Category Archives: nutrition

McKinsey: How big food actually thinks…

 

 

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Source: http://www.mckinsey.com/insights/consumer_and_retail/tough_choices_for_consumer_goods_companies

Tough choices for consumer-goods companies

Increasingly empowered consumers, rising yet volatile input prices, and tricky emerging markets mean global consumer-packaged-goods companies must rethink how they do business. Here’s a guide.

December 2013 | byJim Brennan, Greg Kelly, and Anne Martinez

Over the past half century, the consumer-packaged-goods (CPG) industry has achieved enviable growth in both revenue and shareholder returns. At first blush, continued growth seems a sure thing—after all, the burgeoning economies of emerging-market countries are fueling an unparalleled boom in global consumption. And given that global CPG companies are selling more of their products to more people in more parts of the world, shouldn’t revenue growth—and, with it, healthy returns—be theirs for the taking?

If only success were that simple. A look back at recent decades of developed-market based CPG companies shows that they have consistently managed to grow, but not always profitably. And today, a series of large-scale trends is causing industry upheaval, forcing companies in mature markets to make tough choices about where to play and how to win. Investment in emerging markets isn’t foolproof: growth, although strong, is uneven, with certain markets and categories far outpacing others. Severe resource constraints are causing volatility in commodity costs. Digital technologies are affecting every part of the value chain, and in sometimes unpredictable ways. New—and newly acquisitive—competitors are emerging. And regulatory risk is rampant as government exerts ever-greater influence over the industry.

Given how fundamentally these trends will transform the industry over the next decade, we believe the strategic choices that CPG manufacturers make in the next few years will be more consequential than those they’ve made in the recent past. Every company will respond to the trends differently. Some companies may choose to keep their focus on core franchises with the hope of delivering stable, even if not stellar, earnings; others may opt for more assertive but riskier moves. In this article, we discuss each of the aforementioned trends, the kinds of choices they will require companies to make, and the actions every company should take regardless of its specific strategic choices.

Changes and choices

In recent decades, CPG companies have posted better returns than other sectors. Between 1967 and 2012, the industry’s 7 percent annual growth in total return to shareholders (TRS) outpaced the S&P 500’s 6 percent. But it hasn’t been a smooth and steady road. In our analysis of the CPG industry since 1967, we see four distinct eras, with one in particular—the period from 1985 to 2000—accounting for the bulk of value creation (Exhibit 1). The years 1967 to 1985 marked a golden age of growth, a time when sales of food, beverages, and household and personal products soared. Americans doubled their consumption of soda (from an average of one serving a day to two), for example, and cheese (from half an ounce a day to a full ounce). However, revenue growth came at the expense of margins, which declined by almost 300 basis points.

Exhibit 1

In recent decades, the consumer-packaged-goods industry has seen four distinct value-creation cycles.

Margins shot up—largely thanks to declining input prices—during what we call the era of expansion (1985–2000), allowing CPG companies to finance forays into new global markets. A wave of mergers and acquisitions followed in the years 2000 to 2007, but the success of these deals was mixed; revenue increased but TRS growth dipped. Then, during the Great Recession and the subsequent recovery, the industry grappled with a tough economy and persistently high commodity costs, limiting both revenue growth and value creation.

How CPG companies fare in the current era remains to be seen: will they sacrifice margins for revenue, as they did during the golden age of growth? Will they be able to grow profitably, as they did between 1985 and 2007? But what’s already evident is that the industry is on the cusp of sweeping change, presenting companies with a range of strategic choices. We believe the five most influential changes, and their implications for CPG companies, are as follows.

Granular growth, globally

By 2025, a staggering 4.2 billion people will be part of the consuming class. For the first time ever, the number of people with discretionary income will exceed the number still struggling to meet basic needs—a phenomenon that may well be the biggest opportunity in the history of capitalism.1 Another golden age of growth could be in the making. Consumption growth, however, isn’t even; it’s happening much faster in certain categories and markets. Some emerging-market cities have higher growth potential than entire countries. In Shanghai, for instance, the skin-care category will grow three times as fast in absolute terms as in all of Malaysia, based on 2010–20 compound annual growth rate (CAGR).

This uneven growth presents tremendous potential for companies—whether they are multinationals or local players—to quickly become industry shapers, if they choose to play in the fastest-growing subcategories in the fastest-growing markets. For example, The Coca-Cola Company, recognizing Chinese consumers’ preference for pulpier juices, launched Minute Maid Pulpy—which became the company’s first billion-dollar brand developed for and in an emerging market. Local companies, too, are making winning choices: our research shows that in the fastest-growing CPG categories in China, Brazil, and Mexico, eight of the top fifty companies are headquartered in emerging markets. These local entities—companies like Mexico’s Grupo Bimbo—are venturing outside their home markets and skillfully leveraging their emerging-market know-how, favorable cost positions, and proximity to a rapidly expanding customer base. As a result, their sales growth in emerging markets (19 percent CAGR in the 2009–12 period) far exceeds that of US-based CPG companies (5 percent).

Emerging-market companies’ budding success on the global stage introduces a new element to strategic planning. We believe CPG companies should take a more data-driven approach to understanding how competitors will grow in each market, and how their own strategic positions will change as a result. They will then be able to predict critical inflection points for particular products in particular cities and regions. McKinsey research has found that consumption growth in each product category follows its own distinct variant of the classic S-curve pattern. Companies that invest just as a category enters the “hot zone” will likely generate the most value. Better insights into competitor evolution, and how it will affect the microeconomics of product categories in each country and globally, will become increasingly important.

Not all growth is coming from emerging markets; companies must identify and invest in pockets of growth in developed markets as well, particularly as growth in emerging markets slows. In the United States, for example, the spending power of certain demographic groups, such as baby boomers and Hispanics, is significant and growing. The “value” segment, which flourished during the recession, continues to appeal to a broad swath of consumers. These and other “niche” opportunities in developed markets can hold as much growth potential as entire countries. Colgate-Palmolive, for one, has launched products targeting Hispanics; P&G has introduced new products and brands to compete in lower price tiers.

No matter what investment decisions a company makes, one key to success will be its ability to allocate resources quickly to the businesses that will yield the highest returns.2 In our experience, companies often underestimate both how big a shift they need to make and how big a shift emerging-market players are already making. The growth of Anheuser-Busch InBev—from a national beer player in Brazil to the world’s biggest brewer and a top 5 CPG manufacturer in less than a decade—shows just how quickly the game can now change.

Volatile commodity costs

Profitability in the CPG industry is tightly linked to commodity costs. When CPG companies raise their prices to offset commodity-price hikes, as they did in the era of expansion, they enjoy strong returns. But when they aren’t able to pass on price increases to consumers, as was the case in the early 2000s, margins and TRS suffer.

Until recently, commodity costs have been trending up. Due to global consumption growth, the rising cost of new supply (the real cost of a new oil well, for instance, has doubled in the past decade), and the interconnectedness of resources (biofuels being one illustration), the spike in commodity prices in the past 10 years has undone the decline of the previous 100 years.3

CPG companies must prepare for continuing volatility in commodity costs. The standard deviation of the McKinsey Global Institute (MGI) commodity-price index is more than twice its historical average. And the majority of key CPG inputs are subject to supply risk, either due to concentration in only a few countries (for example, 75 percent of phosphate reserves are in Morocco); absolute shortages, as is the case with water; a lack of substitutes (for potash, for example); or low recycling rates (such as with tin). Furthermore, the prices of soft commodities could increase by 50 to 450 percent, given unpriced environmental externalities such as CO2 emissions and water withdrawals.4

Sidebar

Questions to ask yourself to stay ahead

Every CPG company must undertake a rigorous risk analysis—including an assessment of “tail” risks—for major commodities across its entire supply chain. It should come up with a productivity plan that exceeds the reasonable range of commodity-price increases by at least 200 basis points. It must then make choices about how to mitigate commodity risks. Some CPG manufacturers are vastly reducing or even eliminating parts of their portfolio that rely heavily on constrained commodities. Some are reformulating their product recipes and using substitutes (for example, high-fructose corn syrup for sugar), taking into account weight and manufacturing trade-offs. Others are pursuing procurement excellence through supplier collaboration or even vertical integration. Still others are experimenting with ways to drive a more “circular” economy—for example, through greater use of recycled materials—that yield cost benefits as well as environmental benefits.

And because commodity risk puts strong pressure on margins, companies must continually find margin-enhancing opportunities. Making operations more efficient is one such opportunity. Our analysis shows that when CPG companies undertake large-scale, cross-functional operations-improvement programs rather than one-off projects in isolated business units, they can boost productivity by 300 basis points. Kraft Foods and SC Johnson have recently achieved this kind of productivity gain. Better revenue management is another margin-enhancing opportunity. Some companies are deploying an arsenal of revenue-management and pricing tools: for instance, they’re investing in sophisticated revenue-management processes and IT, hiring revenue-management experts, and making smaller but more frequent changes to pricing and promotions to reduce the risk of competitive followership.5

Transformative technologies

A recent MGI report identifies 12 technologies that could have massive, economically disruptive impact between now and 2025.6 Of the 12, we see three that could potentially transform the CPG sector and underpin a golden age of growth or an era of expansion: the mobile Internet and, in the longer term, the “Internet of Things” and 3-D printing.

MGI projects that by 2025, 50 percent of retail purchases will be made on a mobile device. That estimate could prove low, given that many product categories are quickly migrating from the physical store to online (Exhibit 2). The online market has shown itself to be supply driven: Zappos.com’s offer of free shipping and no-hassle free returns, for instance, lured consumers who previously never considered buying shoes online. The same could happen in grocery, where companies like Peapod and Amazon.com are making bold moves. Peapod’s mobile sales in 2012 were close to $150 million, up 50 percent from 2011. And Amazon, which plans to expand its AmazonFresh business to as many as 20 urban areas in 2014, could shake up grocery retail the same way Wal-Mart Stores did in the 1990s.

Exhibit 2

Digital technology is shaping all markets and categories.

To benefit from the mobile Internet, companies will need to make careful choices about where to place their bets and how big those bets will be. Which of their products should they sell online? How, if at all, should they engage with Amazon? (Some CPG players are putting their best people on Amazon-dedicated account teams. CPG companies will, of course, need to weigh the risks and trade-offs of partnering with Amazon, including the potential for channel conflict and the loss of control over the “virtual shelf.”) How much of their marketing budget should they shift to mobile media? Digital marketing, including mobile, now accounts for 22 percent of global ad spending and could grow to 27 percent by 2017, according to eMarketer.

The mobile Internet is already prevalent; the Internet of Things—the embedding of networked sensors in physical objects—is just beginning to make waves. It’s not a stretch to imagine that in a few years CPG companies will be using sensors to track consumers’ use of products (for example, sensors that can be ingested to measure caloric intake), customize marketing messages (as in shelf displays that change depending on who is standing in front of them), or revolutionize their manufacturing and logistics processes.

3-D printing, or additive manufacturing, is already in use in the CPG sector, with 3-D-printed jewelry and toys being sold in online marketplaces. Other CPG categories—apparel, furniture, sporting goods—may soon follow. In the near term, product designers can use 3-D printing to reduce prototyping time from weeks to minutes; in the longer term, it will open up mass-customization opportunities.

Taking full advantage of these transformative technologies will require companies to invest in building the relevant capabilities, including digital-content creation, mobile marketing, and advanced data analytics. CPG manufacturers should closely follow the evolution of these technologies and foster a test-and-learn mind-set within their organization, building an experimentation “engine” that can quickly scale up successful pilots.

Merger mania—with a global twist

A new M&A wave seems to be gathering strength—and this time it’s global. As we said earlier, emerging-market companies are expanding aggressively and becoming global winners. Our analysis shows that since 2007, Brazilian companies have made 13 CPG deals valued at more than $500 million each; Chinese companies have completed 7 such deals, and Mexican companies another 7. Most of these deals were in categories in which global or regional scale is an advantage, such as snacks, nonperishable beverages, paper products, personal care, and tobacco. (US-based companies completed 51 deals of comparable size over the same period.) The combined 27 major CPG deals originating in Brazil, China, and Mexico represent a huge jump from the 5 deals those three countries completed in the 2000–06 time frame (3 for Brazil, 2 for Mexico, and none for China).

Even after recent mergers, many CPG categories remain fragmented both within and across countries. Companies will need to make choices about how best to capture synergies in both developed and emerging markets. How will they position themselves to be the acquirer rather than the acquired? How will they avoid paying too much for acquisitions—a mistake many companies made during the M&A wave in 2000–07? How—and how aggressively—will US manufacturers lower their cost base to compete with emerging-market players?

We see three potential growth archetypes: global giants, from both developed and emerging markets, will consolidate categories that benefit from economies of scale (such as those previously mentioned as well as apparel and footwear); regional leaders will concentrate on value segments in categories where scale is less of an advantage (such as food, paper products, and dairy); and small, agile innovators will introduce new business models and capture premium niches.

In any case, CPG companies would do well to build their M&A capabilities. They should identify and carefully assess potential targets or partners in emerging markets. And they should be financially prepared to pounce on an M&A opportunity when it arises—specifically, by reducing their debt and loading up on cash.

Regulatory risk and the expanding role of government

Government’s influence on the consumer sector is increasing rapidly and will only continue to do so, given the ubiquity of CPG products and the role they play in people’s daily lives. The financial impact of regulation on the industry won’t be trivial: extended producer responsibility regulation, for example, which has been implemented in Europe, could cost the US CPG industry upwards of $7 billion per year according to prior McKinsey research.

Some industry leaders are taking action before government—or the public—demands it. Wrigley, a division of Mars, took its Alert Energy caffeinated chewing gum off the market in order to give the Food and Drug Administration time to pass regulations on caffeine-enhanced food and drinks.7 Coca-Cola is partnering with groups in Mexico to invest in an effort to increase recycling of materials for sustainable packaging. CPG companies and industry associations have formed coalitions to tackle issues such as front-of-package labeling, tax policy, and waste management.

CPG companies must decide what stance to take toward government. Will they take a leading role on one or more topics, or will they instead take a wait-and-see position and be prepared to act quickly when regulations change? Our prediction is that more companies will choose to be proactive and collaborative, following the example set by Unilever, whose Sustainable Living Plan outlines a set of ambitious social and environmental goals for the company.

Regardless of its regulatory strategy, each company must earn the “social license” to be in business. It must become aware of the issues and the potential impact of regulation on its business and on the overall industry, particularly in three areas: economic, environmental, and health-related. Best-practice companies regularly review emerging regulatory issues and plan for plausible scenarios, give regulatory issues a place on the agenda at both the top-management level and the board level, and ensure that exposure to government affairs is part of leadership development and job rotation for high-potential managers.8

The CPG industry will look very different in just a few years. It will be a bigger industry, with much larger global players and more competition from up-and-coming companies in emerging markets. Resource constraints and scale will lead to very different value-chain structures. New technologies will play an increasingly central role in business, as will regulation and government affairs. Already, these changes are compelling CPG companies to rethink how they do business and pursue growth. Companies that fail to adapt to these changes—or that make suboptimal choices—will be left behind by more thoughtful, action-oriented competitors.

About the authors

Jim Brennan is a principal in McKinsey’s New Jersey office, Greg Kelly is a director in the Atlanta office, and Anne Martinez is a specialist in the Stamford office.

Frozen peas may retain vitamins better than fresh stored

A potential food processing ally… worth considering alongside broccoli farmers.

Freezing is nature’s pause button.

Frozen produce may retain vitamins better than fresh stored: study

By Maggie Hennessy, 25-Nov-2013

Related topics: Fruit, vegetable, nut ingredients, R&D, Markets

Frozen produce is statistically equal to fresh when it comes to vitamin and mineral content, and retains vitamins equally so or better than produce stored in the refrigerator for a few days, according to a recent study from the University of Georgia in Athens.

“Consumers tend to have the impression that fresh is generally superior to frozen, but that assumption is misplaced,” Ronald Pegg, study co-author and associate professor at The University of Georgia College of Agricultural & Environmental Sciences, told FoodNavigator-USA.

For the study, titled “Nutritional comparison of fresh, fresh stored and frozen fruits and vegetables: Vitamin C, Vitamin A, Folate and Minerals,” fresh and private-label frozen blueberries, strawberries, broccoli, green beans, corn, spinach, cauliflower, and green peas were purchased from six local supermarkets over a two-year period. A composite sample of each fruit or vegetable was prepared with equal quantities of the produce from each supermarket. Fresh produce was analyzed for nutrients on the purchase day and again after five days of storage in a kitchen refrigerator, to mimic consumers’ typical purchasing and storage habits of fresh produce.

Vitamins C, A, and folate proved to be susceptible to degradation by enzymatic and oxidative mechanisms in the fresh-stored versions, whereas minerals did not. And in most cases, the frozen produce was not statistically different from its fresh counterpart in terms of vitamin content.

If you put fresh produce in the fridge, it degrades over time and loses nutrients

Dr. Pegg said he wasn’t surprised by the study’s results, as he’s “always had the point of view that frozen was going to be similar to fresh,” though he was intrigued by the nutritional degradation of fresh-stored produce noted in each instance.

“What we did see, and this was interesting, that the vitamin content of samples stored in fridge for a little time, in every single case, always decreased from their fresh counterparts.

“And in many cases, the frozen version was superior to fresh-stored: be it in vitamin A, folate or vitamin C levels,” he said.

“If you put fresh produce into the refrigerator, this vegetable or fruit is a living material—it respires, there’s oxidation and enzymes operating. It degrades over time and loses nutrients. That’s normal and to be expected.

“Freezing in essence is nature’s pause button. It maintains freshness in what we call fresh foods, slows down enzymatic reactions, increases the time it takes for anything to degrade.”

Freezing is nature’s pause button

There were some small variations (e.g., vitamin C levels in fresh-stored and blanched, frozen spinach was significantly less than fresh; frozen green peas had significantly higher vitamin A levels than means of fresh and fresh-stored; and mean folate levels for blueberries, corn and green peas were significantly greater than their fresh-stored counterparts).

“The way the study was designed, we tried to reduce variability in that we prepared composite samples, went to six supermarkets, and purchased certain quantities of each,” Dr. Pegg said.

“But there is always some inherent variability. When a significant difference existed, such as frozen was superior to fresh-stored, that difference was not of huge magnitude. We’re not talking about a difference of 100 times. But it does bring back the message that frozen fruits and vegetables are not inherently different from their fresh counterparts.”

Industry walks away from regulation…

The food industry play book in action in Scotland…

Scotland abandons responsible food marketing standard

By Caroline Scott-Thomas+, 11-Dec-2013

Related topics: Food safety and labelling, Legislation, Sugar, salt and fat reduction, Marketing

The Scottish government has shelved a standard for responsible food and drink marketing intended to tackle Scotland’s obesity problem, after food industry participants withdrew from discussions.

The government said in April that it would develop a third party certified publically available specification (PAS 2500) on responsible food and drink marketing in partnership with the British Standards Institute (BSI). A Steering Group was set up, consisting mainly of food industry and marketing associations “to give the process credibility and to ensure engagement and industry buy-in.”

However, in a letter addressed to Steering Group members seen by FoodNavigator, the BSI said that although there seemed to be agreement that the project should be attempted, “it was apparent that there was considerable scepticism in respect of the validity of the objectives for the PAS, amongst some sections of the stakeholder community”.

The industry ‘supports balance’

The standard was intended to provide a benchmark for the responsible marketing of food and drink to cut consumption of food high in fat, salt and sugar, but industry trade body, the Food and Drink Federation (FDF), says that it did not recognise that current approaches to food promotion already encourage balanced diets.

“By changing product recipes, creating new healthier options, investing in consumer education, providing clear labelling and promoting a wide range of products, the industry supports individuals to find the right balance,”said FDF director of communication Terry Jones.

“The PAS process did not recognise this context. It would restrict the information available to consumers and risk undermining one of Scotland’s most important industries and putting up prices for hard pressed consumers.”

No one from the FDF responded prior to publication to a query about which information would be restricted.

Government ‘could not continue without industry involvement’

The Scottish government said that it was now considering industry responses to draft proposals on other voluntary measures to encourage healthy choices, and aims to publish strategies for marketing and reformulation in April next year.

Referring to the shelved specification, a government spokesperson told this publication: “Unfortunately it could not continue without the food industry’s involvement. However, we welcome the assurance from all parties that they remain committed to constructive engagement on the issue of marketing of HFSS foods.”

Consumer watchdog organisation Which? urged the Scottish government to set out how it is now going to ensure action on more responsible marketing.

“People tell us that responsible marketing is one of the main areas they think Government should address to make it easier for people to eat healthily so it’s disappointing that talks have ended because of the withdrawal of the main industry groups,” a spokesperson said.

RAND: Top 5 Obesity Myths

  •  Obesity is not genetic
  • Obesity is not due to lack of self-control
  • Lack of fresh fruit and veg is not responsible
  • We are not too sedentary – we simply eat too much
  • Education about diet and nutrition will not conquer obesity
  • What’s really needed is regulation – for example, limits on marketing that caters to our addiction to sugar and fat — OH DEAR

The top five obesity myths

Published: December 29, 2013 – 1:01PM

The obesity epidemic is among the most critical health issues facing countries like the US and Australia. Although it has generated a lot of attention and calls for solutions, it also has served up a super-sized portion of myths and misunderstandings.

1. If you’re obese, you can blame your genes

As obesity rates have soared, some researchers have focused on individuals’ genetic predisposition for gaining weight. Yet, between 1980 and 2000, the number of Americans who are obese has doubled – too quickly for genetic factors to be responsible.

So why do we eat more than we need? The simple answer: Because we can. At home and at restaurants, a dollar puts more calories on our plates than ever before. Before World War II, the average US family spent as much as 25 per centof its total income on food – in 2011, it was 9.8 per cent. And people eat out now more than in the past. In 1966, the average US family spent 31 per cent of its food budget dining from home – in 2011, it was 49 percent. Because restaurant meals usually have more calories than what we prepare at home, people who eat out more frequently have higher rates of obesity than those who eat out less. Meanwhile, the food industry has developed tens of thousands of products with more calories per bite, as well as new, effective marketing strategies to encourage us to buy and consume more than necessary. We should blame these business practices, which are modifiable, for obesity rather than our genes, which are not.

2. If you’re obese, you lack self-control

According to a 2006 study, “research on restrained eating has proven that in most circumstances dieting is not a feasible strategy”. In other words: People won’t lose weight by trying to eat less because they can’t easily control themselves. Unfortunately, this puritanical view of personal resolve plays down how our surroundings and mental state determine what we eat.

Research shows that if we are overwhelmed with too much information or preoccupied, we have a tendency to surrender to poor dietary choices. In one study, for example, people asked to choose a snack after memorising a seven-digit number were 50 per cent more likely to choose chocolate cake over fruit salad than those who had to memorise a two-digit number. When adults in another study were asked to sample a variety of foods after watching a television show with junk-food commercials, they ate more and spent a longer time eating than a similar group watching the same show without the junk-food ads. In the same study, children ate more goldfish crackers when watching junk-food commercials than those who saw non-food commercials.

Our world has become so rich in temptation that we can be led to consume too much in ways we can’t understand. Even the most vigilant may not be up to the task of controlling their impulses.

3. Lack of access to fresh fruits and vegetables is responsible for the obesity epidemic

The US Department of Agriculture estimates that fewer than 5 per cent of Americans live in low-income communities without access to fresh food, but about 65 percent of the nation’s population is overweight or obese. For most of us, obesity is not related to access to more nutritious foods, but rather to the choices we make in convenience stores and supermarkets where junk-food marketing dominates. Since we are buying more calories than we need, eating healthily could be made more affordable by eliminating unnecessary cheaper low nutrient foods and substituting higher quality foods that may be slightly more expensive.

Obesity is usually the consequence of eating too much junk food and consuming portions that are too large. People may head to the produce section of their grocery store with the best intentions, only to be confronted by candy at the cash register and chips and soda at the end of aisles. Approximately 30 per cent of all supermarket sales are from such end-of-aisle locations. Food retailers’ impulse-marketing strategies contribute significantly to obesity across the population, not just for those who do not live near a green grocer or can’t afford sometimes pricier healthful choices.

4. The problem is not that we eat too much, but that we are too sedentary

According to the US Centers for Disease Control and Prevention, there was no significant decrease in physical activity levels as obesity rates climbed in the 1980s and 1990s. In fact, although a drop in work-related physical activity may account for up to 100 fewer calories burned, leisure physical activity appears to have increased, and Americans keep tipping the scales.

There is compelling evidence that the increase in calories consumed explains the rise in obesity. The National Health and Nutrition Examination found that people consume, on average, more than 500 more calories per day now than they did in the late 1970s, before obesity rates accelerated. That’s like having a Christmas dinner twice a week or more. It wouldn’t be a problem if we stuffed ourselves only once a year, but all-you-can-eat feasts are now available all the time. It’s nearly impossible for most of us to exercise enough to burn off these excess calories.

5. We can conquer obesity through better education about diet and nutrition

According to a physicians’ health study, 44 per cent of male doctors in the US are overweight. A study by the University of Maryland School of Nursing found that 55 per cent of nurses surveyed were overweight or obese. If people who provide health care cannot control their weight, why would nutrition education alone make a difference for others?

Even with more information about food, extra-large portions and sophisticated marketing messages undermine our ability to limit how much we consume. Consider Americans’ alcohol consumption: Only licensed establishments can sell spirits to people older than 21, and no alcohol can be sold in vending machines. Yet there are very few standards or regulations to protect Americans from overeating.

In the 19th century, when there were no controls on the quality of drinking water, infectious disease was a major cause of death. Once standards were established, the number of these fatalities plummeted. Similarly, if Americans did not live in a world filled with buffets, cheap fast food, soft drinks with corn syrup, and too many foods with excess fat, salt and sugar, the incidence of obesity, heart disease, high blood pressure and diabetes probably would plummet. Education can help, but what’s really needed is regulation – for example, limits on marketing that caters to our addiction to sugar and fat.

The Washington Post

This story was found at: http://www.smh.com.au/lifestyle/diet-and-fitness/the-top-five-obesity-myths-20131229-301ch.html

Future Diets Report

  • with wealth comes an increase in animal products, fat and sugar, but globalisation is not leading to a convergence towards a single international norm with income becoming a weaker determinant of diet over time – this allows scope for public policy to intervene
  • Trajectories are not pre-ordained; there is scope to  influence the evolution of diet to get better outcomes for health and agriculture.
  • This has never been attempted, with the rare exception of the wartime rationing in Britain, which stands out as an unusual natural experiment that  led to better health; but one that the British public were delighted to abandon once supplies had been
    restored after the Second World War.
  • Studies such as that of Cecchini et al. (2010) show large benefits compared to costs from measures to influence people to  adopt healthier diets.
  • A final comment (and paradox): interest in diet has never been stronger in high-income countries as  we obsess about our waistlines, worry about the social impacts of the marketing strategies of (very) large food retail chains, and enthuse over the culinary art and tradition shown in countless television programmes. Scientifically, a plethora of papers have been drafted in the past 10 years that ponder the  rise of obesity worldwide and its implications.
    It seems, then, that it is only a matter of time before people will accept and demand stronger and effective measures to influence diets. When that time comes, we will need the evidence – provided in a very preliminary way by this review – on the main problems of emerging diets, and which policies  (and combinations of policies) will be most effective in addressing the emerging challenges.
  • overweight and obese in developing countries grew from 250M in 1980 to almost a billion (mostly Indians) in 2008
  • consumption of sugar has risen 20% per person between 1961 and 2009
  • 1 in 8 people (852m) in poor countries do not have sufficient access to food
  • 1/3 of infants in the developing world are stunted
  • 2 billion affected by micro-malnutrition
  • this impacts on the number of people developing certain types of cancers, diabetes, strokes and heart attacks
  • politicians are fearful of interfering in the dinner table, combined with powerful lobbying
  • South Korea has seen an increase in fruit and vegetable consumption after publicity, social marketing and an education campaign including large-scale teaching of women in preparing traditional, low-fat, high-vegetable meals

Future Diets Report (PDF):  http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinion-files/8776.pdf

Source: http://www.foodnavigator-asia.com/Markets/Obesity-is-a-weighty-issue-for-almost-1bn-in-developing-world

By RJ Whitehead, 06-Jan-2014

Related topics: Markets, Asian tastes

The number of overweight and obese adults in developing countries has ballooned from some 250m in 1980 to almost a billion today, with Indians forming a huge chunk of this number.

This figure is highlighted in a major new review by the UK’s Overseas Development Institute to expose the global scale and consequences of overweight and obesity, and what it calls governments’ failure to address this growing crisis.

The Future Diets report is an analysis of public data detailing what the world eats. It selected five middle-income countries—India, China, Egypt, Peru and Thailand—as case studies to illustrate changes in dietary trends.

One in three overweight

The results highlight that the number of adults who are obese or overweight in the developing world more than tripled between 1980 and 2008, while in richer countries the figure has risen by over 200 million. One in three of the world’s adults are now overweight or obese, it found.

According to ODI research fellow Steve Wiggins, who authored the report, the growing rate of overweight and obesity in developing countries is alarming.

On current trends, globally, we will see a huge increase in the number of people suffering certain types of cancer, diabetes, strokes and heart attacks, putting an enormous burden on public healthcare systems,” Wiggins said, warning governments that they are not doing enough to tackle the growing crisis.

The percentage of obese and overweight in India rose from about 9% of the population in 1980 to 11% in 2008.

India’s consumption of animal products is approaching that of China’s in terms of its contribution to the average plate, but here the increase is almost entirely in milk consumption, with only limited increases for meat,” the report said.

Many Indians are vegetarian, avoiding beef or pork for cultural and religious reasons. The consumption of pulses remains relatively high in India, although it has been on the decline.”

Politicians fearful of meddling

Wiggins believes that the rise in obesity is partly due to politicians’ reluctance to interfere at the dinner table, along with the powerful influence of farming and food lobbies in the developing world and a large gap in public awareness of what constitutes a healthy diet.

Governments have focused on public awareness campaigns, but evidence shows this is not enough. The lack of action stands in stark contrast to the concerted public actions taken to limit smoking in developed countries.

Politicians need to be less shy about trying to influence what food ends up on our plates. The challenge is to make healthy diets viable whilst reducing the appeal of foods which carry a less certain nutritional value.”

However, the report does cite some successful examples of governments’ changing diets for the better. In South Korea, for example, policies that have led to an increase in fruit and vegetable consumption largely thanks to a publicity, social marketing and education campaign, including large-scale training of women in preparing traditional low-fat, high-vegetable meals.

Analysis of existing data shows that, amongst others, since 1980 overweight and obesity rates have almost doubled in China.

One indicator of changing diets is an increase in the consumption of sugar. Sugar and sweetener consumption has risen by over one-fifth per person globally from 1961 to 2009.

Fat consumption is also an issue. Among developing countries the highest consumption of fat is in East Asia, however industrialised countries still have much higher levels of fat consumption—often more than double.

Worryingly, despite a 50 per cent increase in the amount of food sourced from animals and a doubling in the quantity of fruit and vegetables being harvested, the report also notes that one in eight people (852m) in poor countries still do not have enough food to satisfy their basic needs.

WHO leaks sugar report – industry will be displeased

  • WHO will recommend sugar be limited to 5 teaspoons per day or 5% of total calories (current AU consumption around 35-45 teaspoons)

Source: http://www.raisin-hell.com/2014/01/the-world-health-organisation-has-taken.html

Sunday, January 5, 2014

The World Health Organisation has taken a tough stand on sugar. It’s about time we listened.

Last week the WHO (World Health Organization) leaked a draft report about sugar. The report will tell the world’s health authorities that they should be severely limiting the amount of sugar we all eat. It will recommend that we consume no more than 5 teaspoons of sugar a day. Given the average Australian is putting away somewhere closer to 35-45 teaspoons a day, it’s a very big call indeed.
The WHO is the health policy unit of the United Nations. Its aim is provide evidence based leadership on health research. It is well funded, free from corporate influence and motivated entirely by a desire to ensure that the 92 UN member countries get the best possible, evidence based, health advice. The WHO doesn’t run a Tick program or receive sponsorship from the processed food industry. Indeed it has even recently taken the extraordinary step of banning one ‘research’ group sponsored by industry from participating in its decision making processes.
Shrinath Reddy, a cardiologist and member of the WHO panel of experts, told the Sunday Times the WHO is moving on sugar because “There is overwhelming evidence coming out about sugar-sweetened beverages and other sugar consumption links to obesity, diabetes and even cardiovascular disease.”
The worldwide burden for those diseases is accelerating very quickly. According to a new report out this week the number of overweight and obese in the developing world has quadrupled since 1980.
A billion people in the developing world are now on the chronic disease express. But don’t worry, we still win. Less than a third of the population in China and India is overweight compared to our two thirds or more. They are just starting to get the hang of this Western Diet Thingy, so expect very big rises in the very near future.
The WHO have looked dispassionately at the evidence and have seen the tsunami of human misery caused by sugar coming for more than a decade They publicly warned that sugar was strongly implicated in obesity, type II diabetes, hypertension and heart disease in 2003.
They then took the extraordinary step of telling member governments that they should ensure their populations limited sugar consumption to a maximum of 10% of total calories (around 10 teaspoons of sugar a day – the same amount you would find in a Coke or a large Apple Juice). They did this despite an overt and vicious public campaign conducted by the Food industry.
The US sugar lobby demanded that the US Congress end its $406 million funding of the WHO. This is the same WHO that co-ordinates global action against epidemics like HIV, Bird Flu and SARS. But the US food industry wanted it destroyed because it dared to suggest we eat less sugar.
The lobbying behind the scenes was even more ruthless. Derek Yach, the WHO Executive Director who drove the sugar reduction policy work told a British documentary crew in 2004, that millions were spent trying to torpedo the policy. US Senators wrote directly to the WHO threatening its very existence. They also threatened the Food and Agriculture Organisation (a sister UN department concerned with food production) with a cut in funding.
In the end the food industry campaign paid off. The WHO removed its 10% recommendation from the final text of its recommendation. It was watered down to a suggestion that people ‘cut the amount of sugar in the diet’.
As one of the people involved at the time, Professor Phillip James, Chairman of the International Obesity Taskforce, predicted “we’ll end up with nice little policies telling [us] to have ‘just a bit less sugar and a little more balanced diet’ the nonsense that’s gone on since the Second World War during which time we’ve had this vast epidemic of heart disease, diabetes and obesity.”
Even the briefest glance at the official dietary guidance on sugar in Australia or the UK will tell you Professor James wasn’t too far from the mark with his prediction. Our guidelines are stuffed with words like ‘moderation’ and ‘balanced diet’ when it comes to sugar.
But the thing about evidence is, it doesn’t go away. And in the 10 years since the WHO last tried to save us from sugar, the evidence has become overwhelming (to quote Dr Reddy).
The WHO got a serious kicking when they tried to suggest a 10 teaspoon upper limit on sugar consumption, so you can imagine that the evidence they have reviewed must be truly overpowering to have them step up to the plate again. But this time they want the limit to be 5% (5 teaspoons) or less. I hope they’re wearing their flak jackets because I suspect a whole heap of blood money from the processed food industry is pouring into ‘lobbyists’ pockets as we speak.
The WHO is not running down sugar because it hates sugar farmers. It is not doing it because it likes getting mauled by the US Government (and its sponsors). It’s doing it because we will all suffer immensely if we don’t act on its advice.
I don’t know if the WHO can withstand the punishment they are about to receive. And I have no confidence that their recommended limit will make it through the firestorm of food industry sponsored ‘science’ which will suddenly surface. But I do know that when good people decide the evidence is so powerful that they should say it anyway, then the rest of us better be bloody listening.

EU food regulation in the pipeline

The Swedish Institute for European Policy Studies (SIEPS) has established a discussion around how to develop laws of sufficient impact to make a difference and strength to withstand inevitable industry challenge.

Report summary: 2013_7_ SUM WEBB_Regulation lifestyles in the EU

Full report: 2013_7_WEBB_Regulation lifestyles in the EU

From: http://www.foodnavigator.com/content/view/print/860169

EU law on NCDs not a question of ‘whether’ but ‘how’, warns expert report

By Nathan Gray+, 20-Dec-2013

Related topics: Legislation, Nutrition labelling, Sugar, salt and fat reduction, Marketing

Passing EU-wide regulations on the food industry for reducing non-communicable diseases (NCDs) is not a question of ‘whether’ but ‘how’, according to a new report published as part of the Swedish Institute for European Policy Studies (SIEPS) research project, known as Social Europe.

Health researchers and policy makers must engage more thoroughly with the legal issues relevant to regulations that aim to reduce NCDs to ensure that such strategies ‘can withstand industry challenges’, the report says.

The report (found here) examines the development of EU regulation targeting three risk lifestyle factors (tobacco, alcoholic drinks, and unhealthy diets) and analyses the role of law in developing successful transnational NCD control and prevention strategies.

“Our analysis has shown, a broad range of strategies exists to prevent and control NCDs. These different strategies have different natures, involve different actors and vary in scope, yet as they all require some forms of legal intervention, they illustrate how the law may offer opportunities for the prevention and control of NCDs as well as constraints,” reads the report – which is authored by two leading experts in the field; Professor Alberto Alemanno of l’Ecole des Hautes Etudes Commerciales (HEC), and Professor Amandine Garde at the University of Liverpool.

“The question is not so much whether the law can play an important role in promoting healthier lifestyles. Rather, the question is how the law can be validly designed to support effective NCD prevention and control policies.”

Writing in the preface of the report, Anna Stellinger, director of SIEPS noted that the laws and regulations surrounding NCDs are a ‘highly sensitive area,’ in which the law needs to be seen not just as a source of opportunity, but also as a potential source of problems.

“The importance of this question cannot be understated: good laws concerning NCDs must be able to withstand legal challenges as much as can possibly be anticipated,” commented Garde and Alemanno.

Indeed, they suggested in turn that the public health community develop the skills it both lacks and urgently needs to oppose the audacious legal arguments industry operators have relied upon to challenge in court the development of NCD agendas at global, regional, national and local levels.

The more the public health community can deal with the legal constraints that the law imposes on public authorities, the more it can maximize the opportunities that the law offers to the NCD prevention and control agenda.”

Speaking with FoodNavigator, Professor Garde said the report argues that while the European Union has a range of regulatory tools at its disposal to promote healthier lifestyles, it has used much more in relation to tobacco than alcoholic beverages and unhealthy diets, “not least in relation to marketing regulation”.

“We are also calling on the health community to engage more systematically and thoroughly with legal issues relevant to NCD prevention and control to ensure that the strategies they are calling for can withstand industry challenges,” she said.

Artificial sweeteners are alright by Pepsi…

  • they are safe in the “toxic” sense of the word
  • there is evidence that they help with weight loss along with other interventions
  • this all smacks of industry obfuscation – they’re not an essential dietary element, so don’t reference them as such

http://www.foodnavigator-usa.com/content/view/print/849807

Artificial sweeteners are safe and effective tools for weight management, says obesity specialist

By Elaine WATSON, 26-Nov-2013

Related topics: Sweeteners (intense, bulk, polyols), R&D, Food safety, The obesity problem, Health & Wellness, Beverage, Healthy Foods

While consumer concerns over artificial sweeteners have been blamed – in part – for the funk the diet soda market currently finds itself in (click here ), the fact remains that they are safe and effective tools for weight management, according to one obesity specialist.

Suzanne Phelan, PhD, associate professor in the kinesiology department at California Polytechnic State University and adjunct associate professor in the department of psychiatry, Brown Medical School, is an expert in the application of behavioral methods to prevent and treat obesity.

She is also co-principal investigator of the National Weight Control Registry, an ongoing longitudinal study evaluating 5,000+ successful weight losers.

People trying to manage their weight need to spend their calories wisely

Speaking to FoodNavigator-USA after contributing to a myth-busting session on low- and no-calorie sweeteners at the recent ObesityWeek conference in Atlanta, Georgia, Dr Phelan said that in an ideal world, we’d all just drink water to stay hydrated.

However, if people want something sweet, beverages using high intensity sweeteners can quench thirst without adding empty calories, she said, noting that people that successfully lose weight – and keep it off – are less likely to consume sugar sweetened beverages.

Long term successful weight losers consume smaller proportions of sugary drinks

No one food is to blame for obesity, and soft drinks companies are right that balancing calories consumed with calories expended is a key factor in weight management, she said.

However, achieving this balance is a lot harder if you regularly consume large amounts of empty calories from sugar sweetened beverages, she added.

On the firm’s latest earnings call, PepsiCo CEO Indra Nooyi said: “In the last 6-9 months, there has been an accelerated decline in diet drinks as people say they don’t want artificial sweeteners, they want more natural sweeteners, they don’t mind some calories. We are seeing a fundamental shift in consumer habits and behaviors.”

People trying to manage their weight need to spend their calories wisely and if you want to save calories, cutting out sugar-sweetened beverages and replacing them with water or beverages sweetened with low or no calorie sweeteners is a good way to do this.

“If you look at long term successful weight losers, they are consuming smaller proportions of sugary drinks – they are minimizing their consumption of sugary drinks and juices.”

(Click here to read about a recent Harvard meta-analysis showing that sugar-sweetened beverage consumption promotes weight gain in children and adults.)

No evidence that diet sodas make people crave sweeter foods or serve as an appetite stimulant  

Asked if she thought former NYC mayor Michael Bloomberg’s attempts to cap sizes of sugary drinks sold in certain outlets at 16oz were helpful, she said: “We should give initiatives like this a try. I’m in favor of government efforts to make it easier for people to consume fewer calories.”

As for the oft-quoted hypothesis that diet soda and other artificially sweetened products make people crave sweeter foods or serve as an appetite stimulant, there is “no evidence” to support this claim, she said.

(Click here  to read a 2010 review in the British Journal of Nutrition which found that “there is no consistent evidence that low-energy sweeteners increase appetite or subsequent food intake, cause insulin release or affect blood pressure in normal subjects”. A more recent study –click here –  published in the American Journal of Clinical Nutrition in Feb 2013 came to the same conclusion.)

Correlation, not causation

Meanwhile, a 2012 study also published in the American Journal of Clinical Nutrition (click here ) showed that replacing caloric beverages with non-caloric beverages was an effective weight-loss strategy, while a 2009 study co-authored by Dr Phelan in 2009 and published in the International Journal of Obesity (click here ) showed that those who have lost weight and successfully kept it off adopt a number of strategies, including drinking more artificially sweetened beverages, she said.

Dr Suzanne Phelan: People trying to manage their weight need to spend their calories wisely

So why do some commentators still insist that diet soda is responsible for all manner of problems?

For example, a recent opinion article published in the journal Trends in Endocrinology and Metabolism by behavioral neuroscientist Dr Susan Swithers alleged that regular consumption of diet sodas induced “metabolic derangements”putting users at “increased risk of excessive weight gain, metabolic syndrome, type 2 diabetes, and cardiovascular disease.”.

In the literature, there are some large scale epidemiological studies showing a correlation between consumption of low and no calorie sweeteners and increased risk of some of these health problems, said Dr Phelan, “so that has created a natural state of confusion.”

But this is correlation not causation, she said, and randomized controlled trials do not show similar results.

Meanwhile, a study by Harvard researchers published in the journal Circulation in 2012 (click here ) analyzing the Health Professionals Follow-Up Study, a prospective cohort study including 42,883 men, found that artificially sweetened beverage intake was not associated with increased risk of coronary heart disease risk.

The authors also said their results “highlight the need for cautious interpretation of studies reporting positive associations between diet drinks and cardiometabolic and cardiovascular outcomes”.

Artificial sweeteners and safety

As for safety, aspartame and sucralose are among the most thoroughly tested ingredients in the food supply and have been deemed safe by all major scientific and regulatory bodies from Health Canada to the FDA, the Joint Expert Committee on Food Additives (JECFA) of the World Health Organization (WHO) and Food and Agriculture Organization (FAO); and the European Food Safety Authority, added Dr Phelan.

emulin food additive addresses metabolic impact of junk food

  • who needs a healthy diet when you can fortify it with metabolic sensitizers? Mubadala does, and they want to put it in the food supply.
  • “It addresses the metabolic impact of both the milkshake you’re drinking and the cheeseburger you’re having with it”
  • It impacts on the glycaemic and metabolic impact of ingested junk foods by 30%
  • it apparently works acutely and chronically
  • it sounds like snake oil.. I hope Marc has run an interpol check on these guys
  • http://www.foodnavigator-usa.com/content/view/print/837344

Glucose management ingredient gets UAE distribution, ‘needs to be in food supply,’ founder says

By Maggie Hennessy, 25-Oct-2013

Related topics: Suppliers, Markets

Sometimes the best way to build a new market is to step back.

This is the case for ATM Metabolics, whose cofounders Dr. Daryl Thompson and Dr. Joseph Ahrens created Emulin, a patented blend of plant-sourced chlorogenic acid, myricetin and quercetin that claims to help maintain healthy blood sugar levels and facilitate weight loss in diabetics.

Facing hesitation from American corporations about incorporating Emulin into foods, the company has signed a licensing deal with United Arab Emirates development company Mubadala to distribute Emulin as both a medical food and as an additive to fortify diabetically sensitive food products. The firm hopes the distribution and resulting“dramatic improvement in glycemic management for type 2 diabetics,” who make up a growing percentage of the population in the UAE, will be a springboard to deploying Emulin as a medical food in the US.

“We need this to be in the food supply,” Thompson told FoodNavigator-USA. Emulin is currently available in the US as Diabetix, a dietary supplement supplied by VREV.

Blocks GI of the ‘whole meal’

Developed by ATM Metabolics cofounders Dr. Daryl Thompson and Dr. Joseph Ahrens, Emulin works by interrupting the metabolic pathways of carbohydrate metabolism. It claims to reduce glucose synthesis in the liver, enhance glucose uptake from the bloodstream, and increase the sensitivity of insulin receptors in the signaling pathways—thereby making insulin more efficient, according to Thompson.

What makes it so important for Emulin to be incorporated into food, he added, is it will not only block the glycemic impact of what you’re eating and drinking, but the whole meal. In other words, it addresses the glycemic impact of both the milkshake you’re drinking and the cheeseburger you’re having with it.

“Emulin when added to foods had the ability to reduce the entire glycemic impact and caloric impact of a whole meal by up to 30%,” he said. “This is because Emulin actually inhibits or ‘puts to sleep’ the enzymes in the body that are responsible for breaking down, transporting and storing sugars while inducing activity in metabolically useful enzymatics such as those in muscle tissue. Emulin reduces the amount of sugars that the body absorbs and at the same time enhances the body’s ability to utilize the sugars instead of storing them as fat.

“The good thing about this is that it is a ‘chaperone’ process that was developed by nature to properly regulate sugar transportation and usage in the human body. Our research team was lucky enough to identify this process and learn how to adapt it to our processed foods to make them safer glycemically.”

Thompson claims that Emulin works at both the acute and chronic level, meaning “the longer you take it, the less diabetic you become.”

Reeducating corporate America on ‘disruptive technology’       

The primary motivators for taking Emulin to the UAE were twofold: the growing incidence of diabetes in the UAE and the hesitance of American food companies to embrace new, disruptive technology in the diabetes realm.

The UAE has experienced remarkable economic growth in a relatively short period of time, which has raised the prosperity of its population. But this new-found wealth has also brought with it a growing incidence of metabolic syndrome and diabetes. According to the World Health Organization and International Diabetes Federation, 32% of the adult UAE population (age 20-79) may have diabetes or pre-diabetes, with other data indicating that the adult UAE population (ages 18 and above) has already reached a diabetes or pre-diabetes rate of 44%.

“The UAE is rife with diabetes and metabolic syndrome, but it also has a very forward-thinking healthcare system. And they’ve shown they really want to address this growing problem,” Thompson said. “We’re developing a plan there to get this distributed throughout the country and use it as model of how we will model foods here.”

The second reason for crossing the pond is the resistance of American food companies to embrace  “We’ve met with every American food company out there and the story is the same: they’ve gotten too big to be able to properly handle new disruptive technology,” he said. Thus, by spearheading the effort in the UAE, ATM Metabolics can demonstrate the practical approaches to dealing with metabolic diseases like diabetes with physical evidence. The product will be rolled out in the next six months, and Thompson expects to bring it back to the US within a year.

“We are working diligently to use UAE as a showcase to show how diabetes can be rapidly treated using Emulin in the food supply,” he said. “We’re hoping that this will serve as a blueprint for reeducating corporations here in the US.”

sugar-sweetened beverages and endometrial cancer

  • great to know Sugar Nutrition UK and Dr Glenys Jones are mouth-pieces for industry
  • non-causal association
  • questionnaire-based study

Sugar-sweetened drinks linked to higher cancer risk: Study

27-Nov-2013

Consumption of sugar sweetened beverages may be associated with an increased risk of developing endometrial cancer in postmenopausal women, according to new data.

Sugar-sweetened drinks linked to higher cancer risk: Study

By Nathan Gray+, 27-Nov-2013

Related topics: Carbohydrates and fibers (sugar, starches), R&D, HFCS, Beverage

Consumption of sugar sweetened beverages may be associated with an increased risk of developing endometrial cancer in postmenopausal women, according to new data.

The study, published in Cancer Epidemiology, Biomarkers & Prevention, revealed that postmenopausal women who consumed sugar-sweetened beverages were more likely to develop the most common type of endometrial cancer compared with women who did not drink sugar-sweetened beverages.

Led by Dr Maki Inoue-Choi from the University of Minnesota School of Public Health, the team found postmenopausal women who reported the highest intake of sugar-sweetened beverages had a 78% increased risk for oestrogen-dependent type I endometrial cancer (the most common type of this disease).

This association was found in a dose-dependent manner: the more sugar-sweetened beverages a woman drank, the higher her risk, the team said.

“Although ours is the first study to show this relationship, it is not surprising to see that women who drank more sugar-sweetened beverages had a higher risk of oestrogen-dependent type I endometrial cancer but not oestrogen-independent type II endometrial cancer,” said Inoue-Choi.

“Other studies have shown increasing consumption of sugar-sweetened beverages has paralleled the increase in obesity,” she added. “Obese women tend to have higher levels of estrogens and insulin than women of normal weight. Increased levels of estrogens and insulin are established risk factors for endometrial cancer.”

However, because the new study is the first to show an association between high sugar-sweetened beverage consumption and endometrial cancer, the findings need replication in other studies, Inoue-Choi explained.

Sugar Nutrition UK: This type of study has a number of significant limitations

Commenting on the study findings Dr Glenys Jones of Sugar Nutrition UK noted that the findings only appear to hold true for sugar-sweetened drinks, and not for glucose, fructose or  for sweets/baked goods.

“As the authors mention in the discussion, this type of study has a number of significant limitations and is unable to show any cause and effect relationships,” she added.

“A single questionnaire at the beginning of a study cannot account for any changes in dietary habits, reformulation or body weight during the subsequent 24 years of the study, all of which could be confounding factors in the statistical analysis.”

The American Beverage Association added: “This study does not show that sugar-sweetened beverage consumption causes endometrial cancer.  In fact, its findings conflict with the results of several other published studies that showed no association between consumption of sugar and risk for endometrial cancer. 

“The Mayo Clinic states common risk factors as changes in female hormones, older age, obesity, and inherited genetic conditions – not sugar or beverage consumption.  Moreover, the study only measured dietary behaviors at the very beginning of the study, yet makes conclusions about health outcomes over 12 years.”

Study details

Inoue-Choi and colleagues analysed data from 23,039 postmenopausal women who reported dietary intake, demographic information, and medical history in 1986, prior to the cancer diagnosis, as part of the Iowa Women’s Health Study. Dietary intake was assessed using the Harvard Food Frequency Questionnaire (FFQ), which asked study participants to report intake frequency of 127 food items in the previous 12 months.

The team explained that the FFQ included four questions asking usual intake frequency of sugar-sweetened beverages, including 1) Coke, Pepsi, or other colas with sugar; 2) caffeine-free Coke, Pepsi, or other colas with sugar; 3) other carbonated beverages with sugar, such as 7-Up; and 4) Hawaiian Punch, lemonade, or other non-carbonated fruit drinks.

‘Sugar-free soft drinks’ included low-calorie caffeinated and caffeine-free cola (for example Pepsi-Free), and other low-calorie carbonated beverages such as  Fresca, Diet 7-Up, and Diet Ginger Ale, said the authors.

The ‘sweets and baked goods’ category comprised 13 items in the FFQ, including chocolate, candy bars, candy without chocolate, cookies (home-baked and ready-made), brownies, doughnuts, cakes (home-baked and ready-made), sweet rolls, coffeecakes or other pastries (home-baked and ready-made), and pies (home-baked and ready-made).

Inoue-Choi and the research team then categorised the sugar-sweetened beverage consumption patterns of these women into quintiles, ranging from no intake (the lowest quintile) to between 1.7 and 60.5 servings a week (the highest quintile).

Between 1986 and 2010, 506 type I and 89 type II endometrial cancers were recorded among the women studied.

The team did not find any association between type I or type II endometrial cancers and consumption of sugar-free soft drinks, sweets/baked goods, and starch, but did find an association with sugar-sweetened beverage consumption after controlling for other lifestyle and risk factors.

“Too much added sugar can boost a person’s overall calorie intake and may increase the risk of health conditions such as obesity, diabetes, heart disease, and cancer,” Inoue-Choi commented.

Source: Cancer Epidemiology, Biomarkers & Prevention
Published online ahead of print, doi: 10.1158/1055-9965.EPI-13-0636 
“Sugar-Sweetened Beverage Intake and the Risk of Type I and Type II Endometrial Cancer among Postmenopausal Women” 
Authors: M. Inoue-Choi, K. Robien, A. Mariani, et al