Citerank: (10) 351043Public health interventions are often resistedEvidence suggests that, for example, some food and beverage companies are adopting similar tactics to those adopted earlier by the tobacco companies to avoid public health interventions (such as taxation and regulation) that might threaten their profits.555CD992, 351051Some degree of public regulation is necessarySome degree of public regulation is necessary to achieve public health targets on obesity – and this needs to be supported by standards set and monitored by public health expert committees to improve industry performance in the nutritional quality of food products and in marketing the products to children.1198CE71, 351336Insufficient countervailing checks to oligopoly in food supply chainsThe majority of what most people eat is driven increasingly by the production and distribution decisions of a few multinational food companies, whose oligopolistic interest are not necessarily aligned with the public health interest. Successive governments have failed to establish sufficient countervailing public policy measures to ensure that, where these interests are not aligned, the oligopolistic interests of the companies don't impact negatively on public health.555CD992, 368179Production and marketing choices favour profit over diet optimisationDecisions made by many food and beverage companies tend to be shaped more by the immediate corporate financial interests of shareholders (and the associated interests of corporate officers) rather than the social goal of achieving optimal human diets; as reflected in, for example, the production and marketing a high volume of low-cost, highly processed foods that are rich in sugar, salt, and saturated fats.555CD992, 368180Resisting public health interventionsEvidence suggests that some food and beverage companies are adopting similar tactics to those adopted earlier by the tobacco companies to avoid public health interventions (such as taxation and regulation) that might threaten their profits.555CD992, 399591Some degree of public regulation is necessarySome degree of public regulation is necessary to achieve public health targets on obesity – and this needs to be supported by standards set and monitored by public health expert committees to improve industry performance in the nutritional quality of food products and in marketing the products to children.1198CE71, 399888Strategies of some companies are fuelling the obesity crisisSome companies and industries are fuelling the obesity crisis, through a variety of strategies that prioritise profitability and corporate brand value over public health, and, in the process, externalise significant costs.555CD992, 399894Public health interventions are often resistedEvidence suggests that, for example, some food and beverage companies are adopting similar tactics to those adopted earlier by the tobacco companies to avoid public health interventions (such as taxation and regulation) that might threaten their profits.555CD992, 399895Production and marketing choices favour profit over diet optimisationDecisions made by many food and beverage companies tend to be shaped more by the immediate corporate financial interests of shareholders (and the associated interests of corporate officers) rather than the social goal of achieving optimal human diets; as reflected in, for example, the production and marketing a high volume of low-cost, highly processed foods that are rich in sugar, salt, and saturated fats.555CD992, 399901Insufficient countervailing checks to oligopoly in food supply chainsThe majority of what most people eat is driven increasingly by the production and distribution decisions of a few multinational food companies, whose oligopolistic interest are not necessarily aligned with the public health interest. Successive governments have failed to establish sufficient countervailing public policy measures to ensure that, where these interests are not aligned, the oligopolistic interests of the companies don't impact negatively on public health.555CD992

Citerank: (7) 351113Adopting lessons from the Tobacco PlaybookThe tobacco industry had a playbook, a script, that emphasized personal responsibility, paying scientists who delivered research that instilled doubt, criticizing the “junk” science that found harms associated with smoking, making self-regulatory pledges, lobbying with massive resources to stifle government action, introducing “safer” products, and simultaneously manipulating and denying both the addictive nature of their products and their marketing to children.555CD992, 351336Insufficient countervailing checks to oligopoly in food supply chainsThe majority of what most people eat is driven increasingly by the production and distribution decisions of a few multinational food companies, whose oligopolistic interest are not necessarily aligned with the public health interest. Successive governments have failed to establish sufficient countervailing public policy measures to ensure that, where these interests are not aligned, the oligopolistic interests of the companies don't impact negatively on public health.555CD992, 368179Production and marketing choices favour profit over diet optimisationDecisions made by many food and beverage companies tend to be shaped more by the immediate corporate financial interests of shareholders (and the associated interests of corporate officers) rather than the social goal of achieving optimal human diets; as reflected in, for example, the production and marketing a high volume of low-cost, highly processed foods that are rich in sugar, salt, and saturated fats.555CD992, 399888Strategies of some companies are fuelling the obesity crisisSome companies and industries are fuelling the obesity crisis, through a variety of strategies that prioritise profitability and corporate brand value over public health, and, in the process, externalise significant costs.555CD992, 399895Production and marketing choices favour profit over diet optimisationDecisions made by many food and beverage companies tend to be shaped more by the immediate corporate financial interests of shareholders (and the associated interests of corporate officers) rather than the social goal of achieving optimal human diets; as reflected in, for example, the production and marketing a high volume of low-cost, highly processed foods that are rich in sugar, salt, and saturated fats.555CD992, 399901Insufficient countervailing checks to oligopoly in food supply chainsThe majority of what most people eat is driven increasingly by the production and distribution decisions of a few multinational food companies, whose oligopolistic interest are not necessarily aligned with the public health interest. Successive governments have failed to establish sufficient countervailing public policy measures to ensure that, where these interests are not aligned, the oligopolistic interests of the companies don't impact negatively on public health.555CD992, 399915Adopting lessons from the Tobacco PlaybookThe tobacco industry had a playbook, a script, that emphasized personal responsibility, paying scientists who delivered research that instilled doubt, criticizing the “junk” science that found harms associated with smoking, making self-regulatory pledges, lobbying with massive resources to stifle government action, introducing “safer” products, and simultaneously manipulating and denying both the addictive nature of their products and their marketing to children.555CD992

Context: In 1954 the tobacco industry paid to publish the “Frank Statement to Cigarette Smokers” in hundreds of U.S. newspapers. It stated that the public's health was the industry's concern above all others and promised a variety of good-faith changes. What followed were decades of deceit and actions that cost millions of lives. In the hope that the food history will be written differently, this article both highlights important lessons that can be learned from the tobacco experience and recommends actions for the food industry.

Methods: A review and analysis of empirical and historical evidence pertaining to tobacco and food industry practices, messages, and strategies to influence public opinion, legislation and regulation, litigation, and the conduct of science.

Findings: The tobacco industry had a playbook, a script, that emphasized personal responsibility, paying scientists who delivered research that instilled doubt, criticizing the “junk” science that found harms associated with smoking, making self-regulatory pledges, lobbying with massive resources to stifle government action, introducing “safer” products, and simultaneously manipulating and denying both the addictive nature of their products and their marketing to children. The script of the food industry is both similar to and different from the tobacco industry script.

Conclusions: Food is obviously different from tobacco, and the food industry differs from tobacco companies in important ways, but there also are significant similarities in the actions that these industries have taken in response to concern that their products cause harm. Because obesity is now a major global problem, the world cannot afford a repeat of the tobacco history, in which industry talks about the moral high ground but does not occupy it.

Citerank: (7) 351113Adopting lessons from the Tobacco PlaybookThe tobacco industry had a playbook, a script, that emphasized personal responsibility, paying scientists who delivered research that instilled doubt, criticizing the “junk” science that found harms associated with smoking, making self-regulatory pledges, lobbying with massive resources to stifle government action, introducing “safer” products, and simultaneously manipulating and denying both the addictive nature of their products and their marketing to children.555CD992, 351336Insufficient countervailing checks to oligopoly in food supply chainsThe majority of what most people eat is driven increasingly by the production and distribution decisions of a few multinational food companies, whose oligopolistic interest are not necessarily aligned with the public health interest. Successive governments have failed to establish sufficient countervailing public policy measures to ensure that, where these interests are not aligned, the oligopolistic interests of the companies don't impact negatively on public health.555CD992, 368179Production and marketing choices favour profit over diet optimisationDecisions made by many food and beverage companies tend to be shaped more by the immediate corporate financial interests of shareholders (and the associated interests of corporate officers) rather than the social goal of achieving optimal human diets; as reflected in, for example, the production and marketing a high volume of low-cost, highly processed foods that are rich in sugar, salt, and saturated fats.555CD992, 399888Strategies of some companies are fuelling the obesity crisisSome companies and industries are fuelling the obesity crisis, through a variety of strategies that prioritise profitability and corporate brand value over public health, and, in the process, externalise significant costs.555CD992, 399895Production and marketing choices favour profit over diet optimisationDecisions made by many food and beverage companies tend to be shaped more by the immediate corporate financial interests of shareholders (and the associated interests of corporate officers) rather than the social goal of achieving optimal human diets; as reflected in, for example, the production and marketing a high volume of low-cost, highly processed foods that are rich in sugar, salt, and saturated fats.555CD992, 399901Insufficient countervailing checks to oligopoly in food supply chainsThe majority of what most people eat is driven increasingly by the production and distribution decisions of a few multinational food companies, whose oligopolistic interest are not necessarily aligned with the public health interest. Successive governments have failed to establish sufficient countervailing public policy measures to ensure that, where these interests are not aligned, the oligopolistic interests of the companies don't impact negatively on public health.555CD992, 399915Adopting lessons from the Tobacco PlaybookThe tobacco industry had a playbook, a script, that emphasized personal responsibility, paying scientists who delivered research that instilled doubt, criticizing the “junk” science that found harms associated with smoking, making self-regulatory pledges, lobbying with massive resources to stifle government action, introducing “safer” products, and simultaneously manipulating and denying both the addictive nature of their products and their marketing to children.555CD992

The ten largest food and beverage corporations control over half of the food sales in the United States and their share may be increasing.Using data from a range of secondary sources, we examine these corporations and their boards of directors. Social and demographic characteristics of board members gleaned from corporate reports, the business press, and elsewhere are presented.Information on interlocking corporate directorates and other common ties among members of the boards of directors show that US based food and beverage corporations are tied together through a web of indirect interlocks.

Background: In recent years, 10 major multinational food and beverage companies have worked together within the International Food and Beverage Alliance (IFBA) to increase their commitments to public health. Current IFBA commitments include initiatives to improve the nutrition quality of products and how these products are advertised to children. The impact and magnitude of IFBA member contributions to the total market share of packaged foods and beverages consumed remain incompletely understood, however.

Results: Worldwide, the top ten packaged food companies account for 15.2% of sales, with each individual company contributing less than 3.3%. The top ten soft drink companies account for 52.3% of sales worldwide; Coca-Cola and PepsiCo lead with 25.9% and 11.5% of sales, respectively.

Conclusions: Although the top ten soft drink companies account for half of global sales, the top ten packaged food companies account for only a small proportion of market share with most individual companies contributing less than 3.3% each. Major multinational companies need to be joined by the myriad of small- and medium-sized enterprises in developing and implementing programs to improve the health of the public, globally. Without full participation of these companies, the impact of commitments made by IFBA members and other major multinational food and beverage companies will remain limited.

Summary

> The rate of increase in consumption of “unhealthy commodities” (soft drinks and processed foods that are high in salt, fat, and sugar, as well as tobacco and alcohol) is fastest in low- and middle-income countries (LMICs), with little or no further growth expected in high-income countries (HICs).

> The pace at which consumption is rising in LMICs is even faster than has occurred historically in HICs.
Multinational companies have now achieved a level of penetration of food markets in middle-income countries similar to what they have achieved in HICs.

> Higher intake of unhealthy foods correlates strongly with higher tobacco and alcohol sales, suggesting a set of common tactics by industries producing unhealthy commodities.

> Contrary to findings from studies undertaken several decades ago, urbanisation no longer seems to be a strong risk factor for greater consumption of risky commodities at the population level, with the exception of soft drinks.

> Rising income has been strongly associated with higher consumption of unhealthy commodities within countries and over time, but mainly when there are high foreign direct investment and free-trade agreements. Economic growth does not inevitably lead to higher unhealthy-commodity consumption.

The intended effects of these “5Ps” of marketing are to increase consumption by encouraging more types of people to consume the product (broadening the customer base); more frequent consumption amongst people already familiar with the product; and more volume to be consumed at one time. Company data indicates that marketing has had these intended effects on consumption in different markets. There are two types of effects: The clear-cut effects of place, price and product, and the more subliminal effects of promotional activities and public relations.

Given the myriad of factors that influence food choice, it is difficult to understand precisely which marketing techniques are more influential over the development of an entrenched soft drink and fast food culture. Still, the fact that companies have numerous techniques to target children and teens suggests that they are aiming to change soft drink and fast food consumption over the long term. It is therefore recommended that a dialogue begin about whether regulating or setting standards for the marketing of fatty, sugary and salty processed foods would be appropriate, and, if so, at what scale. This dialogue should include the food industry, and take risk prevention as a starting point. It is also recommended that an econometric analysis be carried out to gain greater understanding of the effects of global brands of processed foods on consumption patterns (as opposed to local or regional brands), and of the effects of marketing these products relative to other factors that influence food choice.

OBJECTIVE: Ageing and urbanization leading to sedentary lifestyles have been the major explanations proposed for a dramatic rise in diabetes worldwide and have been the variables used to predict future diabetes rates. However, a transition to Western diets has been suggested as an alternative driver. We sought to determine what socio-economic and dietary factors are the most significant population-level contributors to diabetes prevalence rates internationally.

RESULTS:We found that increased income tends to increase overall food market size among low- and middle-income countries, but the level of food importation significantly shifts the content of markets such that a greater proportion of available joules is composed of sugar and related sweeteners. Sugar exposure statistically explained why urbanization and income have been correlated with diabetes rates.

CONCLUSIONS: Current diabetes projection methods may estimate future diabetes rates poorly if they fail to incorporate the impact of nutritional factors. Imported sugars deserve further investigation as a potential population-level driver of global diabetes.

Consumption of sugar-sweetened beverages (SSBs), particularly carbonated soft drinks, may be a key contributor to the epidemic of overweight and obesity, by virtue of these beverages' high added sugar content, low satiety, and incomplete compensation for total energy. Whether an association exists between SSB intake and weight gain is unclear. We searched English-language MEDLINE publications from 1966 through May 2005 for cross-sectional, prospective cohort, and experimental studies of the relation between SSBs and the risk of weight gain (ie, overweight, obesity, or both). Thirty publications (15 cross-sectional, 10 prospective, and 5 experimental) were selected on the basis of relevance and quality of design and methods. Findings from large cross-sectional studies, in conjunction with those from well-powered prospective cohort studies with long periods of follow-up, show a positive association between greater intakes of SSBs and weight gain and obesity in both children and adults. Findings from short-term feeding trials in adults also support an induction of positive energy balance and weight gain by intake of sugar-sweetened sodas, but these trials are few. A school-based intervention found significantly less soft-drink consumption and prevalence of obese and overweight children in the intervention group than in control subjects after 12 mo, and a recent 25-week randomized controlled trial in adolescents found further evidence linking SSB intake to body weight. The weight of epidemiologic and experimental evidence indicates that a greater consumption of SSBs is associated with weight gain and obesity. Although more research is needed, sufficient evidence exists for public health strategies to discourage consumption of sugary drinks as part of a healthy lifestyle.

Abstract: In recent decades, temporal patterns in SSB intake have shown a close parallel between the upsurge in obesity and rising levels of SSB consumption. SSBs are beverages that contain added caloric sweeteners such as sucrose, high-fructose corn syrup or fruit-juice concentrates, all of which result in similar metabolic effects. They include the full spectrum of soft drinks, carbonated soft drinks, fruitades, fruit drinks, sports drinks, energy and vitamin water drinks, sweetened iced tea, cordial, squashes, and lemonade, which collectively are the largest contributor to added sugar intake in the US. It has long been suspected that SSBs have an etiologic role in the obesity epidemic, however only recently have large epidemiological studies been able to quantify the relationship between SSB consumption and long-term weight gain, type 2 diabetes (T2DM) and cardiovascular disease (CVD) risk. Experimental studies have provided important insight into potential underlying biological mechanisms. It is thought that SSBs contribute to weight gain in part by incomplete compensation for energy at subsequent meals following intake of liquid calories. They may also increase risk of T2DM and CVD as a contributor to a high dietary glycemic load leading to inflammation, insulin resistance and impaired β-cell function. Additional metabolic effects from the fructose fraction of these beverages may also promote accumulation of visceral adiposity, and increased hepatic de novo lipogenesis, and hypertension due to hyperuricemia. Consumption of SSBs should therefore be replaced by healthy alternatives such as water, to reduce risk of obesity and chronic diseases.

Summary: Results from longitudinal studies must be taken into account in order to design preventive strategies to counteract the increased prevalence of obesity and its consequences in children. Lack of breastfeeding, high early energy intake and high intake of sugar-sweetened beverages seem to be the main dietary factors contributing to obesity development.

BACKGROUND: Fast-food consumption has increased greatly in the USA during the past three decades. However, the effect of fast food on risk of obesity and type 2 diabetes has received little attention. We aimed to investigate the association between reported fast-food habits and changes in bodyweight and insulin resistance over a 15-year period in the USA.

INTERPRETATION: Fast-food consumption has strong positive associations with weight gain and insulin resistance, suggesting that fast food increases the risk of obesity and type 2 diabetes.

The PLoS Medicine series on Big Food aims to examine and stimulate debate about the activities and influence of the food industry in global health. We define “Big Food” as the multinational food and beverage industry with huge and concentrated market power. The series adopts a multi-disciplinary approach and includes critical perspectives from around the world. It represents one of first times such issues have been examined in the general medical literature.

Citerank: (19) 348770Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 352528Subsidising the production of sugar and fatGovernments are subsidising production of fat and sugar compared with micronutrient-rich foods.555CD992, 352531Overseeing a decline in physical activitySuccessive governments have overseen a decline of physical activity (e.g. due to policies on transport, public spaces, and sports facilities).555CD992, 366559Encourage individuals and families to make healthier choices565CA4D9, 366896WHO's total budget is less than half the marketing budget of McDonaldsMcDonald’s and Coca-Cola’s marketing budgets are each twice the World Health Organization’s full-year budget.1198CE71, 366897Surgical and pharmaceutical solutions don't resolve societal problemsThere is a danger of searching for pharmaceutical or bariatric solutions; as technological solutions are unlikely to resolve societal problems – at best, they are a ‘sticking plaster’.13EF597B, 368179Production and marketing choices favour profit over diet optimisationDecisions made by many food and beverage companies tend to be shaped more by the immediate corporate financial interests of shareholders (and the associated interests of corporate officers) rather than the social goal of achieving optimal human diets; as reflected in, for example, the production and marketing a high volume of low-cost, highly processed foods that are rich in sugar, salt, and saturated fats.555CD992, 370363Unhealthy foods are cheaper and getting cheaper555CD992, 373987Genetic susceptibility to an obesogenic environmentRoughly 70 percent of obesity risk is genetically inherited; however, this genetic inheritance is best understood as a susceptibility to a fattening environment––i.e. in a healthy environment, genes alone do not usually cause obesity: in an unhealthy environment, genetically susceptible people become obese, while others remain lean because they are not genetically susceptible. [1]555CD992, 399546Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 399576Encourage individuals and families to make healthier choices565CA4D9, 399702Surgical and pharmaceutical solutions don't resolve societal problemsThere is a danger of searching for pharmaceutical or bariatric solutions; as technological solutions are unlikely to resolve societal problems – at best, they are a ‘sticking plaster’.13EF597B, 399888Strategies of some companies are fuelling the obesity crisisSome companies and industries are fuelling the obesity crisis, through a variety of strategies that prioritise profitability and corporate brand value over public health, and, in the process, externalise significant costs.555CD992, 399893Genetic susceptibility to an obesogenic environmentRoughly 70 percent of obesity risk is genetically inherited; however, this genetic inheritance is best understood as a susceptibility to a fattening environment––i.e. in a healthy environment, genes alone do not usually cause obesity: in an unhealthy environment, genetically susceptible people become obese, while others remain lean because they are not genetically susceptible. [1]555CD992, 399895Production and marketing choices favour profit over diet optimisationDecisions made by many food and beverage companies tend to be shaped more by the immediate corporate financial interests of shareholders (and the associated interests of corporate officers) rather than the social goal of achieving optimal human diets; as reflected in, for example, the production and marketing a high volume of low-cost, highly processed foods that are rich in sugar, salt, and saturated fats.555CD992, 399903Subsidising the production of sugar and fatGovernments are subsidising production of fat and sugar compared with micronutrient-rich foods.555CD992, 399904Overseeing a decline in physical activitySuccessive governments have overseen a decline of physical activity (e.g. due to policies on transport, public spaces, and sports facilities).555CD992, 399918Unhealthy foods are cheaper and getting cheaper555CD992, 399927WHO's total budget is less than half the marketing budget of McDonaldsMcDonald’s and Coca-Cola’s marketing budgets are each twice the World Health Organization’s full-year budget.1198CE71

The 2011 UN high-level meeting on non-communicable diseases (NCDs) called for multisectoral action including with the private sector and industry. However, through the sale and promotion of tobacco, alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of global epidemics of NCDs. What role then should these industries have in NCD prevention and control? We emphasise the rise in sales of these unhealthy commodities in low-income and middle-income countries, and consider the common strategies that the transnational corporations use to undermine NCD prevention and control. We assess the effectiveness of self-regulation, public–private partnerships, and public regulation models of interaction with these industries and conclude that unhealthy commodity industries should have no role in the formation of national or international NCD policy. Despite the common reliance on industry self-regulation and public–private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.