In October 2015, the news made headlines around the world – processed meats such as bacon, sausages and ham are carcinogenic, raising the risk of colorectal cancer by 18% for every 50g consumed each day. This conclusion, from the WHO body International Agency for Research on Cancer (IARC), came from a thorough review of more than 800 studies. According to the findings, red meat may be classed as ‘probably carnicogenic’ too.

These results did not come outof the blue. Current public health recommendations already suggest limiting intake of meat, and a possible link with cancer has been examined many times over the years. What is more, the verdict was more nuanced than certain news stories suggested, with headlines such as the Daily Mail’s in the UK – "Health chiefs put processed meat at same level as cigarettes" – seemingly designed to mislead. According to the IARC itself, the findings need to be taken in context.

"Red meat has nutritional value. Therefore, these results are important in enabling governments and international regulatory agencies to conduct risk assessments in order to balance the risks and benefits of eating red meat and processed meat, and to provide the best-possible dietary recommendations," said Dr Christopher Wild, IARC director, in a press release.

This kind of caveat, however, was not sufficient to prevent fightback from the food industry. The North American Meat Institute (NAMI), which lobbies for US meat and poultry producers, said the verdict defied common sense and research, and that the review may not have been as impartial as it appeared.

"It was clear sitting in the IARC meeting that many of the panelists were aiming for a specific result despite old, weak, inconsistent, self-reported intake data," said Betsy Booren, NAMI vice-president of scientific affairs. "They tortured the data to ensure a specific outcome."

In a poll conducted by BEEF magazine, 79% of respondents agreed with the statement ‘Yes, the recently released cancer report saying beef is a carcinogen is bad science’, and Shalene McNeill, executive director of human nutrition research at the National Cattlemen’s Beef Association, claimed the available evidence does not support a causal relationship between any type of red or processed meat, and any type of cancer.

Meat the maker

As this latest ruckus rumbles on, it is plain to see how much weight the nutritional community places on WHO recommendations. It is also clear that the relationship between WHO and the food industry is occasionally adversarial and often fraught.

This was far from the first time a WHO nutritional recommendation had come into conflict with industry lobbyists. Earlier in 2015, WHO released new, stricter, recommendations for sugar consumption, specifying that adults and children should reduce their daily intake of free sugars to less than 10% of total energy intake, and that, for additional health benefits, they should cut down to below 5%.

While most academics supported these recommendations, industry bodies questioned the underlying evidence base, with the US Sugar Association stating the guideline "misleads consumers".

"Few governments prioritise health over big business. As we learnt from experience with the tobacco industry, a powerful corporation can sell the public just about anything." 

"Such a claim is serious and requires high-quality data, particularly given the potential for consumer confusion and the likelihood that the economic impact to developing countries will be severe," said a spokesperson.

This argument reignited a debate from 2003, when WHO first proposed the idea of a 10% upper limit for sugar. Back then, the US Sugar Association was so incensed that it threatened to put pressure on Congress to withdraw US funding to WHO.

At the time, this kind of pressure was not uncommon. According to a 2005 report in the Scandinavian Journal of Nutrition, when WHO created its Global Strategy on Diet, Physical Activity and Health, sections of the food industry did all they could to resist, lobbying directly to WHO and indirectly via member states. While the sugar industry was the main culprit in this regard, the salt industry and palm oil producers protested too. Their efforts persisted until the Global Strategy was adopted in May 2004.

"It was obvious that WHO’s initiative trying to prevent non-communicable diseases in the world by forming a global strategy evoked a lot of serious political issues, which were strongly connected with international industry and trade," wrote Kaare Norum of the Department of Nutrition at the University of Oslo.

Whose WHO?

On other occasions, WHO’s relationship with the food industry has been accused not so much of being overly conflicted but, rather, overly cosy. In November 2012, the organisation was forced to clarify that it did not take funding from the food and beverage industry after several erroneous media articles alleged otherwise.

A press release clarified that WHO uses a rigorous process to protect its work from undue industry influence. While the organisation does engage with the private sector on occasion, it is not allowed to accept funds from enterprises with a direct commercial interest in its projects’ outcomes, and all WHO experts are required to disclose their interests. If a declared interest is potentially significant, that expert is prevented from developing guidelines or is given a restricted role.

This stance is possibly unusual for a nutritional research organisation, with others proving less purist in their funding strategies. The American Society for Nutrition, for instance, which publishes the prestigious American Journal of Clinical Nutrition, has various ties with the food and beverage industry – its session sponsors include PepsiCo, Kellogg’s and the National Dairy Council. Meanwhile, the Academy of Nutrition and Dietetics, responsible for licensing registered dietitians in the US, is sponsored by the likes of Unilever and the Coca-Cola Company Beverage Institute for Health & Wellness.

It is easy to see how this kind of funding may create potential for bias. A 2013 meta-analysis of beverage studies, published in the journal PLOS Medicine, found that those funded by the food industry were five times less likely to find a link between sugary drinks and weight gain than those whose authors had no commercial conflicts of interest.

At a global health promotion conference in Helsinki in June 2013, WHO director-general Dr Margaret Chan described food industry influence as "dangerous". She stated that preventing non-communicable diseases, such as cardiovascular disease and diabetes, went directly against the business interests of "powerful economic operators", and that "Big Food and Big Soda" were prone to "protecting themselves in the same way as Big Tobacco".

"Market power readily translates into political power. Few governments prioritise health over big business. As we learnt from experience with the tobacco industry, a powerful corporation can sell the public just about anything," she said.

Spurred to action

Chan’s rhetoric was certainly damning, and it can’t be denied that WHO’s nutritional recommendations are sometimes at cross-purposes with the interests of major corporations. That said, it would be a mistake to paint the food industry and WHO as two colossi at loggerheads. Since the creation of WHO’s Global Strategy, many manufacturers have proven receptive to its wider aims.

In the previous edition of Ingredients Insight, we explored the WHO European Food and Nutrition Action Plan 2015-20, which was adopted last year by 53 EU countries. A package of policy actions that member states can adopt in order to improve access to healthy food and eradicate health inequalities, the action plan emphasises the importance of private sector engagement.

"The action plan can really motivate different stakeholders – notably the food industry – to develop healthier options and make them available to everybody," Dr João Breda, programme manager for nutrition, obesity and physical activity at the WHO Regional Office for Europe told Ingredients Insight. "I think the action plan can be extremely motivational for the operators in the market to improve their offering as a whole."

This is particularly the case in countries with wide public awareness of healthy eating: under those circumstances, reformulating recipes to make them healthier is as much about consumer pressure as it is about adhering to goals.

As a result, new WHO targets do not necessarily pose a threat; in fact, they may present new opportunities for strategic market positioning. For instance, rather than denying the cancer risk posed by processed meat, a company might endeavor to produce ‘healthier’, less processed versions of the products currently on the market, therefore generating new consumer appeal.

Take the case of a manufacturer that has reduced the amount of salt in its recipe, as per national guidelines. The reformulation may well be due to regulation, which in turn stems from WHO recommendations – but that is not to stop the company from labelling the product ‘lower salt’, loudly trumpeting its newfound nutritional virtues and improving its marketability in the process.

WHO does support greater regulation of the fast-food industry: in 2014, it released a cross-national study showing a link between market deregulation and higher body mass index. According to the study’s authors, their findings have important implications for policy – specifically that "government regulations hindering the spread of fast-food consumption might help to mitigate the obesity epidemic".

Increasingly, however, consumer pressure and WHO guidance are beginning to converge. For manufacturers looking to stay ahead of the curve, it may be wise to look into reformulating recipes before new nutritional guidance becomes policy. It is evident that in the fight to reduce non-communicable diseases, the private sector and governments alike have a critical role to play.

What does WHO recommend?

Some of the organisations current recommendations are as follows:

  • A healthy diet protects against malnutrition as well as non-communicable diseases, including diabetes, cardiovascular disease, stroke and cancer. Poor nutrition, along with lack of physical activity, are leading risks to health across the globe, and it is critical that health dietary practice starts in childhood.
  • Calorie intake should be balanced against total calorie expenditure.
  • Total fat should not exceed 30% of total energy intake to avoid unhealthy weight gain. For instance, in the case of a woman who eats 2,000 calories a day, no more than 600 calories, approximately 66g, should come from fat.
  • Most of this fat should be come in unsaturated, rather than saturated, form, with the exception being trans fats – WHO recommends that member states work towards the total elimination of artificial trans fats.
  • Free sugars – those added to food, rather than naturally occurring – should be limited to less than 10% of energy intake, with a further reduction to less than 5% suggested for additional health benefits.
  • Salt intake should be kept to under 5g a day to prevent high blood pressure, and reduce the risk of heart disease and stroke. WHO member states have agreed to reduce the global population’s intake of salt by 30% by 2025.