The Elephant in the Spoon: Recognizing Food Industry Influence in Nutrition Research

In 2015 Coca-Cola, in association with Mexico’s National Council for Science and Technology, established a yearly $100 000 grant for Mexican scientists.¹ This grant was named after Ruben Lisker, a widely admired clinical researcher who passed away in 2015. The grant review panel includes nine well-established and highly respected Mexican scientists. As Marion Nestle describes in depth in her new book, Unsavory Truth: How Food Companies Skew the Science of What We Eat, Coca-Cola appears to be applying well-known strategies from the industry “playbook” to influence health research. Unsavory Truth’s important contribution is encouraging nutrition and public health professionals to recognize food industry influence and to transparently disclose financial relationships with companies. The book provides some recommendations (although difficult to implement) to manage the impact of industry funding on scientific integrity.

Unsavory Truth: How Food Companies Skew the Science of What We Eat By Marion Nestle

320 pp.; $19.49 New York, NY: Basic Books, 2018 (hardcover) ISBN-10: 9781541697119

Nestle is a New York University emeritus nutrition professor who has spent more than two decades understanding how food industry marketing has influenced people’s food choices. In her book, she takes on a highly personal, timely, and complex problem that nutritional professionals and their professional associations have had difficulty in addressing: the food industry’s funding to advance industry marketing objectives. She is refreshingly honest as she describes her own experience tackling the challenges of engaging with food, beverage, and supplement companies. Her book comes at a time when leaked Coca-Cola e-mails have revealed pressure on reporters writing about the health effects of the company’s products and when Coca-Cola’s funding of university researchers to emphasize the importance of physical activity over diet for weight control has been on the front page of the New York Times.²

In contrast to the pharmaceutical industry’s thoroughly documented research funding to support industry objectives, measuring the impact of industry funding in nutritional research appears to be more difficult. The wide variety of foods, the challenges in measuring diets, and the reliance on observational data (as opposed to randomized experiments) have resulted in a limited literature on the influence of food companies on nutrition research. Nestle brings together examples of research-based food marketing strategies and conflicted nutrition advisory committees and professional societies, and she describes efforts to manage conflicts of interest in nutritional research.

THE INDUSTRY PLAYBOOK

In Unsavory Truth, we learn how food companies fund research designed to be favorable to their interests and influence the interpretation of science, translation of science into policy, and education through advisory committees and nutrition societies. In addition to Coca-Cola, candy companies and meat, dairy, and even “healthy food” producers all use elements of the playbook: attack the science, fund research to advance company products, offer gifts for influence, use front groups, promote self-regulation and personal responsibility, and challenge critics and regulations in the courts.

The most salient example of this type of “marketing research” is Coca-Cola’s initially undisclosed funding of the Global Energy Balance Network (today Coca-Cola’s $140 million research funding and partnership portfolio is publicly available).³ This research network was aimed at advancing the message that obesity is the result of lack of physical activity and not diet (and, most important, not soft drinks). The health food industry’s example of these tactics is pomegranate, a “superfood.” As Nestle reminds us, the term is nutritionally meaningless, yet it is a highly effective advertising concept. POM Wonderful invested $35 million in research to support claims that its products prevent several diseases (including erectile dysfunction). Federal authorities found that evidence from POM-funded peer-reviewed publications (at least 70) was insufficient and that some of the company’s health claims were false. POM sued the federal authorities (and lost), and the company now uses more moderate language in its ads.

CONFLICTS OF INTEREST

The food industry appears to also affect how nutritional research is translated into policy. The US Dietary Guidelines Advisory Committee reviews scientific evidence to formulate nutrition policies. Actual guidelines are written by federal agencies (which may be subject to industry lobbying), and committee appointees often consult with, do research for, or work for the food industry. However, when the 2015 US guidelines advised eating less sugar, the industry-funded International Life Sciences Institute sponsored a review concluding that the guidelines on sugar were not trustworthy.⁴

Nestle ends the first half of her book with examples of how food industry sponsorship by the American Society of Nutrition and the Academy of Nutrition and Dietetics has resulted in public health positions that favor industry interests and marketing endorsements. Smart Choices, an American Society of Nutrition program endorsed by the food industry, identified Froot Loops, a highly processed children’s cereal, as a healthy food option via a stamp on the front of the cereal package. Public uproar resulted in postponement of the program.

Nestle is not a detached observer. She describes awkward situations involving her own interactions with the food industry, her discomfort with travel and honoraria sponsored by the industry, and her efforts to minimize industry influence (reminding us that, in contrast to many of her colleagues, her salary and research stipend are guaranteed). Throughout the book, Nestle presents evidence of how industry-funded research is often favorable to the industry and suggests that industry-sponsored scientists are subject to unconscious funding effects that support positive results. Most professional journals ask authors and reviewers to disclose financial ties with industry. However, disclosure of conflicts does not preclude publication, is often incomplete, and may provide the impression that bias issues have been resolved. Scientists voluntarily reveal funding sources but often do not recognize that the funding represents a conflict of interest.

Nestle suggests that the nutrition community be more forthcoming in recognizing that public health and industry have different goals, that industry payments affect research results, and that transparency does not solve the problem. She describes initial attempts to effectively manage conflicts of interest by clearly articulating principles for engaging with the food industry. It remains to be seen whether such principles will be acceptable to industry.

Similar to many other middle-income countries, Mexico has an obesity epidemic (with a 72% prevalence of overweight or obesity).^5,6 In 2014, the country’s government placed a tax on sugary beverages. Government research funds in Mexico have become scarcer, and institutions actively encourage industry partnerships. The Mexican Academy of Sciences is now a partner in the Lisker Award, and Coca-Cola Mexico is directly funding research on the genetics of obesity and diabetes.¹ In a recently published paper by a Lisker awardee, Coca-Cola was not identified as the funder (although the Lisker prize was mentioned), and there was no recognition of a potential conflict of interest.⁷ Also, in contrast with the company’s pledge in the United States to financially support research only if a non–Coca-Cola entity funds at least 50% of the cost, Coca-Cola funds 100% of the Lisker Award (https://bit.ly/2IECCWQ).

Policymakers and researchers in middle-income countries should recognize that industry funding may be more influential in limited-resource settings. And even for basic research questions for which food company interests may seem more aligned with those of public health, industry investment in research may not be innocuous and will inevitably define the research agenda.

UNANSWERED QUESTIONS

Unsavory Truth ends by asking the following questions: Should food companies fund nutrition research? Should nutrition scientists and their professional societies accept industry funding? What should universities and nutrition journals do to protect their scientific integrity? How should one address these matters? The answers are not easy. However, these are questions that anyone involved in nutrition research should continue asking.