In America and throughout the world, the issue of obesity continues to move to the forefront of the public conscience. Despite major strides in obesity research, like the discovery of the immense evils of trans-fats, and their subsequent ban in 2018, obesity rates continue to rise. As a result, attention in the scientific community has shifted towards another macronutrient: sugar. In one study, researchers sponsored by the European Union and Greek government analyzed data collected from the 2013-2015 Hellenic National Nutrition and Health Survey (HNNHS) and found that Greek children and adolescents whose diets included higher amounts of added sugar were more likely to be overweight and obese than their counterparts who consumed amounts of sugar closer to the recommended amounts (Magriplis et al. 2021). If studies like this can continue to determine key causes of the obesity epidemic, the future of public health may not be so grim.
The obesity epidemic is arguably the biggest public health problem facing Americans today. According to the CDC, as of March 2020, 41.9% of Americans are obese, and conditions resulting from obesity such as heart disease, diabetes, and stroke are among the leading causes of death for Americans (National 2020). The CDC further notes that the annual medical cost of obesity was just short of $173 billion in 2019 (Ward et al. 2021). While researchers in nutritional epidemiology have been researching sugar’s effects on obesity for decades, sugar’s impact on the obesity epidemic remain controversial.
Though some studies are wary to link sugar and obesity so directly, some studies point towards a clear relationship between added sugars and obesity. For example, one 2019 study argues that an increase in added sugar consumption in the 1980s and 1990s closely matches a rapid increase in obesity prevalence, and that a relative decrease in added sugar consumption in the 2000s matched a flattening of the obesity curve in the same timer period (Faruque et al. 2019). Another study claimed the opposite; that too much blame is placed on added sugars in the obesity epidemic (Kahn and Sievenpiper 2014), and that added sugar’s impact on the obesity epidemic is inconsequential. This study, however, has multiple conflicts of interest, such as funding from Coca-Cola and a marital relationship with a Unilever employee. At the end of the day, most studies seem to conclude that high consumption of added sugars has a negative impact on health and contributes towards obesity.
One prime example is a study entitled “Dietary Sugar Intake and Its Association with Obesity in Children in Adolescents”, which was published in 2021 to the journal Children. The study was conducted by ten scientists associated with various Greek and Cypriot universities, who were led by the study’s chief author. Emmanula Magriplis of the Agricultural University of Athens. The study was co-funded by both the European Union’s European Social Fund and the Greek Ministry of Health. The researchers were motivated to conduct this study due to of the lack of conclusive results in previous studies, especially in the question of how the consumption of added sugars, sugar sweetened beverages (SSBs), and total sugars impact childhood obesity rates, especially when controlled for dietary patterns and macronutrients. The data in this study came from the HNNHS, a stratified observational study that had a representative sample of participants report their eating habits during two twenty-four-hour periods over the span of eight to twenty days. This study used the portion of the HNNHS for children and adolescents, or individuals aged 2-18 years old. The survey primarily used the Nutrition Data System for Research, as developed by the University of Minnesota, as a reference for the nutritional value of foods, recording all macronutrients and relevant micronutrients in participant’s diets. The survey also specifically recorded the total sugar, added sugar, and mono and disaccharides found in the participants’ diets. Additionally, they separated foods into food groups, including the separation of SSBs from solid sugars. Outside of diet, the survey measured height, weight, activity level, screen time, and parental educational level. Statistical analysis was conducted using the STATA 12.0 software package. The researchers hypothesized that individuals who consume more added sugars will have higher rates of overweight and obesity than those who consume less (Magriplis et al. 2021).
The results of the researchers’ analysis supported their hypothesis. The researchers found that depending on whether they controlled for food group consumption or macronutrient consumption, children and adolescents who consumed greater than ten percent of their daily calories via added sugars were between 1.77 and 2.57 times more likely to be overweight or obese than children and adolescents who consumed less than ten percent of their daily calories from added sugars (Magriplis et al. 2021). While these results are specific to Greek children and adolescents, a demographic of individuals whose culture consumes considerably less added sugar than do Americans, the message of the study’s results remains the same: a high rate of added sugar consumption is likely a risk factor for overweight and obesity (Magriplis et al. 2021).
This study is not without its flaws, however. Primarily, the study admits that its data is dependent on people accurately reporting their eating habits, and that under- and over-reporters may have had a statistical influence on their results. It is also mentioned how the study’s cross-sectional nature forced it to use probability analysis to predict outcomes rather than being able to analyze the concrete, case-by-case outcomes longitudinal studies provide (Magriplis et al. 2021).
Although it is a weakness for this cross-sectional study, the comparative strength of a longitudinal study highlights potential next steps for the field of nutritional epidemiology. It is further true that while this article does a lot to demonstrate the correlation between the consumption of added sugars and rates of overweight and obesity, we cannot establish causation with a cross-sectional study. Instead, this study will hopefully inspire the creation of a new long-term longitudinal study that will more closely and accurately record the diets and outcomes of a large sample people with the goal of determining the most direct causes of obesity. Like any good study, this study answered one question, but asked many others. While this source and others indicate that high levels of added sugar consumption is a risk factor for overweight and obesity, the magnitude and direct causality of this relationship remains unknown. Moreover, both this study and nutritional epidemiology’s recent focus on sugar remain just small portions of the bigger obesity epidemic, and further research is needed to truly understand the issue. While we still do not know everything there is to know about how bad added sugars are for one’s risk for obesity, we can still say with certainty that it is a good idea to trade your Cheerwine for a glass of water, and to swap a cookie for some cantaloupe.
References
Faruque S, Tong J, Lacmanovic V, Agbonghae C, Minaya DM, Czaja K. 2019. The Dose Makes the Poison: Sugar and Obesity in the United States – a Review. Polish journal of food and nutrition sciences. 69(3):219–233. doi:10.31883/pjfns/110735. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959843/.
Kahn R., Sievenpiper J.L.. 2014. Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes? We have, but the pox on sugar is overwrought and overworked. Diabetes Care. 37: 957–962. Diabetes Care. 2014;37:e189. doi: 10.2337/dc14-1133. https://diabetesjournals.org/care/article/37/4/957/32309/Dietary-Sugar-and-Body-Weight-Have-We-Reached-a.
Magriplis E, Michas G, Petridi E, Chrousos GP, Roma E, Benetou V, Cholopoulos N, Micha R, Panagiotakos D, Zampelas A. 2021. Dietary sugar intake and its Association with obesity in children and adolescents. Children. 8(8):676. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391470/#B21-children-08-00676.
National Center for Health Statistics. 2020. NHANES 2017-2020 pre-pandemic. CDC. https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?cycle=2017-2020.
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Ward ZJ, Bleich SN, Long MW, Gortmaker SL. 2021. Association of body mass index with health care expenditures in the United States by age and sex. Siegel R, editor. PLOS ONE. 16(3):e0247307. doi:10.1371/journal.pone.0247307. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247307.
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