The Times: Selling sugar in the obesity wars - an investigation
Sugar is the new threat in the fight against flab -but it is a cunning enemy, reports David Rowan.
To appreciate the scale of today's childhood diabetes epidemic, just ask Terry Wilkin at Peninsula Medical School, in Plymouth. Since 2000, Professor Wilkin and his team have been tracking 300 healthy local schoolchildren, chronicling their physical development and monitoring everything from insulin to cholesterol in their blood.
When the study began, the children, then aged five, were already showing worrying signs: almost a third of the girls were overweight, a tenth of them clinically obese. In blood tests, the fatter children also tended to be more "insulin resistant" -an early indicator of type 2 diabetes.
Four years on, the pattern is hardening. Type 2 diabetes, once regarded as only an adult disease, is now one of the fastest-growing threats to British children, and Professor Wilkin and his team want to know why. "We're looking both at eating and activities," he says, "but my impression from our studies is that the energy imbalance in young children may not lie with physical activity. What concerns me more is that it's the calorie-consumption element we get wrong. Wherever we have high-energy-dense foods (such as cakes, fast food, chocolate, fizzy sweet drinks), we'll identify obesity."
After years of official advice to cut our fat intake, health campaigners are now focusing their efforts on sugar. Could the sugars added to soft drinks and processed foods be as responsible as fats for Britain's obesity crisis? The sugar industry refuses to accept a link, but with sugar making up the extra calories in many low-fat foods, policymakers are increasingly concerned.
Now the Government is talking tough. "Sugar is next, once the present campaign on salt is over," Imogen Sharp, the Department of Health's head of health improvement and prevention, told the Royal College of General Practitioners in September. Her department, she said, would be "looking at a campaign to reduce the amount of sugar people are eating". The view was echoed, if less specifically, in the Government's health White Paper last month, which called for lower sugar levels in our foods.
In his Plymouth clinic, Professor Wilkin is careful to point fingers at factory-produced food in general, rather than sugar alone. "Yes, whenever you process food, you're adding sugars, but the problem lies with energy-dense foods more generally," he says. "It would help to limit our consumption of refined sugars, but going back to natural food is the solution."
If the Government does take on sugar, it will have picked a powerful enemy. The sugar industry is among the world's most effective food lobbies, securing vast agricultural subsidies and protection under EU quotas. British Sugar -part of Associated British Foods, which as a group has annual sales of £5.2 billion -processes the entire UK sugar beet crop of 9 million tonnes, turning it into 1.3 million tonnes of white sugar. Tate & Lyle, based in London, is Europe's largest cane-sugar refiner, with sales last year of £3.2 billion and profits of £227 million. The industry defends its position through political lobbying, school education campaigns, the sponsorship of favourable scientists, aggressive legal challenges and, critics say, blatant manipulation of health bodies.
The British consume about 2.25 million tonnes of sugar each year, three quarters of it indirectly in drinks, processed foods and confectionery. Overall, added sugar provides 13 per cent of our calories, well above the World Health Organisation's (WHO) recommended 10 per cent limit. Typically, this works out at about 20 teaspoons of added sugar every day for men and about 13 for women.
Consumption is rising disproportionately among younger people. The 2003 National Diet and Nutrition Survey found that men aged 19 to 24 relied on sugar for 17.4 per cent of their calorific intake -almost twice the "healthy" WHO limit. The Department of Health is clear that this is costing lives. In a background paper for its Choosing Health White Paper, the department estimates that every 1 per cent drop in sugar consumption (as a proportion of our calorie intake) would prevent 750 obesity-related deaths. That exceeds the 600 lives it calculates would be saved by a similar cut in saturated fat.
The problem for many consumers is knowing just how prevalent sugar is in their diet. Would you know from a food label that maltose, dextrose, high-fructose corn syrup, hydrolysed starch, muscovado, amazake and carob powder are all sources of sugar? Would parents be aware that heavily advertised children's cereals, such as Kellogg's Frosties Turbos, which claim to benefit bone and heart health, may contain five times as much sugar -40 per cent by weight -as cornflakes?
Campaigners are particularly concerned at the marketing of high-sugar foods to children and, increasingly the media is listening. Cadbury's was forced on the defensive last year over its "Get Active" promotion, offering sports equipment in exchange for chocolate wrappers. School education packs have also raised concern.
A video from the Sugar Bureau, the UK trade association, explained that tooth decay was caused by "bread, rice, crisps and cucumbers". A cucumber, the video stated, was 80 per cent sugar -a calculation based on its dry weight. The video was withdrawn after protests.
"Parents are shocked when you explain that a 500ml bottle of Coke contains 10 teaspoons of sugar," says Kath Dalmeny, policy officer for the independent Food Commission. "When you give a child a drink, you don't think it's the equivalent of two-and-a-half packs of sweets." The industry undermines public health messages through its advertising, she adds: "The NHS spends around £880 per person a year treating disease, yet its budget for health promotion is just £2.20.
The industry, meanwhile, can swamp any official messages. So they use a technical word like 'carbohydrate' rather than sugar, as it sounds healthier. They don't explain that sugar is a simple carbohydrate -exactly what we shouldn't be eating."
The Sugar Bureau sees no scientific link between sugar consumption and weight gain. Indeed, sugar, its literature states, may increase a dieter's chances of losing weight. "By including some low-fat sugary foods such as arctic roll, jaffa cakes, sorbets, fruit yoghurt, rice pudding, jelly beans and currant buns in their diet, slimmers can easily top up their carbohydrate intake, without adding too many calories," it says.
If you exercise, the bureau adds, you "need" sugar to replenish lost energy: "Most people can't manage a heavy starchy meal immediately after exercise. But a soft drink or a sugary snack can start to refill carbohydrate stores straight away."
Also, if children become hyperactive at sugar-fuelled parties, "detailed studies" prove that "this is a consequence of the situation, not their sugar intake".
British Sugar's Silver Spoon website, meanwhile, cites "scientific evidence" that people who consume high levels of sugar tend to be slimmer. Its advice: "Aim to eat more foods which are high in carbohydrates, such as pasta, rice and sugar."
"This is utter baloney," says Jane Clarke, the Times nutritionist. "With today's sedentary lifestyles, we don't burn up enough sugar to justify eating the sugary stuff -pasta and rice fine, but no one can tell me that their body physiologically needs a sweet drink."
The industry's influence has been felt most forcibly at the international level.
Six years ago, two United Nations health bodies -the WHO and the Food and Agriculture Organisation (FAO) -were considering lowering their recommendations for dietary carbohydrate intake. In secret, two industry-funded groups spent $60,000 (£31,000) sponsoring a key meeting in Rome where sympathetic "experts" were heard. The resulting conference press release was headed: "Good news for kids: experts see no harm in sugar". It took a Panorama investigation this year to disclose the involvement of the two industry groups, the World Sugar Research Organisation and the International Life Sciences Institute, backed by Coca-Cola and Tate & Lyle.
The WHO and FAO faced more overt pressure in spring 2003, when their Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases said a healthy diet should comprise no more than 10 per cent of "free sugars" (added sugars plus those naturally present in honey, syrups and juices). The US Sugar Association wrote to Dr Gro Harlem Brundtland, the WHO director-general, promising to "exercise every avenue available to expose the dubious nature" of its "misguided, nonscience-based" findings. This included challenging the WHO's $406 million funding from Washington.
Occasional leaks reveal how the lobbyists solicit influence. A recent letter to a WHO director from Richard Cottrell, the director-general of the World Sugar Research Organisation and head of the Sugar Bureau, suggests that his groups would offer "substantial sponsorship" if offered the status of non-governmental organisations. This would give them access to internal WHO meetings. Professor Philip James, chairman of the International Obesity Task Force, called the proposal "a ruthless and vicious strategy" to undermine efforts to improve health.
He asked: "Does the sugar industry really believe it can bribe the WHO?"
Dr Cottrell refuses to discuss his leaked letter, or the campaign against the 2003 WHO recommendations. "Anybody who thinks that we have a secret mechanism of undue influence is living in a paranoid fantasy" is all he will say. He does, though, believe that his industry-funded bodies deserve NGO status. "Neither organisation is profit-making. Being a non-governmental organisation merely allows you to take part in the debate." He says that he has numerous scientific studies disclaiming any link between sugar and obesity. "Too much of everything causes obesity. I don't see any evidence that targeting certain types of food would work."
Manipulating the food supply, he says, could cause "dramatic" price rises and unforeseen "adverse health risks" for some people.
The industry also finds outside voices of support. Last month, the Oldways Preservation Trust, "a non-profit food issues think tank", invited journalists to Mexico City to cover a conference on the benefits of sugar and sweeteners. Those who accepted heard an epidemiology professor, Adam Drewnowski, criticise the WHO's description of soft drinks as "energy-dense foods", adding that their high water content gives them "the energy density of fresh carrots". Conference sponsors included Coca-Cola's Beverage Institute for Health & Wellness and Tate & Lyle.
Those who challenge the industry can find life tough. When the pressure group Action and Information on Sugars (AIS) challenged advertising claims that Ribena ToothKind "does not encourage tooth decay", it faced more than two years of legal arguments from GlaxoSmithKline that reached the High Court. The Advertising Standards Authority, backed by the AIS, won the case, but only after the pressure group's then chairman, Jack Winkler, claimed to have been threatened six times with legal action unless the group apologised. Today, Winkler, a food consultant, believes the Government is serious about taking on the sugar lobby. "The White Paper is cautious, but the impact on NHS budgets of rising diabetes will force them to act," he says.
Back on the front line, Sarah Jarvis, a GP, treats the consequences of the British diet in her surgery in Shepherd's Bush, West London. "In the past decade the incidence of obesity has jumped," she says. "I see teenagers with type 2 diabetes, people in their twenties who get out of breath walking upstairs, people in their thirties with osteoarthritis." Even so, Dr Jarvis, the author of Diabetes for Dummies, is wary of targeting sugar alone. "Ready-cooked foods contain huge amounts of hidden sugars and fats, yet because people see the words '96 per cent fat free', they presume it's healthy -even though the fat has been substituted for sugar and other refined carbohydrates. We're eating fewer calories than at any time since the Second World War, yet we are getting bigger," she says. "That's because we're eating the wrong kinds of food. This is about more than simply sugar."
LIKE IT? LUMP IT
* OBESITY Three quarters of British adults are now overweight, with 22 per cent of us officially obese. Obesity is a risk factor in diabetes, heart disease, renal failure, joint problems and possibly cancer. Weight gain occurs when the body consumes more energy than it expends. Sugar is a big source of energy. And consuming too much sugar also hinders our ability to burn off stored fat.
* APPETITE A sweet drink or snack before a meal may make you overeat -it affects our body's ability to recognise when we're full.
* HEART Too much sugar can raise levels of fatty acids called triglycerides. High triglyceride levels are linked with high cholesterol, and are a known risk factor for heart disease.
INSULIN The more often we eat sugary food, the more insulin we release to process the sugar -and it has been said that too much sugar can lead to insulin becoming less effective. The result might be type 2 diabetes.
* TEETH Sugar causes tooth decay. A recent study published in the British Dental Journal found that the risk of tooth erosion was 220 per cent higher in 14-year-olds who drank fizzy drinks.
(The Times, December 11, 2004)
To appreciate the scale of today's childhood diabetes epidemic, just ask Terry Wilkin at Peninsula Medical School, in Plymouth. Since 2000, Professor Wilkin and his team have been tracking 300 healthy local schoolchildren, chronicling their physical development and monitoring everything from insulin to cholesterol in their blood.
When the study began, the children, then aged five, were already showing worrying signs: almost a third of the girls were overweight, a tenth of them clinically obese. In blood tests, the fatter children also tended to be more "insulin resistant" -an early indicator of type 2 diabetes.
Four years on, the pattern is hardening. Type 2 diabetes, once regarded as only an adult disease, is now one of the fastest-growing threats to British children, and Professor Wilkin and his team want to know why. "We're looking both at eating and activities," he says, "but my impression from our studies is that the energy imbalance in young children may not lie with physical activity. What concerns me more is that it's the calorie-consumption element we get wrong. Wherever we have high-energy-dense foods (such as cakes, fast food, chocolate, fizzy sweet drinks), we'll identify obesity."
After years of official advice to cut our fat intake, health campaigners are now focusing their efforts on sugar. Could the sugars added to soft drinks and processed foods be as responsible as fats for Britain's obesity crisis? The sugar industry refuses to accept a link, but with sugar making up the extra calories in many low-fat foods, policymakers are increasingly concerned.
Now the Government is talking tough. "Sugar is next, once the present campaign on salt is over," Imogen Sharp, the Department of Health's head of health improvement and prevention, told the Royal College of General Practitioners in September. Her department, she said, would be "looking at a campaign to reduce the amount of sugar people are eating". The view was echoed, if less specifically, in the Government's health White Paper last month, which called for lower sugar levels in our foods.
In his Plymouth clinic, Professor Wilkin is careful to point fingers at factory-produced food in general, rather than sugar alone. "Yes, whenever you process food, you're adding sugars, but the problem lies with energy-dense foods more generally," he says. "It would help to limit our consumption of refined sugars, but going back to natural food is the solution."
If the Government does take on sugar, it will have picked a powerful enemy. The sugar industry is among the world's most effective food lobbies, securing vast agricultural subsidies and protection under EU quotas. British Sugar -part of Associated British Foods, which as a group has annual sales of £5.2 billion -processes the entire UK sugar beet crop of 9 million tonnes, turning it into 1.3 million tonnes of white sugar. Tate & Lyle, based in London, is Europe's largest cane-sugar refiner, with sales last year of £3.2 billion and profits of £227 million. The industry defends its position through political lobbying, school education campaigns, the sponsorship of favourable scientists, aggressive legal challenges and, critics say, blatant manipulation of health bodies.
The British consume about 2.25 million tonnes of sugar each year, three quarters of it indirectly in drinks, processed foods and confectionery. Overall, added sugar provides 13 per cent of our calories, well above the World Health Organisation's (WHO) recommended 10 per cent limit. Typically, this works out at about 20 teaspoons of added sugar every day for men and about 13 for women.
Consumption is rising disproportionately among younger people. The 2003 National Diet and Nutrition Survey found that men aged 19 to 24 relied on sugar for 17.4 per cent of their calorific intake -almost twice the "healthy" WHO limit. The Department of Health is clear that this is costing lives. In a background paper for its Choosing Health White Paper, the department estimates that every 1 per cent drop in sugar consumption (as a proportion of our calorie intake) would prevent 750 obesity-related deaths. That exceeds the 600 lives it calculates would be saved by a similar cut in saturated fat.
The problem for many consumers is knowing just how prevalent sugar is in their diet. Would you know from a food label that maltose, dextrose, high-fructose corn syrup, hydrolysed starch, muscovado, amazake and carob powder are all sources of sugar? Would parents be aware that heavily advertised children's cereals, such as Kellogg's Frosties Turbos, which claim to benefit bone and heart health, may contain five times as much sugar -40 per cent by weight -as cornflakes?
Campaigners are particularly concerned at the marketing of high-sugar foods to children and, increasingly the media is listening. Cadbury's was forced on the defensive last year over its "Get Active" promotion, offering sports equipment in exchange for chocolate wrappers. School education packs have also raised concern.
A video from the Sugar Bureau, the UK trade association, explained that tooth decay was caused by "bread, rice, crisps and cucumbers". A cucumber, the video stated, was 80 per cent sugar -a calculation based on its dry weight. The video was withdrawn after protests.
"Parents are shocked when you explain that a 500ml bottle of Coke contains 10 teaspoons of sugar," says Kath Dalmeny, policy officer for the independent Food Commission. "When you give a child a drink, you don't think it's the equivalent of two-and-a-half packs of sweets." The industry undermines public health messages through its advertising, she adds: "The NHS spends around £880 per person a year treating disease, yet its budget for health promotion is just £2.20.
The industry, meanwhile, can swamp any official messages. So they use a technical word like 'carbohydrate' rather than sugar, as it sounds healthier. They don't explain that sugar is a simple carbohydrate -exactly what we shouldn't be eating."
The Sugar Bureau sees no scientific link between sugar consumption and weight gain. Indeed, sugar, its literature states, may increase a dieter's chances of losing weight. "By including some low-fat sugary foods such as arctic roll, jaffa cakes, sorbets, fruit yoghurt, rice pudding, jelly beans and currant buns in their diet, slimmers can easily top up their carbohydrate intake, without adding too many calories," it says.
If you exercise, the bureau adds, you "need" sugar to replenish lost energy: "Most people can't manage a heavy starchy meal immediately after exercise. But a soft drink or a sugary snack can start to refill carbohydrate stores straight away."
Also, if children become hyperactive at sugar-fuelled parties, "detailed studies" prove that "this is a consequence of the situation, not their sugar intake".
British Sugar's Silver Spoon website, meanwhile, cites "scientific evidence" that people who consume high levels of sugar tend to be slimmer. Its advice: "Aim to eat more foods which are high in carbohydrates, such as pasta, rice and sugar."
"This is utter baloney," says Jane Clarke, the Times nutritionist. "With today's sedentary lifestyles, we don't burn up enough sugar to justify eating the sugary stuff -pasta and rice fine, but no one can tell me that their body physiologically needs a sweet drink."
The industry's influence has been felt most forcibly at the international level.
Six years ago, two United Nations health bodies -the WHO and the Food and Agriculture Organisation (FAO) -were considering lowering their recommendations for dietary carbohydrate intake. In secret, two industry-funded groups spent $60,000 (£31,000) sponsoring a key meeting in Rome where sympathetic "experts" were heard. The resulting conference press release was headed: "Good news for kids: experts see no harm in sugar". It took a Panorama investigation this year to disclose the involvement of the two industry groups, the World Sugar Research Organisation and the International Life Sciences Institute, backed by Coca-Cola and Tate & Lyle.
The WHO and FAO faced more overt pressure in spring 2003, when their Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases said a healthy diet should comprise no more than 10 per cent of "free sugars" (added sugars plus those naturally present in honey, syrups and juices). The US Sugar Association wrote to Dr Gro Harlem Brundtland, the WHO director-general, promising to "exercise every avenue available to expose the dubious nature" of its "misguided, nonscience-based" findings. This included challenging the WHO's $406 million funding from Washington.
Occasional leaks reveal how the lobbyists solicit influence. A recent letter to a WHO director from Richard Cottrell, the director-general of the World Sugar Research Organisation and head of the Sugar Bureau, suggests that his groups would offer "substantial sponsorship" if offered the status of non-governmental organisations. This would give them access to internal WHO meetings. Professor Philip James, chairman of the International Obesity Task Force, called the proposal "a ruthless and vicious strategy" to undermine efforts to improve health.
He asked: "Does the sugar industry really believe it can bribe the WHO?"
Dr Cottrell refuses to discuss his leaked letter, or the campaign against the 2003 WHO recommendations. "Anybody who thinks that we have a secret mechanism of undue influence is living in a paranoid fantasy" is all he will say. He does, though, believe that his industry-funded bodies deserve NGO status. "Neither organisation is profit-making. Being a non-governmental organisation merely allows you to take part in the debate." He says that he has numerous scientific studies disclaiming any link between sugar and obesity. "Too much of everything causes obesity. I don't see any evidence that targeting certain types of food would work."
Manipulating the food supply, he says, could cause "dramatic" price rises and unforeseen "adverse health risks" for some people.
The industry also finds outside voices of support. Last month, the Oldways Preservation Trust, "a non-profit food issues think tank", invited journalists to Mexico City to cover a conference on the benefits of sugar and sweeteners. Those who accepted heard an epidemiology professor, Adam Drewnowski, criticise the WHO's description of soft drinks as "energy-dense foods", adding that their high water content gives them "the energy density of fresh carrots". Conference sponsors included Coca-Cola's Beverage Institute for Health & Wellness and Tate & Lyle.
Those who challenge the industry can find life tough. When the pressure group Action and Information on Sugars (AIS) challenged advertising claims that Ribena ToothKind "does not encourage tooth decay", it faced more than two years of legal arguments from GlaxoSmithKline that reached the High Court. The Advertising Standards Authority, backed by the AIS, won the case, but only after the pressure group's then chairman, Jack Winkler, claimed to have been threatened six times with legal action unless the group apologised. Today, Winkler, a food consultant, believes the Government is serious about taking on the sugar lobby. "The White Paper is cautious, but the impact on NHS budgets of rising diabetes will force them to act," he says.
Back on the front line, Sarah Jarvis, a GP, treats the consequences of the British diet in her surgery in Shepherd's Bush, West London. "In the past decade the incidence of obesity has jumped," she says. "I see teenagers with type 2 diabetes, people in their twenties who get out of breath walking upstairs, people in their thirties with osteoarthritis." Even so, Dr Jarvis, the author of Diabetes for Dummies, is wary of targeting sugar alone. "Ready-cooked foods contain huge amounts of hidden sugars and fats, yet because people see the words '96 per cent fat free', they presume it's healthy -even though the fat has been substituted for sugar and other refined carbohydrates. We're eating fewer calories than at any time since the Second World War, yet we are getting bigger," she says. "That's because we're eating the wrong kinds of food. This is about more than simply sugar."
LIKE IT? LUMP IT
* OBESITY Three quarters of British adults are now overweight, with 22 per cent of us officially obese. Obesity is a risk factor in diabetes, heart disease, renal failure, joint problems and possibly cancer. Weight gain occurs when the body consumes more energy than it expends. Sugar is a big source of energy. And consuming too much sugar also hinders our ability to burn off stored fat.
* APPETITE A sweet drink or snack before a meal may make you overeat -it affects our body's ability to recognise when we're full.
* HEART Too much sugar can raise levels of fatty acids called triglycerides. High triglyceride levels are linked with high cholesterol, and are a known risk factor for heart disease.
INSULIN The more often we eat sugary food, the more insulin we release to process the sugar -and it has been said that too much sugar can lead to insulin becoming less effective. The result might be type 2 diabetes.
* TEETH Sugar causes tooth decay. A recent study published in the British Dental Journal found that the risk of tooth erosion was 220 per cent higher in 14-year-olds who drank fizzy drinks.
(The Times, December 11, 2004)
posted by David Rowan at Saturday, December 11, 2004
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