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Chris Neff: It was Mary Poppins who said, a spoon full of sugar helps the medicine go down. But it seems we're taking our sugar in every which way these days. Whether we're adding to tea and coffee or eating it in our breakfast cereals, cakes and cookies. Adding too much of the sweet stuff is a contributing factor to increasing rates of obesity around the world.
With me today on Open for Discussion is Dr Becky Freeman. Becky is a Senior Lecturer and NHMRC Early Career Research Fellow at The School of Public Health and Charles Perkin Centre at The University of Sydney.
Her main research interests include tobacco control, obesity prevention and how online social media influence public health including how the big sugar industry is using the big tobacco play book to promote products that are heightening the prevalence of obesity and associated lifestyle diseases.
Thank you so much for joining us Dr Becky Freeman.
Dr Becky Freeman: Hi, thank you for having me.
Chris Neff: What is...we always talk about the recommended daily dose of sugar. What is it and does anyone actually stay to it?
Dr Becky Freeman: Well to answer the second question, does anyone stay to it, no...not really...
(laughs)
Chris Neff: Ok good. Thank God.
Dr Becky Freeman: That's the big..that's the big problem and so if you want to talk about how much sugar Australians eat, let's start there. So our latest survey data show that Australians are eating about 14 teaspoons of white added sugar every day. So if you drink say one of those 600ml bottles of soft drink, the most sort of common size sold in Australia, you're already getting your added sugar intake for the day. That's it, you're done. You can't have any more.
The World Health Organisation recommends that we have 6 teaspoons of white sugar a day. That would be equivalent to about 5% of our daily core intake. So 6 teaspoons, you can see how quickly that would get used up.
You can have maybe a quarter of a can of sugar sweetened beverages, a biscuit or two. So it's very...the excess amount of sugar we consume in Australia is stunning. But I think people think that unless I can get down to those 6 teaspoons I'm doing nothing for my health, what's the point and give up, you know walk away.
There's a really good campaign on right now called ‘Sugar by Half’ and if we could reduce the amount of sugar we eat by half we'd have huge health benefits. And I think that sounds sort of more doable. If you think about your own personal habits and the way you eat, you have to think ok well how can I reduce that amount by half? That seems a more reachable goal for somebody.
Chris Neff: Becky...so I am a self confessed sugar lover. I like sweet things.
Dr Becky Freeman: They're delicious.
(laughs)
Chris Neff: I...I am doing sugar by half by switching to diet soda. Does that...is that solving the problem or is that creating another problem?
Dr Becky Freeman: Ooo that's a big question. I'm...just to be really clear I am not a dietitian. I am a social scientist but the evidence is not great that switching to artificially sweetened beverages has that much of an impact.
There's conflicting evidence that it might encourage you to eat sugar from other sources, that there might be their own associated health effects that go along side of that. But I'm really not qualified to get into sort of the metabolic issues at stake there. The best thing you can do for your health is to drink water or water that's been flavoured with like a squeeze of lemon or something like this and just leave the sugar sweetened beverages or artificially sweetened beverages for special occasions and really limit the amount that you consume.
Chris Neff: Ok so for the record Becky, I am taking that as an endorsement...
Dr Becky Freeman: (laughs)
Chris Neff: ...of my 4 diet cokes a day...
Dr Becky Freeman: Ooohhh I think...
Chris Neff: ...and you know we're not going to get into the details cause really I think...I appreciate the endorsement and we can move forward.
Dr Becky Freeman: (laughs) Well that's...let's just be clear. I don't know if 4 diet cokes a day with all that caffeine would be a good thing for you either let alone the artificially sweetened sugars but anyway.
Chris Neff: These are very good points and I hope our listeners are taking them to heart. So we talk about sugar.
Dr Becky Freeman: Mmm hmm.
Chris Neff: What does the sugar do? What is it's relationship to obesity and these other...whether it's co-morbidities or other diagnosis that people get as a result of added sugar?
Dr Becky Freeman: Sure. I just want to make sure that we don't make it sound like sugar’s got some sort of magical property or something like this. That you put it in the human body and something mystical takes place. Essentially, added sugars contribute to overweight and obesity ‘cause we're just eating too much food and too much of that is coming from sources that have absolutely no nutrition associated with them.
So sugar sweetened beverages are the primary one. All you're taking in is sugar. There's no associated fibre or vitamins or essential nutrients. So that's just empty calories and it's those empty calories that's contributing to overweight and obesity. It's clearly a marker for higher rates of type 2 diabetes, cardiovascular disease and of course one of the most immediate health effects of eating and consuming too much sugar is dental health. And this is really felt in children from lower income or low socio-economic areas in particular. Their baby teeth, so that first set of teeth they get often has what we would call dental carries or cavities. Their adult teeth go on to have that.
So it's all these sort of...it's the snow balling of excess sugar intake that is leading to a really alarming health crisis.
Chris Neff: So essentially sugar's metabolising to fat. Is that...that's the issue there and you can't use it for anything else so it just becomes fat because not enough of us sort of do the miracle walk a day. You know...a sedentary lifestyle makes a huge difference.
Dr Becky Freeman: Sure. And I just want to again just emphasise that look I'm a social scientist, I'm not a dietitian or anyone who has a biochemistry background or anything like that. What I'm talking about here is that we take in too many calories and sugar...particularly sugary drinks are a really low hanging fruit of those excess calories because they have no nutritional value.
And so essentially the obesity and overweight statistics that we're seeing in Australia, about two thirds of that is due to eating too many foods in general. So taking in too much of the wrong thing and not eating enough fruits and vegetables. And the other third is from not exercising enough, not having an active enough lifestyle. So yes it's important to be physically active as well but the majority of the cause of the overweight, obesity statistics is due to poor diet.
Chris Neff: So in Australia then, now that we're sort of learning that sugar can have this cascading effect on people's health and well being, how do we regulate the marketing of it in our foods and beverages?
Dr Becky Freeman: So currently the marketing of foods and beverages in Australia is regulated through voluntary pledges and those are as weak as that sounds. You know can you picture a... the sort of CEO of McDonalds holding up his hands and saying I pledge not to market to children. I mean it's a joke, really.
And so you've got these two voluntary codes. One of them covers sort of food and grocery items and the other covers what they call quick service restaurants or fast food outlets I think is sort of a more common term. And what these pledges say is that they will endeavour to reduce marketing to children of foods and beverages that aren't healthy. That they will do their best to market only healthy options to this target audience, to children. And that they'll provide parents with a means of raising any concerns they have about advertising.
So essentially what this means is the companies continue to do whatever they like. If parents see something they don't like they have to file a formal complaint about it to the Australian Broadcasting Service and then the Australian Broadcasting Service debates these issues and decides whether indeed it violates these voluntary codes and if it does they tell the outlet that's responsible for the ad, “oh, please don't do that anymore”. And of course this process takes so long that ad’s probably been off the air for six months and they're onto the next campaign anyway.
There's no fines, there's no sanctions and these voluntary codes only apply to very young children anyway. So in fact they're quite useless.
Chris Neff: So is there something about the sugar industry in Australia that leads it to having such a weak regulatory framework because it seems like, especially when you're talking about you know...obesity in children and across Australia that you would really want to...that's something you wouldn't be lax about. That that's something you'd pay really close attention to but it doesn't sound like that's what's happening.
Dr Becky Freeman: No not at all. We have very...let's compare it to tobacco control and in tobacco Australia's made huge strides. I mean you can't find an ad for a tobacco product anymore. You can't even see it in a shop when you go to buy it, it's all hidden below the counter. And yet for things like sugary drinks or unhealthy foods, junk foods there are ads...literally we are saturated with advertising for them. If it's everything from sponsorship of sport to billboards on the side of the road, you can't escape it even if you wanted to.
Chris Neff: So Becky, what are your thoughts about implementing sugar taxes to try to add a regulatory framework to what we're talking about?
Dr Becky Freeman: I think a sugar tax is absolutely a policy that Australia should adopt. They should adopt it immediately. It's a fantastic way to actually reduce the amount of free sugars we consume.
One of the leading countries in this area is Mexico. Mexico has a huge obesity epidemic. It's one of the most overweight nations in the world and in 2015 they adopted a sugar tax and an analysis of their sugary drink purchases shows that in the first year alone, they had a 5% drop in consumption. And this was followed in the second year, which people were concerned that this would only have an impact for the first year and then people would sort of get used to the new prices and not worry about it anymore. They had a further 9.7% decline and this is significant.
And it's not just that the consumption of these products has gone down, it's the money from that can then be put towards programmes that target people. So either in education programmes in schools, community programmes that subsidise say fresh food and vegetable co-ops, community gardens. So you can do a lot of health promotion good with the money that results from that as well. It's a real win win. It reduces consumption and it provides a source of revenue for governments to implement even more obesity policies that can then build on themselves.
Again, just drawing from my tobacco experience. We have very high tobacco taxes, we have a ban on all forms of advertising and promotion, the packages have graphic health warnings on them, we have national mass media campaigns that tell people very clearly about the health effects of tobacco and we've taken tobacco on in the courts in a legal sense as well. And all of these things working together, this comprehensive approach is what has led to having smoking rates plummet so much over the past 25 years.
And it's going to take that sort of comprehensive approach in obesity as well and so the idea that we could just adopt a sugar tax or just put health star ratings on foods and magically people would you know...eat better and no longer be overweight, is naive. It's going to take a sort of whole community approach, a whole government approach.
Chris Neff: And this is kind of a battle that's going on because on the one side while people are trying to set up regulations or institute taxes, on the other side you've got sort of the big sugar industry that is creating clever marketing campaigns to sell more of it's product. What do they do to try to tap into our brains and get us to want to buy the product?
Dr Becky Freeman: Well...what don't they do? Let's pick say everyone's favourite sugar sweetened beverage, sold internationally, one of the most powerful brands in the world, Coke. When I say the word Coke, I'm sure in everyone's head you immediately get that red and white bottle with the wave going across. We all have these images in our head right? Those have been marketed to us since we were like in utero. We know Coke, we know how it's marketed.
Their slogans are things like open happiness. There's no information in a Coke ad about what Coke is or what it does or how much it costs or where you buy it. These aren't informational campaigns. These are campaigns that generate a feeling in you. They want to induce that feeling of Summer, another well known Coke campaign. Open Summer, open happiness, bonding with your friends, having a good time. All these sorts of emotions, that's the sort of...the number one way.
They give you feelings and not facts. Coke likes to say they need to advertise because they need to communicate with their consumers about their product and I think if you had a coke ad that was actually full of facts you know...this is a bottle of brown water that is full of 16 teaspoons of sugar. The plastic it's in pollutes our oceans, is rarely recycled. It is sold to children in low income neighbourhoods that makes their teeth fall out. Like that's information to me, not this sort of feeling laden campaigns that they run.
We did a study where we looked at how junk food and beverages were being marketed on Facebook. Because television gets a lot of attention say all the ads on TV, maybe we can limit them during children's viewing hours. And I just think that's not how children consume media anymore anyway. Of course everyone knows it's streaming or it's online or it's in little YouTube clips and so we had a look...just had a look at Facebook just to say how are these brands using these pages? And they do really sort of things again that make you feel good.
Skittles is another product I think probably most people are familiar with. You know...taste the rainbow. Well they were very clever as well. So they had this best fan forever which was they'd say we'll pick someone every week who will feature on our social media pages and we'll give them their 15 minutes of social media fame.
So what people would do was take pictures of themselves with Skittles, send them into the Skittles Facebook page and they would pick one a week and sort of pop it up on the page. And what's really striking to me is that this is for a product that is essentially just pure sugar, rot your teeth, has no nutritional qualities whatsoever. You don't get free Skittles for doing this. You don't get paid for doing this sort of advertising and promotion and yet they are flooded with images of people doing things like you know...building things out of Skittles or buying the biggest bag of Skittles they can find and sort of hefting it up over their heads and it's amazing to me the relationship that these brands can build with consumers.
And that's sort of the most striking part about social media is how they try and get into your Facebook feed as if they were just one of your friends. They appear in your Instagram images as if they are you know...giving you inspiring lifestyle tips. Things like this. Another really good example is Red Bull. So obviously an energy drink. Again, a product that is mostly sugar with some added chemicals in for energy. If you look at the Instagram feed of Red Bull, if you were some sort of alien who got parachuted down from Mars and had a look at these pictures, you would have no idea what Red Bull is because all the images are of people either on ski slopes or driving racing cars or on the back of motorcycles. The product is never actually featured. And so you are creating a feeling of obviously excitement, rebellion, high speed sport. You don't even need to show the product, you just creating that feeling with people.
And I look at public health and how we try and run these sort of sad little education campaigns telling people you know...don't eat too much sugar. We just don't have those kind of relationships with people. We're not in that social media space building those feelings with people, making them part of what we're trying to do. And these companies are romping all over it.
And one of the main reasons of course is they have a lot of money. That's why they can do this kind of work. They can pay the best advertising agencies in the world to help them create this emotional connection between their unhealthy products and their target audiences.
Chris Neff: It's interesting because I know Skittles recently ran a campaign where they stripped their rainbows off of the boxes and said the only rainbow that counts is the LGBTI rainbow. And it was essentially social conscious marketing to a community to try to endear them and you know...get brand loyalty...
Dr Becky Freeman: Mmm hmm.
Chris Neff:...and endear them to a brand so it's this point you make that it is...it's an emotional...it's almost a lifestyle brand rather than just a sugary product.
Dr Becky Freeman: Absolutely and I'm sure that's how they think. They're not thinking about ohh, I'm just going to put a commercial on air tomorrow, they're thinking long term. You know...we want Skittles to be around for the next you know...they have customers who are loyal from the age of two all the way until you know...we've killed them off from heart disease (laughs) in their seventies or whatever it is.
And we don't think like that in public health either. Our goals are usually...we've got a government in for the next two years, what is it that we can get them to do in that short amount of time? You know...we're just really fighting with both hands tied behind our back and our opponents have bags of money, long term vision and more freedom to experiment as well and to try things.
Although I will say, this social conscience marketing...brands get it wrong as well. I'm sure you're all very familiar with how Pepsi tried to...
Chris Neff: Mmm hmm.
Dr Becky Freeman:...leverage the...was it a Jenner or a Kardashian? Anyway, one of them as sort of the hero of the Black Lives Matter movement and it was a disaster. I mean it was just...you know people can see right through how revolting that was to try and exploit that to sell sugary beverages to people. So they do get it wrong but you know...for every one they get wrong they probably get two or three right.
Chris Neff: Well and it goes to the point that you're making in that again, there's this emotionality to their advertising that what they're trying to sell you is a feeling and like you say, feelings not facts. Are there other things that companies do to try and portray themselves as the solution to the problem rather than as the problem itself?
Dr Becky Freeman: Absolutely and this is...all sort of falls under their blanket umbrella of corporate social responsibility and it's also a way of trying to prevent public health from making any policy gains.
The number one thing that they do is to fund physical activity programmes or to sponsor sort of...development programmes in low income countries or low income neighbourhoods. But they really try and focus on the yes, we think children should be healthy, they should be active. So they'll sponsor physical activity programmes. So just your run of the mill thing that you would expect, put up soccer pitches for kids, we'll buy them jerseys, we'll get them out running around and then they don't have to worry about what they are eating and drinking. They can eat, drink whatever they like because they're so physically active.
The other thing they do is that they actually fund researchers and this is straight out of the tobacco industry play book. It's a way of let's fund researchers at universities that have great reputations so that they can find research that shows it's not about what you eat, it's about how physically active you are. And so they're corrupting the body of evidence and they get their research published in journals so that it gets cited. It seems like it's you know...that there's two sides to this issue that perhaps it's not about what we eat and drink, it's about our lack of physical activity.
And the global energy balance network was...that was exposed last year. That was fully funded by Coca-cola. That was heavily influencing research agendas to the point where they were consulting with researchers about how the results should be presented, what sorts of studies they should be doing. Again, it's a way of trying to position themselves as part of the solution.
Thankfully, the research community is wising up to that sort of thing. You'd have to be a pretty desperate researcher these days to take tobacco funding. A lot of journals refuse to actually even publish studies that are funded by the tobacco industry and I think if the sugar sweetened beverage industry continues to emulate the tobacco industry, those sorts of policies and regulations will come into place as well.
Chris Neff: I'm in shock. I am literally in shock. As somebody who eats most of his food either in a box or through a window and is an avid sugar lover, it sounds like I am perpetuating a problem here and essentially funding corporations that are using their research and their tools and their resources. This sounds structural and systematic.
Dr Becky Freeman: Yeah, yeah. Exactly and so what bothers me a lot about the sugar debate or the obesity debate as well is that a lot of times we put it back on the individual. That it's about personal responsibility. It's about parents making sure they don't...
Chris Neff: Yeah.
Dr Becky Freeman: ...feed their children bad food and so how are you supposed to be an individual who you know...every time you walk out the front door you're bombarded with advertising. Sometimes the only foods that are available are produced by these companies. The brands are owned...there might be thousands of brands on the market but they're owned by a half a dozen trans national companies. So you can't even avoid them if you wanted to.
And then they're also influencing our government. Lobbying, political donations. A few years ago we were supposed to be getting the health star rating on our packages of food so that people would have some sort of vague idea at whether the thing that they're choosing would be healthy for them. And right before that health star rating website was meant to go live, it was pulled down. And the reason for that is because a member of staff in the health...a political staffer in the health department had worked for Cadbury and had connections. And it's just...it's corrupt.
It's sugar and fake food and fake soda has very long tentacles that reach into our political systems, our economic systems and our research communities. And it's very hard for an individual person to fight back against that. And as someone who's a parent, I have a 5 year old. Even if you're the most vigilant parent, you don't expose your children to advertising, you don't let them come in the grocery store and look at the Freddo Frogs that are up by the till. It's very, very difficult to avoid these sorts of things. And we need to help parents. We need to have better policies in place that help them to raise healthy children.
Chris Neff: So what can we do about this and are there policies like the sugar tax that work as part of a comprehensive approach to dealing with big sugar or big food, big soda, all these different industry influences.
Dr Becky Freeman: Absolutely. Starting with a sugar tax. We've got the best evidence that that will work and it provides a source of revenue to try out other programmes and things. Another thing that we can do, NSW health announced that they are going to be banning the sale of sugar sweetened beverages in all their hospitals and health care clinics. This is going to come into place in 2018. It's very exciting. If it's not available, people simply won't purchase it. Out of sight, out of mind.
Another policy we need to adopt is much stronger. No more of these sort of hokey voluntary pledges of how food and beverages are marketed. There are so many things we could do and try. And then of course, not allowing the industry to influence public policy, keeping them at an arms length. Again we have an excellent framework for this in tobacco where the tobacco industry does not get to decide how tobacco should be sold and marketed in this country. The government has taken...largely taken control of that.
But right now we have big sugar, big soda, big food completely driving what's available for sale, how it's sold, how it's packaged, what price it's set at, who's it sold to and we're just sort of scrambling around at the edges.
Chris Neff: What do you say to people who say well you know Becky, this is just another example of the nanny state trying to add sugar taxes and regulating you know...what is really just an individual person's choice?
Dr Becky Freeman: Yeah to that I kind of roll my eyes.
(laughs)
And I also think wow, you're not very creative. Nanny state, ooooo you know that's not a very well thought of argument. Lots of things are nanny state. Seatbelt laws, pool fences, having to stop at red lights so you don't run over pedestrians. There's a lot of nanny state policies that people really like. One of my favourite nanny state policies is the fact when I go into a restaurant or pub or a bar there's no one smoking in there anymore. I don't have to you know...risk getting lung cancer if I work as a waitress in a pub.
Those are all nanny state laws that the public really likes. It protects public health. And you know I'm not going to say we should reclaim the nanny state or that Mary Poppins...you know we should all become sort of Mary Poppins want to be's but nanny state is just lazy short hand for policies that some people don't like because they're going to affect their companies bottom line.
The public is hugely behind policies that help them live healthier lives that actually make it easier to choose to live a healthier life and most importantly make it easier for them to support their children to live healthier.
Chris Neff: Our listeners who are listening. They're driving in the car, they're running and they're...whatever they are doing and they're thinking ok, how do I cut my sugar in half? Are there top tips or areas to look...
Dr Becky Freeman: Sure.
Chris Neff: ...that we should be keeping in mind?
Dr Becky Freeman: The biggest source of added sugars are in processed food. So they're...and they're often in foods you don't think about like tomato sauce for example, if you like to dip your chips in tomato sauce. For every tablespoon of tomato sauce, there is a teaspoon of sugar so people sometimes aren't aware of that.
Sugar sweetened beverages are the number one. If you are a sugar sweetened beverage drinker, if you could cut that out of your life or cut out half the amount you drink then you will be doing yourself a massive favour.
Obviously there is obvious things like cakes and cookies but other things like muesli bars have huge amounts of sugar. Breakfast cereals are one of the worst sources for sugar particularly for children. So becoming a little bit more label savvy, having a quick look to see how much sugar is in this product.
Chris Neff: And how much do we want? We want...we're looking for six grams a day?
Dr Becky Freeman: Six teaspoons...oh six grams no no no. Six grams is only one teaspoon...
Chris Neff: Ok.
Dr Becky Freeman: ...so six teaspoons. It's a generous amount!
Chris Neff: Good!
Dr Becky Freeman: (laughs)
Chris Neff: Thank you! You just gave me more sugar.
Dr Becky Freeman: Exactly! Go for your life…
Chris Neff: Ok...
Dr Becky Freeman: ...it's heaps of sugar! Yeah and so you know you put a teaspoon of coffee or something like this and I don't want people to worry about fruit and vegetables. We're not talking about the sugar in an apple or the sugar in an orange. Eat that food, it's good for you. People who eat fruits and vegetables live long, happy, healthy lives. But fruit juices are something to stay away from. So it's not equivalent of say eating an orange and then eating a glass of orange juice that's been made from 12 oranges where you've just extracted the sugar and not all the fibre and things like this. So if everyone in Australia did that we would be a long... we would have a really roaring start to reducing obesity rates.
Chris Neff: And is there anything else? I mean...you' were sort of making a very compelling point about the influential role of social media with these companies and spreading sort of these contagions, these social contagions of you know...collective brand loyalty toward Coke or toward Skittles or toward whoever. Is there something that we can do when we see these in...should we leave a comment? Should we block it? Should we share it?
Dr Becky Freeman: Well first of all, if you ever see an ad that you think in any way targets children you can report that to the Australian standards bureau. Even though I've said at the beginning that it's very weak. They do rely on the complaint process. They don't monitor the advertising world and try and find ads that violate the code. So absolutely report it.
Chris Neff: I'm...can I just pause you there?
Dr Becky Freeman: Sure.
Chris Neff: So YouTube has to...
Dr Becky Freeman: Mmm.
Chris Neff: ...self-censor copyright for movies...
Dr Becky Freeman: Yes.
Chris Neff:...but the Australian regulatory system doesn't check to see if companies are selling sugary products to children to make them obese?
Dr Becky Freeman: No, no.
Chris Neff: Oh my goodness. Ok.
Dr Becky Freeman: Yeah. And what's...what's a bigger public concern to you do you think?
(laughs)
Chris Neff: Well yeah. And I mean and again it goes to the strength of the different lobbies that are involved.
Dr Becky Freeman: Yeah and protection of profits right? At the end of the day...
Chris Neff: Mmmm hmm.
Dr Becky Freeman: ...there's no public health framework has been put around these things and I would also challenge your local member of parliament because I think it's going to take policy to get this in place. Become political about it if it matters to you.
Chris Neff: I think those are great comments and I hope all our listeners take it to heart. I'm going to take it to heart and I'm...
Dr Becky Freeman: Awwww.
Chris Neff: ...going to try and cut my sugar in half Becky because...
Dr Becky Freeman: Yay! I'm so pleased.
Chris Neff:...we've had this conversation. So thank you again for joining us on Open for Discussion.
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Dr Becky Freeman: Thanks for having me, it was a lot of fun.
Chris Neff: Thanks for joining us on Open for Discussion. You can subscribe to this podcast on iTunes or Soundcloud. If you'd like to know more about our research, be sure to visit our website sydney.edu.au/news.
