How healthy are food and beverage products promoted by TikTok influencers?

Abstract Objective: To evaluate the healthfulness of the food/beverage products featured by TikTok influencers whose audiences include millions of adolescents. Design: In a cross-sectional study, we collected the maximum available up to 100 videos from the top 100 TikTok influencers in the USA – based on views, likes, comments and shares – in July 2022. For each video, we identified the most prominent food/beverage product featured. We used the Nutrient Profile Index (NPI) to classify food products as healthy/unhealthy. We grouped beverages by category. Setting: TikTok Participants: N/A Results: Our sample included 8871 videos, 1360 (15·3 %) of which featured at least one food ( n 755, 55·5 %), beverage ( n 580, 42·6 %) or dietary supplement ( n 25, 1·8 %). Mean NPI score for foods was 54·73 ( sd 19·95). Most foods (58 %) were considered unhealthy, with a 20-percentage-point difference between branded (70·8 %) and unbranded (50·8 %) foods. Alcohol ( n 154, 26·6 %) and energy drinks ( n 149, 25·7 %) were the most featured beverages overall. Among branded beverages, energy drinks were the largest category ( n 148, 38·9 %). Among unbranded beverages, alcoholic drinks were the largest category ( n 73, 36·5 %). Conclusions: More than half of the foods promoted by TikTok influencers were considered unhealthy, and most beverages featured were alcoholic and energy drinks. Many foods and a large share of alcoholic beverages were unbranded, either reflecting genuine influencer preferences or potentially masking the true extent of commercial marketing. Given the reach of influencers, including millions of adolescents, stronger regulations are needed for social media platforms, influencers and brands to protect consumers from undue harm from food/beverage marketing.