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As adult and childhood obesity levels continue to climb, it is imperative to investigate candidate factors that could be driving the epidemic(1). It is well-established that marketing for energy-dense, nutrient-poor food and beverage products can have a profound impact on unhealthy behaviours in children(2). Historical food marketing research has focused on television advertising, but newer studies have begun to focus on diverse social media platforms (e.g. Facebook and Twitter)(3–6). However, there has recently been a marked shift in the preferred social media source among individuals, particularly teenagers. A 2018 Pew Charitable Trust survey found that only 51 % of individuals aged 13–17 years use Facebook, down from 71 % in 2014 and 2015; those interviewed in 2018 overwhelmingly noted YouTube and Instagram as their most frequented social media applications(7). These platforms incorporate an increasingly popular form of delivering user-generated content called livestreaming, whereby a user can broadcast live audiovisual material to a myriad of viewers around the world.(7,8) While livestreaming functionality exists on YouTube and Instagram, the major drawback of these sites is the pre-recorded content. In contrast, the increasingly popular, hybrid social media platform Twitch.tv (Twitch) relies almost exclusively on livestreaming for the generation of its content. In fact, Twitch is currently the largest livestreaming platform, broadcasting 355 billion minutes of content to an average of 15 million unique daily visitors(9).
The popularity of Twitch was brought to the forefront in 2015 when it was acquired by Amazon for $970 million USD(10). With 1·2 million average concurrent viewers at any given time, Twitch has more viewership than established broadcast networks such as CNN and MSNBC (783 000 and 885 000 in 2017, respectively) and similar viewership to sports networks such as ESPN (approximately 1·5 million in 2017)(11,12). As of January 2017 (the most recently available demographic data), Twitch users are reported to be overwhelmingly male (91 %) and young adults (60 % between the ages of 18 and 34 years). Only 15 % of users are reportedly above the age of 35, and 57 % of individuals are noted to not possess a completed college degree(13). This may suggest that Twitch largely caters to a younger...