International Journal of Consumer Studies ISSN 1470-6423

Chubby cheeks and climate change: childhood obesity as a

sustainable development issue ijcs_893 3..9

Lucia A. Reisch and Wencke Gwozdz

Copenhagen Business School, Department of Intercultural Communication and Management, Centre for Corporate Social Responsibility,
Frederiksberg, Denmark

Keywords
Sustainable development, childhood obesity,
consumer policy.
Correspondence
Lucia A. Reisch, Copenhagen Business
School, Department of Intercultural
Communication and Management, Centre
for Corporate Social Responsibility,
Porceleanshaven 16c, DK 2000 Frederiksberg,
Denmark.
E-mail: lr.ikl@cbs.dk
doi: 10.1111/j.1470-6431.2010.00893.x
Abstract
The rise of obesity is one of today’s biggest societal challenges. Indeed, the obesity
epidemic is not only impairing individuals’ lives, but also societies’ sustainability, most
notably with regard to the social, the cultural and the economic dimension. Thus, to halt
obesity has become a goal in several political sustainability strategies. The focus is on
children since their health behaviour is expected to have a strong impact on consumers in
adulthood. To fight childhood obesity, the challenge is to develop the ‘right’ policy toolbox.
One complicating aspect amongst others is the numerousness of actors involved. To find a
policy mix and assess its consequences for all actors, it is essential to understand the
underlying mechanisms – the impact of external and internal factors on children’s health
behaviour. Tools such as regulation, information and education appear to be insufficient to
curb this unsustainable consumption behaviour. One promising avenue to strike a new path
is to exploit the possibilities of choice architecture as proposed by behavioural economics.
The purpose of this paper is threefold: first, to develop the conceptual nexus between
obesity and sustainable development against the backcloth of obesity and sustainability
research; second, based on a human ecological model, to outline selected influencing
factors of childhood obesity; and third, to sketch the options of market and consumer policy
actors to curb the pandemic.

and Social Development Canada, 2002) and Australia (National

Introduction
Obesity has been pushed into the centre of attention for the public
because of its world-wide soaring rates and its serious social and
economic consequences. World Health Organization (WHO)
figures show that worldwide, over 1 billion adults are overweight
and around 300 million are obese1. Over the past 30 years, the
frequency of overweight children has tripled (Miller et al., 2004).
Increasingly, curtailing and preventing obesity already in child-
hood has become recognized as a goal of a sustainable society.
Recently, many countries such as Germany (Bundesregierung,
2002), Ireland (Irish Ministry for Environment, Heritage and
Local Government, 2007), England (Cross-Government Obesity
Unit, 2008) and Switzerland (Swiss Federal Council, 2008) as
well as the European Union (European Commission, 2006a) have
integrated levels of obesity as one measurable indicator in their
respective sustainability strategies with a focus on young consum-
ers. To date, most European countries (Widhalm and Fussenegger,
2005) and also countries worldwide, e.g. the US (U.S. Department
of Health and Human Services, 2000), Canada (Human Resources
1
Obesity is assessed using body mass index (BMI) above 30 kg/m2 and
represents the upper tail of the population distribution of BMI.
Obesity Taskforce, 2003) have implemented national action plans
to fight the rise of obesity (WHO, 2008). The European Commis-
sion is funding several large research projects with a focus on
children and teenagers to investigate the aetiology and prevention
of obesity.2
Basically, obesity evolves whenever the calorie intake exceeds
calorie consumption over a longer period. This long-term energy
imbalance is determined by characteristics of lifestyle, food intake
and level of physical activity – all three are, in principle, within the
responsibility of the individual. Yet, individuals are embedded in
general trends of development such as less physically demanding
labour, urbanization, increasing purchasing power and modern-
ized food marketing (Witkowski, 2007). Unsustainable lifestyles
2
For instance: IDEFICS (http://www.ideficsstudy.eu/Idefics) and
HELENA (http://www.helenastudy.com), two intervention studies that aim
to identify health effects of dietary and lifestyles changes in young children
(2–10 years) and adolescents respectively. Focusing on marketing strate-
gies are POLMARK (http://polmarkproject.net) and FLABEL (http://
www.flabel.org/en); the former deals with policies of food marketing
towards children in general, the latter analyses the effectiveness of food
labelling.

International Journal of Consumer Studies 35 (2011) 3–9 3

© 2010 Blackwell Publishing Ltd
Childhood obesity as a sustainable development issue
are hence also an issue for health and consumer politics since the
external effects of private consumption are reflected in social costs
and/or when the life chances of future generations are at stake.
While governments’ influence on changing individual consump-
tion behaviour is limited and needs a long-term commitment, a
more promising approach is to actively design the consumption
contexts people live in: the food and drinks offered, the marketing
and advertisements contents broadcasted, the walkability and
bikeability of cities and so forth. Urbanized consumption environ-
ments today have been coined as being ‘obesogenic’, i.e. contain-
ing stimuli that encourage obesity (Swinburn et al., 1999;
Lobstein, 2004; Darnton, 2009).
With the future in mind, the alarming trends in obesity create
a need for immediate action – especially with regard to children:
more than 30% of all European children are overweight or obese
(European Commission, 2007) and numbers in the US and
Canada are even higher. Unlike the rich nations, where obesity is
particularly a problem of lower socio-economic status, obesity is
especially pronounced within better-off city dwellers in the
South Pacific, Latin America and China (Witkowski, 2007).
Since obese children are more likely to become obese adults
(Procter, 2007), it is high time to think about effective strategies
to fight the obesity epidemic. Health and consumer policy-
makers together with the increasingly blamed food industry have
started to employ the whole arsenal of instruments – consumer
information, education, incentives, regulation and creation of
supportive environments – to go about resolving this problem.
As yet, however, no downward trend in obesity is discernable.
What has become clear is that the prevention of obesity needs
the concerted action of all actors involved, including children
and parents, the food industry, retailers, the media and
marketers.
The purpose of this paper is threefold: first, to develop the
conceptual nexus between obesity and sustainable development
against the backcloth of obesity and sustainability research;
second, based on a human ecological model, to outline selected
influencing factors of childhood obesity; and third, to sketch the
options of market and consumer policy actors to curb the
pandemic.
Obesity and sustainable development:
The nexus
According to the 1998 Human Development Report (UNDP,
1998), consumption that enhances human development must be
shared (ensuring basic needs for all); strengthening (improving
human capabilities and enriching the lives of people, encouraging
lively, creative individuals and communities); socially responsible
(not compromising the well-being of others); and sustainable (not
mortgaging the choices of future generations). The ongoing
obesity pandemic meets none of these criteria. Rather, it seriously
affects the social, cultural and economic sustainability of societies
(Reisch, 2003).
Social sustainability is jeopardized as social cohesion, equity
and fairness erode due to the consequences of obesity. In general,
overweight and obese individuals are associated with deteriorating
health, reduced mobility, poorer employment opportunities, pre-
mature mortality and higher living expenses resulting in an overall
poorer quality of life (Harper, 2000; Morris, 2006; Government
4 International Journal of Consumer Studies 35 (2011) 3–9
L.A. Reisch and W. Gwozdz
Office for Science, 2007). For the individuals involved, obesity
may worsen qualify of life in the sense of poor self-image, social
ostracism and the routine difficulties in daily life such as finding
suitable seating (Witkowski, 2007). One alarming consequence of
rising obesity levels is an anticipated decline in life expectancy
(Olshansky et al., 2005). To date, obesity and its co-morbidities
are the second most frequent causes of death (after tobacco con-
sumption) (HM Government, 2008). At a Body Mass Index (BMI)
of 30–35, life expectancy is already reduced by 2–4 years; a BMI
of 40–45 shortens the expected age even by 8–10 years (Prospec-
tive Studies Collaboration, 2009). In the UK for example, the
average life expectancy of men has already decreased by 2 years
due to obesity and will even decrease up to 5 years until 2050 if
forecasted trends of obesity rates come true (Haslam and James,
2005). This trend is ever more challenging when looking at the
most affected social groups: There is ample of scientific evidence
that, in the rich nations of the West, low socio-economic status
families are more likely to be obese than any other social group
(McLaren, 2007). This has been explained by poor access to and
higher prices for healthy food as well as by fewer opportunities
for physical activity (Robertson et al., 2007). Scientific evidence
backs up both causalities resulting in a vicious circle: belonging
to lower socio-economic status families increases the probability
of becoming overweight or obese while being obese decreases
chances to generate well-being. Decreasing incomes – as caused
by the current worldwide financial and economic crisis – amplify
unhealthy lifestyles especially at the bottom end of the social
scale.
Cultural sustainability depicts the diversity and adaptability of
local cultures that are conducive to both stability and balance
(Reisch, 2005). This also applies to food cultures that are a result
of food consumption. which in turn responds to biological and
cultural stimuli such as hunger or advertisements respectively.
With the rise of the ‘McDonaldization’ of consumption, fast food
and ready meals, together with a high protein and meat diet, have
started to dominate food cultures worldwide (Wilk, 2006). These
have been found to increase the risk of overweight and obesity
(Robinson et al., 2005). Moreover, in the public sphere, food has
become abundant and available everywhere and any time, which
eases uncontrolled access and disturbs cultural meal structures and
rhythms. This technology-driven ubiquitiousness and omnitempo-
rality of food has profoundly changed and homogenized national
food cultures (Reisch, 2001). Hence, some philosophers have
called for new ‘food cultures’ where food should be seen again as
an issue of enjoyment, of delight, of sociality and of a (re-
)connection of man with nature, region and season (Korthals,
2004), and that a new ‘food democracy’ based on deliberative
processes and food networks is needed for more sustainable soci-
eties (Coff et al., 2008).
Economic sustainability means to maintain or increase current
standards of living without decreasing the standard of living of
others and especially that of future generations. The economic
consequences of obesity are severe not only with regard to health
care systems but also to labour markets. National health systems –
chronically underfunded anyway – bear the burden of obesity’s
many co-morbidities such as type 2 diabetes, cardiovascular dis-
eases and hypertension. Moreover, statistics have shown that
obese individuals have lower employment rates due to their health
status or due to other reasons such as workplace discrimination:
© 2010 Blackwell Publishing Ltd
L.A. Reisch and W. Gwozdz
the productivity of obese people is assumed to be lower because of
more sick days or premature mortality (McCormick and Stone,
2007). Another aspect of economic unsustainability are agricul-
tural subsidy patterns that boost unhealthy foods into markets and
might thus contribute to the rise of obesity: an article in the
Observer Food Monthly from 2006 about the Scottish sugar indus-
try serves as an illustrative example. In Scotland, the sugar indus-
try had been the most important industry since the 1800s and sugar
became one of the most popular foods due to easy access for which
high subsidy is one of several reasons. Even today, there are severe
consequences for the Scots: dental decay rates are comparable to
developing countries and moreover, they experience overweight
and obesity rates much higher than in other parts of the UK – all
resulting in severe health costs (Renton, 2006). Thus, unsustain-
able subsidy patterns may impose external health costs on current
and future generations.
Finally, obesity is closely connected to the ecological unsus-
tainability of the current food production, characterized by an
excessive use of energy and water to produce and transport food
accompanied by a sharp increase in greenhouse gases. Food pro-
duction accounts for about one-fifth of global greenhouse gas
emissions (McMichael et al., 2007) and transport accounts for an
estimated 14% (Woodcock et al., 2007). The overuse of natural
sources and sinks reduces life chances of both, future genera-
tions and poor people today. A population with a higher BMI
moves less and uses larger cars with more internal space. A
recent epidemiological study (Edwards and Robert, 2009) has
estimated the additional greenhouse gas emissions due to higher
fuel energy use for transporting and feeding a heavier popula-
tion: Compared with a normal population distribution of BMI
with about 3% obese, a population with 40% obese requires 19%
more food energy for its total energy expenditure. Greenhouse
gas emissions from food production and car travel due to
increases in obesity in a population of 1 billion are estimated to
be 0.4–1.0 Giga tons of carbon dioxide equivalents per year.
Hence, reducing the BMI has equally beneficial effects for the
environment.
Influencing factors: empirical evidence
of determinants of obesity
The issue of obesity is very complex. Many interdependencies
between a wide variety of factors related to individual biology,
eating behaviours and physical activity, set within a social, cul-
tural and environmental landscape, emerge and complicate the
identification of single causes. The British Foresight ‘Tackling
Obesities’ project report (Government Office for Science, 2007)
sums up this complex picture in a system map, which charts 108
factors that influence weight gain, each supported by bodies of
evidence of varying quantity and quality (see Darnton, 2009). In
the following, based on an ecological model of obesity approach
(Kumanyika et al., 2002; Story et al., 2002; Witkowski, 2007;
Rayner et al., 2008), five different interrelated levels of influenc-
ing factors are selected and some empirical evidence will be pre-
sented. These are: individual behaviour; the influence of parents
as gatekeepers; the increased purchasing power of children; the
role of today’s food environment supplied by the food industry,
retailers and restaurants; and today’s highly efficient food
marketing.
International Journal of Consumer Studies 35 (2011) 3–9
© 2010 Blackwell Publishing Ltd
Childhood obesity as a sustainable development issue
Individual behaviour
Explaining individual behaviour allows us to understand the reac-
tion to stimuli that are created by other stakeholders. As behav-
ioural economists have pointed out, we do not always observe the
rational consumer that neoclassical economics portrays. In fact,
consumers are often aware of acting against their own interests.
This is certainly true when it comes to overweight and obesity
despite widespread knowledge about how – and why – to live
healthily (Prendergrast et al., 2008). For example, individuals’
long-term energy imbalance is neither rational nor sustainable in
the long run, but they are a matter of fact despite increased edu-
cation and knowledge of consumers. One explanation could be an
inconsistency between long-term (inherent) and short-term (con-
structive) preferences of individuals, their pronounced preference
for the present (so called ‘hyperbolic discounting’) as well as their
limited ability to control their impulses (Scharff, 2009).
Parents as gatekeepers
As far as children are concerned, the major responsibility for
obesity lies with their parents and families as well as with second-
ary socialization agents such as caretakers and teachers. All men-
tioned agents act as gatekeepers. This means that they have, to a
larger or lesser degree, the power to control the impact the media,
retailers, the food industry, restaurants and food marketers exer-
cise on children’s food preferences and physical activities. Parents
influence children’s health behaviour both directly and indirectly.
Children of overweight parents are more likely to be overweight
themselves (Maffeis, 2000). While this can partly be explained by
genetics (Maffeis, 2000), it is also due to parents’ food and health
regimes, their own behaviour and the values and knowledge they
convey to their children on food marketing. To date, there is no
consensus in the scientific community about the transference of
parental beliefs and attitudes on children: there is some evidence
for parental effects on children’s preferences for vegetable and
fruit consumption (Nicklas et al., 2001); on the contrary, Grier and
colleagues (2007) could not find a causal relationship between
parental exposure to and attitude towards fast food marketing and
children’s fast food consumption.
The style and contents of parental health communication
depend heavily on the parental style, on how parents act as role
models and, additionally, on the children’s stage of socialization
(Roedder John, 1999). Moreover, families and their environments
can be rather obesogenic or rather non-obesogenic. reflecting the
number of stimuli – such as facilities for physical activities like
bike lanes or playgrounds or faculties for (un)healthy food intake
like the density of fast food restaurants – that increase the risk of
obesity (Lobstein et al., 2004). Nevertheless, there are limits to the
extent of parents’ capability to act as gatekeepers. This is not only
due to the influence of peers and the pushing of the market, but is
also due to existing social norms and installed practices – such as
using candies to reward children – that are seldom challenged and
difficult to circumnavigate once they are installed (Thaler and
Sunstein, 2008).
Increased purchasing power
Children today experience an increased purchasing power and
spending autonomy. This, in turn, has led to increased dietary
5
Childhood obesity as a sustainable development issue
intake (Witkowski, 2007). Children’s purchasing power makes
them very attractive customers for the food and beverage industry,
leading to newly developed, specifically targeted products that are
systematically advertised. In the US, children aged between 4 and
12 spent about $2.2 billion in 1968 on children’s goods (i.e.
clothes, toys and food); in 2006, their spending power exceeded
$51 billion (Dotson and Hyatt, 2005). This also leads to a higher
conflict potential between children and parents in purchasing situ-
ations. Attempting to get these advertised and thus, very attractive
products, children often make use of the so-called ‘pester power’,
which is defined as a ‘child’s attempt to exert control over a
purchase situation as a simple battle of wills’ (Nicholls and Cullen,
2004, p. 80). Pester power is not mitigated by the industry and
retailers as they have long ago recognized the potential of young
consumers and consequently invested in targeted development of
products and their marketization. Some studies even suggest that
nagging is one the most successful techniques to influence paren-
tal consumption that children apply (Gunter and Furnham, 1998).
A modernized food environment
The food industry, retailers and restaurants are considered as
important actors in the matter of childhood obesity. They shape the
context in which food choice takes place. Behavioural economics
has shown that the influence of the immediate context (e.g.
in-store marketing, product offers, built environment and easy
access to food) has a decisive impact on consumers’ decisions, that
access and availability of healthy alternatives are crucial and that
many preferences are ‘constructed’ right at the point of sale (‘con-
structive preferences’) (Thaler and Sunstein, 2008).
Highly processed and prepared foods as well as the increase of
package and portion sizes over the past 20 years have made it more
difficult to discover hidden energy (Diliberti et al., 2004). For
many years, it has been debated whether consumers actually use
the nutritional information provided on the package at all and if
yes, which of the competing systems is the best. For instance,
information about included fat seems to make consumers choose
lower fat alternatives (Roefs and Jansen, 2004). Latest research
has shown that consumers do indeed use provided health-related
on-pack product information – such as General Daily Allowances
or the traffic light system – but only if it is easy to understand and
eye-catching (Grunert and Wills, 2007).
Modernized food marketing
The food industry has increased the number of channels used to
advertise their products to children. While television is still an
attractive medium for the small children and advertisements are
a successful strategy for brand building (Dammler and
Middelmann-Motz, 2002), online marketing such as ‘advergames’
(Weber et al., 2006; Moore and Rideout, 2007), in-school market-
ing and sponsoring, as well as toys and games produced in asso-
ciation with food producers are increasingly used (Hastings et al.,
2003; Story and French, 2004). To increase consumption, market-
ers create positive attitudes for their products and try to channel
social norms of parents and children – i.e. for instance shared
beliefs about health behaviour – by strengthening already existing
behavioural patterns and convincing consumers of the product’s
benefits (Grier et al., 2007). Experiments suggest that food brand-
6 International Journal of Consumer Studies 35 (2011) 3–9
L.A. Reisch and W. Gwozdz
ing changes children’s preferences in favour of the branded food
(Robinson et al., 2007). This is problematic since the majority of
advertised foods are snacks, soft drinks and sweets that are high in
fat, sugar or salt (Hastings et al., 2003; Batada and Wootan, 2007).
A large proportion of television advertisements deliberately targets
young consumers. In the US, children aged 2–11 years watch
about 5500 food-related TV advertisements per year (Holt et al.,
2007) or an average of 11.5 minutes of per day (Powell et al.,
2007). There is empirical evidence that the exposure to TV food
advertisements leads to unhealthier food choices (Taveras et al.,
2006) and that overweight and obese children have higher recall
rates and intakes of advertised food products than normal-weight
children (Halford et al., 2008). A recent study estimates that TV
food advertising may be responsible for 15–40% of the obesity
prevalence among 6- to 12-year-old US children (Veerman et al.,
2009). The authors conclude that limiting the advertising of high-
calorie foods could well be an element to improve children’s diets.
Implications for consumer policy
The factors presented above are valuable starting points to change
young consumers’ behaviour into a healthier direction. While the
goal to reduce obesity is broadly accepted, the motives, strategies,
possibilities and dependencies of the various actors in the food
system and in food and health politics differ. In the following we
argue that policy actions are necessary, but that they can only be
effective if all stakeholders support these policies with the means
in their reach.
The European Commission (2007) notes that parents having the
main responsibility for their children should be able to make
informed choices and transfer their knowledge to their offspring.
Hence, consumer policy should, in the first place, inform, educate,
empower, support and engage consumers in general and consum-
ers in their role as parents responsible for their children’s health in
particular. There are three main strategic goals: raise awareness of
the risks of obesity, reduce energy intake and increase energy
output (Witkowski, 2007). To reach these goals, consumer infor-
mation, education and advice are relevant tools, but they might not
be far-reaching enough, especially not if constructive preferences
crow over inherent preferences when it comes to nutritional or
physical activity decision-making processes. Strengthening con-
sumer organizations and listening to them in a constant dialogue
on the consumer interest is another relevant tool (Viswanathan and
Gau, 2005). Sometimes, it might be worth to actively steer con-
sumption gently – ‘to nudge’ (Thaler and Sunstein, 2008) – into
healthier choices by shaping the consumption context, i.e. access
and default settings. Examples in case are guidelines or regula-
tions on vending machines in schools, smart defaults in canteens
and codes of conduct banning food advertising and sponsoring in
children’s TV programmes.
In 2004, the European Commission brought together all stake-
holders of the obesity crisis to start a roundtable discussion of
appropriate approaches to tackle obesity. Among them were the
food industry and retailers that are, of course, primarily interested
in satisfying their shareholders. Nevertheless, a voluntary contri-
bution of the food industry could comprise a shifting focus from
short-term goals to an investment in long-term programmes
(Layton and Grossbart, 2006) to alleviate children’s as well as
parents’ consumption process of making healthier and more
© 2010 Blackwell Publishing Ltd
L.A. Reisch and W. Gwozdz
sustainable choices. The national action plans as well as evidence-
based, food-based dietary guidelines provided by academia
(Goyens and Ramsay, 2008) – even if being constantly questioned
and adapted – are a sound basis for corporate activities. Guidelines
can be used to inform consumers in an easy and understandable
way via food labelling. There is a large potential for improving and
standardizing the existing food-labelling systems in order to
reduce consumers’ confusion (Procter, 2007). Easily understand-
able labelling and visual displays in the marketplace are of utmost
importance in particular for the sizable portion of ‘functionally
illiterate’ consumers (Viswanathan and Gau, 2005). Easing the
decision process of all consumers, there is a need for easy and
low-cost access to healthy food such as vegetables and fruits by
improving the availability by food producers as well as the in-store
promotion by retailers (Government Office for Science, 2007).
Moreover, recipes could be reformulated by modifying levels of
fat, sugar or salt. Another approach would be to decrease package
and portion sizes (European Commission, 2008). Recent trends
and developments of products such as diet sodas or reduced-
calorie foods illustrate the way the industry is trying to meet
consumer needs (of taste, convenience and costs), corporate finan-
cial targets and achieve positive, healthy product images at the
same time. Indeed, a ‘stealth health’ approach, i.e. an ongoing
process of product reformulation to improve the nutritional quality
of staple products without necessarily making explicit health
claims (Goyens and Ramsay, 2008) is increasingly seen as a
‘golden bullet’ to combat rising obesity incidence. Instead of
trying the impossible to market healthy products successfully to
unconvinceables, ‘companies should simply continue with their
successful marketing strategies, consumers continue their normal
purchasing behaviours, companies’ profit margins remain intact,
and the public health improves’ (Royne and Levy, 2008, p. 474).
Marketers and advertisers know that advertisements have
effects on children’s food preferences (Hastings et al., 2003) and
exacerbate parents’ role as gatekeepers through tailored appealing
promotion strategies to children. Marketers are already subject to
policy regulations on national levels, but within these boundaries,
they become very innovative in discovering new channels and
methods. There are attempts to force the industry to act accord-
ingly by regulations, but evidence of success is weak (Lang and
Rayner, 2007). Furthermore, a ban of unhealthy food advertise-
ments would have unknown consequences especially with regard
to where the banned advertisements would go and what the
replacement for them would be (Desrochers and Holt, 2007).
Thus, policy-makers seek to establish best practices to curb food
advertisements targeted at children. For instance, the European
Commission implemented a roundtable for this purpose where not
only the policy-makers were present, but also representatives from
the European Advertising Standards Alliance and interested non-
governmental organizations (NGOs) (European Commission,
2006b). In the US, the Council of Better Business and the National
Advertising Review Council implemented self-regulated limits
to unhealthy advertisements (Desrochers and Holt, 2007). In
Denmark, a voluntary code of responsible food marketing com-
munication to children has recently been implemented (Forum of
Responsible Food Marketing Communication, 2008). These are
promising starting points to create a marketing environment in
which youths are encouraged to eat a healthier diet (Goldberg and
Gunasti, 2007).
International Journal of Consumer Studies 35 (2011) 3–9
© 2010 Blackwell Publishing Ltd
Childhood obesity as a sustainable development issue
Conclusion
In a nutshell, childhood obesity has become and important issue of
consumer policy and there are several policy approaches to tackle
the spread of this epidemic. Following behavioural economics
and the psychology of consumer behaviour, ‘making the healthy
choice the simple choice’ and setting healthy defaults in product
supply are important drivers to promote healthy nutrition, espe-
cially when it comes to children. The common denominator of the
current expert debate can be put as follows: behind-the-scenes
initiatives such as product reformulation to lower energy density
(up to a third before consumers are aware of the difference;
Goyens and Ramsay, 2008) in a wide range of foods together with
a smart choice architecture of health-promoting defaults (Thaler
and Sunstein, 2008) seem to be more effective than communica-
tion campaigns and behavioural change interventions that have not
proved to be sustainable and long-lasting. It is high time for public
health and consumer policy officials to partner with marketing
experts from the food industry, NGOs and academia to develop
effective interventions.
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