Sugar's role in global health crisis deserves more attention: BMJ essay

04 Jan 2018 --- The idea that sugar could be a fundamental cause of the global obesity and diabetes epidemics, with health effects that go beyond just empty calories, deserves more serious consideration, argues journalist and author Gary Taubes in an essay published in The BMJ today. Sugar and the potential harmful effects of its consumption have come under intensifying scrutiny in recent times, with sugar taxes being implemented, or at least debated, in a number of countries this year and consumers increasingly opting for low sugar products. According to Taubes, efforts to improve our knowledge of the harmful effects of sugar should receive priority and consumers should be dissuaded from consuming it until uncertainties have been resolved. 

In 2016, World Health Organization (WHO) Director General Margaret Chan described the twin epidemics of obesity and diabetes worldwide as a “slow-motion disaster” – and suggested that the likelihood of preventing the current “bad situation” from getting “much worse” was “virtually zero.” According to Taubes, a simple explanation for why, despite all our best efforts, these epidemics have gone unchecked, could be that our understanding of the cause of the disease is flawed.

In the midst of such a huge public health crisis, Taubes says “we must do more to discourage consumption while we improve our understanding of sugar's role.”

Doctors have long suspected sugar is not simply a source of excess calories but a fundamental cause of obesity and type 2 diabetes, writes Taubes. But until recently, fat consumption and total energy balance have dominated the debate about obesity and the nature of a healthy diet. 

The past decade has seen a renewed interest in the possibility that calorific sweeteners – particularly sugar and high fructose syrups – have major roles in causing obesity and diabetes – and major public health organizations are now recommending strict limits to the consumption of these “free sugars.”

However, Taubes argues that these recommendations target sugar only for its calories rather than as a potential causal agent of disease.

He asks the question “What if the problem is the sugar itself?” Sugar is metabolized differently than other carb-rich foods and could have deleterious effects on the human body independent of its calorific content.

The evidence that sugar has harmful qualities independent of its calories is still ambiguous, says Taubes. “If it is true, though, it changes how we must communicate the dangers of sugar consumption.”

Setting an upper limit to the amount of sugar that should be consumed in a healthy diet is a good start, but Taubes points out that it is as of yet unknown if the level recommended is safe for everyone. 
“It could be that for people who have obesity or diabetes, or both, even a little is too much. And the ubiquity of sugar-rich products may make it difficult for many people to maintain a healthy level of sugar consumption,” he warns.

Given the scale of the obesity and diabetes epidemics, “then a concerted program of research to establish reliable knowledge on this subject should be among our highest priorities,” he concludes in his essay. “Meanwhile, we can acknowledge the uncertainties while still recommending strongly against consumption.”

Consumer attitudes 
Consumer attitudes towards sugar have changed markedly over the past years. In the food and drink industry, reducing sugar content by swapping out the white stuff for sweeteners and natural alternatives has become a top priority for food innovators and manufacturers the world over and across countless applications. From bakery to beverages, breakfast cereals to infant nutrition, flavors to fragrances, slashing sugar and telling everyone about it is paramount.

Innova Market Insights consumer research conducted in 2016 found that 28 percent of UK consumers pay attention to the amount of sugar when purchasing a sugar confectionery product and 23 percent pay attention when buying a chocolate product. A low/no/reduced sugar claim was found to be the most important influencer for the sugar confectionery purchasing habits of 23 percent of UK consumers in 2016, well ahead of indulgence claims (13 percent and low/no/reduced fat claim (10 percent). In most countries, label reading has become the norm, with more than 50 percent of global consumers saying they check the sugar content of foods before they buy. 

Despite a growing concern for sugar content, consumers are also actively avoiding artificial sweeteners. The majority prefer to see products that claim they are sweetened with “only natural sweeteners” followed by a preference for “no sugar added products.” When it comes to paying more for healthier options, natural is key as 50 percent of consumers say they are willing to pay more for products that claim “only natural sweeteners” are used and 45 percent are willing to pay more for “no artificial sweeteners.” Hence the challenge of delivering lower sugar products that deliver on taste and clean label continues to be a major focus and opportunity for the industry. 

One of the big stories of 2018 will undoubtedly be the implementation of a sugar tax in the UK. Sugar-filled soft drinks will see a tax hike in April 2018 in an attempt to combat rising levels of obesity. UK Chancellor of the Exchequer Philip Hammond announced details of the new sugar tax in his March 2017 budget statement, noting that the money raised would go to the Department for Education (DfE) for school sports. A tax on drinks with more than five grams of sugar per 100ml will be levied by 18p per liter, while those with eight grams or more of sugar per 100ml will have an extra tax of 24p per liter. 

By Lucy Gunn