In 2012, the United Nations World Health Assembly advocated a significant new health goal: to reduce avoidable deaths from non-communicable diseases (NCDs) by 25% by 2025. Cardiovascular disease, diabetes, cancer and respiratory disease kill 35 million per year. The UN has identified tobacco, alcohol and poor diet as central risk factors. The first two have been regulated by governments in order to protect public health, but poor diet is actually responsible for more disease than smoking, alcohol and physical inactivity combined.
But what component of the western diet should be targeted? The evidence suggesting that added sugar should be the target is now overwhelming. Unlike fat and protein, refined sugars offer no nutritional value and, contrary to what the food industry want you to believe, the body does not require any carbohydrate from added sugar for energy. Thus it is a source of completely unnecessary calories.
Sugars are added to the majority of processed foods in the UK. Yet disturbingly, many consumers are unaware of its presence in such large quantities. In the UK and Europe guideline daily amounts for sugar have not been updated since 2003. These obsolete guidelines still suggest one can consume a staggering 22 teaspoons of sugar daily.
The World Health Organisation has recently been advised by scientific experts that added sugar or, more specifically, non-milk extrinsic sugar should constitute no more than 5% of energy. That would give a limit to the average man of a maximum of eight teaspoons a day and the average woman to six tea spoons a day. And that would include sugars from fruit juice and honey.
The misleading labelling and health claims on "low fat" foods that actually have shocking levels of sugar added is a scandal. Worse still, it has created the perfect storm for public health. Therefore, last Thursday, a group of UK and international experts, including myself, launched Action On Sugar. The main aim is to pressure the food industry to reduce added sugar in foods by 40% over four years. That would mean 100 fewer calories per person, which according to the UK Department of Health would reverse the obesity epidemic.
However, the industry remains in denial. Barbara Gallani, director of regulation at the Food and Drink Federation, made a statement of immediate resistance, denying sugar's role in obesity and failing to acknowledge the multitude of scientific studies to the contrary. We mustn't forget that it took 50 years from when the first scientific studies between smoking and lung cancer were made before any effective legislation was introduced through regulation. Why? Because Big Tobacco very successfully adopted a corporate strategy of denial. By planting doubt, confusing the public, bribing political allies and even buying the loyalty of rogue scientists.
The comparisons with the sugar industry are quite chilling. Leader of the Commons Andrew Lansley's aggressive intervention in parliament on Thursday was thus intriguing. He attempted to rubbish respected public health expert Professor Simon Capewell's statement that sugar is the new tobacco. Lansley then compounded his errors by ignorantly asserting in the House that "sugar is essential to food". It is not. He would have been more accurate in saying "sugar is essential to food industry profits and lining the pockets of its co-opted partners". Lansley was a paid director of marketing company Profero to the end of 2009. Profero's clients have included Pepsi, Mars, Pizza Hut and Diageo's Guinness.
During his unhappy time as health secretary, Lansley promoted his brainchild, the Responsibility Deal. There, he invited fast-food companies in for cosy discussions on how to tackle obesity, cynically generating the impression of progress, but only achieving weak and meaningless voluntary calorie reduction pledges.
The food industry spends billions in junk food and sugary drink advertising, targeting the most vulnerable members of society, including children. Worse, the industry cynically associates fitness and sport with junk food and sugary drinks. Thus Mars is one of the official sponsors of the England football team. Yet one regular sized bar contains eight teaspoons of sugar, almost triple the amount recommended as a limit for a four- to eight-year-old child by the US Department of Health and Human Services' dietary guidelines. The commonest cause of chronic pain in children is tooth decay with sugar as the number one risk factor. Regular physical activity has a multitude of health benefits; however, its effect on sustained weight loss is often weak. Furthermore, activity levels have changed little in the past 30 years as obesity has rocketed.
We are all vulnerable, because you don't have to be overweight to be affected by diet-related disease. Of all the chronic diseases, type 2 diabetes, which is entirely preventable, is perhaps the most damaging. Diabetes increases the risk of heart attack, stroke, kidney failure, eye disease and leg amputations. Up to half of all diabetic patients go on to suffer acute or chronic pain, and two-thirds will ultimately develop dementia. The direct and indirect costs to the UK of diabetes is over £24bn and projected to approach £40bn by 2030. If we do nothing, this will cripple the NHS.
How does sugar compare to tobacco? A teaspoon of sugar or one cigarette will not harm you. But over time, the habit can be fatal. Unlike Big Tobacco, Big Sugar deliberately targets children. And added sugar has become so pervasive within the food environment that we can't avoid it even if we wanted to. It is thus not simply a matter of personal choice. But perhaps most disturbing of all the similarities is the financial and political muscle that both industries have exerted to try and protect their profits, at the expense of our health. It's time to wind back the harms of too much sugar, reverse the "diabesity" epidemic and the unspeakable suffering it causes. It's time for Action On Sugar.
Dr Aseem Malhotra, a London cardiologist, is the science director of Action on Sugar
