“We are eating too much sugar and it is bad for our health.” And so begins Public Health England’s much publicised report on how to reduce the nation’s sugar consumption. Their recommendations are welcome: nutritionists and dietitians have known for some time that foods high in free sugars (refined sugars added to food and those naturally present in honey, fruit juices and the many natural sweeteners like agave, maple syrup and malt extract) contribute to weight gain and should therefore be consumed in moderation.
The more difficult question is how we go about reducing sugar intake across the population. The debate has been largely overtaken by the focus on the sugar tax, not least because of the support from popular celebrities (Jamie Oliver, for example). The bottom line is that no one action will reduce sugar consumption. What we need is a multifaceted, holistic approach. PHE recommends (prioritised in order of likely impact):
1. Reduce and rebalance the number and type of price promotions in all retail outlets including supermarkets and convenience stores and the out of home sector (including restaurants, cafes and takeaways)
2. Significantly reduce opportunities to market and advertise high sugar food and drink products to children and adults across all media including digital platforms and through sponsorship
3. The setting of a clear definition for high sugar foods to aid with actions 1 and 2 above. Currently the only regulatory framework for doing this is via the Ofcom nutrient profiling model, which would benefit from being reviewed and strengthened
4. Introduction of a broad, structured and transparently monitored programme of gradual sugar reduction in everyday food and drink products, combined with reductions in portion size
5. Introduction of a price increase of a minimum of 10-20% on high sugar products through the use of a tax or levy such as on full sugar soft drinks, based on the emerging evidence of the impact of such measures in other countries
6. Adopt, implement and monitor the government buying standards for food and catering services (GBSF) across the public sector, including national and local government and the NHS to the ensure provision and sale of healthier food and drinks in hospitals, leisure centres etc
7. Ensure that accredited training in diet and health is routinely delivered to all of those who have opportunities to influence food choices in the catering, fitness and leisure sectors and others within local authorities
8. Continue to raise awareness of concerns around sugar levels in the diet to the public as well as health professionals, employers, the food industry etc., encourage action to reduce intakes and provide practical steps to help people lower their own and their families’ sugar intake
A tax alone cannot impact obesity. While there are positive studies, suggesting that a tax MAY reduce intake of sugar sweetened beverages and MAY reduce obesity prevalence (Escobar et al, 2013), there is the risk that it will unfairly penalise the poor. In addition, the evidence that a tax will actually reduce obesity prevalence is scant compared with other measures: individuals simply buy more of other items that are not taxed and so overall consumption is not impacted.
Education alone is not effective either. Individuals are free to eat what they choose and treats in moderation of course do no harm but it is essential that consumers have the ability to make informed decisions about what they buy for themselves and their children.
A multi-pronged approach is needed, building on PHE’s recommendations (with or without a tax) to also encompass product labelling. The Scientific Advisory Committee on Nutrition this year recommended, in line with the World Health Organisation’s findings, that no more than 5% of calories should come from free sugars. However, legally, product labels may only provide information on total sugar, which includes sugars found naturally in milk and whole fruit or vegetables. For a consumer to work out the free sugar content from a label, they would need a calculator and a degree in nutrition! Hardly easy when doing the weekly shop.
What’s needed is a whole food approach – we all know that sugary drinks and snacks aren’t good for us if consumed to excess but if we knew how many teaspoons of sugar were present in them, would we eat as many?
It’s also about improving access to healthier alternatives and removing the real and perceived barriers to healthier eating, especially for those on low incomes. Fresh vegetables, meat and fish are more expensive than ready meals and need more skill, time and confidence to prepare, not to mention cooking equipment. It IS possible to eat healthily on a budget but it takes planning and it takes time to retrain taste buds. Not easy when you have young children.
PHE’s recommendations are just the start. We need a carrot approach not just the stick of debatably effective fiscal penalties – incentivise and motivate healthier choices while taking measures to reduce the consumption of less healthy foods.