Society’s Sweet Struggle

The Science Communication paper I submitted in my undergraduate in 2012 that convinced me that food and nutrition was where my career was destined as opposed to forensic pathology. Please note that some of the policies are now outdated. I hope to follow with an updated article on the current sugar and nutrition communication arena in the coming months. 

The link between nutrition, lifestyle and chronic disease has been recognised for centuries across many cultures[1] and is now supported by a wealth of scientific research (Nestle, 2007). Despite the availability of this evidence and the widespread availability of nutritional food, the incidence of nutrition-related chronic diseases such as obesity and diabetes has surged to epidemic proportions, partly due to an increase in sugar intake (WHO: Obesity and overweight, 2012). Since the 1970s sugar intake has increased by over 30 pounds (Lustig, 2011).

Sugar-consumption.jpg

Research has shown that sugar has a similar addictive nature and chronic health outcomes to ethanol and cocaine, but unlike alcohol and many other addictive substances, sugar is not currently regulated by the government (Lustig, 2011).

Communication Confusion

The question science communicators are asking is – why the average caloric intake has continued to increase when public health campaigns over the past fifty years have encouraged the public to ‘eat less’ – particularly less high energy (high sugar) foods (Nestle, 2007)? Why have these communication campaigns failed to effectively change behaviour?

Communication is more complex than just encoding and decoding transmissions between parties; not only are messages and information rarely interpreted by the receiver exactly as they were intended by the sender but they are also influenced during transmission by interfering signals from a variety of different stakeholders.

Stakeholders generally have individual communication objectives and priorities, which results in contradictory communication strategies towards behavioural change. Individuals, communities, industry and governments all have vested interests in manipulating the interpretation of nutrition messaging and promoting the consumption of sugar products. Identifying and understanding these stakeholder groups, including their respective motivations and interrelationships, is an important step towards generating communication to achieve effective and sustainable changes in nutritional behaviour.

Food Choices

At a conscious level, the way individuals choose to act on health information is influenced by social and behavioural factors (Goldberg, J. 2000). Research by the American Dietitian Association found that the motivation for people to eat certain foods is determined firstly by taste, secondly on convenience, then by cost and nutritional benefits (Glanz, et al 2000).

At a sub-conscious emotional level, sweet food is typically associated with ‘treat’ or reward (Protudjer, et al, 2010) despite its harmful effects on the body. Biological effects of sugar on the human body impede the ability of individuals to resist the desire for sugary products[2], particularly when exposed to constant advertising.

The increasing proportion of dual-income families has also seen increase in packaged and fast food consumption (Nestle, 2007).   Many modern families no longer know how to cook healthy meals using raw materials such as fruit and vegetables and therefore rely to convenient pre-packaged and processed products that are often full of sugar (Goldberg, J. 2000).

Humans are social creatures influenced by their environments. Evidence from community-based interventions have shown that individuals are reluctant to change their dietary behaviour if this behaviour means eating and acting different from their community (Walls et al 2011). Effective communication strategies must also target collective community perceptions.

Skewing the evidence

Food industries often place the interests of their stakeholders above public health, similar to tobacco or alcohol companies. (Nestle, 2007). Profit margins depend upon sales of sugar products and also from the ability to exploit the addictive nature of sugar to influence consumer behaviour.

Many large corporations use their economic and political influence to manipulate their surroundings for the benefit of their shareholders. Food industries support science and research that promotes their products (Walls et al 2011) and oppose research that could adversely affect sales [3]. The report ‘The Australian Paradox’ counters the argument that increased sugar intake is linked to obesity [4]. Coca-cola and the Australian Food and Grocery Council have supported the study and used it in their argument to prevent the government from recommending a reduction in sugary drinks and foods in the new dietary guidelines (Metherel, 2012). When consumers read articles, like this one by Metherel, in newspapers which highlight opposing research they often support it when it is something they want to hear. Many individuals do not want to believe that sugar is as toxic for them as other research is telling them.

Individual consumers gain most of their nutritional information from media and advertising[5] (Nutrition and You: Trends, 2002; Trends in American Eating Patterns, 2002; Nestle, 2007). The Food and Beverage Industry saturates media coverage to promote specific buyer behaviour.[6] Labels such as ‘Low-fat’, ‘No Cholesterol’, ‘High Fibre’ or ‘Nutrient Added’ lead to incorrect inferences about a products nutritional value (Nestle, 2007). Such misdirected claims that create consumer confusion in turn undermine public trust in nutritional information (Position of the American Dietetic Association: Food and Nutrition Misinformation, 2006).

In addition to intercepting nutritional research and messages; many food industries actively design their products to target individual behaviour at a subconscious or biological level. For example, many soft-drink products such as Coca-Cola contain large amounts of salt to increase thirst (Lustig, 2011). Increasing the amount of sugar in products has an additional benefit of enhancing biological preservation, which aids foods exporting ability, and thus further increasing economic gain (Lustig, 2011).

The public and politics

The Australian Federal Government legislature (or parliament) is responsible for debating and voting on new laws to be introduced. However, the strategic aim of Government is to remain in power, by effectively managing its policy agenda to maintain the political and financial viability of its decisions; including support from the voting public and the many industry and political lobby groups. Governments must therefore balance legislative and policy changes to nutritional directions with potential opposition from the general public or powerful lobby groups such as the food and beverage industry (Walls et al 2011).

While the impact of obesity and diabetes on the populace and on the public purse is significant and there is increasing community demand for government action, policy changes have so far had minimal impact. For example, recent Government initiatives such as the Australian ‘Swap it, don’t Stop it’ campaign (Swap it, Don’t stop it, 2012) focus on reducing the quantity of food consumed despite ample scientific and nutritional studies that argue convincingly that many high-sugar products do not belong in a healthy diet. The prevalence of sugar-related advertising undermines these public health campaigns.

What now?

Further research is required to determine the most effective strategies to compulsive pressures from industry advertising, widespread general availability and addictive traits of high-sugar foods. Deliberate government policy implementation is needed to appropriately engage all stakeholders to actively shape behavioural change towards improved nutrition through coordinated communication. This could mean educating individuals to identify sugar as a toxic and harmful substance, ensuring families understand how to prepare cheap, quick, tasty nutritional food; and analysing the lessons learnt through tobacco and alcohol regulation and communication.

“We recognize that societal intervention to reduce the supply and demand for sugar faces an uphill political battle against a powerful sugar lobby, and will require active engagement from all stakeholders” (Lustig, 2011).

Footnotes: 

[1] The health hazards associated with obesity were well known to the Ancient Greek physician Hippocrates, who stated that ‘sudden death is more common in those who are naturally fat than in the lean’ (Littré, 1839).

The Hindu physicians, Sushrut (Susrata) and Charak (500–400 B.C.) are credited with very early recognition of the sugary taste of diabetic urine, and also observed that the disease often affected indolent, overweight people who ate excessively, especially sweet and fatty foods. Avicenna, one of the most prominent figures of the Arabic medical tradition in the early twelfth century, also described the sweet taste of diabetic urine, and referred to obesity and its dangers to health.

[2] Sugar, in particular high fructose corn syrup, causes a pleasure high and ‘binging’ can increase this sensation (Pirisi, S. 2003). The mere subconscious thought of consuming sugar stimulates a biological response in humans such that, when sugar is not ingested in response to this stimulus ‘withdrawal’ symptoms often occur (Shiuchi T, et al 2009). This cycle is due to sugar affecting the body in the same way as do addictive drugs (Melanson, K. et al 2010). Sugar also interferes with hormones that inform the brain that the stomach is full – inhibiting natural restraints on over-consumption (Melanson, K. et al 2010).

[3] In 1988 a US government report on research linking nutrition and chronic disease was limited from concluding that any particular food should be minimised or excluded from people’s diets regardless of the research findings. This was enforced to prevent food industries complaining to congress which would stop the report being published (Position of the American Dietetic Association: Food and Nutrition Misinformation, 2006). In Australia this year Choice put pressure on the $166.5 million juice market, with an analysis of Australian fruit juice and found that the amount of sugar was extremely high with no fibre and very little fresh fruit (Collier, K. 2012; Foods that make kids fatter, faster, 2012). Fruit juice companies fought back by stating that scientific evidence supported the benefit of fruit juice for children’s health and that it contributed to their daily intake of fruit(Media Release: Fruit Juice Australia, 2011). Many parents listen to the Fruit juice companies as they have an interest in sticking with convenient methods they are familiar with; they don’t want to believe that fruit juice is unhealthy. Therefore demand continues and industries succeed in swaying the minds of consumers.

[4] In particular arguing against Lustig’s article in Nature.

[5]According to the ADA’s Nutrition and You: Trends 2002 survey (2) and data from the Food Marketing Institute (14), consumers report that they received the majority of their nutrition information from media sources such as magazines (47%), television (34%), books (29%), and newspapers (28%). Other important sources of nutrition information are physicians (31%), the Internet (21%), product labels (19%), and friends and family (18%). Only 13% of consumers claimed their nutrition information came directly from dietetics professionals”

[6] Most US food companies that distribute nationally spend more on advertising their products than the entire US government budget for nutritional promotion and education (Nestle, 2007)

 

References

Collier, K. 2012, Report shows alarming levels of sugar, kilojoules in kids’ fruit drinks Juice is no substitute ‘Herald – Sun’

Food Addiction Summit, n.d. viewed 1 May 2012, http://www.foodaddictionsummit.org/epidemic.htm

Foods that make kids fatter, faster, 2012, ‘Choice’, viewed 1 May 2012, http://www.choice.com.au/reviews-and-tests/food-and-health/food-and-drink/nutrition/foods-that-make-kids-fatter-faster.aspx

Glanz K, Basil M, Maibach E, Goldberg J, Snyder D. Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption. J Am Diet Assoc 1998;98:1118

Goldberg, J. 2000, Nutrition Communication in the 21st Century: What Are the Challenges and How Can We Meet Them? Nutrition Vol 16, No. 8 pp. 644-646.

Lustig, R. et al. 2012 Public Health: The toxic truth about sugar, ‘Nature’, vol. 482 pp. 27-29

Melanson, K. et al, 2010, Effects of high-fructose corn syrup and sucrose consumption on

circulating glucose, insulin, leptin, and ghrelin and on appetite in normal-weight women, ‘Nutrition’, vol. 23 pp. 103-112.

Metherel, M. 2012, Study Suggests sugar not cause of obesity, viewed 2 May 2012, http://www.canberratimes.com.au/national/study-suggests-sugar-not-cause-of-obesity-20120330-1w43r.html

Media Release: Fruit Juice Australia, 2011, ‘Australian Associated Press Media Net Press Release’ 

Nestle, M. 2007, Food Politics: How the Food Industry Influences Nutrition and Health, University of California Press, California.

‘Nutrition and You: Trends 2002: Final Report of Findings’ 2002 ‘American Dietetic Association’. Accessed 28 April 2012, http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/media_1578_ENU_HTML.htm.

Painter J, Wansink B, & Hieggelke J, 2002. How visibility and convenience influence candy consumption. ’Psychology Today’, vol. 38 no. 3, pp. 237-238.
Protudjer, J. et al. 2010, Children’s Perceptions of Healthful Eating and Physical Activity ‘Canadian Journal of Dietetic Practice and Research Vol. 71 No 1 pp. 19-23
Shiuchi T, et al 2009, Hypothalamic orexin stimulates feeding-associated glucose utilization in skeletal muscle via sympathetic nervous system,
‘Cell Metabolism’, vol. 10 no. 6, pp. 466-480.

 

Swap it, Don’t stop it, 2012, viewed 1 May 2012,

http://swapit.gov.au/

Trends in American Eating Patterns 2002, 2002, ‘Food Marketing Institute’. Washington, DC: Food Marketing Institute

 

Walls et al. Public Health Campaigns and Obesity: a critique, BMC Public Health 2011, 11:136
http://www.biomedcentral.com/1471-2458/11/136

 

Wansink B. 2006 Mindless Eating (Why We Eat More Than We Think). New York, NY: Bantam-Dell

 

WHO: Obesity and Overweight, 2012, viewed 25 April 2012, http://www.who.int/mediacentre/factsheets/fs311/en/

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