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Why Banning Sugar Will Not Solve Obesity


Last week, the media erupted in reports and commentaries prompted by an article by Robert Lustig and colleagues front the University of California, published in the journal NATURE, calling on governments to regulate sugar in a fashion akin to alcohol.

Although the media referred to this piece as a ‘new study’, the article did not actually provide any new data – it was merely an ‘opinion piece’ suggesting legislative approaches to the ill-effects of eating too much sugar.

Presented as a possible solution to the obesity epidemic, the jist of the arguments more or less were as follows: worldwide sugar consumption has increased, sugar is toxic and addictive and, therefore, regulating sugar like alcohol or tobacco (including taxation and limiting access to individuals below the age of 17), would reduce obesity and prevent metabolic syndrome.

In a number of media interviews, I took issue both with the proposal to tax and ban sugar as well as the rather simplistic causal linking of sugar to the obesity epidemic.

Here is why:

1) While there is no doubt that overconsumption of sugar (like consuming too much salt (not sodium!), trans-fats, alcohol, or perhaps processed foods in general) may well promote ill health, these links may be far less robust or scientifically proven than the article suggests. More importantly, there is very little evidence from high-quality intervention studies (outside of the rather artificial setting of a clinical trial) that the proposed population measures (namely attempting to restrict sugar consumption by banning or taxing it) would have the desired effect on obesity or anything else – if there are such examples, the article certainly fails to mention them.

2) As any reader of these pages will also realize, obesity is a multifactorial complex condition driven by a myriad of socioeconomic, psychological, and biological factors – some of which do indeed make many of us prone to ‘overconsume’ salt, sugar, fats, and perhaps alcohol or illicit drugs. In the case of sugar, the article unfortunately fails to seriously delve into what exactly these socioeconomic, psychological, or biological drivers to consume more sugar may be (beyond simply suggesting that sugar is cheap, omnipresent and ‘addictive’). Unfortunately, by reducing the solution to the obesity epidemic to simply a matter of banning and taxing sugar, the article not only reinforces the widely held stereotype that obese people are obese simply because they eat too much (in this case sugar) but also that obese people, because of the damage they do to themselves and society, need to be punished and policed for the benefit of all.

3) But, even if sugar was indeed a major driver of obesity (a few years ago we would have thought it was fat, others have recently suggested it is wheat or indeed all carbs, some think it is not enough protein, others point to our industrialized meat production, or is it simply having too much variety on the shelf?), calling for interventions primarily on the demand side (making sugar less accessible and more expensive) rather than the supply side (making sugar less attractive for farmers to produce) is problematic. Paradoxically, changing demand without changing supply, at least in the short term, may well have exactly the opposite effect – sugar becomes even cheaper, thus making it an even more attractive ingredient for food producers. Reductions in the price of raw materials will likely quickly neutralize any increased cost of taxation with the net effect on consumption being zero. If, in the long run, such interventions did actually reduce sugar consumption in countries where it is regulated, we would simply be diverting streams to countries where it is not (worldwide tobacco consumption is the perfect case study for this).

4) The article is also rather cavalier about how exactly such measures would be implemented and enforced. As we well know from the hopelessly lost ‘war on drugs’, if people really want something (like sugar, assuming it is indeed as addictive as the authors suggest), they’ll find ways to get it. So making something ‘illegal’ is meaningless unless government is also prepared to enforce any such legislation. For a substance as omnipresent as sugar, this would require a rather expensive bureaucracy (I can already see food and drug inspectors raiding schools, recreation facilities, and grocery stores to ensure that no candy is sold to anyone below the legal age). I would imagine that the money required to effectively police and enforce any such new legislation would more than outweigh any potential revenues from the ‘sugar tax’ thereby snuffing any hope that such revenues could perhaps be used for other efforts to reduce obesity (like building bicycle lanes).

5) Finally, it is not clear to me why the authors would chose to simply focus their attention on sugar – it would have made as much sense to include all refined carbs, as it takes very little for our digestive systems to turn a slice of Wonder Bread or pizza into glucose. Will all refined carbs (and what exactly is the definition of ‘refined’ in this context? Do we include polished rice?) be next on the list of toxic substances that require a permit? And what about other natural sources of sugar – are we going to tax cane sugar, beets, honey, or perhaps even Maple syrup? Let us also not forget that biologically there is little difference (if any) between the ample sugar in fruit juice and the sugar I add to my cup of tea.

But in the end, my main criticism would be that, as so often, the authors have chosen to focus on the ‘what’ (eating to much sugar) rather than on the far more complex issue of the ‘why’ (why is this happening?). That of course would have been a very different paper requiring some very uncomfortable and complex analyses of the very core of how industrialized societies operate.

While the article is no doubt well intended, I sincerely fear that these rather simplistic and superficial ‘one-size-fits-all’ solutions to the obesity epidemic based on principles of shame, blame, tax, and ban, merely distract us from having a value-driven and non-judgemental discussion about the true drivers of the societal (e.g. industrialization and centralization of food production), psychological (e.g. stress, lack of sleep, emotional deprivation) and biological (e.g. fetal imprinting, endocrine disrupters) changes that have led to this epidemic, we will fail to even remotely begin to reverse this problem.

AMS
Ottawa, Ontario

ResearchBlogging.orgLustig RH, Schmidt LA, & Brindis CD (2012). Public health: The toxic truth about sugar. Nature, 482 (7383), 27-9 PMID: 22297952

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15 Comments

  1. I agree with you that banning sugar isn’t the answer. Re your point 5 though, the authors point the finger at added sugar and not white bread specifically because of the role fructose plays in their theory. So as far as I understand it, they *would* be just as opposed to fruit juice for this reason as the added sugar in your tea.

    As far as natural sugar goes, I don’t know if Lustig has changed his view, but as of his “Sugar: The Bitter Truth” video days, he was opposed to natural sugar that did not come packaged as nature intended, i.e., with fiber and nutrients. So beets would be fine.

    That said, Lustig and friends clearly show the usefulness of considering the foes of obesity as the six blind men and the elephant in the legend!* He’s got a hold of the elephant’s trunk pretty darn hard so don’t try and tell him it’s something else.

    * http://en.wikipedia.org/wiki/Blind_men_and_an_elephant

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  2. Thank you, Dr. Sharma! The first sane professional voice I have heard on this issue. The proposal is just so wrong, on so many levels.

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  3. If we, the people, quit consuming sugar in all forms, grains (animal foods), and seed oils, there would be great unemployment… in the medical industry. and obesity industry.

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  4. Thank you, Dr. Sharma for speaking in favour of complexity. Everyone wants a quick fix, a simple reason, an easily identifiable enemy, to whit: lazy, fat people; carbs; sugar; etc. etc. In fact, as you point out, it’s so much more complicated than that. Keep on telling it like it is, even if only a few are listening.

    And thanks for inspiring me to adopt my new favourite acronym: SBTB (shame, blame, tax, ban).

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  5. I think points 3 and 4 alone of Dr. Sharma’s letter are sufficient rebuttal to Lustig’s proposal. Regarding the complex nature of obesity, Dr. Sharma’s might be right, but what of it? We have a saying on this http://www.lowcarb.ca forum: “Being fat is hard. Being healthy is hard. Pick your hard.”

    Eating low-carb resolves two huge parts of the obesity problem: insulin regulation and, by extension, hunger. Once those are solved, it becomes easier to apply effort to the other factors that Dr. Sharma mentions.

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  6. It’s amazing that the most puritanical we get about food, the heavier we get. I honestly believe that messing with our natural ability to eat the right amount and the right types of foods at a given time (including those that are mostly energy!), we’re making ourselves larger. This “ban sugar” idea is a perfect example. People have been eating refined sugar and sweet foods for many, many centuries. Sugar is not crack. The pathways for addiction developed for food, because we need a constant supply of it to stay alive.

    Alcohol is a bit more problematic than sugar (though also a traditional part of our diet), and look what happened when they tried to ban it. Organized crime developed on an unprecedented scale and everyone started drinking more.

    “Being fat is hard. Being healthy is hard.” My god. I’m both. I must have the world’s hardest life! (No, not really :-)

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  7. Absolutely! Focusing on sugar alone is in no way going to reduce obesity, that is just my opinion. Obesity is like the Doc says more complex then just removing sucrose from the daily diet. There are other substantial scientific findings located at http://www-weight-management-control.com under the clinical studies tab that are suggesting obesity may be coming to a hault soon. Very interesting results of the TNO Studies presented

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  8. Taxing sugar is absolutely ridiculous! Proposing to tax sugar makes everyone angry. Possibly taxing sugar gets people talking and discussing the sugar issue.

    I think the purpose of proposing a tax on sugar IS to get people talking.

    If everyone is talking, someone may actually LISTEN….. and then quit eating so much sugar!

    At least Lustig is getting people to discuss the issue!!!!

    OUTRAGEOUS PROPOSALS may get us all stirred up in the right direction: i.e.: eating properly!

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  9. I just listened to Dr. Lustig’s talk and all I hear is the idea (not even his idea) that sugar is bad for us. Not that it is the ONLY bad thing, but that the world has (perhaps wrongly) turned against fat as the main culprit in hypercholesterolemia and heart disease. Perhaps taxation and banning aren’t the way to go to reduce sugar / fructose consumption, but regulating the extreme overuse of sugar and HFCS in processed foods is probably wise. So I like the talk. We don’t have to accept every point Dr. Lustig makes with religious fervor, but we should thank him for pointing to a problem that needs to be addressed.

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  10. Hi Rory,

    The point is not whether or not sugary pop is bad – it is the simplistic notion that SSB = obesity and banning them will solve the problem that I object to. It is not that watching too much TV or sitting in front of a computer is not part of the problem – but I would object to anyone suggesting a TV or PC tax to reduce screen time – even if they propose using that money to fight obesity. How about a tax on people who don’t use public transportation or refuse to walk to work even if they live within walking distance? How about taxing people for not getting enough sleep? It is the whole blame and shame holier-than-thou agenda based on overly simplistic messages that I object to – they do little more than reinforce stereotypes (fat people are fat because they drink too much pop and too stupid to not know better) and I don’t think they offer realistic solutions that address the root of the problem.

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  11. Dr Sharma,

    Across the world, poor (and often uneducated) parents and their kids are haplessly sucking down litre after litre of SSBs daily as if it were water, fast-tracking disastrous trends to obesity and diabetes.

    Besides alcohol and tobacco, is there a single food/drink item that is a more obvious driver of global obesity and diabetes than SSBs?

    In my opinion, there’s no mystery or complication here. Greatly reducing the intake of SSBs – via education and taxes – from everyday people’s diets – as public authorities have done with tobacco – would be a major advance for public health globally.

    I don’t understand your argument that somehow that strategy is unreasonable.

    I think you might concede that your suggestion “How about taxing people for not getting enough sleep?” is not a sensible response to this issue.

    The poor uneducated indigenous populations in the north of Australia are not suffering the misery of diabetes and dying young because they are not getting enough sleep.

    Regards,
    Rory

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  12. I agree with Rory. Experience from decades of tobacco epidemiology has shown that early users (i.e., teenagers) are very price-sensitive, and that taxing cigarettes has had a profound effect on reducing uptake of tobacco use. Some people have used unscientific arguments that this is a ‘holier-than-thou’ approach, but I think that type of thinking is now discredited. Mono- and di-saccharides are not a minor cause of obesity. Of course it is complex, but that is exactly the argument that the soft drink industry is using to deflect criticism (and threat to profits) of their products, and unfortunately in this case, Dr. Sharma’s comments merely reinforce that. Tobacco is not the only cause of heart disease, or even of lung cancer and COPD, but it a powerful driver. Further, I don’t think introducing straw man arguments about taxing TV or PC screen time or sleeping poorly has any place in a public health debate. It is irrelevant.
    I do agree that obesity is multi-factorial, and not caused by stupidity or laziness, and that those who are obese should not be blamed or shamed, if only from practical grounds, as it has been shown to have no effect on reducing the problem – it merely pushes it underground.
    Rory, I do have to differ with you on your last point – I suspect that chronic sleep deprivation (caused by stress, sleep apnea, and poor living conditions) are actually a major cause of diabetes in Aboriginal Australians and other marginalized populations. A tax on that would of course be ridiculous (but on the contrary, using financial incentives that might help improve sleep in such groups, such as enforcing limits on the operation of factories at night, or even restricting TV offerings after midnight, could be interesting).
    One of the problems with Dr. Sharma’s argument is that it fails to address the fact that non-sugary foods are essentially taxed at a very high level (since they are not subsidized by government the way that corn, and thus HFCS are). So, maybe we could all agree that no taxes would be needed if governments would stop making toxic foods ridiculously cheap and maybe subsidize fresh vegetables instead.

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  13. Please define sugar.
    Here is why:

    1) While there is no doubt that overconsumption of sugar (like consuming too much salt (not sodium!), trans-fats, alcohol, or perhaps processed foods in general) may well promote ill health, these links may be far less robust or scientifically proven than the article suggests.

    You said it in one line! I can say it bald and unproven by scientists: overconsumption of sugar, salt (not sodium!), trans-fats, alcohol and processed foods (carbohydrates) in general will promote ill health! I make this claim after developing type 2 diabetes, got metformine and a diet, with no results. after this (2 years)I stopped processed foods (all), replace shop milk for raw milk and other foods back to basic. I lost a lot of weight (without having cancer or AIDS) and do not need medicine anymore since a year. If I take any of the above mentioned processed foods, my blood glucose level raise.

    This is why I ask “define sugar”, what sugar is bad or good? And what else: I can not see if scientists speak the mouth of science or the mouth of the industry that hired them to investigate and research in advantage of the industry that hired him??

    More and more scientists act like rating bureaus for big industrial brands, and are part of the maketing strategies.

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  14. Such a tax would not incriminate those consuming sugar, and it is certainly not punishing them. It is rather providing disincentive to organizations who use sugar and market their sugary product. I think there is enough literature present to indicate that too much can have deleterious effects to health and I am thankful that this article was published to open up a dialogue that could lead to bettering human health. However, this would be a very controversial bill for politicians to implement and I think I would have limited success. I agree completely with Dr. Wolkoff’s suggestion of subsidizing vegetables rather than foods that are questionable for human consumption. In addition, education our youth about healthy eating and it’s benefits would empower future generations with making their own, healthy decisions on what they put in their bellies instead of letting marketing do the job.

    The impression I am left with after reading this article and others written by Dr. Sharma, is one of hopelessness. It seems that there are too many causes for obesity to even try to eliminate one is futile and a waste of time. If you were to prioritize the major contributing factors to obesity, I think you would find sugar near the top. It makes perfect sense to me to attack these high-risk factors one at a time, making the overall task of reducing this epidemic much more feasible. Rome wasn’t built in a day.

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  1. Is sugar really toxic? - Science-ish - Macleans.ca - [...] just that: a hypothesis. And, as Canadian obesity researcher┬áDr. Arya Sharma points out on his blog, it’s only one …

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