1 POLICY MEMORANDUM To: Sonja L. Conner, MS, RDN, LD, President of Academy of Nutrition and Dietetics From: David Lee Problem: Misleading Nutrition Education Date: December 5, 2014 Executive Summary: As nutrition education is becoming an important strategy for preventing chronic diseases, such as obesity, there is a major concern with the Academy of Nutrition and Dietetics (AND), the world’s largest nutrition education organization partnering with big food companies. The big food companies are providing deceptive nutrition information to the public and dominating the AND’s nutrition conventions with misleading nutrition education as a marketing scheme. The AND’s financial ties with the big food companies misaligns with the AND’s mission and vision to “empower members to be food and nutrition leaders” and “optimize health through food nutrition.” This policy memorandum will provide an in-depth analysis of the problem and evidence of misleading nutrition education from big food companies. In addition, this policy memorandum will provide three policy options and a recommendation to solving the problem. Background: According to the Centers for Disease Control and Prevention (CDC), one-third (78.6 million) of U.S. adults are obese. Nutrition education has been an important strategy for preventing chronic diseases and maintaining a healthy population. The interest in learning about nutrition has been growing through multiple avenues such as dietary books, health fairs, magazines, television, radio, and social media. While dietary and nutrition education is easily accessible, it has become difficult for consumers to distinguish nutrition facts and nutrition paid advertising. It is perplexing that nutrition information shared with the public is tainted with bias because of big food manufacturers and their sponsorship of organizations such as, the Academy of Nutrition and Dietetics (AND). In a recent controversy, Dr. Oz was questioned by Senator Claire McCaskill on Capitol Hill for false health claims on his talk show. Dr. Oz claimed weight loss products on his show to be “lightning in a bottle” and “a miracle flower” without any scientific evidence to back up the claims. This language is completely meaningless but has a devastating effect on convincing the public into believe that the products work. As a result of his claims, manufacturers of the 2 products have drastically increased sales for the products (Christenson & Wilson 2014). Dr. Oz has also been alleged to be financially tied to the manufacturers. It is not surprising that he helped promote the products, as Americans spent 2.4 billion dollars on weight loss products in 2013 (Christenson & Wilson 2014). It is simply not easy for an average consumer to discern if health information given is actually fact or false. After all, Dr. Oz is a practicing physician and well-respected television personality (with 3.5 million Twitter Followers), right? Unfortunately, because of financial sponsorships and incentives, health information is often misled to the public. Correspondingly, it is striking that the world’s largest organization of food and nutrition, the AND, is sponsored by big food manufacturers such as Coca-Cola, Kellogg’s, Univeler, and Pepsico (see Appendix A for a list of the sponsors on the AND’s website). The AND comprises of 74,000 members comprising of Physicians, Nursing Professionals, and Registered Dieticians who support and rely on the organization for nutrition education. Over the last 10 years, the AND’s sponsorship is steadily increasing (see Appendix B). In 2011, the AND collaborated with 38 big food companies. The big food companies are collaborating with the AND as a business strategy to increase sales. Alternatively, the AND’s financial ties with big food companies is to gain revenue. Simon (2014) reported that the AND gained $1.5 million in revenue or 38% of contributions were attributed to corporate sponsorships in 2011. This relationship can be harmful as the big companies are partnering with the AND to provide deceptive nutrition information to the public. The Issue: The relationship of big food manufacturers with the Academy of Nutrition and Dietetics (AND) is misaligned with the AND’s mission and vision to be a leading distributor of nutrition information to the public and to mitigate nutrition-related health problems, such as the obesity. Obesity rates have been rising and have become an epidemic that has showed no signs of slowing down. According to the CDC, 34.9% of U.S. adults are obese and it has led to obesity related diseases such as, “heart disease, stroke, type 2 diabetes and certain types of cancer.” The AND is supposed to slow down the obesity epidemic through promoting nutrition education for the public to live a healthier lifestyle. The AND also develops Registered Dieticians (RDs) so that they are equipped with nutritional tools and material to educate the public. According to the AND, they train RDs to translate “the science of nutrition into practical solutions for healthy living…when you need food and nutrition information based on fact…they are able to separate facts from fads and translate nutritional science into information you can use.” The ability for Registered Dieticians to decipher scientific-based nutrition information is complicated when big food companies supply the public with nutrition material that are bias (see Appendix C for example of a flyer given at the AND nutrition conference in 2012, with a selling point on moderate candy consumption can be part of a healthy diet). This bias information is a misalignment of the AND’s mission and vision. 3 The AND’s association with big food companies can ruin their reputation and lose their members due to AND’s misalignment with their mission and vision. According to the Chicago Tribune, Eng (2013) reports an advocacy called “Dieticians for Professional Integrity” which was started by Andy Bellatti who is a RD. The advocacy’s objective is to convince the AND to remove their financial ties with big food companies because RDs are relying on the AND for reliable training and continuing education credits. In addition, the big food companies are dominating the AND’s nutrition conventions by distributing deceptive nutrition education material to sell their products (see Appendix D of handout from Frito-Lay distributed at the AND’s annual conference). The information provided is deceiving because Frito-Lays, a division of the AND’s sponsor, PepsiCo. is selling their product by using misleading semantics of language. Notice that Frito’s Lay’s corn chip product is on the handout and is labeled to contain fewer than 100mg of sodium. However, the handout omits other common snack foods like nuts, seeds, and vegetables that are more healthy options. The information conveyed by big food companies is not solely evidencebased. There is a need to examine the sponsorships and companies that are funding the research for AND. Furthermore, there is a moral obligation for AND to inform the public that the nutrition and food information provided may be influenced by the sponsors. There is much harm associated with misleading nutrition education. Through the deceptive marketing schemes set by the junk-food sponsors, people are fooled by food labels and consume big-portion sizes of food. According to an article in Everyday Health titled, “How Portion Size Adds Up to Obesity,” Americans eating bigger portions have increased substantially since the late 1900s. Today individual Americans are consuming portion sizes and calories that could feed small size families. In addition, big fast food restaurants are a major contributor to serving “supersized” portion meals (Hook 2009). Americans eating big portions have contributed to the rising epidemic of obesity and chronic diseases. Furthermore, the deceptive marketing schemes established by junk-food sponsors have led the public to eat poor choice of food as part of the Standard American Diet (S.A.D.). Food that Americans eat are unhealthy such as “heavy in saturated fats, partially-hydrogenated oils, refined carbohydrates, and highly processed foods” (Leonard 2013), which the public do not pay attention to because it is part of the American standard set by many of the big food companies. It is important that AND to deliver health conscious messages to the public and not be part of the issue for the obesity epidemic. The Evidence: The concept of major health organization joining forces with big corporations due to financial ties or sponsorship is well known in history. For several decades, The American Medical Association (AMA), which is recognized for enhancing the healthcare system in the U.S. through physicians, had financial ties with the tobacco industry and even after cigarettes was proven to be detrimental to consumer’s health. It was not until years of advocacy that the AMA decided to separate themselves from the tobacco industry because information provided to the public did not align with their mission (Adams 2007). The AND is no different from other health organizations who have partnered with sponsors to fund the organizations and in-return provide non-evidence based information to the public. The AND states in their mission statement that 4 they are “committed to improving the nation's health and advancing the profession of dietetics through research, education and advocacy.” In addition, the AND describes that their role as an organization is to provide “reliable and evidence-based nutrition information for the public.” The AND’s sponsorship ties with big food companies are misaligned with their mission to improve health through reliable nutrition education. How can the information that is provided be “reliable” when one of the sponsors is Coca-Cola, who manufactures soft drinks that are filled with sugar that contributes to obesity? How can consumers trust Coca-Cola who has falsely advertised their products to reduce the risk of chronic diseases? How creditable is AND when the big food manufacturer’s mission do not align with AND’s? By creating fiscal ties with Coca-Cola, the AND lost their credibility and should be known for providing bias and not evidence-based nutrition facts. In 2009, Coca-Cola was hit with a lawsuit for claiming that their Vitamin Water line of beverages will “reduce the risk of chronic disease, reduce the risk of eye disease, promote healthy joints, and support optimal immune function.” (Center for Science in the Public Interest, also known as CSPI). Coca-Cola tried to market the Vitamin Water as a “healthy” beverage and mislead consumers into believing the beverage can reduce risk of chronic diseases. In 2013, CSPI was able to prove in front of court that Coca-Cola violated several Food and Drug Administration (FDA) regulations, one that the beverage is not a vitamin-fortified food because Vitamin Water contains only half a percent of juice from vitaminfilled fruits such as dragon fruit, kiwi-strawberry, and acai-blueberry-pomegranate, which are flavors sold by Vitamin Water. The other violation of FDA was the claim that variety of Vitamin Water could reduce the risk of eye diseases. In fact, according to CSPI, there are 33 grams or 8 teaspoon of sugar that can promote obesity and other diseases. The Executive Director of CSPI, Michael F. Jacobson believes that the misleading of nutrition labeling by Coca-Cola is a major mistake. He was quoted for saying, “The marketing of Vitamin water will go down in history as one of the boldest and brashest attempts ever to affix a healthy halo to what is essentially a junk food, a non-carbonated soda. Vitamin water, like Coca-Cola itself, promotes weight gain, obesity, diabetes, heart disease, and cannot deliver on any of the dishonest claims it has made over the years." Coca-Cola continues to sell their products and offers their drink options under their brand at AND conventions (see Appendix E for a picture a Coca-Cola information booth at an AND conference). The AND is also guilty for providing nutrition paid-advertisements to the public and not respecting their mission. The list below contains various articles and evidence pertaining to this situation: According to a New York Times article titled, “Report Faults Food Group’s Sponsor Ties,” AND has increased their financial ties with big food companies over the years. The article states, “paid sponsors of the academy more than tripled between 2001 and 2011 — to 38, from 10 — and that roughly 23 percent of about 300 speakers at its annual meeting had undisclosed financial ties to the food industry (Strom 2013).” In addition, according to Eng (2013), the AND sent a McDonald’s “representative to the Utah Dietetic Association meeting to discuss its "'healthful' offerings some of which are 5 cooked in trans fats, the very fats strongly condemned by the American Heart Association due to their definitive links to heart disease.” At the 2013 the Academy of Nutrition and Dietetics Food and Nutrition Conference and Expo (FNCE), the official FNCE bag contained pamphlets on aspartame (a type of artificial sweetener) being safe, which was provided by Coca-Cola (Watson 2013). A Coca-Cola bias message was presented as dietary recommendation for children at a conference by Robert Kleinman who works for Coca-Cola stating, “Majority of studies have not found link between sugar and behavior in children. Despite the evidence, parents continue to believe sugar leads to behavioral problems in children due to their perceptual biases” (Simon 2013). To date, the AND has not taken a position on GMO’s (genetically modified foods), a topic that many consumers have raised concerns about (Stocking 2014). See Appendix F which demonstrates a corporate sponsor, Dietz & Watson reporting in 2011 that there is “no salt added” in their meat at the AND’s annual nutrition conference. The meat is in fact processed meat which the American Institute for Cancer Research, the Harvard School of Public Health, and the World Health Organization have discussed the various health risks (heart disease, colorectal cancer, and type 2 diabetes) with consumption of processed meat. See Appendix G which shows a picture of misleading information displayed at the McDonald’s booth in the AND’s nutrition expo. McDonald’s is using the 300 calories as a selling point that the Egg McMuffin is a health breakfast option. The Egg McMuffin is composed of over 30 ingredients including processed meat and cooled in partially hydrogenated oils, which is associated with high cholesterol and weight gain leading to heart diseases. It is also packed with 780 milligrams of sodium. See Appendix H which exhibits the bias of information and the use of deceptive semantics to misinform the public into believing that the fast food options can be healthy because it is less than 400 calories. However, it is not revealed that many of the fast food options from McDonalds are cooked with trans fat, which is strongly condemned by the American Health Association due to link to heart disease. This demonstrates how deceiving and biased AND’s nutrition information provided to the public can be because of the financial ties with their sponsors. In additional, the examples show that the sponsors are taking over the AND conventions and using them as an opportunity to market their products. The use of marketing schemes by big food companies and to join forces with nutrition educational organizations like AND are a major concern. Big food companies market their products by relying deceptive nutrition information to the public. According to the Strategic Marketing and Research Incorporated (SMRI), the implications of portion-size mislabeling in food products can lead to people overeating. An article published by SMRI, discussed the marketing method of mislabeling food products. The article states, “When people consumed a large item that was labeled “small,” they felt less guilty;…call this effect “guiltless gluttony.” This is marketing method that many big food companies and fast food chains use to deceive people from eating large portion sizes and feeling less guilty when eating the portions. In 6 addition, big food companies are increasing food portions to charge more on their consumers. According to Hook (2009), obesity is rising because Americans today are spending half of their food money on fast food restaurants while consuming more calories than they did in the late 1900s. She states in her article, “Women consume over 335 more calories per day than they did in 1971, and men, 168 more calories per day.” In addition, the following fact presented by Hook (2009) is very alarming. She states, “In 1950s, a regular fast-food burger was 2.8 ounces and 202 calories. In 2004, the same burger was 4.3 ounces and 310 calories. [Also,] a regular Coke grew from six ounces in 1916 to 21 ounces in 1996.” Along with big food companies setting unhealthy standard diets, Americans’ health is deceptively put in jeopardy by big food companies. AND’s collaboration with big food companies worsens the issue with the misleading nutrition information provided to the public. Policy Options: Drop Problematic Sponsors: There should be strict criteria for who can become an Academy of Nutrition and Dietetics (AND) sponsor to ensure that the influence is aligned with the association. The more the Academy supports big food companies, the more power we give to them to continue with their mission and vision – global domination of the consumer market. The AND should restrict sponsorship from for-profit corporations, especially big food companies that are deceptively marketing their food products. It is proven that the big food companies are partnering with AND not to improve the health of the public. The big food companies are taking advantage of their opportunity to market their products and mislead the public into believing that there are health benefits with their products, without integrating any scientific evidence (Strom 2013). As a leading organization that preaches to provide evidence-based nutrition information and to help tackle the disease epidemic through nutrition education, the AND has failed to meet their mission. The AND’s contradictory relationship with for-profit sponsors should end. This is a necessary step to establish so that their mission is realigned and they begin to practice what they preach. The question now is whether the AND can raise enough money to sustain their present activities if big sponsors are dropped. According to the AND’s annual report in 2011, if the AND is to remove their corporate sponsors, the AND’s revenue will be short by $496, 609 (see Appendix I for AND’s financial report that includes expenses, revenue, and the revenue shortage calculation in 2011). There are two methods to make up for the revenue shortage. The first method is to increase the membership fees, which is currently $300 annual fee per member. If AND could reassess their revenue stream and financial status of their organization, they could rely on membership funding. The increase in membership fees is rational if AND could break their financial ties with corporate sponsors and work to gain credibility from their members. The second method is to downsize the operations and reduce expenses. Although the AND might offer less services to their members, it is important that the AND works on fixing their image and realigning itself to their mission. 7 When evaluating other nutrition education corporations that have removed their financial ties with corporate sponsors, they have found other methods to financially sustain themselves. An excellent example is American College of Nutrition (ACN), who in 2006 was under scrutiny for having financial ties with corporate sponsors and not publishing it on their website. Many of the sponsors were big food companies that are currently sponsoring AND. Some examples of the sponsors are ConAgra, Unilever, Campbell's Soup Company and Coca-Cola. It was not until September 28, 2011 when they reevaluated their mission and made a unanimous decision to stop taking funding from for-profit corporations. Today ACN is financially sustained through membership fees of $150 per year, non-profit organizations, and individuals who chooses to donate to ACN (Dietitians for Professional Integrity 2013). These are funding methods that could be adopted by AND. The Executive Director of ACN, Michael Stroka agrees that without sponsorship from big food companies, they have lost a portion of their funding that could go toward expanding their organization. Although there is lost in revenue, ACN is capable of financially sustaining the organization with the benefit of delivering nutrition information that is aligned to their mission. Stroka emphasized that, “The College would not accept money from any entity trying to subvert our funding policy by cloaking themselves in another form, such as a non-profit front group for interests misaligned with nutrition science for human health.” As a corporation that strives to tackle health issues through healthy eating, the size of the corporation is not what matters, but it is the quality of the messages that are delivered to the public that matters. Stroka highlighted this point by saying, “The ACN's purpose is to advance nutrition science to prevent and treat disease. We believe the route to achieving that mission is not being the biggest, but being the best and most uncompromising source for nutrition science (Dietitians for Professional Integrity 2013).” The AND should find alternative methods to fund their programs and ultimately change their policy to align with their mission. They should imitate ACN who are now proud to state the following on their website: The American College of Nutrition accepts no funding from for-profit corporations. This policy fosters our mission and our ability to advance unbiased science without compromise. We are proud to adhere to this important policy as a scientific body, and believe this further strengthens the voice of the College as an advocate for the crucial role of rigorous, unbiased nutrition science in improving human health. Fully Disclose All Details of Relationship with Sponsors: The AND should increase its transparency with its collaboration with its corporate sponsors. It is the right for members and the public to know who their money is supporting. The AND website is too vague for its members to truly understand the big food company’s role in financing AND. There should be disclosure of the benefits that the 38 corporate sponsors receives when they fund AND. Without transparency, both the AND and the corporate sponsors cannot be held accountable for the deceptive information that are dispersed to the public. It is important that AND increases transparency with its members so that the members are informed of the financial ties with big food companies and the marketing strategies used by corporate sponsors exist. 8 It is a right for every member to know about the AND’s financial ties with corporate sponsors. Obtaining input from its 74,000 members and listening to them on how they feel about corporate sponsorships is important to retain their members. Furthermore, information disclosed about the sponsors can assist members to decide whether they want to deactivate their membership with the AND. In 2009, the Dieticians for Professional Integrity surveyed the AND members surrounding their opinion on AND’s partnership with big food companies. According to Strom (2013), 80% of 2, 968 members that were surveyed thought that AND should verify that a corporate sponsor’s missions is consistent prior to collaborating with them (see Appendix J for a breakdown of acceptable and unacceptable corporate sponsors rated by AND members). The members of AND have a vested interest in the kinds of sponsors AND chooses because it represents them as a professional entity. However, there does not seem to be much movement in limiting corporate sponsors that do not further the credibility of AND. Write Guidelines for Sponsor Conduct into the Bylaws: The AND along with the government should intervene and limit the influence that sponsors have on dispersing non-scientific-based nutrition information to the public. The AND should create bylaws that state that the corporate sponsors cannot push certain junk-food products on its members and the public. This will highly weaken the authority that the corporate sponsors have over the AND and ensure the sponsors don’t go pass their boundaries to market their products. It is also important that AND address with the government to create public policies around evaluation corporate sponsors. The purpose of the evaluations will be to access the programs that are set by the sponsors, such as the material given out at conferences are 100% scientific-evidence based. It is time for big food companies to stop deceiving the public into buying their unhealthy food products. In addition, the corporate sponsor’s authority should not prevent AND from taking a stance against the big food companies when it comes to food policy. In 2012, while Mayor Michael Bloomberg was trying to implement a public health law regarding the portions sizes of sugar beverages, many revered public health professionals came out in support of the movement. However, the AND’s stance on the issue seems to be related to the connection that the AND has with the major soda giants, Coca-Cola and PepsiCo. Some of the stance, or lack thereof stated, “The nutrition profession must face the reality that our nation’s chronic disease epidemic has worsened because educational measures have failed miserably (Simon 2013).” There was no mention of the research and evidence surrounding the negative health implications of the overconsumption of sugar-sweetened beverages. With a lackluster response to such a hot topic, the corporate sponsors must have an influence on AND to challenge the big food companies. It is time for AND to point out the big food companies who continue to deceive the public into buying their unhealthy food products. Recommendation It is recommended for the AND to write strict guidelines for sponsor conduct into the bylaws if they choose to keep their mission and vision. The sponsors should no longer be able to push 9 certain products on its members and allow the big food companies to control the AND. The bylaws will weaken the authority of the big food companies and prevent them from running rampant at the AND conventions. Information shared at the AND conventions should only be free of bias and fully evidence-based. The AND should take a long, hard look at its moral compass and see where it is pointing. If the AND honestly believes the corporate sponsors have no moral issues then it is time to change their mission and vision to reflect it. The AND just needs to be honest with the public of what they believe to be “evidence-based” information. 10 References Adams, M. (2007, July 25). Doctors, American Medical Association hawked cigarettes as healthy for consumers. Natural News. Retrieved September 12, 2014, from http://www.naturalnews.com/021949_Big_Tobacco_the_AMA.html# Adult Obesity Facts. (2014, September 9). Centers for Disease Control and Prevention. Retrieved September 12, 2014, from http://www.cdc.gov/obesity/data/adult.html ACN Accepts No Corporate Funding. (2014, January 1). American College of Nutrition. Retrieved October 10, 2014, from http://www.americancollegeofnutrition.org Christensen, J., & Wilson, J. (2014, June 19). Congressional hearing investigates Dr. Oz 'miracle' weight loss claims. CNN. Retrieved September 12, 2014, from http://www.cnn.com/2014/06/17/health/senate-grills-dr-oz/ Coke Loses Again as Vitaminwater Case Moves Forward (2013, July 18). Center for Science in the Public Interest. Retrieved September 12, 2014, from http://www.cspinet.org/new/201307182.html Coke Sued for Fraudulent Claims on Obesity- Promoting "Vitamin Water" (2009, January 15). Center for Science in the Public Interest. Retrieved October 10, 2014, from https://www.cspinet.org/new/200901151.html Dietitians for Professional Integrity. (2013, July 17). Retrieved December 3, 2014, from http://integritydietitians.org/resources/learn-the-issues Eng, M. (2013, June 17). Food policy: Dietetic association should not take money from McDonald's, Coca-Cola, Pepsi and other 'junk food' makers, says petition. Chicago Tribune. Retrieved September 12, 2014, from http://articles.chicagotribune.com/2013-06-17/features/chifood-policy-dietetic-association-should-not-take-money-from-mcdonalds-cocacola-pepsi-andother-junk-20130617_1_petition-mcdonald-dietitian Hook, D. (2009, August 5). How Portion Size Adds Up to Obesity. Everyday Health. Retrieved October 10, 2014, from http://www.everydayhealth.com/diet-nutrition/weight-management/bigfood-are-we-eating-more.aspx Leonard, B. (2013, August 28). How Does Diet Impact Health? | Taking Charge of Your Health & Wellbeing. University of Minnesota. Retrieved October 10, 2014, from http://www.takingcharge.csh.umn.edu/enhance-your-wellbeing/health/diet-nutrition/how-doesdiet-impact-health Misleading Food Labels Lead to Overeating. (2010, November 16). Strategic Marketing & Research, Inc. Retrieved October 10, 2014, from http://smari.com/news/article/misleading-foodlabels-lead-to-overeating 11 Simon, M. (2013, January 1). Are America’s Nutrition Professionals in the Pocket of Big Food?. Eat Drink Politics. Retrieved September 12, 2014, from http://www.eatdrinkpolitics.com/wpcontent/uploads/AND_Corporate_Sponsorship_Report.pdf Stocking, C. (2014, February 27). A Call for the Academy of Nutrition and Dietetics to Take a Stance on GMOs. Eat Righteousness. Retrieved September 12, 2014, from http://eatrighteous.org/more-info-on-gmos-and-a-call-for-the-academy-of-nutrition-and-dieteticsto-take-a-stance-on-gmos/ Strom, S. (2013, January 22). Report Faults Food Group’s Sponsor Ties. The New York Times. Retrieved October 10, 2014, from http://www.nytimes.com/2013/01/23/business/reportquestions-nutrition-groups-use-of-corporate-sponsors.html?_r=0 Who We Are and What We Do. (2014, January 1). Academy of Nutrition and Dietetics. Retrieved September 12, 2014, from http://www.eatright.org/About/Content.aspx?id=7530 Watson, E. (2013, October 23). Dietitians for Professional Integrity: Our hope is that, with time, AND will realize partnerships with big corporate sponsors send out the wrong message. Food Navigator USA. Retrieved September 12, 2014, from http://www.foodnavigatorusa.com/People/Dietitians-for-Professional-Integrity-Our-hope-is-that-with-time-AND-willrealize-partnerships-with-big-corporate-sponsors-send-out-the-wrong-message 12 Appendix A The Academy of Nutrition and Dietetics Website Listing Several Corporate Sponsors (2014) Appendix B Steady Increase of the AND’s Corporate Sponsorship (Simon 2013) 13 Appendix C A Flyer for Moderate Candy Consumption (Dietitians for Professional Integrity 2013) 14 Appendix D A Handout Containing Bias Information (Dietitians for Professional Integrity 2013) Appendix E A Photograph of a Coca-Cola Booth at a AND Conference (Dietitians for Professional Integrity 2013) 15 Appendix F A Dietz & Watson Booth at a AND Conference Showcasing their Product (Dietitians for Professional Integrity 2013) 16 Appendix G Information Seen at the AND Conference (Dietitians for Professional Integrity 2013) Appendix H A Picture of a McDonald’s Booth at the AND Conference (Dietitians for Professional Integrity 2013) 17 Appendix I The AND’s Financial Report (The Academy of Nutrition and Dietetics 2014) Calculations of the AND’s Revenue Shortage Revenue from Non-Corporate Contributions= Total Revenue-Corporate Contributions= $3,430,902-$1,258,858= $2,172,044 Revenue Shortage= Total Expenses- Revenue from Non-Corporate Contributions= $2,668,653- $2,172,044= $496,609 Appendix J A Survey Given to the AND Members (Simon 2013)