The Centers for Disease Control and Prevention recently released a whimsical-looking infographic showing colorful, cartoon hamburgers drizzled with ketchup, french fries poking out of striped paper trays and sky-blue cups of soda.
One look at the iconic American combo meals in their bold, primary colors and it's all one can do not to run to the nearest burger joint and order a double - of everything.
Yet, these colorful meals carry a smack of sobering reality.
They are actually part of a graph. At the bottom left of the graph, where it reads "1950s," there is a family of three in silhouette, perfectly svelte as they walk hand-in-hand. But
as you look at the bottom right and see the word "Now," suddenly Mom, Dad and son have ballooned about four sizes and the burger, fries and drink above their heads look like they were made in the Land of the Giants.
FONDNESS FOR SWEET FOODS
The gist of the CDC illustration, titled "The New (Ab)Normal," is that since the 1950s our portion sizes have grown exorbitantly, which has contributed to a rise in obesity of epidemic proportions.
According to the graph, for example, our burgers are about three times bigger than they used to be, our portions of french fries nearly three times larger - and our sodas? Six times larger than the 7-ounce versions sipped by the bobby soxers of 60 years ago.
Surprised? Think 7-Eleven's giant 50-ounce Double Gulp sodas.
But recently there seems to be more of a shift toward acknowledging these kinds of supersize-me statistics, particularly when it comes to foods laced with added sugar such as sweetened beverages.
Researchers are taking a closer look at the high consumption of processed sugar and its correlation with the current epidemic of obesity, not to mention associated conditions such as cardiovascular disease and diabetes.
Even cancer is being looked at as having a possible link to the excess consumption of sugar.
The media also are following more outspoken opponents to sugary foods, such as New York City Mayor Michael Bloomberg.
He led the way for a citywide ban on the sale of oversized sodas this year that will affect every restaurant, sports arena, movie theater and outdoor vendor within the city limits.
Patricia Alpert, chairwoman of the physiologic department at the University of Nevada, Las Vegas, School of Nursing, said as a society we have known for years that excess sugar is not healthful, but that does not mean it's an easy habit to kick.
Humans are born with a fondness for foods that taste sweet, but sugar consumption rose as society became industrialized and more foods started being processed.
At the end of the 19th century, Americans were eating about 5 pounds of sugar a year, but experts estimate we now consume about 140 pounds of sugar annually, she said.
"If you look at it evolutionarywise, we were out there foraging and hunting and gathering, and a lot of it was all-natural; so we ate a lot more fiber, had very little sugar in our diet," Alpert said. "And so this is not something that is a natural kind of thing as we evolved; this is sort of the plague of the industrialized country. And in the United States even more so because we supersize everything."
BODY NEEDS SUGAR
Sugar is a simple carbohydrate that comes in different forms, such as sucrose, which is mainly from sugar cane and sugar beets, and the basis for table sugar; fructose, which is found in fruit; lactose, which is the sugar in milk; and glucose, which is found in a variety of foods and is the major source of energy for the body's cells, according to Alpert.
Although the body needs sugar, too many of sugar's empty calories, especially from processed foods, can replace beneficial nutrients and lead to the storage of the sugar as excess fat, increasing the risk for obesity, she said.
Overindulgence of sugar can also suppress the immune system by, for example, interfering with the body's absorption of vitamin C.
Alpert also points to metabolic syndrome - a host of conditions such as hypertension, increased cholesterol and obesity - that can increase the risk for heart disease, stroke and diabetes.
Basically, the continual consumption of excess sugar can wreak havoc with the body's production of insulin, according to Dr. Kenneth Izuora, an endocrinologist and director of the University of Nevada School of Medicine Diabetes Center.
It can put the pancreas into a kind of overdrive as it produces more and more insulin to deliver glucose to the cells, but eventually the insulin can become ineffective as the body's response to it diminishes, he said.
"After a while, it's like you're borrowing money from the bank. You keep taking money from the bank, after a while the bank will be like, you know what, I can't do this anymore," he said.
"Over time, either you gain so much weight that insulin resistance becomes overwhelming, or the pancreas burns out so that you don't even make enough insulin to match the resistance; then sugar starts to go up because if you eat something, you will never have enough insulin to match it. ... Now the problem is that excess sugar in the blood; this is diabetes."
Izuora also pointed to the risk of cardiovascular disease because of a diet of excess sugar, and associated problems such as high cholesterol and inflammation of the blood vessels.
"You pour soda on the counter and you let it dry ... it gets very sticky, so you can imagine what that would do floating around in your blood," he said.
Izuora tells his patients the key is to consume everything in moderation, not only foods with added sugars, but carbohydrates such as rice and pasta, and fruits.
"Everything in excess causes trouble. I have patients that take watermelon and they eat a whole watermelon at one sitting, and that will cause trouble, because if they take enough, the benefits they get goes away. So I think the key is taking things in moderation."
The American Heart Association came out with a statement on sugar intake in 2009, recognizing the increased evidence of the association between high sugar intake and cardiovascular disease, and providing specific guidelines for the consumption of sugar, said association spokeswoman Rachel Johnson, a professor of nutrition at the University of Vermont.
Just like the intake of salt, the association is advocating for a reduction of sugar in foods such as children's cereals, she said.
"We're predicting we're looking at the first generation of children who won't live as long as their parents because of increased rates of diabetes and hypertension and heart disease that will occur because of the childhood obesity epidemic," Johnson said.
At the same time, she believes the attention sugar is receiving will not go away, especially when it comes to sweetened beverages.
"I think the pounding of the drum over sugar-sweetened beverages is just going to get louder. ... There were some recent papers in the New England Journal of Medicine that really showed conclusively in children that cutting back on their intakes of sugar-sweetened beverages reduces the amount of weight that they gain."
The American Heart Association recommends that women consume no more than six teaspoons of added sugar a day, while men should have about nine teaspoons.
According to Gail Lopez, associate director of the Atkins Center for Weight and Health at the University of California, Berkeley, most Americans get as much as 22 teaspoons of added sugar a day, or about 355 calories.
There are about 17 teaspoons of added sugar in a 20-ounce container of soda alone, she said.
Lopez explained that while high-fructose corn syrup has been in the news a lot lately, it is not necessarily any worse than other added sugars; it is simply used more in the United States because of its availability and low cost.
She added, however, that there is still more to be learned about it and the way it functions in the body.
While added sugars are in almost every packaged item purchased at the store, it's the "big guns" such as sodas, cookies, cakes, ice cream and candy, even sweetened yogurts (which can have, for example, 26 grams of sugar), that are the biggest culprits.
The occasional sweet is not the problem, Lopez added. It is when access to sweets is unlimited and the consumption becomes excessive that it becomes an issue.
Parents, for example, should limit the amount of sugary treats at home, have regular meal times and serve measured portions of foods, she said.
Healthful foods should be treated as something as enjoyable as sweets, especially now when children are surrounded by holiday cookies and pies.
"I think there are kids that really look forward to the turkey. I think we have come to believe that sugary treats are so shaded with fun so that everyone believes you can't have fun without having a lot of those," she said.
In the long run, it's going to take the effort of everyone - public health officials, food manufacturers, parents, educators, children - to change the way sugar has become such a huge part of the American diet, Lopez said.
"It is the whole society's responsibility to stop that. Parents cannot do it alone, and certainly children can't do it on their own in this environment."