COMMENTARY

Weighty Matters: Public Health Aspects of the Obesity Epidemic Part III -- A Look at Food and Beverage Industries

Martin Donohoe, MD, FACP

Disclosures

March 25, 2008

Introduction

Parts 1 and 2 of this 5-part series on the obesity epidemic reviewed the health and economic consequences of obesity and described the contributing roles of nutrition, exercise, and television. This column, part 3, will focus on the food and beverage industries and on their links to schools, healthcare organizations and facilities, and government.

Soda/Beverages

Besides the increase in food portion size which has become commonplace in the United States in the past decade, another major contributor to increased caloric content is use of high fructose corn syrup, an artificial sweetener found in many processed products such as sodas and fruit drinks. In fact, one of the largest changes in the human diet over the last few decades has been the 1000+% increase in consumption of this calorie-laden artificial sweetener.[1] A meta-analysis of 88 studies found a clear association between soft drink intake and increased energy intake and body weight; lower intakes of milk, calcium, and other nutrients; and increased risk for diabetes and other health problems.[2]

Pouring Contracts and Soda Consumption. Over the last decade, cash-strapped school districts attempting to gain additional income to compensate for cuts in educational and athletic programs have signed "pouring rights" contracts with soda manufacturers.[3] In 2002, 240 US school districts had exclusive "pouring rights" contracts with soft-drink companies. In return for the placement of soda machines on campus and exclusive marketing rights to district children, companies sponsor sports and other extracurricular activities. One school was required to print the soda's name on its rooftop so that it could be seen by planes arriving and leaving from a nearby airport. Schools, which should be promoting proper nutrition, have instead been offered incentives to sell sugar-laden beverages because the majority of revenue from such contracts is realized through student purchases.

Some school districts, such as Los Angeles and Pittsburgh, have bowed to parental and health professional pressure and banned the sale and marketing of soft drinks.[4,5] Additionally, federal law now requires school districts to have nutritional wellness policies in place; these will be strengthened over the coming few years and should help to curb pouring contracts.[5]

In early 2006, Coca-Cola, Pepsi, and other soft drink manufacturers announced new voluntary policies to remove soda and other sugary drinks from schools nationwide.[6] Nevertheless, soft drink advertising still reaches students through television and magazine advertisements and, in the classroom, via Channel One, a ubiquitous, free, corporate-sponsored advertising-laden news summary watched daily by millions of school children.[7]

The Food Industry, Medical Groups, and Government

One would hope that organizations of medical professionals would take a strong stand against the purveyors of fast foods, sodas, and sweets. However, a number of such groups have taken money from these companies, presenting a troubling conflict of interest. For example, the American Dietetic Association published a fact sheet entitled "Straight Facts about Beverage Choices," supported by an unrestricted grant from the National Soft Drink Association.[8] The group has also accepted money from other corporate sponsors, such as Mars and Coca Cola, to support its professional meetings.[9] In exchange for getting to use the American Diabetes Association's (ADA's) label on its diet drinks, Cadbury Schweppes (makers of Dr. Pepper and chocolate candies) donated a few million dollars to the ADA.[10] The American Academy of Family Physician's magazine, Family Doctor: Your Essential Guide to Health and Well-Being, mailed to 50,000 US family physicians in 2004, contained advertisements from food companies that included McDonald's, Kraft (maker of Oreo cookies), and Dr. Pepper, among others.[10] And although children's hospitals should be providing healthy environments for patients, parents, and staff, many in the United States (more than in Canada) have fast food outlets and vending machines that sell suboptimal food choices.[11]

US sugar producers, the packaged food industry, and producers of high-fructose corn syrup sweeteners contribute generously to high-level politicians, and have exercised their influence on a number of occasions to weaken food standards and labeling laws in the United States. They have also successfully applied pressure, through their "representatives" at the Department of Health and Human Services, to the World Health Organization, causing it to revise and thereby weaken the organization's antiobesity guidelines.[12]

In 2005, the US Federal Trade Commission asked industry to self-regulate its food advertising. In response, companies accounting for an estimated two thirds of children's food and beverage television advertisements pledged to improve the mix of foods advertised to children under age 12 and to reduce their total number of food advertisements overall.[13,14] These companies included Burger King, Cadbury Adams, Campbell Soup, Coca-Cola, ConAgra, General Mills, Hershey, Kellogg, Kraft Foods, Mars, Masterfoods, McDonald's, PepsiCo, and Unilever.

Given historical examples of industry failing to self-regulate, more formal, government-mandated rules may become necessary. However, many of these companies have, and are continuing to develop, healthier food choices in response to consumer demand. Also, major political figures, such as former President Bill Clinton and former Arkansas governor and current Republican presidential candidate Mike Huckabee, have launched antiobesity initiatives.

 

Conclusion

Food industry practices have contributed to the obesity epidemic, often with the tacit support of schools and medical and other healthcare organizations. However, growing public concerns regarding the food industry's role in obesity have prompted many companies to pledge to decrease advertising of less healthy food choices while developing more nutritious offerings.

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