Sugars and obesity: Is it the sugars or the calories?

Sugars containing fructose are emerging as the dominant public health targets for their role in the epidemic of overweight and obesity. This position is largely supported by ecological observations, rodent models of overfeeding and select human trials. Higher level evidence from systematic reviews and meta‐analyses of controlled dietary trials has yet to show convincingly that fructose‐containing sugars behave differently from any other forms of energy (especially refined starch and fat). Prospective cohort studies, which provide the strongest observational evidence, have shown an association between risk of overweight and obesity and fructose‐containing sugars consumed as sugar‐sweetened beverages but not as total sugars or other important sources of added sugars such as cakes, pastries and sweets. Comparative analyses show that high intakes of other highly palatable foods such as refined grains, processed meats, red meats, French fries and potato products, as well as physical inactivity may play an equal or greater role in weight gain and the risk of overweight and obesity. The contributions of these factors are also difficult to disentangle from that of sugar‐sweetened beverages owing to their collinearity with sugar‐sweetened beverages as part of a Western dietary pattern and lifestyle. Attention needs to remain focused on decreasing overconsumption of all foods associated with overweight and obesity. Sugar‐sweetened beverages and foods are certainly an important place to start but should not draw attention away from the issue of overconsumption in general.