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Sugar-Sweetened Beverages Coverage in the British Media: an Analysis of Public Health Advocacy Versus Pro-Industry Messaging

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Sugar-Sweetened Beverages Coverage in the British Media: an Analysis of Public Health Advocacy Versus Pro-Industry Messaging Open Access Research BMJ Open: first published as 10.1136/bmjopen-2016-011295 on 19 July 2016. Downloaded from Sugar-sweetened beverages coverage in the British media: an analysis of public health advocacy versus pro-industry messaging Alex Elliott-Green, Lirije Hyseni, Ffion Lloyd-Williams, Helen Bromley, Simon Capewell To cite: Elliott-Green A, ABSTRACT Strengths and limitations of this study Hyseni L, Lloyd-Williams F, Objectives: To assess the extent of media-based et al. Sugar-sweetened public health advocacy versus pro-industry messaging ▪ beverages coverage in the Systematic analysis of media coverage relating to regarding sugar-sweetened beverages (SSBs). British media: an analysis of sugar-sweetened beverages for one calendar public health advocacy versus Design: We conducted a systematic analysis to year. pro-industry messaging. BMJ identify and examine all articles regarding SSBs ▪ Inclusion of online newspapers as well as print Open 2016;6:e011295. published in all mainstream British print newspapers versions. doi:10.1136/bmjopen-2016- and their online news websites from 1 January 2014 to ▪ Only examined media articles in mainstream 011295 31 December 2014. We initially conducted a brief national newspapers. literature search to develop appropriate search terms ▪ Study only comprised coverage from January to ▸ Prepublication history and and categorisations for grouping and analysing the December 2014; further analysis of develop- additional material is articles. Articles were then coded according to the ments in sugar policy during 2015 and 2016 is available. To view please visit publishing newspaper, article type, topic, prominence recommended. the journal (http://dx.doi.org/ and slant (pro-SSB or anti-SSB). A contextual analysis 10.1136/bmjopen-2016- was undertaken to examine key messages in the 011295). articles. INTRODUCTION Results: We identified 374 articles published during One of the main causes for increasing 2014. The majority of articles (81%) suggested that http://bmjopen.bmj.com/ Received 26 January 2016 obesity rates is excessive consumption of Revised 27 April 2016 SSBs are unhealthy. Messaging from experts, sugar. The UK Scientific Advisory Committee Accepted 14 June 2016 campaign groups and health organisations was on Nutrition (SACN) concluded that drink- fairly consistent about the detrimental effects of ing high-sugar beverages results in weight SSB on health. However, relatively few articles gain and increased body mass index in teen- assessed any approaches or solutions to potentially combat the problems associated with SSBs. Only agers and children and increases the risk of one-quarter (24%) suggested any policy change. developing type 2 diabetes independently of 1 Meanwhile, articles concerning the food industry obesity. on September 29, 2021 by guest. Protected copyright. produced consistent messages emphasising UK and global populations are consuming consumer choice and individual responsibility for increasing amounts of sugary drinks and making choices regarding SSB consumption, and junk foods (high in salt, sugar and saturated promoting and advertising their products. The food fats).2 The UK has been progressing towards industry thus often managed to avoid association a tax on sugar-sweetened beverages (SSBs). with the negative press that their products were Evidence from all recent scientific reports receiving. supports substantial reductions in sugar con- – Conclusions: SSBs were frequently published in sumption.136 On the basis of this evidence, mainstream British print newspapers and their Public Health England, SACN and the WHO online news websites during 2014. Public health media advocacy was prominent throughout, with a recently recommended reducing the intake growing consensus that sugary drinks are bad for of free sugars, initially to <10% of total people’s health. However, the challenge for public energy intake in adults and children, and 136 University of Liverpool, health will be to mobilise supportive public opinion then to <5% of total energy intake. On 6 Liverpool, Merseyside, UK to help implement effective regulatory policies. Only March 2016, the Chancellor included in his then will our population’s excess consumption of Correspondence to Budget an announcement of a levy on Dr Ffion Lloyd-Williams; SSBs come under control. sugary drinks manufacturers equivalent to a [email protected] 10% excise tax. However, implementation Elliott-Green A, et al. BMJ Open 2016;6:e011295. doi:10.1136/bmjopen-2016-011295 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2016-011295 on 19 July 2016. Downloaded from would be delayed until 2018 to allow the industry time Piloting and selection of search terms to respond and reformulate.7 Search terms were originally identified by examining a SSBs provide a substantial proportion of the UK popu- small sample of newspaper articles and evaluating ter- lation’s sugar intake, particularly in children and adoles- minology and phrases that were commonly employed cents.89SSBs thus contribute importantly to obesity, with regard to this SSB. These search terms were then diabetes and cardiovascular disease (CVD) and there- piloted over a 1-month period and the results were ana- – fore represent an increasing public health concern.10 13 lysed for material and contents. As a result of the pilot The persistent high consumption rates of free sugars in study, key terms were identified and search terms were SSBs highlight a pressing need to evaluate which factors purposefully kept broad to ensure the inclusion of a determine and promote their use.12 Public health has large variety of articles covering this topic. had a chequered career in highlighting the potential Articles were sourced via the Nexis database using the harms of sugar, particularly the free sugars in SSBs. The following search terms: Sugar* W/5 beverage* (Sugar* first notable communicator, John Yudkin, published and followed by beverage maximum of five words later); ‘Pure White and Deadly’ in 1972.14 Several decades of Sugar* W/p soft drink* (Sugar* within the same para- low-level advocacy, mostly by dentists then followed. graph soft drink*); Fizz* Drink*; Sugar* drink*. However, this started to change from 2009 onwards, Other synonyms were piloted such as ‘soda’, ‘sugar- after Robert Lustig’s student lecture on fructose became sweetened beverages’ and ‘pop’. However, it was noted a YouTube hit. Subsequent advocacy and activism in the that ‘soda’ and ‘pop’ were highly unspecific towards the USA and UK initially increased slowly, but then acceler- topic and articles in which these terms were used. ated.1 However, effective policies to reduce SSBs remain Conversely, ‘sugar-sweetened beverages’ was too specific limited. and many articles were being overlooked using the One possible explanation for this may be multi- search term. Using the search term ‘Sugar* W/5 bever- national corporations’ concerns that negative publicity age*’ ensured a large yield of relevant articles. regarding the health harms of sugar may threaten profits. Thus, the food industry, for instance, has made Study design and search strategy considerable efforts to try to neutralise any media cover- We conducted a systematic analysis of articles focusing age of adverse research. These strategies show remark- on SSBs in the major national print and online websites able similarities to the tactics previously used by Big of British newspapers (figure 1). Articles produced – Tobacco corporations.15 18 They include creating doubt between 1 January 2014 and 31 December 2014 were regarding scientific studies or scientists who criticise the considered for inclusion (table 1). Flexible search terms industry, political lobbying, criticising potential policies were used to include all potentially relevant articles relat- ‘ ’ as nanny state or a threat to personal choice, emphasis- ing to SSBs including fruit juices, sugar or a synonym of http://bmjopen.bmj.com/ ing personal responsibility and emphasising physical SSBs, for example, fizzy drinks, and the industry. activity rather than curtailing consumption as a remedy Ovid, Embase and MEDLINE databases were also for obesity.15 19 searched to provide supplementary data and related arti- The media potentially play an important role in com- cles to the topic which informed study design and municating such information to the wider public. This strategy. messaging will thus be subject to targeting by industry The time period for this study was discussed with and by health groups. The public health community, other experts and academics in the field who felt that it therefore, have a potentially big role in agenda-setting was necessary to assess articles over a 1-year period to on September 29, 2021 by guest. Protected copyright. (the theory that what the public think is set by the gather a wide scope of media representation on this media)20 and subsequent policy development for popu- topic. The period 1 January 2014 to 31 December 2014 – lation health.21 24 It is hence important to analyse how was selected as this was seen as a crucial time with public health advocacy and food industry messages are regard to public health advocacy on sugary drinks. framed (defining something as a problem, identifying There was increasing debate and support for a sugary causes, assignment responsibility and suggesting/ drinks tax, reflected in an increase in media cover- endorsing solutions)25 in the media. This study there- age.27 28 This enabled the tracking of movement and fore aims to examine coverage
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