If you are fed up and wish the U.S. could reduce sugar consumption ...

The new documentary movie Fed Up, by Stephanie Soechtig, will be released widely tomorrow. It rightly focuses on sugar consumption as a key contributor to chronic disease in the United States.

If you see this movie and want some links to reliable information, here is a quick rundown of both the diagnosis and the potential solutions.

Diagnosis of the problem

1. Mainstream sources agree with the movie that sugar consumption is a problem. Based on an exhaustive review of the balance of evidence in the scientific literature, the federal government's Dietary Guidelines for Americans plainly recommends that Americans reduce their consumption of calories from added sugars. Fed Up's broad indictment of sugar is endorsed by the movie's most reliable interviewees, such as former FDA Commissioner David Kessler.
2. Sugar is not consumed in the abstract -- it comes from particular foods. As noted in a "Sugar 101" primer from the American Heart Association, the leading sources of added sugars in our diet include soft drinks, baked goods, candy, and ice cream. Americans would live longer and have better health if we reduced consumption of these foods.
3. Unless you are prepared to critically evaluate the complex scientific literature, it is optional and not necessary to buy in to a variety of specific scientific claims about sugar. Among the interviewees in Fed Up's trailer, which I watched today, I have heard nutrition scientist Robert Lustig focus more narrowly on fructose, and I've heard Gary Taubes more broadly criticize all carbohydrates. I personally find the sources cited in #1 above more persuasive than either Lustig or Taubes, but who knows? Either or both of them may turn out right. It doesn't matter for the basic indictment of the foods in #2 above.
4. Some people blame marketing, and others blame federal subsidies. The influence of marketing is real, while the subsidy story is generally unconvincing. To understand how federal subsidies affect corn syrup, for example, one must pay attention not just to price-suppressing corn subsidies (which have been tiny in recent years anyway), but one also must pay attention to corn-based ethanol policies that have made corn syrup more expensive. I think critics of "subsidies" mostly have not taken the time to learn about specific subsidy programs, but rather are expressing -- correctly -- their recognition of the longer term impact of the industrialization of the food system. Regardless, the specific blame doesn't matter much. However we assess the relative contribution of these factors, we should always remember the more fundamental fact that will remain with us even if marketing policies or subsidy policies are reformed: products with sugar are sweet and people desire them. That's the big source of our challenge.

Solutions to the problem

1. Tax. Jenny Hopkinson and Helena Bottemiller Evich report that, in connection with the premier of Fed Up, some in Congress are expressing renewed interest in a tax on sugar sweetened beverages. USDA research shows that an increase in the price of these beverages likely would make a considerable difference on consumption. It is true that part of the gains -- but only part -- would be offset by increased intake of other caloric beverages that substitute for the beverages that are taxed. It is also true that higher beverage prices would be regressive (affecting low income folks relatively more than high income folks). Finally, the most important thing about a tax is that it political death to seek to tax, as if taxes were a good thing. The only politic way to pursue a beverage tax is to institute it as part of the Congress' unavoidable responsibilities to fund essential government services (such as military and roads), reduce the deficit, and seek to balance the budget. The sound argument is, "so long as we are reluctantly compelled to institute a small sensible tax on something, we might as well save some public health expenditures by placing the tax on sugar sweetened beverages."
2. The food environment. I think it is time for schools, offices, restaurants, and all sorts of public venues to revisit their role in making sugary foods -- and especially beverages -- available to excess. At one time in the past, somebody might have seemed overwrought or joyless for enforcing limits on bake sales in schools, for example, or an occasional fast food meal as a reward for good school performance. But, decades into the current nutrition dilemma, I think we should be more grateful and supportive of those who propose holding a firm line on making the food environment healthier, especially for our children.
3. Improving nutrition assistance programs. First, nobody should even contemplate any part of solution #3 unless they also are boldly supporting proposals in #1 and #2. It is poisonous to discuss improving changes to nutrition assistance programs for low-income Americans unless we are firmly on the record supporting corresponding changes in the food environment for people of all income groups. Second, any proposed improvements should incorporate input from anti-hunger advocates as well is public health advocates, and they certainly should draw on input from program participants themselves. If bold new nutrition assistance program options are pursued on a pilot scale, we may be surprised at the response from program participants.