In Asia’s Fattest Country, Nutritionists Take

Money From Food Giants
When the food industry funds nutritionists, critics say it subverts science to preserve its
market.

By Thomas Fuller, Anahad O’Connor and Matt Richtel

Dec. 23, 2017

KUALA LUMPUR, Malaysia — Over the past three decades this increasingly prosperous nation
has become the fattest country in Asia, with nearly half the adult population now overweight or
obese. Several years ago, Dr. Tee E Siong, Malaysia’s leading nutrition expert, decided to act,
organizing a far‑reaching study of local diets and lifestyle habits.

The research, conducted by scientists from the Nutrition Society of Malaysia, which Dr. Tee
heads, has produced several articles for peer‑reviewed academic journals. But scientists weren’t
the only ones vetting the material. One of the reviewers was Nestlé, the world’s largest food
company, which financed the research.

Among the published articles was one that concluded that children who drank malted breakfast
beverages — a category dominated in Malaysia by Milo, a sugary powder drink made by Nestlé
— were more likely to be physically active and spend less time in front of a computer or
television.

The research exemplified a practice that began in the West and has moved, along with rising
obesity rates, to developing countries: deep financial partnerships between the world’s largest
food companies and nutrition scientists, policymakers and academic societies.
 Dr. Tee E Siong, in front of a restaurant menu at a mall outside Kuala Lumpur, heads the Nutrition Society of
Malaysia, which is financed in large part by some of the world’s largest food companies.
Rahman Roslan for The New York Times

As they seek to expand their markets, big food companies are spending significant funds in
developing countries, from India to Cameroon, in support of local nutrition scientists. The
industry funds research projects, pays scholars consulting fees, and sponsors most major
nutrition conferences at a time when sales of processed foods are soaring. In Malaysia sales have
increased 105 percent over the past five years, according to Euromonitor, a market research
company.

Similar relationships have ignited a growing outcry in the United States and Europe, and a
veritable civil war in the field between those who take food industry funding and those who argue
that the money manipulates science and misleads policymakers and consumers. But in
developing countries, where government research funding is scarce and there is less resistance to
the practice, companies are doubling down in their efforts.

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Few examples of close ties between industry and science are as striking as those held by Dr. Tee,
70, a relationship that has deepened in recent years.
“He’s a God in the region,” said Barry M. Popkin, a professor of nutrition at the University of
North Carolina. “But at the same time, he’s very linked to industry.”

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When corporate money influences nutrition science, Dr. Popkin said, the evidence of what is
healthy for people “gets obscured, gets confounded.”
In addition to Nestlé, Dr. Tee’s work has been funded by Kellogg’s, PepsiCo and Tate & Lyle, one of
the world’s biggest makers of high‑fructose corn syrup, among others. He said scientists need
cooperation and financial support from companies, who can supply much‑needed resources.

He noted that traditional Malaysian cuisine — curries and other sugar‑laden street foods — are
key contributors to obesity but said that working with street vendors and mom‑and‑pop
companies to make their food healthier is difficult. Working with multinational companies is
easier and more productive, he said.

Dr. Tee said he has used his position in the government to push for important steps to regulate
companies, including a 2003 rule that required food companies to put nutritional information —
the levels of fat, sugars and protein — on their packaging.

A worker arranging products on a supermarket shelf in Kota Bharu. “We have to stop blaming the
multinationals,” Dr. Tee said. Rahman Roslan for The New York Times

“We were one of the first countries in Asia to do it,” he said.

Nestlé said it is important for the company to collaborate in efforts to improve nutrition around
the globe.

“Nestlé believes that public health issues can only be addressed by a broad multi‑stakeholder
approach and that we can play a catalyst role,” the company said in an emailed statement.
Nestlé reads papers before publication as part of a written agreement between the company and
Dr. Tee’s Nutrition Society. The company said its review of the article on the breakfast study and
other research was intended “to ensure that the methodology was scientifically correct.”

The statement said: “We approach our research transparently and apply strict standards to
ensure project integrity until the publication of the study.”

Exercising at a health program at Universiti Sains Malaysia. Dr. Tee, as well as some large food companies, has
emphasized that lack of exercise, more than diet, is to blame for rising obesity rates in Malaysia.
Rahman Roslan for The New York Times

Educated Food Choices
Dr. Tee recently wandered with a reporter through brightly lit supermarket aisles in a suburb of
the Malaysian capital. The shelves were packed with products now found across the globe:
instant noodles, spaghetti sauce, soda and rows of sugary cereals, including Nestlé’s Stars, which
is 28 percent sugar and has a bright red circle on the bottom right of the box that says “Selected
Healthier Choice Malaysia Ministry of Health.”

“We have to stop blaming the multinationals,” Dr. Tee said. The real problem, he continued, isn’t
the type of food people eat, but how much of it, and their lifestyle.

“Malaysians are always eating. They don’t exercise,” he said. “But you don’t need to go the gym.
You need to walk outside. It’s free. Get off your chair and move!”
Dapper and soft‑spoken, Dr. Tee, who has a doctorate in food science from the Universiti Sains
Malaysia, Penang, bounces around the globe attending and organizing conferences. In 2002, he
started a consulting business, TES NutriHealth, whose clients are small food companies. At the
same time he sits on seven government committees and was chairman of the committee on
nutrition and health claims until 2011.

A snack stall outside a school in Kota Bharu. Some nutritionists say Malaysia’s dietary
guidelines, which Dr. Tee helped craft, are not as tough on sugar as they might otherwise be.
Rahman Roslan for The New York Times

In 2014, he created the Southeast Asian Public Health Nutrition Network, or SEA‑PHN, with
nutrition leaders from Thailand, Indonesia, Philippines and Vietnam. Much of the network’s
funding comes from Danone, Nestlé, PepsiCo and other large food companies, whose logos are
displayed prominently on the SEA‑PHN website and its annual reports. Dr. Tee says nearly all of
the group’s funding comes from corporate sponsorship and fees for attending conferences.

The food companies are not only sponsors of the network, but also “associate members” who plan
and participate in its activities, including the financing of scientific papers and launching nutrition
education programs in schools throughout Southeast Asia.

In Malaysia, Dr. Tee’s nutrition society created an education pamphlet for parents that explained
“the wonders of whole grains.” The brochure includes ads for Nestlé’s Koko Krunch and Cookie
Crisp cereals, which have a “whole grain” label but are more than a quarter sugar by weight.
The nutrition society has promoted “Nestlé Healthy Kids,” a program that promotes the value of
breakfast and exercise, reached 4,200 children in 77 schools in 2014, and that is marketed with a
video promoting Nestlé and quoting children. Nestlé says the program itself does not include
product brands, but the booklets and posters in the program are stamped with the company’s
name, the video shows.

Breakfast rush hour in Ipoh, Malaysia. Dr. Tee argues that traditional Malaysian foods — sweets, curries and
other sugar‑laden street foods — are key contributors to obesity, and that working with multinational companies
is easier and more productive than working with mom‑and‑pop stores or street vendors.
Rahman Roslan for The New York Times

One girl in the video explains: “I eat cereal with milk for breakfast because it gives me energy
and I don’t feel sleepy in class.”

Shaping Public Thinking
Two of Malaysia’s top health officials recently sat down at the health ministry’s offices to discuss
obesity and Dr. Tee’s role in the country’s response to it.

“I really admire him,” said Zalma Abdul Razak, the head of nutrition at the ministry. “Nobody can
replace him as the president of the Nutrition Society of Malaysia.”
According to their annual accounting reports, the nutrition society has received hundreds of
thousands of dollars from industry, including at least $188,000 from Nestlé and Cereal Partners
Worldwide — a joint venture between Nestlé and General Mills — for the breakfast study. It has
also received at least $44,000 directly from Nestlé for other projects and collaborations; about
$11,000 from the dairy industry; $10,000 from the artificial sweetener company Ajinomoto, which
makes aspartame; and at least $40,000 from Philips Avent, the baby and consumer products
company, for projects related to infant and maternal nutrition.

Packing up plates of Nasi Kandar Vanggey, a dish made of white rice, curry, fried chicken, eggs and vegetables
at Yong Suan Restaurant in Ipoh. Rahman Roslan for The New York Times

PepsiCo and Tate & Lyle, the corn syrup producer, have sponsored the nutrition society’s annual
conference as well as Dr. Tee’s Southeast Asia Public Health Network, but the companies declined
to say how much money they contribute.

The ethos of corporate partnership runs through a number of health initiatives in Malaysia. A
Health Ministry committee teamed up with the Federation of Malaysian Manufacturers, which
includes representatives of major food companies, to develop a labeling system for the public. The
labels tells consumers which packaged foods are a “healthier choice” than others in the same
category.

Among the products that obtained the label were children’s sugar cereals and Gatorade Quiet
Storm, which has 16 grams of sugar per serving (roughly four teaspoons) and is given a grade of
D‑minus for its nutritional content by “Fooducate,” an app that grades the health of various foods
and won a surgeon general’s award.

The Malaysian health minister S. Subramaniam said the government’s job was not to be a
watchdog over big food companies.

Elyza Ismail, participates in Dr. Rohana’s obesity awareness class. Before she attended the class she did not
know that Milo, the Nestlé breakfast drink, contained so much sugar. “I had this idea of Milo as healthy and
strong,” she said. Rahman Roslan for The New York Times

“It’s more cooperation,” he said.

But some nutritionists say Malaysia’s dietary guidelines, which Dr. Tee helped craft, are not as
tough on sugar as they might otherwise be. They tell people to load up on grains and cereals, and
to limit fat to less than 20 to 30 percent of daily calories, a recommendation that was removed
from dietary guidelines in the United States in 2015 after evidence emerged that low‑fat diets
don’t curb obesity and may contribute to it.

Corporate funding of nutrition science in Malaysia has weakened the case against sugar and
processed foods, said Rohana Abdul Jalil, a Harvard‑trained diet expert based in the rural state of
Kelantan, where obesity is as high as in the biggest cities.

“There’s never been an explicit, aggressive campaign against sugar,” she said.

She works in Kota Bharu, the state’s capital, where vendors set up food stalls outside schools,
dosing out cups of soda from big plastic bottles and hawking chocolates and puffed corn and rice
snacks flavored with squid, shrimp and cheese.
Dr. Rohana runs an obesity awareness class and was surprised to learn that many who attended
it were not aware of the dangers of excess sugar consumption.

Malaysia’s health minister, S. Subramaniam, said the

government’s job was not to be a watchdog over big
food companies.
Rahman Roslan for The New York Times

“I knew that sugar caused diabetes but I didn’t realize it caused obesity,” said Wan Maznah binti
Hamzah, an employee in the public works department, adding she has now cut down sharply on
cakes, ice cream and other sweets.

Elyza Ismail, who lives in a house beside rice paddies and has a business selling plus‑sized
clothes, said before she attended the class, she did not know that Milo, the Nestlé breakfast drink,
contained so much sugar.

“I had this idea of Milo as healthy and strong,” Ms. Elyza said, repeating an advertising slogan
that has echoed in the ears of Malaysians for years.

Dr. Rohana, who doesn’t take research money from companies, is promoting a back to basics
approach: whole grain rice and other natural foods that are native to Malaysia.
 Dr. Tee at a supermarket outside Kuala Lumpur. He and his colleagues published a study that pointed to
breakfast cereals as an “important source of nutrients,” although the study also cited high sugar levels in the
cereals. Rahman Roslan for The New York Times

She criticized the research papers that came out of the nutrition society’s breakfast study. In
addition to the paper that linked drinking malted beverages with more exercise and less screen
time, Dr. Tee and his colleagues published a study that pointed to breakfast cereals, which are not
part of the traditional Malaysian diet, as an “important source of nutrients,” although the study
also pointed to high sugar levels in the cereals.

Dr. David Ludwig, a Harvard nutrition expert, described the study on breakfast beverages as
“wildly overstated.”

“There is no reason supplemental nutrients need to come in the form of a sugary beverage,
especially for low‑income populations at risk of obesity,” he said.

Malaysian researchers involved in the breakfast study say in one instance Nestlé requested a
reference to their Healthy Kids Program, which the researchers agreed to. But Dr. Tee says he
has final say over the research.

The research findings have been useful in Nestlé’s marketing efforts.

In one commercial, a child is falling asleep and having trouble concentrating in class, then drinks
a Milo and springs to life with energy.
For his part, Dr. Tee said the obesity risk in Malaysia would be worse without companies’ help,
and he couldn’t accomplish his goals without their support.

“There are some people who say that we should not accept money for projects, for research
studies. I’m aware of that,” Dr. Tee said. “I have two choices: Either I don’t do anything or I work
with companies.”

Correction: Dec. 26, 2017

An earlier version of this article misstated the name of an application that grades various foods in
terms of their health value. It is Fooducate, not Food Educate.

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A version of this article appears in print on Dec. 23, 2017, on Page A1 of the New York edition with the headline: Food Giants Are Funding
Nutritionists in Asia’s Fattest Country