tag:theconversation.com,2011:/africa/topics/sugary-drinks-7693/articlesSugary drinks – The Conversation2024-03-28T12:18:54Ztag:theconversation.com,2011:article/2232392024-03-28T12:18:54Z2024-03-28T12:18:54ZWhat is sugar and what would happen if I stopped eating it? A scientist explains<p>The world has declared a time-out on sugar consumption. The harmful link between disease and dietary sugar was recently outlined in a <a href="https://pubmed.ncbi.nlm.nih.gov/37019448/">comprehensive assessment</a> of published studies. </p>
<p>Recognising this link between widely consumed food and disease is essential in marshalling forces to <a href="https://www.who.int/tools/elena/interventions/free-sugars-adults-ncds">change harmful outcomes</a>. These include coronary heart disease, obesity, type 2 diabetes, tooth decay and some cancers. For over a decade, <a href="https://www.researchgate.net/profile/Grace-Jones-10#publications">my research</a> has focused on the mechanisms by which fructose intake plays into disease. </p>
<p>A growing number of African countries have joined the worldwide efforts to reduce sugar intake. For instance, in an attempt to address obesity, diabetes and other non-communicable diseases, South Africa introduced a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9597050/#:%7E:text=South%20Africa%20became%20the%20first,implemented%20on%201%20April%202018.&text=Referred%20to%20as%20the%20Health,billions%20of%20rands%20in%20revenues.">tax on sugar-sweetened drinks</a> in 2018. </p>
<p>It’s hard to avoid sugar when it’s become a normal part of diets and when we celebrate special times with sweet treats. But being more aware of what sugar is and how it can affect our health is the first step.</p>
<h2>What is sugar?</h2>
<p>Sugar is a class of naturally occurring sweet-tasting molecules found in fruits, vegetables, plants and the milk of mammals. It can be extracted from these natural sources and concentrated in processed foods. </p>
<p>The sweet-tasting molecules in sucrose (table sugar) are glucose and fructose. </p>
<p>Sucrose is a disaccharide. This is a molecule made of two simple sugars – glucose and fructose – in a 1:1 ratio and chemically bound. Sucrose is used in many processed foods.</p>
<p>High fructose corn syrup, also used in processed foods, is a mixture of the monosaccharides glucose and fructose. Usually the combination is 45% glucose and 55% fructose. </p>
<p>Sucrose and high fructose corn syrup are more concentrated in processed foods than in fruits and vegetables. </p>
<p>Both are considered added sugars when they are <a href="https://ift.onlinelibrary.wiley.com/doi/abs/10.1111/1541-4337.12151">added to foods and drinks</a>. Besides the sweet taste, they may be <a href="https://www.sciencedaily.com/releases/2015/08/150818131807.htm#:%7E:text=Sugar%20aids%20in%20the%20fermentation,reducing%20water%20activity%20in%20foods">added</a> for colour and texture, as a preservative or to aid fermentation. </p>
<p>There are other natural sugars found in the foods we eat. Lactose, or milk sugar, is a disaccharide made of two simple sugars – glucose and galactose – in a 1:1 ratio. It’s found in mammals’ milk and produced naturally to provide nutrition to offspring, and in other dairy products, such as cheese and ice cream. </p>
<p>Honey, made from nectar by honeybees, is primarily a mixture of glucose and fructose monosaccharides with some maltose, sucrose and other carbohydrates. Maltose, which is found in breakfast cereals and breads, is a disaccharide of two glucose molecules. </p>
<p>Naturally occurring sugars are made by plants, bees or mammals based on their needs. </p>
<p>The human body needs glucose as a fuel for every cell, especially brain cells. That’s one of the reasons why we need a stable blood glucose level throughout the day and night.</p>
<p>The way our bodies use fructose is different. It can be turned into glucose, used as fuel, or processed into fats, called triglycerides. Excessive fructose in our diets can lead to <a href="https://pubmed.ncbi.nlm.nih.gov/29408694/">increases</a> in blood triglycerides, liver fat, blood glucose, body mass index and insulin resistance (where the body cannot easily remove glucose from the bloodstream). </p>
<p>Increases in these markers can lead to an increased risk for metabolic dysfunction, type 2 diabetes and non-alcoholic fatty liver disease (or metabolic dysfunction-associated steatotic liver disease). </p>
<p>Because of the difference in how the body uses glucose and fructose, and evidence that a higher consumption of sugar leads to worse health outcomes, we must be mindful of the added sugar we eat.</p>
<h2>What would happen if we quit eating sugar?</h2>
<p>A group of scientists performed a study and published a set of research papers that detailed <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.21371">exactly what happened</a> when over 40 children (aged eight to 18) stopped eating sugar and fructose for 10 days. The participants didn’t stop eating bread, hotdogs or snacks. They stopped eating fructose. These studies found <a href="https://pubmed.ncbi.nlm.nih.gov/28579536/">significant reductions</a> in:</p>
<ul>
<li><p>newly made triglycerides (or fats)</p></li>
<li><p>fasting blood glucose</p></li>
<li><p>blood pressure</p></li>
<li><p>fat stored on organs, including the liver</p></li>
<li><p>AST, which is a marker of liver function</p></li>
<li><p>insulin resistance, as their cells were better able to remove glucose from the bloodstream</p></li>
<li><p>body mass index.</p></li>
</ul>
<p>The participants also reported feeling better and were better behaved.</p>
<p>The World Health Organization has made <a href="https://iris.who.int/bitstream/handle/10665/149782/9789241549028_eng.pdf?sequence=1">recommendations</a> for adults and children to reduce their sugar intake to about 58 grams, or 14 teaspoons, per day or between 5% and 10% of total caloric intake. </p>
<p>This is not a lot of sugar. </p>
<p>Consider that a 300ml bottle of Coca-Cola or 240ml cup of sugarcane juice contain about <a href="https://www.coca-cola.com/ke/en/brands/brand-coca-cola/product-coca-cola-original#accordion-d588759a1d-item-8b5bb499cf">30 grams</a> of sugar. One piece of mandazi, a popular deep-fried Kenyan wheat snack, has about <a href="https://www.nutritionix.com/i/nutritionix/mandazi-1-small-piece-3-diameter/5c4f552f21b2c9e80f1748f2">4 grams</a> of sugar, or about 6% of the WHO’s recommended intake contained in each small piece.</p>
<h2>What can I do to lower my sugar intake to recommended levels?</h2>
<p>First, keep track of everything you eat during a typical day, what you eat, when you eat and how much you eat. Secondly, give yourself a star for the fresh vegetables and whole fruits you eat, and identify the foods that have added sugars. </p>
<p>Now, set an attainable goal that details one thing you can change to either:</p>
<p>1) increase the whole fruits or vegetables you eat or </p>
<p>2) decrease the amount of added sugar that you eat each day. </p>
<p>This way, you can be mindful of the added sugar you consume and adjust what you eat accordingly.</p><img src="https://counter.theconversation.com/content/223239/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grace Marie Jones receives funding from The National Institutes of Health (US). </span></em></p>A higher consumption of sugar leads to worse health outcomes, so we need to be mindful of the added sugar we eat.Grace Marie Jones, Associate Professor, College of Osteopathic Medicine, Touro UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2232132024-02-28T13:11:58Z2024-02-28T13:11:58ZAre slushies really bad for young children’s health?<p>Recently there have been concerning reports <a href="https://www.thescottishsun.co.uk/health/11883723/parents-risks-expert-slushie-kid-collapse/">in the news</a> of a three-year-old boy who collapsed and was admitted to hospital after drinking a slushy drink. Fortunately, after a few days, the child recovered completely. </p>
<p>This has led to calls for improved labelling where slushies are sold so that parents are better educated about the potential risks to young children consuming these drinks. It has also led to calls for the drinks to be removed from sale at certain venues, such as soft-play centres. </p>
<p>This follows from reports of <a href="https://www.food.gov.uk/news-alerts/news/not-suitable-for-under-4s-new-industry-guidance-issued-on-glycerol-in-slush-ice-drinks">three other young children</a> being admitted to hospital following consuming slushy drinks containing glycerol, which in 2023 led to the Food Standards Agency in the UK reviewing the safety of glycerol in slushies. These children had low blood glucose and high levels of glycerol before recovering. </p>
<p>This led to the recommendation that slushy drinks containing glycerol should not be offered to children aged <a href="https://www.food.gov.uk/news-alerts/news/not-suitable-for-under-4s-new-industry-guidance-issued-on-glycerol-in-slush-ice-drinks">four years and younger</a>.</p>
<p>Using these figures it was also recommended that children under ten should not be offered free refills. This advice also includes the recommendation that these customers should be informed of these <a href="https://www.foodstandards.gov.scot/publications-and-research/publications/industry-guidelines-for-the-food-additive-glycerol-e-422-in-slush-ice-drinks">risks and restrictions</a> for young children, but no recommendations were made about restricting where they could be sold.</p>
<h2>What is glycerol?</h2>
<p>Glycerol also known as glycerine <a href="https://www.food.gov.uk/business-guidance/approved-additives-and-e-numbers#:%7E:text=Glycerol%20E%20422">or E422</a> is recognised as being <a href="https://www.fda.gov/files/food/published/GRAS-Notice-000583---Esterified-propoxylated-glycerol.pdf">generally safe as a food additive</a> by the EU and the US Food and Drug Administration. Chemically, it is described as a <a href="https://foodinsight.org/what-is-glycerin/#:%7E:text=Highlights,vinegar%2C%20wine%20and%20wine%20vinegar.">sugar alcohol</a>. </p>
<p>Aside from slushies, glycerol is also found in flavourings such as vanilla essence and is often used to keep icing soft.</p>
<p>Normally, in our bodies, glycerol is connected to fatty acids, so levels in the blood are low. Also, our bodies do not have a way of regulating or controlling glycerol in the same way we produce insulin to control glucose (blood sugar). So there is no way for our body to simply start using more glycerol in cells in the way we can with glucose after a meal. </p>
<p>This does not mean glycerol is toxic, it just means it can stay in blood for longer than glucose. As this adds to the amount of things dissolved in our blood, it means the plasma in blood becomes more concentrated and can draw water from other parts of the body, including the brain, which can lead to symptoms such as headache, nausea and dizziness.</p>
<figure class="align-center ">
<img alt="Two girls share a slushy" src="https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is no way for our body to use more glycerol.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-cute-little-sisters-drinking-colorful-530498500">MNStudio/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Why use glycerol in slushies?</h2>
<p>How slushies are made has changed, at least partly in response to a UK government policy on sugar reduction and the <a href="https://www.gov.uk/money/soft-drinks-industry-levy">Soft Drinks Industry Levy</a> (the “sugar tax”). Where most sweetened soft drinks, were able to use a mix of low- and no-calorie sweeteners – such as aspartame – this doesn’t work when it comes to slushies.</p>
<p>The challenge when making slushies, compared to normal soft drinks, is the sugar does more than provide sweetness. Sugar has the physical function in slushies of decreasing the freezing point of water. Water freezes at 0°C, but adding sugar reduces the ability of the water molecules to connect by hydrogen bonds and form ice. </p>
<p>Adding sugar to water and churning as the temperature drops below zero produces slush rather than ice. To do this, you need at least 12g of sugar per 100ml, which would mean sugar-containing slushies would be liable for the highest rate of <a href="https://www.gov.uk/government/statistics/soft-drinks-industry-levy-statistics/soft-drinks-industry-levy-statistics-commentary-2021#:%7E:text=Soft%20Drinks%20Industry%20Levy%20net%20liabilities,-SDIL%20rates&text=In%20April%202023%2C%20SDIL%20was,rate%20(24p%20per%20litre).">tax at 24p per litre</a> in the UK. </p>
<p>In line with <a href="https://www.gov.uk/government/collections/sugar-reduction">sugar reduction strategies</a>, aimed at helping people consume the target set by the government’s <a href="https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report">Scientific Advisory Committee on Nutrition</a> of less than 5% of energy from added sugar, manufacturers have looked for another solution.</p>
<p>In a slushy, intense sweeteners, such as aspartame, won’t work as it is a very intense sweetener <a href="https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report">being 200 times sweeter</a> than sugar. So you can’t just swap out sugars for aspartame. A different solution is needed, one where a similar quantity of sweetener is used compared with sugar. These so-called bulk sweeteners, such as sorbitol and mannitol, can have a laxative effect, so they aren’t great options. </p>
<p>Glycerol was the chosen solution, which can make a slushy with around 5g per 100ml. But is that amount safe to consume?</p>
<p>European Food Safety Agency reassessed the <a href="https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2017.4720">safety of glycerol</a> in 2017. It reported that consuming 125mg per kilogram of body weight per hour was enough to increase the concentration of blood and potentially cause symptoms in patients. This was based on how glycerol was used in the past to treat swelling in the brain (cerebral oedema). However, there is little data on the effect of glycerol outside of hospitals, and it was assumed that this level of intake could be linked to potential risks. </p>
<p>For an adult, there are no risks of drinking an average-sized slushy, simply because they are bigger and unlikely to achieve a blood level high enough to bring on symptoms. But for a young child, because of their size, it was considered that the risk was deemed high enough for warnings to be issued.</p>
<p>However, the Food Standards Agency’s response and recommendations to restrict the supply of slushies to young children could benefit from being more clearly communicated and more effectively applied.</p><img src="https://counter.theconversation.com/content/223213/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Duane Mellor consulted with Frozen Brothers as part of the Food Standards Agency work on the safety of glycerol as a sweetener in slush drinks</span></em></p>The Food Standards Agency advises that children under four should not be given these drinks.Duane Mellor, Lead for Evidence-Based Medicine and Nutrition, Aston Medical School, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2202552024-01-15T17:52:22Z2024-01-15T17:52:22ZUltra-processed foods: here’s what the evidence actually says about them<figure><img src="https://images.theconversation.com/files/568397/original/file-20240109-27-idrupq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6709%2C4476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ultra-processed foods have received a lot of attention in recent months.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/healthy-unhealthy-food-background-fruits-vegetables-1766495423">Julia Sudnitskaya/ Shutterstock</a></span></figcaption></figure><p>The perils of ultra-processed foods received widespread coverage in recent months – thanks in no small part to the publication and promotion of TV presenter and doctor of virology Chris Van Tulleken’s book Ultra-Processed People. </p>
<p>Ultra-processed foods, in short, are commercially manufactured food products that include ingredients you <a href="https://pubmed.ncbi.nlm.nih.gov/30744710/">wouldn’t cook with at home</a>. Some of this processing makes foods more palatable, some increases shelf life and makes them more affordable – such as wholemeal supermarket bread, for example. </p>
<p>Scientists have long known that foods high in <a href="https://www.bhf.org.uk/informationsupport/support/healthy-living/healthy-eating">saturated fat</a>, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13852">salt</a>, <a href="https://www.bmj.com/content/346/bmj.e7492/">sugar</a>, calories or which contain too few <a href="https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/diet-and-cancer/wholegrains-fibre-and-cancer-risk">wholegrains and fibre</a> contribute to greater risk of health problems – such as obesity, hypertension, heart disease and <a href="https://www.mdpi.com/2072-6643/12/9/2722">type 2 diabetes</a>.</p>
<p>A fair number of ultra-processed foods will have some of these unfavourable nutritional profiles – but many don’t. What is new and controversial about ultra-processed food is the idea that food processing itself is deadly. </p>
<p>Van Tulleken’s book argues that “it is the ultra-processing, not the nutritional content, that’s the problem”. Musing on why some pizza isn’t great for our waist lines, he writes “the only question is whether it is an ultra-processed food”. Van Tulleken also claims ultra-processed food is linked to more deaths than tobacco, and is the <a href="https://twitter.com/DoctorChrisVT/status/1651605966167629828">number one cause of early death globally</a>. </p>
<p>But, in my view a lot of this is just wrong. </p>
<h2>Myths scrutinised</h2>
<p>Ultra-processed foods haven’t been shown to be the largest cause of deaths globally and no scientific study has ever found this.</p>
<p>I believe this bold but misleading claim appears to be a misinterpretation of research which suggests that poor diet is a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30041-8/fulltext">leading cause of death</a>. Most deaths attributed to poor diet in this and similar studies are due to factors such as not eating enough fruit and veg, oily fish or wholegrains.</p>
<p>Nor is there strong evidence that whether a food is ultra-processed or not is what determines how it may affect your health.</p>
<p>Many studies have shown that people whose diets are high in ultra-processed foods have poorer health compared to those whose diets contain <a href="https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/consumption-of-ultraprocessed-foods-and-health-status-a-systematic-review-and-metaanalysis/FDCA00C0C747AA36E1860BBF69A62704">fewer ultra-processed foods</a>. However, <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00190-4/fulltext">research suggests</a> that it’s some <a href="https://pubmed.ncbi.nlm.nih.gov/36854188/">specific types of ultra-processed foods</a> foods that are linked to worse health in studies that examine this, rather than all ultra-processed foods. </p>
<p>This includes categories like <a href="https://diabetesjournals.org/care/article/33/11/2477/26589/Sugar-Sweetened-Beverages-and-Risk-of-Metabolic">sugary drinks</a> and <a href="https://www.tandfonline.com/doi/full/10.1080/01635580701684872?casa_token=hRJZpZZm3mcAAAAA%3AvN_DTeb3WTaPbLV89nRw0Jj98L05sy4i6PVKzPvmSqDBS3P6yG9eZ-WISzGZZ9rLxnsTB87xTNlmUfc">processed meats</a>, which we have known for some time are bad for health. Eating other foods classed as ultra-processed <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00190-4/fulltext">does not predict worse health</a>. And some studies have even shown them to predict better health. <a href="https://pubmed.ncbi.nlm.nih.gov/36854188/">Brown bread and cereals</a>, are good examples.</p>
<p>Pretty much all scientific studies used as evidence on the harms of ultra-processed foods are <a href="https://www.tandfonline.com/doi/full/10.1080/10408398.2022.2084359">“observational studies”</a>. This means the researchers don’t change a person’s diet to see what happens to their health – they observe the health of people based on what they report they eat. </p>
<figure class="align-center ">
<img alt="A loaf of sliced brown bread." src="https://images.theconversation.com/files/568399/original/file-20240109-15-7d9pme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568399/original/file-20240109-15-7d9pme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568399/original/file-20240109-15-7d9pme.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568399/original/file-20240109-15-7d9pme.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568399/original/file-20240109-15-7d9pme.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568399/original/file-20240109-15-7d9pme.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568399/original/file-20240109-15-7d9pme.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Not all ultra-processed foods are associated with poorer health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/delicious-rye-bread-on-table-1859709994">Dar1930/ Shutterstock</a></span>
</figcaption>
</figure>
<p>As such, observational studies can only try to account for all the ways in which people who eat a lot of ultra-processed foods versus fewer ultra-processed foods differ. </p>
<p>This is key to ultra-processing, because there may be unmeasured factors about a person or their diet that cause worse health – making it appear the number of ultra-processed foods in a person’s diet is harming their health, when it isn’t. <a href="https://link.springer.com/article/10.1007/s00394-023-03270-1">A recent study</a> captures this perfectly. </p>
<p>The study looked at whether ultra-processed food consumption was associated with developing cancer. It was, as shown in other <a href="https://pubmed.ncbi.nlm.nih.gov/37087831/#:%7E:text=Conclusion%3A%20In%20conclusion%2C%20the%20available,%2C%20breast%2D%20and%20pancreatic%20cancer.">studies</a>. But it also looked at whether ultra-processed food consumption was associated with a health outcome it should have no plausible reason to be associated with: accidental death. People who ate a lot of ultra-processed foods were more likely to die in car crashes, falls and other accidents, it turns out. </p>
<p>There’s no plausible reason why processed food would cause accidental death. Rather, the reason is probably something else that has either not been accurately measured and accounted for or not measured at all – known as a “confounding factor”. </p>
<p>People from <a href="https://www.sciencedirect.com/science/article/abs/pii/S0049089X13001348">poorer backgrounds</a> are more likely to be victims of accidental death – as are people who have <a href="https://pubmed.ncbi.nlm.nih.gov/23969485/">worse mental health</a>. We also know that people from <a href="https://www.cambridge.org/core/journals/nutrition-research-reviews/article/who-consumes-ultraprocessed-food-a-systematic-review-of-sociodemographic-determinants-of-ultraprocessed-food-consumption-from-nationally-representative-samples/017138E7EFE0FEE6C32C2B42510935B4">poorer backgrounds</a> or who have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9268228/">worse mental health</a> often eat more ultra-processed food. </p>
<p>A study can measure a person’s income, but the many ways in which living in poverty or having worse mental health can damage physical health are very difficult to measure with any accuracy. They therefore may be examples of confounding factors that make ultra-processed food appear to predict worsening health, like cancer.</p>
<p>Given the doom and dread about food processing, you’d think there’s convincing evidence that has identified how food processing harms health in humans. But there isn’t. Panels of scientists from the <a href="https://www.sciencedirect.com/science/article/pii/S2161831323013789">US</a> and <a href="https://www.gov.uk/government/publications/sacn-statement-on-processed-foods-and-health">UK</a> (both with and without histories of food industry funding) agree on this and agree that it currently isn’t clear if food processing itself harms health. </p>
<p>I believe there’s good reason to conduct more research to understand ultra-processed food and health. But this is a long way from Van Tulleken’s assertion that we’re eating <a href="https://www.theatlantic.com/ideas/archive/2023/05/ultra-processed-food-chris-van-tulleken/674101/">“food that isn’t food”</a> and that ultra-processed food is worse for health than <a href="https://www.youtube.com/watch?v=dzUDhstqXbg">smoking</a>.</p>
<p>Hype around ultra-processed food is problematic because it may be causing unnecessary anxiety among people who already struggle with food or worry about their health.</p>
<p>As well as confusing the public on what food is and isn’t healthy, ultra-processed food hype may also distract attention from much-needed government action to restrict food industry marketing and sales of the types of foods we already know are bad for health – foods higher in sugar, salt, saturated fat and calories. </p>
<p>Perhaps in the future, convincing evidence might show that some specific types of food processing can cause severe health problems. But until then, sensationalist messages and misleading claims about ultra-processed food are very real problems.</p><img src="https://counter.theconversation.com/content/220255/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I receive research funding from the ESRC, NIHR and ERC. During 2014-2016, I was a named investigator on projects funded by Unilever and the American Beverage Association. I do not receive any funding, financial awards or fees from the food industry.</span></em></p>Hype around ultra-processed food may be causing unnecessary anxiety among people who already struggle with food or worry about their health.Eric Robinson, Professor in Psychology, University of LiverpoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2169152023-11-13T14:43:04Z2023-11-13T14:43:04ZBad food choices: clearer labels aim to help South Africans pick healthier options<p>South Africans have a hard time figuring out which foods are unhealthy when they go shopping. But this is about to change.</p>
<p>South African supermarkets currently sell <a href="https://doi.org/10.1017/S1368980022000374">large amounts of unhealthy, ultra-processed foods</a>. Packaged foods in particular have high levels of sugar, salt and saturated fat – all things that are bad for our health.</p>
<p><a href="https://www.nature.com/articles/s41366-020-00650-z">Research</a> shows that the consumption of these foods is linked to increasing rates of obesity and related diseases such as diabetes.</p>
<p>Many countries have been looking for better labelling systems which help consumers understand whether a product is unhealthy. Countries that have adopted simpler labelling systems have seen consumers making <a href="https://www.oecd-ilibrary.org/content/paper/c1f4d81d-en">healthier choices</a> about food. </p>
<p>South Africa’s health minister published draft <a href="https://www.gov.za/sites/default/files/gcis_document/202304/48428rg11572gon3287.pdf">food labelling regulations</a> in April. These will introduce a new labelling scheme, limit advertising of unhealthy foods, and restrict the use of misleading health claims.</p>
<p>The draft regulations propose clearer food labels, which include a new triangle highlighting that the food contains ingredients that are unhealthy. These logos will be placed on the front of a product.</p>
<p>We are part of the <a href="https://www.globalfoodresearchprogram.org/nutrient-warning-labels-work-in-south-africa-results-from-a-randomized-controlled-trial">working group</a> that advised the Department of Health on front-of-package nutrition labelling, drawing on our expertise in dietetics, nutrition, public health and the law. </p>
<p>We worked with consumers and experts on food labelling, advertising and obesity prevention to create a system designed to work well in South Africa.</p>
<p>But it was a complicated process. This is how we did it. </p>
<h2>How do we know which food is unhealthy?</h2>
<p>The first step is to find a way to identify unhealthy foods. There are <a href="https://www.emro.who.int/nutrition/reduce-fat-salt-and-sugar-intake/index.html">international guidelines</a> on how much sugar, salt and saturated fat people should be eating. These can be used to measure whether a food has too much of these ingredients. </p>
<p>Figuring out whether a food is unhealthy can be tricky, but luckily, other countries around the world have adopted systems like this before, known as <a href="https://doi.org/10.3390/nu13082584">nutrient profile models</a>, and we could build on what they had already done. </p>
<p>We looked at what foods were being sold in South African supermarkets. We searched for nutrient profiling models that identify unhealthy foods and work well in other countries and tested these on the South African food supply.</p>
<p>We found that the <a href="https://doi.org/10.3390/nu13082584">Chilean model</a>, which focuses only on unhealthy ingredients, sugar, sodium and saturated fat, would work well because it was simple to implement and was able to identify unhealthy products very easily and accurately. </p>
<p>We then modified the Chilean model to make it work for South Africa.</p>
<h2>Choosing the right label</h2>
<p>The next thing to decide was what kind of label South Africa should use. There are lots of different systems but not all work well. </p>
<p>One uses colour coding. For example, a low level of salt would get a green marker while high sugar would get a red one.</p>
<p>There are also descriptive labels which don’t tell consumers whether the amounts are good or bad – just whether they are present.</p>
<p>Then there are warning labels, often shaped like traffic signs, to alert consumers to the high levels of unhealthy ingredients such as saturated fat, sugar and salt.</p>
<p>We looked at how to design a label that would be <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257626">understandable</a> to the average South African. We consulted South Africans on each element of the label, from the wording and size to the symbols and colour.</p>
<p>We developed a black triangle – inspired by a danger warning sign – which would stand out on colourful food packages and included pictures so that anyone, even those who can’t read or speak English, would be able to understand them.</p>
<p>The last part of this work was a nationally representative randomised, control trial of different labelling systems. Almost <a href="https://www.sciencedirect.com/science/article/pii/S0195666322003749">2,000</a> people across different income groups and education levels participated. </p>
<p>We also found that the warning labels led to consumers <a href="https://www.sciencedirect.com/science/article/pii/S0195666322003749">changing their minds</a> about what food they would consider buying.</p>
<p>Earlier this year, South Africans had the opportunity to give comments on the regulations that will see this labelling system implemented. Now it’s up to the department to decide when and how to put these regulations into action.</p>
<p>Hopefully soon all South Africans will be able to see at a glance which foods are bad for their health.</p><img src="https://counter.theconversation.com/content/216915/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Safura Abdool Karim receives funding from Bloomberg Philanthropies. </span></em></p><p class="fine-print"><em><span>Makoma Bopape receives funding from Bloomberg Philanthropies</span></em></p><p class="fine-print"><em><span>Rina Swart receives funding from Bloomberg Philanthropies, the National Department of Health and the DSI/NRF COE in Good Security. </span></em></p><p class="fine-print"><em><span>Tamryn Frank receives funding from Bloomberg Philanthropies. </span></em></p>Countries that have adopted clear food labels have seen the health benefits. Researchers explain how a new system to alert South African consumers to unhealthy choices was developed.Safura Abdool Karim, Postdoctoral fellow, Johns Hopkins UniversityMakoma Bopape, Lecturer in Department of Human Nutrition and Dietetic, University of LimpopoRina Swart, Professor, University of the Western CapeTamryn Frank, Researcher, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1927422022-10-27T19:26:41Z2022-10-27T19:26:41ZHow taxing sugary drinks reinforces weight stigma<figure><img src="https://images.theconversation.com/files/491565/original/file-20221025-246-osvds4.jpg?ixlib=rb-1.1.0&rect=4%2C98%2C2972%2C2090&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Newfoundland and Labrador has implemented a tax of 20 cents per litre on sugary drinks.</span> <span class="attribution"><span class="source">(AP Photo/Jenny Kane)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/how-taxing-sugary-drinks-reinforces-weight-stigma" width="100%" height="400"></iframe>
<p>Newfoundland and Labrador made history in September as the first Canadian province to <a href="https://www.cbc.ca/news/canada/newfoundland-labrador/rethink-your-drink-campaign-1.6548570">implement a sugar-sweetened beverage tax</a>. Sugar-sweetened beverage taxes also exist outside of Canada, including in <a href="https://doi.org/10.1017/s1368980016003086">Mexico, Philadelphia, Penn. and the United Kingdom</a>. In Newfoundland and Labrador the tax amounts to <a href="https://www.gov.nl.ca/budget/2021/what-you-need-to-know/promoting-a-healthier-newfoundland-and-labrador">20 cents per litre</a> of sugar-sweetened beverage.</p>
<p>Sugar-sweetened beverage taxation is supported by many global and national health organizations, such as the <a href="https://www.who.int/europe/publications/i/item/WHO-EURO-2022-5721-45486-65112">World Health Organization</a>, <a href="https://www.diabetes.ca/advocacy---policies/our-policy-positions/sugar---diabetes">Diabetes Canada</a> and the <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/position-statement/liquidcandy-factsheet-en.ashx?la=en&hash=E21D8E5A8708FD82915931DEC2C768361D130CC7">Heart and Stroke Foundation</a>. Taxes are a popular public health policy because of associations between sugary beverage consumption and <a href="https://doi.org/10.2337/dc10-1079">Type 2 diabetes</a> and <a href="https://doi.org/10.3945/ajcn.113.058362">weight gain</a>. </p>
<p>Sugar-sweetened beverage taxes are excise taxes, or flat taxes, which also make them regressive taxes. This type of taxation has real potential to have <a href="https://theconversation.com/a-sin-tax-on-sugary-drinks-unfairly-targets-indigenous-communities-instead-of-improving-health-155108">harmful effects on equity</a> as lower-income populations will pay a higher proportion of their income through this tax. Previous critiques of sugar-sweetened beverage taxation also include the <a href="https://vocm.com/2022/09/06/opposition-fielding-questions-on-new-sugar-tax/">potential harm to small business</a> and First Nations communities.</p>
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Read more:
<a href="https://theconversation.com/a-sin-tax-on-sugary-drinks-unfairly-targets-indigenous-communities-instead-of-improving-health-155108">A sin tax on sugary drinks unfairly targets Indigenous communities instead of improving health</a>
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<h2>Weight stigma</h2>
<p>Notably absent from this list of harms is the potential of sugar-sweetened beverage taxation to create or exacerbate stigma, including weight stigma. Weight stigma in health policies has received global attention and there are <a href="https://doi.org/10.1038/s41591-020-0803-x">many calls to action</a> to end <a href="https://doi.org/10.1016/S2468-2667(19)30186-0">weight-stigmatizing policies</a>.</p>
<figure class="align-center ">
<img alt="Overweight parents walking outdoors with their child" src="https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=509&fit=crop&dpr=1 600w, https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=509&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=509&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=639&fit=crop&dpr=1 754w, https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=639&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/491963/original/file-20221026-21-c74v42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=639&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Weight stigma includes stereotypes of laziness and stupidity, which are not supported by evidence.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>Stigma occurs, in part, when a label — such as “obesity” — is associated with negative stereotypes, <a href="https://doi.org/10.1146/annurev.soc.27.1.363">leading to discrimination and loss of status</a>. Weight stigma includes stereotypes of <a href="https://doi.org/10.1037//0278-6133.22.1.68">laziness and stupidity</a>. It can lead to <a href="https://doi.org/10.1038/oby.2008.636">discrimination in health-care and workplace settings</a>. </p>
<p>Weight stigma has negative effects on <a href="https://doi.org/10.1111/cob.12264">mental</a> and <a href="https://doi.org/10.1111/jan.13511">physical health</a>, including <a href="https://doi.org/10.1038/sj.ijo.0803105">health-care avoidance</a>, <a href="https://doi.org/10.1016/j.eatbeh.2020.101383">disordered eating</a>, <a href="https://doi.org/10.1186/s12889-021-10565-7">self exclusion from sport and exercise</a> and <a href="https://doi.org/10.1111/jan.13511">stress</a>. Contrary to what many people think, <a href="https://doi.org/10.2105%2FAJPH.2009.159491">stigma is not an effective strategy for weight loss</a>. </p>
<p>Even before Newfoundland and Labrador declared its intentions with sugar-sweetened beverage taxation, significant interest in Canada and globally led us to explore attitudes and acceptability of a tax in our province of Manitoba. We conducted an <a href="http://hdl.handle.net/1993/36863">interview-based study</a> with residents of many different locations, including a middle-to-upper class, liberal neighbourhood in the provincial capital, Winnipeg. </p>
<p>Our participants from this location were white, food secure and primarily highly educated. In our analysis, we specifically sought out instances of weight stigma in the interview transcripts. </p>
<h2>Stigmatizing messages</h2>
<p>We were interested in the language participants used because people absorb the messages they hear and the images they see. They may push back, change or repeat these messages. </p>
<figure class="align-center ">
<img alt="A hand pouring sugar out of a soda can" src="https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/491753/original/file-20221025-18-2ajurj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People absorb the messages they hear and the images they see.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>In our analysis of the interviews, we found that many participants repeated weight-stigmatizing messages when discussing sugar-sweetened beverages. A more overt way this occurred was through the judgement of higher-weight individuals who were buying or consuming sugar-sweetened beverages. </p>
<p>Weight stigma also occurred in more covert or subtle ways. For example, some participants talked about their “disgust” and other negative emotions associated with their weight and others’ weight. Many participants also spoke of their “responsibility” to lose weight or to protect their children from becoming overweight by not consuming sugar-sweetened beverages and juice. </p>
<p>Weight dissatisfaction is <a href="https://doi.org/10.1155/2013/291371">harmful to one’s health</a>. Disgust also has justice implications for public health. Being disgusted by someone <a href="https://doi.org/10.1080/09581596.2014.885115">makes them seem less than human. It can contribute to blaming people</a> for conditions caused by multiple biological and social factors and can reinforce prejudice. </p>
<p>Participants also described higher weight individuals as a “burden” on the health-care system and that a tax on sugar-sweetened beverages would help offset these perceived costs. While this myth of obesity bankrupting the health-care system is pervasive, research suggests otherwise. In Manitoba, the health service usage for <a href="http://mchp-appserv.cpe.umanitoba.ca/reference/MCHP-Obesity_Report_WEB.pdf">individuals classified as overweight was found to be similar to those classified as normal weight</a>. Health-care usage was only marginally higher for individuals classified as obese. </p>
<h2>Policies and stigma</h2>
<p>Hearing these comments repeated in our interviews indicated to us how pervasive and widespread weight stigma was in participants’ attitudes toward sugar-sweetened beverage intake. Most importantly, these beliefs informed support or acceptability of sugar-sweetened beverage taxation. </p>
<p>This finding echoes <a href="https://doi.org/10.1016/j.socscimed.2013.09.023">existing research suggesting reciprocal processes</a> between stigma at inter- and intra-personal levels and policies. This indicates that interpersonal stigma may contribute to the creation of stigmatizing policies and that stigmatizing policies may in turn legitimize and worsen existing stigma. </p>
<p>Our specific research population was chosen because it was a good representation of the dominant social group in Canada — a white, middle-to-upper class, highly educated segment of the population. This dominant population is also likely to be similar to many policymakers, further supporting the perspectives of this group within Canadian policies. </p>
<p>Our findings demonstrate how weight-stigmatizing comments were used in support of sugar-sweetened beverage taxation. Weight stigma has <a href="https://theconversation.com/how-anti-fat-bias-in-health-care-endangers-lives-115888?">serious health consequences</a>. If Canadian <a href="https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/addressing-stigma-toward-more-inclusive-health-system.html">public health professionals</a> are committed to tackling weight stigma in health policies, we need to reconsider our support for this policy.</p><img src="https://counter.theconversation.com/content/192742/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne Katherine Anderson Waugh received Canada Graduate Scholarship-Masters funding from CIHR. She has also received funding from the University of Manitoba, Faculty of Graduate Studies. </span></em></p><p class="fine-print"><em><span>Andrea Bombak receives funding from New Brunswick Health Research Foundation, Social Sciences and Humanities Research Council, and Banting Discovery Award. </span></em></p><p class="fine-print"><em><span>Natalie Diane Riediger receives funding from the Canadian Institutes of Health Research, Canadian Celiac Association, Social Sciences and Humanities Research Council, University of Manitoba, Mitacs, and Universities Canada. </span></em></p><p class="fine-print"><em><span>Patty Thille currently receives funding from Research Manitoba. </span></em></p><p class="fine-print"><em><span>Kerstin Roger does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Taxation of sugar-sweetened drinks is not only inequitable, but also has the potential to create or perpetuate weight stigma, which has negative effects on mental and physical health.Anne Katherine Anderson Waugh, Research Coordinator, Department of Food and Human Nutritional Sciences, University of ManitobaAndrea Bombak, Associate professor, Department of Sociology, University of New BrunswickKerstin Roger, Full Professor, Department of Community Health Sciences, University of ManitobaNatalie Diane Riediger, Assistant Professor of Nutritional Epidemiology, University of ManitobaPatty Thille, Assistant Professor in Physical Therapy, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772882022-02-18T11:33:54Z2022-02-18T11:33:54ZBanning the promotion of soft drinks could be more effective than a sugar tax<figure><img src="https://images.theconversation.com/files/446986/original/file-20220217-17-9296a4.jpg?ixlib=rb-1.1.0&rect=11%2C0%2C3870%2C2566&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unhealthy-food-concept-sugar-carbonated-drink-323040389">Evan Lorne/Shutterstock</a></span></figcaption></figure><p>Obesity is one of the most serious health problems facing the UK, where around <a href="https://commonslibrary.parliament.uk/research-briefings/sn03336/#:%7E:text=Adult%20obesity%20in%20England,is%20classified%20as%20'overweight'.">65% of adults</a> are either <a href="https://www.obesityactionscotland.org/media/1457/prevalence_causes__impact_f-2904.pdf">obese or overweight</a>. This has implications. In 2006/2007, <a href="https://pubmed.ncbi.nlm.nih.gov/21562029/">obesity cost the NHS £5.1 billion</a>. That means we are likely to pay more taxes in the future to keep the NHS functioning unless something is done. Obesity also predisposes people to a risk of several serious health issues, including cardiovascular disease, diabetes, certain cancers, depression and anxiety.</p>
<p>The consumption of high sugar products such as soft drinks are a major cause of obesity and diabetes. In April 2018, the UK government <a href="https://www.gov.uk/government/news/soft-drinks-industry-levy-comes-into-effect">introduced a soft drinks levy</a> on sugar-sweetened beverages in an effort to reduce the amount of sugar people consumed and control the situation.</p>
<p>The levy was imposed on industries which manufactured or imported sweetened beverages in three tiers: drinks with a sugar content of less than 5g/100ml attracted no tax; drinks with sugar content 5-8g/100ml attracted the basic level tax of 18p/litre, and those containing more than 8g/100ml attracted a higher tax level of 24p/litre.</p>
<p>In an attempt to assess the effectiveness of the policy, researchers from the University of Cambridge <a href="https://www.bmj.com/content/372/bmj.n254.long">concluded</a> that two years after the implementation of the policy, though the sugar content of soft drinks was reduced by 30g per household per week, the volume of soft drinks purchased has remained the same.</p>
<p>This troubled us so we conducted the first <a href="https://www.sciencedirect.com/science/article/pii/S0306919221001706">study</a> comparing the effectiveness of the soft drinks levy to <a href="https://www.gov.uk/government/consultations/restricting-promotions-of-food-and-drink-that-is-high-in-fat-sugar-and-salt/outcome/restricting-promotions-of-products-high-in-fat-sugar-and-salt-by-location-and-by-price-government-response-%20to-public-consultation">proposed mandatory restrictions</a> on soft-drinks promotions. </p>
<p>Sales promotions are marketing strategies used by retailers to lure consumers to buy their products. These include temporary price reductions, Buy One Get One Free (BOGOF), buy Y for £X, coupons, and so on. Unfortunately, more unhealthy foods – those high in fat, salt and sugar – are promoted than healthy ones. While the overall aim is to boost sales, consumers take advantage of promotions for the thrill – the <a href="https://www.acrwebsite.org/volumes/6945">excitement of getting a bargain</a>. This <a href="https://link.springer.com/article/10.1007/s13668-019-00287-z">leads</a> to impulse buying, stockpiling and over-consumption. </p>
<figure class="align-center ">
<img alt="A line of bottles containing fizzy drinks, such as Coke, Sprite and Pepsi." src="https://images.theconversation.com/files/446987/original/file-20220217-19-ly30he.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446987/original/file-20220217-19-ly30he.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=364&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446987/original/file-20220217-19-ly30he.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=364&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446987/original/file-20220217-19-ly30he.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=364&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446987/original/file-20220217-19-ly30he.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=458&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446987/original/file-20220217-19-ly30he.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=458&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446987/original/file-20220217-19-ly30he.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=458&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A 330ml can of Coke contains nine teaspoons of sugar.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/poznan-poland-oct-28-2021-bottles-2070738581">Monticello/Shutterstock</a></span>
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<h2>Finding the right strategy</h2>
<p>In June 2018, the UK government announced its intention to ban promotions of products high in fat, sugar and salt (HFSS) by location and price through legislation. It then began a <a href="https://www.gov.uk/government/consultations/restricting-promotions-of-food-and-drink-that-is-high-in-fat-sugar-and-salt/outcome/restricting-promotions-of-products-high-in-fat-sugar-and-salt-by-location-and-by-price-government-response-%20to-public-consultation">consultation on the plans</a> between January 12 and April 6, 2019.</p>
<p>The consultation received 807 responses from individuals, businesses and organisations. Around 60% of respondents were in favour of the government’s proposal to restrict HFSS promotions. Although the study was carried out to encourage the government to implement the policy as quickly as possible, it will only <a href="https://www.ed.ac.uk/spectrum/news-insights-events/insights/legislation-unhealthy-food-promotions#:%7E:text=On%2028th%20December%202020,(UK%20Government%2C%202020a).">come into force in April 2022</a>. </p>
<p>In our study, we looked at the spending of 2,568 households in Scotland and compared the impact of both policies on different groups of consumers according to income levels, location, life stage and <a href="https://www.gov.scot/collections/scottish-index-of-multiple-deprivation-2020/">Scottish index of multiple deprivation</a>.
Those in more deprived areas were more likely to continue to buy high sugar drinks despite the tax. </p>
<p>We also predicted how consumers would react to a restriction on the promotion of sweetened drinks based on their spending patterns. Our results suggest that when the government goes ahead with this policy in April, the annual quantity of drinks purchases could reduce by 35.8% compared to 1.4% by the soft drinks levy. That’s around 25 times effective more than the soft drinks tax.</p>
<p>Studies <a href="https://www.bmj.com/content/372/bmj.n254.long">assessing its impact</a> conclude that the sugar tax policy is very effective. But promotions are a major driver of retail purchases and tend to be heavily directed towards less healthy options. The results from our study suggest that banning promotions on soft drinks will have more success in cutting down the consumption of sugary drinks.</p>
<p>This would be good news for the government, the NHS and the health of consumers. The reduction in sugar intake could help to tackle diabetes, the <a href="https://www.independentnurse.co.uk/news/diabetes-continues-to-be-the-most-expensive-condition-for-the-nhs/117826">most expensive burden</a> on the NHS, reduce obesity and increase life expectancy across the UK. And in turn the government could save on the amount it contributes towards the treatment of obesity and weight-related diseases.</p><img src="https://counter.theconversation.com/content/177288/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wisdom Dogbe receives funding from The Scottish Government as part of Rural and Environment Science and Analytical Services (RESAS) Strategic Research Programme.</span></em></p><p class="fine-print"><em><span>Cesar Revoredo-Giha receives funding from The Scottish Government as part of Rural and Environment Science and Analytical Services (RESAS) Strategic Research Programme.</span></em></p>New research shows that a ban on aggressive hi-vis promotion of sugary drinks could be far more successful in reducing consumption than a sugar tax.Wisdom Dogbe, Research Fellow, University of AberdeenCesar Revoredo-Giha, Senior Economist and Team Leader of Food Marketing Research, Scotland's Rural CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1624342021-06-10T01:16:06Z2021-06-10T01:16:06ZHow much longer do we need to wait for Australia to implement a sugary drinks tax?<figure><img src="https://images.theconversation.com/files/405521/original/file-20210609-39830-7zo37v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bottles-soda-drinks-supermarket-109206149">Shutterstock</a></span></figcaption></figure><p>The Australian Medical Association (AMA) has <a href="https://ama.com.au/media/sugar-tax-will-cut-disease-and-save-lives">once again called for</a> a tax on sugary drinks in Australia. This time, the proposed tax is a key part of the AMA’s <a href="https://ama.com.au/vision-for-australias-health">blueprint</a> to make Australia the healthiest country in the world.</p>
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<p>The strong call for a sugary drinks tax echoes the concerted <a href="https://www.abc.net.au/radionational/programs/drive/sugar-is-toxic:-australian-of-the-year-calls-for-sugar-tax/11904210">campaign</a> by 2020 Australian of the Year, Dr James Muecke. </p>
<p>And it follows years of advocacy from <a href="https://www.opc.org.au/what-we-do/tipping-the-scales">public health groups</a> and <a href="https://grattan.edu.au/wp-content/uploads/2016/11/880-A-sugary-drinks-tax.pdf">think tanks</a> that have long-argued the many potential benefits of a sugary drinks tax for Australia.</p>
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Read more:
<a href="https://theconversation.com/lets-declare-war-on-type-2-diabetes-australian-of-the-year-james-muecke-on-why-we-need-to-cut-back-on-sugar-131024">Let’s 'declare war on type 2 diabetes' – Australian of the year James Muecke on why we need to cut back on sugar</a>
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<h2>What does the evidence say?</h2>
<p>A sugary drinks tax is <a href="https://www.who.int/news/item/11-10-2016-who-urges-global-action-to-curtail-consumption-and-health-impacts-of-sugary-drinks">consistently identified</a> as a critical part of efforts to improve our diets and prevent obesity.</p>
<p>There is strong <a href="https://openknowledge.worldbank.org/bitstream/handle/10986/33969/Support-for-Sugary-Drinks-Taxes-Taxes-on-Sugar-Sweetened-Beverages-Summary-of-International-Evidence-and-Experiences.pdf?sequence=6&isAllowed=y#page=22&zoom=100,0,0">evidence</a> linking sugary drink consumption to a range of negative health effects including tooth decay, excess weight gain, and increased risk of developing obesity and type 2 diabetes.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/33929703/">International evidence</a> clearly shows sugary drinks taxes are effective in reducing consumption of the taxed products.</p>
<p>Available <a href="https://pubmed.ncbi.nlm.nih.gov/33411708/">evaluations</a> have also consistently shown taxes on sugary drinks lead to increases in purchases of untaxed drinks, particularly bottled water. These effects have been shown to persist over many years. </p>
<h2>What tax design works best?</h2>
<p>The AMA <a href="https://ama.com.au/articles/tax-sugar-sweetened-beverages-what-modelling-shows">proposes</a> Australia implement a tax of A$0.40 per 100 grams of sugar (per unit of product). Under the proposed tax rate, the amount of tax paid on a 375ml can of Coke with 40g sugar (sugar content is 10.6g/100ml) would be A$0.16.</p>
<p>This tax rate is consistent with <a href="https://openknowledge.worldbank.org/bitstream/handle/10986/33969/Support-for-Sugary-Drinks-Taxes-Taxes-on-Sugar-Sweetened-Beverages-Summary-of-International-Evidence-and-Experiences.pdf?sequence=6&isAllowed=y">global recommendations</a> that price increases of at least 20% are needed to have a meaningful health effect.</p>
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<img alt="" src="https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405524/original/file-20210610-14856-9cpmas.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Higher prices encourage people to choose healthier options, like bottled water.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/soft-drinks-371246386">Shutterstock</a></span>
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<p>The proposed AMA tax design is also in line with <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003412">international evidence</a> that shows sugary drink taxes work best when the tax rate is based on sugar content.</p>
<p>These taxes can incentivise people to switch to healthier (lower sugar) substitutes while simultaneously incentivising manufacturers to reformulate their products (lowering the sugar content) to avoid a higher tax rate.</p>
<p>For example, the UK has <a href="https://www.bmj.com/content/372/bmj.n254">documented</a> success with a tiered approach, whereby products with sugar content above particular thresholds attract high tax rates. The UK tax has led to decreases in consumption and impressive levels of <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003025">reformulation</a>.</p>
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Read more:
<a href="https://theconversation.com/sugary-drinks-tax-is-working-now-its-time-to-target-cakes-biscuits-and-snacks-124325">Sugary drinks tax is working – now it's time to target cakes, biscuits and snacks</a>
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<p>The products to be taxed under the AMA proposal include all non-alcoholic drinks containing free sugars, but exclude 100% fruit juice, milk-based and cordial drinks.</p>
<p>Given the international and Australian evidence of the <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0495-5">fierce opposition</a> to sugary drinks taxes from the food industry, practical decisions such as this are likely to help reduce resistance to the tax (from fruit growers, for example, and the dairy industry).</p>
<h2>Impact of a sugary drinks tax in Australia</h2>
<p>The AMA estimates the proposed tax would lead to reduced sugar consumption, improved diets and a <a href="https://ama.com.au/articles/tax-sugar-sweetened-beverages-what-modelling-shows">2% reduction in obesity</a>.</p>
<p>Over a 25-year period, <a href="https://theconversation.com/australian-sugary-drinks-tax-could-prevent-thousands-of-heart-attacks-and-strokes-and-save-1-600-lives-56439">modelling</a> has shown this would result in 16,000 fewer cases of type 2 diabetes, 4,400 fewer cases of heart disease, 1,100 fewer cases of stroke, and 1,600 fewer deaths.</p>
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Read more:
<a href="https://theconversation.com/australian-sugary-drinks-tax-could-prevent-thousands-of-heart-attacks-and-strokes-and-save-1-600-lives-56439">Australian sugary drinks tax could prevent thousands of heart attacks and strokes and save 1,600 lives</a>
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<p>These health benefits would <a href="https://ama.com.au/articles/tax-sugar-sweetened-beverages-what-modelling-shows">translate</a> to health-care expenditure savings of between A$609 million and A$1.73 billion.</p>
<p>The AMA estimates the tax would raise government revenue of around A$800 million each year. This revenue could be earmarked for preventive health initiatives.</p>
<h2>International groundswell of support for sugary drinks taxes</h2>
<p>There is global momentum behind sugary drinks taxes.</p>
<p>Sugary drinks taxes are now in place in more than <a href="https://openknowledge.worldbank.org/bitstream/handle/10986/33969/Support-for-Sugary-Drinks-Taxes-Taxes-on-Sugar-Sweetened-Beverages-Summary-of-International-Evidence-and-Experiences.pdf?sequence=6&isAllowed=y#page=22&zoom=100,0,0">45 countries</a> around the world. The majority of these taxes have been implemented in the last five years.</p>
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<img alt="Orange sodas from Mexio in esky." src="https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405525/original/file-20210610-39515-15c4kjy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Sugary drinks taxes now operate in 45 countries, including Mexico.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/costa-mesa-californiaunited-states-08252019-several-1514465477">Shutterstock</a></span>
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<p>While Australia led the world in preventive health for many decades through strong action on <a href="https://tobaccocontrol.bmj.com/content/12/suppl_2/ii1">tobacco control</a>, it is now lagging <a href="https://6caf7727-1efc-419a-8b13-d58f79d7351f.filesusr.com/ugd/2e3337_e5e00a466691430488f99ed1f4a357af.pdf">far behind</a> in efforts to address unhealthy diets.</p>
<h2>Arguments against sugary drinks taxes</h2>
<p>The food industry routinely parades a <a href="https://www.obesityevidencehub.org.au/collections/prevention/arguments-against-an-ssb-tax-in-australia">range of arguments</a> against sugary drinks taxes. But their arguments have been <a href="https://theconversation.com/dont-believe-the-myths-taxing-sugary-drinks-makes-us-drink-less-of-it-130694">thoroughly debunked</a>. </p>
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<strong>
Read more:
<a href="https://theconversation.com/dont-believe-the-myths-taxing-sugary-drinks-makes-us-drink-less-of-it-130694">Don't believe the myths – taxing sugary drinks makes us drink less of it</a>
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<p>For example, the food industry has <a href="https://theconversation.com/rejecting-a-sugar-tax-is-based-on-faulty-logic-about-the-poor-50230">argued</a> a sugary drinks tax would leave disadvantaged people poorer. </p>
<p>But <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002326">rigorous studies</a> indicate lower socioeconomic groups would likely experience a disproportionate health <em>benefit</em> as a result of the tax.</p>
<p>Industry has also <a href="https://www.britishsoftdrinks.com/write/MediaUploads/Publications/The_Economic_Impact_of_the_Soft_Drinks_Levy.pdf">claimed</a> there would be job losses for sugar producers.</p>
<p>The AMA report makes it clear a sugary drinks tax in Australia would have minimal impact on Australia’s sugar industry. This is because <a href="https://grattan.edu.au/report/a-sugary-drinks-tax-recovering-the-community-costs/">about 80%</a> of Australia’s domestic sugar production is exported.</p>
<h2>Time to put health above corporate profits</h2>
<p>The failure of the Australian government to implement a sugary drinks tax is a clear case of putting corporate interests ahead of population health. </p>
<p>Given the powerful evidence indicating the likely benefits and <a href="https://bmjopen.bmj.com/content/9/6/e027962">strong public support</a> for a sugary drinks tax, its implementation in Australia feels inevitable.</p>
<p>All that’s needed is political leadership that recognises the value of prioritising health above the profits of a select few multinational soft drinks manufacturers.</p>
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Read more:
<a href="https://theconversation.com/sweet-power-the-politics-of-sugar-sugary-drinks-and-poor-nutrition-in-australia-95873">Sweet power: the politics of sugar, sugary drinks and poor nutrition in Australia</a>
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<img src="https://counter.theconversation.com/content/162434/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gary Sacks receives funding from the National Heart Foundation of Australia, National Health and Medical Research Council, Australian Research Council and VicHealth</span></em></p>The evidence is clear: a tax on sugary drinks would reduce consumption. All that’s needed is political leadership that prioritises health above the profits.Gary Sacks, Associate Professor, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1606212021-05-16T07:51:45Z2021-05-16T07:51:45ZSouth Africa must ban sugary drinks sales in schools. Self regulation is failing<figure><img src="https://images.theconversation.com/files/400513/original/file-20210513-21-1bdlcs8.jpg?ixlib=rb-1.1.0&rect=418%2C23%2C1083%2C812&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">White River Primary school in South Africa, sponsored by Coca Cola.</span> <span class="attribution"><span class="source">Roo Reynolds/Flickr</span></span></figcaption></figure><p>In 2017, Coca-Cola Beverages South Africa voluntarily <a href="https://www.timeslive.co.za/sunday-times/news/2017-08-12-how-coke-is-keeping-sugar-on-the-school-menu/">announced</a> that it would stop supplying sugary beverages to primary school outlets. The company also pledged to remove all branding and advertising from schools. The announcement took the form of a letter noting that that Coca-Cola Beverages wanted to play “an active role in addressing rising obesity rates in South Africa, especially among children”. </p>
<p>Childhood obesity is a serious and growing problem is South Africa. More than <a href="https://www.samrc.ac.za/sites/default/files/attachments/2019-01-29/SADHS2016KeyFindings.pdf">13% of children</a> are either obese or overweight. The consumption of liquid sugar is particularly harmful because it is absorbed so quickly into the bloodstream. Not surprisingly, sugary drinks and their marketing has been linked to obesity especially among children. Just a single sugary beverage per day increases that child’s chance of overweight by 55%. Similarly, once they become an overweight teen, there is a 70% chance they will not be able to lose the weight.</p>
<p>The food environment in schools plays a significant role in increasing access to sugary drinks. Children spend a lot of time in school during their developmentally important periods. Among others, the types of food and beverages children are exposed to at school influence their eating patterns and food preferences. </p>
<p>This is a concern for South Africans as children are exposed to <a href="https://pubmed.ncbi.nlm.nih.gov/26513442/">aggressive marketing</a> and <a href="http://www.sajcn.co.za/index.php/SAJCN/article/view/528">unhealthy foods and beverages</a> at schools. Of particular concern is learners’ excessive sugary drinks consumption. An average grade 4 learner (10-year-old) has around one to two <a href="https://www.ajol.info/index.php/jfecs/article/view/53995">sugary drinks per day</a>, with each soft drink containing up to nine teaspoons of sugar. </p>
<p>Obesity prevention efforts are clearly needed in schools. But what should these efforts entail? Our <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1898130">new research</a> shows that voluntary actions by industry are not part of the recipe. </p>
<p>The aim of our research was to see what drinks were available at schools after Coca-Cola’s announcement. Our audit showed that the company’s brands remained available in most of the schools. Our study highlights that ceding regulation to industry is risky; government regulations and legislation are needed.</p>
<h2>Tuck shop audit</h2>
<p>We studied the food environment across 105 public primary schools in South Africa’s Gauteng province. Schools were located in both affluent and in poorer areas. This allowed us to see if there were any differences in outcomes based on the socioeconomic status of the school. Fieldworkers visited tuck shops and other food outlets on school premises. They spoke to school staff to find out what was being sold to the children through the school stores or tuck shops. </p>
<p>In general, food consumed at schools can constitute up to <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1898130">20%–30%</a> of learners’ total daily caloric intake. This is either through the government school meal programmes in poorer areas, from the school tuck shops or learners’ lunch boxes brought from home. </p>
<p>Our study showed that two years after Coca-Cola Beverages pledge, carbonated sugary drinks were available in 54% of primary school tuck shops. These drinks were more available in fee-paying schools (86%) than no-fee schools (21%). When researchers looked at the availability of alternative low-calorie products, they found that none of the school tuck shops sold only low-calorie drinks. </p>
<p>Decision makers explained that schools faced challenges such as financing general school maintenance and staff salaries. They felt like they had to make a trade-off between revenue generation and the healthfulness of the products they sold in the tuck shops. We found that Coca-Cola Beverages South Africa is not the sole distributor to school tuck shops. Therefore, even when Coca-Cola Beverages South Africa would not supply sugary beverages, schools stocked their tuck shops through general commercial wholesalers. </p>
<p>When it came to advertising, only some schools reported that the company had done what was promised in the pledge, to remove all branding and advertising from schools. But this was the exception rather than the norm. Nearly one-third (31%) of schools had Coca-Cola branding or advertising on school premises. Much of the branding are billboards with the name of the school. Respondents reported that branding, in particular branded fridges, remained unchanged. </p>
<p>Less than half of the school decision makers interviewed in the study were aware of the pledge. This suggests that they either did not recall the letter or had not seen it. The study also revealed that there was easy access to unhealthy products outside school premises through informal food vendors and nearby stores.</p>
<h2>Recommendations</h2>
<p>Despite the common reliance on self-regulatory measures by commercial food entities there is no evidence to support either their effectiveness or safety, according to policy expert <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)62089-3/fulltext">Professor Rob Moodie and colleagues</a>.</p>
<p>A ban on sugary drinks sales and advertising is likely to hold more promise than voluntary actions in improving the diets of school-going children and contribute to obesity prevention efforts among children. There is promising evidence from other developing countries, like <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305159">Chile</a>, where a ban on unhealthy foods and beverages resulted in substantial reduction in sales of such products in schools.</p>
<p>Change must also happen in the wider school community, in line with our constitutional basis in the best interests of the child. </p>
<p>Students, school staff, parents, and tuck shop owners all play a significant role in creating a healthier food environment at schools. Making a change at the tuck shop might feel risky but small changes such as banning sugary drinks are an excellent start. This already happening across the globe. </p>
<p>Lastly, it is important that these changes are communicated with the wider school community. The health benefits of the changes should be explained, emphasising the positive impact on students’ nutrition, well-being and school performance. Learners should be able to question what they can buy at school tuck shops or are served for lunch. Every school child in South Africa is entitled to an easy and healthy dietary choice on a daily basis.</p><img src="https://counter.theconversation.com/content/160621/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Agnes Erzse receives funding from from the SA MRC, IDRC Canada, the UK National Institute for Health Research through the University of Cambridge and Bloomberg Philanthropies, through UNC Chapel Hill.</span></em></p><p class="fine-print"><em><span>Karen Hofman receives funding from the SA MRC, IDRC Canada, the UK National Institute for Health Research through the University of Cambridge and Bloomberg Philanthropies, through UNC Chapel Hill.</span></em></p><p class="fine-print"><em><span>Nicola Christofides receives funding from European Research Council, UKRI. </span></em></p>A ban on sugary drinks sale and advertisements in schools is likely to hold more promise in improving the diets of children and help prevent obesity in children than voluntary actions.Agnes Erzse, Researcher, SAMRC/Centre for Health Economics and Decision Science- PRICELESS SA, University of the WitwatersrandKaren Hofman, Professor and Programme Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandNicola Christofides, Associate Professor, School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1579082021-04-20T08:08:01Z2021-04-20T08:08:01ZKenya doesn’t have a stand-alone tax on sugary drinks: we set out to find out why<figure><img src="https://images.theconversation.com/files/395266/original/file-20210415-20-r25nse.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The consumption of a lot of soft drinks is linked to increased obesity. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Kenya is <a href="https://www.health.go.ke/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf">experiencing a rise</a> in obesity. Overweight and obesity among women increased from 25% in 2008 to 33% in 2014. An estimated one in four Kenyan urban children are <a href="https://www.dhsprogram.com/pubs/pdf/sr227/sr227.pdf">overweight or obese</a>. At the same time there has been a rise in associated <a href="https://globalnutritionreport.org/resources/nutrition-profiles/?country-search=kenya">noncommunicable diseases</a>. These include diabetes, cardiovascular diseases and cancer. Noncommunicable diseases now account for over <a href="https://www.health.go.ke/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf">50% of hospital admissions</a> in the country.</p>
<p>Globally, the rise in noncommunicable diseases has been attributed to the growing consumption of unhealthy foods such as sugar-sweetened beverages. Between 2018 and 2019 Kenya registered a 30% spike in <a href="https://apps.fas.usda.gov/newgainapi/api/report/downloadreportbyfilename?filename=Sugar%20Annual_Nairobi_Kenya_4-12-2018.pdf">sugar production</a> and an <a href="http://www.parliament.go.ke/sites/default/files/2019-08/Report%20on%20the%20Crisis%20Facing%20the%20Sugar%20Industry%20in%20Kenya%20%28%20Annexures%29.pdf">increase</a> in sugar consumption from the growth of retail, industrial and food service sectors. </p>
<p>To control the rising burden of obesity and noncommunicable diseases the World Health Organisation (WHO) <a href="https://www.who.int/dietphysicalactivity/publications/fiscal-policies-diet-prevention/en/">recommends</a> a tax on sugar-sweetened beverages. It views such taxes as a population-level, cost-effective measure to discourage consumption of sugar-sweetened beverages. </p>
<p>The approach has been widely used in several countries including South Africa. However, to date, Kenya has no standalone sugar-sweetened beverage tax policy.</p>
<p>We undertook <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1902659">research</a> into the possibility of implementing a sugar-sweetened beverage tax in Kenya. </p>
<p>The study entailed a desk review of existing evidence on noncommunicable diseases and sugar-sweetened beverages. We also conducted interviews with a wide range of experts to explore the policy and political context as well as the enablers of and barriers to such a policy.</p>
<p>We identified a number of barriers to adopting a tax on sugary drinks in Kenya. These included limited evidence on sugar-sweetened beverages as a risk factor for noncommunicable diseases in Kenya. We also found industry interference in the development of sugar-sweetened beverage taxation policy. </p>
<p>But we also found that existing policies provided an opportunity to pursue a sugar tax in the country. These include the <a href="http://publications.universalhealth2030.org/uploads/kenya_health_policy_2014_to_2030.pdf">Kenya Health Policy</a> and the <a href="https://www.who.int/nmh/ncd-task-force/kenya-strategy-ncds-2015-2020.pdf?ua=1">National Strategy for Control and Prevention of Noncommunicable diseases</a>. </p>
<h2>Barriers</h2>
<p>A number of factors accounted for the fact that Kenya hasn’t pursued a tax on sugar-sweetened beverages.</p>
<p>The first was a dearth of up-to-date publicly available information on sugary drinks sales and consumption in Kenya. Data are essential to guide the decisions and process of development and adoption of a stand alone sugar-sweetened beverage tax. </p>
<p>Interviewees also cited lack of information in the general population about sugar-sweetened beverages and how they affect health. They attested to the fact that tobacco and alcohol are widely recognised risk factors for noncommunicable diseases. Not so with sugar-sweetened beverages.</p>
<blockquote>
<p>An important barrier when we are dealing with sugar-sweetened beverages is the fact that the public does not appreciate that this is a problem. What do respectable old men and women in the village, church elders, take when they go for a meeting? It is tea, Coca-Cola, Sprite, Fanta. I think it presents a subtle challenge that we don’t have when we are dealing with tobacco or alcohol. Nobody argues about the adverse consequences of tobacco or of alcohol.</p>
</blockquote>
<p>A second barrier we identified was that government ministries held different and sometimes opposing interests. </p>
<p>For instance, the ministry of health was interested in improving health and discouraging the trade, production and marketing of sugary drinks. But the ministry of industry, trade and cooperatives promoted the sugar and food processing industries as major revenue for government. </p>
<p>Our key informants felt that these opposing priorities might get in the way of a sugar-sweetened beverage taxation policy being developed. </p>
<p>A third factor we identified was industry lobbying against sweet drinks taxation. The sugar-sweetened beverage companies were described by key informants as having major influence over government decision making. This was because of the power they wielded in terms of their operations, and their contribution to the government revenues. They also use industry alliances and formations to fight sugar-sweetened beverage taxes, which may overwhelm an under-resourced government like Kenya’s. </p>
<p>As one interviewee put it: </p>
<blockquote>
<p>… unfortunately, there’s a lot of industry interference with policy (on sugary drinks). This is a big industry; very big in terms of capital and also in terms of influence. They pay a lot of tax to government and they have a lot of leverage … An industry like that of course has a lot of policy interference because they have big money they can compete with us.</p>
</blockquote>
<p>Kenya does charge an excise tax on all soft drinks of 10 Kenya shillings (0.10 USD) per litre. This includes sugar-sweetened beverages. And in <a href="http://kenyalaw.org/kl/fileadmin/pdfdownloads/bills/2018/FinanceBill__2018.pdf">2018</a> an excise tax of 20 shillings (0.20 USD) per kilogram was imposed on sugar confectionery and chocolate. </p>
<p>But these taxes were introduced as a revenue generation strategy, not as a means to manage noncommunicable diseases. They are likely to have only a minimal impact on the consumption of sugary drinks.</p>
<h2>Going forward</h2>
<p>We made a number of recommendations on how a sugar-sweetened beverage tax could be developed and implemented in Kenya.</p>
<p>First, public and policymaker education is critical to challenge the prevailing attitudes to sugary drinks.</p>
<p>Second, strategies to develop industrial growth should be critically examined to understand how they could undermine the government’s commitment to addressing noncommunicable diseases. This will require wide stakeholder engagement beyond the ministry of health in policy development.</p>
<p>Third, civil society needs to be involved in sustained advocacy to ensure that Kenyans understand the issues at hand.</p>
<p>And more research evidence is needed to support an explicit sugar-sweetened beverage taxation policy. Kenya also needs to gather local and regional or international evidence to inform and guide its decisions in the development and adoption of a standalone tax on sugary drinks.</p><img src="https://counter.theconversation.com/content/157908/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This work was carried out with support from the International Development Research Centre (IDRC),Ottawa Canada (grant number 108648-001)</span></em></p><p class="fine-print"><em><span>Gershim Asiki does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Between 2018 and 2019 Kenya registered a 30% spike in sugar production and an increase in sugar consumption.Milka Wanjohi, Research officer, African Population and Health Research CenterGershim Asiki, Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1575812021-03-24T01:07:39Z2021-03-24T01:07:39ZNew Zealand needs urgent action to tackle the frightening rise and cost of type 2 diabetes<figure><img src="https://images.theconversation.com/files/391047/original/file-20210323-17-164z2xb.jpg?ixlib=rb-1.1.0&rect=23%2C79%2C3087%2C1981&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock/Kwangmoozaa</span></span></figcaption></figure><p>Type 2 diabetes has reached epidemic proportions in New Zealand and will get much worse unless action is taken now, according to a new <a href="https://healthierlives.co.nz/2021/03/15/cot2dlaunch/">report</a> on the economic and social cost of the disease. </p>
<p>Already 228,000 New Zealanders (4.7% of the population) have type 2 diabetes. The estimated annual cost is NZ$2.1 billion — a staggering 0.67% of GDP. </p>
<p>The report projects that if nothing is done to change the current trajectory, the number of people with type 2 diabetes will increase by 70-90% (to 6.6%-7.4% of the population) in 20 years. Costs are expected to rise by 63% to $3.5 billion by 2040.</p>
<p>Hospital care is the biggest cost to the public purse but losses from tax revenue, personal income and unpaid labour contribute to overall economic losses. The human cost of lives cut short cannot be quantified. Māori, Pacific and Asian communities bear the brunt of the <a href="https://healthierlives.co.nz/2021/03/15/cot2dlaunch/">disease burden</a>.</p>
<p>The scale of New Zealand’s type 2 diabetes epidemic underscores the urgent need for prevention at a population level. It is a societal problem that needs a societal solution. </p>
<p>While individuals’ lifestyles must change if their health is to improve, New Zealanders need a supportive environment to make changes that stick. </p>
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<h2>A public health approach</h2>
<p>A range of approaches would help to reduce the risk of developing type 2 diabetes. Re-introducing a national healthy eating and activity policy for schools and young people would likely also benefit parents and carers. At school, children should be free from harmful drinks and foods which are packed with sugar, fat and salt. Our children must be protected from being bombarded by junk food advertising in their homes and neighbourhoods.</p>
<p>More effective food labelling would help consumers to better understand what they are putting in their supermarket trolleys, and encourage food producers to forge ahead with reformulating products so they contain less harmful ingredients.</p>
<p>Many other countries have introduced policies to protect their populations, including the UK’s 2018 <a href="https://www.legislation.gov.uk/uksi/2018/41/contents/made">soft drinks industry levy regulations</a>. It’s time for New Zealand, which has among the highest rates of <a href="https://www.oecd.org/health/obesity-update.htm">adult</a> and <a href="https://bmjopen.bmj.com/content/11/2/e044205#F1">childhood obesity</a> in the western world, to catch up with our international peers.</p>
<p>We must not forget that in some parts of New Zealand, families experience <a href="https://www.cpag.org.nz/news/new-paper-series-aotearoa-land-of-the-long/">food scarcity and insecurity</a> and buy cheaper, less healthy foods. We must remedy this by tackling the root causes of poverty.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/a-disease-that-breeds-disease-why-is-type-2-diabetes-linked-to-increased-risk-of-cancer-and-dementia-139298">A disease that breeds disease: why is type 2 diabetes linked to increased risk of cancer and dementia?</a>
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</em>
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<h2>Cost-effective health programmes</h2>
<p>In addition to public health measures, there are also things we can do immediately to improve the treatment and care of people who already have type 2 diabetes and to prevent people with pre-diabetes from progressing further. </p>
<p>The report recommends rolling out four cost-effective programmes which could help thousands of New Zealanders:</p>
<ul>
<li>lifestyle interventions that reduce the risk of progression from pre-diabetes to type 2 diabetes (sustained changes in diet and exercise)</li>
<li>intensive lifestyle interventions to achieve remission of type 2 diabetes (clinical nutrition therapy) </li>
<li>“gold standard” medications to better manage type 2 diabetes</li>
<li>optimal foot screening and protection services.</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/got-pre-diabetes-heres-five-things-to-eat-or-avoid-to-prevent-type-2-diabetes-80838">Got pre-diabetes? Here's five things to eat or avoid to prevent type 2 diabetes</a>
</strong>
</em>
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<p>Two new medications for managing type 2 diabetes have recently been <a href="https://pharmac.govt.nz/news-and-resources/consultations-and-decisions/decision-to-fund-two-new-medicines-for-type-2-diabetes/">funded</a> by New Zealand’s medicines-funding agency PHARMAC. This is a great start but we can do much more.</p>
<p>Pre-diabetes is being identified in many New Zealanders as part of screening for heart disease risk factors. Healthy lifestyle support programmes have been shown to halve the risk of <a href="https://healthierlives.co.nz/2021/03/15/cot2dlaunch/">progressing to type 2 diabetes</a>. Culturally appropriate support should be made widely available to people with pre-diabetes. </p>
<p>International <a href="http://eprints.gla.ac.uk/180894/">evidence</a> has recently shown that it is possible to achieve remission of type 2 diabetes through clinical nutrition therapy. Investment in such services could save our hospital system from becoming overwhelmed by serious medical complications arising from type 2 diabetes, including kidney failure, heart attacks, stroke and blindness.</p>
<p>We could avoid around <a href="https://healthierlives.co.nz/2021/03/15/cot2dlaunch/">600 diabetes-related amputations</a> each year if all District Health Board foot screening and protection services were operating at an optimal level. Some are already close to achieving this.</p>
<p>Such measures, along with a public health approach to disease prevention, are essential if we are to prevent health costs from escalating out of control and our healthcare system from being overwhelmed.</p>
<h2>Lessons from the COVID-19 response</h2>
<p>New Zealand’s response to the COVID-19 pandemic has shown us how effective a co-ordinated, government- and science-led approach can be in tackling a major health problem. </p>
<p>In New Zealand we have seen how aiming high — for elimination of an infectious disease — has saved lives and livelihoods. Excellent communication has been key to New Zealanders’ enthusiasm for playing their part.</p>
<p>We need a similar approach and resolve to tackle the type 2 diabetes epidemic.
This problem is too big to leave to individual district health boards, which are dealing with competing health problems on strained budgets. </p>
<p>We urgently need a national strategy for tackling type 2 diabetes to change the trajectory New Zealand is currently on. If we don’t act now the scale of the problem in 20 years’ time is almost unimaginable.</p><img src="https://counter.theconversation.com/content/157581/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jim Mann is Director of Healthier Lives - He Oranga Hauora National Science Challenge (funded by MBIE, hosted by the University of Otago), and Co-Director of the Edgar Diabetes and Obesity Research Centre at the University of Otago, and receives some research funding from the Riddet Institute.</span></em></p>Almost a quarter of a million New Zealanders have type 2 diabetes. If nothing is done to change the current trajectory, the number will increase by 70-90% within 20 years, warns a new report.Jim Mann, Professor of Medicine and Director, Healthier Lives National Science Challenge and the Edgar Diabetes and Obesity Research Centre, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1423452020-07-17T13:32:54Z2020-07-17T13:32:54ZPoorest Americans drink a lot more sugary drinks than the richest – which is why soda taxes could help reduce gaping health inequalities<figure><img src="https://images.theconversation.com/files/348142/original/file-20200717-37-tjdn6g.jpg?ixlib=rb-1.1.0&rect=219%2C78%2C5628%2C3410&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Soda contributes to obesity and other diseases. </span> </figcaption></figure><p>Many countries such as the <a href="https://www.lshtm.ac.uk/research/research-action/features/uk-sugar-tax-will-it-work">U.K.</a> and <a href="https://www.latimes.com/science/sciencenow/la-sci-sn-soda-tax-mexico-20161102-story.html">Mexico</a> and a handful of U.S. cities such as <a href="https://drexel.edu/now/archive/2020/February/Soda-Tax-and-Beverage-Consumption/">Philadelphia</a> and <a href="https://sftreasurer.org/business/taxes-fees/sugary-drinks-tax">San Francisco</a> have imposed soda taxes in an effort to fight rising obesity. </p>
<p>Lots of research shows a link between drinking sugary substances and a <a href="https://www.cdc.gov/nutrition/data-statistics/sugar-sweetened-beverages-intake.html#:%7E:text=Frequently%20drinking%20sugar%2Dsweetened%20beverages,gout%2C%20a%20type%20of%20arthritis">whole host of negative health outcomes</a>, including type 2 diabetes, heart disease, liver disease, tooth decay and gout. </p>
<p>As economists who study <a href="https://www.researchgate.net/profile/Jay_Zagorsky">economic status</a> and <a href="http://www-personal.umd.umich.edu/%7Epksmith/research.htm">health</a>, we wanted to look at this from another perspective: Does how wealthy you are affect how much soda you consume? And could reducing sugary beverage consumption narrow the <a href="https://www.nationalacademies.org/news/2017/01/new-report-identifies-root-causes-of-health-inequity-in-the-us-outlines-solutions-for-communities-to-advance-health-equity">double-digit life expectancy gap</a> between the richest and poorest Americans? </p>
<h2>Wealth and soda</h2>
<p><a href="https://www.doi.org/10.1016/j.ehb.2020.100888">We analyzed data</a> for over 24,000 U.S. adults in two nationally representative random samples from the <a href="http://www.nlsinfo.org/">National Longitudinal Surveys</a>, which follow groups of people over a period of time, asking them hundreds of questions each year on a variety of topics like employment, health and attitudes. Some questions are asked every year, while others are included less frequently. </p>
<p>We looked at two groups of people. The first is referred to as the <a href="https://www.nlsinfo.org/content/cohorts/nlsy79">NLS 1979 cohort</a> and includes people born from 1957 to 1964. They were asked how often they consumed sugary drinks in the previous week every other year from 2008 to 2016, meaning the respondents were in their 40s and 50s when asked the question. </p>
<p>The second group is known as the <a href="https://www.nlsinfo.org/content/cohorts/nlsy97">NLS 1997 cohort</a> and includes people born from 1980 to 1984. They were asked the sugary drink question four times from 2009 to 2015, putting them in their 20s and 30s. </p>
<p><a href="https://www.cdc.gov/nchs/products/databriefs/db122.htm">Prior studies</a> <a href="http://www.doi.org/10.3945/ajcn.111.018366">have found</a> that consumption of sugary drinks <a href="http://www.doi.org/10.1016/j.jand.2012.09.016">tend to rise</a> as income falls. But few of them controlled for the range of other factors that could also matter, such as gender, race and ethnicity, education, cognitive skills and interest in health and nutrition. Moreover, none of them focused on wealth, which can offer unique insights on the issue. </p>
<p>Wealth represents an accumulation of resources rather than a regular flow of income. Newly graduated doctors have high income and low wealth, while retirees may have high wealth, but little income. The difference between income and wealth means they could affect consumption patterns differently. Wealth is distributed much more unequally. In addition, individuals may signal their membership in the upper economic echelons through the foods they consume.</p>
<p>[<em><a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=experts">Expertise in your inbox. Sign up for The Conversation’s newsletter and get expert takes on today’s news, every day.</a></em>]</p>
<p>We first looked at the share of respondents who reported drinking any sugar-sweetened beverages in the survey week by income and wealth deciles, which divides them into 10 equal groups depending on their income or wealth. </p>
<p>The number of sugar-sweetened beverages consumed generally falls as income rises. We found the same pattern when we looked at wealth, but the differences by wealth are more pronounced. Our analysis suggests that adults living in the richest 10% of families drink about 2.5 fewer sugary drinks a week than those in the poorest 10%. </p>
<p>This decline in sugary drink consumption as income and wealth rise holds up even after taking into account things like education, race, gender, cognitive abilities and interest in nutrition. </p>
<p>What’s the impact of 2.5 more sugar drinks a week? Rough calculations based on the typical sugar amounts in these drinks – <a href="https://sphhp.buffalo.edu/content/dam/sphhp/emergency-responder-human-performance/understanding-nutrition-labels.pdf">about 9.5 teaspoons</a> per 12-ounce can – suggest that it could result in <a href="https://www.livestrong.com/article/532975-how-to-calculate-how-many-calories-comes-from-sugar/">about 5.6 pounds of weight gain</a> over a year, assuming no increase in physical activity or decrease in consumption of calories from other sources.</p>
<p><iframe id="VBqlQ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/VBqlQ/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>For richer or poorer</h2>
<p>We also wondered whether soda consumption might change as people gain or lose wealth or make more or less money. Would increases in economic status correlate with decreases in sugary drink consumption?</p>
<p>Over the four-year periods we could observe, changes in income and wealth, even large ones, were not correlated to changes in sugary drink intake. We did not observe that adults who had gotten richer tended to report a drop in the number of sugary drinks consumed.</p>
<p>One possible explanation is that while economic status shapes our early drinking habits, those habits don’t much change in adulthood. Another possible explanation is that four years is not enough time for noticeable changes in sugar-sweetened beverage consumption to happen.</p>
<p>Our finding that people who are wealthier or make more money consume fewer sugary drinks supports the idea that soda consumption contributes to <a href="https://www.nationalacademies.org/news/2017/01/new-report-identifies-root-causes-of-health-inequity-in-the-us-outlines-solutions-for-communities-to-advance-health-equity">health inequities</a> along the economic distribution.</p>
<p>However, that doesn’t mean soda taxes are the best way to reduce these inequities. Since we find that sugary beverage consumption is higher for poorer Americans, these taxes can be regressive – meaning they fall more heavily on those with less income. On the other hand, if people with lower incomes respond to the higher prices caused by “soda taxes” by cutting consumption substantially, they can avoid the tax and improve their health. </p>
<p>A <a href="http://doi.org/10.1161/CIRCULATIONAHA.119.042956">just-published study</a> suggests that some soda taxes may be more effective than others at changing drinking habits. Specifically, it found that taxes based on the quantity of sugar in a drink are more successful than those simply based on volume, which <a href="https://www.cnn.com/2020/06/22/health/soda-tax-sugar-content-wellness/index.html">are more common in the U.S.</a></p>
<p>So well-designed soda taxes can help reduce rich-poor health disparities, but we’ll need a range of strategies to achieve that goal.</p><img src="https://counter.theconversation.com/content/142345/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>But the taxes have to be well-designed to avoid being overly regressive and targeting the poor.Patricia Smith, Professor of Economics, University of MichiganJay L. Zagorsky, Senior Lecturer, Questrom School of Business, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1310242020-02-27T05:35:20Z2020-02-27T05:35:20ZLet’s ‘declare war on type 2 diabetes’ – Australian of the year James Muecke on why we need to cut back on sugar<figure><img src="https://images.theconversation.com/files/315130/original/file-20200212-187223-qdkwir.jpg?ixlib=rb-1.1.0&rect=35%2C8%2C5955%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/american-donuts-570984256">Shutterstock</a></span></figcaption></figure><p>Humans are physiologically hardwired to love and seek out sweet things. It’s an ancient survival mechanism that evolved to prepare our bodies for periods of fasting when food supplies were scarce. </p>
<p>Like nicotine, alcohol and other drugs, sugar activates the reward system in our brains, resulting in <a href="https://www.ncbi.nlm.nih.gov/pubmed/31125634">the release of the neurotransmitter dopamine</a>. It feels good, so we want to do it again. </p>
<p>It can also give us solace when we’re down and can alleviate stress, as the dopamine hit counters cortisol, a stress hormone which is released during anxious times. </p>
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Read more:
<a href="https://theconversation.com/fact-or-fiction-is-sugar-addictive-73340">Fact or fiction – is sugar addictive?</a>
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</em>
</p>
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<p>The problem is, the more sugar we ingest, <a href="https://www.ncbi.nlm.nih.gov/pubmed/31125634">the more we need</a> to make us feel good. It’s a vicious cycle that’s hard to break.</p>
<p>Excessive and sustained sugar consumption increases the risk of developing type 2 diabetes, a metabolic disorder where the body can’t maintain healthy levels of glucose (sugar) in the blood. </p>
<p>Globally, the number of adults with type 2 diabetes, which is related to diet and lifestyle, has <a href="https://www.who.int/news-room/fact-sheets/detail/diabetes">quadrupled over the past 40 years</a>. In 2017-18, <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001%7E2017-18%7EMain%20Features%7EDiabetes%20mellitus%7E50">one million Australians had type 2 diabetes</a> and many more were at <a href="https://www.diabetesaustralia.com.au/what-is-diabetes">risk of developing the condition</a>. </p>
<p>It’s not impossible to cut down on sugar. Some strategies require change on a personal level, while others must be taken on by industry and governments. </p>
<h2>Personal strategies</h2>
<p>At the personal level, it’s a matter of slowly winding down our addiction. Going cold turkey would be incredibly difficult, given <a href="https://care.diabetesjournals.org/content/37/4/950">75% of our food and drinks have added sugar</a>.</p>
<p>I started omitting the obvious products loaded with sugar – soft drinks, fruit juices, dried fruit, chocolate, candy, ice cream, cakes and sweet biscuits. I stopped sprinkling sugar on my cereal and stirring it into my tea and coffee.</p>
<p>Even these simple strategies gave me <a href="https://theconversation.com/heres-what-happens-to-your-brain-when-you-give-up-sugar-for-lent-37745">withdrawal symptoms</a> such as irritability, headache, sluggish thoughts, and fatigue, which began on the very first day. These symptoms and the cravings were unpleasant but only lasted three days. </p>
<p>Progressing to the next level might include cutting out commercially produced foods that contain excessive amounts of added sugar such as jams, condiments, and most breakfast cereals.</p>
<p>It might also mean cutting out or down on heavily processed products that contain refined carbohydrates such as white flour (white bread, pastries and pasta), white rice, and white potatoes (especially fries and crisps). Such carbs are broken down to glucose in the gut, and are really just another form of sugar consumption.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/317211/original/file-20200225-24651-3xxbmy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Is it time to cut back on jams and sugary spreads?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-young-caucasian-man-wearing-casual-1243183228">Shutterstock</a></span>
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</figure>
<p>It helps to be aware of the times we’re consuming sugar out of habit, such as eating a bag of sugary treats at the movies or a block of chocolate in front of the TV, or using sugar as a reward for a job well done. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-sugar-is-so-bad-for-us-why-is-the-sugar-in-fruit-ok-89958">If sugar is so bad for us, why is the sugar in fruit OK?</a>
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</em>
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<hr>
<p>It’s also important to be aware of those times when we’re using sugar to make us feel better or alleviate stress. The <a href="https://www.ncbi.nlm.nih.gov/pubmed/31125634">brain doesn’t care where it gets its feel-good chemicals</a> from, so try going for a walk, run or cycle, listen to your favourite music playlist, or try doing a good deed instead. </p>
<h2>Government response</h2>
<p>From a public health perspective, the government must play a pivotal role in helping Australians cut down on sugar. </p>
<p>Strategies at the government level should be aimed at accessibility, addition and advertising.</p>
<p>Making sweet products less obvious and accessible in supermarkets, delicatessens, post offices and service stations would be a good start. Moving them away from check-out counters means those reflex purchases are less likely to happen. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/317216/original/file-20200225-24694-1tz0qbb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Lollies and chocolates should be moved away from supermarket checkouts.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cash-desk-cashier-serving-customers-supermarket-273291662">Shutterstock</a></span>
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<p>Second, we need a levy (or a tax) on products containing high levels of added sugar, particularly on sugar-sweetened drinks. There is <a href="https://theconversation.com/dont-believe-the-myths-taxing-sugary-drinks-makes-us-drink-less-of-it-130694">strong evidence</a> a tax on such drinks would reduce consumption and <a href="https://care.diabetesjournals.org/content/early/2019/09/18/dc19-0734">result in a decline in type 2 diabetes</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-believe-the-myths-taxing-sugary-drinks-makes-us-drink-less-of-it-130694">Don't believe the myths – taxing sugary drinks makes us drink less of it</a>
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</em>
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<hr>
<p>Third, a more transparent system for labelling of the added sugar content of products should be implemented. The current health star rating system is only voluntary and is in need of reform. </p>
<p>Fourth, advertising time and space for sugary products should be restricted, as we have done for cigarettes, starting with ads targeting children on TV and social media.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/317206/original/file-20200225-24672-1d20gak.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Kids shouldn’t be exposed to ads for sugary foods.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-cute-girl-watching-tv-250881613">Shutterstock</a></span>
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</figure>
<p>Fifth, powerful and hard-hitting awareness campaigns should be introduced, as we have done for cigarettes. Who could forget those graphic TV adds of tar being poured over lungs or fat being squeezed out of an artery?</p>
<p>Finally, we need a multi-disciplinary think tank to raise awareness about the health dangers of sugar. Such a body could engage endocrinologists (medical doctors who treat diabetes), public health physicians, neuroscientists, nutritionists, marketers, PR experts, and government representatives to deliver clear and united messages. </p>
<p>The sugar industry and the food and beverage industries will need to be included in discussions about reform, but we can’t let commercial interests stop us from acting. </p>
<p>Type 2 diabetes is a growing epidemic and one of the nation’s biggest health challenges. It’s time for Australia to declare war on type 2 diabetes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/abc-four-corners-five-articles-to-get-you-informed-on-sugar-and-big-sugars-role-in-food-policy-95775">ABC Four Corners: five articles to get you informed on sugar and Big Sugar's role in food policy</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/131024/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Muecke does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We’re hardwired to love sweet things, but too much sugar is leading to an increase in type 2 diabetes. Here’s what individuals and policymakers can do cut our collective sugar intake.James Muecke, Clinical senior lecturer in Ophthalmology and Visual Sciences, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1296552020-02-20T13:27:02Z2020-02-20T13:27:02ZSome infant formula milks contain more sugar than soda drinks – new research<figure><img src="https://images.theconversation.com/files/315015/original/file-20200212-61952-1cvrhiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unhealty-baby-food-concept-problem-hidden-1365243554">Shutterstock/Lithiumphoto</a></span></figcaption></figure><p>Some formula milks have double the sugar per serving than a <a href="https://www.bbc.co.uk/news/magazine-35831125">glass of soda</a>. That was the key finding of our <a href="https://www.nature.com/articles/s41415-020-1252-0">global investigation</a> into the sugar content of infant formula and follow-on milks. But perhaps more shocking is the fact that there are so few regulations in place to control sugar content and to make sure consumers are well informed. </p>
<p>We all love sugar. But too much of the sweet stuff can lead to obesity, type 2 diabetes and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133084/">dental disease</a>. Our preference for sugary foods stems from our primitive ancestors, who were scavengers and sought out sweet foods for energy. But if we are hardwired to like sweet foods, being fed lots of sugar as babies can increase our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738223/">desire for sweet things</a> and increase the risk of developing disease in later life. </p>
<p>Breast milk is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882692/">the recommended</a> source of nutrition for infants, especially during the first six months of life. Although it is sweet and high in energy, the sugar is mainly lactose and the content is specific to the needs of the growing infant. Conversely, infant formula milks have a standardised make-up and contain added sugars such as corn syrup which are added during production and are not found in breast milk. This is bad for babies because high consumption of added sugars <a href="https://www.sciencedirect.com/science/article/pii/S2212267219313401?via%3Dihub">may contribute</a> to tooth decay, poor diet and lead to obesity in children.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A baby being fed formula milk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-mother-feeding-her-little-cute-1300509853">Shutterstock/OlenaChukhil</a></span>
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<p>We investigated the sugar content of 212 commercially available infant formula milk products targeted at infants under three. The products were being sold in supermarkets in 11 countries. We collected data on sugar content from nutrition labels and compared it to average breast milk compositions and sugar content guidelines. We also noted the clarity of the labels and the marketing strategies used on the packaging. </p>
<p><a href="https://www.nature.com/articles/s41415-020-1252-0">Our findings</a> revealed that over half of the products contained more than 5g of sugar per 100ml. In many cases, the sugar content was over 7.5g per 100ml, which exceeds <a href="http://www.babymilkaction.org/archives/8274">European parliament</a> recommended levels for infants. For example, we found that a powdered product for infants under six months sold in France contained 8.2g of sugar per 100ml, or nearly two teaspoons, while a ready-to-drink milk formula for infants under 12 months sold in the UK contained 8.1g of sugar per 100ml. </p>
<p>This comes at a time when sugar-sweetened beverages have been subject to widespread taxation to reduce their sugar content due to <a href="https://www.wcrf.org/sites/default/files/PPA-Building-Momentum-Report-WEB.pdf">negative impacts on health</a>. As a result, many formula products included in our study contained almost double the sugar of well known drinks such as <a href="https://www.coca-cola.co.uk/drinks/fanta/fanta-orange">Fanta Orange</a>. </p>
<h2>Nutritional information</h2>
<p>Obtaining information from the labels of these formula products was difficult as the fonts used were small and the facts provided varied between countries. For example, some products listed sugar content per 100g while others listed it per 100kcal. This is despite <a href="http://www.legislation.gov.uk/uksi/2007/3521/regulation/18/made">guidelines</a>, such as those in the UK, which state that values should be expressed as kJ/kcal per 100ml.</p>
<p>There are also <a href="https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/international-code-marketing-breastmilk-substitutes-resources/the-code/">codes</a> in place to limit the marketing of infant formula products because they are not the best way to feed a growing baby. But most of these are voluntary codes of practice which manufacturers do not have to abide by. </p>
<p>Even guidelines which are enforced by law can be side-stepped by manufacturers, since they are <a href="https://www.savethechildren.org.uk/content/dam/gb/reports/health/dont-push-it.pdf">not strictly monitored</a> and have loopholes. In some cases, manufacturers themselves have even influenced their development. </p>
<p><a href="https://www.savethechildren.org.uk/content/dam/gb/reports/health/dont-push-it.pdf">For example</a> it was revealed that the industry has funded research into infant health and has given doctors free formula products. This almost certainly helps ensure that their sale is affected as little as possible by such guidelines. It is possible that the sale of infant formula products has increased worldwide as a result. </p>
<p>The World Health Organization’s <a href="https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/international-code-marketing-breastmilk-substitutes-resources/the-code/">International Code of Marketing of Breastmilk Substitutes</a> stipulates that infant formula products should not be promoted over breastfeeding. <a href="http://www.legislation.gov.uk/uksi/2007/3521/regulation/17/made">In the UK</a> the guidelines state that the labels on products targeted at infants under six months should not include images of infants or any other pictures that idealise their use. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-pregnant-woman-choosing-milk-powder-632850146">Shutterstock/VirojtChangyencham</a></span>
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<p>But we found that many of the formulas had labels that included images of infants or cute toys of animals, presumably designed to entice caregivers into buying. Such findings are not unsurprising as there is evidence that <a href="http://www.babymilkaction.org/monitoring-global">harmful marketing strategies</a> have been used extensively by infant formula and follow-on milk manufacturers. </p>
<h2>Recommendations</h2>
<p>Our findings are alarming, as is the potential negative impact of the high sugar content on the health of babies. We urge parents and caregivers to opt for breast milk whenever possible. However, to help those families unable to breastfeed their babies, we also have two key recommendations for policymakers:</p>
<p>1) Regulate the amount and type of sugar in infant formula products as a matter of urgency. Encourage manufacturers to aim for formulations as close to breast milk as possible. Such regulations could be conducted in a similar way to the taxes on sugar-sweetened beverages which have been <a href="https://www.worldobesity.org/resources/policy-dossiers/pd-1/case-studies">implemented across the world</a>. </p>
<p>2) We are also calling for the mandatory disclosure of added sugar by manufacturers and suggest that this could be implemented alongside the introduction of a clear front-of-pack labelling system. Such disclosures and clear labelling could aid consumers to make informed choices about what products they purchase.</p><img src="https://counter.theconversation.com/content/129655/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gemma Bridge is affiliated with the World Federation of Public Health Associations. She thanks the members of the organisation for helping to collect the data included in the study. This article was published with the support of co-researchers Raman Bedi, an emeritus professor at Kings College London, and Marta Lomazzi, a Medical Biotechnologist, from the University of Geneva.</span></em></p>Researchers investigated 212 commercially available infant formula milk products on sale in 11 countries.Gemma Bridge, Research Evidence Impact Officer, Leeds Business School, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1306942020-01-30T03:52:32Z2020-01-30T03:52:32ZDon’t believe the myths – taxing sugary drinks makes us drink less of it<figure><img src="https://images.theconversation.com/files/312710/original/file-20200130-154354-gk17rc.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C3988%2C2676&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">2020 Australian of the Year James Muecke has called for a tax on sugary drinks – and the evidence is behind him.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/melbourne-vicaustraliaaugust-18th-2018-variety-soft-1417058798">Shuang Li/Shutterstock</a></span></figcaption></figure><p>This year’s Australian of the Year, Dr James Muecke, is an eye specialist with a clear vision. He wants to <a href="https://www.australianoftheyear.org.au/news-and-media/media-releases/article/?id=2020-australian-of-the-year-awards-announced">change the way the world looks at sugar</a> and the debilitating consequences of diabetes, which include blindness. </p>
<p>Muecke is pushing for Scott Morrison’s government to enact a tax on sugary drinks to help make that a reality. </p>
<p>Such a tax would increase the price of soft drinks, juices and other sugary drinks by around 20%. The money raised could be used to fund health promotion programs around the country.</p>
<p>The evidence backing his calls is strong. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-sugary-drinks-tax-could-recoup-some-of-the-costs-of-obesity-while-preventing-it-69052">A sugary drinks tax could recoup some of the costs of obesity while preventing it</a>
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<h2>Taxes on sugary drinks work</h2>
<p><a href="https://www.obesityevidencehub.org.au/collections/prevention/countries-that-have-implemented-taxes-on-sugar-sweetened-beverages-ssbs">Several governments</a> around the world have adopted taxes on sugary drinks in recent years. The evidence is clear: they work.</p>
<p>Last year, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12868">a summary of 17 studies</a> found health taxes on sugary drinks implemented in Berkeley and other places in the United States, Mexico, Chile, France and Spain reduced both purchases and consumption of sugary drinks. </p>
<p>Reliable <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12868">evidence</a> from around the world tells us a 10% tax reduces sugary drink intakes by around 10%.</p>
<p>The United Kingdom soft drink tax has also been making <a href="https://theconversation.com/sugary-drinks-tax-is-working-now-its-time-to-target-cakes-biscuits-and-snacks-124325">headlines</a> recently. Since its introduction, the amount of sugar in drinks has decreased by almost <a href="https://www.gov.uk/government/publications/sugar-reduction-progress-between-2015-and-2018">30%</a>, and six out of ten leading drink companies have <a href="https://doi.org/10.1186/s12916-019-1477-4">dropped the sugar content</a> of more than 50% of their drinks.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sugary-drinks-tax-is-working-now-its-time-to-target-cakes-biscuits-and-snacks-124325">Sugary drinks tax is working – now it's time to target cakes, biscuits and snacks</a>
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</em>
</p>
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<p>In Australia, modelling studies have shown a 20% health tax on sugary drinks is likely to <a href="https://doi.org/10.1371/journal.pmed.1002326">save almost A$2 billion in healthcare costs</a> over the lifetime of the population by preventing diet-related diseases like diabetes, heart disease and several cancers. </p>
<p>This is over and above the <a href="https://doi.org/10.1093/eurpub/cky087">cost benefits</a> of preventing dental health issues linked to consumption of sugary drinks.</p>
<p>Most of the health benefits (nearly 50%) would occur among those living in the lowest socioeconomic circumstances. </p>
<p>A 20% health tax on sugary drinks would also <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002326">raise over A$600 million</a> to invest back into the health of Australians. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312726/original/file-20200130-41554-1lwq00w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">After sugar taxes are introduced, people tend to switch from sugar drinks to other product lines, such as bottled water and artificially sweetened drinks.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pretty-young-woman-buying-groceries-supermarketmallgrocery-229037452">l i g h t p o e t/Shutterstock</a></span>
</figcaption>
</figure>
<h2>So what’s the problem?</h2>
<p>The soft drink industry uses <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12639">every trick in the book</a> to try to convince politicians a tax on sugary drinks is bad policy. </p>
<p>Here are our responses to some <a href="https://doi.org/10.1017/S1368980017003330">common arguments against</a> these taxes: </p>
<p><strong>Myth 1: Sugary drink taxes unfairly disadvantage the poor</strong> </p>
<p>It’s true people on lower incomes would feel the pinch from higher prices on sugary drinks. A 20% tax on sugary drinks in Australia would cost people from low socioeconomic households about <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002326">A$35 extra per year</a>. But this is just A$4 <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/impact-of-a-tax-on-sugarsweetened-beverages-according-to-socioeconomic-position-a-systematic-review-of-the-evidence/587CFDC392441741771A93E7F652E222">higher</a> than the cost to the wealthiest households.</p>
<p>Importantly, poorer households are <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/impact-of-a-tax-on-sugarsweetened-beverages-according-to-socioeconomic-position-a-systematic-review-of-the-evidence/587CFDC392441741771A93E7F652E222">likely</a> to get the biggest health benefits and long-term health care savings. </p>
<p>What’s more, the money raised from the tax could be targeted towards reducing health inequalities. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australian-sugary-drinks-tax-could-prevent-thousands-of-heart-attacks-and-strokes-and-save-1-600-lives-56439">Australian sugary drinks tax could prevent thousands of heart attacks and strokes and save 1,600 lives</a>
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</em>
</p>
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<p><strong>Myth 2: Sugary drink taxes would result in job losses</strong></p>
<p>Multiple studies have shown <a href="https://www.obesityevidencehub.org.au/collections/prevention/arguments-against-an-ssb-tax-in-australia">no job losses</a> resulted from taxes on sugar drinks in <a href="https://doi.org/10.1016/j.ypmed.2017.09.001">Mexico</a> and the <a href="https://doi.org/10.1371/journal.pone.0213218">United States</a>. </p>
<p>This is in contrast to some <a href="https://www.britishsoftdrinks.com/write/MediaUploads/Publications/The_Economic_Impact_of_the_Soft_Drinks_Levy.pdf">industry-sponsored studies</a> that try to make the <a href="https://theconversation.com/case-against-soft-drink-levy-is-sugar-coated-66067">case otherwise</a>.</p>
<p>In Australia, job losses from such a tax are likely to be <a href="https://www.obesityevidencehub.org.au/collections/prevention/arguments-against-an-ssb-tax-in-australia">minimal</a>. The total demand for drinks by Australian manufacturers is unlikely to change substantially because consumers would likely switch from sugary drinks to other product lines, such as bottled water and artificially sweetened drinks. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312724/original/file-20200130-41495-1khzec2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A tax on sugary drinks is unlikely to cost jobs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-drinking-cola-617854511">Successo images/Shutterstock</a></span>
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</figure>
<p>Despite industry <a href="http://www.acfa.com.au/industry-opposes-amas-sugar-tax-news-mail/">protestations</a>, an Australian tax would have minimal impact on sugar farmers. This is because 80% of our locally grown sugar is <a href="https://grattan.edu.au/report/a-sugary-drinks-tax-recovering-the-community-costs/">exported</a>. Only a small amount of Australian sugar goes to sugary drinks, and the expected 1% drop in demand would be traded elsewhere. </p>
<p><strong>Myth 3: People don’t support health taxes on sugary drinks</strong></p>
<p>There is <a href="https://www.obesityevidencehub.org.au/collections/prevention/the-case-for-a-tax-on-sweetened-sugary-drinks#cite1362">widespread support</a> for a tax on sugary drinks from major health and consumer groups in Australia.</p>
<p>In addition, a national survey conducted in <a href="https://www.ncbi.nlm.nih.gov/pubmed/31248926">2017</a> showed 77% of Australians supported a tax on sugary drinks, if the proceeds were used to fund obesity prevention. </p>
<p><strong>Myth 4: People will just swap to other unhealthy products, so a tax is useless</strong></p>
<p>Taxes, or levies, can be designed to avoid substitution to unhealthy products by covering a broad range of sugary drink options, including soft drinks, energy drinks and sports drinks. </p>
<p>There is also evidence that shows people <a href="https://doi.org/10.3945/jn.117.251892">switch to water</a> in response to sugary drinks taxes. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sweet-power-the-politics-of-sugar-sugary-drinks-and-poor-nutrition-in-australia-95873">Sweet power: the politics of sugar, sugary drinks and poor nutrition in Australia</a>
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</em>
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<p><strong>Myth 5: There’s no evidence sugary drink taxes reduce obesity or diabetes</strong></p>
<p>Because of the multiple drivers of obesity, it’s difficult to isolate the impact of a single measure. Indeed, we need a <a href="https://doi.org/10.1017/S1368980018003324">comprehensive policy approach</a> to address the problem. That’s why Dr Muecke is calling for a tax on sugary drinks alongside improved food labelling and marketing regulations. </p>
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<h2>Towards better food policies</h2>
<p>The Morrison government has previously and repeatedly <a href="https://www.news.com.au/national/breaking-news/health-minister-rebuffs-sugar-tax-calls/news-story/fc89cd403d68e6c931ae5edbd78bd18f">rejected</a> pushes for a tax on sugary drinks. </p>
<p>But Australian governments are currently developing a <a href="https://consultations.health.gov.au/population-health-and-sport-division/national-obesity-strategy/">National Obesity Strategy</a>, making it the ideal time to revisit this issue. </p>
<p>We need to stop letting myths get in the way of evidence-backed health policies. Let’s listen to Dr Muecke – he who knows all too well the devastating effects of products packed full of sugar.</p><img src="https://counter.theconversation.com/content/130694/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gary Sacks receives funding from the National Heart Foundation of Australia, National Health and Medical Research Council and VicHealth. </span></em></p><p class="fine-print"><em><span>Christina Zorbas receives funding from the Australian Government Research Training Program, The Cancer Council Victoria and VicHealth. </span></em></p><p class="fine-print"><em><span>Kathryn Backholer receives funding from the National Heart Foundation of Australia, The Cancer Council Victoria and VicHealth</span></em></p>Myths that taxes on sugary drinks unfairly disadvantage the poor and will result in job losses don’t hold up. Here’s what the evidence says.Gary Sacks, Associate Professor, Deakin UniversityChristina Zorbas, PhD Candidate, Deakin UniversityKathryn Backholer, Senior research fellow, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1254212019-10-31T14:45:36Z2019-10-31T14:45:36ZHow business misrepresented evidence: the South African sugar tax story<figure><img src="https://images.theconversation.com/files/298110/original/file-20191022-28120-18f8v22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Corporations misused evidence to manipulate health policy.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>In a <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0495-5">recently published study</a> on the political activities of the soft drinks industry in the lead up to <a href="https://theconversation.com/south-africas-sugar-tax-a-bold-move-and-the-right-thing-to-do-72010">South Africa introducing a sugar tax</a>, we outlined the complex and systematic way in which big corporations and business associations misrepresented evidence to the country’s National Treasury.</p>
<p>The issue of evidence being cited by representatives from companies has become increasingly important. This is because of the growth of public consultations to collate evidence before new laws are passed. </p>
<p>We examined a selection of submissions that big companies made to South Africa’s National Treasury during a consultation process on the country’s proposed new tax on sugar. Chief among these were Coca-Cola South Africa, the largest soft drinks manufacturer in the country, the Beverage Association of South Africa, the business association for the soft drinks sector in South Africa, and the American Chamber of Commerce in South Africa, a collective voice of US transnational corporations in South Africa. </p>
<p>Our analysis showed that the evidence cited by the three organisations was either not evidence at all, or had been twisted to suit the industry’s narrative.</p>
<h2>The analysis</h2>
<p>Our analysis built on <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001629">a method used to evaluate evidence use by tobacco companies</a>. There are several components to the method.
The most important centres on something called backward-mapping. This involves comparing evidence presented in submissions with supporting sources and examining how they have been used. </p>
<p>To the casual reader, most of the claims that the industry made would have looked credible. They were often supported by references to peer-reviewed journals, data produced by respected organisations, such as the United Nations’ Food and Agriculture Organisation, and sophisticated-looking economic impact studies which had been commissioned by the industry. </p>
<p>By using the backward-mapping technique we were able to show that the evidence provided didn’t stand up to scrutiny.</p>
<p>For example, we found that in some cases industry representatives simply made things up. The American Chamber of Commerce in South Africa cited a 2013 report by Oxford Economics to support the claim that the impact of sugar sweetened beverages “on health outcomes is uncertain and unproven”.</p>
<p>But we found that the report didn’t in fact examine the relationship between sugar sweetened beverages and health.</p>
<p>Coca-Cola and the Beverage Association of South Africa also used what’s referred to as the “<a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0495-5/tables/1">tweezers method</a>” to get their case across. This involved changing the intended meaning of original text in peer reviewed journals by picking phrases out of context. </p>
<p>For example, Coca-Cola reported that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592517/">a review by two researchers from Harvard School of Public Health</a> had</p>
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<p>concluded that there is limited evidence that consumers do not reduce their calorie intake to offset calories consumed in liquid form. </p>
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<p>These comments were aimed at refuting the idea that someone’s overall daily energy intake was likely to go down if they lowered their intake of sugary drinks. The inference was that the research had found some evidence that people eat more to compensate for reduced sugary drink intake. </p>
<p>In fact the Harvard review had used “limited evidence” to highlight the dearth of studies on the issue. Moreover, the review had indicated that existing findings indicated that intake of sugary drinks may not suppress intake of solid foods to the level needed to maintain energy balance.</p>
<p>Another method we identified was <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0495-5/tables/1">“data dredging”</a>.</p>
<p>Coca-Cola and the Beverage Association of South Africa drew heavily on <a href="http://www.fao.org/faostat/en/#data/FBS">Food Balance Sheets</a> produced by the Food and Agriculture Organisation to argue that sugar wasn’t responsible for the rise in obesity in South Africa. They argued that sugar consumption had declined over time in contrast to the consumption of vegetable oils and cereals which they claimed accounted for the rise in average daily energy intake among South Africans. According to them, this was the biggest cause of obesity.</p>
<p>But they’d specifically selected a time period (1991-2011) that would illustrate this. They used Food and Agriculture Organisation balance sheets for 1991 as the starting point – a year in which the highest per capita daily supply of sugar was recorded over 25 years. In fact <a href="http://www.fao.org/faostat/en/#data/FBS">sugar consumption has risen</a> – and vegetable oils and cereals have fallen – in both the 10 and 20-year period prior to the most recent reported figures (2013).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sugary-drinks-tax-is-working-now-its-time-to-target-cakes-biscuits-and-snacks-124325">Sugary drinks tax is working – now it's time to target cakes, biscuits and snacks</a>
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</em>
</p>
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<p>We also uncovered creative accounting.</p>
<p>The soft drinks industry had commissioned the British-based research consultancy, <a href="https://www.oxfordeconomics.com/">Oxford Economics</a> to model the potential impact of the tax on employment, tax revenue, and gross domestic product. Oxford Economics reported that the tax could lead to between 60,600 and 70,700 job losses. In their submission the beverage association and Coca-Cola pushed these numbers up to between 62,000 and 72,000.</p>
<p>Other aspects of Oxford Economics’ estimates raised questions too. It claimed that a <a href="https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0105287">key study</a> that underpinned their estimates had reported that, “drinkers of sugar-sweetened beverages (were) unlikely to switch to bottled water” and that</p>
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<p>other studies (had) not found statistically robust evidence that people switch from sugar-sweetened beverages to water when the price of sugar-sweetened beverages increase. </p>
</blockquote>
<p>In fact, the study had made no explicit reference to bottled water, but had in fact observed that</p>
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<p>other studies have shown that the demand for tea and coffee, as well as water goes up with sugar sweetened beverages price increases. </p>
</blockquote>
<h2>Vigilance needed</h2>
<p>The above examples represent a small selection of the techniques we identified. Taken in isolation they may not seem that serious. However, the key to understanding the problem is to consider them together, as an alternate system of <a href="https://www.researchgate.net/publication/37702656_Agnotology_The_Making_and_Unmaking_of_Ignoranceg_of_Ignorance">“agnotological”</a> reasoning, which deliberately aims to produce ignorance and doubt about scientific evidence.</p>
<p>Our work highlights the degraded nature of business evidence and underlines the need to rethink the elevated position sometimes given to big corporations’ views in public health policy conflicts.</p><img src="https://counter.theconversation.com/content/125421/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gary Fooks is a member of the UK Labour Party. He has previously received grant funding from CRUK and Healthway and has worked on projects funded by the US National Institutes of Health. He is currently in receipt of grant funding from the Wellcome Trust.</span></em></p><p class="fine-print"><em><span>Gary Sacks receives funding from the National Heart Foundation of Australia, the Australian National Health and Medical Research Counil (NHMRC), the World Health Organization and the Victorian Health Promotion Foundation (VicHealth).</span></em></p><p class="fine-print"><em><span>Simon Williams has worked on projects funded by the US National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Graham Box does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We found that evidence cited by three organisations - a big corporate and two industry lobby groups - was either not evidence at all, or had been twisted to suit the industry’s narrative.Gary Fooks, Reader in Sociology and Public Policy, Aston UniversityGary Sacks, Associate Professor, Deakin UniversityGraham Box, Sessional lecturer, University of ReadingSimon Williams, Lecturer in Sociology, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1229622019-09-12T13:21:31Z2019-09-12T13:21:31ZPure fruit juice: healthy, or not?<figure><img src="https://images.theconversation.com/files/291726/original/file-20190910-190061-76ysrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Yes, fruit juice contains natural sugar, but it has other benefits over sugar-sweetened drinks.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-pouring-fresh-orange-juice-jug-118749622?src=V4WQJoCPLnRRJoPVNE_XMQ-1-8">Carlos Horta/Shutterstock</a></span></figcaption></figure><p>Fruit juice was once viewed as part of a healthy diet, but today it is often seen as supplying little more <a href="https://www.itv.com/news/2019-05-17/fruit-juices-just-as-bad-for-your-health-as-sugary-drinks/">than a high dose of sugar</a>. Increasingly, fruit juices are seen as <a href="https://www.theguardian.com/lifeandstyle/2014/jan/17/how-fruit-juice-health-food-junk-food">junk foods</a>, and consumption is <a href="http://www.fruitjuicefocus.com/aijn-juice-report-2017-highlights/">falling</a>. But, as we argue in our <a href="https://doi.org/10.1093/nutrit/nuz031">recently published paper</a>, fruit juice should not be cut from our diets. Major reasons for not consuming fruit are that it involves effort and it is often inconvenient. But fruit juice avoids the problems of intact fruit while providing the same range of health-promoting chemicals. </p>
<p>Most of us have heard we should be eating <a href="https://www.nhs.uk/live-well/eat-well/5-a-day-what-counts/">five portions of fruit and vegetables a day</a>. Yet <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835355/">several</a> <a href="https://www.efsa.europa.eu/en/efsajournal/pub/1462">surveys</a> have shown that few people meet this target. This is despite the Global Burden of Disease study concluding that a poor diet is responsible <a href="https://www.sciencedaily.com/releases/2019/04/190403193702.htm">for one in five deaths</a> and suggesting that greater health benefits might result from increasing consumption of whole grains, nuts, fruit and vegetables rather than concentrating on reducing the intake of sugar and fat.</p>
<p>Research has shown that drinking pure juice can be good for us. <a href="https://www.ncbi.nlm.nih.gov/pubmed/29242527">The Food4Me study</a>, funded by the European Commission, revealed that lower weight was associated with a greater intake of fruits, vegetables and fruit juice. While a national nutritional survey in the US <a href="https://www.ncbi.nlm.nih.gov/pubmed/21677126">found that</a> adults who drink pure juice were at a lower risk of obesity and had better insulin sensitivity. </p>
<h2>Sugar-sweetened drinks</h2>
<p>Yet despite these benefits, several pressure groups and other organisations still suggest that juice should not be part of our diet. But their concerns rely on an analogy with sugar-sweetened fizzy drinks, and confusion over what a fruit juice actually is. The fear is that because fruit juice contains naturally occurring sugar, it increases the risk of obesity. Although fruit juice does contain sugar it should not be viewed as similar to sugar-containing drinks. </p>
<p>The term “fruit juice” includes drinks sweetened with sugar that contain little (if any) juice from fruit. Take Sunny Delight, for example. Thought to be a juice by many consumers, a 240ml serving contains <a href="https://sunnyd.com/product/tangy-original/">14 grams of sugar</a> and only <a href="https://www.tesco.com/groceries/en-GB/products/264468556">13% fruit juice from concentrate</a>. Fruit squashes and cordials meanwhile are a mixture of fruit pulp and sugar syrup. In contrast, pure fruit juice is just that, it has no added sugar. </p>
<p>Research has shown these drinks have very different effects on our bodies. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/24682091">joint American and Chinese study</a> of nearly 200,000 people found that drinking sugar-sweetened fruit juice increased the risk of diabetes, while drinking pure fruit juice did not. <a href="https://www.ncbi.nlm.nih.gov/pubmed/28336576">While another showed</a> that while sugar-sweetened drinks increase the weight of children over six years, pure fruit does not.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/291727/original/file-20190910-190044-1y5vgok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/291727/original/file-20190910-190044-1y5vgok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/291727/original/file-20190910-190044-1y5vgok.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/291727/original/file-20190910-190044-1y5vgok.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/291727/original/file-20190910-190044-1y5vgok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/291727/original/file-20190910-190044-1y5vgok.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/291727/original/file-20190910-190044-1y5vgok.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Juicing retains many of the health benefits associated with the original fruit.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-glasses-orange-juice-fruits-68566873?src=cVAMFeQIAZLuD7kFSOf6Zw-2-64">monticello/Shutterstock</a></span>
</figcaption>
</figure>
<p>Juices contain many health-promoting nutrients – such as vitamin C, polyphenols and carotenoids – that occur only to limited extents in sugar-sweetened drinks. Vitamin C, in particular, has been associated with <a href="https://www.ncbi.nlm.nih.gov/pubmed/22492364">reduced blood pressure</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/12875759">lower risk of heart disease</a> and a <a href="https://www.ncbi.nlm.nih.gov/pubmed/10871572">better life expectancy for men</a>.</p>
<p>Polyphenols – which gives fruit its red, purple and blue colours – have antioxidant, anti-inflammatory and anti-viral properties. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/28472215">summary of 22 studies of flavonoids</a> (a type of polyphenol) found that high intake cuts the risk of premature death by a quarter. And intake of anthocyanidins – another polyphenol – <a href="https://www.ncbi.nlm.nih.gov/pubmed/12198000">reduces the risk of developing diabetes</a>.</p>
<p>Finally, carotenoids (responsible for orange, yellow and red colourings) have been associated with lower cancer risks. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/25873578">summary of studies</a> linked them with a lower risk of developing oral and laryngeal cancer. Similarly, greater levels of carotenoids in the blood have been <a href="https://www.ncbi.nlm.nih.gov/pubmed/22760559">related to a reduced rate of breast cancer</a>.</p>
<h2>Loss of fibre</h2>
<p>But what about fibre? A second argument for not drinking juice is that it provides less dietary fibre than intact fruit. As the Mayo Clinic <a href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/juicing/faq-20058020">has pointed out</a>, although fruit juice “contains most of the vitamins, minerals and plant chemicals (phytonutrients) found in the whole fruit … healthy fiber is lost during most juicing”. </p>
<p>Fibre helps to prevent diabetes, heart disease and some forms of cancer, but the Western diet doesn’t provide <a href="https://www.efsa.europa.eu/en/efsajournal/pub/1462">enough</a>. There is a view that if people don’t drink juice, they will instead eat more intact fruit and the fibre that goes with it. But it’s improbable that juice and intact fruit are often alternatives. If you stop drinking juice for breakfast you will replace it with another drink. We drink because we’re thirsty not because we want to eat more fruit. The convenience of a drink allows consumption when it is impractical to eat fruit. </p>
<p>Nobody suggests that we should not eat meat or fish because they do not contain fibre. Instead, we look at the benefits of overall consumption – which is something we must start to do with fruit juice.</p>
<p>In 2017, an extensive survey of the benefits of fruit and vegetables found that the chances of premature death in those eating five to seven portions a day <a href="https://www.ncbi.nlm.nih.gov/pubmed/28338764">are 30% less</a> than those eating none, or just one portion. As the health-promoting chemicals in intact fruit are also found in juice, it is unsurprising that this – and other studies – have found fruit juice beneficial to our health. This research also showed that drinking either citrus or other fruit juices was associated with a lower risk of coronary heart disease, stroke or death from any cause.</p>
<p>Although it should not be seen as an alternative to intact fruit, having a daily pure fruit juice is a simple way to increase intake of beneficial chemicals. As part of a healthy diet, pure juice should be viewed as a health food – not a junk food.</p><img src="https://counter.theconversation.com/content/122962/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Benton has in the past been a member of the Scientific Advisory Board of the European Fruit Juice Association.
but the views are entirely those of the authors and the EFJA had no role in the development of this article. Hayley Young has no interest to declare.</span></em></p><p class="fine-print"><em><span>Hayley Young does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People often avoid fruit juice due to its sugar content and low fibre, but it still contains lots of good chemicals our bodies need.David Benton, Professor of Psychology, Swansea UniversityHayley Young, Associate Professor of Psychology, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1064902019-08-07T02:11:40Z2019-08-07T02:11:40ZTaxing sugary drinks can benefit Indonesia, research suggests<figure><img src="https://images.theconversation.com/files/286303/original/file-20190730-186841-1gzy33p.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C998%2C730&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Indonesia, the highest-income group spends about 27 times as much on sugary drinks as the lowest.</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>Obesity and diabetes used to be rich world problems. But diets in lower-income countries are shifting. More people are eating more processed foods and foods high in <a href="https://www.nature.com/articles/nrendo.2012.199">salt, sugar and saturated fat</a>. As a result, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60460-8/fulltext">obesity</a>, diabetes, heart disease and stroke are becoming major health concerns in middle-income countries, including Indonesia. </p>
<p>As of 2018, <a href="https://www.thejakartapost.com/news/2018/11/02/national-health-survey-finds-one-in-five-adults-obese.html">35.4% of Indonesians were overweight or obese</a>. Ten years earlier, <a href="https://pdfs.semanticscholar.org/c92b/62c0cb078547ae6b2078d5154a35fd00434e.pdf">over 5% were living with diabetes</a>. Indonesia’s healthcare system lacks the capacity to cope with this escalating chronic disease burden.</p>
<p>The rising burden is linked to Indonesia’s increasing sugar consumption over the last decade, particularly from sugary drinks. </p>
<p>Indonesia is a large and growing market for soft drinks and energy drinks. Demand is growing around 8-10% each year. Total sales are expected to be <a href="https://www.statista.com/outlook/20020000/120/soft-drinks/indonesia">US$12.9 billion</a> in 2019 – that works out to about 39 litres per person.</p>
<p>The Indonesian government has <a href="https://asia.nikkei.com/Spotlight/Asia-Insight/Southeast-Asian-sugar-taxes-Bitter-pills-for-better-health">considered</a> taxing sugary drinks to solve the increasing health problems. A <a href="https://www.bbhub.io/dotorg/sites/2/2019/04/Health-Taxes-to-Save-Lives.pdf">recent study</a> has shown that the tax can be implemented and would be <a href="https://blogs.worldbank.org/governance/taxing-sugar-sweetened-beverages-sweet-deal">economically beneficial</a>.</p>
<p>In our research, published in <a href="https://gh.bmj.com/content/3/6/e000923">BMJ Global Health</a>, we developed a model to estimate how much benefit taxing sugary drinks could bring to Indonesia. </p>
<p>From this model, we find wealthier Indonesians will benefit most from reductions in chronic disease risk, but the whole population will get healthier in the end.</p>
<h2>Benefits</h2>
<p>Our model for Indonesia is based on <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-1072">our previous research</a> that shows sugary drink taxes can help slow the growth in obesity and reduce chronic diseases.</p>
<p>The model aims to measure the health benefit if a <a href="https://www.idea.int/data-tools/data/international-dollars">$0.30</a> per litre tax were spread across income groups in Indonesia. </p>
<p>To do this, we looked at people’s responsiveness to price changes, including whether they switch to other drinks that are not taxed. We also looked at potential changes to the energy content in all of the drinks, and impacts on disease patterns in the population. </p>
<p>All of these factors were estimated by income group, from the poorest 20% to richest 20%. </p>
<p>We found that over 25 years the tax paid by the poorest people would be $0.5 billion, and $15.1 billion for the richest. </p>
<p>While it increases the health status of all groups, the health benefits of the tax were mostly in the higher-income groups because they have the highest consumption and are most at risk of chronic diseases. </p>
<p>In Indonesia, the highest-income group spends about 27 times as much on sugary drinks as the lowest. This is because richer people are more able to afford this lifestyle. </p>
<p>Our model shows cases of overweight and obesity would decrease by about 15,000 for the lower-income people, but decrease by 417,000 for the highest. </p>
<p>Similarly, 63,000 cases of diabetes could be averted in the lower-income group and up to 1,487,000 in the highest. Incidences of heart disease and stroke were similarly reduced. </p>
<h2>Other studies</h2>
<p>Our case study on Indonesia produces a result that contrasts with similar research in richer countries. In richer countries, the health benefits are often <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3070">greater for the poorer in society</a>. This is because they generally consume more low-quality food that is high in sugar, fat and salt.</p>
<p>In most studies of the impacts of sugary drink taxation, benefits are highest for those groups that already consumed large quantities of beverages.</p>
<p>Our model in Indonesia fills the gap in research on the effect of a sugary drink tax on income groups in lower-income countries.</p>
<h2>Benefit for all</h2>
<p>The World Health Organisation and the United Nations have made reducing excess sugar consumption <a href="https://www.who.int/nutrition/publications/guidelines/sugars_intake/en/">a key policy target</a>. </p>
<p><a href="https://www.who.int/bulletin/volumes/94/4/16-020416.pdf">Many countries</a> have begun taxing sugary drinks, <a href="https://www.wcrf.org/int/blog/articles/2018/06/sugary-drink-taxes-%E2%80%93-new-normal">including</a> Mexico, Ecuador, Brunei, Vanuatu, the UK, Portugal, India, South Africa, Saudi Arabia, the Philippines, Thailand and Sri Lanka. </p>
<p>It is about time Indonesia followed in their footsteps.</p>
<p>For countries still in the early phase of a shift to diets high in processed foods, like Indonesia, a sugary drink tax may at first benefit the health of wealthier people most. </p>
<p>However, a tax may also slow the adoption of sugary drink consumption across population groups, by offsetting aggressive marketing by the industry that is designed to increase market share. </p>
<p>Indonesia could thus slow the rise in obesity by taxing energy-dense, nutrient-poor foods and beverages such as sugary drinks. </p>
<p>This could reduce the incidence of non-communicable diseases, both directly due to reduced sugar and through their impact on weight. </p>
<p>Given the difficulties Indonesia is facing in treating chronic conditions, this would also be good for its health system. </p>
<p><em>Emily Bourke from The University of Queensland, Australia, contributed to this article</em></p><img src="https://counter.theconversation.com/content/106490/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lennert Veerman has received funding from the Australian National Health and Medical Research Council, the World Bank, the World Health Organisation and ASEAN. He is affiliated with the Public Health Association of Australia.</span></em></p><p class="fine-print"><em><span>Anne Marie Thow receives funding from public research bodies for related research. </span></em></p><p class="fine-print"><em><span>Febi Dwirahmadi tidak bekerja, menjadi konsultan, memiliki saham, atau menerima dana dari perusahaan atau organisasi mana pun yang akan mengambil untung dari artikel ini, dan telah mengungkapkan bahwa ia tidak memiliki afiliasi selain yang telah disebut di atas.</span></em></p>Our research estimates how much benefit taxing sugary drinks could bring to Indonesia.Lennert Veerman, Professor of Public Health, Griffith UniversityAnne Marie Thow, Lecturer in Health Policy, University of SydneyFebi Dwirahmadi, Lecturer in Global Health, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/909212018-02-08T05:44:32Z2018-02-08T05:44:32ZDoes a sugar tax cause alcohol sales to spike? The research doesn’t give a decisive answer<figure><img src="https://images.theconversation.com/files/204690/original/file-20180204-19948-1j8cqgb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's no direct evidence that taxing sugary drinks will lead to more consumption of alcohol.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Consuming sugar-sweetened drinks is associated with a <a href="https://theconversation.com/health-check-how-much-sugar-is-it-ok-to-eat-57345">range of health issues</a> including weight gain and obesity. These are risk factors for diabetes, heart disease, high blood pressure, strokes and certain cancers. </p>
<p>Taxing these drinks is an <a href="https://theconversation.com/taxing-sugary-drinks-would-boost-productivity-not-just-health-79410">effective means of reducing their consumption</a> and related health issues – as well as generating revenue for the government.</p>
<p>A recent study in the <a href="http://jech.bmj.com/content/early/2018/01/11/jech-2017-209791">Journal of Epidemiology and Community </a> set out to test whether a sugar tax might impact on other behaviours affecting public health, along with whether such a tax would prompt people to choose no- or low-calorie drinks.</p>
<p>The researchers ended up finding an <em>association</em> between higher soft-drink prices and higher demand for some alcoholic beverages in terms of family food and drink purchases. </p>
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<strong>
Read more:
<a href="https://theconversation.com/clearing-up-confusion-between-correlation-and-causation-30761">Clearing up confusion between correlation and causation</a>
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<p>They did not find that a sugar tax, let alone higher soft drink prices, <em>caused</em> people to drink more lager, as <a href="http://www.dailymail.co.uk/health/article-5302821/Sugar-tax-soft-drinks-drive-alcohol-consumption.html">news reports suggest</a>. In fact, the study provided no direct evidence a sugar tax will lead alcohol sales to increase. </p>
<h2>How was the study conducted?</h2>
<p>In this study, researchers from the London School of Hygiene & Tropical Medicine estimated elasticity of demand on non-alcoholic and alcoholic drinks in the UK, based on households’ response to price differences in sugary drinks. </p>
<p>They used existing consumer survey expenditure data collected between 2012 and 2013 from nearly 32,000 households. </p>
<p>Households recorded their individual groceries and drinks they had purchased and brought home using scanned bar codes (or manually entered them if there was no bar code). The researchers tracked how much the household spent, where they purchased, the day of purchase and volume of beverage purchased. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/australian-sugary-drinks-tax-could-prevent-thousands-of-heart-attacks-and-strokes-and-save-1-600-lives-56439">Australian sugary drinks tax could prevent thousands of heart attacks and strokes and save 1,600 lives</a>
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<p>They didn’t track consumption, or drinks which were bought and consumed elsewhere (for instance, in a bar or at a tuckshop), just the purchase of these products. </p>
<p>The researchers then compared how much one family bought and brought home of each beverage type when faced with a particular set of prices, against how much another family bought of each beverage type with a different set of prices. </p>
<h2>What were the results?</h2>
<p>The results were mixed, with variations between beverage types and income groups. There were several key outcomes.</p>
<p>In families where the price paid for high sugar-sweetened beverages such as Coke and Red Bull was higher, there were greater purchases of lager (such as Stella Artois, Beck’s or Corona), but less purchasing of spirits. </p>
<p>Where the price paid for medium sugar-sweetened drinks (including Fanta, Sprite and Powerade) was higher, there were fewer purchases of beer, lager and wines, but more of spirits. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sugar-tax-is-not-nanny-state-its-sound-public-policy-59059">Sugar tax is not nanny state, it's sound public policy</a>
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<p>Higher prices for diet or low sugar-sweetened drinks were associated with higher purchases of all alcoholic beverages except spirits, for which purchases were less. </p>
<p>Taking into account also relationships with other categories of drinks, the study concludes that a price increase for medium sugar-sweetened drinks would have the most significant positive impact from a public health perspective, given the drinks’ impact on dietary sugar and energy intake.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/204747/original/file-20180204-19937-rqxmxp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The amount of alcohol bought and drank outside of the home wasn’t taken into account in the study.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/AMwYylKQsUc">Photo by Julia Nastogadka on Unsplash</a></span>
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</figure>
<h2>How we should read the results</h2>
<p>In principle, elasticity is about what happens over time when there is a change – such as a new tax – which results in a higher price. </p>
<p>But the study was not actually measuring the effects of change in price over time. Rather, it correlated how much one family bought of each beverage type when faced with a particular set of prices against how much another family bought of each beverage type with a different set of prices. </p>
<p>But because the study isn’t actually measuring and correlating the change that elasticities would measure – a new tax and the change in consumption over time – it offers no direct evidence of what would happen in case of a change like a new tax, and should not be interpreted as having done so.</p>
<p>It is commonplace in economics to estimate elasticities this way, as a kind of modelling of what might happen with an actual price change, so it is not wrong for the authors to follow this common procedure. We just need to be careful how we interpret the results. </p>
<p>The study results indicate that an increase in the price of sugar-sweetened drinks potentially has both positive and negative impacts, from a public health perspective, on the consumption of alcoholic beverages. It suggests more nuanced price options across different ranges of beverages should be considered rather than a single tax only on high-sugar-sweetened beverages. </p>
<h2>What else should we take into account?</h2>
<p>The study’s measure of the amount of alcoholic beverages purchased was the number of bottles/containers of alcohol purchased – not the total units of pure alcohol (standard drinks) purchased. The demand for alcohol may not be accurately measured given different alcoholic beverages have different alcohol strengths and are in different sizes of containers.</p>
<p>And while the study looked at relationships between prices of sugar-sweetened drinks and consumption of other non-alcoholic and alcoholic drinks, the impact on other sugary products was not taken into account. For instance, <a href="https://www.sciencedirect.com/science/article/pii/S1570677X15000611">previous studies</a> suggest higher prices of sugar-sweetened drinks may have people substituting their sugar intake through things like sweets. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-sugary-drinks-tax-could-recoup-some-of-the-costs-of-obesity-while-preventing-it-69052">A sugary drinks tax could recoup some of the costs of obesity while preventing it</a>
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<h2>The paper’s unspoken contribution: counting the calories in alcoholic drinks</h2>
<p>The paper takes for granted that the calories in alcohol drinks count when thinking about avoiding obesity. But alcohol is often overlooked when we are thinking about calories and obesity. </p>
<p>And it is not easy for consumers to take the calories in alcohol drinks into account. Unlike for every other packaged food or drink sold in Australia, the caloric content does not have to be listed on the label of alcoholic beverages. So one important contribution of the article is to underline that, aside from being intoxicating, alcoholic beverages are also high in calories.</p>
<p>As the paper points out, a bottle of lager beer contains slightly more calories than a can of Coca-Cola. This means arguments for discouraging obesity with a tax on drinks might well be directed at alcohol content as well as sugar content.</p><img src="https://counter.theconversation.com/content/90921/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The research centre Robin Room heads receives funding from federal government research bodies, the Foundation for Alcohol Research and Education, VicHealth, Australian state government commissions, the U.S. National Institutes of Health and the World Health Organization.</span></em></p><p class="fine-print"><em><span>The research centre Heng Jiang works for receives funding from federal government research bodies, the Foundation for Alcohol Research and Education, VicHealth, Australian state government commissions, the U.S. National Institutes of Health and the World Health Organization.</span></em></p>A recent study was reported as saying a sugar tax would have us drinking more alcohol. But the study didn’t establish this fact. The results were mixed with no evidence one thing caused another.Robin Room, Professor, Centre for Alcohol Policy Research, La Trobe UniversityHeng Jiang, Research Fellow, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/858832017-10-18T22:30:35Z2017-10-18T22:30:35ZThe hidden connection between obesity, heart disease and trade<p>This week, representatives from most of the world’s governments are meeting at a <a href="http://www.who.int/nmh/events/2017/montevideo/about/en/">World Health Organization global conference</a> in Uruguay to tackle the global pandemic of noncommunicable diseases (NCDs). </p>
<p>These NCDs are the chronic diseases — including cancers, cardiovascular diseases, respiratory diseases and diabetes — that <a href="http://www.who.int/mediacentre/factsheets/fs355/en/">now kill around 40 million people each year</a>. They are responsible for 70 per cent of all deaths globally and have a much bigger impact than infectious diseases such as HIV and malaria. Reducing the preventable deaths they cause is one of the <a href="http://indicators.report/targets/3-4/">key health targets of the new Sustainable Development Goals</a>.</p>
<p>The good news is that the meeting’s <a href="http://www.who.int/ncds/governance/montevideo-roadmap.pdf?ua=1">draft agreement</a> recognizes the need to address conflicts between public health goals and private sector interests in tobacco, unhealthy foods and alcohol products. Alongside physical inactivity, consumption of these products is one of the main drivers of NCDs. </p>
<p>The bad news is that the agreement is virtually silent on the role of trade and investment agreements in promoting the global rise in NCDs.</p>
<h2>Trade agreements boost heart disease and obesity</h2>
<p>There is plenty of research evidence of the impact of trade and investment agreements on NCDs such as heart disease, and on major risk factors such as <a href="http://www.who.int/topics/obesity/en/">obesity</a> and <a href="http://www.who.int/topics/tobacco/en/">tobacco use</a>.</p>
<p>One of our studies, for example, revealed that <a href="https://globalizationandhealth.biomedcentral.com/track/pdf/10.1186/s12992-015-0127-7?site=globalizationandhealth.biomedcentral.com">consumption of sugar-sweetened beverages in Vietnam spiked dramatically</a> after that country opened itself to trade and foreign investment. Soft drink companies based in the United States increased their market presence even as the World Health Organization identified the rise in consumption of high-sugar content drinks as a <a href="http://www.who.int/dietphysicalactivity/childhood/WHO_new_childhoodobesity_PREVENTION_27nov_HR_PRINT_OK.pdf">major cause of rising youth obesity</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/190712/original/file-20171017-30436-ei85jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/190712/original/file-20171017-30436-ei85jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/190712/original/file-20171017-30436-ei85jt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/190712/original/file-20171017-30436-ei85jt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/190712/original/file-20171017-30436-ei85jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/190712/original/file-20171017-30436-ei85jt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/190712/original/file-20171017-30436-ei85jt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sugary carbonated drinks for sale at a market in Vietnam.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Another study found that <a href="https://globalizationandhealth.biomedcentral.com/track/pdf/10.1186/s12992-017-0240-x?site=globalizationandhealth.biomedcentral.com">consumption of unhealthy foods and sugary drinks increases after implementation of trade agreements</a>, often those with the U.S. There was also a correlation between such trade agreements and higher rates of heart disease and obesity. </p>
<p>Other research has found that <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/1744-8603-7-21">when countries opened themselves to trade, cigarette consumption rose</a>; as more cigarettes entered the domestic market, price competition made them more affordable. </p>
<h2>Limiting government power to prevent disease</h2>
<p>Trade and investment agreements are not the only cause of these NCD-promoting patterns. <a href="http://www.onlinepcd.com/article/S0033-0620(13)00169-2/fulltext">Globalization processes more generally are also involved</a>. This includes the way that products such as high-sugar drinks and cigarettes can function as symbols that people in low-income countries have “made it” to the middle class. But as <a href="http://www.ijhpm.com/article_3186_741c0738f19120039415d58aedff5602.pdf">our analysis of the Trans-Pacific Partnership Agreement</a> has found, such agreements can limit the ability of governments to implement laws, policies and regulations aimed at controlling these NCD risk factors. </p>
<p>These agreements require governments to have scientific proof for any new control measure they introduce that could interfere with trade rules. But what if the measure, by being new, has only limited evidence? Agreements also call on governments to prove that their control measure is “necessary” and that no other less trade-restrictive options might exist, such as mass education campaigns. </p>
<p>Extended patent protection on drugs used to treat NCDs, meanwhile, price them beyond poor peoples’ reach. And they drain limited government health budgets.</p>
<h2>Government fear of being sued</h2>
<p>Many trade agreements also contain rules that allow foreign investors to sue governments over perceived losses due to new regulations. Philip Morris did just that when Australia introduced tobacco plain packaging. Several <a href="http://untobaccocontrol.org/kh/legal-challenges/australias-plain-packaging-laws-wto/">tobacco-exporting countries launched government-to-government disputes</a> under the World Trade Organization (WTO) system.</p>
<p>These challenges were not successful in the end, although the final WTO ruling has yet to be made public. But the very fact that they were considered possible <a href="http://www.globalhealthequity.ca/webfm_send/12">creates a “regulatory chill”</a> in which governments grow reluctant to enact new public health measures for fear of a future trade or investment dispute. This is especially concerning for low-income countries that lack the financial resources to fight such a regulatory challenge.</p>
<p>Few NCD control measures have actually gone to formal trade or investment dispute. But under the WTO system, there are an increasing number of challenges being raised against <a href="https://academic.oup.com/heapro/article-lookup/doi/10.1093/heapro/daw109">government policies on food or alcohol labelling</a> intended to inform consumers of health risks, on marketing restrictions and on <a href="http://pubmedcentralcanada.ca/pmcc/articles/PMC4994523/pdf/nihms806911.pdf">tobacco control measures</a>. As a result of these informal challenges, governments in some instances have delayed or backed away from their policies to avoid the risk of a dispute.</p>
<h2>Three steps to reduce preventable deaths</h2>
<p>So what should governments do, especially since much of the liberalized global diffusion of NCD risks has already occurred? Fortunately, there are three simple steps they can take to ensure the “policy coherence” that is the theme of the Uruguay meeting.</p>
<p>First, governments should agree that all future trade and investment agreements contain a full carve-out for any non-discriminatory public health measure aimed at controlling NCD risks (or any other health concern), whether or not there is scientific proof or other less trade-restrictive means available.</p>
<p>Second, since there are already scores of existing agreements potentially tying public health’s regulatory hands, governments should commit to not initiating a dispute against another country’s non-discriminatory public health measure.</p>
<p>Third, governments should refrain from increasing patent protection on drugs used to treat NCDs. These diseases will continue to surge before prevention measures lead to their eventual decline; affordable treatments will be needed.</p>
<p>These three commitments should be written into the final Uruguay agreement. They respect the aim of global trade by ensuring public health measures are not used to discriminate against another country’s products or trade interests. They also respect the policy space governments need now, and into the future, to protect the health and well-being of their citizens.</p><img src="https://counter.theconversation.com/content/85883/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ronald Labonte receives funding from the Canada Research Chairs program, the Canadian Institutes for Health Research, and and National Institutes of Health. He is affiliated with the Trade and Investment Research Project of the non-profit Canadian Center for Policy Alternatives, and the non-profit Health and Trade Network. He is Editor-in-Chief of the peer-reviewed BMC journal, Globalization and Health. </span></em></p>As government representatives meet at the WHO global conference on noncommunicable diseases in Uruguay this week, their focus should be on reducing the health impacts of trade deals.Ronald Labonte, Professor and Canada Research Chair, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/673702016-11-27T19:15:56Z2016-11-27T19:15:56ZThe ten things Australia needs to do to improve health<figure><img src="https://images.theconversation.com/files/146915/original/image-20161122-24543-u7opfn.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There should be a tax on sugary drinks and people need assistance to quit.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>In Australia, <a href="http://www.aihw.gov.au/media-release-detail/?id=60129552034">one in every two people</a> has a chronic disease. These diseases, such as cancer, mental illness and heart disease, reduce quality of life and can lead to premature death. Younger generations are increasingly at risk.</p>
<p>Crucially, <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129555476">one-third</a> of the disease burden could be prevented and chronic diseases often share the same risk factors.</p>
<p>A collaboration of Australia’s leading scientists, clinicians and health organisations has produced <a href="https://www.vu.edu.au/sites/default/files/AHPC/pdfs/targets-and-indicators-for-chronic-disease-prevention-in-australia.pdf">health targets</a> for Australia’s population to reach by the <a href="http://www.who.int/nmh/ncd-tools/definition-targets/en/">year 2025</a>. </p>
<p>These are in line with the World Health Organisation’s agenda for a 25% global reduction in premature deaths from chronic diseases, endorsed by all member states including Australia.</p>
<p>Today the collaboration is announcing its <a href="https://www.vu.edu.au/sites/default/files/getting-australias-health-on-track-ahpc-nov2016.pdf">top ten priority policy actions</a> in response to a recent <a href="https://theconversation.com/too-much-salt-and-sugar-and-not-enough-exercise-why-australians-health-is-lagging-61165">health report card</a> that identifies challenges to meeting the targets. The actions will drive down risk factors and help create a healthier Australia.</p>
<h2>1. Drink fewer sugary drinks</h2>
<p>One in two adults and three out of four children and young people consume <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0112011-12">too much sugar</a>. Sugary drinks are the <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4364.0.55.011main+features12011-12">main source of sugar</a> in the Australian diet and while many other factors influence health, these drinks are directly linked to weight gain and the risk of developing diabetes. </p>
<p>Putting a 20% tax on sugary drinks could <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0151460">save lives and prevent heart attacks, strokes and diabetes</a>. The tax would also generate A$400 million each year that could be spent on much needed health programs. </p>
<h2>2. Stop unhealthy food marketing aimed at kids</h2>
<p>Almost 40% of children and young people’s energy comes from <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0072011-12?OpenDocument">junk food</a>. Children are very responsive to marketing and it is no coincidence almost two-thirds of food marketing during popular viewing times are <a href="http://onlinelibrary.wiley.com/doi/10.1111/1747-0080.12040/abstract">unhealthy products</a>.</p>
<p>Restricting food marketing aimed at children is an effective way to significantly reduce junk food consumption and <a href="https://www.vichealth.vic.gov.au/programs-and-projects/victorias-citizens-jury-on-obesity">Australians want action</a> in this area. Government-led regulation is needed to drive this change.</p>
<h2>3. Keep up the smoking-reduction campaigns</h2>
<p>Smoking remains <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129555476">the leading cause</a> of preventable death and disease in Australia, although the <a href="https://theconversation.com/australias-health-2016-report-card-experts-respond-65244">trends are positive</a>. </p>
<p>Campaigns that highlight the dangers of smoking reduce the number of young people who start smoking, increase the number of people who attempt to quit and support former smokers to remain tobacco free. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/146916/original/image-20161122-24533-3is6j8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/146916/original/image-20161122-24533-3is6j8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/146916/original/image-20161122-24533-3is6j8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/146916/original/image-20161122-24533-3is6j8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/146916/original/image-20161122-24533-3is6j8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/146916/original/image-20161122-24533-3is6j8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/146916/original/image-20161122-24533-3is6j8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/146916/original/image-20161122-24533-3is6j8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Smoking remains the leading cause of preventable death and disease in Australia.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>4. Help everyone quit</h2>
<p>About <a href="https://www.vu.edu.au/sites/default/files/AHPC/pdfs/australias-health-tracker.pdf">40% of Aboriginal people and 24% of people with a mental illness</a> smoke. </p>
<p>To support attempts to quit, compliance with <a href="http://www.tobaccoinaustralia.org.au/chapter-15-smokefree-environment/15-7-legislation">smoke-free legislation</a> across all work and public places is vital. <a href="http://www.quitnow.gov.au/internet/quitnow/publishingcp.nsf/content/home">Media campaigns</a> need to continue to reach broad audiences. <a href="http://www.health.gov.au/internet/anpha/publishing.nsf/Content/667CA10FF85FD2CDCA257B8C0031F7D3/$File/Screen%20res-Smoking&Disad_ev%20brief.pdf">GPs and other local health services</a> that serve disadvantaged communities should include smoking cessation in routine care. </p>
<h2>5. Get active in the streets</h2>
<p>More than <a href="https://www.vu.edu.au/sites/default/files/AHPC/pdfs/australias-health-tracker-children-young-people.pdf">90% of Australian young people</a> are not meeting guidelines for sufficient physical activity - the 2025 target is to reduce this by at least 10%. </p>
<p>Active travel to and from school programs will reach 3.7 million of Australia’s children and young people. This can only occur in conjunction with safe paths and urban environments that are designed in line with the latest <a href="http://www.thelancet.com/series/urban-design">evidence</a> to get everyone moving. </p>
<h2>6. Tax alcohol responsibly</h2>
<p>The <a href="http://www.taxreview.treasury.gov.au/content/FinalReport.aspx?doc=html/publications/Papers/Final_Report_Part_2/chapter_e5-3.htm">Henry Review</a> concluded that health and social harms have not been adequately considered in current alcohol taxation. A 10% increase on the current excise, and the consistent application of volume-based taxation, are the 2017 priority actions. </p>
<p>Fortunately, the trends suggest most people are drinking more responsibly. However approximately <a href="https://www.vichealth.vic.gov.au/media-and-resources/publications/alcohols-burden-of-disease-in-australia">5,500 deaths and 157,000 hospital admissions</a> occur as a consequence of alcohol each year.</p>
<h2>7. Use work as medicine</h2>
<p>People with a mental illness are over-represented in national unemployment statistics. The 2025 target is to halve the employment gap. </p>
<p>Unemployment and the associated financial duress exerts a significant toll on the health of people with a mental illness, and costs an estimated <a href="https://www.researchgate.net/publication/257464365_Costs_of_psychosis_in_2010_Findings_from_the_second_Australian_National_Survey_of_Psychosis">A$2.5 billion</a> in lost productivity each year. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266767/">Supported vocational programs</a> have 20 years of evidence showing their effectiveness. Scaling up and better integrating these programs is an urgent priority, along with suicide prevention and broader efforts. </p>
<h2>8. Cut down on salt</h2>
<p><a href="https://www.vu.edu.au/sites/default/files/AHPC/pdfs/australias-health-tracker.pdf">Most Australian adults</a> consume in excess of the recommended maximum salt intake of 5 grams daily. This contributes to a high prevalence of elevated blood pressure among adults (<a href="https://www.vu.edu.au/sites/default/files/AHPC/pdfs/australias-health-tracker.pdf">23%</a>), which is a major risk factor for heart diseases. </p>
<p>Around 75% of Australian’s salt intake comes from processed foods. Reducing salt intake by 30% by 2025, via food reformulation, could save <a href="https://www.vu.edu.au/sites/default/files/getting-australias-health-on-track-ahpc-nov2016.pdf">3,500 lives a year</a> through reductions in heart disease, stroke and kidney disease. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/146917/original/image-20161122-24569-1j2b7dq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/146917/original/image-20161122-24569-1j2b7dq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/146917/original/image-20161122-24569-1j2b7dq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/146917/original/image-20161122-24569-1j2b7dq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/146917/original/image-20161122-24569-1j2b7dq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/146917/original/image-20161122-24569-1j2b7dq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/146917/original/image-20161122-24569-1j2b7dq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/146917/original/image-20161122-24569-1j2b7dq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Reducing salt intake by 30% by 2025 could save 3,500 lives a year.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>9. Promote heart health</h2>
<p>Heart disease is Australia’s single largest cause of death, and yet an estimated <a href="https://www.mja.com.au/journal/2016/204/8/absolute-risk-cardiovascular-disease-events-and-blood-pressure-and-lipid-lowering">970,000 adults</a> at high risk of a cardiovascular event (heart attack or stroke) are not receiving appropriate treatment to reduce risk factors such as combined blood pressure and cholesterol-lowering medications. Under-treatment can be exacerbated by people’s lack of awareness about their own risk factors. </p>
<p>National heart risk assessment programs, along with care planning for high-risk individuals, offer a cost-effective solution.</p>
<h2>10. Measure what matters</h2>
<p>A comprehensive <a href="http://www.abs.gov.au/australianhealthsurvey">Australian Health Survey</a> must be a permanent and routine survey every five years, so Australia knows how we are tracking on chronic disease. </p>
<p>All of these <a href="https://www.vu.edu.au/sites/default/files/getting-australias-health-on-track-ahpc-nov2016.pdf">policies</a> are effective, affordable and feasible opportunities to prevent, rather than treat, Australia’s biggest killer diseases.</p><img src="https://counter.theconversation.com/content/67370/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca Lindberg works for the Australian Health Policy Collaboration. </span></em></p><p class="fine-print"><em><span>Kevin Mc Namara receives funding from the Department of Health, and has previously received funding from the National Heart Foundation of Australia, for preventative health research. Kevin Mc Namara is rapporteur for an Australian Health Policy Collaboration working group, and a member of Standards Review Group Subcommittee F developing pharmacy practice standards around screening and risk assessment on behalf of the Pharmaceutical Society of Australia.</span></em></p><p class="fine-print"><em><span>Sharleen O'Reilly receives funding from National Health and Medical Research Council.</span></em></p>A collaboration of Australia’s leading scientists, clinicians and health organisations announce ten priority policy actions needed for Australia to reach its health targets by the year 2025.Rebecca Lindberg, Research Coordinator, Victoria UniversityKevin Peter Mc Namara, Senior Research Fellow in Health Services Research, Deakin UniversitySharleen O'Reilly, Senior Lecturer in Nutrition and Dietetics, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/690522016-11-22T19:26:34Z2016-11-22T19:26:34ZA sugary drinks tax could recoup some of the costs of obesity while preventing it<figure><img src="https://images.theconversation.com/files/146529/original/image-20161118-19383-v1arna.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A tax on sugary drinks wouldn't just prevent obesity, it could recoup some of the costs from obesity to the taxpayer. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Obesity is a major public health problem In Australia. More than <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument">one in four adults are now classified as obese</a>, up from one in ten in the early 1980s. And about 7% of children are obese, up from <a href="http://sydney.edu.au/medicine/public-health/prevention-research/pdf/SPANS_ShortReport_2010.pdf">less than 2% in the 1980s</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/146526/original/image-20161118-19375-cnx3zu.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/146526/original/image-20161118-19375-cnx3zu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/146526/original/image-20161118-19375-cnx3zu.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/146526/original/image-20161118-19375-cnx3zu.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/146526/original/image-20161118-19375-cnx3zu.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/146526/original/image-20161118-19375-cnx3zu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/146526/original/image-20161118-19375-cnx3zu.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/146526/original/image-20161118-19375-cnx3zu.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Prevalence of obesity in Australia.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Obesity not only affects an individual’s health and wellbeing, it imposes enormous costs on the community, through higher taxes to fund extra government spending on health and welfare and from forgone tax revenue because obese people are <a href="http://www.sciencedirect.com/science/article/pii/S0167629615000296">more likely to be unemployed</a>. </p>
<p>In our new Grattan Institute report, <a href="https://grattan.edu.au/">A sugary drinks tax: recovering the community costs of obesity</a>, we estimate community or “third party” costs of obesity were about A$5.3 billion in 2014/15.</p>
<p>We propose the government put a tax on sugar-sweetened beverages to recoup some of the third-party costs of obesity and reduce obesity rates. Such a tax would ensure the producers and consumers of those drinks start paying closer to the full costs of this consumption – including costs that to date have been passed on to other taxpayers. There is the added benefit of raising revenue that could be spent on obesity-prevention programs.</p>
<p>The scope of our proposed tax is on non-alcoholic, water-based beverages with added sugar. This includes soft drinks, flavoured mineral waters, fruit drinks, energy drinks, flavoured waters and iced teas. </p>
<p>While a sugary drinks tax is not a “silver bullet” solution to the obesity epidemic (that requires numerous policies and behaviour changes at an individual and population-wide level), it would help.</p>
<h2>Why focus on sugary drinks?</h2>
<p>Sugar-sweetened beverages are high in sugar and most contain no valuable nutrients, unlike some other processed foods such as <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/chocolate">chocolate</a>. Most Australians, especially younger people, consume too much sugar already. </p>
<p>People often drink excessive amounts of sugary drinks because the body does not send appropriate “full” signals from calories consumed in liquid form. Sugar-sweetened beverages can induce hunger, and soft drink consumption at a young age can create a life-long preference for sweet foods and drinks.</p>
<p>We estimate, <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/to-what-extent-have-sweetened-beverages-contributed-to-the-obesity-epidemic/591E6F0B7DF9ED6D309239AD661C643D#">based on US evidence</a>, about 10% of Australia’s obesity problem is due to these sugar-filled drinks.</p>
<p>Many countries have implemented or announced the introduction of a sugar-sweetened beverages tax including the <a href="https://www.gov.uk/government/news/soft-drinks-industry-levy-12-things-you-should-know">United Kingdom</a>, <a href="http://www.lemonde.fr/economie/article/2011/12/29/la-taxe-sur-les-boissons-sucrees-entrera-bien-en-vigueur-au-1er-janvier_1624009_3234.html">France</a>, <a href="http://www.treasury.gov.za/public%20comments/Sugar%20sweetened%20beverages/POLICY%20PAPER%20AND%20PROPOSALS%20ON%20THE%20TAXATION%20OF%20SUGAR%20SWEETENED%20BEVERAGES-8%20JULY%202016.pdf">South Africa</a> and parts of the <a href="http://www.forbes.com/sites/brucelee/2016/11/14/5-more-locations-pass-soda-taxes-whats-next-for-big-soda/#46285003193f">United States</a>. The overseas experience is tax reduces consumption of sugary drinks, with people mainly switching to water or diet/low-sugar alternatives. </p>
<p>There is <a href="https://search.informit.com.au/documentSummary;dn=786412793691680;res=IELHEA">strong public support</a> in Australia for a sugar-sweetened beverages tax if the funds raised are put towards obesity prevention programs, such as making healthier food cheaper. Public health authorities, including the World Health Organisation and the Australian Medical Association, as well as advocates such as the Obesity Policy Coalition, support the introduction of a sugar-sweetened beverages tax.</p>
<h2>What the tax would look like</h2>
<p>We advocate taxing the sugar contained within sugar-sweetened beverages, rather than levying a tax based on the price of these drinks, because: a sugar content tax encourages manufacturers to reduce the sugar content of their drinks, it encourages consumers to buy drinks with less sugar, each gram of sugar is taxed consistently, and it deters bulk buying. </p>
<p>The tax should be levied on manufacturers or importers of sugar-sweetened beverages, and overseas evidence suggests it will be passed on in full to consumers. </p>
<p>We estimate a tax of A$0.40 per 100 grams of sugar in sugary drinks, about A$0.80 for a two-litre bottle of soft drink, will raise about A$400-$500 million per year. This will reduce consumption of sugar-sweetened beverages by about 15%, or about 10 litres per person on average. <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0151460">Recent Australian modelling</a> suggests a tax could reduce obesity prevalence by about 2%. </p>
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<img alt="" src="https://images.theconversation.com/files/146707/original/image-20161121-30380-1arfi85.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/146707/original/image-20161121-30380-1arfi85.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=810&fit=crop&dpr=1 600w, https://images.theconversation.com/files/146707/original/image-20161121-30380-1arfi85.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=810&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/146707/original/image-20161121-30380-1arfi85.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=810&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/146707/original/image-20161121-30380-1arfi85.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1018&fit=crop&dpr=1 754w, https://images.theconversation.com/files/146707/original/image-20161121-30380-1arfi85.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1018&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/146707/original/image-20161121-30380-1arfi85.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1018&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Author provided/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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</figure>
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<p>Low-income earners consume more sugar-sweetened beverages than the rest of the population, so they will on average pay slightly more tax. But the tax burden per person is small – and consumers can also easily avoid the tax by switching to drinks such as water or artificially sweetened beverages. </p>
<p>People on low incomes are generally more responsive to price rises and are therefore more likely to switch to non-taxed (and healthier) beverages, so the tax may be less regressive than predicted. Although a sugar-sweetened beverages tax may be regressive in monetary terms, the greatest health benefits will flow through to low-income people due to their greater reduction in consumption and higher current rates of obesity. </p>
<p>The revenue could also be spent on obesity programs that benefit the disadvantaged, reducing the regressivity of the tax. </p>
<p>While the beverage and sugar industries are strongly opposed to any tax on sugar, their concerns are overblown. Most of the artificially sweetened drinks and waters, which will not be subject to the tax, are owned by the major beverage companies. </p>
<p>A sugar-sweetened beverages tax will reduce domestic demand for Australian sugar by around 50,000 tonnes, which is only about 1% of all the sugar produced in Australia. And while there may be some transition costs, this sugar could instead be sold overseas (as 80% of Australia’s sugar production already is).</p>
<p>A tax on sugary drinks is a public health reform whose time has come.</p><img src="https://counter.theconversation.com/content/69052/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Obesity imposes enormous costs on the community, through higher taxes to fund extra government spending on health and from foregone tax revenue because obese people are more likely to be unemployed.Stephen Duckett, Director, Health Program, Grattan InstituteTrent Wiltshire, Associate, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/682952016-11-07T20:13:55Z2016-11-07T20:13:55ZWhy Africa should resist the power of Big Sugar to undermine public health<figure><img src="https://images.theconversation.com/files/144825/original/image-20161107-4694-1tpj0hw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">South Africa's proposed tax on sugary drinks will help improve public health despite the overwrought opposition from the industry.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/shardayyy/7539177816">Shardayyy/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The South African government has <a href="http://www.fin24.com/Budget/the-secrets-out-sa-to-get-a-sugar-tax-20160224">decided to tax sugary drinks</a> to help cut excess sugar consumption, which is <a href="https://theconversation.com/obesity-why-south-africans-need-to-can-soft-drinks-50424">contributing to a burgeoning epidemic</a> of obesity, diabetes and cardiovascular disease. This follows the <a href="https://www.theguardian.com/world/2014/jan/16/mexico-soda-tax-sugar-obesity-health">lead of Mexico</a> and the US <a href="http://www.npr.org/sections/thesalt/2016/08/23/491104093/berkeleys-soda-tax-appears-to-cut-consumption-of-sugary-drinks">city of Berkeley</a>, where <a href="https://theconversation.com/what-the-world-can-learn-from-mexicos-tax-on-sugar-sweetened-drinks-56696">results</a> have been <a href="https://www.theguardian.com/world/2015/jun/18/mexican-soda-tax-cuts-sales-first-year">very positive</a>.</p>
<p>In Mexico, <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002158">research predicts</a> a win-win outcome: it may greatly decrease disease and death from diabetes and cardiovascular disease while reducing health care costs.</p>
<p>What can be expected in South Africa is overwrought and highly emotive opposition from the sugary drink industry. The tax has been described as <a href="http://www.dailymaverick.co.za/article/2016-08-31-sas-proposed-sugar-tax-claims-about-calories-job-losses-checked/#.WCBCIuh97IU">“murderous” and “highly discriminatory”</a>. </p>
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<figcaption><span class="caption">Coca-Cola Beverages Africa chairman Phil Gutsche denounces the sugar tax as murderous and discriminatory.</span></figcaption>
</figure>
<p>This opposition to an effective measure to protect and improve the public’s health occurs in the context of a seven-decade battle between public health (David) and unhealthy industries (Goliaths). During that time the tobacco, junk food, sugar-sweetened beverage and alcohol industries have become the drivers of the major non-communicable diseases (cancers, lung disease, diabetes and cardiovascular diseases) that now <a href="http://www.who.int/mediacentre/factsheets/fs355/en/">dominate the global health landscape</a>.</p>
<p>The junk food, sugary drink and alcohol industries claim to be part of the solution. The solution requires them to help improve their consumers’ health by decreasing advertising to children, reducing levels of salt, fat and sugar in their products, and labelling food honestly and clearly. These are all measures they are convinced are in conflict with their responsibility to make money for their shareholders. </p>
<p>How can these industries be part of the solution in these circumstances? Expecting them to support effective health measures is like expecting the Springboks to support the Wallabies. </p>
<h2>Why industry is not part of the solution</h2>
<p>In 2008, as chair of Australia’s <a href="http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/home-1">Preventative Health Task Force</a>, I did think they might be part of the solution. Our task was to recommend ways to reduce the burden of death and disease due to obesity, tobacco and alcohol. </p>
<p>Big Tobacco was denied any influence on our work and the results have been <a href="http://www.abc.net.au/news/2016-09-29/smoking-rates-at-record-lows-as-number-of-smokers-almost-halves/7886316">spectacularly effective</a>: <a href="https://theconversation.com/the-slow-burn-devastating-impact-of-tobacco-plain-packs-51727">plain packaging</a>, <a href="http://www.tobaccoinaustralia.org.au/13-2-tobacco-taxes-in-australia">annual increases in tobacco taxes</a> and one of the <a href="http://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-13-international-comparisons-of-prevalence-of-sm">lowest rates of smoking</a> in the world. </p>
<p>On the other hand, Big Food and Big Alcohol were allowed to be “in the room”. Over the past eight years I have seen them undermine, obstruct and fight tooth and nail every potentially effective policy to diminish death and disease related to overconsumption of their products. I no longer believe they can be part of the solution.</p>
<p>How do these industries oppose the protection and improvement of people’s health? They use a sophisticated long-term approach of tracking, monitoring and attacking key researchers and advocates, attacking and undermining the science of public health and clinicians, influencing bureaucratic and political decision-makers, creating industry front groups, donating to political parties, sponsoring sporting and cultural groups and funding research that is much more likely to produce results that support their own arguments. </p>
<p>They are particularly adept at promoting self-regulation. With this tactic – called <a href="http://www.investopedia.com/terms/r/regulatory-capture.asp">regulatory capture</a> – they introduce a form of self-regulation, such as an industry code of practice. </p>
<p>These approaches have been found to be “<a href="https://www.ncbi.nlm.nih.gov/pubmed/24713622">relatively vague and permissive</a>”, ineffective, and to result in relatively small measurable effects. And, of course, they are non-binding and impossible to enforce. </p>
<p>A prime example of this occurred in 2009, when the <a href="http://www.afgc.org.au/our-expertise/health-nutrition-and-scientific-affairs/advertising-to-children/">Australian Food and Grocery Council</a> and the <a href="http://www.abc.net.au/mediawatch/transcripts/1035_service.pdf">Quick Service Restaurant Industry</a> introduced “responsible marketing” self-regulation. Both voluntary initiatives promised not to advertise unhealthy food products to children under 12.</p>
<p>At face value this looked like a great initiative. In reality it had <a href="https://theconversation.com/side-stepping-the-censors-the-failure-of-self-regulation-for-junk-food-advertising-2006">no proven effect</a>. Ingeniously designed, these promises encompassed only children’s viewing times – which is not actually when children watch most of their TV. </p>
<p>The industry initiative “captured” any potential for public regulation and resulted in years of continued saturation advertising of junk food and sugary drinks to Australian children. It was a brilliant, but very unhealthy, tactical ploy by the junk food industry. Beware of the industry association bearing gifts.</p>
<p>A related concern is the global consolidation of transnational corporations. An example is the <a href="http://www.forbes.com/sites/taranurin/2016/10/10/its-final-ab-inbev-closes-on-deal-to-buy-sabmiller/#43a0dc6937d6">recent merger</a> between the two largest beer producers, AB InBev and SABMiller. </p>
<p>The capacity of these corporate Goliaths to undermine the public’s health and to influence or control health policy is becoming stronger with each merger and takeover. In Africa particularly, governments are susceptible given that their economies are often much smaller than the corporations they are dealing with.</p>
<h2>A way to provide healthy sponsorship</h2>
<p>Using taxes to diminish the consumption of unhealthy products has been highly successful. The <a href="https://www.vichealth.vic.gov.au/media-and-resources/publications/the-story-of-vichealth">Victorian Health Promotion Foundation</a> started this 30 years ago using a dedicated tax on tobacco. This was used to replace sport and arts sponsorships that tobacco companies had provided.</p>
<p>Sponsorship by <a href="http://www.quit.org.au/">Quit</a> – an organisation dedicated to helping people give up cigarette smoking – replaced harmful tobacco sponsorship in sport. A sugary drinks tax in South Africa can be used in this way to replace sponsorship by promoters of unhealthy drinks.</p>
<p>The sugary drinks industry in South Africa <a href="http://businesstech.co.za/news/government/134146/sugar-tax-will-cost-south-africa-economy-r14-billion-and-push-the-country-into-recession/">will claim</a> the new tax will wipe out jobs and slash profits. We know, however, from experience in Australia and elsewhere that these industries know how to protect profits. When cigarette taxes are increased, tobacco companies cynically increase their prices – and then blame the government.</p>
<p>The sugary drinks industry will throw everything into stopping the sugar tax in South Africa, just as they tried in Mexico and Berkeley. They do not want <a href="https://theconversation.com/australian-sugary-drinks-tax-could-prevent-thousands-of-heart-attacks-and-strokes-and-save-1-600-lives-56439">sugar taxes spreading</a> across the world. It’s the same motive that drove Big Tobacco to <a href="https://theconversation.com/cluster-bomb-of-new-research-explodes-tobacco-industry-lies-about-plain-packs-38978">fight so hard</a> against plain packaging in Australia. </p>
<p>The introduction of a tax in South Africa might provoke the ire of the sugary drinks industry, but it will decrease death and disease <a href="https://theconversation.com/rejection-of-sugar-tax-is-based-on-faulty-logic-about-the-poor-50230">among the poorest</a>, while providing much-needed finances to improve health and sponsor healthy sports. It’s worth the ire!</p><img src="https://counter.theconversation.com/content/68295/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rob Moodie has received funding from the Australian Department of Health, and chaired the National Preventative Health Taskforce from 2008-2011. He chairs the GAVI Alliance Evaluation Advisory Committee and his University receives sitting fees. He has worked with WHO as an adviser over many years. He is currently on the WHO expert panel on Health Promotion.</span></em></p>The decision to tax sugary drinks in South Africa faces furious industry opposition, but global experience shows industry cannot be trusted to put public health before profits.Rob Moodie, Professor of Public Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/497852015-10-30T10:05:36Z2015-10-30T10:05:36ZA sugar tax is needed to kickstart companies into action – not consumers<figure><img src="https://images.theconversation.com/files/99824/original/image-20151027-5007-13nejkw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Time for a tax?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/gallery-2105663p1.html">Bychykhin Olexandr / Shutterstock.com</a></span></figcaption></figure><p>Celebrity chef Jamie Oliver’s campaign to introduce a sugar tax on fizzy drinks and snacks has been <a href="http://www.theguardian.com/society/2015/oct/24/sugar-tax-poll-obesity-cameron-oliver">gaining momentum</a>. Oliver has a history of trying to persuade the British public to eat more healthily, with mixed results – his campaign for healthier school dinners led to some parents <a href="http://news.bbc.co.uk/1/hi/england/south_yorkshire/5349392.stm">feeding their children chips</a> through the school railings. And his current crusade has <a href="http://www.telegraph.co.uk/news/health/11948432/Jamie-Oliver-is-a-patronising-bully-and-he-can-stick-his-sugar-tax.html">suffered the usual backlash</a> of people decrying both that you have to be a celebrity to get yourself heard and that this is just another “nanny state” move. </p>
<p>We know from previous attempts to put punitive taxes on foods that there can be unintended consequences. In 2011, for example, Denmark introduced a fat tax: food containing more than 2.3% of saturated fat was subject to a surcharge, including dairy produce, meat and processed foods. It was <a href="http://www.bbc.co.uk/news/world-europe-20280863">abolished within a year</a>. </p>
<p>The reasons for the withdrawal of the tax included the overall inflation in food prices, job losses that resulted from the impact of taxes on businesses producing and selling high fat foods, and people circumventing the tax by buying cheaper fatty foods across the border in Germany. Small specialist retailers such as butchers and delicatessens were particularly hard hit as their stock was primarily high-fat foods.</p>
<h2>The easy option</h2>
<p>Taxing people on what they eat will always be problematic. Food is not the same as tobacco or alcohol. While we can live without smoking or drinking alcohol, we cannot live without food. Plus we are predisposed toward eating the sugary and fatty foods that lead to obesity and its associated diseases. The problem with food is that it’s more an issue of the amount and type we eat.</p>
<p>One area where a sugar tax could easily be introduced, with positive effect, is on sugary drinks. They form part of multibillion dollar industry. In 2013, the US soft drink market was <a href="http://www.statista.com/statistics/422532/united-states-soft-drink-market-size/">valued at about US$98 billion</a>, up from US$92 billion in 2010. Meanwhile, studies have <a href="http://search.proquest.com/docview/215084540?pq-origsite=gscholar">consistently shown</a> that the health impact includes, increased energy intake and concomitant weight gain, diabetes, tooth decay and a lower intake of milk, calcium and other nutrients. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/99827/original/image-20151027-5004-19ea562.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/99827/original/image-20151027-5004-19ea562.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=334&fit=crop&dpr=1 600w, https://images.theconversation.com/files/99827/original/image-20151027-5004-19ea562.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=334&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/99827/original/image-20151027-5004-19ea562.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=334&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/99827/original/image-20151027-5004-19ea562.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=420&fit=crop&dpr=1 754w, https://images.theconversation.com/files/99827/original/image-20151027-5004-19ea562.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=420&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/99827/original/image-20151027-5004-19ea562.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=420&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Companies have already shown that it’s possible to reduce the amount of sugar in their drinks.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/jeepersmedia/15486970180/in/photolist-pAwLFf-pAwLMN-pSRXG4-pAwLHj-pArg4t-pSRXVa-pAtLh3-pAtKpw-pArfgg-pAwKN3-pSRXwV-7bSnbd-dgnUTb-mez15v-cQstjL-8xxxuH-7B9hEU-8prJSd-6EdaZT-7B5trP-6uF1ug-83GD6t-5TqEAt-rWHSc-r28tTw-7wKrmz-81TtR4-5rFgLB-oFHZQ-3XbTck-4GyTqP-7LyYoJ-ePMwsv-e4XjE3-6DWZ5q-cN7xDE-sevrSh-6DSL1Z-cmXKrh-7JGMe5-cC7kB-5eK12o-4SsAbP-dmoRAL-oJyc9Z-6a59qB-7u1EM-cyUhmG-4SwN6o-41Pna">Mike Mozart</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Most sugary drinks are produced by large multinational firms that are unlikely to go out of business if a small country like Britain introduces a levy of this kind and the effects on business do not have to be entirely punitive in the long term. Perhaps it is time to see the positive side of this so-called nanny state imposition. </p>
<p>Governments are typically fond of promoting self-regulation and engaging with business for a better outcome. The current government has the <a href="https://responsibilitydeal.dh.gov.uk/">Responsibility Deal</a> which includes a number of pledges from companies to improve the health of the British public, including reducing calorie and salt content. Nevertheless it has received a lot of bad press for its limited role, and the power of the companies involved. This in turn has led to many public health organisations <a href="http://www.telegraph.co.uk/foodanddrink/foodanddrinknews/8381179/More-health-bodies-criticise-Government-deal-with-industry.html">leaving the deal</a> and criticisms as to <a href="http://www.theguardian.com/politics/2015/may/12/food-industry-responsibility-deal-little-effect-health-study">what it has achieved</a>.</p>
<h2>Give it a go</h2>
<p>It currently appears that the government will ignore Oliver despite his celebrity status. Indeed, a previous opportunity for introducing a tax on consumption of problematic substances was turned down by the government when it <a href="https://theconversation.com/minimum-pricing-for-alcohol-helps-poorer-heavy-drinkers-23062">backtracked on setting minimum prices for alcohol</a>. At that time I suggested that given evidence from Canada on the success of minimum alcohol pricing it was worth <a href="http://www.theguardian.com/commentisfree/2013/mar/13/alcohol-minimum-pricing-could-work-government-wrong">just giving it a try</a>. Nanny state or not, I think the same should be said of Jamie’s sugar tax. It is worth giving it a go, given the evident problems this country has with obesity and its associated health issues. </p>
<p>In the first instance I would limit it to fizzy drinks to see, not what the consumers do, but how producers respond. We have already seen that drinks manufacturers are perfectly capable of developing fizzy drinks that have lower calories. In most soft drinks the calorie intake is from sugar whether naturally occurring from fruit or added for taste and in colas the calorie content is entirely made up <a href="http://www.sugarstacks.com/beverages.htm">from the added sugar</a>. With the recent introduction of its Coca-Cola Life product, Coke shows that it is possible to have a range of options:</p>
<ul>
<li>Coca-Cola = 42 calories per 100ml.</li>
<li>Coca-Cola Life = 27 calories per 100ml.</li>
<li>Coca-Cola Zero = Less than one calorie per 100ml.</li>
<li>Diet Coke = Less than one calorie per 100ml.</li>
</ul>
<p>If there was a sugar tax, this might encourage Coca Cola and other companies producing sugary drinks to limit their product range to just those products with lower sugar content and indeed spend money on formulating new low sugar drinks. That is what a sugar tax could do – actually kick start companies into researching, producing and marketing drinks with less sugar. </p>
<p>While it will always be healthier to be drinking water, the sugar tax might just put the responsibility back in the court of the producer rather than the consumer.</p><img src="https://counter.theconversation.com/content/49785/count.gif" alt="The Conversation" width="1" height="1" />
Celebrity chef Jamie Oliver’s campaign to introduce a sugar tax on fizzy drinks and snacks has been gaining momentum. Oliver has a history of trying to persuade the British public to eat more healthily…Isabelle Szmigin, Professor of Marketing, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/480072015-09-24T20:15:42Z2015-09-24T20:15:42ZExpert is as expert does: in defence of US dietary guidelines<figure><img src="https://images.theconversation.com/files/96033/original/image-20150924-17074-xcuzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The main thrust of the advisory committee’s report is that diets should be focused on whole foods, not specific nutrients.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/usdagov/8263905087/">U.S. Department of Agriculture/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>National dietary guidelines have become an easy target for those looking for a scapegoat for bad diets in prosperous countries. And an article just <a href="http://www.bmj.com/content/351/bmj.h4962">published in the BMJ</a> about the scientific evidence for the US dietary guidelines provides further needless fuel for the fire.</p>
<p>In February 2015, an advisory committee of 14 experts appointed to review research evidence and inform the government of the relevant science underpinning the US dietary guidelines issued a <a href="http://health.gov/dietaryguidelines/2015-scientific-report/">570-page report</a>. Among its conclusions, the report recommended guiding the population to dietary patterns that are:</p>
<ul>
<li>rich in vegetables, fruit, whole grains, seafood, legumes and nuts </li>
<li>moderate in low-fat and non-fat dairy products and alcohol (among adults) </li>
<li>lower in red and processed meat, and </li>
<li>low in sugar-sweetened foods and beverages and refined grains.</li>
</ul>
<p>The report also recommended limiting marketing of unhealthy foods to children, clearer food labelling, and greater consideration of sustainability issues. </p>
<p>The report generated much angst. This was not unexpected – because so many people feel they’re experts in nutrition, and because it upset many <a href="http://www.usda.gov/factbook/chapter2.pdf">groups with vested interests</a> in maintaining the current US diet with its high levels of meat, junk foods and drinks. </p>
<p>The advisory committee received more than 29,000 written responses to its recommendations. <a href="http://www.sugar.org">The Sugar Association</a>, the National Pork Producers Council, the National Cattlemen’s Beef Association and the National Chicken Council <a href="http://union-bulletin.com/news/2015/mar/14/meat-industry-wages-war-new-guidelines/">all challenged the report</a>. </p>
<p>Senators <a href="http://www.grassley.senate.gov/news/news-releases/grassley-extension-public-comment-period-dietary-guidelines-advisory-committee">complained directly to Congress</a>, <a href="http://www.thune.senate.gov/public/index.cfm/press-releases?ID=2cbe42da-eac8-48c1-a820-44a392b57195">especially upset</a> that health and nutrition experts <a href="http://www.fcrn.org.uk/fcrn-blogs/samuel-lee-gammage/who-will-win-battle-over-sustainability-dietary-guidelines-americans">should consider sustainability</a>. <a href="http://www.futureoffood.ox.ac.uk/blog/us-dietary-guidelines-report-%E2%80%93-whats-fuss-over-sustainability">Others</a>, including <a href="http://www.hsph.harvard.edu/nutritionsource/2015/06/16/the-new-focus-on-sustainability-the-dietary-guidelines-for-americans-and-for-our-planet/">experts in the field</a>, were <a href="http://www.foodpolitics.com/2015/03/my-plate-my-planet-support-sustainability-in-dietary-guidelines/">supportive of its inclusion</a>. </p>
<p>A congressional hearing on the report has been scheduled for October 7.</p>
<h2>People in glass houses</h2>
<p>The recommendations also met with displeasure from those who promote high-fat, low-carbohydrate diets. And this week the BMJ has unfortunately given voice to one such person. US journalist and author of <a href="http://thebigfatsurprise.com/">The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet</a> Nina Teicholz has published an “investigation” into the report and its authors.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/96030/original/image-20150924-17087-1o9rtjz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/96030/original/image-20150924-17087-1o9rtjz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/96030/original/image-20150924-17087-1o9rtjz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/96030/original/image-20150924-17087-1o9rtjz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/96030/original/image-20150924-17087-1o9rtjz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/96030/original/image-20150924-17087-1o9rtjz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/96030/original/image-20150924-17087-1o9rtjz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A new advisory report on US dietary guidelines has upset many in the meat and junk food industries.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/brizzlebornandbred/9375507295/in/photolist-fhtVFv-ff52LL-ff52BN-4z5AkF-6CMYYq-6CMZ9s-7cXRW8-4z5D48-4z5vot-4z5yqD-4z9T2w-4z9TrA-4z5za8-y4gkiG-4z9TJL-a95RFU-4z5BKM-4z5DiH-e1iERv-5kk29W-aj1328-5B1sk7-sMsxA-e1NAEK-4z9RyY-czfSzC-h">Paul Townsend/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In line with the arguments of her book, Teicholz criticises the scientific report for the 2015 guidelines. She claims the advisory committee didn’t conduct thorough reviews of recent evidence and failed to identify their conflicts of interest. </p>
<p>But, after a close look, I could find little evidence of conflict of interest among the committee members. Its members were carefully selected to provide balanced viewpoints on the scientific evidence, and to not represent the viewpoints of any specific group. They conducted public meetings and also invited various other experts to present data. </p>
<p>It’s hard to understand Teicholz’s criticism of such an extensive, systematic and practical report. The methodology <a href="http://health.gov/dietaryguidelines/2015-scientific-report/05-methodology.asp">the panel used</a> was thorough, clearly outlined and followed strict scientific guidelines.</p>
<p>Over a two-year period, the committee examined a vast amount of data in a detailed and scientifically rigorous way. Its answers to science-based research questions were published at the <a href="http://www.nel.gov/">USDA Nutrition Evidence Library</a> (NEL). The committee also used systematic reviews that pay great attention to sources and types of bias, and graded all this evidence according to strict and well-defined criteria. </p>
<p>Perhaps in keeping with her own conflict of interest in promoting the ideas in her book and the listed conflicts in the BMJ piece (honorariums from the restaurant, meat and dairy industries), Teicholz is especially critical of the advice concerning saturated fat. The US diet is high in saturated fat, with much of it coming from vegetable oils hydrogenated for use in commercial frying, pizzas, pastries, cakes and desserts, biscuits, savoury and sweet snack foods. Some of it comes from a high intake of processed and fatty meats, including burgers. And cheese is a major source. </p>
<h2>Saturated fat controversy</h2>
<p>The advisory committee’s report doesn’t ignore the recent controversy over saturated fat and heart disease. In fact, it <a href="http://health.gov/dietaryguidelines/2015-scientific-report/11-chapter-6/d6-2.asp">specifically discusses major studies</a> of randomised controlled trials and prospective cohort studies conducted between 2009 and 2014. The committee placed particular emphasis on reviews that looked at what <em>replaces</em> saturated fat in most diets, a move suggested by authors of recent research reviews that reported a lack of relationship between total intake of saturated fat and heart disease. </p>
<p>The <a href="http://www.cochrane.org/CD011737/VASC_effect-of-cutting-down-on-the-saturated-fat-we-eat-on-our-risk-of-heart-disease">best evidence</a> still points out that when saturated fats are replaced with polyunsaturated fats, cholesterol levels improve and the risk of cardiovascular disease declines. But the key is where these polyunsaturated fats come from; getting them from deep-fried foods or snack foods, for instance, won’t improve heart health.</p>
<p>The claim by some critics that the committee’s report advocates a low-fat or high-carb diet is wrong. Indeed, the report specifically notes that swapping saturated fat for sugar and refined grains is useless. Instead, it recommends foods high in unsaturated fats, echoes the recommendation from the <a href="http://www.who.int/mediacentre/factsheets/fs394/en/">World Health Organization</a> that added sugars be limited to no more than 10% of total daily calories, and recommends big reductions in refined grains.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/96031/original/image-20150924-17062-11jw54q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/96031/original/image-20150924-17062-11jw54q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/96031/original/image-20150924-17062-11jw54q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/96031/original/image-20150924-17062-11jw54q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/96031/original/image-20150924-17062-11jw54q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/96031/original/image-20150924-17062-11jw54q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/96031/original/image-20150924-17062-11jw54q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The US diet is high in saturated fat, with cheese being a major source.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/cogdog/8690615113/">Alan Levine/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Teicholz claims the committee ignored many studies of low-carbohydrate diets. But, as the report notes, most have been small, short-term, often pilot or case-control studies that rely on subjective recall of information (both of which rate poorly as evidence). When you look at <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0100652">published trials</a> of such diets being undertaken for six months, there’s little difference in weight-loss outcomes compared to more balanced approaches.</p>
<p>Teicholz accepts that effects of low-carb diets are not maintained in the long term but defends them with reference to only <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0056190/">one meta-analysis of stricter low-carb diets</a>. It’s an odd choice since the authors include “grey” literature, which is not peer reviewed, and comes from organisations outside of academic publishing channels. Her chosen study also concludes that, in the long term, and when compared with conventional therapy, results of even strict low-carb diets appear to be of little clinical significance. </p>
<p>Had the advisory report made recommendations on this basis, Teicholz would have a valid complaint.</p>
<h2>Eat food, not nutrients</h2>
<p>The <a href="https://theconversation.com/eat-food-not-nutrients-why-healthy-diets-need-a-broad-approach-45823">food sources</a> for fats or carbohydrates matter; talking in broad terms of these macronutrients fails to distinguish between healthy foods and junk foods. The main thrust of the advisory committee’s report is that diets <a href="http://www.ncbi.nlm.nih.gov/pubmed/24572039">should be focused on whole foods</a>, not specific nutrients. And that makes a lot of sense.</p>
<p>Consider this: bacon, lard, olive oil and nuts all contain saturated fat to some extent. Dietary patterns containing plenty of the latter two are linked to health benefits. As for the first two, back slowly away from the bookshop when anyone is trying to sell you on these being the keys to good health and weight loss. The report notes evidence showing benefits for dietary patterns that favour olive oil and nuts.</p>
<p>Teicholz is not the only one to complain about the committee’s report. Nor is this anything new. Dietary guidelines produced in other countries, <a href="https://www.nhmrc.gov.au/guidelines-publications/n55">including Australia</a>, also attract mud-slinging. Sadly, this serves to confuse the public and leads some to abandon advice because “experts are always changing their minds”.</p>
<p>So it’s not surprising that lobbyists for the sugar and meat industries as well as companies marketing junk foods <a href="http://blog.aicr.org/2015/06/25/lobbyists-move-to-weaken-the-dietary-guidelines-help-us-protect-them/">have been vocal</a> about the US report. It’s just a pity that a reputable journal such as the BMJ decided to publish such an article from a journalist rather than an expert scientific appraisal.</p><img src="https://counter.theconversation.com/content/48007/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>National dietary guidelines have become an easy target for those looking for a scapegoat for bad diets in rich countries. And a BMJ article about draft US guidelines adds further fuel for the fire.Rosemary Stanton, Nutritionist & Visiting Fellow, UNSW SydneyTim Crowe, Associate Professor in Nutrition, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/429862015-06-12T19:29:22Z2015-06-12T19:29:22ZBlame sugar? We’ve been doing that for over 100 years<figure><img src="https://images.theconversation.com/files/84751/original/image-20150611-11424-uku1dd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sugar has always been vilified. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-233628199/stock-photo-sugar-bad-face.html?src=oTgXQvsQ0vQ2nZEEmTyyJw-1-0">Sugar cubes via www.shutterstock.com. </a></span></figcaption></figure><p>After a successful soda tax was passed in 2014 in Berkeley, California, copycat laws are being proposed across the US, often with the support of nutritionists, medical professionals and a <a href="http://grist.org/politics/soda-taxes-bubbling-up-all-over/">majority of the voting public</a>. In 2015, the Illinois chapter of the American Academy of Pediatrics <a href="http://illinoisaap.org/2015/05/140-physicians-from-state%E2%80%99s-leading-pediatric-health-organization-endorse-the-healthy-eating-and-active-living-heal-act/">endorsed</a> an act that would use a tax on sugary drinks.</p>
<p>Research has implicated sugar (meaning both table sugar and high fructose corn syrup) in the rising obesity rate and in health conditions like Type 2 Diabetes. Some researchers, including Robert Lustig, a pediatric endocrinologist from the University of California San Francisco, have described sugar as toxic. While we know that Americans are consuming a lot more sugar <a href="http://www.usda.gov/factbook/chapter2.pdf">now</a> than they have in the past, we don’t know at what amount it goes from being a sweet treat to something dangerous. Nor do we know how much of that danger is due to sugar’s unique effects, as opposed to its being a contributor to excessive caloric intake.</p>
<p>Lustig’s criticisms, detailed in his bestseller <a href="http://www.amazon.com/Fat-Chance-Beating-Against-Processed/dp/0142180432/ref=pd_sim_14_4?ie=UTF8&refRID=0HNNY94WYSEA8CE4N8H9">Fat Chance</a> and the documentary <a href="https://www.sciencebasedmedicine.org/does-the-movie-fed-up-make-sense/">Fed Up</a>, can verge on apocalyptic. Sugar is “evil,” “toxic” and “poisonous.” His preferred analogies are tobacco, alcohol, cocaine, heroin and morphine. Soda is “a fructose delivery vehicle, similar to cigarettes.” <a href="http://www.nytimes.com/2011/04/17/magazine/mag-17Sugar-t.html">Journalists</a>, <a href="http://ww2.kqed.org/news/2014/09/12/berkeley-is-talking-about-sugar-and-the-conversation-isnt-sweet/">policymakers</a> and food activists have become devoted followers, and they support his call to regulate sugar “like alcohol and tobacco.”</p>
<p>But this furor over sugar isn’t anything new. Crusaders have been warning about the evil effects of sugar for hundreds of years, with no positive effect on our health. And isn’t that the goal of this kind of rhetoric? Without attending to this history of bias and failed rhetoric, we may be doomed to continue repeating it. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/84753/original/image-20150611-11424-a0kxib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84753/original/image-20150611-11424-a0kxib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84753/original/image-20150611-11424-a0kxib.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84753/original/image-20150611-11424-a0kxib.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84753/original/image-20150611-11424-a0kxib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84753/original/image-20150611-11424-a0kxib.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84753/original/image-20150611-11424-a0kxib.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Toxic?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-107192183/stock-photo-white-organic-cane-sugar-against-a-background.html?src=lvCA9qa_6hY8qdjOkIzhbA-1-61">Sugar and spoon via www.shutterstock.com.</a></span>
</figcaption>
</figure>
<h2>Casting a dietary villain – sugar takes center stage</h2>
<p>Social history – too often ignored by science – reveals a consistent pattern of irrational beliefs about sugar. In 1974, pediatrician William Crook wrote a letter to a medical journal in which he named cane sugar “<a href="http://pediatrics.aappublications.org/content/54/5/656.1.full.pdf+html">a leading cause of hyperactivity</a>” (what we now call ADHD). This truism has been so persistent that it was immortalized on an Old Navy “<a href="https://www.pinterest.com/pin/426012445975482229/">Let’s Blame the Sugar</a>” T-shirt for babies. <a href="http://www.sciencedirect.com/science/article/pii/0272735886900346">Researchers debated</a> <a href="http://pediatrics.aappublications.org/content/54/5/656.1.short">Crook’s claim</a> for decades. The scientific consensus now? According to the National Institute of Mental Health, “<a href="https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-adhd-the-basics-qf-16-3572/index.shtml">more research discounts this idea than supports it</a>.” They cite one study as a possible explanation for the myth’s persistence, in which “mothers who thought their children had gotten sugar rated them as more hyperactive […] compared to mothers who thought their children received aspartame.” It was belief about sugar’s ill effects that biased the mothers’ perception.</p>
<p>Going back further in time, the demonization of sugar gets increasingly absurd. In 1968, holistic lifestyle crusader Jerome Irving Rodale – founder of health and wellness behemoth Rodale Inc – wrote <a href="http://www.amazon.com/Natural-Health-Sugar-Criminal-Mind/dp/B000E1RPBC">Natural Health, Sugar, and the Criminal Mind</a>, the thesis of which is evident from the title. Murder; domestic violence; the rise of Nazi Germany: blame sugar! </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/84906/original/image-20150612-1471-1xub9yg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/84906/original/image-20150612-1471-1xub9yg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/84906/original/image-20150612-1471-1xub9yg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=922&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84906/original/image-20150612-1471-1xub9yg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=922&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84906/original/image-20150612-1471-1xub9yg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=922&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84906/original/image-20150612-1471-1xub9yg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1159&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84906/original/image-20150612-1471-1xub9yg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1159&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84906/original/image-20150612-1471-1xub9yg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1159&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Death serves soda.</span>
<span class="attribution"><a class="source" href="https://books.google.com/books?id=FLTZRAL1WooC&pg=PT63&lpg=PT63&dq=death+serves+a+soda+wendy+woloson&source=bl&ots=cR6ofy3M9u&sig=1cBGRPyaGAUG98nVIxKohWcFepY&hl=en&sa=X&ved=0CB4Q6AEwAGoVChMI5IWd89iKxgIVRJINCh3ZOwBT#v=onepage&q=death%20serves%20a%20soda%20wendy%20woloson&f=false">Wendy Woloson via Library of Congress</a></span>
</figcaption>
</figure>
<p>The scapegoating of sugar dates to at least to the 18th century, when people lived in mortal fear of sexuality. British author Jonas Hanway blamed sugar for creating “fantastic desires and bad habits in which nature has no part” – and it’s not hard to guess what he meant. Children, he warned, were particularly susceptible to sugar’s detrimental effects, which also included “scurvy [and] weak nerves.” </p>
<p>Romanticizing “unprocessed” sweeteners also has historical antecedents. In 1852, physician James Redfield claimed that each stage of sugar processing was a “stage in the down-hill course of deception and mockery, of cowardice, cruelty, and degradation.” Animals that lived on honey were courageous and careful, “as, for example, the bee, the humming-bird, and the bear,” while those that preferred sugar were deficient in virtue, “as, for example, the housefly [and] the ant that lives in the sugar-bowl.”</p>
<p>Nor is it new to demonize sugar by associating it with drugs and alcohol. In the 19th century, temperance advocates spoke of sugar as a gateway drug, and a taste for sweets was thought to foreshadow deadlier habits. That’s what happened to Henry Haycroft, the fictional protagonist of an <a href="https://books.google.com/books?id=FLTZRAL1WooC&printsec=frontcover&dq=woloson+sugar&hl=en&sa=X&ved=0CB4Q6AEwAGoVChMI0YuT08OIxgIVyBysCh3iIgCK#v=onepage&q=toddy&f=false">1843 temperance tale</a>, who eats “the sugar out of the bottom of his father’s toddy-glass,” before graduating to real drinks of sweet peppermint cordial. Redfield himself warned that “the use of sugar is the stepping-stone to intemperance.” </p>
<p>It’s hard not to be a little skeptical when you know your history. I’ve had a number of people ask me about a recent article called “<a href="https://www.yahoo.com/health/3-ways-sugar-kills-your-libido-118212496472.html">Three Ways Sugar Kills Your Libido</a>.” In response, I point them to nutritionist John Harvey Kellogg (yes, <em>that</em> Kellogg), who in 1881 argued that “candie … excite the genital organs.” Sugar stimulated animal appetites, went the scientific logic of the day, so it led to hypersexuality. It seems we’ve come full circle when it comes to sugar and libido.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/84757/original/image-20150611-11437-1xodd8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84757/original/image-20150611-11437-1xodd8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=433&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84757/original/image-20150611-11437-1xodd8z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=433&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84757/original/image-20150611-11437-1xodd8z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=433&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84757/original/image-20150611-11437-1xodd8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=544&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84757/original/image-20150611-11437-1xodd8z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=544&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84757/original/image-20150611-11437-1xodd8z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=544&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Demonizing sugar may not help people eat better.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-160886558/stock-photo-sugar-background-sweet-food-ingredient-with-a-close-up-of-a-pile-of-delicious-white-lumps-of-cubes.html?src=NXXwtuchaMBqAI3slH7n6g-1-94">Sugar cubes via www.shutterstock.com.</a></span>
</figcaption>
</figure>
<h2>We need to talk about sugar, but not like this</h2>
<p>Anti-sugar advocates like Lustig have adopted a fire-and-brimstone approach: Demonize a macronutrient. Tell people they should consider removing sugar and sugary foods from their pantries, that it is toxic, that we need to regulate it like cigarettes, alcohol, and other drugs of abuse. Remember his analogies to cocaine and heroin. </p>
<p>But before we ransack our kitchens to rid them of ketchup and jam, it’s worth pausing to heed a warning from Stanford epidemiologist John PA Ioannidis. In his seminal 2007 article, <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124">Why Most Published Research Findings Are False</a>, Ioannidis helps explain the endless flipflopping on nutritional guidelines. “For many current scientific fields,” he writes, “claimed research findings may often be simply accurate measures of the prevailing bias.”</p>
<p>Real science, as Ioannidis reminds us, is slow and humble. Only time will tell if the current level of sugar alarmism is warranted, or if many years from now the comparison of sugar to cocaine will look a bit ridiculous. Should that be the case, governments and policymakers will be in the unenviable position of backtracking on yet another dietary guideline, further undermining the public’s trust in science as an enterprise. The research on sugar might be right – but our history of bias shows that we have a tendency to jump the gun on sugar due to moral furor. </p>
<p>That doesn’t mean that excessive sugar consumption is safe, nor that we should accept sugar’s role in our national diet. Caloric excess is often due to sugary treats, and companies market sugary foods rapaciously to children. So how do we address these problems?</p>
<p>Telling people “don’t eat that” doesn’t seem to have had a huge effect in the past. When Americans were told to fear fat, fat consumption dropped only slightly, while consumption of carbohydrates increased. Between <a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm">1971 and 2000</a>, average daily calories from fat decreased by a mere 46 calories, while carbohydrate consumption increased by 240 calories. At the other extreme, some took the recommendation to limit fat and turned it into a prohibition, just as paranoia about fructose is now fueling a <a href="https://www.bulletproofexec.com/start-the-bulletproof-diet/">taboo on eating fruit</a>.</p>
<p>Perhaps extremism, not sugar, is the real enemy. If that’s the case, the best approach to fixing our culinary culture doesn’t involve demonization or government regulation, strategies that promote dichotomous thinking – clean or unclean, toxic or safe – which <a href="https://books.google.com/books?id=UMfH764f3dAC&pg=PA24&lpg=PA24&dq=binge-eating+forbidden+foods&source=bl&ots=xl95TvbYZT&sig=qxLx6kMnC3MPOehPsnLi6sOzugw&hl=en&sa=X&ved=0CF0Q6AEwB2oVChMI4LGpj7yIxgIVhwmsCh3iHgAJ#v=onepage&q=binge-eating%20forbidden%20foods&f=false">experts warn may contribute to eating disorders</a> like binge-eating and orthorexia, while having marginal positive effects on overall public health. </p>
<p>There are other strategies available. We could recognize that a <a href="http://www.sciencedirect.com/science/article/pii/S0195666399902441">healthy attitude toward food</a> needn’t involve worrying about which foods are healthy. We could focus on making convenience food fresher, more diverse, and more affordable, because not everyone has a local farmers’ market, or money to shop there, or time to cook, or a backyard garden in which to grow heirloom vegetables. </p>
<p>We could also strive to make home cooking more feasible by funding community cooking classes and reintroducing home economics. Culinary students – children and adults alike – could learn to prepare and appreciate delicious meals without feeling coerced, guilty or frightened. And they would do so in kitchens equipped, as all good kitchens are, with sugar.</p><img src="https://counter.theconversation.com/content/42986/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alan Levinovitz does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Crusaders have been warning about the evil effects of sugar for hundreds of years,
with no positive effect on our health.Alan Levinovitz, Assistant Professor of Religion, James Madison University Licensed as Creative Commons – attribution, no derivatives.