Amid obesity epidemic, Coke shifts 'health' focus from exercise to calories

For the first time in human history, more people are obese than underweight, with America leading the way. Yahoo News examines the way the food industry has contributed to the worldwide epidemic, and how soda companies in the U.S. have tried to deflect blame for the increase in obesity, particularly in children.

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For years, Coca-Cola and other soda companies promoted exercise as a way to fight obesity and argued that their products could be part of an overall healthy lifestyle. But recent science shows weight loss has far more to do with nutrition and that exercise, although extremely beneficial for other reasons, has little effect on weight.

Public health advocates and medical doctors say that the soda industry’s campaign to promote physical fitness was a calculated maneuver to shift the blame for its prominent contribution to the nation’s obesity epidemic. Now, as soda consumption falls in the United States, Coca-Cola is backing away from funding its fitness initiative. But public health officials accuse it of exporting America’s obesity problem to developing nations.

Coke’s exercise campaign was an example of “trying to be slick,” Sara Bleich, a professor of public health policy at the Harvard T.H. Chan School, told Yahoo News. “Why are we getting heavier? We’re getting heavier because we’re taking in too many calories, not because we’re exercising too little. Of all the different behavior changes you could do, there’s probably the most evidence that if you drink fewer sugary beverages you would reduce your risk for obesity.”

There’s a case to be made that soda companies are responding to a market demand for sugary beverages and have little obligation to promote the public’s well-being. After all, Coca-Cola is a publicly traded company with responsibilities to its shareholders — not a government agency or nonprofit.

But responding to market demand is different from fostering market demand. Coke and its competitors engage in multimillion-dollar marketing campaigns to encourage consumption of their products, which consist of flavored, sugary water with little nutritional value.

Nowadays about 17 percent of children (one in six) in the United States are obese and therefore at a higher risk of chronic health conditions, including cancer, type 2 diabetes and heart disease. More than one-third of adult Americans is obese. Sugary beverages like soda and sports drinks are the top calorie source in the average teen’s diet: 226 calories per day.

Lauren Kane, senior director of communications for the American Beverage Association, the trade organization representing Coca-Cola, Pepsi, Dr. Pepper and other soft drinks, pointed out that all sugar-sweetened beverages combined only account for about 6 percent of the calories in the average U.S. diet.

“We understand that we make products that have calories, so we have a responsibility, but at the same time, you have to look at the obesity epidemic in the big picture,” she told Yahoo News. “There are lots of different calories that people consume every single day.”

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‘Sunsetting’ physical fitness

Yahoo News contacted Coca-Cola to discuss the obesity epidemic and the company’s physical fitness programs. A company spokesman said via email that they “have been on a journey to evolve the way [their] company approaches health and wellness.”

“We’ve been listening to and learning from our consumers, the public health community and other stakeholders about the most appropriate role we can play to support the fight against obesity in a way that is credible, transparent and beneficial for everyone. As a result, we have said we will no longer support programs that center on personal fitness,” he said.

Gradually throughout the 2000s, as public awareness of the health risks surrounding soda and fast food grew, Coca-Cola started to pour money into healthy lifestyle projects, such as exercise and sports events.

In 2016, Coca-Cola began to implement guidelines for how it would support research, nutrition and physical activity programs. This includes “sunsetting any funding of company-owned or branded health and wellness platforms that promote well-being.” The application of these guidelines is ongoing.

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The truth about exercise and weight loss

There’s no doubt about it: Exercise is associated with many health benefits for the body and mind. But recent studies show it has only a modest impact on weight.

Aseem Malhotra, a cardiologist at Frimley Health NHS Foundation Trust in the U.K., argues that the public perception that physical inactivity — rather than poor diet — is the primary cause of obesity was fostered by pervasive messages from the food industry. Coca Cola has promoted the message that “all calories count” and associates its products with sports, but Malhotra’s research in the British Journal of Sports Medicine shows that “one cannot outrun a bad diet.”

“The messaging of these companies such as Coca-Cola that gives the impression to the public that you can burn off the calories was not in keeping with the science,” Malhotra told Yahoo News. “The evidence is very clear. At best, exercise has a very marginal effect when it comes to obesity. At worst, it’s not linked at all. I would say we should remove exercise when we talk about obesity.”

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Beverage marketing

The U.S. Federal Trade Commission found that American beverage companies spent about $3.2 billion marketing carbonated beverages in 2006. Nearly $500 million was targeted at teens and children as young as two years old. In 2010, children and teens respectively watched an average of 277 and 406 ads for sugary drinks and energy drinks, while preschoolers saw about 213.

But those figures have dramatically declined, according to data from the UConn Rudd Center for Food Policy and Obesity. The report says beverage company advertising to children and teens went down to $866 million on sugary drinks and energy drinks in 2013. Companies spent an additional $465 million to advertise diet drinks, 100 percent juice and plain water.

Erica Kenney, a research fellow in the department of social and behavioral sciences at Harvard T.H. Chan School of Public Health, explained that this decline came after the industry’s voluntary pledge to decrease marketing, but it wasn’t universal and some companies even increased advertising to kids.

Given the beverage industry’s frequent denials that these marketing tactics contribute to the epidemic, Harvard T.H. Chan School of Public Health assembled a fact sheet with “key scientific evidence” linking sugary drinks and obesity.

It shows that “more and more marketing has moved into social media and mobile platforms, so even though there’s less seen on TV, there’s still plenty of advertising online for kids,” Kenney said.

Malhotra draws a parallel to the way cigarettes were marketed: “The junk food industry spends millions in marketing junk food and targeting the most vulnerable members of society, including children. What we know is there are lessons to be learned from Big Tobacco.”

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The new cigarettes

In many ways, this current dilemma mirrors the decades-long controversy surrounding the cigarette industry’s contested right to encourage smoking by the American public. Cigarettes were ubiquitous in mid-20th-century America but public awareness campaigns made them taboo. Here’s another way to think of it: “The Flintstones” and other cartoons once hocked cigarettes — now they promote sugary cereals.

The analogy isn’t perfect but both soda and cigarette manufacturers had campaigns downplaying the links between their products and health problems, and public officials fought to limit access to these products with varying degrees of success.

According to the U.S. Department of Health & Human Services, the proportion of adult smokers in the U.S. dropped from 42 percent in 1964 to 18 percent in 2014. During most of this period, the tobacco industry spent billions trying to sow doubt about the now clear-cut link between smoking and lung cancer.

Malhotra said effective regulations to curb smoking were not implemented until 50 years after the first links between smoking and lung cancer were published in a British medical journal. Big Tobacco, he said, adopted a corporate playbook of planting doubt that cigarettes were harmful, which included subsidizing favorable research from scientists.

“The very same tactics are being used as part of [the soda industry’s] corporate strategy. One of the things they do is emphasize personal responsibility and that a lack of exercise is driving the obesity epidemic,” he said.

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Promoting exercise

The Coca-Cola Company has spent millions of dollars to fund fitness programs across the U.S. intended to help individuals and families “live active, healthy lifestyles.” The company has boasted about supporting more than 280 physical activity and “nutrition education programs” in more than 115 countries.

“They’re playing tennis in Portland, dancing in Atlanta, boot-camping in Chicago and working out in fitness centers all over America. From coast to coast, community organizations are amplifying their active-living and nutrition education programs due in part by local grants from the Coca-Cola Foundation,” reads a 2012 press release titled “Coca-Cola Wants America to Be Fit!”.

The Dr Pepper Snapple Group has committed more than $35.5 million to its “Let’s Play” initiative from 2011 through 2019 “to help encourage active play for kids and families.”

Among Coca-Cola’s many investments in physical activity is the Copa Coca-Cola, an international youth soccer tournament. Coca-Cola said that since 1998, the league has expanded to 60 countries and reached more than 1.3 million boys and girls. In one statement, a Coca-Cola marketing manager said, “We want to inspire teens to lead active healthy lives, form lasting friendships and follow their dreams.”

(When asked if the Copa Coca-Cola program would be phased out as part of the “sunsetting,” a Coca-Cola spokesman said the league’s purpose was not about physical fitness but was more of a “marketing asset,” like sponsoring the Final Four or Major League Baseball.)

Coca-Cola became the first founding corporate partner of Exercise is Medicine, which is coordinated by the American College of Sports Medicine, in 2007 to encourage doctors to prescribe exercise as medical treatment. Coca-Cola provided grant funding for foundational support and marketing.

Rhona Applebaum, chief scientific and regulatory officer at Coca-Cola, said in a statement at the time that the company is committed to advancing “evidence-based science” and underscoring “the importance of an active, healthy lifestyle.”

“And there is irrefutable evidence that exercise truly is medicine, and that fitness extends both the quality and quantity of life,” Applebaum said. “If every sector of society would collaborate to advance this proven remedy, the faster we could eradicate the global pandemic of physical inactivity and improve public health. That’s certainly a health outcome worth striving to achieve.”

According to Coca-Cola, the initiative is active on 200 college campuses and recommended by 2,000 health care providers in the U.S. It has spread to Australia, Italy and Germany, and is “going strong in Latin America, Asia and Africa.”

See the related story by Beth Greenfield : Exporting obesity: How the food industry is changing the world’s diet >>>

To repeat: exercise is good for health and its encouragement should be celebrated. But experts say there has been a major blind spot in Coke’s health advice.

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Undermining scientific objectivity

In August 2015, the New York Times revealed that Coca-Cola was funding something called the Global Energy Balance Network (GEBN): a now defunct nonprofit that ostensibly researched the causes of obesity but promoted the notion that people should focus less on diet and more on exercise. Scientists with the group, described as an “astroturfing” operation, suggested that people should lose weight not by cutting caloric intake but by increasing exercise. Health care professionals criticized GEBN for downplaying the link between sugary drinks and obesity. The group announced it would cease operations by the end of the year, citing “resource limitations” — not public outcry or an approach that no longer reflects the scientific consensus.

The Denver Post reported in December 2015 that James Hill, a nutrition expert who directed the University of Colorado’s Anschutz Health and Wellness Center, had accepted $550,000 from Coca-Cola and traveled the world at company expense to spread GEBN’s message at conferences. He has since resigned.

A team of University of California, San Francisco researchers looked at 60 studies from 2001 to 2016 and found that 34 reported a link between sugary drinks and obesity and diabetes while 26 did not. All the studies that reported no link were funded by the beverage industry.

“There have been studies done that show when the soda industry is funding studies the results are null or negative, meaning they are either not showing an association with obesity or that the risk of obesity goes down. I think that’s sort of the same bias you’re talking about, when money is funneled in,” Bleich said.

Public health lawyer Michele Simon released a study in June 2015 saying that the American Society for Nutrition (ASN), which publishes the American Journal of Clinical Nutrition, one of the nutrition field’s most respected journals, has many ties with the food and beverage industry that hamper scientific objectivity and result in “industry-friendly research.”

“Moreover, the media views health organizations like ASN as purveyors of independent and objective information, largely unaware of the many connections with junk food and beverage giants,” Simon wrote.

For instance, the ASN’s “sustaining partners” — a designation given to companies that give at least $10,000 a year — include manufacturers of highly processed and minimally nutritious foods and drinks, including Coca-Cola and Pepsi. The donations give these companies “print and online exposure, annual meeting benefits and first choice to sponsor educational sessions, grants, awards and other opportunities as they arise.”

“In other words,” Simon said, “food, beverage, supplement, biotech and pharmaceutical industry leaders are able to purchase cozy relationships with the nation’s top nutrition researchers.”

ASN did not respond to a request for comment from Yahoo News.

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Junk food and obesity

Kane of the American Beverage Association said obesity rates have been steadily rising while soda consumption has been going down. In fact, it recently hit a 31-year low, according to Beverage Digest. She said, “If soda consumption was driving obesity rates, obesity should have gone down as consumption went down — but that isn’t the case.”

When presented this argument, Bleich responded that Kane is “not quite right.”

“While it is correct that overall SSB [sugar-sweetened beverage] consumption has declined, obesity has actually leveled among many adults and even declined significantly among young children. Obesity continues to increase among low-income and minority populations who also continue to be the highest consumers of SSBs,” Bleich said.

Kane responds that all calories contribute to obesity and that one source of calories cannot be blamed wholesale: “We are doing our part with our small piece of the pie.”

“To pin it on one source of calories, which is such a small portion of the American diet, is not only wrong, it’s short-sighted and misleading to people because they think, ‘Oh, I’ll cut one thing out of my diet and all of a sudden my weight challenges are stopped.’ That’s just not the case,” she said.

Stephen Neabore, an internist with the nonprofit Barnard Medical Center, a primary care medical center in Washington, D.C., said processed foods are a driving force of the obesity epidemic — decreasing the nutritional value and increasing the calorie density of food. He encourages his patients to focus on whole foods that grow out of the earth.

“I don’t know of any healthy way to incorporate soda into a diet,” Neabore told Yahoo News. “There’s no nutrition benefit to it, but you’re still getting sugar and calories out of it. It’s not as filling as eating a meal would be, so people tend to overdo it quite easily.”

Neabore said when he talks to patients about the benefits of eating fruits or vegetables that they understand there really is no benefit to drinking soda. He said “carbonated sugar-water” is not healthy by any standard.

“There’s no comparison between any kind of soda I’m aware of and any kind of fruits, vegetables, beans or lentils,” he said. “If people say they want to stick with it, I try to say, ‘Why do you want to stick with this? Why not go all the way and make your diet as healthful as possible so you can get all the benefits you can.”

Neabore said there’s a lot of confusion and disagreement over the perfect diet but that a plant-based diet — including fruits, vegetables, whole grains and legumes — is the only one that’s been shown to prevent and reverse heart disease.

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Expansion overseas

As soda sales decline in the United States, companies are looking for new sales potential in foreign markets. For instance, the first Coca-Cola bottling plant opened in the Gaza Strip in November 2016.

The World Health Organization says obesity rates have more than doubled worldwide since 1980.

WHO and the Pan American Health Organization (PAHO) released a report in September 2015 showing that per capita sales of industrially processed food products, which includes fast food and sugary beverages, increased by 26.7 percent in 13 Latin American countries from 2000 to 2013 — along with obesity rates. This strong correlation indicates that these products are a major driver of rising body weight in the region.

According to the report, total sales of carbonated soft drinks doubled from 2000 to 2013, reaching $81 billion (in U.S. dollars) in Latin America. This exceeded soft drink sales figures in North America.

Enrique Jacoby, the nutrition and physical activity adviser for PAHO/WHO, said these food products are not designed to help consumers meet their nutritional needs. He said the increased portion of “ultraprocessed food products” in the Latin American diet has had “very negative results.”

“They are engineered to have long shelf lives and to create cravings that can completely overpower people’s innate appetite-control mechanisms and their rational desire to stop eating,” Jacoby said in a statement. “So they are doubly harmful: They are quasi-addictive and thus increase overweight and obesity, while replacing whole fresh foods that are the foundation of a natural, nutrient-rich human diet.”

The World Food Programme, the food assistance branch of the United Nations, concluded in a study published last April that the burden of under-nutrition and obesity has cost Latin American economies billions of dollars. Malnutrition has negative consequences for educational outcomes and productivity and increases rates of illness and mortality.

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Blame and shame

Sara Kirk, a professor of health promotion at Dalhousie University in Halifax, Canada, said that the food industry’s rhetoric around personal responsibility places the onus on the individual and ignores the environmental impact. She said the current environment encourages unhealthy behaviors — namely to be less active and over-consume — so it becomes more difficult to make healthy decisions.

“The food industry wants that message to be out there. They want people to feel and believe that. They often frame it as ‘You can eat what you’d like as long as you’re active,’ but we know from study after study that you cannot exercise your way out of the amount of food we’re consuming through the environment we’re functioning in,” Kirk told Yahoo News.

She argues that our current social, institutional and political structures are not supportive for people living with obesity.

“You can’t completely absolve responsibility for individuals because there are choices people make between healthy and unhealthy,” Kirk said. “What we need to think about is that at the moment it’s really hard to make a healthy choice.”

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Beverage taxes

Bleich of Harvard said possible solutions to people taking in too many calories from soda range from the heavy-handed (like sugary beverage tax) to the relatively simple (like easy-to-understand menu labeling).

“There’s a huge body of evidence that says the moment you fiddle with prices you change behavior,” she said. “And the specific evidence for sugary beverages show it has a bigger impact of reducing purchases.”

The ABA and Coca-Cola actively lobby against proposed taxes on sugar-sweetened beverages intended to lower soda consumption, diet-related diseases and health care costs. In response, it has created front groups like Americans Against Food Taxes.

Politically, sugary-beverage taxes are much harder to enact than something like menu labeling, which places the onus on the consumer.

Food reform advocates have said that the food-and-beverage lobby was responsible for watering down first lady Michelle Obama’s “Lets Move” public health campaign, which largely shifted its focus from transforming the American diet to staying active.

The Physicians Committee for Responsible Medicine criticized Obama for having abandoned any major effort to improve the nation’s diet and instead focusing on “noncontroversial recommendations” about exercise. The group contended that “Let’s Move” should “combat the myth that increased exercise can compensate for poor eating habits.”

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Menu labeling

A few years ago, Bleich wanted to see if providing calorie information in a meaningful way would actually have an impact on what someone decides to drink. Her team of researchers posted signs at six stores, in low-income African-American neighborhoods in Baltimore from 2012 to 2013.

These signs showed the number of minutes running or miles walking that would be needed to burn off a sugar-sweetened beverage: they calculated that it would take 50 minutes of running for a 15-year-old weighing 110 pounds to burn off a typical 20-ounce bottle of soda (250 calories).

Afterward, they collected data for 4,516 purchases by African-American adolescents. According to Bleich, obesity and the consumption of sugary beverages are in fact going down for children ages 6 to 11 overall, but is still increasing among black and Hispanic children.

They discovered that when adolescents were told how much they would need to walk or run, they were more likely to buy smaller amounts of soda or skip sugary beverages entirely.

“We are just inundated with health information all the time. Right now we find calories uniformly across any consumer packaged good,” Bleich said. “If right next to those calories you saw a stick figure running and the equivalent in running, I do think that would matter, particularly if it was uniform across the board in all places of consumption and that was echoed on menu boards.”

Neabore said it would be nearly impossible for someone to reach their weight-loss goals through exercise if they maintain a poor diet. When talking to patients about weight loss, Neabore said, he spends about 90 percent on diet. He said that people burn about a hundred calories by running a mile on average.

“If you look at soda or any kind of processed food, that’s almost nothing. A candy bar can have 500 calories in it, which means you have to run five miles to burn off that one candy bar,” he said. “So just avoiding it or substituting it with something that’s good for you is a much better option than trying to burn off those calories.”

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Balance Calories Initiative

Kane said the ABA launched a Balance Calories Initiative to reduce the sugar and calories people get from beverages — with a goal of cutting 20 percent of the calories people get from beverages by 2025.

“We’re doing that in a whole host of ways. At the forefront of that is innovating with new products that have less sugar or no sugar. In fact, 48 percent of beverages purchased now have zero calories,” she said.

Many of those, of course, are artificially sweetened versions of traditional soft drinks. But a few recent studies show signs that even diet sodas can contribute to weight gain and to metabolic syndrome, which can be a precursor to diabetes. It’s unclear why that should happen, although some researchers speculate that by encouraging a taste for sweet foods, diet sodas promote higher caloric intake overall. And the studies are preliminary and hard to interpret — but if future research bears them out, the industry could find itself battling on a whole other front.

Susan Neely, president and CEO of the ABA, said in a Balance Calories Initiative video that the association’s member companies will offer smaller beverage sizes, drink choices with less or no sugar and provide calorie information (which is required by federal statute anyway.)

“As a mother, balance is important to me. It’s what we all want for our families,” Neely said in the video. “So this is the hard work that’s required to bring about real change, and it’s happening now.”

Kane said the industry is intensely focused on getting people interested in new beverage options that have less sugar and fewer calories that they might not know about yet.

“If you walk down the beverage aisle today, it’s going to look a lot different than when you walked down the beverage aisle 20 years ago,” Kane said. “You would have full calorie and diet. Now you have a whole range of options.”

The Coca-Cola spokesman told Yahoo News that their current focus is helping consumers reduce the amount of sugar in their diets.

“We agree that too much sugar isn’t good for anyone, which is why we have refocused our business to reformulate many of our drinks with less sugar — and to create new drinks with low-to-no sugar,” he said.

On behalf of Coke, he expressed support for the recommendation of several global health authorities, such as the World Health Organization, that people should limit their added sugar intake to “no more than 10 percent of their total calories.” He said they “are on a journey to support this recommendation.”

See the related slideshow by Silvia Landi: Globesity: Documenting an epidemic >>>

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