Family Medicine's Sweet Tooth -- for Money

A partnership between AAFP and Coca-Cola poses an ethical problem, one doc says.

November 13, 2009, 4:47 PM

Nov. 16, 2009— -- What do family medicine and Coca-Cola have in common?


Except $500,000.

The American Academy of Family Physicians announced this month that it has received a $500,000 donation from Coca-Cola as part of their Consumer Alliance Program.

In theory, this program seeks "to develop robust new programs and educational materials" to help patients and health care providers make "better choices... to achieve a healthy lifestyle."

According to its Consumer Alliance Web site, the Academy recognizes the "significant influence" that corporations have over consumer choices in seeking to make decisions about diet and other health behaviors.

The chief scientific and regulatory officer of the Coca-Cola Company stated that "[o]ur partnership [with AAFP and] will help provide Americans with credible information on beverages and enable consumers to make informed decisions about what they drink based on individual need."

It is hard for me, as a family physician, to see the "individual need" to drink high fructose corn syrup.

This might be an individual desire. It might be an individual choice. But there is no "need" here.

The Academy proudly presents its "Sweetener Education Program" using language eerily similar to Coca-Cola's: "to help consumers make informed decisions about certain natural and artificial sweeteners."

Contrary to what Coke and the AAFP contend, the "informed decision" seems pretty straightforward.

According to a study by the University of North Carolina in 2004, high fructose corn syrup alters the body metabolism in such a way as to increase weight relative to other sugars.

Based on this type of evidence, the American Heart Association put out a statement in September noting that intake of all types of sugars has increased dramatically over the past decade. Consumption is 22 teaspoons per day on average, and a whopping 34 teaspoons per day among adolescents.

For adolescents, that's 170 grams -- 6 ounces -- or about ¾ of a cup! Can you imagine sitting down and eating, teaspoon by teaspoon, all that sugar?

The AHA recommends that calories from sugar intake by Americans be cut down by 70 percent. In addition to these studies, however, there is the very real epidemic of overweight and obesity in the United States. According to the Centers for Disease Control and Prevention, one-third of American adults are overweight, one-third are obese, and 6 percent are very obese.

The CDC has an astounding graphic depicting state-by-state and year-by-year how overweight and obesity have increased over the past decade. Indeed, excess weight is now the second leading cause of preventable death in the United States, responsible for approximately 300,000 deaths -- or 17 percent of all deaths.

In this context, I am extremely disappointed in the American Academy of Family Physician's decision to accept funding from Coca-Cola to help patients "make informed decisions... about sweeteners."

As if there were a decision to make.

Americans must cut down on sugar intake, especially high fructose corn syrup sweeteners found in soft drinks. I am a family physician and counsel my patients daily about diet, exercise and weight management. My Academy's decision to partner with Coca-Cola sends exactly the wrong message to my patients at exactly the wrong time.

I have also received funding from the National Cancer Institute to train medical students in weight management counseling. So I know firsthand, how little we as physicians know about diet and exercise -- and how to counsel patients regarding these health behaviors.

It does not help me as a teacher of family medicine to have Coca-Cola as the resource of health information for both patients and family doctors.

Many of us in family medicine feel we cannot defend this situation. In fact, a good number of family physicians have quit the Academy because of this decision.

If you struggle with your weight, try cutting out about 500 calories a day. Increase your physical activity; walking is an excellent choice. The CDC has excellent resources to help you make the "informed decisions" you need to make in order to control your weight. You do not have to starve yourself or train for a triathlon to be healthy.

But it would definitely help to cut out soft drinks.

And it would help if the American Academy of Family Physicians to give the $500,000 donation back in recognition of the terrible health message this sends to our nation.

Forgoing that money would be an excellent informed decision, indeed.

Dr. John Spangler is director of tobacco-intervention programs and a professor of family medicine at Wake Forest University School of Medicine in North Carolina.

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