Very good question. It seems to me that the dietary composition / analysis of the individual foodstuffs is generally overrated compared to the importance of assesing/influencing the total energy intake that is in my opinion constantly being underrated. So my question to your answer will be yes - there is a lot of analysis of bad influence of sugary drinks (which definitely are not beneficial and I am not at all questioning their negative effects), but even they won't make you obese if you don't exceed certain energy amount per day. Still, high levels of sugars in diet may lead to impaired insulin signaling etc., so it may alter intermediate metabolism in a very specific way making the organism more prone to further store more energy. However, such effects can are extremely difficult to analyze in vivo and it is almost impossible to separate them from other influences, such as epigenetic prenatal programming etc. I mean, if you were subjected to high concentration of sugars in utero, you will develop specific metabolic patterns of "handling" energy that will make you e.g. more prone to develop obesity after exposure to high levels of sugars in sugary drinks.... I think we really need huge longitudinal multigenerational studies here....

This is both an excellent and relevant question at this point in time. My resposnse is no we are not focusing on the top shelf eben though I agree that a high number of foods contribute to the obesity epidemic such as cakes, chocolate, white bread and so on. The issue with sugary drinks is that large volumes are consumed and also by children (mostly), young persons as well as adults. Furthermore, we have to remember that it is not only cane or beet sugar that is used in soft drinks but also high-fructose corn syrup (HFCS) because it is very sweet and cheap. In labelling terms corn syrup can be referred to as glucose syrup so many people will not think too much about the ingredients because they will think glucose is alright and safe. So I think this debate is very relevant and the focus is correct. Sugary drinks are bad for health and are playing a significant role in the increase of obesity. There is no nutriton value in adding HFCS or some other sugar and colour to water and call it a soft drink. All carbohdrates end up being broken down to simple sugars and so we do not need these sugary drinks at all.

The specific problem with energy-containing drinks is that calories consumed in fluid form suppress hunger less than the same calories consumed in solid form.

One thing is knowing and practicing proper nutrition and the other thing is resisting to take something that is in our view level from the shelf. Shelfs that are in the eye level are the most expensive and they should be also reserved for foodstuffs that are in the range of proper nutrition and the forbidden for soft drinks, snacks and sweets.

This is a complex question. Obesity is defined as excessive body fat, so as a starting point we should be measuring body composition to see what people are really losing or gaining. BMI tells you nothing about fat, especially when it comes to a given individual.

When you do measure body composition as I do, it soon becomes clear that the type of food you eat has a much greater influence on body composition than calories consumed. Processed food in general appears to be much more obesogenic than whole foods. For example when you place fat in processed food, it seems to contribute to obesity but when you consume it in whole foods not so much.

Of course it is possible to drive obesity by simply consuming large amounts of healthy whole foods but this is relatively uncommon in free-living individuals.

When you want to become “un-obese” you also need to pay attention to the type of food you are eating. If you continue eating processed food and simply under-eat or diet by drastically reducing your caloric intake, you will lose mostly lean body mass and less fat, leaving your body composition abnormal even as your weight normalizes. In this “thin obese” state you will still have insulin resistance and markers of inflammation.

So there’s really no such thing as a “weight “problem. Focus on the fat and stay away from the shelves containing processed food.

Thanks for all the interesting contributions to my question.

I think there is far too much focus on sugar and it's only a very small part of the problem. People tend to consume processed carbohydrates to excess - bread, potatoes, rice, pasta, chapati and to these foods they often add fat. Many of these foods have a high glycaemic index than sugar causing a great surge to blood glucose levels and great demand for insulin.

Simply taking out sugar/ fat/ or name another evil food from any shelf though well intended seems highly impractical to tackle obesity and NCD. Probably these pproaches are outgrowths of bizzare association studies. i love the one on Chocolate consumption and Nobel Prize

GL has evolved as the culprit behind unhealthy BMI and IRS . Agreed there are a few problems with the variance and trnaslation of this concept. But it offers hope to those with insulin resistance, for Asians in particular with increased body fat % at lower BMI (compared to the Westerners). Was it Sweeden that has recently thrown out the lipid hypothesis from their dietary recommendations? Well is fat is no longer the single villian there?

Trudi--I agree with you that once your metabolism goes south, it is the combination of sugar/high glycemic carbohydrates/fat that drives much of the pathology. Yet there is mounting evidence that excessive fructose (mainly from sugar and HFCS) plays a key role early in this pathological process. Excessive fructose is converted to triglycerides in the liver leading to fatty infiltration of the liver. This is the first step in the process of insulin resistance. Once you have insulin resistance, then consuming high glycemic carbohydrates becomes problematic.

There are some cultures that consume a lot of carbohydrates but don't consume much sugar or HFCS. They usually remain metabolically healthy.

Recent studies, especially those by Lustig, have shown that sucrose and fructose have direct harms when consumed as a significant fraction of the total diet, independent of any change in weight. The important message is that everyone should prudently limit their sugar intake, not just obese people.

Not according to the UK Horizon programme broadcast on BBC 2 tonight at 9pm. After talking to eminent researchers and doing an experiment on twins, the conclusion was that weight gain is caused by eating foods that contain a combination of fat and sugar. I do agree that we cannot point the blame finger at sugar or fat. It is multi-factorial including sedentary lifestyles. If you can watch the programme on BBC iplayer, I really recommend it.

I saw it Trudi, but would be interested to see the peer reviewed papers arising from the work. Do you know if he's published anything yet. It was certainly very interesting.

Trudi, the findings you report are using a single outcome variable: body weight. Body weight is not a surrogate for all measures of health and risk. Body weight correlates with risk factors which in turn correlate with disease risk. But ignoring disease indicators and focusing solely on body weight is not good science.

Hi Paul, the detail is a little hazy now as it was a couple of weeks ago. However, they did analyse blood glucose levels and insulin resistance. The conclusion was that the high fat diet increased levels of insulin resistance and resulted in the pre-diabetes state whereas the high carb diet didn't. The weight loss in the high fat diet also resulted in loss of lean body mass, reducing metabolic rate. As Mary states, it would be interesting to read published papers.

In the clinical world it seems pretty clear that processed food is driving the bus when it comes to metabolic problems and obesity. Typical processed food contains refined sugars, high glycemic carbohydrates (typically grains) and omega 6 fatty acids. For various reasons this combination seems to drive metabolic problems and brain dysfunction. As Rob Lustig believes, in this setting excessive sucrose does contribute greatly to the problem, especially when in comes in sweetened beverages. My medical school classmate Rick Johnson has also shown that excessive fructose drives fat storage in his book “The Fat Switch”.

When you consume moderate amounts of sucrose with a whole foods diet, then there isn’t much of a problem. My wife is Greek and we spend a lot of time in Greece. Sucrose and honey have been a part of the Mediterranean diet for a eons and it didn’t cause problems until Greeks started to eat a lot of processed food. Their grocery stores now look like our grocery stores—very sad indeed.

When you consume fat from whole foods without the other two components, insulin resistance and brain function tend to improve. This is supported by the literature on ketogenic diets. Ketone bodies tend to be neuroprotective. That’s why they are so effective for seizures and other brain disorders. Tom Seyfried from Boston University is even using this type of diet to treat brain tumors!

Nutritional research is definitely a challenge. In a way I feel sorry for my youngest son who just got his PhD in nutritional science. I am very proud of his accomplishment but I know he has entered a field full of landmines. My friend Gary Taubes just sent me a link to his new article outlining the problems with nutritional research:

http://www.nytimes.com/2014/02/09/opinion/sunday/why-nutrition-is-so-confusing.html?emc=eta1&_r=0

That’s why we need to turn to evolutionary biology, empirical science and just plain common sense when it comes to diet. As grandma used to say, you are what you eat! Our experiment to deconstruct food and put it back together along with a long list of unpronounceable chemicals has been an abject failure. The moon shot of the food industry was the Twinkie and it crashed and burned.

Trudi--You are absolutely right. A high carb diet is quite healthy when it comes from whole foods. Steven Guyenet outlines this pretty well in this post:

http://wholehealthsource.blogspot.com/2008/08/kitavans-wisdom-from-pacific-islands.html

He also has a lot to say about a high fat diet:

http://wholehealthsource.blogspot.com/2008/07/inuit-lessons-from-arctic.html

That's what I like about Steven--he thinks outside the box. Now that I think about it, sometimes I can't even find the box!

It is true that people have been consuming sugary drinks for centuries and obesity is a relatively recent phenomena. A main problem is portion control. We live in a society that emphasizes more value, more, more, more. The size of dinner plates have increased dramatically from the 1950's to now. Eating real food has declined and the consumption of processed foods increased. Processed foods together with enormous portion sizes had lead to the obesity intervention. Sugar is a small part. It is eating patterns that need to change.

Joan--I agree with you concerning portion size and processed food but not about sugar. The amount of added sugars consumed today is massive compared to the past. This load of excessive fructose is driving NAFLD, insulin resistance, diabetes and central obesity.

My wife is Greek and we have a home in Greece. The Greeks have consumed some sugar and honey for thousands of years without getting into trouble. Now many Greeks mirror our eating habits--tons of processed food and added sugars. Guess what--their health problems now mirror our health problems. Our diet is truly our Weapon of Mass Destruction.

Hello Mary Rose, you are correct of course that all foodstuffs ought be considered when one tackles the obesity problem. But consider a list of those contributory factors in which those with the "highest profile" in terms of potential intervention are at the top of the list, and the more difficult ones lower down. Sugary drinks certainly would seem to be among the most amenable to intervention. Think of tobacco use - certainly not the only factor implicated in the etiology of some diseases, but likely one of the biggest contributors and politically and socially, amenable to intervention. So like tobacco consumption, sugary drinks get a lot of focus by media, government, etc. It's up to us to raise awareness of other contributing risk factors for obesity.

Hi Mary, I have not seen the debate but would be very interested. I am from the UK and doing currently research on the subject " sugar and obesity" and the more I read, the less I am convinced ( BTW on a personal note, I hate soda drinks and am not fond of sweet items, in fact I cook a lot at home because I found too many food items too sweet, so I was actually looking for a link..cant help it, we are all biased, even if we dont like to acknowledge it). While all forms of excessive sugar intake contribute to obesity, they are not the culprit just for being sugar. Sugar intake contributes to the metabolic syndrome, but since the majority of overweight and obese individuals dont have MS, it is not sugar as such which drives towards obesity.

There is a lot of interesting research going on the lack of satiety, while intaking sugary drinks. So basically your brain is unable to tell you that you have enough, just from the calorie intake through sodas, but this is a question of taking more calories than required without feedback. There is also a lot of interesting research on maternal sugar consumption and childhood obesity, combined with extra calorie intake, without satiety feedback in form of sugared drinks.

Look beyond Western style diet, especially UK diet full of processed food (and full of glucose). Dont get too hyped up about US research which focuses on fructose. Fructose is an American obsession, and they fail to realize that HFCS 42 has actually less fructose than sucrose. Look into emerging countries, see their food pattern. Dont discard life style, long working hours, lack of sleep, and lack of calorie burning, because you now heat a meal instead of shopping, chopping, cooking, cleaning up. Look into environmental impacts of big cities (e.g. pollution) which result in an assault to the system and keeps low burning inflammation up.

Obesity is more than bad choices in food intake, and it is more than just sugared drinks.