BEIJING (NYTIMES) - Happy 10 Minutes, a Chinese government campaign that encourages schoolchildren to exercise for 10 minutes a day, would seem a laudable step towards improving public health in a nation struggling with alarming rates of childhood obesity.
But the initiative and other official Chinese efforts that emphasise exercise as the best way to lose weight were notable for what they did not mention: the importance of cutting back on the calorie-laden junk foods and sugary beverages that have become ubiquitous in the world's second-largest economy.
China's fitness-is-best message, as it happens, has largely been the handiwork of Coca-Cola and other Western food and beverage giants, according to a pair of new studies that documents how those companies have helped shape decades of Chinese science and public policy on obesity and diet-related illnesses like type 2 diabetes and hypertension.
The findings, published on Wednesday (Jan 9) in The BMJ and The Journal of Public Health Policy, show how Coca-Cola and other multinational food companies, operating through a group called the International Life Sciences Institute, cultivated key Chinese officials in an effort to stave off the growing movement for food regulation and soda taxes that has been sweeping the West.
The group, known as ILSI, is a worldwide organisation with a Washington headquarters, funded by many of the biggest names in snack foods, including Nestle, McDonald's, Pepsi Co and Yum Brands as well as Coca-Cola. It has 17 branches, most of them in emerging economies like Mexico, India, South Africa and Brazil, and promotes itself as a bridge between scientists, government officials and multinational food companies.
But in China, ILSI is so well-placed that it runs its operations from inside the government's Centre for Disease Control and Prevention (CDC) in Beijing. In fact, when asked to comment on the studies, the ministry e-mailed a statement not from a government official but from ILSI's China director.
The director, Dr Chen Junshi, said the group had always emphasised the importance of both exercise and a well-balanced diet, and that its activities "are based on science and are not affected by any business". The close relationship with the highest government health policymakers goes significantly beyond what the companies have been able to achieve in the West.
Coca-Cola tried similar tactics in the United States by partnering influential scientists and creating a non-profit called the Global Energy Balance Network to promote a message that exercise, not dieting, was the solution to the nation's obesity crisis. But in 2015, after an article in The New York Times on the efforts and subsequent outcry from public health advocates, the company disbanded the organisation.
In China, beginning in the late 1990s, ILSI organised obesity conferences, paid the way of Chinese scientists who attended the events and helped create national health campaigns aimed at tackling the country's obesity epidemic, according to Dr Susan Greenhalgh, a social scientist and China expert at Harvard who is the author of both studies.
China's public health initiatives almost always promote exercise, and they seldom mention the value of cutting calories or reducing the consumption of processed food and sugar-sweetened beverages, which many experts say is essential for losing weight, keeping it off, and improving health.
"You can't use physical activity alone to get rid of obesity, hypertension or diabetes," said Dr Barry Popkin, a professor of nutrition at the University of North Carolina at Chapel Hill.
Dr Popkin was not involved in the study, but he has spent decades working in China to help the country develop nutrition guidelines and food policy - efforts he said were often thwarted by well-placed officials aligned with ILSI.
Given his experience, he said Dr Greenhalgh's findings were not surprising.
"Over the course of several decades, Coke and ILSI have worked to prevent any kind of food policy that would benefit public health," he said. "What they've been doing in China is insidious."
In a statement, ILSI said it was committed to backing "evidence-based food and nutrition research" and that it did not conduct lobbying activities or make policy recommendations in the countries where it operates.
"ILSI does not profess to have been perfect in our 40-year history," the statement said.
"Not surprisingly, there have been bumps along the way. This is why ILSI has analysed best practices and has committed to ensuring scientific integrity in nutrition and food sector research."
Coca-Cola said in a statement that it had also been changing the way it funded scientific research through greater transparency and by ending its practice of providing the lion's share of money for studies.
In recent years, it added, Coca-Cola has sought to address mounting obesity in China by offering an array of new sugar-free beverages and through improved nutrition labelling on products.
"We recognise that too much sugar isn't good for anyone," it said.
Dr Greenhalgh's findings were based on interviews with Chinese officials and scientists, and a review of public documents produced by Coca-Cola and ILSI.
She said the industry efforts have been wildly successful, in part because China lacks a free media or watchdog organisations that might have been critical of the relationship.
In just a few decades, China has gone from a nation plagued by food shortages to one buffeted by soaring obesity and chronic diseases tied to poor diet. More than 42 per cent of adults in China are overweight and obese, according to Chinese researchers, more than double the rate in 1991. In Chinese cities, nearly a fifth of all children are obese, according to government surveys.
The increases closely follow growing prosperity in China that began in the 1980s as Beijing embraced market economics after decades of isolation. In 1978, Coca-Cola was among the first companies allowed into the country, and ILSI arrived soon afterwards. Seeking to identify influential scientists it could work with, the group found a partner in Prof Chen Chunming, a leading nutritionist who was the founding president of the Chinese Academy of Preventive Medicine, the forerunner of China's CDC.
In 1993, Prof Chen became the head of ILSA-China and she remained a senior adviser to the organisation until her death last year. Dr Greenhalgh and Dr Popkin said that Prof Chen was instrumental in stymying attempts to address soaring obesity by stressing the harmful effect of consuming highly processed food and sugary soft drinks.
In interviews, several Chinese nutrition experts said they were not bothered by the relationship between ILSI and multinational beverage companies like Coca-Cola, and they defended the integrity of ILSI-backed researchers, praising their professional bona fides. Prof He Jiguo, a nutrition professor at the College of Food Science and Nutritional Engineering at China Agricultural University, said that Coca-Cola had only amplified the notion that exercise is essential to human health, an idea long espoused by China's ruling Communist Party.
"The key is that no matter what Cola-Cola or other beverage companies say, these drinks are just a product," he said. "No one is being forced to buy them."
With sweetened beverage consumption dropping in the US and Europe, Coca-Cola increasingly views China and other developing countries as essential to maintaining profits. China is the company's third largest market.
Prof Martin McKee of European public health at the London School of Hygiene and Tropical Medicine, said ILSI and other industry-funded groups that represent the interests of the tobacco, alcohol and fast-food companies have found fertile ground in poorer nations with weak public health bureaucracies.
Prof McKee, who wrote an editorial in the BMJ that accompanies the study, said such groups often claim to be independent think tanks but refuse to disclose detailed information about their funding.
These groups, he said, support and publicise scientific studies whose results sometimes muddy the waters on contentious issues like smoking or alcohol and soda consumption.
"They often cherry pick data in ways that mislead while portraying these issues as so terribly complex that nothing can be done," he said.