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Sugar is Not the “New Tobacco”
As an endocrinologist who is also an anti-smoking advocate, seeing the title "Are sugar-sweetened drinks the new tobacco?" on the cover of my April 2018 CMAJ immediately drew my ire. While "orange is the new black" or "fifty is the new forty" [I hope so!] may be harmless commonly-used axioms, we, as medical professionals, should be more careful when publicly drawing equivalencies in matters of public health. The increasingly common comparison of obesity and sugar (or other "unhealthy" food substances) to smoking and tobacco is an important example of such.
According to Health Canada, smoking remains the leading preventable cause of death in Canada (and worldwide) killing more than five times traffic injuries, alcohol abuse, murder and suicide combined [1]. Obesity, diabetes, dyslipidemia, and hypertension are appropriately excluded from that assessment because they are not in the same sense preventable conditions. They are continuous variables, defined using somewhat arbitrary cut-offs, and cannot be avoided via a single decision or action such as never starting to smoke, wearing a bicycle helmet or outlawing assault weapons. They are much better thought of as modifiable risk factors. Healthy eating is the sum of innumerable decisions that need to be made multiple times daily over an entire lifetime by every one of us, none of which are ever absolutely right or wrong. Making the distinction between truly preventable and only modifiable behaviours is crucial when considering the appropriateness of public health policy measures such as disproportionate taxation or bans.
Comparing the responsible substances themselves further illustrates the above points. Tobacco is an addictive poison, without any benefit to individuals or society, that only a minority use. The fact that smoking it not only harms oneself, but also everyone around you, as well, is actually the strongest moral justification behind our efforts to oppose it. On the other hand, sugar is one of the most indispensable substances of life. We all consume it in some form daily. We all have at least occasionally enjoyed a sugar-sweetened beverage, which can easily be a component of a healthy lifestyle, and in some cases (while exercising or if hypoglycemic) may actually be the most appropriate caloric option. At worst, the choice to consume it only harms oneself, making efforts to restrict or stigmatize it, although worthy of debate, certainly at minimum paternalistic. It follows that while the tobacco industry can never be a true partner for health, the food industry, if carefully overseen, can be.
Modern society's obesity epidemic is unquestionably one of today's greatest public health challenges. However we should avoid trying to address it through the use of technically and morally off-target analogies to our very unfinished business with tobacco. In fact, maybe the most disturbing and dangerous aspect of the title chosen is its false implication that tobacco is yesterday’s news, and has been successfully dealt with.
1. https://www.canada.ca/en/health-canada/services/health-concerns/tobacco/... accessed Apr 20, 2018
Stuart H. Kreisman, MD
Physicians for a Smoke-Free Canada
Div. of Endocrinology, St. Paul's Hospital
Clin. Asst. Prof., University of BC
301-1160 Burrard St.
phone 604 681-3501
fax 604 681-4508
[email protected]