Is sugar as dangerous as alcohol and tobacco?
One group of researchers from the University of California, San Francisco, says so. And they are urging a tax on sugary treats and some action by the government to get Americans to cut back on sugar.
In an editorial published today in the journal Nature, the UCSF doctors, Robert Lustig, Laura Schmidt and Claire Brindis, said the ballooning rates - and costs - of obesity, diabetes and other diseases, mean it's time for regulators to lump sugar into the same category as booze and cigarettes and put similar restrictions on its sale and availability.
Increased control is necessary, they say, because efforts to keep excessive sugar out of the American diet have failed. "So far, evidence shows that individually focused approaches, such as school-based interventions that teach children about diet and exercise, demonstrate little efficacy."
The authors say the government should consider taxing any processed foods that have added sugar, including soda, juice, chocolate milk and sugared cereal.
Other efforts should aim to make sugary foods and drinks hard to get, like imposing age limits for buying soda and controlling when and where sugary foods are sold. They also envision something like a sugar-free zone around schools.
The bans shouldn't be on consumers only, the authors argue. The U.S. Food and Drug Administration should consider removing sugar from its Generally Regarded as Safe list, a designation that allows companies to add as much of an ingredient or nutrient as they want to processed foods.
The authors point to the success of similar "supply-side" restrictions on alcohol and tobacco in preventing some of the health harms from those substances.
Wider control of sugar is already being considered by a number of policymakers across the country. U.S. health and government officials have been debating a penny-per-ounce tax on soda. Other attempts to limit the inclusion of soda and sugary foods from federal food stamp programs or control the availability of soda and chocolate milk in schools have caused uproar across the country.
But support for those measures - even from the health community - have been mixed. In 2011, the American Medical Association declined to give support to a national sugar-sweetened beverage tax, saying it needed more information on the topic before weighing in.
Some nutrition experts note that sugar is not the only culprit in the skyrocketing rates of obesity, diabetes and other diseases that consume billions of dollars health care costs each year.
"Sugar does not cause obesity and diabetes. Excess causes those, and it doesn't matter where the excess comes from," said Keith Ayoob, associate professor of pediatrics at the Albert Einstein College of Medicine in Bronx, N.Y. "There is no evidence that these diseases are caused by a particular food or nutrient."
Others note that the sources of these chronic diseases are more complex than just the foods we eat.
"What about lack of physical activity? Should there be an increased tax on chairs or cars? Both of these decrease physical activity which we also know is associated with increased body weight and chronic disease as well," said Lona Sandon, spokeswoman for the American Dietetic Association. "What about TVs, computers, iPads? Increased screen time is also associated with obesity and the resulting chronic health problems."
Experts agree that the current approaches to addressing chronic diseases aren't working very well. But they say the solutions will need to go beyond regulating one aspect of the food supply.
"Regulating nutrients is a slippery slope," said Dr. David Katz, co-founder of the Yale Prevention Center. "The focus should be on the overall nutritional quality of foods, not just one nutrient."