Regulatory Focus on Added Sugars Presents Road Blocks in Reducing Obesity

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By Catherine Boudreau

Oct. 10 — Efforts to regulate sugary foods and beverages have public health advocates and the industry divided, despite what seems like a shared goal of combating obesity.

Americans consume an average of 22 teaspoons, or 355 calories, of added sugar each day, according to the American Heart Association (AHA). And between 2005 and 2010, people got an average of 15 percent of their calories from the sweetening agent.

This alarms the public health sphere that see targeting the most widely consumed sources of added sugars—such as soda, energy, sport and fruit drinks and processed food—as a good starting point for combating the obesity epidemic. Meanwhile, the food and beverage industry, which has focused on voluntary calorie-reduction strategies, fight regulatory efforts on sugar at every turn.

The 2010 Dietary Guidelines for Americans asserts that added sugars should be limited because they are consumed in excessive amounts and contribute calories that have no nutritional need or benefit in the diet. The AHA suggests women consume no more than 6 teaspoons of added sugar per day, or 100 calories. For men, no more than 150 calories, or 9 teaspoons.

Many health officials favor regulations to curb consumption, including taxes on sugar-sweetened beverages, requiring manufacturers to put “added sugars” on a separate line on the Nutrition Facts label, limiting the size of sugar-sweetened beverages and putting restrictions on advertisements to children.

Companies argue that targeting one ingredient is discriminatory, laws would be ineffective and infringe on personal freedom and industry can implement change faster than a government policy, according to comments by the Grocery Manufacturer's Association (GMA) and the American Beverage Association (ABA).

Added Sugars Are Ubiquitous

Barley malt, anhydrous dextrose, ethyl maltol, corn syrup, mannitol, molasses. All of these ingredients are names of added sugar in processed and prepared products like drinks, canned fruit, cereal, flavored yogurt and baked goods.

There are roughly 50 more names for the sweetening agents, and it isn't easy to isolate them from naturally occurring sugars such as lactose in milk or fructose in fruit. The Nutritional Facts Panel groups both categories together for a total in grams.

“Sugar is the marker for processed food, and nearly 80 percent of food items in the U.S. are laced with added sugar,” Robert Lustig, a professor at University of California, San Francisco, and director of its Weight Assessment for Teen and Child Health Program, said. “Sugar is what food and beverage industry uses as the hook. It is exactly what they refuse to take out.”

The increases in sugar consumption over the past 30 years have paralleled the increase in obesity, diabetes and heart disease, and areas that drink more soda show higher prevalences of these diseases, Lustig told Bloomberg BNA.

“I'm not saying sugar alone is the sole cause. There are various factors on table that are potentially fixable. But sugar is a great place to start," Lustig said, adding that sugar has addictive qualities that cause Americans to desire more.

Focus on Calories, Not Sugar

Over consumption of any caloric food or ingredient, including sugar or foods with added sugars, can lead to obesity or other negative health consequences, Ginny Clemenko, senior director of communications for GMA, said in an e-mailed statement.

“Rather than focus on any one food or ingredient to reduce their risk for obesity, consumers should work towards eating a variety of foods combined with regular physical activity to create an overall healthy lifestyle,” Clemenko said.

The Food and Drug Administration has proposed separating added sugar from naturally occurring on the nutrition label, a move the industry has lobbied against because it may confuse consumers, misinform their food decisions and cause them to focus on one ingredient rather than overall nutrient density and caloric intake, according to August comments by the GMA and the ABA.

Both organizations, which together have more than 500 member companies, also said there is a lack of evidence directly linking added sugar to obesity and heart disease.

The World Health Organization in March 2014 said reducing added sugar intake to below 5 percent of total calories each day would have additional health benefits, as a growing number of studies have shown over-consumption may be associated with increased rates of obesity, diabetes and heart disease.

Americans should be cautious about focusing on one ingredient, said Michele Simon, a public health lawyer that provides legal services to food and beverage companies working of counsel with Foscolo and Handel PLLC, The Food Law Firm.

“It's not so much added sugar, but the vehicles that contain sugar,” Simon said. “By focusing on one ingredient, we're not getting into the underlying issue which is processed and prepared products.”

The Profit Dilemma

“The issue is simple,” says Marion Nestle, a professor of nutrition, food studies and public health at New York University and author of the blog Food Politics. “The food industry's goal is to sell more products to maximize profits, while the goal of consumer advocates is to maximize health. These goals could be congruent in theory, but rarely are in practice. Junk foods are more profitable than fruits and vegetables.”

Even if a food or beverage company wants to act, it takes a long time because of market forces, Derek Yach, executive director of The Vitality Institute said. There will always be a focus on profits, he added, and a company has to stay afloat while the change is happening.

“If you look back six or seven years at the volume of beverages in the low and mid-calorie range, it was somewhere around 20 percent. Now that's at about 50 percent and we're likely to see that increase to 75 percent,” said Yach, a former vice president of global health and agriculture policy at PepsiCo and one of CEO Indra Nooyi's first recruits to ensure the company became healthier.

The industry also has to leverage distribution and marketing expertise to meet the demand for healthier options, and increase access to those choices.

“As a consumer-driven industry, it is not only a social imperative, but also a business imperative that our companies find ways to meet the demand for better-for-you products,” Clemenko said.

Better-For-You Drives Growth

On Oct. 2, the Healthy Weight Commitment Foundation (HWCF) announced that 16 major food and beverage companies had removed 6.4 trillion calories from the marketplace between 2008 and 2012, exceeding its original goal of 1.5 trillion.

The data showed healthier products can be a source of growth for the food and beverage business, Hank Cardello, the director of Obesity Solutions Initiative at the Hudson Institute, said.

The Hudson Institute found that lower-calorie items account for nearly 53 percent of dollar sales, driving almost all of the overall growth for the five-year period. Companies that increased their lower-calorie products increased total sales, and those that emphasized higher-calories products declined.

“This can be a win-win and now I think a corner has been turned because lower-calorie products are driving growth in business,” Cardello told Bloomberg BNA. “And when calories come down, added sugar content is likely to come down with it.”

Cardello, who for three decades was an executive at food and beverage at companies like Sunkist Soft Drinks Inc., Coca-Cola USA and General Mills, said he doesn't favor getting the hammer out and enforcing regulations.

“I've seen enough evidence that they are not effective. You just have to show these companies that this is where the market is moving and they will listen to consumers,” Cardello added.

A Calorie Isn't Just a Calorie

The industry's main focus on calories is not enough, Lustig said, because all calories are not created equal. Although two products may have the same number of calories, the way bodies metabolize the fat, protein or sugar providing those calories will have different effects.

The fructose in high fructose corn syrup and other added sugars is particularly egregious because it is poorly absorbed by the gastrointestinal tract and mainly metabolized by the liver, Lustig told Bloomberg BNA.

“When consumed in excess, the liver starts turning fructose into fat,” Lustig said.

Taxes, Labels, Marketing Restrictions

If the industry were truly committed to reducing obesity rates they would focus on sugary products, among other actions, Harold Goldstein, executive director of the California Center for Public Health Advocacy, said. That includes charging more for sugary drinks and even keeping that profit, as well as not advertising to children under 16.

Sugar-sweetened beverages are the leading source of added sugar in the diet, so it makes sense to go after the biggest culprits first, Goldstein said. He added that industry commitments have largely been PR.

For example, soda consumption in the last decade has already been falling by about 2 percent annually. This takes away from the “Balance Calorie” initiative launched in September by Coca-Cola Co., PepsiCo Inc., Dr Pepper Snapple Group and the ABA.

In an agreement with Alliance for a Healthier Generation, the soda giants pledged to cut calories consumed from beverages by 20 percent by 2025. The companies plan to use marketing strategies to increase consumer interest in smaller portion sizes, water and no- and lower-calorie beverages. The initiative also will promote calorie awareness on point-of-sale equipment and encourage Americans to get active, particularly in communities with little interest like Little Rock, Ark.

“What needs to happen is something like warning labels or taxes, as well as more marketing restrictions,” Goldstein said. “The industry needs to stop fighting these efforts and show us how well they can adapt, and I'm sure their profit margins will remain just fine.”

Millions Spent in San Francisco

The ABA has spent a total of $7.7 million to stop the sugary drink tax initiatives in San Francisco alone, according to campaign finance forms filed on Oct. 9 with the San Francisco Ethics Commission. City residents on Nov. 4 will vote on levying an excise tax on sugar-sweetened beverages (SSBs), a proposal introduced in more than 30 states, all of which have been defeated.

“The only reason the industry is fighting this is because they know it's going to work,” Marlene Schwartz, director for the Rudd Center for Food Policy & Obesity at Yale University, said. “If they believed a tax wouldn't affect their sales, they wouldn't waste money working against it.”

ABA Spokesman Chris Gindlesperger said people don't support soft drink taxes and other restrictions on what they eat and drink because Americans feel they can decide for themselves without help from the government.

Voluntary Commitments From Industry

Other food and beverage industry commitments include ABA's effort to display total calorie counts on the front of all containers up to 20 ounces and the removal in 2012 of full-calorie sodas from schools.

Some companies are on board with reducing added sugar, including PepsiCo that said it has removed approximately 370,000 metric tons of added sugar from its beverage portfolio in North America since 2006.

According to a 2010 GMA Health and Wellness Survey, 57 food and beverage companies have reduced “sugar/carbohydrates” in 3,700 products since 2009.

Change the Subsidy Structure

Yach said several things need to happen, including subsidizing or discounting healthier foods, reducing portion sizes and marketing to children, as well as a change in the perception of value.

Yach has worked on the links between agriculture and nutrition, determining that all of the incentives are aligned with simply producing more as opposed to more nutritional commodities.

“The subsidy structure favors corn, soy, wheat and sugar, so there's no surprise that these are the base ingredients in most products; they're cheaper,” Yach said. “So other foods like fruits and vegetables are more expensive, which has enormous long- term implications.”

People also have to shift their perception of value when it comes to food and beverages, Yach said. Currently, value is placed on getting more for our money. This needs to be shifted toward the quality of products we buy.

Yach added that if the government gave stronger support to healthier products like fruits and vegetables, the market would respond.

To contact the reporter on this story: Catherine Boudreau in Washington at

To contact the editor responsible for this story: Heather Rothman at