The affinity for sugar runs deep—all the way from farm to fork. The consequences are starting to showFruit juices, yoghurts and breakfast cereals that are promoted as healthy choices are often laden with added sugar but the problem could be partly fixed with stringent labelling rules

NEW DELHI : To watch a paediatric dentist at work can be quite amusing: a six-year-old sitting quietly, engrossed with an animated video that is playing on a screen attached to the dentist’s chair. Her gums have been numbed by an anaesthetic. Meanwhile, the doctor goes about fixing a rotten tooth with a root canal. The procedure is often followed by a reward—a scoop of ice cream to assuage the swelling gums and whatever little pain that the child may have had to bear. The whole process is smooth and unfolds like clockwork. If the procedure had an element of discomfort, that might have forced the child to think about what got her on to the dentist’s chair in the first place—which, in most cases, is drinks and chocolates laced with excess sugar. Such moments of forced contemplation, however, are rare.

Over the past decade, multiple surveys have begun to sound the alarm on the changing dietary pattern of India’s children. Refined white sugar is now an integral part of the Indian diet, driven by a swift increase in the consumption of packaged and processed food. The fallout: the paradox of childhood obesity in a country that is still battling malnutrition. Young children, particularly in urban areas, are already battling a host of so-called lifestyle illnesses including dental caries, fatty liver and obesity-induced diabetes, say doctors and nutritionists.

Interestingly, India’s affinity for sugar runs deep—all the way from farm to fork. Farmers tend to grow more sugarcane due to its potential for generating higher returns over costs—about 60-70% more compared to most other crops. Refined white sugar is also cheap for consumers. In fact, over the past decade, retail sugar prices have barely risen when compared to more nutritious food items such as milk and pulses. The question that arises is: Why does India—the largest consumer of sugar and the second-largest producer—continue to encourage the production of cheap sugar despite its enormous health cost? There are also costs associated with the growing of sugarcane in water-starved geographies.

The policy disconnect is palpable. The relative price security encourages farmers to plant more cane. Sugar mills mandated to procure cane at the government-determined fair and remunerative price (FRP) are often unable to make payments on time following surplus production.

To clear the unpaid dues, the government then grants soft loans and export subsidies to the industry. In the process, refined sugar turns out to be the cheapest among food commodities, which fuels a steady rise in consumption. In the absence of any effective regulation on the labelling of packaged food items, households often end up consuming large quantities of sugar unknowingly.

A task force set up under the federal think-tank Niti Aayog, which submitted its report in March last year, recognized the need to encourage farmers to move away from cane and suggested promoting jaggery production, which is considered to be a healthier alternative to refined white sugar. However, given the political weight that a crop like sugarcane carries—be it in Uttar Pradesh, which goes to polls next year, or Maharashtra, where cooperative sugar mills are controlled by politicians—it is unlikely that the Niti Aayog’s suggestions will be implemented in the near future.

At least eight in ten children in India suffer from oral health problems and 44% were in need of treatments such as root canal or extraction, found a 2019 survey by the market research firm Kantar IMRB. India does not conduct periodic dental health surveys like the United Kingdom (UK), where the National Health Service does one every decade.

The 2015 round of the UK survey, for instance, recorded that poor oral health was impacting children’s quality of life “not just functionally, but also psychologically and socially". About half of the 12 and 15-year-olds surveyed were embarrassed to smile, laugh or show their teeth, apart from exhibiting difficulty with eating and brushing. Frequent consumption of sugary drinks and foods resulted in dental cavities as well as obesity, the study said.

In India, the situation is far more severe than just a hidden smile or a painful toothache. The share of deaths due to non-communicable diseases such as diabetes and heart ailments rose sharply from 38% in 1990 to 62% in 2016. About 17% of India’s adult males and 14% of adult females were found to be diabetic in 2019-20.

India is not addicted to sugar but it is afflicted by poor regulation on junk food, most of which is loaded with sugar, said Rujuta Diwekar, nutritionist and author of the book Eating in the age of dieting. According to Diwekar, who has never endorsed a packaged food brand, “direct kitchen consumption of sugar in India is moderate. A teaspoon with a cup of tea or a weekly mithai is nothing to worry about. The problem arises when people stop their own consumption of sugar but consume unknown quantities of it from packaged food—like having tea without sugar, but with biscuits that may have more sugar than a teaspoon."

Diwekar added that the lack of regulations on marketing, pricing and positioning of junk food makes children easy victims. The only way out is to make processed food inaccessible and pricier. “India is seeing the twin burden of obesity and malnourishment among children with both categories picking up junk food…I am treating cases of fatty liver and greying hair in children who are as young as 7 or 8 years old."

Fruits juices, yoghurts and breakfast cereals that are promoted as healthy choices are often laden with added sugar, invisible to their consumers, said Mahesh Balasekar, a paediatrician and senior consultant at SRCC Children’s Hospital, Mumbai. “The bogey of fats causing health problems was largely funded by the (global) sugar lobby…and in India, sugar-rich products are labelled in a surreptitious manner. Almost 40% of children in the 10-18 age group from urban elite schools are either overweight or obese."

At the obesity clinic at SRCC, Balasekar is seeing a flurry of cases ranging from fatty liver and obstructive sleep apnea to obesity-induced diabetes and hip dislocations among adolescent children. There are also several cases of polycystic ovaries among young girls at the clinic.

The problem could be partly fixed with stringent labelling rules. In 2018, an expert committee set up by the Food Safety and Standards Authority of India (FSSAI) proposed simple and effective front-of-the-pack (FoP) labelling for packaged food that could warn consumers as to how much sugar, salt and fat they are consuming and by how much these exceed the daily recommended thresholds.

The rules were diluted in 2019 following strong opposition from the food industry as more than 80% of the packaged food currently available in the market would have exceeded the recommended thresholds. What’s worse, FoP labelling was altogether set aside when FSSAI notified new labelling and display regulations a year later. “We need to follow a gradual and balanced approach…if due to high thresholds the taste (in packaged food) gets compromised, it won’t serve anybody’s purpose," said Pawan Agarwal, chief executive officer of FSSAI between 2016 and 2020.

However, evidence suggests that FoPs work. In Chile, for instance, the adoption of effective FoP labelling such as a warning label of ‘excess sugar’ covering 10% of the front surface of a packet was followed by a 24% drop in consumption of highly sweetened beverages. After the introduction of a sugar tax on soft drinks in the UK in April 2018, a study published in the British medical Journal found that sugar content in the drinks fell by almost 10%. The study was based on 30 million household purchases.

In comparison, Indian consumption of sugary beverages more than doubled between 2010 and 2019 from 8 millilitre (ml) to 18 ml per person per day, shows data from Euromonitor International. “The world is moving towards FoP and we are ten years behind. Existing back-of-the-pack labelling is not consumer-friendly…it is meant to confuse and the only purpose it serves is scientific compliance," said Amit Khurana, who heads the food and toxins unit at the Centre for Science and Environment, a think tank.

Till about 1600, when it underwent a remarkable transformation, sugar was the preserve of the rich and the powerful, wrote historian James Walvin in his book Sugar: The world corrupted from slavery to obesity. “Once the monopoly of kings, by (the) mid-seventeenth century, sugar could be bought from a humble ironmonger in the north of England. It had begun to change from an expensive luxury to the everyday necessity of ordinary people."

Walvin notes that King Louis XIV of France had lost all his teeth by the age of 40, for no one paid any attention to his consumption of sugar. Naturally, most French portraits of the rich and famous from that time rarely showed the sitter’s teeth—eerily similar to the phenomenon of British children, who, three centuries later, are embarrassed to smile. According to Walvin, the global consumption of sugar was revolutionized by the emergence of the soft drink industry after the second world war. A key reason behind the success of Coca-Cola was cheap sugar from tropical producers and the US government’s policy of subsidies and tariffs.

In pre-independent India, the sugar industry was nurtured by the colonial state by inducing farmers to supply cane to the mills, instead of diverting it to traditional village-based industries that made jaggery. At the time of independence, about two-thirds of the sugar consumption in India was in the form of jaggery, but some provincial governments banned jaggery production to promote sugar mills.

Moreover, early research into sugarcane was geared towards creating thick-rind varieties suitable for mills but harder to crush using traditional methods. “This was vigorously opposed by Gandhians like J.C. Kumarappa who advocated (for) increasing (the) production of palm jaggery, which is more environment- friendly and does not require arable land," said Venu Madhav Govindu, Kumarappa’s biographer and a researcher at the Indian Institute of Science, Bengaluru.

The January 1946 issue of Gram Udyog Patrika, the monthly publication of All-India Village Industries Association set up by Gandhi and edited by Kumarappa, pointed out the fallacy of growing more sugarcane at a time when food crops were in short supply and millions suffered due to starvation. Seventy-five years later, the federal think tank Niti Aayog is making a similar suggestion.

“With increased incidences of diabetes and a reduced preference in people for white sugar, there is a case for greater encouragement to the gur industry," the Niti Aayog’s task force report on sugar suggested.

The mismatch in sugar supply and demand—with supplies (at over 30 million tonnes a year) consistently outstripping demand (estimated at around 26 million tonnes)—has led to a buildup of excess stocks, leading to lower prices and higher subsidy outgo for the government.

According to Ramesh Chand, member of Niti Aayog who chaired the sugar task force, about 30% of cane area could be diverted to other crops by providing incentives to farmers at a cost about ₹ 9,200 crore. But in the process, India would benefit by a reduction in subsidies as well as water outgo, especially in drought-prone areas including parts of Karnataka and Maharashtra’s Marathwada and Vidharba regions.

The travails of sugar are not merely limited to its lopsided economics or the toll that it takes on public health and the environment. In its early years, the growth and popularity of sugar was built on the miseries of slave labour, but even today, migrant cane cutters in states such as Maharashtra continue to suffer unimaginable hardships.

Low wages, inhospitable and unsanitary living conditions, and more than 12-hour long working days that begin as early as 3am local time create a “convergence of oppressions" that lead to an epidemic of unnecessary hysterectomy operations among women cane cutters in Maharashtra, wrote activists Abhay Shukla and Seema Kulkarni in a 2019 paper titled Harvest of uteruses in the journal Economic and Political Weekly.

At a workshop in Maharashtra’s Beed district in June 2019, women sugarcane workers who underwent hysterectomies spoke about the intense pressure to not skip work even during menstruation.

In the words of author James Walvin, “the claims that sugar is corrupting are of a recent vintage; if it is bad today, when was it good?... (and) if it is true that sugar is bad for us, how did the world become so corrupted by this single, simple commodity?

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