Recent research linking soft drinks to type 2 diabetes reminds us, once again, that we are what we put in our mouths. This large study from Europe found drinking a 12 ounce (about 355 ml) can of soft drink, or soda, a day was associated with a 20% increase in the risk of developing diabetes. This same effect has previously been observed in populations from the United States, Finland and Singapore.
If this is a real effect, as increasingly looks to be the case, it has massive implications. Half of eight-year-olds in the United States already drink this amount of soda, and teenage males consume more than double that. In conjunction with soft drink consumption among American adults, this represents tens of millions at risk of diabetes in the United States alone. Hundreds of millions more people are affected in other developed and developing countries worldwide.
There’s an obvious reason why soft drink consumption causes diabetes – more sweetened drinks equal more calories, which equals weight gain. Excess weight is the single most important factor in the global diabetes epidemic. While soft drinks may have effects on diabetes independent of obesity, this latest study (again) implicates weight gain as a key factor.
The study’s apparently anomalous finding of an association between diet sodas and diabetes likely reflects “reverse causation” – a phenomenon whereby people switch to diet soft drinks once they start to get the health problems caused by regular ones. So it’s the development of disease that’s causing people to drink diet soft drinks, not the diet soft drinks causing disease.
The real concern is that soft drinks are just the tip of the ice cube when it comes to diet-related ill health.
Like much of the rest of the world, Australians now consume vast amounts of processed foods purchased at major retailers and restaurant chains. Invariably high in salt, sugar or fat, these products have very clear and extremely serious consequences for health.
Where rats and mosquitoes were once the carriers of disease, it’s now the tobacco and alcohol industries and the major food and beverage corporations that are the purveyors of global ill health. Convenience, cost and corporate profits now rule at the expense of physical well-being.
The heart of the problem is that commercial success for these industries is public health disaster. This is a catastrophic failure of the market. As a New York Times investigative reporter and author of Salt Sugar Fat: How the Food Giants Hooked Us so convincingly described on ABC TV’s Lateline, these foods and drinks are designed to achieve the “bliss point” at which consumption is maximised. Solely in pursuit of profit, and regardless of the adverse effects they might cause.
The health problems attributable to unhealthy food and drink are widely recognised. The World Health Organization recently agreed the goal of a 25% reduction in preventable deaths by 2025. Six out of the eight targets defined to deliver this objective are aimed at lifestyle–based problems, and only two cover clinical management issues.
In Australia, the government’s solution to diet-related disease is the Food and Health Dialogue, an initiative that brings the food industry, government and non-governmental organisations together to improve the food supply and reduce diet-related ill health. The initiative relies on the voluntary participation and self-regulation of the food and beverage industries to achieve its goals.
Its priorities are food reformulation on sugar, salt, fat, energy, fibre, wholegrains and fruit and vegetable content, as well as consumer nutrition education and standardisation of portion sizes issues. In the four years since it was established, it has managed to reach targets for salt reduction in a handful of food categories. No substantive action has been reported on any other nutrient, and has been achieved for education or portion size.
Given there is a $100 billion business at the table that perceives itself at risk from the dialogue’s goals, the lack of progress isn’t really surprising. Why would businesses that maximise margins and shareholder value by adding sugar salt and fat to their products seriously engage in any such initiative? The bigger, unanswered question is why government hasn’t acted faster or more effectively when there’s so much at stake.
As a first step, the food and beverage industries must be removed from the policy-setting table. Like tobacco and alcohol, the conflicts are just too great and the public health problems too large. And just as for tobacco, the end game has to be regulation that controls the food and beverage industry – until that happens there will be no decline in diet-related ill health.
Industry will of course argue that it’s all about personal choice and individual responsibility. And that it’s not the role of the state to interfere with what people desire. It will use its massive influence and enormous marketing budget to talk up its success stories and sweep its failures under the carpet.
But sooner or later the problems will get too big to hide, the outrage too great and a significant step forward will have to be taken. We no longer buy industry’s arguments for tobacco and one day we won’t for soft drinks. Let’s just hope it doesn’t take us 50 years, half a million premature deaths, and a hundred billion health-care dollars spent on diabetes before we achieve this.