By Jerome Burne
If this blog included cartoons, the one illustrating this post would show a small mouse-like dietitian held in the fearsome claws of a vast and grinning fat cat wearing a suit covered in brand names such as Coca-Cola, Mars, Nestlé, Unilever Foods and WK Kellogg Institute.
The dietician’s speech bubble would read: ‘It’s OK I’ve got it under control.’ It would be captioned: ‘The delusion of the dietitians’.
This is the picture of the true nature of the relationship between industry and our nutritional experts that emerges from a forensic analysis published last month in the BMJ (British Medical Journal); Sugar: spinning a web of influence.) It comes in four parts and is, sadly, behind the BMJ paywall.
Written by Jonathan Gornall, it set out in impressive detail just how total is the industry’s dominance over what passes for public health food policy in the UK and just how comprehensively the government’s Responsibility Deal has failed.
Fox guarding the henhouse
The Deal was launched in 2011and signed up 39 of the major supermarkets and food manufacturers ‘to support and enable our customers to eat and drink fewer calories’ in England.
From the start critics complained it was a clear case of bringing the fox in to guard the hen house and Gornall convincingly shows the deal is indeed a ‘dead duck’. By last March the food bought by British households was 11.7% higher in calories than it had been the previous year.
But the deal isn’t failing industry. ‘It is in the happy position of being seen to be a good corporate neighbour, embracing public health initiatives, while quietly vetoing those that threaten it financially,’ writes Gornall.
Unfortunately, or perhaps fortunately for the dietitians, the press coverage didn’t concentrate on this depressingly predictable wider picture. Instead it picked up on the, admittedly interesting, revelations about the financial links between top nutritionist Professor Susan Jebb, who is Chair of the Responsibility Deal and the food companies who have funded her work at the Human Nutrition Research Unit to the tune of over a million pounds for the last ten years. Four of the funding companies are partners with her in the Responsibility Deal – Nestlé, Sainsbury’s , Coca-Cola and Unilever.
Sugar funded trials favour sugar
The Guardian gave Jebb considerable space to explain her position. The reality is that that academics have to rely on commercial funding and most defend it by saying – most likely truthfully – that their professional principles wouldn’t allow then to deliberately fudge results to favour their sponsors.
However research published in the online journal PLOS (Public Library of Science) last year found that reviews of the studies to see if sugary drinks caused weight gain were five times more likely to find no link if the sugar industry had paid for it.
What was striking about the response to the article was the apparent inability of the dietitians to understand its implications. Jebb went on about how committed she was to cutting calories and reducing sugar consumption, even though the article had made it clear both targets had been missed. Crucially the reason for the failure was that the companies had simply refused to act.
This failure to understand was also demonstrated by media dietitian Catherine Collins who rushed to support her colleague, confessing herself unable to understand what the investigation was all about. Having read the article (presumably) she was quoted in the Guardian as saying: ‘I remain as confused as the public will be as to what Gornall is trying to say’.
Running rings around dietitians
In fact it is not difficult at all but it’s obvious why she has difficulty seeing it. Quite simply the industry is running rings round the dietitians and years of trying to get meaningful changes that would significantly improve the nation’s health have achieved very little.
Declarations of interest by individual researchers are obviously important but they are peripheral. However once you get on some board or committee you probably shouldn’t have any commercial links at all.
Take Gornall’s revelations about an obscure government body – but one with a major influence on whether we should follow a high fat or a low fat diet – the Department of Health’s Scientific Advisory Committee on Nutrition, otherwise known as SACN. Recently it produced a report saying that the amount of carbohydrates we are eating is about right.
Over a year ago Hannah Sutter wrote a detailed article for HIUK (SACN or Sack ‘em: the committee that’s confused about carbs) revealing the links between the committee members and big food companies whose products depend heavily on carbohydrates. What the BMJ article adds is to show just how cavalier official bodies are about conflicts of interests.
Independent expert’s industry links
When the SCN’s industry links became widely known Public Health England rushed to reassure everyone the all was well. The safeguard against undue industry interest, it said, was that the chair of SACN Ann Prentice, who is also chair of Medical Research Council Human Nutrition Research unit, was an “independent expert.”
The BMJ investigation revealed that Prentice had declared an involvement with 179 commercial organisations and non-personal interests’ in 34 separate food or drink companies.
But the real issue is not whether an individual researcher who has financial links with a company might fudge the results of a trial, it is that wherever you look in research and in policy there you will find food and related companies embedded in various ways. So the question becomes; how likely are they to support policies that don’t suit their bottom line?
The short answer is – not at all. For instance a year ago the firms involved in the Responsibility Deal had already agreed with the ideal of making the contents of consumers shopping trolleys more healthy by ‘altering the offers and promotions they are exposed to’.
Industry refuses to take healthy action
But when Jebb tried to get the firms to do something specific, if hardly radical – ‘reducing the promotion of food high in fat salt and sugar’ – the likes of the Food and Drink Federation, The British Retail Consortium and Tesco, all simply said no.
A few months later the group couldn’t even agree to Jebb’s suggestion of ‘a specific pledge to reduce sugar’. Faced with this refusal to take even the tiniest of steps in the direction of improving consumers diets the co-founder of the body Action on Sugar, pointed out what had been obvious from the beginning: ‘How can you make any industry responsible for policing itself ? It just doesn’t work.’ It’s hard to avoid the clichés retelling this tale; after foxes and hen houses this prompts the one about turkeys and voting for Christmas.
The sort of thing that a food company is prepared to do to as part of its public health commitment can be seen in the case of the shrinking Mars Bar. Mars is signed up to the Responsibility Deal and so in 2013 the company said it was going to cut the size of its ‘single serving products ‘to less than 250 calories.
This might seem like a drop in the ocean of omni-present confectionary but a former health minister declared the move ‘brilliant’ and the company patted itself on the back in the trade press saying they: ‘don’t have to do it but are doing it for all the right reasons.’
Industry plays cat and mouse with dietitians
However a rather more cynical story in The Grocer pointed out that prices of both sugar and cocoa were set to rise in the following year so using less of them but keeping the price the same made good commercial sense
This endless cat and mouse game that the food companies are playing with the unfortunate Jebb and her fellow dietitians is part of deliberate strategy.
“All this falls into the category of efforts to crowd out public regulation or try to weaken public health by working with it,” Professor David Stuckler told the BMJ. ‘That’s why the real threat of government regulation is a necessary ingredient for self-regulation to work.’
But at the moment dietitians have to be cock-eyed optimists, happy to hand over the veto on regulation and then, not surprisingly, being regularly rebuffed when it comes to actually taking action.
Sugar industry vows to fight its critics
Jebb is proud of her consistency in calling for sugar reduction but does she really believe this strategy is going to achieve it? After all the sugar industry hardly makes any secret of its mission statement. A Sugar Association newsletter seen by Gornall declared that it is ‘committed to the protection and promotion of sucrose consumption. Any disparagement of sugar will be met with forceful, strategic, public comments and the supporting science’.
An example of the kind of science they might come up with is a study published in the Nutrition Journal in 2013 which found that American adults who ate more sugar didn’t put on weight or have a greater risk of heart disease.
The beliefs of another sugar industry body – the World Sugar Research Organisation (WRSO) – some of whose members are signed up to the Responsibility Deal – make even more extravagant claims for the benefits of sugar. As well as keeping you slim, it says that eating lots of it makes it easier to follow a low fat diet and that it may even be more satiating than fat.
But what is most striking about the sugar industry’s take on nutrition and healthy eating in general, is that it is now almost perfectly aligned with the standard dietitians view.
Dietitians share sacred cows with industry
Here’s is another statement from the WRSO: ‘A high fat, high energy diet, combined with inactive sedentary life-styles are the two principle (sic) factors increasing the risk of obesity.’ Eating more calories than you use up – and fat has twice the calories of carbs – is what makes you fat. So eating a high carb diet plus exercise; ‘can assist in the maintenance of an ideal body weight.’
For a detailed account as to why the endlessly repeated formula for weight loss – calories in = calories out – is totally wrong, see the HIUK article: The zombie theory that won’t die. It’s worth noting that this article was originally written five years ago; the evidence has been steadfastly ignored.
I’ve sometimes found it puzzling that dietitians, supposedly dedicated followers of scientific evidence, cling so rigidly to this and to another of their mantras – that high fat is dangerous – when there is mounting evidence both that fat is not a problem and that low fat is not a sane and effective approach to diabetes. See: Twelve reasons why diabetes charities should ditch the low fat diet and recommend low carbs.
However Gornall’s remarkable analysis makes the reason very clear. They are firmly and apparently inescapably wedged between a rock and a hard place – admitting they’d been wrong would mean turning on the industry that not only provides them with vital funding but is now firmly embedded in the whole regulatory process. It must certainly be uncomfortable for them but it is deadly for many consumers.
Jerome Burne
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WINNER: 
“reducing the promotion of food high in fat salt and sugar”
The strange thing is that as I understand it, fat (assuming that means saturated) and salt are no longer considered harmful within reason. If the government were to ask them only to reduce sugar levels, perhaps they would be more accommodating.
Not going to happen anytime soon, unless people really start voting for anything but the established political parties. There’s way too much entanglement between the leading caste and the food industry. These types only act if they can feel the guillotine scraping at their necks.
What’s more likely to happen is consumer demand driven change.
Added sugars have been shown to drive T2D, especially so fructose. Wheat seems to be at the root of many health issues as well. All sorts of supposedly harmless food additives have issues (e.g. carrageenan), it is impossible to test for all possible interactions. It is a mess.
Natural fats are benign, if consumed in real whole foods (don’t guzzle seed oils), eggs have been exonerated… the list goes on.
One start of this might be the substantial and steady decline of breakfast cereal revenue in the US of A.
The saber-tooth tiger is out of its cage, not going back in…
I found the following in the health professional area of Sugar Nutrition UK which I hope will be of interest
“For many years, people with diabetes were told to avoid sugar. However, modern scientific research has shown that people with diabetes can include moderate amounts of sugar in their diet as part of mixed meals, without compromising blood glucose control. Indeed, including some sugar in the diet may actually be beneficial to people with diabetes as it makes it easier for them to keep their fat intake down
Also “People rarely eat sugar on its own. Adding sugar to foods improves their taste and increases the range of foods that people will eat. For example, without sugar many breakfast cereals, which provide important vitamins, minerals and fibre, would be less palatable.
Surveys have shown that vitamin and mineral intakes are rarely lower – in fact, they are often higher – in people who eat the most sugar. In any case, most people in the UK are consuming more than enough vitamins and minerals. Those who are not tend to be people who do not eat enough food overall, or who do not have a sufficiently varied diet.”
Food for thought!!
What exactly is evidence based medicine? It seems to have by-passed those promoting statins and sugar and opposed to saturated fat and yet they get a lot of airtime.
Diabetics are okay to eat sugar? Next we’ll be telling alcoholics to drink whisky in ‘moderate’ amounts.
I’d be embarrassed to be a dietician. They only have to deal with one subject and they can’t get that right. I know there are some principled exceptions. The low fat mantra goes on and on and the nation gets fatter and sicker.
Fats are filling and essential to the brain. In contrast, carbohydrates fuel appetite, usually for more sweetened carbs. I’d say this was a more rational explanation for the astonishing rise of obesity (2.5% to 26% in thirty years) than the ridiculous idea that humanity suddenly got greedy and lazy. From 1820 – 1977 all dietary guidance warned that carbs were fattening and should be avoided or eaten in moderation.
Simon Stevens, Chief executive of NHS England, in today’s Times called for bold action and highlighted the problems caused or exacerbated by sugar. He’s right but he shouldn’t hold his breathe. He talked about parents taking responsibility but how can they when there’s so much conflicting and corrupted advice. Much of the advice is simply terrible. Telling diabetics to eat a high carb diet is mad. Wendy Pogozelski is a professor of biochemistry and a Type 1 diabetic. I have attached a link to her excellent Ted-x talk. https://www.youtube.com/watch?v=WIebxoTx408
I wish those fighting for public health were half as good as the appallingly cynical food industry. The public purse pays for dieticians but their leaders and advice are utterly compromised by their links to the industry making and encouraging the problem. I wonder how bad things will have to get before real action is taken?