Rates of obesity have soared in the rich developed world since the 1970s and more recently in low- and middle-income countries. In 2020, three quarters of Americans were overweight or obese. China, India, Indonesia and other countries in the Global South are seeing rising obesity while, perversely, under-nutrition and stunting persist in many of them. According to The Lancet Diabetes Endocrinology (2021, 9: 373), China's national prevalence estimates for 2015–2019 showed half of all Chinese adults were overweight (34.3 per cent) or obese (16.4 per cent). Susan Greenhalgh in Soda Science lays bare the history of the manipulation of nutrition science by transnational food and beverage companies, which has enabled this global pandemic, and their decades-long efforts to thwart curbs on consumption of energy-dense drinks and foods. She does so, forensically, in almost mind-numbing detail, focused on the development of an industry-friendly science in the US and its transplantation into the party-state controlled public-health science of China.
The story of increasing body fat in China is obvious to regular visitors to China since the economic reforms took off in the 1980s. Rising incomes and consumption have made Chinese richer, taller and increasingly fatter, as I recount in “Growing fat on reform” in this journal (2014, 202: 1033–1068). But little did I know the intricate, secretive and devious machination of “Big Food” in this now challenging global health crisis. And, until I read Soda Science, even less how Big Food – especially Coke – had worked their way into the party-state dominated health and science domain to shape the public health policies of the Chinese government. Greenhalgh's expressed purpose is to write a story about “the corporate science of obesity that has been making us [the USA] as a society and people elsewhere on the planet sick” (p. 12).
In the mid-1990s when I began to collect anthropometric data (height, weight and body mass) to study historical change in health, nutrition and inequality in China, the most obvious change was the increase in the average stature of Chinese boys and girls. Economic reforms had delivered positive outcomes for child nutrition. But there was an inkling something was amiss. By 2000, Chinese health specialists were alarmed, as were those in many countries. Many called for regulations to check consumption of “junk food,” such as sugar taxes.
Around that time, Greenhalgh tells us, Big Food in America began in earnest to block the growing call for curbs on sugary and fatty foods, especially soft drinks or soda, as it is called in the US. This previously untold story is the subject of part one, “Making Soda Science in the United States,” comprising four chapters and a coda. After the Journal of the American Medical Association in 1994 reported a dramatic rise in obesity rates, the International Life Sciences Institute (ILSI) in Washington established a programme to study the causes and find solutions to the problem. Unbeknown to most people, this seemingly innocuous scientific organization was industry-funded and had been led by a senior vice-president of the Coca-Cola Company since 1978. Founded to defend the safety of caffeine in carbonated soda drinks, it was repurposed to create a new science to defend the ultra-processed drink and food manufacturers against claims their products had fuelled the rise in obesity.
Greenhalgh argues that “soda science” – or product defence science broadly – is not junk science, pseudo-science or co-opted science as many people would reason, but “a real science that has been manipulated” primarily “to advance the marketing goals” of the carbonated soft drink makers (p. 19). “The overarching goal of Coke and other corporate sponsors of soda science was to create an alternative scientific story” (p. 20). Their science disseminated the idea that “physical activity is the primary answer to obesity”, which was contrary to mainstream thinking that exercise was only a supplement to diet control. This got the soft drink industry – and the increasingly obesogenic food supply chain – off the hook. Product defence science is distinguished from academic science in its narrow focus on “corporate profits and reputations,” which makes it “corrupt” in “systematically” biasing science to protect “companies manufacturing injurious goods” (p. 31).
By 2015, though, Coke had overreached. Coke set up the Global Energy Balance Network (GEBN) that leveraged ILSI's network. But unlike ILSI, in which the role of Coke and other firms was concealed, GEBN was badged as a “public-private, not-for-profit network of experts.” Coke was identified as the primary sponsor. Leaks lead to a New York Times front-page story that severely impacted the reputation of Coke. GEBN was quickly dismantled. ILSI escaped scrutiny and endured in the shadows, while its most successful international convert continued to influence health policy in China, the topic of part two, “Taking Soda-Defense Science to China.”
Over four chapters and a coda, Greenhalgh tells us that the global project of soda science might have been more successful in China than anywhere else. Between 1999 and 2015, Coke and ISLI-Global had soda science endorsed as the dominant science of obesity in China: exercise first and soda tax never. Greenhalgh argues soda science would not have been able to establish itself in China so readily had it not been for “the marketization of everything, science included” (p. 170) that economic reforms had endorsed since the 1980s. In late 2023, the joint venture between Coke and the state-owned conglomerate COFCO Foods operated bottlers covering 81 per cent of China. With such ties, “the state is unlikely to aggressively protect the public from corporate overreach by Coca Cola” (p. 240).
Greenhalgh's book is not simply about the manipulation of science by Big Food. It is also a groundbreaking analysis about the differences in the practice of science in the US (and other democracies) and in China (an authoritarian state-centrist regime). In China the hidden links between Coke and its agent ILSI successfully sidelined critical voices and inserted corporate-scientific orthodoxy (exercise first) into state policies. Grasping these processes is important for understanding the implications of China becoming a world-leading scientific power. Science in China is not an independent domain, she writes, but subordinate to the party-state, and inherently subject to political games, which thwarts good science percolating to the top. This happens in democracies too, she says, but in China science is a servant of the party-state. Once flawed science is inserted into the party-state, as Coke has succeeded in doing, the leader-centric politics in China makes for biased science and bad outcomes in policy making.
Soda Science is an important book for understanding science and policy making in China. My main quibble with the study is that it could have been a lot shorter. All the detail was not necessary but is the stock-in-trade “thick description” of anthropologists. Laying this out – including two appendices, “Core concepts” and “Methods” – makes the book valuable for teaching the fieldwork and reporting practices of anthropologists and ethnologists. Unfortunately, the current political climate and suspicion around foreign researchers makes such studies in China difficult if not almost impossible now.
