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I am a member of the American Society for Nutrition (ASN), the organization that publishes the American Journal of Clinical Nutrition (AJCN) and the Journal of Nutrition.

I’ve become increasingly worried about food company influence on ASN.  Food companies fund sessions at ASN annual meetings.

But I’m even more concerned about food company sponsorship of scientific studies published in AJCN.

The results of sponsored studies almost invariably benefit the sponsor.  Exceptions are scarce.

The conflicts are so blatant that I can often guess from reading an abstract who the study’s sponsor must be.

A look at the conflicts of interest disclosed by the editorial board of AJCN suggests why this problem is occurring.

Of the 12 members of the editorial board, only 3 disclose no corporate conflicts of interest, and 2 others disclose minor conflicts.

But the majority—7 of the 12—list major corporate affiliations.  The list of food companies for which they consult or advise is too long to reproduce but it includes Coca-Cola, PepsiCo, The Sugar Association, The National Restaurant Association, ConAgra, McDonald’s, Kellogg, Mars, and many others.

This raises uncomfortable questions: How does this editorial board deal with papers suggesting harm to health from consuming products from these companies?  How does it deal with sponsored papers suggesting benefits of the products?

Affiliations with food companies may or may not lead to publication bias, but at the very least they give the appearance of serious conflicted interest.  This affects opinion not only of sponsored studies, but also of the overall credibility of research published in the journal.

For the results of papers published in the AJCN to be considered credible, the editorial board should:

• List the editor responsible for review of published papers in the conflict disclosures.
• Recuse individual members with conflicts from reviewing papers in their area of conflict.
• Phase out conflicted editors as quickly as possible.
• Appoint editors who have minimal or no conflicts.
• Give special editorial scrutiny to papers sponsored by food and beverage companies.

ASN is not the only nutrition society raising doubts about its conflicts of interest with food company sponsorship.  The Academy of Nutrition and Dietetics (AND) is the subject of two recent reports analyzing its conflicts of interest.

• The Food Ties that Bind
• And Now a Word From Our Sponsors

I will say more about these reports tomorrow, but it looks like a similar report could be written about ASN, alas.

Can money buy elections?  Apparently so.

Yesterday’s election results indicate that the GMO-labeling initiative in Washington state and the soda tax initiative in Telluride, CO both failed.

Washington’s I-522

According to USA Today, the defeat cost opponents $22 million.  All of that—except $550—came from out of state.

The top five contributors were the Grocery Manufacturers Association, Monsanto, DuPont Pioneer, Dow AgroSciences and Bayer CropScience.

But the Grocery Manufacturers Association was required to list its contributors.  The top five?  PepsiCo, Nestlé (no relation), Coca-Cola, General Mills, ConAgra  at about a million each when you add it all up.

USA Today reports:

Food industry ads claimed that the initiative would raise food prices. Labels would mislead consumers into thinking that products that contain genetically engineered ingredients are “somehow different, unsafe or unhealthy,” said Brian Kennedy of the Grocery Manufacturers Association, a food industry group based in Washington, D.C.

The Yes on 522 campaigns emphasized consumers right to know what’s in their food.

But PoliticoPro points out that because votes are mailed in, more than 600,000 votes may still be left to count.

The food and biotech industries used their considerable war chest to make ad buys across the state, pointing out all of the products that would not be covered under the measure — such as cheese, beer, restaurant food and even, they claimed, pet food — and pushing the message that the bill is misleading and would considerably raise food prices. They said the law would hurt Washington’s farm families.

As I told USA Today, sooner or later, one of these is going to pass. At some point the industry is going to get tired of pouring this kind of money into these campaigns and will beg for labeling, which is what should have happened in the first place.

The Telluride soda tax

Telluride is a small town, so the amounts are much smaller.

According to ProPolitico, the Colorado Beverage Association installed an onsite lobbyist to generate opposition to the measure through meetings and an Internet site.

The largest donors to the opposition campaign were a Texas billionaire who owns a second home in Telluride ($55,000), and the the local and national beverage associations. were the largest contributors to the anti-tax campaign, giving $20,000 and $55,000 respectively.

Taxes, of course, are never popular even when intended for public health purposes, as this one was.

Soda taxes too, will pass eventually.

Patience and fortitude.

Addition: Here’s the Washington State vote as of this morning.

Politics of the Plate

My monthly first Sunday Food Matters column in the San Francisco Chronicle:

Q: I hear that the Mexican government wants to increase taxes on sodas as a way to fight diabetes. The soda industry persuaded voters to defeat soda taxes in Richmond and El Monte last year. Won’t it do the same in Mexico?

A: It might. I’m just back from a lecture trip to Mexico City where I heard plenty about the proposed soda tax and the industry’s response to it.

Last month, the Mexican government proposed an additional soda tax of one peso (about 8 cents) per liter. The idea is to raise $1.5 million per year while discouraging soda consumption, thereby helping to reduce the country’s high prevalence of obesity and Type 2 diabetes.

Mexicans drink lots of soda. By some estimates, average per capita consumption is 50 gallons a year, the highest in the world. It’s no coincidence that more than 70 percent of Mexicans are overweight or obese, and around 15 percent have Type 2 diabetes, a prevalence that terrifies health officials. This type of diabetes, if undiagnosed and untreated, can lead to blindness or foot amputations.

‘Nutrition transition’

Mexico is a classic example of a country in “nutrition transition.” As the economy improves, people increasingly buy high-calorie ready-made foods, put on weight, and raise their risk for diabetes. Meanwhile, the poorer segments of the population continue to experience high levels of stunting, iron-deficiency anemia and vitamin A deficiency.

This makes obesity a relatively new problem in Mexico, one widely understood to result from the introduction of processed foods – especially sodas – into the Mexican food market.

I could easily see how deeply sodas are embedded in Mexico’s food culture. Sodas were advertised and available everywhere. And they come in enormous three-liter bottles that cost less than the price of bottled water – only 17 pesos ($1.35) each. Clean water is not always available, making sodas the easy choice.

Sodas are cheap because Mexico grows its own sugarcane and sells it at market prices. We, however, artificially support the higher price of U.S. sugar through tariffs and quotas. That’s why our sodas are made with high fructose corn syrup. We subsidize corn production so corn syprup costs less than sugar.

Some people think cane sugar tastes better than high fructose corn syrup, although controlled taste tests don’t always back this up. It’s ironic that U.S. supermarkets now carry, at highly inflated prices, Mexican Coca-Cola sweetened with cane sugar.

Industry efforts to defeat the Mexican soda tax have been ferocious, just as they were in Richmond and El Monte last year. Producers argue that if the tax really does decrease consumption, it will cause hundreds of thousands of jobs to be lost.

I saw a newspaper advertisement from the Mexican Beverage Association that not only attacked the science relating soft drinks to obesity, but extolled the health benefits of sodas: “Sugar is nutritious; it’s a carbohydrate. Carbohydrates are essential for life. Sugar is indispensable for the brain. Soft drinks hydrate and bring energy.”

An ad from the sugarcane industry also threatened job losses – “The tax will generate unemployment and discourage productivity and investment” – and noted that workers and the poor will bear most of its burden.

The big questions

As with any such initiative, the big questions are whether the tax is likely to reduce soda consumption, obesity and diabetes, and whether the revenue will be used for widely beneficial public health purposes. Mexico’s Congress will have to address these questions when it votes on the tax in the weeks ahead.

In the meantime, a coalition of consumer and health groups, in part funded by Bloomberg Philanthropies, has been putting posters in subway stations that illustrate the amounts of sugar in soft drinks. The groups are actively advocating for the soda tax and for using its funds to provide free potable water in schools – something that does not now exist. But TV stations have refused to carry their ads for fear of losing soda advertisers.

Like their U.S. colleagues, Mexican public health authorities are searching for effective ways to reverse obesity trends. Sugary drinks are an easy target. Taxing them might happen despite industry opposition – especially if the funds are earmarked for clean water.

Editor’s notes: Marion Nestle will discuss her new book, “Eat, Drink, Vote: An Illustrated Guide to Food Politics,” with Narsai David at the Commonwealth Club on Oct. 15 at 6 p.m., and at Book Passage in Corte Madera on Oct. 19 at 11 a.m.

She is also receiving the James Beard Foundation Leadership Award for her writing about how science and public policy influence what we eat. The award ceremonies are Oct. 21 at the Hearst Tower in New York.

Marion Nestle is the author of “Eat, Drink, Vote,” “Why Calories Count: From Science to Politics,” “Food Politics” and “What to Eat,” among other books. She is a professor in the nutrition, food studies and public health department at New York University, and blogs at www.foodpolitics.com. E-mail: food@sfchronicle.com

Michele Obama’s Let’s Move! campaign to end childhood obesity within a generation has taken on a new angle: Drink Up.  It issued a press release yesterday urging Americans to drink more water.

The “Drink Up: You Are What You Drink” website explains:

Let me be absolutely clear: I am totally in favor of encouraging kids to drink water.

But:

• Water deficiency is not a public health problem in the United States.  Childhood obesity is the problem.
• Drinking water will only help to counter childhood obesity if it substitutes for sugary sodas.

• Bottled water companies such as Dasani (owned by Coca-Cola) and Aquafina (PepsiCo), and their trade group The American Beverage Association (ABA), are the main supporters of this initiative.
• This makes the message sounds like “drink bottled water,” without much attention to environmental implications.

The ABA’s congratulatory press release says:

Staying hydrated is important to staying in balance, and bottled water provides people with a convenient and popular choice. By supporting this new initiative, our industry is once again leading with meaningful ways to achieve a balanced lifestyle.”

Hydrated?  Not an issue for most people (exceptions—elite athletes, people at high altitude, the elderly).

Bottled water?  In places with decent municipal water supplies, tap water is a much better choice; it’s inexpensive, non-polluting, and generates political support for preserving the quality of municipal water supplies.  See, for example, what Food and Water Watch has to say about bottled water.

James Hamblin’s critical account  in The Atlantic indicates that the press conference must have been tough going.  Sam Kass, White House chef and executive director of Let’s Move! took the questions.

Another reporter: Are we talking about replacing sugary drinks and sodas with water?”

Lawrence Soler, president and CEO of Partnership for a Healthier America, fielded that one. “It’s less a public health campaign than a campaign to encourage drinking more water. To that end, we’re being completely positive. Only encouraging people to drink water; not being negative about other drinks. “

I consider Let’s Move! to be a public health campaign, and a very important one.

Hamblin concludes:

I know we’re just trying to “keep things positive,” but missing the opportunity to use this campaign’s massive platform to clearly talk down soda or do something otherwise more productive is lamentable. Public health campaigns of this magnitude don’t come around every day…Keeping things positive and making an important point are not mutually exclusive, you fools.

My interpretation

Let’s Move! staff have stated repeatedly that they must and will work with the food industry to make progress on childhood obesity.  I’m guessing this is the best they can do. Messages to “drink less soda” (or even “drink tap water”) will not go over well with Coke, Pepsi, and the ABA; sales of sugary sodas are already declining in this country.

I’m thinking that the White House must have cut a deal with the soda industry along the lines of “we won’t say one word about soda if you will help us promote water, which you bottle under lots of brands.”   A win-win.

Isn’t drinking water better than drinking soda?  Of course it is.

But this campaign could have clarified the issues a bit better.  Jeff Cronin, communications director of the Center for Science in the Public Interest circulated a poster created by Rudy Ruiz (of the communications firm Interlex) for a public health campaign in San Antonio:

Public health partnerships with food and beverage companies—especially soda companies—are fraught with peril.   Let’s hope this one conveys the unstated message like the one in San Antonio: My balance is less soda and more tap water.

Other resources

As always, Eddie Gehman Kohan writing at ObamaFoodorama provides a clear, detailed summary of the relevant details along with transcripts of Michele Obama’s remarks at the launch in Watertown, Wisconsin (site of a Pepsi bottling plant, among other things).

Amanda Chin has a good piece in the Huffington Post (I’m quoted).

The FDA has announced that it will be studying the effects of nutrient-content claims on consumers attitudes about food products.

FDA does not encourage the addition of nutrients to certain food products (including sugars or snack foods such as [cookies] candies, and carbonated beverages). FDA is interested in studying whether fortification of these foods could cause consumers to believe that substituting fortified snack foods for more nutritious foods would ensure a nutritionally sound diet.

Here’s one of my favorite examples of what the FDA is talking about.

I’m guessing the FDA’s new research project is a response to increasing pressure from food companies to be allowed to add nutrients to cookies, candies, and soft drinks.

Food marketers know perfectly well that nutrients sell food products.  The whole point of doing so is to be able to make nutrient-content claims on package labels.

The FDA has never been happy about the practice of adding nutrients to junk foods just to make them seem healthy.   Its guidance includes what is commonly known as the “jelly bean rule.”   You may not add nutrients to jelly beans to make them eligible to be used in school lunches.

But this does not stop food manufacturers—especially soft drink manufacturers—from trying.  Hence: Vitamin Water (now owned by Coca-Cola).

Plenty of research demonstrates that nutrients sell food products.  Any health or health-like claim on a food product—vitamins added, no trans fats, organic—makes people believe that the product has fewer calories and is a health food.

As I keep saying, added vitamins are about marketing, not health.

In the Munich subway, Marienplatz station, Coca-Cola ads feature bottles with common German (?) names on the labels, in this case Kevin, Tobias, and Sandra.

At the entrance to the tour of the salt mine in Berchtesgaden (definitely worth the visit), Coke (foreground) and Pepsi (far background) sponsor separate outdoor cafes.

The  NY State Supreme Court, Appellate Division, has turned down the Bloomberg administration’s appeal (New York Statewide Coalition of Hispanic Chambers of Commerce v New York City Dept. of Health & Mental Hygiene).

The court’s decision in this case begins on page 22:

Like Supreme Court, we conclude that in promulgating this regulation the Board of Health failed to act within the bounds of its lawfully delegated authority. Accordingly, we declare the regulation to be invalid, as violative of the principle of separation of powers.

…we find particularly probative the regulation’s exemptions, which evince a compromise of social and economic concerns, as well as private interests. As indicated, the regulatory scheme is not an all encompassing regulation. It does not apply to all FSEs [food service establishments]. Nor does it apply to all sugary beverages. The Board of Health’s explanations for these exemptions do not convince us that the limitations are based solely on health-related concerns (pages 17, 18 of the decision).

OK.  So the city should have made the rule apply to all food service places and all sugary beverages.  Live and learn.

Mayor Bloomberg says the city will appeal:

Since New York City’s ground-breaking limit on the portion size of sugary beverages was prevented from going into effect on March 12^th, more than 2,000 New Yorkers have died from the effects of diabetes. Also during that time, the American Medical Association determined that obesity is a disease and the New England Journal of Medicine released a study showing the deadly, and irreversible, health impacts of obesity and Type 2 diabetes – both of which are disproportionately linked to sugary drink consumption. Today’s decision is a temporary setback, and we plan to appeal this decision as we continue the fight against the obesity epidemic.”

The American Beverage Association is pleased.  It’s headline: “Hey New York – Your Beverage Is Still Your Choice!”

We are pleased that the lower court’s decision was upheld.  With this ruling behind us, we look forward to collaborating with city leaders on solutions that will have a meaningful and lasting impact on the people of New York City.

Even if the city loses the final appeal, the 16-ounce soda cap is the writing on the wall for soda companies.

Sales of full-sugar sodas have been falling for years and getting worse for both Coca-Cola and Pepsi.

Cutting down on the portion sizes of sugary drinks is still a really good idea.

Here’s what the news media say about it:

• Reuters
• The New York Times
• The Wall Street Journal