Intended for healthcare professionals


US government rejects WHO's attempts to improve diet

BMJ 2004; 328 doi: (Published 22 January 2004) Cite this as: BMJ 2004;328:185
  1. Owen Dyer
  1. London

    The US government has rejected a link between junk food and obesity in a confidential letter to the director general of the World Health Organization, Dr Lee Jong-wook.

    The letter, from William Steiger, special assistant at the Department of Health and Human Services, has been leaked and is available on the internet. It is the United States's official response to an April 2003 report by WHO and the UN Food and Agriculture Organisation (FAO) which argued that added sugar should comprise no more than 10% of a healthy diet and that governments should take steps to limit children's exposure to the advertising of junk food.

    When the report, Diet, Nutrition, and the Prevention of Chronic Diseases, was released last year (BMJ 2003;326: 515), American food manufacturers' groups began lobbying to prevent their government from accepting its proposals. The Sugar Association wrote to Gro Harlem Brundtland, then director general of WHO, threatening to “exercise every avenue available to expose the dubious nature” of the report. Congressmen recruited by the food industry urged the secretary of health, Tommy Thompson, to cut off the $406m (£226m; €334m) annual US contribution to WHO (BMJ 2003;326: 948).

    Groups such as the National Soft Drink Association, based in Washington, argue that 25% added sugar in the diet is not harmful. WHO counters that 23 countries have produced national reports that recommend limits of about 10%.

    Professor Marion Nestle, chairwoman of the department of food and nutrition studies at New York University, says US domestic guidelines are no different. “If you do the sums in the Department of Agriculture Food Guide Pyramid, you'll find it recommends 7-12% free sugars. But they're afraid to mention actual figures because of the industry, which is being very aggressive at the moment.”

    The leaked letter says that the WHO/FAO report fails to meet the standards of the US Data Quality Act, lacks external peer review, and mixes science and policy making in the same exercise. “Whenever you hear the government or the industry talking about scientific rigour,” said Professor Nestle, “it's code for self interest.”

    Mr Steiger's letter questions the scientific basis for the “linking of fruit and vegetable consumption to decreased risk of obesity and diabetes.” He adds: “There is an unsubstantiated focus on ‘good’ and ‘bad’ foods, and a conclusion that specific foods are linked to non-communicable diseases and obesity… The assertion that heavy marketing of energy-dense foods or fast food outlets increases the risk of obesity is supported by almost no data.”

    Bruce Silverglade, legal affairs director of the Center for Science in the Public Interest in Washington, said that Mr Thompson will bring a delegation from the Grocery Manufacturers of America to Geneva this week, where a WHO executive board meeting is expected to approve the global strategy on diet, physical activity, and health.

    “Publicly, Secretary Thompson offers lip service about fighting obesity, but privately he's flying to Geneva with a squad of lobbyists intent on undermining WHO's recommendations,” said Mr Silverglade.

    The WHO report is at and the leaked letter is at