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Since September, the New York Times has been investigating how the food industry markets its products in the developing world, and how this marketing is encouraging a rising prevalence of obesity and its health consequences. The series is called Planet Fat.   This is the complete set to date, in reverse chronological order.

If you haven’t read them, this week is a good time to catch up.  Enjoy!

One Man’s Stand Against Junk Food as Diabetes Climbs Across India

India is “sitting on a volcano” of diabetes. A father’s effort to ban junk food sales in and near schools aims to change what children eat.

By GEETA ANAND

Dec. 26, 2017

 

Dec. 23, 2017

 

Dec. 11, 2017

 

Nov. 13, 2017

 

Oct. 2, 2017

 

Oct. 2, 2017

 

Sept. 16, 2017

 

Sept. 17, 2017

 

I’ve been following the story of Hillary Clinton’s Wikileaked e-mails (which John Podesta says the Russians released to sway the election)  but never dreamed that I would turn up in them.

But Crossfit’s Russ Greene sent me his blog post yesterday and there I am [the photo comes from an article in the Sydney Morning Herald].

Coke’s Surveillance of Marion Nestle

Strangely, the DC Leaks database does not include any Coca-Cola emails from August 2015, the month that the New York Times first exposed the Global Energy Balance Network. Nonetheless, it does reveal that Coke sent a representative to attend and take notes on Dr. Marion Nestle’s speech at Sydney University in January.

Dr. Nestle, an NYU professor who most recently published “Soda Politics,” spoke on conflicts of interest in health science and government food policy. She mentioned the GEBN as a case study in soda-influenced science.

Nestle moderately concerned Coke. They mentioned the need to “Monitor social media,” but stated that Nestle achieved “very limited pick up from yesterday’s presentation – #sodapolitics.”

Of course the pick up was limited.  This was a private, invitation-only meeting with Sydney nutritionists deliberately kept small so as not to compete with my subsequent public lectures (see below for the media list).

Who was the Coca-Cola note taker?   I have no idea but the notes seem fine.

Coke’s Surveillance of CSPI

I also turn up in the e-mails related to Center for Science in the Public Interest (CSPI).  Evidently, Coca-Cola was tracking the social media response to a CSPI report on its marketing to children.

The most shared tweet was this one – https://twitter.com/CSPI/status/732239510138949633, which was mainly because Marion Nestle re-tweeted it.

By now I assume that someone from Coca-Cola is taking notes at every talk I give and reporting in to headquarters.

What does all this have to do with Hillary Clinton’s campaign?

As Russ Greene explains, the emails reveal that Capricia Marshall, who is working on the Clinton campaign, is also working for Coca-Cola’s communications team.

The evidence that Marshall is working on Hillary Clinton’s presidential campaign is extensive and undeniable. HillaryClinton.com features her prominently at Clinton campaign events.

Just to make things easy for Coca-Cola, here’s my Australia media list

March 10 ABC 7:30, TV interview with Sarah Whyte on Coca-Cola’s funding of research: Sweet Talk

March 2 ABC-FM interview with Margaret Throsby, Classic FM, on Soda Politics

March 1 Lecture to Sydney Ideas: Soda Politics: Lessons from the Food Movement, U. Sydney

March 1 ABC News radio and print interview with David Taylor, on Soda Politics

Feb 29  Interview (online) with ABC Sydney on Soda Politics

Feb 27  “At Lunch With” column in the Sydney Morning Herald: “the powerful foodie”

Feb 24  Podcast of lecture on Soda Politics at the University of Melbourne

Feb 22 Lecture at symposium at Deakin University, Melbourne (this is an mp4 file requiring a lengthy download)

Feb 19 Radio interview with Mark Colvin, ABC News (Sydney) on Soda Politics

Feb 19 Podcast interview with Colvinius, ABC News (Sydney) on Soda Politics

Last summer, Brian Wansink, a friend and Cornell colleague and the editor of the new Journal of the Association for Consumer Research, asked me to write a commentary on a paper to be published in its inaugural issue.

The paper turned out to be by a group of authors, among them John Peters and Jim Hill, both members of the ill-fated Global Energy Balance Network, the subject of an investigation by the New York Times last August.

Titled “Using Healthy Defaults in Walt Disney World Restaurants to Improve Nutritional Choices,” the paper described the benefits of improving the composition of kids’ meals at Disney World.

The healthy defaults reduced calories (21.4%), fat (43.9%) and sodium (43.4%) for kid’s meal sides and beverages sold in the park. These results suggest that healthy defaults can effectively shift food and beverage selection patterns toward healthier options.

The authors explain:

This work was supported by the Walt Disney Company and by the National Institutes of Health…The Walt Disney Company and the National Institutes of Health had no role in the design, analysis, or writing of this article. Full disclosure: JH is a consultant for the Walt Disney Company and for McDonalds; KA is a consultant for the Walt Disney Company.”

I thought Disney’s sponsorship of this research and its withholding of critical baseline and sales data on kids’ meals that the company considered proprietary did indeed deserve comment, and wrote my piece accordingly.  Brian Wansink soon accepted it for publication but to my surprise, gave it to Peters et al. for rebuttal.  They filed a lengthy response.  I was then given the opportunity to respond, and did so, briefly.

The paper by Peters, et al. did was published in the journal’s first issue.   This issue also includes several commentaries on other papers (none of which are accompanied by rebuttals).

My commentary—and the back-and-forth—however, were omitted.

After some discussion, the journal published my commentary online.  You have to scroll down to find it.  The site provides no links to it in the table of contents or in the article by Peters et al.

Is it possible that Disney or the authors’ contractual relationships with Disney could have had anything to do with the omission of my accepted-for-publication commentary?  Brian Wansink says no, they just ran out of room (despite room for others).

Whatever.

Here’s what I wrote:

Dietary nudges for obesity prevention: They work, but additional policies are also needed

In 2006, the Walt Disney Company announced a new initiative to improve the nutritional quality of meals served to children at its theme parks. The company would be changing the default kids’ meals—the components that come without having to be ordered separately–to include low-fat milk, juice, or water rather than soft drinks, and sides such as apple sauce or carrots rather than French fries. Parents who wanted sodas or fries for their children would have to ask for them, something many might not bother to do. Health groups had long advocated for this policy change (Wootan 2012).

As I commented to a reporter at the time, “going to Disney World is an excuse for eating junk food…Disney or its advisers must be feeling they have some responsibility” (Horovitz and Petrecca 2006). Indeed, the healthier defaults were part of a larger effort by Disney to deal with its contribution to obesity in America. After ticket prices, food is the second greatest source of revenue at Disney World. Although reducing the amount of food consumed at the parks might help create a less “obesogenic” food environment, revenues might fall. But the default change might be revenue neutral. By 2008, Disney could report that two-thirds of U.S. customers ordering kids’ meals had accepted the default, with no loss in sales. In Hong Kong Disney parks, nearly all customers accepted the default. The report, however, did not include data on the numbers or proportions of customers ordering kids’ meals (Walt Disney Company 2008).

Disney’s more recent summary of its child health initiatives states that it is funding investigators at the University of Colorado to conduct a more formal evaluation of use of the default options (Walt Disney Company 2015). The paper by Peters et al. (2016) in this issue of the Journal presents the results of that research. Their work confirms the ongoing effectiveness of the strategy. Nearly half the customers ordering kids’ meals accepted the healthy default side dishes and two-thirds accepted the healthier beverages. These choices resulted in significant reductions in the calories, fat, and sodium in purchased kids’ meals, but not sugar (Peters et al 2016).

The authors argue that gentle nudges changes like these are preferable to more coercive policies that smack of nanny statism. Such reductions help, but are they enough to make a real difference? To answer this question, it would help to know what else the children were eating along with the drink and side dishes. Although the authors were given raw sales data, Disney did not permit them to use this information as part of the overall analysis. The company also refused to provide information about the number of children who visited the park or the number of kids’ meals sold.

These missing pieces raise red flags because this is a Disney-funded study that produced results that Disney can use to advertise itself as a company that cares about kids’ health, and to deflect attention from Disney World’s’ reputation as a junk-food paradise. Corporate funding of research introduces conflicts of interest and reduces the credibility of the results, not least because the biases inherent in such research are largely unconscious, unintentional, and unrecognized (Moore et al 2005) The results of this study merit especially careful scrutiny. Taking them at face value, the default strategy worked well for the drink, but the sides are still a problem, and so are the sugars. They do not reveal much about what kids eat in a day at Walt Disney World

Nudges like this default are an important part of strategies to counter childhood obesity. But are they enough to deal with the public health problem? To make a real difference, they need to be accompanied and supported by a range of policy approaches. Current thinking about such approaches recommends combining insights from behavioral research, economics, and public health to establish a food environment far more conducive to making the healthy choice not only easy choice, but also the preferred choice. Doing so is likely to require multiple actions—for example, regulation of nutrient content and marketing; incentives such as subsidies of healthier foods; disincentives such as taxes, warning labels, and nutritional rating systems for unhealthier foods; and education of adults and children (Hawkes et al 2015). Disney’s voluntary default is a small step in the direction of such policies, but many more are needed if we are to make real progress in reducing the prevalence of childhood obesity.

• Margo G. Wootan. Children’s meals in restaurants: families need more help to make healthy choices.   Childhood Obesity 2012;8(1):31-33.
• Bruce Horovitz and Laura Petrecca.  Disney to make food healthier for kids.  USA Today, October 17, 2006.
• Walt Disney Company. Walt Disney Company—2008 Corporate Responsibility Report. 2008.
• Walt Disney Company.  Magic of Healthy Living brochure.  2015. https://thewaltdisneycompany.com/sites/default/files/MOHL_Brochure.pdf.
• John C. Peters, Jimikaye Beck, Jan Lande, Zhaoxing Pan, Michelle Cardel, Keith Ayoob, and James Hill. Using healthy defaults in Walt Disney World restaurants to improve nutritional choices.  J Assoc Consumer Res., 2016;1:1.
• Don A. Moore, Daylian M. Cain, George Loewenstein, and Max H. Bazerman, editors.  Conflicts of Interest: Challenges and Solutions in Business, Law, Medicine, and Public Policy.  Cambridge University Press, 2005.
• Corinna Hawkes, Trenton G Smith, Jo Jewell, Jane Wardle, Ross A Hammond, Sharon Friel, Anne Marie Thow, Juliana Kain.  Smart food policies for obesity prevention. The Lancet 2015;385:2410–2421.

And here’s my response to the rebuttal by Peters et al.

The response from Peters and Hill still fails to acknowledge the severity of the problems posed by Disney’s sponsorship of their research—the company’s failure to produce data essential for proper interpretation of study results, and the level to which sponsorship by food companies biases such interpretations.  At one point, Disney boasted of the results of this research, confirming its benefit to marketing goals.  The threat of industry sponsorship to research credibility has received considerable press attention in recent months, as must surely be known to these authors.^1,2 

1  Anahad O’Connor.  Coca-Cola funds scientists who shift blame for obesity away from bad diets.  New York Times, August 9, 2015. http://well.blogs.nytimes.com/2015/08/09/coca-cola-funds-scientists-who-shift-blame-for-obesity-away-from-bad-diets/

2  Candice Choi.  AP Newsbreak: Emails reveal Coke’s role in anti-obesity group.  US News, November 24, 2015.  http://www.usnews.com/news/business/articles/2015/11/24/apnewsbreak-emails-reveal-cokes-role-in-anti-obesity-group

Coca-Cola, in case you missed the furor over last week’s New York Times article, has a huge public relations problem.

The damage control begins today with Coke’s CEO’s op-ed in the Wall Street Journal:

Our company has been accused of shifting the debate to suggest that physical activity is the only solution to the obesity crisis. There also have been reports accusing us of deceiving the public about our support of scientific research…I am disappointed that some actions we have taken to fund scientific research and health and well-being programs have served only to create more confusion and mistrust. I know our company can do a better job engaging both the public-health and scientific communities—and we will.

By supporting research and nonprofit organizations, we seek to foster more science-based knowledge to better inform the debate about how best to deal with the obesity epidemic. We have never attempted to hide that. However, in the future we will act with even more transparency as we refocus our investments and our efforts on well-being.

He promises that the company will:

• Publish on our website a list of our efforts to reduce calories and market responsibly, along with a list of health and well-being partnerships and research activities we have funded in the past five years, which we will continue to update every six months.

• Charter and recruit an oversight committee of independent experts to advise and provide governance on company investments in academic research.

• Engage leading experts to explore future opportunities for our academic research investment and health and well-being initiatives.

Personally, I can’t wait to see the list of Coke-funded research activities.  Want to bet how many of those studies came out with results that Coca-Cola can use to claim that sugary drinks have no effect on obesity or type 2 diabetes?  I’d also like a count of the number of studies Coca-Cola has funded to cast doubt on the National Health and Nutrition Examination Survey, the country’s major dietary monitoring program, which has the annoying habit of linking sugary drinks to those conditions.

Mr. Kent ends his piece with this plea:

As we continue to learn, it is my hope that our critics will receive us with an open mind. 

Unless Coca-Cola stops pouring millions of dollars into fighting soda caps and taxes, stops targeting its marketing to minorities, and stops lobbying against public health measures to help people eat more healthfully, keeping Mr. Kent’s version of an open mind will be difficult. 

Steven Blair, one of the scientists involved in Coke-funded research, posted this statement today:

I have asked that my video addressing energy balance be taken down from the GEBN website. I regret that a statement I made in this video has been used by some to brand GEBN as a network focusing only on physical activity. This is not true and never has been true. From the beginning the mission of GEBN has been to study the science of energy balance which involves both diet and physical activity. GEBN has some of the top nutritionist experts in the world who have published research showing the importance of diet and in particular of soda consumption in causing obesity. My dismissal of diet as a cause of obesity did a disservice to their work. I hope many of you can relate to feeling so passionate about an issue that you say some things that you later regret. I believe that both diet and physical activity are important in obesity and that we must address both together to help people achieve healthy weights. I look forward to working with other GEBN researchers to do this.

James Hill, another of the scientists involved in this fiasco, also has issued a statement.  When it becomes public, I will post a link to it.

Additions, August 21

• The Global Energy Balance Network’s defense of its funding by Coca-Cola
• James Hill’s letter in response to a query from my NYU colleague Lisa Young.

I wrote this piece for The Guardian in response to the New York Times article earlier this week about Coca-Cola’s funding of scientists who think obesity is more about exercise than drinking sodas:

These days, you almost have to feel sorry for soda companies. Sales of sugar-sweetened and diet drinks have been falling for a decade in the United States, and a new Gallup Poll says 60% of Americans are trying to avoid drinking soda. In attempts to reverse these trends and deflect concerns about the health effects of sugary drinks, the soda industry invokes elements of the tobacco industry’s classic playbook: cast doubt on the science, discredit critics, invoke nanny statism and attribute obesity to personal irresponsibility.

Casting doubt on the science is especially important to soda makers. Overwhelming evidence links habitual consumption of sugary drinks to poor health. So many studies have identified sodas as key contributors to chronic health conditions – most notably obesity, type-2 diabetes and coronary artery disease – that the first thing anyone trying to stay healthy should do is to stop drinking them.

Soda companies know this. For at least the last 10 years, Coca-Cola’s annual reports to the US Securities and Exchange Commission have listed obesity and its health consequences as the single greatest threat to the company profits. The industry counters this threat with intensive marketing, lobbying and millions of dollars poured into fighting campaigns to tax or cap the size of sugary drinks.

But it is also pours millions into convincing researchers and health professionals to view sodas as benign.

Just last month, the Mayo Clinic Proceedings published a study arguing that the results of national dietary surveys, such as those that link sugary drinks to type-2 diabetes, are so flawed that they constitute a major misuse of public funds. The authors report honoraria, speaking and consulting fees from Coca-Cola.

This week’s revelation of Coca-Cola’s funding of the Global Energy Balance Network is only the latest example of this strategy in action. The Network promotes the idea that to prevent obesity you don’t need to bother about eating less or drinking less soda. You just have to be more active. Never mind that most people can’t lose weight without also reducing their intake.

A reporter who looked into this group discovered that Coca-Cola had funded the research of the scientists behind it, and generously. The network’s website was registered to Coca-Cola. None of this, however, had been made explicit.

Most nutrition professional journals now require researchers to declare who funds their studies, making it possible to compare study outcomes with funding sources. Studies sponsored by Coca-Cola almost invariably report no association of sugary drinks with diabetes, they question the validity of studies that do find such associations or, as in the case of Global Energy Balance Network investigators, they find activity to be the most important determinant of body weight.

Analyses of studies funded by Coca-Cola or its trade association demonstrate that they have an 83% probability of producing results suggesting no harm from soda consumption. In contrast, the same percentage of studies funded by government agencies or independent foundations find clear linkages between sugary beverages and such conditions. Coincidence? I don’t think so.

Since March, I’ve been posting industry-funded studies with results that favor the sponsor’s interests every time I find five of them. They are easy to find. Despite pleas to readers to send me industry-funded studies that do not favor the sponsor, I hardly ever get them. Whenever I come across a study that shows no harm from sodas, I immediately look to see who paid for it.

Soda companies spend generously to convince researchers and health professionals not to worry about sodas’ health effects. But why do researchers take the money? It is too simplistic to say that they are “bought.” Industry-funded investigators say they believe the funding has no effect on the design, conduct or interpretation of their research. But research involves choices of questions, assumptions and methods. It is not difficult to carry out a study that appears to meet high scientific standards yet fails to include critical controls that might lead to alternative conclusions.

Researchers funded by Coca-Cola need to take special care to control for unconscious biases but can only do this if they recognize the possibility. Many do not. Neither do many peer reviewers or editors of scientific journals. Although food-company financial support should not necessarily bias results, it appears to do so in practice.

Industry-funded scientists resent questioning of the influence of sponsorship on the quality of their science. They charge that investigators who find adverse effects of sodas on health are equally biased by career goals, righteous zeal or anti-corporate morality. Yes, independent scientists may have biases of their own, but their overarching research goal is to improve public health. In contrast, the goal of soda companies is to use research as a marketing tool.

Disclosure is essential. If a study is funded by Coca-Cola, caveat emptor.

I’ve had a busy week dealing with the aftermath of Anahad O’Connor’s New York Times story about how Coca-Cola pays scientists who argue that obesity is more about activity than what you eat—drinking sodas, for example (I’m quoted).   It’s gotten 1180 comments.

Here’s Dan Wasserman’s from the Boston Globe:

In all fairness, let’s see what Coca-Cola’s Chief Technical Officer, Dr. Ed Hays, says in response (straight out of the tobacco industry’s playbook):

I was dismayed to read the recent New York Times’ inaccurate portrayal of our company and our support of the Global Energy Balance Network (GEBN). The story claimed Coke is funding scientific research to convince people that diets don’t matter – only exercise. In fact, that is the complete opposite of our approach to business and well-being and nothing could be further from the truth.

Yes, we fund scientific research through GEBN and we are proud to support the work that scientists such as Dr. Jim Hill and Dr. Steve Blair do – because their type of research is critical to finding solutions to the global obesity crisis.

At Coke, we believe that a balanced diet and regular exercise are two key ingredients for a healthy lifestyle and that is reflected in both our long-term and short-term business actions.

The article even got the attention of Congress.  Here’s the statement from Rosa de Lauro (Dem-CT), sponsor of The SWEET Act to tax sugars:

This research is reminiscent of the research conducted by the tobacco companies to mislead the public about the health risks of smoking.  The American public will not be fooled. There is a wealth of sound scientific research that demonstrates the link between sugar-sweetened beverage consumption and a host of health conditions, including diabetes, heart disease, and obesity.  This new group and their research are a sham,” DeLauro said.  “People want to be healthy and they want their kids to be healthy and realize that drinks full of empty calories are not good for them. That is why more and more Americans are opting to drink less soda every year.

I wrote a piece for The Guardian, which I will post tomorrow.

I don’t keep track of my interviews or media appearances unless people send me links (I post them under Media), but Rachel Harrison at NYU kept score yesterday.  As I said, a busy couple of days.

• Fortune
• RT
• USA Today
• US News & World Report
• NPR
• Washington Post Wonkblog
• Washington Post Health Section
• CBS Atlanta
• CBC
• PLoS Blog
• Take Part
• Huffington Post
• Latina
• Business Insider
• Journal of Public Heath Policy 

Additions, August 14

Fox News, August 11

• Shepard Smith says “the story “reminds you of exactly what the tobacco industry did back in day, and more recently, it also reminds you of what the climate deniers — the climate change deniers — are doing as well.”
• Rush Limbaugh said the Times‘ Coca-Cola story “undermine[s] the whole notion of a scientific consensus,” because it “can be bought and paid for.”

New York Times editorial, August 14

the evidence continues to mount that sugar-sweetened drinks are a major contributor to obesity, heart disease and diabetes, and that exercise makes only a modest contribution to weight loss compared to ingesting fewer calories.

• ‘Big Food’: taking a critical perspective on a global public health problem, by Simon N. Williams & Marion Nestle. 

• The transitional dynamics of caloric ecosystems: changes in the food supply around the world, by Sanjay Basu.
• Big Food without big diets? Food regimes and Kenyan diets, by K. O’Neill.
• Density of outdoor food and beverage advertising around schools in Ulaanbaatar (Mongolia) and Manila (The Philippines) and implications for policy, by Bridget Kelly, Lesley King, Batjargal Jamiyan, Nyamragchaa Chimedtseren, Bolorchimeg Bold, Victoria M. Medina, Sarah J. De los Reyes, Nichel V. Marquez, Anna Christine P. Rome, Ariane Margareth O. Cabanes,John Juliard Go, Tsogzolmaa Bayandorj, Marie Clem B. Carlos & Cherian Varghese. 
• Snack food advertising in stores around public schools in Guatemala, by Violeta Chacon, Paola Letona, Eduardo Villamor & Joaquin Barnoya.  
• Comparison of food industry policies and commitments on marketing to children and product (re)formulation in Australia, New Zealand and Fiji, by Gary Sacks, Melissa Mialon, Stefanie Vandevijvere, Helen Trevena, Wendy Snowdon, Michelle Crino & Boyd Swinburn.  
• Encouraging big food to do the right thing for children’s health: a case study on using research to improve marketing of sugary cereals, by Jennifer L. Harris, Megan E. LoDolce & Marlene B. Schwartz.  
• Big Soda’s long shadow: news coverage of local proposals to tax sugar-sweetened beverages in Richmond, El Monte and Telluride.  Laura Nixon, Pamela Mejia, Andrew Cheyne & Lori Dorfman.  

Commentaries

• Big Food’ and ‘gamified’ products: promotion, packaging, and the promise of fun, by Charlene Elliott.
• Food as pharma: marketing nutraceuticals to India’s rural poor, by Alice Street.

Thanks to Simon Williams for initiating (and doing the heavy lifting on) this project, and to all the terrific contributors.

Enjoy!

 

Here is the online version of my commentary in New Scientist, March 14, 2015:24-25.

I submitted an illustration with it, which the editors did not use.  It’s from the Ontario Medical Association.

Cigarettes get plain packets – will junk food be next?

The tobacco industry is fighting moves to sell cigarettes in plain packs by claiming food manufacturers will be hit next. Will they?

ANTI-SMOKING advocates will be delighted. MPs have today voted in favour of introducing uniform packaging for cigarettes in the UK. That plain wrappers will undoubtedly further reduce smoking, especially among young people, is best confirmed by the tobacco industry’s vast opposition to this government measure and positive evidence from Australia, the first country to adopt it.

Along with lobbying and appeals to the World Trade Organization, the tobacco industry, when under attack, inevitably wheels out well-worn arguments about the nanny state, personal freedom, lack of scientific substantiation, and losses in jobs and tax revenues.

So to perk up its tired and thoroughly discredited campaign, the tobacco folks have added a new argument. Requiring plain wrappers on cigarettes, they say, is a slippery slope: next will be alcohol, sugary drinks and fast food. This argument immediately raises questions. Is it serious or just a red herring? Should the public health community lobby for plain wrappers to promote healthier food choices, or just dismiss it as another tobacco industry scare tactic?

Let me state from the outset that foods cannot be subject to the same level of regulatory intervention as cigarettes. The public health objective for tobacco is to end its use. So for cigarettes the rationale for plain wrappers is well established. Company logos, attractive images, descriptive statements, package colours and key words all promote purchases. Plain wrappers discourage buying, especially along with other measures such as bans on advertising, smoke-free policies, taxes and health warnings.

Australia’s pioneering law specified precise details of pack design, warning images and statements. The result: cigarette brands all look much alike. Most reports say plain packaging boosts negative perceptions of cigarettes among smokers and increases their desire to quit. Australia expects plain packaging to further reduce its smoking rate, which, at 12.8 per cent, is already among the world’s lowest. Along with the UK, New Zealand and Ireland are well on the way to adding plain packaging to their anti-smoking arsenal. More nations are considering it.

Which is all bad news for the tobacco industry. So it ramps up the slippery slope argument, hoping the food industry will support its fight against plain wrappers. It cites examples such as the regulation of infant formula in South Africa, where pictures of babies on labels are forbidden; that’s a big problem for the Gerber food brand – Gerber’s company logo is a smiling baby.

But those peddling the slippery slope idea ignore the fact that the health message for tobacco is simple: stop smoking. But beyond tobacco, it is more complex. For alcohol it is a little more nuanced: drink moderately, if at all. For food it is much more nuanced. Food is not optional; we must eat to live. Nutritional quality varies widely. Foods are spread across a spectrum from unhealthy to healthy, from soft drinks (no nutrients) to carrots or fish (many nutrients). Most fall somewhere in between. What’s more, an occasional soft drink is fine; daily guzzling is not. So the advice is to choose the healthy and avoid or eat less junk, both in the context of calorie intake and expenditure.

Is there any evidence that plain packaging for unhealthy foods would reduce demand? Research has focused on marketing’s effect on children’s food preferences, demands and consumption. Brands and packages sell foods and drinks, and even very young children recognise and desire popular brands. When researchers compare the responses of children to the same foods wrapped in plain paper or in wrappers with company logos, bright colours or cartoon characters, kids invariably prefer the more exciting packaging.

But the problem is deciding which foods and beverages might call for plain wrappers. For anything but soft drinks and confectionery, the decisions look too vexing. Rather than having to deal with such difficulties, health advocates prefer to focus on interventions that are easier to justify – scientifically and politically.

We know that some regulations and market interventions –analogous to, if not the same as those aimed at smoking cessation – are essential for reducing the damage from harmful products. If not plain packaging, then what? Studies suggest small benefits from a long list of interventions such as taxes, caps on portion size, front-of-package traffic-light labels, nutrition standards for school meals, advertising restrictions, and elimination of toys from fast food meals and cartoons from packaging. Rather than dealing with the impossible politics of plain wrappers on foods, health advocates increasingly favour warning labels.

These first appeared on cigarette packs in the 1960s and have been considered for food products since the early 1990s. Heart disease researchers suggested that foods high in calories and fat should display labels such as: “The fat content of this food may contribute to heart disease.” More recently, health advocates in California and New York proposed warning labels on sugary drinks. The Ontario Medical Association takes a similar view: “To stop the obesity crisis, governments must apply the lessons learned from successful anti-tobacco campaigns.” It has mocked up examples of warnings on foods.

Although no warning label law has passed so far, such messages are the logical next step in promoting healthy food choices, in the same way that plain wrappers are the next logical step for all cigarette packages. Health advocates should recognise the slippery slope argument for the typical tobacco ploy that it is.