The Coke Controversy: The Marketing Message That Could Spell Trouble for People Dealing with Diabetes and Obesity
With commentary by David Katz, MD, founding director of the Prevention Research Center at Yale University and an associate professor of public health practice at the Yale University School of Medicine
Can people who are overweight or at risk for diabetes drop pounds and get healthy via exercise alone, without thinking about calories or what they eat? In the wake of a report in The New York Times about the Coca-Cola Company’s $1.5-million funding of the Global Energy Balance Network (GEBN) and its researchers, experts say the group’s focus on burning calories through activity— and downplaying of the role food intake plays—could spell trouble for people with blood-sugar or weight concerns.
Type 2 diabetes currently affects more than 27 million Americans, 8 million of who are undiagnosed. More than one-third, or 78.6 million American adults are obese.
"It’s true that the balance between calories in and calories out determines weight,” says David Katz, MD, founding director of the Prevention Research Center at Yale University and an associate professor of public health practice at the Yale University School of Medicine. “And it’s true that exercise and a healthy diet are both vital for good health. But the revelation of Coca-Cola’s undisclosed sponsorship is a public health scandal because it’s an enormous conflict of interest. For a company that sells highly-caloric drinks to sponsor a message suggesting exercise may be more important than food turns it into willfully-manipulated gobbled-gook. You can’t lose weight with exercise alone. You can’t prevent or control diabetes without looking at the food you eat —and in particular, avoiding sugar-sweetened soft drinks and even artificially-sweetened versions.”
In a statement released late Monday night, James O. Hill, Ph.D., executive director of the University of Colorado Anschutz Health and Wellness Center and President of the GEBN said, “Recent media reports suggesting that the work of my colleagues and me promotes the idea that exercise is more important than diet in addressing obesity vastly oversimplifies this complex issue. As a researcher on weight control and obesity for more than 25 years, the author of two books on the subject and co-founder of the National Weight Control Registry, I can say unequivocally that diet is a critical component of weight control, as are exercise, stress management, sleep, and environmental and other factors. The problem does not have a single cause and cannot be addressed by singling out only one of those factors in the solution.”
Yet the group’s website does, at times, question the role of calories from food in the growing obesity epidemic: “There is no firm evidence that Americans are eating any more calories/pound/day than they did decades ago,” noted Steven Blair, PED, professor of exercise science at the University of South Carolina’s Arnold School of Public Health and vice-president of the GEBN. “While we believe that energy intake is important for weight management, we think that declining energy expenditure is a critical contributor to the obesity epidemic and should not be ignored. We believe that in order to prevent weight gain, increases in energy expenditure are necessary.
And in a video promoting the network, Blair says, “Most of the focus in the popular media and in the scientific press is, 'Oh they're eating too much, eating too much, eating too much'—blaming fast food, sugary drinks and so on. And there's really virtually no compelling evidence that that, in fact, is the cause."
An occasional glass of soda or bag of fries isn’t a problem, says J. Michael Gonzalez-Campoy, MD, PhD, FACE, Medical Director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology, PA (MNCOME) and medical advisor for EndocrineWeb. “Excessive sugar intake, excessive fat intake, and excessive salt intake do not impact health negatively if it happens infrequently,” he says. “But if any one of these is ingested in excess chronically, the body then has to change to accommodate it.”
For example, a recent analysis from the UK’s University of Cambridge, published in the British Medical Journal, estimates that sipping one sugar-sweetened drink per day increases risk fo type 2 diabetes by 18% —and could be responsible for 1.8 million cases of Type 2 diabetes in the U.S. Sugary drinks may raise risk even for people who are not overweight, the study found. And other research suggests high intake of sweeteners may increase odds for diabetes by reducing insulin sensitivity and increasing inflammation, not just by promoting weight gain.
“A healthy meal plan (not diet) plays a central role in the management of excess weight for someone with diabetes. So does physical activity. Not one or the other, but both,” says Dr. Gonzalez-Campoy. We cannot afford to ignore calories and just focus on getting more activity. Few of us can increase caloric expenditure to the degree where it alone can overcome caloric intake.” The same holds true for people with prediabetes who want to reduce their risk for developing diabetes, he adds.
EndocrineWeb Medical Advisory Board member Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE of the Kovler Diabetes Center in Chicago, agreed. “Just look at the results of the Diabetes Prevention Program study,” she says. “People lost weight and lowered their risk for diabetes by 58% over three years when they reduced calories on a healthy eating plan and got exercise. Calories and food choice matter – you need activity, but it’s very difficult to burn off the hundreds of calories you might get from a big dessert or over-sized portions. Making one healthy eating change, like filling half your plate with fruit and vegetables, is a good place to begin.”