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A gloomy​ headline for early January: four million people in the UK have diabetes. There are 700 new diagnoses every day, the overwhelming majority (90 per cent) with type 2 diabetes, the variety associated with diet and inactivity. In the last decade there has been a 65 per cent rise in the total number of diabetics. By one reckoning, one in five British retirees is a sufferer. Diabetes is an expensive and complicated condition to treat: at the moment it costs the NHS £1 million an hour. From the public health point of view, diabetes is an escalating disaster, on a scale that amounts to an existential threat to the NHS. As Simon Stevens, chief executive of NHS England, says, ‘obesity is the new smoking.’

The culprit or culprits are easy to find: diet and inactivity. And within diet, especially, sugar. If you look for the changes in our diet in recent decades, this is the big one. Eighty per cent of all foods in British supermarkets contain added sugars. Once you start looking at sugar content you find yourself again and again recoiling in horror. Coca-Cola used to be considered a sweet, sugary drink; at 10.6 per cent, though, it contains much less sugar than many officially savoury foods. Heinz tomato ketchup contains twice as much sugar as Coke, at 22.8 per cent. That means it’s damn nearly a quarter sugar. Ready meals often contain a higher percentage of sugar than Coke, and so do many processed foods and condiments. My personal unfavourite is Sainsbury’s ‘American-style mustard’, which clocks up an astounding 16.8 per cent sugar. Two of the four main ingredients are glucose-fructose syrup and sugar. Unsurprisingly, it’s revolting: like very faintly mustardy sugar syrup. Well, OK, I thought, after my first encounter with that horror, but this is really the fault of the American mustard they’re trying to emulate. Not so. French’s mustard (that’s the market-leading brand, in the bright yellow squeezy bottle), immediately next to Sainsbury’s concoction on the supermarket shelf, is a mere 0.9 per cent sugar. It contains no added sugar at all. Sainsbury’s mustard is 19 times more sugary than the thing it’s emulating.

Bee Wilson’s First Bite: How We Learn to Eat (Fourth Estate, £12.99) is a brilliant, heartfelt book about this crisis in our contemporary diet. She has an explanation for that mustard. It’s part of a general shift in our eating habits towards flavours that are, as dieticians call it, SFS: sugar, fat, salt.

No matter what you order in a fast-food restaurant, from hamburgers to salad dressing to apple pie, the odds are it will be united by a common flavour: not sweet-sour but sweet-salty, with an undertow of fat. This matters, because, as we have seen, flavour has a remarkable ability to imprint itself on our memories, and therefore, to drive our future food choices. Repeated exposures to SFS foods early in life teaches us that this is how all food should taste. This homogenised sweet-saltiness is now ubiquitous in many supposedly adult treats, from pretzel croissants to salted caramel to pulled pork sandwiches.

The wrong turn in our diet is linked to how we eat as children – which means the way we feed children. The whole concept of ‘children’s food’, a relatively recent and Westernised one, is in Wilson’s analysis a big part of the problem. We have talked ourselves into thinking that children are inherently tricky and picky eaters, so we give them a diet skewed towards the crowd-pleasing SFS tastes. That food is easy to like, but has the unhappy side effect of giving us cravings for inherently unhealthy foods. The result is where we are today, with 61.7 per cent of the adult population overweight, including 25.6 per cent who are obese, and with both numbers rising yearly.

Wilson, however, has good news. It concerns the question of why we like what we like, and what we can do about it:

One of the questions I wanted to explore was the extent to which children are born with hardwired preferences. As I trawled through endless academic papers in the library, I predicted fierce disagreement among contemporary scientists. On one side I would find those who argued that food likes and dislikes were innate; on the other, those who insisted they were acquired: nature versus nurture. To my astonishment, I found that this was not the case. Far from controversy, there was a near universal consensus – from psychologists, from neuroscientists, from anthropologists and biologists – that our appetite for specific foods is learned. Within this broad agreement, there are, as you might expect, still plenty of scholarly disputes, such as the brouhaha over whether our love-hate relationship with bitter vegetables such as Brussels sprouts has a genetic underpinning. There are also competing theories on the extent to which our food learning is mediated by particular genes, hormones and neurotransmitters. But the fundamental insight that human food habits are a learned behaviour is not the subject of scientific debate.

That’s a very positive development, because it means that we can relearn our food preferences, even in adulthood. Wilson talks about our ‘first-order food preferences’, the things we like, and our ‘second-order food preferences’, which are the things we want to like. Chocolate might be in the first category, watercress in the second. The science now shows that we can turn our second-order preferences into things we actually enjoy eating; we can turn wanting, which is about intent, into liking, which is about pleasure. We can train ourselves to want what’s good for us. Similarly, we can, by disciplining ourselves around our children, by patience, by encouragement, by rational use of small and varied portions, teach them to like the kind of food that is good for them, too. We can prevent ourselves and them from being bullied into a food culture that is skewed entirely towards SFS flavours.

First Bite is movingly open about the author’s own complicated relationship with food, and doesn’t make the difficulties of arriving at a sane relationship with it seem less than they are. It is full of recent findings in all areas of food research, from childhood preferences to autism and anorexia, and has lots of riveting incidental detail: I had no idea, for instance, that in 2008 the Japanese government passed a law fining companies with too high a proportion of fat workers. That fact about 80 per cent of supermarket foods containing added sugar is hers, too. Wilson is intelligent, passionate, sincere, tirelessly curious and endlessly willing to admit mistakes and learn from experience. A dark thought occurs: maybe that’s what you have to be like to rewire your relationship with food, and to feed your children entirely healthily. How many of us are actually going to do this? Is this how we’re going to stop having hundreds of thousands of new diabetics every year, and two-thirds of the population overweight?

We’ve all known for a few decades what we should do about diet and exercise. And yet we aren’t doing it. We’re getting fatter and more inactive by the year. Some people will be able to address the issue for themselves and their families by taking Wilson’s counsel to heart. For society as a whole, though, we are probably going to need to address the question via legislation, regulation and tax. Mexico, which has a huge problem with obesity and diabetes, has set the world an example with a new tax on sugary drinks. There will be more where that came from. If obesity is the new smoking, sugar is the new tobacco. We’re going to have to treat it the same way.

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Letters

Vol. 38 No. 4 · 18 February 2016

‘We have talked ourselves into thinking that children are inherently tricky and picky eaters,’ John Lanchester writes, ‘so we give them a diet skewed towards the crowd-pleasing SFS [sugar, fat, salt] tastes’ (LRB, 21 January). According to this view it is we who pander to children’s degraded tastes, too irresponsible and lacking in self-control to curb dietary habits that are harming us all. But this is to leave out of the equation half a century of the food and advertising industries’ relentless efforts to stimulate precisely those tastes.

The other factor Lanchester cites as a cause of the diabetes epidemic is inactivity. Yet so much modern technology has been designed and marketed to curtail physical activity. This is not a conspiracy; but what started out after the war as ‘labour saving’ has in the computer age become time and money saving as well. Plainly, the problems that ensue shouldn’t merely be left to individuals to deal with as best they may. They require tackling at both governmental and social levels. Lanchester ends: ‘If obesity is the new smoking, sugar is the new tobacco. We’re going to have to treat it the same way.’ We could start, then, with some class actions, which did so much to expose the tobacco companies’ cynicism. But it may be a long haul. Pure, White and Deadly, John Yudkin’s book about sugar, was published in 1972. He was vilified, the sugar industry recruited academics to smear his research and reputation, and reportedly even hired thugs to harass his children on their way to school.

James Hamilton-Paterson
Timelkam, Austria

Thank you, John Lanchester: Sainsbury’s Light Soy Sauce contains 15.4g sugar, so down the sink it went.

Monique Maxwell
London WC1

Vol. 38 No. 5 · 3 March 2016

John Lanchester should be careful in lumping together sugar, fat and salt as the cause of the decline in public health (LRB, 21 January). As a student of economics, perhaps he would appreciate two reports from Credit Suisse that forecast trends in food commodities. ‘Sugar: Consumption at a Crossroads’ (2013) suggests that sin taxes enacted on sugary drinks in particular could have a measurable beneficial effect on public health. But in 2015 the bank published ‘Fat: The New Health Paradigm’, which, on the basis of a review of medical research, exonerated natural fats (but not trans-fats or chemically extracted seed oils) of negative health consequences, including heart disease and obesity. ‘The higher intake of vegetable oils and the increase in carbohydrate consumption in the last 30-40 years are the two leading factors behind the high rates of obesity and metabolic syndrome in the US,’ the report stated. It also raised the issue of official dietary recommendations: ‘Contrary to what might be expected, our analysis suggests we now probably consume not enough fat, not enough saturated fat and too much carbohydrates. This is particularly true in the Western world.’ Fat shouldn’t be blamed for the problems caused by the excessive consumption of carbohydrates. In his memoir Family Romance Lanchester tells us that his mother slimmed down by following her doctor’s simple and effective prescription – to limit starches.

Natalie Smith
Austin, Texas

Vol. 38 No. 6 · 17 March 2016

I don’t understand why the editors published Natalie Smith’s letter saying that I ‘should be more careful in lumping together sugar, fat and salt as the cause of the decline in public health’ (Letters, 3 March). I invite readers to look at the piece I wrote, where it’s perfectly clear I did no such thing (LRB, 21 January). What I said, and what I think, is that the culprit for the current public health problems is ‘especially, sugar. If you look for changes in our diet in recent decades, this is the big one. Eighty per cent of all foods in British supermarkets contain added sugars.’ I go on to argue for a tax on sugar and end the piece as follows: ‘If obesity is the new smoking, sugar is the new tobacco. We’re going to have to treat it the same way.’ I at no point say that fat per se is a health risk and it is a wholesale mischaracterisation of what I wrote to suggest otherwise.

John Lanchester
London SW4

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