Food Marketing and Obesity in Developing Countries: Analysis, Ethics, and Public Policy
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Food Marketing and Obesity in Developing Countries:
Analysis, Ethics, and Public Policy
Terrence H. Witkowski
33 percent overweight in cities such as Beijing (The
Obesity and the chronic diseases with which it is associated Economist 2003). Unlike the rich nations, where obesity is
constitute a serious global health problem that will rapidly more common among the lower social classes, especially in
worsen given current trends. This article introduces a model women, developing country obesity is more often found
of how development processes, biological factors, and food among comparatively better off city dwellers (WHO 2003;
marketing practices are influencing the human energy equa- Fezeu et al. 2006). Throughout the world, excessive weight
tion in the less affluent world. The discussion then turns to is becoming more and more noticeable among children
an ethical analysis of food marketing and obesity and to a (WHO 2000).
formulation of broad ethical guidelines derived from mar- Obesity is associated with higher rates of Type II diabetes,
keting theory. Finally, alternative public policy and social cardiovascular disease, stroke, hypertension, sleep apnea, and
marketing strategies are considered. some types of cancer (WHO 2003). These chronic conditions
are already being detected in developing countries and, after
Keywords: food marketing; obesity; developing countries; a lag period following current weight gains, should become
ethics; public policy even more prevalent. Treating them will put a heavy burden
on poorly funded health care systems and will divert limited
resources away from the prevention and treatment of ram-
E scalating rates of overweight and obesity1 during the
past twenty-five years have alarmed public health officials
pant infectious diseases such as malaria and HIV-AIDS. As
has been the case in rich nations, spreading obesity will
reduce productivity because afflicted workers will experi-
worldwide. The problem is especially acute in the United ence more limited physical mobility, days missed because of
States and certainly prevalent in many other affluent nations attendant illnesses, and premature mortality. For the individ-
but has become global in scope with more than one billion uals involved, obesity may worsen quality of life along the
overweight adults, more than 300 million of them obese. Of dimensions of poor self-image, employment prospects,
this total, 115 million live in developing countries—up from social ostracism, and the routine difficulties their condition
virtually none two generations ago—and every indication entails, such as finding suitably sized clothing and seating.
suggests that this number should continue to grow rapidly This article explores some of the interrelationships
(World Health Organization [WHO] 2000). Figures 1 and 2 among economic development, food marketing, and obesity
show that the percentages of the population who are over- in less affluent nations.2 Figure 3 illustrates the major groups
weight rise across levels of development and, for women of macrovariables and their probable causal influences.
only, vary across selected regions. At the core of the model is a basic energy equation show-
Obesity is especially pronounced within some communities ing that people gain weight when they take in more calories
in the South Pacific, Latin America, and China (Caballero than they expend. Above this equation are four correlates of
2001; Martorell 2001; WHO 2003). Pacific islanders are the development—less physically demanding manual labor,
fattest people in the world with 55 percent of Tongan women, urbanization, rising purchasing power, and modernized food
74 percent of Samoan woman, and 77 percent of Nauruan marketing—that affect energy intakes and expenditures
men and women considered obese (BBC 2001; Gill et al.
2002). According to a recent study by the Organization of The author thanks the reviewers from the 9th International Conference on
Economic Cooperation and Development, 64 percent of women Marketing and Development and from the Journal of Macromarketing who
and 60 percent of men in Mexico are now overweight and 24 gave their time and intellect to improve this article.
percent of the population is obese (Boudreaux 2004). In Journal of Macromarketing, Vol. 27 No. 2, June 2007 126-137
China, with its much larger population, 15 percent of men DOI: 10.1177/0276146707300076
and 16 percent of women are overweight, with as many as © 2007 Sage Publications
126
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25 50
45
20
40
Population (%)
35
15
Population (%)
30
10 25
20
5 15
10
0
Global Least Developing Economies Developed 5
developed countries in transition countries
0
countries Middle CEE/CIS Latin Sub-Saharan South Asia
East and America Africa
Overweight Underweight North Africa and Caribbean
FIGURE 1 OVERWEIGHT RATES AND LEVEL OF DEVELOPMENT FIGURE 2 FREQUENCY OF OVERWEIGHT IN WOMEN ACROSS
SOURCE: Food and Agriculture Organization (2002) REGIONS
CEE/CIS = Central Eastern Europe and the Commonwealth of
Independent States.
directly and through the intervening variable of dietary SOURCE: Food and Agriculture Organization (2002)
changes. Beneath the equation are two biological factors
especially pertinent to developing countries, namely genetic
predispositions and early life malnutrition, that put some programs may forestall the far worse problems that the rich
populations at greater risk of obesity. A cluster of food mar- nations are now experiencing. Two additional objectives, there-
keting practices—increased food availability, variety, value, fore, are to show how food companies might help by adhering
and convenience; adaptation to local conditions; promotion to the ethical standards inherent in marketing principles and to
of a global fast-food culture; and targeting children—will be present and assess alternative public interventions and new
examined for their potential to influence dietary preferences social marketing strategies in developing countries. These ethi-
that ultimately may lead to overweight and obesity. cal, public policy, and social marketing issues will be examined
Obesity may not be the most pressing health problem con- following the description of the macromodel in Figure 3.
fronting developing countries. In many places the scourges of
disease, genocidal war, and environmental degradation are
certainly far worse. The United Nations estimates that 831 DEVELOPMENT PROCESSES AND THE
million people are undernourished (United Nations Develop- ENERGY EQUATION
ment Programme [UNDP] 2004). More than 20,000 people
Less Strenuous Manual Labor
die every day from the effects of abject poverty (Sachs 2005).
Nevertheless obesity is serious enough in its own right and its Development entails processes of economic and social
growing incidence raises important questions about the unin- change that affect both sides of the energy equation. As
tended consequences of global food marketing for consumers economies grow and countries move up the development
in the relatively more successful emerging nations where the ladder, their jobs typically require less physical energy.
condition is most prevalent. Human toil becomes more productive through the introduc-
Thus the first objective of the research is to bring the global tion of capital goods or, in the case of trade liberalization,
problem of obesity to the attention of macromarketers. A sec- through specialization. In agriculture the need for exhaust-
ond goal is to explore potential relationships between food ing labor declines because of mechanization and the substi-
marketing practices and the dietary changes that may lead to tution of local production by imported foods. Indeed food
obesity. The intent is not to accuse food companies of miscon- imports sometimes make subsistence livelihoods untenable
duct but to encourage macromarketers to be alert to the possi- and, like the diffusion of new technologies, result in surplus
ble health consequences of all marketing practices on labor. Some of these displaced workers may end up as day
societies, even seemingly innocuous ones. This precautionary laborers in fields such as construction, whereas others move
stance complements the consumer policy literature that has into factory jobs, and still others find work in occupations
identified several marketing and development downsides, such as transportation or the hospitality industry.
including economic dependency, social inequality, and materi- At the same time, jobs in the manufacturing and service
alism (Hirschman 1986; Ger 1992, 1997; Belk 1993; Ger and sectors may themselves become less physically demanding
Belk 1996) and perhaps will stimulate further basic research. as labor-saving capital equipment and information technol-
Obesity and development have further significance because ogy are introduced, often by foreign investors. The new
timely implementation of intelligent prevention and control types of work that accompany development may not be
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FIGURE 3 INFLUENCES ON THE ENERGY EQUATION IN DEVELOPING COUNTRIES
particularly easy or attractive by rich nation standards, and power. As workers and their families begin to earn additional
the transformation process itself frequently raises serious money, they alter their diets by increasing their intake of ani-
questions about labor standards and social justice, but the mal and vegetable fats and caloric sweeteners at the expense
net result is a reduced expenditure of energy, perhaps as of grains, fruits, and vegetables. Researchers refer to this pat-
much as 1,000 calories a day (Hoffman 2000). Compared tern as the “nutrition transition” (Drewnowski and Popkin
to earlier eras of industrialization, these changes are hap- 1997; Popkin 1999, 2001). In China, for example, the typical
pening very quickly (Popkin 2004). In the late nineteenth meal two generations ago consisted of rice or wheat—and
century redundant farm laborers may have found jobs in even coarser grains for the poor—and vegetables with some
heavy industries such as mining or steel that still required soy sauce. Today most meals include meat, fish, or eggs and
a good deal of brawn and physical exertion. After more ample amounts of vegetable oils (Burslem 2004). Furthermore,
than 100 years of technological evolution and automation, as expanding employment opportunities attract the labor of
however, even working in these occupations is no longer so women, the time available for food preparation decreases
physically taxing. (Boudreaux 2004) and households may substitute more con-
venient and calorie-laden processed foods and prepared meals
for traditional staple fare. Food manufacturing, packaging,
Increased Purchasing Power
storage, and preparation technologies have progressed enor-
Economic development usually produces, albeit not invari- mously throughout time. Foods are less seasonal than they once
ably and certainly not for all, rising incomes and purchasing were, and the immediate gratification provided by heating
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foods in microwave ovens was not available at the turn of the BIOLOGICAL FACTORS AND THE ENERGY
past century. Most important, cheap sugar and vegetable oils EQUATION
have become so widely available that even low-income soci-
eties have access to high-fat diets (Drewnowski and Popkin Although an analysis of the specific metabolic processes
1997; Popkin 2001). Thus people in developing countries are implied by the energy equation is beyond the scope of this
experiencing a much greater and more rapid dietary adjust- article, two biological factors present in some developing
ment than did past generations (Popkin 2004). countries are well worth discussing because they may assist
responsible food marketers and public policy makers in iden-
tifying populations that may be especially vulnerable. One
Urbanization
factor is genetic. Most animals, especially young ones, rarely
Although urbanization is often associated with increased get fat; humans of all ages do all too frequently. Yet not all
purchasing power, these two variables need to be analyzed people become obese. In 1962 geneticist James Neel theo-
separately in low-income countries where contrasts between rized that humans possess a “thrifty gene” that makes them
urban and rural eating patterns are greater than in higher particularly good at storing energy and surviving famine (The
income countries (Drewnowski and Popkin 1997; Popkin Economist 2003). The effect of this gene varies from individ-
1999). Mass migration to large cities may not necessarily alle- ual to individual within any one population. However, some
viate poverty—squatter and slum areas are often extensive— native peoples may have this trait in abundance and are thus
but it does bring behavioral and dietary changes (Popkin and unusually susceptible to obesity when sufficient and high-fat
Bisgrove 1988). Lifestyles become more sedentary than in the food supplies become available. For example, the Pima Indians
countryside. People watch television rather than hunt, fish, living in the United States often are morbidly obese and suf-
and collect firewood. Instead of walking, they use public fer high rates of diabetes, whereas their genetic counterparts
transportation, ride on motor scooters, or drive automobiles. in Mexico do not manifest these tendencies (Hoffman 2000;
Car sales are soaring in India and China. In larger Chinese Marchand 2002; Baier and Hanson 2004). The very high rates
cities, cycling is becoming so dangerous that many people are of obesity among Pacific Islanders may also be attributable to
opting for motorized transport (Lobstein 2004). widespread thrifty genes.
In terms of energy intake, the urban poor are often forced The other factor involves early life experiences. Under-
to purchase prepared food away from home because they lack nutrition in early life may trigger hormonal and metabolic
fuel and proper cooking facilities (Popkin and Bisgrove 1988). changes that put an individual at risk of excess fat accumu-
Equally important, urban consumers are simply exposed to a lation. Evidence of stunting being associated with over-
wider array of fresh, packaged, and prepared foods in cities weight and obesity in young children has been found in
than they would see in small towns and villages. Food sellers Brazil, China, Russia, and South Africa (Popkin, Richards,
ranging from street vendors to hypermarkets are everywhere. and Montiero 1996). Several speculative explanations for
Moreover, through contacts with people from different places this relationship have been offered, including a mechanism
and social classes, urban dwellers are exposed to entirely new similar to what is known as the “yo-yo dieter” syndrome.
types of tasty foods and beverages. Mexicans who move to the Normally humans only absorb about 80 percent of the nutrients
burgeoning border cities of Tijuana and Juarez, for example, from food, but under conditions of deprivation, the body
meet migrants from other states who bring their own cuisines. becomes superefficient, extracting as much as 100 percent
They may also be influenced by their close proximity to the of available nutrients. When people who were once under-
United States. A recent study by the Pan American Health nourished begin to eat normally, the body does not adapt but
Organization (2004) showed that 74 percent of men and 70 continues pulling high levels of nutrients from food
percent of women in the largely Hispanic U.S.-Mexico border (Hoffman 2000; Frisancho 2003). Sadly many of the world’s
region are overweight. It seems reasonable to hypothesize that 831 million undernourished people may become overweight
for many people greater variety in the food supply may trigger or obese if and when their food supplies and economic cir-
greater consumption. cumstances improve. The Economist (2003) observes that
Ironically urban dwellers may be enabling weight gain in Chinese “grandparents were brought up short of food, so
rural areas. Based on his experience working in rural Gambia they think children should eat a lot. They tend to overfeed
for more than twenty-five years, Prentice (2006) has witnessed boys especially” (p. 5).
the impact of the “remittance economy.” People who have
migrated to cities at home and abroad send back money that
“has transformed the range of goods sold in the village shops” MODERNIZED FOOD MARKETING AND
(p. 96). Imported vegetable oils in yellow plastic containers DIETARY CHANGES
are especially prominent according to Prentice. The very
large amount of remittances sent to Mexico and Latin An environment containing stimuli that encourage obe-
America from relatives working in the United States may be sity is said to be “obesogenic” (Swinburn, Egger, and Raza
effecting similar dietary changes. 1999; Lobstein 2004). Urbanization, as discussed earlier,
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creates such stimuli. This section considers some of the cost far less but can take days to prepare. An eighty-five-
ways in which modernized food marketing might independ- gram package of noodles contains 385 calories and 14.5
ently facilitate an obesogenic environment in the less affluent grams of fat versus 145 calories and 4.4 grams of fat for an
world. That is, how might the new types of food marketing equally sized portion of rice and beans (Dickerson 2005).
that accompany development induce dietary changes affect-
ing the energy equation?
Adapting Global Food Products to Local Tastes
Availability, Variety, Value, and Convenience The marketing management literature generally respects
cultural differences as an important environmental variable.
Establishing viable and efficient food distribution channels Textbooks take great pains to explain how the local adapta-
has long been viewed as a positive contribution of marketing tion of the marketing mix is the sine qua non of international
to economic development (Klein and Nason 2001; Shultz marketing:
et al. 2005). Although severe problems still exist in many of the
world’s poorest nations, economic liberalization following the Adaptation is a key concept in international marketing, and
retreat of communism and other restrictive systems generally willingness to adapt is a crucial attitude. Adaptation, or at
has led to more reliable and abundant food supplies. During least accommodation, is required on small matters as well as
the Mao era, for example, the Chinese state completely con- large ones. In fact, the small, seemingly insignificant situa-
tions are often the most crucial. More than tolerance of an
trolled agriculture and limited the amount and selection of
alien culture is required. There is a need for affirmative
food available to consumers. Today the food infrastructure acceptance, that is, open tolerance of the concept “different
has been mightily transformed. The number of retail outlets but equal.” Through such affirmative acceptance, adaptation
and food choices has greatly multiplied and self-service has becomes easier because empathy for another’s point of view
become common (Veeck 2000). In China and other countries, naturally leads to ideas for meeting cultural differences.
the spread of global retailers such as Carrefour and Wal-Mart (Cateora and Graham 2005, 124-25).
or big national chains such as Mexico’s Gigante present con-
sumers with even greater selections than do small, local shops Similarly, Czinkota and Ronkainen (2004), whose text devotes
and public market vendors. The scale of large supermarkets, an entire chapter to the topic, justify adaptation “because
their buying power, and their investments information tech- meeting and satisfying customer needs and expectations is
nology and control of data have enabled them to push down the key to successful marketing” (p. 248). As laudable as
prices (The Economist 2003). The combination of greater product adaptation may appear on the surface, this principle
availability and variety with lower prices at the wholesale and may have unintended consequences by adding more and
retail levels makes it possible for less affluent consumers to more powerful obesogenic stimuli to eating environments.
increase their energy intake. Companies regularly modify their so-called “global”
By and large, improved channel management enhances products to quite literally suit the tastes of consumers in dif-
customer well-being and further stimulates economic devel- ferent markets. Coca-cola is said to use different formulae in
opment. However, competition to offer greater value to different markets. In China, Nestlé has about 100 different
consumers may be adding problematic stimuli to the envi- flavors, including some, such as red bean and sesame-flavored
ronment. Presenting the option of larger portion sizes at chocolate, that are sold nowhere else (The Economist 2003).
minimal additional cost, popularly known as “supersizing,” A visit to the McDonald’s country/region site (McDonalds
encourages people to consume more (Wansink 1996). In the 2006) will show menus that vary from country to country.
U.S. food industry, these practices began in the 1970s McDonald’s India, for instance, promotes “McVeggies,”
(Young and Nestle 2002) and now may be afoot in the devel- “McAloo Tikkis,” and “Maharaja Macs”; McDonald’s
oping world. In Thailand, for example, the sugar packages Uruguay sells “Dulce de Leche” pancakes. KFC in China
served with coffee contain eight grams of the sweet, com- has switched from white meat to dark for its chicken burgers
pared to four grams in Malaysia and three in Japan and and is replacing coleslaw and mashed potatoes—side dishes
England (Wipatayotin 2006). Thailand’s 7-Eleven stores sell popular in the West—with seasonal vegetables, shredded
their own versions of “Big Gulps,” and McDonald’s carrot salads, fungus and bamboo shoots, and rice porridge
Thailand emphasizes its “extra value meals.” Marketing (congee) (Adler 2003).
convenience, through packaging and other means, and vend- Packaging, pricing, distribution, and advertising are also
ing high-fat/calorie snack foods in schools may also lead to tailored for different cultures. Restaurant architecture fre-
increased consumption (Seiders and Petty 2004). Japanese quently incorporates native motifs, and global trade charac-
instant noodles have become a big hit among Mexico’s ters can take on a local flavor. A Starbuck’s in Shanghai has
urban and rural poor who consumed one billion servings in a Ming Dynasty façade, and the entrances of some Chinese
2004. Ramen noodles are filling, quick and easy to prepare KFC restaurants are guarded by full-size, fiberglass models
(dubbed sopa para florjos or “lazy people’s soup”), and rel- of Colonel Sanders, who, in his Asian reincarnation, looks a
atively cheap at about $0.37 a serving. Traditional frijoles little portly like a Happy Buddha (Witkowski, Ma, and
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Zheng 2003). In short, food is marketed not as a commodity food is healthy for you.” On a 7-point scale (7 = strongly
but as a cultural good (Jing 2000), and what are otherwise agree), the Chinese mean was 4.68 (SD = 1.73) versus 2.72
normal marketing adaptations to local conditions may also (SD = 1.60) for the U.S. sample. The Chinese were more sat-
be encouraging levels of energy intake potentially excessive isfied overall with going to KFC for food and were more
for more and more consumers. likely to visit again in the next few months. No wonder that
a 2000 survey, conducted by AC Nielsen Media International
Promoting Global Fast-Foods in thirty Chinese cities based on 16,677 questionnaires,
ranked KFC the most famous international brand in China
Global fast-food chains offer very competitive value (People’s Daily Online 2000). By the end of 2005, KFC had
propositions to the world’s consumers because of economi- 1981 restaurants in China in every province and in 360 cities
cal acquisition of inputs (e.g., raw and processed foods; food (Yum! Brands, Inc. 2005).
preparation and serving equipment), standardized produc- As one headline glibly put it, “West exports obesity to
tion and management processes, and the ability to test new developing world” (BBC 2000). However, modern fast-food
offerings (Alon 2004). They provide sales training to serv- culture also originates in and disseminates from developing
ice workers and frequently introduce higher service stan- countries. Jollibee, a Philippine-based fast-food company
dards from the first world (Watson 1997; Witkowski 2005). noted for its spicy hamburgers and exotic desserts, has
However, evidence is beginning to establish a relationship nearly 1,000 outlets in seven countries, including seven in
between eating fast food and weight problems. Results of a California, and is one of the most admired corporations in
recent national survey (Bowman et al. 2004) indicate that Asia (Jollibee 2006). Local restaurant chains may learn les-
fast-food consumption among U.S. children has an adverse sons in competitive food marketing from their American
effect on dietary quality that plausibly could increase risk rivals (Watson 1997).
for obesity. One of the reasons the French activist José Bové
and his accomplices vandalized the construction site of a
Targeting Children
new McDonalds in Millau in 1999 was their (apparently pre-
scient) belief that the company symbolized the proliferation In some developing countries, children’s eating habits are
of le malbouf, or junk food (Woodruff 2001). undergoing a profound and rapid transformation. Because of
Perhaps every culture has its indigenous “fast foods” China’s one-child policy, families with “little emperors”
(Watson 1997), and traditional snacks, such as Mexico’s (xiao huangdi) are defined by the “4–2-1 syndrome” (si-er-
calorie-laden chatarra (Boudreaux 2004), remain very pop- yi zonghezheng), where four grandparents and two parents
ular. Yet contact with global fast-food chains has increased, pamper one child (Jing 2000). Yuhua’s (2000) fieldwork
and many consumers, even some of the less affluent, appear shows a decline in parental authority over their offspring’s
strongly attracted to these products. American fast-food food consumption. Chinese children now acquire a marketing-
chains are among the very first Western companies to arrive mediated knowledge of food and use pocket money to con-
when a country opens its market. Grand openings can be sume foods their parents prohibit. In fact, the very phrase,
huge events. Thousands queued for hours when the first “children’s food” (ertong shipin), is relatively new (Jing
McDonald’s opening in Beijing in 1992 (Yan 2000), and 2000), and through commercialization, the meaning of eating
two years later, a line of cars waiting at the drive-through is being transformed into something associated with fun
window of a new McDonald’s in Kuwait stretched for seven rather than just mere nutrition (Lozada 2000; Watson 2000;
miles (Schlosser 2001). Chinese dining at KFC or McDonald’s Yuhua 2000). To little kids in Beijing, “Uncle McDonald”
in Beijing can taste a bit of Americana within clean and (a.k.a. Ronald) has become as Chinese as the mythical char-
cheerful surroundings (Yan 2000), and rest assured that they acters of their folklore (Watson 1997; Yan 2000). Children
will have a similar experience at any other such restaurant in have become favorite targets for the fast-food companies, in
their city. Global brands may confer some additional status part because they are less attached to traditional fare
on the user and his or her family in some cultures, as well as (Schlosser 2001). McDonald’s Web sites in developing
help enhance social ties and maintain traditional role rela- countries typically have content designed for children
tionships (Eckhardt and Houston 1998, 2001). (McDonalds 2006). According to its Web site, Jollibee’s
A comparative study of young consumers in China and marketing strategy for children is clear: “Jollibee owns the
the United States found that the Chinese rated KFC restau- children market and will endeavor to keep its stronghold on
rants higher on twenty-three out of twenty-six brand identity this segment” (Jollibee 2006).
items than did their American counterparts (Witkowski et al. Advertising strategies and executions that have worked
2003). They had higher opinions of building décor, restroom well for rich nation food marketers have been equally success-
cleanliness, food appeal and freshness, service interactions ful in developing countries. A study of children’s television in
with employees, and advertising. Ironically the item with four emerging markets of Central Europe—Hungary, Poland,
the single greatest cross-cultural difference stated “KFC Slovakia, and Slovenia—showed advertising frequencies
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approaching the range typical for Western European nations. corruption and other breakdowns in law and order (Klein and
Commercials emphasized toys and food products, mainly con- Nason 2001; Shultz et al. 2005). Developing countries agree
fectioneries, sweetened breakfast cereals, savory snacks, and with some of this analysis. In early 2004 the United Nations
soft drinks (Consumers International 1999). A more recent Food and Agricultural Organization together with the WHO
report for India, Indonesia, Malaysia, Pakistan, the Philippines, proposed a new strategy to combat global obesity by encour-
and South Korea found a substantial increase in commercials aging governments to discourage intakes of sugar and fat and
for foods high in fat, sugar, and salt. In India, 40 to 50 percent to instead promote increased consumption of fruits and veg-
of commercials shown during children’s programming were etables. Representatives from the G77 group of developing
for food; in Pakistan, the Philippines, and Malaysia, the per- nations faulted the report for shoddy science and urged bet-
centages varied between 50 and 75 percent (Consumers Inter- ter nutrition education, not limits on foods (Ross 2004).
national 2004). Marketing to children has been a thorny issue Finally some researchers question whether the connec-
for decades in rich countries and is one of several concerns tion between global marketing and dietary changes, even if
raised by the obesity epidemic deserving of further ethical it exists, makes that much of a difference. According to
analysis and policy consideration. Drewnowski and Popkin (1997),
the globalization of human diet does not appear to be driven
THE OBESITY PROBLEM AND at this point by meat imports, fast foods, or eating away
MARKETING ETHICS from home, at least in the Asian countries studied in depth.
. . . Analyses of food import data for lower-income countries
A Marketing Perspective do not back up this claim. The nutrition transition in China
has been based until now on greatly increased domestic pro-
Marketing theory—or, to be specific, the dominant man- duction and imports of vegetable oils, and not on imports of
agerial paradigm—provides a strong rebuttal to allegations Western foods and a Western way of eating. (p. 42)
that marketing practices contribute to rising obesity rates in
the less affluent world (Witkowski 2005). As rational deci- As fashionable as eating out at McDonald’s may be in the
sion makers, consumers have the right to ingest whatever urban areas of China and of other developing nations, this
legal substance they choose, and if they overeat or neglect to consumption up to now represents just a miniscule portion
exercise, that is their own personal responsibility. Consumers of the total dietary energy their populations put away.
should be given sufficient information to make informed Besides, fast food restaurants are not always so successful.
choices, but then they are on their own (Associated Press KFC in Bangalore, India, has come under attack for sup-
2006). Food marketers, in turn, have the right—and even a posed cruelty to chickens (Alon 2004), and some boycotts of
duty to shareholders—to compete for customers globally American fast foods in the Muslim world have been
whether through new snacks, larger portion sizes, or lower reported (Johansson 2004).
prices. Where national regulations allow the practice, aim-
ing advertising and promotions toward young consumers Ethical Analysis and Guidelines
constitutes a legitimate strategy.
Marketing theory offers a second line of justification. The above rationales may appear compelling, but they are
According to the concept of market segmentation, if enough far from bulletproof. The implication that overweight and
consumers are truly diet conscious and this group can be iden- obese people are personally irresponsible, that they suffer in
tified, targeted, and profitably served, then marketers will effect from a moral failing, may contain a painful grain of
respond with the appropriate marketing mix. Unmistakably truth. However, adult consumers in the less affluent world
this has occurred. Diet foods and a plethora of slimming may not be as well informed about their eating habits or as
products and services have become a multibillion-dollar adept at seeing through and resisting marketing blandish-
industry in the rich world. Moreover, prominent packaged ments as their rich nation counterparts, who themselves are
goods and fast-food companies such as Kraft, Frito-Lay, and confused about food health claims (Redmond 2005). In other
McDonalds have introduced new “healthier” menu choices words the assumption of a “rational consumer” may be rather
around the world. Of course, the threat of product liability tenuous and, when it comes to children, may not pass
lawsuits, at least in the United States, may be motivating their scrutiny at all (Cawley 2006). Overly efficient metabolisms
switch in marketing tactics, but these firms are undoubtedly resulting from childhood undernutrition, as well as the possi-
responding to trends in consumer demand. ble presence of dominant thrifty genes, may make matters
In many of the world’s poorest nations, the much more worse. As far as diet foods and health clubs are concerned, if
serious problem is insufficient food security—physical and too few developing country consumers are aware of the con-
economic access to food—not food abundance and obesity sequences of obesity, or have the wherewithal to purchase
(WHO 2000; Bone and France 2003). Thus the real market- these products even when they are, marketers may not make
ing issue is inefficient distribution caused, in large part, by them available. Lack of information and alternative food
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choices constitute market failures (Seiders and Petty 2004). OBESITY POLICY AND SOCIAL MARKETING
The bane of insufficient food supplies is real but tends to
occur in the least developed countries (see Figure 1). The Public Interventions
obesity problem is more prevalent in “middle- income” Deriving ethical standards from marketing theory is a
nations. In any event “malnourishment” may result from con- rather narrow “within the paradigm” approach that presup-
suming cheap foods deficient in micronutrients (vitamins and poses a more or less privatized discourse on marketing and
minerals) as well as not having enough food (Food and obesity. Clearly one could argue that obesity is a social
Agriculture Organization 2002). Finally the extraordinary problem requiring public solutions that may impose limita-
increase since 1980 in obesity, especially in rich nations tions on food marketing practices. Public health advocates
that already had made the nutrition transition, suggests that argue that nations everywhere need to immediately develop
marketing factors should not be underestimated. The WHO obesity prevention and control programs (WHO 2003).
(2003, 63) concludes that heavy marketing of energy-dense Regulatory approaches might range from taxes on fats and
foods and fast-food outlets is a probable factor behind weight sweets to restrictions on advertising to children to new label-
gain and obesity. Perhaps the full impact of such marketing ing requirements to modifications in farm subsidies to
in the less developed world has yet to be felt. encourage production and consumption of fruits and vegeta-
If marketing is truly concerned about the needs of con- bles (Nestle 2003; Seiders and Petty 2004; Cawley 2006).
sumers, then this basic precept becomes an ethical standard Given the economic importance of the food industry, antag-
on which marketing should be evaluated. When marketing onism from media conglomerates that benefit from food
fails to respond to the consumer’s welfare, it becomes advertising expenditures, and the mission of numerous gov-
unethical according to its own mission. From the above dis- ernmental agencies to promote agriculture, such initiatives
cussion, two ethical principles can be derived. First, although surely will face vigorous political resistance around the
marketing thought recognizes that purchasing decisions are world. Even some academics have raised questions about
influenced by all sorts of impulses, the highest ideal is that the actual prevalence of obesity and its purported effect on
of a rational consumer (Redmond 2005). Ethical marketers mortality, seeing instead a socially constructed “moral
should help consumers make informed choices. They panic” encouraged by widespread media alarms and in the
should not wait for government mandates or legal actions interest of the weight loss industry (see, e.g., Campos et al.
before providing consumers with health information about 2006 and rejoinder by Kim and Popkin 2006). Product lia-
any product, especially the foods they eat. Visible and bility litigation or its threat may change corporate behavior
understandable nutritional and content labeling should not in some rich nations (Lobstein 2004) but would seem a fruit-
be in question, even if it leads some consumers to choose a less endeavor in most developing countries where legal sys-
competitor’s brand or to not purchase at all. Second, ethical tems are usually not well established nor very transparent
marketers should present consumers with alternatives. If (de Soto 2000).
special menus and other products for weight control are
being offered in rich nations, they should also be made
Social Marketing Strategies
available in developing countries. Best marketing practices
should be applied to consumers everywhere. Marketers Assuming funding can be secured—and this will require
have a moral obligation to adhere to the principle of a true communicating the magnitude of the problem to policy
customer orientation. makers (Kennedy 2005)—less threatening social marketing
Although primarily concerned with the obesity problem campaigns may be the most feasible intervention to control
in the United States, Wansink and Huckabee (2005) make obesity. Social marketing entails more than just providing
recommendations for responsible food marketing that may information. It requires consideration of all elements of the
be applicable globally. Companies, the authors argue, should marketing mix, as well as market research (Kotler and
make efforts to reverse four drivers of food consumption— Zaltman 1971; Fox and Kotler 1980). The importance of
convenience, low cost, good taste, and nutritional knowl- thorough research and analysis cannot be overstated. The
edge. Solutions might include downsizing packaging, factors causing overweight and obesity may differ in their
reducing serving sizes, and formulating foods to decrease prevalence and interactions across developing countries.
energy density (caloric content). These changes need not be Just as “differential diagnoses” should be the first step for
drastic and costly—small modifications can make a differ- national poverty reduction strategies (Sachs 2005), social
ence in energy intakes that do accumulate—and should be marketers will need to calibrate their campaigns according
introduced gradually and quietly to existing products rather to their deep understanding of local conditions. A potentially
than to new ones. To its credit, McDonald’s China has made useful tool is ANGELO (analysis grid for environments
plans to list nutritional information on most of its packaging linked to obesity) that posits micro- and macroenvironments
using an easy-to-understand, icon-and-bar chart format on one axis and physical, economic, political, and sociocul-
(Min 2005). tural environments on the other (Swinburn et al. 1999).
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© 2007 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.134 JUNE 2007
Microsettings include local markets and food service out- of culture, learned early, and sometimes very resistant to
lets, whereas macroenvironments consist of food produc- change (Watson 1997). Nevertheless educational programs
tion, processing, distribution, and marketing systems. The could discourage consuming some processed foods and fruc-
authors pilot-tested this 2 X 4 framework on Pacific Island tose-sweetened soft drinks in favor of fruits and vegetable and
lower calorie beverages. There is a further need to explain the
communities and in New Zealand and found it “a flexible
relationship of portion size to energy intake, weight gain, and
and robust instrument for the needs analysis and problem
health (Young and Nestle 2002). Special attention needs to be
identification stages of reducing the obesogenicity of mod- directed at children and at middle-aged women and stunted
ern environments” (p. 563). This model appears capable of population groups who show higher incidences of obesity
scalability, the ability to transport successful programs or (WHO 2003). Advocates of local culture (see, e.g., Cavanagh
program elements across developing countries, cultures, and and Mander 2002) can use the obesity epidemic as a reason
languages (Prahalad 2004, 25). for consuming simpler, traditional foods that may be less fat-
The following are three broad goals, as well as some tening than the highly processed products of multinational
strategic recommendations, for dealing with the problem of corporations.
obesity in developing countries:
Social marketing programs are no panacea. Marketing
1. Create awareness of health risks. People in the less affluent
ideas have been applied to developing world family planning,
world too often have a poor understanding of the connection recycling, and microcredit programs with some success,
between obesity and chronic illness. Customarily foods have albeit with nagging issues of appropriate target selection and
been perceived as more beneficial (nutritional, hedonic) than incentive design on one hand and worries about cultural dis-
risky, and in any event, the harms related to excess weight are ruption on the other (Dholakia 1984; Dholakia and Dholakia
long deferred from the moment of consumption choice 2001). Furthermore social marketing sometimes poses ethi-
(Seiders and Petty 2004). In the South Pacific, being big has cal dilemmas of its own. Obesity control campaigns run the
been a symbol of health, well-being, status, and beauty, and risks of paternalism and asymmetric moral relationships
therefore larger bodies have been viewed favorably (Gill et al. between sponsors and target audiences and may present
2002). Pacific Islanders need to be taught the difference opportunities for corruption (Brenkert 2002). One might
between size because of muscularity and size resulting from
argue further that having first blessed developing countries
flabbiness. Similar misconceptions may be present in other
societies (Watson 2000). Among Mauritanian Arabs, fat
with dubious foods and eating habits, the rich nations are
women traditionally have been seen as more desirable, and to now trying to impose their new enthusiasm for proper exer-
achieve this end, girls are still sometimes force-fed (BBC cise regimens, diets, and body size.
2004). Further research on various market segments within
and across nations will be needed to provide the cultural
understanding necessary for crafting and placing appropriate CONCLUSION
messages. For example, it may not be necessary to target
elites in some developing nations, such as Brazil, who seem Obesity in the less affluent world is indeed a health prob-
as averse to large bodies as their counterparts in rich countries. lem too big to ignore. Ironically it has to a great extent
2. Increase energy expenditure. Populations enjoying the eco- resulted from improved prosperity. With economic develop-
nomic benefits of development must be reminded that an ment, manual work has become less physically demanding,
active lifestyle is conducive to good health. The preference for
discretionary incomes have risen, and men and women have
convenience, “the law of least effort” (Wansink and Huckabee
2005), may be universal. Younger adults and children who
sought opportunities in big cities where they have become less
are experiencing a middle-class lifestyle may need to active and have had more opportunities to eat energy-rich
become less sedentary perhaps, like their rich nation coun- foods. Genetic predispositions and early life undernutrition
terparts, by watching less television and playing fewer com- have added another layer of causes. Finally the rampant eco-
puter games. This is always easier said than done. Children nomic liberalization and globalization of the past quarter
are difficult to motivate, and urban parks and streets in century have enabled food marketers to introduce a great
developing countries may not be safe places for them to variety of new products, distribute them widely, price them
keep fit. Women who desire to control their weight may face reasonably, adapt them to local cultures, and promote them
additional hurdles. For example, some may live in male- to the most responsive target audiences, especially children.
dominated societies that forcefully restrict their ability to Few would disagree that the food industry shows more
move about outside the home. Even in places where these
virtue than tobacco companies, but everyday food marketing
social and cultural barriers are less daunting, people may not
have the financial resources to indulge in interesting physi-
mix decisions ultimately may have equally serious conse-
cal activities. Finding ways to facilitate this behavior change quences for the health of hundreds of millions of consumers
will be a major challenge for social marketing. worldwide. Despite several justifications for a laissez faire
3. Decrease energy intake. Not only is the human appetite for position inherent in marketing management theory, ethical
fats, salts, and sugars deeply ingrained biologically (Wansink analysis based on these same principles indicates that food
and Huckabee 2005), but dietary habits are a central element companies should accept some responsibility for informing
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© 2007 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.JOURNAL OF MACROMARKETING 135
developing nation consumers about nutrition and health and biology 2000, edited by Benjamin Caballero and Najat Mokhtar, sup-
for providing affordable, less energy-dense food alternatives. plement to Journal of Nutrition 131: 866S-870S.
Campos, Paul, Abigail Saguy, Paul Ernsberger, Eric Oliver, and Gleen Gaesser.
Public policy initiatives will be resisted by vested interests. 2006. The epidemiology of overweight and obesity: Public health crisis or
As Nestle (2003) wryly notes, “gaining weight is good for moral panic? International Journal of Epidemiology 35 (February): 55-60.
business. Food is particularly big business because everyone Cateora, Philip R. and John L. Graham. 2005. International marketing,
eats” (p. 781). Political conflicts may limit obesity control to 12th ed. New York: McGraw-Hill/Irwin.
educational and behavioral change programs that will present Cavanagh, John and Jerry Mander, eds. 2002. Alternatives to economic glob-
alization: A better world is possible. San Francisco: Berrett-Koehler
social marketers with another opportunity to do some good. Publishers.
Cawley, John. 2006. Markets and childhood obesity policy. The Future of
Children 16 (Spring): 69-88.
NOTES Consumers International. 1999. Easy targets: A survey of television food and
1. The WHO defines a person as overweight (or preobese) if his or her Body toy advertising to children in Central Europe. A report by the
Mass Index (BMI)—a measure of weight relative to height—is equal to or Programme for Developed Economies and Economies in Transition
greater than 25 kg/m2 (25 lb/in.2 x 730). When BMI equals or exceeds 30 kg/m2, (October). Available via publications link at www.consumersinterna-
that person is labeled obese. A BMI less than 18.5 kg/m2 is undernourished. tional.org (accessed May 4, 2006).
Note that BMI provides guidelines but is not a direct measure of body fat. ______. 2004. Regulate television food advertisements aimed at children,
2. “Less affluent” or “developing” countries, “emerging” markets, and press release, May 14. Available via press and news archive link at
other similar terms are used synonymously to refer to all but the world’s www.consumersinternational.org (May 4, 2006).
thirty richest nations. The United Nations Human Development Index
Czinkota, Michael R. and Ilkka A. Ronkainen. 2004. International market-
(UNDP 2005) ranks 177 countries as follows: 1 to 57 have “high human
development,” 58 to 145 have “medium human development,” and 146 to ing, 7th ed. Mason, OH: South-Western.
177 have “low human development.” Among the top group are nations such de Soto, Hernando. 2000. The mystery of capital: Why capitalism triumphs
as Argentina (#34), Poland (#36), Cuba (#52), and Mexico (#53) that most in the West and fails everywhere else. New York: Basic Books.
observers would not consider affluent. Dholakia, Rub Roy. 1984. A macromarketing perspective on social market-
ing: The case of family planning in India. Journal of Macromarketing 4
(Spring): 53-61.
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