How the ultra-processed food industry uses scientific research to undermine public policy, shift the focus and promote consumer habits
“We really thought that it would be possible to reach a good solution,” said Simón Barquera. A few weeks before, we saw his name in connection with the Latin American Scientific Committee of the Choices International Foundation, an organization created by the food industry to avoid warnings on front-of-pack labelling about (high) salt, fat and sugar content.
And we were surprised: Simón, Director of Mexico’s National Public Health Institute, is one of the leading names in Latin America in the field of obesity and chronic diseases and associate editor of the Public Health Nutrition. He is also a spokesperson for advocates of strong measures to control the effects of large companies on our lives.
“As one might imagine, there was no agreement whatsoever. The industry did not support our labelling proposals, did not support our advertising proposals, and did not support our proposal to withdraw junk food from schools,” he said.
At the turn of the decade, Mexico was preparing a strong agenda to regulate the food sector in response to its inclusion in the group of countries with the highest rates of obesity. As a result of industry efforts to hamper the progress of these proposals, Simón no longer has any doubt: it is impossible to sit down at the table when there are such conflicting interests at stake.
In Brazil, the alarm bells really started to ring at the turn of the century, when the main public research institute reported that 40.6% of the population was overweight, and that 11.1% of those people were obese, almost triple the number of people who were underweight. Nevertheless, the majority of public policies continued to focus on combatting poverty.
Seven years later came the news that 34.8% of five to nine-year-olds were overweight, with 16.6% suffering from obesity, four times the amount of those who were underweight. The percentage of overweight adults was already more than eight points higher, at 49%.
“In the past, people were tremendously influenced by industry dialogue in relation to the food system,” said Patricia Jaime, a professor at the Faculty of Public Health of the University of São Paulo (USP). When she arrived at the Ministry of Health as general coordinator for food and nutrition, in 2011, the conversation had shifted course. “The social determinants that we used to use were no longer sufficient to explain most of the problem.”
The global obesity epidemic highlighted the contradictions between the private funding of science and the scientific exercise of doubt, criticism and reflection. Until recently, the food industry was seen as responsible for filling our stomachs and, accordingly, it had every right to sit down at the table. However, over the past decades, it has become hard to ignore the role played by all those products in overweight. This is where science comes in: it is perfectly clear that studies were manipulated to conceal facts or shift the focus.
There are four main reasons for which a company will sponsor health-related research or events: to influence public policies, health experts, consumer habits and public image.
Change from within
In December 2015, the Brazilian Food Industry Association (ABIA) submitted a presentation by Choices to the regulatory agency responsible for debating labelling changes.
It is easy to understand that the creation of the foundation by Unilever is an attempt to avoid regulation by issuing a positive mark for products that have been reformulated to reduce calorie, sugar, salt and fat content, regardless of the quality of these products.
Just like the Latin American committee, the Brazilian scientific committee comprised eminent personalities in the sector: professors from the USP, the university with the best overall reputation in the country.
They were founders or are members of the Brazilian Food and Nutrition Society (SBAN), which has been embroiled in controversy through its defence of certain products. Professor Franco Lajolo also chairs the Scientific Committee of the International Life Sciences Institute (ILSI), an organization created by Coca-Cola and in which dozens of corporations aimed at the ‘production of knowledge’ used in the debate on public policies currently participate.
Professor Silvia Cozzolino chairs the Regional Council of Nutritionists in São Paulo, which has opposed the measures of the federal council for the sector in favour of greater distance from the private sector. She also rejects the regulation. “All the companies with which I am in contact and have talked about this in some way or another are concerned about the increase in obesity and are to a certain extent seeking product alternatives in terms of reducing sugar, salt and fat content.”
Susan Prescott, a professor of paediatrics at the University of Western Australia’s School of Medicine, spent ten years on the Nestlé Nutrition Institute’s Advisory Board in Oceania. She says that she always questioned the conflicts created by that relationship because, as a paediatrician, she was increasingly noting problems caused by certain products. “Researchers who remain entrenched in their defence of ultra-processed foods are finding themselves on the wrong side of history. Even though by association, I was in fact lending my name to something I consider to be an unhealthy system.”
The last straw for Prescott came with an article written by Michael Gibney, a professor at the University of Dublin in Ireland. Gibney, also a member of Nestlé’s Nutrition Council, attacked the NOVA classification proposed in 2009 by the Brazilian researcher Carlos Monteiro.
The proposal involves classifying foods according to their degree of processing: in natura or minimally processed, processed and ultra-processed. It was an important change in perspective to guide scientific research that has demonstrated the role of ultra-processed foods in the obesity epidemic.
For Susan Prescott, the attacks on Carlos Monteiro were a case of bad faith. “Balanced criticism is an important factor in scientific progress. However, when I see attempts to discredit the NOVA system by people funded by the industry, I can only conclude that those efforts are typical of intellectual escapism,” she said.
Not all science resulting from private research is necessarily bad or should be discredited. One should remember that nothing in life is neutral. Consequently, there are scientists whose ideological vision pushes them to reach a certain conclusion. That is part of the game. What is not part of the scientific game is ignoring relevant aspects simply because they do not meet their assumptions or the assumptions of their sponsors.
“Research is not influenced by the industry. Nor is it influenced at the time of writing the article for publication,” said Felix Reyes, a professor at the Faculty of Food Engineering at the University of Campinas, also very well known in Brazil, and founder of the ILSI. “Regardless of whether or not the result is of interest to the company, it is a scientific result. Scientific data should be published. Our role is not to protect or expose a company. We will help it. If the result is negative for the company, we will find a way of avoiding that negative effect.”
In 2007, a group of US researchers analysed 222 articles published between 1999 and 2003, 22% of which had been funded exclusively by food company capital. The conclusions of each piece of research were evaluated by people who were unaware of the source of the funding. The proportion of conclusions that were unfavourable to the industry in those articles that had received industry money was 0%. The proportion of favourable results was almost eight times greater in those works than in those funded with public resources.
In 2013, a group of Spanish scientists analysed 18 articles reviewing soft drinks. Of six works financed by the industry, five disregarded the link between obesity and the consumption of such drinks or adopted an inconclusive stance. Works of established importance were ignored by the authors. “The interests of the food industry (increased sales of their products) differ greatly to the interests of the majority of researchers (the honest pursuit of knowledge),” was the conclusion.
Recently, a group of researchers from the University of California went through the way in which the sugar industry pointed the finger at fat for decades. What was demonstrated was that, already in the 1950s, there was evidence of the link between sugar and heart disease. A foundation was created to lay all the blame on fat, the consequence of which was that official health recommendations advocated low-fat diets, which in turn may have caused many deaths (we will never know how many).
Shifting the focus
At a recent event in São Paulo, the physician Mário Cícero Falcão, from the Children’s Institute at the USP’s Hospital das Clínicas, whose work is sponsored by Johnson and Aché, presented a slide from 2000 linking infant formulas to richer intestinal flora than in infants fed with breast milk, admitting that it is now acknowledged that this is not true.
Mistakes can be made. Scientific discoveries mean that consensus is constantly changing. But we are not talking about that: we are talking about how science was used to mislead generations of mothers into mistakenly thinking that breast milk is weak, inadequate and deficient. This belief is still widespread.
Faith can move mountains of money
DNA sequencing technologies have advanced in such a way as to promote the unprecedented mapping of our intestinal microbiome, which is the range of microorganisms living in the digestive tract. One of the greatest discoveries is that the gut composition of obese people differs to that of thin people.
We should reach an obvious conclusion: just change the way we eat so that our microbiome regenerates. But, then, an entire event in the area of nutrition would be summarized in one sentence: “Eat real food”. In a nutshell, industry sponsorship of grandiose conferences would be unnecessary and thus fall apart. As would the need to finance certain research. The capacity to cause huge confusion in the minds of people about what to eat and what not to eat. Billions in advertising. The manufacture of supplements, fortified foods, functional foods, probiotics, prebiotics and synbiotics. Billions in ‘solutions’ for obesity.
PubMed, one of the main scientific works databases, has registered almost 5,000 articles on the issue last year, in addition to 6,000 in 2016 and 5,350 in 2015. A decade earlier, there were fewer than 500 a year and, going back a little further, at the turn of the century, not even 100 were registered.
“What worries me is that this agenda has come very much from the industry, which promotes a series of products, primarily dairy, which affect microbiota. They also want to promote that link with obesity. It worries me because the focus on the basics, such as sugar consumption, doesn’t have the same backing,” protested Mexico’s Simón Barquera.
As for the correlation between sugar and obesity, there have been fewer than 1,000 articles published last year. There were 2,000 in 2016 and 2,500 in 2015. Is it easier to imagine that a billion people around the world will lose weight by consuming probiotics or by finding out about the influence of sugar on diet?
Some of those researchers are chosen because they have great technical ability. But we have the right to know that, in that situation, this person is the consultant of a corporation and not a faculty professor. However, using the credibility of an institution is a central part of the story.
“Often what the food industry wants is not to co-opt the person to praise the industry and its products. It simply wants the person not to criticize”, said Carlos Monteiro, a professor at the USP’s Faculty of Public Health. He is one of the leading critics of the relationship between industry and science, and also one of the most criticized by the leading companies.
Despite having participated in the creation of the SBAN, he decided to move away. “Investment in university professors can be very ‘productive’ for the industry. A professor is in contact with hundreds of young people and can reach a lot of people. That forms part of the co-opting strategy. The solution to that is to have a code of ethics and conflicts of interest. It is important to be clear.”
At an event in São Paulo, the president of Cargill said that he had 500 PhD researchers working in the field of animal nutrition alone. If he has so many people with the ability to carry out research full-time, why does he need to attract professors from the best universities in the country? Because we tend to believe professors and mistrust company representatives. Professors are noble disseminators of knowledge, whilst company representatives are mundane spreaders of propaganda.
In the academic field, successive reductions in budgets have meant that the money from major companies represents salvation for increasing numbers of people.
“It is no longer only the major tobacco corporations. The public health authorities also have to fight hard against the major food, soft drink and alcohol companies. All those industries are scared of regulation and protect themselves using the same tactics,” stated the then WHO director-general Margaret Chan at the opening of a conference on health in 2013.
She said that she had no doubt that the states’ fear of corporations was the main factor hampering the regulation of the factors causing obesity. “[The tactics] include front organizations, lobbies, promises to self-regulate, legal action and industry-funded research that confuses the evidence and keeps the public doubting.”