Luis GómezI, II; Enrique JacobyIII; Lorena IbarraI; Diego LucumíI; Alexandra HernandezIV; Diana ParraV; Alex FlorindoVI; Pedro HallalVII
IDivisión Salud. Fundación FES Social. Bogotá, Distrito Capital, Colombia
IIFacultad de Medicina. Pontificia Universidad Javeriana. Bogotá, Distrito Capital, Colombia
IIIAsesoría Regional de Nutrición. Organización Panamericana de la Salud. Washington, DC, USA
IVDepartamento del Medio Universitario. Universidad del Rosario. Bogotá, Distrito Capital, Colombia
VGeorge Warren Brown School of Social Work. Prevention Research Center in St. Louis. Washington University in St. Louis. St Louis, MO, USA
VIEscola de Artes, Ciências e Humanidades. Universidade de São Paulo USP Leste. São Paulo, SP, Brasil
VIIPrograma de Pós-Graduação em Epidemiologia. Universidade Federal de Pelotas. Pelotas, RS, Brasil
The growing evidence on the association between consumption of sugar-sweetened beverages, obesity and other chronic diseases has highlighted the need to implement policy actions that go beyond programs exclusively focused on individual responsibility. In order to protect their commercial goals in Latin America, the sugar-sweetened beverage industry practices intense lobbying at high government levels in several countries across the region. This strategy is accompanied by corporate social responsibility programs that fund initiatives promoting physical activity. These efforts, although appearing altruistic, are intended to improve the industry's public image and increase political influence in order to block regulations counter to their interests. If this industry wants to contribute to human well being, as it has publicly stated, it should avoid blocking legislative actions intended to regulate the marketing, advertising and sale of their products.
DESCRIPTORS: Nutririon, Public Health. Physical Activity. Soft Drinks. Soft Drinks Industries. Conflict of interest.
Sugar-sweetened beverages, which include the majority of soft drinks and fruit drinks,9 have been linked to a higher risk of overweight and obesity, among other health problems.5,10 In contrast to solid foods, these beverages have a low satiety capacity, which increases the probability of a positive energy balance in regular consumers.9 In addition, different studies have found that the consumption of sugar-sweetened beverages is associated with type II diabetes, coronary heart disease and metabolic syndrome.6 This food category is the one with the most scientific evidence showing its negative health effects, which has prompted the need to limit consumption through regulations that go well beyond traditional actions focused on individual responsibility.1
Mexico exemplifies the dimension of this problem in Latin America as consumption of soft drinks doubled in seven years, and overweight and obesity affect nearly three quarters of the adult population and 25% of children.a
All beverage corporations have adopted uniform silence on the scientific evidence and have intense lobbying underway in order to frustrate regulatory efforts.7 Simultaneously, they have publicly pledged to limit advertising aimed at children and assured customers that their products are in fact good and even better if accompanied by physical activity. To this end, the multinational beverage corporations have invested large amounts in support of physical activity programs, as well as studies and initiatives in Latin America. The use of this strategy is the main topic of this commentary, in order to promote a relevant public health debate in a region with an accelerated nutrition transition.
PUBLICITY AND MARKETING STRATEGIES OF THE BEVERAGE INDUSTRY
Growing rates of overweight and obesity in the United States among both adults and children, have generated an intense public debate on the need for policies to regulate marketing strategies for sweetened beverages as well as their price and availability in schools.8 Several states have considered the possibility of increasing taxes on these products, which may have a significant impact on public health.2 An example of the unfavorable environment to the beverage industry is the current campaign led by the New York City Department of Health, which uses mass media to warn how the consumption of these beverages leads to fat deposits with a consequent negative impact on cardiovascular health.b
In this context, it comes as no surprise that consumption trends of sweetened beverages in the United States and Western Europe have leveled off or even shown a small decrease.4
The empowerment of public opinion in North America concerning negative effects of the sweetened beverages industry was acknowledged by an executive of Coca Cola in 2007, who declared: "Our Achilles heel is the discussion about obesity. It's gone from a small, manageable U.S. issue to a huge global issue. It dilutes our marketing and works against it. It's a huge, huge issue." c
Given this growing regulatory environment in developed countries, the beverage industry has redirected its marketing efforts to countries with emerging economies, where their products still have moderate levels of market penetration, favorable legal contexts and a relatively weak civil society in comparison to Europe and the United States.1 This strategy has been successful in Latin America and is directly linked to the fact that Mexico has the highest per-capita consumption of soft drinks in the world.d Likewise, the increase of consumption in Brazil has been considerable, at 14.6% in the period of 1995-1998.e
In Costa Rica the beverage industry has expanded their commercial activities, establishing new points of sale in public and private schools. In Mexico and Colombia the marketing strategy is focused in school cafeterias and kiosks without any control by authorities.4 This presence in schools not only boost sales of its products but also enhances brand awareness among children, thus ensuring future consumers.4
PHYSICAL ACTIVITY AS A "SOCIAL RESPONSIBILITY" STRATEGY
In order to accomplish its commercial goals in Latin America and achieve an appropriate normative environment for its interests, the sweetened beverage industry aggressively lobbies high government levels of several countries in the region.4 This strategy has been accompanied by social corporate responsibility programs aimed at supporting government or private initiatives promoting physical activity.
Coca Cola is probably the beverage company that provides the most support to studies and programs in physical activity. The official website of this company declares that " our goal is to contribute in increasing the standards of physical activity around the world". In addition, it mentions that in order to achieve this objective Coca Cola will establish strong links with governmental agencies and experts from the health sector in different countries of Latin America.f
In addition to the high per-capita consumption of soft drinks, Mexico is one of the Latin American countries with the highest number of physical activity programs supported by Coca Cola. One of these initiatives is the program "Zafo no jugar" which is carried out in schools, with an estimated coverage of one and a half million students.f
In Argentina, this company has supported inter-college football championships since 2007 and also provides "nutritional information to motivate the children in the adoption of healthy lifestyles". f
The Colombian branch of Coca Cola emerges as the official sponsor of the Ciclovías program, carried out in the city of Bogota during Sundays and holidays. This agreement includes the installation of temporary "hydration stand points", 400 sale stands which include the selling of sweetened beverages and an aggressive visual campaign to market their products. g
The same transnational company supports numerous physical activity initiatives in Brazil, which include mass walks in the city of Sao Paulo and the programs "Movimento Bem-Estar", "Corda na Rua" y "Prazer de Estar Bem".4 In addition, Coca Cola signed an agreement with the Health Ministry of Brazil aimed at preventing obesity and "improving the nutrition of Brazilians".f
On the other hand, PepsiCo in Mexico has set up the program "Vive Saludable Escuelas" ("Live Healthy Schools") with the aim of "generating awareness in school children about the importance of adopting a healthy diet and engaging in regular physical activity".h
The aforementioned cases are only some examples of the numerous initiatives of physical activity promotion supported by Coca Cola and PepsiCo in Latin American countries.
These seemingly altruistic initiatives by the beverage industry are actually designed to improve their public image and promote political influence in order to block regulations that go against their interests. These tactics emulate those used by the tobacco industry to offset their negative image, including: deny scientific evidence, discredit its detractors, cultivate allies in governments and academia and increase publicity of its products to youth and their parents.7
The key goal of these tactics is to undermine legislative efforts aimed at reducing the consumption of sweetened beverages among children and youth. Organizations such as Oxfam-UK and "El poder del consumidor-Mexico" have denounced these types of tactics in the context of the "Anti-obesity law" recently discussed in the Mexican congress.i, j Likewise, sections of Brazilian academia have expressed concern about how the industry has blocked regulations to control beverage advertisements through voluntary agreements that they do not follow.3
Another example that shows the influence of the beverage and food companies was the fervent pressure to weaken the Global Strategy on Diet, Physical Activity and Health, approved in May 2004 by the World Health Assembly.7 The industry was resistant to limit levels of trans-fatty acids, saturated fats, free sugars, and salt that are present in an important proportion of processed foods and beverages.7 Due to this situation, these corporations appealed to voluntary agreements in order to convince Latin American governments, including Brazil, of the supposed dedication they had to fulfill this recommendation.7 These agreements have not been respected and, on the contrary, have been very effective in delaying the implementation of appropriate actions.7
Finally, one of the most remarkable public relations actions by Coca Cola was being the principal sponsor of the 3rd International Congress on Physical Activity and Public Health held in Toronto in 2010. This event, which has previously been the face for public health research of physical activity around the world, became a demonstration of the influence gained by Coca Cola,k as summarized in these words by Simon from the University of California: "[food and beverage industries] lobby vociferously against policies to improve children's health; make misleading statements and misrepresent their policies at government meetings and in other public venues; and make public promises of corporate responsibility that sound good, but in reality amount to no more than a public relations campaign".l
CONFLICT OF INTEREST DIFFICULT TO IGNORE
Strategies to promote physical activity by the sugar-sweetened beverages industry are only a smokescreen to divert attention from the negative health effects of its products. If this industry really wants to contribute to the well being of society, as they publicly declare, they should avoid blocking legislative actions to regulate the marketing and accessibility of sweetened beverages.
Despite scientific evidence about the links between sweetened beverages and increasing rates of obesity and overweight, an important number of public institutions and several scientific associations in the area of nutrition and physical activity have received support from the beverage industry, which sends a contradictory message to the population.1
Conflicts of interest should not be ignored in public health. Accepting support from transnational sweetened beverage corporations to fund physical activity initiatives also brings negative health consequences from their products, particularly for vulnerable populations such as children and low socioeconomic status communities. Keeping in mind a commitment to social welfare, public health researchers and health professionals should consider the importance of coherent decision-making that harmonizes with principles of health promotion.
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2. Brownell KD, Frieden TR. Ounces of prevention- the public policy case for taxes on sugared beverages. N Engl J Med. 2009;360(18):1805-8. DOI:10.1056/NEJMp0902392
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9. Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC. Consumo de bebidas para una vida saludable: recomendaciones para la población mexicana. Salud Publica Mex. 2008;50(2):173-195. DOI:10.1590/S0036-36342008000200011
10. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007;97(4):667-75. DOI: 0.2105/AJPH.2005.083782
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Article available from: www.scielo.br/rsp
The authors declare that there are no conflicts of interests.
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k The 3rd International Congress on Physical Activity and Public Health. Toronto; 2010[cited 2010 Sep 01]. Available from: http://www.cfl ri.ca/icpaph/en/sponsors.php
l Simon JD. Can food be companies be trusted to self-regulate? An analysis of corporate lobbying and deception to undermine children's health. Los Angeles; 2006 [cited 2010 Sep 01]. Available from: http://www.ftc.gov/os/comments/foodmktgtokids-pra/526194-00008.pdf