The 'American Dream' May Be Bad for Your Health

This article originally appeared in U.S. News & World Report on Feb. 11, 2014.

By Namratha Kandula

My heart warmed when I saw Coca-Cola’s Super Bowl ad last week and heard the first strands of "America the Beautiful" sung in Hindi. As an Indian immigrant, I felt pride seeing the faces and voices that reflect a modern, diverse United States. Instead of the usual anti-immigrant rhetoric and stereotyped images, I felt like all of us who are immigrants were finally being welcomed.

It didn’t take long, however, before my stomach turned. It was the sinking realization that the smart ad executives at Coca-Cola simply recognize that immigrants have money to spend and that many still want the American Dream.

Research has shown that people associate food with identity. That can be especially true of immigrants who are transitioning into a new culture and trying to integrate into American society. The real message behind the ad was not about embracing diversity, but rather, “Drinking Coca-Cola is American. Coke is part of the American Dream.”

A fascinating 2011 study by researchers in California examined the connection of food and identity on U.S. immigrants. Using a series of experiments, the researchers found that when Asian immigrants felt that their American identity was being threatened or questioned, they were more likely to choose American foods that were higher in calories and less healthy.

Food marketing companies understand this psychology well.

Interestingly, the Coca-Cola ad prominently featured Muslim Americans, who face a lot of discrimination in the U.S. and are under immense pressure to assimilate. The ad suggests there is no better way for a Muslim woman to prove that she is truly American than if she is drinking a Coke.

For more than a decade, the U.S. food, tobacco and alcohol industries have been targeting immigrants as a distinct market segment. As a physician whose research focuses on heart disease and diabetes prevention in immigrants, I have seen the terrible impact that targeted advertising has on the health of immigrants.

It is well known that the over-consumption of sodas and other sugary drinks is an important driver of the high rates of obesity, diabetes, heart disease in the U.S. Just last week, another study showed that too much sugar consumption leads to heart disease. Many studies show that for almost all immigrant groups, living in the U.S. for more years and being a second generation immigrant is associated with more obesity.

And like other minority communities, many immigrant neighborhoods are blanketed with targeted advertisements for junk food, soda and tobacco. These same neighborhoods lack important features that can lead to better health -- walkability, places to exercise and safety. Immigrants also face barriers to accessing health care and understanding health information, making them even more vulnerable to marketing forces and messages.

Of course, globalization and the opening of developing world markets mean that many immigrants had access to junk food and soda in their home countries. However, the availability of these items in the U.S. and the ease with which they can be bought cannot be matched. Even the nutrition content can differ. For example, a 12-oz bottle of American-made Coca-Cola has 240 calories with 65 g of sugar, whereas Mexican-made Coca-Cola has 150 calories per 12-oz bottle with 39 g of sugar. Furthermore, the super-size craze we see in the U.S. is rarely seen in other countries, so that when immigrants come to American they start consuming much larger portion sizes.

In my research, my colleagues and I work to prevent obesity, heart disease and diabetes in recent Indian and Pakistani immigrants, who have some of the highest rates of heart disease and diabetes in the world. Many of them are not fluent in English and find it difficult to understand mainstream public health messages about prevention. Our work has found that the junk food industry is reaching new immigrants long before the public health system can, leading to rapid deteriorations of their dietary habits. In the heart disease prevention classes we offer new immigrants, we show real ads targeting them and talk about how to resist adopting unhealthy behaviors.

In the past, public health systems focused on making sure that immigrants were not bringing in infections and other communicable diseases that could threaten the health of Americans. Today, there is an urgent need to protect the health of an increasingly diverse America by countering the aggressive marketing of junk food, soda and other unhealthy behaviors as part of the American Dream.

- Namratha Kandula is an assistant professor of medicine at Northwestern University.