Across 55 controlled studies enrolling 6,877 children and adolescents (ages 2–18), food and non-alcoholic beverage marketing was associated with a mean excess intake of 34.8 kcal (95% CI: 20.2–49.4) compared with minimal or no marketing exposure. Television advertising drove the largest effect at 44.5 kcal, followed by digital media at 37.5 kcal and product packaging at 20.5 kcal — differences across media reaching statistical significance (p < .001). Children with overweight or obesity showed a markedly amplified response of 146.9 extra kcal versus 55.6 kcal in normal-weight peers, and effects varied significantly by age.
While 35 kcal per exposure may appear modest, repeated daily encounters across television, social feeds, and supermarket shelves could plausibly compound into meaningful weight-gain trajectories over years — a mechanism consistent with the broader literature linking obesogenic food environments to childhood adiposity. The striking vulnerability of already-overweight children (nearly three times the excess intake) deserves particular policy attention, suggesting cumulative exposure may disproportionately entrench dietary inequality. The absence of any socioeconomic-position data across all 55 studies is a striking gap, given that lower-income children typically face heavier marketing loads. Sex differences and long-term effects also remain poorly characterized. Critically, GRADE certainty was rated low, meaning estimates could shift substantially with higher-quality evidence. This is a preprint that has not yet been peer-reviewed, and findings should be interpreted cautiously. Still, the directional consistency across media types strengthens the case for regulatory restrictions on child-directed food marketing.
