OSTON — Take a trip with Sugar Cane and Sugar Beet, cheery cartoon characters in a coloring book.
Sugar Cane, tall and lean, is a proud fellow. “Hello,” he says, “We make food with lots of vitamins and minerals taste good!” Sugar Beet, his short, stubby companion, reminds kids to watch their portion sizes but still likes indulgences. “Eat this,” he suggests, standing besides a small bowl of ice cream.
The book, produced by the Sugar Association, suggests other ways to get the sweet stuff into kids: sprinkle sugar on carrots and peas, for instance, or add it to fruit salad and vegetables.
“Because it’s all-natural, you can consume it with confidence,” the Sugar Association says.
Sugar is natural, indeed. But whether the trade group should be hawking it at an assembly of the nation’s dietitians — as it did here at a conference this month — has become a point of contention.
The event in question is the annual Food and Nutrition Conference and Expo, and it is a veritable feast of food-related promotion. But the event is also made possible by vast sums of money from companies and trade groups, in some cases reinforcing the perception that “Big Food” brands are corrupting the guidance provided to millions of Americans every year.
Over the years, the group hosting the event, the Academy of Nutrition and Dietetics, has exacerbated those concerns.
Among the academy’s missteps: the paid endorsement of Kraft singles; the acceptance of soda company money to underwrite meetings; and a high-profile role as safe haven for corporate-sponsored food research.
In the aftermath of bad publicity, the academy has been seeking an ethics upgrade, vetting potential sponsors more closely and calling on presenters to provide a fuller picture of scientific data when it comes to nutrition.
But balancing the need to polish the group’s image with an equally strong need for money is not easy.
“There’s been so much criticism of the relationship between industry and the societies,” said Katherine Tucker, a nutrition professor at University of Massachusetts, Lowell, who also taught for many years at Tufts University. “I think everybody is really taking a careful look at it and trying to reduce the appearance of conflict of interest.”
Tucker is editor in chief of the journal Advances in Nutrition, which is published by the academy’s academic counterpart, the American Society for Nutrition. She said the reality is that nutrition research relies on the food industry’s payments — more so than scientists in other fields rely on private companies.
“The people who are interested in funding us are the food companies,” said Tucker, who has accepted money from Kraft and other agribusinesses. “We have to be careful not to let them lead where the research is going. Industry funding is helpful, but it’s also important for our society to be seen as independent scientists.”
At this four-day conference, independence is not the main dish.
The event has long been a significant source of income for the academy. It features workshops and other presentations in which dietitians and other experts learn about the latest on food science and disease prevention, as well as an enormous exhibition hall, where purveyors push everything from soup (Campbell’s) to nuts (California walnuts, Georgia pecans).
Dairy farmers offer photo opportunities alongside a giant cow. An oversized avocado mascot wanders an exhibition hall. Dietitians line up for free Subway sandwiches, candy, yogurt, sodas, and countless combinations of smoothies.
Representatives of the high-fructose corn syrup industry hand out green pens with yellow stalks of corn on top and studies touting the wholesomeness of the product.
It is an enormous event.
“We are a very powerful group,” said Lucille Beseler, president of the Academy of Nutrition and Dietetics. “We are the influencers.”
Beseler said she isn’t worried about the influence of food companies.
“I just know that our members know the difference between marketing hype and what is the science-evidence base,” she said. “We leave it to them to look at food products and decide, is the science what the companies say it is?”
That approach isn’t quite good enough for everyone. In 2013, a small group of members formed a rogue offshoot of the academy, Dietitians for Professional Integrity, after revelations about the academy’s financial relationship with America’s food companies.
Before this year’s expo, the splinter group warned participants to beware of corporate influence, and to avoid businesses engaged in what it dubs “healthwashing,” making foodstuffs seem healthier than they really are.
In a bulletin posted on the group’s website and Facebook page, it noted that certain speakers were touting studies paid for by industry, and should be examined closely for spin. A seminar on diabetes, for example, included presenters and reports written by people who were paid advisers for companies that make drugs for diabetics.
“Many people, including those in the profession, may not be aware not just about the fact that these ties exist,” said Andy Bellatti, a Las Vegas nutritionist and cofounder of Dietitians for Professional Integrity.
“We’re not saying everything is wrong and everything is terrible,” Bellatti said. “There is definitely some improvement. McDonald’s and Coca-Cola were not at the expo, as in prior years. But at the same time, there are some companies and groups that we consider not appropriate for a nutrition conference.”
A case in point, he said, is the Sugar Association and its coloring book.
“Their entire reason for existing is to promote sugar and try to defend sugar and try to deflect any of the criticism,” Bellatti said. “It’s well-known as Americans we are overconsuming sugar and that a responsible public health message is to tell people to cut back.”
Courtney Gaine, the CEO of the Sugar Association, defended the group’s efforts in an email.
“Most registered dieticians realize people need to enjoy the foods they eat,” she said, “and sugar can play a role in helping improve the palatability of the nutrient dense foods important in a healthy diet.”
Making her way through the Expo Hall, Tucker noticed plenty of products she didn’t consider nourishing. She was particularly concerned by the startling amounts of sugar in the products, at a time when diabetes rates are high and on the rise. She pointed out the large amounts of salt in some products, and noted the association between consumption of salty food and high blood pressure.
Naked Berry Almond Nutmilk, she said, has “36 grams of sugar, not the best.” Another exhibit listed agave nectar. “That’s another thing people don’t recognize as sugar,” she said. “People think it’s better for you than sugar, but it’s not.”
Tucker was also disturbed by the Subway booth, where dietitians were lining up for mini-sandwiches of turkey and other meats.
“I don’t recommend any cold cuts,” she said. “I worry that they overpromote the healthiness.” There’s no doubt, she said, of the link between processed meat and heart disease.
Tucker is polite when questioning the company representatives, even one who offered sips of a flavored sparkling water, with supplements that he said reduce blood sugar by 25 percent to 30 percent for several hours.
“I’d like to see the long-term studies,” she said.
Jonathan Marks, director of the bioethics program at Pennsylvania State University, studies the effect of corporate funding on academic research, and food research in particular. He agreed that conflicts of interest can distort science.
“There are meta-analyses that show industry-funded research produces more favorable outcomes,” Marks said, “but the interpretation of these outcomes is even more favorable in those studies.”
Past research on the effect of pharmaceutical industry gifts to physicians, Marks noted, has shown that large gifts are not required. “We’ve learned that small gifts can create subtle reciprocity and influence,” he said.
At this year’s expo, the Academy of Nutrition and Dietetics sponsored a workshop about cases in which dietitians themselves should disclose conflicts of interest.
Despite engaging speakers, there were rows and rows of empty chairs at the session.
“There are two schools of thought,” attorney Diane K. Polly, a frequent lecturer on ethics, told the sprinkling of people in the audience.
“One is that we are professionals and we can’t be bought. The other,” she said, “is that appearance is reality.”