Textual analysis of sugar industry influence on the World Health Organization's 2015 sugars intake guideline.

Martin Mckee,Aaron Reeves,Rachel Loopstra,David Stuckler

doi:10.2471/blt.15.165852

Abstract

ObjectiveTo determine whether sugar industry-related organizations influenced textual changes between the draft and final versions of the World Health Organization’s (WHO’s) 2015 guideline Sugars intake for adults and children.MethodsStakeholder consultation submissions on the draft guideline from seven sugar industry-related and 10 public health organizations were assessed using the Wordscores program. Document scores were rescaled using the Martin–Vanberg transformation to improve comparability. Draft and final guidelines were compared to identify changes influenced by the sugar industry and public health organizations.FindingsThere was a small shift in transformed Wordscores score between the draft and final guidelines, from 0.25 to 0.24, towards the industry position. The change was linked to increased use of the word “low” to describe the quality of the evidence, consistent with industry arguments. There was also a shift from use of the word “consumption” to “intake”, irrespective of policy position. Scores for World Sugar Research Organisation and Sugar Nutrition UK submissions ( 0.11 and 0.18, respectively) represented strong pro-industry positions and scores for European Public Health Alliance and Wemos submissions (1.00 and 0.88, respectively) represented the strongest public health positions. Industry tactics included challenging the quality of the evidence, distinguishing between different types of sugar and advocating harm reduction.ConclusionThere was little change between draft and final versions of the WHO sugars intake guideline 2015, following industry consultation. The main change was linked to emphasizing the low quality of the evidence on sugar’s adverse effects. Guideline development appeared relatively resistant to industry influence at the stakeholder consultation stage.

Highlights

In 2013, the World Health Organization (WHO) began the process of updating its guideline on sugars intake for adults and children
Sugar consumption has been a contested area of global public health for at least four decades, initially stimulated by Yudkin’s 1972 classic, Pure, white and deadly,[1] and Cleaves’ 1974 book, The saccharine disease,[2] which linked dietary sugar intake to obesity, diabetes and other noncommunicable diseases
To determine whether the sugar industry was able to influence the recent updating of World Health Organization (WHO’s) sugars intake guideline, we evaluated the textual content of the updated guideline using automated content analysis, a tool that has recently been used to quantify the influence of the tobacco lobby on policy.[15]

Summary

Introduction

In 2013, the World Health Organization (WHO) began the process of updating its guideline on sugars intake for adults and children. Studies linked sugar intake to dental caries and obesity,[3,4] in children,[5] and recent evidence supports an association with conditions such as diabetes and nonalcoholic fatty liver disease.[6,7] discussions continue about the appropriate measure (i.e. grams or percentage of daily total energy intake), type (i.e. free versus added sugars) and saccharide structure (i.e. monosaccharide and disaccharide) of dietary sugars and whether these factors influence the risk to health These debates complicate the process of developing guidelines

Methods

Results

Conclusion