How sugar became the public health crises of our time.

The decline of smoking was the great public health success of the last 50 years, with smoking rates in the USA more than halved since the 1964 Surgeon General’s report and similar rates of decline being observed throughout the world. But the rise of obesity and it’s related metabolic diseases such as diabetes have signaled a new public health crises, and at it’s heart is the problem of sugar. In order to turn this crisis into the next great public health success, there will need to be a major reanalysis of our global food culture and a commitment to sustainable nutrition, not just by individuals but also by governments and the food industry.

The global epidemic of obesity and metabolic diseases has reached unparalleled proportions. Obesity rates doubled in the US between 1980 and 2000, and a similar trend occurred throughout the world. In those 20 years, South Africa experienced an 8.8% increase in obesity. In 1980, there wasn’t a single recorded case of type 2 diabetes among adolescents in the US. In 2010, there were 57 638. At this rate, 1 out of every 3 Americans will have diabetes by 2050.

‘As physicians, we know how to take care of 50 year olds or 60 year olds with type two diabetes.’ Says Dr David Kessler, an American pediatrician and the Commissioner of the Food and Drug Administration from 1990 to 1997. ‘What none of us have done is take care of that ten year old with type two diabetes for five, six, seven decades. We don’t know the consequences of that, and that scares me greatly.”

At the heart of this health crisis is the rise of sugar in the diets of not just Americans, but people throughout the world. This sugar epidemic began in 1977 with the McGovern report, produced by an American specialist committee on nutrition that met to discuss the connection between diet and heart disease. This report warned that obesity would soon be the number one form of malnutrition in the US, and issued the very first dietary goals for Americans. The report recommended that Americans reduce their intake of sugar, cholesterol and fat, which were found to be the primary causes of metabolic disease.

The report was published, but only after the content was drastically altered in response to pressure from the egg, sugar, dairy and meat associations of the United States. These associations united and rejected the report, lobbying in Congress against it’s publication and demanding a rewrite. As a result of this pressure, the dietary guidelines were revised, and the changes that were made profoundly shaped the future of American food culture.

Instead of altering the food products available to the public, the revisions demanded by the food industry to the McGovern report recommended the production of new food products. The words ‘reduced intake’ were removed from the report entirely, and instead it encouraged Americans to buy leaner products. As a result, the 1980’s began with a brand new market, with every food product imaginable reengineered to be low in fat.

As food producers soon came to realize however, taking the fat out of food makes it much less palatable. In order to make their food taste good while still taking out most of the fat, food producers began introducing added sugar to their products in huge volumes. Today, 80% of all food products in the US have added sugar. Since 1977, American have doubled their daily sugar intake.

Another landmark health report was released in 2002 by the World Health Organisation (WHO). Technical Report Series 916, or Diet, Nutrition and the Prevention of Chronic Metabolic Disease, stated that sugar was a major if not the major cause of chronic metabolic disease and obesity. The WHO also recommended that no more than 10% of calories in a diet should come from sugar. But just as certain interest groups had hijacked the McGovern Report in 1977, the sugar industry criticized the findings and resisted the publishing of the WHO report.

Politicians and medical professionals who were funded by the sugar industry argued that the report was based on ‘misguided, non-science based’ research, that ‘entire industries can be put at risk,’ and that it may ‘challenge future funding.’ Lobbyists for the sugar industry recommended that 25% of calories in a daily diet should come from sugar, 2.5x the WHO recommendation.

The American Secretary of Health and Human Services at the time, Tommy Thomson, was pressured by these politicians and medical professionals to stop the WHO report. As a result, Thompson took a jet to Geneva and told the WHO that if they published the report document, the US government would withhold their promised $460 million contribution to the WHO. This act of extortion succeeded, and the requirement that no more than 10% of calories in a diet should come from sugar was deleted from WHO reports completely, up until this very day.

Skip forward 8 years and the obesity epidemic was reintroduced to the national debate by Michelle Obama and her 2010 Let’s Move campaign. The campaign was an effort to combat childhood obesity by calling on the private food industry to radically alter their products and provide healthy food options to the American public. The food industry, particularly the companies of Coco-Cola, Pepsi and Kelloggs, responded to her challenge and agreed to reformulate their products to improve their nutritional value. But as in the case of the McGovern and WHO reports, the food industry again took control of the public health debate to suit their own needs.

In response to the low fat craze of the 1980’s, food companies began producing low-fat versions of their food products that were dangerously rich in sugar. In response to the pressure from the Let’s Move campaign thirty years later, food companies again reengineered their products, but into many more variants. Low-sodium, low-calorie, high-protein and other variations of already existing products were developed after the Lets Move campaign, adding even more sugar to the market.

For example, three Oreo cookies have 160 calories and the equivalent of 3.5 teaspoons of sugar. Three Reduced Fat Oreo cookies have 150 calories, less than the original version but still with 3.5 teaspoons of sugar. These new products and their changes were turned into marketing claims, designed to make consumers buy even more. Instead of offering healthier alternatives to processed food, the food industry introduced all new processed foods that were just as dangerous.

Eventually, the Lets Move campaign became focused on promoting exercise rather than placing pressure on the food industry. The campaign became about how active people were, instead of pressuring the food industry to change products or take nutrition seriously. This refocusing of the campaign was a deliberate move by the food industry to shift the responsibility of obesity and combating metabolic disease onto consumers rather than themselves. In this way, they were able to continue producing food products that were dangerous and addictive, ensuring that their own interests were protected by removing their responsibility for the public health crises that they themselves had engineered.

Part of the reason the food industry has been so successful is the compliance of governments in allowing food companies to operate unregulated, and sometimes even assisting them. While the United States Department of Agriculture recommends limiting your daily sugar intake, it has provided over 8 billion dollars in subsidies for corn-based sweeteners since 1995.

Similarly, 80% of American public schools have deals with coke and pepsi, and school lunches in these public schools include nachos, pizza, fried chicken and hamburgers provided by fast food companies such as Taco Bell, Pizza Hut and Wendy’s.

In their support of fast food companies through the public school system and the producers of corn-based sweeteners, the government is serving food companies rather than their students and implicitly subsidizing the obesity epidemic at the cost of public health.

In order to combat the global rise of obesity and it’s related metabolic diseases, the collaborative efforts of the private food industry and governments to increase profits at the cost of public health need to be challenged. This dangerous and exploitive global food culture has resulted in the great public health crisis of our time.

It took a cultural movement, a national prioritizing of public health over private profit to realize the decline of smoking in the last 50 years. This commitment to public health and stand against private interests may also be the answer to turning the obesity epidemic into the next great public health success.

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