The food industry, in its unceasing quest for profits, has been insidiously undermining public health. Not only are they engineering foods to be more addictive, they are also actively influencing both public policy and research by funding groups and projects that pander to their desired corporate image. To combat the food industry’s deceptive practices, I recommend a government intervention that institutes industry-wide standards that benefit public health with changes based on the recommendations of conflict-free research and unbiased advocacy groups.
In the 21st century, the greatest threat to America’s health is its appetite. If you are what you eat, then America is populated by legions of fatty, sugar-wielding serial killers. Our country’s obesity epidemic is not news to anyone, nor is the fact that it is inextricably linked to the leading cause of death in America: heart disease.
According to the Centers for Disease Control and Prevention, heart disease claimed over 635,000 victims in 2013—a greater number than cancer, accidents, or stroke . But the sad and sobering truth is that most chronic diseases like heart disease are preventable through diet and lifestyle changes. As Hippocrates, the father of western medicine, once said: “Let food be thy medicine and let medicine be thy food.” However, this ideal remains unattainable while health professionals and the food industry continue to place profit before public safety.
Trying to make a profit is a reasonable aspiration for any corporation in our capitalist society. After all, economic success translates to survival. But with a crisis like America’s, where bad habits have increased our mortality rate, we require a new level of accountability from the food industry.
Companies like Nabisco, Kraft, and General Mills are not the ones writing grocery lists or bringing spoons full of trans fats to families’ lips—there is still a matter of personal responsibility. But they do play a role in engineering their foods to make them more palatable and addictive . They also directly influence nutrition research, and therefore public policy, through their “research” funding. On top of that, major junk food purveyors like Nestlé hold influence over nutritionists and dietitians. For example, they sponsor the Academy of Nutrition and Dietetics’ annual trade organization meetings in order to manage the largest booths on the expo floor and lead the educational sessions .
HOW THE FOOD INDUSTRY ENGINEERS OUR CRAVINGS
Food engineers play an important, yet little noticed, role in the food we eat by setting the standards for our preferences.Investigative reporter Michael Moss of The New York Times interviewed inventors and CEOs about how the industry has shaped what people eat and capitalized on changing American eating habits. He found that food companies have engineered “bliss points,” the perfect amount of sweetness before “too sweet,” for most foods—even those that would not normally be sweet, like bread and pasta sauce . In fact, some pasta sauce brands contain as much sugar in a one half-cup serving as the amount found in two Oreo cookies . This engineering creates an expectation in consumers that everything should be sweet. This exacerbates the struggle for children, whose taste buds are so attuned to excessive sweetness levels that the bitterness and lack of sweetness in vegetables are amplified.
INDUSTRY FUNDING LEADS TO CORRUPTED RESEARCH
The food industry has its hands not only on our supermarket shelves, but also in research labs, whose work directly influences our nation’s dietary guidelines and nutrition policy. Although research implies a commitment to scientific truth that many believe cannot be bought, research is actually one of the most easily corruptible fields because researchers need sponsors and funds to stay afloat.
In 2016, the Journal of the American Medical Association’s Internal Medicine published a telling report that the sugar industry funded animal research in the 1960s, looking into the effects of sugar consumption on heart health. However, when researchers suggested that sugar could be harmful, the industry group ended the study and never published the results . Stanton Glantz, a professor of medicine at the University of California, San Francisco, said that the report points to a decades-long strategy to downplay the role of sugar in promoting obesity, diabetes, and heart disease .
Even today, the food industry continues to spend millions of dollars on nutrition research studies that favor their products. Companies can then pick and choose research findings to use on their packaging and promote their products. They highlight nutritional benefits and, more significantly, suppresses the risks, ignoring their civic duty to public health.
In 2015, The New York Times exposed that Coca-Cola paid high-profile scientists and organizations to promote the message that, in battling weight gain, people should pay less attention to unhealthy diets and more attention to exercise . This manipulation of studies is a popular tactic: a systematic review found that beverage studies funded by beverage or sugar industries like Coca-Cola or PepsiCo were five times more likely to find no link between sugary drinks and weight gain than studies whose authors reported no financial conflicts . In the aftermath of the investigation, Coca-Cola released data detailing its funding of scientific institutions between 2010 and 2015. All told, Coca-Cola paid $132.8 million toward scientific research and partnerships . If Coca-Cola spends this much money to influence research, it implies they are hiding a link between sugar and obesity.
INDUSTRY ENTANGLEMENTS IN THE MEDICAL FIELD
Through all the scheming, it would be comforting to believe that physicians, who take the Hippocratic oath of “do no harm,” would faithfully and honestly protect public health to the best of their ability. Unfortunately, much of the $132.8 million given by Coca-Cola ended up in the hands of the American Academy of Family Physicians . In 2009, the AAFP proudly announced its corporate relationship with Coca-Cola to support patient education about healthy eating, which is ironic to say the least .
Using funding from Coca-Cola to promote health education is analogous to accepting tobacco funding to stop smoking. Coca-Cola is a huge benefactor of the obesity epidemic, so it makes no sense that the company would contribute to fighting against it. Yes, it is difficult for AAFP to resist because of economic pressures, but it is decisions like these that establish their voice as credible and honorable, or not, in the long run.
When some members of the AAFP protested its relationship with Coca-Cola, the organization’s vice-president defended the alliance by claiming it was “not without precedent because they’ve had corporate relationships with Pepsi and McDonald’s already for some time” . He also brought up the American Dietetic Association’s policy statement that “there are no good or bad foods” and people just need to make healthy eating choices or eat less.
However, physician Jane Murray rebutted by arguing that it is not just about calories or a healthy weight. She proposed that the chemical makeup of what we eat truly matters because it interacts uniquely and specifically with the chemical processes in our bodies. And according to Tom Frieden, the director of the Center for Disease Control, sugary beverages may be the single largest driver for the obesity epidemic .
It is impossible that the board of AAFP is ignorant of these facts. So the only explanation for their decision is that their inner convictions have been silenced by “group think”— they rationalized each other’s outer voices to justify this alliance. Or perhaps they just needed the money. However, as physicians, their primary and most ethical goal should be to protect the health of their patients, not to decide what is most economically viable.
LOOKING TO THE FUTURE
So how can we make ethical and efficient changes moving forward?
I believe we need the government to implement industrywide standards in the interest of public health. Geoffrey Bible, the former CEO of Philip Morris, the cigarette company that faced accusations and pressures similar to those the food industry faces today, said: “In the case of the processed food industry, what you’re looking at is a total inability on their part to collectively decide to do the right thing by consumers on the health profile of their products. In this case, I can see how you might need government regulation if for nothing else than to give the companies cover from the pressure of Wall Street.” 
The key is not in changing what people eat, as that is a matter of personal responsibility, but in transforming our nation’s food supply. In other words, we need cooperative agreement among academia, the federal government, and the food industry, which will only come about through a clear scientific consensus. We need this scientific consensus to strongly recommend action-oriented and workable public policy, which in turn will rally the private sector to change the food supply.
In the past, nutrition deficiency illnesses like pellagra, rickets, and goiter were eradicated due to the food industry modifying food supply—for example, by adding iodine to salt or by fortifying milk with vitamin D . These changes are an example of positive and productive food engineering made possible because researchers, government, and the food industry agreed on what needed to change.
Another great example of this is Finland’s North Karelia Project. In the 1970s, the country had the highest rate of heart disease in the world and life expectancy was low. But once Finnish scientists realized it was due to diet, the government and World Health Organization worked together to create changes in lifestyle, notably by eliminating saturated fat intake through decreased dairy consumption. Schools, supermarkets, food industries, community leaders, media, and nonprofit organizations all combined to educate the public and encourage participation in the program. For example, the government recognized that dairy farmers might suffer when people changed their consumption habits, so they helped many of them switch to berry farming. Results were astounding: from 1969 to 1995, mortality rates from cardiovascular disease dropped 60 percent .
So it is truly possible to make a nationwide change. Starting from the source, we need to encourage ethical research uninterrupted by industry interaction and lobby for government regulation over food engineering, implementing standards over salt, fat, and sugar content. For example, the government could strengthen sugar labeling requirements, which would increase competition between companies to create and promote products with less added sugar. Or the FDA could seek to regulate and reduce the amount of added sugar in products of specific concern, such as soda and juice drinks. With a strong scientific consensus among government, industry, and consumers, we can promote genuinely healthy nutritional behavior and prevent America from eating its heart out.
By Annie Lee, Ostrow School of Dentistry, University of Southern California
ABOUT THE AUTHOR
At the time of writing this paper, Annie Lee was an undergraduate student at the University of Southern California pursuing a progressive Bachelor’s to Master’s Degree in Occupational Therapy.
 “Leading Causes of Death”, National Center for Health Statistics, 2017. [Online]. Available: https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm.
 M. Moss, “The Extraordinary Science of Addictive Junk Food”, The New York Times, 2013. [Online]. Available: https://www.nytimes.com/2013/02/24/magazine/the-extraordinary-science-of-junk-food.html.
 “Code of Professional Conduct for Members of the Institute of Food Technologists”, IFT.org, 2016. [Online]. Available: http://www.ift.org/about-us/governance/code-of-professional-conduct.aspx.
 “How The Food Industry Helps Engineer Our Cravings”, NPR, 2015. [Online]. Available: https://www.npr.org/sections/thesalt/2015/12/16/459981099/how-the-food-industry-helps-engineer-our-cravings.
 S. Gonzales and B. Sawyer, “How do mortality rates in the U.S. compare to other countries?”, Peterson-Kaiser Health System Tracker, 2017. [Online]. Available: https://www.healthsystemtracker.org/chart-collection/mortality-rates-u-s-compare-countries/.
 C. E. Kearns, L. A. Schmidt, and S. A. Glantz, “Sugar Industry and Coronary Heart Disease Research”, JAMA Internal Medicine, vol. 176, no. 11, p. 1680, 2016.
 A. O’Connor, “Sugar Industry Long Downplayed Potential Harms”, The New York Times, 2017. [Online]. Available: https://www.nytimes.com/2017/11/21/well/eat/sugar-industry-long-downplayed-potential-harms-of-sugar.html.
 A. O’Connor, “Coca-Cola Funds Scientists Who Shift Blame for Obesity Away From Bad Diets”, The New York Times, 2015. [Online]. Available: https://well.blogs.nytimes.com/2015/08/09/coca-cola-funds-scientists-who-shift-blame-for-obesity-away-from-bad-diets/?_r=0.
 M. Bes-Rastrollo, M. B. Schulze, M. Ruiz-Canela, and M. A. Martinez-Gonzalez, “Financial Conflicts of Interest and Reporting Bias Regarding the Association between Sugar-Sweetened Beverages and Weight Gain: A Systematic Review of Systematic Reviews”, PLoS Medicine, vol. 10, no. 12, 2013.
 M. Godoy and R. Chatterjee, “The Food Industry’s Influence In Nutrition Research”, NPR, 2016. [Online]. Available: https://www.npr.org/2016/09/17/494360187/industry-influence-in-nutrition-research.
 J. L. Murray, “Coke and the AAFP—the real thing or a dangerous liaison?”, Family Medicine, vol. 42, no. 1, pp. 57–58, 2010.
 N. Boeschenstein, “How The Food Industry Manipulates Taste Buds With ‘Salt Sugar Fat’,” NPR, 2013. [Online]. Available: https://www.npr.org/sections/thesalt/2013/02/26/172969363/how-the-food-industry-manipulates-taste-buds-with-salt-sugar-fat.
 J. T. Dwyer, et al, “Fortification and Health: Challenges and Opportunities”, Advances in Nutrition, vol. 6, no. 1, pp. 124–131, 2015.
 E. Vartiainen, “The North Karelia Project: Cardiovascular disease prevention in Finland”, Global Cardiology Science and Practice, vol. 2018, no. 2, 2018.