Excerpts from a Review of Sugar Intake, Obesity and Diabetes in India, by Seema Gulati and Anoop Misra; published in Dec 2014 Issue of Nutrients:
The most popular sweetener in the world, sugar, was invented in India.
There is a strong relationship between calorie intake and obesity. In India, the prevalence of obesity is increasing at a rapid pace due to an increase in energy intake owing to increased purchasing power and availability of high fat, energy-dense foods, along with reduction in the energy expenditure consequent to urbanization and mechanization. Parallel to the rise in overweight and obesity, the prevalence of metabolic syndrome and type 2 diabetes mellitus (T2DM) is also increasing in India, and has reached epidemic proportions. India has more than 65 million diabetics, second only to China worldwide.
The term “added sugar” is sometimes used interchangeably with “free sugar” but is considered to include sugars and syrups added to foods during processing, food preparation, or at the table, but does not include honey or fruit juices.
Sugar-sweetened beverages (SSBs) include the full spectrum of aerated drinks, fruit drinks, and energy and vitamin water drinks containing added sugars. Many of these beverages are sweetened with high fructose corn syrup (HFCS), the most common added sweetener in processed foods and beverages, and some with sucrose or fruit juice concentrates. The HFCS that is commonly used in beverages contains 55% fructose and 45% glucose, while sucrose or table sugar consists of 50% fructose and 50% glucose.
In the Indian context, available databases do not define sugars clearly; however, from the data breakdown it appears that “sugar” means white sugar, honey, or brown sugar but not syrups and “traditional sugars” such as jaggery (also called gur in India) and khandsari. These “traditional sugars” are produced from sugarcane in addition to sugar. Jaggery is obtained by boiling clarified sugarcane juice until a solid residue is left after evaporation. It usually contains 65%–85% sucrose and is also source of calcium, potassium, and iron. Khandsari is a finely granulated crystallized sugar that contains 94%–98% sucrose. It is less refined than sugar and retains some calcium.
SSBs constitute a significant contribution as the third largest industry in India after packed tea and biscuits, attracting direct foreign investment of over $1 billion in recent years. Production of SSBs was about 6.6 billion bottles in 2001–2002 in India. SSB sales in India have increased by 13% per year since 1998, exceeding 11 liters per capita per year. Easy availability of SSBs in rural and urban areas significantly contributes to higher per capita consumption. There is an increasing presence of dhabas (small shops) selling SSBs on all roadsides, particularly on highways. Furthermore, the beverages that people consume in India apart from SSBs like milkshakes, sweetened buttermilk, etc. are high in calories and glycemic load.
The consumption pattern of sweets and beverages is rapidly changing among children as well. Importantly, SSBs and other sugar-containing high calorie foods are easily available within and around school premises. Furthermore, the results showed that the consumption of food among children is influenced by television advertisements, peer pressure, and the “fashion” for consuming westernized foods.
To achieve a reduction in free sugar intake in India, concerted efforts are needed from all stakeholders including policy makers, government, consumers, food manufacturers, and other agencies involved in food production (food and SSBs). The most important among these is a firm political will that should specifically focus on curbing the rising prevalence of obesity, T2DM, and cardiovascular diseases in India. Some of the strategies to reduce sugar intake have been listed below. These proposed strategies will not only help in reducing sugar intake but will also have a meaningful impact in reducing the incidence of obesity and T2DM in India.
(1) Strict guidelines regarding sugar intake should be formulated.
(2) Spread awareness among consumers and the medical establishment regarding the ill effects of high sugar intake.
(3) Increasing taxation could be one of the strategies to curb increasing consumption of SSBs.
(4) Sale of SSBs should be banned in school premises. Healthy alternative drinks should be made available to children.
(5) Warning labels such as “Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay” could be mandatory for SSBs.
(6) Increase access to free, safe drinking water in public places, schools, and offices to encourage water consumption instead of SSBs.
(7) Restriction of advertisements for commercial foods on television (during prime time and children’s programs).
(8) Encouragement of transnational food companies to manufacture healthy snacks and beverages.
(9) Decrease taxes on and prices of fruits, vegetables, nuts, and other healthy foods.
(1) Inculcate healthy eating habits in children from early childhood.
(2) Instead of sugar and fat-loaded sweets, opt for fresh fruits for dessert. Raisins and dates can also be consumed to “sweeten the mouth” post meals.
(3) Avoid gifting sweets; instead go for nuts and fresh fruits, etc. The beneficial effects of nuts have been established for Indians.
(4) Cut down sugar in coffee and tea.
(5) Read food labels carefully. Avoid intake of processed and packaged foods as much as possible.
(6) Cut down on intake of sweetened SSBs. Instead opt for natural drinks such as clean plain water, water with certain herbs such as basil, mint, etc., coconut water, buttermilk, lemon water, etc.
You may read the full article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277009/
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