Introduction

The number of marketing strategies and the amount of money spent on marketing have steadily increased year after year as companies leverage mass media to shape perceptions and expectations by influencing consumers’ awareness and interpretation of specific information. Billions of dollars are spent each year on mass media, with food and beverage companies among the leading spenders. Television advertisements are a common medium for food and beverage marketing, defined as any form of commercial communication or message to increase the recognition, appeal, and/or consumption of a product or service [1]. McCombs and Shaw’s Agenda Setting Theory and Goffman and Entman’s Framing Theory explain how mass media, such as television advertisements, influences consumers’ awareness and interpretation of specific information, either positively or negatively [2–4]. These theories illustrate how repeated and continuous exposure to television advertisements can shape viewers’ perceptions and attitudes toward the advertised food, potentially shifting sociocultural norms and expectations [5,6].

Continuous exposure to food advertisements can influence viewers’ behavior, leading to increased consumption of the food advertised among children [7] and adults [8]. Exposure to food advertisements is problematic, as most food and beverage television advertisements use persuasive marketing techniques to promote unhealthy foods [9]. Unhealthy foods already make up a substantial proportion of total dietary intake, and their consumption is projected to increase with globalization, increasing the availability and accessibility of unhealthy foods, and advancements in digital technology, increasing the precision and reach of advertisements. Television viewership in Ghana is high; 72% and 92% of children (4–8 years) exceeded two hours of view time per day on weekdays and weekends, respectively, in South Ghana in 2021 [10]. Among adults (15–49 years), 62% watched television weekly in 2022, higher among the educated, wealthy, and urban residents [11]. Over time, this increased exposure and consumption of unhealthy foods is expected to contribute to excessive caloric intake and diet-related non-communicable diseases (NCDs) [12,13].

Diet-related NCDs are the leading cause of worldwide morbidity and mortality, threatening the attainment of the 2030 Sustainable Development Goals [14–16]. To address NCD risk and improve population health, many countries have developed food-based dietary guidelines, advertisement regulations, and policies to limit consumers’ access to and consumption of sugar-sweetened beverages and foods high in salt, added sugars, and saturated and trans fatty acids [17–19]. In Ghana, longstanding undernutrition, micronutrient deficiency, and malnutrition, combined with the recent increased availability of highly processed foods high in energy, saturated or trans fats, sodium, and added sugars, have hindered the achievement of global nutrition targets and contribute to the increase in diet-related NCDs [15,20]. Ghana only recently implemented food-based dietary guidelines [17,18] and alcohol-based food-marketing policies [17–19], but do not have guidelines, regulations, or policies for food advertisements, which have effectively restricted unhealthy food advertisements in other countries globally [21–23]. Further, there is limited information for program and policy planners on the types of foods and beverages and marketing strategies used for promotion of these products in Ghana. A better understanding of the content of current food and beverage advertisements is needed to inform the development of similar regulations in Ghana.

Globalization has increased not only access to highly processed foods but also introduced new cultural ideas and expectations for physical appearance, shifting sociocultural norms, particularly among younger generations. Younger generations in Africa are navigating between traditional beauty ideals that associate larger female body sizes with dignity, health, fertility, beauty, and wealth [24–32] and Western ideals that prefer thinner bodies, historically associated with poverty and disease [32,33]. Bandura’s Social Learning Theory explains how we observe others and model those we deem influential to our social spheres as we aspire to be more like them [34,35]. This theory helps to explain how promotional characters, the most prominent driver of body aspirations [36], tap into individual desires to model the behaviors of those to whom we look up [34], potentially influencing food consumption and body aspirations. Advertisements that attempt to link consumption of avoidance of certain foods with attractiveness, risk promoting unhealthy aspirations. Most food marketing policies designed to protect children focus on things like the use of cartoon characters to promote junk food marketing to small children but to date have not addressed the influence of actors unhealthy of unrealistic physical characteristics to increase the appeal and consumption of unhealthy foods [37]. A better understanding of the content of food advertisements in Ghana can aid in development of future food advertising policies and regulations.

In response to marketing tactics, many countries have implemented guidelines to restrict the advertisement of unhealthy foods during children’s peak viewing hours [7,38]; however, efforts to reduce these advertisements targeting adults have been limited. There is a lack of evidence on what foods are promoted in mass media, the temporal orientation of when healthy and unhealthy foods appear, and how marketing strategies are used to promote healthy and unhealthy foods. Such information is important for the development of effective policies and practices that encourage healthier diets for the entire population. This study aims to provide a comprehensive overview of what, when, and how foods and beverages are advertised on Ghanaian television with an emphasis on the way physical appearance is used to market healthy and unhealthy foods. We achieved this aim by examining what foods were advertised, when they are advertised, and how they are advertised, including assessment of the physical characteristics of actors, to inform policies and practices to regulate mass media with the intent of increasing healthy food consumption.

Methods

Results

The sample had a total of 607 advertisements, with 20% occurring during soap operas and 20% during news programs. A third (33.2%) of advertisements were for healthy and two-thirds (66.8%) unhealthy foods and beverages (Table 1). Advertisements most frequently included sugar-sweetened beverages (22.6%), unhealthy grains low in fat, sugar, salt, and high in fiber (13.2%), recipe additions (e.g., soup cubes, oil, seasoning) (13.1%), supplements (10.2%), and alcohol (9.9%). Healthy (52.2 ± 15.5 seconds) and unhealthy (49.8 ± 16.4 seconds) advertisements had similar durations.

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Table 1. Time of day and day of week food and beverage were aired during Ghana’s television advertisements.

https://doi.org/10.1371/journal.pone.0325730.t001

Most advertisements aired during evenings (37.7%) and weekdays (69.5%) (Table 1). Foods were advertised using persuasive marketing techniques and with various goal frames (Table 2). Half (49.6%) of advertisements used promotional characters, such as celebrities or famous sportsperson (34.1%), or appealed to children (10.9%), while premium offers were rarely used (5.8%). Advertisements equally used gain (45.1%), hedonic (42.8%), and normative (39.7%) goal frames.

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Table 2. How persuasive marketing techniques and goal frames were used in Ghana’s television advertisements for healthy and unhealthy food and beverages and by actors’ body size and gender.

https://doi.org/10.1371/journal.pone.0325730.t002

Actors (n = 2,043) were evenly distributed by gender (50.9% male) but not by body size. Three-quarters (72.1%) of the actors advertising these foods were underweight, 20.5% normal weight, and 7.4% overweight/obese (Fig 1). Actors classified as underweight were majority male (58.8% male), whereas actors classified as normal weight and overweight/obese were majority female (73.0% and 61.8%, respectively). Half (49.9%) of advertisements portrayed child actors, a quarter (25.0%) portrayed adolescents, and all (100%) portrayed adult actors. Actors were primarily Black (97.8%). Only a few were White (2.0%), and all White actors were underweight.

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Fig 1. Actor’s body size, according to Ettarh’s silhouettes [43], by gender portrayed across 607 food and beverage television advertisements in Ghana.

https://doi.org/10.1371/journal.pone.0325730.g001

Most advertisements took place during evenings (37.7%) and weekdays (69.5%) (Table 1). Time of day and day of week were found to be associated with the airing of unhealthy, but not healthy, food and beverage advertisements: sugar-sweetened beverages were advertised more in the morning (30.5%, p = 0.043) and on weekdays (24.8%, p = 0.042), unhealthy grains in the afternoon (22.9%, p < 0.001) and on weekends (23.8%, p < 0.001), alcohol at night (38.4%, p < 0.001) and on weekdays (12.3%, p = 0.002), and recipe additions on weekends (23.8%, p = 0.25).

Advertisements for unhealthy foods more often used promotional characters (55.1% v. 31.9% healthy, p < 0.001), premium offers (8.2% v. 0% healthy, p < 0.001), and a hedonic frame (49.9% v. 22.9% healthy, p < 0.001), whereas advertisements for healthy foods more often used a gain frame (73.4% v. 35.6% unhealthy, p < 0.001) (Table 2).

There were differences in body sizes, age, and gender of actors included in advertisements for healthy versus unhealthy foods and the time of day and day of week aired. Actors classified as underweight were more often included in unhealthy advertisements (74.3% v. 61.7% normal weight, 63.1% overweight/obese) (Fig 2). Children appeared more frequently in healthy food and beverage advertisements (55%) than in unhealthy ones (45%), whereas adolescents appeared more often in unhealthy (29%) versus healthy (23%) advertisements. Gender of actors in food and beverage advertising did not vary by type of food advertised. Advertisements with actors classified as underweight were more frequent in afternoons (31.5% v. 17.3% overweight/obese) (Table 3). Evenings and nights saw an increase in actors classified as overweight/obese (evening: 48.7% v. 39.7% underweight; night: 21.1% v. 12.6%). Males were more prevalent during the weekdays (77.5% v. 69.0% female). Male actors were more frequent in advertisements that included a promotional character (53.4% v. 37.6% females) (Table 2). Specifically, amateur sportspersons were more prevalent in advertisements that contained a male (23.1% v. 5.8% female) or underweight actor (19.0% v. 1.2% normal weight, 8.6% overweight/obese). Actors classified as overweight/obese appeared in more advertisements that contained a premium offer (21.1%; v. 8.3% underweight, 2.4% normal weight). Male actors were more frequent in gift offers (8.6% v. 5.1% female). Actors classified as underweight were evenly distributed across goal frames while actors classified as normal weight were most frequent in normative frames (60.9% v. 32.9% gain, 40.6% hedonic) and actors classified as overweight/obese were most frequent in gain (46.7%) and normative frames (48.0% v. 34.9% hedonic). Female actors were most frequent in normative frames (51.2% v. 39.8% gain, 39.5% hedonic), while male actors were most frequent in gain frames (46.5% v. 44.4% hedonic, 36.1% normative).

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Table 3. Type of food and/or beverage advertised, time of day and day of week that actors’ body sizes and genders were aired during Ghana’s television food and beverage advertisements.

https://doi.org/10.1371/journal.pone.0325730.t003

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Fig 2. Foods promoted and the proportion of actors’ body sizes portrayed in Ghana’s food and beverage television advertisements.

Excluded advertisements that promoted healthy and unhealthy foods and beverages; Healthy grains included high-fiber cereals, plain breads, rice, and noodles without added fat, sugar or salt; Supplements included vitamin/mineral and sugar-free chewing gum; Healthy dairy included low-fat milks, yoghurts, cheese and dairy alternatives; Baby food excluded milk formulae; Water included unflavored mineral and soda waters; Healthy meats included meat and meat alternatives; Fruits and vegetables included fruits/vegetable without added fats, sugars or salt; Supermarkets advertised healthy food in front of storefronts; Sugar-sweetened beverages (SSBs) included sugar sweetened drinks and fruit juice/drinks; Unhealthy grains included high sugar, low-fiber breakfast cereals and breads, flavored/fried instant rice and noodles; Recipe additions included soup cubes, oils, dried herbs and seasonings; Unhealthy dairy included high-fat milks, yoghurts, and cheese, ice cream, iced confection and desserts; Unhealthy meats included processed or preserved and ready to eat meats; Unhealthy snacks included sweet and savory snack foods, chocolate and candy; Other high fat/salt foods included meat/fish/bean pastes, XO sauce, butter and animal fats, high fat savory sauces and soups.

https://doi.org/10.1371/journal.pone.0325730.g002

Discussion

Globalization and persuasive marketing of food and beverages influence consumption patterns and the appeal of advertised foods. We provide a comprehensive overview of what, when, and how foods and beverages are advertised in Ghana amidst a nutrition transition and shift in sociocultural norms to inform policies and practices to regulate mass media. A content analysis of 486 hours of food and beverage advertisements was conducted across three popular television channels, identifying 607 advertisements featuring a full-body view of 2,043 actors. Most advertisements contained unhealthy foods and persuasive marketing techniques, and actors were classified as underweight with Ettarh silhouettes. Unhealthy advertisements were more frequent during nights, evenings, and weekends, with persuasive marketing techniques, and included more actors classified as underweight, whereas healthy foods were more frequent in the morning and with actors classified as normal weight or overweight/obese.

Two advertisements for foods and beverages high in sugar, salt, and fat appeared for every nutrient-rich, minimally processed food advertisement. The prevalence of unhealthy food and beverage advertisements is concerning, given the rising rates of diet-related NCDs and obesity. While many foods classified as unhealthy in this analysis contain essential nutrients and are often fortified with micronutrients, these foods should be consumed in moderation to reduce diet-related NCDs. As with food and beverage advertisements worldwide [47], most food and beverage marketing occurs from a few transnational companies that are considered the driving force behind food consumption high in sugar, salt, and fat [48,49]. To mitigate unhealthy food advertisements and rising rates of NCDs, more healthy foods should be advertised, which can be done by regulating airtime for unhealthy foods or subsidizing airtime for healthy foods. Ludwig and Nestle explain how the food industry should be held to the same standard as the car industry in that companies that sell cars harmful to the environment are required to pay higher taxes and comply with regulations and mandates [50]. Food companies should be held to the same accountability for their impact on the population’s health [50]. Preventing NCDs through adopting healthy food choices is essential for ensuring the health and well-being of the population [48,51]. The disproportional promotion of unhealthy foods may undermine efforts made through dietary guidelines to promote healthier diets, especially concerning children, as television advertisements are the number one contributor to childhood obesity [52,53]. Media regulations that require transparency when advertising foods that exceed recommended sugar, salt, and fat intake could reduce unhealthy food consumption.

Furthermore, the temporal orientation of advertisements affects consumers’ health motivations, attitudes toward the advertisement, and the effectiveness of the advertisement in influencing purchase behavior and consumption patterns [54]. Advertisements for healthy foods were more frequent in the mornings, whereas advertisements for unhealthy foods and portrayed actors classified as overweight/obese were more frequent in the evenings, nights, and weekends. The temporal orientation of advertisements aligns with the depletion of self-regulation later in the day, as consumers are more health-conscious during the mornings but vulnerable to more indulgent and convenient food purchases and consumption during relaxation and leisure times [55]. Additionally, male actors were more prevalent on weekends than weekdays, suggesting potential gender bias in advertisements that should be further explored. Strategic timing in promoting specific foods and how foods are promoted highlights the need for policies that consider the foods being promoted and how they are being promoted to reduce their influence on unhealthy consumption patterns.

Advertisements used various strategies to increase the desirability and appeal of foods and beverages. Half of the advertisements used persuasive marketing techniques, more frequently when advertising unhealthy foods, consistent with findings from prior research in Ghana [56] and in high- and low-income countries [9]. Persuasive marketing techniques were more frequent for unhealthy foods, on weekends, and with male actors or those classified as overweight/obese. Persuasive marketing techniques have been found to increase the desirability of foods among Ghanaian children, who are susceptible to believing that consuming unhealthy food will help them resemble the celebrity advertising them [41,57]. Similarly, lower-income groups are more susceptible to discount strategies. The disproportional use of discount strategies in unhealthy food advertisements could increase consumption of these foods and contribute to an inequitable risk of developing diet-related NCDs. Instead, these techniques should be used to boost the appeal of healthy foods with normal-weight actors.

Advertisements shape consumer attitudes using normative, hedonic, and gain goal frames to influence how they feel, perceive benefits, or what they believe is socially acceptable behavior, respectively [42]. The higher prevalences of male actors in gain-framed advertisements and female actors in normative-framed advertisements likely reflect societal expectations, where females conform to idealized norms while men fulfill provider roles. Goal frames have been found to shape sustainable food choices in high-income countries [58–60]. Future research is needed to determine if using goal frames in mass media can be an effective large-scale intervention to promote healthy and sustainable food consumption in LMICs.

With globalization, the media’s promotion of Western ideals by portraying ultra-thin bodies is becoming more influential, challenging African norms and shifting Ghanaian body aspirations [36,61,62]. In West Africa, sociocultural norms have historically preferred larger body sizes for older females in urban settings, as a symbol of dignity, health, beauty, and wealth [24,25,27–31], whereas thinner body sizes have been preferred for males [25]. Television advertisements often reflect these shifting ideals, either reinforcing African stereotypes and stigma or promoting Western ideals [63,64]. The use of actors classified as underweight with a normative-frame advertisement suggests a cultural shift from the traditional preference for larger body sizes, still idealized among older women, to thinner bodies, idealized among adolescent girls and young women [26]. Future research is needed to understand the effect of actors’ body sizes on viewers in contexts where larger body sizes are historically preferred.

Exposure to ultrathin bodies in the media can lead to preoccupation with body image, potentially exacerbating eating disorders, disordered eating, body dysmorphia, and poor mental health. In Ghana, for example, youth have engaged in dieting behaviors to achieve the thinner bodies portrayed in the media [65]. When consumers see actors classified as underweight consuming unhealthy foods, they may associate these foods with slimmer body sizes and model the behavior of the actors with expectations of achieving a slimmer body size [66,67]. The use of unrealistic body sizes to advertise unhealthy foods sends conflicting messages that could influence the perceived healthiness of foods [67,68] and could contribute to disordered eating, obesity, and diet-related NCDs. Transitions in body ideals create vulnerabilities in self-image, leading to internalizing unrealistic beauty standards and dietary norms observed in the media. Internalizing body ideals fosters unfavorable comparisons and aspirations toward unattainable body sizes [69–71] and can lead to body dissatisfaction, low self-esteem, and disordered eating behaviors [72–75]. The global rise in eating disorders over the last 20 years [76], with nearly a quarter of children and adolescents experiencing disordered eating in 2023 [77], highlights the severity of unintended consequences of this marketing strategy. While evidence on eating disorders in Africa is scarce [78], it is likely rising, particularly among adolescent females.

Media messages and marketing techniques, particularly around body sizes, permeate every aspect of life, starting with children’s toys (e.g., Barbies), exerting pressure on society to conform to unrealistic body image ideals [79]. In addition to actors being primarily classified as underweight, these actors were disproportionately represented in advertisements promoting unhealthy foods, potentially influencing the perceived healthiness of foods [67,68]. When individuals observe certain stimuli, they tend to form associations through a cognitive process known as observational learning, as described by Social Cognitive Theory [34]. Viewers with more media literacy and nutritional knowledge can recognize these conflicting messages as marketing strategies, understanding that consuming foods high in sugars, fats, and salts generally leads to larger body sizes than the actors portrayed. There is a need for policies that enforce realistic nutrition and health messages and programs to increase media literacy to prevent mixed messages between health information and physical expectations. Social movements and policies in the fashion industry have made efforts to mitigate eating disorders caused by unrealistic body expectations [66,80,81]. Similar social movements and policies should be taken within the food industry to avoid extremely thin and overweight actors by primarily including normal-weight actors, avoid contributing to gender disparities in health, and maintain cultural values by tailoring advertisements to specific contexts.

Conclusion

Television advertisements promoted foods and beverages high in sugar, salt, and fat, particularly during evenings and weekends, using persuasive marketing techniques, goal frames, and actors classified as underweight. These findings support the need for effective policies and practices that regulate food advertising and mass media to align with global nutrition targets and promote realistic messages for healthier populations.

Supporting information

Acknowledgments

We would like to acknowledge the MEALS4NCDs study staff and data collection team. This analysis was presented at Nutrition 2023.