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BOSTON -- A cap-and-trade approach to added sugars may eventually help drive down obesity and type 2 diabetes rates, researchers reported here.
A mathematical model of the strategy projected that within 20 years, obesity prevalence would fall by 1.7 percentage points and the incidence of type 2 diabetes would drop by 21.7 cases per 100,000 people, according to Kristina Lewis, MD, MPH, of the Kaiser Center for Health Research, and colleagues.
They reported their findings simultaneously online in the American Journal of Public Health and at the Obesity Week meeting here.
The cap-and-trade strategy debuted in the U.S. in the 1990s in response to high levels of sulfur dioxide and nitrogen oxides released into the atmosphere as waste from the electrical power industry. The government placed a cap on the amount of sulfur dioxide that a company could produce, but allowed companies to trade pollution rights.
Thus, those companies that could afford to cut their emissions could sell their pollution rights to those companies that deemed it too expensive to cut their emissions on their own.
As long as the national cap wasn't exceeded, the government didn't intervene, allowing the market to work out the details on its own, Lewis and colleagues wrote in an earlier paper.
They noted that since the program's implementation, overall levels of sulfur dioxide emissions have been halved, and air and water quality have improved.
So Lewis and her colleagues investigated what would happen if this cap-and-trade approach to environmental pollutants was applied to the food industry with added sugars -- looking specifically at how such a policy could impact caloric consumption and obesity and diabetes rates, should manufacturers decide among themselves whether to reformulate their products or to buy and sell added sugar "emissions" permits.
They relied on data from the USDA, the U.S. Census Bureau, and NHANES to construct a mathematical model of a cap-and-trade policy that aimed to reduce added sugar emissions into the food supply by 20% over 20 years.
They found that this policy could substantially reduce obesity and type 2 diabetes rates -- driving down obesity prevalence by 1.7 percentage points and the incidence of type 2 diabetes by 21.7 cases per 100,000 people during that time period.
Racial and ethnic minorities would be expected to experience the largest declines in obesity prevalence and type 2 diabetes incidence, she added.
A sugar cap-and-trade could also avert about $9.7 billion in healthcare spending, they added.
Lewis said such a policy may produce larger health and cost benefits than other proposed policies such as excise taxes on added sugars or on sugar-sweetened beverages.
The FDA has proposed new food labeling in the U.S., and those updated labels require that manufacturers list added sugars. The last time nutrition labels were altered was in 2006 when the agency required trans fats to be added under total fats.
When they were released, nutrition and policy experts offered high praise, with renowned food policy expert Marion Nestle, PhD, MPH, of NYU, calling the label "a big step forward."
Much evidence in recent years has shown that added sugars pack extra calories into food and lead to excess weight gain.
A second study presented at the meeting found that Americans have been increasing amounts of added sugars -- although they may be on a downturn.
Elyse Powell, PhD, of the University of North Carolina at Chapel Hill, and colleagues looked at data from five nationally representative surveys of food intake from 1977 to 2010.
During that time, consumption of added sugars rose by more than 30%, from 228 calories per day to 283 calories per day.
However, daily caloric intake from added sugars peaked in 2004, she reported, and has since been on a slight decline.
She also noted that the top 20% of adult and pediatric consumers are eating 721 and 673 calories from added sugar per day, respectively.
Chris Ochner, PhD, of Mount Sinai Hospital in New York and a spokesperson for the Obesity Society, who was not involved in either study, said the updated labels come at a time when public awareness of sugar intake is at an all-time high -- which has implications for industry-wide reform.
"Finally, the public is catching on to the fact that sugar is everywhere, that it's dangerous, and that it's as bad if not worse for you than fat," Ochner said. "Some of the major players [in the food industry] have made vast strides" in diminishing their added sugar content.
Jason Block, MD, of Harvard, and a spokesperson for The Obesity Society, noted that while it's good to turn attention to the problem of added sugars, there must also be a focus on reducing overall caloric intake.
"As we work to address the issue," he said, "we also need to think about calorie density in foods. Foods that are high in sugars and fats and lower in water content provide excess calories per unit of weight."
Lewis disclosed no relevant financial relationships with industry.
- Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner