Last year’s contentious finding that intakes of sugar in Australia have declined over recent decades as obesity rates rose was attacked mercilessly, but the publication of a new report has vindicated the researchers.
In the last few years sugar has become public enemy number one in the fight against obesity. Not only is sugar supposedly making us all fat, sugar is actually toxic (Is sugar ‘toxic’?) and even addictive (Now sugar is ‘addictive’). Or at least that’s the story you hear from the popular press.
With anti-sugar sentiment at fever pitch, two Australian nutritionists had a radical thought: why not look at some scientific evidence?
The ‘Australian Paradox’
Last year, Dr Alan Barclay and Professor Jennie Brand-Miller published an assessment of trends in intakes of sugars and obesity rates in Australia, the United Kingdom and the United States between 1980 and 2003. Not surprisingly, the researchers reported that the prevalence of obesity had increased in all three countries. Consistent with previous findings, the researchers found that per capita consumption of total sugars in the United States had increased by 23% during this period, confirming an association with the increased rate of obesity. However, they also found that the intake of sugars had fallen marginally (5%) in the United Kingdom and fallen substantially in Australia, by 16%. The authors dubbed the divergent trends in the obesity rate and sugar consumption in this country as the ‘Australian Paradox’.
An inconvenient truth?
In scientific circles, the response to controversial findings is usually an exchange of letters and some polite debate as different points of view and sources of evidence are presented and discussed, but the Australian Paradox paper was attacked with uncommon ferocity.
A website was even established with the sole intent of discrediting the findings. And there was nothing polite about it: the report or its authors were described as shonky, hopeless, negligent, sloppy, a disgrace, incompetent, reckless, factually incorrect, idiosyncratic, a major embarrassment, hopelessly wrong, spectacularly false, and a threat to Australian public health. And the little-known journal that published the paper was hopeless too, its editors incompetent, underperforming and asleep at the wheel, and its peer-review process hopelessly broken. You get the idea.
It is worth contemplating why so much effort and hostility would be invested in challenging the findings of one scientific paper. Maybe someone’s interests were under threat.
A valid criticism?
Buried in all the invective, the website actually made a reasonable criticism of the Australian Paradox paper i.e. a major source of the data on sugar consumption was ‘apparent consumption’ data, which had ceased to be collected by the Australian Bureau of Statistics (ABS) after 1998/9. So, any suggestion that sugar consumption had continued to fall from 2000 could not be supported. It was argued that the sugar availability data collected by the Australian Bureau of Agricultural and Resource Economics and Sciences (ABARES) was current and did not suggest that sugar intakes were falling.
A new analysis ‘Sugar consumption in Australia: a statistical update’ was released last week and provides some clarity on this issue. The 20-page report was prepared by Green Pool Commodity Specialists, a private analytical firm based in Brisbane. Their approach was to replicate the ABS methodology to enable the updating of the ABS dataset to cover the period 1999 to 2011. The result was a continuous data series for the apparent consumption of sugar in Australia from 1938 to 2011. And what did they find?
• The long-term trend in sugar consumption is down, falling from about 55kg per person per year in 1938 to about 42kg in 2011.
• Sugar consumption fell by 23% between 1980 and 1998, which was more than suggested by Barclay and Brand-Miller. However, the report notes that 1998 was a ‘low point’ in the long-term downward trend in apparent sugar consumption and rebounded in following years. So perhaps the 23% figure overestimates the actual fall during this period.
• Between 2004 and 2011 sugar consumption fell from about 47kg to about 42kg, a decline of 10%.
What about the ABARES data?
The new report also considers the ABARES data but challenges its accuracy. It highlights the high volatility of the sugar availability estimates, which vary by as much as 40% from year to year, and the fact that some relevant imports and exports are not included. Tellingly, the authors note that even ABARES discourages the use of their data as a proxy for sugar consumption.
So there you have it. It would appear that sugar intakes are indeed declining in Australia and that rates of obesity have increased against this backdrop. The authors of the Australian Paradox can claim vindication.
But is it really a paradox? Only if you have assumed that sugar intake is driving the obesity epidemic, but this is hardly a safe assumption. The data discussed above showing positive, flat and negative associations between sugar intakes and obesity rates in different countries suggest that sugar intakes per se have little to do with trends in obesity. The amount of added sugar in foods (or fat content or energy density) does not reliably predict weight gain (see Do calorie-rich foods make you fat?).
However, one thing is crystal clear: increasing obesity rates are driven by energy imbalance i.e. calorie intakes above requirements. Addressing obesity will require that total calorie intakes be lowered, irrespective of whether these calories come from sugar, starch, fat, protein or alcohol. It may not be a message that the general public wants to hear but we all need to eat and drink a bit less.
If we have learned one lesson from the last 15 years of failed policy in relation to the prevention of obesity, it should have been that focussing on just one source of calories, firstly fat and more recently sugar, is a waste of time. But we repeat the error.