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Marketing campaigns for highly processed food and non-alcoholic drink brands on TikTok generate billions of views, leading to a staggering capability to engage and influence children, according to an observational study.

Looking at TikTok posts from the top 16 "unhealthy" food and drink brands based on global brand share, a single hashtag challenge campaign -- which encourages TikTok users to post videos touting a specific product -- generated anywhere from 12.7 million to 107.9 billion views, reported Kathryn Backholer, PhD, of the Global Obesity Centre at Deakin University in Geelong, Australia, and colleagues in .

"By encouraging TikTok users to create and share videos featuring food company branding and products, junk food companies are effectively turning TikTok users into advertising producers and distributors," Backholer told 乌鸦传媒 in an email. "While junk food companies benefit from this marketing, users receive little to no reward and expose other users to even more junk food marketing."

Among a sample of 626 brand-related video posts created by users, 96% featured product branding, 68% included product images, and 41% featured branded effects, including stickers, filters, or special effects showcasing the brand.

Most (73%) portrayed the brand positively, while 25% were more neutral or unclear. Only 3% portrayed the brand in a negative light.

This marketing reach, based largely on "unofficial brand ambassadors" has the potential to influence young users, according to Backholer and colleagues. TikTok, which had over 1 billion monthly users as of September 2021, provides brands with a platform to engage with an especially young audience, as "over a third of its daily users in the USA are reportedly aged 14 or younger," the authors noted.

"The evidence is very clear that food marketing increases kids' preferences and consumption for unhealthy foods, ultimately leading to weight gain and obesity," Backholer said in her email. "The greater the reach of these marketing campaigns, the more embedded junk food marketing becomes in our children's everyday lives. We need to put health before profits and provide our children with an online environment that is free from the marketing of harmful products."

The key to this marketing strategy is that TikTok allows brands to directly encourage its users to create social media posts that market the brands' content for them, she noted. These campaigns are "highly orchestrated" to push users to create brand-promoting videos that often feature the company's products and logos, which allows for the brands to be more positively viewed by a user's peers, she added.

These marketing tactics are an evolution of brand promotion, said David Jernigan, PhD, of the Boston University School of Public Health, who has studied similar trends in alcohol brand advertising. He noted that social media has created a new platform for marketing strategies.

"The hashtag challenges, they're incredibly effective at stimulating engagement, and that's what this study is showing," Jernigan told 乌鸦传媒. "Some forms of engagement are more dangerous to the health of young people than others."

The end result of these campaigns is that kids will adopt an artificial peer group based on the imagery of the marketing -- a view of the brand that never shows the other side of consuming the product, such as weight gain, he added.

"It's so different from traditional marketing, because these platforms are all about stimulating engagement. Traditional marketing was push marketing, where we're trying to push a message out to you and grab your attention," he explained. "Social media is pull marketing, where we're trying to pull you in to engage over and over again with the marketing messaging. It's completely different and much more powerful because you've got an active participant as opposed to a passive one."

For physicians, this kind of marketing creates a challenge in communicating healthy lifestyle practices, he said. Physicians can try to counteract these marketing campaigns by emphasizing the health benefits of not consuming these products and by reminding all patients that just because it's trending on TikTok doesn't mean that everyone is eating or drinking these products, he suggested.

The researchers pointed to showing that "few countries have statutory regulations to protect children from unhealthy food marketing and restrictions on unhealthy food marketing on the internet are uncommon."

The U.K.'s Health and Care Bill would ban "paid-for" online marketing of unhealthy foods and beverages starting Jan. 1, 2023 and would also "effectively prohibit in-app advertising and paid-for advertisements, including use of influencers, if foods or non-alcoholic beverages that are high in fat, sugar and/or salt are present in the advertisement," they noted.

To determine the reach of these campaigns, Backholer and team focused on TikTok-verified accounts from the top five brands in different categories, such as candies, snacks, and carbonated drinks, totaling the number of followers, video posts, and "likes" as of June 30, 2021. They then coded all video posts for branding type, such as product image, celebrity influencer, or branded hashtag challenge. Finally, they collected the brand, hashtag, challenge description, and total views, as well as a sample of user-created posts for each challenge, to analyze the overall reach of the campaigns.

More research into the potential public health impact of these marketing practices on major social media sites are needed, they said.

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