Brand marketing gone bad

{***Pause/Music***}

{***Amie***}

Coming up on Harvard Chan: This Week in Health…

The downside of a popular brand marketing program.

{***Elsie Taveras Soundbite***}

(In essence, what programs like Box Tops is doing, is leveraging poor school funding and caring parents to promote the purchase of poor quality foods)

{***Amie***}

In this week’s episode: How the Box Tops for Education program may be driving parents and kids toward unhealthy food choices—and what can be done to combat the program’s impact.

{***Pause/Music***}

{***Amie***}

Hello and welcome to Harvard Chan: This Week in Health…it’s Thursday, September 14, 2017. I’m Amie Montemurro.

{***Noah***}

And I’m Noah Leavitt.

We’ll get to our interview on Box Tops in a moment—but first we wanted to quickly touch on another round of devastating severe weather in the U.S. and the Caribbean.

In our last two episodes we covered the recovery from Hurricane Harvey.

And now people across the Caribbean and Southern United States are now beginning to recover from the devastation left behind by Hurricane Irma.

The is being blamed for at least 17 deaths on the U.S. mainland and left millions without power—most in Florida.

Caribbean islands were hit particularly hard. At least 38 people were killed and there is widespread damage. On the island of Saint Martin, more than three-quarters of structures were damaged and destroyed.

In last week’s episode we discussed the best way to help following a disaster—by sending money directly to aid organizations. We encourage you to go back to listen to that episode—it’s called disaster recovery. We also spoke to an expert about the long and difficult recovery areas face after a natural disaster.

And now we’ll pick up with the rest of this week’s episode.

{***Amie***}

In recent weeks students across the U.S. have returned to school.

And for many students and their parents, a familiar part of back-to-school season is redeeming Box Tops to raise money for their schools.

{***Noah***}

If you don’t know the program by name—you’ve probably seen the Box Tops on General Mills products.

It was created by the company in 1996 and is now one of the largest so-called school brand-marketing programs.

{***Amie***}

Schools that opt to participate can receive funding when parents and students buy participating products with the “Box Tops” logo.

And when those box tops are redeemed, schools can receive cash for discretionary purposes.

{***Noah***}

More than 90,000 schools have participated—with each school receiving an average of $7,000 over the lifetime of the program.

But a new study from researchers at the Harvard Chan School and Mass General Hospital for Children is raising concerns that the program may be driving parents and kids to make unhealthy food choices.

{***Elsie Taveras and Alyssa Moran Soundbite***}

(ELSIE TAVERAS: My name is Elsie Taveras and I am division chief of general academic pediatrics at Mass General Hospital for children, professor of Pediatrics at Harvard Medical School, and professor in the Department of nutrition at the Harvard Chan School of Public Health.

ALYSSA MORAN: I’m Alyssa Moran, and I’m a doctoral student in the Department of Nutrition at the Harvard Chan School.)

{***Amie***}

Elsie Taveras and Alyssa Moran analyzed nearly 1,000 foods and beverages in the Box Tops program and found that many were unhealthy—with high amounts of sugar, sodium, and even trans fats.

{***Noah***}

And to see how these products stacked up nutritionally, they compared these foods to the standards set under the federal Healthy, Hunger-Free Kids Act of 2010.

{***Amie***}

But what’s notable is that programs like Box Tops don’t have to meet those so-called “Smart Snacks” standards, because the products are not actually sold in schools.

{***Noah***}

I started our conversation by asking Taveras and Moran to explain what these Smart Snacks standards are—and why programs like Box Tops are exempt.

{***Taveras/Moran Interview***}

ELSIE TAVERAS: Schools are a significant source of food for children, and because of that, because children, in some cases, receive up to two to three of their meals in the school system, in 2010, the Healthy Hunger Free kids act provided guidelines for schools on the types of foods that could be sold in, or– or available in the schools. And they were based on USDA guidelines that are otherwise known as, kind of, the smart snacks guidelines and those guidelines provide information to schools and other services that offer food for children on products and the helpfulness of different types of foods. They’re based on USDA standards and they look at things like the amount of sugar, the amount of sodium, the amount of trans fat in foods, and they come up with a recommendation of the foods that meet certain standards based on their– the quantity of– and the distribution of those different types of nutrients in those foods.

NOAH LEAVITT: Foods in the Box Tops program are kind of exempt from that. So why is that? Why are they exempt from that, even though these are essentially being served to kids through a school program?

ALYSSA MORAN: Yeah, well, actually, so we had this conversation, I think, last July. And politically speaking, it was a really interesting time to be looking into the program because it was right at the time that the USDA was writing their final rule on local school wellness policies, which were– the USDA was given power to regulate local school wellness policies under the Healthy Hunger-Free Kids Act. And the aim of these policies were to reduce the negative impact of food marketing to kids in schools by prohibiting foods that don’t meet the smart snacks standards from being sold and advertised in schools. So, when the USDA solicited public comments on the final rule, there was a lot of debate around these brand marketing programs which don’t specifically advertise specific products in the schools, but they do promote the brand and products that are eligible under the brand marketing program. So, in the final rule the USDA decided to actually leave the decision to participate in these programs up to the schools who could, sort of, weigh the financial benefits of participating. So, that’s one way that these products slipped through the cracks under the local school wellness policies, because the brand and the program can be advertised in schools as long as the specific products aren’t actually sold.

NOAH LEAVITT: And so what your research showed was that if the food in the boxtops program were subject to these smart snack standards, many of them would basically not meet the standards that are being set.

ALYSSA MORAN: Well we found that, pretty unsurprisingly, very few products met all of the smart standards. In total, 24% of snacks and entrees marketed under the program met the standards. While products generally met standards for things like trans fat, sugar, and saturated fat, products tended to be very high in sodium and didn’t meet this one key standard, which requires that products have a healthful ingredient as the first ingredient, so contain a high amount of things like whole grains, fruits, and vegetables.

NOAH LEAVITT: And so what types of food are most concerned, because I guess in my– in my head I’m picturing a lot of sugary products, refined grains, I mean, so what kind of foods are we talking about that were so concerning?

ELSIE TAVERAS: The food that introduced me to the box top program through my then 8-year-old in third grade was Cinnamon Toast Crunch. Little did she know that that would be the start of what then became this– this study and analysis. So it includes snacks, it includes entrees, it includes beverages, and foods like cereals and other snack foods. I think the most egregious products, if I can call them that, are the high sugary cereals that are calorically dense and nutrient poor. So Cinnamon Toast Crunch is a great example. Reese’s Puffs cereals is another example, Toaster Strudels, Gushers. These are foods that we probably wouldn’t– wouldn’t necessarily call high quality foods for children in our schools and even for children in our own homes.

ALYSSA MORAN: Yeah, it’s interesting. Actually, a lot of the sugary cereals have been reformulated by food companies to just barely meet the smart snack standards, because a lot of those cereals are still sold in schools. So, we found that cereals, things like Cookie Crisp, or Reese’s Puffs, fell just under the threshold for sugar and have been reformulated to contain whole grains. So, those types of products actually did meet the standards, although they’re sort of the borderline products that you don’t necessarily think of as being healthful. The biggest offenders were things like meal kits. So, there were a lot of things marketed under the program like Hamburger Helper, El Paso taco and enchilada kits. Those contained over 1,000 milligrams of sodium per serving, and still contain trans fats, which we were really surprised to find. Other products that didn’t meet the standards were things like fruit snacks, Gushers, Fruit Roll Ups, which were more than 50% sugar. Other offenders were things like Toaster Strudels, which were talking about earlier, and things like macaroni and cheese and pizza.

NOAH LEAVITT: And so you mentioned that, for a lot of students, school is a major source of food, and then I guess kind of the other part of this is how much food marketing kids are just subjected to at home, probably of the same products. So how does a program like Box Tops kind of fit into the overall picture of food marketing to children?

ELSIE TAVERAS: Food marketing targeted at children is a billion dollar industry and so if it is now extending into the school system and in essence this program, Box Tops for Education, is creating brand marketers for this big food system, it’s furthering the marketing of these products in the school system, as well as in the homes. All right, because the products actually stay at home, but I feel as though and I think one of the implications of our findings of this program is that the schools indirectly are contributing and by participating in this program, they’re also contributing to making our children brand ambassadors and affecting the quality of the foods that children and their families are eating in their homes as these products are being brought into the home.

NOAH LEAVITT: Could you put this in perspective, into, just the larger concerns over childhood obesity. I mean, how does the foods that kids are eating through Boxtops overall increase their risk of obesity? Not just as children, but I guess later in life.

ALYSSA MORAN: Well, we know that exposure to food marketing increases kids preferences and consumption of marketed foods. We also know that these types of programs can foster brand loyalty, which can impact kids food choices well into adulthood. So, we were talking earlier about this program not existed when I was younger called Planet Lunch, and it was really similar to the Box Tops program, where you could redeem chip packages– it was sponsored by Frito-Lay– in exchange for prizes. So, when I was in middle school, I remember one of my really close friends was actually collecting these chip packages at lunchtime, and she saved them up over a year and she was able to buy this hot pink inflatable couch, and those were like all the rage at the time. So, I still, to this day, remember that inflatable couch and remember this plan at lunch Frito-Lay program. So these kind of things these, kind of positive associations with the brands, stick with kids over time and can impact their food choices much later in life.

NOAH LEAVITT: Is this challenging for schools, because I guess there’s a balance to strike where they, on one hand, can get funding, but also as you kind of mentioned that, they’re now playing a role in kids be exposed to these unhealthy foods, so what is the balance for schools and do they kind of face a difficult choice here?

ELSIE TAVERAS: So I think there– there is a balance that parents make and that schools are making, right, so let’s take the schools first. So $7,000 per school over the life of the program doesn’t seem like a lot of money, but these are discretionary funds that matter and make a big difference potentially to low resource schools, all right. We know that schools are– and many schools are poorly funded so any discretionary funds that schools can put into their school environment and other educational purposes, we should all get behind that, right. That’s a great idea and so I want to be really careful about– and in my own home, we want to participate in the program, of course, we want to support our schools, but I don’t want to do that by sacrificing my children’s diet quality and so the schools they are almost in this bind, because if they don’t participate in a program like this, they lose out on some discretionary funds. But the other part that’s in the balance here are parents, parents like myself, like many parents would love to support their children’s classrooms, their school system and Box Tops seems like a great way to do that, right. But I think parents are buying into this program not realizing that it’s making their children become brand ambassadors and we know– we know that diet in early childhood tracks into later childhood and adulthood and so if we’re introducing children to these poor quality foods so early in life, it’s likely that they will– this will become part of their diet as they get older. And so I think while we want to be sensitive to the– the poorly funded schools and the potential loss of funding to the school systems, we also want to be sensitive to the fact that parents are looking for ways to support their schools, but in essence, what programs like Box Tops is doing is leveraging poor school funding and caring parents to promote the purchase of poor quality foods.

ALYSSA MORAN: The Boxtops program is really clever because it uses the influence of kids’ food preferences to impact household food choices. So, we know that parents want to make kids happy, that as much as they might know that these products are unhealthful, they’re susceptible to their kids food preferences and what their kids want to buy. What’s interesting about the Boxtops program is that I’ve noticed how it works in collaboration with other marketing tactics used to target children. So, many of the products that are eligible under the Boxtops program use spokescharacters. So, I noticed things like Dora the Explorer, or Despicable me characters that are plastered all over these Fruit Roll Up and Gushers packages to try to speak to kids and get kids to want to purchase those things.

NOAH LEAVITT: I feel like it almost makes it harder for parents to say no, because the kid can say, but it’s for school.

ALYSSA MORAN: Yeah, and it’s interesting. We recently did some focus groups with parents last spring, and we asked them about, how do you make food choices in the supermarket. What are the biggest influences on what you buy? And across the board, the biggest influence on the parents food choice was their kids food preferences and particularly having the child with them in the store. It’s really hard. I think anyone with kids know that’s really hard to say no when your kid really wants something, and when they ask for it repeatedly, when they place items in the cart that you wouldn’t typically buy, and then to layer on top of this that you’re theoretically doing something good by raising money for the classroom, it makes a really, really, really difficult to say no, even if it goes against your best intentions.

NOAH LEAVITT: Is there any incentive from the perspective of General Mills, or any of the other companies running these programs, is there any incentive for them to start including more nutritious foods in these programs?

ELSIE TAVERAS: Obviously I don’t work for General Mills, but some things to consider, all right, one is this is a really successful program. Is there a way for more of the foods that meet the national standards be promoted? We sometimes tend to think of these big food industries as kind of villains, but how do we turn that around and leverage the fact that they have a very powerful and widely disseminated program in most schools in the United States to do the opposite, which is to promote high quality– the purchase of high quality foods? I think that would be a natural next step and a point for advocacy for parents and schools, but I also think I personally, in order to continue supporting the programs so that our own school receives those discretionary funds, I use the– the Box Tops program, or I contribute to the Box Tops program by purchasing the non-food items, Ziploc bags, freezer bags, other types of products that get me away from the food items. But it shouldn’t have to come to that and I think that it would require and it should require some advocacy on the part of schools, parents, and others to try to influence the types of foods that are available to parents through the Box Tops program.

ALYSSA MORAN:  There are other products other than foods that are included under the Box Tops program, so they could expand things like office supplies or household supplies like Ziploc bags and garbage bags that are eligible for redemption, and take the focus off of some of these less healthful food items. There are also other products that fall under the General Mills brand that aren’t even included in the program that are actually healthful. So for example, General Mills owns Cascadian Farms and they offer some of their cereals under the Box Tops program, but none of their frozen fruit products. So, trying to, maybe, renegotiate the types of products that are eligible, and including more of the products from Green Giant, like the bagged produce or some of the low sodium canned vegetables, including more of those Cascadian Farms frozen fruits. That’s one way they might be able to revamp the program to appeal to both the financial needs of the school and the health needs of the child. And then lastly, food companies could think about reformulating some of these packaged foods to actually meet the smart snack standards. And we know that food companies have already been doing this with cereal so that they can be sold in schools. General Mills, in particular, has reduced sodium in a number of their packaged products as part of the national salt reduction initiative. So there are a number of things that food companies could do to continue to give money to schools, while also promoting health.

NOAH LEAVITT: And so the advocacy is one part of it, but kind of on the day to day level, just kind of where you touched on there about maybe buying some of the non-food items, I mean, are there things that– that parents can do in order to still support the program and the funding for schools, but also still kind of keep their kids nutritional best interests In mind.

ELSIE TAVERAS: Yes, for sure and I think that the first place to start is to become familiar with the list of food items that are available through the Box Tops program. We went through about 1,000 different products and personally, there were only about a third of those that I think I would even bring in to my home, but taking a look at that list, becoming more aware and more familiar with the food items on there that still allows us to– to support the program, but that wouldn’t compromise our ability to provide a high quality diet for our children. That’s for sure one easy thing that parents can do and maybe that schools can provide– schools that are going to participate in Box Tops can provide to parents as a resource so that parents know which are the products that meet those smart snacks nutrition standards, and then just as I shared, in my own home, we– we do a lot of the purchasing of the non-food items that also are eligible for– for the Box Tops program.

NOAH LEAVITT: And just a last question I’d be interested– I mean, has– what has the reaction to this paper been from schools? Have you heard from schools? Have you heard from parents who were– maybe were not aware of this or now maybe kind of have new concerns over the program?

ELSIE TAVERAS: I’ve heard from both. I think the main concern I hear from parents is the fact that the amount of funding going back to the schools is minimal and really does not justify having the program create brand ambassadors of their children. I think that’s been the reaction I’m hearing from many parents of, I’m going to call my school to find out how much money Box Tops even contributed and whether it’s worth it, to in return create brand marketers. I don’t think that’s what parents intend and– for sure not what the schools are intending and so that’s been part of the reaction I’m hearing from parents is, I want to know more about how much the program is actually contributing to my own school. What is that funding going towards and is it really worth it, if in return we’re creating and worsening the diet of our children.

{***Noah***}

That was our conversation with Elsie Taveras and Alyssa Moran on concerns surrounding the Box Tops for Education program.

{***Amie***}

And as Taveras and Moran mentioned there are some healthy options among the Box Tops product.

So we’ve put together a list of some of those products so that you can use that as resource when you’re shopping.

The list includes fresh and frozen vegetables, low-sodium soups, and whole-grain snacks.

{***Noah***}

You’ll find the list, as well as more information about the Box Tops program on our website, hsph.me/thisweekinhealth.

{***Amie***}

That’s all for this week’s episode, but a reminder that you can always listen on iTunes, Soundcloud, and Stitcher.

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