Sugar Wars and Globesity - Elected officials need to stand up to the food industry on behalf of consumers


By Laura A. Schmidt, UCSF

Many people feel like Bloomberg’s proposed Big Gulp Ban represents the worst form of government paternalism. Why should this hand-wringing nanny of a mayor make decisions for me about the size of my morning Coke? As one soft drink industry spokesman put it, it’s not the public, but the New York City Health Department, that has an “unhealthy obsession” with sugar.

I would be in total agreement with these views if I didn’t do addiction research for a living. But from where I sit, the whole sugar debate is riddled with misinformation (As David Miller and Claire Harkins explain in their recent AR blog piece) and false assumptions. One of the worst is the assumption that we are completely free to choose what we eat and drink.

No matter what we might like to think, we don’t actually have much choice. The food and beverage industry makes most of the choices for us. And they make sure that sugar is added to 80% of the foods and drinks that line our grocery store aisles. Why? Because sugar sells, it’s cheap, and the more we consume, the more we want.

Sugar production is a global industry and therefore a global vector for chronic disease. In the quantities consumed by the average person in developed countries, and an increasing proportion of people worldwide, added sugar is causing liver damage, setting us up for heart attacks and hormonal imbalances.

Here is a whistle stop tour of what we’ve learnt to date about the health consequences of sugar consumption:

--More people on the planet earth are dying from chronic diseases-- heart disease, stroke, cancer and diabetes—than anything else. This is even true for developing countries where they’ve turned a critical page on health: people in those countries are now more likely to die from the “diseases of affluence” than from the “diseases of poverty” like malaria and cholera. Major risk factors in chronic disease, of course, are alcohol, tobacco and junk food consumption.

--Many of the health hazards of drinking too much alcohol-- such as high blood pressure and fatty liver-- are the same as those for eating too much sugar. When you think about it, this actually makes a lot sense. Alcohol, after all, is simply the distillation of sugar. Where does vodka come from? Sugar.

--We may be thinking about obesity and chronic disease crisis in the wrong way.-- Most experts are worried about sugar because its “empty calories” that make people fat. But what leads to chronic disease is actually something called “metabolic syndrome” which can be caused by the toxic effects of sugar. Added sugar at the levels consumed by many changes our metabolism, it raises blood pressure, critically alters the signaling of hormones that turn hunger on and off (so people continue to feel hungry even when overeating), and can damage the pancreas and liver. Worldwide consumption of sugar has tripled over the past 50 years and along with that has come an obesity pandemic. But obesity may just be a marker for the damage caused by the toxic effects of too much sugar. This would help explain why up to 40 percent of people with the metabolic syndrome—which leads to diabetes, heart disease and cancer—are not clinically obese.

If you think you have freedom of choice then try a little experiment: Stop eating all foods with added sugar for a week (or even just a day). Most people give up before they start. They find it virtually impossible to even know what foods comprise that small 20% sliver of our food supply that doesn’t contain added sugar. Poor Mayor Bloomberg! My guess is that even he doesn’t know that his favorite bagel has almost as much added sugar as a regular-sized Coke.

If we continue to allow the global food industry unfettered freedom to choose for us, we can count on it to keep the sugar spigot flowing freely. After all, the people running these companies are paid—and in fact, legally required—to do one thing: To turn a profit for their shareholders. Where tobacco, alcohol and the junk food are concerned, industry self-regulation has proven a wholesale failure. Companies in competition have great difficulty cooperating on ratcheting down their marketing and distribution.

We have global institutions in place that are responsible for protecting health (WHO), food systems (the FAO) and for balancing trade and creating a level playing field between developing and developed countries (the WTO, international courts). To address the growing crisis of globesity and chronic disease, we need these institutions to pursue regulatory strategies, such as those suggested by the "Best Buys for Public Health" conclusions from the 2011 WHO Moscow meeting. Virtually all of these recommendations involve macro-level interventions, often involving trade policies, which are currently set up to favor corporations and make it extremely difficult for the governments of lower and middle income countries to use evidence-based regulatory strategies to protect the health of their populations.

The current Sugar War is not a battle over consumer choice. It’s a battle over who will choose for the consumer. We need overarching regulatory strategies, and we also need our elected officials around the world to follow Bloomberg’s lead: To stand up to the food industry and stand up for us - To put reasonable controls on how much of our food supply is saturated by sugar.