A few days ago, a press release summarizing the results of a study of food marketing techniques popped up in my inbox. To wit: “In research published on March 31, 2014 in JAMA Pediatrics, Dartmouth researchers found that one-half to one-third of children did not identify milk when shown McDonald’s and Burger King children’s advertising images depicting that product. Sliced apples in Burger King’s ads were identified as apples by only 10 percent of young viewers; instead most reported they were French fries.”

Well… gee. I looked at the picture of apple slices. I thought they were French fries – thin, long, rectangular slices of something light colored nicely packaged in a small red cardboard container that looked like a French fry container.

And it took a grant from the Robert Wood Johnson Foundation and a group of Very Smart People from Dartmouth to figure out that when kids looked at it, they might think the package contained fries, too? They probably could have saved a whole lot of foundation dollars and asked McDonald’s and Burger King to share some of their market research before the ads went to press. Both companies, I’m sure, had done plenty of research on the anticipated impact of the ads – and were perfectly aware that kids would be confused about the French fries versus apples question. Nor, I’m sure, did top execs at either McDonald’s or Burger King care whether the kids actually ate the apples – the whole point is selling the meal with enough mark-up to make a profit, and making it appealing enough that kids come back.

Such tactics are designed to sell food – and not just any food – to parents and kids. Parents want their kids to eat apples and drink milk; the kids want the fries and burgers (okay, so do parents, most of the time). Fast food, which is appealing because of its high fat, sodium, and sugar content, sells to kids and parents alike. For kids, the apples are just a way to get that burger and the fries that come in the other red cardboard container. For parents, it’s all too often a way to get their kids to eat something while feeling only a little guilty (and maybe indulging in that Big Mac or Whopper themselves while they’re at it).

These tactics are also eerily reminiscent of the methods used by tobacco companies to sell their products, as obesity researchers Kelly Brownell and Kenneth Warner point out in a detailed analysis of the parallels between the two. Adding the apples and milk to a meal that’s really built on a greasy burger and fries is a lot like adding a filter to cigarettes – a token harm reduction effort, but in both cases, the harmful elements still remain. Increasingly, it’s becoming clear that Big Food understands that many of the processed and packaged foods they sell at premium, “value-added” prices are contributing to obesity, heart disease, stroke, diabetes, and myriad other chronic health problems. And it’s also becoming crystal clear that they will continue to invest in research and market to sell more food, no matter what the public health consequences.

Even though there’s clear evidence that both tobacco and high-calorie/low nutritive value foods harm health, companies go to great efforts to formulate products that are appealing and market them to specific populations – especially children. These tactics should come as no surprise. After all, Big Tobacco and Big Food are often one and the same companies: Phillip Morris owns Kraft Foods, the largest U.S. food company, which includes Oscar Mayer, Jell-O, Post cereals, and Maxwell House; RJR Nabisco, maker of all those yummy cookies and crackers, is also the R.J. Reynolds Tobacco Company and maker of Winston, Camel, Dora, Salem, and Magna cigarettes.

No wonder that Brownwell and Warner found that Big Tobacco and Big Food’s “playbooks” are essentially the same — they come from the same source.

But there’s also a big difference between food and tobacco: Food is a necessary part of life (and if you think tobacco is the same, please click on our quit smoking resources right now). We need to be able to make healthful food choices. Food is part of our cultural and familial histories, often tying us to places, people, and traditions. Food is us in a fundamental way. Even the way we talk about our food choices reflects our identification with foods. We more often say “I am a vegetarian,” than “I eat only vegetarian foods.”

There’s another challenge to finding our way through the grocery store: the incredible diversity of the food industry in the United States – which includes not only Big Food but small companies, cooperatives, local growers, and others that do produce healthful foods. There’s a key difference between the two goods: It is possible to make healthful food choices, while there is no such thing as a healthful cigarette.

But how do we make those choices, when we don’t really know what’s in the foods we buy? The obfuscation of food industry is prevents us from making healthy food choices — and they’re doing it on purpose. Millions of dollars are poured into anti-obesity research every year, while food manufacturers pour even more money into obscuring the truth about their products — and creating products that are addictive, high-calorie,

That’s why addressing the obesity problem by focusing on increasing physical activity and eating a better diet is only a partial solution. “Big Food” needs to be held to a high standard of transparency regarding their products. Effective regulations must focus less on restricting access (e.g. soda bans) and more to provide truthful information (e.g. truth in advertising, clear labeling).

It’s time for tighter regulation of marketing standards for foods. For instance, Coca Cola’s “Simply Orange” brand of orange juice recently came under scrutiny because the “all natural” marketing techniques used to sell the juices do not match actual production techniques, which involve a highly technical process that involves gathering a specific mix of oranges from different parts of the country. Many consumers felt deceived, but Coca-Cola isn’t alone in the discrepancy between its “pure and natural” orange juice marketing techniques and the reality of how most orange juice is produced.

Plus, food labels don’t give us the information we need as consumers. Despite FDA regulations, foods still aren’t clearly and understandably labeled in a way that most people can understand. The food industry should be held accountable not only for providing information about the nutritional value of the foods they produce, but also for helping people to understand what it means.

Thus, we must be cautious about regulating foods. We preserve our ability to make food choices when we allow free access to foods but demand concrete information about those foods — what is in them, how they were developed, and how they might help or harm our health. Bans on large sodas or other non-nutritive foods aren’t likely to really impact health, while they take away autonomy and choice. As ethicists would say, the ratio of harm reduction to infringement is too small.

On the other hand, “sin taxes” preserve the ability to choose while emphasizing, using economic forces, the consequences of consuming a certain food. I’ll pay a “sin tax” for an occasional Oreo, but I don’t want to be banned from ever buying Oreos again. In a sense, I’m asking for enough information to be able to provide informed consent. If I purchase that box of Oreos and eat them with full knowledge of their nutritional content – or lack thereof – then my choice is informed. But if I am not informed of their potentially addictive nature or impact on my health, then the pact between me and the food manufacturer is violated.

We must be careful not to lay blame for obesity in one camp but to adopt an “all at once” approach. Yes, it is individual choice. Yes, it is food companies creating addictive foods. Yes, it is marketing. Yes, it is food science. Yes, it is culture. Yes, it is Twiggy and today’s prepubescent runway models. Yes, it is the obese five-year-old. Yes, it is all of these things – and it’s the incredible diversity of the people and players in “the” food industry that poses both challenges and hope.

So what are some of the things we can do — and ask policymakers to do — to break up the Big Food/Big Tobacco marriage? Here’s a start:

Marketing restrictions: Current self-regulation of the industry is not working (as the Dartmouth study I started off with here showed all too well). While many companies have signed pledges to market only “better for you” foods and beverages to children, that phrase leaves to question what, exactly, is “better for you?”
Transparency: Food companies should be held to transparent standards regarding not only nutritional content of their foods, but their processes. I’m not talking industry secrets here — I’m talking about consumers’ right to know that the “fresh-squeezed” orange juice they just put in their grocery cart has actually been held in a vat for nearly a year.
Address conflicts of interest: Conflicts of interest exist not only with individual scientists, but across organizations. Even organizations such as the American Heart Association and the American Diabetes Association, in agreeing to label certain foods as “heart healthy” or “diabetes friendly,” have often endorsed foods that are not as healthful as they appear. You know that “healthy” fruit yogurt in your fridge? Read the label — it’s sugar content probably matches or surpasses the cookie you were planning to have for dessert.
Limits on research: There’s another ethical dilemma regarding obesity research, one that we don’t often speak of. Not only is the food industry making money on selling obesity, so are researchers with and without industry affiliations. Universities have set up entire obesity research departments; people make careers out of researching obesity. While much of this research is essential to public and population health, strict limits should be put on research that is funded by or in any way tied to food industry.
Media responsibility: Too often, health writers uncritically accept the results of nutrition-related studies, spurring sales of particular foods. Health writers, too, must be held accountable for high-quality journalism that probes scientific claims.
Education: To make healthful food choices, people need to know what that looks like. For many people – especially in low-income families – the idea of a balanced diet is a mystery. Education about healthful eating patterns should begin during the prenatal period and extend through infancy, preschool, elementary school, and high school. Adults should have access to high-quality nutrition education as well, which should include information about buying, choosing, preparing, and storing healthful foods.
Local foods: Local growers, small farmers, and cooperatives offer a chance to tip the balance of food autonomy back to communities. Urge your elected officials to support farmers’ markets, CSAs, community gardens, and other local projects.

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