I’m curious what you think. Do you think companies that make, sell, and market soda can improve the challenges we face with obesity? I’m asking sincerely. I was struck by the Coca-Cola ad (below) recently released. I’m a pediatrician and I’ve never worked for a beverage company or any company that sells products to children. I don’t like that these companies market salty, fatty, sugary products to children. As a pediatrician, I would suggest I’m very biased. The food industry spends $15 BILLION marketing and advertising to children every year. Food advertising, directly to children, is known to increase rates of obesity. Even familiarity with fast-food ads has been found to be problematic. As parents, this isn’t hard to believe; I’ve seen my boys introduced to a product on TV and then ask for it at the grocery store. Because of my bias, I’m asking you—do you think companies like Coca-Cola and Pepsi can help?
As the obesity problem persists, strategies have turned to protocols and regulation. Today, the American Academy of Pediatrics (AAP) released it’s first policy on managing weight-related diabetes. And in the past few years, the American Heart Association released a statement asking for increased regulation on advertising high-calorie, low nutrient-dense (“junk”) foods to children. In 2006, The Institutes of Medicine (IOM) said, “Food marketing intentionally targets children who are too young to distinguish advertising from truth and induces them to eat high-calorie, low-nutrient (but highly profitable) “junk” foods; companies succeed so well in this effort that business-as-usual cannot be allowed to continue.” Similar sentiments are shared by the American Psychological Association, the Center for Science in the Public Interest (CSPI), Children Now, the American Medical Association, and the American Academy of Pediatrics. The public, too. Last fall, the majority (67%) of international readers polled in The New England Journal of Medicine believed we should regulate sugary-beverage consumption. This on the heels of New York’s regulation banning sale of large sugary drinks. This isn’t just about a tax. Can these companies help?
Soda consumption is going down in the US. But instead of soda, our children may be reaching for sports drinks and/or vitamin-infused sweet water. When thirsty, they still may not be reaching for water.
Clearly, there’s no one thing that will solve all of our children’s risk for unhealthy weight. It will take changes in diet, portions, activity, habits, and attitude to improve obesity rates.
A powerful story on NPR this morning heightened my curiosity about partnerships. The report detailed Dr Derek Yach’s 6 years working with Pepsi. His role has became emblematic to conflicts of interest. By choosing to work at Pepsi, he showed his belief that working with companies who make soda will improve health. But as NPR reports, skeptics and nutritionists, like Food Politics author Marion Nestle, believe Yach may have helped the “sugar-water” build credibility, further advancing the problem of sugary beverage consumption.
Is Dr. Derek Yach a good guy who went to the dark side? Or is it possible that he’s right, good people work everywhere and with help and education, advocacy from within will improve the way we live and eat?
This conversation about soda companies and health initiatives is similar to the debates about doctors “selling out” and working for pharmaceutical companies. I don’t believe Pharma is all evil and I certainly don’t think all doctors and researchers sell out who help make or promote drugs they believe in. Pharma companies research, make, and sell drugs. They market them to potential patients. They spend millions (perhaps billions–feel free to set me straight) to get physicians all around the world to write prescriptions for the medications or products. They have goals of increasing market share, too. I suspect most people working in pharmaceuticals believe they are easing the pain and suffering of others. I also recognize the complexity of that belief and the slippery slope. The easiest argument I keep close to my heart is one presented to me on day one of my ethics training: if drug companies didn’t think the pens or pads of paper or trips to Hawaii they give doctors improved sales, they wouldn’t give them.
But what about nutrition? Can companies that sell sweetened formula, toddler snacks, soda, chips, and sugar-sweetened beverages do good in the fight to return our nation to a healthy weight? Check out the ad that Coca-Cola recently released and then watch the “honest” reworked, editorialized version below.
Please, share your take. Is Coca-Cola’s new ad simply another marketing tactic or a true push in the right direction? Do you think it’s possible for these companies–with stock holders demanding them to maintain or grow market share–to improve the lives of our children? Will their enormous platforms and their massive boxes of food and beverages help innovate and redirect our thinking about what and how we eat?
Meagan says
Haven’t seen it.
I may still be in the ignorance is bliss phase of parenting … my 20 month old isn’t talking yet, much less making demands for soda. He drinks water and milk, that’s all. We don’t have TV, we have netflix. Right now, it doesn’t matter if they’re marketing to my son (who yes, watches a bit of Phineas and Ferb )So or us… we don’t see any of it.
Peter Bryan says
It’s hard to not feel skeptical or even cynical when presented with face-saving marketing material masked as corporate responsibility. When the tobacco companies acknowledged the fact that smoking kills, did they stop producing cigarettes? I think my take-away from this is that Coke realizes it’s in the cross-hairs and that it’s now just a matter of time until soda is taxed in the same crushing manner that tobacco was.
Christie Ison says
The second one is hilarious. All the information in it is true, but even if they did say those things, most folks would just hear “blah blah blah.” Even for those of us who agree, it drones on a bit.
This is a tough subject. Coke is part of our culture. I got a little misty at the “I’d like to buy the world a Coke” shot. But it’s also wasteful calories and probably the only liquid that many (possibly most) Americans drink. I was shocked to learn years ago that the fastest-selling items in the grocery store are sodas.
After becoming significantly healthier myself and drinking mostly water with lemon and stevia, I do occasionally indulge in a Coke. I mean, like once or twice a month. Changing the habits of an entire nation to do the same will be challenging, but I’m doing my part, teaching with Cooking Matters/Share Our Strength. I think a significant step will be to ban the purchase of sodas with SNAP, but that’s just my opinion.
Here’s hoping we can change what people drink, eat and believe about food.
Nick Dawson says
Kudos for calling the question!
I think, despite the messaging in the voiceover, there’s a fundamental conflict at play. Coca-cola sells these products and they don’t intend to go out of business. In fact, they have an obligation to shareholders not to go out of business. From a simple economics perspective, coke is able to sell its products at a phenomenally cheap price because many of the basic ingredients are subsidized. Corn sweeteners are subsidized. The result is a product which is both biologically addicting and accessible to virtually every part of the population. To boot, in many economically depressed areas, food deserts, and schools, it’s the most attractive option for $1.00.
I’ll add to my skepticism with some specific comments about the ad. Notice that the narration doesn’t say Coke or Coca-Cola until about 1:30 into the spot. Youtube and online videos, the prime platform for this contrived bit of viral manipulation, has an audience with a notoriously short attention span (https://daws.in/VjZYyj ). So, do people even make it to the part of the video where the voiceover admonishes the brand? Secondly, the imagery is in conflict with the message. The images are of Coke logos, cold drinks, healthy looking people, smiling faces with clean skin and fit bodies. Translation: hook ’em with an insincere message, inundate ’em with product and lifestyle shots, get ’em talking by making it appear like we care. I can hear people everywhere with 20-60 lbs to lose (I fit that bucket, by the way) thinking “whew, I’m not obese…I mean, really obese…and man those drinks look good, and this brand cares…I’m going to buy a case of coke at the store to support them, but it’s ok, because I’m not like, you know, one of the people they are talking about”
How’s that for cynical?
And that’s the point, they cannot care. If they did, they’d be in conflict with their shareholders and bottom line margin. I don’t fault that. It’s their business. What I take issue with is a brand pretending otherwise.
To address your thought provoking question —which will keep my hamster wheel brain going for some time to come —I’m obviously skeptical that a junk food company can be part of the solution.
Who _can_ be part of the solution? Doctors like you, dietitians, coaches, schools, parents… anyone who is willing to say “no really, when coke says they have zero nutritional value, let me tell you how true that is and exactly what it means.” And then offer some cognitive support and behavior coaching to help. “are you willing to try water instead of a coke next time you eat out?” (clearly I don’t know about these things, but I I’m sure there’s a proper construct for conversations like that).
Wendy Sue Swanson, MD, MBE says
Nick,
Thanks. We do this–we talk about this, we explain energy gap and empty-non-nutritive calories, we talk about moderation, saving treats for once a week, having water with meals. I’m not aware of much data (outside of a bit on motivational interviewing) that this is enough…
Remember when Mead Johnson (2010) started selling chocolate toddler formula with 18g of sugar per serving? They marketed as the complete and perfect food for a picky eater. If these toddlers learn to crave sweet liquids, it potentially becomes a lifelong habit. it took public OUTCRY to get it off the shelves.
Not an excuse, but remember, we only get 15-20 min visits for an entire well child exam. Leaves very little time for deep conversations about choice, energy gap, sugar content, and nutrition counseling.
Visits to nutritionists are often not covered under insurance either. Which leaves us stuck. We’ll have to augment this teaching and this learning with other tools. The exam room just isn’t enough.
Jennifer Isaacs says
Everything that Coca-Cola does is a marketing tactic; however, this may be an act of social responsibility. I think that the changes that they made to the labeling of their beverages is a significant step. While it isn’t as great as the “traffic light” labeling in the UK (https://www.nhs.uk/Livewell/Goodfood/Pages/food-labelling.aspx). This is a step in the right direction. I have recently begun to re-evaluate my caloric intake, and having the calorie count on the front of the can helps me make my decision.
I think that expecting Coca-Cola to change all of its products to healthy products is idealistic. Since consumption of red meat increases colorectal cancer risk should farmers stop raising and selling their steer at the market? No.
Instead we should rely on the public to make decisions regarding their health. Additionally, healthy eating and drinking is not the end-all-be-all for a healthy lifestyle. Genetic factors are out of our control.
Because of this, I don’t think that Coca-Cola products should be altered. I like being able to enjoy my once-a-week or once-a-month Coke (regular, HFCS and all). I don’t want this luxury to be taken away just because someone else drank two liters per day for years on end and suffered consequences.
I also feel that this “honesty” coke commercial is a tad extreme. Rather than inform the public of healthy options and dietary recommendations, they just resorted to scare tactics. Perhaps this is supposed to only be funny and not an educational resource for its audience, but they lacked responsibility.
Wendy Sue Swanson, MD, MBE says
Thanks, Jennifer.
Kai says
For those looking to watch a very eye opening discussion on the topic, check out this lecture by Robert H. Lustig, MD, UCSF Professor of Pediatrics.
https://www.uctv.tv/shows/Sugar-The-Bitter-Truth-16717
What is your take, mama doc?
Wendy Sue Swanson, MD, MBE says
Haven’t seen it. Will watch. Gimme a bit of time, it’s a full lecture!
Viki says
Thanks for posting the Lustig lecture! I was very strongly influenced by him and a couple of related TED talks. It prompted me to examine many sources of sugar in our family’s diet. While relatively low, we still consumed more than I’d estimated.
Carolyn says
Great question, MamaDoc. You say you are biased. We all are. My job is to market groceries for a mass retailer. The root of my support for the Coca-Cola Company’s move is the same as the root of my clean conscience in helping sell chips and soda to the country as a mass retailer: we offer choices. Along with the soda, vegetables, blueberries, lean meat and plain yogurt.
In my role, I have had the privilege of working with strong partners at the Coca-Cola Company. The people who work at Coca-Cola are humans who care about their own well-being and that of their children. They struggle with hypertension, anxiety, stress and obesity just like the general population of the U.S. does. They want the best for their families, and they truly believe that their products are capable of helping to deliver happiness in the world. And we all better believe that they do.
In my house, growing up as a child, there were two occasions for Coke: Friday nights while watching the Dukes of Hazard and eating popcorn, and 3 PM on hot summer days at my grandparents’ lake cabin. Those were the times we Minnesota kids got “pop”. The Friday night version came in a glass bottle, and my older brother and I split the 10 ounces that it held. He poured, and I got to choose the first glass. The 3 PM at the lake cabin version came with sitting on my grandpa’s lap in the front yard while he challenged me with math problems related to the number of “fish in the bucket.” For me, these memories are loaded with the promise of happiness that the Coca-Cola Company makes. I challenge your readers, Mama Doc, to not be able to conjure up similar idyllic memories of a Coca-Cola product from their past.
From a child with a healthy, balanced diet that included soda and chocolate-chip cookies in moderation, I have grown into one of the more healthy adults who I know. As I raise my own child, I hope to do so with a similar eye toward moderation that my mom had, and I hope that he grows up to have happy memories of soda and chocolate-chip cookies, along with those of green beans and tomatoes from the garden. Indeed, in moderation, like a delicious glass of wine can accompany the joyful, delicious, love-filled dinner that may represent a BPOD for us adults, so, too, can a soda in moderation accompany and contribute to joy for a child. I hope to teach my child habits of moderation, such that when he grows up and makes his own decisions, he will continue to choose a happy, healthy balance.
Like some of your other readers, and as a believer in capitalism, I don’t want my consumption to be limited by laws. The reality, of course, as the data shows, is that children’s drinking occasions are no longer limited, on average, to 5 ounces per week + a few more on occasional summer afternoons. And that, sadly, actual consumption is inversely correlated with wealth in this country. That is a problem. It is EVERYONE’S problem. It is not Coke’s responsibility to fix, but it would be negligent for them to ignore the problem. We could debate whether or not this was effective marketing by Coke (a topic for countless other blogs I am sure!), but for now I will add that I think it is a positive step that Coke is joining (and in some cases, starting) the conversation.
Wendy Sue Swanson, MD, MBE says
Thanks, Carolyn. Your childhood memory is delicious. The way you two were taught to share was exactly how we did it–one person cut (or poured), the other chose. We didn’t have much soda in our house, either. It perhaps was a different time. Marketing to children was much lower and “super-size” didn’t yet exist…
Your professional reflections are exactly what I was hoping to learn about. The debate has tensions extending into freedom, capitalism, health, dependency and uncomfortable realities. Of course those who work for Coca-Cola are struggling with the same issues as the rest of us…precisely what I was saying–we’re all people who care about community.
Two issues I don’t know how to resolve:
What do we do when the bigger sizes of coke are cheaper? Although the video mentions the minis, I noticed recently that although cute, they are more expensive than standard sizes of coke. What mother (with limited resources) will buy the smaller container?
Direct marketing to children: when one of these companies takes a stand for children (dependent on their parents’ choices) and stop marketing directly to them, that will be something. Tired parents fold into children’s demand. If we can stop some of that pant-tugging demand we may get somewhere. Right?
Chris Morley says
Dr. Swanson, thank you for taking on this topic. As Mr. Bryan notes in a comment above, this is reminiscent of the tobacco industry’s tactics. When tobacco really came under fire in the 1970’s and 1980’s, they began promoting their own prevention programs. You may remember “It’s the Law” (referred to as “ITL”) or the “We Card” programs. The approach to prevention under these programs was to tell underage smokers that they weren’t allowed to purchase cigarettes. Other youth-directed smoking prevention techniques the tobacco companies employed included brochures for parents on “How to talk to your child about smoking,” advising the parent to make it clear that smoking was a decision to be made, and an adult one.
Unfortunately, what happens when you tell a teenager that they can’t do something, because it is for adults only? Think on that, and realize that the companies, and the industry public communications/lobbying group (The Tobacco Institute) rarely mentioned anything at all about the health consequences of smoking, and certainly did not use the “C” word.
In fact, there was one internal Tobacco Institute memo describing how the point of the ITL program was to have something to hold up to legislators during city council hearings on marketing and sales restrictions.
I know this because I started out in health research working on this very issue. I bring up tobacco, because if you read one of our papers, “Marketing to America’s youth: evidence from corporate documents” at https://bit.ly/WyfZkK with a mind towards the activities of sweetened beverage manufacturers today (such as Coke), the parallels are clear. To me, at least.
The larger issue, for me, is not just about cola, high fructose corn syrup, or tobacco; it is the fundamental absurdity of expecting an industry that requires excess revenue over expense – profit – to regulate itself. Corporations and industries are not moral agents; ethics and morality really don’t come into play. It is probably silly to cast the corporation or the industry (of any sort) as either moral or immoral. They are necessarily amoral. This is probably defensible philosophically, but empirically there is a lot of evidence for that point. Corporations implicitly protect shareholders from loss – loss of profit, loss due to liability – and large corporations internally diffuse responsibility. We CANNOT expect them to self-regulate, or to come up with a viable solution. It is illogical, but my point with the tobacco comparison above also points out that such efforts are cynical attempts to ward off the imposition of external monitoring and regulation. We must learn from history.
Heck, even physicians really aren’t that good at self-regulating: propub.ca/X8XvIf 😉
Keep up the good work, Dr. Swanson. Love the blog and the Twitter posts.
Wendy Sue Swanson, MD, MBE says
Thanks for this, Chris.
LJStewartTweet says
MamaDoc. Curious. Can you officially prescribe , write an Rx, to not drink sugar drinks? Or to exercise ? If a patient has infection you can write Rx for antibiotic and probably patients comply. For obesity can you actually write Rx for exercise and no sugar drinks? Would the Rx be taken more seriously than just recommendation?
Will says
The framing here is a little naive. “Soda companies” is a misnomer. These are companies that sell soda.
FYI, The Coca Cola Company sells: Dasani water, Simply lemonade, Minute Maid orange juice, Fuze green tea, Odwalla smoothies & food bars.
Pepsico, in addition to drinks, sells Tostito’s Chips and Quaker Oatmeal.
They are not soda companies. They are companies. Their goal is not to sell soda. Their goal is to make money. At the moment they make a great deal of money from soda, but there is nothing to say that couldn’t change if they could make better profits in another manner. Always try and understand what you’re dealing with.
Wendy Sue Swanson, MD, MBE says
Will — this is clear. Coca-Cola even outlines this in their Youtube vid. When kids don’t reach for Coke, they’d prefer they reach for Dasani or Vitamin Water.
I think it’s tap water children really crave. Or at least that’s what I want them to crave.
I called them “Soda Companies” to hone the discussion. But I do understand what you’re pointing out…
Janine says
My childhood experiences were similar to Carolyn’s. Pop (in my case, root beer) and cookies were a treat, not a mainstay. Even though my childhood was a different time than now, I used the same boundaries with my children who are in their late teens/early twenties. I think good ideas can come from any time-frame regardless of how the world changes. And all my children, gratefully, have a healthy relationship with food.
My children and I had lots of talks about marketing and ads and how to be discerning all throughout their childhood. I think that is the education that needs to happen here for parents and children: how to be discerning. My opinion is that ads are ads, they will never be education, no matter how well-intentioned or packaged. We need to grow kids up with the idea of how to be in charge of their own bodies and how to stay feeling good. That is a personal responsibility that shouldn’t be abdicated to anyone. Companies are companies, their goal, bottom line, is to sell product.
I realize that choosing these foods is an economics and access issue for many families and that’s a complex situation. Gratefully, I could always afford other options and didn’t have to work full-time when my children were little so I had time to cook and didn’t have to rely on processed foods. I realize this isn’t the case for many families. In the absence of the possibility of a dietitian consulation for those who need it, could pediatricians have access to a fact sheet or website that talks about healthy choices? Like the book, “Eat this, not that!” or ideas on how to make healthy alternatives that are easy and hopefully available to everyone: Add lemon juice or orange slices to water (or have your child do it!) and make your own applesauce (without sugar). These are very small things and seem simplistic but maybe these are small steps in the right direction. It seems like pediatricians are being asked to do more and more when parents either don’t know, don’t know how, or need support when they are just tired of the constant harrangue so pediatricians should have access to as many easy tools as possible.
Viki says
It’s late, so I regret that I can’t put the same thought in my reply that you put in your question…
Overall, I think it’s a crock of —-. McDonalds started selling salads and apple slices, but I still don’t take my kids to eat there. At 6 and 4, they are very, very sensitive to branding. They will remember the McDonalds brand more than te choices mom made at McDonalds. Just from seeing friends hold McD smoothies, they assume that they’re the same nutritional smoothies mom makes. From seeing indoor playgrounds, they think it’s a kid-friendly and wholesome place. People smiling on billboards reinforce the safe, friendly, inviting atmosphere.
Take the above and repeat for all brands and chains of fast foods and products that I don’t want to become iconic, nostalgic, “safe” in my kids’ psyche. In early childhood, I find my kids are best served by limiting their exposure to the vast array of junk food available so that their palates are grounded in wholesome choices. Try as you might, but you’ll have a hard time becoming obese on veggie crudités. “Sometimes” foods are evaluated on a case-by-case basis, not promised on a schedule.
As for the content of the ads themselves, I find them offensive in their deliberate manipulation of facts:
1) stated: we have over 600 products, 180 of which are low calorie or diet. Inference: a) we’ve given you choices, it’s your own failure to make a better choice that causes obesity. b) choosing a low calorie or diet soda is a good choice.
2) stated: we’ve introduced smaller portioned cans. Thanks, can I have “slim”, low tar, extra filtered cigarette to go with it?
3) stated: we all know excess calories, any calories, are a risk for obesity. Inference: it’s only about calories and your consumption, not the ingredients.
All this weight watchers speak about overall calories and portion control obscures the facts that: it really isn’t just about the calories! Over consumption of fructose is of particular concern in obesity. Consumption of fructose prior to a meal reduces the brains signals of satiety and leads to overheating. That little can of coke is still not doing you any favors.
Btw, I do appreciate that you’re fostering a more nuanced discussion by asking rather than preaching. I do disagree with the comparison to big pharma. For all their ills, pharmaceutical companies do produce products that improve the human lives. I can’t say that for soft drinks.
Wendy Sue Swanson, MD, MBE says
Thanks, Viki.
I don’t know if you understood me on Pharma. I don’t think they are all bad. In fact, I think pharmaceutical companies enhance our lives immensely. It’s why it’s simply too easy to blame them (or the researchers and doctors) who work there. It’s just an easy out for a v complex problem…