Impact of Food Advertising Restrictions in Portugal on Children’s Exposure to Unhealthy Foods and Beverages: A Before-and-After Study

Background Portugal has one of the highest prevalences of childhood obesity in the world. Food advertising, which largely affects the most vulnerable children, contributes to childhood obesity by fostering the consumption of ultra-processed foods and beverages. To prevent this pernicious influence, Portugal passed Act 30/2019 which introduces food advertising restrictions targeted at children and adolescents under 16 years of age. The aim of this study was to assess the Act’s effectiveness in reducing the exposure of children and adolescents under14 years of age to television advertising of unhealthy foods and beverages. Methods We conducted a before-and-after study by measuring the impact of food sector television advertising over the course of two, week-long periods, the first in February 2019 and the second in February 2022. The respective samples included 1121 and 983 children and adolescents aged 4 to 14 years, representative of the Portuguese population in this age range. The nutritional quality of the products advertised was analysed using the nutritional profile issued by the Directorate-General of Health. Before-and-after mean impacts and coverages were compared, using the Chi-squared test to analyse differences in the latter. Results The weekly mean impacts of unhealthy food and beverage advertisements remained stable from 2019 to 2022 (18.9 vs. 18.7). Even so, impacts decreased in the case of low-class children and increased in the case of middle and high-class children. While overall coverage did not vary, it decreased in the morning and afternoon time slots, and increased across the night time slot. As compared to 2019, the weekly number of unhealthy food and beverage commercials increased by 25% in 2022. Conclusions Act 30/2019 did not reduce Portuguese children’s overall exposure to advertisements for unhealthy foods and beverages. In order to be effective, restrictions would, at minimum, have to cover television advertising during the 7 am-12 pm time band, regardless of the intended recipients of the messages, target public or percentage of children’s audience.