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A Look at Food Industry Responses to the Rising Prevalence of Overweight

Posted on: Saturday, 25 February 2006, 03:01 CST

By Grotz, V Lee

The role of the food industry in the response to the epidemic of obesity is guided by many factors, including the current state of knowledge of the problem. There have been efforts among food and beverage companies to help increase our knowledge about the factors contributing to overweight and to investigate product and marketing changes that may help reduce the risk of weight gain. The value of their future contributions is dependent on corporate resolve, but also on interactive guidance from government and health institutions on the best strategies to take and the best research to support. This is especially clear given the complex nature of the causes of obesity and approaches for treatment.

Key words: food industry, obesity, overweight

2006 International Life Sciences Institute

doi: 10.1301/nr.2006.feb.S48-S52

INTRODUCTION

With the current epidemic presence of overweight,1-3 its related health risks,4-6 and staggering costs,7 it is not surprising that there has been an intense interest in the actions of US food industries in response. It may be useful to consider the kinds of actions taken to date by the food industry, as well as the causative factors involved. This paper, while not meant to be an all- encompassing report on food industry activities, may shed light on some that are perhaps not so widely known to the public, and may help us all to know how best to work with a potentially valuable resource in addressing the public health problem of overweight.

HISTORICAL PERSPECTIVE

The food industry has been faced with a changing climate, with research at varying stages of depth along the way and with ever- increasing media attention (International Food Information Council Foundation 1990-1999 data, personal communication).8 An assessment of steps that the food industry has taken in response must take into account this climate and these changes.

For example, in the not-too-distant past, obesity was not considered to be a widespread public health threat. Rather, it was mainly perceived as a cosmetic issue related to individual choice.9 Therefore, the serious health risks associated with obesity were less clearly appreciated, as was the value of modest weight loss and/ or prevention of excess weight gain. In such a climate of thinking, the responsibility of the food industry in helping to prevent a rising prevalence in obesity was not considered as critical as it seems to be today, by either food companies or by outside experts.

In contrast, obesity has been recently perceived as a multifactorial issue affecting all segments of the population.1- 3,10,11 Portion control, the readier availability of prepared foods over fresh foods, poorer eating behaviors, and food advertising practices, among other factors, have been linked to the epidemic of overweight.12-19 Weight loss as modest as 5% is now accepted as a reasonable goal that can improve existing comorbid conditions and prevent the development of new adverse health conditions. In short, new research has altered the perception of how foods may affect the prevalence of overweight and how even small dietary changes may be key to successful weight management,11,20,21 which provides a direct path for the food industry to follow to help provide support.

THE INITIAL RESPONSE: RESEARCH

The first response of food industry to the growing problem of obesity was to conduct research, either initiated on its own or through support of others' efforts. This included marketing and academic research. Marketing research has helped the food industry to understand whether its consumers have an interest in new food choices, presentations, marketing strategies, etc. Most food companies, however, typically do not have significant experience in the business of conducting scientific research into the causes, treatment, or prevention of obesity. Further, clinical research is quite cost-intensive. Many companies have found that a collaborative approach helps to pool funds that separately might either be deployed with less impact or be insufficient to significantly support an academic study or series of studies. While there may be several approaches to this, one approach has been for companies to support the International Life Sciences Institute (ILSI).

ILSI is a non-profit, worldwide foundation that seeks to positively impact public health through increased understanding of scientific issues related to nutrition and food safety.22 To provide sound scientific and policy guidance, ILSI has respected academic leaders on its advisory board and has sought input on various projects from high-level governmental organizations. The ILSI North America branch is supported by about 50 companies, the majority of whom are major food, or food ingredient, companies. ILSI has also identified overweight/obesity as a key issue for its efforts in helping to achieve scientific solutions to help improve public health.

Through activities at ILSI, the food industry has helped to make possible research that touches upon many aspects of overweight and its related health risks. For example, ILSI, through its Research Foundation, has sponsored scientific research on the role of physical activity,23 as well as on the early feeding practices of mothers and how these practices can impact children's weight.24 ILSI has also sponsored an expert review of the effects of sugars and carbohydrates in nutrition,25 and through its Research Foundation, research on the needs of health care professionals in pediatric weight management and what is indicated for effective weight management practices.26-31

While there are many, many other important sources of obesity- related research to consider in the evaluation of the right and best approaches to understanding, treating, and preventing obesity, ILSI- sponsored research, funded by grants from companies related to the food business, as well as independent foundations, has helped to improve our collective understanding of the problem and what our next steps should be.

SECONDARY STEPS

Support of Intervention Programs

Following the early investigations and thoughts and beliefs about the causes and treatments of overweight, some food companies have also lent support to certain intervention programs.

One such intervention program is TAKE 10!, a school-based program for children in kindergarten through grade 5.32 This program was created by teachers and students and was initiated by the ILSI Research Foundation. By linking 10-minute age-appropriate activities to learning objectives, this program incorporates physical activity into lessons. Children participating in this program have demonstrated not only increased physical activity but also increased attention in class.33 Research has also shown the program to be sustainable: teachers are overall positive towards the program and are willing to continue to use it.

Another example is a Web-based program, Kidnetic. com, which was designed to promote active living and healthy eating among children ages 9 through 12.34 For example, children can enter games that challenge them to do a series of physical activities while racing against a clock. Other links contain activities that promote learning about better nutrition. The Kidnetic.com website is an initiative funded by the International Food Information Council (IFIC) Foundation. The website lists 13 major food organizations as the sole sources of unrestricted grants that provided funding.

America on the Move(TM) is also a Web-based, not-for-profit program. In contrast to the other examples, this program is not solely focused on children. Instead, it is a program that attempts to prevent weight gain by encouraging modest changes in lifestyle, such as decreasing energy intake by 100 calories a day and increasing activity by 2000 extra steps a day.35 Participants can register online to receive a free regular newsletter and track their progress. Such novel approaches to lifestyle intervention can potentially provide a widespread, low-cost strategy for weight management. The Web program lists numerous food/beverage-related companies as sources of funding.

New Products and Marketing Strategies

In some ways, new products and marketing strategies represent a more aggressive response of the food industry to the problem of overweight, insofar as these steps are self-initiated and self- sustained, and may not equate to short-term business "wins." Thus, their existence comes with the acceptance of certain risks, which may not be inconsequential.

One example of new products are those recently offered by Kraft Foods following a 1993 public commitment by Kraft to reduce the fat and calorie content of a wide range of its products and the portion sizes of its single-serve packages.36 These feature low-calorie snacks, called "100 Calorie Packs," that are single-serve portions of products under well-known brands, such as Oreo, Kraft Cheese Nips, and Wheat Thins, that are intentionally marketed as sensible snacks. Similarly, the McDonald's Corporation has made less calorie- and fat-dense items, such as salads and water, available in its restaurants.

Some major juice manufacturers, such as Tropicana and Ocean Spray, have introduced lower-calorie versions of juice products, and some major carbonated soft drink manufacturers have expanded their redu\ced calorie product line to include products such as Coca- Cola's C2 and PepsiCo's Pepsi Edge. All of these drinks have significantly fewer calories than do the full-calorie/sugar versions. In the case of the soft drinks, they are not as low in calories as soft drinks that qualify for a "diet" or "no calorie" claim according to FDA standards, but each of these products still has some sugar/high-fructose corn syrup and so may still possess some of the hedonic properties associated with these ingredients. Such products may represent an attractive first step into lower- calorie beverages for consumers who might otherwise purchase only full-calorie soft drinks. For consumers who have a significant calorie intake from soft drinks, these changes may be helpful in the overall management of calories.

There have also been changes in food industry marketing strategies. McDonald's Corporation has phased out its supersize portions of fries and drinks.37 Additionally, while more attention may be warranted here, some vending contracts between soft drink companies and elementary and middle schools have been changed to help reduce the visibility and temporal availability of full-sugar soft drinks to younger children. Similarly, with increased research showing the relationships of television food advertising and overweight in children26 and potential risks of poorer eating habits into older years,25 some companies have increased the target age of their television advertising of certain foods and beverages away from younger children and towards an older audience. This could translate into reducing the risk of poorer food selection among growing children and increasing parental influence over food choices.

In addition, many food companies with websites now post responsible nutrition information on their sites. Beyond nutrition information about a company's products, this can include information on healthy weight and active lifestyle programs. One company, Subway, an international sandwich corporation, which has had a successful advertising campaign focused on the potential utility of its products in weight management, has also sponsored talks to children about the health risks of overweight, given by "Jared," someone who has been made widely known as a Subway success story.38

New Collaborations

The food industry has also responded to the problem of overweight with new collaborations. Shaping America's Youth, for example, is a program developed in cooperation with the Office of the Surgeon General and is sponsored by several major food companies.39 One of the first goals of Shaping America's Youth was to create an online database of programs for managing or preventing overweight in children. With the creation of this database within the past year, its next goal is to assess what kinds of programs are best suited to meeting specific needs for the prevention and treatment of childhood overweight. Another example is Salsa Sabor y Salud, a program sponsored by Kraft Foods, which is implemented in conjunction with the National Latino Children's Institute. This program was designed to bring healthier eating and living practices to Latino children in the United States, and emphasizes making appropriate food choices and increasing physical activity.

In addition to work within organizations such as ILSI and IFIC, some food industries have initiated their own conferences and symposia to discuss the issues and potential solutions possible within/by the food industry. These include conferences such as the Fifth Nestl Nutrition Conference, at which approaches to the prevention and treatment of obesity was the focus. Similarly, a recent symposium held by McNeil Nutritionals, LLC, a Johnson & Johnson company, attended by senior executives representing over 20 major food companies, included world-recognized medical experts and opinion leaders in consumer insights and innovations and focused on candidly discussing how the food industry can best respond to the obesity epidemic.

Unrestricted Grants

Many food companies have also made unrestricted grants to relevant health care professional organizations in an effort to help them determine the best ways to combat obesity, including continued research. High on the list for these companies are organizations such as the American Heart Association, the American Diabetes Association, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Dietetic Association.

Continued Research

Food companies continue to support academic research efforts aimed at improving our ability to respond to the obesity epidemic through ILSI. ILSI North America recently held a conference on "Portion Size, Weight Gain and Children" to identify scientific issues that should be addressed, and continues to support research on eating patterns and effective intervention strategies. Support of other academic research efforts is also likely taking place, and marketing research is continually adding to the picture shaping the actions of food companies.

CONCLUSIONS, COMMENTS, AND FUTURE DIRECTIONS

Obesity is the result of a complex mix of factors10,11,40,41 that are not just related to the intake of prepared foods and beverages. In the face of this knowledge, and given its varied responsibilities, including to its customers, stockholders, employees, and supporting and surrounding communities, food companies have to consider to what extent, and how, they should be involved. In general, the food industry has helped to increase our understanding of the epidemic of obesity and has been part of initiatives aimed at improving the situation. It goes without saying that more can be done. However, to gain the best support from food and beverage companies in the fight against obesity, it may be critical for government and major health and research organizations to work more closely with them.

Food companies do respond to research and, as seen in the examples given in this paper, can help support it. They should be encouraged to continue that support. Food companies also may need assistance in finding the right place to target research support. For example, a review of the Shaping America's Youth database of weight management strategies revealed that, although over seven million dollars have been invested in these programs by academic and other organizations, only 4% of the programs have reported outcomes.42 Without effective outcome measurements, the utility of such programs is difficult to understand. Similarly, food companies may need guidance on what are the best strategic initiatives for helping to combat the problem of overweight. Given the historical difficulty of treating obesity,11 support of programs designed to help prevent excess weight gain, especially in children and higher- risk populations, may be of the highest priority.

Wherever possible, however, food companies should also take additional, reasonable initiatives without prompting. The epidemic of overweight is a global health threat. With increased awareness of the role of portion size in overweight, the restaurant industry needs to focus on supporting portion control. Similarly, food and beverage companies, with their significant marketing expertise, may want to consider ways to help disseminate information wanted and needed by both consumers and practicing physicians. They may also want to introduce programs to help their own employees and their families to have healthier weights, which might also lower overall company health care costs.

Changing our nation's general approach to eating and physical activity will not be accomplished overnight. Therefore, it is that much more important to engage the food industry, and all other major industries, in efforts to help reduce the prevalence of overweight. Many food companies have a serious commitment to optimum public health, and we should all make efforts to embrace and capitalize on that commitment.

REFERENCES

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2. World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: World Health Organization; 1998.

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8. International Food Information Council. Trends in Obesity- Related Media Coverage. Available online at: http://ific.org/ research/obesitytrends.cfm. Accessed January 8, 2006.

9. Brown PJ. Cultural perspectives on the etiology and treatment of obesity. In: Stunkard AJ, Wadden TA, eds. Obesity: Theory and Therapy. 2nd ed. New York: Raven Press; 1993; 179-193.

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21. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.

22. International Life Sciences Institute. About ILSI (website). Available at: http://www.ilsi.org/AboutILSI/. Accessed January 8, 2006.

23. Physical Activity and Obesity. Satellite Symposium of the 8th International Congress of Obesity. Maasricht, Netherlands, August 1998. Proceedings and abstracts. Int J Obes Relat Metab Disord. 1999; 23(suppl 3):S1-S87.

24. Baughcum AE, Powers SW, Johnson SB, et al. Maternal feeding practices and beliefs and their relationships to overweight in early childhood. J Dev Behav Pediatr. 2001;22:391-408.

25. Sugars and Health Workshop. Am J Clin Nutr. 2003; 78(suppl4):813S-897S.

26. Trowbridge FL, Sofka D, Holt K, et al. Management of child and adolescent obesity: study design and practitioner characteristics. Pediatrics. 2002;110:205-209.

27. Story MT, Neumark-Stzainer DR, Sherwood, NE, et al. Management of child and adolescent obesity: attitudes, barriers, skills, and training needs among health care professionals. Pediatrics. 2002;110:210-214.

28. Jonides L, Buschbacher V, Barlow SE. Management of child and adolescent obesity: psychological, emotional, and behavioral assessment. Pediatrics. 2002;110:215-221.

29. Barlow SE, Dietz WH, Klish WJ, et al. Medical evaluation of overweight children and adolescents: reports from pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics. 2002;110: 222-228.

30. Barlow SE, Trowbridge FL, Klish WJ, et al. Treatment of child and adolescent obesity: reports from pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics. 2002;110:229- 235.

31. Barlow SE, Dietz WH. Management of child and adolescent obesity: summary and recommendations based on reports from pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics. 2002;110:236-238.

32. What is TAKE 10!? Available at: http://www. take10.net/ whatistake10.asp?page=new Accessed January 8, 2006.

33. Stewart JA, Dennison DA, Kohl III HW, et al. Exercise level and energy expenditure in the Take 10! in-class physical activity program. J Sch Health. 2004;74:397-400.

34. Kidnetic.com website. Available at: http://kidnetic. com Accessed January 8, 2006.

35. Americaonthemove.org website. Available at: http:// www.americaonthemove.org/. Accessed January 8, 2006.

36. Horovitz B. Kraft plans to start putting its food on a diet. Available online at: http://www.usatoday.com/money/industries/food/ 2003-07-01-kraft_x.htm Accessed January 8, 2006.

37. CBS News. McDonald's scrapping 'supersize.' Available online at: ttp://www.cbsnews.com/stories/2004/03/03/health/ main603735.shtml. January 8, 2006.

38. Morgan J. Jared takes steps to help kids fight fat. Available online at: http://www.usatoday.com/news/health/spotlighthealth/2004- 07-15-jared_x.htm Accessed January 8, 2006.

39. Shaping America's Youth website. Available at: http:// www.shapingamericasyouth.com/Default. aspx. Accessed January 8, 2006.

40. Strauss RS, Knight J. Influence of the home environment on the development of obesity in children. Pediatrics. 1999;103:e85.

41. Lyznicki JM, Young DC, Riggs JA, et al. Council on Scientific Affairs, American Medical Association. Obesity: assessment and management in primary care. Am Fam Physician. 2001;63:2185-2196.

42. Shaping America's Youth press release September 29, 2004. U.S. Surgeon General, American Academy of Pediatrics and Corporations Unite to Develop National Action Plan to Address Nation's Epidemic of Overweight Children. Available online at: http:/ /www. shapingamericasyouth.com/pressrelease.pdf? pressreleaseid=31 Accessed January 8, 2005.

V. Lee Grotz, PhD

Dr. Grotz is with the Department of Medical and Nutritional Affairs, McNeil Nutritionals, LLC, a Johnson & Johnson Company, Fort Washington, Pennsylvania, USA.

Please address all correspondence to: Dr. V. Lee Grotz, Department of Medical and Nutritional Affairs, McNeil Nutritionals, LLC, 601 Office Center Dr., Fort Washington, PA 19034; Phone: 215- 273-7000; E-mail: lgrotz@mcpus.jnj.com.

Note: The mention of product or company names is not intended as an endorsement or advertisement and should not be construed as such. Such names, when provided, are either necessary for clarity or to illustrate the type of organizations involved in the changes described.

Copyright International Life Sciences Institute Feb 2006

Source: Nutrition Reviews

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