Claire Meek from the University of Cambridge, UK, reviews “Fat Chance: The Bitter Truth about Sugar” by Robert Lustig.
As an obesity researcher and metabolic physician, I seem to spend a lot of time giving lifestyle advice to patients with diabetes, dyslipidaemia and obesity. This is perhaps the most stimulating but challenging aspect of my work. We see many examples of people who have never really engaged with behaviour change and many who have tried hard but failed to achieve any meaningful outcome. So, how do we encourage real, life-changing and long-lasting behaviour change in our patients? When faced with many disappointments, can it even work?
Robert Lustig alludes to this point in his new book, ‘Fat Chance’ which highlights both the essential nature of individual behaviour change while also demonstrating its limitations. Lustig spends most of the first half of the book explaining why behaviour change alone is so difficult. Our bodies have multiple adaptations to protect our body weight and we do not relinquish it without a fight. This battle is waged day by day in our guts (gut hormones) and our brains (leptin) making sustained weight loss incredibly difficult. Lustig clearly believes that individual behaviour change, while important, is inadequate to fully tackle the global obesity epidemic. To a large extent, I agree with this. Our behaviour is determined by many things, including nature, nurture and our response to the environment we find ourselves in. The Moriarty orchestrating this disaster, according to Lustig, is a food environment which has changed dramatically over the last 50 years in the Western World, in parallel to the rise in obesity, and Lustig argues that tackling this aspect of our culture should be a greater concern. Lustig believes that Moriarty’s major weapon is fructose, a breakdown product of the sucrose (table sugar) molecule and a major component of high fructose corn syrup. Regular readers of this blog will already know my thoughts on sugar (see Sugar: A Popular Poison?) and Lustig’s opinions here seem reasonable.
Lustig does not neglect the human cost of obesity, using a series of vignettes about patients from his paediatric obesity clinic to highlight the scale of the problem. As an adult obesity physician, I found these vignettes fascinating. The US CDC estimates that 12.5 million (17%) of US children and adolescents aged 2-19 years are obese with around 2% of the population (almost 1.5 million) suffering from morbid obesity. This is staggering. Rates of obesity are also climbing in children in many other countries worldwide. Obesity ruins lives. Obesity reduces quality of life and sometimes, length of life. This is perhaps most apparent in children, who are particularly susceptible to an adverse food environment and less able to make independent, healthy choices. It is interesting that in many countries, the marketing of cigarettes to children is forbidden, but marketing of unhealthy foods in not. Unfortunately, we are likely to see many lives ruined through uninterrupted access to high sugar, high fat foods.
Who is really in control of this situation? Lustig argues that the food industry controls our food environment. Over the last few decades, a trend to enhance food affordability has resulted in a reduction in the health benefits of food. The food industry has supported this and received huge economic gains; unfortunately, it is easier to make a profit on hamburgers and cookies than on apples and bananas.
So, did this book help me give lifestyle advice to my patients? No, but it helped me think more about the concept of a food environment and about the importance of regaining control over the food we access. After all, the food we access becomes the food we eat.
“Fat Chance: The Bitter Truth About Sugar” by Robert Lustig is published by Fourth Estate, ISBN: 978-0-00-751412-0
The author declares no conflict of interest.
Books reviewed in Speaking of Medicine are independent of the book’s publisher. Reviewers do not receive a fee but are allowed to keep the review copy of the book.