by James Walvin
In 2005, a specialist dental division of the Royal College of Surgeons stated it was ‘seriously concerned about the state of children’s oral health in England’. The reason was straightforward – almost one third of five-year-olds suffered from tooth decay, and the most common reason why 5–9-year-olds were currently admitted to hospital was because of dental problems – sometimes ‘for multiple tooth extraction under anaesthetic . . .’35
Notwithstanding the shortcomings in dental provision (some areas have no appropriate dental care for the young), the underlying problem is diet and parenting. Many parents remain astonishingly unaware of the need to encourage their children to adopt appropriate dental healthcare. Routine teeth cleaning, regular visits to the dentist, and attention paid to a child’s diet – as obvious as they may seem, these basic actions need to be encouraged. In the words of another report, ‘Parents and children should be educated about the risks of tooth decay and the importance of good oral health and prevention.’ Successful campaigns in Scotland and Wales had led the way, and England needs to follow suit. Local authorities were also urged to implement fluoride schemes where they are lacking. Most significant, perhaps, the report urged that ‘efforts should be made to raise awareness of the impact on tooth decay and explore ways to reduce sugar consumption’.
Behind all this lay some stark and indisputable evidence. Of the 46,500 children and young people admitted to hospital for multiple extractions, the largest numbers were aged 5–9, and dental decay was the most common reason for surgery on children in that age group. Despite three generations of national health cover, and in one of the world’s richest countries, children’s dental health was poor.
The problem was, however, uneven, with striking regional variations. Not surprisingly, the nation’s poorer regions showed the highest levels of poor dental health among the young.36 ‘The north-west of England (home to a string of struggling industries and the towns that sustained them) had much worse dental problems among children than the prosperous regions of the south-east of England. But everywhere, the basic point is simple, and bluntly stated by dental experts: ‘It is lamentable that tens of thousands of children need to be admitted to hospital when poor oral health is largely preventable. The cost of all this is an estimated £30 million.’37
Quite apart from the pain involved, children’s dental problems create other significant difficulties. They result in eating and sleeping problems, children missing school, and parents having to take time off work to take children to emergency dental appointments. Although it is accepted that oral health has improved since the 1970s – partly because of a number of educational drives and the impact of widespread fluoride programmes – one third of English five-year-olds continues to suffer from dental problems.38
So far, all this is at the level of dental treatment. More important still, however, is how to tackle the problem at source; how to eradicate the cause of poor dental health? How can dental decay among children be avoided, and thus avert painful and costly medical intervention? Medical opinion is once again unambiguous: regular tooth brushing; early examination by a dentist; and, critically, parents insisting on a healthy diet and limiting consumption of sugar or acidic food and drink to mealtimes. Even fruit juice is acidic and high in sugar, so parents should try to give young children only water or milk.’ Parents also need to be careful about medicines given to small children. ‘Use only sugar-free medicines if possible.’39
The historical irony here is striking. For 2,000 years, from the world of classical antiquity to the present day, parents have coaxed sick children to accept unpleasant-tasting medicines by adding honey or sugar to the medicine. Now, the received wisdom is that sweetness itself is a health issue.
Throughout all this medical discussion, it was abundantly clear that English children consume much more sugar than recommended by the medical authorities. Between the ages of four and ten, English children consumed 48lb (22kg) each year, the equivalent of 5,500 sugar lumps. The recommended maximum is 8kg – and even that is regarded as excessive by some.40 The danger is even greater for American children. The twenty-seven teaspoons of sugar they consumed in 1970 had risen to thirty-two teaspoons in 1996 – all of it added to their food and drink before they were even purchased.41 The major obstacle is the nature of modern drinks and food, and knowing if, or how much, sugar is used as an ingredient. The history of sugar (and other sweeteners), as we have seen, has traditionally been that of an additive. People simply chose to add sugar to their food and drink according to their taste. Today, however, most of the sugar consumed is added (and often in astonishing volumes) even before the meal or drink comes to the table. The end result is that sugars are to be found ‘in almost all food and are the most important factor in the determination of oral health. It is especially problematic in children who have become accustomed to sugar at an early age.’42
The list of food and drinks which contain sugar is broadly familiar, and most of them are promoted by clever and lavish advertising campaigns. That list has also grown ever longer with the industrialisation of foodstuffs and the complex process of refrigeration and chilling, to say nothing of the chemical experimentation on the various ingredients used. The obvious foods include sweets and chocolates, cakes and biscuits, fruit pies and puddings, breakfast cereals, jams and honey, ice cream, fruits in syrups, sweet sauces and ketchups. Apart from the famous carbonated, canned sodas, a range of other drinks have sugar added: fruit juices, cordials, sports drinks, caffeinated energy drinks and yoghurt drinks.43 Many of these items pass into children’s hands as snacks, as refreshments, as pacifiers – or when children themselves simply demand them. It was no surprise to hear the Director of Public Health England in 2015 stress ‘the need to urgently reduce the amount of sugary snacks and drinks in our children’s diets’.44 The main obstacle, however, is the massive power of a food industry that has come to consider sugar as a vital ingredient – especially in children’s food, and the millions of dollars and pounds spent on targeting children.
British children have long enjoyed a sugary diet (the poor, as we saw, traditionally relied on jam in the late nineteenth century), but the problem has become more acute and more damaging in recent years. Modern British children are thought to consume ‘thirty times the amount of soft drinks and twenty-five times the amount of confectionery they did in 1950’. The volumes of soft drinks consumed doubled between 1992 and 2004. It was as if post-war austerity gave way to a cornucopia of sugary drinks and food for children. These sweet temptations were dangled before children by a new and powerful advertising industry which had itself been transformed into a multi-million-pound business, especially via the explosion of TV and, in Britain, after the advent of commercial TV from the mid-1950s. Thereafter, TV became as much a means of advertising as it was of entertainment. By the early twenty-first century, the British food industry was spending £450 million a year on advertising – three quarters of which was directed at children. In 2001–02, for example, Coca-Cola spent £23 million, Walkers Crisps £16.5 million, and Müller’s pot dessert £13.15 million. Food advertising fell into four distinct categories: sugary cereals, confectionery, soft drinks and snacks (mainly crisps). On children’s TV, more than half of all advertisements were for food and drink. Critically, 99 per cent of that amount is to promote ‘junk food’.
On both sides of the Atlantic, a veritable tidal wave of subliminal ‘educational propaganda’ emerged, directly aimed at children.45 In the late twentieth century, Western parents were confronted by a problem never faced by earlier generations – an uphill battle to resist children’s demands for the sweet temptations dangled before them on their TV screens.
As huge as these British figures relating to food and drink advertising are, they are dwarfed by the data for the USA, even allowing for an American population five times larger than Britain’s. American children and adolescents form a major target for advertisers and their products – they watch one hour of adverts for every five hours of televis
ion viewing. In the course of a year, an American child will see 40,000 TV adverts – 80 per cent of which fall into four categories: toys, cereals, candy and fast foods.
It was in the very years that TV viewing boomed that obesity rates among American children tripled. In the late 1970s, about 5 per cent of US children were overweight or obese. By the early twenty-first century, that had risen to 35 per cent (boys) and 32 per cent (girls). While all critics accept that this was brought about by a multitude of factors, they broadly agree that advertising for food and drink played a critical role. Only the automobile industry spent more money on advertising than the US food industry – understandably, perhaps, when we realise that 12.5 per cent of all American consumer spending goes on food. More revealing still, the advertising industry specifically targets children and teenagers because they form a large and lucrative market. American teenagers currently spend $140 billion of their own money, and advertisers and their sponsors are keen to tap into that enormous spending power. It’s no surprise, then, that adverts overwhelmingly targeted at the young account for remarkable amounts of advertising money: $792 million on breakfast cereals; $549 million on soft drinks; and $330 million on snacks. All this – a treasure trove of dollars passing back and forth for foodstuffs – is in addition to ‘product placement’, with logos and signs for certain foods and drinks carefully located on toys, in videos and movies, on the Internet and in sports stadiums. More blatant still – and even less defensible – is the placing of the same drinks and foods in dispensing machines inside American schools. In the slightly opaque words of one team of critics, it is hard to deny ‘the existence of a relationship between media use and diet-related outcomes (namely, overweight and obesity . . .)’.46
TV has given millions of children an utterly new and almost irresistible commercial power. Dubbed ‘pester power’ by critics, children have been drilled (by clever marketing) to demand foods, drinks and ‘treats’ which serve little purpose except to quieten the babble of children’s noise, and swell the coffers of advertisers and food and drink manufacturers. The irony is that the great bulk of children’s foodstuffs advertised in this way is both sweet and of little nutritional value.
A 2013 study of 577 food advertisements aimed at children revealed that ‘nearly three-quarters of them were promoting foods of “low nutritional quality” . . .’ By the late twentieth century, such foods came in an astonishing variety of shapes, colours, textures – many ready-made for ‘dunking’ – and most of them laden with sugar. Some breakfast cereals manufactured and aimed specifically at children consist of 50 per cent refined sugar.47 And it may surprise some that many of these products are apparently endorsed by an in-house, sponsored, scientific expert (dentist, doctor or researcher), whose name and approval is appended to the bottle, package or carton. It is a curious giveaway. Why should manufacturers need such support and approval, unless they face doubtful or sceptical consumers? Why even need to claim that the food or drink is healthy?
The background to all this is, of course, the serious food and health crises of the past generation – some of them catastrophic. But all of them stemming from endemic flaws in the way food is produced by the modern agri-industry. The British disaster of BSE (‘mad cow disease’) from the late 1980s; a crisis about salmonella in eggs in 1988; the British foot-and-mouth epidemic of 2007; dioxin found in Belgian sheep; and more recently, horse meat masquerading as beef . . . the list is depressingly long, and has had a corrosive effect on consumers’ confidence in the food they bought or were served. Yet equally troubling was the related transformation in diet brought about by the food-processing industry. A range of scientists toiled long and hard in the service of major food and drink manufacturers to create tastes, flavours and sensory feelings in a wide range of drinks and foodstuffs. Their efforts have been incorporated into (and, in some cases, totally displaced) the basic foodstuffs we buy. And sugar and other sweeteners have been at the heart of this entire process. Colours that are merely chemical creations, flavours conjured up in the laboratory, tastes that originate solely from chemical experiments – all this and more is the story of processed food and drink. And hovering over the entire issue is the contentious question of genetically modified crops.
The end result has been the evolution of a distorted human diet. Nutritionists are generally agreed that a balanced diet should consist of 50 per cent carbohydrate, about 15 per cent protein, and no more than 3 5 per cent in fat. But the revolution wrought by food processing has significantly affected these ideal proportions, with the modern diet for many being more likely to consist of 45 per cent carbohydrate and 40 per cent fat. Moreover, the carbohydrates we consume tend to consist not of starch and fibres, ‘but of sucrose, fructose and glucose – monosaccharides – or simple sugars’. The sugars we consume – spooned into our beverages, dissolved into fizzy drinks, and baked into confectioneries, sweets and treats all provide up to 20 per cent of our total energy intake. But they form ‘empty calories’, and are devoid of minerals, vitamins and other ingredients present in non-processed foods.48
This entire phenomenon has been promoted by an advertising blitz of unprecedented ferocity and ingenuity. And the barrage of commercial propaganda promoting sugary foods that are nutritionally dubious reminds one of another product that shares a similar story – tobacco. Defenders of sugary drinks and foods were quick to trot out the defence of ‘personal responsibility’ in matters of consumption. Should it not be the individual’s right to choose what to buy or not? The promotion of sugar-laden food and drink has begun to look remarkably like the activities of the old tobacco lobby. They, too, had fallen back on arguments about individual choice. Now it was the turn of sugar and food – shouldn’t parents be free to choose what their children eat and drink? And shouldn’t they be able to resist their children’s shrill demands for sweet breakfasts, juices and snacks? Such questions form a cynical deception – a fraudulent pretence to mask cleverly devised promotions of goods which do little but fatten and rot. The old tobacco lobby must recognize the familiar strategic manoeuvring when they see and read protestations issued by defenders of sugar and the food industry.
* * *
When the data about obesity began to make a serious impression in the latter part of the twentieth century, it prompted growing concern about sugar which evolved into a major assault on the use of sugar in food and drink. It was an assault which also targeted all the major agencies thought to be responsible for the global rise of obesity. But it prompted an inevitable counter-offensive by the food and drink industry and its lobbyists. In the USA, where that industry wields enormous commercial and political influence, lobbyists were hugely successful in rallying legislation to head off any damaging legal attacks. They knew, from earlier experience, that punitive legal cases might be heading their way. So they launched a pre-emptive strike.
In 2004–05, the US House of Representatives approved a bill with a curious but revealing title: ‘The Personal Responsibility in Food Consumption Act’. The ‘Cheeseburger Bill’, as it became known, was designed to absolve the fast-food industry of all blame for people who became overweight via their diet, to shield the food industry ‘from being sued by obese consumers’. What lay behind this bill was the recent experience of the tobacco industry. The food and drink industry was fearful of the fate of the tobacco industry which had been hit in 2004 by the threat of astronomical damages – totalling $280 billion – for the health damage caused by tobacco. Though the award was later struck down by a superior court, the lesson was not lost on the coalition of interests which lay behind the fattening diet of millions of Americans.
Despite the tobacco industry ultimately dodging culpability, by 2004 a crucial link had been established in the USA – obesity, and especially the role sugar played in the process, was being widely compared to the impact of tobacco. Whatever short-term victories of the sugar-food lobby, and however obstructionist their political allies in Congress, the tide had begun to turn against sugar.49
In large measure, the tide had begun to turn because attention had shifted away from the USA. As long as obesity was considered to be essentially an American problem, it seemed both contained and isolated. Clearly, no one can any longer doubt the depth and extent of American obesity. But that had initially served to deflect attention from the global problem. By the early twenty-first century, however, it had become abundantly clear that obesity was not solely an American – nor even a Western – problem. The human desire for sweetness, and the power of sugar producers, food and drinks manufacturers, and advertising agencies to satisfy that craving were all combining to produce a health crisis of global proportions. But what else was responsible for driving growing numbers of the world’s population towards the dangers of obesity?
14
The Way We Eat Now
IN THE YEARS when people were buying less sugar for use in the home, the food and drink which came to dominate the dining table (or on the tray in front of the TV) were laden with hidden amounts of sugar. Anyone keen to avoid sugar in their food had to study the contents printed on the packaging. Moreover, that information was only made available by manufacturers after a prolonged rearguard battle against campaigners who demanded to know exactly what ingredients, and in what proportions, go into the foods we eat.
Today, there is scarcely a mass-produced item that arrives on the supermarket shelves without the addition of sugar. Foods which we would never associate with sweetness are prepared with a range of additives, and most notably with sugar. The presence of sugar in industrialised foodstuffs arose from two major factors. First, the long-term history of mankind’s taste for sugar; and second, and more immediately, the more recent development of scientific analysis of food and human taste. Although sugar has been embedded in the human diet for centuries, that relationship changed – quickly and unpredictably – in the late twentieth century, and it did so on the back of modern nutritional science working in league with new, high-powered food industries and their relentless promoters in the modern media.