The sugar wars: be careful to define the enemy and choose your weapons
BY PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR, PUBLIC HEALTH, UNIVERSITY OF SYDNEY
The statistics do not support the view that there are big differences in sugar consumption between the fact and the thin. We need to define our enemy clearly in the battle against obesity and stop beating up individual consumers.
The Sydney Morning Herald has announced a war on sugar. Its rationale is that we need to combat obesity with all its attendant ills. Good thinking. Sugar may appear to be easy pickings. Beware.
It is vital that sugar consumption by individuals not be cast as the behaviour that we must attack (willpower, my friends, willpower) with all our might to solve the problem of obesity. That will be a waste of energy – no pun intended – and leave the real changes essential for reversing our current trend to a fatter, less healthy community untouched.
Just how critical is sugar to obesity? A study of 132, 479 individuals in the UK, published in the International Journal of Epidemiology* in 2016, analysed their consumption of macronutrients – fat, protein, carbohydrate and sugar – and compared how much energy in the diet of obese versus non-obese individuals came from these food categories. This group was assembled for the UK Biobank genetic study and the current study made use of the comprehensive health data collected on all participants.
Anderson and Pell, the lead authors of the study from the University of Glasgow, made the point that in this study: “Dietary intake was self-reported outside the clinic, which may encourage more truthful reporting, and was collected using a 24 hour recall questionnaire which produce more accurate results than a food frequency questionnaire (the usual approach adopted in large-scale studies).” Their general conclusion was: “66.3 per cent of men and 51.8 per cent of women were overweight/obese.”
Anderson et al wrote: “Compared with [those participants with] normal BMI, obese participants had 11.5 per cent higher total energy intake and 14.6 per cent, 13.8 per cent, 9.5 per cent and 4.7 per cent higher intake from fat, protein, starch and sugar, respectively.” So while the fat folk were consuming more energy than the thin, the excess due to sugar intake between the two groups was quite small. “There is only a weak correlation between absolute energy derived from sugar and from fat. Therefore, targeting high sugar consumers will not necessarily target high consumers of fat and overall energy.”
They concluded that: “Fat is the largest contributor to overall energy. The proportion of energy from fat in the diet, but not sugar, is higher among overweight/obese individuals. Focusing public health messages on sugar may mislead on the need to reduce fat and overall energy consumption.”
Do these observations mean that we should not include sugar as needing attention in our approach to obesity? Not at all. Many drinks and processed foods are overloaded with sugar and that should change. But it cannot be said to be the main game in obesity, like tobacco is in lung cancer.
Unlike tobacco – a single and inessential commodity – there is no case to ban sugar completely. A sugar tax would make all sugar-containing foods and drinks more expensive and hence less accessible to less affluent consumers who may at present depend on these sugar-laden commodities. It passes the penalty for consuming foods with high sugar content onto the consumer and so a tax would needs careful calibration using the criterion of equity. Also, Anderson et al warn of the tendency to substitute one source of energy for another and if the substitute for less sugar is more fat, then we are no further ahead.
The power of the sugar industry – cane, corn and beet – is immense and it is far from squeaky clean when it comes to promoting a healthy diet. It is at the level of production and marketing that our attention needs to focus in creating a healthier approach to sugar.
Encouraging individuals to lobby for less sugar in processed foods and drinks will not be easy but that is what is needed. Blood will be spilt as that battle plays out. But it is to this battle – and not by beating up individuals to reduce their individual consumption of sugar (desirable but neither necessary nor sufficient) – that our efforts should be applied for sustainable community-wide gains.
An international comparison of cost-effective ways of reducing obesity by McKinsey and Co, a consultancy, nominated reducing portion size as the best approach among about 30 useful options. Given the nearly 12 per cent difference in total energy intake between the obese and non-obese participants in the Anderson study, reducing the size of meals we eat by 10 per cent (and we would need the cooperation of restaurants, processed meal manufacturers and others) would seem a wise recommendation.
(* Professor Leeder is also editor of the International Journal of Epidemiology.)