Key facts

  • Free sugars should provide no more than 5 per cent of total dietary energy
  • Since the sugar tax was announced, many manufacturers have reduced sugar content in drinks
  • People who use a sugary drink or food to treat hypoglycaemia should regularly check the label


From April, manufacturers have had to pay a tax of 24p per litre of drink containing more than 8g of sugar per 100ml and 18p per litre for beverages with 5-8g per 100ml.

Our liking for sugar combined with its cheapness has helped fuel an epidemic of obesity-related diseases – in England, one-third of children are obese or overweight when they leave primary school. And then there’s the effect on teeth.

According to Public Health England (PHE), 24.7 per cent of five-year-olds have had at least one tooth decayed, extracted or filled because of caries, which is the commonest reason for hospital admission among children aged five to nine years. More than 60,000 children and teenagers were admitted to have teeth removed under general anaesthesia during 2015/2016.1

For anyone over two years of age, free sugars (i.e. those added to foods and drinks, as well as natural sugars in honey, syrups and fruit juice) should provide no more than 5 per cent of total dietary energy. However, according to the House of Commons Health Committee report, ‘Childhood obesity – brave and bold action’, sugar accounted for 12.0 per cent of energy intake in children aged one to three years in 2008-12, and 14.7 and 15.6 per cent in those aged four to 10 and 11-18 years respectively.

The Government says that, since the sugar tax was announced in March 2016, over 50 per cent of manufacturers have reduced the sugar content of drinks – “the equivalent of 45m kg of sugar every year”. The Government plans to invest the money raised to help fund improved sports facilities for children and boost healthy breakfast clubs at schools.

“Responding to consumer demand, the soft drinks sector committed voluntarily to reduce calories in soft drinks by 20 per cent by 2020, before the levy was announced,” a spokesperson for the Food and Drink Federation told PM.

“In fact, sugar in soft drinks has reduced by 19 per cent since 2013. Manufacturers across the wider food industry have already responded positively to PHE’s sugar reduction programme as well as the more recently announced calorie reduction programme.

“While these targets are ambitious, manufacturers have been taking major steps towards these goals for a number of years by reformulating products, limiting portion sizes and introducing healthier products to the market.”

Moot point

The extent to which the levy will reduce sugar consumption and rates of associated diseases in the UK is a moot point, although evidence is beginning to accumulate. In April, for example, the American Journal of Preventive Medicine2 reported the impact of a tax ($0.015 an ounce; roughly 4p per 100ml) on regular and diet soft drinks that was introduced in Philadelphia in January 2017.

According to a telephone survey of 899 people in Philadelphia and 878 respondents in three nearby cities, the decline in diet soft drinks was not statistically significant but, within the first two months, daily consumption of regular and energy drinks were 40 and 64 per cent lower respectively than in the comparison cities. Consumption of bottled water rose by 58 per cent. The frequency of regular soft drink consumption over 30 days was 38 per cent lower.

In Berkeley, California, consumption of sugar-sweetened soft drinks fell by 9.6 per cent within a year of a sugar tax being introduced ($0.01 an ounce). Sales of water rose by 15.6 per cent, untaxed fruit, vegetable and tea drinks by 4.4 per cent and plain milk by 0.63 per cent.3 Further studies need to assess whether these improvements are maintained long-term and the impact on diseases linked to high sugar consumption.

“Evidence shows that [the UK’s sugar] levy has the potential to prevent obesity in up to 140,000 adults and children each year and, in turn, prevent nearly 19,000 cases of type 2 diabetes. We’ve long supported this policy and welcome it coming into force,” says Bridget Turner, director of policy, campaigns and improvement at Diabetes UK.

“There are clear health benefits to the whole population if we are all able to reduce the amount of free sugar in our diet. This policy will go some way to helping make this possible.”

Nevertheless, Diabetes UK warns that, “it won’t always be clear if and when companies have reduced the sugar content of their food or drinks, and they may not publicise any changes”. For a time, old and new recipes may be on sale, so people who use a sugary drink or food to treat hypoglycaemia should regularly check the label.

“It is important to note that many people with type 1 and type 2 diabetes use high sugar products to treat hypos. Reformulation and price increases will both have an impact on this,” says Bridget Turner. “People with diabetes who use sugary drinks to treat hypos should be sure to read the labels to check the sugar content,” she confirms.

Sugar is, of course, only one element in an unhealthy lifestyle and there is a risk that focusing on any one issue could weaken the message supporting a varied diet – but you have to start somewhere. Whether through tax, reformulation or both, cutting sugar in drinks is an important first step. However, it is only the first step in a much longer journey.

Cutting sugar in drinks is an important first step

References
1. Arch Dis Child 2018; 103:5-10
2. DOI: 10.1016/j.amepre. 2018.02.017
3. PLoS Med 2017; 14: e1002283

Originally Published by Pharmacy Magazine

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