There is no standardized or validated definition or measure of “child-appeal” used in food and beverage marketing policy or research, which can result in heterogeneous outcomes. Therefore, this pilot study aimed to develop and validate the child-appealing packaging (CAP) coding tool, which measures the presence, type, and power of child-appealing marketing on food packaging based on the marketing techniques displayed. Children (n = 15) participated in a mixed-methods validation study comprising a binary classification (child-appealing packaging? Yes/No) and ranking (order of preference/marketing power) activity using mock breakfast cereal packages (quantitative) and focus group discussions (qualitative). The percent agreement, Cohen’s Kappa statistic, Spearman’s Rank correlation, and cross-classification analyses tested the agreement between children’s and the CAP tool’s evaluation of packages’ child-appeal and marketing power (criterion validity) and the content analysis tested the relevance of the CAP marketing techniques (content validity). There was an 80% agreement, and “moderate” pairwise agreement (κ [95% CI]: 0.54 [0.35, 0.73]) between children/CAP binary classifications and “strong” correlation (r_s [95% CI]: 0.78 [0.63, 0.89]) between children/CAP rankings of packages, with 71.1% of packages ranked in the exact agreement. The marketing techniques included in the CAP tool corresponded to those children found pertinent. Pilot results suggest the criterion/content validity of the CAP tool for measuring child-appealing marketing on packaging in accordance with children’s preferences.

Federally mandated restrictions on food and beverage marketing to kids (M2K) have been re-introduced as a national public health priority in Canada by the newly elected government, following the failure to implement a similar policy first proposed in 2016. This study examined the extent to which Canadian packaged foods, including products already displaying M2K on the packaging, would be permitted to be marketed, based on the nutrient criteria for marketing restrictions defined by Health Canada (in December 2018) as part of the previous policy proposal. Products from the University of Toronto Food Label Information Program 2013 database (n = 15,200) were evaluated using Health Canada’s published criteria: thresholds for sodium, sugars and saturated fats that products cannot exceed in order to be M2K. The proportion of products exceeding no thresholds (i.e., permitted to be M2K), the number of thresholds exceeded, and the proportion exceeding each individual threshold were calculated overall and in the subsample of products displaying M2K on the packaging (n = 747). Overall, 18.0% of products would be permitted to be M2K, versus 2.7% of products displaying M2K. Sodium was the most exceeded threshold overall (57.5% of products), whereas sugars was the most exceeded by products displaying M2K (80.1%). Only 4.7% of all products versus 10.4% of products displaying M2K exceeded all three thresholds. These results highlight the importance of reintroducing federal regulations restricting M2K in Canada and including marketing on product packaging in the regulatory scope.

Free sugars are a major source of calories in diets and contribute to the burden of many non-communicable diseases (NCDs). The World Health Organization (WHO) recommends reducing free sugars intake to less than 10% of total energy. This study aimed to estimate the number of diet-related NCD deaths which could be averted or delayed if Canadian adults were to reduce their calorie intake due to a systematic 20% reduction in the free sugars content in foods and beverages in Canada. We used the Preventable Risk Integrated ModEl (PRIME) to estimate the potential health impact. An estimated 6770 (95% UI 6184–7333) deaths due to diet-related NCDs could be averted or delayed, mostly from cardiovascular diseases (66.3%). This estimation would represent 7.5% of diet-related NCD deaths observed in 2019 in Canada. A 20% reduction in the free sugars content in foods and beverages would lead to a 3.2% reduction in calorie intake, yet an important number of diet-related NCD deaths could be averted or delayed through this strategy. Our findings can inform future policy decisions to support Canadians’ free sugars intake reduction, such as proposing target levels for the free sugars content in key food categories.

Recommendations suggest limiting the intake of free sugar to under 10% or 5% of calories in order to reduce the risk of negative health outcomes. This study aimed to examine Canadian free sugar intake and model how intakes change following the implementation of a systematic reformulation of foods and beverages to be 20% lower in free sugar. Additionally, this study aimed to examine how calorie intake might be impacted by this reformulation scenario. Canadians’ free sugar and calorie intakes were determined using free sugar and calorie data from the Food Label Information Program (FLIP) 2017, a Canadian branded food composition database, and applied to foods reported as being consumed in Canadian Community Health Survey—Nutrition (CCHS-Nutrition) 2015. A “counterfactual” scenario was modelled to examine changes in intake following the reformulation of foods to be 20% lower in free sugar. The overall mean free sugar intake was 12.1% of calories and was reduced to align with the intake recommendations at 10% of calories in the “counterfactual” scenario (p < 0.05). Calorie intake was reduced by 3.2% (60 calories) in the “counterfactual” scenario (p < 0.05). Although the overall average intake was aligned with the recommendations, many age/sex groups exceeded the recommended intake, even in the “counterfactual” scenario. The results demonstrate a need to reduce the intake of free sugar in Canada to align with dietary recommendations, potentially through reformulation. The results can be used to inform future program and policy decisions related to achieving the recommended intake levels of free sugar in Canada.

Foods with voluntary nutritional additions are a fast-growing sector of the global food industry. In Canada, while the addition of nutrients to foods has been regulated through fortification regulations, parallel policies which aim to encourage product innovation have also allowed for the voluntary addition of nutrients and other novel ingredients to ‘supplemented’ and ‘functional’ foods. Concerns have been raised that the consumption of these products may have negative repercussions on population health, such as high nutrient intakes inappropriate for certain population subgroups (e.g., children) and the shifting of dietary patterns to include more unhealthy foods. The aim of this study was to evaluate the prevalence, nutritional quality, and marketing characteristics of foods with added nutrients in the Canadian market. We found many nutritionally-enhanced foods contained high levels of nutrients beyond recommended intakes, despite these nutrients having no evidence of inadequacy in the Canadian population. Additionally, a large proportion of foods with added nutrients had poor nutrient profiles (were deemed ‘less healthy’ than their non-enhanced counterparts) and carried heavy marketing on their labels, regardless of their nutritional quality. Taken together these findings raise concerns about foods with voluntary nutrient additions and suggest the need to further investigate consumer attitudes and decision-making towards these foods.