Endorsements should not endanger health

Over several years, celebrities have been advertising sugar-loaded soft drinks, chips, tobacco and alcohol, among other products of dubious value or proven harm.
Image used for illustrative purposes only. (Express Illustrations | Soumyadip Sinha)
Image used for illustrative purposes only. (Express Illustrations | Soumyadip Sinha)

Controversy recently erupted over an endorsement by Amitabh Bachchan of biscuits as a nutritious breakfast for children. The Nutrition Advocacy in Public Interest (NAPi) has written to the actor, protesting against the advertisement and requesting him to sever his connection with the manufacturer. Though NAPi has yet to receive a reply from the great thespian, the YouTube video of the advertisement has been withdrawn.

The reason for the protest was that the product contained high levels of sugar, fat and sodium, exceeding the upper limits set by WHO. It is also high in calories but low in the quality of nutrients. While it should by no means be promoted as a healthy food, much less as a substitute for home-cooked meals, there are health dangers which are associated with high levels of sugar, fat and salt consumption. Packaged products like these are often ultra-processed foods (UPFs). There has been mounting evidence, accompanied by rising public health concerns, about the health hazards of UPFs.

These foods are made from industrially processed extracts of natural foods like oils, fats, starches and proteins. They can also be synthesised in laboratories or factories. Either way, they bear little similarity to the nutrient balance that natural foods provide. The interactions that exist between the wide range of nutrients and chemicals found in natural foods are not found in these products. The latter strip away the natural structure of food and remove fibre, vitamins, minerals and a wide variety of phytochemicals that nourish the body. The addition of a few vitamins or minerals does not restore that nutritional balance or composite structure of the food.

While they are not labelled as UPF, they can be identified by their composition which includes ingredients such as emulsifiers, thickeners, protein isolates and other products of industrial origin. They often contain chemical additives intended to enhance colour, taste or texture. There is little or no intact natural food in these products. With high levels of sugar, salt or fats, they are hyper-palatable, highly addictive and increasingly replace health-promoting natural foods in the diet.

The list of health disorders associated with UPF is long and keeps growing as new evidence accumulates. Increased risk of cardiovascular disease, diabetes, obesity and cancer has been noted. Especially alarming, in the context of advertisements targeting children, is the rise in childhood obesity and a very early onset of insulin-resistant adult type of diabetes.

UPF has been shown to erode the body’s immunity and stoke inflammation which damages many organs. A recent Italian study, which followed the life course of 22,895 healthy adults over a 14-year period, found that those who consumed the highest number of UPF products had the greatest risk of dying prematurely from any cause. Scientists noted that inflammatory markers (such as high white blood cell counts) were higher in people who ate the most

UPF items. Chronic inflammation has been linked to cardiovascular disease, cancer and diabetes. Even the ability to fight off infections is eroded by disordered immunity.

Over several years, celebrities have advertised sugar-loaded soft drinks, chips, tobacco and alcohol products and their name-sharing surrogates, paan masala, and fairness creams, among other products of dubious value or proven harm. The channels used for advertising and promotion range from print and radio to electronic and social media. Celebrities roped in for such advertising are popular film and television stars or sportspersons, with some social media influencers now joining them. Sponsorship of films and sports-related events gives extensive visibility to commercial products in their original or brand-sharing surrogate forms. Promotion by celebrities generates peer pressure which is difficult for young people to resist.

Celebrities claim that they have the right to earn money by promoting a legally permitted and licensed product that is available in the market. In exercising their judgement, they must pay heed to warnings put out by agencies such as the WHO and national health authorities. There is often a lag time between the emergence of scientific knowledge about the harm from widely marketed consumer products and the regulatory action needed to contain it. This delay should not become an alibi for turning one’s back on credible scientific evidence.

Often, the manufacturing industries deny or distort evidence and try every trick in the trade to delay, dilute and derail regulatory controls. The tobacco industry is a clear example of such a powerful force that for long successfully thwarted actions to control harm from the consumption of tobacco products. Industries which manufacture UPFs and other unhealthy food substitutes often follow the playbook of the tobacco industry.

It is commendable that several celebrities have refused or recanted from endorsing harmful products. Pullela Gopichand rejected a brand endorsement offer from Coca-Cola after he won the All England Badminton Championship in 2001. Speaking at a Global Youth Meet in Agra in 2006, he said he was appalled to see that the customary serving of buttermilk to visitors was replaced by colas in the villages of Andhra Pradesh. His mentee P V Sindhu is reported to have stated that she “won’t be endorsing products that are harmful to one’s health ever and will stay away from them”.

Rahul Dravid has been exemplary, not only by staying away from the promotion of unhealthy food products but also by acting as the health ministry’s ambassador for tobacco control. Others have taken up causes ranging from depression to diabetes. Many provided public interest messages during health emergencies such as Covid-19. Celebrities should help educate and motivate people to adopt healthy living habits and not promote unhealthy products.

Film actors in particular like to act in and promote patriotic movies. It is also a patriotic duty to promote the health of India and, at any rate, not undermine it. Amitabh Bachchan has, in the past, stopped advertising for cola and a paan masala brand. He has probably responded to the outcry against the “biscuit as food” advertisement by having it stopped. If so, he deserves applause.

More importantly, he should guide younger celebrities to adopt socially responsible norms for promoting consumer products. As one who greatly contributed to the success of India’s pulse polio vaccination programme, Bachchan would surely wish to see the babies he protected grow to become healthy children, adolescents and adults. Can he help other celebrities to break free from the Zanjeer of financial allure that binds them to the promotion of unhealthy products?

(Views are personal)

Dr K Srinath Reddy

Cardiologist, epidemiologist and Distinguished Professor of Public Health, PHFI

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