Monday, September 24, 2012

ADA, AAP, AAFP, and ADA: Whose Side are You On? Rest of the Story Challenges Health Groups to Reject Big Soda Money After Coke and Pepsi Deny Link Between Sugar-Sweetened Beverages and Obesity

Today, the Rest of the Story has a question for the American Dietetic Association (ADA), American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and American Diabetes Association (ADA2):

Whose side are you on?

The side of the public's health, or the side of helping to market sugar-laden soft drinks?

In response to a salvo of articles published in the prestigious New England Journal of Medicine which demonstrate -- using the most rigorous methodology available -- a strong link between the consumption of sugar-sweetened beverages and obesity, the Coca-Cola Company and PepsiCo, Inc. responded by denying that there is any link between sugar-sweetened beverage consumption and obesity.

In the first study, investigators examined the interaction between genetic predisposition to obesity and consumption of sugar-sweetened beverages. Their findings were as follows: "In two prospective cohorts of U.S. women and men, we found that greater consumption of sugar-sweetened beverages was associated with a more pronounced genetic predisposition to an elevated BMI and an increased risk of obesity. The findings were further replicated in an independent large cohort of U.S. women. In all three cohorts, the combined genetic effects on BMI and obesity risk among persons consuming one or more servings of sugar-sweetened beverages per day were approximately twice as large as those among persons consuming less than one serving per month. These data suggest that persons with greater consumption of sugar-sweetened beverages may be more susceptible to genetic effects on adiposity. ... Our findings further underscore the need to test interventions that reduce the intake of sugary drinks as a means of reducing the risk of obesity and related diseases."

The authors conclude that "these data support a causal relationship among the consumption of sugar-sweetened beverages, weight gain, and the risk of obesity."

In the second study, normal weight children ages 4-10 were randomized to receive 8 ounces of either a sugar-sweetened or sugar-free beverage each day at school. After just 18 months of providing merely 8 ounces of this beverage a day, there was a significant weight difference between the two groups. The researchers conclude that: "Masked replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in normal-weight children." They note that: "Children in the United States consume on average almost three times as many calories from sugar-sweetened beverages as the amount provided in our trial. We speculate that decreased consumption of such beverages might reduce the high prevalence of overweight in these children."

In the third study, obese and overweight adolescents were randomized either to receive or not receive an intervention which consisted mainly of providing them with non-caloric beverages. Children in the intervention group greatly reduced their consumption of sugar-sweetened beverages and after one year, had significantly lower body mass indices. The effect was attenuated after two years, with children in the intervention group still having lower weights, but there was not a statistically significant difference between the groups.

An accompanying editorial which synthesizes the findings of all three studies emphasizes that: "These randomized, controlled studies — in particular, the study by de Ruyter et al. — provide a strong impetus to develop recommendations and policy decisions to limit consumption of sugar-sweetened beverages, especially those served at low cost and in excessive portions, to attempt to reverse the increase in childhood obesity. ... Taken together, these three studies suggest that calories from sugar-sweetened beverages do matter. ... The time has come to take action and strongly support and implement the recommendations from the Institute of Medicine, the American Heart Association, the Obesity Society, and many other organizations to reduce consumption of sugar-sweetened beverages in both children and adults."

The Rest of the Story

Despite this strong evidence that sugar-sweetened beverages contribute to obesity, two major corporations which produce such drinks - the Coca-Cola Company and PepsiCo, Inc. - continued to deny any link between consumption of sugar-sweetened beverages and obesity. The companies responded by stating: "Sugar-sweetened beverages are not driving obesity. By every measure, sugar-sweetened beverages play a small and declining role in the American diet."

The statement of the soft drink companies is analogous to the repeated denials of the tobacco industry in past decades that its products contribute to lung cancer, heart disease, and chronic obstructive lung disease. In light of evidence to the contrary, the tobacco industry continued to deny any link between smoking and disease.

Now, the soft drink companies are acting exactly like Big Tobacco. In the face of strong evidence - from multiple independent studies - published in a reputable medical journal, these companies publicly deny that there is any link between consumption of sugar-laden beverages and obesity. Furthermore, they have the chutzpah to suggest that sugar-sweetened beverages play a small role in the American diet and that their consumption is going down.

These claims are in stark contrast to the boasting proclamations of the Coca-Cola Company that its sales volume grew 4% last year in North America. It's funny because I don't see anything in this investment report about how sugar-sweetened beverage consumption is declining in America. These companies are talking out of both sides of their mouths: one side for the damage control due to the New England Journal studies; the other side for their investors.

There's More to the Story

It would be great if this were the end of the story. But it doesn't end here.

Four public health organizations - the American Dietetic Association, American Academy of Pediatrics, American Academy of Family Physicians, and American Diabetes Association - have accepted money from the Coca-Cola Company and/or PepsiCo and have forged corporate partnerships with these companies, in some cases going so far as to call these companies leaders in the movement to reduce obesity.

American Academy of Family Physicians

The American Academy of Family Physicians (AAFP) has entered into a corporate partnership with the Coca-Cola Company, in which Coca-Cola is providing money to AAFP in return for public recognition, improvement of its public image, distraction of public attention away from the role of Coca-Cola's products in the obesity epidemic, a lucrative marketing opportunity for Coke, and ultimately, an increase in its bottom line (Coke sales).

The large expenditure on the part of Coca-Cola is very well spent, and should be applauded vigorously by Coca-Cola stockholders. The corporation is already starting to reap the benefits of this rare marketing opportunity.

On the web site that is apparently being supported by Coca-Cola, the AAFP actually goes so far as cautioning people not to necessarily limit their consumption of soda: "Sugar-sweetened drinks, such as fruit juice, fruit drinks, regular soft drinks, sports drinks, energy drinks, sweetened or flavored milk and sweetened iced tea can add lots of sugar and calories to your diet. But staying hydrated is important for good health."

American Academy of Pediatrics

The American Academy of Pediatrics accepted funding from Coca-Cola to sponsor its "Healthy Children" web site. On that site, the AAP states that the Coca-Cola Company is committed: "to better the health of children worldwide."

Whatever Coca-Cola contributed to the American Academy of Pediatrics to garner that statement and recognition as a leader in the child health movement internationally was nowhere near enough. This is blatant prostitution, where the AAP is essentially selling its site to the highest bidder. Do you want to be recognized as a leader in children's health internationally? Simply pay off the AAP. Never mind the fact that you market a product which is a major contributor toward childhood obesity.

American Dietetic Association

According to a press release issued on August 31 by the Coca-Cola Company, the American Dietetic  Association has accepted $125,000 from Coca-Cola. This donation was originally reported over at the Fooducate blog in a post entitled "Here's How Coke is Buying the Silence of Health Organizations. For Pocket Change."


I defy anyone to find information on the ADA's web site about the billions of dollars that Coke is spending annually to market its sugar-laden products. Given the role of soda marketing in the obesity epidemic, that is what I call total silence.

In fact, the public's health would be better served if the ADA were completely silent. The media outreach that it is doing stands in opposition to what many of us in public health are trying to accomplish through policy measures to reduce soft drink consumption. Concurrent with its acceptance of money from Coca-Cola, the ADA has actually become an enemy of critical public health measures to reduce obesity, not merely an innocent bystander, and at the far extreme from being a leader in the nutrition policy movement.

American Diabetes Association

According to a press release issued on August 31 by the Coca-Cola Company, the American Diabetes Association has accepted $125,000 from Coca-Cola. This donation was originally reported over at the Fooducate blog in a post entitled "Here's How Coke is Buying the Silence of Health Organizations. For Pocket Change."

The Challenge

Today, I am issuing a challenge to the American Academy of Pediatrics, American Academy of Family Physicians, American Dietetic Association, and the American Diabetes Association:

Now is your chance to change sides on this issue. Right now, you have chosen to take the side of aiding in the marketing of sugar-laden soft drinks and other sugar-sweetened beverages by partnering with corporations that are spending millions of dollars to market these drinks and to oppose every reasonable measure introduced at the state and local level to improve school nutrition. You have chosen to serve as a pawn in the marketing and public relations efforts of corporations that to this day, are publicly denying that there is even a link between sugar-sweetened beverage consumption and obesity. And which even have the gall to publicly claim that sugar-sweetened beverages play a minor and declining role in the American diet, despite their investor reports which boast the exact opposite.

I challenge these four organizations to switch sides, and to come over to the side of the public's health by renouncing their corporate partnerships with Coca-Cola and Pepsi, returning their checks, and vowing not to accept funding from these companies.

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