Jan 11, 2019 07:15 PM

How Coca-Cola Put Its Own Health First

A new report says that Coca-Cola Co. has ingratiated itself with Chinese officials in order to promote a self-serving message: What matters most in preventing obesity is exercise, not diet. Photo: VCG
A new report says that Coca-Cola Co. has ingratiated itself with Chinese officials in order to promote a self-serving message: What matters most in preventing obesity is exercise, not diet. Photo: VCG

Ask an economist when the Coca-Cola Co.’s syrupy drinks first washed up on Chinese shores, and they will likely point you to the Deng Xiaoping-era embrace of market economics four decades ago. The company entered the country in December 1978, just weeks before China and the U.S. established full diplomatic relations.

But that was the quintessentially American beverage giant’s second coming. Coca-Cola began selling its sodas in China in 1927. It was booted out in 1949 when Mao Zedong, the leader of the young People’s Republic, deemed Coke too bourgeois for Communist China.

Even in the reform era, the company was treated cautiously. For its first few years in China, Coke was sold primarily in closely watched import stores catering mainly to foreigners. When an on-the-street Coke promotion was felt to have crossed a red line, sales of the soda were banned outright for a year.

“Coca-Cola was an archetypal symbol of Western capitalism and consumerism,” Mark Pendergrast, author of the history “For God, Country & Coca-Cola,” told the magazine Fortune.

It is remarkable, then, that China today is Coca-Cola’s third-largest market by volume. Cokes and Coke-branded products are ubiquitous on convenience store shelves and restaurant menus.

A new report has found that Coca-Cola’s inroads have gone far beyond China’s supermarket shelves though — and into public health policy. The company has ingratiated itself with officials in order to sell not just high-calorie drinks, but a self-serving message: What matters most in preventing obesity is exercise, not diet. It’s a claim that defies science, independent obesity specialists say.

Coca-Cola has “leveraged a complex web of institutional, financial, and personal links” to shape China’s health policy to its own interests, wrote Harvard sociologist Susan Greenhalgh in a paper published Wednesday by the British Medical Journal.

Greenhalgh and her team’s research show that from 1999 to 2015, as Coca-Cola’s policymaking influence increased, China’s obesity science and policy shifted markedly toward physical activity — all while the obesity problem ballooned. In 2016, 41 percent of Chinese people were overweight or obese, up from 1 in 10 in 1979, the World Health Organization (WHO) estimates. Lifestyle diseases have spiked in turn — diabetes rates are now comparable to the U.S., and nearly half of Chinese people aged 35 to 75 have high blood pressure. In 2015, China had the grim title of being home to more obese children than any other nation — 15 million of the world’s 108 million.

From capitalist roader to government influencer

Coca-Cola’s influence in China comes from using an industry-funded institute as its beachhead, Greenhalgh wrote. The International Life Sciences Institute (ILSI) was founded by Coca-Cola Senior Vice President Alex Malaspina in the U.S. the same year that Coca-Cola re-entered China in 1978. Its funders include Coca-Cola, PepsiCo Inc. and McDonald’s Corp.

The China branch of the ILSI established itself as a “premier scientific body capable of providing access to the best that Western science has to offer.”

Chen Chunming, a nutritionist with high-level government connections, started ILSI-China in 1993. ILSI-China is now housed within the government’s Chinese Center for Disease Control and Prevention under the National Health Commission.

Close government ties mean that ILSI-China has more power than an average policy institute. In an interview with Greenhalgh, Chen said the organization “puts scientific evidence into policy.”

ILSI-China began to specialize in obesity research after 1999, when ILSI’s Washington headquarters asked its regional offices to do so. ILSI-China created a team of obesity experts and issued guidelines regarding the prevention of obesity with China’s Ministry of Health. “Though not openly recognized, its substantive role in tackling obesity was arguably greater than that of the government,” Greenhalgh wrote.

This was the same time that American governmental bodies were beginning to fight obesity in the U.S., potentially threatening Coca-Cola’s bottom line. In 2004, the WHO began advocating for governments to place restrictions such as taxes on sugary drinks.

But ILSI-China’s obesity studies tended to focus on the impact of physical inactivity on weight, rather than the consumption of calorie-rich foods and drinks.

China’s obesity policy echoed this, the researchers said. “Hard-hitting dietary policies recommended by the World Health Organization — taxing sugary drinks and restricting food advertising to children—were missing, and national plans and targets emphasized physical fitness over dietary restrictions.”

One initiative that aimed to combat growing obesity rates among Chinese schoolchildren, Happy 10 Minutes, focused solely on promoting exercise among students, not nutrition education, the New York Times reported Thursday.

Corporate interests at ISLI-China events were sometimes disclosed; other times, Coke’s “myriad ties to experts and ILSI-China remained hidden.”

It’s a strategy that has been roundly rebuffed in the U.S. since a New York Times investigation found the company had quietly paid more than $100 million to fund research and advocacy in what critics called “tobacco industry tactics” to defeat soda advertising regulations and a campaign to tax sugary drinks.

ILSI-China did not respond to Caixin’s request for comment.

Misleading advice

Of course, Coca-Cola can’t take all the blame for China’s growing chronic disease burden.

“They’re looking after their interests,” said associate professor Tim Crowe, a nutritional scientist with Deakin University in Australia. “I don’t have a problem with that. But they want to sell a product that has very little nutritional merit and that has been linked to obesity.”

For an independent Western health experts like Crowe, the revelations about the company’s moves in China are all too familiar. “This has been their modus operandi for a while,” he told Caixin. “What these companies do is take the focus off junk food and sugar when very clearly diet has the biggest role to play in weight gain and weight loss.”

That’s because calories from a single high-calorie drink could take hours of exercise to work off, he explained. Countries that have introduced so-called sugar taxes in the name of public health have been specifically targeting products like Coca-Cola.

“There’s nothing positive about these drinks from a nutritional perspective,” Crowe said. “The only people who dispute the science are the manufacturers of soft drinks, and they try to produce their own science. But there is a clear link between soft drinks and weight gain.”

Responding to the British Medical Journal report, Coca-Cola said it supported the WHO’s recommended limits on sugar intake, saying: “We’ve begun a journey toward this goal.” The statement then pointed to Coca-Cola’s efforts to adjust its recipes and introduce more low- and no-sugar drinks.

Echoing this is an August article in the state-run China Daily, “Coca-Cola embarks on ‘healthy’ growth route,” which makes note of new Coke products launched in China that include Coca-Cola Plus, a sugar-free Coke alternative with added fiber.

These products, of course, constitute only a tiny fraction of Coca-Cola’s China sales, which remain dominated by the kind of high-sugar drinks linked with various chronic diseases. Rather, the article by a state-run newspaper is emblematic of the Coca-Cola China’s dramatic rise: from banned symbol of the bourgeoisie to one of China’s favorite brands.

Contact reporter Noelle Mateer ( and Flynn Murphy (

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