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Is Sugar a Killer?

A doctor who treats obese children thinks that sugar is far more dangerous than Americans realize.


Among the least likely viral megahits on YouTube is  a 90-minute lecture by the food scold and pediatric endocrinologist Robert Lustig entitled “Sugar: The Bitter Truth.” He delivers it in a windowless room at the Osher Center for Integrative Medicine at the University of California, San Francisco. The talk is simultaneously boring and powerful, combining the gravitas of a national health crisis, the thrill of conspiracy theory, and the tedium of PowerPoint slides. Midway through the talk he scans the hall for approval. “Am I debunking?”

The UCSF extension students mutter “yeah”—most of them, at least. Lustig has a way of seeking validation and pissing off people at the same time. His combined love of showmanship and need for approval led to acting in 12 musical-theater performances during his three years as an undergraduate at the Massachusetts Institute of Technology. His greatest role yet may be as the loudest, most contrarian voice in the public-health debate over why we get fat and what we should do about it.

Lustig is an imperfect front man for abstemious eating. At age 55, his face is puffy. He looks disheveled even in a coat and tie. People love him and people love to hate him, especially after  he proposed in the journal Naturethat sugar should be regulated like alcohol and that people who buy soda should be carded. Almost three million people have watched Sugar: The Bitter Truth. Alec Baldwin publicly lost 30 pounds by following Lustig’s rules and giving up toxic foods, even trying to avoid the sugar in a dish his mother calls “love pie.” Still, a leading endocrinologist, who asked to go unnamed, called Lustig an “idiot.”


Public reception of Lustig’s new book,  Fat Chance, will likely be just as divided. The book repeats and expands on the main point of contention in the sugar wars: whether our bodies treat all calories the same. The old guard says yes: A calorie is a calorie; steak or soda, doesn’t matter. Eat more calories than you burn, you’ll gain weight. Lustig believes that our bodies react to some types of calories differently than others. Specifically he believes that sugar calories alter our biochemistry to make us hungry and lazy in ways that fat and protein calories do not. As a result, he says, the ubiquity of sugar in the Western diet is making Americans sick, obese, and bankrupt.

But Lustig does not stick to explaining his reasoning and raising public-health awareness. “Education has not worked. Labeling has not worked. And they’re not going to work,” he told me in his characteristically emphatic way. “Education hasn’t worked for any addictive substance.” According to Lustig, we need to accept that America’s obesity problem can’t be fixed by a Puritan resolution by each individual to eat fewer calories. To fix America’s obesity problem, we need a regulatory framework for selling and serving less sugar-laden food.

A morning spent in Lustig’s UCSF Weight Assessment for Teen and Child Health Clinic (next door to Lustig’s endocrinology clinic) puts a person in touch with the Sisyphean absurdity of trying to solve the nation’s weight problem one patient at a time. The exam rooms fill up with fat kids. They empty and fill again. Tucked in a back corner of the second floor of a clinic building across the street from Benioff Children’s Hospital is Lustig’s office, a cramped galley that he shares with two doctors, two nurses, a nutritionist, and a social worker. The computers look vintage, circa 1997.

“This kid is a disaster—an unmitigated disaster,” Lustig muttered one day in October as he read aloud an old case file on the ancient screen. “No breakfast, two lunches, two dinners, eats in the middle of the night.”

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