Professionalism/Rhona Applebaum, Coca-Cola, and Health Research

=Background=

Obesity and Trends
Obesity is a health problem that can lead to other issues such as heart disease, diabetes, and high blood pressure. An individual is considered obese if their body mass index is over 30.

Due to the increase in portion size, convenience, and unhealthy appetites, obesity rates increased within the past decade and the United States leads the way. In 2012, 34% of adults and 15-20% of children were obese. In 2014, nearly 37% were obese. Portion sizes have increased and thus people eat excessively without realizing it. Americans also tend to eat at fast foods restaurants because of the convenience. Compared to the 1950s, Americans have been eating more fats, oils, and sugars and less vegetables and fruits. A healthy diet includes vegetables, fruits, whole grains, and high-quality protein.

Energy Balance
To maintain a stable body weight, over time, energy intake must exactly equal energy expenditure. This is the idea of energy balance or energy homeostasis. For someone to lose weight they must have a negative energy balance. Negative energy balance is when energy expenditure exceeds energy intake, and results in weight loss. Whereas positive energy balance where energy intake exceeds energy expenditure would result in weight gain.

Health Research
A research done by WC Miller, DM Koceja & EJ Hamilton in 1997 found sources of all human research reported in peer-reviewed scientific research to determine effectiveness of diet, exercise, and diet and exercise for weight loss. The researchers looked over 700 studies with 500 participants where intervention of diet, exercise, and diet and exercise were employed. In many of the 700 studies analyzed, the subjects were over 40 years and obese who participated in the studies for a short period (15-16 weeks). For exercise studies the duration tend to be shorter, younger, and had lower BMI than diet or diet plus exercise. The results show that the diet and diet plus exercise showed a larger amount of weight loss. It should also be noticed that diet plus exercise tend to be the superior program.

An analysis was done in 2014 on studies long-term efficiency of diet, diet plus exercise, and exercise. 22 reports met the criteria to be analyzed. The results show that diet and exercise had the greatest reduction with blood lipids and blood pressure compared to diet or exercise. In conclusion, "diet and exercise are recommended for long-term obesity management."

Most experts agree that exercise alone would not help obese people lose weight. Many studies have shown that diet and exercise would be the best for combating the obesity epidemic.

=Rhona Applebaum=

As the Chief Science and Health Officer of Coca-Cola, Rhona Applebaum was responsible for developing and executing the company's health and well-being strategy. Applebaum began this position with Coca-Cola in 2004. At this point, she was already considered a food scientist and had her Ph.D. in microbiology. While at Coke, Applebaum worked to improve the public's perception of the health effects of Coca-Cola products.

As a part of this position, Applebaum planned and developed the Global Energy Balance Network (GEBN), a network of health researchers using energy balance to advance the position that physical exercise is more important in counteracting obesity than diet. Applebaum retired from her position at Coca-Cola in October of 2015 after the extent of influence that Coca-Cola and Applebaum had in the GEBN was discovered.

=Global Energy Balance Network=

Overview
The Global Energy Balance Network (GEBN) was a health research network funded by Coca-Cola. “The group’s members were university scientists who encouraged the public to focus on exercise and worry less about how calories from food and beverages contribute to obesity." Coca-Cola gave the group a gift of $1.5 million, $1 million of which was given to the University of Colorado Medical School where James O. Hill, the president of the GEBN, was a professor and researcher. Coca-Cola played an instrumental role in the creation and funding of the GEBN.

According to the GEBN website, which has since been removed, "Energy balance is not yet fully understood, but there is strong evidence that it is easier to sustain at a moderate to high level of physical activity (maintaining an active lifestyle and eating more calories). Not many people can sustain energy balance at a low level of physical activity (maintaining a sedentary lifestyle and eating fewer calories), as attempts to restrict calorie intake over the long term are likely to be ineffective." The GEBN was proposing that it is easier to maintain a balance with "a high level of exercise and caloric intake." This view aligned with Coca-Cola's mission to reduce the negative press surrounding sugary beverages yet contradicted the results of previous studies.

James O. Hill (President)
Dr. James Hill is currently the Director of the Center for Human Nutrition at the University of Colorado Health Sciences Center and is a prominent researcher in weight management. He has 25 years of experience researching the causes of weight gain and obesity and is a strong proponent of more exercise in balancing the energy equation. As the president of the GEBN, Dr. Hill had direct contact with Coca-Cola executives during the GEBN's early development.

Steven N. Blair (Vice President)
Dr. Steven Blair is a professor the Arnold School of Public Health at the University of South Carolina whose research focuses on physical activity and health. Dr. Blair believes that the public is "blaming fast food, blaming sugary drinks and so on and there’s really virtually no compelling evidence that that in fact is the cause [of obesity].” Many of the referenced works on the GEBN website are attributed to Dr. Blair.

=Investigation= News outlets start to investigate the funding and relations between Coca-Cola and GEBN in 2015.

Applebaum Presentation
Applebaum laid out a strategy called "Balancing the Debate" in 2012 in a conference for Coke. This strategy is to discredit what the company describes as "detractors" in the scientific community. One of her equations used: research findings + professional opinion + dissemination => balance debate. She stated in the presentation that they will use science to help with Coke's strategy.

New York Times Article
On August 9th 2015, New York Times published an article of Coca-Cola's funding of GEBN. The article made transparent of the relationship between Coca-Cola and GEBN. Coca-cola has provided financial and logistical funding to the group to get the word out of a new science-based solution to the increase numbers of obesity. They believe the solution is "to maintain a healthy weight, get more exercise and worry less about cutting calories." According to the article, it is believed that Coke is using the group to convince the public that exercise can offset bad eating habits. While other health experts believe this message is misleading and was used for Coke to deflect criticism on sugary drinks. Coke donated $1.5 million to the group in 2014 to start the organization. Since 2008, Coke provided $4 million to the founders of GEBN, Dr. Blair and Gregory A. Hand, to support their projects. After the first publication from New York Times many other news outlets looked into the controversy.

Wall Street Journal Article
On August 19th 2015, Muhtar Kent wrote a response to the controversy in a Wall Street Journal article. Kent disclosed the advocacy for scientific research. He also said that the company would gather a panel of independent advisers on the financial support for research. In this article he stated, “By supporting research and nonprofit organizations, we seek to foster more science-based knowledge to better inform the debate about how best to deal with the obesity epidemic. We have never attempted to hide that. However, in the future we will act with even more transparency as we refocus our investments and our efforts on well-being.”

Coca-Cola/GEBN Emails
Applebaum's emails were obtained by The Associated Press on November 25, 2015. The Associated Press shared excerpts of emails from late 2012 between Applebaum and GEBN executives. An email on October 16, 2012 subject line by Applebaum wrote, "Ready for a stimulus pkg?" In the email, she tells Hill that she sold the concept of GEBN.

June 4, 2014
Hill emails Coca-cola executive to let them know the focus of the research should be energy balance. Stating, “We have given you ideas here. We have also given you ideas for research projects that might be very specific to coke interests."

July 9, 2014
Applebaum emails GEBN group with a revised proposal for the establishment of the group. In the proposal, “inject sanity and reason” into the debate about obesity and become the go-to resource for media.

Aug. 30, 2014
Hill emailed a Coke executive, “Here is my concept. I think it could provide a strong rationale for why a company selling sugar water SHOULD focus on promoting physical activity. This would be a very large and expensive study but could be a game changer. We need this study to be done.”

Oct. 14, 2014
Applebaum writes: “There you go! Than (sic) the # of experts and reputable orgs is too large for any naysayers to cull the pack and attack.”

Nov. 9, 2014
Hill writes: “It is not fair that Coca-Cola is signaled out as the #1 villain in the obesity world, but that is the situation and makes this your issue whether you like it or not. I want to help your company avoid the image of being a problem in peoples’ lives and back to being a company that brings important and fun things to them.”

=Aftermath=

Rhona Applebaum's Retirement
On November 25, 2015, directly following the release of her emails exchanged with GEBN, Rhona Applebaum stepped down from her position as chief science and health officer and retired. A spokeswoman for Coca-Cola indicated that Applebaum's decision to retire was made in October of 2015, and that her retirement “has been accepted and the transition is underway." Her position at Coca-Cola was never replaced.

Shut Down of GEBN
Following several condemning news articles and the release of emails exchanged between members of GEBN and Coca-Cola, GEBN officially discontinued its operations. A statement published on their website on December 1, 2015 claims that the group was shut down "due to resource limitations." The group also expressed its support of the advancement of energy balance research, stating, "We appreciate the commitment to energy balance that the membership has demonstrated since our inception, and encourage members to continue pursuing the mission 'to connect and engage multi-disciplinary scientists and other experts around the globe dedicated to applying and advancing the science of energy balance to achieve healthier living'."

Lawsuit
Following the discontinuation of GEBN and many similar scandals involving Coca-Cola, a lawsuit was filed against Coca-Cola on January 4, 2017 by Reverend William H. Lamar IV, Reverend Delman Coates, and the Praxis Project. The Praxis Project is a non-profit organization founded in 2002 by Makani Themba to "forge a more capable, diverse, effective, connected and visionary cadre of changemakers worldwide." The plaintiffs claimed that Coca-Cola had been deceiving customers by denying and obscuring soda's link to obesity, type-2 diabetes, and heart disease. According to Reverend Coates, "For far too long, Coca-Cola has been convincing people, including children, that soda is a source of fun and happiness and that it is safe to drink... Efforts to talk about the role of sugar drinks and advertising in these epidemics, including many of my own efforts—are hampered by the effects of Coca-Cola’s deceptive marketing.” In an interview with USA Today, a Coca-Cola spokesperson stated, "There is no scientific evidence that connects sugary beverages to obesity." The plaintiffs quoted this statement as an example of the deception and marketing that Coca-Cola propogates to improve its public image and sell more product, despite the acknowledgement of the link between soda and obesity by several prominent medical and health authorities. Steven Blair's assertion of a lack of evidence linking soda and obesity was also cited as evidence of Coca-Cola's deceptive practices. Their case compared Coca-Cola's campaign to diminish the link between sugary drinks and obesity to cigarette companies' attempts to portray smoking as glamorous to obscure its link to lung cancer. On February 23, 2017, the case was voluntarily dismissed without prejudice by the Praxis Project.

Consequences for Coca-Cola
Despite numerous articles and a lawsuit condemning Coca-Cola for their deceptive campaigning strategies, Coca-Cola saw minimal financial consequences as a direct result of GEBN's discontinuation. Coca-Cola had a reported quarterly revenue of $12.156 billion as of June 30, 2015. This number dropped to $11.427 billion by September 30, 2015 and continued to drop to $10 billion by December 20, 2015. However, during the following 6 months, their quarterly revenue increased to $11.539 billion. Coca-Cola has seen a decrease in revenue since then, although it is not clear if this decline can be attributed to Coca-Cola's involvement in the GEBN scandal. As of March 31, 2019, their quarterly revenue was reported to be $8.02 billion.

Coca-Cola's decline in revenue may be attributed to a steady increase in the number of states that impose a sugary drink tax. According to the Tax Foundation, as of 2018, 22 US states tax soda higher than groceries, up from none in January of 2015.

=Astroturfing= Following the shut down of GEBN, many have accused Coca-Cola of astroturfing, a practice in which an organization creates a group that appears to be originated from grassroots participants in order to indirectly portray their message. The created group provides the organization with credibility by withholding information of their financial connection.

Barry Popkin, a professor of global nutrition at the University of North Carolina at Chapel Hill, compared Coca-Cola's funding of GEBN to that of tobacco companies that enlisted the help of researchers to downplay the harmful effect of cigarettes, stating, "Coke is following the strategy used by the tobacco industry as they tried to create doubt among the general public and also politicians. It was very effective in the fights to regulate cigarettes and we have learned from this that it is essential to address these attempts and uncover what they are very rapidly."

By using a nonprofit group headed by university professors that strove to perform research on the cause of obesity, Coca-Cola was seeking to gain public trust and divert attention away from their products’ ties to obesity. Coca-Cola attempted to withhold information on their financial backing of GEBN, and when their funding was made public, GEBN was discontinued, further solidifying GEBN as an example of astroturfing.

=References=