy eating them?” on a ten-point scale (1 = “not at
all,” 10 = “very”) for each cracker version. To test whether
the influence of the unhealthy = tasty intuition can occur
implicitly, we assessed explicitness of participants’ beliefs in
the intuition by eliciting participants’ agreement with the
same two statements we used in Experiment 1. Finally, par-
ticipants provided information on their liking for cheddar-
flavored snack crackers and also indicated their perceptions
of the unhealthiness of the three cracker versions.
Results
We dropped 4 participants from the analyses for indicating
that they did not like any type of cheddar-flavored snack
cracker (a rating of 1 on the scale that assessed liking). This
left 106 participants (48 men and 58 women).
Manipulation check. We first wanted to assess whether
our unhealthiness manipulation worked as intended. We
regressed perceived unhealthiness of crackers on their pur-
ported bad fat content. The results revealed a positive
monotonic relationship between purported bad fat content
and perceived unhealthiness (f3 = +.39, t(101) = 9.32, p <
.001), revealing that the unhealthiness manipulation worked
as we intended.
Taste inferences. The items used to measure tastiness
and enjoyment of the crackers were highly correlated
(Cronbach’s a = .86); thus, we averaged them to form a
tastiness index. The items used to measure explicitness of
belief in the intuition were also highly correlated (Cron-
bach’s u = .73); thus, we averaged them to form an
explicitness-of-belief index, as in Experiment 1. Using the
taste inference index of the crackers as the dependent
variable, we conducted a mixed analysis of variance
(ANOVA) with three levels of portrayed unhealthiness of
the cracker (healthy, control, unhealthy) as a repeated factor
and explicitness of belief in the intuition as a continuous
between-subjects factor. The results revealed a marginal
main effect of unhealthiness (F(2,103) = 2.44, p = .09). As
we predicted, mean inferred tastiness was highest for the
cracker portrayed as containing the highest amount of bad
fat (M = 7.33) and lowest for the cracker portrayed as con-
taining the lowest amount of bad fat (M = 5.16), with the
control cracker falling in between (M = 6.38). Although the
differences between the inferred tastiness of the unhealthy
and the control cracker and those between the healthy and
the control cracker were not significant (F(1, 104) = 1.53
and 1.84, respectively, both ps > .12), the focal contrast
between tastiness ratings of the unhealthy and healthy
crackers was significant (F(1, 104) = 17.02, p < .001).
These results offer evidence consistent with HI and indicate
that consumers infer the taste of food products when infor-
mation relevant to assessing their healthiness is provided in
a manner consistent with the unhealthy = tasty intuition.
The Unhealthy = Tasty Intuition 1175
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Role of explicitness of belief. The results of the ANOVA
also revealed a significant unhealthiness x explicitness-of-
belief interaction (F(2, 103) = 12. 12, p < .001), suggesting
that the inference that crackers with more bad fat tasted bet-
ter was made to differing degrees, depending on partici-
pants' strength of belief in the unhealthy = tasty intuition.
To test whether the unhealthy = tasty intuition influenced
the taste inferences of participants who did not report
explicit belief in it, we assessed the mean difference in
inferred tastiness ratings of the unhealthy versus healthy
cracker at each level of reported explicitness of belief in the
intuition (Irwin and McClelland 2001). The results revealed
that this difference was significant at every level of belief.
That is, as we depict in Figure 2, at all reported levels of
disagreement and agreement with the intuition, the differ-
ence in inferred tastiness of the unhealthy versus healthy
cracker was significantly different from zero (all is > 2.68,
all ps < .01).3
Discussion
The results from Experiment 2 lead us to conclude that the
unhealthy = tasty intuition influences taste inferences.
Although participants in the experiment did not taste any of
the crackers, and the total amount of fat was the same
across the different versions of the cracker, they readily
assumed that crackers with more bad fat would taste better.
Furthermore, we also found that though the effect of por-
trayed healthiness on taste inferences was particularly
strong among those who reported an explicit belief in the
unhealthy = tasty intuition, we also obtained the effect
among participants who reported disagreement with the
intuition. This suggests that consumers may implicitly sub-
scribe to the view that healthiness and tastiness are
inversely correlated, thus conceptually corroborating the
results we obtained in Experiment 1.
Experiment 3: Enjoyment of Mango
Lassi
We wanted to expand on our findings in several ways in
Experiment 3. First, we attempted to address a potential
3To ensure that our results hold when the unhealthy = tasty intu-
ition is measured as such (i.e., that unhealthy implies tasty rather
than that healthy implies not tasty), we conducted an additional
study with 287 undergraduate students that reversed the wording
of the explicitness-of-belief measure. That is, participants were
asked to rate their agreement with the statement “The more
unhealthy a food, the better it tastes” rather than the statement
“There is no way to make food healthier without sacrificing taste.”
The results were nearly identical to those we found in Experiment
2. Participants rated the unhealthy cracker (M = 7.31) as signifi-
cantly tastier than the healthy cracker (M = 5.33; F(1, 286) =
163.71, p < .0001), and this difference in taste ratings interacted
with explicitness of belief (F(1, 285) =10.99, p < .001), such that
higher levels of belief were associated with greater differences in
taste ratings. Furthermore, when we used Irwin and McClelland's
(2001) method, the difference in rated taste between the unhealthy
and the healthy cracker was significantly different from zero at
every level of explicit belief in the intuition (all is > 2.57, all ps <
.05) except at the lowest level. At the lowest level of explicit
belief, this difference approached significance (t =1.55, p = .12).
limitation arising from the within-subjects design used in
Experiment 2. Because participants were asked to infer the
tastiness of three different cracker versions that varied only
in terms of portrayed healthiness, it could be argued that the
participants may have guessed our hypotheses. Although
the significance of the two-way unhealthiness x
explicitness-of-belief interaction suggests that demand
effects cannot fully explain our findings, we wanted to act
conservatively and conceptually replicate these findings
using a between-subjects manipulation of unhealthiness.
Second, we wanted to demonstrate that the portrayed
healthiness of food affects actual (versus inferred) enjoy-
ment (see Figure 1, Stage 2). Such a finding would indicate
that the unhealthy = tasty intuition acts as a hypothesis that
participants confirm after sampling stimuli (e.g., Hoch and
Ha 1986; Shiv, Carmon, and Ariely 2005). Third, we
wanted to assess whether the implicit nature of the influ-
ence of the unhealthy = tasty intuition can be replicated in
the context of actual enjoyment. Such a finding would fur-
ther attest to the robustness of H4. Finally, we tested the
generalizability of our results by using a different (1) prod-
uct category, (2) unhealthiness manipulation, and (3) exper-
imental setup.
Forty adults were invited to a housewarming party at the
residence of one of the authors of this article. In the invita-
tion to the event (sent by e-mail), invitees were informed
that refreshments would be served at the party. The refresh-
ment item targeted for testing our predictions was Mango
Lassi (an East Indian delicacy similar to a milkshake). We
used the context of the housewarming party, which pro-
vided a more realistic setting than the laboratory, to test our
predictions.
FIGURE 2
Experiment 2: Difference in Inferred Tastiness of
an Unhealthy Versus a Healthy Cracker at Each
Level of Explicitness of Belief in the Unhealthy =
Tasty Intuition
0 2 4 6 8 10
Belief
1761 Journal of Marketing, October 2006
Belief
Belief
Badgood rating
difference
Linear (Badgood
rating difference)
7
.00
6.00
5.00
4.00
3.00
2.00
1.00
.00
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Participants, Stimuli, and Procedure
At the party, invitees were told that snacks had been ordered
from a newly opened Indian restaurant (Hyderabad Masala)
and that the operators of this restaurant were interested in
catering mainly to an American audience. To lend credibil-
ity to the cover story, during appropriate moments at the
party, the host nonchalantly expressed that “when the
restaurant operators realized that I was going to have a pre-
dominantly American crowd at the party, they wondered if
the guests would be willing to fill out a short questionnaire
about the food. I didn’t see any harm in agreeing, especially
since they promised to give you a 25% discount on your
next visit to the restaurant” A coupon for “25% off the next
meal at Hyderabad Masala” was made available to the invi-
tees. To lend further credibility to the cover story, a confed-
erate (a graduate student of East Indian origin) was hired to
play the role of an agent representing the restaurant. The
confederate handed out the one-page questionnaire that pro-
vided information about the following food items offered at
the party and elicited participants’ judgments of the tasti-
ness and enjoyment of the following items using a ten-point
scale (1 = “not at all,” 10 = “very”): (1) Idlis, (2) Samosas,
and (3) Mango Lassi.4 These items were placed on a dining
table in the formal dining area. The Idlis and Samosas were
served on paper plates, and the Mango Lassi was served in
prefilled 12-ounce plastic cups.
Because the invitees arrived at various times during a
fairly large (four hours) time interval and because the din-
ing area was physically distant from the family room, where
people congregated, the invitees tended to be separated
from the other guests at the time of sampling the food items
and filling out the questionnaire. This minimized potential
response bias effects due to social influence (Raghunathan
and Corfman 2006). To encourage candidness further, the
confederate (who was always present next to the food)
stressed to every invitee, “Since we [the restaurant opera-
tors] are interested in catering to the American taste, we
request that you respond as candidly as possible. Please
don’t worry about hurting our feelings.”
Unhealthiness manipulation. Across all participants, the
Idli was portrayed as a healthy item, and the Samosa was
portrayed as an unhealthy one. These two items were not
the focus of this experiment, but we included them to lend
credibility to the cover story and to mask the main target of
this experiment (the Mango Lassi). For roughly half of the
participants, the Mango Lassi was portrayed as a healthy
item (“made out of real mango pulp and milk; generally
considered very healthy”), and for the other half, it was por-
trayed as an unhealthy one (“made out of real mango pulp
and milk; generally considered unhealthy”). Note that this
manipulation (unlike the one we used in Experiment 2)
serves to alter perceptions of unhealthiness directly (rather
than manipulate it by altering the content of an ingredient
considered unhealthy).
4Idli is a traditional South Indian dish made by steaming a mix-
ture of mainly lentils and rice. Samosas are deep-fried vegetable
dumplings. Lassi refers to sweet drinks made with a base of
yogurt.
Measurement of explicitness of belief in the intuition.
Two days after the party, the host e-mailed the invitees indi-
vidually, attaching an article that had recently appeared in
the local newspaper. The newspaper article suggested that
the “low-carb fad” was waning. The purported purpose of
the e-mail was to alert the recipients to the content of the
“interesting” article, but the true purpose was to gauge the
invitees’ explicitness of belief in the unhealthy = tasty intu-
ition. Using the news article as a backdrop, the host
assessed the invitees’ beliefs in the relationship between
healthiness and tastiness by asking the following question,
“On a scale of one to nine, how much would you agree with
the following statement: `Food that is unhealthy generally
tastes better’?” We took invitees’ ratings as a measure of the
explicitness of their beliefs in the unhealthy = tasty intu-
ition; higher numbers indicated greater explicitness of
belief.
Results
About a week after the party, the invitees were individually
e-mailed and asked if they had suspected that the true pur-
pose of the questionnaire administered during the party was
different from the purported one. We dropped data from one
individual who reported suspicion.
Taste inferences. Tastiness and enjoyment of the Mango
Lassi were highly correlated with each other (Cronbach’s
a = .73); thus, we averaged them to form an enjoyment
index. Using this index as the dependent variable, we con-
ducted a mixed ANOVA with two levels of unhealthiness of
Mango Lassi (healthy, unhealthy) as a between-subjects
factor and explicitness of belief in the intuition as a contin-
uous between-subjects factor. The results from this analysis
appear in Figure 3. Consistent with our prediction (H2), the
mean enjoyment ratings were higher for participants in the
condition in which the milkshake was portrayed as being
unhealthy (M = 5.13) than for participants in the condition
in which the milkshake was portrayed as being healthy
(M=3.30;F(1, 35)=24.29,p<.001).
Role of explicitness of belief Echoing findings from
Experiment 2, the ANOVA also revealed a marginal health-
iness x explicitness-of-belief interaction (F(1, 35) = 3.91,
p = .06), indicating that the relationship between enjoyment
of the milkshake and its perceived healthiness depended on
participants’ explicitness of belief in the unhealthy = tasty
intuition. Follow-up analyses revealed that the effect of
unhealthiness on enjoyment was significant both at one
standard deviation above the mean belief level (t(1, 35) =
4.84, p < .001) and at one standard deviation below it (t(1,
35) = 2.00, p = .05), indicating that portrayed healthiness of
food significantly influenced participants' enjoyment of the
food, even among those who did not report agreeing with
the unhealthy = tasty intuition. These results provide further
support for our hypothesis that the influence of the intuition
on consumption decisions can take place outside of
awareness.
Discussion
Viewed in conjunction with the results from Experiments 1
and 2, the results from Experiment 3 indicate that taste
The Unhealthy = Tasty Intuition 1177
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FIGURE 3
Experiment 3: Mango Lassi Enjoyment Ratings x
Explictness of Belief That Food That Is Unhealthy
Generally Tastes Better
Healthy Con ition Unhealthy Condition
inferences made on the basis of perceived unhealthiness are
confirmed on sampling the food, implying that a mecha-
nism akin to the hypothesis confirmation bias may underlie
the prevalence of the unhealthy = tasty intuition. Further-
more, the finding that even participants who reported dis-
agreeing that healthiness needs to be sacrificed in order to
enhance tastiness enjoyed the milkshake more when it was
portrayed as unhealthy (versus healthy) indicates that the
influence of the unhealthy = tasty intuition can be implicit,
thus conceptually replicating results from Experiments 1
and 2. Finally, the results were consistent with our predic-
tions even though we used a different (1) design (between-
versus within-subjects), (2) product category, and (3)
unhealthiness manipulation; this attests to the robustness of
the influence of the unhealthy = tasty intuition.
Experiment 4: Choice of Crackers
The results from Experiments 2 and 3 suggest that people’s
belief in the unhealthy = tasty intuition is sufficiently strong
to influence taste inferences and enjoyment of food. The
objective in Experiment 4 was to further explore whether
the intuition would influence choice decisions (see both
Figure 1, Stage 3, and H3). We know from previous research
that when consumers are faced with the task of choosing
among food products, better-tasting options have a higher
likelihood of being chosen when a hedonic goal is relatively
more salient (e.g., Dhar and Simonson 1999; Shiv and
Fedorikhin 1999). Extrapolating from these results, we
expect that participants will prefer an option portrayed as
being more (versus less) unhealthy when a hedonic goal is
relatively more salient because according to our hypothesis,
people will infer this option to taste better (and thus will
judge it as a better candidate for fulfilling the hedonic goal).
Participants, Stimuli, and Procedure
Two hundred ninety-three undergraduate students (107
men, 184 women, 2 unknown gender) participated in this
experiment for course extra credit. They were first told that
a national manufacturer of crackers was interested in
assessing which of two versions of a cheddar-flavored
snack cracker is preferred in choice tasks. Subsequently,
information about good and bad fat (identical to the infor-
mation we used in Experiment 1) was provided before par-
ticipants chose between a cracker version with 11 grams of
bad fat and 2 grams of good fat (unhealthy version) and one
with 2 grams of bad fat and 11 grams of good fat (healthy
version).
Before indicating their choice, approximately half of the
participants were told to imagine that they were “craving
something really tasty” and that “they wanted to reward
themselves with a nice snack.” The purpose of these state-
ments was to prime a hedonic, or enjoyment, goal. The
remaining participants were not exposed to such a prime;
they were simply told to imagine that they were “in the
mood for a snack.” The dependent variable was which
cracker version participants selected in a forced-choice task.
We elicited participants’ explicitness of belief in the
unhealthy = tasty intuition using the same questions we
used in Experiments 1 and 2. Consistent with H3, we
expected that the relative preference for the unhealthy (ver-
sus healthy) cracker version would be higher among partici-
pants who were primed with the hedonic goal.
Results and Discussion
Manipulation check and choice. As we expected, par-
ticipants perceived the cracker with the higher content of
good (versus bad) fat content as healthier (Ms = 6.13 and
3.05; t(291) = 1067.71, p < .01). To test our prediction that
the relative preference for the unhealthy (versus healthy)
option would be higher among those primed with a hedonic
goal, we conducted a chi-square test. As we predicted, the
proportion of participants who chose the unhealthy option
was significantly greater among those who were primed
with the hedonic goal (M = 21%) than among those who
were not primed with this goal (M = 8%; x2 = 15.88, p <
.001; .001; = .23).5
Role of explicitness of belief. To test the role of explicit-
ness of belief, we conducted an ANOVA using the prime
and explicitness of belief in the intuition as the predictor
variables and choice as the dependent variable. The results
revealed a nonsignificant prime x explicitness-of-belief
interaction (F(1, 258) = .59, p > .44), indicating that,
regardless of whether the participants reported agreeing
5The proportion of participants who chose the unhealthy cracker
was low even in the hedonic prime condition, presumably because
participants did not want to indicate that they were interested in
consuming a cracker that was explicitly portrayed as being
unhealthy.
178 I Journal of Marketing, October 2006
Low belief that food that is
unhealthy generally tastes
better
High belief that food that is
unhealthy generally tastes
better
6.00
5.00
4.00
3.00
2.00
1.00
.00
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with the unhealthy = tasty intuition, they made choice deci-
sions as if they did.
Thus, the results from Experiment 3 conceptually repli-
cate those we obtained previously, providing evidence that
the unhealthy = tasty intuition affects not just inferences
and judgments but actual choice decisions as well. We
found that when a hedonic goal was made temporarily more
salient, participants were more likely to select the unhealthy
cracker, presumably because they inferred that it would
taste better. Furthermore, the lack of significance of the
prime x explicitness-of-belief interaction suggests that the
influence of the intuition can take place outside the aware-
ness of consumers, indicating that controlling for the influ-
ence of the intuition may be difficult.
General Discussion
Understanding the effects of food consumption habits on
health has emerged as a topic of significance in recent
years. The question of why consumers overconsume food
despite the negative consequences of doing so has espe-
cially piqued the interest of academics (e.g., Kozup, Creyer,
and Burton 2003; Oakes 2005; Oakes and Slotterback 2005;
Seiders and Petty 2004; Smith 2004; Tepper and Trail 1998;
Urala and Lahteenmaki 2004; Verbeke 2005; Wansink 2004
a, b; Wansink and Chandon 2006; Wansink and Huckabee
2005). Previous findings are consistent with the idea that
people overconsume food that is considered unhealthy
either because they are unaware of the negative conse-
quences of doing so (presumably because of poor marketing
and/or presentation of nutritional information) or because
they lack the willpower to resist such foods. In what we
believe is the first rigorous empirical demonstration of its
kind, our findings indicate that in addition to these factors, a
more subtle force may be at work; namely, consumers over-
consume foods that they perceive as unhealthy because they
assume that such food tastes better.
The results from Experiment 1, in which we used the
well-established IAT procedure (Greenwald, McGhee, and
Schwartz 1988), demonstrated not only that people sub-
scribe to the unhealthy = tasty intuition but also that this
intuition operates at an implicit level. Both participants who
reported an explicit belief in the intuition and those who did
not took longer to categorize stimuli in the incongruent
(versus congruent) condition, which suggests that the
implicit subscription to the unhealthy = tasty intuition is
robust.
The results from three other experiments confirmed our
predictions that when information pertaining to the assess-
ment of the healthiness of food items is provided, foods per-
ceived as less healthy are (1) inferred to taste better, (2)
enjoyed more during actual consumption, and (3) preferred
in a choice task when a hedonic goal is more (versus less)
salient. We obtained these patterns of results even among
those who disagreed that healthiness is inversely related to
tastiness, which suggests that the influence of the
unhealthy = tasty intuition can take place outside of aware-
ness; this result conceptually replicates Experiment 1’s
results, which demonstrate that subscription to the
unhealthy = tasty intuition is implicit.
Theoretical Implications
Validity of the intuition and reasons for its propagation.
In light of our findings, an important question that emerges
is whether the unhealthy = tasty intuition is valid, that is,
whether the healthiness and tastiness of food items are
indeed negatively correlated with each other in the real
world. Although the intuition appears to enjoy widespread
subscription (e.g., Keller, Sternthal, and Tybout 2002), there
is little scientific evidence to support the view that tastiness
and healthiness are negatively correlated with each other.
Indeed, from an evolutionary standpoint, evidence points to
the opposite, namely, that tastiness and healthiness are posi-
tively correlated with each other. For example, in general, it
is accepted among researchers (e.g., Drewnowski 1997;
Smith 2004) that certain food groups (e.g., carbohydrates,
fat) are perceived as tastier precisely because these foods
have proved effective for survival; in these researchers’
view, tastiness has served humans well as a proxy for
healthiness.
Why then do negative health consequences result from
consuming the food groups (e.g., carbohydrates, fat) that
are, evolutionarily speaking, considered healthy? Medical
evidence suggests that it is the overconsumption, not mod-
erate levels of consumption, of these food groups that leads
to negative health consequences (e.g., Drewnowski 1997).6
Indeed, consuming fat and carbohydrates in moderation has
been found to have salutary effects on health (Better Health
Channel 2004). Consistent with this view, findings indicate
that overconsumption of any food group can result in nega-
tive health consequences.
There is yet another reason to question the validity of
the unhealthy = tasty intuition. Note that to assess the actual
relationship between healthiness and tastiness, it is first
necessary to measure the healthiness and tastiness of van-
ous food options accurately. We believe that this is a decep-
tively difficult task because neither judgments of healthi-
ness nor those of tastiness are likely to be stable across time
or across people. Oakes’s (2005) findings demonstrate how
judgments of healthiness are notoriously susceptible to con-
textual influences. In one study, for example, Oakes finds
that a lower-calorie snack portrayed as being “disreputable”
in terms of health (i.e., a Snickers miniature bar with 47
calories) was inferred to promote greater weight gain than
one portrayed as being more “reputable” in terms of health
(i.e., a half cup of green peas with 62 calories). Thus, par-
ticipants in this study relied on their subjective perceptions
of the snacks’ healthiness rather than on more diagnostic
information (the snacks’ caloric value) to infer their poten-
tial for weight gain. There is reason to believe that judg-
ments of tastiness may be similarly susceptible to contex-
tual influences. For example, Carpenter and Nakamoto’s
(1989) findings suggest that what people happen to taste
6Needless to say, underconsumption of nutrients can also lead to
negative health consequences. Indeed, malnourishment is the
world’s deadliest cause of premature death (World Health Organi-
zation 2002). However, because this research is restricted to the
context of the United States, where food is plentiful, we restrict
our discussion to negative consequences of overconsumption.
The Unhealthy = Tasty Intuition 1179
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first (e.g., Coke or Pepsi) may become their preferred
option. An overview of other relevant findings suggests that
there is little agreement (among adults) about tastiness rat-
ings of food (see, e.g., Drewnowski 1997, p. 240).
Nonconscious influence. It is well known that con-
sumers’ decisions are influenced by their lay theories and
intuitions even when the lay theories are invalid (Broniar-
czyk and Alba 1994; Shiv, Carmon, and Ariely 2005). What
is noteworthy in the current research is that our predictions
were confirmed across two different types of food products,
three types of judgment tasks, and two conceptually differ-
ent types of unhealthiness manipulations. The generality of
our findings across these experimental differences hints at
the prevalence and strength with which people believe in
the unhealthy = tasty intuition. Even more intriguing, how-
ever, is the indication of the implicit nature of the influence
of the intuition. The results from Experiment 1 confirmed
that people may have implicitly learned to correlate
unhealthiness with tastiness. The results from Experiments
2 and 3 offer conceptual replication by showing that even
participants who reported disagreeing with the view that
healthiness and tastiness are inversely correlated behaved as
if they did. These findings indicate that the influence of the
intuition may lie outside the awareness of consumers mak-
ing judgments about what to consume. At a conceptual
level, this notion shares similarities with Lewicki and col-
leagues’ (e.g., Lewicki 1986; Lewicki and Hill 1989;
Lewicki, Hill, and Czyzewska 1997) work on nonconscious
learning. The idea that a person’s judgments and decisions
may be influenced by factors outside his or her awareness is
also echoed in various other findings, such as mere expo-
sure effects (Zajonc 1980), truth effects (Hawkins and Hoch
1992), and assimilation/contrast effects (e.g., Schwarz and
Bless 1992).
Managerial, Consumer, and Public Policy
Implications
Although the obesity problem afflicting people in the
United States may be due, in part, to the ubiquity of food
high in fat content, our findings indicate that even if options
with less fat were available, consumers may choose to con-
sume foods high in fat because of a misguided notion that
they need to eat unhealthy to eat tasty or that eating healthy
means having food that is not tasty. Evidence from food sci-
entists suggests that despite current concerns about healthy
eating, health is secondary to taste in selecting many food
products (for a discussion of taste versus health in con-
sumer selection of corn chips, see Tepper and Trail 1998).
There is also evidence in recent research on functional
food -a new category of products that promise consumers
improvements in targeted physiological functions, such as
lowering cholesterol (Urala and Lahteenmaki 2004)–that
consumers are unwilling to compromise on taste even for
the sake of the health benefits these foods offer (Verbeke
2006). This lesson was perhaps most starkly revealed in the
interesting story of the McLean, a low-fat burger that
McDonald’s tried to market in the early 1990s. Although
the burger was actually preferred to burgers that contained
more fat in blind taste tests, it was a miserable market fail-
ure (Gladwell 2001).
Given our evidence that the influence of the unhealthy =
tasty intuition is strong and may take place outside the con-
sumer’s awareness, this intuition could be a major con-
tributing factor to obesity in consumers. Therefore, a key
question is, What (if anything) can be done to counteract its
potentially devastating impact on consumer food choice
decisions and, subsequently, on consumer health?
More research is being directed at understanding both
how to market products such that consumers make better
food choices (Andrews, Netemeyer, and Burton 1998;
Kozup, Creyer, and Burton 2003; Seiders and Petty 2004;
Wansink and Huckabee 2005) and how to help consumers
make changes in their environment to help control their
food consumption (Wansink 2004a). These streams of
research offer guidance to the food industry, which has been
accused of contributing to the obesity epidemic, and to con-
sumers who want to make healthier choices that are still
enjoyable, despite the pervasiveness of a belief in the
unhealthy = tasty intuition. Possibilities for controlling the
effect of the unhealthy = tasty intuition (and its potential for
causing negative health consequences) include (1) control-
ling the volume of unhealthy but tasty food that is eaten, (2)
changing unhealthy foods to make them less unhealthy but
still tasty, and (3) providing consumers with better informa-
tion about what constitutes “healthy.” We address each of
these possibilities in the remainder of this discussion.
Limiting consumption volume of unhealthy foods. If
consumers infer that unhealthy foods are tastier, they will
possess a strong desire to eat foods that are relatively
unhealthy (e.g., foods that are high in fat or high in calo-
ries). A possible solution to this problem would be for both
marketers and consumers to take steps to ensure that if
these foods are going to be eaten, they are eaten in reason-
able quantities. Such steps are important because, as we
mentioned previously, medical evidence suggests that it is
the overconsumption, not moderate levels of consumption,
of foods considered unhealthy that leads to negative health
consequences (e.g., Drewnowski 1997). Therefore, mea-
sures aimed at restricting consumption of foods considered
unhealthy (but tasty) to moderate levels can go a long way
toward counteracting the potential negative health conse-
quences of a belief in the unhealthy = tasty intuition.
Responsible marketers and individual consumers can
take such steps to control consumption volume of unhealthy
foods. For example, Wansink and Huckabee (2005) suggest
that marketers can guide consumers’ volume decisions by
changing packaging (e.g., offering multipacks with smaller
individual servings, offering premium-priced smaller pack-
aging), changing the volume of implied serving sizes in
packaging information (e.g., designating a serving as three
cookies versus six), and providing consumers with easier
ways to assess how much they are consuming (e.g., placing
markers on the outsides of packaging to indicate a serving
size, placing indicator lines inside packaging). Consumers
can also make changes to their personal environment to
help reduce consumption.
Wansink (2004a) offers many practical alterations that
can be made to both the eating and the food environments,
including pre-serving portions when snacking while dis-
tracted (e.g., while watching television); repackaging foods
180 I Journal of Marketing, October 2006
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into small containers to suggest smaller consumption
norms; never eating directly from a package; and using
smaller plates, bowls, and eating utensils. Such steps can
allow marketers to continue to market unhealthy foods in
responsible ways and allow consumers to continue to enjoy
the foods they consider tasty, albeit in moderation.
Although many of these changes seem small, Wansink and
Huckabee (2005) point out that 80% of the population gain
weight because of a calorie excess of less than 50 calories a
day. The changes suggested here could allow consumers to
enjoy the foods they consider tasty in smaller, controlled
quantities, perhaps enough to avoid consumption of those
additional 50 calories.
Reformulating unhealthy foods. Another possibility for
controlling the effects of the unhealthy = tasty intuition is to
change the composition of unhealthy foods. One alternative
is to reformulate high-energy-density foods (i.e., foods high
in calories) to lower their energy density (i.e., calorie con-
tent) by replacing some of the fat with water, fiber filler, or
vegetables (Wansink and Huckabee 2005). Although evi-
dence from our studies suggests that people believe that
food cannot be made healthier without sacrificing taste
(and, thus, that these lower-energy-density foods would be
less appetizing), taste tests indicate otherwise. Rolls, Ello-
Martin, and Tohill’s (2004) research suggests that con-
sumers who eat lower-energy-density foods eat the same
volume as they would of the unmodified food (resulting in
fewer calories consumed), rate themselves as equally satis-
fled as those who eat full-calorie dense foods, and, most
important in our research context, do not perceive the foods
as tasting worse (Kral and Rolls 2004; Rolls 2005; Wansink
and Huckabee 2005). Research suggests that up to 20% of
the fat in a high-energy-density food can be replaced with
low-density items (e.g., fruits, vegetables) without con-
sumers noticing a difference in taste (Rolls, Ello-Martin,
and Tohill 2004).
Such findings suggest that many consumers are not
knowledgeable enough about food composition to realize
that the unhealthy foods they love can be successfully refor-
mulated to be just as tasty without being as unhealthy.
Because such modifications could have a large impact on
the number of calories consumed, they could be very bene-
ficial if consumers are educated to believe that the healthier
version of their favorite unhealthy food is just as tasty.
However, because of the pervasiveness of the unhealthy =
tasty intuition, such a strategy could backfire (i.e., despite
research evidence suggesting the taste had not truly
changed, consumers could respond to such a modification
as they did in Experiment 3, in which they allowed the
knowledge that a food is now healthier to color their actual
taste perceptions).
To combat this problem, an obvious solution would be
to stress both taste and health for these items, with the taste
dimension being the dominant dimension. By stressing the
taste dimension first, companies could work on breaking
down the unhealthy = tasty intuition and increasing the
probability of choice. Marketing strategies involving sam-
pling, credible sources, and opinion leaders would be criti-
cal. First, sampling would be a key factor in gaining accep-
tance for these new, healthier products because consumers
will not believe that they are tasty unless they have tried the
product themselves. A free sample represents a low-risk
way to experience the taste. These samples could be distrib-
uted through the mail or, more appropriately, handed out in
health clubs or at sporting/fitness events.
Second, well-respected health or fitness experts could be
employed to endorse these products. To change engrained
beliefs, a credible source is needed. Consumers are more
likely to accept a message about a product when the source
is considered trustworthy and viewed as an expert on the
topic (e.g., Goldsmith, Lafferty, and Newell 2000; Sternthal,
Dholakia, and Leavitt 1978). This technique could be par-
ticularly effective if these sources are opinion leaders. For
example, health club employees and trainers are often
looked to by consumers for tips on exercise and diet. A mar-
keting or public policy program could educate and persuade
these people on the tastiness and health benefits of the new
products. They could then be important transmitters of this
information to consumers. Thus, this message would be
more likely to be accepted and acted on.
Another possibility might be to stimulate “buzz” for
certain products among consumers. If marketers could con-
vince a key group of consumers in the word-of-mouth net-
work that their food products taste good and are part of a
healthy diet, this group could influence and excite other
groups of consumers. A similar phenomenon occurred in
the fast and widespread acceptance of the Atkins diet, in
which consumers were willing to give up foods high in car-
bohydrates for quick weight loss.
Reeducating consumers about what is “healthy.” A final
avenue for counteracting the effects of the unhealthy = tasty
intuition is to educate consumers about what constitutes
healthy. Determining what is healthy or unhealthy is a
deceptively difficult task because, as we discussed previ-
ously, healthiness is not an inherent quality of food; rather,
it depends on the conditions (e.g., quantity, genetic makeup
of the person consuming it) under which it is consumed.
Nevertheless, consumers can be educated to approach nutri-
tion in a more balanced fashion than they currently do. In
Oakes’s (2005) study, which we described previously, con-
sumers overemphasized fat content when they assessed the
healthiness of foods and relied on a categorization system
(of foods as bad versus good) using stereotypes about types
of food/ingredients to determine how much weight a food
would cause someone to gain. Had they relied instead on a
more complete nutritional assessment of the foods, they
would have found that the food they considered healthy on
the basis of fat content (peas) would actually lead to more
weight gain than the food they considered unhealthy
(Snickers) because of the caloric content of the two foods.
What can be done to convince consumers to consider all
types of nutritional information? A possibility is to develop
an easy-to-use nutrition index that combines the various
types of relevant information into a single number, which
consumers could then use to make easy comparisons across
different types of foods. This would enable consumers to
choose healthier food with minimal effort and confusion.
Furthermore, reeducating consumers to evaluate the health-
iness of a food could actually change consumers’ percep-
tions about what constitutes healthy and unhealthy.
The Unhealthy =Tasty Intuition 1181
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Limitations and Further Research
An interesting implication of our main hypothesis (that
people subscribe to the unhealthy = tasty intuition) is that
regardless of which food group is associated with unhealth-
iness, food items that are higher (versus lower) in that
ingredient will be inferred to be tastier. Thus, for example,
in contexts in which carbohydrates are considered
unhealthy (as is likely to be the case among those following
the Atkins diet), food items higher (versus lower) in carbo-
hydrates will be (1) inferred to taste better, (2) enjoyed
more, and (3) preferred when a hedonic goal is more (ver-
sus less) salient. Indeed, the results from Experiment 3, in
which no mention was made of the particular ingredients
APPENDIX
Experiment 1: Stimuli Used in IAT
Word List
Unhealthy Foods Healthy Foods Enjoyable Not Enjoyable
Tasty Disliked
Delicious Less tasty
Yummy Unappealing
Appetizing Bland
Flavorful Flavorless
Appealing Unappetizing
Mouthwatering Unpalatable
1821 Journal of Marketing, October 2006
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that made the Mango milkshake more or less healthy, offer
conceptual support for this hypothesis.
An important related empirical question that is still
unanswered by the current research is whether other
manipulations of unhealthiness would produce similar
results in terms of taste inferences, enjoyment, and choice.
For example, would altering the content of preservatives
(assuming that they are considered unhealthy) alter percep-
tions of tastiness in a manner consistent with the
unhealthy = tasty intuition? If not, identifying the manipula-
tions that lead to the types of results we document in this
research would be important for both theoretical and sub-
stantive reasons. Similarly, further research should ascertain
the boundaries of the content of unhealthy ingredients
within which results consistent with the unhealthy = tasty
intuition will be obtained. Is there a limit beyond which
increasing unhealthiness does not lead to enhanced infer-
ences of tastiness? Levin and Gaeth’s (1988) results suggest
that there is. They find that beef that was portrayed as 25%
fat was expected to taste worse than beef that was portrayed
as 75% lean. These results indicate that there is a range
within which increasing the portrayed unhealthiness of food
leads to enhanced perceptions of tastiness but also a range
beyond which it does not.
A final and interesting extension of our work would be
to assess whether and to what extent socioeconomic and
cultural factors moderate our effects. In contexts in which
food is not plentiful (e.g., in developing countries, such as
India or China, and in underdeveloped countries, such as
Somalia or Cambodia), people may believe tastiness is posi-
tively correlated with healthiness, as evolution intended
(Drewnowski 1997; Smith 2004). If so, we may expect to
find a pattern of results that is opposite to that which we
find in this research. Similarly, in epicurean cultures (e.g.,
France), in which food is valued primarily for its tastiness,
it is possible that the perception of an inverse relationship
between healthiness and tastiness is held with less
conviction.
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- Article Contents
- Issue Table of Contents
p. 170
p. 171
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Journal of Marketing, Vol. 70, No. 4 (Oct., 2006), pp. 1-210
Volume Information
Front Matter
Corporate Social Responsibility, Customer Satisfaction, and Market Value [pp. 1-18]
The Influence of Avatars on Online Consumer Shopping Behavior [pp. 19-36]
Creating a Market Orientation: A Longitudinal, Multifirm, Grounded Analysis of Cultural Transformation [pp. 37-55]
It Just Feels Good: Customers’ Affective Response to Touch and Its Influence on Persuasion [pp. 56-69]
Marketing’s Credibility: A Longitudinal Investigation of Marketing Communication Productivity and Shareholder Value [pp. 70-91]
Upgrades and New Purchases [pp. 92-102]
Influence Tactics for Effective Adaptive Selling [pp. 103-117]
How Biased Household Inventory Estimates Distort Shopping and Storage Decisions [pp. 118-135]
Factors Influencing the Effectiveness of Relationship Marketing: A Meta-Analysis [pp. 136-153]
Achieving Marketing Objectives through Social Sponsorships [pp. 154-169]
The Unhealthy = Tasty Intuition and Its Effects on Taste Inferences, Enjoyment, and Choice of Food Products [pp. 170-184]
Broadening the Scope of Reference Price Advertising Research: A Field Study of Consumer Shopping Involvement [pp. 185-204]
Back Matter
Portion Sizes and Obesity: Responses of Fast-Food Companies
Author(s): Lisa R. Young and Marion Nestle
Reviewed work(s):
Source: Journal of Public Health Policy, Vol. 28, No. 2 (2007), pp. 238-248
Published by: Palgrave Macmillan Journals
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Portion Sizes and Obesity: Responses of
Fast-Food Companies
LISA R. YOUNG” and MARION NESTLE
ABSTRACT
Because the sizes of food portions, especially of fast food, have increased in parallel
with rising rates of overweight, health authorities have called on fast-food chains to
decrease the sizes of menu items. From zoo2 to zoo6, we examined responses of
fast-food chains to such calls by determining the current sizes of sodas, French fries,
and hamburgers at three leading chains and comparing them to sizes observed in
1998 and zooz. Although McDonald’s recently phased out its largest offerings,
current items are similar to 1998 sizes and greatly exceed those offered when the
company opened in 1955. Burger King and Wendy’s have increased portion sizes,
even while health authorities are calling for portion size reductions. Fast-food
portions in the United States are larger than in Europe. These observations suggest
that voluntary efforts by fast-food companies to reduce portion sizes are unlikely
to be effective, and that policy approaches are needed to reduce energy intake from
fast food.
Journal of Public Health Policy (2007) 28, 238-248.
doi:Io.Io57/palgrave.jphp.3 200127
Keywords: overweight, obesity, portion sizes, serving sizes, fast food,
calories
INTRODUCTION
Overweight and obesity have increased sharply since the early I98os
in the United States (I-4) and worldwide (5,6). As weight gains show
no signs of abating, these conditions constitute a major public
health concern (i), as they raise risks for a variety of medical
conditions including type z diabetes, hyperlipidemia, hypertension,
coronary heart disease, and certain cancers (7), as well as for
premature death (8,9).
Since the early I98os, increases in the portion sizes of foods
commonly eaten away from home have occurred in parallel with
*Address for Correspondence: New York University, Nutrition, Food Studies, and Public
Health, ioth floor, 35 West, 4th Street, New York, NY IooIz, USA. E-mail: lisa.young
@nyu.edu
Journal of Public Health Policy 20zoo7, 28, 238-248 ? zoo7 Palgrave Macmillan Ltd o0197-5897/07 $30.00 .
www.palgrave-journals.com/jphp
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YOUNG & NESTLE – PORTION SIZES AND OBESITY 239
increases in body weights, and constitute an important contributing
factor to rising rates of obesity (io,i i). Portion sizes offered by fast-
food chains are often two to five times larger than when first
introduced (i2). Large portions contribute to overweight in three
ways: they provide more calories, than smaller portions (io,Iz),
encourage people to consume significantly more calories and to
greatly underestimate those calories (13-16).
The United States food supply (food produced, less exports, plus
imports) currently provides 3,9oo kcal/day, a per capita increase of
700kcal/day since the early 1980s (17), whereas dietary intake
surveys report only an additional zoo-300kcal/day (18). Although
the precise size of the increase in caloric intake is uncertain, data
from many sources suggest that people are consuming more calories
than they did in the I98os (I9,zo).
Americans spend nearly half of their food budget on foods
prepared outside of the home and consume about one-third of daily
calories from outside sources, much of it from fast food (2,zz22).
Concerns about the effect on body weight of calories from restaurant
foods in general, and from fast foods in particular, make sense;
regular fast-food consumption is associated with weight gain and
obesity in both adults (23,24) and children (25).
In zooi, the US Surgeon General’s Call to Action to prevent
obesity challenged health professionals, communities, and the food
industry to confront portion size as a factor in weight control,
provide foods in more appropriate amounts, and raise consumer
awareness of appropriate portion sizes (z6). In z004, the filmmaker,
Morgan Spurlock, released Super Size Me!, a documentary account
of his 25-pound weight gain from consuming all meals at
McDonald’s for just i month. Perhaps in response, McDonald’s
announced plans to phase out its Supersize menu items (27). No
agency, however, holds fast-food companies accountable for
responding to calls for decreases in portion sizes. Here, we report
recent trends in the portion sizes of commonly consumed menu items
from leading fast-food chains.
METHODS
In 1998 (28) and zooz (io,Iz), we reported the increasing sizes of
fast-food portions from leading chains. For the present study, we
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240 JOURNAL OF PUBLIC HEALTH POLICY * VOL. z8, NO. 2
examined subsequent changes through zoo6, a 4-year period in
which calls for methods to address and prevent childhood obesity
have become much more pronounced (21,29). To assess the response
of fast-food companies, we compared current portion sizes to earlier
ones. Because consumption of soft drinks is associated with weight
gain and obesity (30,3i), and French fries and hamburgers are the
most popular foods consumed in fast-food restaurants (32), we
examined the sizes of these items at McDonald’s, Burger King, and
Wendy’s, the chains ranked highest in sales of such foods (33).
We obtained information about portion weights, volumes, and
calorie contents from nutrition information provided in company
brochures and Websites. To observe how companies are marketing
newly introduced portion sizes, we also examined newspaper
accounts, promotional advertisements, brochures, materials provided
by manufacturers in trade publications, and marketing materials.
RESULTS
Table i compares the portion sizes of fountain soda, French fries,
and hamburgers served at McDonald’s, Burger King, and Wendy’s in
1998, zooz, and zoo6.
Sodas
As promised, McDonald’s phased out its 42-oz Supersize soda; its
largest size is now a 3 z-oz Large. In 1998, the largest size soda at
Burger King was 32 oz. In zooz, however, the chain increased the
largest size to 42 oz. At Wendy’s, a Medium soda was 22 oz in 1998
and the largest soda was a 3z-oz Biggie. In zooz, Wendy’s reduced the
Medium to zo oz, but increased the size to 32 oz in zoo6. Also in zoo6,
this company introduced a new 4z-oz size. Wendy’s accompanied these
additions with some name changes. The former 3 z-oz Biggie is now
called Medium, and the new 42-oz soda is called Large.
French fries
McDonald’s offered French fries in three sizes in 1998: Small (2.4 oz),
Large (5-.3oz), and Supersize (6.3 oz). In zooz, it increased the
Supersize to 7.1 oz, and renamed the other three sizes Small, Medium,
and Large. Following the release of Super Size Me!, McDonald’s
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YOUNG & NESTLE – PORTION SIZES AND OBESITY Z41
Table I: Portion sizes of soda, French fries, and hamburgers available at three of the
largest fast-food establishments in the U.S in 1998, zooz, and zoo6
Size 1998 Size 2002 Size 2006
(oz or fl oz) (oz or fl oz) (oz or fl oz)
Fountain soda
McDonald’s I2 Child i2 Child Iz Child
16 Small 16 Small 16 Small
zi Medium zi Medium zi Medium
32 Large 32 Large 32z Large
42 Supersize
Burger King 12 Kiddie i z Kiddie No change
16 Small 16 Small
zi Medium zi Medium
32 Large 32 Large
42 King
Wendy’s z12 Kid iz Kid iz Kid
16 Small 16 Small 20 Small
zz22 Medium 20 Medium 32 Medium
32 Biggie 32 Biggie 42 Large
French fries
McDonald’s 2.4 Small 2.4 Small 2.4 Small
5.3 Large 5.3 Medium 4.0 Medium
6.3 Supersize 6.3 Large 6.o Large
7.1 Supersize
Burger King z.6 Small z.6 Small No change
4.1 Medium 4.1 Medium
6.1 Large 5.7 Large
6.9 King
Wendy’s 3.2 Small 3.2 Kids’ meal 3.z Kids’ meal
4.6 Medium 5.0 Medium 5.0 Small
5.6 Biggie 5.6 Biggie 5.6 Medium
6.7 Great Biggie 6.7 Great Biggie 6.7 Large
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242 JOURNAL OF PUBLIC HEALTH POLICY * VOL. z8, NO. 2
Table i (continued)
Size 1998 Size 200oo2 Size 2oo6
(oz or fl oz) (oz or fl oz) (oz or fl oz)
Hamburger, beef only (Precooked wt)
McDonald’s 1.6 No change No change
3.2
4.0
8.0
Burger King 1.9 No change I.9
3.8 3.8
4.0 4.0
8.0 8.0
12.0
Wendy’s z.o No change No change
4.0
8.0
12.0
New introductions indicated in bold face.
eliminated the Supersize and reduced the sizes of the Large and
Medium. The zoo6 Large was just slightly smaller (6.o oz) than the
1998 Supersize (6.3 oz). In zooz, Burger King introduced a new
larger French fries, called King, a size that the company still sells.
Wendy’s discontinued the terms Biggie and Great Biggie to describe
French fries in zoo6, replacing them with Medium and Large, but its
portion sizes remain the same as they were 4 years earlier.
Hamburgers
McDonald’s and Wendy’s still offer the same size hamburger patties
as they did in 1998, but Burger King has introduced a larger, 12z oz
(precooked) hamburger. The sizes of the largest hamburgers at all
three chains now exceed the amount recommended by the USDA for
an entire day – 5.5 oz for someone consuming z,ooo kcal/day (34).
The largest meat portion at McDonald’s is 8 oz. The I z-oz portions
at Burger King and Wendy’s constitute z days’ recommended
portions of meat.
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YOUNG & NESTLE * PORTION SIZES AND OBESITY 243
Table z highlights recent events in the history of portion sizes at
these chains. In the last several years, McDonald’s discontinued its
Supersize French fries and sodas, but both Burger King and Wendy’s
introduced new portions in larger sizes. Burger King has also
introduced several large specialty hamburgers.
Table z: Selected events in the history of portion sizes from McDonald’s, Burger
King, and Wendy’s, zooz-zoo6
zooz Burger King introduces the Meaty-Cheesy-Bacony-X-treme Whop-
per (940kcal) with an advertising campaign featuring basketball
player Shaquille O’Neal; adds 42-oz King soda (390 kcal).
Wendy’s introduces Classic Triple with Everything (14.5 oz,
103o0 kcal).
2004 McDonald’s discontinues Supersize sodas and French fries.
2005 Burger King introduces Triple Whopper (17oz, I230kcal); adds
King Kong-themed Triple Whopper (132zokcal); introduces En-
ormous Omelet sandwich (9.5 oz, 730 kcal) and Pounder’Normous
(10.5 oz, 770 kcal) with slogan: “a full pound of sausage, bacon, and
ham. Have a meaty morning.”
zoo6 Burger King advertising campaign features Texas Whopper (iz.2 oz,
8zokcal), Double Whopper (IS.Ioz, Iosokcal), and Triple
Whopper (8.ioz, I290 okcal), with mob of men waving signs
saying “Eat This Meat” and singing “I am Man, I am incorrigible,
and I am way too hungry to settle for chick food”; also introduces
BK Stacker sandwiches in four sizes: Single, Double, Triple and
Quad; Quad size has 4 beef patties, weighs i. i oz and contains
1ooo kcal, Slogan: “It’s the flame-broiled meat lover’s burger and it’s
here to stay – no veggies allowed.”
Wendy’s drops the terms Biggie and Great Biggie to describe soda
and French fries and instead adopts the terms Small, Medium, and
Large; changes 32-ounce Biggie to Medium; adds Large 42-oz soda
(advertised as “a whole river of icy cold refreshment”); changes
Medium French fries to Small, Biggie to Medium, and Great Biggie
to Large.
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244 JOURNAL OF PUBLIC HEALTH POLICY * VOL. z8, NO. 2
Hamburger 8.0
meat +500%
(precooked) 1.6
Soda32.0+457%
6.0
French fries +250%
2.4
0 5 10 15 20 25 30 35 40 45
o Original size, 1955 m Largest size, 2006
Figure i
Actual difference (oz or fluid oz) and percent difference between the largest size currently
available and the original size of selected foods at McDonald’s.
Despite McDonald’s steps to reduce the sizes of its largest items,
its current portions remain much larger than they were in 1955 when
first introduced (see Figure I). In 1955, for example, the company’s
only hamburger meat weighed 1.6 oz; today’s largest portion weighs
8.o oz and is 5oo% larger. Its largest soda was 7.0 fl oz in comparison
to today’s 32.0 floz size, and 457% larger. And today’s largest
portion of French fries weighs 6.0oz and is o50% larger than the
2.4 oz size in 1955-
DISCUSSION
Our observations indicate that fast-food chains have responded little or
not at all to calls to reduce the portion sizes of soda, French fries, and
hamburgers. McDonald’s has made the most progress in reducing its
portion sizes, but its sizes greatly exceed those offered in 1955. As
indicated in Tables i and z, Burger King and Wendy’s have added
larger sized sodas, and Burger King has introduced several larger
hamburgers. Other US chains have followed suit (35). In 2003, for
example, Hardee’s introduced the “Monster Thickburger” with I2 oz
beef and 1,420 calories – two-thirds of the calories recommended for
an entire day for certain segments of the population.
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YOUNG & NESTLE * PORTION SIZES AND OBESITY 245
Rather than reducing portion sizes, the top fast-food chains are
engaged in sleight of name. McDonald’s and Wendy’s have dropped
descriptors such as Supersize, Biggie, and Great Biggie and replaced
them with Medium or Large. Name changes, however, are unlikely
to help with weight maintenance as they may induce people to
believe they are eating smaller amounts of food (3 5).
Our observations also indicate that the portion sizes of these items
offered in the United States exceed those available in Europe. The
largest orders of French fries and soda at McDonald’s in the United
States contain about ioo calories more than the largest sizes offered
in Sweden, for example. The largest portion of French fries available
at US Burger Kings is nearly z oz larger – and contains z250o calories
more – than the largest size offered in the United Kingdom (UK). The
US Burger King offers a Triple Whopper, but the largest size available
in the UK is a Double Whopper.
Nevertheless, fast-food portions in Europe also are larger today
than they were in 1998. Today’s largest soda at Burger King in the
UK is io oz larger than in 1998. Also since 1998, McDonald’s added
double cheeseburgers to UK menus.
Thus, fast-food chains have not responded to any great extent to
the zooi Surgeon General’s Call to Action (26) or to more recent
calls on restaurants to reduce portion sizes (21,29) nor are they likely
to do so voluntarily. Because portion size has such a large effect on
caloric intake and balance, public health efforts to explain and act on
the relationship between portion sizes, calorie intake, and weight
gain are urgently needed. The New York City Health Department
recently approved regulations to require fast-food chains to post the
calorie counts of foods directly on menu boards (36). This and other
policies to make it easier to reduce energy intake deserve serious
consideration by any government agency concerned about the effects
of obesity on public health.
Acknowledgment: We thank Somantha Peterson for technical assistance.
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- Article Contents
- Issue Table of Contents
p. [238]
p. 239
p. 240
p. 241
p. 242
p. 243
p. 244
p. 245
p. 246
p. 247
p. 248
Journal of Public Health Policy, Vol. 28, No. 2 (2007), pp. 185-298
Front Matter
Preparing for and Responding to Public Health Emergencies in China: A Focus Group Study [pp. 185-195]
Commentary
Global Preparedness for Public Health Emergencies [pp. 196-200]
Diversionary Reframing of the Great Lakes Water Quality Agreement [pp. 201-215]
Commentary
The Importance of the Great Lakes Water Quality Agreement [pp. 216-220]
History of Public Health Crises in Japan [pp. 221-237]
Portion Sizes and Obesity: Responses of Fast-Food Companies [pp. 238-248]
An End to Perinatal HIV: Success in the US Requires Ongoing and Innovative Efforts That Should Expand Globally [pp. 249-260]
Applying an Equity Lens to Tobacco-Control Policies and Their Uptake in Six Western-European Countries [pp. 261-280]
The Federation’s Pages
Editorial: Challenging Developments in Universal Insurance Coverage [pp. 281-289]
Letter
Health Worker Emigration from Poland [pp. 290-292]
Editorial
Thanks to Reviewers [pp. 293-295]
Back Matter [pp. 296-298]
Physical Activity and Food Environments: Solutions to the Obesity Epidemic
Author(s): James F. Sallis and Karen Glanz
Reviewed work(s):
Source: The Milbank Quarterly, Vol. 87, No. 1 (Mar., 2009), pp. 123-154
Published by: Wiley-Blackwell on behalf of Milbank Memorial Fund
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Physical Activity and Food Environments:
Solutions to the Obesity Epidemic
JAMES F. SALLIS and KAREN GLANZ
San Diego State University; Emory University
Context: Environmental, policy, and societal changes are important contribu
tors to the rapid rise in obesity over the past few decades, and there has been
substantial progress toward identifying environmental and policy factors related
to eating and physical activity that can point toward solutions. This article is
a status report on research on physical activity and food environments, and it
suggests how these findings can be used to improve diet and physical activity
and to control or reduce obesity.
Methods: This article summarizes and synthesizes recent reviews and provides
examples of representative studies. It also describes ongoing innovative in
terventions and policy change efforts that were identified through conference
presentations, media coverage, and websites.
Findings: Numerous cross-sectional studies have consistently demonstrated
that some attributes of built and food environments are associated with physi
cal activity, healthful eating, and obesity. Residents of walkable neighborhoods
who have good access to recreation facilities are more likely to be physically
active and less likely to be overweight or obese. Residents of communities with
ready access to healthy foods also tend to have more healthful diets. Disparities
in environments and policies that disadvantage low-income communities and
racial minorities have been documented as well. Evidence from multilevel stud
ies, prospective research, and quasi-experimental evaluations of environmental
changes are just beginning to emerge.
Conclusions: Environment, policy, and multilevel strategies for improving
diet, physical activity, and obesity control are recommended based on a rapidly
Address correspondence to: James E Sallis, Active Living Research, 3900 Fifth
Avenue, Suite 310, San Diego, CA 92103 (email: sallis@mail.sdsu.edu).
The Milbank Quarterly, Vol. 87, No. 1, 2009 (pp. 123-154)
? 2009 Milbank Memorial Fund. Published by Wiley Periodicals Inc.
123
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124 J’P- Sallis and K. Glanz
growing body of research and the collective wisdom of leading expert orga
nizations. A public health imperative to identify and implement solutions to
the obesity epidemic warrants the use of the most promising strategies while
continuing to build the evidence base.
Keywords: Built environment, policy, nutrition, health behavior, ecological
models.
Environmental Change as an Essential Part
of the Solution to Obesity
EXPANDING PORTION SIZES, COMPUTER GAMES, HIGH-FRUCTOSE
corn sweeteners, automobile-dependent community designs, food
advertising everywhere, transportation investments
to support
only automobile travel, more and cheaper foods high in fat and sugar,
school facilities off limits to the community, soft drinks in schools,
Internet entertainment options, and ubiquitous fast food. Changes in
these and other factors have been blamed for the obesity epidemic in
the United States and across the world. Although it is unlikely that
biologically based preferences for
sweet and fat have changed, there now
is a greater variety of these preferred foods; there
are more places to get
them; they are advertised
more widely; and they
are
cheaper and come
in larger sizes. Our ancestors probably obtained most of their physical
activity during work, household chores, and transportation, but today
these requirements for
movement have been greatly reduced owing
to
automation and computers at work, labor-saving devices at home, and
building and transportation practices that require driving for most trips.
The consensus among public health experts is that changes in genes,
biology, and psychology at the individual level cannot explain the rapid
rise in obesity,
so the explanation
must lie in broader environmental,
policy, and societal changes (Hill and Peters 1998; Koplan and Dietz
2000; Koplan, Liverman, and Kraak 2004; Kumanyika et al. 2000;
WHO 2004).
Even though attempts to identify those environmental and policy
changes responsible for the obesity epidemic have not produced any
clear answers, there are, nonetheless, numerous changes that, by altering
patterns of eating and physical activity, may have contributed to
the
epidemic (Jebb and Moore 1999; Popkin 2007; Sturm 2005). Although
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Solutions to the Obesity Epidemic 12 5
it may not be possible to establish the exact degree to which various en
vironments and policies contribute to the epidemic, substantial research
progress has been made to identify environmental and policy factors that
can point us toward solutions. This article is
a status report on research
on physical activity and food environments, and it suggests how these
findings can be used to guide policy actions to control obesity.
Physical activity environments are places where people can be physi
cally active. Of most interest are places that can be designed to support
daily activities, such
as
parks, sidewalks, trails, schools, workplaces, play
grounds, child
care settings, and private recreation facilities. Common
settings for sedentary behavior include homes (filled with electronic en
tertainment and labor-saving devices), workplaces, sports
venues (where
the vast majority sits and watches others move around), schools, and
roadways built to optimize travel by
car. It thus is essential to consider
“information environments” that directly
or
indirectly encourage
un
healthy eating behaviors and sedentary habits through numerous media
that usually do not encourage healthy behaviors. Sedentary behaviors
are those that involve sitting
or minimal energy expenditure. Television
viewing, computer use, computer games, and driving/riding in cars
are
some of the largest contributors.
Several levels of the food environment have been identified. The com
munity environment refers to the places where food can be obtained, like
grocery stores, convenience stores, specialty stores, restaurants, and farm
ers’ markets that are generally open to the public. Microenvironments
accessible to limited groups include homes, workplace and school cafe
terias, and churches. The consumer environment describes what a person
is exposed to inside the food sources, especially in regard to the avail
ability of different types of foods, promotions, and prices (Glanz et al.
2005).
Policies are the primary mechanism for making environmental
changes and include formal and informal rules, laws, and regulations.
Both government and industry policies control food environments. Poli
cies pertaining to parks and recreation, education, transportation, and
planning departments in governments at multiple levels have direct
responsibility for physical activity environments. School and employer
policies dictate the resources, incentives, and/or deterrents to healthy
eating and active lifestyles in organizations where children and adults
spend most of their days. Finally, at a very local level, family policies
control food and physical activity environments in the home.
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126 J.F. Sallis and K. Glanz
The thinking and research on eating, physical activity, sedentary
behaviors, and obesity have been guided until recently by biological and
psychological models and theories focusing on individuals, families, and
small social groups such as friends and coworkers. The rapidity of the
rise of the obesity epidemic and the discovery that most interventions
to help individuals change their eating and physical activity behaviors
have only weak and short-lived effects (Kumanyika et al. 2000; Marcus
et al. 2000) reveal the limitations of the dominant individually focused
models of behavior.
Ecological models are characterized by their specification of multi
ple levels of influence on behaviors, including individual (biological,
psychological), social and cultural, organizational (schools, workplaces,
health care), community (including physical activity and food environ
ments), and policy levels. Although ecological models have been used for
decades in public health and the behavioral sciences, their influence has
been modest. More recently, improved measurement methods, advances
in multilevel analyses, the development of models specific to each target
behavior, and dedicated funding for environmental and policy research
have enhanced the impact of ecological models (Sallis, Owen, and Fisher
2008).
A central lesson of ecological models is that because behavior is in
fluenced at multiple levels, the most effective interventions also should
operate at multiple levels. Diet and physical activity interventions that
build knowledge, motivation, and behavior change skills in individuals
without changing the environments in which they live are unlikely to
be effective. Similarly, merely changing the physical activity or the food
environment may not be sufficient for a substantial change in behavior.
Based on ecological models we expect the most effective interventions
to operate on multiple levels to create
an environment that makes it easy
to make the healthy choice (e.g., renovate the park, stock skim milk
in stores), enhance social norms and social support (e.g., with
a media
campaign), educate and motivate individuals to take advantage of the
opportunities for healthy behaviors, and use policy to reduce prices for
healthy foods or to provide activity programs in parks. The benefits
of including environmental and policy components in a comprehensive
intervention are their ability to affect every person living in the environ
ment or jurisdiction affected by that policy. Effects should last as long as
the person is in the environment or the policy is in effect (Sallis, Owen,
and Fisher 2008).
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Solutions to the Obesity Epidemic 127
This article draws on reviews and recent studies to demonstrate the
state of knowledge regarding environmental and policy correlates of eat
ing and physical activity, especially equity of access to health-promoting
environments. We then use this evidence to recommend environmental
and policy changes that are likely to improve eating, physical activity,
and obesity.
Lessons from Research on Physical Activity
Environments
One principle of ecological models is that they need to be tailored to
specific behaviors. Accordingly, environmental and policy influences
are expected to have particularly behavior-specific effects (Sallis, Owen,
and Fisher 2008). One recent ecological model proposes interventions
for each of four domains of physical activity: occupation, recreation,
transportation, and household (Sallis et al. 2006). The following section
discusses research findings organized by domains of physical activity
and specific settings. Because the number of research publications in
this field has increased dramatically since 2000 (Sallis et al. 2009), we
summarize recent review articles when available and provide examples
of representative studies.
Environments to Support Active Recreation
People can find recreational physical activities in public parks and trails,
on sidewalks or streets, at private facilities like health clubs, and in
their homes. There is substantial evidence that people who live closer
to a variety of recreation facilities are more physically active overall.
Of the ten review articles that Bauman and Bull (2007) summarized,
nine recognized the value to adults of proximity to recreation facilities.
Davidson and Lawson (2006) reviewed the literature for children and
concluded that living
near
parks, playgrounds, and recreation areas was
consistently related to children’s total physical activity. The research
finding that people
were more active in some areas of parks (e.g., basket
ball and racquet courts) than in other areas (e.g., baseball fields, picnic
areas) (Floyd et al. 2008) can guide the design of recreation facilities.
The aesthetics of physical activity settings is consistently related to
adult activity, with five of six reviews that covered aesthetics supporting
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128 J.F. Sallis and K. Glanz
this conclusion (Bauman and Bull 2007). In addition, features like trees,
attractive buildings, and water views may make recreational physical
activity more pleasant. Sidewalks can be used for walking for both
recreation and transport purposes, and nearly all the reviews concluded
that the availability of sidewalks was positively associated with physical
activity and walking (Bauman and Bull 2007) for adults and children
(Sallis and Kerr 2006).
Environments to Support Active Transportation
Walking from place to place was surely a major source of physical ac
tivity in preindustrial times. Currently, in many European countries,
30 percent or more of trips are made by walking and cycling, a figure
that shrinks to less than 10 percent in the United States (Pucher and
Dijkstra 2003). To reduce air pollution and traffic congestion, trans
portation planners studied how the design of communities is related to
choices of travel modes, and they consequently developed the concept
of “walkability,” referring to people’s ability to walk (or cycle) to des
tinations. The key concepts are proximity of destinations to residences
and street networks that create a relatively direct route. For thousands of
years, towns and cities were built according to these principles, because
most people walked to where they needed to go. But now, with the
mass adoption of automobiles
as the primary mode of transportation,
land use and transportation practices have changed
to ensure that most
trips must be taken by
car. Therefore, instead of the mixed-use zoning
required for walkability, zoning has increasingly separated uses, and as
a result, shopping
areas and employment
centers are far from where
people live (Schilling and Linton 2005). And instead of streets built on
a grid pattern providing direct routes, suburban subdivisions contain
disconnected and winding streets, making trips by the street network
much longer than straight-line distances. Likewise, roads are designed
to facilitate high-speed travel by cars, often with little consideration of
the needs of pedestrians
or cyclists.
Dozens of studies show that adults who live in walkable neighbor
hoods walk and cycle more for transportation and are more physically
active than are those who live in suburbs designed to be dependent on
automobiles. In Bauman and Bull’s (2007) review of reviews, four of
four reviews found that the walkability of a neighborhood or region was
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Solutions to the Obesity Epidemic 129
positively related to physical activity, and the components of mixed use
(five of six reviews), connectivity (three of three reviews), and residential
density (six of six reviews) also were supported as physical activity cor
relates. A smaller number of recent studies showed similar associations
of walkability and physical activity among youth, including active com
muting to school, and among older adults (Sallis and Kerr 2006). As an
example, Frank and colleagues (2005) used a walkability index based on
Geographic Information Systems and measured physical activity objec
tively with accelerometers. They found that 37 percent of adults in the
highest-walkability neighborhoods met the recommendation of physical
activity for thirty minutes per day, compared with 18 percent of those
in the lowest-walkability neighborhoods.
Based on a systematic review,
an expert panel from the Transportation
Research Board and Institute of Medicine (2005) concluded that built
environment factors were indeed related to physical activity. The Centers
for Disease Control and Prevention’s (CDC) Task Force for Community
Preventive Services determined that land-use changes are
an evidence
based intervention for promoting physical activity (Heath et al. 2006).
Characteristics of transportation systems and practices have been
linked with the physical activities of youths and adults. The findings
for children and adolescents include parental concerns about traffic
as a
strong correlate of children’s active transport to school (Kerr et al. 2006),
and having to cross busy streets as a barrier to children’s physical activity
(Davidson and Lawson 2006). Among adults, people drive more when
they live in low-walkable suburbs. Driving itself is an independent risk
factor for obesity (Frank, Andresen, and Schmid 2004; Lopez-Zetina,
Lee, and Friis 2006), whereas users of public transit are more likely to
meet physical activity guidelines (Besser and Dannenberg 2005).
Physical Activity Environments and Obesity
According to a recent review by Papas and colleagues (2007), about
twenty studies have examined associations between built environment
attributes and indicators of weight status. Sixteen of those studies ex
amined built environment variables related to recreation facilities or
community design, and almost all of them found significant associa
tions with obesity. For example, Frank and colleagues (2004) discovered
that neighborhood walkability was related to the risk of obesity in adults
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130 J.F. Sallis and K. Glanz
and that physical activity partially explained this association. In a na
tional study of adolescents, Gordon-Larsen et al. (2006) demonstrated
that the proximity of recreation facilities was correlated with the risk
of overweight and obesity. Thus, a substantial database associates liv
ing in areas lacking recreation facilities and not supporting walking for
transportation
as a risk factor for obesity.
Designing Schools to Support Active Students. Because schools are central
to children’s lives, it is important to consider how they can be built
to support physical activity. Several studies illustrate the connection.
Schools with a richer activity environment, including basketball hoops
and soccer goals, combined with adult supervision or equipment, had
significantly more students who chose to be active after lunch or after
school (Sallis et al. 2001). A controlled study in the United Kingdom
found that simply marking elementary school playgrounds with designs
that stimulated active games was associated with a 20 percent long
term improvement in physical activity (Ridgers et al. 2007). Although
one study associated having large school grounds with physical activity
(Cradock et al. 2007), there is concern that requirements for large school
yards may force new schools to be placed on the periphery of commu
nities, which ironically could prevent most students from walking or
cycling there.
Designing Buildings to Support Physical Activity. Although people
spend most of their lives in buildings, there is surprisingly little study of
building design and physical activity (Zimring et al. 2005). Numerous
studies have found that signs promoting stair
use (i.e., an intervention
in the information environment) had modest effects at low cost (Kahn
et al. 2002). A few studies have shown that the attractiveness of stairs
(Kerr et al. 2004) and more convenient access to stairs than to elevators
(Nicoll 2007) were associated with greater stair use. However, where
buildings are built may affect physical activity more than how they
are
designed. As described earlier, separate-use zoning
forces most workers
to drive to their workplaces because they are too far from their homes to
walk or cycle.
Disparities in Access to Activity-Friendly Environments. Because of the
dramatic disparities among race, ethnicity, and
socioeconomic status
in regard to obesity (Ogden et al. 2006), it is important
to
con
sider to what extent disparities in
access to activity-friendly environ
ments might explain these findings. Substantial evidence shows that
access to parks and other recreation
facilities is lower in low-income,
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Solutions to the Obesity Epidemic 131
low-education, and minority communities, at least in the United States.
Two national studies documented this trend (Gordon-Larsen et al. 2006;
Powell et al. 2006), with one study finding less access to every category of
recreation facility in low-education communities (Gordon-Larsen et al.
2006). A study in Austin, Texas, showed that low-income, majority
Latino neighborhoods were more walkable than high-income, mostly
non-Hispanic white neighborhoods in the suburbs. The low-income
Latino neighborhoods, however, had poorer safety ratings, maintenance,
and aesthetics that could interfere with residents’ ability to benefit from
the walkable design (Zhu and Lee 2008). Maclntyre (2007) concluded
that not all studies found disparities in access to parks and other physi
cal activity environments. Although quality of activity facilities may be
more important than presence, it has seldom been studied.
A disturbing early finding was that walkability was related to physical
activity (Frank et al. 2005) and obesity (Frank, Andresen, and Schmid
2004) among non-Hispanic whites, but not among African Americans.
Perhaps the less favorable safety and aesthetic features of the African
American neighborhoods could explain the lack of walkability effects,
as suggested by Zhu and Lee’s (2008) results, but further studies are
needed. A contrasting result is that access to nearby recreational facili
ties was strongly related to physical activity among African Americans
and Latinos, but not among non-Hispanic whites (Diez Roux et al.
2007). Currently there
are more questions than answers about the role
of physical activity environments in explaining racial, ethnic, and so
cioeconomic disparities in physical activity and obesity.
Evaluating Environmental Changes to Promote
Physical Activity
Most of the studies of physical activity environments have been
cross-sectional, leading
to criticism about whether apparent effects of
environments can be explained by active people tending to choose
activity-friendly communities (Handy, Cao, and Mokhtarian 2006). Be
cause it is not feasible to randomly assign people to neighborhoods, other
study designs must be used to determine whether the environment is a
true cause of behavior. A study of people who changed their residence
found that activity levels tended to increase among those who moved to
more walkable neighborhoods and that activity decreased among those
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132 J.F. Sallis and K. Glanz
who moved to less walkable areas (Handy, Cao, and Mokhtarian 2008).
A study of low-income women who moved partially supported a con
clusion that changing environments can stimulate expected changes in
physical activity (Wells and Yang 2008), even though a study of adoles
cents showed that moving was not related
to changes in weight status
(Ewing, Brownson, and Berrigan 2006).
A more powerful approach is
to use quasi-experimental designs, of
ten called “natural experiments,”
to evaluate environmental changes
as
opportunities arise. A review of United Kingdom studies found that
opening new sections of cycling trails led to long-term increases in cy
cling, especially when they were located in highly populated areas (NICE
Public Health Collaborating Centre 2006). Evaluations of new trails in
the United States have had mixed effects, with some finding increased
physical activity (Gordon, Zizzi, and Pauline 2004) and others finding
no impact (Evenson, Herring, and Huston 2005). These studies indicate
that environmental modifications can change physical activity, but it is
not clear which environmental changes
are most effective.
Limitations of Available Research
The cross-sectional design of most physical activity environment studies
is often cited as their major methodological limitation (Transportation
Research Board and Institute of Medicine 2005), so recent prospective
and quasi-experimental evaluations
of environmental changes are
re
garded as important advances. These more rigorous designs should also
be applied to other environmental attributes
and to more diverse popula
tions, including subgroups at high risk of obesity. Other areas for future
research are examining
more detailed environmental measures and es
tablishing dose-response relationships so the results can be
more directly
applied by designers and policymakers. Although sedentary behaviors
are risk factors for obesity, few studies have examined the environmental
correlates of these behaviors.
Because studies use a diversity of environment and physical activity
measures, it is difficult to compare findings across studies. Nonethe
less, high-quality objective measures of both environments and physical
activity,
as well as validated self-report measures, do exist, and
the
environmental measures are available at www.activelivingresearch.org
(accessed December 4, 2008). The challenge is for investigators to
use a common core of measures routinely so that key findings
can be
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Solutions to the Obesity Epidemic 13 3
replicated in various populations and
can facilitate meta-analyses and
pooled analyses.
It is difficult to generalize built environment findings across popula
tions or across behaviors. Most studies have been conducted with adults,
and analyses stratified by race, ethnicity,
or socioeconomic status are rare.
It thus is a high priority to improve our understanding of environmental
correlates of physical activity and sedentary behaviors in diverse samples,
especially those at high risk for obesity.
Summary of Physical Activity
Environment Studies
Living in walkable communities and having parks and other recreation
facilities nearby has been consistently associated with higher levels of
physical activity in youth, adults, and older adults. Several studies of
adults link walkable communities and park access to a lower risk of over
weight and obesity. At least in the United States, however, low-income
populations and communities of color have less access to public and
private recreation facilities. But a few studies go beyond cross-sectional
designs and indicate that behavior may change when individuals move to
new neighborhoods and that building trails can stimulate more people
to be physically active. Traffic appears to be a barrier to physical ac
tivity, and school environments have been related to students’ physical
activity on campus. Many public health professionals, therefore, con
sider the evidence sufficient to recommend changes in urban planning,
transportation, recreation, and school policies.
Lessons from Research on Food
and Nutrition Environments
Several conceptual models of food and nutrition environments have
been proposed (Booth et al. 2001; Story et al. 2008). One useful?and
parsimonious?ecological model for understanding food and nutrition
environments incorporated constructs from the fields of public health,
health psychology, consumer psychology, and urban planning (Glanz
et al. 2005). The model identified four types of nutrition environments
(community, consumer, organizational, and information) that need to
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134 J’F. Sallis andK. Glanz
be understood, and those environments can be affected by policies of
governments and other organizations (Glanz et al. 2005).
This synthesis of knowledge related to food environments?as is the
preceding section on physical activity environments?is based, whenever
possible, on review articles published between 1988 and 2008. Of the
twenty-one review articles, twelve focused on environmental correlates of
eating and/or obesity, and nine on environmental intervention strategies.
Examples of representative studies and policy reports also are provided.
Community Food Environments
The community food environment is defined as the distribution of food
sources, that is, the number, type, location, and accessibility of food
outlets, with stores and restaurants being the most common (Glanz
et al. 2005). Many studies have cited both stores and restaurants as
either indicating access to healthful food choices or reflecting high
concentrations of often inexpensive foods of low nutritional value.
Food Stores. The presence of food stores appears to contribute to
the eating patterns of neighborhood residents (Ford and Dzewaltowski
2008; Glanz and Yaroch 2004), and racial and ethnic disparities in access
to full-service supermarkets frequently have been documented (Morland
et al. 2002; Zenk, Schulz, Hollis-Neely, et al. 2005; Zenk, Schulz,
Israel, et al. 2005). One study found that African Americans’ intake
of fruits and vegetables was significantly higher when they lived close
to a supermarket (Morland, Wing, and Diez Roux 2002). Accordingly,
the availability of supermarkets in neighborhoods was associated with a
better-quality diet (Moore et al. 2008) and a lower prevalence of obesity
and overweight in adults (Morland, Diez Roux, and Wing 2006) and
adolescents (Powell et al. 2007). Although those lower-income, minority
urban neighborhoods and rural
areas
lacking supermarkets
are sometimes
referred to as “food deserts” (Morton and Blanchard 2007), some studies
have found no disparities in access to food stores (Apparicio, Cloutier,
and Shearmur 2007; Maclntyre 2007; Pearson et al. 2005).
Restaurants. The proportion of meals eaten outside the home has
increased in the United States (Kant and Graubard 2004). This greater
reliance on restaurants could have negative nutritional and health
conse
quences because individuals eating
at restaurants more frequently
con
sume, on average, more calories and fat and fewer fruits, vegetables, and
fiber (French et al. 2001; Satia, Galanko, and Siega-Riz 2004; Schmidt
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Solutions to the Obesity Epidemic 135
et al. 2005) and consequently gain more weight (Pereira et al. 2005;
Thompson et al. 2004).
Fast-food restaurants in particular have been identified as a poten
tial contributor to a higher prevalence of obesity (Brownell 2004). The
higher concentration of fast-food restaurants in poorer neighborhoods
(Cummins and Macintyre 2002; Powell, Chaloupka, and Bao 2007) thus
is thought to partially explain the higher prevalence of obesity among
economically disadvantaged populations. One analysis found that the
density of fast-food restaurants accounted for 6 percent of the variance
in obesity across the United States (Maddock 2004). However, evi
dence regarding the relationship between individuals’ weight status and
the density of restaurants in their neighborhood is weak and has not
been supported in large studies of children and adults in both rural and
urban areas (Burdette and Whitaker 2004; Simmons et al. 2005; Sturm
and Datar 2005). One review concluded that the results across studies
were mixed on the question of fast-food density, noting methodological
limitations (Papas et al. 2007).
Policy and Environmental Interventions
Related to Community Food Environments
Almost all community food environment studies have been cross
sectional, but efforts are being made to change food environments that
could be evaluated as natural experiments. Although bringing
new su
permarkets into disadvantaged areas is not strongly supported by the
available research (Cummins and Macintyre 2002; Papas et al. 2007),
a moratorium on opening new fast-food restaurants in one poor area
in urban Los Angeles has been proposed (Hoag 2008). As these sorts
of environmental changes gather momentum, it will be important to
evaluate their effects on food-purchasing patterns, eating behaviors, and,
ultimately, weight outcomes.
Consumer Food Environments
Consumer food environments are what consumers encounter within and
around retail food outlets (stores, restaurants, and within-organization
food sources) (Glanz et al. 2005). The consumer food environment
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136 J.F Sallis and K. Glanz
constructs of interest include the availability and price of healthful food
choices, quality of food, portion sizes, within-outlet promotions, and
point-of-choice nutrition information (French, Story, and Jeffery 2001;
Giskes et al. 2007; Kamphuis et al. 2006).
The target categories of food of broadest interest in retail food stores
are those most closely related to the causes or prevention of obesity and
other chronic diseases. The categories of foods with the highest priority
for studies of consumer food environments are dairy products, meat and
poultry, baked goods and sweets, high-fat snack foods, and fruits and
vegetables (Cheadle et al. 1990; Cheadle et al. 1991; Glanz, Sallis, et al.
2007).
Variations in consumer nutrition environments may explain some of
the racial/ethnic and socioeconomic disparities in nutrition and health
outcomes. Some healthy foods, such as low-fat dairy products (Wechsler
et al. 1995) and fruits and vegetables (Horowitz et al. 2004), are less
often available and/or are of poorer quality in minority and lower-income
areas. The fewer healthful food options in lower-income neighborhoods
and in convenience stores compared with those in supermarkets were
documented in a study in the Atlanta area (Glanz, Sallis, et al. 2007).
Early studies of the availability of healthy foods and individual diets by
Cheadle and others found that the availability of low-fat milk and cheese
and lean meats was associated with a lower fat intake by the residents of
surrounding neighborhoods (Cheadle et al. 1990).
Assessments of the consumer food environment within restaurants,
including fast-food outlets, have proved to be more challenging than
those at food stores (Cheadle et al. 1994). Recent studies found that only
a minority of chain restaurants provide nutrition information about their
main menu items and that when they do, it is usually on websites rather
than at the point of purchase (Saelens et al. 2007; Wootan and Osborn
2006; Wootan, Osborn, and Malloy 2006).
An observational study of 217 fast-food and sit-down restaurants
conducted in conjunction with the development of the Nutrition Envi
ronment Measures Survey for Restaurants (NEMS-R) tool found that a
minority of both types of restaurants offered any main dishes that could
be considered healthy by current dietary guidelines, such as fresh fruit,
non-fried vegetables, or whole-grain breads (Saelens et al. 2007). The
study had a somewhat paradoxical finding: whereas fast-food restaurants
had more “supersized” choices, promotions of overeating
or unhealthy
choices, and “value pricing” for multiple food items, these fast-food
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Solutions to the Obesity Epidemic 137
restaurants were also more likely
to offer at least one healthy entree,
to highlight healthy options, and to provide some form of consumer
nutrition information (Saelens et al. 2007).
Policy and Environmental Interventions Related
to Consumer Food Environments
One reason that the distinction between community and consumer food
environments is important pertains to the different potential environ
mental and policy intervention strategies. Consumer food environments
are better able to change without “bricks and mortar”
or governmen
tal intervention. That is, individual proprietors and corporations can
change the foods they sell, the information they offer to consumers,
their recipes, and their portion sizes, with or without encouragement
from public health professionals. In fact, some local projects have been
working with merchants and restaurateurs to make such changes, though
to date no evaluations have been published.
Government policymakers at the local and national levels may be
able to achieve broader changes in consumer food environments but
also must address resistance by the industry. According to interviews
with corporate executives, large restaurant chains’ main motivations
are increasing sales and profits, not providing healthful choices (Glanz,
Resnicow, et al. 2007). The most promising, and most active, area for
policy change is providing calorie, fat, and other nutritional information
on menus. Such policies
are now in place in two large cities, New York
and Seattle. A health impact assessment of menu labeling finds this
promising, even with conservative estimates of consumers’ use of the
information (Simon et al. 2008). As a result, the national debate on
menu
labeling is growing more insistent (Berman and Lavizzo-Mourey
2008), and ongoing evaluations should provide valuable information.
School and Worksite Food Environments
School food environments can have a large impact on children’s and
adolescents’ dietary intake because students obtain and eat meals and
snacks at school (see the article by Story, Nanney, and Schwartz in
this issue; Story et al. 2008). Designing schools to support healthy
eating habits requires policies at both the federal and local levels, as
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138 J.F. Sallis and K. Glanz
well as local implementation, including school nutrition standards and
limiting offerings of competitive foods (IOM 2007). In the past few years,
there has been renewed attention to providing support and regulations
for healthier school food environments, including expansion of a U.S.
Department of Agriculture fruit and vegetable pilot program, farm-to
school programs that link local farmers providing fresh locally grown
produce to school cafeterias, and federally mandated school wellness
policies (Story et al. 2008). This topic is addressed in greater detail
by Story, Nanney, and Schwartz in this special issue of The Milbank
Quarterly.
Few school environment and policy interventions have been eval
uated, despite the School Nutrition Policy Initiative, which contains
school nutrition policies, menu planning, nutrition education, social
marketing, and parent outreach targeting grades 4 through 6. After two
years, significantly fewer children in the intervention schools became
overweight (Foster et al. 2008), thereby demonstrating the potential of
multilevel interventions by schools and communities.
Worksites for adults are comparable to schools for children: they
are organizational environments where adults spend most of their days
and consume meals and snacks. Several studies showed that changes
in worksite environments are feasible and can positively affect food
intake (Engbers et al. 2005). These interventions have achieved healthful
changes in worksite cafeterias (Jeffery et al. 1994) and vending machines
(French et al. 2001). Interventions in worksite settings are described
in greater detail by Heinen and Darling in this issue of The Milbank
Quarterly.
Home Environments
The home is a complex and dynamic food environment and has been
well studied with respect to families’ and, particularly, children’s eating
habits (Story et al. 2008). Food at home is affected by its availability in
the neighborhood (Glanz et al. 2005), and its availability at home and
the influence of parents are especially relevant to children (Bryant and
Stevens 2006; Koplan, Liverman, and Kraak 2004).
Although family outreach has been used as an adjunct to school
based nutrition interventions and obesity treatment in clinical settings,
few reports show that home-based interventions improve eating patterns
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Solutions to the Obesity Epidemic 139
(Story et al. 2008). This remains a fertile area for future research. Policies
affecting community and consumer food environments (e.g., proximity
to food stores, food prices) are likely to influence home food environments
that in turn determine eating behaviors.
Limitations of Available Research
Similar to research on physical activity environments, the cross-sectional
design of most food environment studies is a major limitation (Black
and Macinko 2007; Ford and Dzewaltowski 2008; Giskes et al. 2007;
Holsten 2008; Papas et al. 2007). Additional prospective studies and
field experiments (planned or “natural”) are needed for our knowledge
base to expand. In addition, more multilevel intervention studies are
needed, especially those that simultaneously address activity and food
environments as they relate to obesity.
The advancement of research partly depends on the availability of
valid, reliable measures of nutrition environments and policies (Glanz
et al. 2005). Measures used in research on school food environments,
neighborhood food environments (stores, restaurants), and state poli
cies are illustrative of well-developed measurement tools in this area
(Glanz, Sallis, et al. 2007; Masse et al. 2007; Saelens et al. 2007; Story
et al. 2008). But much more work must be done in designing and
testing food environment measures that are feasible for large studies,
adaptable
to a
variety of locations, allow for comparability
across stud
ies, and provide nutritionally meaningful indicators (Saelens and Glanz
2009).
Summary of Food Environment Studies
Evidence is rapidly growing that proximity to supermarkets is associ
ated with an intake of more fruits and vegetables and that proximity
to fast-food restaurants is associated with an intake of higher-energy
foods and a lower-quality diet. Low-income and racial/ethnic minor
ity communities usually have less access to supermarkets and a greater
concentration of fast-food restaurants, and the quality of foods offered
tends to be worse in these neighborhoods. The community food envi
ronment has not been consistently related to weight status, as it has
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140 J.F. Sallis and K. Glanz
been difficult to link the quality of food within restaurants with eating
behaviors. Most restaurants provide very little nutritional information
at the point of decision, although the recent enactment of menu-labeling
laws offers an opportunity to evaluate these policy interventions. Food
environment, policy, and pricing interventions have been successful
in promoting healthier choices in schools, workplaces, and vending
machines.
Ongoing Efforts to Create Healthier Places
for People to Live
Environment, policy, and multilevel strategies for improving diet, phys
ical activity, and obesity control are recommended by respected national
and international groups. The World Health Organization (2004) and
the International Obesity Task Force (Kumanyika et al. 2000) strongly
recommend environmental and policy changes. In the United States,
the surgeon general’s call to action to prevent obesity (USDHHS 2001),
the Institute of Medicine’s report on preventing childhood obesity
(Koplan, Liverman, and Kraak 2004), the Centers for Disease Control
and Prevention (Koplan and Dietz 2000), and an expert panel organized
by the American Medical Association and other organizations (Barlow
and the Expert Committee 2007) all concluded that environmental and
policy changes will be essential components of a solution to the obesity
epidemic.
Box 1 highlights efforts to implement environmental and policy
changes, mainly in the United States. A few of these are research
based projects; several are community demonstrations that are being
evaluated; and others are part of organizations’ advocacy work. Many
of these initiatives target low-income communities of color because the
people in these communities are at the highest risk of obesity (Ogden
et al. 2006), and finding effective solutions for such groups is chal
lenging but urgently needed. These diverse intervention models
are
building experience in environmental and policy change, are provid
ing opportunities for research and evaluation, and,
we hope,
are offering
lessons that others can use to disseminate effective approaches
on a wider
scale.
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Solutions to the Obesity Epidemic 141
BOX 1
Examples of Built Environment Change Strategies in the United States
1. Active Living by Design is working with twenty-five communities across
the country to increase physical activity and healthy eating through community
design, public policies, and communications strategies. It is funded by the
Robert Wood Johnson Foundation, www.activelivingbydesign.org (accessed
December 4, 2008).
2. Healthy Eating Active Communities is working with six communities
in California to demonstrate that by transforming the food and physical activ
ity environments of resource-poor, low-income communities, it is possible to
change norms that foster unhealthy food choices and inactivity. It is funded
by the California Endowment, www.healthyeatingactivecommunities.org (ac
cessed December 4, 2008).
3. Healthy Eating Active Living: Community Health Initiatives is working
with twenty-seven communities across the United States to make changes
like installing bike racks, getting more fresh fruits and vegetables on the
shelves of corner stores, building walking paths and bike trails, planning safe
routes for kids to walk or bike to school, supporting school cafeteria reforms,
offering physical education in schools, and making health considerations part
of planning and development decisions. It is funded by Kaiser Permanente,
http://info.kp.org/communitybenefit (accessed December 4, 2008).
4. New York City’s restaurant menu-labeling regulations that require
some restaurants to display calorie information are now in effect; see
www.nyc.gov/html/doh/html/cdp/cdp_pan-calorie.shtml (accessed December
4, 2008).
5. The mission of Philadelphia’s Food Trust is to ensure that everyone has
access to healthful, affordable food. Its programs emphasize environments,
policies and education in communities, schools, farmers’ markets, and stores;
see www.thefoodtrust.org/ (accessed December 4, 2008).
6. Shape Up Somerville is a project in this city near Boston to make environ
mental changes to prevent obesity in culturally diverse, elementary school chil
dren. This intervention is focused on increasing the number of physical activity
options available to children throughout the day and improving dietary choices
in schools and the whole community. It is funded by the Centers for Disease
Control and Prevention, http://www.shapeupsomerville5k.org/aboutsus.html
(accessed December 4, 2008), and for evaluation results, see Economos et al.
2007.
7. Smart growth and the new urbanism are related movements that advo
cate community designs, transportation investments, zoning ordinances, and
community participation that lead to walkable and environmentally sustainable
neighborhoods and cities. The principal membership organizations are Congress
for the New Urbanism (www.cnu.org; accessed December 4, 2008) and Smart
Growth America (www.smartgrowthamerica.org; accessed December 4, 2008).
(Continued)
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142 J.F. Sallis and K. Glanz
BOX 1?Continued
8. PolicyLink is a national research and action institute for economic and
social equity. It provides technical training and capacity building, policy ad
vocacy, and communications training for advocates working to create health
ier communities. These advocates are working to improve socioeconomic and
environmental conditions that affect health and are related to income, seg
regation, pollution, crime, availability of fresh foods and safe recreational
facilities, transit-oriented community design, and accessible quality hous
ing. It has multiple funders; see www.policylink.org (accessed December 4,
2008).
What Is Needed to Accelerate Movement
toward Nonobesogenic Environments?
The anticipated health and economic consequences of the obesity epi
demic mean that we must find and implement solutions quickly. Because
changes in policy and practice rarely wait for definitive answers from
research, we need to draw lessons from the best available research (a
point well made by the Institute of Medicine; see Koplan, Liverman,
and Kraak 2004) and experience from the field. There is, in fact, a great
deal of consensus on some promising approaches, and this section dis
cusses some of the principles and practices. As research advances and
experience with environmental and policy intervention deepens, these
approaches should be updated.
Intersectoral Collaboration
Physical activity and food environments are controlled by a wide range
of public and private interests involving government agencies at all
levels, multiple major industries, professional organizations, and non
profits. Those sectors of society with obvious relevance are agriculture,
food manufacturing and sales, recreation, transportation, education, real
estate, architecture, communication media, advertising, and entertain
ment industries. All these groups are stakeholders, along with the public
health, medicine, and health care industries, that need to be engaged in
efforts to create less obesogenic environments. Although some of these
stakeholders will perceive benefits from recommended changes, oth
ers will oppose them. A good model of intersectoral collaboration is the
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Solutions to the Obesity Epidemic 143
whole-of-government approach
to physical activity promotion pioneered
by New South Wales in Australia (Sallis, Bauman, and Pratt 1998).
Every government department
was instructed to promote physical ac
tivity, with an emphasis on environmental and policy change.
Community Engagement and Participation
The involvement of community residents is essential to advocating for,
and implementing, changes to create more healthful environments and
policies. Community engagement also is critical to the success of new
initiatives (Minkler, Wallerstein, and Wilson 2008). Even though scien
tists and public health experts may determine that environmental change
could help reduce obesity?for example, by restricting the number of
fast-food restaurants in a disadvantaged neighborhood?the residents
may regard such a regulation as punitive or stigmatizing (“blame the
victim”) because they depend on cheap, convenient food sources and
lack reliable transportation options. Accordingly, those people living
in the neighborhood or working in local organizations should be asked
to help identify what is acceptable and promising for increasing the
healthfulness of their environments.
Changing Policies on Land Use,
Transportation, Recreation, and Building Codes
Zoning ordinances continue to favor low-walkable developments; trans
portation investments for pedestrian and cycling facilities are trivial;
parks are low priorities in many communities; school-siting decisions
are not coordinated with community planning; and building codes do
not consider physical activity inside and around buildings. Thus every
day, buildings, communities, and roads are constructed that discourage
or prevent physical activity, and these built environments will last a
long time. Zoning laws and tax incentives can attract grocery stores
and prevent an excess of fast-food restaurants in communities, demon
strating that policy changes are the key to creating healthy physical
activity and food environments. To achieve these policy changes, pub
lic health professionals must improve their advocacy skills, develop
partnerships with advocacy organizations, and establish intersectoral
collaborations.
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144 JF Sallis and K. Glanz
Evaluating, Building the Evidence Base,
and Growing Knowledge in Changing Times
Many ideas about changing environments to improve eating and physi
cal activity are promising but speculative, so they need to be evaluated
for effectiveness, unintended consequences, and, ultimately, their effects
on health and weight. First-level evaluations should be close to the
change, for example, studying customers at
a new
supermarket instead
of conducting a community wide survey that may include few of the
new store’s customers. Policymakers and public health experts should
thoughtfully construct case studies to better understand how environ
mental and policy innovations will affect their communities. Studies
should be designed to inform policy debates, and the search for evidence
should be both unbiased and multilayered.
Connections with Climate Change and Energy Policy. Similar to obesity,
the predicted consequences of climate change are near the top of the
public agenda (Ewing et al. 2008). Many actions recommended to con
trol obesity are also expected to decrease carbon emissions. Reducing
driving by walking and cycling more helps solve several problems, and
people living in walkable neighborhoods are estimated to generate about
30 percent less carbon than suburban residents do, largely because they
drive less (Ewing et al. 2008). More compact, walkable development
patterns can preserve (1) forests that absorb carbon, (2) open space where
people can be physically active, and (3) farmland that enhances access
to local produce while reducing carbon from transporting food long
distances. Policies with beneficial effects for both obesity and climate
change need to be evaluated, and opportunities for collaboration with
the environmental protection movement should be considered.
A New Environmental Education
Some of the success of the environmental protection movement has been
attributed to effective educational curricula in schools (Economos et al.
2001), many of which include hands-on learning. Teaching students
about their food and physical activity environments could produce a
generation of advocates for healthy community
environments. Examples
of class projects are observations of the food and physical activity envi
ronments in their local areas, surveys of community preferences,
com
parison of results with neighborhoods of contrasting sociodemographic
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Solutions to the Obesity Epidemic 145
characteristics, written reports, and the presentation of findings and
recommendations to community leaders. These activities could be inte
grated into health, science, social studies, math, and physical education
lessons. This is a topic ripe for research.
Additional strategies that engage the community, involve multiple
stakeholders, and strengthen advocacy need
to be developed, evaluated,
and refined to implement the evidence-based policy changes expected to
lead to nonobesogenic food and physical activity environments. Even
though widespread environmental changes may take years to show
results, the beneficial effects can be expected to contribute to long
lasting improvements in physical activity, eating, and obesity.
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Acknowledgments: Work on this article was supported by the Active Living
Research Program of the Robert Wood Johnson Foundation, NIH grant
HL083454 (Sallis), and a Distinguished Research Scholar Award from the
Georgia Cancer Coalition (Glanz).
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- Article Contents
- Issue Table of Contents
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The Milbank Quarterly, Vol. 87, No. 1 (Mar., 2009), pp. 1-334
Front Matter
In This Issue [pp. 1-5]
Obesity Metaphors: How Beliefs about the Causes of Obesity Affect Support for Public Policy [pp. 7-47]
Reducing Obesity: Motivating Action while Not Blaming the Victim [pp. 49-70]
Schools and Obesity Prevention: Creating School Environments and Policies to Promote Healthy Eating and Physical Activity [pp. 71-100]
Addressing Obesity in the Workplace: The Role of Employers [pp. 101-122]
Physical Activity and Food Environments: Solutions to the Obesity Epidemic [pp. 123-154]
A Cross-Sectional Prevalence Study of Ethnically Targeted and General Audience Outdoor Obesity-Related Advertising [pp. 155-184]
Innovative Legal Approaches to Address Obesity [pp. 185-213]
Public Health Law and the Prevention and Control of Obesity [pp. 215-227]
Food Prices and Obesity: Evidence and Policy Implications for Taxes and Subsidies [pp. 229-257]
The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food? [pp. 259-294]
The Politics of Obesity: A Current Assessment and Look Ahead [pp. 295-316]
Back Matter
