The intentions and underpinnings of our current food system—industrial agricultural and food processing—were well intended. Diseases of hunger, starvation, and vitamin deficiencies were rampant in the early twentieth century, and while many around the world are still food insecure, we have taken giant steps in fixing these issues with mass production of abundant (albeit highly starchy processed) calories and vitamin fortification. But over the last 40 years the very systems that helped humanity now endanger it and our environment. The legacy methods and products of the food and agriculture system are a monstrous ship to turn and often resist threats of change and fear financial loss. However, new global problems of overconsumption, undernutrition, obesity, chronic disease, and increasingly destructive agricultural production methods driving environmental degradation and climate change demand a new perspective. The current food and agriculture monopoly sees change as a financial threat. But innovations and consumer and market pressures, especially the millennials’ demand for brand integrity, sustainability, and health promotion, are driving very rapid innovations in the food and ag sectors. Taking a sober look at the existing food system and the corporations behind it and their behavior is important in defining the obstacles and opportunities for transforming our food system.
Obesity and chronic disease are no longer just first-world problems. For a long time, I thought our Western diet was just that—a diet that was killing mostly people in the developed world with access to lots of processed foods and fast-food outlets. Turns out we created the worst diet on the planet and shipped it across the globe. As sales of processed food are going down in the United States and Europe, they are dramatically rising in Asia, Africa, and Latin America. This is not an accident. It is by design. The globalization of processed, industrial food has allowed Big Food and Big Ag to flood the world with their disease-causing products. From Mexico to Nigeria, India, China, and the South Pacific, giant food companies are transforming the local diets, uprooting the healthy traditional foods that people have eaten for centuries and replacing them with ultraprocessed Frankenfoods.
“Growth is very stagnant for global food companies in places like Western Europe and the United States and Japan because they’ve saturated the market,” says Barry Popkin, an expert on global obesity and professor of nutrition at the University of North Carolina at Chapel Hill. “All the profit gain that every global food company sees is in low- and middle-income countries.”
Not only are multinational companies pushing aggressively into developing markets, but they are also proudly explaining their strategy to investors. “Half the world’s population has not had a Coke in the last 30 days,” Ahmet Bozer, the president of Coca-Cola International, told a group of investors in 2014. “There’s 600 million teenagers who have not had a Coke in the last week. So, the opportunity for that is huge.”1 With data showing that soda kills, that sugar is addictive, this thinking is immoral and unethical.
Chains like McDonald’s, Burger King, and KFC now have more locations in other countries than they have in the United States. Only a couple of decades ago Yum! Brands, the parent company of KFC, Pizza Hut, and Taco Bell, derived less than a third of its profits from outside the United States. Today, more than 60 percent of its profits come from outside America. As of 2019, the company had more than 1,000 Pizza Hut and KFC locations in Indonesia, 600 locations in Mexico, and more than 800 fast-food outlets in India.2 In Ghana, where KFC has a growing presence, obesity rates have increased by 650 percent since 1980.3 Yum! is spreading across the globe like wildfire and shows no signs of slowing down.
As top company executive Keith Siegner told investors at a conference in December 2018, the company is operating at an unprecedented scale: “We’ve got 46,000 restaurants. We’re opening seven new restaurants a day. In the last 12 months alone, we opened—we’ve got 10,000 more restaurants doing delivery.”4
This phenomenon has had a dramatic effect: Obesity rates have doubled in more than seventy countries since 1980 and tripled in children.5 A 2014 Lancet study found that two-thirds of the world’s obese live not in affluent countries but in low- and middle-income countries.6 There are now more overweight people on Earth than there are people who are hungry (2.1 billion vs. 800 million), though the two aren’t mutually exclusive. In many developing countries the new trend is people who are simultaneously overweight and malnourished, thanks to a steady diet of foods that are energy dense and nutrient poor. In some developing countries, it is common to find an obese mother and father raising underweight children with vitamin deficiencies.
In countries such as Vietnam, China, Indonesia, and Brazil, up to two-thirds of households suffer from this dual burden, creating what one recent report in the International Journal of Obesity called “a significant public health concern.”7 The Population Reference Bureau, a nonprofit that works to protect public health and the environment, studied the double burden of disease and found that it was a direct result of steering people in developing nations away from their traditional diets and physically active lifestyles.8
Traveling to countries where political barriers have kept out Big Food underscores the difference. I recently traveled to Cuba, where there are no chains and few Big Food brands, the result of the American trade embargo. Almost no one was overweight. Cuba’s life expectancy is greater than that of the United States while spending only 1 percent of what the United States spends on health care.
Food industry marketing in these emerging markets is clever and insidious. In the Western world, fast food is associated with low socioeconomic status. McDonald’s, Burger King, and KFC are not exactly fancy food choices in New York or London. But in poorer countries, fast-food companies market their brands as “aspirational”—a symbol of wealth and high status. In China, KFC uses cosmopolitan young professionals to create the impression that their fried chicken and biscuits can provide a taste of high society.
In addition to slick and manipulative marketing, fast-food chains establish a foothold by catering to local tastes. In Ghana and Nigeria, for example, Domino’s Pizza franchises offer a pizza topped with jollof rice—a popular West African staple made with spices, peppers, and onions. Fast-food companies use these local favorites that would otherwise be nutritious and satisfying on their own as a Trojan horse. Travel to China and you can get a dried pork and seaweed doughnut full of sugar and vegetable oils at Dunkin’ Donuts. In Japan you can get a giant pizza topped with tuna at Domino’s Pizza. Take a trip over to India and you can pick up a veggie burger dripping with melted paneer served alongside a mango shake at one of the more than one hundred Burger King locations across the country.
The effects of Big Food’s incursions into these countries is clear. India is now known as the diabetes capital of the world, with more than 73 million people suffering from the disease.9 One public health watchdog in India described the country as sitting on a volcano of diabetes. This is in a country where obesity was once unheard of. Only a couple of decades ago infectious diseases like malaria, pneumonia, and tuberculosis were the leading causes of death in India, but today those infections have been eclipsed by the epidemic of heart disease, which is now India’s number one killer.10 What is worse is that those infectious diseases haven’t gone away. They still kill hundreds of thousands of Indians every year. It’s just that now the country’s health care system has to grapple with the crises of infectious and chronic diseases simultaneously.
China is close behind. Diabetes is spreading so quickly there that some experts say the country cannot build enough hospitals to keep up. The International Diabetes Federation projects that by 2030 roughly 130 million people in China will have diabetes. That’s more than 1 in 10 people, whereas 30 years ago it was 1 in 150!11
The Arab world has also been flooded with soft drinks and processed food. The Middle East and North Africa have had the second-highest increase in diabetes globally; the number of people with the disease is projected to soar more than 95 percent by 2035.12 In some Arab countries, one in three or four people have type 2 diabetes. In one or two generations they transformed from a nomadic people without chronic disease to a people with the highest rates of obesity and type 2 diabetes in the world.
The unintended consequences of free trade in Mexico (NAFTA) allowed the American food industry to quickly expand there as purveyors of soda and fast food.13 Now water costs three times as much as Coke in Mexico. In the United States one in ten American adults have type 2 diabetes; in Mexico one in ten children have it. We used to call it adult-onset diabetes because it never existed in children until recently.
The fast-food pandemic has spread to some surprising places too. Thailand is well-known for its large population of Buddhist monks, many of whom follow an age-old tradition of daily intermittent fasting to protect their health and aid their meditation sessions. But in 2018, public health experts reported that nearly half of all Buddhist monks in Thailand are obese and at least 10 percent are diabetic. When researchers studied the monks’ dietary habits, they were initially baffled. The monks generally consume fewer calories than the average man in Bangkok, and they fast daily. What could be making them so fat and sick? Then they discovered the problem: The monks tend to sip on soft drinks throughout the day to keep up their energy levels. “When we really do research about this, we are surprised,” a Thai nutritionist told the Australian Broadcasting Corporation. “It is the drink.”14
In the same week that Thai health experts raised the alarm about the outbreak of obesity among Buddhist monks, the WHO declared that the home of the world’s so-called healthiest diet, the Mediterranean, was also being ravaged by the spread of ultraprocessed food. Mediterranean countries now have some of the highest rates of obesity in Europe. In Italy, Spain, Greece, and Cyprus, childhood overweight and obesity rates have surged past 40 percent. If the birthplace of the world’s healthiest diet is not safe, then no place is—the food industry is certainly making sure of that.
In 2017 the New York Times published an investigative series called “Planet Fat” that exposed some of the more brazen and shocking tactics that Big Food is using to uproot traditional diets in its quest to squeeze profits out of developing countries. The series showcased how the world’s largest food company, Nestlé, recruits thousands of women in some of the poorest towns in Brazil to go door-to-door selling candy and processed foods as part of its plan to expand its reach to a quarter million Brazilian households. The series profiled one young woman named Celene da Silva, a twenty-nine-year-old mother of three who sells candy in Fortaleza, where many people do not have access to grocery stores.
As she dropped off variety packs of Chandelle pudding, Kit-Kats and Mucilon infant cereal, there was something striking about her customers: Many were visibly overweight, even small children. She gestured to a home along her route and shook her head, recalling how its patriarch, a morbidly obese man, died the previous week. “He ate a piece of cake and died in his sleep,” she said. Mrs. da Silva, who herself weighs more than 200 pounds, recently discovered that she had high blood pressure, a condition she acknowledges is probably tied to her weakness for fried chicken and the Coca-Cola she drinks with every meal, breakfast included.15
In Colombia, where soft drinks are cheaper than water, public health advocates were threatened when they pushed for a 20 percent soda tax and produced television commercials warning the public that soft drinks could lead to diabetes. One outspoken anti-soda advocate raced through the streets of Bogotá as food industry strongmen on motorcycles chased her, warning her to keep her mouth shut. Other anti-soda advocates in Latin America accused the industry of tapping their phones and computers with spyware. News outlets that published stories and columns criticizing the soda industry in Colombia faced enormous pressure from the food industry and censorship by the government. Even health groups that tried to run ads warning about the health hazards of soda found themselves censored.16 The food industry made the government an offer they couldn’t refuse, “encouraging” them to pass a law making it illegal to talk about soda taxes in the media or advertising.
“They have threatened advocates in Colombia physically,” Popkin told me. “Walking, driving by them and making threats. They have worked their power to ban marketing in a country like Colombia, where you had to take them to court to stop it. They are doing everything they can to stall.”
Hope is on the horizon. Big Food finally met its match in Chile. More than half of all six-year-olds and three-quarters of adults in Chile are overweight or obese. The country’s health care system spends roughly $800 million every year on obesity-related conditions.
In 2006, a doctor from Santiago named Guido Girardi, also a deputy in congress, was elected to the country’s senate. Having seen the health crisis firsthand, Girardi vowed to take on the food industry by aggressively going after their predatory marketing practices. Girardi became president of the Chilean senate’s Health Commission, and later president of the senate in 2011, and spearheaded an alliance of nutrition experts to study and gather evidence on the best ways to rein in Big Food. The alliance brought in advisers from around the world, such as Barry Popkin. What did they come up with? A groundbreaking and sweeping new law called Ley de Etiquetado Nutricional y Su Publicidad, which roughly translates to the Food Labeling and Advertising Law. While there are challenges in its approach, the overall effort is laudable. Here are some of its major changes:17
1. Food companies must display big black warning logos in the shape of a stop sign on processed foods that are high in sugar, salt, saturated fat, or calories. If a food is high in one of these, then it gets a single black warning logo. Packaged foods that are high in all four of these—whether it’s ice cream, potato chips, salad dressing, flavored yogurt, or Nutella—get four warning logos on their labels. However, this unduly focuses on ingredients such as calories, saturated fat, salt, and sugar, which are easy for processed food companies to manipulate (remember low-fat SnackWell cookies), rather than on overall diet quality and protective foods. It is a step in the right direction, but this type of oversimplification, though well intentioned, may in fact lead to other unintended problems, as we saw with the low-fat revolution that resulted in our current obesity crisis.
2. Strict new limitations have been instituted on food advertisements, especially those aimed at children younger than fourteen. The measure bans the use of cartoon characters to market junk food to kids. Tony the Tiger was removed from Frosted Flakes. Toucan Sam was pulled from boxes of Froot Loops. Candies that use trinkets to lure kids, like Kinder Surprise, were banned. This may be the most important and effective piece of the legislation.
3. There are restrictions on the sale and marketing of junk food to children. No longer can ice cream, potato chips, and chocolate chip cookies be sold in schools or advertised during cartoons or on websites that target kids. In fact, junk-food commercials are no longer allowed on television or radio between 6 a.m. and 10 p.m.
4. Food companies must incorporate messages that promote physical activity and healthy eating in the advertisements for some of their products.
All of this came on top of a whopping 18 percent tax on sugary drinks—among the highest in the world. Girardi and his alliance tried to push the sweeping new measures into law but had to overcome ferocious resistance from the food industry, which packed the halls of congress with food lobbyists determined to block it.
For a while, the food industry’s lobbying efforts worked. The former Chilean president, Sebastián Piñera, a conservative businessman, vetoed the measure in 2011, offering an alternative: a health initiative financed by Big Food companies that emphasized the importance of exercise and moderation. But Girardi and his allies refused to give up. They spent weeks protesting outside Piñera’s home, holding cardboard signs accusing him of turning his back on the Chilean people.
“When transnational companies put pressure on Piñera to veto the law, we mobilized,” Girardi said in an interview. “I was president of the senate, and I went to the presidential palace with a big sign that said, ‘President Piñera is selling out the health of the kids to McDonald’s and Coca-Cola.’ I was there many days with the sign, and Piñera came out and asked me to leave because it was embarrassing. I said I’m not going to leave until you discuss this law with me. So, he took away the threat of the veto and we began to have a discussion.”
In 2014 Piñera was swept out of power and a new president came to power, Michelle Bachelet, a pediatrician and former health minister who was passionate about halting the chronic disease epidemic. Bachelet resisted the food industry’s lobbying efforts and in June 2015 approved the new regulations. They rolled out the changes over the next three years.18
Researchers are now studying exactly what impact the measures have had on consumers. Already there’s been a sea change in behavior. “Kids are telling their parents, ‘Don’t buy these foods because the teacher says they’re not healthy if they have the black logo,’” Popkin says. “That’s norm changing.” Popkin was crunching the numbers and in the process of publishing the data in a peer-reviewed journal when I spoke to him. He told me that the results of the regulations are “fourfold in impact of what we’ve seen from any tax or anything else in the world on sugar-sweetened beverages, let alone junk food and other things. The impact has been amazing.” No wonder the US food lobby works mightily, spending millions and millions, to prevent any restrictions on food marketing or labeling by the FDA or the Federal Trade Commission.
Chile has inspired more than a half dozen countries, including many of its neighbors in Latin America. Argentinian health officials are examining what Chile did. Brazilian health authorities are looking at adopting similar measures. And Uruguay and Peru have already taken concrete steps toward slapping the black warning logos on junk foods.20 But one of the most admirable new food-labeling systems is in Israel, where health authorities have created new laws requiring negative warning labels for junk foods and positive logos for nutritious foods like fresh produce, whole grains, and legumes. That may be the best way to get people to purchase more whole foods. Girardi says that it’s important to spread these policies because consumers need to be better informed about the food choices they’re making. At the same time, lawmakers, academics, and consumers need to continue building coalitions to counter the power and manipulative tactics of the food industry.
Even beyond food labeling, the radical new system in Chile that Girardi spearheaded proves that strict regulations and taxation are the levers that can force multinational food companies to change—because they will not do it voluntarily. In the United Kingdom, for example, food companies complied with new regulations forcing them to reduce the amount of sodium in their products. But they did not make those same changes to their products in the United States until the New York City Health Department under Michael Bloomberg required similar changes. It was the same with trans fats: Even though they had the technology to replace these deadly fats with healthier ingredients, many food companies refused to make the change until laws in various countries required them to do so.
It’s sad to see how far Big Food has reached with its tactics for pure profit. Fortunately, many countries are recognizing the detrimental effects and taking action to protect their people. Chile’s successes with labeling and the soda tax provide an example of how in our great country we most certainly can do the same. It’s time we act.