The rhetoric over added sugars in our diet has reached fever pitch on both sides of the Atlantic. Advocacy groups are popping up out of nowhere to take on the big food giants. FDA and WHO are now engaged. At this point, analyses of why this movement has gained so much traction and the goals of this effort are warranted.

 “Companies should develop projects with schools and hospitals”

There are three myths promulgated by the food industry to maintain the status quo.

1. It’s about obesity. In fact, metabolic syndrome, linked to excess intake of added sugars, is the problem and up to 40% of the normal weight population experiences some clinical manifestation of the metabolic syndrome.

2. All calories are the same. Not true. Certain foods convey disease risk exclusive of their calories. Alcohol is toxic, not because of its calories - but because it is alcohol. Sugar is metabolised the same way as alcohol and causes the same diseases. How else do we explain the stunning rise in “non-alcoholic fatty liver disease” in one third of the American population, and one-seventh of children? Sugar is the “alcohol of the child”.

3. It’s about personal responsibility. There are three problems with this theory. First, every personal responsibility issue (eg tobacco, alcohol, HIV) eventually morphs into a public health crisis because these diseases are not due to behaviours but exposures. Second, the cost is borne by all of society. Witness the problems of Medicare and the NHS in coping with diabetes. Third, it absolves “corporate responsibility” in the same way tobacco companies wangled free of culpability. “Personal responsibility” is a lame meme that denies the biology of addiction.

It is up to elected representatives to ensure the public good when the market fails to do so. In the case of sugar, the market has failed miserably.

The preconditions for society to regulate any substance include: ubiquity, toxicity, abuse, and negative impact on society. Substances that meet all four criteria include heroin, cocaine, amphetamine, tobacco, and alcohol - and societies regulate them.

Sugar meets all four criteria too . Yet the food industry is hunkering down in a posture reminiscent of Big Tobacco. Food industry leaders should consider all their options, keeping in mind the damaging fight that consumed the tobacco industry for decades. Companies should stop undermining peer-reviewed science and stop flooding the market with dubious research. They should commit to authenticity in advertising and stop positioning products to intentionally addict our most vulnerable citizens.

Instead of sponsoring school scoreboards and equipment while dispensing sugar in the cafeteria, they should develop projects with schools and hospitals to educate students and patients about the risks of added sugar. And funding for these projects should match revenue that might be lost from pulling all high-sugar products from vending machines and cafeterias.

Sugar is like putting sand in your petrol - the damage cannot be undone. It’s time to act on the knowledge that while we are individuals, we are also the ‘public’ in public health.

Robert H Lustig, MD, MSL, is a pediatric endocrinologist

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