Jeremy Laurance: Health reforms? Americans should start with their diet

Medical Life

I had a "dining experience" in Washington last week – in fact several, at some of the city's best eateries. Butternut squash soup figured on several menus, served with citrus cream and cranberries in one restaurant. It was so sweet I thought they had made a mistake and started the meal with dessert.

One of the first things that strikes anyone on crossing the pond is the quantity of sugar in American cooking. Even the bread tastes like cake. I was on a 48-hour visit looking at Obama's health reforms – badly holed but not yet sunk – and my first impression was that it is the US diet that needs reform.

At almost every meeting, we were offered cans of soda, cookies, sweets, brownies. It was one (hundred) calorie(s) after another. Even on the city's grandest streets you can spot its effects – Michelin men (and women) so large you wonder at their capacity to move.

Sitting across a table from a $500,000-a-year chief executive of a hospital corporation slurping his can of lemonade made me wonder, not for the first time, about the role of the soft drinks industry in the obesity crisis.

Most sodas these days are made in versions with artificial sweeteners that pack zero calories and can thus claim the "healthy" label. Yet by conditioning the palate to expect sweetness, they fuel the appetite for excess calories. That is the drawback of so-called "diet" sodas – they do the opposite of what it says on the tin.

Consumption of fizzy drinks, fruit juices, smoothies and other sweetened beverages is soaring around the world and is recognised as a major contributor to obesity, especially among children. Americans are drinking twice as much of the drinks as they did 25 years ago, and they now contribute 172 calories daily to the average US child's diet. Experts say the UK is close behind.

Last year academics from Yale and Harvard universities proposed a "cola war", with a tax on sweetened beverages, raising the price of the average can of cola by 15 to 20 per cent.

That followed a report by the respected Institute of Medicine calling for an increase in local taxes on soft drinks and junk food. In the UK, the British Medical Association narrowly defeated a proposal for a chocolate tax at its annual meeting in 2008. Gordon Brown vetoed a plan for a tax on burgers and sweets in 2004, when Chancellor of the Exchequer, on the grounds that it would disproportionately affect the poor.

Economic sanctions, I suspect, are the only weapon likely to prove effective against increasing obesity – combined, perhaps, with economic incentives for those who successfully shed the pounds. How big must we grow before Governments decide to act?


The General Medical Council is often accused over the snail-like progress of its disciplinary process. But in the case of Andrew Wakefield, the doctor who sparked the MMR scare, has it done us all a favour? Last week's preliminary verdict was expected two years ago. Had it emerged then it might have provoked a much stronger reaction – and done yet more damage.