E108: Can we Trust Industry to Reformulate Food for Health?

Tuesday, January 26, 2021

When the food industry promises to police itself and pledges to improve nutrition in public health, can it be trusted to make meaningful change or must government mandate those changes? Our two guests today have done groundbreaking work to help address this very question. Dr. Jessica Fanzo, Professor of Global Food and Agricultural Policy and Ethics at Johns Hopkins University, and Dr. Jennifer Harris is Senior Research Advisor for Marketing Initiatives at the Rudd Center for Food Policy and Obesity at the University of Connecticut.

Can We Trust Industry to Reformulate Foods for Health?

Interview Summary

So Jess, let's begin with you. You coauthored what I thought was a very important and novel report released by the Global Alliance for Improved Nutrition on product reformulation by the food industry. Would you might explain what's meant by reformulation?

When we think about reformulation, it's really defined as the process of altering a food or a beverage product. You can alter that by improving the products' health profile or reducing the content of harmful nutrients or ingredients. So it's a process of either removing those negative ingredients or nutrients or adding back positive ones into foods. Why is that done? Because people consume a lot of processed foods. Almost every food that we consume has gone through some form of processing, but there's a whole range of that processing from very minimal to very highly processed, what's often called ultra-processed or junk food that doesn't have a lot of nutritional value. In the report, we were looking at what are the challenges with reformulating food? What are some of the opportunities to reformulate food? And in the realm of reformulation, has it had a positive impact on public health? So we were looking at those aspects of the reformulation of processed foods.

So I'm assuming there could be enormous advances to public health if reformulation were done on a broad scale and/or if it were done in a meaningful way. So what were your main findings then? Have there been examples of industry being successful with voluntary reformulation?

Somewhat. And absolutely it could have potentially really important positive impacts for public health, but it's also not a panacea for improving diets and nutrition. And while there are some examples where voluntary reformulation has had some impact, the UK with salt and some other examples, overall we found that it's important for governments to mandate reformulation through different tools, whether it's labeling, taxes, et cetera. For foods that are not reformulated, we felt that it was really important for governments to mandate with clear, transparent and direct targets, particularly removing the unhealthy ingredients like added sugars, salts, unhealthy fats like trans fats. The food industry should be involved in implementing reformulation policies but not in their design. And governments need to really step in and step up. But that said, that doesn't mean that reformulation is going to solve all the problems. Governments also need to invest in many other tools to protect consumers and to invest in other ways to improve diets for nutrition. So reformulation shouldn't be the only answer.

So I'm assuming the reason that food industry won't go far enough on their own is that these things that make the food less healthy also tend to make them pretty palatable, or give them long shelf life or properties that make people enjoy them a lot. And that why in the world would they do something that would make their products less desirable? Does that pretty much the case or do you see other reasons why?

That's definitely true. I mean, these highly processed foods are cheap in their ingredients to make, they are very palatable, there's a high demand for them. We're seeing this shift now into low-income countries like with tobacco when consumers catch on that these foods are not so healthy, they go to populations where there's a bit of a lag in that knowledge. But also reformulating foods from the industry's perspective is not so easy. It's quite expensive to do it. It's difficult to reduce salt and sugar, which are vital not only for the taste of foods, but for their composition and shelf-life and texture. So it has a lot of ramifications to remove those ingredients. So meeting government mandates around reformulation can be really challenging and sometimes impossible for companies. So they often will deal with getting a warning label, for the example in Chile, they'll just take the warning label because they can't reformulate some foods. But there's a change in consumer demand and tastes. Consumers like their brands, but the more and more consumers are caring about clean labels, environmental sustainability, their health, people are concerned about the amount of sugar in foods so they're going to have to answer to that, that changing demand as consumers demand better foods whether it's from a health or sustainability or transparency perspective.

Let me ask one more question related to this. Is it also the case that it's pretty difficult for some company to be the first out of the gate if they were inclined to do this voluntarily because then their products would become less desirable and their competitors would be kind of stuck in the old ways? So isn't that another argument for government intervening that everybody is on the same playing field?

Absolutely, yes. I mean, why not hold every player accountable and to the same standards and mandates? It pushes them all to take action. So when we were interviewing some of the industry players, they really struggle because when they did try to reformulate some of the foods, consumers no longer bought them because they're very wedded to their brands, they're wedded to certain tastes, it's a real challenge for them to keep their consumer base, but at the same time, try to adhere to government mandate. And some companies care more about health and sustainability than others. We definitely learn that some companies have no interest in that, because they know they'll always be a big consumer base for these {quote} "less healthy foods." So there's a real issue from company to company of who's willing to take more action to reformulate and who doesn't really care to reformulate at all and they're willing to live with warning stickers and taxes.

So Jennifer, let's turn to you. So you've done really pioneering work on the impact of food marketing on children that began when we were colleagues together at the Rudd Center when it was at Yale University. And there I was witness to the fact that you created a very impressive methodology for studying what's a pretty complicated issue and you paid a lot of attention to industry promises for self-policing of children's food marketing. Do you mind giving us a quick sense of what's being marketed to who and how, and how much marketing children are exposed to?

Annually, companies spend over $13 billion in advertising food to all consumers and just to put that number in perspective, the whole chronic disease prevention budget at the CDC is one billion. So the companies are really controlling the messages about what people should eat. And most of that money is spent to advertise very unhealthy products, the products that are contributing to poor diet and disease in this country. The biggest ones are fast food, sugary drinks, sweet and salty snacks and candy. Those categories represent about 80% of all foods that are advertised. Healthier categories of foods, if you look at all of juice, water, fruits, and vegetables and nuts combined, it's less than 3% of the total. So they're really pushing these very high fat, high sugar, high salt products extensively. Companies spend most of their advertising dollars on television ads.

On an annual basis, kids see about 4,000 of those ads per year. So almost 4,000 ads, that's over 10 a day for unhealthy food. Kids of color, so black kids see twice as many of those ads. A lot of the worst products, their advertising is targeted to Black and Hispanic communities, and especially adolescents. But TV isn't the only way companies advertise. And in the last few years, the ways that companies market just increased exponentially. Now with smartphones and tablets, they can reach kids any place and any time through things like ads on YouTube videos, social media, smartphone apps, with games and ordering programs, even educational websites teachers are using in grade school have ads on them. This kind of marketing is personalized. So what you see depends on what you do online. They know who you are and they can reach you. And unfortunately, this kind of marketing also is the kind of thing that parents can't monitor as easily as what your child is watching on TV. So the companies basically try to be wherever the consumer is to reach them with their advertising.

Well those are really stunning numbers. I know one of the arguments the industry has made for years, and one of the things that you've addressed directly in your research, is their claim that this food advertising doesn't really make kids or adults eat an unhealthy diet, it just shifts their preference from brand to brand. So if Coke is advertising a lot, they might say, "Well we just want to take market share from Pepsi, but we're not encouraging sugar beverage consumption." What would you say to that?

That is something they've argued for a long time. And one thing that we showed is that just watching a television program with food advertising makes kids and adults eat a lot more both while they're watching and afterwards. And another of our colleagues, Ashley Gearhardt has done some really interesting research showing how the food advertising actually activates the reward regions of the brain and leads to increased consumption. So that's one way that food marketing affects more than brand preferences. There's also been a lot of research showing that if you advertise Coke, it increases consumption and purchases of all sugary drinks. They also affect sales of the categories, not just the specific brands.

So with you and others doing so much work showing how much of the marketing there is and how disastrous the impact is, you can imagine the industry feels vulnerable to the possibility of outside regulation or perhaps even litigation. And so one of the things the industry has done and this links back to what Jessica was talking about in the context of reformulation, is to say that they can police themselves. So can you explain how they've gone about doing that?

Well in the U.S. there's a program called the Children's Food and Beverage Advertising Initiative, which is the food industry self-regulatory program to address food advertising to kids. And there are similar programs in countries around the world. But basically what the industry has promised is that they will only advertise products that meet nutrition standards in child-directed media. That sounds really great. They implemented the program in 2007, but you said, Kelly, we've done a lot of research showing how many limitations and loopholes there are in this program. One is that they only define children as 11 years and younger. So they only have promised to reduce unhealthy advertising to young children and more and more of the research is showing that adolescents are just as affected and maybe even more effected by the advertising.

Since their program was implemented, they've increased their advertising to the slightly older group that isn't covered by the CFBAI. Another limitation is their definition of what is child-directed is advertising in media where children are the primary audience. So on television that would basically be children's TV. So Nickelodeon, Cartoon Network, those kinds of programs. But children watch a lot more television than just children's television. And so they can still advertise anything they want on programs that are also watched by adults and older children. And then the third major limitation is that they've set their own nutrition standards. So they have defined what is healthy. And maybe not surprisingly, a lot of the products that they say are healthier choices that can be advertised to kids are things like sugary cereals, fruit drinks that maybe have less sugar but they also have artificial sweeteners in them. Things like goldfish crackers, fast-food kids' meals, all of those can still be advertised to children under their nutrition standards.

What we found is since the program was implemented in 2007, food advertising on children's television has gone down quite a bit, 45%, but at the same time, advertising on other types of television that children watch has gone up about 30%. So now kids see almost as much food advertising as they used to, but most of it is not on children's television, it's on the other kinds of television that they're watching. And a lot of the harder things to monitor, things like apps and social media and websites do not qualify as child-directed media under this program.

Now the reason I asked both of you to be on this podcast at the same time as I figured there would be interesting similarities, even though you're working on somewhat different topics, and boy does it turn out to be they're real themes weave through this. So let's talk next about what might be done then. So Jessica, with your work on industry reformulation, what have you concluded can be done voluntarily?

Kelly, I think government needs to be much more involved than they are. The challenges that we see with voluntary regulation, whether it's in reformulation or marketing of unhealthy foods to children, we know that voluntary reformulation, industry sets its own agenda, they set their own targets, they have no accountability to meet those targets, they may pledge to reduce harmful ingredients but if the product has a very high level of these unhealthy ingredients, the reformulation may not make much of a difference from a public health point of view. So I think we need much more regulation. Governments need to hold industry accountable and ensure that they are meeting national standards for public health. I think government has been too laissez-faire about industry and the power that they hold. And I think now we're seeing the consequences of that not only in the United States, but everywhere in the world with rising levels of obesity and NCDs and unhealthy diets being a big risk factor with these processed foods playing a huge role in that. So we really need to see government step up in a much more profound way and hold industry to account having public health goals. It's a little bit of enough is enough.

So Jess, just out of curiosity, let's say you were the government official in charge of taking such action and you have the authority to do it, where would you start? Would you start with particular nutrients across the food chain or would you start with certain categories of food and would you worry first about sugar, salt, fat?

That's a good question. In the paper we outline four types of processed foods. To me I would probably look across the entire food supply chain at those highly, highly processed foods. And it would be good to start with at least the three categories of sugars, salt, and trans fats to even start with and setting key targets for those and marking those ultra-processed foods that go beyond that target. You know, Chile had the great food law that's been enacted that's put warning labels on the front of packages and has regulated I think some of the advertising of those foods. Jennifer, you probably know about this. And I think that's been an important case study for the rest of the world to look at of how Chile has done that because sales of those foods that have the warning label have gone down somewhere in the ballpark of I think between 23 and 28%, depending on the population. But I think there's lessons to be learned of how Chile has done that that other governments could learn from.

Now I'm happy that you pointed out the advances in Chile because there have been some very impressive impacts reported from the studies that have been done so far. So I agree that that is really a model to look to. So Jennifer, let's just get your opinion on this. Where do you come down on this issue of voluntary versus mandated?

So we've given the industry 12 years now to show that they can market healthier products to kids. And basically what they've done is they're marketing slightly healthier products to kids but the products they're marketing are not nutritious products that children should be consuming a lot of, like sugared cereals. So it's pretty clear that they can't do it on their own and that regulation is required.

In the U.S., we have a little bit of an issue that not all countries have because of the First Amendment and advertising is protected speech according to the Supreme Court. So we can't just say companies cannot advertise anything. So we have to be more strategic about the kinds of regulations that we can implement here. If we could do anything we wanted, Chile is a great example. In the next year, they won't be able to advertise any products that are high in fat, sugar and salt before 9:00 p.m. So it's not just children's programming, they won't be able to advertise it. They had to take all their characters off their packages. And so Tony the Tiger can't be on the package of frosted flakes anymore because it's high in sugar. They've done a lot of great things in Chile and sure we can adapt some of what they've done. In other countries also, for example the UK has very strong laws about marketing foods in digital media. So that would be another thing that we could import from other countries.

Jessica Fanzo, Ph.D., is the Bloomberg Distinguished Professor of Global Food Policy and Ethics at the Berman Institute of Bioethics, the Bloomberg School of Public Health, and the Nitze School of Advanced International Studies (SAIS) at the Johns Hopkins University in the USA. She also serves as the Director of Hopkins’ Global Food Policy and Ethics Program, and as Director of Food & Nutrition Security at the JHU Alliance for a Healthier World.  From 2017 to 2019, Jessica served as the Co-Chair of the Global Nutrition Report and the UN High Level Panel of Experts on Food Systems and Nutrition. Before coming to Hopkins, she has also held positions at Columbia University, the Earth Institute, Food and Agriculture Organization of the United Nations, the World Food Programme, Bioversity International, and the Millennium Development Goal Centre at the World Agroforestry Center in Kenya. She was the first laureate of the Carasso Foundation’s Sustainable Diets Prize in 2012 for her research on sustainable food and diets for long-term human health.

Jennifer Harris, Ph.D., is a Senior Research Advisor, Marketing Initiatives at the Rudd Center. Previously, Dr. Harris worked as Director of Marketing Initiatives and was an Associate Professor in Allied Health Sciences at the University of Connecticut. Harris received her B.A. from Northwestern University and M.B.A. in Marketing from The Wharton School. Before returning to graduate school, she was a marketing executive for eighteen years, including at American Express as a Vice President in consumer marketing and as principal in a marketing strategy consulting firm. Harris completed her PhD in Social Psychology at Yale University with John Bargh and Kelly Brownell.