COMMENTARY

The Case Against Sugar

Tom G. Bartol, NP

Disclosures

August 21, 2018

Sugar: Shift the Focus to Vested Interests

It took more than 40 years from the publication of studies that pointed to the dangers of smoking cigarettes to begin to rein in the tobacco industry and reduce cigarette smoking among the public.[1] Now, we are seeing similarities with the sugar industry, which is wreaking havoc on public health by influencing both science and public opinion.

We don't actually need any dietary sugar, yet sugar is added to approximately 74% of food on grocery store shelves.[1] In a recent commentary, Malhotra and colleagues[1] argue that the sugar industry has tried to deflect culpability for the public health consequences of sugar through such means as linking sugar with obesity (rather than with diabetes), blaming saturated fat for cardiovascular disease, coopting scientists as well as public health experts, obfuscating research findings on sugar, and influencing public opinion. Other efforts revolve around weakening government oversight and lobbying on behalf of industry with vested interests in promoting sugar consumption.

Top Ways to Lower Sugar Consumption

Malhotra and colleagues[1] offer eight public health interventions aimed at reducing sugar consumption. These were successfully used in curbing tobacco use in the United States.

Educate the public. Emphasize the lack of a biological need or any nutritional value of added sugar. The industry should be forced to list added and free sugars on the labels of food products in teaspoons rather than grams to make it easier to understand.

Ban sugar promotion at sporting events. Manufacturers of sugary products should be banned from sponsoring sporting events. Celebrities in the entertainment industry and elite athletes who serve as role models should publicly dissociate themselves from sugary product endorsement. Widely admired athletes and celebrities should follow the lead of Indian cricketer Virat Kohli and American basketballer Stephen Curry, who have already done so.

Ban on sugar product promotion in grocery stores. A ban on the practices of loss-leading and running end-of-aisle loss-leading displays of sugary junk foods and drinks is called for.

Taxes on sugar-sweetened products. Taxes on sugary drinks should extend to sugary foods as well.

Advertising ban. All sugary drink advertising (including fruit juice) on TV and internet demand services should be banned.

End food subsidies. All government-supported subsidies (especially for commodity crops, such as sugar) should be discontinued. Food subsidies distort the market and increase the costs of nonsubsidized crops, making them unaffordable for many people. No industry should receive a subsidy for a food that is detrimental to health.

Ensure that dietary advice is independent of bias. Diabetes organizations should not be permitted to accept money from or endorse manufacturers who market processed foods. If they have such conflicts of interest, they cannot be allowed to claim that their dietary advice is independent.

Separate diet and exercise goals. Healthy eating and physical activity should be separate and independent public health goals. Linking these goals suggests that exercise can compensate for poor eating habits (as the saying goes, you can't outrun a bad diet). There is no doubt that patients should avoid a sedentary lifestyle and engage in physical activity. To reduce the burden of nutrition-related disease, however, the focus needs to be primarily on diet rather than physical activity alone.

Viewpoint

The trend of increasing sugar consumption is largely a consequence of ingesting sugar-sweetened beverages, including sodas, sports drinks, and energy drinks. Adults consume an average of 18 teaspoons of sugar daily, and adolescents average 19 teaspoons daily.[2]

Famous athletes, often admired by youth, are often seen endorsing and appearing in advertisements for sugar-sweetened beverages. Sporting and other events are frequently sponsored by companies that make sugar-sweetened beverages. Young people who are exposed to advertisements may be more likely to consume the sugar-sweetened beverages endorsed by their role models.[3]

Deceptive research, data-framing, and blame-shifting have suggested to consumers that sugar-sweetened beverages pose no harm to their health, and in fact, can improve their performance. A public health approach with policy changes and legislation is needed to counter these beliefs. It worked for tobacco, so why not for sugar?

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