Over two decades, obesity rates have more than doubled in China. 

The major culprit?

Junk food invasion.

Susan Greenhalgh is a Professor of Anthropology at Harvard University.

Her speciality – China.

She is writing a book tentatively titled – Making the World Safe for Coke.

In 2010, Greenhalgh began to investigate China’s public policy response to obesity.

Would the emphasis be on exercise or diet?

Coca Cola wanted the emphasis to be on exercise. 

“Around 2010, I became concerned about corporate involvement in making obesity science and policy,” Greenhalgh told Corporate Crime Reporter in an interview earlier this month. “I went to China to understand better the possible role of the pharmaceutical and food industry in China’s science and policy of obesity. I started by doing intense interviews and field work in China.”

“It became very clear that the main organization making these science and policy decisions in China turned out to be a branch of this organization I had never heard of – the International Life Sciences Institute (ILSI). It was incredibly baffling. The local ILSI branch in China claimed they were doing objective disinterested science. The organization was company funded. It made no sense.”

“Then I began many years of research on what is ILSI Global – how does it work? I looked into the history of Coke’s involvement. I looked into exercise as medicine, a Coke funded major public health program.” 

“I have probably done about six years of research and I have been writing it up over the past few years.” 

You stumbled across ILSI in China, not in the United States. What is ILSI?

“It is a non-profit based in Washington, D.C. with some 15 branches around the world. They put together the resources of academic, industry and government scientists to provide science that improves human health and safeguards the environment. That’s the public promise of ILSI.” 

“But beneath that promise there is a very complicated operation that in effect allows ILSI to be the most important science making entity for the processed food industry.” 

Who funds it?

“ILSI is funded primarily by several hundred mostly very large corporations. Most of them are in the food and beverage industry. Some of them are in pharma and chemical. But if you look closely, most of those companies have connections to the food industry. They provide materials and food input – like caffeine for example, that the food industry uses in making its products.” 

What role does Coca Cola play at ILSI?

“Coca Cola was the corporate home of ILSI’s founder, Alex Malaspina. He was a senior vice president at the time. He founded and led ILSI from 1978 until 2001. But Coke’s influence is greater than that. Coca Cola was one of about five or six companies that founded ILSI. There were not that many others. My research shows that in several years that I studied it closely in the early 2010s, Coca Cola was a member of every single one of ILSI’s branches. Technically, the members of ILSI are the member companies of each of the branches, not of ILSI Global. You need to take an accounting of each of the 15 branches to see who are the corporate members.”

“That means that Coca Cola was a corporate member of 15 branches – that was more than any other food company. Nestle may have been second with ten or eleven. But Coke’s influence is pervasive.” 

In 2015, the New York Times revealed that Coca-Cola paid scientists to form a Global Energy Balance Network promoting the notion that exercise, not dietary restraint, is the solution to the obesity epidemic. 

“Since the scandal in 2015 broke in the New York Times over Coke’s funding of the Global Energy Balance Network, ILSI has been actively trying to distance itself from those activities and from Coke. Someone would have to look closely to discover what Coke’s role is right now.”

Did you have anything to do with that New York Times story?

“No I didn’t. No one knew. That was a bombshell in the public health community. All of a sudden, people started paying much more attention. That was the article that alerted people to the pervasive role of the food industry in trying to distort the science of obesity. It has shifted the attention of the research community.”

Were you onto Coca Cola before that article?

“I did attend a major international obesity conference in China in late 2013. The main speakers were two academics – the same ones who turned out to be at the center of the Global Energy Balance Network – James Hill and Steven Blair. A third keynote speaker was a vice president at Coke – Rhona Applebaum. I heard her presentation and watched her power points. And I was astonished to see that she was using her talk to promote Coke products as being beneficial to those concerned about obesity.” 

“The three talks were linked together by their emphasis on activity rather than dietary restraint. This raised big questions in my mind. I never imagined in my mind that there was a major concerted effort on the part of the soda industry, and especially by Coca Cola, to distort the science.” 

Who did ILSI recruit to head ILSI China?

“A woman named Chen Chunming. She was a leading nutritionist. She was one of the very few people trained back in the 1940s in the field of nutrition. And she happened to be politically well connected. She had been working for the Chinese medical group doing research for many decades. There are rumors that she is connected high up into the central government. I have heard so many rumors. I have not been able to track down to whom she was connected.”

“They recruited her in 1978. They informally worked with her from 1978 until the 1990s. During that time, she became a high official in the health ministry. She headed the chronic disease division of the health ministry. Then she became the founding head and director of the organization that became the China CDC. She was an influential figure in health policy. It was very advantageous for ILSI to be working with someone who had direct access to the Ministry of Health.”

Once obesity became an issue, how did ILSI China affect policy on obesity?

“ILSI China created obesity policy in China. It wasn’t supposed to happen. They used all sorts of mechanisms to make it look like the policy was being created by the Ministry of Health. But in effect, it was an open door that Chen Chunming had to the Ministry of Health.”

“There were several instances in which ILSI China made the policy. The first important policy was the guidelines for the treatment and prevention of obesity in adults. It was issued in 2003 by the Ministry of Health. Those guidelines were prepared by ILSI China. ILSI China informed the Ministry of Health that they thought China should have guidelines. And would the Ministry please request that ILSI China create them? ILSI China then created them, sent them to the Ministry of Health and there were a number of revisions. And then the Ministry of Health issued the guidelines, not mentioning ILSI’s involvement.”

“That’s one example. Another example is the major public health intervention was called Healthy Lifestyles for All Campaign. That campaign idea emerged out of an international conference on obesity organized by ILSI China in December 2006. ILSI China also helped create a number of public health interventions that became standard features of that Healthy Lifestyles for All Campaign.”

“ILSI China was just a small organization. There were a few leaders and a handful of staff members. But the two leaders were influential academics and officials in the public health community in China. They had an incredible number of connections. When ILSI China organized these conferences, they virtually always collaborated with the top health organizations in China – namely the Ministry of Health and the China CDC. And they also collaborated with the top UN bodies working on health in China – WHO and UNICEF.” 

“Any conference that ILSI China would organize had the names and influence of these major organizations attached to it. These conferences were public policy making or advising events.”

“Obesity was the major focus of ILSI China’s work for at least ten to twelve years beginning in 1999. They had these major international obesity conferences every two years. ILSI operated on a principle of participation by invitation only. The foreign experts who were always the keynote speakers were those who were suggested usually by ILSI leaders in Washington, D.C. ILSI leaders in D.C began recommending the folks who were working with ILSI Global and promoted activity.”

“ILSI structured who got to speak. And they also had say over who could attend. It was a closed world of ILSI science. This was really important. Who got to speak, who got to present the best of international science was critically important. These international conferences represented a who’s who of the entire obesity community in China. Top academics, top policy makers. ILSI controlled the message about what counts as the best of international science on obesity. It was a sophisticated and powerful institution system for shaping public health discourse around the world.”

The Chinese diet seems so healthy. When pitted against a processed food invasion, it doesn’t stand much of a chance. Were there public health dissidents in China?

“When I first discovered ILSI China and learned that it was funded by food companies, I could not believe my ears. I interviewed twenty five leading experts. Ten of them had been intimately involved with ILSI China’s work over many years. I asked every one of them about funding. How important was corporate funding? Were they concerned about it?” 

“And the vast majority said no – that’s not an issue. That’s not a concern in China. We don’t care about corporate funding of corporate research. To the contrary, it’s government policy in China to encourage industry funding of research. The government had defunded the health establishment starting in the 1980s. And by the time I was there a few decades later that was just an institutional fact. Of course, companies funded these groups.” 

“I kept pressing. Weren’t they concerned that the companies might try and buy the science? And they said – no, we have the answer to that. They had a rule whereby the companies that were members of ILSI China were not allowed to use their logo in ILSI events and they were not allowed to advertise their products in anything related to ILSI.” 

“Almost everyone insisted that that was totally effective. There were a handful of public health specialists, mostly in an older generation, who saw that the intense involvement of companies in making policy was a terrible risk to the integrity of public health science. And they were deeply concerned. But they did not dare speak on the record about that issue with me. ILSI China was a major force in public health in China. And they knew how politically risky it would be for them to speak out against that organization and against Chen Chunming.”

[For the complete q/a format Interview with Susan Greenhalgh, see page 34 Corporate Crime Reporter 39 (October 12, 2020, print edition only.]