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Does sugar cause obesity?

What is sugar?

 

Most of us think of “sugar” as the white stuff we put in coffee, or maybe what makes up 90% of those colored marshmallow cereals.
However, “sugar” is actually a group of molecules that share a similar structure. So we might actually call them “sugars”, plural.
This group includes lots of members such as:
·       glucose
·       fructose
·       sucrose, aka table sugar (which is glucose + fructose)
·       maltose (which is glucose + glucose)
·       galactose
·       lactose (galactose + glucose, found in dairy)
And so on.
Sugars naturally occur in biology and in most foods (even if just in trace amounts). For example, here’s what the breakdown of sugars looks like in a banana:

There is, of course, much more sugar in processed and refined foods than in less-processed and unrefined foods.
(We’ll come back to this important point in a moment.)

Sugars live under the larger umbrella of “carbohydrates”.

 

Along with the sweet stuff, this macronutrient group also includes:
·       starches (like in potatoes or rice),
·       fiber (like the husks of whole grains), and
·       structural building blocks like chitin (which makes up the shells of crustaceans) or cellulose (which makes up things like the trunks of trees).
The more complex the molecule, the slower it digests.
·       Sugars, which are simpler, digest more quickly.
·       Starches and fiber, which are bigger, more complicated molecules, digest more slowly, if at all. (This is why eating more fiber can help us feel fuller, longer.)
Most carbohydrates are actually broken down into simpler sugars once they’re digested.
Other carbohydrates (such as insoluble fiber) don’t really get broken down nor absorbed fully, although our intestinal bacteria often love munching on them.
So: Sugars are a type of carbohydrate, but not all carbohydrates are sugars. And some carbohydrates break down quickly/easily into sugars. Others don’t.
This point is important to understand, because it tells us that not all carbohydrates do exactly the same things in our bodies.
Sugar-type molecules react with receptors on our tongue, which then tell our brain “OM NOM NOM DELICIOUS!”
Sugar tastes good to us, because in nature, sweet foods like fruits are often full of good stuff like vitamins, minerals, and energy.

But we differ in our physiology and behavior.

 

In all things, humans are diverse and variable.
Some of us like and seek out sugar more than others. This may be genetic. Or we may have learned it as we grew up. Or both.
For example, some of us like sugar in small doses; we can only eat a little before pushing the dessert plate away. While others like it a lot; the more we eat the more we want. The idea of “too much sugar” doesn’t compute.
Likewise, some of our bodies seem better suited to sugar than others.
For example, some of us can eat sugar all day long and feel fine. While others can only tolerate a little bit before our pancreas (which secretes insulin, a hormone that helps sugar get into the cells) tells us to knock it off.
In general, most of us like at least some sweetness.
When we’re young, we tend to like sweetness more and avoid bitter foods more. Yet each person’s response to sugar and sweet taste is unique.
With that said, let’s get back to the questions at hand. Starting with…

 

Question #1:
Does sugar cause obesity?

The term “obese” (or “overweight”) is, like sugar, a contentious thing. In this article we’ll use it just for the purpose of discussion, so bear with us.
The World Health Organization defines “obese” as having a Body Mass Index higher than 30. Of course, some fit athletes (like heavyweight boxers or rugby players) might have a higher BMI but still have a low body fat percentage.
However, for most folks, having a BMI higher than 30 signifies that they have a higher-than-average level of body fat. 
(Indeed, some studies that correlate BMI with body fat testing suggest that BMI may even under-estimate how much body fat a person has.)
When it comes to obesity, there have always been people who are heavier, and/or who have more body fat, than most other folks like them.
However, over the last several decades, “average people” in industrialized countries have gotten heavier, bigger, and gained more body fat fairly rapidly.
It’s now statistically “normal”.
Although this shift is happening worldwide, and there are differences by ethnic group and socioeconomic class, it’s particularly noticeable as a general trend in the United States.

Along with body weights, we can look at changes in body fat percentage and overall fitness levels. Here, we also see that over time, body fat percentage has gone up, and fitness levels have gone down.
Currently in the United States, the average body fat percentage for men is around 28%, and the average for women is around 40%.
For comparison:
·       In general, 11-22% for men, and between 22-33% body fat for women, is considered a “healthy” range.
·       Lower than that is still “healthy” (to a point), but generally considered “athletic” or “lean”.

Does increased sugar consumption explain body weight trends?

Could sugar be responsible for changing body weights and body compositions in industrialized countries?
By reviewing data from the USDA Economic Research Service, National Health and Nutrition Examination Surveys (NHANES), as well as Food Frequency Questionnaires from the long-running Framingham Heart Study, we can track food intake from multiple angles. These varying streams of data all show fairly consistent trends.
They tell us that, since 1980, Americans:
·       Continued to eat the same total amount of fat.
(Though they generally ate less naturally-occurring fats, like in whole fat dairy, and ate more added fats, like oils.)
·       Ate more carbohydrates.
(Especially refined ones that included added sugars.)
So, as a percent of total calories consumed, fat dropped. But we didn’t end up eating less fat. We just added more sugar and other carbs on top of the fat we were already eating.
This added up to approximately 200-400 extra calories per day.
In terms of calories, that’s like eating an extra McDonald’s hamburger or a double cheeseburger, on top of your existing meals, every day.
Whether those calories came from sugar is probably irrelevant.
This increased energy intake alone, combined with decreasing rates of daily physical activity, is probably enough to explain people getting heavier.

Bottom line here: No single thing — including sugar — causes obesity.
Many factors work together to contribute to a consistent energy (calorie) surplus, which ultimately leads to fat gain. One of those things is often sugar, but not always, and not alone.

What to do next:

1. Recognize that health concerns are more complex than a single smoking gun.

The fitness and nutrition industry loves to say that one factor is responsible for everything (or that one magical food / workout / mantra will cure everything). It also loves to over-simplify and moralize (e.g. this is “bad”, this is “good”).
You don’t have to understand physiology to grasp the idea that things are complex.
There are many factors that go into good health, athletic performance, physical function, and wellbeing.
This means you should…

 

2. Begin with fundamental behaviors.

Sugar is one part in a much bigger puzzle.
Review this checklist and see how many of these fundamental behaviors you do well and consistently. That means every day, or most days:
·       Don’t smoke.
·       Eat slowly and mindfully.
·       Eat enough lean protein.
·       Eat 5+ servings of fruit and/or veggies per day, ideally colorful ones.
·       Eat some healthy fats.
·       Get some movement for at least 20-30 minutes a day.
·       Get 7-9 hours of good-quality sleep every night.
·       Reduce stress.
·       Spend time with people you love, and/or who support you.
·       Do things that are meaningful and purposeful to you.
These are all behaviors that we know for sure are health-promoting and disease-preventing.

3. Become aware of your overall energy balance.

Take a clear-headed look at how much food you’re eating for your body’s needs, and how much activity you’re doing.
Are you eating the right amount for your physiological requirements?
If you’re heavier or carrying more body fat than you’d prefer, you may need to adjust how much you are eating and/or exercising.
This may mean lowering your sugar intake, and/or it may mean eating a little less of other foods overall.

4. Become aware of what’s in your food.

Read labels. Sugar lives in processed foods, even foods you wouldn’t expect (like salad dressings or frozen dinners).
Better than reading labels, ask how you can eat more foods without labels. (Like fruits and veggies, beans and legumes, nuts and seeds, meats and seafood, etc.)
Transitioning to less-processed and less-sweetened versions of various foods is a simple way to lower your sugar intake and get the benefits of a better nutrient intake. Double win!

5. Maintain a healthy weight.

There is no single “healthy” weight. Your weight may be higher than average, or it may be within a “normal” range.
What is most important is that this weight is healthy for you (which you’ll know because all your indicators like blood work or athletic performance and recovery look good).
If you think you need to lose a little weight / fat to look, feel, and/or perform better, the good news is that you often don’t need to lose very much to see metabolic benefits.
You don’t have to be super-lean… and in fact, many people won’t benefit from trying to do that anyway.

6. Be mindful of your overall eating patterns, habits, and perspectives.

Consider…
·       Are you eating slowly and mindfully? Can you stop when you’re satisfied?
·       Are you using sugar-rich foods as a “treat”? How often?
·       Do you feel “deprived” if you don’t “get” to have sugar?
·       If you have a sugary food, can you stop eating it when you’ve had “enough”? Is there an “enough” with some foods?
·       How does sugar fit into your life and overall habits? Is that working for you?

7. Keep it in perspective. Add “treats” in moderation.

Around here, we keep it real.
We like “treats”, “junk food” and tasty stuff just as much as anyone else, whether that’s a glass of wine, a bowl of ice cream, or a hot dog at the ball game.
We just keep the portions moderate and don’t have “treats” for breakfast, lunch, and dinner every day.
For most people, a little bit of sugar fits just fine into an overall healthy diet pattern.
If you’re looking for numbers, we suggest you shoot for including “treats” or other discretionary indulgences at 10-20% of your meals. If you eat 3 meals a day for a week, that means about 2-4 of those 21 meals might include something fun or “less nutritious”.

8. Ask yourself what works for you and what doesn’t.

If you struggle with sugar (for instance, if it makes you feel ill, or you feel like you can’t eat sweet foods in appropriate amounts), then it’s probably not a good food for YOU.
Try experimenting with lowering your sugar intake gradually (for instance, by making simple substitutions like drinking water or seltzer instead of soda), and see what happens.
Look for foods that you love, and that love you back — that make you feel good and perform well, that give you sustained and long-lasting energy, that keep your moods level, and that keep you feeling “normal” as an eater.

9. Use data.

Track your health and physical performance indicators.
Schedule regular medical checkups.
Look at stuff like how you feel, how your mood is, how you sleep, how your bloodwork looks, how well you recover from workouts (and life in general), etc.
Follow the evidence. If everything looks stellar, keep doing whatever you’re doing.


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