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Profits And Pandemics: Prevention Of Harmful Effects Of Tobacco, Alcohol, And Ultra-Processed Food And Drink Industries
Abstract
The 2011 UN high-level meeting on non-communicable diseases (NCDs) called for multisectoral action including with the private sector and industry. However, through the sale and promotion of tobacco, alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of global epidemics of NCDs. What role then should these industries have in NCD prevention and control? We emphasise the rise in sales of these unhealthy commodities in low-income and middle-income countries, and consider the common strategies that the transnational corporations use to undermine NCD prevention and control. We assess the effectiveness of self-regulation, public-private partnerships, and public regulation models of interaction with these industries and conclude that unhealthy commodity industries should have no role in the formation of national or international NCD policy. Despite the common reliance on industry self-regulation and public-private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.
... The established link presented in international literature between the high consumption of SSBs and unhealthy food and the rising rates of non-communicable diseases among children and adolescents (Lim et al., 2012;Piemas et al., 2016;Alcaraz et al., 2021;Nguyen et al., 2023) underscores the urgency of addressing the marketing practices of the food industry. Despite this link being not explored in the current study, it is important to note that strategies adopted by ultra-processed food and beverage industries operating in South Africa (Delobelle et al., 2016;Igumbor et al., 2012;Moodie et al., 2021), reminiscent of those used by the tobacco industry (Moodie et al., 2013;Dorfman et al., 2012), aim to circumvent public health policies and promote unhealthy products to susceptible populations, including children, as a means to normalise unhealthy diets and raise profits. Strategies implemented by industry include influencing research findings, policymakers, health professionals, and voters; lobbying public officials to resist certain regulations; and distracting from criticism by supporting non-related health promotive strategies (Moodie et al., 2013(Moodie et al., , 2021. ...
... Despite this link being not explored in the current study, it is important to note that strategies adopted by ultra-processed food and beverage industries operating in South Africa (Delobelle et al., 2016;Igumbor et al., 2012;Moodie et al., 2021), reminiscent of those used by the tobacco industry (Moodie et al., 2013;Dorfman et al., 2012), aim to circumvent public health policies and promote unhealthy products to susceptible populations, including children, as a means to normalise unhealthy diets and raise profits. Strategies implemented by industry include influencing research findings, policymakers, health professionals, and voters; lobbying public officials to resist certain regulations; and distracting from criticism by supporting non-related health promotive strategies (Moodie et al., 2013(Moodie et al., , 2021. A regulation to restrict the advertising of 'non-essential' food and beverage items such as SSBs, potato chips, sweets, and certain fast foods to children under 16 years was drafted in South Africa in 2007, however, it was never implemented (Igumbor et al., 2012). ...
... We recommend the creation of buffer zones free from certain outdoor marketing around vulnerable populations like schools (Lowery et al., 2014), and the requirement of permits for any outdoor food and beverage advertising (Lowery et al., 2014). Furthermore, the marketing practices of food and beverage industries, particularly advertisements targeted towards children and adolescents, should be strictly regulated and monitored by national policies, as opposed to self-regulation by industry (Moodie et al., 2013). ...
... Harmful consumer product industries are a major driver of the substantial and increasing global burden of preventable death and disease [1][2][3][4][5][6]. It has been estimated that the products and practices of just three industries -tobacco, alcohol, and ultra-processed food and drinkcurrently contribute to more than one quarter of all preventable deaths worldwide [3]. ...
... These include measures such as comprehensive bans on tobacco advertising and sponsorship [8], minimum unit pricing of alcohol [9], and taxes on sugary drinks [10]. Nevertheless, policy efforts to curb the rising global burden of preventable death and disease propagated by harmful consumer product industries have been largely piecemeal and inadequate [1,4,7,11]. In this respect, it is helpful to recognise that population health is not just an outcome of public health policies or health sector programs, but that it is also shaped to a large degree by government policy and regulatory frameworks beyond the health sector [11,12]. ...
... Such power, for instance, enables the firms in question to generate profits in excess of what can be generated in a competitive market environment [78]. Accordingly, the same firms have a greater capacity to accumulate and funnel resources towards shaping the market and regulatory environments in which they operate in their favour -that is, into an environment that promotes and compels the consumption of their products [4]. Excessive market power, which can be reinforced by and further reinforce financial and production economies of scale, can also translate into a structural and relational form of power in which the respective firms become increasingly important for governments to achieve their economic policy objectives [17,79]. ...
Background and methods
Competition regulation has a strong influence on the relative market power of firms. As such, competition regulation can complement industry-specific measures designed to address harms associated with excessive market power in harmful consumer product industries. This study aimed to examine, through a public health lens, assessments and decisions made by competition authorities in four jurisdictions (Australia, South Africa, the United States (US), and the European Union (EU)) involving three harmful consumer product industries (alcoholic beverages, soft drinks, tobacco). We analysed legal case documents, sourced from online public registers and dating back as far as the online records extended, using a narrative approach. Regulatory decisions and harms described by the authorities were inductively coded, focusing on the affected group(s) (e.g., consumers) and the nature of the harms (e.g., price increases) identified.
Results
We identified 359 cases published by competition authorities in Australia (n = 202), South Africa (n = 44), the US (n = 27), and the EU (n = 86). Most cases (n = 239) related to mergers and acquisitions (M&As). Competition authorities in Australia, the US, and the EU were found to make many decisions oriented towards increasing the affordability and accessibility of alcohol beverages, soft drinks, and tobacco products. Such decisions were very often made despite the presence of consumption-reduction public health policies. In comparison, South Africa’s competition authorities routinely considered broader issues, including ‘Black Economic Empowerment’ and potential harms to workers.
Conclusion
Many of the competition regulatory decisions assessed likely facilitated the concentration of market power in the industries we explored. Nevertheless, there appears to be potential for competition regulatory frameworks to play a more prominent role in promoting and protecting the public’s health through tighter regulation of excessive market power in harmful consumer product industries.
... A major challenge in public health is confronting the multinational billion-dollar corporations that profit from selling products such as alcohol, tobacco/nicotine, and ultraprocessed foods (UPFs, e.g., soda, chips, snack cakes) known to accelerate poor health [1]. Unfortunately, public regulatory and market intervention efforts typically rely on industry self-regulation (e.g., reformulating products to barely meet school lunch standards, such as 51% whole grain [2]), an approach that has been ineffective in preventing the adverse health outcomes associated with these commodities [1]. ...
... A major challenge in public health is confronting the multinational billion-dollar corporations that profit from selling products such as alcohol, tobacco/nicotine, and ultraprocessed foods (UPFs, e.g., soda, chips, snack cakes) known to accelerate poor health [1]. Unfortunately, public regulatory and market intervention efforts typically rely on industry self-regulation (e.g., reformulating products to barely meet school lunch standards, such as 51% whole grain [2]), an approach that has been ineffective in preventing the adverse health outcomes associated with these commodities [1]. ...
... To better understand the context surrounding the debate about the role of UPFs in mental health treatment, it is prudent to consider the range of "corporate scientific activities" that influence the public discourse around nutrition [5]. Such activities include (1) in-house nutrition research related to their products (with publication bias favoring findings beneficial to their products), (2) sponsoring scientific seminars and expert meetings to create consensus policies in their favor, (3) involvement in scientific standards through policy committees, (4) publishing papers in scholarly journals (often with high article processing fees), (5) funding scientific front groups (such as the International Food Information Council), and (6) delivering nutrition education programs (providing continuing education credits) [5]. Industry-sponsored messages appear to successfully manufacture doubt about the quality of the evidence regarding harms associated with their products, thereby downplaying the risk of UPFs by increasing public uncertainty [6]. ...
Ultra-processed foods (UPFs) like pastries, packaged snacks, fast foods, and sweetened beverages have become dominant in the modern food supply and are strongly associated with numerous public health concerns. While the physical health consequences of UPF intake have been well documented (e.g., increased risks of cardiometabolic conditions), less empirical discussion has emphasized the mental health consequences of chronic UPF consumption. Notably, the unique characteristics of UPFs (e.g., artificially high levels of reinforcing ingredients) influence biological processes (e.g., dopamine signaling) in a manner that may contribute to poorer psychological functioning for some individuals. Importantly, gold-standard behavioral lifestyle interventions and treatments specifically for disordered eating do not acknowledge the direct role that UPFs may play in sensitizing reward-related neural functioning, disrupting metabolic responses, and motivating subsequent UPF cravings and intake. The lack of consideration for the influences of UPFs on mental health is particularly problematic given the growing scientific support for the addictive properties of these foods and the utility of ultra-processed food addiction (UPFA) as a novel clinical phenotype endorsed by 14–20% of individuals across international samples. The overarching aim of the present review is to summarize the science of how UPFs may affect mental health, emphasizing contributing biological mechanisms. Specifically, the authors will (1) describe how corporate-sponsored research and financial agendas have contributed to contention and debate about the role of UPFs in health; (2) define UPFs and their nutritional characteristics; (3) review observed associations between UPF intake and mental health conditions, especially with depression; (4) outline the evidence for UPFA; and (5) describe nuanced treatment considerations for comorbid UPFA and eating disorders.
... More recently, scholars have stressed the importance of adopting a political economy approach, placing actors and the power relationships between them at the heart of analysis, to examine how power has been consolidated amongst national and transnational food and beverage companies to favor the widespread availability, affordability and accessibility of UPFs [10][11][12]. Such analyses have pointed to factors such as trade and investment liberalization [13,14], increasing market concentration [15], and the rise of hybrid food governance arrangements, such as public-private partnerships [16,17], as key drivers of corporate power in food governance. This consolidation of power is not unique to food: in 2018, of the world's largest economies, 29 were countries and 71 ...
... This emerging body of literature on corporate power in food governance has also increasingly been called upon to explain why, despite calls to action on the need for regulatory approaches [16], and guidance on policies needed to ameliorate unhealthy food environments characterized by widespread UPFs [20][21][22][23], policy responses to date have been glaringly inadequate [12]. Indeed, country governments to date have predominantly favored the adoption of interventions targeting individual behavior change, such as education (75% of countries) and media campaigns (61%) over regulatory actions on UPFs, such as front-of-pack (FOP) labelling schemes (25%), and restrictions on child-directed marketing (31%) [24]. ...
Background
The use of corporate power to undermine public health policy processes is increasingly well understood; however, relatively little scholarship examines how advocates can leverage power to promote the successful adoption of public health policies. The objective of this paper is to explore how advocates leveraged three forms of power – structural, instrumental and discursive – to promote the passage of the Promotion of Healthy Eating Law (Ley 27,642) in Argentina, one of the most comprehensive policies to introduce mandatory front-of-package (FOP) warning labels and regulate the marketing and sales of ultra-processed foods (UPFs) adopted to date.
Methods
We conducted seventeen semi-structured interviews with advocates from different sectors, including civil society, international agencies, and government. Both data collection and analysis were guided by Milsom’s conceptual framework for analyzing power in public health policymaking, and the data was analyzed using hybrid deductive and inductive thematic analysis.
Results
Advocates harnessed structural power through the leveraging of revolving doors, informal alliances, and formal coalitions, enabling them to convene discussion spaces with decision-makers, make strategic use of limited resources, and cultivate the diverse expertise (e.g., research, nutrition science, advocacy, law, political science, activism and communications) needed to support the law through different phases of the policy process. Advocates wielded instrumental power by amassing an armada of localized evidence to promote robust policy design, building technical literacy amongst themselves and decision-makers, and exposing conflicts of interest to harness public pressure. Advocates exercised discursive power by adopting a rights-based discourse, including of children and adolescents and of consumers to transparent information, which enabled advocates to foster a favorable perception of the law amongst both decision-makers and the public. Key contextual enablers include a political window of opportunity, the COVID-19 pandemic, and the ability to learn from the regional precedent of similar policies.
Conclusions
Public health policymaking, particularly when encroaching upon corporate interests, is characterized by stark imbalances of power that hinder policy decisions. The strategies identified in the case of Argentina provide important insights as to how advocates might harness and exercise structural, instrumental, and discursive power to counter corporate influence and promote the successful adoption of comprehensive UPF regulation.
... These environments result from the low effectiveness or absence of public policies and actions in various areas (7). Food environments are defined as "the collective physical, economic, political and socio-cultural environments, opportunities and conditions that influence food and beverage choices, including food composition, food labeling, food promotion, food provision in schools and other settings, and trade policies affecting food availability, price and quality" (8)(9)(10). ...
... It is therefore useful to analyze public policies aimed at improving the country's food environment, in order to identify shortcomings in these policies and subsequent corrective actions. The Food-EPI module is an appropriate tool to meet the country's needs in monitoring food environments (8)(9)(10). ...
Background and aim: Despite national policies and food-related interventions, Benin still faces a number of nutritional problems. The food environment, which is crucial to health, receives little attention in food policies. Monitoring food environments is essential to combat the double burden of malnutrition (DBM). The objective was to assess the level of implementation of public policies and government actions aimed at creating healthy food environments in BENIN. Methods: The evaluation was carried out using the INFORMAS Food-EPI module. Initially, the module contained 47 indicators relating to the prevention of obesity and diet-related non-communicable diseases. This tool was initially adapted to the Benin context. Following its implementation in sub-Saharan Africa (Ghana, Kenya and Senegal), 12 new indicators were added to make the Food-EPI tool more sensitive to the DBM. A group of independent experts (n=22) and government experts (n=21) assessed the level of the implementation of public policies using a Likert scale and identified the priority actions. Results: Of the 59 indicators compiled from 61 policy documents, the implementation level of public policies was assessed as "very low" for 27 indicators, "low" for 24 indicators and "me-dium" for 8 indicators. The inter-rater reliability index was estimated at 0.94 (CI: 0.92-0.97) and considered good. The experts identified 116 actions, 10 of which were prioritized in terms of importance, achievability and effect on the DBM, and recommended to the Beninese government. In the "Policy" component, priority actions focused mainly on food promotion, supply, pricing and retailing. In the "Infrastructure Support" component, priority actions focused on governance, leadership, monitoring and evaluation. Conclusions: This study proposes a list of priority actions to the government to transform the food environments towards reducing the DBM in Benin.
... Also, multilevel barriers have made it stressful for Americans to engage in healthy eating [17][18][19]. Over the past few decades, the food system has been flooded with aggressively marketed ultra-processed foods and sugarsweetened drinks, making it psychologically taxing to engage in healthy eating [20][21][22][23][24]. Thus, identifying psychological assets that can serve as a stress buffer could be a key protective strategy to improving and sustaining a better diet quality, particularly in vulnerable populations [25,26]. ...
... Our findings add to the theoretical and empirical evidence suggesting that perceived resilience, perceived stress, and diet quality increase with age and are therefore modifiable. Considering that addressing mental health in behavioral intervention research is becoming increasingly important, resilience may be an important starting point in the development of effective dietary interventions for CVD prevention at all ages, but especially among early young adults (18)(19)(20)(21)(22)(23)(24) [47][48][49]. ...
Despite evidence suggesting the importance of psychological resilience for successful aging, little is known about the relationship between diet quality and resilience at different ages. Our study aims to examine the association between diet quality and resilience across the stages of adulthood. Using Stanfords’ WELL for Life (WELL) survey data, we conducted a cross-sectional study of diet quality, resilience, sociodemographic, perceived stress, lifestyle, and mental health factors among 6171 Bay Area adults. Diet quality was measured by the WELL Diet Score, which ranges from 0–120. A higher score indicates a better diet quality. Linear regression analysis was used to evaluate the association between the WELL Diet Score and overall resilience and within the following age groups: early young (18–24), late young (25–34), middle (35–49), and late adulthood (≥50). To test whether these associations varied by age groups, an age group by resilience interaction term was also examined. In the fully adjusted model, the WELL Diet Score was positively and significantly associated with overall resilience (all ages (β = 1.2 ± sd: 0.2, p < 0.001)) and within each age group (early young (β = 1.1 ± sd: 0.3, p < 0.001); late young (β = 1.2 ± sd: 0.3, p < 0.001); middle (β = 0.9 ± sd: 0.3, p < 0.001); and late adulthood (β = 1.0 ± sd: 0.3, p < 0.001)). Young adults demonstrated the strongest associations between diet quality and resilience. However, there were no significant age-by-resilience interactions. Diet quality may be positively associated with resilience at all stages of adulthood. Further research is needed to determine whether assessing and addressing resilience could inform the development of more effective dietary interventions, particularly in young adults.
... • Regulatory and fiscal policies: Taxation and regulation are well recognised as the most effective policy measures to lower alcohol use [48]. Moderate impacts can also be expected from stricter regulation of availability, such as restrictions on hours of sale or advertising [49] and higher alcohol taxes to discourage excessive consumption. Some of these policies, however, will have to be designed very prudently vis-a-vis the socioeconomic demographics of each country, in order to avoid unintended consequences like black-market sales or hitting lower-income groups disproportionately. ...
This paper analyses the degree of persistence in the level of consumption of alcohol in the Group of Seven (G7) countries by using fractional integration. The series under examination are annual sales of pure alcohol in litres per person aged 15 years and older, annually from 1960 to 2021, and we look at the influence that external shocks might have had on the series in these countries. The results indicate that only France displays a significant negative trend and thus a continuous decrease in the level of alcohol consumption. For the rest of the countries, the time trend is insignificant. Dealing with persistence, Japan is the only country that shows clear evidence of reversion to the mean. Policy recommendations are reported at the end of the manuscript.
... The increased consumption of these ultra-processed food products in place of unprocessed/whole food could cause nutritional deficiencies (Hall et al. 2019;Moodie et al. 2013). Further, in an effort to closely mimic the nutritive and organoleptic attributes of meat, some synthetic or animal-origin additives are used during the preparation of plant-based meat analogs. ...
Various alternatives to meat in the form of plant-based meat alternatives are becoming popular among consumers and occupy a significant market share. As compared to conventional meat products, meat analogs have inherent merits of lower environmental impact/ footprint (land, water, and carbon), the potential to supply high-quality protein to the burgeoning population, and the absence of animal welfare and ethical issues. The present focus of the food industry is to develop advanced meat analogs mimicking the physical, functional, and sensory qualities of conventional meat. Various advanced technologies are applied in the processing of plant proteins for texturization and improving functionality, such as electrospinning, extrusion, sonication, high-pressure processing, antisolvent precipitation, mechanical elongation, shear structuring/Couette shear cell, mechanical elongation, freeze-alignment, and 3D/4D printing. The application of unconventional and sustainable sources of plant proteins could further improve sustainability in the future. However, the high level of processing, organoleptic attributes, and lack of bioactive compounds are some challenges faced by the meat analog industry.
... However, current tests of water sources in factories do not consider plastic particles, which does not guarantee safety in beverages (Arijeniwa et al., 2024). During this process, water can carry most nutrients and micronutrients and acts as a good solvent, which leads to the transfer of MPs and NPs from natural water to beverages (Moodie et al., 2013). A study revealed that microplastics in ice cubes can be spread to humans by adding them to beverages . ...
The widespread use of plastics in beverage packaging has led to the accumulation of microplastics (MPs) and nanoplastics (NPs) in beverages, which poses significant environmental and health hazards. This review explores the sources, entry pathways, and risk factors for MPs and NPs in beverages, emphasizing their toxicological profiles and harmful effects on human health and the environment. Methods for detecting MPs and NPs in beverages are discussed, highlighting the need for standardized testing protocols. Furthermore, future solution strategies, challenges, and preventive measures for mitigating MP and NP contamination in beverages are proposed, including advanced filtration systems, the development of alternative packaging materials, and the strengthening of regulatory standards. Collaborative efforts among industry stakeholders, scientific institutions, and policymakers are essential to address this complex issue and ensure the safety and purity of beverages for consumers worldwide.
... Tobacco, alcohol and ultra-processed food (UPF; including the sugar-sweetened beverage [SSB] and infant formula) industries have used corporate political activity (CPA) to delay or prevent regulations that threaten their businesses. While most research has focused on corporate influence on governments and policy-makers, research has also revealed UCI attempts at monitoring, undermining and discrediting, those who campaign and provide evidence for increased regulation (Bialous et al., 2001;Ibrahim and Glantz, 2007;Vedwan, 2007;Brownell and Warner, 2009;Landman and Glantz, 2009;Moodie et al., 2013;Avery et al., 2016;Savell et al., 2016;Ulucanlar et al., 2016Ulucanlar et al., , 2023Matthes et al., 2021;Reed et al., 2021;Lauber et al., 2022). However, the scale of the intimidation experienced by advocates and researchers, its form and impact, as well as the responses of those intimidated, have not been examined in detail across UCI sectors. ...
Unhealthy commodity industries (UCIs) engage in corporate political activity, using diverse practices, including intimidatory tactics, to thwart, delay and dilute regulations that threaten their businesses. While examples of such intimidation exist across multiple sectors, no attempt has been made to synthesize these. Furthermore, much of the literature focuses on intimidation of policy-makers. Less is known about the types of intimidation experienced by advocates and researchers and their responses to this intimidation. This scoping review explores the literature across the tobacco, alcohol and ultra-processed food spaces for instances of intimidation and categorizes them inductively and deductively based on a framework of intimidation types. Similarly, responses to intimidation were mapped onto a pre-existing framework. We found intimidatory tactics towards advocates and researchers in every sector. Public discreditation, followed by legal threats and action, complaints and freedom of information requests were most frequently mentioned and often attributed to UCIs or their third parties. Surveillance, threats of violence, violence, burglary and bribery were less prevalent in the literature and their perpetrators were unknown. Those intimidated reported carrying on as normal, defensive action (changing/adapting work, taking security precautions) or, as was most reported, offensive action (exposing intimidation, correcting misinformation, taking legal action). The similarity of intimidation across sectors suggests that UCIs engage in similar intimidatory tactics regardless of sector. Understanding more about the scale of intimidation and how it impacts the work and wellbeing of those affected is essential, as is learning more about the ways researchers and advocates can effectively pre-empt and respond.
... The commercial determinants of health (CDoH), defined in a recent Lancet series as 'the systems, practices and pathways through which commercial actors drive health and equity' , reflect the now overwhelming evidence that some commercial actors have a significant negative impact on human and planetary health (Freudenberg, 2012; Moodie et al., 2013;Baum et al., 2016;Gilmore et al., 2023). Beyond the production, marketing and sale of unhealthy commodities, corporations actively work to shape the policy context in favour of the ways in which they conduct their business (Ulucanlar et al., 2016;Gilmore et al., 2023). ...
Unhealthy commodity industries (UCIs) such as tobacco, alcohol, gambling, ultra-processed food and beverage producers are known to influence policy-making to advance their interests, often to the detriment of public health goals. This study mapped the complex system underpinning UCI’s influence on public health policy formulation in the UK and identified potential interventions to shift the system towards being able to better attain public health goals. We conducted a participatory systems mapping workshop with ten experts to build a causal loop diagram (CLD) and identify potential interventions to address UCI’s influence on public health policy development. The resulting CLD depicts a highly interconnected and reinforcing system driving UCI’s involvement in public health policy formulation across five thematic areas. Among the most connected elements were the ‘dominance of market mechanisms’, ‘perception of partnership as good governance principle’, ‘industry involvement lending perceived legitimacy to the policy formulation process’, ‘industry is seen as part of the solution’ and ‘industry ties to policy-makers’. Participants identified a total of 22 interventions within this system. Analysis of the CLD and interventions identified the potential for two key paradigmatic changes in this complex system: de-normalizing the perception of unhealthy commodity industry actors as legitimate stakeholders in policy formulation; and prioritizing public health and wellbeing objectives over profit and economic gain. In order to shift the system towards better attaining public health goals, interventions should reinforce each other and be supportive of these two key paradigmatic shifts.
... 5,67,68 Indeed the resulting commercial profits associated with obesity are substantial for many industries (eg, the food industry and pharmaceutical industry). [68][69][70] Aligning with the 2019 Commission report, 5 the 2023 American Academy of Pediatrics (AAP) clinical practice guideline for the evaluation and treatment of children and adolescents with obesity 71 now acknowledges that obesity is an embedded social issue, with complex drivers interacting across public policy, society, community, and built environments. 71 In the past three decades, the USA has undergone extensive economic, demographic, and technological transitions that have triggered profound changes to agriculture practices, food security, food supply systems, commercialisation, urbanisation, densifi cation, neighbourhood liveability, sedentariness, and wealth and educational inequalities, coupled with underlying structural racism and gender inequalities, that all interact to drive population-wide obesity. ...
Background
Over the past several decades, the overweight and obesity epidemic in the USA has resulted in a significant
health and economic burden. Understanding current trends and future trajectories at both national and state levels is
crucial for assessing the success of existing interventions and informing future health policy changes. We estimated
the prevalence of overweight and obesity from 1990 to 2021 with forecasts to 2050 for children and adolescents (aged
5–24 years) and adults (aged ≥25 years) at the national level. Additionally, we derived state-specific estimates and
projections for older adolescents (aged 15–24 years) and adults for all 50 states and Washington, DC.
Methods
In this analysis, self-reported and measured anthropometric data were extracted from 134 unique sources,
which included all major national surveillance survey data. Adjustments were made to correct for self-reporting bias. For
individuals older than 18 years, overweight was defined as having a BMI of 25 kg/m² to less than 30 kg/m² and obesity
was defined as a BMI of 30 kg/m² or higher, and for individuals younger than 18 years definitions were based on
International Obesity Task Force criteria. Historical trends of overweight and obesity prevalence from 1990 to 2021 were
estimated using spatiotemporal Gaussian process regression models. A generalised ensemble modelling approach was
then used to derive projected estimates up to 2050, assuming continuation of past trends and patterns. All estimates
were calculated by age and sex at the national level, with estimates for older adolescents (aged 15–24 years) and adults
aged (≥25 years) also calculated for 50 states and Washington, DC. 95% uncertainty intervals (UIs) were derived from the
2·5th and 97·5th percentiles of the posterior distributions of the respective estimates.
Findings
In 2021, an estimated 15·1 million (95% UI 13·5–16·8) children and young adolescents (aged 5–14 years),
21·4 million (20·2–22·6) older adolescents (aged 15–24 years), and 172 million (169–174) adults (aged ≥25 years) had
overweight or obesity in the USA. Texas had the highest age-standardised prevalence of overweight or obesity for male
adolescents (aged 15–24 years), at 52·4% (47·4–57·6), whereas Mississippi had the highest for female adolescents
(aged 15–24 years), at 63·0% (57·0–68·5). Among adults, the prevalence of overweight or obesity was highest in North
Dakota for males, estimated at 80·6% (78·5–82·6), and in Mississippi for females at 79·9% (77·8–81·8). The
prevalence of obesity has outpaced the increase in overweight over time, especially among adolescents. Between
1990 and 2021, the percentage change in the age-standardised prevalence of obesity increased by 158·4% (123·9–197·4)
among male adolescents and 185·9% (139·4–237·1) among female adolescents (15–24 years). For adults, the percentage
change in prevalence of obesity was 123·6% (112·4–136·4) in males and 99·9% (88·8–111·1) in females. Forecast
results suggest that if past trends and patterns continue, an additional 3·33 million children and young adolescents
(aged 5–14 years), 3·41 million older adolescents (aged 15–24 years), and 41·4 million adults (aged ≥25 years) will have
overweight or obesity by 2050. By 2050, the total number of children and adolescents with overweight and obesity will
reach 43·1 million (37·2–47·4) and the total number of adults with overweight and obesity will reach 213 million
(202–221). In 2050, in most states, a projected one in three adolescents (aged 15–24 years) and two in three adults
(≥25 years) will have obesity. Although southern states, such as Oklahoma, Mississippi, Alabama, Arkansas, West
Virginia, and Kentucky, are forecast to continue to have a high prevalence of obesity, the highest percentage changes
from 2021 are projected in states such as Utah for adolescents and Colorado for adults.
Interpretation
Existing policies have failed to address overweight and obesity. Without major reform, the forecasted
trends will be devastating at the individual and population level, and the associated disease burden and economic
costs will continue to escalate. Stronger governance is needed to support and implement a multifaceted whole-system
approach to disrupt the structural drivers of overweight and obesity at both national and local levels. Although clinical
innovations should be leveraged to treat and manage existing obesity equitably, population-level prevention remains
central to any intervention strategies, particularly for children and adolescents.
... La industria alimentaria como parte del avance tecnológico y científico, ha implementado una serie de mecanismos que incluyen el procesamiento de los alimentos con el fin de facilitar su producción, distribución y comercialización, así como el consumo de estos, lo que implica ciertos procesos físicos, biológicos y químicos, desde que, los alimentos se encuentran en forma natural hasta antes de ser consumidos (Moodie et al., 2013). ...
Este trabajo tuvo como objetivo; caracterizar el consumo de alimentos ultraprocesados en 179 estudiantes universitarios de Ciencias de la Salud de reciente ingreso, mediante el registro de alimentos y bebidas, por tres días, llevando a cabo el cálculo de; calorías, sodio y azúcares consumidas a partir de los alimentos ultraprocesados, mediante un software, que tiene la información del sistema mexicano de alimentos equivalentes, para el análisis estadístico se utilizó, el programa estadístico SPSS 23.0. Registrando un consumo global energético; mediana de 1353 kcal (RIC 1147-1781), en el consumo de alimentos ultraprocesados; mediana de 614 kcal (RIC 421-873), en los hombres la mediana fue 555 kcal (RIC 443-934) y en la mujeres fue de 626 kcal (RIC 401-856), el sodio; una mediana de 925 mg (RIC 579-1322), los hombres obtuvieron una mediana 939 mg (RIC 456-1166) y las mujeres de 925 mg (RIC 580-1408), y por último, los azúcares; una mediana de 20 g (RIC 5-51), en los hombres la mediana fue 33 g (RIC 12-46) y en la mujeres fue de 18 mg (RIC 4-53), es importante enfatizar en disminuir el consumo de estos alimentos en estos universitarios, ya se trata de los futuros expertos del área de la salud.
... These foods can be anything from highly processed, high-calorie products such as potato chips and baked products to less processed items such as nuts and dry fruits. The market has expanded due to the increased consumption of processed foods caused by sedentary lifestyles and demanding work schedules (2). Meanwhile, it has been anticipated that the worldwide snack market is expected to grow at a compound annual growth rate (CAGR) of 5.8% (1). ...
Background
Food packaging includes labels with specific nutrient contents to provide consumers with nutritional information. Legislative actions and consumers’ growing interest in nutrition information have increased the disclosure of nutrition information. The study was planned to examine packaged snack foods carrying nutritional claims for nutrition labeling.
Methods
The selected packaged chips were divided into categories based on the primary ingredients mentioned on the nutrition label, such as cereal/pseudocereal-based, millet-based, vegetable-based, and pulses/legume-based chips. Four threshold levels, such as total sugar, sodium, total fat, and saturated fat, were used for categorization.
Results
Out of a total of 23 packaged chips, the corresponding 2, 7, 8, and 13 products had a higher content of sugar, saturated fat, sodium, and total fat than the threshold levels. A significant (p ≤ 0.01) difference was observed in the values of nutrients analyzed through laboratory methods in comparison with the values given on the nutrition label in the majority of the products.
Conclusion
The majority of the products belonged to national brands and differed from the nutrition-related information given on the product label in terms of the nutrient content claim.
... Food processing has advanced significantly due to the industrialization and globalization of food systems [8]. ...
Background
Results from studies investigating the association between ultra-processed foods (UPFs) and breast cancer are scarce and, in some cases, contradictory. Therefore, we aimed to evaluate the association between the intake of processed foods (PFs) and UPFs with the risk of breast cancer in Iranian women.
Methods
The present case (n = 133) - control (n = 266) study was carried out at two general hospitals in Tehran, Iran. A 168-item semi-quantitative food frequency questionnaire was used to assess the participants’ dietary intake. Also, the NOVA classification was used to identify PFs and UPFs. The association between PFs and UPFs with the odds of breast cancer was analyzed using logistic regression models.
Results
According to Model 1 of conditional logistic regression, the odds of breast cancer were higher in the last tertile of UPFs than in the first tertile (odds ratio (OR) = 1.930; 95% confidence interval (CI): 1.080–3.449). In Model 2, no significant association was observed between the second and last tertiles of PFs and UPFs with the odds of breast cancer compared to the reference tertile. Also based on menopause status, the odds of breast cancer increased in the last tertile only among premenopausal women in Model 2 (OR = 3.656; 95% CI: 1.326–10.079).
Conclusions
This study demonstrated that higher consumption of UPFs is associated with higher odds of breast cancer in premenopausal women.
... fossil fuels, tobacco, alcohol and ultra-processed foods), shareholder primacy likely propagates so-called 'industrial epidemics' insofar as it normalizes and promotes corporate strategies that have the potential to maximize profits and shareholder value to the detriment of the public's health (Majnoni d'Intignano, 1995;Gilmore et al., 2023). Such practices can include aggressive and predatory marketing to drive consumption in disadvantaged and marginalized population groups, as well as the use of various practices to undermine public policies and collective actions seeking to protect and promote public health (Moodie et al., 2013;Baker et al., 2023;. As highlighted by the recent dismissal of Emmanuel Faber from Chief Executive Officer (CEO) of Danone (Van Gansbeke, 2021), shareholder primacy also serves as a major barrier against the incorporation of health and other sustainability-related objectives into the policies and strategies of corporations active in harmful commodity industries (Wood et al., 2023b). ...
A relatively small number of for-profit asset managers—financial intermediaries that invest capital on behalf of other investors—have emerged in recent decades to become some of the most influential commercial actors in the global political economy. Despite their important role in society, asset managers have received little attention from a public health perspective. In this article, we aimed to propose a conceptual framework of potential pathways and mechanisms through which asset managers may influence health and equity. The framework included asset class-specific pathways related to investments in publicly listed corporate equity, private equity, ‘real assets’ (e.g. housing, hospitals, farmland) and commodities. The framework also included more generalized pathways, focusing on ways in which the large and highly concentrated asset management sector can drive economic inequities, influence policy and political decision-making and shape the global ‘development’ agenda. We argue that measures challenging so-called ‘asset manager capitalism’, such as promoting and protecting the public ownership of companies and assets in essential sectors, are imperative to address the commercial determinants of ill health and inequity.
... 10,11 UPFs are also high in energy density and glycaemic load, coupled with a high palatability that favours their over-consumption. 12 To date, the most robust evidence on the direct link between UPF and excess body weight comes from studies conducted amongst adults, 13 and the generally consistent evidence on this link suggests that this causal association may translate to the paediatric population. 13 Although available evidence is less conclusive amongst children and adolescents, 11 a tendency of higher intake of UPF and added sugar was for instance reported amongst children with overweight and who had food addiction. ...
Introduction
Limited evidence exists on the relationship between ultra‐processed food (UPF) consumption and overweight/obesity amongst young children. This study aimed to assess UPF consumption, its socioeconomic correlates and its association with overweight/obesity amongst under‐five children in Lebanon.
Materials and Methods
Data pertinent to children aged 6 months to 4.9 years (n = 893) from a cross‐sectional national survey were used. Anthropometric measurements were obtained, and multi‐component questionnaires were administered to mothers. Dietary intake was assessed using the 24‐h recall approach. NOVA classification was used to assign food items into four groups according to the extent of industrial processing. Contributions of each group to total energy intake (EI) and macronutrient and micronutrient intakes were estimated. Regression models were conducted to explore the correlates of UPF consumption as well as the association between UPF consumption and overweight/obesity status.
Results
UPFs were found to contribute 47% of daily EI. Girls and children with higher household income had significantly higher UPF intakes. Children whose mothers had an intermediate, high school, or technical diploma and were employed and whose fathers had higher education levels consumed significantly less EI from UPFs. Children whose %EI fell within the second and third tertiles of UPF intake had significantly higher odds of overweight/obesity as compared to those in the first tertile (adjusted odds ratio [AOR]: 1.21, 95% confidence interval [CI]: 1.09, 1.32 and AOR: 1.61, 95% CI: 1.47, 1.76, respectively), after adjusting for confounders.
Conclusion
The high intake of UPFs coupled with its association with overweight/obesity call for public health nutrition interventions aimed at improving feeding and dietary practices in this age group.
... Negative attitudes were related to industrial processing and the products' nutritional content. In general, UPFs have unfavourable nutrient profiles and several other characteristics linked to negative health outcomes [11,13,14,38,39]. An American study found that the ultraprocessed diet caused increased ad libitum (i.e. as much or as often as desired) energy intake and weight gain. ...
Background
The consumption of ultra-processed foods (UPF) is increasing in many countries. Simultaneously, there is a growing number of consumers that follow a vegetarian or vegan diet, many due to its possible positive impact on sustainability and food waste. However, little is known about attitudes towards and experiences with UPF among vegetarians and vegans. Thus, this study investigates vegetarians’ and vegans’ experiences with and attitudes towards UPFs.
Methods
We conducted semi-structured, individual interviews with 14 participants between September and December 2021. The participants were from different areas in Norway. The data were analysed using a thematic analysis by Braun and Clarke.
Results
In general, participants appeared to have diverse knowledge of and divergent attitudes towards UPFs. However, participants mainly associated substitute products (e.g. meat substitutes, dairy substitutes) as UPFs. They appreciated the increased availability of vegetarian and vegan UPF which made it easier for them to follow a plant-based diet. They enjoyed the taste and consistency of vegetarian and vegan UPF. However, participants expressed concerns about the effects that industrial processing has on the products’ nutritional content.
Conclusion
This study indicated that there was a diverse knowledge of and various attitudes towards UPFs among the participating vegetarians and vegans. Public information and guidelines about using UPF (e.g. meat substitutes, dairy substitutes) in vegetarian and vegan diets are needed, as well as information about their possible impact on health and sustainability.
... [22][23][24] These economic and technological changes have affected both the amount and types of food that are consumed, including higher total calories, and higher consumption of animal-source foods, sugar, vegetables, and oil crops in many low-and middle-income countries, whereas animalsource foods and possibly sugar consumption have declined in high-income countries. [25][26][27][28][29] Furthermore, changes in food processing technology and increasing commercialisation and industrialisation of food 30 have increased the consumption of processed foods, which leads to higher caloric intake and weight gain than fibre-rich foods such as whole grains and fruits. 31,32 In some countries, equitable economic and agricultural policies and food programmes have improved the quality of nutrition, especially for the poor, 33-36 resulting in gains in height, whereas elsewhere weight gain occurred without substantial height gain, leading to increasing obesity. ...
... The supply and consumption of ultra-processed foods (UPF), characterized by foods of low nutritional quality and high energy density, has increased significantly in many countries over the past two decades, and are replacing traditional diets based on unprocessed/minimally processed food (MPF) [8][9][10]. According to the NOVA classification, UPF are foods that have undergone intensive industrial physical, chemical or biological processes (such as hydrogenation, forming, extrusion, frying pretreatment) or contain industrial substances not commonly found in home kitchens (such as maltodextrin, hydrogenated oil or modified starch), cosmetic additives (such as dyes, emulsifiers, artificial sweeteners) or flavoring agents [11]. ...
Aim
Nutritional characteristics and additives in ultra-processed foods (UPF) are directly related to bone health. Physical activity as a modifiable lifestyle intervention also plays a possible role in bone mineral density (BMD), but effect of physical activity on association between UPF and osteoporosis is not fully understood. Herein, this study aims to explore the association of UPF with osteoporosis, and assess the potential mediating effects of some related factors on this pathway.
Methods
Data of adults were extracted from the National Health and Nutrition Examination Survey (NHANES) database in this cross-sectional study. Associations of unprocessed/minimally processed food (MPF), processed culinary ingredient (PCI), processed foods (PF) and UPF with femur neck BMD, total femur BMD and osteoporosis were investigated using linear regression and weighted univariate and multivariate logistic regression analyses respectively. Subgroup analyses of age, gender, physical activity, poverty income ratio (PIR), hypertension, diabetes mellitus (DM), cardiovascular disease (CVD), and dyslipidemia were performed. The potential mediating and interaction effects of physical activity and related factors on association of UPF with osteoporosis were also assessed. The evaluation indexes were β, odds ratios (ORs) and 95% confidence intervals (CIs).
Results
Among 10,678 eligible persons, 454 had osteoporosis. After adjusting for covariates, elevated UPF intake was associated with decreased demur neck and total femur BMD (β=-0.003). A higher UPF intake level (> 57.51%) was linked to higher odds of osteoporosis (OR = 1.789). These relationships were also significant in different subgroups. Physical activity had a potential mediating effect on the association between UPF and osteoporosis (OR = 0.47, mediating proportion = 21.54%).
Conclusion
UPF intake levels were associated with BMD and osteoporosis. Physical activity had an interaction effect with UPF, and had a potential mediating effect on relationship between UPF and osteoporosis.
... The new recommendations are based on recent evidence on how exposure to food marketing affects children's health, eating behaviors, and food choices [135]. The rise in the consumption of unhealthy food commodities in children is mainly driven by the aggressive marketing of transnational corporations [136,137]. Regrettably, only a handful of governments have approved a policy framework to restrict all marketing to children up to 18 years of age of unhealthy foods and nonalcoholic beverages. ...
Promoting a healthy diet is an effective strategy for preventing cardiovascular disease (CVD). The characteristics of a healthy diet are known. However, an unhealthy diet has become a significant contributor to the global burden of diseases, mainly due to its effect on CVD, diabetes, and cancer. A healthy diet is not accessible and affordable to most people worldwide. Marketing influences food choices and promotes unhealthy diets that contribute to obesity, CVD, diabetes mellitus, and cancer. Governments are responsible for transforming food systems to deliver healthy, sustainable, and affordable diets using coherent policies, regulations, and legislation portfolios. This review highlights the role of a healthy diet in preventing CVD. It summarises the current scientific evidence underpinning dietary recommendations and the strategies for translating them into action.
... Studies link higher cancer rates to pollution in the air (Dockery et al., 1993) and groundwater (Griffith et al., 1989), ultra-processed foods (Fiolet et al., 2018), and pesticide use (Bassil et al., 2007;Van Maele-Fabry et al., 2019). Other literatures point to the ability of commercial interests to wield substantial influence over policy even in democracies, often while performing ethically questionable business practices (Freudenberg & Galea, 2008;Moodie et al., 2013;Moss, 2014;Stuckler et al., 2010Stuckler et al., , 2012. So if economic development and industrialization are hallmarks of inclusive political institutions like democracy (Acemoglu & Robinson, 2012), these same factors could exacerbate cancer risk in democratic countries especially. ...
Much literature acknowledges the importance of political systems for population health. People living in democratic countries tend to have higher life expectancies and lower rates of infant mortality compared to those in other countries. However, few quantitative comparative studies explore the political origins of chronic disease. To address this gap, this study examines the impact of political democracy on cancer risk. Using data from the Global Cancer Observatory (GLOBOCAN), regression models test differences in age-adjusted cancer rates across 170 countries. Counter to study hypotheses, overall incidence of cancer is not any lower in democratic countries. This is evident even when removing the confounding influence of economic and several other factors. However, among children and adolescents, cancer mortality rates and leukemia incidence are exceptions since these are lower in democratic countries in some models. Results otherwise do not support the view that political regime type alone prevents cancer. Overall findings appear robust to threats of endogeneity, higher average age in developed countries, comparative differences in the ability to diagnose cases, and several other threats. The broader literature indicates that democratic countries have better health overall. However, findings are that democratic countries have higher cancer incidence on average, which is likely due to having higher levels of economic prosperity compared to more autocratic countries. Economic policy is likely to be an important consideration for preventing cancer. Longitudinal analysis was not possible for these data, which is reason for caution when interpreting these findings.
... In sectors where the product can potentially harm the customer, harm-minimization strategies are often developed as part of corporate social responsibility initiatives (Moodie et al., 2013). In the context of gambling, the industry, government agencies, and academic researchers have adopted the Reno Model (Blaszczynski et al., 2004). ...
This research explores the engagement of player-facing casino employees with GameSense, a responsible gambling (RG) program, and referral of players to GameSense. We surveyed 280 employees across three casinos in Massachusetts that use this RG program as part of their RG strategy. We found that although most player-facing casino employees were aware of GameSense, slightly over half visited a GameSense Information Center, and about two-thirds interacted with a GameSense Advisor. In terms of the reason for visiting, Latent Class Analysis (LCA) revealed three distinct classes: Comprehensive Interests, RG Interests, and Focused Interests. As for those who have yet to visit, LCA two classes emerged: RG Proficiency Beliefs and Tempered RG Proficiency Beliefs. Engaged employees were more likely to refer players to GameSense, highlighting the need for targeted approaches addressing the diverse interests of player-facing employees for engaging or not engaging with GameSense. These findings underscore the importance of have player-facing casino employees engage with RG programming, and targeted approached for engagement, to enhance the efficacy of RG initiatives, and contribute to a more robust RG framework within the gambling industry.
... Concurrently, the market economy has commercialized a wide range of products whose overuse and misuse have had severe adverse effects on human health and wellbeing [3]. Examples include cigarettes [4][5][6], sugar [7][8][9][10][11], prescription opioids [12][13][14][15], alcohol [16][17][18], ultra-processed foods [19][20][21], commercial milk formula (also called infant formula or breast milk substitute) [22][23][24], firearms [25][26][27], and social media [28][29][30]. Each year, such products are significant contributors to the health conditions responsible for more than 850,000 U.S. deaths and 23 million worldwide deaths [31]. ...
Misuse and overconsumption of certain consumer products have become major global risk factors for premature deaths, with their total costs in trillions of dollars. Progress in reducing such deaths has been slow and difficult. To address this challenge, this review introduces the definition of market-driven epidemics (MDEs), which arise when companies aggressively market products with proven harms, deny these harms, and resist mitigation efforts. MDEs are a specific within the broader landscape of commercial determinants of health. We selected three illustrative MDE products reflecting different consumer experiences: cigarettes (nicotine delivery product), sugar (food product), and prescription opioids (medical product). Each met the MDE case definition with proven adverse health impacts, well-documented histories, longitudinal product consumption and health impact data, and sustained reduction in product consumption. Based on these epidemics, we describe five MDE phases: market expansion, evidence of harm, corporate resistance, mitigation, and market adaptation. From the peak of consumption to the most recent data, U.S. cigarette sales fell by 82%, sugar consumption by 15%, and prescription opioid prescriptions by 62%. For each, the consumption tipping point occurred when compelling evidence of harm, professional alarm, and an authoritative public health voice and/or public mobilization overcame corporate marketing and resistance efforts. The gap between suspicion of harm and the consumption tipping point ranged from one to five decades–much of which was attributable to the time required to generate sufficient evidence of harm. Market adaptation to the reduced consumption of target products had both negative and positive impacts. To our knowledge, this is the first comparative analysis of three successful efforts to change the product consumption patterns and the associated adverse health impacts of these products. The MDE epidemiological approach of shortening the latent time to effective mitigation provides a new method to reduce the impacts of harmful products.
... These factors are incorporated into everyday life, partly as a result of various exposures, particularly the food environment (4). The food environment, which is characterized by the physical, economic, political, and socio-cultural conditions that influence dietary decisions and marketing strategies, is a key factor in the spread of unhealthy eating, and a major risk factor for all forms of malnutrition (5)(6)(7). Burkina Faso's actual food environments are similar to those of the global food environment in that they do not support the consumption of healthy, sustainable diets and are therefore subject to increasingly high prevalence of all forms of malnutrition and non-communicable diseases. ...
Introduction
The food environment is an important factor in the efforts of countries worldwide to achieve a transition to sustainable food systems. The objective of this study is to formulate and prioritize actions to be addressed to the government of Burkina Faso for the creation of a healthy food environment, which will contribute to reducing malnutrition in all its forms and non-communicable diseases.
Methods
National experts were brought together to identify and prioritize actions to fill the gaps identified through a multi-step assessment process following the methodology of the Healthy Food and Environment Policy Index (Food-EPI).
Results
Up to 20 priority policy actions were recommended to the Burkina Faso government. Actions in the policy component focused mainly on regulation of food promotion and marketing, particularly to children, and others in the infrastructure support component focused largely on political leadership, i.e., strong and visible political support from the government to improve the food environment, population nutrition, diet-related non-communicable diseases and their inequalities.
Conclusion
The priority actions to be recommended to the government will strengthen advocacy for government decisions to create a healthier food environment in the country.
... Despite challenges for the US healthcare systems to reduce chronic diseases, some retail pharmacies sell consumer products that increase risks for chronic diseases and premature death. In doing so, these pharmacies enable health-harming industries to target Americans who visit them [135][136][137]. For example, retail pharmacies sell alcohol and tobacco products that are recognized as the leading cause of preventable death in the US [9]. ...
United States healthcare outcomes, including avoidable mortality rates, are among the worst of high-income countries despite the highest healthcare spending per capita. While community pharmacies contribute to chronic disease management and preventive medicine, they also offer consumer products that increase mortality risks and the prevalence of cardiovascular diseases, diabetes, cancer, and depression. To resolve these contradictions, our perspective article describes opportunities for major pharmacy chains (e.g., CVS Pharmacy and Walgreens) to introduce digital health aisles dedicated to prescription and over-the-counter digital therapeutics (DTx), together with mobile apps and wearables that support disease self-management, wellness, and well-being. We provide an evidence-based rationale for digital health aisles to replace spaces devoted to sugar-sweetened beverages and other unhealthy commodities (alcohol, tobacco) that may increase risks for premature death. We discuss how digital health aisles can serve as marketing and patient education resources, informing customers about commercially available DTx and other technologies that support healthy lifestyles. Since pharmacy practice requires symbiotic balancing between profit margins and patient-centered, value-based care, replacing health-harming products with health-promoting technologies could positively impact prevention of chronic diseases, as well as the physical and mental health of patients and caregivers who visit neighborhood pharmacies in order to pick up medicines.
... However, tobacco may not be the sole lifestyle factor that contributes to the adverse health outcomes observed in cigarette smokers. UPFs, prevalent in the American diet and characterized by their high sugar, sodium, and fat content, along with inadequate nutrient profiles [59][60][61][62], also pose significant health risks to the public. The frequent consumption of UPFs is associated with chronic diseases, such as cardiovascular disease, type 2 diabetes, and cancer [26,27,[29][30][31], exacerbating health disparities, especially among smokers from low socioeconomic backgrounds. ...
Diet behavior and nutrition are critical for maintaining health and improving quality of life. Cigarette smoking remains the leading cause of preventable death in the United States. Poor dietary choices, such as excessively frequenting restaurants, consuming ready-to-eat foods from grocery stores, and ingesting ultra-processed foods (like frozen meals and pizzas), can adversely impact health. Despite this, research comparing dietary behaviors between smokers and non-smokers is limited. Using data from the National Health and Nutritional Examination Survey 2017–2018, we analyzed diet behavior based on smoking status. Our findings reveal that smokers had a significant increase (90%) in the frequency of consuming frozen meals/pizzas in the past 30 days compared to non-smokers (coefficient: 1.9; 95% CI: 1.4, 2.6; p-value < 0.001). Additionally, over 70% of participants, regardless of their smoking status, were unaware of MyPlate, a nutritional guide created by the United States Department of Agriculture (USDA) to encourage Americans to make healthier food choices. There is an urgent need to increase public awareness of MyPlate and promote a better understanding of healthy dietary behaviors.
... Made from substances extracted or derived from whole foods, UPFs are typically high in sugar, unhealthy fats, and salt, but low in protein, fiber, vitamins, and minerals. UPFs usually also contain artificial substances like sweeteners, emulsifiers, and preservatives (68,69). The low vitamin, mineral, and fiber content of UPFs have been shown to decrease GMB diversity, richness, abundance of fiberfermenting bacteria, and SCFA production (70)(71)(72)(73)(74). ...
The gut microbiome (GMB) plays a substantial role in human health and disease. From affecting gut barrier integrity to promoting immune cell differentiation, the GMB is capable of shaping host immunity and thus oncogenesis and anti-cancer therapeutic response, particularly with immunotherapy. Dietary patterns and components are key determinants of GMB composition, supporting the investigation of the diet-microbiome-immunity axis as a potential avenue to enhance immunotherapy response in cancer patients. As such, this review will discuss the role of the GMB and diet on anti-cancer immunity. We demonstrate that diet affects anti-cancer immunity through both GMB-independent and GMB-mediated mechanisms, and that different diet patterns mold the GMB’s functional and taxonomic composition in distinctive ways. Dietary modulation therefore shows promise as an intervention for improving cancer outcome; however, further and more extensive research in human cancer populations is needed.
... Studies also demonstrate how this industry has attempted to influence responses by UN agencies, and across the global food and governance systems more broadly (Lauber et al. 2021). This includes the promotion and initiation of public-private and multi-stakeholder partnerships, a development that coincides with the emergence of multi-stakeholderism as a prominent model of GFG (Moodie et al. 2013). ...
The rise of multi-stakeholder institutions (MIs) involving the ultra-processed food (UPF) industry has raised concerns among food and public health scholars, especially with regards to enhancing the legitimacy and influence of transnational food corporations in global food governance (GFG) spaces. However, few studies have investigated the governance composition and characteristics of MIs involving the UPF industry, nor considered the implications for organizing global responses to UPFs and other major food systems challenges. We address this gap by conducting a network analysis to map global MIs involving the UPF industry, drawing data from web sources, company reports, business and market research databases, and academic and grey literature. We identified 45 such global food system MIs. Of these, executives from the UPF industry or affiliated interest groups held almost half (n = 263, or 43.8%) of the total 601 board seat positions. Executives from a small number of corporations, especially Unilever (n = 20), Nestlé (n = 17), PepsiCo Inc (n = 14), and The Coca-Cola Company (n = 13) held the most board seat positions, indicating centrality to the network. Board seats of these MIs are dominated by executives from transnational corporations (n = 431, or 71.7%), high-income countries (n = 495, or 82.4%), and four countries (United States, Switzerland, United Kingdom, and the Netherlands) (n = 350, or 58.2%) in particular. This study shows that MIs involving the UPF industry privilege the interests of corporations located near exclusively in the Global North, draw legitimacy through affiliations with multi-lateral agencies, civil society groups and research institutions, and represent diverse corporate interests involved in UPF supply chains. Corporate-anchored multi-stakeholderism, as a form of GFG governance, raises challenges for achieving food systems transformation, including the control and reduction of UPFs in human diets.
... Reducing alcohol harms is, like obesity prevention, a 'wicked problem' in health improvement that presents significant implementation challenges -not just in SIDS, but almost everywhere, including wealthy liberal democracies of the Global North (see Moodie et al., 2013). Our last comparison focuses on a couple of 'islands' within two such states -the Northern Territory in Australia and the Far North in New Zealand. ...
The success of the Small Island Developing States (SIDS) agenda rests on effective policy implementation. We look to the literatures in public administration and development studies for key insights on implementation. Translating these insights for the socio-political geography of small island contexts, we identify the trade-offs that SIDS encounter in managing coordination and capacity for implementation. We study examples of success and failure in navigating these trade-offs in practice to draw lessons for policy-makers in SIDS. We advocate 'working with the grain' to improve implementation by: leveraging social networks; collaborating with external actors; and working with existing institutional structures.
... Even after creating quartiles of UPF consumption, we detected no significance in both cases; HRs were >1, but p-values did not show significance; our test to calculate p for trend using medians also showed no associations. Generally speaking, developing countries consume fewer UPFs (19); this is particularly the case in rural areas and small cities in these countries like Ravansar County; we think that is why the mean percentage of UPF intake in grams was only 3.0% of total grams of foods and beverages consumed. Compared to other countries namely South Korea (4.9%) (16), Spain (9.5%) (14), France (17.3%) (15), United Kingdom (22.1%) (13), and United States (36.1%) (12) it is the lowest. ...
Background: Following rapid population growth and urbanization, global ultra-processed food consumption levels have increased. Additionally, type 2 diabetes mellitus, a non-communicable disease, is affecting one-tenth of the people worldwide. In this study, we aimed to investigate the association between ultra-processed food consumption and the risk of type 2 diabetes mellitus in different scenarios in a prospective cohort study in the western part of Iran.
Methods: The RaNCD cohort includes 10047 participants aged 35 to 65; the main phase commenced in March 2015; we included participants susceptible to diabetes at enrolment with follow-up data. We used the widely accepted NOVA classification to define ultra-processed foods. A multivariable Cox proportional hazards regression model was used as the main model; furthermore, the Cox model with different adjustments and the logistic regression model were used as sensitive analysis to evaluate the association between ultra-processed foods consumption and type 2 diabetes mellitus.
Results: A total of 8827 participants with a mean age of 46.92y, a mean follow-up time of 7.1y, and a mean daily ultra-processed food intake of 87.69 grams were included. During the follow-up phases, we included 255 incidences of type 2 diabetes mellitus cases. After adjusting for cofounders in the primary model, including age, gender, residence type, socioeconomic status, physical activity, body mass index, and familial history of diabetes despite the elevated hazard ratio of 1.08 (0.75, 1.55) in the fourth quartile compared to the first quartile, the P-value was insignificant (p-value = 0.665); p for trend in the UPF quartiles was also insignificant.
Conclusion: Our study has shed light on the association between ultra-processed food consumption and the risk of type 2 diabetes mellitus in the Middle East region. We have identified significant associations between diabetes incidence and some covariates. However, further investigations are necessary to confirm or refute the UPFs/T2DM association.
... Poor lifestyle choices, including the consumption of harmful products such as tobacco, alcohol, and junk food, are another barrier to societal sustainability. The consumption of harmful products is driving the epidemic of non-communicable diseases (NCDs), which is the leading cause of chronic disease and death in the world [55], far outpacing COVID-19 [56]. ...
This multidisciplinary study revises the concept of sustainability. It aims to provide a more holistic view of this notion. It develops a model that provides a frame of reference for ensuring the sustainability of decisions taken. This paper reviews and integrates concepts and proposes a new framework. Comparative analyses of the Sustainable Development Goals (SDGs), a definition of sustainability and its components, the pyramid of needs and the medical wheel were carried out. Sustainability encompasses the economic, social, ecological, governance, political, technological, legal and spiritual spheres. The SDGs and this pyramid can be complemented by the need to find meaning in one's life and work through spirituality. This makes it possible to balance the components of sustainability and to consider all the needs. The aspiration to find meaning or purpose in life through spirituality could be added as the 18th SDG. Sustainability is about meeting the physical, mental, emotional and spiritual needs of current and future generations. Thus, managers will be able to monitor progress in meeting these needs, strike a balance between the components of sustainability and consider all the needs of their employees. This article provides a missing piece in relation to the needs addressed by the SDGs and those we have categorised into the four strands of the medical wheel that evoke aspects of the human : physical, mental, emotional and spiritual.
A key driver of obesity and diet‐related illness globally has been the increased consumption of ultra‐processed foods (UPFs). This paper aimed to identify the key actors, structures, incentives, and dynamics that characterize the global UPF system and have led to the dominance of UPFs in population diets. Based on a narrative review and using a systems thinking approach, we developed a causal loop diagram (CLD) of the global UPF system. The CLD comprises nine reinforcing loops: the commodification of diets; increasing market concentration; increasing UPF levels in food retail environments; the financialization of diets; direct corporate political influence; increasing capture of science, public opinion, and policy narratives; shifts from private to public food governance; state accommodation of corporate power; and an “agricultural regime” promoting the production of relatively cheap UPF inputs. The CLD also contains two balancing loops relating to market saturation and public health policies that curb UPF consumption and a countervailing reinforcing loop depicting other forms of food systems in tension with the UPF system. This study suggests the need for innovative and expansive government policies to protect and promote healthy, sustainable diets and coordinated advocacy efforts among those seeking to challenge the exploitative aspects of corporate food systems.
Health outcomes are influenced by social and environmental determinants of health. As places where people work, live, meet and consume, high street retail environments are influential in shaping health. In recent decades, high streets have been in decline, prompting policies to revitalise retail environments and support local businesses, particularly in European and North American countries. The aim of this scoping review was to systematically map evidence on retail environment interventions, to gain a deeper understanding of the current evidence base assessing their possible health and wellbeing impacts. The objectives were to identify different types of interventions and the outcomes they address; and the mechanism through which interventions are theorised to influence health and equity. Peer-reviewed studies were identified through academic databases (MEDLINE, Embase, EconLit, Web of Science and Social Policy and Practice) using relevant search terms. Additional (grey) literature was identified using citation scanning and online searches. Studies were eligible if they evaluated interventions with a significant focus on supporting the retail environment, reported on at least one health and wellbeing outcome and were written in English. Relevant data were extracted and presented descriptively. An interpretive approach was taken to analyse theories of change. The searches identified 53 peer-reviewed studies and nine grey literature reports. Interventions were categorised as follows: area-based initiatives, business improvement districts, business incentives, and demand-side incentives. Studies predominantly evaluated impacts on social and environmental determinants of health. Some studies measured impacts on self-rated (mental) health, physical activity and food consumption and purchasing. Studies reported evidence of both improved and worsening outcomes. Theories of change were often under-specified and reductionist, lacking a clear understanding of the complex systems in which interventions take place. Future interventions could benefit from more comprehensive theories of change that meaningfully integrate economic, and health and wellbeing outcomes. This requires intersectoral collaboration.
The White House National Strategy on Hunger, Nutrition, and Health (National Strategy) encourages actions across government and society to promote nutrition security. Nutrition security includes adequate food, diet quality, and equity, and food retail settings can promote these major concepts. Of all National Strategy whole-of-society calls to action, food retailers can contribute to 15 calls as key actors. However, there is currently no standardized monitoring tool to track food retailers’ commitments and actions toward the National Strategy to promote nutrition security. The Business Impact Assessment-Obesity and population-level nutrition (BIA-Obesity), a tool originally developed for corporate accountability monitoring, can be tailored for the National Strategy and nutrition security, given its standardized indicators and process to assess food company policies and commitments across six domains. We discuss the fit of the BIA-Obesity indicators for tracking food retailers’ commitments and actions across four pillars of the National Strategy. Existing indicators are appropriate to monitor components of Pillar 1: Improve Food Access and Affordability; Pillar 2: Integrate Nutrition and Health; Pillar 3: Empower All Consumers to Make and Have Access to Healthy Choices; and Pillar 5: Enhance Nutrition and Food Security Research. We suggest expanding current indicators to include equity, local foods, the digital food environment, and food waste reduction to improve alignment of the BIA-Obesity with the National Strategy. Application of the BIA-Obesity as an existing tool can facilitate data cohesion and more rapid assessment of the food retailer landscape to mutually meet nutrition security goals by 2030.
Following rapid population growth and urbanization, global ultra-processed food consumption levels have increased. Additionally, type 2 diabetes mellitus, a non-communicable disease, is affecting one-tenth of the people worldwide. In this study, we aimed to investigate the association between ultra-processed food consumption and the risk of type 2 diabetes mellitus in different scenarios in a prospective cohort study in the western part of Iran.
The RaNCD cohort includes 10,047 participants aged 35 to 65; we included participants susceptible to diabetes at enrolment with follow-up data. We used the widely accepted Nova classification to define ultra-processed foods. A multivariable Cox proportional hazards regression model was used as the main model; furthermore, the Cox model with different adjustments and the logistic regression model were used as sensitive analysis to evaluate the association between ultra-processed foods consumption and type 2 diabetes mellitus.
A total of 8827 participants with a mean age of 46.92y, a mean follow-up time of 7.1y, and a mean daily ultra-processed food intake of 87.69 g were included. During the follow-up phases, we included 255 incidences of type 2 diabetes mellitus cases. After adjusting for confounders in the primary model, including age, gender, residence type, socioeconomic status, physical activity, body mass index, and familial history of diabetes despite the elevated hazard ratio of 1.08 (0.75, 1.55) in the fourth quartile compared to the first quartile, the P-value was insignificant (p-value = 0.665); p for trend in the UPF quartiles was also insignificant.
Our study has shed light on the association between ultra-processed food consumption and the risk of type 2 diabetes mellitus. However, further investigations are necessary to confirm or refute the UPFs/T2DM association.
The greater prevalence of small and medium-sized enterprises (SMEs), which have an important place in country economies, in the supply chain structure is very important in the development of country economies in a complex and competitive business environment. However, while SMEs can make significant contributions to achieving the Sustainable Development Goals (SDGs), food SMEs can also have indirect effects on agricultural productivity in the agricultural sector. Food and Agriculture Organization of the United Nations (FAO) and similar international organizations support practices that may lead to this. SMEs are businesses whose number of employees, annual turnover or annual balance sheet total is below a certain threshold. In addition to making positive contributions to economic life, SMEs also fulfill an important function by providing food supply for food products, which are people's most basic needs. In a competitive and complex business environment, implementing appropriate strategies is a particularly important effort to advance the development of SMEs. This article analyzed the digital transformation and success factors of SMEs with new technologies in agriculture & food marketing. In the study, a systematic analysis method was proposed by nominating important databases such as Web of Science, Scopus and Google Scholar. Articles obtained from different literature platforms were reviewed using validated keywords in accordance with the research purpose. Research results confirm that SMEs' success factors and adoption of new technologies will affect all aspects of agriculture & food marketing. Therefore, when determining strategies for SMEs, more importance should be given to integrating new technologies into all processes, taking into account all these factors.
This study contributes to a neglected aspect of health policy analysis: policy formulation processes. Context is central to the policy cycle, yet the influence of crises on policy formulation is underrepresented in the health policy literature in low- and middle-income countries (LMICs). This paper analyses a detailed case study of how the COVID-19 crisis influenced policy formulation processes for the regulation of alcohol in South Africa, as part of COVID-19 control measures, in 2020 and 2021. It provides a picture of the policy context, specifically considering the extent to which the crisis influenced the position and power of actors, and policy content. Qualitative data were collected from nine key informant interviews and 127 documents. Data were analysed using thematic content analysis. A policy formulation conceptual framework was applied as a lens to describe complex policy formulation processes. The study revealed that the perceived urgency of the pandemic prompted a heightened sense of awareness of alcohol-related trauma as a known, preventable threat to public health system capacity. This enabled a high degree of innovation among decision-makers in the generation of alternative alcohol policy content. Within the context of uncertainty, epistemic and experiential policy learning drove rapid, adaptive cycles of policy formulation, demonstrating the importance of historical and emerging public health evidence in crisis-driven decision-making. Within the context of centralization and limited opportunities for stakeholder participation, non-state actors mobilized to influence policy through the public arena. The paper concludes that crisis-driven policy formulation processes are shaped by abrupt redistributions of power among policy actors and the dynamic interplay of evolving economic, political and public health priorities. Understanding the complexity of the local policy context may allow actors to navigate opportunities for public health-oriented alcohol policy reforms in South Africa and other LMICs.
This content analysis aimed to assess misinformation themes regarding sodium reduction and blood pressure on X with the goal of providing strategies to address and debunk such misinformation. A total of 531 posts were manually coded into sodium-related misinformation themes, with inclusion criteria for posts asserting no association between sodium reduction and hypertension or claiming consuming sodium is beneficial for health. Numbers and post frequencies per misinformation theme were calculated. Post characteristics, including information sources, advertisements and narratives, were coded, and a correlation analysis was conducted to assess their association with each misinformation theme. Fourteen sodium-related misinformation themes were identified and consistently disseminated on X. The predominant theme, ‘Natural Salt’, accounted for 37.7% (n = 200), reaching 1.6 million followers, followed by ‘Reducing salt could be bad for my health’ theme, comprising 28.6% (n = 152) and reaching 1.5 million followers. There was a statistical correlation between the natural salt misinformation theme and advertisements. Many of the most frequent misinformation themes identified in this study have not been systematically debunked by organizations such as the World Health Organization and the American Heart Association. This study underscores the importance of continuous monitoring and analysis of sodium-related misinformation on social media platforms and their underlying commercial interests. Such monitoring has the potential to identify prevalent misinformation themes that may pose harm to the public and to inform public health organizations, enabling them to proactively address potential issues through debunking.
Every day, we make decisions on topics ranging from personal investments to schools for our children to the meals we eat to the causes we champion. Unfortunately, we often choose poorly. The reason, the authors explain, is that, being human, we all are susceptible to various biases that can lead us to blunder. Our mistakes make us poorer and less healthy; we often make bad decisions involving education, personal finance, health care, mortgages and credit cards, the family, and even the planet itself. Thaler and Sunstein invite us to enter an alternative world, one that takes our humanness as a given. They show that by knowing how people think, we can design choice environments that make it easier for people to choose what is best for themselves, their families, and their society. Using colorful examples from the most important aspects of life, Thaler and Sunstein demonstrate how thoughtful "choice architecture" can be established to nudge us in beneficial directions without restricting freedom of choice. Nudge offers a unique new take-from neither the left nor the right-on many hot-button issues, for individuals and governments alike. This is one of the most engaging and provocative books to come along in many years. © 2008 by Richard H. Thaler and Cass R. Sunstein. All rights reserved.
Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time.
METHODS We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden.
FINDINGS In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania.
INTERPRETATION Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.
FUNDING Bill & Melinda Gates Foundation.
Background: The purpose of this research was to identify, through alcohol industry documents, similarities between tobacco and alcohol companies in approaches to evidence and counter-arguments to public health measures. Method: A search of the tobacco document archives through the World Wide Web for alcohol industry documents was conducted. Alcohol-related search terms were entered into search fields of the tobacco document archives. Results: The documents show that alcohol and tobacco companies have worked closely together, have shared information, share similar concerns and have used similar arguments to defend their products and prevent or delay restrictions being placed on their products. Conclusion: This paper provides evidence that alcohol and tobacco companies are similar in a number of ways and there is scope to use these similarities in developing more effective public health approaches to addressing alcohol consumption and related harms.
In an article that forms part of the PLoS Medicine series on Big Food, Kelly Brownell offers a perspective on engaging with the food industry, and argues that governments and the public health community should be working for regulation, not collaboration.
In an article that forms part of the PLoS Medicine series on Big Food, Carlos Monteiro and Geoffrey Cannon provide a perspective from Brazil on the rise of multinational food companies and the displacement of traditional food systems, and offer suggestions for the public health response.
In an article that forms part of the PLoS Medicine series on Big Food, David Stuckler and colleagues report that unhealthy packaged foods are being consumed rapidly in low- and middle-income countries, consistent with rapid expansion of multinational food companies into emerging markets and fueling obesity and chronic disease epidemics.
In an article that forms part of the PLoS Medicine series on Big Food, guest editors David Stuckler and Marion Nestle lay out why more examination of the food industry is necessary, and offer three competing views on how public health professionals might engage with Big Food.
In an article that forms part of the PLoS Medicine series on Big Food, Andrew Cheyne and colleagues compare soda companies' corporate social responsibility (CSR) campaigns - which are designed to bolster the image and popularity of their products and to prevent regulation - with the tobacco industry's CSR campaigning.
In many instances, the politics of public health is directly related to the problem of state power. This is especially true for automobile injuries and the 64-year history of the effort to reduce their number in the United States. This article looks at the continual redefinition of the automotive injury problem through these phases: (1) 1920–60, when the automobile manufacturers controlled prevention programs that defined the driver as the cause of accidents, (2) 1960–79, when federal regulations targeted vehicle technology as the best source of prevention strategies, and (3) 1979 to the present, when, during the Reagan years, the framework shifted toward defining health and injury prevention as economic commodities. Throughout this history the dominance of a market ideology in U.S. political culture has largely defined both the character of public health programs to reduce injuries and the capacity of the state to curtail industrial power to design hazardous technologies.
Objective:
Ageing and urbanization leading to sedentary lifestyles have been the major explanations proposed for a dramatic rise in diabetes worldwide and have been the variables used to predict future diabetes rates. However, a transition to Western diets has been suggested as an alternative driver. We sought to determine what socio-economic and dietary factors are the most significant population-level contributors to diabetes prevalence rates internationally.
Design:
Multivariate regression models were used to study how market sizes of major food products (sugars, cereals, vegetable oils, meats, total joules) corresponded to diabetes prevalence, incorporating lagged and cumulative effects. The underlying social determinants of food market sizes and diabetes prevalence rates were also studied, including ageing, income, urbanization, overweight prevalence and imports of foodstuffs.
Setting:
Data were obtained from 173 countries.
Subjects:
Population-based survey recipients were the basis for diabetes prevalence and food market data.
Results:
We found that increased income tends to increase overall food market size among low- and middle-income countries, but the level of food importation significantly shifts the content of markets such that a greater proportion of available joules is composed of sugar and related sweeteners. Sugar exposure statistically explained why urbanization and income have been correlated with diabetes rates.
Conclusions:
Current diabetes projection methods may estimate future diabetes rates poorly if they fail to incorporate the impact of nutritional factors. Imported sugars deserve further investigation as a potential population-level driver of global diabetes.
Recent attempts by large tobacco companies to represent themselves as socially responsible have been widely dismissed as image management. Existing research supports such claims by pointing to the failings and misleading nature of corporate social responsibility (CSR) initiatives. However, few studies have focused in depth on what tobacco companies hoped to achieve through CSR or reflected on the extent to which these ambitions have been realised.
Iterative searching relating to CSR strategies was undertaken of internal British American Tobacco (BAT) documents, released through litigation in the US. Relevant documents (764) were indexed and qualitatively analysed. In the past decade, BAT has actively developed a wide-ranging CSR programme. Company documents indicate that one of the key aims of this programme was to help the company secure access to policymakers and, thereby, increase the company's chances of influencing policy decisions. Taking the UK as a case study, this paper demonstrates the way in which CSR can be used to renew and maintain dialogue with policymakers, even in ostensibly unreceptive political contexts. In practice, the impact of this political use of CSR is likely to be context specific; depending on factors such as policy élites' understanding of the credibility of companies as a reliable source of information.
The findings suggest that tobacco company CSR strategies can enable access to and dialogue with policymakers and provide opportunities for issue definition. CSR should therefore be seen as a form of corporate political activity. This underlines the need for broad implementation of Article 5.3 of the Framework Convention on Tobacco Control. Measures are needed to ensure transparency of interactions between all parts of government and the tobacco industry and for policy makers to be made more aware of what companies hope to achieve through CSR.
In recent years, 10 major multinational food and beverage companies have worked together within the International Food and Beverage Alliance (IFBA) to increase their commitments to public health. Current IFBA commitments include initiatives to improve the nutrition quality of products and how these products are advertised to children. The impact and magnitude of IFBA member contributions to the total market share of packaged foods and beverages consumed remain incompletely understood, however.
In order to evaluate this impact, we examined packaged food and soft drink company shares provided by Euromonitor, an international independent market analysis company. Packaged foods include baby food, bakery, canned/preserved food, chilled/processed food, confectionery, dairy, dried processed food, frozen processed food, ice cream, meal replacement, noodles, oils and fats, pasta, ready meals, sauces, dressings and condiments, snack bars, soup, spreads, and sweet and savoury snacks. Soft drinks include carbonates, packaged fruit/vegetable juice, bottled water, functional drinks, concentrates, ready-to-drink tea, ready-to-drink coffee and Asian specialty drinks. We calculated the market shares for IFBA companies, globally and within nine countries--the US, China, India, Egypt, South Africa, Brazil, Mexico, Turkey and the UK.
Worldwide, the top ten packaged food companies account for 15.2% of sales, with each individual company contributing less than 3.3%. The top ten soft drink companies account for 52.3% of sales worldwide; Coca-Cola and PepsiCo lead with 25.9% and 11.5% of sales, respectively.
Although the top ten soft drink companies account for half of global sales, the top ten packaged food companies account for only a small proportion of market share with most individual companies contributing less than 3.3% each. Major multinational companies need to be joined by the myriad of small- and medium-sized enterprises in developing and implementing programs to improve the health of the public, globally. Without full participation of these companies, the impact of commitments made by IFBA members and other major multinational food and beverage companies will remain limited.
It has been proposed that alcohol industry 'social aspects/public relations' organizations (SAPROs) serve the agenda of lending credibility to industry claims of corporate responsibility while promoting ineffective industry-friendly interventions (such as school-based education or TV advertising campaigns) and creating doubt about interventions which have a strong evidence base (such as higher taxes on alcoholic beverages). This paper investigated whether submissions to Australia's National Preventative Health Taskforce (NPHT) from alcohol industry bodies regarding the Australian SAPRO, Drinkwise, have used this organization to demonstrate corporate responsibility while promoting industry-friendly interventions.
Submissions to the Australian National Preventative Health Taskforce (NPHT) discussion paper Australia, the healthiest country by 2020 (n = 375) were examined to identify those with primary alcohol content. A thematic analysis of the resulting 33 submissions was conducted to determine which organization, institution or individual discussed Drinkwise.
Australia.
Nine of the 33 submissions discussed Drinkwise; all were submitted by the alcohol industry or its affiliates. Every industry submission referred to Drinkwise either as providing evidence of social responsibility or by suggesting the industry-friendly actions of Drinkwise as alternatives to those recommended by the NPHT report.
Drinkwise has been used by the alcohol industry to create an impression of social responsibility while promoting interventions that maintain profits and campaigning against effective interventions such as higher taxes on alcohol.
David Stuckler and colleagues examine five large private global health
foundations and report on the scope of relationships between these tax-exempt
foundations and for-profit corporations including major food and pharmaceutical
companies.
Adam Oliver (doi:10.1136/bmj.d2168) maintains that nudges may help people to make healthier choices, but Geof Rayner and Tim Lang worry that government proposals are little more than publicly endorsed marketing
BACKGROUND:Internal tobacco industry document searches have led to the discovery of hitherto unpublisheddocuments that provide insights into the drinks industry. The documents uncover key concerns andstrategies for the drinks industry with focus on the Miller Brewing Company and the Beer Institute.METHODS:The identification of the Philip Morris 1996 CEO Issues Book from the tobacco document archives led to asystematic search for alcohol-related documents. The search was conducted by entering alcohol-relatedterms into search fields of tobacco document archive sites available on the World Wide WebRESULTS:Key areas of concern for the Miller Brewing Company, the Beer Institute, and more broadly, the alcoholindustry include developments of legislative and regulatory controls such as tax increases, advertisingrestrictions and blood alcohol content lowering and public perceptions of harms relating to drunk driving,binge drinking and underage alcohol consumption. Strategies proposed by the Miller Brewing Companyand the Beer Institute to combat these concerns include ally development and maintenance and thepromotion of personal responsibility.CONCLUSIONS:These once confidential internal documents provide new evidence on the drinks industry’s concernsabout possible alcohol control measures and the strategies used to help overcome these concerns. The document findings justify the public health community’s cynicism about the alcohol industry whileproviding a new source of information to assist development in the regulation and control of the drinksindustry.
High platelet reactivity while receiving clopidogrel has been linked to cardiovascular events after percutaneous coronary intervention (PCI), but a treatment strategy for this issue is not well defined.
To evaluate the effect of high-dose compared with standard-dose clopidogrel in patients with high on-treatment platelet reactivity after PCI.
Randomized, double-blind, active-control trial (Gauging Responsiveness with A VerifyNow assay-Impact on Thrombosis And Safety [GRAVITAS]) of 2214 patients with high on-treatment reactivity 12 to 24 hours after PCI with drug-eluting stents at 83 centers in North America between July 2008 and April 2010.
High-dose clopidogrel (600-mg initial dose, 150 mg daily thereafter) or standard-dose clopidogrel (no additional loading dose, 75 mg daily) for 6 months.
The primary end point was the 6-month incidence of death from cardiovascular causes, nonfatal myocardial infarction, or stent thrombosis. The key safety end point was severe or moderate bleeding according to the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) definition. A key pharmacodynamic end point was the rate of persistently high on-treatment reactivity at 30 days.
At 6 months, the primary end point had occurred in 25 of 1109 patients (2.3%) receiving high-dose clopidogrel compared with 25 of 1105 patients (2.3%) receiving standard-dose clopidogrel (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.58-1.76; P = .97). Severe or moderate bleeding was not increased with the high-dose regimen (15 [1.4%] vs 25 [2.3%], HR, 0.59; 95% CI, 0.31-1.11; P = .10). Compared with standard-dose clopidogrel, high-dose clopidogrel provided a 22% (95% CI, 18%-26%) absolute reduction in the rate of high on-treatment reactivity at 30 days (62%; 95% CI, 59%-65% vs 40%; 95% CI, 37%-43%; P < .001).
Among patients with high on-treatment reactivity after PCI with drug-eluting stents, the use of high-dose clopidogrel compared with standard-dose clopidogrel did not reduce the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or stent thrombosis.
clinicaltrials.gov Identifier: NCT00645918.
To assess time trends in the contribution of processed foods to food purchases made by Brazilian households and to explore the potential impact on the overall quality of the diet.
Application of a new classification of foodstuffs based on extent and purpose of food processing to data collected by comparable probabilistic household budget surveys. The classification assigns foodstuffs to the following groups: unprocessed/minimally processed foods (Group 1); processed culinary ingredients (Group 2); or ultra-processed ready-to-eat or ready-to-heat food products (Group 3).
Eleven metropolitan areas of Brazil.
Households; n 13,611 in 1987-8, n 16,014 in 1995-5 and n 13,848 in 2002-3.
Over the last three decades, the household consumption of Group 1 and Group 2 foods has been steadily replaced by consumption of Group 3 ultra-processed food products, both overall and in lower- and upper-income groups. In the 2002-3 survey, Group 3 items represented more than one-quarter of total energy (more than one-third for higher-income households). The overall nutrient profile of Group 3 items, compared with that of Group 1 and Group 2 items, revealed more added sugar, more saturated fat, more sodium, less fibre and much higher energy density.
The high energy density and the unfavourable nutrition profiling of Group 3 food products, and also their potential harmful effects on eating and drinking behaviours, indicate that governments and health authorities should use all possible methods, including legislation and statutory regulation, to halt and reverse the replacement of minimally processed foods and processed culinary ingredients by ultra-processed food products.
This paper describes a new food classification which assigns foodstuffs according to the extent and purpose of the industrial processing applied to them. Three main groups are defined: unprocessed or minimally processed foods (group 1), processed culinary and food industry ingredients (group 2), and ultra-processed food products (group 3). The use of this classification is illustrated by applying it to data collected in the Brazilian Household Budget Survey which was conducted in 2002/2003 through a probabilistic sample of 48,470 Brazilian households. The average daily food availability was 1,792 kcal/person being 42.5% from group 1 (mostly rice and beans and meat and milk), 37.5% from group 2 (mostly vegetable oils, sugar, and flours), and 20% from group 3 (mostly breads, biscuits, sweets, soft drinks, and sausages). The share of group 3 foods increased with income, and represented almost one third of all calories in higher income households. The impact of the replacement of group 1 foods and group 2 ingredients by group 3 products on the overall quality of the diet, eating patterns and health is discussed.
Cost-effectiveness analyses are important tools in efforts to prioritise interventions for obesity prevention. Modelling facilitates evaluation of multiple scenarios with varying assumptions. This study compares the cost-effectiveness of conservative scenarios for two commonly proposed policy-based interventions: front-of-pack 'traffic-light' nutrition labelling (traffic-light labelling) and a tax on unhealthy foods ('junk-food' tax).
For traffic-light labelling, estimates of changes in energy intake were based on an assumed 10% shift in consumption towards healthier options in four food categories (breakfast cereals, pastries, sausages and preprepared meals) in 10% of adults. For the 'junk-food' tax, price elasticities were used to estimate a change in energy intake in response to a 10% price increase in seven food categories (including soft drinks, confectionery and snack foods). Changes in population weight and body mass index by sex were then estimated based on these changes in population energy intake, along with subsequent impacts on disability-adjusted life years (DALYs). Associated resource use was measured and costed using pathway analysis, based on a health sector perspective (with some industry costs included). Costs and health outcomes were discounted at 3%. The cost-effectiveness of each intervention was modelled for the 2003 Australian adult population.
Both interventions resulted in reduced mean weight (traffic-light labelling: 1.3 kg (95% uncertainty interval (UI): 1.2; 1.4); 'junk-food' tax: 1.6 kg (95% UI: 1.5; 1.7)); and DALYs averted (traffic-light labelling: 45,100 (95% UI: 37,700; 60,100); 'junk-food' tax: 559,000 (95% UI: 459,500; 676,000)). Cost outlays were AUD81 million (95% UI: 44.7; 108.0) for traffic-light labelling and AUD18 million (95% UI: 14.4; 21.6) for 'junk-food' tax. Cost-effectiveness analysis showed both interventions were 'dominant' (effective and cost-saving).
Policy-based population-wide interventions such as traffic-light nutrition labelling and taxes on unhealthy foods are likely to offer excellent 'value for money' as obesity prevention measures.
Drawing on published tobacco document research and related sources, this article applies Farnsworth and Holden's conceptual framework for the analysis of corporate power and corporate involvement in social policy (2006) to the transnational tobacco companies (TTCs). An assessment is made of TTCs' structural power, the impact upon their structural position of tobacco control (TC) policies, and their use of agency power. The analysis suggests that, as a result of the growth of TC policies from the 1950s onwards, TTCs have had to rely on political agency to pursue their interests and attempt to reassert their structural position. The collapse of the Eastern bloc and the liberalisation of East Asian economies presented new structural opportunities for TTCs in the 1980s and 1990s, but the development of globally coordinated TC policies facilitated by the World Health Organisation's Framework Convention on Tobacco Control has the potential to constrain these.
Although the content of alcohol advertisements is restricted, Gerard Hastings and colleagues find that advertisers are still managing to appeal to young people and promote drinking
In this paper, we describe an analysis of alcohol policy initiatives sponsored by alcohol producer SABMiller and the International Center on Alcohol Policies, an alcohol industry-funded organization. In a number of sub-Saharan countries these bodies have promoted a 'partnership' role with governments to design national alcohol policies.
A comparison was conducted of four draft National Alcohol Policy documents from Lesotho, Malawi, Uganda and Botswana using case study methods.
The comparison indicated that the four drafts are almost identical in wording and structure and that they are likely to originate from the same source.
The processes and the draft policy documents reviewed provide insights into the methods, as well as the strategic and political objectives of the multi-national drinks industry. This initiative reflects the industry's preferred version of a national alcohol policy. The industry policy vision ignores, or chooses selectively from, the international evidence base on alcohol prevention developed by independent alcohol researchers and disregards or minimizes a public health approach to alcohol problems. The policies reviewed maintain a narrow focus on the economic benefits from the trade in alcohol. In terms of alcohol problems (and their remediation) the documents focus upon individual drinkers, ignoring effective environmental interventions. The proposed policies serve the industry's interests at the expense of public health by attempting to enshrine 'active participation of all levels of the beverage alcohol industry as a key partner in the policy formulation and implementation process'.
The Corporate Play Book, Health and Democracy: The Snack Food and Beverage Industry’s Tactics in Context.
Chapter 6, Part 2
By William H. Wiist
In Stuckler, David and Karen Siegel. 2011. Sick Societies: Responding to the Global Challenge of Chronic Disease. Oxford: Oxford University Press.
Abstract
In this chapter the food industry’s tactics and potentially adverse effects on public health are evaluated. Lessons from the tobacco and other industries are applied to the food industry, using material from from PepsiCo’s proposals. Our analysis suggests that food companies may be replicating several of the tactics used by tobacco companies to promote a positive image and influence research as part of an effort to reduce the prospects for public regulation and taxation. A series of Recommendations are offered about how public health practitioners should engage with the food industry to promote healthy transformation with industry while avoiding potential conflicts-of-interest and adverse influences on the public’s health and democracy.
Table 6.3. Twenty-three questions to ask about the food and beverage industry: Corporate operations, Products, testing and standards.
Table 6.4. Thirty-six examples of the corporate play book: Public relations, distortion of science, political influence, financial tactics, legal and regulatory tactics, products and services.
Table 6.5. Forty-one examples of actions corporations could take to gain the trust of potential public health partners, government and human citizens.
This article summarizes the contents of Alcohol: No Ordinary Commodity-Research and public policy (Babor et al. 2003). The first part of the book describes why alcohol is no ordinary commodity, and presents epidemiological data on the global burden of alcohol-related problems. The second part of the book reviews the scientific evidence for strategies and interventions designed to prevent or minimize alcohol-related harm: pricing and taxation, regulating the physical availability of alcohol, modifying the drinking context, drinking-driving countermeasures, regulating alcohol promotion, education and persuasion strategies and treatment services. The final section considers the policymaking process on the local, national and international levels, and provides a synthesis of evidence-based strategies and interventions from a policy perspective.
Deceit and Denial details the attempts by the chemical and lead industries to deceive Americans about the dangers that their deadly products present to workers, the public, and consumers. Gerald Markowitz and David Rosner pursued evidence steadily and relentlessly, interviewed the important players, investigated untapped sources, and uncovered a bruising story of cynical and cruel disregard for health and human rights. This resulting exposé is full of startling revelations, provocative arguments, and disturbing conclusions--all based on remarkable research and information gleaned from secret industry documents. This book reveals for the first time the public relations campaign that the lead industry undertook to convince Americans to use its deadly product to paint walls, toys, furniture, and other objects in America's homes, despite a wealth of information that children were at risk for serious brain damage and death from ingesting this poison. This book highlights the immediate dangers ordinary citizens face because of the relentless failure of industrial polluters to warn, inform, and protect their workers and neighbors. It offers a historical analysis of how corporate control over scientific research has undermined the process of proving the links between toxic chemicals and disease. The authors also describe the wisdom, courage, and determination of workers and community members who continue to voice their concerns in spite of vicious opposition. Readable, ground-breaking, and revelatory, Deceit and Denial provides crucial answers to questions of dangerous environmental degradation, escalating corporate greed, and governmental disregard for its citizens' safety and health. After eleven years, Markowitz and Rosner update their work with a new epilogue that outlines the attempts these industries have made to undermine and create doubt about the accuracy of the information in this book.
Objectives:
We estimated the relationship between soft drink consumption and obesity and diabetes worldwide.
Methods:
We used multivariate linear regression to estimate the association between soft drink consumption and overweight, obesity, and diabetes prevalence in 75 countries, controlling for other foods (cereals, meats, fruits and vegetables, oils, and total calories), income, urbanization, and aging. Data were obtained from the Euromonitor Global Market Information Database, the World Health Organization, and the International Diabetes Federation. Bottled water consumption, which increased with per-capita income in parallel to soft drink consumption, served as a natural control group.
Results:
Soft drink consumption increased globally from 9.5 gallons per person per year in 1997 to 11.4 gallons in 2010. A 1% rise in soft drink consumption was associated with an additional 4.8 overweight adults per 100 (adjusted B; 95% confidence interval [CI] = 3.1, 6.5), 2.3 obese adults per 100 (95% CI = 1.1, 3.5), and 0.3 adults with diabetes per 100 (95% CI = 0.1, 0.8). These findings remained robust in low- and middle-income countries.
Conclusions:
Soft drink consumption is significantly linked to overweight, obesity, and diabetes worldwide, including in low- and middle-income countries.