Paediatrician Susan Prescott leaves Advisory Board after ten years. ‘When I see attempts to disparage the NOVA system by industry-funded players I can only conclude that such efforts are the hallmarks of intellectual escapism’
“Researchers who remain entrenched in defending ultra-processed foods are finding themselves on the wrong side of history”, decrees Susan Prescott. Professor of Paediatrics in the University of Western Australia, she is a respectful researcher about allergies on children. “Even by association, I was in effect lending my name to what I consider to be an unhealthy system.”
She decided to rescind her contract with Nestlé at the end of 2017 amidst the attacks on Carlos Monteiro, a professor at the School of Public Health, University of São Paulo, coordinator of the Centre for Epidemiological Studies on Health and Nutrition (NUPENS) and the person behind the NOVA food classification system, which forms the basis of the current Dietary Guidelines for the Brazilian Population. Criticism of the system, which classifies foods according to their degree of processing, came from scientists with financial ties to the multinational, which was the last straw for the researcher.
“I always deeply questioned the conflicting issues of many multinational corporations,” Susan Prescott told us. She is the Director of inFLAME Global Network, an organization that brings together researchers from around the world interested in the impact of the environment on intestinal microbial diversity. It’s been an important key to think about the effects of ultra-processed foods in our bodies.
The professor spent ten years on the Nestlé Nutrition Institute’s Advisory Board in Oceania, and resigned after reading an article published in the American Journal of Clinical Nutrition by the group headed by Michael Gibney, a researcher at the University of Dublin, in Ireland. “Ultra-processed foods in human health: a critical appraisal” is a direct attack on the NOVA classification, proposed in 2009 by Monteiro with a view to classifying foods according to their degree of processing: in natura or minimally processed, processed and ultra-processed, as well as cooking ingredients.
We dealt with the matter recently, with Monteiro’s view that the article by Gibney contained extremely serious errors and omissions, and the American Journal of Clinical Nutrition’s refusal to issue a response, in a case exposing the ties between scientific organizations and corporations.
Facts: Michael Gibney has a contract with Nestlé. The American Journal of Clinical Nutrition is one of the publications of the American Society for Nutrition, which currently has 28 partner companies, including Coca-Cola, Kellogg’s, Pepsi, Nestlé and Monsanto. The organization supports these corporations. It has already succeeded in organizing the issue of a positive mark decorating the packaging of cereal with an extremely high sugar content, as well as other ultra-processed foods.
In contrast, the NOVA system proposes a clear distinction between processed and ultra-processed foods. However, its detractors typically delete this line, making the classification appear to be simply against industrialization.
In addition to the article, other attacks were launched recently against the Brazilian researcher. Last October, the theme for one of the opening symposia at the International Congress of Nutrition, which was held in Buenos Aires, Argentina, was “Processed foods: food technology for better nutrition”. Our article covered the presentations on-site and there was a clearly orchestrated assault on Monteiro and the NOVA system, with verbal attacks that were unseemly for the cautious scientific sphere.
Next: an interview with Susan Prescott, a paediatrician who puts forward a holistic vision of the body and the environment.
- When you first read about NOVA, how did you react? Did it change the way you understood obesity and NCDs problems?
I’ve known about the NOVA system for several years.
Dr Monteiro and colleagues have produced a simple but effective way to separate out the forms of food processing that are essential to global food supplies (providing safe, healthy nutrition) from those that are generally unhealthy. NOVA system avoids the intellectual escapism and intellectual dishonesty which conflates the “processing” of ancestral fermentation and canned salmon with ultra-processed, additive-rich products.
The latter are largely a collection of isolated components of foods, often assembled with non-nutritive ingredients, with little resemblance to the nutrition of our evolutionary past. In the NOVA system ultra-processed foods are those which the public already knows to be generally unhealthy. It is simple and separates out minimally-modified foods from the soft drinks, snacks, meat patties, mass-produced frozen ready-to-heat meals. The available evidence over the last 4 years shows that the NOVA system can be tied to chronic, non-communicable diseases and biological markers of disease.
For many years consumers have been told that the additives in ultra-processed foods are safe. However, research in the area of the gut microbiome – that is the trillions of microbes (and genes) that inhabit the intestinal tract – has called this into question. Beyond the obvious macronutrients – sugar and refined linoleic-acid-rich vegetable oils – ingredients such as emulsifiers, artificial sweeteners, sodium, advanced glycation endproducts (AGEs), carrageenan, plant protein isolates and phthalates (via packaging) have all been shown to promote disturbances in the microbiome of animals.
In many cases these disturbances have been further linked to metabolic and even behavioral disturbances. Many questions remain, including the extent to which this animal research translates to humans. For now, the available research clearly favors a diet with minimally-modified foods and avoidance of the Group 4 ultra-processed soft drinks and foods.
How long have you been at the advisory board of Nestlé Institute? Do you think your initial goals were reached?
I was on the Nestlé Nutrition Advisory Board in Australia and New Zealand for over 10 years. As a paediatrician and a University academic, a major focus of my work has been early life nutrition and disease prevention. As a clinician working with children, it isn’t difficult to see how dietary choices and lifestyle are a focal point in their health and well-being.
I saw this was an opportunity to share my perspectives and hoped to influence awareness and attitudes. I met and worked with a lot of people, good people, who genuinely cared about health and nutrition of young families and reducing health disparities. I was involved in many educational programs and training workshops for healthcare professional all around the world.
Most discussions I was involved with were around science and education, rather than commercial products. This was actually a positive environment, and much of what we did was constructive. I did take every opportunity to highlight the social and economic determinants of health, the importance of social responsibility and the role of business in the solutions to global challenges.
Why did you decide to resign?
I was always deeply troubled by the conflicting sides of many multi-national corporations, especially those in the business of global food supplies. On the one hand you have the tagline ‘we feed the world’ and there is no doubt that under or malnutrition is unacceptably high. Companies are working to fix this, and they should be commended for that. But the product development and marketing is often at odds with the major threat to human health – that is, non-communicable diseases (NCDs). The production and global dissemination of ultra-processed foods are driving obesity and many of the NCDs we were striving to prevent. This was always the elephant in the room.
It is even more troubling to see industry driven attacks on scientists and experts who are working to address these major drivers in disease and health inequities. This is not new. And it has been a common tactic of most of the Big Industries over the last 50 years. Very much part of the Industry ‘play book’ recently illuminated by Rob Moodie in his new American journal of public health paper ‘What Public Health Practitioners Need to Know about Unhealthy Industry Tactics’.
Industry-backed research and industry front organizations seem threatened by the terms highly-processed and ultra-processed. Balanced criticism is an important part of scientific progress; however, when I see attempts to disparage the NOVA system (while avoiding the realities of food additives and the microbiome) by industry-funded players I can only conclude that such efforts are the hallmarks of intellectual escapism. The unseen members of global biodiversity – trillions of microbes – are calling out the policies and practices of the purveyors of the Grade 4 ultra-processed foods. Researchers who remain entrenched in defending ultra-processed foods are finding themselves on the wrong side of history.
I cannot control how apologists for ultra-processed foods go about defending these items and the policies and marketing efforts that magnify their distribution. However, even by association, I was in effect lending my name to what I consider to be an unhealthy system. Each day as the sun rises there are scientists discovering the detrimental effects of ultra-processed foods; at the same time, other groups of scientists are exploring ways in which more of these foods can be consumed by more people. So I felt it was time to have a bigger conversation. This is about much more than just ultra-processed food, or one Big Food company. It is about the broken systems that are destroying our health, our communities and our environment.
How do you think science and industry can work together to create solutions to society?
Yes I do. Eventually. We have to. But not the way things are right now. Business must be part of the solutions. And not just through partnership with science, but with meaningful partnerships with communities and society at large – for mutual benefit. In ways that do not cause avoidable harm in the endless quest for greater profit. There is no question that the activities of industry, in general, are a major factor in most of our global challenges including environmental degradation, human disease (particularly the consequences of obesity and smoking), economic instability, crime, and social inequalities. This destruction of the human and planetary health is not sustainable. We must to act. But we need to be constructive.
We are already progressively moving into an age of transparency, accountability and social justice. I am confident that these core values will become increasingly unquestioned and difficult to corrupt. With growing anti-business sentiment, it is increasingly necessary that industry and businesses respond meaningfully and genuinely to avoid increasing reprisals.
On a more positive note, there is now a growing engagement in corporate social responsibility, using the power of enterprise to solve social and environmental problems. There are more than 2,000 businesses worldwide who have earned ‘B Corp’ certification, for socially responsible practices. ‘B Corp’ assessments promote a level of transparency in how businesses go about making profits, encouraging them to provide benefit to society at the same time, rather than put profit before people. Our future prosperity will depend on this. Consumers need to demand this. We might reasonably hope that these incentives, core values and social conscience will be reason enough for industry to follow these principles!
Your critics about ultraprocessed foods caused any bad reaction on the private sector?
Not so far, but I expect it might. But we really hope for a more constructive way forward. Our global problems cannot be solved by more hostility and polarization. The intention of our recent papers on ultraprocessed foods – and many other manifestations of human, environmental and social disease – are intended to shed light on the need for change, so that we can do things better.
These conversations that we are having now are cause for hope. The seeds of change are there. Not only in the rising discontent with current systems, and the desire for change, but in progress towards creative collaborative solutions. What is really needed are philosophical shifts in our value systems. Although stories of control, greed and self-interest are strong – we can make them less acceptable and increasingly challenged. The structures, processes and the consequences of these attitudes will likely be far harder to change than the attitudes themselves. But attitudes must change first. So the rest can then follow.
As a paediatrician I want to remind people that, by looking ahead with our children’s future in mind, we can better find common ground in the face of conflict, complexity and competing interests. This reminds us that we all ultimately share the same destiny. We need technology to solve the problems in our world today, but to put it to the best use we also need our heart and our humanity. This is where the true power of humanity lies. We cannot underestimate our influence, as individuals and together to change this story.