Dr Barry Popkin is W. R. Kenan Distinguished Professor of Nutrition at the University of North Carolina. He is one of the world’s leading experts on dietary behaviour - including eating patterns, socioeconomic and sociodemographic determinants of health, and policy for managing change. He is responsible for developing the much-cited nutrition transition framework and is author of The World is Fat: The Fads, Trends, Policies, and Products that are Fattening the Human Race.
For the past two decades I, and many other scientists, have noted a huge rise in the use of added sugar in a large array of processed foods and soft or sugary drinks.
Initially the concern was related primarily to sugary drinks. Research conducted by Richard Mattes, Barbara Rolls, and others showed that when we consumed a beverage - with or without calories - it did not lead to any changes in our food intake. For reasons we did not understand, our intake of sugary drinks, fruit juice and other caloric beverages was not compensated by a reduction in calories from food intake. Then came dozens of studies by scientists that showed the significant positive association of sugary drinks on weight gain, risk of diabetes, cardiovascular disease, and an array of other cardio-metabolic problems. Aside from a few studies by industry-sponsored scientists, a consensus grew globally that the marked increase in consumption of sugary drinks must be tackled.
Countries started to take action with the aim of reducing intake through a range of measures. Many of them – such as Brazil, Costa Rica, Hungary, Slovenia and France – restricted the availability of sugary drinks in public institutions, especially schools. The most important recent action has taken place in Mexico and France. Both countries have instituted taxes of approximately 10% on sugary drinks, and 5 to 6 other countries are considering adding even higher rates of taxes on them of 18-20%. Research has shown that a tax of at least 20% is needed to seriously reduce consumption. Nevertheless, our initial evaluation of the Mexican 10% sugary drinks tax at the University of North Carolina shows that even this lower than recommended tax has had a marked impact in reducing the consumption of sugary drinks and encouraging people to drink water instead.
These beverage taxes have all varied. None has considered tackling 100% fruit juice. This is not because the scientific evidence does not exist, but rather that there are fewer long-term studies that link 100% fruit juice to weight gain, diabetes, and many other similar problems. This is only a matter of time as ‘big beverage’ is going to buy up juice bars and fruit juice companies and we will see increasing intake of 100% fruit juice.
75% of all foods in the USA contain added sugar
The role of added sugar in food has been more complex to unravel. The industry argues that a carbohydrate consumed as sugar is no different than any other. However, recent review articles by Lisa Te Morenga and colleagues and the World Health Organization’s (WHO) revised sugar guideline published in March 2015, shows that adding sugar in food has a similar effect on weight gain and several measures of cardiometabolic risk. The WHO’s work is critical since my research group at the University of North Carolina has shown that 75% of all foods in the USA contain added sugar and the penetration of such processed foods to all corners of the globe is incredibly rapid. Our work shows a marked increase in the use of fruit juice concentrate, the new natural sugar used increasingly in the USA, Europe and globally to make consumers think this is a natural and healthy component of our food.
New sugar policy brief published today
In this context, World Cancer Research Fund International’s new sugar policy brief – published today - is welcome. The brief can be used by governments to quickly identify effective policies that can help curb sugar consumption. Although countries are beginning to introduce a range of policies to tackle the issue - such as labelling foods and beverages with excessive added sugar as dangerous, or labelling only healthier foods with minimal added sugar as healthy, and taxing sugary drinks and non-essential foods (often called junk foods) that contain excessive added sugar and unhealthy saturated fats – much more needs to be done.
We must monitor policy interventions to ensure success
We must improve the quality of our diets overall and reducing added sugars is just one most welcome step. But there is an equally critical need for careful rigorous evaluations to know if the policy actions on taxation, labelling, and other attempts to eliminate or minimize access to foods and beverages with excessive added sugar, are indeed successful. Non-communicable diseases like cancer and diabetes are on the increase around the world, so the policy interventions we make have to work - and to do so requires active ongoing assessments and, ultimately, serious evaluations of their impact both on our diet and our health.
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