Outdoor Ads Near Iranian Schools Push Ultra-Processed Foods, Linked to Higher Adolescent BMI

Outdoor food advertising around upper secondary schools in Shiraz, Iran, is dominated by ultra-processed products, and a new cross-sectional study reports that higher densities of these school-adjacent advertisements are associated with higher body mass index measures among the students attending those schools. The research, published in Archives of Public Health, analyzed 423 food advertisements within 500 meters of 24 upper secondary schools and collected anthropometric measurements from 656 students at the selected schools.

The content analysis was carried out using photo-elicitation in MAXQDA 2020, with each advertisement classified by product food group and marketing strategy. The researchers then evaluated the advertisements against three separate benchmarks: Iran’s national list of health-threatening products, the WHO Eastern Mediterranean Region Nutrient Profile Model, and the NOVA classification system. The results reveal a striking gap between regulatory frameworks. Under the WHO-EMR-P model, 76.1 percent of the advertisements were classified as non-permissible, compared with 48.9 percent under Iran’s national criteria, suggesting the national standard flags a considerably smaller share of the advertised products as problematic.

By product type, 67.85 percent of the advertisements promoted ultra-processed foods. The most common unhealthy advertised products were extruded snacks and chips, ice cream, carbonated soft drinks, and other sugar-sweetened beverages. Marketing tactics also leaned heavily toward young audiences: 47.75 percent of the advertisements used child-targeted strategies, while 79.20 percent contained general marketing strategies.

The study also examined whether advertisement density around a school related to students’ nutritional status. A higher density of school-level food advertisements was significantly associated with higher BMI z-scores (B = 0.008, P = 0.043) and with greater odds of being in a higher BMI-for-age category (OR = 1.016, P < 0.001). These associations were stronger for advertisements promoting ultra-processed foods, and stronger still for those using child-targeted marketing strategies, with BMI z-score coefficients of 0.009 and 0.013 and BMI-for-age odds ratios of 1.019 and 1.025 respectively.

The authors frame these findings within the broader concept of an obesogenic food environment, in which widespread marketing of unhealthy foods may influence children’s food and taste preferences and their purchase requests, potentially contributing to overweight and obesity. Because the study is cross-sectional, it documents associations at a single point in time and cannot establish that advertising causes higher BMI; other features of the school neighborhoods or student behaviors could contribute to the observed patterns. Nevertheless, the researchers conclude that outdoor food advertising around schools predominantly promotes ultra-processed and non-permissible products and is significantly associated with overweight and obesity among adolescents, highlighting the need to strengthen policies that protect children, restrict unhealthy food marketing, and create healthier school food environments.

Subject of Research: Outdoor food advertising around secondary schools in Shiraz, Iran, and its associations with adolescents' nutritional outcomes

Article Title: Food marketing near schools: content, permissibility, and associations with adolescents’ nutritional outcomes

Article References: Rostami, M., & Babashahi, M. (2026). Food marketing near schools: content, permissibility, and associations with adolescents’ nutritional outcomes. Archives of Public Health. https://doi.org/10.1186/s13690-026-02109-5

Image Credits: AI Generated

DOI: 10.1186/s13690-026-02109-5

Keywords: food marketing, ultra-processed foods, schools, adolescents, obesity, BMI, WHO nutrient profile, Iran, child-targeted advertising, food environment, public health, nutrition policy