Search results: research bias

For months now, I haven’t posted an industry-funded studies with results favorable to the sponsor, but this one about deserves mention.

Title: Critical review of the current literature on the safety of sucralose, by BA Magnuson, A Roberts, and ER Nestmann.

Journal: Food and Chemical Toxicology 2017:106:324-355.

Conclusion: “Collectively, critical review of the extensive database of research demonstrates that sucralose is safe for its intended use as a non-caloric sugar alternative.

Financial support was provided by the Calorie Control Council, Atlanta GA, to the employers of the authors for the preparation and publication of this review.

My comment: This lengthy review of literature on the safety of sucralose (Splenda) was commissioned by the Calorie Control Council, a trade association representing “manufacturers and suppliers of low- and reduced-calorie foods and beverages, including manufacturers and suppliers of more than two dozen different alternative sweeteners, fibers and other low-calorie, dietary ingredients.”

It paid authors affiliated with Health Science Consultants, Inc and Intertek Scientific and Regulatory Consultancy to produce this review.

• The Calorie Control Council has a vested interest in demonstrating Splenda to be safe.
• The consultant groups have a vested interest in pleasing the Calorie Control Council.
• Therefore, this review has a higher-than-average likelihood of bias.

Is Splenda safe?  It very well may be safe, but some contrary evidence exists (this paper dismisses it).  It would be interesting to see how independent scientists view the matter.

The article, which starts on the front page and continues to another two full pages and more, is headlined How Big Business got Brazil Hooked on Junk Food.

It’s mostly about how Nestlé (no relation) recruits women in low-income countries to sell the company’s products from small mobile carts.

Here are a few quotes:

• Nestlé’s direct-sales army in Brazil is part of a broader transformation of the food system that is delivering Western-style processed food and sugary drinks to the most isolated pockets of Latin America, Africa and Asia. As their growth slows in the wealthiest countries, multinational food companies like Nestlé, PepsiCo and General Mills have been aggressively expanding their presence in developing nations, unleashing a marketing juggernaut that is upending traditional diets from Brazil to Ghana to India.
• Sean Westcott, head of food research and development at Nestlé, conceded obesity has been an unexpected side effect of making inexpensive processed food more widely available.  “We didn’t expect what the impact would be,” he said.
• Ahmet Bozer, president of Coca-Cola International, described to investors in 2014.  “Half of the world’s population has not had a coke in the last 30 days.  There’s 600 million teenagers who have not had a coke in the last week. So the opportunity for that is huge.”
• “What we have is a war between two food systems, a traditional diet of real food once produced by the farmers around you and the producers of ultra-processed food designed to be over-consumed and which in some cases are addictive,” said Carlos A. Monteiro, a professor of nutrition and public health at the University of São Paulo.  “It’s a war,” he said, “but one food system has disproportionately more power than the other.”
• [From Felipe Barbosa, a  Nestlé supervisor:] “The essence of our program is to reach the poor,” Mr. Barbosa said. “What makes it work is the personal connection between the vendor and the customer.”
• But of the 800 products that Nestlé says are available through its vendors, Mrs. da Silva says her customers are mostly interested in only about two dozen of them, virtually all sugar-sweetened items like Kit-Kats; Nestlé Greek Red Berry, a 3.5-ounce cup of yogurt with 17 grams of sugar; and Chandelle Pacoca, a peanut-flavored pudding in a container the same size as the yogurt that has 20 grams of sugar — nearly the entire World Health Organization’s recommended daily limit.

The article is worth the read.  Or see the 3-minute video for a quick summary.  It also comes with a nifty interactive map of world obesity.

Politico Pro Agriculture asked Nestlé for a comment (this may be behind a paywall):

A Nestlé spokesperson defended the company while acknowledging the deeper childhood obesity problems currently plaguing Brazil. “We are disappointed by the New York Times’ biased approach in this article, which we believe does not accurately reflect the breadth and reality of our product portfolio in the context of the public health issues impacting the people of Brazil,” the spokesperson said. “However, we do agree that the real and serious issues raised in the article should be discussed in a balanced and constructive way that focuses on practical solutions.”

Resources

Here’s the article en Español.

And here it is em Português.

Take a look at Center for Science in the Public Interest’s report on Carbonating the World, which covers much of the same territory for Coca-Cola.  In the meantime, subsequent articles in this series are promised for soft drinks and fast food.

I am an advisor to the American Society of Nutrition’s Early Career Nutrition group and was asked to address this question for its spring/summer newsletter (my piece starts on page 9).  Here’s what I said:

As a newly appointed advisor to ASN’s Early Career Nutrition (ECN) group, I am pleased to be asked to explain why I do not think it a good idea for nutrition scientists, practitioners, and societies to be funded by food, beverage, and supplement companies (collectively, the food industry) for research that is in any way related to their products. If we do, we run the risk of appearing as if our interests are conflicted. More than that, we risk being conflicted—influenced to be less critical or silent about nutrition issues related to the donor’s products. There is no getting around it: whatever the reality of the relationship, taking money from a for-profit food company makes us appear to be supporters of whatever products the company sells.

I worry a lot that financial ties between food companies and ASN tarnish its reputation and ours. It troubles me when critics outside our profession view us as “on the take” and publish reports exposing ASN’s financial ties to companies that have a marketing stake in what we study or say about their products. When ASN meetings are sponsored by food companies, it makes these financial ties seem normal. ASN provides a platform for industry-sponsored sessions such as the one this year on the benefits of Stevia, but you can bet they don’t include speakers who might say anything critical. Sponsorship excludes that possibility.

Most of what we know about the effects of sponsorship comes from a very large body of research on funding by the cigarette, chemical, pharmaceutical, and medical device industries. The results of this research are remarkably consistent: they demonstrate that industry funding influences the design, interpretation, and outcome of research. Nutrition is late to this type of investigation, but several recent studies show that studies funded by the food industry almost invariably favor the interests of the sponsor. Publication bias against negative studies explains only a small part of these findings.

Industry funding of nutrition research is an important issue where there are diverse opinions. ASN is a welcoming place encouraging discussion from members with all perspectives on topics including this one. ASN members share a common unifying goal of advancing nutrition science to promote the public welfare. Working together we can and we will continue to disclose potential conflicts of interest and advance the field for the public benefit. Dr. Mary Ann Johnson, ASN President
Investigators who take such funding insist that it has no effect on the design, conduct, interpretation, or publication of their research. This insistence is consistent with another large body of research demonstrating that gifts have a profound influence on attitudes, behavior, and action–but that recipients are blind to these effects. The medical literature shows that even small gifts—pens and pads—are enough to influence prescription practices, and that larger gifts have even greater effects. But the influence occurs below the radar of critical thinking. It is unintentional, unconscious, and unrecognized.

What most troubles me is the lack of questioning of industry penetration into our societies and research. I think we should be raising questions about ASN’s involvement with companies whose profits might be affected by our opinions or research results. Should ASN have competed to manage the industry-funded Smart Choices program that ended up putting a seal of approval on Froot Loops? Does it make sense for ASN to endorse public policy statements promoting the benefits of processed foods or opposing “added sugars” on food labels? Is it reasonable for ASN to argue on social media that it is inappropriate to question industry funding of research? Must ECN sessions at the annual meeting really be funded by companies such as PepsiCo (last year) or Abbott Laboratories? These actions send the message that ASN is an arm of the food industry and that we uncritically support what it makes, sells, or does.

But let’s turn to a more immediate concern: research funding. As early investigators, you face intense pressures to bring in external grants to pay for your studies, overhead, and maybe even your salaries. Government funding for many areas of nutrition research is declining. These pressures are real. But just as real are the effects of industry funding on research.
From March 2015 to March 2016, I posted summaries of industry-funded studies on my blog. During that year, I collected 168 studies. Of these, 156 yielded results favoring the sponsor’s interests. I only could find 12 studies that did not. This was a casually collected convenience sample but it did allow one conclusion: it is easier to find industry-funded studies with positive results than those with negative results. Nevertheless, recent systematic studies come to the same conclusion. Studies funded by Coca-Cola, for example, are far more likely to conclude that its products have no effect on obesity or type 2 diabetes than do studies funded by government or foundations.

Because we are generally unconscious of the influence of financial ties, it is easy for us to deny the influence or argue that nonfinancial interests—preferences for hypotheses and desires for career advancement–are just as biasing. Yes they may be biasing, but all scientists have them. In contrast to financial ties to industry, it is not possible to eliminate nonfinancial biases and still do science.

I am often asked whether there is a way to take money from food companies and maintain intellectual independence and professional reputation. I regret that I cannot think of any viable way to do that. The ASN has appointed a “Truth” commission to examine this issue and I look forward to its report. In the meantime, I am hoping that you will give thought to the potential conflict of interest and reputational loss that you risk with food industry ties. You must figure out for yourself whether you think the risks are worth taking.

If you do decide to engage with industry, you will need to disclose it. Most journals now require authors to reveal who pays for their work, but even when done diligently, disclosure is not sufficient to alert readers to the extent to which industry funding influences research outcome and professional opinion. Yes, disclosure is uncomfortable, perhaps explaining why so many studies identify frequent lapses. It is likely to become more uncomfortable. In response to a petition from the Center for Science in the Public Interest (which I co-signed), the National Library of Medicine has announced that it will henceforth add funding disclosures and conflict-of-interest statements to PubMed abstracts.

It is only fair to tell you how I handle these issues. My disclosure statement says:

Dr. Nestle’s salary from NYU supports her research, manuscript preparation, Website, and blog at https://foodpolitics.com. She also earns royalties from books and honoraria from lectures to university and health professional groups about matters relevant to this topic.” I also on occasion speak to food industry groups. When I do, I accept reimbursements for travel expenses but ask that honoraria be donated to the NYU library’s food studies collection.

This policy, imperfect as it may be, is the best I can do. I ask only that you think seriously about these issues and figure out for yourself how best to deal with them. I am happy to discuss these matters and am most easily reached at marion.nestle@nyu.edu.

References

• Nestle M. Food company sponsorship of nutrition research and professional activities: A conflict of interest? Public Health Nutrition 2001;4:1015-22.
• Nestle M. Corporate funding of food and nutrition research: science or marketing? JAMA Internal Medicine 2016;176(1):13-4.
• Krimsky S. Science in the Private Interest: Has the Lure of Profits Corrupted Medical Research. Rowman and Littlefield, 2004.
• Lo B, Field MJ, eds. Conflict of Interest in Medical Research, Education, and Practice. Washington, DC: National Academies Press; 2009.
• Simon M. Nutrition Scientists on the Take from Big Food. Eat Drink Politics and the Alliance for Natural Health, Jun 2015.

I have asked repeatedly to have my short interview clip removed from this film.  The director refuses.  He believes his film is fair and balanced.  I do not.

I am often interviewed (see Media) and hardly ever quoted incorrectly or out of context.  This film is one of those rare exceptions.

In my 10-second clip, I say that I am unaware of convincing evidence that eating GM foods is unsafe—this is what I said, but it is hugely out of context.

Safety is the industry’s talking point.  In the view of the GMO industry and this film, if GMOs are safe, they ought to be fully acceptable and nothing else is relevant.

I disagree.  I think there are plenty of issues about GMOs in addition to safety that deserve thoughtful consideration:  monoculture; the effects of industrial agriculture on the environment and climate change; the possible carcinogenicity of glyphosate (Roundup); this herbicide’s well documented induction of weed resistance; and the how aggressively this industry protects its self-interest and attacks critics, as this film demonstrates.

Food Evolution focuses exclusively on the safety of GMOs; it dismisses environmental issues out of hand.  It extols the benefits of the virus-resistant Hawaiian papaya and African banana but says next to nothing about corn and soybean monoculture and the resulting weed resistance, and it denies the increase in use of toxic herbicides now needed to deal with resistant weeds.  It says nothing about how this industry spends fortunes on lobbying and in fighting labeling transparency.

Instead, this film hammers hard on three out-of-context points:

1. GMOs are safe.
2. Anyone who thinks otherwise is anti-science, ignorant, and stupid.
3. Organic foods are bad and proponents of organic foods are deceitful.

Its biases are apparent throughout but the bias against organics is particularly striking.

For example, in arguing that proponents of organic agriculture are paid by the organic industry, the film refers to an article on the front page of  the New York Times.  But most of that article was about how the GMO industry recruits and pays academic researchers to front for it.  The film fails to mention that.

The obvious question: Who paid for this film?

The official answer: The Institute for Food Technologists (IFT).

IFT is a professional association for food scientists and technologists involved in the processed food industry.  I have been a member of it for years; its journal, Food Technology is useful for keeping up with what the food industry is doing.

I had no idea that IFT sponsored films, let alone one that must have been very expensive to produce (on location in Hawaii and Uganda, among other places.)

I can’t help but think Monsanto or the Biotechnology Innovation Organization must have given IFT a grant for this purpose, but IFT takes complete responsibility for commissioning the film (if you have any information about this, please let me know).

Food Evolution is opening in New York on Friday this week.  I view it as a slick piece of GMO industry propaganda.

If you want a thoughtful discussion of the real issues raised by food biotechnology, you will need to look elsewhere.

Full disclosure: half of my book Safe Food: The Politics of Food Safety deals with GMO issues.  These have not changed much since the book appeared in 2003 and in a revised edition in 2010.  The GMO industry’s defenses and attacks are much the same, just louder and more expensively produced.

Last week, StatNews.com revealed that the Walt Disney company tried to withdraw a research study it had funded because its University of Colorado authors, Jim Hill and John Peters, were behind the Global Energy Balance Network, the group funded by Coca-Cola to minimize the role of sugary drinks in obesity.

The headline: “Disney, fearing a scandal, tried to press journal to withdraw research paper.”

StatNews.com based the story on e-mails obtained from the University of Colorado by Gary Ruskin of US Right to Know through open records requests.

An e-mail from John Peters to a Disney representative says “could I ask you to look this [draft press release] over and edit as you see fit.”

But the authors’ conflict-of-interest disclosure statement says:

This work was supported by the Walt Disney Company and by the National Institutes of Health (grant no. DK48520). The Walt Disney Company and the National Institutes of Health had no role in the design, analysis, or writing of this article.

This may be strictly true, but the authors were asking Disney to approve their press release, which is not exactly “no role.”

Readers: does any of this sound familiar?  In February, I wrote a blog post about precisely this article for which I wrote an invited Commentary, accepted by the journal but not published.  I said:

The paper turned out to be by a group of authors, among them John Peters and Jim Hill, both members of the ill-fated Global Energy Balance Network, the subject of an investigation by the New York Times last August…I thought Disney’s sponsorship of this research and its withholding of critical baseline and sales data on kids’ meals that the company considered proprietary did indeed deserve comment, and wrote my piece accordingly.  Brian Wansink [the journal editor] soon accepted it for publication but to my surprise, gave it to Peters et al. for rebuttal.  They filed a lengthy response.  I was then given the opportunity to respond, and did so, briefly.

My Commentary—and the back-and-forth—were omitted (although they are online and will be published in a later issue, apparently).

Brian Wansink wrote colleagues who are editing the next issue of the journal that the back-and-forth debate over the article “was heated, and it also dragged on (because of Disney approvals) and – as we feared – it missed the deadline of our issue.”

This suggests that Disney had even more of an involvement, but when I asked Wansink if Disney approvals were responsible for his having dropped my Commentary, he said no, they just ran out of room.

We now know that Disney was more involved than disclosed.  How involved?  We dont know but perhaps other e-mails will surface to answer that question.

In their Rebuttal to my Commentary, Hill and Peters said

We were disappointed by Dr. Nestle’s assertion that Disney’s decision to not allow publication of kid’s park attendance numbers or raw kid’s meal sales numbers (because of their proprietary nature in the competitive business of theme parks) and the fact that Disney funded the study raises “red flags” about the veracity of the data presented…While we believe caution and transparency are always key ingredients when working with industry we also believe that solving the obesity problem will require finding a productive model for working together that can channel everyone’s energy toward finding solutions.  The Disney study is a good example of why partnering with industry can help move the field forward.

I am sorry I disappointed them, but I disagree.

The e-mails demonstrate even more forcefully that the Disney study is a good example of why partnering with industry should raise acres of red flags.

To repeat my response:

The response from Peters and Hill still fails to acknowledge the severity of the problems posed by Disney’s sponsorship of their research—the company’s failure to produce data essential for proper interpretation of study results, and the level to which sponsorship by food companies biases such interpretations.  At one point, Disney boasted of the results of this research, confirming its benefit to marketing goals.  The threat of industry sponsorship to research credibility has received considerable press attention in recent months, as must surely be known to these authors. [References one and two]. 

Because of Disney’s funding, the company must have thought it had the right to determine whether and how its funded study would be published.  And, as these e-mails reveal, therein lies the problem.

Julia Belluz of Vox has just done a story on my collection of studies funded by food companies.  Here are a few excerpts.  For the entire article and its excellent illustrations, click on the link):

Corrections, February 25:  Several readers have written in to comment that two of these papers do not actually appear to benefit the sponsors.  I have written their comments in red.  A reader also filed a correction to one of listings for February 18.  That brings the score down to 132/12.

It’s been 11 months since I started collecting studies funded by food companies with results favorable to the company’s marketing interests.  I’ve now found 135 such studies versus just 12 with results unfavorable.

When the year is up, I will do an overall interpretation of what this collection does and does not signify, but for the moment I will just state the obvious: it is easier to find industry-funded studies with favorable rather than unfavorable results.

Enjoy this week’s collection.

Latin American Study of Nutrition and Health (ELANS): rationale and study design. M. Fisberg, I. Kovalskys, G. Gómez, A. Rigotti, L. Y. Cortés, M. Herrera-Cuenca, M. C. Yépez, R. G. Pareja,Guajardo, I. Z. Zimberg, A. D. P. Chiavegatto Filho, M. Pratt, B. Koletzko, K. L. Tucker and the ELANS Study Group. BMC Public Health (2016) 16:93.  DOI 10.1186/s12889-016-2765-y.

• Conclusion: This study will provide valuable information and a unique dataset regarding Latin America that will enable cross-country comparisons of nutritional statuses that focus on energy and macro- and micronutrient intakes, food patterns, and energy expenditure.
• Funding: The ELANS study and authors were partially supported by a scientific grant from the Coca Cola Company and by different grants and support from the Instituto Pensi/Hospital Infantil Sabara, International Life Science Institute of Argentina, Universidad de Costa Rica, Pontificia Universidad Católica de Chile, Pontificia Universidad Javeriana, Universidad Central de Venezuela (CENDESUCV)/Fundación Bengoa, Universidad San Francisco de Quito, and Instituto de Investigación Nutricional de Peru. The funders had no role in study design, data collection and analysis, the decision to publish, or the preparation of this manuscript. KLT received consulting fees from the Coca Cola Company to participate. MF is member of the directory of Danone Institute International.
• A reader writes: Coca-Cola undoubtedly hopes that this study will support their efforts to put the blame on lack of exercise. However, the present paper gives no data, and the design does not seem biased. I do not think this paper can support marketing of Coca-Cola.  My response: OK.  Let’s call this one neutral and delete it from the list.

Biofortified yellow cassava and vitamin A status of Kenyan children: a randomized contr.  Am J Clin Nutr 2016; 103:258-267 doi:10.3945/ajcn.114.100164

• Conclusion: In our study population, consumption of yellow cassava led to modest gains in serum retinol concentration and a large increase in β-carotene concentration. It can be an efficacious, new approach to improve vitamin A status.
• Funding: Supported by the European Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement 211484, conducted within the framework of INSTAPA Project. HarvestPlus provided financial support for biochemical analyses and supplies. Capsugel (Bornem, Belgium), Laboratory&Allied (Nairobi, Kenya), DSM Nutritional Products/Sight and Life (Basel, Switzerland), and Laboratorium Medisan (Heerenveen, Netherlands) provided financial and technical support in producing supplements…None of the authors reported a conflict of interest. The funders had no role in the design, implementation, analysis, or interpretation of the data.
• A reader writes: This study came out somewhat favorably for yellow cassava (non-GMO) and thus for HarvestPlus, but HarvestPlus is a charity with no commercial interests. DSM company provided the carotene capsules for the positive control group, but the study shows you might as well eat cassava naturally high in carotene instead of capsules.  My response: This one is not industry-funded.  Delete from list.

Effects of Diet Composition and Insulin Resistance Status on Plasma Lipid Levels in a Weight Loss Intervention in Women.Tran Le, BA; Shirley W. Flatt, MS; Loki Natarajan, PhD; Bilge Pakiz, EdD; Elizabeth L. Quintana, MS, RD Dennis D. Heath, MS1; Brinda K. Rana, PhD; Cheryl L. Rock, PhD, RD.  J Am Heart Assoc.2016; 5: e002771.  Originally published January 25, 2016.  doi: 10.1161/JAHA.115.002771.

• Conclusions Weight loss was similar across the diet groups, although insulin‐sensitive women lost more weight with a lower fat, higher carbohydrate diet versus a higher fat, lower carbohydrate diet. The walnut‐rich, higher fat diet resulted in the most favorable changes in lipid levels.
• Funding: This study was supported by the NIH (CA155435) and the California Walnut Commission.

Regular Fat and Reduced Fat Dairy Products Show Similar Associations with Markers of Adolescent Cardiometabolic Health. Therese A. O’Sullivan, Alexandra P. Bremner, Trevor A. Mori, Lawrence J. Beilin, Charlotte Wilson, Katherine Hafekost, Gina L. Ambrosini, Rae Chi Huang and Wendy H. Oddy.   Nutrients 2016, 8(1), 22; doi:10.3390/nu8010022.

• Conclusions: Although regular fat dairy was associated with a slightly better cholesterol profile in boys, overall, intakes of both regular fat and reduced fat dairy products were associated with similar cardiometabolic associations in adolescents.
• Funding: Therese A. O’Sullivan received a grant from The Dairy Health and Nutrition Consortium Australia (DHNC-MetX06-2011) which provided funding for the analysis and write up of this study. No other authors declare a conflict of interest.

Concord grape juice, cognitive function, and driving performance: a 12-wk, placebo-controlled, randomized crossover trial in mothers of preteen children. Daniel J Lamport, Clare L Lawton, Natasha Merat, Hamish Jamson, Kyriaki Myrissa, Denise Hofman, Helen K Chadwick, Frits Quadt, JoLynne D Wightman, and Louise Dye. AJCN. First published ahead of print February 10, 2016 as doi: 10.3945/ajcn.115.114553.

• Conclusions: Cognitive benefits associated with the long-term consumption of flavonoid-rich grape juice are not exclusive to adults with mild cognitive impairment. Moreover, these cognitive benefits are apparent in complex everyday tasks such as driving. Effects may persist beyond the cessation of flavonoid consumption….
• Funding:  Supported by Welch Foods Inc…. JDW is an employee of Welch Foods Inc. None of the other authors reported a conflict of interest.
• Comment: Welch sent out a press release: “New research by the University of Leeds in the UK suggests that drinking Concord grape juice daily can benefit certain aspects of memory and everyday tasks in people with stressful lifestyles – specifically working mothers.”  Yoni Freedhoff has additional comments on Weighty Matters:Welch’s Study Finds Grape Juice Makes You Smarter #NotTheOnion.

Last summer, Brian Wansink, a friend and Cornell colleague and the editor of the new Journal of the Association for Consumer Research, asked me to write a commentary on a paper to be published in its inaugural issue.

The paper turned out to be by a group of authors, among them John Peters and Jim Hill, both members of the ill-fated Global Energy Balance Network, the subject of an investigation by the New York Times last August.

Titled “Using Healthy Defaults in Walt Disney World Restaurants to Improve Nutritional Choices,” the paper described the benefits of improving the composition of kids’ meals at Disney World.

The healthy defaults reduced calories (21.4%), fat (43.9%) and sodium (43.4%) for kid’s meal sides and beverages sold in the park. These results suggest that healthy defaults can effectively shift food and beverage selection patterns toward healthier options.

The authors explain:

This work was supported by the Walt Disney Company and by the National Institutes of Health…The Walt Disney Company and the National Institutes of Health had no role in the design, analysis, or writing of this article. Full disclosure: JH is a consultant for the Walt Disney Company and for McDonalds; KA is a consultant for the Walt Disney Company.”

I thought Disney’s sponsorship of this research and its withholding of critical baseline and sales data on kids’ meals that the company considered proprietary did indeed deserve comment, and wrote my piece accordingly.  Brian Wansink soon accepted it for publication but to my surprise, gave it to Peters et al. for rebuttal.  They filed a lengthy response.  I was then given the opportunity to respond, and did so, briefly.

The paper by Peters, et al. did was published in the journal’s first issue.   This issue also includes several commentaries on other papers (none of which are accompanied by rebuttals).

My commentary—and the back-and-forth—however, were omitted.

After some discussion, the journal published my commentary online.  You have to scroll down to find it.  The site provides no links to it in the table of contents or in the article by Peters et al.

Is it possible that Disney or the authors’ contractual relationships with Disney could have had anything to do with the omission of my accepted-for-publication commentary?  Brian Wansink says no, they just ran out of room (despite room for others).

Whatever.

Here’s what I wrote:

Dietary nudges for obesity prevention: They work, but additional policies are also needed

In 2006, the Walt Disney Company announced a new initiative to improve the nutritional quality of meals served to children at its theme parks. The company would be changing the default kids’ meals—the components that come without having to be ordered separately–to include low-fat milk, juice, or water rather than soft drinks, and sides such as apple sauce or carrots rather than French fries. Parents who wanted sodas or fries for their children would have to ask for them, something many might not bother to do. Health groups had long advocated for this policy change (Wootan 2012).

As I commented to a reporter at the time, “going to Disney World is an excuse for eating junk food…Disney or its advisers must be feeling they have some responsibility” (Horovitz and Petrecca 2006). Indeed, the healthier defaults were part of a larger effort by Disney to deal with its contribution to obesity in America. After ticket prices, food is the second greatest source of revenue at Disney World. Although reducing the amount of food consumed at the parks might help create a less “obesogenic” food environment, revenues might fall. But the default change might be revenue neutral. By 2008, Disney could report that two-thirds of U.S. customers ordering kids’ meals had accepted the default, with no loss in sales. In Hong Kong Disney parks, nearly all customers accepted the default. The report, however, did not include data on the numbers or proportions of customers ordering kids’ meals (Walt Disney Company 2008).

Disney’s more recent summary of its child health initiatives states that it is funding investigators at the University of Colorado to conduct a more formal evaluation of use of the default options (Walt Disney Company 2015). The paper by Peters et al. (2016) in this issue of the Journal presents the results of that research. Their work confirms the ongoing effectiveness of the strategy. Nearly half the customers ordering kids’ meals accepted the healthy default side dishes and two-thirds accepted the healthier beverages. These choices resulted in significant reductions in the calories, fat, and sodium in purchased kids’ meals, but not sugar (Peters et al 2016).

The authors argue that gentle nudges changes like these are preferable to more coercive policies that smack of nanny statism. Such reductions help, but are they enough to make a real difference? To answer this question, it would help to know what else the children were eating along with the drink and side dishes. Although the authors were given raw sales data, Disney did not permit them to use this information as part of the overall analysis. The company also refused to provide information about the number of children who visited the park or the number of kids’ meals sold.

These missing pieces raise red flags because this is a Disney-funded study that produced results that Disney can use to advertise itself as a company that cares about kids’ health, and to deflect attention from Disney World’s’ reputation as a junk-food paradise. Corporate funding of research introduces conflicts of interest and reduces the credibility of the results, not least because the biases inherent in such research are largely unconscious, unintentional, and unrecognized (Moore et al 2005) The results of this study merit especially careful scrutiny. Taking them at face value, the default strategy worked well for the drink, but the sides are still a problem, and so are the sugars. They do not reveal much about what kids eat in a day at Walt Disney World

Nudges like this default are an important part of strategies to counter childhood obesity. But are they enough to deal with the public health problem? To make a real difference, they need to be accompanied and supported by a range of policy approaches. Current thinking about such approaches recommends combining insights from behavioral research, economics, and public health to establish a food environment far more conducive to making the healthy choice not only easy choice, but also the preferred choice. Doing so is likely to require multiple actions—for example, regulation of nutrient content and marketing; incentives such as subsidies of healthier foods; disincentives such as taxes, warning labels, and nutritional rating systems for unhealthier foods; and education of adults and children (Hawkes et al 2015). Disney’s voluntary default is a small step in the direction of such policies, but many more are needed if we are to make real progress in reducing the prevalence of childhood obesity.

• Margo G. Wootan. Children’s meals in restaurants: families need more help to make healthy choices.   Childhood Obesity 2012;8(1):31-33.
• Bruce Horovitz and Laura Petrecca.  Disney to make food healthier for kids.  USA Today, October 17, 2006.
• Walt Disney Company. Walt Disney Company—2008 Corporate Responsibility Report. 2008.
• Walt Disney Company.  Magic of Healthy Living brochure.  2015. https://thewaltdisneycompany.com/sites/default/files/MOHL_Brochure.pdf.
• John C. Peters, Jimikaye Beck, Jan Lande, Zhaoxing Pan, Michelle Cardel, Keith Ayoob, and James Hill. Using healthy defaults in Walt Disney World restaurants to improve nutritional choices.  J Assoc Consumer Res., 2016;1:1.
• Don A. Moore, Daylian M. Cain, George Loewenstein, and Max H. Bazerman, editors.  Conflicts of Interest: Challenges and Solutions in Business, Law, Medicine, and Public Policy.  Cambridge University Press, 2005.
• Corinna Hawkes, Trenton G Smith, Jo Jewell, Jane Wardle, Ross A Hammond, Sharon Friel, Anne Marie Thow, Juliana Kain.  Smart food policies for obesity prevention. The Lancet 2015;385:2410–2421.

And here’s my response to the rebuttal by Peters et al.

The response from Peters and Hill still fails to acknowledge the severity of the problems posed by Disney’s sponsorship of their research—the company’s failure to produce data essential for proper interpretation of study results, and the level to which sponsorship by food companies biases such interpretations.  At one point, Disney boasted of the results of this research, confirming its benefit to marketing goals.  The threat of industry sponsorship to research credibility has received considerable press attention in recent months, as must surely be known to these authors.^1,2 

1  Anahad O’Connor.  Coca-Cola funds scientists who shift blame for obesity away from bad diets.  New York Times, August 9, 2015. http://well.blogs.nytimes.com/2015/08/09/coca-cola-funds-scientists-who-shift-blame-for-obesity-away-from-bad-diets/

2  Candice Choi.  AP Newsbreak: Emails reveal Coke’s role in anti-obesity group.  US News, November 24, 2015.  http://www.usnews.com/news/business/articles/2015/11/24/apnewsbreak-emails-reveal-cokes-role-in-anti-obesity-group