9:00 a.m. EST, Monday, Nov. 3, 2014
Mollie Turner, The Obesity Society: firstname.lastname@example.org
U.S. Adult Consumption of Added Sugars Increased by More Than 30% Over Three Decades
Cap and Trade Policy for Added Sugars Shown a Promising Strategy to Reduce Consumption, Improve Health
BOSTON, MA: As the United States Food and Drug Administration considers a new food label detailing the amount of added sugars in foods, new research shows this non-nutritive calorie source has crept into the American diet over the past three decades. The study details an increase in added sugars consumed by American adults by more than 30% (228 calories per day in 1977 to 300 calories in 2009-2010). During that same time period, calories from added sugars consumed by children increased by approximately 20% (277 to 329 calories per day). This study of added sugar consumption by Americans will be presented this week at The Obesity Society (TOS) Annual Meeting at ObesityWeek, and recognized by TOS Pediatric Obesity Section with a Poster of Excellence Award, an honor given each year to the most outstanding abstracts in the research area.
"Added sugars increase excess energy and reduce nutrient density in our diets, often contributing to
weight gain and obesity," said study author Elyse Powell, Royster Fellow at the University of North Carolina Chapel Hill who identified a peak in added sugar consumption from 2003-04 and then a slight decline leading up to 2009-10. "Many American adults and children are consuming so much added sugar, that despite recent declines, consumption is still well above the recommended amount."
According to MyPlate.gov, added sugars are sugars and syrups mixed into foods and drinks when they are processed or prepared. They are found in obviously sweet foods, such as candy, soft drinks, sports drinks and other sweets. But, insidiously they also are found in pasta sauces and condiments, like ketchup and salad dressings. The term "added" is key, because there are other sugars that occur naturally in healthy, nutritious foods, such as milk and fruits.
"We've long known that the high amount of added sugars in our diets is concerning; and the 30% increase is only the average consumption among adult Americans," continued Ms. Powell. "Even more alarming is the fact that the top 20% of adult consumers are eating 721 calories from added sugar per day, on average. This is equally alarming for the top 20% of children who are consuming on average 673 calories from added sugar per day."
In addition to efforts by the FDA to include added sugars on nutrition labels, other innovative solutions include limiting the amount of added sugar allowed in the food supply, using a cap-and-trade policy, similar to those used for environmental pollutants. Researchers Kristina Lewis, MD, MPH, of the Kaiser Center for Health Research and Sanjay Basu, MD, PhD, of Stanford University unveiled a study this week at ObesityWeek that evaluates how cap and trade might impact caloric consumption and obesity rates, compared to other measures such as taxes on sugar or sugar-sweetened beverages.
"Cap and trade works by setting an overall limit on the 'emissions' of a 'pollutant' – in this case, added sugars, and then letting manufacturers in the marketplace decide amongst themselves whether to reformulate their products or buy/sell permits to 'emit,'" said Dr. Lewis.
To conduct the study, the researchers examined data on the nutritional content of food and a nationally representative data set of what Americans eat. They then determined the likely impact of a sugar cap-and-trade policy using mathematical modeling.
"We found that a cap-and-trade policy that would gradually reduce added sugar in the food supply by 1% per year over 20 years could significantly reduce obesity and type 2 diabetes," said Dr. Lewis. "Financially, this cap and trade policy has the potential to avert about $9.7 billion in healthcare spending, and may produce larger health impacts than taxing added sugars or sugar-sweetened beverages." The full study will appear in the American Journal of Public Health today.
TOS recognizes that added sugars are a concern and encourages proven efforts to create a healthier food environment.
"Added sugars pack non-nutritive calories into foods and can lead to weight gain," said Jason Block, MD, of Harvard Medical School speaking on behalf of The Obesity Society. "And as we work to address the issue, we also need to think about calorie (or energy) density in foods. Foods that are high in sugars and fats and lower in water content provide excess calories per unit of weight – they are referred to as energy dense foods."
Earlier this year, TOS called for reduced energy density of food products, which includes a reduction in added sugars. Further, in February it commended FDA for its proposed new food-labeling requirement, which includes detailing the amount of added sugar in foods, calling it "motivation for manufacturers to start lowering the amount of added sugars in products."
The full abstracts are below.
Recent Trends in Added Sugar Intake among U.S. Children and Adults from 1977 to 2010
Elyse Powell Chapel Hill North Carolina, Lindsey Smith Carrboro North Carolina, Barry Popkin Chapel Hill North Carolina
Background: Added sugars increase excess energy and reduce nutrient density. While recent studies indicate that added sugars have begun to decline, to our knowledge no research has examined whether these changes have persisted, or are consistent across critical subpopulations or the distritibution of consumers.
Methods: 5 nationally representative surveys of food intake in the US from 1977 to 2010 we used linear regression to estimate adjusted added sugar intake in children and adults ≥2y. We use multinomial logistic regression to examine whether critical subpopulations, including racial/ethnic minorities and low income populations, had a higher probability of being in the highest quintile of added sugar intake in 2009-2010.
Results: Estimated adjusted added sugar intake rose from 277 kcal/day in 1977 to 388kcal/day in 2004, and then decline to 329 kcal/day in 2010 for children 2-18y. Adult intake similarly rose from228 kcal/day in 1977 to 341 kcal/day in 2004, and then decreased to 300 kcal/day in 2010. However, this decline was not significant for children 12-18y and adults >40y. For adults in 2009-2010, the 5th quintile of added sugar consumers consumed a mean of 722 kcal/day.
Conclusions: Added sugar consumption has decreased from a peak in 2003-2004 to 2009-2010. However, declines were not found in certain sub groups, including children 12-18y and adults >40y. Despite declines, all but the lowest quintiles did not meet recommended levels for added sugar consumption.
Comparative Effectiveness of Three Policy Alternatives for Reducing Added Sugar Consumption: How do Cap and Trade, Taxation of Added Sugars and Taxation of Sugar-Sweetened Beverages Stack Up in Terms of Impact on Obesity and Type 2 Diabetes?
Sanjay Basu Stanford California, Kristina Lewis Atlanta Georgia
Background: Added sugar intake in the U.S. exceeds recommended levels and contributes to obesity and type 2 diabetes. Reducing added sugars in the food supply through a cap-and-trade policy has been proposed to generate financial incentives for food manufacturers to lower the added sugar content of foods and beverages, but has not been previously evaluated or compared to alternative policy proposals.
Methods: Using large-scale data on food content and formulations (USDA and U.S. Census Bureau Annual Survey of Manufacturers), along with nationally-representative data on food consumption behaviors among the U.S. population (NHANES, 1999-2010), we constructed a mathematical model of a cap-and-trade policy to decrease added sugar emissions into the food supply by 20% over 20 years, and compared its public health implications to proposals to tax sugar-sweetened beverages or added sugars. We modeled the projected effects of the three policies on consumption, as well as on obesity prevalence and type 2 diabetes incidence over a 20-year time horizon, and compared effects across racial and ethnic groups.
Results: Capping added sugar emissions by food manufacturers into the food supply at a rate of 1% per year would be expected to reduce the prevalence of obesity by 1.7 percentage points (95% CI: 0.9-2.4, a 4.6% decline) and the incidence of type 2 diabetes by 21.7 cases per 100,000 people (95% CI: 12.9-30.6, a 4.2% decline) over 20 years, averting approximately $9.7 billion in healthcare spending (95% CI: $4.5-14.9 billion). Racial and ethnic minorities would be expected to experience the largest declines in obesity prevalence and type 2 diabetes incidence. By comparison, exacting equivalent price penalties through excise taxes on sugar-sweetened beverages or added sugars would be expected to generate smaller benefits for health and health disparities.
Conclusions: A cap and trade policy to reduce added sugar intake may significantly reduce obesity and type 2 diabetes, meriting consideration alongside other policies currently being evaluated.
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ObesityWeek is the premier, international event focused on the basic science, clinical application, prevention and treatment of obesity. TOS and the American Society for Metabolic and Bariatric Surgery (ASMBS) host the world's pre-eminent conference on obesity, ObesityWeek 2014, Nov. 2-7, at the Boston Convention and Exhibition Center in Boston, Mass. For the second year, both organizations hold their respective annual scientific meetings under one roof to unveil exciting new research, discuss emerging treatment and prevention options, and network and present.