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’.
Image: source
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.
Image: source
New analysis
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.
A paradox?
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.
Hi Bill,
I’m confused. You say that it is not a specific increase in sugar (or fat?) in itself that is contributing to greater prevalence of obesity, but all four macronutrients together. Shouldn’t we still see increases in apparent consumption for all four, then? Has there been a paper written on apparent consumption of alcohol?
Hi Jenna. The key point is that many dietitians, the media and the public are focussed on macronutrient composition, when the emphasis should be on total energy intake. Different groups of people may over-consume sugary foods or fatty foods or starchy foods, but the important thing is the over-consumption.
If I were recommending which foods to cut back on in order to lose some weight, my focus would be on nutrient-poor foods and beverages. Some of these may well be higher or lower in sugar or fat or starch, but who cares? Pulling these foods out of the diet will save calories but cost little in terms of nutrients.
Regards, Bill
Ecologic correlations are pretty meaningless in terms of causality but are easy to understand and resonate with many. It seems that because they have been used since Seven Country Study, they keep coming and stirring the nutrition world.
There are recent systematic reviews which have shown that at least sugary drinks are clearly tied to obesity (in prospective cohorts and randomized trials). These data is based on the findings around th globe and is much more solid that ecologic correlations in a single country.
The whole discussion is alike to what Gary Taubes etc. seem to drive in US. Consuming more carbs at population level is timely matched up with increasing obesity prevalence. Well, he choose to dismiss that in Europe consuming *less* carbs is timely matched up with increasing obesity prevalence.
Hi Reijo. The European experience is interesting. Again, it suggests that we should focus less of the macronutrient profile of the diet and more on total energy intake. Regards, Bill
Hi Bill
I only briefly read the Green Pool report, but I am wondering if the measures for ‘sugar consumption’ include the HFCS from Corn, not sugarcane, that softdrink manufacturers use. I am not across the Coca-Cola process in Australia, but I would find it hard to believe that this manufacturing process would be very different to that in the US. If, these sugars are included then are we Australians consuming less sweetened beverages?
Are our dentists noticing a change in oral health due to this apparent trend?
Hello Fiona. Page 12 of the Green Pool report deals with fructose. It states that Australia does not have a fructose industry, unlike the US. The report identified very low imports of fructose into Australia, of the order of 0.13kg per person per year, some of which was re-exported to Japan
I don’t know exactly what Coca-Cola does, but from what the Green Pool report says I assume that Coke is sweetened with high fructose corn syrup in the US and sweetened with sucrose in Australia.
Not sure if Australians are consuming less sugar-sweetened beverages, but I do know that these data are currently being collated. Maybe we will hear next year. Regards, Bill
Hi Bill,
Thanks for highlighting the new information from the recently published study. However I do take exception to your statement that “The authors of the Australian Paradox can claim vindication”.
If I were to make the claim today that the scientific evidence proves that aliens regularly visit earth, I would be wrong on the balance of available evidence. (If you do believe aliens regularly visit earth, pick some other scientific fabrication that you prefer). And yet if a giant flying saucer were to land on The Mall in Washington DC next week, I would not be vindicated. I would merely have been lucky.
A claim made that doesn’t stack up on the published evidence (as the paradox appears to be, as I read it) can’t be vindicated by new evidence. It can only turn out to have been a lucky guess that was contrary to the evidence of the time. The conclusions of the original paper would still be wrong, or at least, poorly supported by the evidence presented in the paper.
Lucky guesses are not good science. They aren’t even science, not even in retrospect.
Hello Paul. I don’t think you can label the researchers’ original findings as a lucky guess. They looked at all the available evidence – from the FAO, dietary surveys, ABS data and industry data – and then came to a conclusion. They got bagged out for using outdated ABS data. Now the ABS data have been updated, and the original findings have been confirmed. If I were one of these researchers I would feel vindicated.
The perplexing thing is the belief system that states that increasing sugar intake is driving the obesity epidemic. What’s it based on? Obviously not scientific evidence, maybe it’s just a guess. Regards, Bill
The authors of this report have updated ABS data that the ABS stopped using more than 10 years ago because they said it was unreilable. So if they methodology wasn’t good enough for the ABS, then why is it good enough for Green Pool?
It isn’t simply a matter of the orginal data being out of date, the data wasn’t giving an accurate picture of sugar comsumption. Green pool’s “findings” are not going to change this.
Hello Zack. It is important that nutritionists base their beliefs on the best available data. The authors of the Australian Paradox paper looked at various sources of data and came to a conclusion. The Green Pool report supports their conclusion. So I am inclined to base my beliefs relating to trends in sugar consumption on this evidence.
Why would I think otherwise? On what evidence could I base a different conclusion? Regards, Bill
Hi Bill,
The ABS data on sugar consumption used in the Australian Paradox paper was deemed unreliable by the ABS!
Is it good scientific practice to base one’s conclusion on data that is deemed to be not up to scratch? Can such information ever be called “best available data”?
Furthermore the other data sets used by the authors in their study point to sugar consumption going up in the time period they assessed. Is it reasonable for anyone to come to the conclusion that the authors of the Australian Paradox did based on this data?
Quite how the green pool report supports their conclusion is beyond me. For one, if you claim consumption has sugar fallen in the last 30 years, yet your main source has no figures beyond 1999, that is not a finding. The technical term for that is a guess. I guess a lot of things, but none of them would ever make it in a scientific paper. The green pool report is immaterial to this point, as you can’t make finding on data that doesn’t exist.
Secondly, as I have said in my previous comment, all the green pool report has done is use the methodology of the ABS sugar series for the last decade or so. The do not constitute an accurate picture of sugar consumption in Australia. If they did the ABS would not have junked the series.
One does not have to be a rocket scientist to say this, nor does one have to be overly skeptical. I am just pointing out the obvious.
Regards,
Zack
Hi, Stephen Long, Economics Correspondent at the ABC here. Your post misses the critical point that the new statistics by the Brisbane consultancy merely replicate the methodology abandoned the ABS as unreliable. Rory Robertson is right: the Australian Paradox research rests on a completey flawed data and the new commission research does nothing to change that.
Hello Stephen. Thanks for your comment. I contacted Mr Tom McNeil, the Director of Green Pool (the company that prepared the recent report) for his response. Here it is:
Green Pool’s report canvassed two internationally accepted methodologies. Both have been used in Australia, both are still used internationally. The first – a straight stocks, production, import/export balance for food grade sugar – gave an 2011 per capita consumption figure of 40.85 kg. The second – using ABS methodology to account for the sugar content of imported/exported food – gave 41.97 kg/capita consumption.
Both measures have sound methodology. ABS did not “abandon as unreliable” their methodology – they abandoned the collation of all apparent consumption statistics. Some industries paid ABS to have the series reinstated using the same methodology. The sugar industry did not. Feel free to contact Green Pool to discuss.
I’ll let readers make up their own minds on the accuracy of these data. Regards, Bill
What about exploring the appetite mechanisms? What NATURALLY triggers our feelings of being satisfied and full with enough food for maintaining health? Rather than explore the effects on obesity of the various nutrients, what does research indicate regarding what might INTERFERE with this brain/appetite mechanism to a degree what we can over-eat. Many a poor rat has been in on these types for experiments finding any over consumption of food will result in fattened bodies. Maybe fructose, now in many more foods than just beautiful fruit could be one of these additives that leave the “I’m still hungry” switch ON. Let’s explore before putting it back on the individual and their lack of moderation for I get a sense that our food supply is not as easy for individuals to navigate as it once was. Also, is sugar addictive? It’s in many processed foods, if it did keep the “I’m still up for more food” switch ON, that could have an almost mysterious population wide effect of gradual ongoing weight gain? More focus research needed?
Hello Sue. In relation to appetite and its possible disruption I think you have put your finger on a very important issue. You have given me an idea for my next post! Regards, Bill
You seem to have neglected to mention that this new study by Greenpool Commodity Specialists was commissioned and funded by The Australian Sugar Refiners and CANEGROWERS.
Conflict of interest?
I know Greenpool call themselves independent, but when all they are doing is manipulating numbers, with no actual hard data to go on, it really does make one suspicious that they found the result they were looking for.
Hi Jay
I guess whenever an industry group commissions research there will always be the conflict of interest question. However, the backdrop to the Green Pool report was independent work by Brand Miller and Barclay, which was criticised for potential methodological shortcomings. In this context it is logical that the relevant industry would commission work that addresses the methodological issues. I don’t have any problem with this.
So now we have two pieces of work by different groups giving similar results. These are the best data we have available and this is what I’ll be basing my opinion on. However, a new national nutrition survey has been conducted and will provide new insights. If the evidence changes I will change my view. Regards, Bill.
Hi Bill
I’d like to add my take on the ‘Paradox’ paper. The authors of this paper assert that the consumption of refined sugar has decreased in Australia since 1980, over the same time frame that rates of obesity have increased. They propose that a literal interpretation of this association suggests that reductions in sugar intake may have contributed to the rise in obesity. The authors’ conclusion that refined sugar consumption has decreased over 30 years is based on FAO data, national sales figures of sweetened beverages and surveys of children’s drinking preferences.
Assessing what and how much Australians eat is difficult and every method of assessment has well documented limitations. Take for example FAO data, which is the lynch pin on which the authors’ proposition is based. FAO does not collect data itself but collates what is provided by the Australian Bureau of Statistics (ABS). In the case of refined sugar, ABS data includes how much sugar is grown in Australia, imported, exported, used in industry, lost during storage or transport etc. From this it is calculated how much is available for human consumption. By dividing the amount of refined sugar available in Australia from this calculation by the population, the FAO arrives at an average figure of sugar availability for every Australian. The figure of availability for consumption is not equivalent to the amount consumed. This is clearly stated on page 32 in the ABS document APPARENT CONSUMPTIONOF FOODSTUFFS 1997–98 AND 1998–99, which states, “This publication contains detailed statistics on the apparent consumption of foodstuffs in Australia. Estimates of total consumption and per capita consumption are included. In the context of this publication, ‘consumption’ is not ‘intake’. Apparent consumption data for most items are derived using information relating to the supply and utilisation of foodstuffs. Limitations inherent in this approach mean that the data are an approximate estimate of foodstuffs available for consumption by persons in Australia, after allowing for other uses and losses.”
Consumption data can only be assessed by dietary methods that aim to determine what people actually eat. Such methods include food frequency questionnaires, 24-hour food recall, food records etc. The authors miss this fundamental distinction. They mistakenly use FAO data as indicating consumption rather than availability, when they assert, “In Australia …… per capita consumption of refined sucrose decreased by 23% …. from 1980 to 2003.”
It’s important to note the difficulty in accurately assessing how much refined sucrose Australians are consuming or indeed, how much is available for consumption. The ABS recognized this and in 1999 stopped collecting and publishing availability data for refined sucrose. FAO, however, kept publishing Australian sugar availability data until 2003. In the absence of ABS data on which to base their estimates, the figures produced by the FAO, and quoted by the authors, are guesswork. This is further evidence of the inaccuracy of the author’s conclusion regarding refined sucrose consumption.
The second part of the authors’ proposition that refined sucrose consumption has decreased in Australia revolves around figures for consumption of just one out of a myriad of sources of refined sucrose ie sweetened beverages. However, data used by the authors from beverage sales provided by grocery stores contradicts their proposition. The authors’ own figures for reported sales data of nutritively sweetened drinks, provided by Australian grocery stores, were 96 mL/day/person in 1994 and 125 m/L/day/person in 2006. This indicates an increase in consumption of refined sucrose in beverages over this time, not a decrease.The use of unsupported FAO data, mistaking availability for consumption with actual consumption and misinterpreting sales figures is evidence that the authors’ belief in Australians having reduced their consumption of refined sucrose since 1980 is clearly flawed. Health reporter for the SMH, Mark Metherell, interviewed Boyd Swinburn for his opinion on the study’s findings. http://www.smh.com.au/national/health/research-causes-stir-over-sugars-role-in-obesity-20120330-1w3e5.html He reports, ‘Professor Swinburn, who is the director of the World Health Organisation collaborating centre for obesity prevention at Deakin University, says the study’s summary of the data as showing ”a consistent and substantial decline in total refined or added sugar by Australians over the past 30 years” belies the facts ”and is a serious over-call in my opinion”. His conclusion is that ”the ecological trends of sugar and obesity are pretty well matched and I do not believe there is any paradox to explain”.’
Regards, Jennifer
Thanks for your contribution Jennifer. I doubt that we will see any resolution of this issue until more and better data are available. I hope to have some data available myself soon and the national survey will be out later in the year, which should shed some light on it.
I know and like Professor Swinburn and the following comments are not directed at him but at obesity experts more generally. I think they have really let us down. They took us down the ‘eat less fat’ route knowing full well that there was very little evidence to support it and in doing so mislead health professionals and the general public alike. Why focus on the source of one-third of daily calorie intake and ignore the rest? Rather than learn from this failure the latest approach seems to be “let’s replicate our mistakes of the last 20 years, this time with sugar”.
Do you know why anti-obesity campaigns don’t just say that everyone needs to eat and drink a little less? Because focus group testing shows that the general public simply doesn’t want to hear the message. So, instead of telling people the facts we send them endless messages about food composition and ‘swapping it’, and we get nowhere. We deserve better. Regards, Bill.
These criticisms are not new, and they have been addressed in detail elsewhere (e.g., The Australian Paradox Revisited (http://www.mdpi.com/2072-6643/3/4/491/s3) and http://www.theaustralianparadox.com.au).
To recap:
FAOStat data are congruent with ABS apparent consumption data for the period 1980 – 1999. During this period, rates of overweight/obesity nearly doubled from 37% to 60%. Green Pool used the ABS apparent consumption method and extended the data to 2011 and confirmed the overall downward trend. FAOStat data are now available to 2010, and is congruent with the Green Pool analysis. FAOStat data is therefore not guesswork.
With respect to the volume of nutritively sweetened soft drinks sold over the 1994-2006 period, this is a common misunderstanding. The composition of nutritively sweetened beverages changes constantly as manufacturers introduce new varieties and new flavour variants of existing varieties. Consequently, the sugar content of nutritively sweetened beverages changes over time. Figure 6 in The Australian Paradox (http://www.mdpi.com/2072-6643/3/4/491) shows clearly that the total amount of added sugar (tonnes) in soft drinks decreased from the mid 1990′s to the mid 2000′s.
Boyd Swinburn is entitled to his opinion but it does not mean that he is correct.
Alan and Bill,
I note that BMC Public Health journal now is investigating the veracity of your extraordinarily faulty Australian Paradox paper, in response to this letter.
Hello Rory. I was not an author on that paper and was not involved in it in any way. I understand there is new data in the pipeline. Also, the Australian Health Survey should give us a clearer picture of what is going on. Everyone will benefit from better data. Regards, Bill
I find it very alarming that there is even a debate on this. Sugar/glucose is the preferres fuel for the brain. A sugarfree or restricted diet is essentially depriving the brain of its number one fuel. Dietary intake should be sensible, like bill said, energy balance is the key. Calories in, no matter where they come from, should be controlled if weight management is the goal. Low sugar intakes aren’t the answer, they will just leave you cranky and unable to concentrate.
@chantelle: “Sugar/glucose is the preferres fuel for the brain. A sugarfree or restricted diet is essentially depriving the brain of its number one fuel.”
Check out Gluconeogenesis.
The simplest thing to do if you’re unhappy with the figures is surely to produce your own graph of per capita sugar consumption and obesity over the last 30 years.
It’s the same in the UK – we only make about 2.5M tonnes of sugar and have done so since ~1980 and the population is fairly steady at 50-60m. Obesity has of course grown exponentially in the same time frame.