India: food, marketing and children's health
Higher disposable incomes, changing consumption patterns and the marketing might of powerful western brands are bringing fast food to India's children
The camera pans in. The grins of smiling school children fill the frame. An enthusiastic teacher, played by a famous Bollywood actress, sits in the centre. The scene is a "remote picturesque setting". And all are munching happily on Domino's Pizza.
The advert is typical of the marketing bombardment now filling TV screens and billboards as the world's big brands fight it out for a slice of India's growing fast food market.
McDonald's, Dunkin' Donuts, Subway, Pizza Hut, KFC, Coca-Cola and PepsiCo are just some of the international food brands now aggressively touting their wares to the Indian public.
The stakes are high. Last month, for instance, Coca-Cola announced plans to invest $5bn over the next eight years to "further capture growth" in India's ready-to-drink market.
Muhtar Kent, the US brand's chief executive, said: "Achieving continued sustainable, responsible growth in India is core to achieving our 2020 vision of doubling system revenues in this decade."
Betting on the sweet tooth of India's 1.2 billion population certainly makes good business sense. Economic reforms introduced two decades ago have seen the middle classes swell. As disposable incomes in the country grow, so the consumption patterns of millions are changing.
Sugary soft drinks and fast food chains are "all the rage now", says Shobha Shukla, a teacher and public health activist in Luknow, Uttar Pradesh.
Coca-Cola is a clear beneficiary of India's dietary shift. Sales across its 1.5m outlets nationwide have increased every quarter for the past six years. Its two bestselling drinks – Thums Up and Sprite – shot up by more than a quarter (27%) in the first three months of this year alone.
Sweet tooth troubles
What's good for business, however, may not be best for India's public health. Diet-related illnesses are skyrocketing. With more than 50 million sufferers, India has the largest diabetes population in the world, according to the World Health Organisation (WHO).
Meanwhile, heart disease has also spiked, becoming the biggest single cause of death in both urban and rural areas, a recent study by the Indian Council of Medical Research shows.
Public health campaigners have been quick to make the link with India's growing taste for high processed, high-calorie food and drinks. "Excess consumption of these so-called 'fast foods', coupled with low levels of physical activity, can lead to obesity", said professor Anoop Misra, chairman of India's National Diabetes, Obesity and Cholesterol Foundation.
Young people are especially vulnerable. A recent study by Misra on adolescents in New Delhi found that the prevalence of obesity had increased from 16% to 24% between 2002 and 2007. "These foods are available right in the school canteen and in the outside markets well within the reach of children," Misra added.
The results carry significant economic as well as health implications. The WHO predicts the net losses in national income from diabetes and cardiovascular disease at 336.6bn international dollars (ie US$ corrected for purchasing power).
Half of India's 1.2 billion population is under 25 years old. That holds out the possibility of "a massive public health burden for years to come," says Raj Patel, a writer and activist. "India's public health officials need to do something about that now."
That's beginning to happen, albeit slowly. The state government of Uttar Pradesh has taken the lead. It recently banned the sale of fast food in or immediately around government-run schools. Delhi is due to follow suit.
Little action has been taken on the issue at the heart of the debate: namely marketing to children.
The huge marketing muscle of western brands is rapidly altering public perceptions, argues health activist Shukla: "It has become a kind of status symbol to eat in McDonalds' and similar fast food chains, and to drink colas and soft drinks."
"Even the very poor people think it is something like a show of upward mobility if they consumer these products", she added.
Misra agrees. "As a result [of product advertising], children have started preferring these so called fast foods over balanced diets … This can have a devastating effect on their nutritional status."
International campaigners are ringing alarm bells too. Sara Deon, campaign director at Boston-based Corporate Accountability International, sees patterns of "predatory marketing" that were honed in the US and Europe being transferred to the developing world.
Deon said: "The goal of their [corporations'] marketing is to create cradle-to-grave consumers … As markets become more regulated in the west, corporations ultimately begin to push abusive practices into emerging markets."
Medical experts that have been following the impact of fast food diets in western countries express similar concerns.
Robert Lawrence, professor of environmental health sciences at Johns Hopkins Bloomberg School of Public Health, notes that between 7-8% of average calorie intake in the US comes from sweetened beverages that are "empty of nutrients. In the US, an alarming percentage of the population is obese … It is rather sobering to watch India heading down the same pathway", he said.
Indians' genetic makeup could make them "particularly vulnerable" to diet-related conditions such as diabetes, he adds. Their higher-risk status is based in part on a recent study in Abu Dhabi, which shows 26% of the indigenous population to have type 2 diabetes.
Some brands are unequivocal about their marketing tactics. Jubilant FoodWorks, which owns the franchise for Domino's Pizza in India, talks proudly of having "massified pizza consumption" in the country. A large part of its success comes from having "embedded in the mindset of consumers" the message that pizzas are affordable and a route to "happiness".
It makes no bones about targeting children. In Jubilant's own words, its 2010 Pizza Mania advert made "a powerful, emotional appeal" through its depiction of schoolkids "enticed to attend school through a Domino's Pizza treat".
Samir Kuckreja, president of the National Restaurant Association of India, admits that the issue of marketing to children is "still in its infancy" in India.
Some of the association's 1,000 or so members may have internal policies on the issue, he said, but he's "never seen or heard" any evidence of these in the marketplace. "Children are a target market for all the quick-service restaurant chains, and more marketing is skewed towards them", he added.
The beverage industry appears marginally ahead of the game. Coca-Cola, which has had a torrid history in the country, insists its global ban on marketing to children under 12 years old is applied fully in India.
Dana Bolden, spokesperson for the company, insists that public dialogue efforts have clarified that there are "places that they [carbonated soft drinks] should be, and places that they shouldn't".
Coca-Cola and PepsiCo are among seven foreign brands to have signed up to the International Food and Beverage Alliance's India Pledge. The commitment allows companies to advertise to under-12s only when the promoted products meet "strict science-based nutrition criteria".
Big brands in India's food and beverage market are increasingly providing nutritional information on menus and packaging. This is mandatory for processed snacks and drinks but remains voluntary for restaurants.
Lawrence says the "jury is still out" when it comes to the success of such information in changing consumption patterns. "If you tell someone that a fast food item is 800 calories and they don't realise that 800 calories is half of their daily requirement, then there's evidence that it doesn't help very much", he argues.
Indian researchers are more sceptical still about voluntary nutritional messaging. Research by the Delhi-based Centre for Science and Environment (CSE) on 16 fast food brands suggests the practice is riddled with inaccuracies or misinformation.
Top Ramen Super Noodles (Masala), for example, claims zero trans fats content, yet CSE's study found 0.7 grams of these "bad fats" per 100g rams. Haldiram's Aloo Bhujia has more than three times that figure despite similar no-fat claims.
The default option for many fast food chains is to provide no information at all. McDonald's Happy Meal packaging is silent on the issue of trans-fats despite containing 90% of a child's recommended daily allowance.
CSE, along with a number of health professionals, are calling for tougher rules to increase the nutritional content of fast food, as well as mandatory public information. Swati Bhardwaj, senior research officer at India's Diabetes Foundation, goes one step further in demanding restrictions on advertising.
"The Advertising Standards Council of India is now looking into this matter and is coming up with stricter guidelines for such misleading advertisements," Bhardwaj points out. The food and drink industry is anxious to avoid regulation. Kuckreja stresses that global brands such as McDonald's, KFC and Subway are now introducing low-fat alternatives on their menus.
In a similar vein, PepsiCo insists it is putting "significant marketing muscle" behind healthier offers, such as baked Lay's crisps, which recently launch in India.
Deflecting blame is another key tactic. According to PepsiCo's Wadhwa: "Attempting to single out one source of calories as a unique contributor to these diseases will not solve the problem."
Hence's PepsiCo preference in referring to diabetes and similar diet-related conditions as "lifestyle diseases". The inference being that consumers are as guilty for not burning off excess calories as companies are for providing them.
PepsiCo India's Get Active programme is a manifestation of that logic. The US drinks firm is working in 477 schools in a dozen cities to educate children on managing calorie intake through physical exercise.
Such programmes are all well and good. Indeed, they complement civil society programmes, such as Chetna and Marg, which are also providing nutritional and physical activity education to young people. Without curbs on fast food advertising, however, it's only too easy for these healthy living messages to be drowned out.
"It's parents' responsibility to bring up children to make smart choices", says Raj Patel. "But when the global ratio of junk food marketing to health food marketing is about 500-1 … then parents haven't got a chance in hell."