The real contribution of added sugars and fats to obesity

Obesity rates in the United States are a function of socioeconomic status. Higher rates are found among groups with lower educational and income levels, among racial and ethnic minorities, and in high-poverty areas. Yet, the relation between obesity, nutrition, and diet continues to be viewed in biologic terms, with the search for likely causes focused on consumption of specific macronutrients, foods, or food groups. Epiderniologic evidence linking diet composition and body weight has mostly relied on ecologic comparisons, time trends, and analyses of cross-sectional studies. Plausible physiologic mechanisms have included the metabolic effects of dietary components, mostly sugars and fats, on regulation of food intake and deposition of body fat. However, the evidence could not have been convincing since the blame for rising obesity rates seems to shift regularly, every 10 years or so, from fats to sugars and then back again. This review demonstrates that much of past epidemiologic research is consistent with a single parsimonious explanation: obesity has been linked repeatedly to consumption of low-cost foods. Refined grains, added sugars, and added fats are inexpensive, good tasting, and convenient. The fact that energy-dense foods (megajoules/kilogram) cost less per megajoule than do nutrient-dense foods means that energy-dense diets are not only cheaper but may be preferentially selected by the lower-income consumer. In other words, the low cost of dietary energy (dollars/megajoule), rather than specific food, beverage, or macronutrient choices, may be the main predictor of population weight gain. Examining past studies of the contribution of added sugars and fats to obesity rates through the prism of food prices and diet costs is the purpose of this review.