Lessons on salt for dietitians ... by a chip maker

HOUSTON - Snack and soda makers that often are blamed for fueling the nation's obesity rates also play a role in educating the dietitians who advise Americans on healthy eating.

Companies such as Frito-Lay, Kellogg and Coca-Cola are essentially teaching the teachers. They're offering seminars, online classes and workshops that are usually free to the nation's dietitians as part of their behind-the-scenes efforts to burnish the image of their snacks and drinks. The practice has raised ethical concerns among some who say it gives the food industry too much influence over dietitians, who can take the classes for education credits to maintain their licenses.

With two-thirds of Americans considered overweight or obese, the makers of processed foods have shouldered much of the blame for aggressively marketing sugary and salty products. Critics argue that companies use the classes, which are usually less expensive and more convenient than other courses dietitians can take, as a way to cast their products in a positive nutritional light. Not to mention that companies often collect the contact information of dietitians to mail them samples or coupons, in some cases to share with their patients.

"It's not education. It's PR," says Andy Bellatti, a Las Vegas-based dietitian who helped found Dietitians for Professional Integrity, a group of about a dozen dietitians who are calling for an end to the practice.

Food and beverage companies, meanwhile, say their classes are intended to inject perspective into the public debate over nutrition.

At the annual Food and Nutrition Conference and Expo, the food and beverage industry holds several workshops and classes on nutrition for many of the thousands of dietitians who show up there each year.

Last year at the conference in Houston, Frito-Lay explained to dietitians how it removed trans fats from its Lay's potato chips and other snacks. The makers of high fructose corn syrup encouraged them to question a study that ties the prevalence of the sweetener derived from corn to higher rates of Type 2 diabetes. And the company famous for its Frosted Flakes cereal taught about the benefits of fiber.

"Has anyone tried our new chickpea burgers?" asked an employee of Kellogg, which also makes Special K and Morningstar veggie burgers.

FOOD COMPANIES AS EDUCATORS

Of course, the matter of corporate influence isn't limited to dietitians. In 1997, the Food and Drug Administration issued guidance intended to address concerns regarding the role of drugmakers in continuing medical education for doctors. The guidance drew distinctions between ads and education, essentially stating that drug companies shouldn't influence the latter.

Those barriers don't exist between food companies and dietitians, however. The Academy of Nutrition and Dietetics, a professional group that's based in Chicago and has more than 75,000 members, governs the path to becoming a registered dietitian and oversees the accreditation for continuing education providers.

Glenna McCollum, president of the Academy of Nutrition and Dietetics, says that dietitians know how to question any findings that might that may not seem sound. "Some of the information provided may need to be challenged," she says. "That's part of the job."

For registered dietitians, continuing education is a requirement, not an option. After earning a bachelor's degree in nutrition, completing an internship program and taking an exam, they must earn 75 credits of continuing education every five years. An hour-long class typically translates to one credit.

Education providers, which must pay a $250 application fee and a $300 annual maintenance fee thereafter, have to abide by certain standards. Classes must be based on relevant subjects, for example, and conducted by qualified personnel. But materials for individual classes are not pre-screened.

A variety of organizations provide continuing education, including universities and professional groups. But the classes can be costly. Meanwhile, the classes offered by food companies are usually online and free.

Deborah Myers, chair of the nutrition and dietetics program at Bluffton University, a small school in Ohio, estimates she spends between $700 and $1,000 a year on continuing education when factoring in travel.

She is reimbursed for professional development costs by her employer. That's not a luxury all dietitians have.

AN OLD PRACTICE UNDER SCRUTINY

Teaching dietitians isn't a new practice to food makers. Companies have been doing it for quite some time. For instance, General Mills, which makes Cheerios, Lucky Charms, Yoplait yogurt, Pillsbury dough and Progresso soup, has been an education provider through its Bell Institute of Health and Nutrition for at least 15 years.

But the practice came under scrutiny after a report by public health lawyer Michele Simon last year that detailed the industry's deep ties to the field. Shortly afterward, a small but vocal group formed Dietitians for Professional Integrity to call for changes.

A petition by the group on the subject got more than 25,000 supporters on Change.org; the academy provided an audit to the AP that says only 600 of those signatures were by its members.

Others also question the practice.

Bill Dietz, a former director of the division of nutrition and physical activity at the Centers for Disease and Control and Prevention, notes that an online class by Coke entitled "Understanding Dietary Sugars and Health" was taught by instructors who both had industry ties. One listed ties to the Sugar Association and companies including candy bar maker Mars. The other disclosed ties to the Corn Growers Association on the subject of high fructose corn syrup.

At one point during the online class, one instructor says he doesn't think there should be dietary guidelines regarding sugar intake; Dietz notes that viewpoint is in contrast to the positions held by many reputable groups, including the American Heart Association, which recommends women consume no more than 6 teaspoons daily and men consume no more than 9 teaspoons daily.

When classes are approved for continuing education, there's an assumption that the content is essentially endorsed by the Academy of Nutrition and Dietetics, Dietz notes. As such, he says the academy should be responsible for ensuring they provide balanced perspectives.

Still, he says that doesn't mean companies should outright be banned from playing a role in the education of dietitians.

"It's hard to be black and white about this," he says, noting there are experts on nutrition who work in the industry.

LESSONS THAT CAN FUEL BUSINESS

Companies say their classes present simply nutritional information to dietitians.

Coca-Cola, which makes drinks including Dasani water and Minute Maid juice, offers about a dozen seminars each year through its Beverage Institute for Health and Wellness. On average, Coke says the live, hour-long classes get more than 5,000 participants. It plans to increase the number of webinars it offers each year.

Ben Sheidler, a spokesman for Coca-Cola, says the company's course materials are based on independent, third-party research. He says Coca-Cola is acting responsibly by working to provide professionals with the facts surrounding its products.

Coca-Cola, for one, says its surveys show the vast majority of participants in its classes find them helpful and "free of commercial bias."

But some say companies would never present information that doesn't serve their interests. Elizabeth Lee, a registered dietitian in Los Angeles and one of the founders of Dietitians for Professional Integrity, notes that the classes typically have a message that supports the company's products.

"It's getting harder and harder to really find something that isn't total baloney," says Debra Riedesel, another registered dietitian based in Des Moines, Iowa.

Part of what makes the issue so thorny is the deluge of research on nutrition, which is rarely definitive and often conflicting.

It's often said, for example, that snacking between meals can lead to weight gain. But a report earlier this year in the prestigious New England Journal of Medicine contended that no high-quality studies supported the claim. Underscoring how tangled matters can become, many of the report's authors had financial ties to food, beverage and weight-loss product makers.

"When it comes to research, the truth is somewhere in the middle," says Tina Miller, a registered dietitian in South Lyon, Mich.

INFLUENCE IN AND OUTSIDE THE CLASSROOM

For companies, the classes can be a chance to spotlight new products. At culinary demonstrations at the conference in Houston, for example, Kellogg and PepsiCo taught how to make a variety of recipes that incorporated their products, such as All-Bran cereal or Naked juices, respectively.

And the educational outreach to dietitians doesn't end in the classroom. Frito-Lay, which is owned by PepsiCo Inc., says more than a thousand dietitians are signed up to receive "SnackSense," a newsletter from its online resource for health professionals. A recent issue highlighted the moderate sodium levels of a new line of Tostitos and offered recipes using the chips.

Several times a year, the company also hosts tours of its plants for dietitians it identifies as being quoted in the media on healthy eating tips, according to a Frito-Lay spokesman.

PepsiCo also recently established the Quaker Center for Excellence to research and promote the benefits of oats. Candace Mueller Medina, a spokeswoman for the company's Quaker division, which makes a variety of products including oatmeal packets, bars and breakfast cookies, says the center's "first goal is to educate key opinion makers and influencers."

At the convention in Houston, Frito-Lay's booth displayed an ear of corn, a bottle of oil and a small bowl of salt; the idea was to illustrate the simple ingredients used in its snacks. Nearby, a Frito-Lay employee explained to a packed class of dietitians during a 20-minute briefing how the company removed trans fats from its chips over the years.

"Another thing I like to remind people about is that not all our chips are that high in sodium," she says, noting that bread is the No. 1 source of sodium for Americans. Later, she invited them to try the company's new barbecue flavored chips.

Attendees earned a credit for sitting in on three such sessions.