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Is Sugar a Killer?

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

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He turned to me and asked, “What’s your tolerance for swearing?”

I shrugged. He swore and said, “What a mess.”

In the exam room Lustig encountered an overweight 14-year-old boy dressed in orange and black—it was Halloween and the San Francisco Giants had just won the World Series—with the telltale dark ring around his neck that signals insulin resistance. Lustig high-fived the boy, put down the old leather doctor’s bag in which he keeps his stethoscope and prescription pad, and asked what he was eating. The boy knew exactly what to say. No snacking, no fast food, no soda, no eating after dinner. “That’s good,” Lustig said nonchalantly. Patients’ self-reports of their diets are notoriously unreliable. “You want to know why you’re gaining weight?”

The kid didn’t move.

“Let me tell you what’s happening. You’re not a glutton. You’re not a sloth. But if you eat a lot of carbohydrates or drink those sweetened drinks, the sugar makes your insulin shoot up. You know that ring around your neck? It means your body has chronically high insulin. That’s not good. Insulin steals the energy from your blood and puts it into your fat. Say you eat 1,000 calories. Your insulin grabs 500 of those calories and stores them in your fat tissue. And guess what? You’re still hungry and you feel tired.”

The second patient’s file appeared more promising. When Lustig last saw this boy he’d been doing well, losing weight. But that was nine months ago. Since then the child had skipped four appointments and gained 33 pounds.

“You were doing so fantastically! You were so stable! What happened?” Lustig said when he entered the room.

The kid shook his head.

“Are you going to fast-food restaurants?”


“Are you drinking sweet drinks?”


“No horchata, agua fresca, Jarritos, tamarindo?”

The boy’s trim father jumped in. “This is not really what’s happening. He’s spending more time with his friends”—separating from his parents. “We have a lot less structure.”

And so the morning went: every 30 minutes, a new obese kid, most of them hunched and mumbling, self-esteem crushed under their weight. Lustig walked into each exam room full of vim, with his rap about how insulin works. Yet it’s an endless, uphill battle. For every family he gets to understand the relationship between sugar, metabolism, and weight gain, there are tens of thousands more to help. Lustig’s last patient of the morning was a 13-year-old girl. He high-fived her and set down his leather doctor’s bag.

“Do you eat breakfast?” Lustig asked.


“Do you eat lunch?”


“How do you do in school?”

“As and Bs.”

“You want to get As and As? Eat breakfast.”

“I don’t have time to eat breakfast,” the girl said.

“She’d rather put on makeup than eat breakfast,” the girl’s mother interrupted.

“You want to know something?” said Lustig, trying to contain his ennui and frustration. “Nobody has time to eat breakfast. I don’t have time to eat breakfast. Go to bed 10 minutes earlier and get up 10 minutes earlier. A lot of kids who don’t eat breakfast eat in the middle of the night. Those kids are a disaster. Those kids gain weight the fastest. Eat breakfast. And pack a lunch.”

Lustig ended the appointment slapping the girl on the back and saying, “Breakfast. As and As.”

Out in the hall he said, “If we keep thinking about obesity in terms of personal responsibility, we’re not going to work our way out of it.”

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