PUBLIC HEALTH
March 13, 2013

The Bitter Truth about Sugar

The World Health Organization reviews the global effects of sugar on obesity. Guess what they found.

When the World Health Organization (WHO) decided to mount a huge review study regarding consumption of sugar around the globe, the findings were a no-brainer — people who eat more sugar weigh more. But that's not the end of the story. The personal and policy implications of these findings have the power to make a huge difference to health.

"This finding did not surprise me at all," Robert Lustig, a professor of pediatrics at the University of California at San Francisco, told TheDoctor. "Sugar is definitely a cause of obesity." The WHO study found that people who reduced their intake of sugar lost on average nearly two pounds, while those who increased their intake gained nearly the same amount.

The findings prompt the suggestion to shop along the edges of the supermarket, where the fresh fruit, vegetables, meat, and fish are. Processed food is generally sold in the center of the store.

Sugar is the primary driver of chronic metabolic disease, explains Lustig. Because of the way sugar is metabolized by the body, it is a major reason why obesity turns into metabolic syndrome, that cluster of diseases including high blood pressure, cardiovascular disease, and high cholesterol.

One way to address the issues of sugar over-consumption and obesity is through legislation. New York City’s controversial "Big Gulp ban,” a law restricting the sale sugar-sweetened drinks in restaurants, food carts, and other venues to sizes of 16 ounces or less, is a start. “It’s a baby step,” Lustig says. The law would have gone into effect yesterday but a judge blocked it. New York Mayor Michael Bloomberg has vowed to appeal the decision.

WHO researchers found that sugary sodas are a major source of excess sugar and overweight, particularly among children. Efforts to make it more difficult to over-indulge sodas, along with other items sweetened with high fructose corn syrup, will have to be part of a strategy to reduce sugar consumption and obesity in the future.

With anti-smoking efforts, many different pieces of legislation, such as additional taxes on cigarettes and indoor smoking bans, were required to significantly reduce tobacco consumption. To control sugar consumption, a broad-based approach targeting a variety of unhealthy, high calorie foods, will likewise be needed — especially given the powerful opposition of soft drink manufacturers.

Try This At Home

The easiest way to reduce sugar consumption, says Lustig, the author of Fat Chance, is to just eat real food. Real food is low in sugar and high in fiber. “If you just ate what came out of the ground, or the animals who ate what came out of the ground, you’d be fine!”

And shop along the edges of the supermarket, where the fresh fruit, vegetables, meat, and fish are. Processed food is generally sold in the center of the store. It has been clear that processed food is a problem for a long time, says Lustig, but because of our two-parent, no-time, and no-money lifestyle, the warnings have fallen on deaf ears.

In the WHO study, investigators at the University of Otago and the Riddet Institute in New Zealand analyzed the results of 71 studies that looked at sugar intake and body weight to examine the association between free sugar intake and body weight in both adults and children. For their purposes, the researchers defined free sugars as sugars that are added to foods; plus those naturally present in honey, syrups, and fruit juice.

The authors acknowledge that the effect of reducing sugar intake is relatively small, but they add, "…[W]hen considering the rapid weight gain that occurs after an increased intake of sugars, it seems reasonable to conclude that advice relating to sugars intake is a relevant component of a strategy to reduce the high risk of overweight and obesity in most countries."

The study and a related editorial were published online in the British Medical Journal which also commemorated the 40th anniversary of the publication of Pure, White and Deadly.

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