How the food industry misleads consumers on sugar

The food industry uses misleading marketing and industry-supported interest groups to obscure the health consequences of added sugar in their products, according to a new report, Sugar-Coating Science: How the Food Industry Misleads Consumers on Sugar, from the Center for Science and Democracy at the Union of Concerned Scientists.

“Companies are going out of their way to promote products with added sugar in them as healthier than they really are,” said Deborah Bailin, lead author. “In many cases, they’re adding sugar to otherwise healthy foods and misleading customers about it. It’s not just soda and snacks, either. Added sugar is in everything from bread to salad dressing and even frozen dinners.”

Medical researchers have linked sugar overconsumption to diabetes, cardiovascular disease, and hypertension. Despite these dangers, companies advertise products with added sugar using healthy-sounding language. For instance, Apple Cinnamon Cheerios are marketed as “whole grain,” which they are, but the product also contains 10 grams of sugar—10 times the amount in General Mills’ regular Cheerios.

Since 1970, average daily U.S. sugar consumption has increased from 74.7 grams to 82.1 grams (20 teaspoons). That is more than double the U.S. Department of Agriculture’s dietary guideline recommendation of no more than 42 grams of sugar a day. The report documents that eating just a few sugar-added products during the day could easily cause someone to exceed the recommendation level.

The food industry spends nearly $7 billion annually advertising its products. About a quarter of its spending is directed at youth advertising and sugar-heavy products make up the bulk of that spending. GoGurt yogurt, for instance, contains large amounts of added sugar, but has been advertised as healthy because it is free of “high fructose corn syrup.” The report also tracks misleading marketing campaigns for sugar-added products that have been specifically directed at women, minorities and low-income consumers.

Food industry-supported interest groups also play a significant role in misinforming the public, the report finds. Court documents recently revealed that the Corn Refiners Association (CRA) paid Berman and Company to run a misleading ad campaign through the Center for Consumer Freedom, a nonprofit run by Berman and Company’s founder. The ads conveyed the message that all sugars—whether from corn, cane, and beets—are “natural” and pose no health concerns. This message is misleading, the report says, because it distracts people from the risks associated with over-consuming sugar in any form. In internal emails, CRA’s then-president Audrae Erickson counseled colleagues to deny that CRA was financing the campaign.

The report makes the following recommendations in order to hold the food industry and its interest groups accountable for their efforts to obscure the science on sugar and its detrimental health effects:

• The media should publicly call out sugar interests’ misstatements.
• Scientific experts should disclose all real or perceived conflicts of interest.
• Investors and citizens should pressure companies to align their public messaging with science and to cease funding to trade and front groups that spread misinformation.
• U.S. Congress should restore the Federal Trade Commission and Federal Communications Commission to their full capacity to regulate marketing to children so that the agencies can regulate youth-targeted marketing.
• The U.S. Food and Drug Administration should implement a strong rule requiring the labeling of added sugar in nutrition labels as the agency announced it intends to do.
• Federal, state, and local health agencies should develop aggressive public information campaigns to emphasize the scientific evidence demonstrating sugar’s health impacts and counter the misinformation from sugar interests.

The report is being released at the Science, Democracy, and a Healthy Food Policy forum on integrating public health science into U.S. food policy, sponsored by Union of Concerned Scientists and the University of Minnesota’s School of Public Health.

Citation:
1. Bailin D, Goldman G, Phartiyal P. Sugar-Coating Science: How the Food Industry Misleads Consumers on Sugar. Cambridge, Mass.: Union of Concerned Scientists, 2014.

Open access textbook on diabetes public health

Diabetes Public Health: From Data to Policy is now available open access as a Google eBook. This book provides effective approaches to prevent and manage diabetes through the practice of public health. It focuses on diabetes control in the United States and North America, and it is recommended for public health practitioners and researchers and anyone involved in health policy, administration and management.

Citation:
1. Narayan KMV, Williams D, Gregg EW, Cowie CC. Diabetes Public Health: From Data to Policy. New York: Oxford University Press, 2011.

Diabetes death rates on the decline in the U.S.

Death rates among U.S. adults with diabetes has been on the decline since the late 1990s, reports a new study. The study found that between 1997 and 2006 among diabetic adults, the rate of deaths due to cardiovascular disease (CVD) declined by 40 percent and the death rate due to all causes decreased by 23 percent. There was no difference in the rates of decline between diabetic men and women.

The CVD death rate, compared with non-diabetic adults, decreased by 60 percent, while the all-cause death rate declined by 44 percent.

Although these findings are encouraging, the study points out that “diabetes prevalence is likely to rise in the future if diabetes incidence is not curtailed.”

Citation:
1. Gregg EW, Cheng YJ, Saydah S, et al. Trends in death rates among U.S. adults with and without diabetes between 1997 and 2006: findings from the National Health Interview Survey. Diabetes Care 2012; 35(6): 1252-1257. (open access)

White rice linked to 11% rise in diabetes risk

A study published in BMJ.com indicates that a higher consumption of white rice is associated with a significantly increased risk of type 2 diabetes, especially in Asian populations.

Each serving per day of white rice consumption increases the risk of diabetes by 11 percent, according to the study.

Rice provides food for more than half of the world’s population, especially those living in some of the most populous countries, such as China, India, and Japan. And white rice—which is produced through a series of mechanized processes including hulling and milling and has higher glycemic levels than whole grains—is the predominant type of rice consumed worldwide.

The high glycemic levels of white rice, in combination with dramatically decreased levels of physical activity and increased access to unhealthy foods, has led to a rise in obesity insulin resistance in Asian countries.

In addition, the study shows that even for Western populations with typically low intake levels, relatively high white rice consumption may still modestly increase risk of diabetes.

Citation:
1. Hu EA, Pan A, Malik Va, Sun Q. White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. BMJ 2012; 344: e1454. (open access)

Adults in southern China at high risk of metabolic syndrome

A study indicates that close to eight percent of adults in Guangdong, China, have the metabolic syndrome. The metabolic syndrome is the constellation of cardiovascular risk factors including abdominal obesity, raised blood-sugar and high cholesterol. The metabolic syndrome is known to increase the risk of diabetes, heart disease and subsequent death.

The results of the study translate to a total of about four million adults age 20 years and older with the metabolic syndrome in this Chinese province of 85 million residents. More than 60 percent were found to have at least one individual component of the metabolic syndrome. Urban residence were more likely to have the syndrome than the rural population (close to 11 percent compared to four percent).

As China continues to be the fastest economic development in the world, it is expected to further increase its rate of modernization and urbanization–translating to more people consuming energy-dense diets and living increasingly sedentary lifestyles. The prevalence of the metabolic syndrome and related cardiovascular disease is therefore expected to increase enormously, according to the study.

“Urgent public health actions are needed to control this observed worsening situation in China,” the study concludes.

Citation:
1. Lao XQ, Zhang YH, Wong MCS, et al. The prevalence of metabolic syndrome and cardiovascular risk factors in adults in southern China. BMC Public Health 2012; 12: 64. (open access)

Case management guide for diabetes, heart disease and related conditions

The UK Department for International Development has made available Type 2 Diabetes, Cardiovascular Disease, Obesity and Hyperlipidaemia Care in Adults: Case Management Desk Guide. This document guides health care workers on the screening, detection and management of type 2 diabetes and its related conditions (hypertension, obesity, high cholesterol, alcoholism and smoking). The guide is currently in draft form.

Click here to access a PDF of the guide.

Advocacy toolkit and charter for global diabetes awareness

Calling the World to Action on Diabetes: An Advocacy Toolkit is a guide by the International Diabetes Federation (IDF) that bridges global to local diabetes advocacy through information, guidance and key tools and resources. The toolkit provides an overview of the upcoming United Nations High-Level Summit on Non-Communicable Diseases, practical guidance on effective advocacy and campaigning and useful downloadable resources such as sample letters, press releases, downloadable media such as podcasts and PowerPoint presentations, key messages and sound bites and other advocacy publications.

The advocacy toolkit includes the International Charter of Rights and Responsibilities of People with Diabetes. The charter sets out the rights as well as the responsibilities of people with diabetes in terms of care, information and education and social justice. It represents the gold standard to which all countries and people can aspire. IDF hopes the charter will raise awareness of the rights of people with diabetes, inspire collective action to tackle the stigma and discrimination that many people with diabetes face, and prove to be a powerful advocacy tool for the global diabetes community.

Click here to access the PDF of Calling the World to Action on Diabetes: An Advocacy Toolkit.

Click here to access the PDF of the International Charter of Rights and Responsibilities of People with Diabetes.

Diabetes linked to higher risk of tuberculosis in U.S./Mexico border

Patients with diabetes are at higher risk of contracting tuberculosis (TB) than non-diabetic patients, according to a study conducted in the Texas/Mexico border.

The prevalence of diabetes among TB patients was 39 percent in Texas and 36 percent in Mexico. Diabetes contributed 25 percent of the TB cases studied, whereas HIV infection contributed only five percent or fewer.

Among TB patients, fewer Mexicans than Texans were aware that they had diabetes before this study (four percent and 19 percent, respectively). Men were also less frequently aware than women that they had diabetes. Patients who knew that they had diabetes before the study had an eight-year history of the disease, on average, before being diagnosed with TB.

Citation:
1. Restrepo BI, Camerlin AJ, Rahbar MH, et al. Cross-sectional assessment reveals high diabetes prevalence among newly-diagnosed tuberculosis cases. Bulletin of the World Health Organization 2011; 89: 352-359. (open access)

Management of diabetes and associated cardiovascular risk factors in seven countries

A substantial proportion of individuals with diabetes remain undiagnosed and untreated, both in developed and developing countries, according to a multi-country study using nationally representative health examination surveys from Colombia, England, Iran, Mexico, Scotland, Thailand and the United States.

The figures range from 24 percent of women in Scotland and the United States to 62 percent of men in Thailand. The proportion of individuals with diabetes reaching treatment targets for blood glucose, arterial blood pressure, and serum cholesterol was very low, ranging from one percent of male patients in Mexico to about 12 percent in the United States. Income and education were not found to be significantly related to the rates of diagnosis and treatment anywhere except in Thailand, but in the three countries with available data insurance status was a strong predictor of diagnosis and effective management, especially in the United States.

Based on this comparison of how well these seven countries are performing in terms of population-level management of diabetes, hypertension and high cholesterol, the study researchers make the following recommendations:

1. It is critical to track diabetes care at the population level and to focus on actual outcomes, rather than on the process of care. It is also critical to study other countries with larger numbers of individuals with diabetes, such as China and India, for which nationally representative studies are not readily available.
2. It is important to prioritize the development and implementation of national guidelines and the use of new incentive programs for the management of hypertension and high cholesterol among individuals with diabetes in developing countries. The study findings suggest that such progress may be more feasible and more likely to have a larger population health impact than blood glucose control.
3. There are opportunities for innovation in providing incentives, in the technology of diabetes management and in improving financial access to care.

Real progress at the population level in the management of diabetes will likely require all three: monitoring performance in meeting treatment targets, expanding management of hypertension and high cholesterol in individuals with diabetes, and innovations in the delivery of and access to care.

The estimated global prevalence of diabetes is around 6.4 percent and more than 280 million people in the world have diabetes—the majority live in the developing world. Projections indicate that diabetes accounted for almost four million deaths worldwide in 2010. The burden of diabetes will only continue to grow, since the number of adults with diabetes in developing countries is projected to rise by more than two-thirds between 2010 and 2030.

Source:
1. Gakidou E, Mallinger L, Abbott-Klafter J, et al. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys. Bulletin of the World Health Organization 2011; 89: 172-183. (open access)

High blood pressure, high cholesterol and diabetes rates in Switzerland

High blood pressure, high cholesterol and diabetes rates in Switzerland have increased in the last decade, according to data from three national health surveys conducted in 1997-2007.

The prevalence of self-reported hypertension, hypercholesterolemia and diabetes was 22.1 percent, 11.9 percent and 3.3 percent in 1997, respectively; and increased to 24.1 percent, 17.4 percent and 4.8 percent in 2007.

Self-reported treatment rates among people with these three cardiovascular risk factors also increased from 52.1 percent, 18.5 percent and 50 percent in 1997 to 60.4 percent, 38.8 percent and 53.3 percent in 2007 for hypertension, hypercholesterolemia and diabetes, respectively.

Self-reported control levels increased from 56.4 percent, 52.9 percent and 50 percent in 1997 to 80.6 percent, 75.1 percent and 53.3 percent in 2007. Finally, screening during the last 12 months increased from 84.5 percent, 86.5 percent and 87.4 percent in 1997 to 94 percent, 94.6 percent and 94.1 percent in 2007.

Source:
1. Estoppey D, Paccaud F, Vollenweider P, Marques-Vidal P. Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults, 1997-2007. BMC Public Health 2011; 11: 114. (open access)