PERSPECTIVAS PERSPECTIVES 1

Conflicts of interest in food and nutrition

Conflitos de interesse em alimentação e nutrição

Conflictos de interés en alimentación y nutrición

Fabio da Silva Gomes 1

1Instituto Nacional de The existence of conflicts of interest in the field of recognize nutritional problems as expressions of
Câncer José Alencar Gomes
da Silva, Rio de Janeiro,
food and nutrition is not new, but has intensified flaws in the food system 1,2. It is thus possible to
Brasil. and has been better documented during the past identify common, structural causes that account
decade, in terms of both knowledge production for different problems, such as obesity, micronu-
Correspondence
F. S. Gomes
and dissemination, and of policy formulation trient deficiencies, and other forms of malnutri-
Instituto Nacional de Câncer and management. Since the 1970s, more than tion, therefore avoiding ineffective or palliative
José Alencar Gomes da Silva. eight thousand articles about conflicts of inter- solutions. Moreover, it is necessary to identify
Rua Marquês de Pombal 125,
5 o andar, Rio de Janeiro, RJ est were published in health sciences reference and characterize the responsible for such flaws.
20230-240, Brasil. databases (MEDLINE and LILACS). In contrast, There is broadly documented evidence that
fabiodasilvagomes@gmail.com
only a few dozen food and/or nutrition-related these dramatic changes in the food systems and
articles were published during the past 20 years, in the feeding of populations have been imposed
three fourths of which in the last decade alone. globally by large transnational corporations 1,2,3.
The recent increase in documenting food and Such changes affect the way food is produced,
nutrition-related conflicts of interest is propor- supplied, prepared and eaten, with the ultimate
tionally higher than what was observed for the goal of generating wealth for these corporations
overall publications in the same databases. This and increasing their market share in a concen-
indicates that the conflicts intensified or that trated way (Table 1). Therefore, in addition to the
the recognition of conflicts as such expanded, nutritional problems they trigger, these corpo-
and/or there was stronger motivation to make rations also cause an important negative effect
them visible. on inequity, starting from the corporate environ-
Both in knowledge production and dissemi- ment itself. A study conducted in 2013 revealed
nation and in the formulation of food and nu- that an employee of the McDonald’s Corporation
trition policies, the growth, intensification and in the United States needs to work 1,196 hours to
increased visibility of the conflicts of interest, and receive the equivalent of one hour’s work of the
lack of compliance with them are partially based company’s CEO 4.
on the increase of flaws in food systems, which The socioeconomic, environmental and cul-
prevent them from fulfilling their purpose of en- tural impact 5,6 of this model imposed by such
suring suitable, healthy food to the population. corporations also favors an increase in the rec-
Therefore, in order to move forward in facing ognition of conflicts that previously were not
conflicts of interest in this field, it is necessary to acknowledged as such. Therefore, the intensifi-

http://dx.doi.org/10.1590/0102-311XPE011015 Cad. Saúde Pública, Rio de Janeiro, 31(10):1-8, out, 2015

2 Gomes FS

Table 1

Characterization of the ten largest transnational corporations that are members of the International Food & Beverage Alliance (IFBA) according to their
products, practices, policies and market share.

Company Global market share Examples of associated Policies *** Products # Practices ##
* (product) organizations and
initiatives operating
internationally **

The Coca-Cola Co. 52% (soft drinks and IFBA, ILSI, Beverage “In 2011, we built Sugary drinks Yes (e.g., placement
other carbonated Institute for Health strong momentum soft drinks vending
beverages) & Wellness, EPODE toward our 2020 goal of machines in schools
International Network, doubling our business and health care
GAIN Business Alliance over the course of this facilities)
decade”; “For 2011, we
ramped up our efforts
to win with Coca-Cola,
the oxygen of our
business” ###
Ferrero 8% (chocolate IFBA, ILSI, EPODE “Ferrero has been Sweets, candies, Yes (e.g., associating
confectionery) European Network present in Brazil chocolate confectionery sugary edible products
since 1994, when it and other sugary with toys that are
introduced the Kinder products attractive to children)
Surprise in the market.
At first there were
only 10 employess,
all with the common
goal of developing
and expanding the
company” §
General Mills 15.7% (snack bars) IFBA, ILSI, The Bell “As we turn to our Cereal extrudates and Yes (e.g., the use of
Institute of Health 2015 fiscal year, our other sugary products; websites and interactive
and Nutrition, Cereal number one priority is ice creams with high games associated
Partners Worldwide, to accelerate our net concentrations of with products
SUN Business Network sales growth”; “Our sugar, fats and energy; adevertisement – i.e.
advertising and media ready-to-eat meals and “advergames” –
investment has grown soups, sauces, cookies targeted for children)
by 19 percent from and other snacks with
2009 levels to $870 high concentrations of
million worldwide in salt, sugar, fats and/or
fiscal 2014” §§ energy

(continues)

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 CONFLICTS OF INTEREST IN FOOD AND NUTRITION 3

Table 1 (continued)

Company Global market share Examples of associated Policies *** Products # Practices ##
* (product) organizations and
initiatives operating
internationally **

Kellogg Co. 29.9% (cereal extrudates IFBA, ILSI, W. K. Kellogg “The most recent and Sugary cereal Yes (e.g., the use of
and breakfast cereals) Foundation largest program that extrudates characters with appeal
is currently active is to children on packages
Project K (...). The of colorful sugary
focus of the program cereal extrudates)
will be to strengthen
existing businesses in
core markets, increase
growth in developing
and emerging markets,
and drive an increased
level of value-added
innovation” §§§
Mars Inc. 14.1% (chocolate IFBA, ILSI, IDFA, EPODE “We are very pleased to Sugary drinks; Yes (e.g., promoting
confectionery) European Network, have a leader of Jean- confectionery, candies, the purchase of ultra-
GAIN Business Alliance, Christophe’s caliber at chocolate confectionery processed products
SUN Business Network the helm of the global and other products with through social media
chocolate business. high concentrations of advertisement, e.g.,
Jean-Christophe’s sugar and/or energy Facebook, Twitter;
proven leadership, designing of excessively
strategic mindset colorful ultra-processed
and background in products to attract
finance and general children)
management will help
continue the growth of
this important segment
within our business”
(Grant Reid, president
of Mars Inc., about the
president of Global
Chocolate, Mars Inc.) †
McDonald’s Corp. 13.5% (fast-food snacks) IFBA, ILSI, Ronald “Vision, mission, Sandwiches with high Yes (e.g., association
McDonald House aspiration: be our concentrations of of ultra-processed
Charities customers’ favorite energy, salts and fats; products with children-
place and way to eat” †† sugary drinks and appealing characters,
other products with such as clowns and
high concentrations of animation characters)
energy, sugar, salt, and/
or fat

(continues)

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4 Gomes FS

Table 1 (continued)

Company Global market share Examples of associated Policies *** Products # Practices ##
* (product) organizations and
initiatives operating
internationally **

Mondelez 18.2% (cookies); 14.3% IFBA, ILSI, Save the “We promote Sugary drinks, Yes (e.g., promoting
International Inc. (candies, chocolates and Children our products with confectionery, candies, contests, competitions,
other confectionery) advertising, marketing, chocolate confectionery sales and give away
sales incentives and and other sugary prizes to encourage
trade promotions”; “We products; ice creams purchase and intake
expanded our brand with high concentrations of sugary drinks and
presence across digital of sugar, fat and energy; other ultra-processed
media and continue ready sauces, cookies products)
to make our working and other snacks with
media more effective” high concentrations of
††† sugar, fat, salt and/or
energy
Nestlé SA 12.2% (ice creams and IFBA, ILSI, IDFA, EPODE “We have deep roots Sugary drinks, cereal Yes (e.g., placement
chocolate confectionery) International Network, in emerging markets, extrudates and other and expansion of
Nestlé Nutrition where we have sugary products; ice ultra-processed
Institute continued to expand creams with high products with high
our presence” ‡ concentrations of concentrations of
sugar, fat and energy; sugar, salt, fat and/or
ready-to-eat meals energy in indigenous
and sauces, instant, and low-income
soups, cookies and communities)
other snacks with high
concentrations of salt,
sugar, fat and/or energy
PepsiCo Inc. 29% (sweet and IFBA, ILSI, Save the “A growing perecntage Sugary drinks, savory Yes (e.g., sponsorship
savoury snacks); 19.8% Children, GAIN Business of our advertising and cereal extrudates of scientific meetings
(soft drinks and other Alliance, SUN Business marketing spend is now and other savory and and organizations
carbonated beverages) Network dedicated to digital sugary products; ready- related to the nutrition,
platforms as consumers to-eat meals, soups, and of sports events)
dramatically change sauces, cookies and
the way they engage other snacks with high
with media. We are concentrations of salt,
leveraging Facebook, sugar, fat and/or energy
Twitter, Instagram
and other channels
in innovative ways to
produce compelling
content, drive
engagement and build
brand equity”; “In 2014,
we launched our largest
ever global campaign
for Pepsi and Lay’s,
cross-promoting these
brands in 28 markets” ‡‡

(continues)

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 CONFLICTS OF INTEREST IN FOOD AND NUTRITION 5

Table 1

Company Global market share Examples of associated Policies *** Products # Practices ##
* (product) organizations and
initiatives operating
internationally **

Unilever 20.9% (ice creams); IFBA, ILSI, IDFA, “Vision – to double the Sugary drinks, cereal Yes (e.g., using images
15.8% (instant and Choices Programme, size of the business”; extrudates and other of ingredients on labels
ready soups) Save the Children, GAIN “We spend about €7 sugary products; ice of products that do not
Business Alliance, SUN billion annually on creams with high contain, or contain only
Business Network marketing, making concentrations of sugar, a trace of the ingredient
us one of the world’s fat and energy; ready- portrayed on the label)
biggest advertisers” ‡‡‡ to-eat meals, soups,
sauces, cookies and
other snacks with high
concentrations of salt,
sugar, fat and/or energy

GAIN: Global Alliance for Improved Nutrition; IDFA: International Dairy Food Association; ILSI: International Life Sciences Institute; SUN: Scaling Up Nutrition.
* Global market share in 2014 (percentage of retail value). Source: Euromonitor International;
** Organizations and/or alliances and initiatives designed, founded, funded, led, controlled or organized by such company (jointly with other companies or
not);
*** Policies, objectives, principles, visions, missions and/or goals that reinforce the expansion of the referred products and practices;
# Products manufactured by the company that are not recommended for healthy and sustainable diets (e.g. edible products with high concentrations of sugar,
fats, salt, energy, other ultra-processed products or any other product whose demand, offer or availability should be reduced to improve the population’s
nutrition and health);
## Practices adopted by the company to increase the demand, offer or availability of non-recommended products, or to encourage non-recommended eating
practices (e.g. overeating, lonely eating, mindless eating, binge eating, fast eating);
### The Coca-Cola Company 2011 Annual Review;
§ http://www.ferrero.com.br/ferrero-do-brasil;
§§ General Mills 2014 Annual Report;
§§§ Kellogg Company 2014 Annual Report;
† http://www.mars.com/global/press-center/press-list/news-releases.aspx?SiteId=94&Id=6036;
†† http://news.mcdonalds.com/Corporate/news-stories/2014/McDonald-s-Reports-First-Quarter-2014-Results; http://www.mcdonalds.co.za/story;
http://www.mcdonalds.com.my/about_us/corporate_info/mission.aspx; https://www.mcdonalds.es/empresa/quienes-somos/principios-y-valores;
††† Mondelez International, Inc. Annual Report 2014;
‡ Nestlé Annual Report 2012;
‡‡ PepsiCo, Inc. Annual Report 2014;
‡‡‡ Unilever Annual Report and Accounts 2014.

cation of conflicts of interest in the field of food the previously mentioned wealth accumulation
and nutrition also results from advances in so- and market concentration. As a result, the busi-
cial recognition of food and nutritional prob- ness sector begin to work even more aggressively
lems by sectors other than those directly related in preventing and delaying solutions focused
to the matter. The United Nations General As- on structural causes that are sustained and en-
sembly held in 2011 is a milestone that formal- hanced by transnational corporations. Instead of
izes the broad recognition of the matter, since, only defending itself or avoiding regulation, the
for the first time in history it was on the agen- sector openly (e.g., on behalf of a particular com-
da of the Member States represented by Heads pany) or covertly (e.g., by means of foundations,
of State, and not food, nutrition and health or professional, research, or non-for-profit orga-
authorities only. nizations that defend the interests of companies
This broader recognition of malnutrition as that founded, fund or control them) interfere in
a problem for societies signals an intensifica- the policy-formulation process.
tion of the search for solutions. The solutions Since the 2011 United Nations General As-
should tackle the causes and repercussions of sembly, the interferences towards supranational

Cad. Saúde Pública, Rio de Janeiro, 31(10):1-8, out, 2015

6 Gomes FS

organizations, such as the World Health Organi- vate Relationship in Food and Nutrition (http://
zation (WHO), have been intensified, but they regulacaopublicoprivado.blogspot.com), with
also reach the countries. Recently, the WHO one of its goals being the articulation of collective
launched a public consultation on its draft prin- actions to tackle and regualte conflicts of interest.
ciples and policies of engagement with non- Notwithstanding, there are still a number of
States actors, which has at the core of discussion situations in which individuals, organizations or
the distinction between actors in the public and institutions that act in favor of the public interest
in the commercial interest, and the avoidance, have difficulties in breaking conflicting interac-
prevention anf management of conflicts of in- tions with sectors of opposing interests. For this
terests. The public consultation has been closed, reason, some elements that may contribute to
but the document is still under discussion, and make such interactions be perceived as conflic-
at the center of the dispute, is the interaction of tual and justify their discontinuance will be pro-
private commerical actors with WHO, as well as vided here.
their role in the formulation of policies. In the case of food and nutrition, in order to
In addition to the direct pressure the WHO materialize or characterize the interests so as to
to interfere with policies, transnational corpora- identify those that oppose healthy and sustain-
tions also lobby within Member States in order able diets, one should go beyond the analysis of
to influence their position before WHO 7. As an the products manufactured by the companies,
example, it was recently exposed Italy’s position and also take into consideration their practices
against the new (more restrictive) recommen- and policies (including mission, goals, aims,
dations of WHO on sugar intake 8. The isolated principles, vision) 10. In addition to companies,
opposing position of that country surprised all organizations and initiatives in which they take
other 33 Member States of the WHO Executive part should also be considered, as presented in
Board. Later, the Italian Observatory on Global Table 1 and Figure 1.
Health revealed that a former advisor of the Fer- It is noteworthy that, just by the products,
rero group, an Italian manufacturer of confec- the non-interaction of a food and nutrition or-
tionary products, was a member of Italy’s Foreign ganization, for instance, with a manufacturer of
Relations delegation 9. products that are not recommended for healthy
Despite the growing visibility of conflicts of and sustainanble diets would already be justi-
interest situations, there are still cases where fied. However, there is often the argument that
the interaction between individual or collective the company manufactures other products that
parties is not clearly recognized as conflictual. are not contraindicated, and the discussions get
Moreover, with the political power highly sen- lost in defining what a healthy or non-healthy
sitive to economic pressures, United Nations’ product is, and do not advance. For this reason,
agencies and governments are more and more it is essential to gather information on the cor-
encouraged to take a favorable position in re- porate practices and policies that will reveal,
gards to the involvement of the private sector in undoubtedly, the interest of the company and
the formulation and development of food and related organizations.
nutrition policies, adopting an indiscriminate Table 1 presents examples of products, prac-
and quite reductionist perspective, commonly tices and policies of the ten largest transnational
stated as: “we must engage the private sector”. In corporations that are members of the Interna-
addition, transnational corporations make huge tional Food & Beverage Alliance (https://ifbal
investments to make conflicts of interest in food liance.org/about/members/) to illustrate the
and nutrition seem natural and/or invisible, and application of the criteria presented on Figure
reinforce a cynical denial about them. 1. These companies manufacture products and
On the other hand, there is a growing mo- promote practices that are not recommended for
bilization of initiatives to protect health public healthy and sustainable diets, and adopt policies
policies from the interference of commercial in- that reinforce the expansion of such products
terests. In 2011, a coalition of 160 national, re- and practices. Moreover, they hold significant
gional and international networks and organi- shares of these products’ global market (Table
zations endorsed a statement demanding from 1). Table 1 also serves as a basis to support the
the United Nations a clear distinction between discontinuance of conflictual interactions of or-
public-interest and business-interest organi- ganizations and professionals that do not recom-
zations (Conflicts of Interest Coalition; http:// mend or endorse the products, practices and/
coicoalition.blogspot.com/). In Brazil, dozens of or policies of the referred companies with these
individuals and civil society entities, research in- and others companies that manufacture such
stitutions and other organizations established, in products, promote such practices and/or adopt
2013, the Front for the Regulation of Public-Pri- such policies.

Cad. Saúde Pública, Rio de Janeiro, 31(10):1-8, out, 2015

 CONFLICTS OF INTEREST IN FOOD AND NUTRITION 7

Figura 1

Criteria for the identification of actors in the commercial sector that should not be engaged * in policy formulation processes, knowledge production and
dissemination, or capacity building in food and nutrition **.

Actors in the commercial sector that should not be engaged:

1. Arms, tobacco and alcohol industry.

2. Related industries, companies and organizations *** whose...

2.1. Products include genetically modified organisms, pesticides, synthetic fertilizers, beverages and edible products with high concentrations
of sugar, fats, salt, energy, other ultra-processed products or any other product that is not recommended or need to have its demand, offer,
production and/or availability reduced to improve population’s health and nutrition;

and/or whose...

2.2. Practices include:

2.2.1. Advertisement, promotion and other marketing strategies that aim at increasing the demand for the referred products and/or
promote or stimulate unhealthy ways of eating, such as overeating, lonely eating,mindless eating, binge eating, fast eating, or ways of
producing/growing foods that are based on the use of pesticides and genetically modified organisms, or;

2.2.2. Lobbying against legislative, economic, juridical or sociocultural measures that aim at reducing the production, supply, availability or
demand of the referred non-recommended products and/or the exposure to the referred unhealthy and unsustainable ways of eating and
producing foods;

and/or whose...

2.3. Policies, objectives, principles, visions, missions and/or goals include or related to the increase on the production, supply, availability or
demand of the referred non-recommended products and/or to the expansion of opportunities and promotion of the referred unhealthy and
unsustainable ways of eating and producing food.

* Not even as funders or supporters;

** Including courses, conferences and other technical-scientific meetings;
*** Any other organization and/or alliance and initiative conceived, founded, funded, led, controlled or organized by these industries and companies.

Other companies not listed on Table 1 may mainly the ones maintaining and disseminating
be similarly analyzed by the same criteria (Figure the problem and its causes. It could then be pos-
1) in order to identify those that oppose the pub- sible to achieve robust solutions that tackle the
lic interest in regards to improving population’s structures and actors responsible for the faults in
diet and health. The information about products, food systems that prevent the adequate nourish-
practices and policies of companies and related ment of populations.
organizations may be easily obtained in prod-
uct sales points, websites of the companies and
of their products, and/or annual reports of the
companies and related organizations.
The problems associated with the opera-
tion of transnational corporations, such as those
mentioned here, are evident. However, most
proposed or attempted solutions avoid this is-
sue, and those that face the issue are strongly op-
posed. For this reason, corporations and related
organizations responsible for that opposition
should be vigorously exposed and recognized as

Cad. Saúde Pública, Rio de Janeiro, 31(10):1-8, out, 2015

8 Gomes FS

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