This is what obese patients tell us. The question is, is sugar addictive . Has anybody seen this movie . Ive got another clip. Im hoping this one works. Yes. [indiscernible] im feeling really, really sick and unhappy. I started eating and over eight. Over ate. I felt so good, it was crazy. Now, does everybody know the story . Morgan spurlock was a vegan because his girlfriend was a vegan chef. He started eating mcdonalds for 30 days nonstop every meal. This is day 18. He just described withdrawal. It can happen to anybody. If you down regulate those dopamine receptors, youre going to need a bigger hit in order to do that. That is called abuse. Finally, externality, in negative impact on society. Societal intervention says that your abuse of a substance has to affect me in a negative way for us to regulate it. For instance, nobody is saying we should regulate caffeine. Your use of caffeine does not affect me. If you smoke or drink or take drugs, that is bad for me, because of Secondhand Smoke, Car Accidents, declining housing prices when your house turns into a coke den. Also Work Productivity and absenteeism. These are the reasons we regulate these substances. How does your obesity affect me . 274 million extra for jet fuel. That doesnt quite do it. Discomfort on the subway . Sinking of boats due to the weight . 2003, the late george very ferry coded for 25 190pounded else, and the ship capsized. It aint going to do it. A 65 billion decrease in Work Productivity. A 50 increase in Health Insurance premiums. Currently, we are at 2750 per employee for obesity, whether the employee is obese or not. It is breaking the bank. Employers know this is unsustainable. We spent 245 billion for diabetes. That is one third of the entire medical budget, for diabetes and dementia. Obesity is a threat to national security. On a seven percent of recruits cannot pass the physical education exam 27 of recruits cannot pass the physical education. The government pays twice, for corn subsidies and er visits. We are going to take 30 to 6 32 million sick people onto the rolls, and we cannot stop the heart attacks or the dementia. It is going to break the bank. Medicare will be broke by the year 2026. This is why your obesity affects me. We have toxic substances that are not abused. Everything is toxic in the right dose, even water will kill you. Here are some substances that will definitely kill you. Iron, vitamin d, oxygen, pseudoephedrine, water. These are all toxic substances that are not abused. We dont have to regulate them. We also have abused substances that are not toxic thomas like caffeine. Nicotine, until the towers are added. You can buy nicorette gum and walgreens, and it is no problem. When you have toxic substances that are abused, now youve got a problem, like morphine, heroin, amphetamine, cocaine, and ethanol. Guess what . Sugar meets all the same criteria for all the reasons i just laid out for you. The question is, what are we going to do about it . The American Heart Association says, this is a problem. They said i contributed to this scientific statement, that we currently consume 22 teaspoons of added sugar per day. We need to reduce that to nine teaspoons per day for males and six teaspoons per day for females. That is a reduction by two thirds to three quarters. Is that achievable . Can we do that in America Today . What does the sugar industry say back to this, what is the politics of this . Here we go. What they say is fructose for glucose exchange studies showindifference, and if you look at issa caloric were you just change the fructose for the glucose at the same level of of calories, you see no change. That is what they point to. If you look at hyper caloric trials, people over consuming, which is what we all are we are over consuming by 275 calories per day you start seeing these effects. That is what we are dealing with. What they say is, everybody, eat moderately. The problem is, you cannot eat moderately because it is being abused. We are all addicted. They also say it shows a muslim indifference, but the problem is, oral fructose absorbs poorly. The amount of factors that goats turned into liver fat is quite low. It is not fructose for glucose. It is fructose and glucose. Sugar and High Fructose Corn Syrup is sugar is fructose and glucose. When you do the studies with fructose alone, you dont get much. And you do them together, not a liver fat jumps and triples. If you double the amount, it goes up six times. The more sugar you consume, the lower liver fat you make, especially in the hypercaloric state, which is what we are all in. This is a problem. They also say, fructose doesnt raise blood sugar. It has a low glycemic index. Who here knows about glycemic index . So, the glycemic index is the amount of blood sugar rise that 50 grams of carbohydrates will give you. That means the amount of insulin rise that will come with that. Fructose doesnt stimulate blood glucose. Why . It is fructose. It stimulates fructose instead. The question is, is that dangerous by itself . The answer is, absolutely yes. It causes cardiovascular disease by itself, because it binds to the proteins in your arteries and causes them to become less flexible. That is what starts the foam cell process. It has nothing to do with your blood glucose. A little fructose has been shown to improve insulin secretion, like alcohol, but that is dose dependent. As long as you stay under that goes, it is ok. The problem is, we are over that goes by a lot. Information on total sugars is available on the food label for everyone to see and for everyone to make their own judgment choice. It is the nanny state arguments. That is not really true. Here is why. The nutrition labeling and education act of 1990 lists total sugars. That includes glucose, galactose, and fructose, altogether. That is how it works. The reason is, they dont want to tell you about added sugars. They want to obfuscate what they have added to the food, because they say that that is proprietary. If we told all of our customers how much added sugar we put in all of our foods, processed foods, our competitors could duplicate our recipes. This is proprietary information. You cant know it. That is a problem. Yogurt is a perfect sample. Example. How many grams of sugar in it, granite yogurt . Does anybody in a pomegranate yogurt . 19. Many of those are lactose and how many of those are added sugar . You cant know. You are not allowed to know. How many grams of sugar are there in a plain yogurt . Seven. That means that 12 grams of added sugar to that pomegranate yogurt. That is the same as a bowl of captain crunch. When you have a pomegranate yogurt, youre having plain yogurt plus a bowl of captain crunch. Are you ok with that . Is that what you bought it to . Is that what you expected when you purchased that item . Yogurt is supposed to be healthy. Not only that, but there are 56 names for sugar. That is on purpose. They do not want you to know that sugar has been added. Yogurt is a perfect example. Evaporated cane juice. Does anybody know what that is . [laughter] what happens when you evaporated cane juice . You get sugar. Evaporated cane juice is not a sweetener by the fda. Ecj is not one of them. This is ms. Branding could 30 of foods and the American Grocery store today are 30 of foods and the American Grocery store today are misbranded to keep you from knowing what is going on. Here is the list of the 56 names in case you thought i was a little hyperbolic. The question is, where is the sugar, and what foods . One third of the sugar we consume is and beverages. We know about those. 16, desserts 1 6, desserts. That means fully one half of the foods that have sugar we didnt know had sugar, like salad dressing, yogurt, and mayo sauce, crackers, other products, all things we didnt know. Does anybody like wheat thins . Check it out. [laughter] and next, they say, we were wrong about that. We also do, fat was bad, and now you are telling me, it is sugar. What makes you think you are right now . We need more research. Indeed, we do. I dont argue that. Do you know what that is called . That is called the pessimistic metainduction theory. Look it up on wikipedia. This says that whatever we thought 10 years ago is already wrong hum and whatever we think today will be wrong 10 years from now. True. I have seen these cycles come and go in medicine. The question is, why should we do anything if everything is going to be wrong anyway . Why should we change anything . Do you know what that is . That is moving the goalposts. That means we will never do anything. It means we might as will stick with the dogma of the day, because everything will be wrong. Ask galileo. That is what they wanted to do with him. The question is, what level of proof do we need in order to make change . 90 of what we know today in medicine today is causal medical inference. Only 10 is scientific proof. But the Food Industry says we need scientific proof to make any change. Why . Because they know we will never get it. Finally, regulation is tantamount to the nanny state, like michael bloomberg, the nanny. That fact is, we have already been told what to eat. It is too late. Everyone says, keep your hands out of my kitchen. Fact is, your kitchen has already been invaded and you have already been told what to eat. Of the 600,000 items in the american supermarket, 80 have added sugar. Added by the Food Industry for their own purposes, not for yours. Youve already been told what to eat. This is not about big brother. Big brother is here. So the big question is who do you want in your kitchen . Do you want government, who will take your money and your freedom . Or do you want the Food Industry, who has already taken your money, your freedom, and your health . That is your choice. Everything else is a false choice. And the question is how does the Food Industry stay where they are . Well, this is published by michelle simon, a former graduate of uchastings, and a former research associate. And now a word from our sponsor. And and is very specific academy of nutrition and dietetics. Are americas nutrition professionals in the pocket of big food . That is who is paying their bill. How about this . Coopting health professionals. I give a talk at the American Academy of pediatrics in october, 2009, and i had this slide. And the American Academy of pediatrics said if you show the slide, we will not let you on the dais. I had to take it out, but im showing it now. Here is what has happened to our food dollars. 1982, 30 years ago, 2012. Meat down 10 , because we were told to go lowfat. Fruits and vegetables exactly the same. Everyone tells us, we need to get more. We are eating all the fruits and vegetables we can. Grains and baked goods. Up 1 . Not even a big deal. Dairy products down from 13 to 10 because we are all lactose intolerant. Finally, processed foods and sweets. 11. 6 to 22. 9 , a doubling in 30 years. That is where the money went. That is what you are paying for, and that is what is causing the chronic metabolic disease youre looking at. And this is a war, because what is good for them is bad for us. Whats good for us is bad for them. There is no middle ground. Its a war. The question is whos winning . Here is the stock price of the s p 500 against mcdonalds, coke, and pepsi for the last five years. Here is the economic downturn of 2008. Mcdonalds, coke and pepsi are doing quite well, thank you. And here is monsanto, hormel, adm, general mills, con agra, procter and gamble, kraft, they are all doing better than the s p. If you want to make money, invest in a food company because they have a winning formula. They have a formula that cannot miss, because it is legal and addictive. The problem is, we are all dying in the process. So this paper just came out a couple of months ago in lancet. Profits and pandemics. The prevention of harmful effects of tobacco, alcohol, and ultraprocessed food. They make the argument, and i subscribe to this, that we use to practice old medicine which was about infections. And the vector was microbes. That is what i learned. Now the new medicine is Something Else entirely. It is about chronic disease and the vector is multinational corporations who have figured out how to game the system. Now, what are we going to do about it . This is a Public Health problem, and that means we need a Public Health solution. Take a look at all of these diseases. Every disease on this list was a personal responsibility issue before the sheer gravity of the problem made it a Public Health crisis. As we talked about hiv, as an example. How about guns . Is that a Public Health problem . Except that it is a personal responsibility problem, isnt it . Depends who you ask. If you asked the Supreme Court, it is a personal responsibility problem. But its not. It is a Public Health problem. And i would put sugar right down there as well. So here we have with the government is doing right now. It is called the lets move campaign. Michelle obamas campaign to try to reduce obesity in a generation. What she says his focus on individual, focus on the family, and focus on the community. But she leaves government and the Food Industry out. Now, anybody remember her very first speech after lets move was rolled out in 2010 . It was to the Grocery Manufacturers Association of america. And she pointed directly at them, just as i am to you right now, and said, this is your fault. You see this on youtube. This is your fault, and you have to come up with a solution. She never said it again. Not once. Why is that . Why . Shes been muzzled by her own administration because they do not want this fight. And i know they do not want this fight because they told me they do not want this fight. Sam caste is Michelle Obamas personal chef and her point person to her obesity task force, and he told me after reading the New York Times article, everyone including the president said they are in agreement and they will do nothing about it, not a wink, not a nod, because they have enough enemies. That is what this is about. And youll notice, anita dunn who founded lets move now lobbies for the Food Industry. And now a word from our sponsors. The question i will leave you with can our Food Environment to change without government or societal intervention, especially for potentially addictive substances . Did just say no work . Does education work for substances of abuse . The answer is no. Question two can we afford to wait when health care will be bankrupted to chronic metabolic disease . We have got 13 years, people, and we have to do something now. Not wait for more research. We have the research. We have what we need. Policy what do we do . There is called targeted prevention. That is treat the patient, right . Treat the obese person. Except for one thing. Weve just learned that there are more nonobese people who are sick. It is targeted to the individual. The benefit to risk ratio is high. The weaknesses is the medicalization of prevention, which is hard. Behavior medication, which is impossible. Cost feasibility and limited success across the board. But it is not targeted. It is Public Health prevention we need. What are the strengths there . It is radical. It is going to work because we will make it work. Its powerful, because everyone is onboard. Environmental modification, fix the environment, not fixed behavior. That is what our data show about obesity, fix the environment. The limitations are the libertarians, limitations of acceptability, the feasibility, and cost. What can we do . We could tax and restrict access and intervene. I am not suggesting we intervene. We tried that with alcohol. It was a disaster. You cannot have storm troopers invading peoples homes for baking an apple pie. That is not going to happen. I do not even suggest it. Because my wife would be the first one they would have to take away. What we need to do, like we have with every other substantive abuse is come to peaceful coexistence. We have to find the right amount of legislation, regulation to be able to manage the problem rationally, like we tried to do with tobacco. We can argue about the wisdom of that, especially worldwide, and alcohol. No interdiction but plenty of taxation and restriction of access as needed. So what factors contribute to increased soft drink consumption . Price. Since the 1980s, the price has and the introduction of High Fructose Corn Syrup, the price has only increased 50 versus food. Food has gone up higher than sodas have. Sodas increased only 20 against fruits and vegetables. We are supposed to be eating fruits and vegetables. Sodas are cheap and fruits and vegetables keep going up because they are not subsidized. Weve allow the serving size to rise. In most developing nations, soda is cheaper and safer than water. Until Potable Water is cheaper than soda, we cannot solve this Global Health crisis. I totally agree with that. Access. What is available worldwide, especially in schools. 50 of flavored milk, that is chocolate milk, is available in schools. And marketing. In 2006, food marketer spent 1. 05 billion to marketing, half for soda, to children and adolescents. The question is our children a rational target . Is that acceptable . Why is alcohol so relevant to this question . I think the analogies between sugar and alcohol are very strong. And we should look to alcohol control policy. And my colleague and i and allen taylor, a visiting professor at georgetown, are planning to write a book on exactly this shortly. Both are nutrients, but aside from energy they have no health value. Metabolic and central pathways in the brain are similar. Both are substances that produce when overused. There is little danger from moderate consumption. The problem is what is moderate and how do you keep things moderate when they are abused . And the burden of harm falls disproportionately on the poorest people who can afford the problem least. Here are the strategies that have actually b