by Marion Nestle

Search results: global energy balance network

Feb 17 2016

The strange story of my accepted but then unpublished commentary on a Disney-sponsored study

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

Jan 6 2016

Viewpoint: Food-industry Funding of Food and Nutrition Research

My latest Viewpoint, “Corporate funding of food and nutrition research: science or marketing,” was published yesterday in JAMA Internal Medicine 2016;176 (1):13-14.  doi:10.1001/jamainternmed.2015.6667.

The longstanding influence of food industry funding on nutrition research, researchers, and professional societies1 threatens the credibility of nutrition science. So much research is sponsored by industry that health professionals and the public may lose confidence in basic dietary advice. Although most journals now require authors to disclose who pays for their work, disclosure—even done diligently—is not sufficient to alert readers to the extent to which industry funding influences research results and professional opinion. As is well established from experimental and observational research, drug company gifts and grants can have substantial effects. To recipients, however, these effects are almost always unconscious, unintentional, and unrecognized, making them especially difficult to prevent.

Medical schools and medical journals have increased efforts to minimize and manage conflicts of interest with industry. But from my observations, nutrition researchers, journals, and professional societies, like medical researchers, often fail to realize that food-industry funding may affect their work and its credibility.

Two recent investigative articles in the New York Times illustrate the concerns about biases introduced by industry funding. The first3 described the support by Coca-Cola of academic researchers who founded a new organization, the Global Energy Balance Network, to promote physical activity as a more effective method than calorie control (eg, from avoiding sugary sodas) for preventing obesity. The second4 analyzed emails obtained through open-records requests to document how Monsanto, the multinational agricultural biotechnology corporation, on the one hand, and the organic food industry, on the other, recruited professors to lobby, write, and testify to Congress on their behalf.

Both articles3,4 quoted the researchers named in these reports as denying an influence of industry funding and lamenting the paucity of university research funds and the competitiveness of federal grants. Despite leaving their organizations open to accusations that they have sold out to industry,5 officers of nutrition research societies tell me that they cannot function without industry funding of journals and conferences. They have a point. Although the investment by federal agencies in food and nutrition research has increased steadily since the early 1990s, US Department of Agriculture grants are diminishing, and the National Institutes of Health are funding fewer researchers at state agricultural colleges. Investigators have a hard time obtaining grants for projects related to food composition, food technology, nutrients, and nutrient metabolism as federal agencies have understandably shifted priorities toward research on obesity, genetics, and chronic diseases.6

Food companies, such as Quaker Oats, used to support basic research conducted by in-house scientists, but Unilever and Nestlé (no relation) are among the very few companies that continue to do so. Instead, food companies outsource research, much of which can appear as designed for marketing purposes. Recently, in preparation for what I intend to be a more systematic analysis of corporate funding of nutrition research, I began collecting a convenience sample of studies funded by food and beverage companies or trade associations as they appear in journals I happen to be reading. I sort them by whether their results do or do not favor the interests of the sponsor, and post examples online at my blog, https://foodpolitics.com.7

Between March and October 2015, I identified 76 industry-funded studies. Of these, 70 reported results favorable to the sponsor’s interest. Despite ongoing requests to readers of my blog to help me identify funded studies reporting results contrary to a funder’s interest, I have found only 6.  [Note: Since writing this, the score has gone to 90:9.] This discrepancy is consistent with the results of systematic investigations of industry sponsorship, such as one on the role of sugar-sweetened beverages in obesity.8 In general, independently funded studies find correlations between sugary drinks and poor health, whereas those supported by the soda industry do not.9 In the studies I collected, companies or trade associations promoting soft drinks, dairy foods, eggs, breakfast cereals, pork, beef, soy products, dietary supplements, juices, cranberries, nuts, and chocolates supported the study itself, the investigators, or both. These studies all found significant health benefits or lack of harm from consuming the foods investigated, results that can be useful for deflecting criticism of a company or promoting its products.

Mars Inc, for example, the maker of chocolate candies such as M&Ms, funds studies on the effects of cocoa flavanols on arterial function and blood pressure. One such study, published in September 2015,10(p1246)concluded that these compounds “improved accredited cardiovascular surrogates of cardiovascular risk, demonstrating that dietary flavanols have the potential to maintain cardiovascular health even in low-risk subjects.” The study investigators,10 one of whom is employed by Mars, followed well-established scientific protocols in conducting the research. Science is not the issue here. Marketing is the issue. The question is why Mars would fund a study like this and assign one of its employees to help design and write it. In this instance, the answer is obvious. Mars issued a press release “Cocoa flavanols lower blood pressure and increase blood vessel function in healthy people,” and noted these results in a full-page advertisement in the New York Times on September 27, 2015, Neither the press release nor advertisement explained that cocoa flavanols are largely destroyed during all but the most careful processing of chocolate, nor did they mention chocolate at all. They didn’t have to. Uncritical readers are likely to interpret the statements as evidence that chocolate is good for them and that its sugar and calories can be ignored.

The second New York Times article4 raised more insidious concerns about industry involvement with scientists, using Monsanto and organic food companies as cases in point. Although both industries recruit scientists to speak on their behalf, Monsanto has far greater resources. In 1994, I was a member of the Food Advisory Committee to the US Food and Drug Administration (FDA) when that agency approved genetically modified (GM) foods. I observed how Monsanto-funded scientists convinced the FDA that labeling GM foods would be misleading.

Confronted with increasing public support for labeling foods that are produced with GM ingredients, the biotechnology industry supported—and the House of Representatives passed—H.R. 1599 in July 2015. This bill, expected to be considered by the Senate before the end of 2015, has the Orwellian title, “The Safe and Accurate Food Labeling Act,” but some critics call it the “Denying Americans the Right to Know (DARK) Act.” Proposed by Representative Mike Pompeo (Kansas) on the basis that GM foods are safe and, therefore, acceptable, the act would block states from enacting labeling laws (as Vermont has already done) and permit GM foods to be labeled as “natural.” Opponents question the safety of GM foods. But they also raise additional reasons for full transparency in labeling—patents, control of seed stocks, the widespread application of chemical herbicides to GM crops, and the increasingly widespread resistance of weeds to those herbicides. When evaluating conflicting scientific and policy arguments about GM foods, it is useful to know who funds the researchers and their studies.

Should nutrition researchers and professional societies accept funding from food companies? Not without careful thinking. It’s time that food and nutrition researchers and societies recognize the influence of food-industry sponsorship, take steps to control its effects, and ensure that sponsored studies promote public health, not the marketing of food products. Journal editors should ensure that editors and members of editorial boards are free of industry conflicts, require peer reviewers to note food-industry funding in manuscript evaluations, and be wary of accepting industry-funded publications with evident commercial implications. If food companies and trade associations want to fund research, they should consider pooling resources and setting up an independent foundation to administer the grants. Everyone involved in this system should be doing everything possible to advocate for more research funds from federal granting agencies. Nothing less than the credibility of nutrition research and advice is at stake.

REFERENCES

1 Nestle  M. Food Politics: How the Food Industry Influences Nutrition and Health.3rd ed. Berkeley: University of California Press; 2013.
2 Lo  B, Field  MJ, eds. Conflict of Interest in Medical Research, Education, and Practice. Washington, DC: National Academies Press; 2009.
3 O’Connor  A. 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/?_r=0. Accessed October 22, 2015.
4 Lipton  E. Food industry enlisted academics in G.M.O. lobbying war, emails show. New York Times. September 5, 2015. http://www.nytimes.com/2015/09/06/us/food-industry-enlisted-academics-in-gmo-lobbying-war-emails-show.html. Accessed October 22, 2015.
5 Simon  M. Nutrition scientists on the take from Big Food: has the American Society for Nutrition lost all credibility? June 2015. http://www.eatdrinkpolitics.com/wp-content/uploads/ASNReportFinal.pdf. Accessed October 22, 2015.
6 Toole  AA, Kuchler  F. Improving health through nutrition research: an overview of the U.S. nutrition research system. Econ Res Rep No. 182. January 2015.http://www.ers.usda.gov/media/1760111/err-182.pdf. Accessed October 27, 2015.
7 Nestle  M. Food Politics blog. https://foodpolitics.com. Accessed October 27, 2015.
8 Lesser  LI, Ebbeling  CB, Goozner  M, Wypij  D, Ludwig  DS.  Relationship between funding source and conclusion among nutrition-related scientific articles. PLoS Med. 2007;4(1):e5. PubMed   |  Link to Article
9 Massougbodji  J, Le Bodo  Y, Fratu  R, De Wals  P.  Reviews examining sugar-sweetened beverages and body weight: correlates of their quality and conclusions. Am J Clin Nutr. 2014;99(5):1096-1104. PubMed   |  Link to Article
10 Sansone  R, Rodriguez-Mateos  A, Heuel  J,  et al; Flaviola Consortium, European Union 7th Framework Program.  Cocoa flavanol intake improves endothelial function and Framingham Risk Score in healthy men and women: a randomised, controlled, double-masked trial: the Flaviola Health Study. Br J Nutr. 2015;114(8):1246-1255. doi:10.1017/S0007114515002822PubMed   |  Link to Article

ARTICLE INFORMATION

Corresponding Author: Marion Nestle, PhD, MPH, Department of Nutrition, Food Studies, and Public Health, New York University, 411 Lafayette, Fifth Floor, New York, NY 10003-7035 (marion.nestle@nyu.edu).

Published Online: November 23, 2015. doi:10.1001/jamainternmed.2015.6667.

Conflict of Interest Disclosures: Dr Nestle’s salary from New York University 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 Viewpoint.

Dec 23 2015

Five more industry-sponsored studies with results favorable to the sponsor. The score since mid-March: 95:9

Systematic Review of Pears and Health. Holly Reiland, BS Joanne Slavin, PhD, RD.  Nutrition Today November/December 2015 – Volume 50 – Issue 6 – p 301–305.  doi: 10.1097/NT.0000000000000112.  

  • Conclusions: Animal studies with pears suggest that pears may regulate alcohol metabolism, protect against ulcers, and lower plasma lipids. Human feeding studies with pears have not been conducted. In epidemiological studies, pears are combined with all fresh fruits or with apples, because they are most similar in composition. The high content of dietary fiber in pears and their effects on gut health set pears apart from other fruit and deserves study.
  • Funding: The authors received a grant from USA Pears in the past. The authors provided their own funding to allow this article to publish as Open Access.
  • Comment: Pears are a great fruit but the marketing purpose of this study is evident from this press release from the Pear Bureau Northwest: “While the body of evidence connecting pear intake and health outcomes is still limited, USA Pears has been contributing to research efforts by commissioning independent studies to learn and affirm the heath attributes of pears. Visit www.usapears.org for additional pear research, nutrition resources and recipes.”

Whole Grain Intakes in the Diets Of Malaysian Children and Adolescents – Findings from the MyBreakfast Study.  Norimah AK , H. C. Koo, Hamid Jan JM, Mohd Nasir MT, S. Y. Tan, Mahendran Appukutty, Nurliyana AR, Frank Thielecke, Sinead Hopkins, M. K. Ong, C. Ning, E. S. Tee.  PLoS ONE 10(10): e0138247. doi:10.1371/journal.pone.0138247

  • Conclusion: Whole grain is consumed by only a minority of Malaysian children and adolescents and even among consumers, intakes are well below recommendations. Efforts are needed to firstly understand the barriers to whole grain consumption among Malaysian children in order to design effective health promotion initiatives to promote an increase in whole grain consumption.
  • Funding: The Nutrition Society of Malaysia received an unrestricted research grant from Cereal Partners Worldwide, Switzerland and Nestleé R&D Center, Singapore. This financial support was provided in the form of salaries for authors but the funders did not have any additional role in the study design, data collection and analysis or decision to publish. Frank Thielecke was an employee of Cereal Partners Worldwide at the time this study was conducted. He now works for Nestec SA. Sinead Hopkins is employed by Cereal Partners Worldwide (CPW), Switzerland and Moi Kim Ong and Celila Ning are employed by Nestleé R&D Center, Singapore….Nestlé and Cereal Partners Worldwide have a commercial interest in breakfast cereals.
  • Comment: I learned about this study from a comment on Retraction Watch, which reported that PLoS One had filed a correction to the funding section.  The correction says that the salaries were for research assistants, not authors.

Walnuts Consumed by Healthy Adults Provide Less Available Energy than Predicted by the Atwater Factors.  David J Baer*, Sarah K Gebauer, and Janet A Novotny. J Nutrition First published November 18, 2015, doi: 10.3945/​jn.115.217372.

  • Conclusion: Consistent with other tree nuts, Atwater factors overestimate the metabolizable energy value of walnuts. These results could help explain the observations that consumers of nuts do not gain excessive weight and could improve the accuracy of food labeling.
  • Funding: This research was funded by the USDA and the California Walnut Commission… DJ Baer was funded by the USDA and the California Walnut Commission.

Cardiorespiratory Fitness, Body Fatness, and Submaximal Systolic Blood Pressure Among Young Adult WomenPrasad Vivek Kumar, Drenowatz Clemens, Hand Gregory A., Lavie Carl J., Sui Xuemei, Demello Madison, and Blair Steven N.  Journal of Women’s Health, 2015 ahead of print. doi:10.1089/jwh.2015.5307.

  • Conclusion: CRF, BF%, and BMI seem to have critical roles in determining SSBP with CRF and BF% being more potent at lower intensity exercise, whereas BMI was more strongly associated at higher intensity exercise.
  • Funding for this project was provided through an unrestricted grant from The Coca-Cola Company. The sponsor played no role in the study design, data collection, analysis, and interpretation, or preparation and submission of this article. The authors thank the Energy Balance staff and study participants for their contributions. No competing financial interests exist. 
  • Comment: This is one of the papers produced by participants in the now defunct Global Energy Balance Network formerly sponsored by Coca-Cola.

Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including metaanalyses, of the evidence from human and animal studies. PJ Rogers, PS Hogenkamp, C de Graaf , S Higgs , A Lluch , AR Ness , C Penfold , R Perry , P Putz , MR Yeomans and DJ Mela.  International Journal of Obesity advance online publication, 10 November 2015; doi:10.1038/ijo.2015.177

  • Conclusion¨The preponderance of evidence from all human randomized controlled trials indicates that LES [low-energy sweeteners] do not increase EI [energy intake] or BW [body weight], whether compared with caloric or non-caloric (for example, water) control conditions. Overall, the balance of evidence indicates that use of LES in place of sugar, in children and adults, leads to reduced EI and BW, and possibly also when compared with water.
  • Conflict: This work was conducted by an expert group of the European branch of the International Life Science Institute (ILSI Europe). The expert group received funding from the ILSI Europe Eating Behaviour and Energy Balance Task Force. Industry members of this task force are listed on the ILSI Europe website at www.ilsi.eu.
  • Comment: ILSI is funded by food companies.
Dec 22 2015

Coca-Cola reveals who it funds in England—organizations, researchers, other individuals

Last Friday, Coca-Cola UK joined its US counterpart in revealing the names of the organizations, researchers, and individuals it funds and the amounts it pays for these services.

As Jon Woods, General Manager of Coca-Cola Great Britain and Ireland, explains:

Earlier this year, my colleagues in the US published a list of the health and wellbeing partnerships, research and individuals funded there, dating back to 2010. In October, I committed to do the same and today we have published the details of what we have funded in Great Britain.  I believe this is the right thing to do…The total amount of funding we have provided in GB since 2010 is £9,328,095.

Like the US list, which has been analyzed extensively by Ninjas for Health, this one is interesting to read.

Here is a small sample from the list of organizations:

  • Biotechnology and Biological Sciences Research Council — £20,000
  • British Dietetic Association — £5,600
  • British Feeding & Drinking Group Annual Meeting — £1,200
  • British Nutrition Foundation — £33,000

A sample from the list of scientists and other individuals (not otherwise identified, alas):

  • Fiona Hunter
  • Prof. Ken Fox
  • Lynne Garton
  • Dr. Geoffrey Livesey
  • Dr. Sigrid Gibson
  • Dr. David Haslam
  • Prof. Marion Hetherington
  • Penny Hunking
  • Angie Jefferson
  • Prof. Ian Macdonald

I’m sure British public health advocates will have fun looking up what these people have said about sugary drinks and obesity.

The Times of London explained who some of them are:

The advisers include Stuart Biddle, of Loughborough University, who was chairman of a health department group on obesity in 2010; Alan Boobis, a director at Public Health England, who stopped receiving funding in 2013; Ken Fox, who advised the government on obesity in 2009; and Carrie Ruxton, now on the board of Food Standards Scotland. In 2010 Dr Ruxton co-wrote a study sponsored by the UK Sugar Bureau, an industry group, that found no proven association between sugar intake and obesity.

According to Der Spiegel, Coca-Cola plans to reveal everyone it sponsors in Europe.  All of this is further fallout from August’s New York Times’ revelations of Coca-Cola sponsorship of the now defunct Global Energy Balance Network.

More to come, no doubt.  Stay tuned.

Dec 7 2015

Another five sponsored studies with expected results. The score: 85:6.

These are coming in so quickly that I am having a hard time keeping up with them.  Note that the first three are sponsored by Coca-Cola and that some of the investigators were involved with the ill-fated Global Energy Balance Network, now defunct.  As we now know from the e-mails obtained by the Associated Press, the statement that “the sponsor played no role…” is not necessarily correct.

As for the score: since mid-March, I have collected 85 sponsored studies with results just as the sponsor wanted, versus 6 with results that must have disappointed.  But stay tuned: tomorrow I will post 3 more in the disappointing category.

Low levels of physical activity are associated with dysregulation of energy intake and fat mass gain over 1 yearRobin P Shook, Gregory A Hand, Clemens Drenowatz, James R Hebert, Amanda E Paluch, John E Blundell, James O Hill, Peter T Katzmarzyk, Timothy S Church,11 and Steven N Blair.  Am J Clinical Nutrition November 11, 2015 as doi: 10.3945/ajcn.115.115360.

  • Conclusions: These results suggest that low levels of physical activity are a risk factor for fat mass gain. In the current sample, a threshold for achieving energy balance occurred at an activity level corresponding to 7116 steps/d, an amount achievable by most adults.
  • Funding: Supported by an unrestricted research grant from The Coca-Cola Company.

Association between cardiorespiratory fitness and submaximal systolic blood pressure among young adult men: a reversed J-curve pattern relationship. Vivek K. Prasada, Clemens Drenowatza, Gregory A. Handb, Carl J. Laviec, Xuemei Suia, Madison Demelloa, and Steven N. Blair.  Journal of Hypertension 2015, 33:2239–2244.

  • Conclusions: There was a reverse J-curve pattern relationship between SSBP [submaximal systolic blood pressure] and CRF [cardiorespiratory fitness], with the lowest SSBP among men with fair or good CRF and highest among those with poor CRF.
  • Funding: Funding for this project was provided through an unrestricted grant from The Coca-Cola Company. The sponsor played no role in the study design, data collection, analysis and interpretation, or preparation and submission of this manuscript.

Relation of Body’s Lean Mass, Fat Mass and Body Mass Index with Submaximal Systolic Blood Pressure Among Young Adult MenVivek K. Prasad, MD, MPH, PhD, Clemens Drenowatz, PhD, Gregory A. Hand, PhD, Carl J. Lavie, MD, Xuemei Sui, MD, MPH, PhD, Madison Demello, MS, Steven N.Blair.  Am J Cardiology 2015 DOI: 10.1016/j.amjcard.2015.10.060 .

  • Conclusion: there was a J curve pattern between SSBP [submaximal systolic blood pressure] and components of body composition whereas, a linear relation between SSBP and BMI.
  • Funding: Funding for this project was provided through an unrestricted grant from the Coca-Cola Company. The sponsor played no role in the study design, data collection, analysis, and interpretation,or preparation and submission of this manuscript.

Sugar- and artificially sweetened beverages and intrahepatic fat: A randomized controlled trial. Vanessa Campos, Camille Despland, Vaclav Brandejsky, Roland Kreis, Philippe Schneiter, Arnaud Chiolero, Chris Boesch and Luc Tappy.  Obesity Volume 23, Issue 12, pages 2335–2339, December 2015.

  • Conclusion: In subjects with overweight or obesity and a high SSB intake, replacing SSB with ASB decreased intrahepatic fat over a 12-week period.
  • Disclosure:  LT received research support from Nestlé SA, Switzerland, and Ajinomoto Co Inc, Japan, for studies unrelated to this work and speaker’s honoraria from Nestlé SA, Switzerland, Ferrero, Italy, and C3 collaborating for health, UK. The other authors declared no conflict of interest.

Probiotic supplementation attenuates increases in body mass and fat mass during high-fat diet in healthy young adults. Kristin L. Osterberg, Nabil E. Boutagy, Ryan P. McMillan, Joseph R. Stevens, Madlyn I. Frisard, John W. Kavanaugh, Brenda M. Davy, Kevin P. Davy and Matthew W. Hulver.  Obesity Volume 23, Issue 12, pages 2364–2370, December 2015.  DOI: 10.1002/oby.21230.

  • Conclusion: VSL#3 [the probiotic] supplementation appears to have provided some protection from body mass gain and fat accumulation in healthy young men consuming a high-fat and high-energy diet.
  • Funding agencies: This study was funded by VSL Pharmaceuticals, Inc.
  • Disclosure: The authors declared no conflict of interest.
Dec 3 2015

The soda industry is having a very bad month: a roundup of events

It’s been a tough month for the soda industry.

  • Yesterday, members of Mexico’s Nutritional Health Alliance held a press conference to complain that a Coca-Cola Christmas television ad violated the human rights of the indigenous people of the Mixe community of Totontepec.

    The ad, released by Coca-Cola in late November on social media as part of its “OpenYourHeart” Christmas advertising campaign shows young people who are outsiders to the Mixe indigenous community arriving to build a Christmas tree of wood and Coca-Cola bottle caps, distributing Coca-Cola to young people from the community and transmitting the message “Stay United” in the Mixe language.

    Coca-Cola removed the ad from its social media channels, but you can watch a version produced by the Alliance in which Mixe youth comment on the ad. The Alliance also has produced a translation.

Al Jazeera produced a video analysis.

  • On November 6, the New York Times reported that the University of Colorado was returning a million dollar grant that had paid for the Global Energy Balance Network (GEBN), the group funded by Coca-Cola that said you didn’t need to worry about what you ate as long as you were active.
  • On November 24, AP reporter Candice Choi published e-mails between the U. Colorado scientist behind the GEBN.  These revealed that “Coke helped pick the group’s leaders, edited its mission statement and suggested articles and videos for its website.”
  • Coca-Cola’s chief scientist, Rhona Applebaum, immediately resigned.
  • On November 29, Helena Bottemiller Evich wrote in Politico how health advocates are running endless campaigns for so taxes, and that these will soon be coming to a polling place near you.
  • On November 30, the UK’s Commons Health Committee called for a 20% tax on sugar-sweetened beverages.
  • On December 1, the GEBN closed shop as a result of loss of funding.
  • This week’s issue of The Lancet Diabetes and Endocrinology contains an opinion piece by U North Carolina professor Barry Popkin and Corinna Hawkes of City University London arguing that the world is eating too much sugar and that changes in policy are needed to encourage reduced consumption of sugary drinks.  According to Politico Morning Agriculture, the American Beverage Association (ABA) is most unhappy about the piece.  It claims that the prevalence of obesity and diabetes are rising but soft drink sales are falling in the U.S., saying “This proves that beverages are not driving these epidemics.”  [Comment: as I discuss in Soda Politics, only half the population drinks sugary beverages meaning that those who do drink them drink a lot.  Also, diabetes rates are falling in the U.S.]
  • The ABA won a battle in San Francisco, but is surely losing the public relations war.  It sued the city over a Board of Supervisors ban on ads for sugary drinks on city property and requiring warning labels on all billboards and other surfaces within the city.  The ABA argued that both laws violate the First Amendment.  You might think this argument would get thrown out of court immediately, but you would be wrong, as the Supreme Court is becoming more hostile to such laws.  If you want to hear how the Board of Supervisors reacted to this, click here for the meeting transcript. (thanks to Politico Morning Agriculture for this item too and to Michele Simon for clarifying the legal issues).

I keep getting asked “why pick on sodas?”  The answer: they are an easy target, low-hanging fruit in public health terms.  They contain sugars but nothing else of redeeming nutritional value, are strongly associated with diets that raise the risk of obesity and its consequences, and are heavily marketed as what you need to be happy.  The industry is fighting hard and on many fronts to maintain sales.  Advocates are keeping its lawyers and lobbyists busy.

All this was just in the last month.  Expect more to come.

Nov 25 2015

A retraction and apology

The Journal of Public Health Policy (JPHP) will soon announce the retraction of a Viewpoint—an opinion piece—I co-authored with a Guatemalan physician, Dr. Joaquin Barnoya, “The food industry and conflicts of interest in nutrition research: A Latin American perspective.” Because of factual errors in the piece, and in response to valid objections about the errors from its subjects, they and we requested its retraction and JPHP is doing so.

I believe it is useful to explain how this happened.  In late summer, Dr. Barnoya brought to my attention an advertorial, a sponsored news account, published in el Periódico and other Guatemalan newspapers announcing an alliance among the Central American Bottling Corporation (cbc), the largest beverage distributor in Guatemala and bottler for PepsiCo; the Guatemala-based Institute of Nutrition of Central America and Panama (INCAP); and the U.S.-based Shalom Christian Foundation to distribute a supplemental food product, Mani+, to chronically malnourished children in rural areas (here is a translation of the advertorial).  Mani+ is a sweetened, peanut-based, nutrient-fortified supplemental food made from local ingredients in Guatemala, used to prevent malnutrition in young children.  The advertorial displayed a photograph of the directors of the three organizations holding the agreement.  It also displayed statements from all three directors emphasizing the alliance’s importance in addressing childhood malnutrition.

As readers of this blog should know, I have long been concerned about the conflicts of interest that arise when food companies—especially soda companies—enter into alliances with public health organizations.   The New York Times made the consequences of such alliances clear in its recent revelations of Coca-Cola sponsorship of the Global Energy Balance Network and the fallout from those revelations.  The announced alliance between cbc and INCAP raises similar concerns, particularly in the light of more general food industry partnerships with research and health institutions in Latin America.  Our intention in writing the Viewpoint was to question the appropriateness of this alliance, as well as of other such partnerships and alliances.

We should, however, have exercised more care.  Shortly after publication of the Viewpoint, Carolina Siu Bermúdez, the director of INCAP who appears in the advertorial, wrote to object that our piece incorrectly implied a financial relationship with cbc, and that Dr. Barnoya had failed to disclose that INCAP paid a substantial portion of his salary via a grant from yet another organization.  We also received letters from Dr. Edward Fischer, the founder of NutriPlus/Mani+, Professor of Anthropology and Director of the Center for Latin American Studies at Vanderbilt University, objecting to our statement that the alliance was responsible for manufacturing (rather than just distributing) the product.   Both asked us to retract the Viewpoint.

Upon investigation, we realized their objections had merit.  Indeed, further investigation by us and by the editors of the JPHP exposed additional errors.  Together, these include the following clarifications and corrections:

  • The alliance is involved only in the distribution of Mani+, not its manufacture (as we had asserted).
  • The actual nature of the alliance between cbc, INCAP, and the Shalom Christian Foundation—who does what—is, in fact, unclear. The Viewpoint should have characterized the relationship with less certainty and specified that cbc has no financial relationship with either INCAP or the Foundation.
  • Dr. Barnoya should have disclosed his financial relationship with INCAP, and I should have insisted that he do so.
  • The Viewpoint was triggered by the advertorial, and we should have made this connection more explicit.
  • The reference in the Viewpoint to the advertorial is incorrect. It is listed as (2015) cbc co. Unidos contra la desnutricion. INCAP, cbc y Fundacion Crisitiana Shalom Firman Convenio 23(July): 9.  The correct reference is Alianza Contra la Desnutricion. elPeriódico. July 23, 2015;Advertorial: 9.

To correct and clarify these issues, we would need to revise the Viewpoint.  Doing so, however, is not possible once a paper is published.  That left us no choice but to request a retraction, which I believe is the right course of action in this situation.

In my books and other writing, I try as hard as I can to be precise and accurate.  This incident is a lapse that I regret deeply, for which I take responsibility, and for which I apologize to Carolina Siu Bermúdez, to Dr. Fischer, and to my readers.  I also apologize to Phyllis Freeman and Anthony Robbins, the editors of JPHP, and to Lucy Wheeler of Palgrave, who have set an exemplary standard of ethics and integrity throughout these investigations and discussions.

As for lessons learned: Although I fully intend to continue to write critically about alliances between food companies and public health organizations, I also intend to use this experience to recommit myself to accountability and to diligence in checking and double-checking facts and disclosures going forward.   Again, my deepest apologies.

Addition, December 14: The actual retraction notice is published here.  The discussion on Retraction Watch is here.

Aug 20 2015

Muhtar Kent, Coca-Cola’s CEO, and scientist Steven Blair respond to critics

Coca-Cola, in case you missed the furor over last week’s New York Times article, has a huge public relations problem.

The damage control begins today with Coke’s CEO’s op-ed in the Wall Street Journal:

Our company has been accused of shifting the debate to suggest that physical activity is the only solution to the obesity crisis. There also have been reports accusing us of deceiving the public about our support of scientific research…I am disappointed that some actions we have taken to fund scientific research and health and well-being programs have served only to create more confusion and mistrust. I know our company can do a better job engaging both the public-health and scientific communities—and we will.

By supporting research and nonprofit organizations, we seek to foster more science-based knowledge to better inform the debate about how best to deal with the obesity epidemic. We have never attempted to hide that. However, in the future we will act with even more transparency as we refocus our investments and our efforts on well-being.

He promises that the company will:

• Publish on our website a list of our efforts to reduce calories and market responsibly, along with a list of health and well-being partnerships and research activities we have funded in the past five years, which we will continue to update every six months.

• Charter and recruit an oversight committee of independent experts to advise and provide governance on company investments in academic research.

• Engage leading experts to explore future opportunities for our academic research investment and health and well-being initiatives.

Personally, I can’t wait to see the list of Coke-funded research activities.  Want to bet how many of those studies came out with results that Coca-Cola can use to claim that sugary drinks have no effect on obesity or type 2 diabetes?  I’d also like a count of the number of studies Coca-Cola has funded to cast doubt on the National Health and Nutrition Examination Survey, the country’s major dietary monitoring program, which has the annoying habit of linking sugary drinks to those conditions.

Mr. Kent ends his piece with this plea:

As we continue to learn, it is my hope that our critics will receive us with an open mind. 

Unless Coca-Cola stops pouring millions of dollars into fighting soda caps and taxes, stops targeting its marketing to minorities, and stops lobbying against public health measures to help people eat more healthfully, keeping Mr. Kent’s version of an open mind will be difficult. 

Steven Blair, one of the scientists involved in Coke-funded research, posted this statement today:

I have asked that my video addressing energy balance be taken down from the GEBN website. I regret that a statement I made in this video has been used by some to brand GEBN as a network focusing only on physical activity. This is not true and never has been true. From the beginning the mission of GEBN has been to study the science of energy balance which involves both diet and physical activity. GEBN has some of the top nutritionist experts in the world who have published research showing the importance of diet and in particular of soda consumption in causing obesity. My dismissal of diet as a cause of obesity did a disservice to their work. I hope many of you can relate to feeling so passionate about an issue that you say some things that you later regret. I believe that both diet and physical activity are important in obesity and that we must address both together to help people achieve healthy weights. I look forward to working with other GEBN researchers to do this.

James Hill, another of the scientists involved in this fiasco, also has issued a statement.  When it becomes public, I will post a link to it.

Additions, August 21