Highlighting health issues related to fast food has only added to other worldwide pressures on McDonald’s operations. Externally these include an epidemic of mad cow disease foot-and-mouth disease, the SARS epidemic in the Asia-Pacific region, a fall in economies leading to weaker foreign currencies, and high commodity costs. lnternally these problems were compounded by McDonald’s aggressive international expansion strategy that made future growth more difficult. As the then CEO, James Cantalupo, admitted, 'we took our eyes off our fries and paid a price.”