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Open access Original research
Comparing McDonald’s food marketing BMJNPH: first published as 10.1136/bmjnph-2021-000229 on 21 December 2021. Downloaded from
practices on official Instagram accounts
across 15 countries
1 2 2 2 2
Omni Cassidy , Hye Won Shin, Edmund Song, Everett Jiang, Ravindra Harri,
2 1 1 1,2
Catherine Cano, Rajesh Vedanthan , Gbenga Ogedegbe, Marie Bragg
To cite: Cassidy O, Shin HW, ABSTRACT What this paper adds
Song E, et al. Comparing Background Social media advertising by fast food
McDonald’s food marketing companies continues to increase globally, and exposure
practices on official to food advertising contributes to poor diet and ► McDonald’s posts 154% more posts in lower-
Instagram accounts across negative health outcomes (eg, cardiovascular disease). middle- income countries compared to higher-
15 countries. BMJ Nutrition, McDonald’s—the largest fast food company in the income countries.
Prevention & Health world—operates in 101 countries, but little is known ► McDonald’s uses more child- targeted marketing
2021;0:e000229. doi:10.1136/ themes in lower-middle- income countries com-
bmjnph-2021-000229 about their marketing techniques in various regions. The pared to higher- income countries.
objective of this study was to compare the social media ► McDonald’s uses more health promotion themes in
► Additional supplemental advertising practices of McDonald’s—the largest fast food higher- income countries compared to lower- middle-
material is published online only. company in the world—in 15 high- income, upper- middle-
To view, please visit the journal income and lower- middle- income countries. and upper- middle- income countries.
online (http:// dx. doi. org/ 10. Methods We randomly selected official McDonald’s
1136/ bmjnph- 2021- 000229). Instagram accounts for 15 high- income, upper- middle-
1Department of Population income and lower- middle- income countries. We captured obesity and non-communicable diseases, such
Health, NYU Langone Health, all the screenshots that McDonald’s posted on those as type 2 diabetes, cardiovascular disease and
New York, New York, USA Instagram accounts from September to December 2019. 2 3
certain cancers. Although several factors
2Department of Public Health We quantified the number of followers, ‘likes’, ‘comments’ influence diet, fast food has been linked to
Nutrition, New York University and video views associated with each account in April poor diet and obesity because of its calori-
School of Global Public Health, 2020. We used content analysis to examine differences in 4–6
New York, New York, USA the marketing techniques. cally dense, nutritionally poor quality.
More than 30% of US youth consume fast
Correspondence to Results The 15 accounts collectively maintained food daily,7 and fast food restaurant chains http://nutrition.bmj.com/
Dr Omni Cassidy, NYU Langone 10 million followers and generated 3.9 million ‘likes’, have rapidly increased their global pres-
Health, New York, New York, 164 816 comments and 38.2 million video views. We 8
USA; identified 849 posts. The three lower- middle- income ence, particularly in lower- income countries.
omni. cassidy@ nyulangone. org countries had more posts (n=324; M, SD=108.0, 38.2 McDonald’s is the largest fast food company
posts) than the five upper- middle- income countries in the world with more than 14 000 restau-
Received 29 March 2021 (n=227; M, SD=45.4, 37.5 posts) and seven high- income rants in the US and nearly 22 000 restaurants
countries (n=298; M, SD=42.6, 28.2 posts). Approximately in other countries.9 Given fast food’s impact
Accepted 29 June 2021 12% of the posts in high- income countries included 4
on nutrition and negative health outcomes,
child- targeted themes compared with 22% in lower- the growth of fast food companies’ interna- on January 2, 2023 by guest. Protected by copyright.
middle- income countries. Fourteen per cent of the posts in tionally, especially in lower-income countries,
high- income countries included price promotions and free may exacerbate the double healthcare and
giveaways compared with 40% in lower- middle- income economic burden of communicable and non-
countries. communicable diseases.1 10
Conclusions Social media advertising has enabled Although the relationship between the
McDonald’s to reach millions of consumers in lower-
middle- income and upper- middle- income countries with growth of fast food companies internationally
disproportionately greater child- targeted ads and price and the individual demand for fast food is
promotions in lower- middle- income countries. Such reach complex, fast food advertisements (‘ads’) play
is concerning because of the increased risk of diet- related an influential role in persuading individuals
illnesses, including cardiovascular disease, in these to consume fast foods.11 Food and beverage
regions. ads are ubiquitous on television and in
© Author(s) (or their outdoor settings, but social media ads are an
employer(s)) 2021. Re- use 12
emerging area of concern. Instagram is one
permitted under CC BY- NC. No INTRODUCTION of the most popular social media platforms in
commercial re- use. See rights Poor diet is the leading cause of mortality 13
and permissions. Published by the world, and allows fast food companies
1 2
BMJ. worldwide, and places individuals at risk for to advertise products through posting images
Cassidy O, et al. bmjnph 2021;0:e000229. doi:10.1136/bmjnph-2021-000229 1
BMJ Nutrition, Prevention & Health
and videos, and engaging with their followers through METHODS BMJNPH: first published as 10.1136/bmjnph-2021-000229 on 21 December 2021. Downloaded from
accompanying captions and comments. Currently, 60% We identified a sample of 15 countries based on three
of the world’s population uses the internet and 50% of criteria: (1) if McDonald's was sold in the country; (2)
14 if the country had an official McDonald’s Instagram
the users are active on social media. According to one
growth projection, nearly 60% of global internet users page and (3) if the country could be categorised as an
were using social media in January 2020, which equates HIC, UMIC or LMIC based on 2019 World Bank classifi-
15 21
to over 3.8 billion social media users. In an online study cations. We chose McDonald’s because it is the largest
13
surveying over 15 000 adults from the US, the UK, Canada, global fast food chain, and selected Instagram because
Mexica and Australia, 64% of participants reported expo- it is one of the most popular social media platforms for
sure to sugary drink marketing through online ads or adolescents and young adults with approximately one
16 22 23
social media. Fast food companies that advertise on billion active users per month.
social media, therefore, are capable of increasing their
market to people around the world who regularly access Data collection
social media. We collected data from September 2019 to April 2020,
Data increasingly show that the majority of food and and the Instagram posts were gathered from September to
beverage ads on social media are for unhealthy foods December 2019. We used McDonald’s corporate website
and beverages.17–19 In one study examining social media to generate a list of all the countries with McDonald’s fast
food and beverage ads in Australia, all of the foods food chains (see figure 1 for flow chart). We then made a
advertised on Facebook pages managed by the food list of all official McDonald’s Instagram accounts for each
and beverage brands were for energy- dense, nutrition- of the countries. To determine if the Instagram account
17 was officially associated with McDonald’s, we confirmed
ally poor foods. Another study showed that 77% of the the presence of a ‘verification badge’ on the Instagram
social media ads Canadian adolescents viewed within a profile. A verification badge is a blue checkmark logo
5- minute period were for unhealthy food and beverage that appears next to the account’s name that signifies
ads, and 97% of these foods were considered high in that Instagram has confirmed the account is associated
18
fat, sugar and salt. Exposure to these types of ads may with a celebrity, public figure or global brand. McDon-
contribute to food preferences and consumption that ald’s only had one official account for most of the coun-
may precipitate poor diet and adverse health outcomes tries. If McDonald’s had more than one official account
in these communities.11
One of largest qualitative analyses of fast food ads across for the country, we used the account with the most
different countries examined 16 food and beverage followers. From this list, we selected a subset of 15 coun-
company websites in Germany and the US (high- income tries, ensuring that at least one country was represented
countries (HICs)), China and Mexico (upper-middle- in each of the continents in which McDonald’s operates.
The country remained in the sample pool if it met the
income countries (UMICs)) and India and the Phil- inclusion criteria. If a country did not meet the criteria, http://nutrition.bmj.com/
20
ippines (lower- middle- income countries (LMICs)). it was excluded, and another country was randomly
Results suggested that fast food companies advertised selected. This process was repeated until all 15 countries
more healthy products in wealthier countries compared met the criteria. We initially identified and selected coun-
with lower- income countries, demonstrating segmenta- tries based on GDP. On further reflection, we determined
20
tion in their advertising techniques across countries. that classifications from the 2019 World Bank Database
That study also found that food and beverage companies 21
promoted more philanthropic activities in lower-income were more appropriate. We then grouped the coun-
tries into their respective economic categories based on
20 on January 2, 2023 by guest. Protected by copyright.
countries compared with wealthier countries. Another the three classifications defined by the 2019 World Bank
content analysis examining 2 000 social media posts in 21
the US demonstrated that 30% of posts included captions Database: HIC, UMIC and LMIC. We screen captured all
posts on the official McDonald’s Instagram accounts from
that attempted to interact directly with social media 1 September 2019 to 31 December 2019. In April 2020,
19
users. Little is known, however, about the marketing we recorded image type (image or video) and number of
techniques of a single food company in countries with ‘likes’, comments and video views, if applicable.
varying economic statuses.
To determine if there are differences in the marketing Establishing the qualitative codebook
techniques across multiple countries of varying To evaluate the posts for their marketing content, we devel-
economic statuses, the objective of this study was to oped a qualitative codebook based on similar qualitative
compare Instagram posts for McDonald’s, the largest 19 24
food marketing studies. The codebook (online supple-
13
global fast food franchise, in a subset of 15 countries mental appendix 1) included the following variables: (1)
of varying gross domestic products (GDPs) and: (1) food and/or beverage shown; (2) celebrity/influencers/
determine the number of followers, ‘likes’, comments, sponsorships; (3) healthy habits (eg, exchanging fries
posts, video posts and total views of videos and (2) quan- for apples); (4) child- targeted (eg, showing a picture of
tify the frequency with which McDonald’s uses different a child or adolescent); (5) special price promotions; (6)
marketing strategies. promote McDonald’s app, website or McDelivery; (7) free
2 Cassidy O, et al. bmjnph 2021;0:e000229. doi:10.1136/bmjnph-2021-000229
BMJ Nutrition, Prevention & Health
BMJNPH: first published as 10.1136/bmjnph-2021-000229 on 21 December 2021. Downloaded from
http://nutrition.bmj.com/
on January 2, 2023 by guest. Protected by copyright.
Figure 1 Flow chart of country selection.
giveaway/voucher; (8) culturally relevant (eg, religious Pilot coding
symbols); (9) engagements (eg, encouragements to like, Pilot coding was conducted to establish interrater reli-
comment or read the bio); (10) philanthropy/charity; ability using 10% of the posts. An acceptable level of
(11) emotional appeal; (12) new branch (ie, promoting a reliability was determined by at least a 90.0% agreement
newly opened McDonald’s restaurant) and (13) humour 25
or Krippendorf alpha coefficient of 0.70 or above. Five
(eg, memes). We discussed the definition of each code- coders were initially trained on the codebook and partic-
book category to ensure consistency among coders. The ipated in the pilot coding. However, only two coders
definition of each marketing technique is summarised in achieved a Krippendorf alpha coefficient of at least 0.70
table 1. or 90.0% agreement for all variables, and they coded the
Cassidy O, et al. bmjnph 2021;0:e000229. doi:10.1136/bmjnph-2021-000229 3
BMJ Nutrition, Prevention & Health
BMJNPH: first published as 10.1136/bmjnph-2021-000229 on 21 December 2021. Downloaded from
Table 1 Definition of the marketing techniques
Marketing technique Definition
Food and/or beverage shown Any visual food or beverage item. (For food, this does not include packaging. For beverage, this can
include beverage cups as long as the post does not clearly show that the cup is empty. Background
menu with images of food/beverage does not apply to this category as well as animated food/
beverage unless it is part of the concept of the post)
Celebrity/influencer/sponsorships Includes a reference to the person or organisation (must have over 10K followers) on the post or is
partnering with McDonald’s
Healthy habits Promotes healthy diet, exercise, conservation efforts, local farms, education or any other ideas that
promote the well- being of the person or environment
Child- targeted Shows a child, cartoons, Happy Meal, toys, characters (eg, from films) or any other child-r elated
themes
Special price promotions Discount offers, 2- for- 1 deals, buy- one- get- free deals or any other reduced- price promotions
Promote McDonald’s App, website or Promotes app, website or McDelivery in any way (eg, app store logo)
McDelivery
Free giveaway/voucher Includes competitions with free prizes, free food offers and any other free giveaways that do not
include purchasing another item
Culturally relevant Includes holidays, famous monuments (has to be relevant to its country), religious symbols or any
other reference to the country’s culture
Engagement Encourages to like, comment, read the bio or any other way to interact with the post
Philanthropy/charity Undertakes any charitable work
Emotional appeal Evokes emotional reaction (eg, happiness) or allows to reminiscence
New branch Markets a new regional McDonald’s that has opened
Humour Any post that attempts to use comic marketing (eg, memes, jokes, comic actions)
remaining 90% of the data. The codes for the remaining (HICs); Romania, Lebanon, Malaysia, Brazil and South
three coders were discarded. Because the two coders rated Africa (UMICs) and Indonesia, Egypt and India (LMICs).
the same sample of data, there were two potential sets of These countries collectively maintained 10 million
data. The final dataset was composed of half of each of followers, generated 3 883 952 ‘likes’, 164 816 comments,
the two coders’ sets of data based on random selection. and 38 247 012 video views, and posted 849 times during
Some of the countries’ Instagram accounts had posts that the 4- month data collection period (see table 2). The
were not in English, so we used Google Translator in the average numbers of followers were 2.1 million (LMICs; http://nutrition.bmj.com/
Chrome extension to translate these posts into English. 0.9% of Instagram users), 3.5 million (UMICs; 2.0% of
Data analytical plan Instagram users) and 4.4 million (UICs; 1.5% of Insta-
We used R V.1.2.1578 to conduct descriptive analyses to gram users; see table 2). The countries with the highest
calculate the number of followers, ‘likes’, comments, number of followers included the US (3.7 million; HIC),
posts, video posts and video views associated with each Brazil (2.6 million; UMIC) and Indonesia (1.1 million;
McDonald’s Instagram account. We also calculated the LMIC).
We identified 153.7% more posts on average in LMICs
frequency that McDonald’s used each marketing tech- compared with HICs. That is, we identified an average on January 2, 2023 by guest. Protected by copyright.
nique across the 15 countries. (SD) of 108.0 (38.2) posts in the LMICs as compared
Patient and public involvement with 42.6 (28.2) posts in the HICs during the same time
The project does not include human subjects and was period.
exempt from human subjects ethics review committee. It Qualitative analysis of marketing strategies
was not appropriate or possible to involve patients or the
public in the design, or conduct, or reporting, or dissem- Child- targeted marketing themes appeared more
ination plans of our research. frequently in lower- income countries than HICs (see
figure 2). The reverse was true for health promotion
themes. We identified 71 (22.0%, see table 3) child-
RESULTS targeted posts in LMICs, but just 33 child- targeted posts
Descriptive characteristics (14.5%) in UMICs and 37 (12.4%) in HICs. The HICs’
We identified McDonald’s franchises in a total of 118 coun- accounts also portrayed more healthy habits (n=14,
tries, and McDonald’s had official Instagram accounts 4.7%) compared with the UMICs’ accounts (n=6, 2.6%)
for 62 countries. Our subset of 15 countries (25% of all and LMICs’ accounts (n=8, 2.5%).
accounts) included: the US, Australia, Canada, the UK, Two forms of price-related themes—free giveaways and
United Arab Emirates (UAE), Portugal and Panama price promotions—appeared more frequently in LMICs'
4 Cassidy O, et al. bmjnph 2021;0:e000229. doi:10.1136/bmjnph-2021-000229
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