Physical Activity Promotion as a Means to Foster Human and Planetary Health: The Need to Avoid Potential Conflicts of Interests With Unhealthy Commodity Industries

in Journal of Physical Activity and Health
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  • 1 Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Morelos, México

The COVID-19 pandemic has been a reminder of the relevance of underlying health conditions and planetary health for buffering new and future global health challenges.1 This situation has also highlighted the need to curb overconsumption and reliance on fossil fuels to preserve planetary and human health.2 Addressing the complex and interconnected underlying causes of all forms of malnutrition and physical inactivity can deliver multiple benefits for health, the environment, and the economy. For example, promoting walking and bicycling can increase physical activity, improve mental health, and prevent noncommunicable disease (NCD), while also reducing air pollution, energy consumption, and greenhouse emissions. Changing food systems to deliver healthy, safe, affordable, and sustainable diets for all can help prevent NCD while reducing land and water use as well as greenhouse emissions. Nonetheless, these changes may not be achieved through siloed interventions and will require systemic and aligned changes.

Health conditions, mainly NCD, are substantially driven as a result of unhealthy commodity industries, including alcohol, tobacco, and ultra-processed food producers, including sugary beverages.3 Automobile, construction, and entertainment business sectors are also contributors to noncommunicable disease epidemics given their influence on physical inactivity and unhealthy lifestyles.4 Ironically, unhealthy commodity industries have relied on physical activity as a strategy to seek corporate interests, oftentimes in detriment of public health.

Physical activity and sports are universally acknowledged for providing an opportunity to promote and encourage healthy behaviors; yet a range of unhealthy products have been promoted through sport and physical activity sponsorship. To date, common sponsors of sport and physical activity events include manufacturers of alcoholic beverages and ultra-processed foods, including sugary beverages, with a high content of critical ingredients for the development of NCD, such as saturated and trans-fat, sugar, and salt.5 Indeed, sports programs represent some of the most common means to promote junk food and sugary drinks among children.6 Evidence indicates that sport sponsorship by such companies creates an erroneous association between the sponsor and the promotion of community health and wellbeing.7 Furthermore, marketing exposure to unhealthy commodities have been consistently linked with unhealthy behaviors among children and adolescents.6 Sponsorship of sport by unhealthy products clearly opposes global efforts to reduce consumption of ultra-processed foods and promote physical activity to tackle increasing NCD rates.

Physical activity and exercise have also been used by the food and beverage industry to influence food and nutrition policies. Specifically, the concept of ‘energy balance’ has been often used to shift blame from food consumption to the lack of exercise and energy expenditure. For example, marketing strategies used by manufacturers of junk food and sugary drinks invite consumers to be physically active to burn calories and ‘enjoy’ the unhealthy, ultra-processed foods produced by them. This discourse focuses responsibility of unhealthy behaviors on consumers and refrains policies from addressing social, environmental, and commercial determinants of health. Intense lobbying at high government levels by the food industry has been documented in several countries trying to implement policy actions that go beyond programs exclusively focused on individual responsibility. Lessons from Mexico and other Latin American countries pioneering in the implementation of obesity related policies, such as taxing unhealthy food products, regulating the school environment, and adopting front-of-pack warning labels, have shown that these policies generally face strong opposition from the junk food and sugary drinks industry at the local level.8,9 At the same time, these industries develop corporate social responsibility activities related to physical activity,10 or fund nongovernment or civil society organizations dedicated to promoting physical activity.11 Although appearing altruistic, evidence has shown how most of these activities are in fact compensatory strategies used to deflect attention (ie, strategies that focus attention on health-enhancing physical activity as a mere means for caloric expenditure that compensates for intake, but are not paralleled by coherent strategies to promote healthy food consumption).10

Finally, the food industry has also invested in physical activity research and scientific partnerships. To date, various examples demonstrate how junk food and sugary drinks companies have established alliances with academic bodies and research institutions.12,13 Evidence suggests that these companies have used soft power techniques to influence the design and implementation of large international physical activity research studies.14 These alliances have also been used to delay and undermine policy efforts trying to address the nutrition-related commercial determinants of health.13 Additionally, one of the most pressing risks for researchers accepting funding with potential conflicts of interests is the “endorsement by association.” By establishing alliances with academic bodies, companies seek the endorsement of their products or activities by renowned researchers or academic associations.

In order to reach the proposed target of a 15% relative reduction of the global prevalence of physical inactivity by 2030, and “to ensure all people have access to safe and enabling environments and to diverse opportunities to be physically active in their daily lives,” the Global Action Plan on Physical Activity 2018–2030 urges nations to establish multisectoral partnerships, including partnerships with the private sectors.15 Although strategic partnerships are needed, strategies used by the unhealthy commodity industries should be considered when establishing new partnerships or reconsidering existing ones. In an attempt to prevent potential conflicts of interest in the promotion of physical activity, the plan suggests that partnerships may be established provided that the promotion of any brand or product is consistent with World Health Organization (WHO) recommendations on the restrictions of marketing to children of unhealthy foods and nonalcoholic beverages high in fat, salt, and sugar.1517 Such recommendations should be translated into effective mechanisms at the local level in order to safeguard public health strategies and research from commercial interests.

Mechanisms to identify, prevent, and manage conflicts of interest in health education, research, and policy have been put in place in various areas to avoid industry interference. The WHO Framework Convention on Tobacco Control set the first standards on how to promote transparency and accountability related to conflicts of interest.18 Other initiatives aiming to establish mechanisms to address potential conflicts of interest can be found in Latin America, where more than 1000 public health professionals in Mexico signed a pledge on priority activities to tackle the obesity epidemic, which includes a clear stand to shield health prevention and control efforts from conflicts of interest19; and a group of physicians, called Médicos sin Marcas,20 committed to providing evidence-based health care services responsibly and without influence of pharmaceutical and medical devices industries.20 These experiences may be drawn on to prepare a similar instrument to promote transparency and accountability related to conflicts of interest and avoid industry interference in the establishment of nutrition and physical activity policies. Recommendations should be disseminated and discussed among different sectors and actors, including government bodies, academic and research institutions, private industries, nongovernmental organizations, professional associations, physical activity and health care promoters and providers, and the community, in order to reach a consensus and contribute toward better policies, research, and practice in the physical activity area.

Addressing physical inactivity requires, now more than ever, a systems-oriented response embedded in a comprehensive human and planetary health-oriented strategy. Despite strategic partnerships being needed to reach the proposed reductions in the global prevalence of physical inactivity and contribute to sustainable development goals,15 it should be recognized that some of these partnerships may risk global efforts to promote human and planetary health. Stakeholders and industries interested in promoting or investing in physical activity that at the same time counteract at the local level other public health initiatives in favor of human and planetary health, should not be allowed to participate in public policy making or bias the science that underpins this process. Importantly, unhealthy commodity industries interested in being part of the solution should parallel their physical activity promotion efforts with coherent strategies to promote healthy food consumption and overall wellbeing. We must act now and collectively to safeguard future human and planetary health.

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    World Health Organization. Report of the Commission on Ending Childhood Obesity: implementation plan: executive summary. 2017. https://apps.who.int/iris/handle/10665/259349. Accessed May 10, 2022.

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    World Health Organization. WHO Framework Convention on Tobacco Control Overview. 2003. https://fctc.who.int/who-fctc/overview. Accessed May 11, 2022.

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    • Export Citation
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    Barquera S, Véjar-Rentería LS, Aguilar-Salinas C, et al. Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud. Salud Publica Mex. 2022;64(2):225229. PubMed ID: 35438918 doi:10.21149/13679

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Address author correspondence to alejandra.jauregui@insp.mx.

  • 1.

    The Lancet. COVID-19: a new lens for non-communicable diseases. Lancet. 2020;396(10252):649. doi:10.1016/S0140-6736(20)31856-0

  • 2.

    The Lancet Public Health. No public health without planetary health. Lancet Public Health. 2022;7(4):e291. doi:10.1016/S2468-2667(22)00068-8

  • 3.

    Moodie R, Stuckler D, Monteiro C, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet. 2013;381(9867):670679. PubMed ID: 23410611 doi:10.1016/S0140-6736(12)62089-3

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Parra DC, de Sá TH, Monteiro CA, Freudenberg N. Automobile, construction and entertainment business sector influences on sedentary lifestyles. Health Promot Int. 2018;33(2):239249. PubMed ID: 27561906 doi:10.1093/HEAPRO/DAW073

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Maher A, Wilson N, Signal L, Thomson G. Patterns of sports sponsorship by gambling, alcohol and food companies: an Internet survey. BMC Public Health. 2006;6(1):19. doi:10.1186/1471-2458-6-95/TABLES/5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Smith R, Kelly B, Yeatman H, Boyland E. Food marketing influences children’s attitudes, preferences and consumption: a systematic critical review. Nutrients. 2019;11(4):875. doi:10.3390/NU11040875

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Jones SC, Phillipson L, Barrie L. ‘Most men drink… especially like when they play sports’ – alcohol advertising during sporting broadcasts and the potential impact on child audiences. J Public Aff. 2010;10(1–2):5973. doi:10.1002/PA.340

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Pedroza-Tobias A, Crosbie E, Mialon M, Carriedo A, Schmidt LA. Food and beverage industry interference in science and policy: efforts to block soda tax implementation in Mexico and prevent international diffusion. BMJ Glob Health. 2021;6(8):e005662. doi:10.1136/BMJGH-2021-005662

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Barquera S, Rivera JA. Obesity in Mexico: rapid epidemiological transition and food industry interference in health policies. Lancet Diabetes Endocrinol. 2020;8(9):746747. PubMed ID: 32822599 doi:10.1016/S2213-8587(20)30269-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Leone L, Ling T, Baldassarre L, Barnett LM, Capranica L, Pesce C. Corporate responsibility for childhood physical activity promotion in the UK. Health Promot Int. 2016;31(4):755768. PubMed ID: 26082449 doi:10.1093/HEAPRO/DAV051

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Gómez L, Jacoby E, Ibarra L, et al. Sponsorship of physical activity programs by the sweetened beverages industry: public health or public relations? Rev Saude Publica. 2011;45(2):423427. PubMed ID: 21225220 doi:10.1590/S0034-89102011000200022

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Serodio P, Ruskin G, McKee M, Stuckler D. Evaluating Coca-Cola’s attempts to influence public health ‘in their own words’: analysis of Coca-Cola emails with public health academics leading the Global Energy Balance Network. Public Health Nutr. 2020;23(14):26472653. PubMed ID: 32744984 doi:10.1017/S1368980020002098

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    UK Health Forum. Public Health and the Food and Drinks Industry: The Governance and Ethics of Interaction | Nutrition Connect. 2018. https://nutritionconnect.org/resource-center/public-health-and-food-and-drinks-industry-governance-and-ethics-interaction. Accessed May 11, 2022.

    • Search Google Scholar
    • Export Citation
  • 14.

    Stuckler D, Ruskin G, McKee M. Complexity and conflicts of interest statements: a case-study of emails exchanged between Coca-Cola and the principal investigators of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). J Public Health Policy. 2018;39(1):4956. PubMed ID: 29180754 doi:10.1057/S41271-017-0095-7

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    World Health Organization. Global Action Plan on Physical Activity 2018–2030: More Active People for a Healthier World. World Health Organization; 2018. doi:10.1016/j.jpolmod.2006.06.007

    • Search Google Scholar
    • Export Citation
  • 16.

    World Health Organization. Set of Recommendations on the Marketing of Foods and Non-Alcoholic Beverages to Children. World Health Organization; 2012.

    • Search Google Scholar
    • Export Citation
  • 17.

    World Health Organization. Report of the Commission on Ending Childhood Obesity: implementation plan: executive summary. 2017. https://apps.who.int/iris/handle/10665/259349. Accessed May 10, 2022.

    • Search Google Scholar
    • Export Citation
  • 18.

    World Health Organization. WHO Framework Convention on Tobacco Control Overview. 2003. https://fctc.who.int/who-fctc/overview. Accessed May 11, 2022.

    • Search Google Scholar
    • Export Citation
  • 19.

    Barquera S, Véjar-Rentería LS, Aguilar-Salinas C, et al. Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud. Salud Publica Mex. 2022;64(2):225229. PubMed ID: 35438918 doi:10.21149/13679

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Médicos Sin Marca – Médicos Sin Marca – Chile. https://medicossinmarca.cl/. Accessed May 10, 2022.

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