The hunger for profit. (Book Review).

Marion Nestle, Food Politics: How the Food Industry Influences Nutrition and Health (Berkeley: University of California Press, 2002).

After reading Food Politics, I visited a local McDonald's restaurant to see for myself how food companies are influencing eating habits. Over the course of an hour I watched more than 200 people eat lunches that consisted mostly of burgers, fries, and soda. I was surprised to find that, according to my tally, the average meal consisted of a large--not a "supersized"--meal, even though the latter provided an extra 170 calories for just 39 cents. When I asked one customer why he didn't supersize, he told me that he knew his limits: "I can't eat that many fries and the drink is, like, gigantic."

Leaving the restaurant I felt hopeful that the premise of Food Politics, that "the food industry influences health and nutrition," was more vitriol than reality. That is until I read the McDonald's "Nutrition Facts" website. After a few calculations, it became clear that eating an average medium-sized meal (let alone the large or supersized) would provide more than half a day's 2,250 suggested calories and two-thirds of the daily recommended intake of fat--not the most healthy meal choice one could make. Yet, each day 45 million people make similar choices in 29,000 McDonald's restaurants around the world.

These dietary choices affect health. Worldwide, one in six people is overweight or obese. In the United States, more than three in every five adults are overweight or obese, according to a report released last year by the U.S. Surgeon General. These conditions, which lead to heart disease, diabetes, and many cancers, were associated with approximately 300,000 U.S. deaths in 2000--not far below the 400,000 deaths connected with smoking during the same year.

What has led to this obesity epidemic? Simply put, calories consumed exceed calories burned. Ninety-seven percent of Americans do not maintain a balanced diet, while fewer than a third exercise enough. Food Politics does not tackle the causes behind sedentary lifestyles, but it offers some insights as to why so many people are overeating, starting with the food industry's "imperative to encourage people to eat more in order to generate sales and increase income in a highly competitive marketplace."

Like any industry, food companies are under intense pressure to satisfy shareholders by maximizing earnings. Companies employ sophisticated marketing campaigns and produce cheap and ubiquitous products to attract consumers. But the book reports that food companies have been working behind the scenes as well, influencing policy-makers, nutritionists, and industry watchdog organizations.

For example, the food industry has successfully lobbied government agencies to convert proposed health recommendations that consumers eat less, to more palatable--and profitable--dietary advice. The original draft of the U.S. Department of Agriculture's year 2000 dietary guidelines read: "go easy on beverages and foods high in added sugars." But after an intensive campaign, according to Food Politics, sugar industry lobbyists convinced. 30 senators (half from sugar-growing states) to challenge whether the agriculture department had the right to "change the sugar guidelines based on existing science." In the end, the recommendation was reworked to read "choose beverages and foods to moderate your intake of sugars."

The $800 billion U.S. food industry utilizes its vast finances to influence the scientific community as well. As Food Politics explains, companies can "engage nutritionists as allies," by funding nutritionists' research, journals, and professional societies, often influencing research topics, what is published, and organizational agendas. One example highlights the close ties between the food industry and the American Dietetic Association (ADA), a professional society of more than 65,000 dietitians. The ADA promotes "optimal nutrition and well being for all people." Yet, the ADA has received a significant percentage of its income from corporate sponsors like M&M Mars, McDonalds, and CocaCola. Looking at the ADA's website, I found one fact sheet on drinks explaining that "all beverages can have a place in a well-balanced eating pattern." It was sponsored by the National Soft Drink Association.

In another chapter, Food Politics examines the industry practice of marketing soda to children. Consisting of water, sweeteners, flavors, and in most cases caffeine, soda combines a number of cheap inputs to produce a profitable and often mildly addictive product. In the United States, the average person drank 211 liters of soda in 1999--almost twice the amount of tap water consumed. Soda is a central source of added sugar in the U.S. diet, providing, on average, 185 nutrient-devoid calories per day--more than the USDA recommended daily maximum for total added sugars. The Coca-Cola Company and PepsiCo alone spent $4.6 billion dollars in 2000 marketing their products around the world. Of this, a significant portion directly targets children--the consumers who are the most susceptible to advertising and whose dietary patterns and product loyalties are still malleable.

In the United States, soda companies sign contracts directly with school districts to obtain exclusive "pouring-rights" in schools along with permission to place logos on vending machines, sportswear, and even the school buildings. As Food Politics explains, "In this manner, all students in the school, even those too young or too difficult to reach by conventional advertising methods, receive constant exposure to the logos and products." The icing on the cake (or the fizz in the soda) is that many contracts have clauses that if the schools reach a certain quota, payments will increase. Not surprisingly, between 1985 and 1997, school districts increased purchases of soda by 1,100 percent.

Because its primary focus is on the United States, Food Politics leaves two important issues unexplored. First, food companies, regardless of their country of origin, are using these aggressive tactics to influence the diets and policies of all nations. Second, as these companies enter new markets, more of the world's population is confronted with an array of unhealthy products. This is creating a "nutrition transition" in which traditional diets that are usually rich in vitamins and minerals are displaced by ones high in fat, sugar, and salt. As this occurs, the number of people already facing vitamin deficiencies--now between 2 and 3.5 billion--will increase. Just as soda has displaced milk in the United States, industry experts predict that it will displace milk worldwide within a few years, shifting consumption from a nutrient-filled beverage to one loaded with sugar.

Food Politics does address food companies' impact on global malnutrition in one case study. Over the past several decades, infant formula makers have orchestrated an aggressive public relations campaign, offering free samples and lobbying health professionals to advise mothers to use formula. The World Health Organization recommends that mothers exclusively breast feed, as formula does not have the natural immune benefits found in breast milk and can cause serious illness due to water contamination and improper use. Yet, marketing efforts have promoted formula consumption, according to the book--and in many cases have increased infant mortality. In response, a global coalition of activists mobilized in the late 1970s to stop marketing practices that favored bottle-feeding. Declaring a boycott of the Nestle Corporation, the largest international formula company, the coalition brought worldwide attention to this issue which in turn pressured governments to better regulate formula marketing.

Food Politics documents several instances in which grassroots pressure has effectively resisted the agenda of food companies. A final section offers some further strategies in combating food industry influence. Suggestions range from the obvious (such as increasing "dietary literacy," and mandating more accurate product labeling) to the idealistic (encouraging companies to halt misleading advertising and adhere to new health regulations). The most intriguing suggestion is to apply the lessons learned from the fight with Big Tobacco to Big rood. In recent years a number of food companies seemingly have taken their cues from tobacco companies, influencing regulators, manufacturing supportive research, or peddling their unhealthful products to consumers too young to protect themselves. To wrestle with Big Food, Food Politics recommends utilizing the tactics of antismoking groups by developing "a firm research base, a clear message, well defined targets," and employing strategies that educate consumers and counte r the promotion of poor nutrition.

While these suggestions target the U.S. market, many apply to other countries as well. Currently, there is a worldwide movement to create a global tobacco treaty that will establish international standards on marketing and labeling cigarettes. With the detrimental effects of overnutrition rivaling that of tobacco, the creation of an international nutrition-labeling program, and guidelines on marketing (especially to children) could help to significantly reduce health problems. Creating political pressure to win better regulation at the local, national and international levels is a plausible first step. Food Politics makes it clear that poor nutrition has more to do with the corporate-constructed food environment than with simply weak will power.