Major findings
The present study findings suggest a high exposure of the Brazilian population to unhealthy food marketing. More than 80% of all foods and non-alcoholic beverages advertised on the three most popular free-to-air TV channels were considered eligible for marketing restrictions according to the PAHO and the WHO/Europe NP models, due to their high content of critical nutrients. In addition, most of food and beverage ads shown were of UPP, exceeding six times the number of unprocessed/minimally processed food ads. Considering that 77% of Brazilians (≥16 years) watch TV regularly (seven days/week) and dedicate at least three hours of their day to this activity [
41], this frequent exposure to unhealthy food advertising constitutes a particular concern from a public health perspective. Evidence shows that the increasing availability of UPP in the food environment combined with persuasive industry marketing strategies are associated with excessive consumption of these products, leading to an increased risk of developing obesity and NCDs [
42]. Besides, there is robust scientific literature demonstrating the role of TV food advertising in shaping food preferences and purchase behaviors among different age groups, particularly children and youth [
14,
43,
44].
The predominance of unhealthy food advertising on Brazilian TV has been previously reported by studies conducted in the country over the last 10 years [
45,
46], and aligns with research developed according to the INFORMAS protocol in other middle- and high-income countries [
47‐
49]. However, the present study brings an improved understanding of the nutritional quality of food products advertised on Brazilian TV by applying, for the first time, international NP models. Although previous studies carried out in Brazil have also focused their analysis on free-to-air TV channels, they either excluded programs broadcast during the evening hours (from 6 pm to midnight) [
46] or analyzed a much smaller sample (
n = 2732 TV ads), obtained from only two days of TV programming [
45]. Additionally, the use of the INFORMAS protocol allowed this paper to extensively categorize all food-related ads according to the NOVA classification system, and to evaluate the distribution of food ads by day and time of the day. This goes beyond of what previous national studies presented.
Consistent with our findings, recent studies carried out in Mexico [
50] and New Zealand [
35] found that 84 and 69% of food and beverage ads broadcast on free-to-air TV, respectively included at least one food item that did not meet the WHO/Europe NP nutritional quality standards. In Argentina, a survey investigating the nutritional quality of food products advertised on TV between 2013 and 2014 identified that 93% of food and beverage ads did not comply with the PAHO NP model [
34].
Based on our sample, sugary drinks (including sodas, sweetened dairy drinks and fruit-flavored drinks), ultra-processed meats, convenience foods, and candies and desserts accounted for the majority of food items containing excessive amounts of critical nutrients according to both NP models. These categories were identified as the most frequently advertised products on TV by both national [
45,
46] and international studies [
51,
52]. This is also consonant with previous research conducted in Brazil which demonstrated a significant increase in the consumption of UPP, such as sausages, ready meals, sweets, soft drinks and other sugary drinks, between 2002 and 2003 and 2008–2009 [
53]. The similarities between the main types of food products advertised and consumed in different countries reinforce existing evidence demonstrating that current food systems are becoming more globalized, industrialized, and dominated by large actors responsible for governing food supply chains, which are increasingly delivering highly palatable, cheap and convenient food products [
3,
42,
54,
55].
Although both NP models applied in the present study identified the food categories contributing the most to unhealthy food advertising on Brazilian TV, the results obtained from the PAHO NP model were more aligned with the recommendations presented in the Brazilian Dietary Guidelines [
30]. This could be explained by the fact that both the PAHO model and the Brazilian Dietary Guidelines use the NOVA classification system as a basis for identifying less healthy food items by considering their degree of industrial processing. Likewise, the PAHO model was specifically designed to be applied by the PAHO Member States in a wide range of food policies and, for this reason, is considered a more robust criterion for Latin American countries, which are facing a rapid replacement of foods and ingredients used in the preparation of traditional diets by ready-to-eat products [
56]. The WHO/Europe NP model, on the other hand, is primarily focused on identifying foods with a high content of critical nutrients excluding, from the group of foods eligible for marketing restrictions in our study, ready-to-eat sandwiches advertised by a fast food retailer that did not exceed the thresholds for fats and salt – even being classified as UPP. At the same time, food items eligible for marketing restrictions by the WHO/Europe model, such as whole milk and table sugars (due to their high content of saturated fat and sugar), would be considered, respectively, as minimally processed food and culinary ingredient, thus, not eligible for marketing restrictions by the PAHO model.
Differences in the nutritional profile of foods and beverages advertised on the three selected channels by day, time of the day and types of programs identified in the current study, demonstrate a significantly higher exposure of the Brazilian population to unhealthy food advertising on weekends, in the afternoon and during soap operas programming. These results can be considered key points of concern for several reasons. First, a survey performed in 2016 found that over half of Brazilians (52%; ≥16 years) reported watching two to five hours of TV on weekends [
41]. Second, findings from a recent study carried out in all Brazilian state capitals demonstrated a positive association between the habit of watching TV for more than three hours per day and unhealthy eating behaviors (e.g. higher consumption of sodas and meat products high in fats) among adults (≥18 years) [
57]. Third, a higher frequency of unhealthy food and beverage ads in the afternoon period might imply an increased risk of children and adolescents being exposed to them. According to research conducted in Brazil in 2009, which analyzed TV food advertising during children’s programming, the exposure of children to ads promoting “sugars and desserts” over a period of 10 consecutive days was significantly higher in the afternoon compared to the morning [
46]. Besides, only one of the three channels selected in the current study has children’s programming [
26], which means that children and youth could be exposed to unhealthy food advertising at any time, and particularly during weekends, school breaks or holiday periods. Finally, a literature review on TV food marketing geared towards children in Latin American concluded that the majority of TV advertising was directed to children and their family, and that this exposure was associated with both food preferences and purchases behaviors of families and children being overweight or obese [
17].
The limited number of food and beverage manufacturers and food retailers contributing the most to unhealthy food advertising on Brazilian TV is consonant with evidence showing that the global food system is currently controlled by a small number of transnational food and beverage corporations [
55,
58,
59]. Our results demonstrate that 10 transnational and local food and beverage companies, two fast food retailers and two of Brazil’s largest supermarket retailers accounted for almost 90% of all unhealthy food ads shown on Brazilian TV. Further, sugary drink companies were responsible for 40% of all unhealthy food ads, followed by ultra-processed meat companies (18.8%). These findings reinforce data presented in previous reports demonstrating that transnational companies, collectively known as Big Food and Big Soda corporations, allocate significant annual budgets to advertising and promotion, including cross-advertising between their brands, to make their products more attractive to consumers and increase their market share, particularly in low- and middle-income countries [
60,
61]. Such facts are particularly relevant from a public health perspective and for regulatory purposes, since exposure to unhealthy advertising and promotions can influence consumers’ brand recognition, preferences, purchases and consequently their consumption, especially among children [
62].