Is sugar causing the obesity 'epidemic'?

Sugar hit the headlines last week when the Daily Mail and The Independent led with the quote “Sugar is the new tobacco”. Many news outlets focused on a reported link between high sugar consumption and the rise in obesity and diabetes.

The reports stem from the newly formed campaign group Action on Sugar, whose well-timed press release coincides with New Year's resolutions and January diet crazes.

Action on Sugar warns that as well as being “a major cause of obesity”, there is “increasing evidence that added sugar increases the risk of developing type 2 diabetes, metabolic syndrome and fatty liver”.

In a separate story, several newspapers also highlighted an expert's perhaps surprising opinion that fruit juice contains so much sugar that it should no longer count as one of the 5 A DAY portions of fruit and vegetables.

"I would support taking it out of the 5 A DAY guidance,” Professor Susan Jebb is quoted as saying.

“Fruit juice isn’t the same as intact fruit and it has got as much sugar as many classical sugar drinks," she said.

What is Action on Sugar?

Action on Sugar is a group of specialists concerned with sugar and its effects on health. It says it is working to reach a consensus with the food industry and the government over:

  • the harmful effects of a high-sugar diet
  • reducing the amount of sugar in processed foods

It stresses the importance of protecting children from this “public health hazard” and calls for the food industry to “immediately reduce the amount of sugar that they are adding, particularly to children’s foods, and stop targeting children with massive advertising for high-calorie snacks and soft drinks”.

Action on Sugar is supported by 18 expert advisers. Its chairman is Professor Graham MacGregor, professor of cardiovascular medicine at the Wolfson Institute, Queen Mary University of London. Professor MacGregor also chairs Consensus Action on Salt and Health.

What is Action on Sugar calling for?

Action on Sugar believes the link between calories and obesity is caused in part by high sugar consumption, and that not enough is being done to tackle what they call “the obesity and diabetes epidemic”. It says that the right approach is to “target the huge and unnecessary amounts of sugar that are currently being added to our food and soft drinks”. It highlights the work that is already being carried out by food manufacturers to reduce the amount of salt that is added to processed foods.

Salt intake is estimated to have fallen in the UK by 15% (between 2001-2011) and the salt contained in most products in the supermarkets has been reduced by 20-40%. This is calculated to have led to at least 6,000 fewer strokes and heart attack deaths a year, and a reported healthcare saving cost of £1.5billion, according to Action on Sugar.

Action on Sugar says that a similar programme can be developed to gradually reduce the amount of added sugar in food and soft drinks (with no substitution for alternative sweeteners or sugars) by setting targets for foods and soft drinks. Action on Sugar has calculated that a 20-30% reduction in sugar added by the food industry over the next three to five years is “easily achievable”. This, they say, would result in a reduction in calorie intake of approximately 100kcal (420kilojoules) a day for everyone and more in those people who are particularly prone to obesity.

Professor Graham MacGregor said: “We must start a coherent and structured plan to slowly reduce the amount of calories people consume by slowly taking out added sugar from foods and soft drinks. This is a simple plan which gives a level playing field to the food industry, and must be adopted by the Department of Health to reduce the completely unnecessary and very large amounts of sugar the food and soft drink industry is currently adding to our foods.”

How did critics receive Action on Sugar’s claims?

The organisation Sugar Nutrition UK has rejected Action on Sugar’s claims, saying that they "are not supported by the consensus of scientific evidence”.

Sugar Nutrition UK cites a review on sugar and obesity published in 2013 and funded by the World Health Organization, which they say concluded that “any link to body weight was due to overconsumption of calories and was not specific to sugars”.

Sugar Nutrition UK, which is largely funded by sugar manufacturers, also disagrees that reducing the amount of sugar in foods will always result in a reduction of calories. “In most cases the sugar will need to be replaced by another ingredient and the reformulated recipes can contain more calories than the original,” it says.

It also argues that, “the balance of available evidence does not implicate sugar in any of the so-called 'lifestyle diseases', such as diabetes”.

Is sugar really “as harmful as tobacco”?

The headlines comparing sugar to tobacco were prompted by a quote from Simon Capewell, professor of clinical epidemiology at the University of Liverpool, in Action on Sugar's press release.

Professor Capewell said: “Sugar is the new tobacco. Everywhere, sugary drinks and junk foods are now pressed on unsuspecting parents and children by a cynical industry focused on profit not health.”

The Times subsequently quoted Tam Fry, a spokesman for the National Obesity Forum and a non-medical adviser to Action on Sugar, as saying that while tobacc o was still a bigger danger it was now a “close-run thing” and that Britain was falling behind the US in improving diets.

However, there is more than one factor associated with Britain’s obesity problem, so the comparison to tobacco is not particularly helpful. Unlike tobacco, it is possible to consume moderate amounts of sugar within a healthy balanced diet.

Most people in the UK eat too much sugar, and much of this sugar is hidden in the foods we eat. According to the British Dietetic Association (BDA), added sugar is not necessary for a healthy diet. Many foods that contain added sugars also contain lots of calories, but often have few other nutrients, such as proteins, vitamins and minerals. Eating too many of these foods often can contribute to you becoming overweight.

Being overweight can increase your risk of health conditions such as:

However, the BDA also states that “there does not seem to be any evidence that sugar itself causes type 2 diabetes at present”.

How much sugar can we safely eat?

Sugar is added to many foods such as sweets, chocolate, cakes and some fizzy and juice drinks, often in surprisingly large quantities (sometimes this added sugar is in the form of honey or fruit juice). For example, a can of cola drink has as much as 35g of added sugar in it (the equivalent of about seven sugar cubes).

The government recommends that added sugars shouldn’t make up more than 10% of the energy (calorie intake) you get from food and drink each day. This is a maximum of around 70g for men and 50g for women but it varies depending on your size, your age and how active you are.

Food labels will give you the total amount of sugars in the food. This includes naturally occurring sugar found in foods such as milk and fruit, which form part of a healthy balanced diet. Sometimes the food label may say “No added sugar”, but otherwise you can tell if the food contains lots of added sugars by checking the ingredients list on the food label. Types of sugar to look out for include glucose, sucrose, maltose, hydrolysed starch and honey.

According to the BDA, small amounts of sugar used to sweeten foods are “quite harmless” if limited to mealtimes only. It’s the overall amount of sugar and the number of times sweet foods are eaten and drunk that counts.

The government's Scientific Advisory Committee on Nutrition (SACN) is currently reviewing advice on sugar intake as part of a wider review of carbohydrates and health.

Is fruit juice too sugary to count as one of your 5 A DAY?

Although some brands of fruit juice do contain added sugar, the current government advice is that one glass (150ml) of unsweetened 100% fruit or vegetable juice counts as one of your 5 A DAY due to the vitamins and minerals it provides.

However, juice only ever counts as a maximum of one portion a day, even if you drink more than one glass. This is mainly because it contains less fibre than whole fruits and vegetables. Therefore, it's a good idea to limit the amount of fruit juice you drink. Ideally, your 5 A DAY target should be made up of a balanced variety of fruit and vegetables.

The BDA advises that if you want to drink fruit juice, it is best to have this at mealtimes only. It’s fine to eat fresh fruit as a snack between meals it says, but the ‘free’ acid and sugars in pure fruit juices can damage teeth. Water or milk is the best choice of drink between meals. Read more on water and drinks

What is the government doing currently to tackle obesity?

In 2011, the Department of Health published a report on obesity in England that emphasised the importance of reducing calorie consumption, alongside increased levels of physical activity. It included a calorie reduction challenge with the aim of cutting our national energy intake by 5 billion calories (kcal) a day.

Since then the government has encouraged food manufacturers to sign up to a range of pledges as part of the Public Health Responsibility Deal. As well as the afore-mentioned reduction in salt targets, there is also a pledge to reduce the number of calories in food. The work to cut down calories in food involves:

  • reformulating products and menus
  • reviewing portion sizes
  • educating the public about calories
  • marketing lower-calorie options

This led to brands such as Lucozade and Ribena pledging to cut the calories and sugar in their drinks by up to 10 per cent.

Public Health England's Change4Life campaign has recently launched its national Smart Swaps campaign to encourage the public to cut excess calories, fat and sugar from their diets.

NHS Attribution