Sugars and obesity: Is it the sugars or the calories?

Abstract

Sugars containing fructose are emerging as the dominant public health targets for their role in the epidemic of overweight and obesity. This position is largely supported by ecological observations, rodent models of overfeeding and select human trials. Higher level evidence from systematic reviews and meta‐analyses of controlled dietary trials has yet to show convincingly that fructose‐containing sugars behave differently from any other forms of energy (especially refined starch and fat). Prospective cohort studies, which provide the strongest observational evidence, have shown an association between risk of overweight and obesity and fructose‐containing sugars consumed as sugar‐sweetened beverages but not as total sugars or other important sources of added sugars such as cakes, pastries and sweets. Comparative analyses show that high intakes of other highly palatable foods such as refined grains, processed meats, red meats, French fries and potato products, as well as physical inactivity may play an equal or greater role in weight gain and the risk of overweight and obesity. The contributions of these factors are also difficult to disentangle from that of sugar‐sweetened beverages owing to their collinearity with sugar‐sweetened beverages as part of a Western dietary pattern and lifestyle. Attention needs to remain focused on decreasing overconsumption of all foods associated with overweight and obesity. Sugar‐sweetened beverages and foods are certainly an important place to start but should not draw attention away from the issue of overconsumption in general.

Eating dependence and weight gain; no human evidence for a ‘sugar-addiction’ model of overweight

“…The current study extends these findings by indicating that an increase in BMI as a function of YFAS symptoms is most profound in individuals that attribute such YFAS problems to combined high-fat savoury and/or high-fat sweet foods rather than sugary and LF foods. This also fits the average findings from prospective cohort studies showing that HFSA foods play an equal or even greater role in weight gain and/or risk for obesity than sugar itself or HFSW food sources enriched with sugars (25). In addition, there nowadays exists consensus that palatability and/or energy density of food is a more determining factor for food intake and/or the risk to binge rather than that a particular type of macro-nutrient directly causes obesity.…”

“…This then has boosted the proposition that the animal model of sugar-bingeing provides valuable insight into the mechanisms involved in the onset and course of human obesity. Yet, ample evidence from human (and animal) studies fails to support the assumption that sugar differs from fat or other carbohydrates in equi-caloric amounts in increasing risk of overweight and obesity (25,(57)(58)(59). Furthermore, trends for dietary sugar intake are in decline (60) whereas the prevalence of overweight and obesity is clearly rapidly increasing.…”

“…Although rodent research may generate meaningful hypotheses for understanding human behavior, their translational value for human eating behavior, food addiction and binge eating or obesity is highly controversial in the current scientific community (20)(21)(22)(23)(24). Ample evidence from systematic reviews and meta-analyses of controlled human dietary trials do not support the assumption that a particular macronutrient like sugar causes binge eating and weight-gain more so than other food sources (20,24,25). Yet, in contrast to the available human evidence regarding the association between food and weight gain, the validity of the sugar-specific addiction model of binge eating and/or weight gain has only rarely been explored in human studies.…”

Lactose, Maltose, and Sucrose in Health and Disease

“…Sugar excesses are associated extensively with obesity. [ 7,16,19,28–30,38,39 ] A diet rich in fructose (including sucrose) does in particular, according to some authors, contribute to the onset and treatment‐resistance of obesity and obesity‐related complications. [ 28–30,37–39 ] Fructose and thus sucrose (over consumption) seem to be particularly problematic in terms of excess bodyweight and hence growing concerns over fructose utilization in drinks.…”

“…[ 7,16,19,28–30,38,39 ] A diet rich in fructose (including sucrose) does in particular, according to some authors, contribute to the onset and treatment‐resistance of obesity and obesity‐related complications. [ 28–30,37–39 ] Fructose and thus sucrose (over consumption) seem to be particularly problematic in terms of excess bodyweight and hence growing concerns over fructose utilization in drinks. [ 38 ] Later articles by some of the authors [ 30 ] are not so heavily focused on fructose but more generally on the reduction of dietary calories (in the form of soft drinks especially).…”