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

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

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