NEWS

Nutritionists unimpressed by sugar lobby's outcry

Michael Hagmann

Zurich

Threats by the US sugar industry to lobby Congress to cut off the American contribution to WHO have failed to make the organization withdraw a contentious expert report on nutrition and health. The report, entitled Diet, nutrition and the prevention of chronic disease, was formally launched in Rome on 23 April. It concluded that a diet low in saturated fat, sugar and salt and high in fruit and vegetables was required to tackle the epidemic rise in chronic diseases worldwide.

In a series of letters to WHO's Director-General Dr Gro Harlem Brundtland, the sugar lobby attacked the report's recommendation that sugar should represent at most 10% of the daily energy intake. They claimed that the report's conclusions were scientifically flawed and reflect "the expert panel's complete disregard of the preponderance of scientific evidence."

At WHO, however, these reproaches made little impression. "We took into account all the comments we received from various stakeholders [upon publication of a draft version on the Internet]. But we felt no need to reconsider the recommendations," said Dr Pekka Puska, Director of Noncommunicable Diseases and Health Promotion at WHO. "Denouncing a WHO report as unscientific," he adds, "is a standard procedure if big commercial interests are at stake. That's what the tobacco people used to say."

Though the situation is reminiscent of WHO's fight with big tobacco companies, which has been going on for years, Puska is quick to point out that "food is not tobacco. Tobacco is an unnecessary product that kills its consumers, whereas food is necessary for life. So it's a question of changing dietary patterns from unhealthy to healthy. Besides, there is already a lot of collaboration going on between WHO and vast parts of the food industry."

The nutrition and health report, which had been commissioned jointly by WHO and the UN Food and Agriculture Organization (FAO), is the result of a two-year expert consultation. Thirty independent experts from 20 countries analysed "the best currently available scientific evidence on the relationship of diet, nutrition and physical activity to chronic diseases," says Dr Ricardo Uauy from the London School of Hygiene and Tropical Medicine who chaired the expert group. "The strength of the report is that it is a real consensus document. At the end, 30 scientists were happy with every single word in it."

The 100-page report provides the scientific basis on which WHO can build its "global strategy on diet, physical activity and health" in accordance with a World Health Assembly resolution adopted in May 2002. The strategy aims at reducing the growing burden of chronic conditions such as cardiovascular disease, cancer, diabetes and obesity, which have reached epidemic proportions — not only in industrialized countries but in developing ones as well. Chronic diseases were the cause of some 60% of the 56 million deaths reported globally in 2001. "We have known for a long time that foods high in saturated fats, sugars and salt are unhealthy; that we are, globally, increasing our intake of energy-dense nutritionally poor food as our lives become increasingly sedentary," said Dr Brundtland at the launch of the report. The report began the work, she said, of "laying the foundation for a global policy response."

That is probably why the sugar industry's reaction was "unusually strong," as Dr Puska put it. "Our recommendations are nothing new. They are in line with about 25 national expert reports, which all come up with a sugar limit of more or less 10%. What's different this time is that we don't want the report to be just another paper, we want action. And dietary changes are the most cost-effective way to prevent these chronic diseases. Maybe the sugar lobby was afraid WHO is serious this time."

That would explain their heavy-duty lobbying efforts. Besides trying to persuade Dr Brundtland to prevent publication of the report, the Sugar Association, a US trade organization, also wrote to US health secretary Tommy Thompson, asking him to use his influence to get the report withdrawn. "We will use every avenue available to us to expose the dubious nature of the ... report, including asking Congressional appropriators to challenge future funding ... to the WHO," one of the letters says. "Taxpayers' dollars should not be used to support misguided, non-science-based reports."

In support of their claims that the harm sugar does is vastly overstated by the WHO report and that up to a quarter of our energy intake can safely consist of sugar, the Sugar Association cited a report published last year by the prestigious US National Academy's Institute of Medicine (IOM). That report, however, did not spell out a specific sugar limit for achieving a healthy diet, as was made clear in a letter to Secretary Thompson by Harvey Fineberg, President of the IOM. "Interpretations suggesting that a sugar intake of 25% of total calories is endorsed by the Institute's report are incorrect," Dr Fineberg wrote.

Dr Uauy agrees, saying, "the available data simply do not support a 25% limit [for sugar] as a safe recommendation for populations that become more and more sedentary. We felt we should not be more liberal on sugar now that obesity is a much greater challenge than 15 years ago. That's why we decided to go with the 10% figure from the 1990 report; we were using a precautionary approach."

With the report's recommendations in hand WHO is currently consulting its Member States, nongovernmental organizaitons and the private sector about how best to turn the recommendations into a global strategy. In early May WHO officials led by Dr Brundtland, together with Dr Uauy, met with food company representatives in Geneva. According to Dr Uauy, the meeting went "quite well. They have no problem [with our recommendations]. On the contrary, they are mainly interested in producing healthier food."