Food and Behaviour Research

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4 Aug 2013 - The Observer - Isn't it time we got to grips with Big Sugar

Excess sugar in our diets is causing obesity and diabetes. Now is the time for tough legislation to regulate the food industry

Michael Rubens Bloomberg, the mayor of New York, last week received a setback in his estimable campaign to improve the health of his city. In March, he attempted to impose a ban on all sugary drinks in portions larger than 16oz. Last week, an appeals court decided his action was an illegal over-reach of executive power: the super-size continues to sell. Over the past 10 years Mayor Bloomberg has fought hard to contain the city's obesity epidemic. Measures include banning trans fats and stipulating that chain restaurants list calorie counts. "Since New York's groundbreaking limit on the portion size of sugary beverages was prevented from going into effect by a lower court ruling in March … more than 2,000 New Yorkers have died from the effects of diabetes," Mayor Bloomberg said. "Today's decision is a temporary setback… we continue to fight."

It is an important battle, and one which global food and drinks industries are determined not to lose. According to the 2012 Health Survey for England, one in four adults is obese (rising to 60% if the overweight are also included) as are one in three children aged two to 15. On average, we are carrying three stones more than 40 years ago. Dr Jimmy Bell of Hammersmith hospital, London, has also identified another obesity concern to which he has given the anagram Tofi – thin on the outside, fat on the inside. An MRI scan of an average-sized man may well reveal a liver flooded with fat as a result of his diet that may be stuffed with items marketed as "pure" and "healthy" .

Obesity is a personal misery for many and, as Alex Renton points out, writing in the Observer Magazine, it is also extremely costly to the public purse. Obese people suffer from diabetes, cancer, fatty liver disease, dementia and heart problems, costing the NHS over £5bn a year. Initially, the solution appeared simple. Count calories, eat less, exercise more. This is the remedy much promoted by the Department of Health and the 550 businesses and companies that are partners in its Public Health Responsibility Deal, aiming to reverse the UK's overweight trend by 2020. Coca-Cola, for instance, is a partner and boasts that the soft drink Sprite now contains 30% fewer calories. Nestlé, another partner, says that 39% of its confectionary contains fewer that 110 calories per serving. But research – and the determination of a handful of champions from the medical professions such as paediatrician Dr Robert Lustig, author of Fat Chance, a scientific analysis of the dangers of processed food and sugar in particular – has revealed a far more insidious process that encompasses all the horrors of addiction.

A couple of decades ago fat was the main area of concern. Now added sugar is seen as the single most important factor in what some term the "diabesity" epidemic. Sugar, ironically, is often added to "healthy food" to compensate for loss of taste when fats are reduced or removed. Most rich countries saw sugar consumption increase by 30-40% between 1970 and 2000. Since the 1970s, when US agriculture embarked on the mass production of high-fructose corn syrup (HFCS) – a highly sweet byproduct of waste corn – it has became a cheap way to "flavour" a whole range of products, savoury as well as saccharine.

Whether knowingly (fizzy drinks and chocolate bars) or unknowingly (pizza, sauces and ready-made "wholesome" dishes), we are swallowing sackfuls of HFCS over a lifetime. According to Dr Lustig, this has an impact on leptin, a hormone produced by fat tissues, which relays important messages to the brain, such as how much we should eat and when it's time to stop. Over-exposure to high levels of the hormone – caused by eating too much sugar – make some of us "leptin resistant". Our bodies can no longer "hear" the message to stop eating and burn fat. The food and drinks industry would insist that this is an issue of willpower and individual responsibility but Dr Lustig argues that it is extremely difficult for someone to single-handedly wage a 24-hour fight to keep addiction under control. So what more is required?

As Alex Renton argues, the food and drinks industry is in a state of denial about added sugar that is akin to the attitude of the tobacco industry 40 years ago. That must change. Government, in Europe and the US, is still subsidising the production of cheap (and unnecessary) sugar, queering the world sugar market, damaging farmers in poor countries, subsidising the big food and drink companies and ruining the health of many, and the poor in particular. The food and drink industries are disinclined to have it any other way. Earlier this year Coca-Cola launched its global anti-obesity campaign. It has annual revenue of $47.5bn and a business that includes Diet Coke, Fanta and Sprite, selling 1.8bn bottles of Coke a day. Its anti-fat remedy is familiar: cut calories and exercise more. A shift is urgently required. Too much responsibility is on the individual and not enough on the corporations. Regulation has yet to catch up with science. The fact that we don't have tougher rules is in part due to powerful lobbying that must be resisted more effectively.

Earlier this year, Chancellor George Osborne and health secretary Jeremy Hunt rejected the call for a sugary drinks tax without discussion – even though such a move was backed by over 60 health organisations. So called "soda taxes" exist in France and some other European countries and they should be imposed here – not least to meet the cost of the expanding waist of the nation. Scotland may lead the way. In addition, companies should be bound to provide clear information, not muddle even the most erudite of consumers. To give just one example, Britvic's Robinson Fruit Shoot was launched in 2010, as a candidate for one of five portions of fruit or vegetables a day for a child. It contains four teaspoons of sugar – 40% of what a child aged four to six should consume in 24 hours, and no fibre – so fructose in the sugar goes straight to the liver. Public health campaigns to provide counter information are also urgently required – and a politician (Mr Miliband?) to argue that if ethical capitalism has a place, it should begin at the nation's table.

Dr Lustig's aim is to ensure fructose is identified as a potentially hazardous substance that should be regulated by government, much as alcohol and tobacco are. The reaction to Mayor Bloomberg's modest ambition to reduce the giant-sized soda drink to a more moderate portion indicates the scale of the battle ahead. It is a battle that must be fought – and won.