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John Hoffman & Alexandra Moss—The giant at the table: McDonald’s, health, and the right balance of skepticism and partnership

Last month, McDonald’s made headlines with the announcement that it is making a commitment to offer and promote healthier options in twenty of the chain’s largest markets around the world, including here in the United States. For the first time, customers in these markets will be able to substitute a side salad, fruit or vegetable for the French fries that, until now, have been an inextricable part of their value meals.

Even more significantly, the global behemoth, which feeds more than 69 million people in more than 100 countries every day, announced that it will no longer feature soda as a beverage option for Happy Meals or promote it as such on menu boards or in advertising. (For additional nuance on this announcement, keep reading.)

In the face of an obesity epidemic of epic proportions, however, what does such an action mean?

Justified skepticism

The nutrition and food policy community has, by and large, viewed the move with skepticism.

In The Huffington Post, public health lawyer Michele Simon asked whether there’s a mechanism in place for ensuring that the disparate network of franchisees, who own more than 80 percent of McDonald’s restaurants worldwide, complies with the corporate commitment to provide customers a choice of a healthy side option instead of fries. As she points out, “the fine print says only that McDonald’s will encourage franchises ‘to make this choice available to customers at no additional charge’ and that the company ‘anticipates’ that the majority will do so.”

Casey Hinds, a Kentucky-based mother and health advocate, pointed out that many of the beverages being touted as healthy Happy Meal options are no such thing—and may in fact contain more sugar (and calories) per serving than the soda they’re replacing.

Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest (CSPI), dove into the small print of the original formal agreement between McDonald’s and the Alliance for a Healthier Generation to find the most egregious cause for criticism: that soda can still be listed as an option on menu boards. (Apparently in response to such criticism, McDonald’s and the Alliance released an updated agreement on Friday clarifying that soda will be phased out of the Happy Meal menu over the next five years.)

Despite this rightful criticism, we shouldn’t underestimate the potential public health impact of McDonald’s commitment—especially in terms of making the default option on kids’ meals the healthier option.

Default options, stealth health and behavioral norms

Such defaults play a crucial role in establishing behavioral norms. For generations now, Americans have grown up believing that nothing goes better with a burger or McNuggets than a soda and a side of fries. The Golden Arches has significant power when it comes to reshaping those preferences—a fact that’s been hinted at by McDonald’s efforts to reformulate their standard kids’ meal offerings at Disney World resorts. The default there now includes apples rather than fries and low-fat milk instead of soda; two-thirds of parents stick with these healthier combinations rather than consciously choosing to substitute the fattier, saltier, more sugary classics.

The impact of this “stealth health” approach—as obesity expert Barry Popkin of the University of North Carolina describes moves like these—is potentially powerful. As Popkin told NPR last year, the typical overweight kid is only consuming 150-200 calories per day more than they should, so small changes to menus can add up to big improvements in health.

With this latest initiative, McDonald’s is taking an incremental step in the right direction. The company has been public about the failure of previous efforts to burnish its image by tapping into the growing market for healthy fast food options. In May, officials admitted that salads, which it’s offered for a number of years, comprise less than 3 percent of its U.S. sales. In other words, simply adding healthy options to the menu has had limited impact.

The recent changes, which give consumers the option to make their value meals healthier at no extra charge and improve the healthfulness of the Happy Meal, a product line essential to the chain’s core identity and profit margins, may prove far more meaningful.

McDonald’s and public health: The role of advocates; the power of giants

Few of the issues facing our nation today are more complex—or more crucial to understand—than obesity and preventable chronic diseases. If we are going to succeed at creating a culture of health in this country, we must assemble a broad coalition across all sectors: from non-profits and foundations to all levels of government; from schools, community-based organizations and advocacy groups to small businesses, media and entertainment companies, and multinational corporations.

It’s critical that public health advocates shine a skeptical light on such initiatives, and that they push for more change faster. But it’s also crucial that we work with brands that have the ability to shape our culture in a pervasive and permanent way. Without giants like McDonald’s at the table, it will be far more difficult, if not impossible, to change the way Americans eat for the better and ensure that everyone in this country has the opportunity to live a long, healthy, happy life.

John Hoffman and Alexandra Moss are, respectively, the executive producer and co-producer of HBO’s The Weight of the Nation and co-authors of its companion book. This year, together with Jon Bardin, they founded The Public Good Projects, a non-profit media organization that seeks to make complex issues easier to understand so Americans can take better care of themselves and their families.

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  • caseyhinds

    Did you see Chelsea Clinton’s appearance on the Rachel Ray show? The takeaway was similar to Coke’s “we’re part of the solution” ad campaign with the addition of McDonald’s. It wasn’t a message of “good, now do more.” As Marion Nestle put it, “Coca-Cola fights obesity? Oh, please.”

    • Ashley Craddock

      Just watched the segment, Casey. We’ll stand our ground on the original post, “It’s critical that public health advocates shine a skeptical light on such initiatives, and that they push for more change faster.” That category includes you, the other folks cited above, and many, many more people trying to change our food culture and health profile for the better. To your point and Marion Nestle’s, multinational corporations don’t make the cut.

  • Ashley Craddock

    Points well taken, Casey. It’s an uneasy balance. The key idea in the post is that we need to understand the power of brands like McDonald’s to move the needle on a cultural level, not to trust that their primary interest is in promoting better health. It’s not. Their primary interest is and will be their bottom line. The challenge is determining how to marry that business interest with public health needs, and how to hold McDonald’s and other industry players accountable for meaningful action, without, as you say, allowing them to “silence” health advocates or slow down the momentum we’ve begun to gain re childhood obesity rates or public awareness.

    Recognition of the power of brand and the potential impact of incremental change doesn’t cancel out the ongoing need to keep pushing for change across multiple fronts. As you say, the history of how we changed our cultural POV on cigarettes (and how hard cigarette companies struggled to maintain market share) is extremely pertinent here, and is well worth study. And you’re likewise right that we need to scrutinize (and limit) marketing aimed at children and vulnerable communities, especially in places like schools.

    A small step is a small step. It moves us incrementally forward, but if we stop there, we lose. No question. If we acknowledge it, say, “good, now do more,” and keep pushing hard, maybe we’ll see fast food go the way of cigarettes sooner rather than later. Something to work toward, anyway.

  • caseyhinds

    Additional points to consider: The value meal substitutions are also small steps similar to when cigarette companies rolled out low-tar cigarettes when the pressure from health advocates started to build. The nutrition messages on the Happy Meals packaging send a confusing signal to children who may associate the McDonald’s brand with healthy eating. All of these small steps were designed to silence the very health organizations that should be pushing for McDonald’s to take the most important step of not marketing to children.
    In determining whether the small steps are a deflection from taking the big steps, it is important to look at the company’s history. Trust is earned and in the case of McDonald’s, they have a long track record of abusing the trust of the public health community. Instead of lauding a company like McDonald’s for taking small steps, advocates need to continue to push for companies to take the big steps which will lead to meaningful change instead of postponing it.
    For more on these points see my post at: