An executive of the Coca-Cola-funded Global Energy Balance Network has said there is no evidence that sugary drinks are to blame for obesity.
The Global Energy Balance Network (GEBN) is an international organization led by reputable scientists of public health based in universities across the world. The research focus of the group is energy balance - a state of equilibrium between calories consumed and calories burned through physical activity.
In a promotional video, one member of the group's executive committee, Steven N. Blair, a professor at the Arnold School of Public Health at the University of South Carolina, states that the current message about unhealthy diets and the obesity epidemic is inaccurate:
"Most of the focus in the popular media and in the scientific press is that they're eating too much, eating too much, eating too much, blaming fast food, blaming sugary drinks and so on. And there's really virtually no compelling evidence that that in fact is the cause. Those of us interested in science, public health, medicine, we have to learn how to get the right information out there."
Many people have seen this statement suggesting that there is no compelling evidence that sugary drinks cause obesity and seen that the research group is funded by Coca-Cola and thought that something is amiss.
However, the practice of industry funding science is nothing new. It costs a lot of money to conduct scientific research, and many researchers - in the fields of medicine and technology, as well as nutrition - are funded through grants from corporations that are directly associated with the area of research.
In this Spotlight, we take a look at industry-funded research and the problems associated with it. Are companies such as Coca-Cola merely a welcome source of funding and ideas for research? Or does the threat of bias undermine the science that is being conducted?
Coca-Cola's media image problem
It has not been a good few weeks for Coca-Cola in terms of how the company has been portrayed on the Internet. Prior to this article in The New York Times, an infographic detailing what happens to the body within an hour of drinking a can of Coca-Cola went viral online.
The infographic, based on research by a health writer, warns that the regular consumption of Coca-Cola and other caffeinated fizzy drinks can lead to hypertension, heart disease, diabetes and obesity.
Michel Simon, a public health lawyer, believes that the funding of GEBN is a response to how Coca-Cola is currently perceived by the public:
"Coca-Cola's sales are slipping, and there's this huge political and public backlash against soda, with every major city trying to do something to curb consumption. This is a direct response to the ways that the company is losing. They're desperate to stop the bleeding."
The direct references to popular media and the scientific press in Dr. Blair's promotional video certainly indicates that the backlash against soda is high in the researchers' minds.
At present, more than one third of adults in the US are obese, around 78.6 million people. Dr. Blair says that the main reason for this is that too many people are eating more calories than they burn on too many days:
Some elite athletes need to consume huge amounts of calories to get the energy they need to perform. Does this support GEBN's claims?
"But maybe the reason they're eating more calories than they need is because they're not burning many," he suggests. "So we need to be in balance. We need to be in energy balance and at a healthy level, which means getting a proper amount of physical activity."
Energy balance advocates could point to the example of swimmer Michael Phelps, winner of eight gold medals in the 2008 Olympics and the most decorated Olympian of all time. At the time, a lot of attention was paid to the size of Phelps' diet, in which he could consume 12,000 calories a day.
Three fried egg sandwiches, one five-egg omelet, one bowl of grits, three slices of French toast and three chocolate-chip pancakes. And this was just for breakfast.
Mark Klion, a sports medicine doctor and orthopedic surgeon at Mount Sinai Medical Center in New York, NT, told The Wall Street Journal that if Phelps did not consume that amount of calories, his "body won't recover, the muscles will not recover, there will not be adequate energy stored for him to compete in his next event."
However, there is an overwhelming amount of scientific evidence that demonstrates that, although sedentary behavior can lead to weight gain, a bad diet is the most influential factor in obesity.
'You cannot outrun a bad diet'
One study of sedentary, overweight adults published in Obesity examined the effects of exercise on weight loss. Around 200 adults were recruited and randomly assigned to exercise between 5-6 hours a week - more than twice the recommended weekly amount of exercise - while following the same diets as before.
After following the exercise programs for a year, the researchers found that the male participants had lost an average of 3.5 pounds and the female participants an average of 2.5, with nearly all of the participants remaining overweight or obese.
Lead author Dr. Anne McTiernan, of the Fred Hutchinson Cancer Center in Seattle, WA, admits that adding exercise to a diet program helps. "But for weight loss, you're going to get much more impact with diet changes," she says.
With specific regard to sugary drinks like Coca-Cola, Harvard T.H. Chan School of Public Health state that while a 20-ounce soda contains around 15-18 teaspoons of sugar and upwards of 240 calories, people who drink these beverages do not satisfy their appetites as they would if they had consumed these calories from solid food.
An observational study of children and sugar-sweetened drink consumption published in The Lancet reported that for each additional 12-ounce soda children consumed each day, their risk of becoming obese increased by 60% during a 1.5 year follow-up period.
In an editorial published in the British Journal of Sports Medicine, Dr. Aseem Malhotra and colleagues also state that physical activity does not promote weight loss.
"It is where the calories come from that is crucial," they argue. "Sugar calories promote fat storage and hunger. Fat calories induce fullness or 'satiation.'" Poor diet is described by the authors as generating "more disease than physical inactivity, alcohol and smoking combined."
Although it is worth noting that the editorial attacks high-carbohydrate diets and that one of the authors is a paid member of the Atkins Scientific Advisory Board, the main target of the editorial is the junk food industry's public relations machinery:
"The 'health halo' legitimization of nutritionally deficient products is misleading and unscientific. This manipulative marketing sabotages effective government interventions such as the introduction of sugary drink taxes or the banning of junk food advertising. Such marketing increases commercial profit at the cost of population health."
The risk of bias
Coca-Cola responded to The New York Times article with a statement from Dr. Ed Hays, the company's Chief Technical Officer. He describes the article as an inaccurate portrayal of the company by claiming Coca-Cola was funding research to convince people that diets don't matter, only exercise.
"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," he states.
This response distances the company from the overt and problematic claims made by one of GEBN's executives. However, it is the mere presence of Coca-Cola as a major funding source for the organization that is an issue for some public health experts.
Industry funding of research is commonplace and, unfortunately, studies have demonstrated that funding sources can influence the outcomes of clinical trials.
A systematic review of 206 studies and reviews about soft drinks, juice and milk was conducted and published in PLOS Medicine in 2007. Of these articles, 111 declared financial sponsorship, with 22% receiving industry funding, 47% receiving no industry funding and 32% receiving mixed funding.
Multiple studies indicate that industry funding increases the likelihood of a study producing positive results.
Among interventional studies, the researchers found that 0% of the studies with any industry funding came to unfavorable conclusions compared with 37% of the studies with no industry funding.
The authors stated their study indicated that beverage industry-funded studies are four to eight times more likely to produce results favorable to the industry in comparison with studies that are independently funded.
A similar level of bias has been found in other studies examining the influence of pharmaceutical company funding on drug trials and for-profit organizations on trials of new treatment strategies.
The findings of such studies suggest that the financial support Coca-Cola gives to GEBN could be very influential in the researchers' output. The article in The New York Times states that the company donated $1.5 million last year to set up the organization, while nearly $4 million in funding has been provided since 2008 to Dr. Blair and another GEBN executive, Gregory A. Hand.
Even if the research conducted can be proved to be influenced by bias, however, experts believe that the mere existence of such research contributes to "health halo legitimization."
Marion Nestle, a professor of nutrition, food studies and public health at New York University, says that the agenda is to "get these researchers to confuse the science and deflect attention from dietary intake."
On her website Food Politics, Nestle regularly posts links to industry-funded studies that reach expected results that can be used for marketing purposes.
Creating doubt: comparisons with big tobacco
Dr. Bruce Lee, director of the Global Obesity Prevention Center at Johns Hopkins University, told Healthline that Coca-Cola and GEBN's arrangement crosses a line by promoting a view that sits outside of scientific consensus.
"When you start trying to say that something is a greater cause of obesity, that's potentially when we get into a problem," he said.
The article in The New York Times compares what Coca-Cola is doing with GEBN with a well-documented strategy employed by tobacco companies: paying for health experts to create doubt about the health hazards of smoking.
Last month, Medical News Today reported on a study that analyzed cases in which patients were suing tobacco companies for damages.
The researchers discovered that a group of physicians testified for the tobacco industry against patients dying of cancer on multiple occasions, repeatedly stating that their smoking did not cause cancer.
Three major tobacco companies - R.J. Reynolds, Philip Morris and Lorillard - paid a pool of six board-certified otolaryngologists to testify in over 50 cases, using methods to support their testimony that researchers deemed unscientific.
"By highlighting an exhaustive list of potential risk factors, such as alcohol, diesel fumes, machinery fluid, salted fish, reflux of stomach acid, mouthwash and even urban living, they created doubt in the minds of the jurors as to the role of smoking in the plaintiff's cancer," the authors report.
With the prevalence of obesity and sugary drinks in the US, arrangements such as the one between Coca-Cola and GEBN cannot but appear problematic. The Centers for Disease Control and Prevention (CDC) state that around half of the US population consume sugary beverages every day.
While many policy-making groups are looking to reduce the rate at which such beverages are consumed, the existence of scientific research arguing that sugary drinks are not hazardous to health will prove to be a stumbling block.
Consuming small amounts of sugary drinks from time to time will not necessarily harm an individual, but repeated messages suggesting that such drinks are fine and that exercise is more important could have a long-lasting effect on public health.