America is sicker and fatter than ever before.1 Data from the U.S. Centers for Disease Control and Prevention (CDC) show that 42.4% of U.S. adults are obese. This is the first time in our history that the national obesity rate has surpassed 40%.2 This statistic suggests that either you or someone you know is obese and likely living with any combination of aches, pains, bowel and digestive issues, inflammation, or other obesity-related chronic diseases. Childhood obesity rates have also been spiking. Nearly one-fifth of U.S. youth ages 2 to 19 are obese.2 What explains this troubling trend?
The Souring Effects of Sugar
Although scientists and nutritionists have debated the “best” diets for decades, nutritionists, dieticians, and diet “gurus” agree on one thing: excess sugar is damaging to our health. Nearly half of U.S. cardiometabolic deaths (deaths from heart disease and diabetes) each year are due to diet, and sugar is a major culprit.3 Americans consume about three times more added sugar than the maximum amount recommended by nutritional experts in a given day, which totals 57 pounds of added sugar each year, on average.4 Too much sugar can overload our organs, leading to disease and dysfunction.4 Excess sugar consumption causes obesity, diabetes, heart disease, premature aging, irritable bowel syndrome,5,6 and has even been tied to depression.7 Have you ever wondered why something that is so bad for our health is so abundantly available? Our country’s obesity problem is due in large part to the influence of the sugar industry.
The Sugar Industry – A Commercial Determinant of Health and Manufacturer of Illness
Commercial determinants of health (CDoH) are “strategies and approaches used by the private sector to promote products and choices that are detrimental to health”.8 Corporations and associations like soda and candy companies, the Sugar Association, and the American Sugar Refining Group have a unifying goal: to make money from our sugar consumption. Their bottom line depends on us consuming their products so much that we become sick. In short, the sugar industry is a “manufacturer of illness”. Their strategies include advertising sugary products to children, adding sugar to everyday products that we do not think of as sweets (e.g., bread, granola bars, low-fat yogurt, and milk), using the media and health organizations to create campaigns that promote purchasing high-sugar foods, and lobbying policymakers to enact policies that subsidize the sugar industry and promote the consumption of high-sugar foods.8,9 Their strategies are widespread but often invisible to the public.
The Sweet Talk of the Sugar Industry
Let me give you an example of how the sugar industry protects its bottom line at the expense of your health. Have you grown up with the notion that fat and cholesterol are the main dietary causes of heart disease? This idea gained popularity during the 1960s because the sugar industry sweet-talked scientists into misrepresenting their research findings.10 The sugar industry persuaded scientists to downplay the strong correlation between sugar and heart disease and identify saturated fat as the dietary cause of heart disease instead.10 For example, Coca Cola gave millions of dollars to scientists to downplay the role of sugary drinks in the obesity epidemic.11 The sugar industry literally paid off scientists to blame fat, instead of sugar, as the dietary cause of heart disease. The corporate shills of the sugar industry lie to consumers, which negatively affects our diet and perception of healthy and unhealthy foods.
Poisonous Foods Produce Profits
Another twisted strategy the sugar industry uses to make a profit is the creation of hyperpalatable foods. Hyperpalatable foods are food products that “give eaters greater physiological and psychological rewards” than normal foods.9 The food industry intentionally designs foods – in scientific laboratories – with the perfect amount of fat, salt, sugar, and various other artificial flavorings to keep us drooling over and addicted to their products. Hyperpalatable foods are specifically designed to enact a “supernormal stimuli” response in the brain through the release of dopamine. Dopamine is the brain’s pleasure center and reward system and is also responsible for cravings. These man-made, fake, hyperpalatable foods flood our brain with dopamine to keep us constantly craving and addicted to these products.9 Sugar industry scientists create foods with the hope that they will cause overeating and addiction among consumers. Unlike other addictive products, the over-consumption of food is accepted, and even celebrated, by our culture, social norms, and relentless advertising.9
The Cost of Advertising
Aggressive marketing and advertising help the sugar industry ensure widespread consumption of its unhealthy products. Public health experts have long known that food advertising has a major impact on what adults and children eat, which is why the food and beverage industry spends billions of dollars on advertising each year.9 One advertising tactic is to claim these products have nutritional benefits and are healthy. For example, Nestlé falsely claimed that their BOOST Kid Essentials drink “prevents upper respiratory tract infections in children, protects against cold and flu by strengthening the immune system, and reduces absences from daycare or school due to illness”.9 Other major corporations create brands that are associated with happiness and health (e.g., McDonald’s: “I’m Lovin’ It’; Coke: “Open Happiness”) and label food as “natural,” “healthy,” and even “organic”.
Children are a major target of the sugar industry. Food advertisements in schools have increased over the past two decades. This is particularly powerful as children are usually not in a position to scrutinize advertisements and they are even less likely to do so in an environment that has perceived credibility, like school.9 School-based advertisements take place in many forms, from banners and posters plastered around cafeteria walls (e.g., ‘Got Milk?’ campaign) to the distribution of branded educational materials and the purchase of sports and school equipment.9 Viral or buzz marketing is especially effective among children. Video clips, games, and text messages are spread through the consumer on social networks to increase brand awareness and sales. In this way, the company is using the consumer to do its job for them. Viral marketing leaves parents in the dark, is less regulated than traditional advertisement strategies, and enables companies to hide from the criticism of their inaccurate and misleading health claims.9 Even more manipulative, companies use children to market to their parents via “pester power.” Pester power is children’s’ repeated request for certain food products. Companies target children knowing that will catalyze pester power and product sales.
Neuromarketing is another tactic that exploits human behavior and technology at the price of our health. Neuromarketing uses clinical information about the brain to explain and influence what is happening in a consumer’s brain.9 This phenomenon brought about the discovery of “brand communities,” people whose personal identity includes their brand preferences. By exploiting the primal and human need to belong in social groups, advertisers make us feel that we will be less lonely when using their product. While marketing and advertisement have been prevalent for decades, the novel pervasiveness and sophistication of these marketing techniques bring about a powerful ability to manipulate our behavior, social lives, and children.
The U.S. Government Undermines Our Health through Sugar Subsidies & Regulatory Failures
Hyperpalatable foods are high in cheap fats and sugar, so they are more profitable than less-processed, healthy, whole foods. Part of the reason why hyperpalatable foods are so cheap is due to government subsidies of corn, sugar, and soy production.9 The U.S. spends $4 billion annually to subsidize domestic sugar production.12 That’s right, the U.S. government pays farmers to produce corn, sugar, and soy. Subsidizing corn, sugar, and soy makes them cheaper to produce, resulting in an abundance of high-sugar products on the market. The production and overconsumption of the food that is making America sick is facilitated by our very own government.
Why does the government subsidize the sugar industry? It’s simple: Food and beverage companies contribute millions of dollars each election cycle to political action committees (PACs), lobbyists, and campaigns to encourage policymakers to pass laws that make them more money (e.g., subsidies, deregulation of advertising) and prevent laws that would reduce profits (e.g., taxes or bans on sugary foods).13 To bypass federal laws that prohibit corporations to donate directly to political candidates, sugar industry CEOs donate to political action committees that provide funding to political candidates. Corporations also hire lobbyists to advocate for their business and food products to Congress. In 2020, the Democratic and Republican parties received $828,300 and $876,700, from the food and beverage companies, respectively.13 Some of the major corporations that routinely give hundreds of thousands of dollars to political campaigns are McDonalds, Starbucks, Chipotle, Yum brands (KFC, Pizza Hut, Taco Bell), Dunkin’ Donuts, and Restaurant Brands International (Burger King, Popeyes, Tim Hortons), just to name a few.14 These campaign contributions go a long way toward ensuring that U.S. food and consumer policies are friendly to the sugar industry at the expense of American health. The candidates many Americans voted for in the 2020 election received thousands of dollars from these companies, which feeds the unrelenting production and advertisement of harmful foods.
European countries are more conscious of keeping the sugar industry at bay. They have regulations that limit the amount of sugar that can be added to foods, and they have a “banned foods” list comprised of artificial, processed, and unhealthy foods that are illegal to sell due to their negative health effects. The U.S., on the other hand, is not so sugar savvy. Nearly three-quarters of packaged foods sold in U.S. supermarkets include added sugar.4 The guidelines for U.S. food labels are also difficult to read. Although total sugar is listed on food labels, manufacturers are not required to indicate if that total sugar content includes added sugar. This makes it virtually impossible to know how much of the food’s total sugar comes from added sugar and how much is naturally occurring. How can we know our total consumption of added sugar when we don’t know how much added sugar is in the products we are ingesting?
Freedom of Choice?
The sugar industry and its advocates have been crafty in convincing Americans that any type of regulation or taxation represents a danger to individual freedom of choice. Some argue that we should be able to make our own personal dietary decisions and that the government should not interfere in such choices. However, the reality is that the government is already interfering through its billions of dollars in subsidies to U.S. sugar growers every year. Second, sickness and premature death are not freedom. Real freedom would mean knowing what ingredients are in the foods we buy, not being bombarded with advertisements for unhealthy products, and having policymakers who worry about protecting public health more than corporate profits.
Protecting Public Health from the Sugar Industry
In summary, the sugar industry accrues profits while making us sick by adding sugar to as many products as possible, using science to create “hyperpalatable” foods that encourage sugar addiction, aggressively advertising their products to children, and lobbying policymakers to enact policies that subsidize sugar production and promote consumption of high-sugar foods. So, what can be done to combat this major commercial determinant of health?
Margaret Chan, the former Director-General of the World Health Organization, once said “Efforts to prevent non-communicable diseases go against the business interests of powerful economic operators. In my view, this is one of the biggest challenges facing health promotion.”8 While CDoH are powerful forces in our society, there are various ways we can reclaim our right to know what foods we are ingesting and how they affect our health. Here are some suggestions for policy change and personal practices:
• Buy whole foods, keep sugar out of the house, look at ingredients for things like sugar, sugar alcohol, and high fructose corn syrup. Check out these 61 names for sugar.
o Tip #1: If you can’t pronounce an ingredient, it’s most likely artificial or a preservative.
o Tip #2: If you’re going to have sugar, then savor, celebrate, and enjoy it.
o Tip #3: Now that you know where commercial determinants of health are lurking, try to spot them.
• Advocate for improved food labels that are less confusing and easier to read.
• Advocate for a federal limit on added sugar in foods.
• Increase your awareness about the corporate determinants of health. A good place to start is Nicholas Freudenberg’s book: Lethal but Legal: Corporations, Consumption, and Protecting Public Health.
Necessary Policy Changes
The U.S. government should enact strategies to:
• Incentivize businesses and local governments to increase access to healthy foods and safe and accessible public recreation spaces.
• Phase-out corn and sugar subsidies to farmers and instead subsidize the production of healthier foods.
• Limit the amount of sugar that can be added to processed food. Disincentivize unhealthy food purchases by implementing sugar taxes.
• Prohibit advertising and in-store promotion of high-sugar foods. This could include a United Kingdom style restriction of junk food advertising before 9:00 pm and banning the running of junk food ads during children’s shows.
- Agatson, A. (2012). Why America is sicker and fatter than ever. Circulation, 126(1), 3-5.
- The State of Obesity. (2020) Trust for America’s Health. Retrieved from https://www.tfah.org/wp-content/uploads/2020/09/TFAHObesityReport_20.pdf
- Micha, R., Peñalvo, J.L., Cudhea, F., Imamura, F., Rehm, C.D., & Mozaffarian, D. (2017). Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA, 317(9), 912-924.
- Sugar Science: The Unsweetened Truth. 2020. University of California, San Francisco. Retrieved from https://sugarscience.ucsf.edu/
- Nilholm, C., Roth, B., & Ohlsson, B. (2019). A dietary intervention with reduction of starch and sucrose leads to reduced gastrointestinal and extra-intestinal symptoms in IBS patients. Nutrients, 11(7).
- Nguyen, H.P. & Katta, R. (2015). Sugar sag: Glycation and the role of diet in aging skin. Skin Therapy Letter, (20)6. Retrieved from https://www.skintherapyletter.com/aging-skin/glycation/?utm_source=rss&utm_medium=rss&utm_campaign=glycation
- Westover, A.N., & Marangell, L.B. (2002). A cross‐national relationship between sugar consumption and major depression? Anxiety & Depression, 16(3), 18-120.
- Mialon, M. (2020). An overview of the commercial determinants of health. Globalization and Health, 16(74).
- Freudenberg, N. (2016). Lethal but Legal. Oxford University Press: New York, NY.
- O’Connor, A. (2016). How the Sugar Industry Shifted Blame to Fat. New York Times. Retrieved from https://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry-shifted-blame-to-fat.html
- O’Connor, A. (2015). Coca Cola Funds Scientists Who Shift Blame for Obesity Away from Bad Diets. New York Times. Retrieved from https://well.blogs.nytimes.com/2015/08/09/coca-cola-funds-scientists-who-shift-blame-for-obesity-away-from-bad-diets/?mtrref=undefined&assetType=REGIWALL&mtrref=well.blogs.nytimes.com&gwh=75A3E3A645A62696024AFB65B704E867&gwt=regi&assetType=REGIWALL
- Smith, V.H. (2018) The U.S. spends $4 billion a year subsidizing ‘stalinist-style’ domestic sugar production. MarketWatch. Retrieved from https://www.marketwatch.com/story/the-us-spends-4-billion-a-year-subsidizing-stalinist-style-domestic-sugar-production-2018-06-25
- Dixon, V. (2020). Red Chains, Blue Chains: Which politicians are America’s largest fast-food chains donating to? Eater. Retrieved from https://www.eater.com/2020/10/21/21505080/mcdonalds-wendys-political-donations-trump-biden
- Doering, C. (2020). Where they stand: Political donations from 10 of the largest food and beverage makers. FoodDive. Retrieved from https://www.fooddive.com/news/where-they-stand-political-donations-from-10-of-the-largest-food-and-bever/585516/
About the Authors
Mary Kate Schutt is the Program Coordinator for the Lerner Center for Public Health Promotion in the Maxwell School of Citizenship and Public Affairs at Syracuse University and a research assistant in the Syracuse University Mind Body Lab (email@example.com). Shannon Monnat (firstname.lastname@example.org) is the Lerner Chair for Public Health Promotion, Associate Professor of Sociology, and Co-Director of the Policy, Place, and Population Health (P3H) Lab in the Maxwell School at SU.