Consumers are getting fatter, lazier and more and more unhealthy, according to public health organisations. And governments can no longer afford to ignore the problem.
Quite apart from the human cost of premature deaths, treating victims of preventable cardiovascular diseases is putting a huge financial strain on health services worldwide - obesity alone costs the NHS £500m annually.
The World Health Organisation (WHO) will next week (February 26) publish a wide-ranging report into obesity and nutrition. Judging by a draft published last April, it won't make happy reading for marketers.
Among the draft recommendations were: limiting the use of vending machines, particularly in schools; reducing demand for high-sugar and high-fat foods; increasing the use of recommended daily amounts of nutrients on packaging; and educating children to be more discriminating about advertising.
Somewhat more controversially, WHO floated the idea that governments could consider fiscal pricing policies - that is, taxes - to control sales of foods deemed unhealthy.
In November, the International Obesity Taskforce reported that obesity "presents the biggest single European public health challenge of the 21st century" and recommended restrictions on the targeting of young children to consume 'inappropriate' food and drink. The Health Survey for England (1995-97) found that 10% of six-year-olds and 17% of 15-year-olds are obese (classed as more than double 'normal' weight).
In the US, publicity over a recent lawsuit alleging that McDonald's is responsible for teenage obesity has focused world attention on the content of fast food. Although the company won a crucial first case last month, the PR damage had already been done.
Now the battle is getting dirty. The chairman of the American Academy of Child and Adolescent Psychiatry's media committee, Michael Brody, told a conference in New York in September: "Just like paedophiles, marketers have become child experts."
Of course, there's nothing new about the healthy eating lobby taking on the food industry. The first wave of pressure erupted in the 70s, prompting reductions in the salt content of processed food and the first attempts to create low-fat alternatives. By the late-80s - more in response to the slimming craze than government intervention - low-fat foods started to flood supermarket shelves. The irony is that this is where much of the current debate is founded: in altering their products to make them low-fat, many manufacturers cranked up the sugar content to maintain the taste. In 2003, it is sugar, rather than fat, that has become the dirty word.
So the political battle over diet and nutrition is a gathering storm for global food and drink marketers. But no health expert would claim that poor diet is the only cause of obesity, and many in the food and drink industry question whether it is a cause at all.
The focus now is on how the food and drink industry can be persuaded to help contribute to healthier diets by reducing consumer intakes of salt, sugar and fat.
For manufacturers, there is reason to fear the international health lobby this time: the EU has become more powerful, with European governments quicker to implement recommendations; the WHO research was commissioned on the request of national governments needing to reduce the burden on their health services; and the UK government has become more interventionist than at any period in the past 30 years.
So how is the issue affecting those in charge of marketing brands judged to be sugar- or fat-rich?
Much effort has been spent trying to mitigate WHO's recommendations.
The UK Food and Drink Fed-eration sent a hefty submission to WHO, much of it questioning the scientific basis of the organisation's assumed relationship between sugar intake and obesity. Its stance reflects arguments used by the food industry when faced with criticism over the nutritional value of products - that there are no intrinsically bad foods, only bad, unbalanced diets. It also pointed out that decreasing levels of physical activity are a far bigger contributor to obesity than diet.
WHO has been trying to engage in what it calls 'transparent and positive' dialogue with the food and drink industry. It has learned from the confrontational slanging matches it has had with the tobacco industry that by working with the private sector, it can encourage the production of the healthy products it wants consumers to eat and drink more of. It has also been keen to engage directly with individual firms, rather than just trade bodies.
Most companies affected by the WHO report will make no direct comment on the issues raised until it comes out. But some have been proactive in responding to the threat.
Coca-Cola, for example, devotes a large share of its web site to a defence of why its brand is not intrinsically unhealthy. It contends that there is no more sugar in a glass of Coke than in a glass of orange juice.
McDonald's, meanwhile, has unveiled plans to phase out the use of trans-fatty acids (identified as causing heart disease and cancer) and is considering adding nutritional information to all its wrappings. It is also thinking about integrating healthy eating messages into ads - part of a plan to tackle the obesity allegations in a more upfront way. And McDonald's needs to act.
A UBS Warburg report written last November analysed the risks to share values of the WHO report and the health lobby. It produced an 'Obesity Ranking' that shows which firms are most at risk. Those with the highest number of products falling into the category of 'unhealthy' featured highest on the list (see box). McDonald's came in at number two - ahead of sugar producer Tate & Lyle.
But as with any commercial threat, the change in public policy over diet and nutrition presents significant opportunities. The UBS report states: "The food and drink industry will have to change the products they sell, the way they label them and the way they market them. The winners will be those that successfully capture the change in attitudes in order to halt the spread of this obesity epidemic."
In the UK, there have been active attempts at industry level to head off the threat to marketing to children. At the end of 2002, the Chartered Institute of Marketing promoted research showing children's savvy when faced with ads, while the MediaSmart programme, which is backed by Unilever, Procter & Gamble, Kellogg and Masterfoods, will send materials to schools to teach kids how to understand when they are being sold to.
Other companies are effectively using greater awareness of healthy eating as a marketing platform. US sandwich franchise Subway, which claims to have helped Americans slim down, has itself been expanding fast. There are now more of its yellow-and-black signs than McDonald's golden arches in the US, and the chain has aggressive plans for the UK.
In parallel with international public health policy changes, Britain's Department of Health (DoH) has pioneered a campaign to encourage people to eat five pieces of fruit and vegetables a day. A scheme will licence sellers of fresh, frozen and dried fruit and vegetables, as well as pure juices, to display an official logo.
Tesco has used its own 'five-a-day' logo on its fruit, vegetables and some ready meals for two years. A spokes-man told Marketing that "customers appreciate the guidance", although he could not confirm whether sales had risen as a result of the technique.
Masterfoods last year released details of a scientific study showing that chocolate has some positive health benefits for the heart through cocoa's antioxidants. Last month it emerged that the company, which owns the Mars brand, is testing a maximum-antioxidant version of a chocolate milk drink under a division called The Positive Food Company. The marketing will make heavy claim of the fact that a glass of the drink delivers as many antioxidants as four glasses of cranberry juice.
Coca-Cola has responded to parental concerns over children's drinks with added sugar by launching Roo Juice in the UK, aimed at two- to five-year-olds. Comprising only fruit juice and water, a spokeswoman claims it has been hugely successful since its introduction last August.
And Britvic, which owns the Pepsi distribution franchise in the UK, has been keen to capitalise on the popularity of less sugary alternatives.
It has put substantial advertising support behind its J20 range of juice drinks and plans to introduce Freekee Soda, a mixture of milk and fruit juice.
But anyone newly using health to market food or drink products to children should bear in mind Procter & Gamble's Sunny Delight experience to realise that it can be a risky game.
Sunny D was conceived as a brand that was "healthier than a fizzy drink, but not as healthy as orange juice," former brand manager Jon Walsh said last month. "We never claimed it was (as healthy as orange juice), but consumers got the impression they were being cheated," he admits.
Unilever Bestfoods last month promoted its new Knorr Vie soups by pointing out that they can make up part of the five recommended pieces of fruit or vegetable. But the DoH is still considering whether it will issue licences for processed food to use its logo - discussions with the food industry on the subject are said to be "sensitive".
Earlier this month, the European Commission revealed proposals to stamp down on food and drink manufacturers making 'misleading' claims about the health-enhancing properties of its products.
At the very least, this represents another tough lobbying battle. And for many marketers of high-sugar or high-fat food or drinks, there is an inherent problem in bringing out a 'healthy' alternative.
By doing so, companies effectively admit their core brand is unhealthy by comparison - unless they can put clear blue sky between the brands, as Masterfoods is doing with The Positive Food Company, and McDonald's did when it bought Pret A Manger.
LISTEN TO THE PUBLIC
I'm not in favour of over-emphasising food products' health benefits.
If you shout too much, consumers are liable not to believe you.
One slimming magazine recently found that Nando's food contains half the calories of other high-street fast foods.
We would rather consumers find this message out for themselves or by reading it in a magazine - the effect will be much more powerful than us directly telling them.
On the Cranks brand, which we bought last year, we have a core of consumers who write in and question us on our ingredient choice. If we listen to these experts, we can create something that will also be satisfactory for consumers who don't check out the nutrient labels.
I don't believe in the functional food theory of adding ingredients to boost nutrient values. Fresh, well-made food will have enough right nutrients in abundance anyway.
SHARE VALUES AT RISK
3 Tate & Lyle
5 Pepsi Bottling Group
7 Coca-Cola Enterprises
Source: UBS Warburg
GIVE CONSUMERS CHOICE
Sugar is a natural substance, a fact often lost in this debate. However, I believe the most problems lie where sugars are added to savoury products to boost the taste. Consumers wouldn't expect them to be there, so they are effectively hidden.
For our business, I would say it's all about horses for courses. We are seeing a trend of people actively avoiding more artificially sweetened carbonated drinks and returning to full-strength versions, as they see them as being more natural. But we should always offer choice.
It's easy to criticise the food and drink industry, but people forget we are living better, longer lives because of its industrialisation. It was only the beginning of the last century when people in this country were dying of malnutrition. Few people truly understand the issues surrounding diet, and it's all overshadowed by left-wing organisa-tions predisposed to be anti-commercial.