A panel advising the UK government on nutrition has recommended halving the official guidance on the consumption of free sugars. Attention now turns to how the country's politicians will respond. Ben Cooper argues the UK government should act – but some policies are more likely than others.
As the eagerly awaited final report on the consumption of carbohydrates from the UK government's Scientific Advisory Committee on Nutrition (SACN) was published on Friday (17 July), attention turned immediately to a further report from Public Health England (PHE), originally expected to be published at the same time, and the policy response from the Government itself.
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While PHE published a response the SACN report, its full report will now probably not be published until mid-September, with its policy proposals being reviewed in the context of a broader childhood obesity strategy to be unveiled by the Department of Health.
PHE began preparing a review of possible policy measures to reduce sugar consumption following the publication of the SACN draft report in June last year. In addition to product reformulation, these also include measures to restrict marketing and promotions of high-sugar food and drink and, crucially, fiscal measures, with PHE analysing the possible impact they could have on consumption.
The Government asked PHE to use evidence from this review to frame advice on actions it could take to lower sugar consumption. The agency has now confirmed it is finalising this evidence review and it will be published "later this summer".
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The SACN findings – chiefly its recommendation that free sugars, defined as sugars added to foods by the manufacturer, cook or consumer along with those naturally present in honey, syrups and unsweetened fruit juices – should not exceed 5% of total dietary energy for age groups from two years upwards, leave the UK government in an awkward position.
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By GlobalDataThe SACN guidelines go further than those published in March by the World Health Organization (WHO), which kept its guidance for sugar consumption at 10% of total calorie intake with a recommendation this should "ideally" be reduced to 5%.
Quite simply, to achieve the 5% limit – given the current average level of sugar intake is around 12% – will require dramatic changes in dietary habits and quite possibly significant policy changes.
As PHE points out in the response to the SACN report, adults are consuming over double the amount of sugar than recommended, and children and teenagers almost three times as much. As PHE also stresses, this 5% limit is now the UK government's official dietary guidance.
It is little surprise that the UK's Food and Drink Federation (FDF), which represents food manufacturers, and the British Soft Drinks Association (BSDA), both questioned the wisdom of recommending a 5% limit, given the impact its successful implementation would have on sales of some of members' products.
However, theirs were somewhat lone voices as health campaigners, charities, public health professionals and medical organisations weighed in with their support for the SACN recommendations.
There is now a clear expectation on the part of the medical community of government action, in the form of policy intervention, from a government that has to date been extremely reluctant to legislate in this area.
Moreover, the sort of policy interventions being urged by medical professionals and, crucially, being analysed in the PHE review, could not be in sharper contrast to the Conservative Party's default approach to the issue since it came to power in 2010, as the controlling party in a coalition with the Liberal Democrats.
Since that time, the flagship government health policy has been the Public Health Responsibility Deal (PHRD), which places emphasis on voluntary action by the private sector to encourage the changes in lifestyle necessary to achieve preventive health objectives.
A report on the PHRD from the Policy Innovation Research Unit (PIRU) at the London School of Hygiene & Tropical Medicine in May was harshly critical of the PHRD, undermining its already shaky credibility. While the Government will certainly persevere with the PHRD, and continue to endorse voluntary action by industry, there is now a real possibility that in parallel it may be compelled to introduce measures of a significantly more draconian nature.
Once again, the prospect of a tax on sugar-sweetened beverages is being widely discussed. This is among the measures being reviewed by PHE. It is also, notably, a measure that has been publicly supported by Professor Susan Jebb, chair of the Public Health Responsibility Deal Food Network.
Recent developments add further piquancy to that specific debate. First, last month saw the publication of research into the efficacy of a tax on sugar-sweetened beverages (SSBs) introduced in Mexico in 2014. The study by the Mexican National Institute of Public Health and the University of North Carolina revealed an average reduction in SSB sales in the year since the implementation of the tax of 6%. The year-on-year decline had risen to 12% by the end of the year. It also showed drink purchases had reduced faster among lower socio-economic groups, with a reduction of 17% revealed for the lowest-income consumers by the end of the year.
The tax on SSBs is among a suite of measures introduced by the Mexican government, including restrictions on advertising less healthy foods to children and, most recently, the introduction of new nutritional labelling.
The Nutritional Health Alliance, a coalition of health and consumer organisations in Mexico, are now demanding the SSB tax be increased from 10% to 20%, on the back of the success achieved to date.
Earlier this month in the UK, the British Medical Association urged the UK government to introduce two fiscal measures to help tackle the obesity crisis. In its report, the BMA recommends introducing a tax on all sugar-sweetened beverages, which increases the price by at least 20%, while also recommending consideration be given to the introduction of fiscal measures to subsidise the sale of fruit and vegetables.
The BMA has also urged the UK government to consider a range of other measures including tightening restrictions on advertising junk food to children, notably through online media; improving nutritional standards for food provided in schools and hospitals; and regulating the nutritional content of processed food and drink products if current voluntary targets on trans fats, salt and calorie reduction are not achieved.
Following the publication of the SACN report, campaign group Action on Sugar called for the UK government to introduce three measures: sugar reduction targets for food and drinks products of 40% by 2020; banning all advertising and promotion of unhealthy foods and drinks to children and adolescents; and a 20% duty on sugary drinks.
These are all policy options being reviewed by the PHE and its findings will soon become public. Among these possibilities, arguably the option that would be most consistent with the UK government's approach to date would be a specific sugar reduction – and possibly restrictions on promotion – to be incorporated into the PHRD. However, Prof. Jebb told just-food in May a sugar reduction pledge would only likely "bring modest additional gains". Meanwhile, a voluntary measure on food promotion has so far proved impossible to achieve within the PHRD.
All of which suggests a greater likelihood than there has been to date of a tightening of regulation governing the advertising and promotion of less healthy foods, for example through revision of the UK Code of Broadcast Advertising and the UK Code of Non-broadcast Advertising and, even though this still seems a more remote possibility, a tax on sugar-sweetened drinks.
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