This week on Obesity Panacea we’re looking at the new series on “Big Food” published by PLoS Medicine (the same PLoS that publishes PLoS Blogs, the host of Obesity Panacea). Wednesday we looked at the evidence linking sugar sweetened beverages with the rise in obesity rates in North America, while yesterday we looked at how the Corporate Social Responsibility Campaigns of Big Food compare with those of Big Tobacco.
Today, we look at an editorial by David Stuckler and Marion Nestle, discussing possible approaches for engaging with Big Food. But first, a quick reminder that (like everything Peter and I post on this blog), today’s post reflects my own personal thoughts, rather than those of any other organization or individuals that I may be affiliated with.
How should public health advocates engage with Big Food?
If you conclude (as I do) that sugar sweetened beverages play a role in the increasing weight of North Americans, what is the best way to move forward? In the editorial by Stuckler and Nestle, they argue that there are 3 general views on whether and/or how we should engage with Big Food [emphasis mine].
1. The first favors voluntary self regulation, and requires no further engagement by the public health community. Those who share this view argue that market forces will self-correct the negative externalities resulting from higher intake of risky commodities. Informed individuals, they say, will choose whether to eat unhealthy foods and need not be subjected to public health paternalism.
2. The second view favors partnerships with industry. Public health advocates who hold this view may take jobs with industry in order to make positive changes from within, or actively seek partnerships and alliances with food companies. Food, they say, is not tobacco. Whereas tobacco is demonstrably harmful in all forms and levels of consumption, food is not. We can live without tobacco, but we all must eat. Therefore, this view holds that we must work with Big Food to make healthier products and market them more responsibly.
3. The third approach is critical of both. It recognizes the inherent conflicts of interest between corporations that profit from unhealthy food and public health collaborations. Because growth in profit is the primary goal of corporations, self-regulation and working from within are doomed to fail. Most proponents of this viewpoint support public regulation as the only meaningful approach, although some propose having public health expert committees set standards and monitor industry performance in improving the nutritional quality of food products and in marketing the products to children.
I’ve been blogging about this topic for several years, including two podcasts on the issue that I have included below (email subscribers can listen to the podcasts by visiting the blog itself, or by searching for Obesity Panacea in iTunes).
The first podcast is from a discussion that I had with Dr Diane Finegood, who I would characterize as subscribing to the 2nd view from the above list (e.g. favouring engagement with industry).
The second podcast is with Michele Simon, who is of the 3rd view (self-regulation is doomed to fail).
As a bonus, here is a video on this same topic from Yoni Freedhoff, from a debate that took place at The Obesity Society conference in the fall of 2011 (Yoni is also of the view that engagement and self-regulation are misguided).
In the past I have always leaned more towards the view of engaging with industry (e.g. view # 2 above). While I felt that people like Michele and Yoni made good arguments against engaging with Big Food, I felt it was possible that the positive aspects of engagement (primarily in the form of money for research or other programs that might not be possible otherwise) outweighed their potential to do harm.
But I’m gradually feeling myself pulled toward the views held by Yoni and Michele. Why? Because Big Food seems willing to say or do just about anything to promote their own interests.
In the interview, Katie claims that there is no such thing as an empty calorie:
A calorie is a calorie. What our drinks offer is hydration. That’s essential to the human body. We offer great taste and benefits whether it’s an uplift or carbohydrates or energy. We don’t believe in empty calories. We believe in hydration.
She weighs in on the evidence linking sugar sweetened beverages and obesity (emphasis mine):
There is no scientific evidence that connects sugary beverages to obesity. If you look at the data, you can see that during the same period obesity was rising, sugar intake from beverages was decreasing. Between 1999 and 2010, sugars from soda consumption decreased by 39%, but the percentage of obese children increased by 7%, and 13% for adults.
Note that she didn’t say that the research isn’t air-tight, or that some questions remain, which would be true. She said there is “no scientific evidence”, which can be easily disproved by heading back to my post from 2 days ago which surveyed the rather large body of evidence on this exact topic.
She goes on:
Q: Shouldn’t teens drink less cola and more milk and water?
A: Teens should get a healthy diet through food and beverage choices throughout the day.
Q: How much Coke should a kid drink a day?
A: We don’t make recommendations on what kids should drink. But a 12-ounce can of Coke has 140 calories, the same as a lunch-box-size bag of pretzels.
Finally, here is her son’s post-workout hydration regimen:
If my son has lacrosse practice for three hours, we go straight to McDonald’s and buy a 32-ounce Powerade.
Now if Big Food executives were able to respond to these sorts of questions as a reasonable, rational person, then I would continue to agree that partnerships with industry are the way to go. But it’s tough to maintain that view after seeing the above interview and others like it, that suggest to me that the food industry has no goal other than profit. I don’t think that any reasonable person could honestly say that there is no such thing as an empty calorie (especially in the context of obesity), or duck a simple question asking whether it’s healthier for kids to drink more water and less soda.
My other big problem is with an issue that was discussed yesterday related to corporate social responsibility campaigns. In short, a primary goal of these campaigns is to prevent regulation. That really worries me. There are certain areas (for example, a restriction on advertising to children) where I feel that regulation is absolutely warranted. While I still believe that some individual partnerships with Big Food can have public health benefits, I worry that those benefits may be out-weighed by the ability of industry to argue that these beneficial programs make regulation (which could potentially have a larger overall impact on public health) unnecessary.
To be clear, I’m not just concerned with the partnerships of Big Food, but with industry partnerships more generally. I don’t think they are all bad, but (I’m paraphrasing Yoni Freedhoff here) they should probably be avoided when the company’s core products work directly against the goals of the public health organization that they are partnering with. So while New Balance might be a good fit for a physical activity advocacy group, Apple (which makes money by selling us screen-based devices) likely would not.
If all public health advocates were to stop partnering with Big Food, this would create a pretty large vacuum in terms of funding (unfortunately, those corporate social responsibility campaigns fund a lot of worthwhile projects… which, as we learned yesterday, is the whole point). This has always been a big concern for me, and I still don’t know how that vaccuum could be filled (this is far from inconsequential – if we had another way to fill that vacuum, there would be far less need to partner with Big Food in the first place). But if the end goal is to improve public health, then I’m starting to think that the ends may not justify the means.
There will be 5 more papers coming out in the PLoS Medicine Big Food collection in the coming weeks. They will all be available for free as they are published here.