Earlier this week, Action on Sugar and the Obesity Health Alliance reported the results of their "Blueberry Muffins Survey" - a survey of the sugar content of a range of blueberry muffins available at supermarkets and in other out of home (OOH) outlets such as coffee shops. Drawing on nutritional information provided by outlets, or in a handful of cases, analysing the muffins in a lab to determine sugar content, the report compared sugar content, concluding:
1. Blueberry muffins are not a healthy snack, with 17 / 28 samples exceeding the daily sugar allowance for a small child (6 teaspoons)
2. Muffins from OOH outlets were bigger and more sugary than those from supermarkets.
3. The sugar content of the muffins varies between outlets.
4. The variation in sugar content and portion size shows that there is plenty of room to adjust content and portion sizes to meet the Public Health England of a 20% sugar reduction by 2020.
5. 42% of products provided full nutrition info at the point of sale, with a further 29% displaying limited information.
The report concludes with the following recommendations:
1. Products should be reformulated to reduce sugar content and muffin size.
2. All manufacturers, retailers and OOH outlets should publish full nutrition information, including traffic light labelling, at point of sale.
I'm not sure that we needed either a survey or a big press fanfare to learn that cakes have sugar in them; that some cakes are bigger than others; and that bigger cakes have more sugar than smaller cakes. But the survey also raises some more serious questions for me about the way sugar is being reported and the assumptions upon which recommendations are being made.
First - the choice of the blueberry muffin. They claim they picked this particular item "due to their wide availability, indicating their popularity", but this must apply to many baked goods. The key findings, however, provide a further clue to the blueberry muffin choice, declaring that 'blueberry muffins are not a healthy snack" - an assertion that appears to counter a prior claim that they are. There is an unspoken assumption here that consumers are mistakenly motivated to buy the blueberry muffins (rather than, say, chocolate ones) because the presence of fruit codes them as a healthy option, although no evidence is provided to support this premise. Furthermore, no data is provided on who is purchasing and consuming the muffins, and how regularly. Following on from this, if we understand what constitutes a 'healthy' choice as contextual rather than absolute, then it's entirely possible that the selection of a blueberry muffin is an informed attempt to reduce dietary sugar. For example, the Costa blueberry muffin has 28.6g of sugar per muffin (approx 7 teaspoons)*, placing it 14/28 among the chain's cake offerings for sugar content. However, a health-conscious consumer might have switched from their regular carrot cake (56.9g of sugar) or the triple chocolate muffin (38.6 g of sugar) to the lower sugar blueberry option, achieving a sugar reduction that far exceeds the 20% PHE sugar reduction target.
Second - like all "hidden sugar shock" media stories, the report assumes, firstly, that reformulation is a benign process, and second, that it is a lack of information that leads people to foods identified as problematically high in sugar. In the case of reformulation, history has some warnings for us. Trans fats - now widely perceived as harmful to health - were introduced as part of efforts to reduce saturated fat in food, and the increased demand for low-fat foods led manufacturers to introduce higher levels of sugar to preserve texture and palatability. Calls for the reformulation of processed foods should always begin with questions about how those reformulations will be achieved and at what potential costs. And secondly, the belief in the power of information through labelling to change purchasing and consuming behaviour is not supported by the current evidence. A 2018 Cochrane review on nutritional labelling, looking across a range of laboratory and real-world contexts, concluded that while labelling may impact on purchasing and consumption, the evidence is of too low quality to reach confident conclusions. Problematically, the review also concludes that in "the absence of observed harms", labelling could be used as part of a wider set of anti-obesity measures, but as with reformulation, I would question the assumption here that even if not effective, a move towards visible labelling is at least benign. For example, if we take the demands from Change4Life to be "Sugar Smart", we can see a potentially stigmatising shift of responsibility for health through food onto individuals, whose 'bad' choices are patronisingly rendered failures to be 'smart'. Furthermore, the focus on labelling assumes that people select 'unhealthy' foods because they don't know any better, but that once they know, they will change their eating behaviours and tastes to more closely match those of those advocating dietary change. This assumption dislocates food from its social context in ways that have the potential to exacerbate rather than ameliorate social inequalities, and to strip food of its affective and cultural meanings. Consequently, when, as in this report, we are told that "we are all eating too much sugar", who is included in this 'we' requires careful consideration.
This may seem like a lot to make of a short report about something as banal as muffins, but it is precisely in these wide-eyed "hidden sugar shock" stories that we can see in action the reductive and dislocated understandings of health and food that govern mainstream anti-sugar discourse.
And if anybody is asking, mine's a (vegan) chocolate muffin, please.
*The OHA press release for the report includes a footnote from Costa Coffee which notes that that in the report, the Costa blueberry muffin is listed as containing 40.3g of sugar. This was the result of a mistake on the Costa nutrition information pages for January - March 2018 and has since been amended (to 28.6g per muffin).