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February 11, 2019

On January 9, 2019 Susan Greenhalgh from the Faculty of Anthropology of Harvard University published two articles in The BMJ and the Journal of Public Health Policy, respectively titled “Making China safe for Coke: how Coca-Cola shaped obesity science and policy in China” and “Soda industry on obesity science and policy in China”. Also, on January 9, The New York Times published an article “The shadow of junk food company behind the China Nutrition Policy”. As a result, many English, Chinese, and international media outlets have reported on these articles.

Greenhalgh’s articles conclude that “The Coca-Cola Company (for its own commercial interest) (exploits) the ILSI Focal Point in China to influence obesity control policy within the Chinese government”. This conclusion significantly deviates from fact, and it has serious misleading effects. The following response provides background on Chinese government obesity prevention and control policies over the last 20 years and a comprehensive overview of ILSI Focal Point in China’s obesity work, which includes many projects focused on nutrition as well as physical activity. There is also information on ILSI and ILSI China’s mission and operating principles to provide operational transparency.

Key Messages

  • ILSI Focal Point in China has proactively led the dialogue for obesity prevention in China through promoting healthy eating and exercise.
  • For 20 years, the Chinese government has been focused on a combination of dietary and physical activity solutions to combat obesity.
  • Coke has not dictated ILSI Focal Point in China’s agenda nor the Chinese Health Ministry policies. Like all ILSI entities, ILSI Focal Point in China complies with ILSI’s Mandatory Policies, which require a minimum of three companies to fund all projects, to ensure that no one company dominates the research agenda.
  • No ILSI entity – including ILSI Focal Point in China – lobbies, conducts lobbying activities, or makes policy recommendations in any nation.
  1. Chinese Government Obesity Prevention and Control Policies Over the Last 20 Years

Chinese government obesity prevention and control policies have always been comprehensive and in line with international recommendations, mainly to advocate healthy living, especially healthy diet and appropriate physical activity, that is, to balance eating and exercise. Below is a brief history:

  • In 2003, the Department of Disease Control of the Ministry of Health adopted the “Guidelines on the prevention and control on overweight and obesity for adults in China” [1].
  • In 2007, the Bureau of Disease Control of the Ministry of Health adopted the “Guidelines on the prevention and control on overweight and obesity for school-aged children and adolescents in China” [2]; in 2011 the Bureau of Disease Control of the Ministry of Health adopted the “Guidelines on Physical Activity for Chinese adults” [3].
  • The Bureau of Disease Control of the Health and Family Planning Commission issued “Dietary Guidelines for the Chinese People (2016)[4] of which the second recommendation is to “balance eating and physical activity, healthy body weight”.
  • In 2016, the Central Committee of the Communist Party and the State Council published “Healthy China 2030 Programme[5]; the contents included recommendations  “to guide reasonable diet” and “to widely launch physical activity campaign for all Chinese people”.
  • In 2017, the State Council issued the “National Nutrition Plan (2017-2030)” [6], the main goals included “effective control of the upward trend of obesity rate of students” and “significant slow- down of the growth rate of overweight and obesity of people”; “balance in eating and physical activity” is one of the six major actions which include the special action “Three Reductions and Three Health Actions” (salt reduction, oil reduction, sugar reduction and healthy oral cavity, healthy body weight, healthy bones) widely carried out by the National Health Commission and several ministries and commissions.
  • In 2007, the campaign “Healthy Living Action for all Nationals” with the theme “Harmonious living, Healthy Chinese People” was jointly initiated by the Bureau of Disease Control of the Ministry of Health, National Patriotic Campaign Office and China Center for Disease Control and Prevention. The first phase recommended a balanced diet and an appropriate level of physical activity as well as to disseminate the concept of healthy living, develop technical measures and supporting tools, and participate in related national activities. In 2017, the action of the second phase was “Three Reductions: salt reduction, oil reduction and sugar reduction, Three Healthiness: healthy oral cavity, healthy body weight and healthy bones”. Please refer to the related documents issued in 2007 by the Ministry of Health and in 2017 by the Health and Family Planning Commission, which include “Work Plan in the Prevention and Treatment of Chronic Diseases in China (2012-2015), “Medium and Long-Term Plan for the Prevention and Treatment of Chronic Diseases in China (2017-2025)[7].
  1. ILSI Focal Point in China’s Work on Obesity Prevention and Control in China
  • Since the 1990’s, obesity and its related chronic diseases have become increasingly documented and have received widespread attention in developed countries such as Europe and the U.S. However, at that time in China, obesity as a common risk factor for disease or chronic disease, was still largely not recognized and/or valued.
  • ILSI Focal Point in China was the first to organize and lead a series of scientific discussions on the prevention and control of obesity in China. In April 2000, the Workshop “Issues in Obesity in China”, which brought together more than 30 speakers from China (including Hong Kong and Taiwan), Germany, United Kingdom, and Australia, was the beginning of the series of work on obesity and related chronic diseases coordinated by ILSI Focal Point in China.
  • To carry out the follow-up work, ILSI Focal Point in China established the Working Group Obesity in China (WGOC), to promote civic cooperation in the research on obesity prevention and control work in China. The WGOC consisted of government officials, clinicians, epidemiologists, nutritionists, sports medicine scientists and paediatric scientists.
  • The first work of WGOC was to organize a team to work on the analysis and summary of Chinese-based obesity and disease risk data, and proposed BMI ≥ 24 as the cut-off point of overweight for Chinese adults and BMI ≥ 28 as the cut-off point for obesity.
  • In June 2001, ILSI Focal Point in China and the Chinese Society of Cardiology of the Chinese Medicine Association, the Chinese Endocrine Society of the Chinese Medical Association, Hypertension League and China Nutrition Association jointly held the “Workshop in Obesity and Disease Risk in Whole Chinese Population” in Beijing, which strengthened the viewpoint that obesity is an important risk factor of chronic disease. Thereafter, the “Scientific Conference on Obesity in China” was held every two years. By 2017, it had been held 7 times.
  • ILSI Focal Point in China and the relevant expert institutions, academic groups and experts have worked together, under the leadership and coordination of government related departments, to provide technical support and recommendations for the formulation of “Guidelines on the Prevention and Control on Overweight and Obesity for Chinese Adults” [1], “Guidelines on the Prevention and Control on Overweight and Obesity for Chinese School-Aged Children and Adolescents” [2]. In the guidelines for  adults, the content includes “change diet”, “correct the over-eating behavior and habit”, “encourage diet intake that is low energy and low fat, with appropriate amount of protein and carbohydrate,  and rich in trace elements and vitamins”; and in the guidelines for children, the adoption of “balanced diet” and “cultivation of healthy eating behavior” are the relevant content of “targeted prevention”; at the same time, “creating a supporting environment” is also included.
  • In the long-term work on the prevention and treatment of obesity, the significance of physical activity in the control of obesity and related chronic diseases is recognized. In 2004, ILSI Focal Point in China, in conjunction with health and sports related departments, organized the first “International Seminar on the Health Benefit of Physical Activity”. Thereafter, it was held every two years. By 2017, it had been held 5 times.
  • In 2004, ILSI Focal Point in China in cooperation with the Food Safety and Nutrition Institute of Chinese Centre for Disease Control and Prevention created the program “Happy 10 Minutes”, with the aim to promote physical activity for primary school students in the classroom, which was piloted in Beijing. It was based on the program “Take 10” developed by ILSI Research Foundation. After this, the Institute of Nutrition and Health, China CDC expanded the pilot nationally in about 100 schools of 9 provinces and it was widely recognized. This project also became one of the components in the Action on Healthy Living for all Nationals in 2011, the program was conducted in nearly 2,400 schools by June 2018.
  • In 2005, the Working Group on Physical Activity and Health (WGPAC) in China was established, and it participated in the “First International Conference on Physical Activity and Public Health” organized by the U.S. Centre for Disease Control and Prevention in 2006; this provided technical support in the formulation of the “Guidelines on Physical Activity for Chinese Adults”.
  • ILSI Focal Point in China has gathered experts to research and develop appropriate tools to support the “Action on Healthy Living for all Nationals”, such as technical research and development on oil-control pots, salt-limitation shakers and designated-quantity salt spoons; BMI rulers and waist circumference rulers. A public education book “Follow me to Learn Balance in Eating and Physical Activity” [8] has been published in 2009 by ILSI Focal Point in China, which provided technical support to the launch of the Action.
  • Exercise is Medicine (EIM) is a program initiated by the American College of Sports Medicine (ACSM). It aims to introduce an appropriate amount of physical activity in the prevention, treatment and rehabilitation of chronic diseases through medical doctors’ advice to patients on physical activity. ILSI Focal Point in China, under the support of ACSM, introduced the concept of EIM to China in June 2012, and has cooperated with various related academic institutions like the Chinese Medical Association and the Chinese Preventive Medicine Association to organize training for related experts, medical doctors in the field of cardiology, diabetes; to date over 2,000 clinicians have been trained. These trainings increased the awareness of clinicians on how important physical activity in the treatment and recovery of NCD patients is.

It is important to reiterate that ILSI Focal Point in China’s role in the organizing or supporting of the above-mentioned research, scientific conferences, and related activities, has always valued healthy diet and nutrition, and also physical activity.

  1. ILSI and ILSI Focal Point in China’s Mission

The International Life Sciences Institute (ILSI), was established in 1978, is a non-profit organization, with headquarters in Washington, DC. ILSI’s mission is to provide science that improves human health and well-being and safeguards the environment. It addresses the ongoing need, as the food sector and supply and public demands evolve, for objective, evidence-based food and nutrition research and its ethical application.

The global organization of ILSI is comprised of 17 entities, one of which is ILSI Focal Point in China. ILSI Focal Point in China is unique and is represented as a Focal Point to comply with the local regulations. It has a Scientific Advisory Committee which oversees all scientific activities and conferences, comprised of five academic and four industry experts. ILSI Focal Point in China, like all ILSI entities, is required to comply with ILSI’s Mandatory Policies.

ILSI’s Mandatory Policies require a minimum of three companies to fund all projects, to ensure that no one company dominates the research agenda. All ILSI entities are required to work under the same operating principles and shared values. ILSI believes scientists from industry, government, and academia and other sectors of society can and should work together to identify and address topics of common interest. Because of its unique public-private structure, ILSI fills knowledge gaps and serves society in ways that any one entity on its own cannot. ILSI does not lobby, conduct lobbying activities, or make policy recommendations.

The activities organized by ILSI Focal Point in China are in line with ILSI’s mission with objective science as basis. ILSI Focal Point in China has conducted research projects and  organized various scientific meetings in the area of obesity prevention and control.  It can be noted that ILSI Focal Point in China has played an important role in convening experts from government, academia, and industry to address obesity in a collaborative way.

The first Director of ILSI Focal Point in China was Professor Chen Chunming - the late renowned public health expert, and the Founding Director of the Chinese Academy of Preventive Medicine. The current Director is Dr. Junshi Chen, a member of the Chinese Academy of Engineering.

In conclusion, ILSI Focal Point has proactively led the dialogue for obesity prevention in China through promoting healthy eating and exercise. No program has ever been a platform to promote consumption of soft drinks.

Updated 15 February 2019 to remove:

  • “No program has ever been a platform to promote the consumption of soft drinks”. This statement is true; however, it is not a direct reflection of the findings in the BMJ and Journal of Public Health Policy. To the contrary, Greenhalgh found “Support for limiting sugary-beverage consumption in China’s 2016 dietary guidelines is encouraging” [9]. Greenhalgh’s point is that China’s policies fail to tax soda consumption, “Dietary policies advocated by the World Health Organization (WHO) and leading US experts – taxing sugary drinks, restricting food advertising to children – are missing” [9].
  • The characterization that the articles conclude that public health advocates in China have always almost entirely focused on physical activity.

References

  1. Department of Disease Control, Ministry of Health Guidelines on the Prevention and Control on Overweight and Obesity for Chinese Adults People's Medical Publishing House: Beijing, 2006.
  2. Bureau of Disease Prevention and Control, Ministry of Health Guidelines on the Prevention and Control on Overweight and Obesity for Chinese School-Aged Children and Adolescents People's Medical Publishing House: Beijing, 2007.
  3. Bureau of Disease Prevention and Control, Ministry of Health Guidelines on Physical Activity for Chinese adults People's Medical Publishing House: Beijing, 2011.
  4. Chinese Nutrition Society Dietary Guidelines for the Chinese People (2016) People's Medical Publishing House: Beijing, 2016.
  5. The Central Committee of the Communist Party and the State Council, Healthy China 2030 Programme, October 25, 2016 http://www.gov.cn/zhengce/2016-10/25/content_5124174.htm  (Chinese,accessed January 23, 2019)
  6. The State Council, Medium and Long-Term Plan for the Prevention and Treatment of Chronic Diseases in China (2017-2025), February 14, 2017. http://www.gov.cn/zhengce/content/2017-02/14/content_5167886.htm (Chinese,accessed January 23, 2019)
  7. The State Council, National Nutrition Plan (2017-2030), July 13, 2017. http://www.gov.cn/zhengce/content/2017-07/13/content_5210134.htm (Chinese,accessed January 23, 2019)
  8. Chen Chunming. Follow me to Learn Balance in Eating and Physical Activity People's Medical Publishing House: Beijing, 2009.
  9. Greenhalgh, Susan J Public Health Pol (2019) 40: 5. https://doi.org/10.1057/s41271-018-00158-x

Learn more about ILSI Focal Point in China's work: