Obesity Surgeon Website | Obesity Surgeon Website: External News Articles relating to Obesity

Obesity Surgeon Website: External News Articles relating to Obesity

â€œSugar is so harmful that it should be controlled and taxed in the same way as tobacco and alcohol,â€ according to health experts quoted in todayâ€™s Daily Express. The researchers say that sugar indirectly contributes to 35 million deaths a year worldwide.

The news is based on a comment article by US health scientists, who argue that there has been a massive rise in diseases such as heart disease, cancer and diabetes since we began eating more sugar contained in processed food. The researchers argue that many of the health effects of excess sugar consumption are similar to those of alcohol, and that sugar should, therefore, be controlled and taxed in a similar way. They advocate introducing a tax on processed foods with added sugar, limiting sales during school hours and placing age limits on purchase. Interestingly, the authors rate sugar as more dangerous to health than saturated fat and salt, which they call dietary â€œbogeymenâ€.

It is important to highlight that the researchersâ€™ article is a comment piece and, therefore, primarily reflects their views and opinions, rather than presenting direct research on the issue. While it is certainly an interesting concept, there is still a lack of evidence supporting the effectiveness of such measures and, crucially, whether the public would actually accept them.

Where did the story come from?

The article was written by researchers from the University of California. There is no information about any external funding. It was published in the comment section of the peer-reviewed scientific journal Nature.

The article was covered fairly by the papers, many of which included comments from UK experts including the UK Food and Drink Federation, which represents food manufacturers. The BBC also quoted an expert from the British Heart Foundation, who reportedly said that taxing salt and fat alongside sugar should also be considered.

What kind of article was this?

This was a comment piece in which experts discuss the global burden of general chronic disease related to sugar consumption and the need to regulate certain dietary items. In particular, the authors draw parallels between the health effects of sugar and the use of alcohol and tobacco, arguing that sugar should be regulated in a similar manner.

It is important to highlight that this was a comment piece only and, as such, it primarily reflects the views and opinions of the authors. A formal systematic review of the literature does not appear to have been conducted and, as such, it is not certain whether all relevant evidence and resources related to sugar consumption and its health effects will have been consulted.

Also, the short piece looks at the issue from a global perspective and, therefore, is not a direct commentary on sugar consumption in the UK. In fact, a map showing average added sugar consumption per day across different nations shows that people in the UK consume a relatively low amount of sugar, at least compared with the rest of the world. Much of the articleâ€™s content may be focused on policies suited to the US, which has by far the greatest per-head sugar consumption, at more than 600 calories worth of sugar per day.

What does the article say?

The article points out that, for the first time in human history, non-communicable diseases such as heart disease, cancer and diabetes, pose a greater health burden worldwide than infectious disease. While alcohol, tobacco and diet are all targeted as risk factors for these diseases by policymakers, only the first two â€“ alcohol and cigarettes â€“ are regulated by governments to protect public health. (Although, as it points out, Denmark taxes food high in saturated fats and is now considering taxing added sugar.) The authors argue that fat and salt have become the current â€œdietary bogeymenâ€ in the US and Europe, but that most doctors no longer believe that fat is the â€œprimary culpritâ€ of such disease. Doctors are apparently calling for attention to be turned towards the dangers of excess sugar consumption.

The authors estimate that over the past 50 years sugar consumption has tripled worldwide, mainly as a result of it being added to cheap processed foods. While excess sugar is thought to be a key cause of the obesity epidemic, they argue that obesity itself is not the root cause of disease but that its presence is a marker for metabolic damage. This, they say, could explain why 40% of those with metabolic syndrome (a collection of the key metabolic changes that lead to heart disease and diabetes) are not obese.

Why do they think sugar is dangerous?

The authors say that although sugar is described as â€œempty caloriesâ€, a growing body of evidence suggests that fructose (one component of table sugar) can trigger processes that lead to liver toxicity and a host of other chronic diseases. â€œA little is not a problem but a lot kills â€“ slowly,â€ they say.

The authors argue that sugar meets all the four criteria used by health policy makers to justify the regulation of alcohol. These are:

Unavoidability. While sugar was only available as fruit and honey at certain times of the year to our ancestors, it is now present in nearly all processed foods. In some parts of the world people are consuming more than 500 calories worth of sugar per day.
Toxicity. There is growing evidence that excess sugar has an effect on human health beyond simply adding calories and can cause many of the same problems as alcohol, including high blood pressure, high blood fats, insulin resistance and diabetes.
Potential for abuse. The authors argue that, like tobacco and alcohol, sugar acts on the brain to encourage dependence. Specifically, it interferes with the workings of a hormone called ghrelin (which signals hunger to the brain) and it also affects the action of other important compounds.
Negative impact on society. The economic and human costs of these diseases place excess consumption of sugar in the same category as smoking and drinking.

What do they think should be done?

While the authors accept that sugar is â€œnaturalâ€ and a â€œpleasureâ€, they argue that, like alcohol, too much of a good thing is toxic. Strategies to reduce consumption of alcohol and tobacco show that government controls, such as taxation and imposing age limits, work better than educating people. They make several proposals for controlling sugar, including:

taxing any processed foods with added sugar, including drinks
reducing the hours during which retailers can sell food containing added sugar
tightening the licensing requirements on vending machines and snack bars selling sugary products
controlling the numbers of fast food outlets and convenience stores
limiting sales during school hours or imposing an age limit for drinks with added sugar

Finally, they argue that regulating sugar will not be easy, but it can be done with enough pressure for change, citing bans on smoking in public places as an example of what can be achieved.

What does this mean for me?

This article will be of interest to food scientists, health policy makers and the public alike, but the use of strategies to restrict the consumption of added sugar is complicated and, indeed controversial. The implications of such moves would need to be considered in both medical and societal terms. They would need both medical evidence to support their effectiveness and assurance that the public would accept drastic changes, such as age limits on buying sweets. For example, in recent years, Denmark has imposed taxes on fatty foods, a move that has divided opinions greatly.

It is generally accepted that added sugar or excessive sugar consumption is bad for health and dietitians advise restricting sugar intake to the occasional â€œtreatâ€. However, to what extent sugar is directly to blame for the rise in chronic disease and how much is due to other dietary components, such as saturated fat and salt, is open to debate. The current article does not appear to be a formal systematic review of the literature, and it is not certain whether all relevant evidence and resources related to sugar consumption and its health effects have been consulted. As such, it should be considered primarily to reflect the views and opinions of the authors.

In the UK at present, policymakers generally favour encouraging healthier eating through education and the provision of healthier options. This is carried out through public health campaigns such as 5 A DAY or by introducing new food ranges to schools. Whether this approach alone is adequate and whether healthier eating patterns should be encouraged by government regulation, is a crucial area of debate.

Links To The Headlines

Sugar 'is toxic and must be regulated just like cigarettes', claim scientists. Daily Mail, February 2 2012

Sugar tax needed, say US experts. BBC News, February 2 2012

Tax harmful sugar. Daily Express, February 2 2012

Links To Science

Lustig RH, Schmidt LA, Brindis LD. Public health: The toxic truth about sugar. Nature, February 2 2012

Where did the story come from?

The study was carried out by researchers from the University of Maine in the US and the University of South Australia. It was published in the peer-reviewed International Dairy Journal. It was partly funded by the Maurice de Rohan International Scholarship, the University of South Australia and the National Heart, Lung and Blood Institute, the National Institute on Aging and the National Institutes of Health, all in the US.

The Mail reported the study uncritically. Its suggestion that milk could help stave off mental decline is not supported by this research. Itâ€™s worth noting that the study was released to the press by a US PR company on behalf of the National Fluid Milk Processor Promotion Board, which is an industry-funded organisation set up by the US government to promote milk. This may explain how it found its way into the Daily Mail.

What kind of research was this?

This was a cross-sectional analysis of nearly 1,000 participants that aimed to investigate whether dairy food intake was associated with mental functioning. This type of study can provide a â€œsnapshotâ€ of various lifestyle factors and peopleâ€™s health at one point in time, but it cannot establish cause and effect. A cohort study that recorded peopleâ€™s dairy consumption over time and then tested their mental function more than once would provide more reliable results although even this type of study cannot establish cause and effect.

The researchers say that as the whole population ages, cognitive decline and dementia place a severe strain on both families and healthcare systems. Change in diet may have a role in preventing cognitive decline, but they say little attention has so far been paid to the relationship between dairy foods and mental performance.

The researchers say there is growing evidence that dairy products may be of benefit to cardiovascular health. Many experts would dispute this. Some dairy foods are high in saturated fat, which is associated with obesity and heart disease. Most dietitians advise a restricted intake of dairy products or consumption of low-fat varieties.

What did the research involve?

Researchers recruited 1,049 adults of all ages who were taking part in research looking at cardiovascular health and mental functioning. They collected health and lifestyle data from the participants by various methods including self-reports, medical examination, diagnostic interviews, health records and neuropsychological testing.

After excluding those who did not fulfil eligibility criteria (for example, because dietary or cognitive data were missing or because they had suffered a stroke), they were left with 972 participants.

To measure mental functioning of the participants, the researchers used a validated series of tests measuring memory, verbal recall, visualâ€“spatial perception, organisational and verbal skills, and abstract reasoning ability. For dietary intake, they used a recognised questionnaire that included questions about nutrition and lifestyle.

The dietary component of this questionnaire included questions about dairy products. Milk was considered separately from total dairy foods. Total dairy foods were grouped as followed:

cheese
yoghurt and dairy desserts
cream and ice-cream

Participants were asked how frequently they consumed such foods, with six possible responses:

never
seldom
once a week
2-3 times a week
5-6 times a week
once or more a day

Participants were also asked which type of milk they consumed â€“ full fat, reduced fat or skimmed.

The researchersÂ used validated statistical methods to analyse the relationship between mental performance scores and dairy intake. They adjusted their results for other factors that might affect the results, including age, education, smoking and alcohol.

What were the basic results?

The researchers report that participants who consumed dairy products at least once a day had â€œsignificantly higher scores on multiple domains of cognitive functionâ€ compared with those who never or rarely consumed dairy foods. In addition, those who reported eating dairy foods between two and four times a week performed significantly better on some of the tests than those who ate dairy foods once a week. The association between greater dairy food consumption and mental performance remained significant after adjusting for a number of risk factors. There was no significant association, however, between intake of specific categories of dairy foods (such as milk, cheese or yoghurt) and results of the tests.

How did the researchers interpret the results?

The researchers say their results support an association between high dairy food consumption and cognitive function. Although little is known about how dairy foods might influence mental functioning, they say that one possibility is that dairy food consumption may be beneficial for mental functioning through its â€œfavourable effectâ€ on cardiovascular risk factors such as obesity.

Conclusion

Contrary to the headlines, this study does not show that dairy food consumption has benefits for mental functioning. All it can do is provide a â€œsnapshotâ€ of a group of peopleâ€™s dairy consumption and their mental functioning at one point in time. Some limitations are that:

It relied on people self-reporting their dairy intake, which introduces the possibility of error.
It is possible that many other factors (known as confounders) might have affected the results, including exercise habits, alcohol and stress levels, although researchers tried to adjust their findings for some of these.
As the authors acknowledge, the dietary questionnaire did not specify size of portions or servings, which undermines the accuracy of estimated intakes.

Dairy products contain many nutrients that are needed for good health, in particular for the development of healthy bones and teeth. However, they are also high in saturated fat, which is associated with heart disease and obesity. At present there is no good evidence that dairy foods are especially beneficial for brain functioning.

Find out how dairy fits into a healthy dietÂ using the Eatwell Plate.

Links To The Headlines

The white stuff: Drinking just one glass of milk a day could boost your brain power. Daily Mail, January 31 2012

Links To Science

Crichton GE, Elias MF, Doreb GA, Robbins MA. Relation between dairy food intake and cognitive function: The Maine-Syracuse Longitudinal Study. International Dairy Journal 2012:22;15-23

Where did the story come from?

The study was carried out by researchers from the University of Oxfordâ€™s Department of Public Health. The individual authors were funded by various institutions, including the Medical Research Council and the British Heart Foundation. Part of the research was funded by the National Institute for Health Research. The study was published in the peer-reviewed British Medical Journal.

Newspapers generally covered the research accurately and appropriately.

What kind of research was this?

This study examined recent trends in heart attack rates and deaths from heart attacks, with specific focus on the influence of factors such as sex, age and geographical region. To do so it used information about heart attacks in over 800,000 people, taken from a national database of hospital and mortality records. It also looked at whether any drop in heart attack deaths was primarily due to those people having heart attacks now having a lower risk of dying, or whether it was due to fewer people now experiencing heart attacks.

The authors point out that while many developed countries have seen a decline in heart attack deaths since the 1970s, in England at least, reasons for this decline are not fully understood: it is hard to tell whether increased prevention or improved treatment Is primarily responsible. Given this lack of clarity the researchers attempted to examine whether the trend was due to people having fewer heart attacks or to those having heart attacks being less likely to die.

What did the research involve?

The researchers obtained data from national datasets on both hospital admissions and mortality statistics. From this data they were able to include all residents in England who had had a heart attack (called an acute myocardial infarction) between 2002 and 2010, as defined by diagnostic codes applied to patient records during treatment. They categorised heart attacks as either fatal (defined as death occurring within 30 days of admission) or non-fatal. To study regional differences they obtained regional data.

Using standard statistical methods they calculated both the new heart attack rate (incidence or event rates) and heart attack death rate (mortality rate) per 100,000 of the population. They did so according to age group and sex, and for each year and each region. They used these figures to calculate the changes in heart attack mortality rates during this period and also the relative contributions of â€˜event ratesâ€™ (i.e. the number of heart attacks) and â€˜case fatality ratesâ€™ (i.e. the number of deaths among people who had heart attacks).

What were the basic results?

The researchers found that from 2002-10 in England, 840,175 people of all ages were admitted to hospital with heart attack or died suddenly from a heart attack. Some 61% of heart attack patients were men, and 39% were women. The main findings are listed below:

During this period the mortality rate from heart attacks fell by 50% in men and by 53% in women when the results were â€˜age standardisedâ€™, i.e. adjusted to account for the changing age structure of the population.
The greatest rate of decline in events occurred in men and women aged 65-74, and the lowest decline was among those aged 30-54 and 85 or older.
In men, rates of heart attacks, deaths due to heart attack, and overall death all declined. The average annual rates of decline were, respectively, 4.8% (95% confidence interval [CI] 3.0% to 6.5%), 3.6% ([CI] 3.4% to 3.7%) and 8.6% ([CI] 5.4% to 11.6%).
In women, the corresponding rate reductions were 4.5% ([CI] 1.7% to 7.1%), 4.2% ([CI] 4.0% to 4.3%) and 9.1% ([CI] 4.5% to 13.6%).
The researchers then calculated how far the decline inÂ heart attack deaths was caused by lower heart attack rates and how far by the chances of surviving after after a heart attack. Reductions in the number of new cases were estimated to account for 57% of the reduction in deaths among men and 52% among women. The chance of surviving aÂ heart attack was estimated to account for 43% of the drop in deaths in men, and 48% in women.
The relative contributions of these two factors differed by age, sex and geographical region.

How did the researchers interpret the results?

They point out that just over half the decline in deaths from heart attacks over the period can be attributed to a fall in people experiencing heart attacks and just under half to improved survival rates when people did experience a heart attack.

However, the researchers say that it is possible there has been no â€˜real improvementâ€™ in heart attack rates in the younger people and the very old. They say that rising rates of obesity and diabetes may be contributing to a â€˜levelling offâ€™ of the decline in numbers of heart attacks.

They suggest that the decline in the numbers of heart attacks could be explained by lifestyle changes and the use of preventative drugs in those at risk, although further research is needed to gain a clearer understanding of the specific elements of prevention and treatment that have contributed to the fall in death rates.

Conclusion

The strengths of this study lie in its very large size and its complete national coverage. One possible limitation is its reliance on the accuracy of routine data and diagnosis codes used from English hospitals, although, as the authors point out, research has shown high accuracy rates for this type of hospital data.

It should be noted that although the study shows a fall in heart attacks and also in death rates among heart attack patients, it does not tell us the precise causes of either. The fall in heart attacks is likely to be linked to healthier lifestyles, earlier detection and a better management of risk factors such as high blood pressure in people at risk. Also, the study only examined deaths from heart attacks and the definition of this has changed over the years, so the researchers say that they could not report on changes in hospital admissions as the diagnostic coding for this has also changed.

Overall, while we cannot fully explain the drop in heart deaths observed in this report, the good news is that the trend is clearly going in the right direction.