Retrospective #154: Salt, Sugar and Fat

When it was published in 2013, I resisted commenting on Michael Moss’s eBook, Salt Sugar Fat: How the Food Giants Hooked Us. I did not want to be negative. Mr. Moss, a New York Times investigative reporter since 2000, had made a career out of sensationalizing popular causes, even when the idea was a myth. Lumping together salt, sugar and fat as an unhealthy agglomeration is just one of those myths. I get curmudgeonly just thinking about it.

So, when The Lancet, a peer-reviewed medical journal, later published a “Perspective” titled “Salt, Sugar and Fat or branding, marketing, and promotion,” by Dariush Mozaffarian, it caught my attention. Mozaffarian is a cardiologist and epidemiologist at the Harvard School of Public Health. I hoped and assumed, therefore, that his take would be “informed” and “professional,” vs. a rant such as I might have written, and it was. Dr. Mozaffarian’s “perspective” is well-reasoned, balanced and, to my delight, in the end, also negative, at least in the areas of interest to me.

According to Mozaffarian, Moss “shines” and “the text sparkles” as he “argues that the food industry manipulates and is deeply dependent on these three ingredients to create maximally alluring, addictive products that drive overconsumption, obesity and other chronic diseases. Moss “deftly walks us through these fascinating stories, yet he seems to miss his own point.” Mozaffarian concludes, “Salt Sugar Fat is, however, unconvincing when Moss attempts to link these fascinating stories and products…back to salt, sugar and fat.”

Mozaffarian allows that the case made by Moss for salt is “reasonable,” but that “a central tenet – that fat content in foods induces overconsumption and poor health – has been disproven by prospective studies and randomized trials.” Hallelujah, I say! “Yet this folklore is repeatedly asserted,” Mozaffarian continues, “overlooking the evidence that both the total fat content of foods and the overall fat content of the diet has little, if any, influence on major diseases, including type 2 diabetes, heart disease, or cancers” AMEN! Would that this message were broadcast on a continuous loop over the air. Drumbeaters and axe grinders like me would have to find other ‘work,’ or go fishing.

Dr. Mozaffarian’s indictment of the 3^rd member of this cabal, sugar, starts off a bit timidly, by today’s standard: “All refined carbohydrates – whether white bread, white rice, breakfast cereals, or packaged foods containing these refined grains, cereals, and starches – have LARGELY INDISTINGUISHABLE METABOLIC HARMS AS SUGARS.” “Whereas sugars in liquid form are most obesogenic, there is only limited reliable evidence to suggest that sugars in foods are any worse for health than other refined carbohydrates and starches – all are detrimental.”  Mozaffarian asserts, “This key issue is only mentioned by Moss in the first chapter, then seems to be promptly forgotten.”

Nevertheless, “the focus on how diet affects obesity and its complications, including diabetes,” was the impetus for this eBook. “People have recognized for millennia that overeating leads to weight gain,” Mozaffarian says, but then he brightens my day with this follow-up: “Yet, this was historically attributed to weakness of individual will.” But, Dr Mozaffarian the epidemiologist notes, “Obesity’s remarkable and rapid contemporary rise across diverse races, social classes, cultures and nations – including perhaps most influential of all, in children – has created a new awareness that external influences on dietary choices are likely powerful and widespread…”

Here is the common thread that links Moss and Mozaffarian: “external influences on dietary choices,” but here is also where they depart. Mozaffarian concludes: “Throughout Salt Sugar Fat, Moss attempts to indict these three ingredients as principal forces behind product development and sales, Yet, time and again, the stories reveal the true drivers of the success of individual products and our modern overconsumption: the immense and pervasive power of modern advertising and promotion.”  Mozaffarian cites how Coca Cola came to dominate globally with its systematic, data-driven strategy to infiltrate life’s “special moments” and create early brand adopters.

“Ultimately, the irony is that in trying to bring everything back to these three ingredients- whether related to food formulations, product success, or health – Salt Sugar Fat sensationalizes their true role.

The real story for me is how the Harvard School of Public Health got it right. Props to Mozaffarian and Harvard!