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JAMA Forum Archive, 2012-2019: Health policy commentary from leaders in the field
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The Influence of “Big Food” Promotes Healthy Profits but not Healthy Consumers

Like many industries, “Big Food”—the business sector that comprises agribusiness, food manufacturers, and marketers for the food industry—aims to expand its profit margins. But it does so at the cost of expanding US waistlines and contributing to high rates of obesity and associated health problems. The industry produces and aggressively markets foods, many marketed as “healthy” or “natural,” that are laden with added sugars, salt, and unhealthful fats, with calories far beyond what are necessary for healthful living.

Lawrence Gostin, JD

(Image: Georgetown University Law Center)

The shift away from fresh, whole foods like fruits and vegetables toward high-caloric diets that feature heavily processed and extensively marketed food products has contributed to obesity rates that have reached historic highs, reaching 37% for 2013-2014. Cancer, diabetes, and cardiovascular disease attributable to unhealthful lifestyles drive up health care costs, decrease productivity, and contribute to human suffering and early death.

The tobacco industry’s deception of consumers and government about tobacco-related health risks is well known. But the food industry influence, which has resources and influence greater than that of Big Tobacco, has largely escaped public notice.

A principal difference between tobacco and food is that there is no safe level of inhaled tobacco products, whereas there are certainly safe levels of virtually all food products.  Food is a necessity of life, but it can also pose health risks.

The food industry has the money to purchase influence with policy makers. In 2013 and 2014, the industry contributed $6 million directly to House and Senate members who sit on committees with food regulation oversight. In 2015, the industry spent $34 million in federal lobbying, not counting lobbying at the state and local level.

When influence is not enough to keep interventions at bay, the food industry uses its considerable resources to litigate against laws or regulations that are likely to be effective in curbing consumption of its products. The industry also has the wherewithal to run mass social marketing campaigns to sway public opinion away from commonsense interventions, using arguments that such interventions are “nanny state” measures that violate “personal choice.” The industry has used its lobbying power to effectively block most consumer litigation against deceptive practices and unhealthful food. The American Legislative Exchange Council, a conservative, industry-financed, think tank, drafted a model law virtually blocking food litigation that has been enacted in nearly half the states.

Here are some of the ways the food industry has infiltrated federal and local decision making to stave off effective public health laws and regulations.

Influencing Nutritional Guidelines

A comparison of the expert report from the Dietary Guidelines Advisory Committee and the 2015 Dietary Guidelines for Americans shows the power of Big Food to influence nutritional guidance. Although the expert committee recommended that US consumers prevent chronic diseases by eating less red meat, the final guidelines included red meat (along with poultry and seafood) as part of a healthful eating pattern. Some progress was made with respect to sugar consumption, with the guidelines recommending that consumers reduce the amount of added sugars in their diets to no more than 10% of daily calories. However, despite the expert group advising reductions in consumption of sugar-sweetened beverages, this recommendation was not included in the guidelines.

According to the Department of Agriculture and the Department of Health and Human Services, the new edition of the guidelines is “grounded in the most current scientific evidence and is informed by the recommendations of the 2015 Dietary Guidelines Advisory Committee.” However, when these agencies reject their own expert committee’s recommendations, it becomes clear that evidence-based public health measures often lose out to the power and influence of the industry.

Financing Shadow Groups

In 2013, then Mayor Michael Bloomberg tried to limit portion sizes of sugary beverages in the city of New York. The food industry surreptitiously financed community-based organizations to oppose the plan, orchestrating a “Nanny Bloomberg” campaign to the amount of $12.9 million. What the public thought were poor, grassroots minority advocacy groups were actually fronts for the beverage industry. To make sure the soda portion size rule never took effect, the industry sued the city, successfully blocking what most public health experts viewed as a major innovation in portion control.

In 2015, Berkeley, California, became the first US jurisdiction to levy an excise tax on sugary drinks. The penny-per-ounce tax generated approximately $700 000 in the first 6 months, which will be used to promote healthier communities. However, a similar proposal in San Francisco was defeated, largely thanks to the American Beverage Association’s $11 million campaign. Recently in Philadelphia, the industry spent $4 million on ads to sway public opinion against a now successful ordinance taxing sugary drinks, which is estimated to bring in $91 million annually. The city of Philadelphia is now bracing for a lawsuit from the industry. All in all, the American Beverage Association has defeated 45 soda tax measures nationwide since 2008, which undoubtedly means millions of undisclosed dollars spent.

Influencing Scientific Research

Reminiscent of tobacco industry practices, food companies fund scientists to conduct research discounting the scientific evidence of harms from sugar, salt, and saturated fats.

A report published in 2015 by the corporate watchdog consulting firm Eat Drink Politics outlined an extensive list of significant financial contributions to the American Society of Nutrition (ASN) and its leadership by industry bodies including McDonald’s, Coca-Cola, and the National Dairy Council. The ASN represents the lead scientific experts in the field of nutrition and is the curator of 3 of the major scientific journals on nutrition, and thus shapes what nutrition research will be published. The potential influence of industry on research is a concern if compromised “evidence” is used to design guidelines and policies.

Consumers are, of course, entitled to make their own choices about what they eat. And government should not legislate what people can and cannot eat or drink. But many consumers live in a world where healthful foods are less available and less affordable, making choosing healthful foods the hard choice. Changing the “default” to healthful food options requires untangling industry’s web of influence. Rather than subsidizing unhealthful foods, tax them and subsidize fruits and vegetables. Rather than allowing deceptive labeling and advertising, demand transparency. Rather than yielding to “food deserts” and fast-food outlets, promote farmers markets and grocery stores.

Consumers deserve appropriate information about the nutritional content of the foods they consume. Evidence-based policies to incentivize more healthful eating and physical activity are a matter of public health and social justice.

About the author: Lawrence O. Gostin, JD, is University Professor and Faculty Director, O’Neill Institute for National and Global Health Law, Georgetown University Law Center, and Director of the World Health Organization Collaborating Center on Public Health Law and Human Rights. His most recent book is Global Health Law (Harvard University Press).
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