guardian.co.uk, Jacques Peretti, Monday 11 June 2012
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| Who is responsible for making us fat? Photograph: Pat Doyle/Corbis |
Up a
rickety staircase at the Newarke Houses Museum in Leicester, England hangs a
portrait of Britain's first obese man, painted in 1806. Daniel Lambert weighed
53st (335kg) and was considered a medical oddity. Too heavy to work, Lambert
came up with an ingenious idea: he would charge people a shilling to see him.
Lambert made a fortune, and his portrait shows him at the end of his life:
affluent and respected – a celebrated son of Leicester.
Two hundred
years on, I'm in a bariatric ambulance (an alternative term for obese, favoured
by the medical world because it's less shaming to patients) investigating why
the UK is in the midst of an obesity crisis. The crew pick up a dozen Daniel
Lamberts every week. Fifty-three stone is nothing special, it's at the lower
end of the weight spectrum, with only the 80st patients worthy of mention when
a shift finishes. The specially designed ambulance carries an array of
bariatric gizmos including a "spatula" to help with people who have
fallen out of bed or, on a recent occasion, an obese man jammed between the two
walls in his hallway. As well as the ambulance, there's a convoy of support
vehicles including a winch to lift patients onto a reinforced stretcher. In
extreme cases, the cost of removing a patient to hospital can be up to
£100,000, as seen in the recent case of 63st teenager Georgia Davis.
But these
people are not where the heartland of the obesity crisis lies. On average, in
the UK, we are all – every man, woman and child – three stone heavier than we were in the mid-60s. We haven't noticed it happening, but this glacial shift
has been mapped by bigger car seats, swimming cubicles, XL trousers dropped to
L (L dropped to M). An elasticated nation with an ever-expanding sense of
normality.
Why are we
so fat? We have not become greedier as a race. We are not, contrary to popular
wisdom, less active – a 12-year study, which began in 2000 at Plymouth hospital, measured children's physical activity and found it the same as 50
years ago. But something has changed: and that something is very simple. It's
the food we eat. More specifically, the sheer amount of sugar in that food,
sugar we're often unaware of.
The story
begins in 1971. Richard Nixon was facing re-election. The Vietnam war was
threatening his popularity at home, but just as big an issue with voters was
the soaring cost of food. If Nixon was to survive, he needed food prices to go
down, and that required getting a very powerful lobby on board – the farmers.
Nixon appointed Earl Butz, an academic from the farming heartland of Indiana,
to broker a compromise. Butz, an agriculture expert, had a radical plan that
would transform the food we eat, and in doing so, the shape of the human race.
Butz pushed
farmers into a new, industrial scale of production, and into farming one crop
in particular: corn. US cattle were fattened by the immense increases in corn
production. Burgers became bigger. Fries, fried in corn oil, became fattier.
Corn became the engine for the massive surge in the quantities of cheaper food being
supplied to American supermarkets: everything from cereals, to biscuits and
flour found new uses for corn. As a result of Butz's free-market reforms,
American farmers, almost overnight, went from parochial small-holders to
multimillionaire businessmen with a global market. One Indiana farmer believes
that America could have won the cold war by simply starving the Russians of
corn. But instead they chose to make money.
By the
mid-70s, there was a surplus of corn. Butz flew to Japan to look into a scientific
innovation that would change everything: the mass development of high fructose corn syrup (HFCS), or glucose-fructose syrup as it's often referred to in the
UK, a highly sweet, gloppy syrup, produced from surplus corn, that was also
incredibly cheap. HFCS had been discovered in the 50s, but it was only in the
70s that a process had been found to harness it for mass production. HFCS was
soon pumped into every conceivable food: pizzas, coleslaw, meat. It provided
that "just baked" sheen on bread and cakes, made everything sweeter,
and extended shelf life from days to years. A silent revolution of the amount
of sugar that was going into our bodies was taking place. In Britain, the food
on our plates became pure science – each processed milligram tweaked and
sweetened for maximum palatability. And the general public were clueless that
these changes were taking place.
There was
one product in particular that it had a dramatic effect on – soft drinks. Hank
Cardello, the former head of marketing at Coca-Cola, tells me that in 1984,
Coke in the US swapped from sugar to HFCS (In the UK, it continued to use
sugar). As a market leader, Coke's decision sent a message of endorsement to
the rest of the industry, which quickly followed suit. There was "no
downside" to HFCS, Cardello says. It was two-thirds the price of sugar,
and even the risk of messing with the taste was a risk worth taking when you
looked at the margin, especially as there were no apparent health risks. At
that time, "obesity wasn't even on the radar" says Cardello.
But another
health issue was on the radar: heart disease, and in the mid-70s, a fierce
debate was raging behind the closed doors of academia over what was causing it.
An American nutritionist called Ancel Keys blamed fat, while a British researcher
at the University of London Professor John Yudkin, blamed sugar. But Yudkin's
work was rubbished by what many believe, including Professor Robert Lustig, one
of the world's leading endocrinologists, was a concerted campaign to discredit
Yudkin. Much of the criticism came from fellow academics, whose research was
aligning far more closely with the direction the food industry was intending to
take. Yudkin's colleague at the time, Dr Richard Bruckdorfer at UCL says:
"There was a huge lobby from [the food] industry, particularly from the
sugar industry, and Yudkin complained bitterly that they were subverting some
of his ideas." Yudkin was, Lustig says simply, "thrown under the
bus", because there was a huge financial gain to be made by fingering fat,
not sugar, as the culprit of heart disease.
The food
industry had its eyes on the creation of a new genre of food, something they
knew the public would embrace with huge enthusiasm, believing it to be better
for their health – "low fat". It promised an immense business
opportunity forged from the potential disaster of heart disease. But, says
Lustig, there was a problem. "When you take the fat out of a recipe, food
tastes like cardboard, and you need to replace it with something – that
something being sugar."
Overnight,
new products arrived on the shelves that seemed too good to be true. Low-fat
yoghurts, spreads, even desserts and biscuits. All with the fat taken out, and
replaced with sugar. Britain was one of the most enthusiastic adopters of what
food writer Gary Taubes, author of Why We Get Fat, calls "the low-fat
dogma", with sales rocketing.
By the
mid-80s, health experts such as Professor Philip James, a world-renowned
British scientist who was one of the first to identify obesity as an issue, were
noticing that people were getting fatter and no one could explain why. The food
industry was keen to point out that individuals must be responsible for their
own calorie consumption, but even those who exercised and ate low-fat products
were gaining weight. In 1966 the proportion of people with a BMI of over 30
(classified as obese) was just 1.2% for men and 1.8% for women. By 1989 the
figures had risen to 10.6% for men and 14.0% for women. And no one was joining
the dots between HFCS and fat.
Moreover, there
was something else going on. The more sugar we ate, the more we wanted, and the
hungrier we became. At New York University, Professor Anthony Sclafani, a
nutritionist studying appetite and weight gain, noticed something strange about
his lab rats. When they ate rat food, they put on weight normally. But when
they ate processed food from a supermarket, they ballooned in a matter of days.
Their appetite for sugary foods was insatiable: they just carried on eating.
According
to Professor Jean-Marc Schwarz of San Francisco hospital, who is currently
studying the precise way in which the major organs of the body metabolise
sugar, this momentum creates "a tsunami" of sugar. The effect this
has on different organs in the body is only now being understood by scientists.
Around the liver, it coalesces as fat, leading to diseases such as type-2
diabetes. Other studies have found that sugar may even coat semen and result in
obese men becoming less fertile. One researcher told me that, ultimately,
perhaps nothing needs to be done about obesity, as obese people will wipe
themselves out.
The organ
of most interest, however, is the gut. According to Schwarz and Sclafani, the
gut is a highly complex nervous system. It is the body's "second
brain", and this second brain becomes conditioned to wanting more sugar,
sending messages back to the brain that are impossible to fight.
The Sugar Association is keen to point out that sugar intake alone "is not linked to
any lifestyle disease". But evidence to the contrary appears to be
emerging. In February, Lustig, Laura Schmidt and Claire Brindis of the University of California wrote an opinion article for the journal Nature citing
the growing body of scientific evidence showing that fructose can trigger
processes that lead to liver toxicity and a host of other chronic diseases, and
in March, the New York Times reported a study that had been published in the journal Circulation, which found that men who drank sweetened beverages most
often were 20% more likely to have had a heart attack than those who drank the
least. David Kessler, the former head of the US government's most powerful food
agency, the FDA, and the person responsible for introducing warnings on
cigarette packets in the early 90s, believes that sugar, through its
metabolisation by the gut and hence the brain, is extremely addictive, just
like cigarettes or alcohol. He believes that sugar is hedonic – eating it is
"highly pleasurable. It gives you this momentary bliss. When you're eating
food that is highly hedonic, it sort of takes over your brain."
In London,
Dr Tony Goldstone is mapping out the specific parts of the brain that are
stimulated by this process. According to Goldstone, one of the by-products of
obesity is that a hormone called leptin ceases to work properly. Normally,
leptin is produced by the body to tell you that you are full. However, in obese
people, it becomes severely depleted, and it is thought that a high intake of
sugar is a key reason. When the leptin doesn't work, your body simply doesn't
realise you should stop eating.
Leptin
raises a big question: did the food industry knowingly create foods that were
addictive, that would make you feel as though you were never satisfied and
always wanted more? Kessler is cautious in his response: "Did they
understand the neuroscience? No. But they learned experientially what
worked." This is highly controversial. If it could be proved that at that
some point the food industry became aware of the long-term, detrimental effects
their products were having on the public, and continued to develop and sell
them, the scandal would rival that of what happened to the tobacco industry.
The food
industry's defence has always been that the science doesn't prove its
culpability. Susan Neely, president of the American Beverage Association, a
lobby group for the soft-drinks industry, says: "there's a lot of work to
try to establish causality, and I don't know that I've seen any study that does
that." But it looks as though things might be changing. According to
Professor Kelly Brownell at Yale University, one of the world's foremost
experts on obesity and its causes, the science will soon be irrefutable and we
may then be just a few years away from the first successful lawsuit.
The relationship
between the food industry and the scientists conducting research into obesity
is also complicated by the issue of funding. There is not a great deal of money
set aside for this work and so the food industry has become a vital source of
income. But this means that the very same science going into combating obesity
could also be used to hone the products that are making us obese. Many of the
scientists I spoke to are wary about going on the record because they fear
their funding will be taken away if they speak out.
The
relationship between government and the food industry is also far from
straightforward. Health secretary Andrew Lansley worked, until 2009, as a
non-executive director of Profero, a marketing agency whose clients have
included Pizza Hut, Mars and PepsiCo. In opposition, Lansley asked public
health expert Professor Simon Capewell to contribute to future policy on
obesity. Capewell was amazed at the degree to which the food industry was also
being consulted: the equivalent, he says, "of putting Dracula in charge of
the blood bank". Lansley has made no secret of his work for Profero, and
denies a conflict of interest, saying that he did not work directly with the
company's clients. And the government argues, not unreasonably, that it's essential
to have the industry on board to get anything done. But the relationships are
not always kept at arms length. Professor James was part of a WHO committee to
recommend global limits on sugar in 1990. As the report was being drafted,
something extraordinary happened: the US secretary of state for health Tommy Thompson flew to Geneva to lobby on behalf of the sugar industry. "Those
recommendations were never made," says James.
In New
York, Mayor Bloomberg is currently planning to reduce soft drink super-sizing
while last week, a former executive at Coca-Cola Todd Putman spoke publicly
about the need for soft drink companies to move their focus to "healthy
products". But it's not going to be easy to bring about change. A previous
attempt to bring in a soda tax was stopped by intense lobbying on Capitol Hill.
The soft-drinks industry paid for a new ward at Philadelphia Children's
Hospital, and the tax went away. It was a children's obesity ward.
Why has
Kessler, when he has had such success with his warnings on cigarette packets,
not done the same thing for processed foods high in sugar? Because, he tells
me, when the warnings came in on cigarettes, the game was already up in the
west for the tobacco industry. Their new markets were the far east, India and
China. It was no concession at all. The food industry is a different matter.
For one thing, the food lobby is more powerful than the tobacco lobby. The
industry is tied into a complex matrix of other interests: drugs, chemicals,
even dieting products. The panoply of satellite industries that make money from
obesity means the food industry's relationship to obesity is an incredibly
complex one.
Anne Milton, the minister for public health, tells me that legislation against the
food industry isn't being ruled out, because of the escalating costs to the
NHS. Previous governments have always taken the route of partnership. Why?
Because the food industry provides hundreds of thousands of jobs and billions
in revenue. It is immensely powerful, and any politician who takes it on does
so at their peril. "Let's get one thing straight," Milton tells me,
however. "I am not scared of the food industry."
And I
believe her, because now, there is something far bigger to be frightened of.
Eventually, the point will be reached when the cost to the NHS of obesity,
which is now £5bn a year, outweighs the revenue from the UK snacks and
confectionery market, which is currently approximately £8bn a year. Then
the solution to obesity will become very simple.
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| New York Mayor Michael Bloomberg with Linda Gibbs, the deputy mayor for health, with sodas and the corresponding amount of sugar they contain at City Hall in New York, on May 30, 2012. Photographer: Chang W. Lee/ The New York Times via Redux |
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