There’s an industry selling a product that is bad for one’s health. A generation ago that industry was tobacco and its product was cigarettes. Today it is the food and beverage industry and its product is sugar – sugar that is being added to food and drink. After 20 years working in tobacco control, Jane Martin, executive manager of the Obesity Policy Coalition, a policy think tank of the Cancer Council Victoria, has taken up the battle against sugar-laden food and drinks. She charges that the food industry has borrowed the corporate playbook of the tobacco industry to fend off regulation.
“The sugar industry has been very similar to the tobacco industry in how they work,” she says. “They fund their own research studies and criticise research they see as harmful. They focus on personal responsibility, saying it’s up to parents and the individual.”
But the parallels don’t stop there. “The tobacco industry pushed self-regulation over legislation. And now we have self-regulation around marketing to children of junk food and drinks, which is exactly what the tobacco industry got away with.”
Added sugar – not natural sugars that exist in fruits and vegetables – is everywhere. One of the largest sources is beverages such as soft drinks, energy drinks and fruit drinks. But a stroll though the supermarket shows that there is added sugar in bread, yoghurt, peanut butter, soup, wine, sausages – indeed, in nearly any processed food. A single tablespoon of tomato sauce can contain a teaspoonful of sugar.
This ‘invisible sugar’ comes under many names. For example, there are more than 40 different names for sugar listed on food labels in Australia, New Zealand and Singapore, ranging from ‘agave nectar’ to ‘high-fructose corn syrup’ and ‘molasses’, along with a whole host of names you will have never heard of.
According to Lisa Renn, an accredited practising dietitian, sugar has a range of purposes in food manufacturing. “It’s not only used as a sweetener, it’s used as a colouring for food consistency and as something to hold the ingredients together,” she explains. “Having small amounts of sugar in moderation is OK. But large amounts every day are not good. Soft drinks have become the new water.”
Dr Robert Lustig, a paediatric endocrinologist at the University of California, San Francisco, and a world leader in the anti-sugar campaign, points out that sugar consumption worldwide has tripled in the past half-century.
“Our food supply now contains so much added sugar that our metabolic (energy-processing) systems just can’t handle it,” he says. “Your body does different things with different types of calories. Fructose (added sugar) in quantities eaten today primarily gets stored as fat. Usually, that fat will go to your belly.”
And the danger to our health is not just obesity: there is evidence linking sugar to liver disease, type 2 diabetes, heart disease and tooth decay. Nevertheless the food and beverage industry continues to promote sugar with extensive advertising of its sugary products. It also spends large sums of money opposing clearer labelling of its products, as well as fighting increased taxation on sugary foods and drink.
Hundreds of millions of dollars is spent each year promoting unhealthy foods – those high in sugar and/or fat. As well as advertising in conventional media, the industry also invests heavily in sponsoring sports events, product placements on TV shows and Facebook marketing – all the places likely to reach children.
In 2015, the World Health Organization (WHO) reaffirmed its previous recommendation that ideally our intake of sugar – except that naturally occurring in fruits and vegetables – should not exceed ten per cent of total energy intake, and that less than five per cent would bring additional health benefits. The WHO presented strong data linking the consumption of sugar to rates of obesity and, as type 2 diabetes is linked to obesity, to this disease as well.
In the average diet, ten per cent of total energy intake would work out to be about 50 g, or 12 teaspoons of sugar per day. A single 375 ml can of soft drink typically contains around 35 g of added sugar. The Australian Health Survey found that in 2011-2012, Australians were consuming an average of 60 g of sugars each day, or the equivalent of 12 teaspoons of white sugar. Soft drinks, energy and sports drinks, as well as fruit and vegetable juices made up more than a third of these added sugars.
“Sugar-sweetened soft drinks and juices are the dietary version of the cigarette,” says Professor Merlin Thomas, NHMRC Senior Research Fellow at the Baker IDI Heart and Diabetes
Institute. “They may provide a short-term kick, but in the long term they contribute to a range of diseases and ultimately premature mortality.”
It’s not just that soft drinks represent a major source of unnecessary kilojoules, increasing our risk of diabetes, heart disease and some cancers, Thomas says. “In fact, our expanding waistlines may represent a risk as grave as smoking.”
Thomas points out that sugars in soft drinks are absorbed fast, requiring an equally fast response in the body and putting extra demands on the pancreas, the job of which is to regulate our metabolism. Some studies suggest that regularly drinking soft drinks can thin your bones, and all soft drinks cause tooth decay.
An industry group, the Australian Food & Grocery Council (AFGC), brushed aside the WHO report. “The WHO recommendation relates to dental caries, not weight issues or diabetes,” says AFGC deputy chief executive Dr Geoffrey Annison.
He says the recommendation covers dietary ‘free’ sugars and not ‘added’ sugars, in line with the Australian Dietary Guidelines. “This is consistent with the industry’s view that healthy eating requires moderation, variety and balance.”
Meanwhile, the advertising of sugary foods continues. Overweight and obesity in children, and the amount of sugary food children continue to eat and drink, are of particular concern to health professionals as well as parents. One area where experts see that a difference can be made is in reducing or stopping TV advertising of sugary foods and beverages around children’s programming.
A recent study by the Cancer Council and the National Heart Foundation of Australia found that teenage boys who watched more TV were more likely to eat junk food, and were more likely to be obese.
“We thought obesity was high in people with high TV viewing habits because they may not be as active, but most studies show that it’s about what they are watching and how that’s impacting on the foods they are consuming,” says Kathy Chapman, chair of Cancer Council Australia’s Nutrition and Physical Activity Committee.
Despite voluntary industry guidelines that say junk food and soft drinks cannot be advertised directly to children, these guidelines are not mandatory and the manufacturers set their own criteria of what they deem to be healthy or unhealthy, Chapman says.
“Advertising works, that’s why these companies spend a lot of money on it. It is up to parents to teach their children about safety, but it doesn’t stop us having a pedestrian crossing.”
The Canadian province of Quebec has been a leader in this regard, restricting such ‘junk food’ TV advertising to children since 1978. Quebec now has substantially lower obesity rates than the rest of Canada. Other countries that have restricted commercials for sugary drinks, cereals and other junk food during times when kids watch TV include Norway, Sweden, Denmark, Mexico and the UK.
Another area of food and beverage advertising that anti-sugar campaigners strongly oppose is the association of products with athletes, a tactic used by the tobacco industry just over 50 years ago when both celebrities and athletes were employed to endorse cigarettes.
Public health advocates say two approaches that worked to reduce smoking – consumer education and taxation – are needed to combat over-consumption of sugar.
A ten per cent tax on sugary drinks was introduced in Mexico in January 2014 and drinks sales there fell by 12 per cent in the first year. In France, a tax on soft drinks introduced in 2012 has resulted in a gradual decline of consumption. Norway has been active in taxing sugary foods and drinks as well as education for many years, with good results.
In Australia, New Zealand, Singapore and Malaysia, calls for a tax on sugar have come from a range of public health advocates. A recent Australian study found that placing a 20 per cent tax on sugar-sweetened beverages could save more than 1600 lives over 25 years and raise at least $400 million a year for health initiatives.
And as obesity continues to rise in Asia, several countries such as India, Indonesia and the Philippines are also considering placing a tax on sugary drinks. In 2013, the Malaysian government removed the subsidy on sugar over health concerns, and it is currently studying whether other measures are necessary to further reduce sugar consumption.
Not surprisingly, a sugar tax is strongly opposed by powerful groups in the food and beverage industry, such as the AFGC.
“Advocates for a tax cannot reconcile that Australia has had a de facto sugar tax for 16 years – it’s called the GST, which is applied to processed food – and obesity has not dropped during this time. In fact, evidence suggests that Australia’s sugar consumption declined significantly (6% for women, 14% for men) from 1995–2011 while obesity continued to rise,” Annison says.
“[Comparing the sugar industry to tobacco] is ill-informed and simply designed to grab a headline. There is no safe level of tobacco consumption and it has absolutely no health benefits. All foods can be incorporated into a healthy diet, and conversely unhealthy diets can also be constructed solely from so-called ‘healthy’ foods.”
Another approach is to inform consumers of the levels of added sugars in food through the health star rating system. In Australia, the system was developed by the government in collaboration with industry, public health and consumer groups. It rates the overall nutritional profile of packaged food and assigns it a rating from half a star to five stars on the front of the pack. The more stars, the healthier the food.
The problem with health star ratings, says Jane Martin, is they still allow many foods that are high in sugar. And they’re still voluntary. “We want to see the health star labelling being mandatory and changes made to the algorithm, so the products are more aligned to Australian Dietary Guidelines,” she says.
The industry disputes this claim, saying that the algorithm is entirely consistent with Australian Dietary Guidelines, and that eating foods with higher star ratings will lead to less intake of energy, saturated fat, sodium(salt) and sugar, and more dietary fibre, fruits, nuts, vegetables and legumes.
The evidence against sugar and its ill effects on our health continues to mount as study after study is published. Dr Kimber Stanhope, a nutritional biologist at the University of California, Davis, completed a five-year investigation in 2015 linking high-fructose corn syrup – a common sweetener in the US – to increased risk of heart attack and stroke.
“People should realise that there are no risks associated with reducing sugar intake,” says Stanhope, “but there are risk factors in continuing to eat high amounts while waiting for more evidence. Parents should wean their kids and themselves off daily sugar consumption and consider it a special occasion food.”
New research also indicates that sugar, like tobacco, may be addictive. Eric Stice, a US neuroscientist, is using MRI brain scans on adolescents that show that “sugar activates the brain in a way that is reminiscent of a drug like cocaine.”
He adds that people build up a tolerance to sugar much the same way smokers and drug users do. “That means the more sugar you eat, the less you feel the reward. The result, you eat more than ever.” Other studies point to sugar being addictive because it activates the brain’s pleasure-generating circuitry.
What can you do to reduce your intake of added sugars? Despite the hype, it’s important not to get too hysterical about sugar, says dietitian Lisa Renn. It’s a non-essential nutrient but small amounts in moderation are fine.
For example, you might be worried that a simmer sauce contains a lot of sugar – but if you’re eating it with lean meat and vegetables, then the meal as a whole is nutritious. The same goes for cereals: the sugar content might be relatively high if they contain dried fruit, but if the rest of the cereal is made of whole grains then don’t discount it just because of the sugar.
“You don’t have to be anxious about tiny bits of sugar that add to the palatability of food. It’s about eating fresh, healthy foods, fruits and vegetables, lean meat and wholegrain cereal, and cooking from scratch. Use common sense when you look at a product and aim for less than 15 g per 100 g, especially if you have diabetes,” she says.
When it comes to soft drinks, Professor Thomas says turning to diet varieties might be a sensible first step, but water is still the best choice.
“But the most important step is personal,” Thomas says.
“When everyone commits to looking after their health, soft drinks will not be on the menu. And the companies will follow your money, wherever it goes, so make it count to better health and a better future.”
Terms that mean 'added sugar'
- agave nectar
- beet sugar
- maple syrup
- cane juice
- rice syrup
- powdered sugar
- corn syrup
- date sugar
- brown rice syrup
- corn syrup
- dri sweet
- dried raisin sweetener
- edible lactose
- kona ame
- inverted sugar
- sorghum syrup
- golden syrup
- mizu ame