Two years have elapsed since who passed its global strategy -- in May 2004 -- on diet, physical activity and health but the world is still nowhere near engaging industry and consumers on issues relating to healthy lifestyles, of which diet is a crucial element. A meeting in Delhi on September 18, 2006, by the Global Alliance for the Prevention of Obesity and Related Chronic Disease, was a welcome attempt to engage with the specifics of the Indian dimensions of the problem, even if it demonstrated how poorly equipped we are to tackle it.
India is one of the 10 countries that have been identified by who as a seeding bed for working out its global strategy on obesity, especially among children. It has a history of state failure, lacking the will to get the implementation process on song that makes it a somewhat oddball choice as a model.
India has, however, been identified because it faces a major obesity problem and linked chronic diseases, as have Malaysia Singapore, Thailand Hong Kong, Pakistan, Brazil, Canada, China and a group of Pacific Ocean islands. Political considerations, such as balancing ethnic and religious communities, also played a role in who's calculations. The global alliance was formed on February 22, 2005, with the task of implementing obesity prevention plans.
The meeting brought together researchers in the field of nutrition and health to assess whether enough evidence was available to formulate workable policies. What the members of the meeting discovered was that some data was available, but it was scattered and there was no consensus on the policies needed. Philip James, chairperson of the alliance, warned that the government might not do much to set down policies because they were under corporate pressure. More has to be done at individual and community levels, he suggests.
The agenda, as currently envisaged, will now be managed by a national alliance under the guidance of the global alliance. "Though the problems that India faces are not the same as those of the developed world as yet, the entry of major investors like Reliance and Sunil Mittal into the food industry makes it essential that we position ourselves in advance and ensure that they provide healthy rather than unhealthy food," says K Srinath Reddy, president of the Public Health Foundation of India (phfi). There are suggestions that phfi will be used as a platform to engage with the government. The engagement is being seen in a broad-spectrum format at national consultation in 2005, 16 ministries and departments had been identified as crucial for the fight against obesity and chronic diseases.
The civil society-government group has, at its disposal, recommendations for the national plan of action for the implementation of a strategy developed in April 2005, independent of the global initiative. Amongst these are plans to prevent the food industry from targeting children and vulnerable groups through advertising campaigns.
Uphill task The experience of other countries has, however, proved that this kind of legislation is not easy to enforce. In the first week of September, when the health select committee of the New Zealand parliament questioned food companies including the representatives of fast-food chain McDonald's and soft drink-manufacturer Coca-Cola, they said that there is little evidence that restrictions on their products would cut obesity rates. They cited the example of Sweden, where there was a ban on advertising unhealthy foods to children, but the obesity rate was 21 per cent, just 3 per cent lower than in New Zealand.
The companies went on to actually suggest that restricting advertising would be harmful.
McDonald's country marketing manager Ian Sutcliffe said banning advertising -- if the restriction had a wide enough compass -- might also proscribe advertising aimed at promoting sports and the company's widely known seat-belt safety campaign. The Ronald McDonald Charity contributes
nz $40,000 to the New Zealand Police Road Safe Series Programme and gives
nz $1.2 million annually as sponsorship of children's sports. Coca-Cola's Oceania managing director Geert Broos said the company does not directly market to children below the age of 12 and opposed a total ban on fizzy drinks in schools as this would affect companies manufacturing sugar-free diet drinks. Sales of these drinks have been increasing steadily in the last four years, sales of sugar-free drinks have risen from 20 per cent to 32 per cent of the company's market share. McDonald's New Zealand managing director Grainne Troute also said that their healthier options make up about 20 per cent of all sales and about 50 per cent of children's 'happy meals' sales contained such a component.
Parents responsible
Coca-Cola's spokesperson in New Zealand, Alison Sykora, said people liked a sugary taste and it would be counter-productive to ban sugar-free drinks. A ban might even increase the intake of sugary drinks among teenagers who were looking for restrictions to rebel against. She also said that the caffeine content increased alertness. The McDonald's representative said advertising told children what was available to them -- and, in any case, parents were responsible for taking a call.
It's not just the food industry, even hospitals are complicit in promoting bad diets. The September/October issue of the
Journal of the American Board of Family Medicine carried a survey, which shows that
us hospitals are contributing to unhealthy lifestyle choices by housing fast-food establishments. In 2005, 233 hospitals were surveyed and it was seen that 42 per cent had at least one brand-name fast food served on campus. McDonald's, Taco Bell, Pizza Hut, Wendy's, Dunkin Donuts were some of the prominent companies in hospitals.
These are just a few examples. There are others around the world that show how the food industry gets its way. A 2006
uk Food Standards Agency review shows that food and products like soft drinks dominate advertising aimed at children. To make matters worse, advertised diets fly in the face of healthy diets recommended by the government. Some experts defend choice. Kamala Krishnaswamy, former director of National Institute of Nutrition, Hyderabad, says regulating the food industry is not necessary as their products are consumed by only a small proportion of the people. More focus should be on educating people about changing their lifestyles and consume less of sugar, fat and salt in the food they cook, she suggests.
Technological advances have compounded the problem. The food industry now uses the Internet to popularise its message. For example, a July 2006 report of the
ngo Henry J Kaiser Family Foundation shows how the Internet was being used to promote food items. One of the sites mentioned in the report is
http//www.millsberry.com/. On this site, a child can create a character and a neighbourhood. The fictional character can shop at different stores when it's hungry. General Mills cereals are embedded in parts of the site, but there are many sectors where there is no visible brand presence.
Curbs essential But experts say curbs on this kind of marketing are essential.
who's global strategy on diet, physical activity and health will fail to have an impact unless such curbs are operationalised. In May 2006, the global alliance gave a call for action on marketing of foods and beverages to children and starting an initiative through
who to develop an international code. The group hopes to present guidelines at the 2007 World Health Assembly to help national action plans.
"Since the global strategy there is no overt confrontation and industry has a more conciliatory approach. But they have not delivered. The challenge is that they should really accept that they have to change," says Neville Rigby, director of policy and public affairs, the International Association for the Study of Obesity (
iaso).
It is not just children who are being targeted by the food industry. At the International Congress on Obesity in Sydney, 2,500 experts had a breakfast sponsored by Coca-Cola to talk about the benefits of Coke consumption as it relates to hydration. James reveals that this was despite strict criteria set down for sponsorship. But despite widespread concerns, the Australian government follows a clearly pro-industry stand. When Claude Bouchard,
iaso president, suggested at the impugned obesity congress that there should be a ban on advertising junk food, Australia's federal health minister Tony Abbott ruled out proscriptive measures, arguing that parents had to exercise control.
There are others who do not believe regulating the food industry is the only answer. Philip Stevens, director of the health programme at the International Policy Network, a London-based development think-tank, suggests that as scientists learn more about the physiology of obesity, new drugs will make this modern scourge a thing of the past. As India and China move up the global economy ladder, they too will be able to carry out this research, he suggests. Ben Lilley, chief executive officer of the advertising agency
smart, says deterioration in family values, which means parents are not educating their children well enough on making healthy choices, is a bigger problem than advertising.
The argument has a specious ring. What might be a more balanced view is that parental control and state regulation must make common cause to control juvenile obesity.
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