Can you trust dietitians who are in bed with Big Food?

Weight Loss Signpost Showing Fiber Exercise Fruit And CaloriesShould you follow advice from dietitians who are bed partners with the food industry? Even when they say it’s just for the sponsorship money, and food companies have no influence on their advice whatsoever? 

The spotlight falls often on the Association for Dietetics in South Africa (ADSA), but it’s  a global concern. Food companies exert influence subtly through orthodox-trained dietitians who act as proxies whether by default or design. British investigative health journalist Jerome Burne has written a scathing blog on it: Cuddly dietitians in cosy embrace of industry fat cats.

In the first of a two-part series, Eategrity consumer activist  Sonia Mountford looks at ADSA’s links with Big Food and what effect this may be having on the advice it gives. But do you really need independent dietary advice? As an ancient Ayurvedic sage once said: When diet is wrong, medicine is of no use; when diet is right, medicine is of no need. – Marika Sboros

By Sonia Mountford*

Like many consumers, you are likely to be more aware these days than you were in the past, of what certain foods or food components may be doing to promote your health, and reduce your risk of disease.

But who are those advising you – and consumers in general – on which foods to eat and which to avoid? Do they advise you to make dietary choices according to what processed food manufacturers are telling them?

You might think it would be extremely foolish for anyone to listen to profit-driven companies, but it seems that that is exactly what nutrition “experts” are doing — in effect putting your health in the hands of Big Food (as large commercial entities that dominate the food and beverage environment are popularly known) without even being aware of it – or at least one would hope they are not aware of it.

Strong ties

One of these bodies is the Association for Dietetics in South Africa (ADSA) that influences government food policy, and has very strong ties with Big Food.

A study in the open-access, peer-reviewed journal Plos (Public Library of Science) One in 2012, titled “Big Food”, the Consumer Food Environment, Health, and the Policy Response in South Africa, confirmed that Big Food’s reach is becoming longer, and is implicated in unhealthy eating.

The study, by South African researchers at the University of the Western Cape, Bellville’s School of Public Health and Department of Dietetics, and a British researcher at the Centre for Food Policy, City University, in London, say that Big Food has developed corporate social responsibility (CSR) programmes that involve health in response to an increase in consumer health awareness.

These company CSR programmes often promote products with questionable ingredients as healthy or align themselves with health institutions, the researchers say.

The generally weak national response to the influential promotion of these products is illustrative of the rudimentary status of South Africa health policy regarding regulation of the food environment,” the study further says.

To make an informed choice you need sufficient knowledge. That is key to improving nutrition security, given the links between diet and global epidemics of non communicable diseases (NCDs), such as obesity, heart disease, diabetes, respiratory disease, some cancers, and increasingly these days dementia (it is called type 3 diabetes, because of its links with diet and sugar), and malnutrition. And since both NCDs and malnutrition are shown to occur even when a household has access to adequate amounts of nutritious food.

Obesity burden

Wits University public health professor Dr Karen Hofman says obesity-related diseases together rival the burden of HIV/Aids in SA.

“The economic development of a nation depends in part on the health of its population. Addressing the non-communicable disease (NCD) epidemic is critical to a virtuous cycle of improved public health outcomes and better economic growth.

“Decreasing premature mortality from NCDs is now on the post-2015 development agenda. The accumulated losses to South Africa’s gross domestic product between 2006 and 2015 from diabetes, stroke and coronary heart disease alone are estimated to cost the country US$1.88 billion.”

Claire Strydom

Claire Julsing Strydom

ADSA president Claire Julsing-Strydom tweeted recently that it was “great” to see that the South African Food-Based Dietary Guidelines (SA FBDGs) are very much in line with the US guidelines

“SA RD’s getting it right!” she said.

But what exactly are South African registered dietitians getting “right”?

You don’t have to be an expert in dietetics to know that the guidelines are basic ,and don’t adequately address the issue of, for example, sugar.

The recommendation to “use foods and drinks that contain sugar sparingly and not between meals” does not go nearly far enough, considering the implications of poor-quality diets which has been long associated with obesity and the rise of NCDs, which are becoming more serious among the poor.

It raises the question why these guidelines also downplay the responsibility of Big Food?

Could it be because Big Food also had direct influence on the guidelines?

The South African Sugar Association and the South African Meat Board funded initial workshops for the South African FBDGs. Delegates from the food industry were given opportunity for input.

ADSA also helped develop the guidelines and elected Sue Cloran, currently Senior Manager for Kellogg’s European Snacks Nutrition, to represent the food industry.

Kellogg's cerealsWhile she was Nutrition Manager for Kellogg’s South Africa, Cloran was integral in the launch of the South African Kellogg corporate website. She represents the Kellogg Company in extensive media appearances, including TV, radio and press.

In February 2015, I asked ADSA president Claire Julsing-Strydom if ADSA could be considered a credible source of dietary advice when they are sponsored by companies that make products associated with an increased risk of NCDs, if not a direct cause of them.

ADSA sponsors include
 Sea Harvest, Huletts Sugar (EquiSweet), Kellogg, Pick n Pay, DSM, Woolworths, Nativa, Unilever, Parmalat, Pronutro and Health Connection.

In particular, she  asked about their Gold Sponsor — Kellogg’s:

ADSA responded predictably enough: “Our sponsors have never influenced decisions made by ADSA and donate funds to the association to promote the dietetics profession in South Africa and ultimately improve nutrition education to the public through dietitians and we are grateful to our sponsors for their assistance.”

This response did not surprise me since denial over conflicts of interest between Big Food and dietetic groups is common and a growing global concern.

Now a word from our sponsors

In January 2013, US public health lawyer Michele Simon released an investigative report, titled “AND Now A Word From Our Sponsors” that delved further into the ties between Big Food and the Academy of Nutrition and Dietetics (AND), formally the American Dietetics Association.

She posed the questions: does forming partnerships with the food industry compromise such a group’s credibility? What does the food industry gain from such partnerships?

The report shows the food industry’s deep infiltration of the top US nutrition organisation that is also a world body, raising serious questions not only about that profession’s credibility, but also about its policy positions.

nutrition Watchdogs Sheldon Rampton, and John Stauber, the authors of Trust Us, We’re Experts!: How Industry Manipulates Science and Gambles With Your Future – note that the AND rarely criticises food companies, believing it to be out of fear of “biting the hand that feeds them.

Recently, the AND licensed its “Kids Eat Right” seal to processed cheese Kraft Singles. In response to criticism, the AND claimed that this is “not an endorsement”. Kraft is merely a “proud supporter of” AND’s Kids Eat Right program.

The AND told ABC News that the appearance of the logo on the processed cheese product is not an endorsement or seal of approval, but more like an ad for Kids Eat Right. However, in a reversal of how most ads work, Kraft paid the advertiser — AND — an undisclosed amount to place the logo.

Dr Arthur Caplan, a bioethicist at New York University’s Langone Medical Centre, told ABC news  that he was “99.9 percent” sure consumers would read the logo as an endorsement from nutritionists and dietitians.

In a statement to ABC News, Kraft spokeswoman Jody Moore said Kraft and Kids Eat Right will collaborate on a “nutrition education campaign” for three years “to raise awareness that the diets of America’s kids are lacking in three important components – dairy, calcium and vitamin D.”

AND has since revoked the decision, in part, due to pressure from their constituent group and US consumers’ outcry.

The ADD’s guidelines for corporate sponsorship state:

“(Our) procedures and formal agreements with external organizations are designed to prevent any undue corporate influence, particularly where there is a possibility that corporate self-interest might tend to conflict with sound science or ADA positions, policies and philosophies.”

Sounds familiar, right? But just how the ADSA and the AND define “influence” is unclear.

ADSA further responded  in February:

“At the same time we don’t believe in endorsing brands to the communities within which we work, hence the decision to remove logos from our public-facing channels as this can influence public perception. Our sponsors are also not allowed to use the ADSA logo on their websites or with their products.”

So ADSA has stopped displaying logos of sponsors publically but these sponsors, along with ADSA and sponsors’ logo, are heavily promoted to member dieticians, mostly through the, RDs members only portal. Some of the dietary recommendations are even supplied by Kellogg’s for ADSA to disseminate. In fact, ADSA assures their sponsors of this access to the member RDs:

Visible sponsors

“Visibility of our Sponsors on the ADSA Website (accessed by ADSA members, associate Medical Professionals as well as the General Public searching for a Dietician), delivers strong Brand/Company association

  • With over 1300 ADSA members on our database, having access to communication tools with our target audience is vital. Sponsor benefits are — notices , ie adverts, company events, services etc via Tuesday Bulletin (Valued at R2500 each)
  • Stand alone ADSA Bulletin attachments under 2MB Value R 5 000 each
  • Branded Promotional Items Stationery Leaflets Brochures sent to 11 Branches
  • Unlimited Address Postage labels on request only”

In 2014, when questioned about their sponsorship by Huletts Sugar and Nestlé in a Times Live article, ADSA’s Strydom said the association’s advice was independent and they did not endorse products. The article further stated that the “NGO only gets 34% of fund (sic) raised from businesses.”

But 34% of what amount?

Companies have also apparently supported ADSA in other ways, such as offering meals or providing venues for meetings. Anyone with a gut must have a feeling about the absurdity and clear conflict of interest with ADSA having Big Food as sponsors.

“It’s deeply troubling when commercial companies with vested interests are sponsoring organisations responsible for guidelines” said Wits HIV professor Francois Venter in 2014.

Scratching the surface

ADSA have diamond, silver, gold and platinum sponsors. An annual Association Investment cost R63 669,50 in 2014 for diamond status.

Just what various sponsorship benefits are offered by ADSA is still uncertain but since ADSA influences health and dietary policy, every South African is entitled to know exactly how the sponsorships work. Here are some of the links:

  • Claire Julsing Strydom – ADSA President, consults to Kellogg’s. Just scratching below the surface, uncovers further concerns about the many links between ADSA exco members and their “Gold Sponsor” Kellogg’s:
  • Linda Drummond – ADSA Membership Relations and is currently the Nutrition and Corporate Affairs Manager at the Kellogg Company of South Africa.
  • Cheryl Meyer – ADSA Communications and currently Nutrition Assistant at Kellogg Company of SA.
  • Leanne Tee – ADSA Gauteng South Sponsorship portfolio. Tee currently works at the Kellogg Company of South Africa in the capacity of Nutrition Assistant.

To be clear, the problem seems to lie with ADSA, not with all RDs. However, there appears to be no overt unhappiness among RDs with ADSA’s Big Food sponsorship. Should their silence be interpreted as acquiesce? And this is only an example of one organisation and one Big Food manufacturer.

What about the other sponsors?

How many of the people in charge of advising South African government policy makers about health and food related issues have conflicting industry links? How deep does the influence go and how do we dig it out?