In Population Health

Follow this topic

Bookmark

Record learning outcomes

Mary Poppins may have advocated sugar as an aid to taking medicine but health campaigners are adamant that we all need to cut back

THERE HAS BEEN more than a sprinkling of sugar-related health coverage in the media of late, with sugar being labelled by some as the ‘new tobacco’ and a modern-day ‘poison’. So what is the evidence that too much sugar is bad for our health?

Free fall

The latest flurry of excitement about sugar came with the arrival of a draft report from the Scientific Advisory Committee on Nutrition (SACN), the committee of independent experts that advises Government on matters relating to diet, nutrition and health.

The report, ‘Carbohydrates and Health’, released at the end of June, recommended that the consumption of ‘free sugars’ be lowered to around 5 per cent of daily dietary energy intake (the previous recommendation being no more than 10 per cent).

The report also advised an increase in daily total fibre intake and that consumption of sugar-sweetened beverages, such as fizzy pop and squash, be minimised by children and adults. (The term ‘free sugars’ refers to sugar added to foods by the manufacturer, cook or consumer and sugar naturally present in syrups and unsweetened fruit juices.)

Speaking on the day of the release of the draft report, Dr Alison Tedstone, chief nutritionist at Public Health England (PHE), said: “Eating too much sugar is harming our health. Excess sugar and calorie intake leads to being overweight and obese and consequently having a higher risk of developing type 2 diabetes, heart disease and breast and colon cancer.”

The SACN report is a “comprehensive” and “authoritative” review of the evidence, believes Susan Jebb, professor of diet and population health at the University of Oxford.

“It shows that higher sugar intakes are an increased risk for dental caries and weight gain. Independent of the effects on body weight, evidence also shows that sugar may have small but measurable adverse effects on some aspects of blood lipids and blood pressure, each of which are important risk factors for cardio-metabolic disease.”

Evidence

So what is the evidence linking too much sugar with obesity and ill health? “The SACN report rated the evidence as strong enough to suggest that public health advice on sugar is changed,” points out Gaynor Bussell, a dietitian and British Dietetic Association spokesperson.

The problem is that the calories we get from sugar do not make us feel full, she explains. “This means that if we were to consume a food which had no added sugar, we would feel just as full as if we had consumed the same food with added sugar, yet we would have consumed fewer calories. Soft drinks are a particular culprit as we consume these and yet can eat just as many calories with them or after them as if we had only drunk water.”

Professor Jebb says that meta analysis of data from cohort studies shows an association between sugar-sweetened beverages and weight gain. As these drinks add calories “but no essential micronutrients to the diet”, they are “an obvious place to reduce energy intake without compromising the nutritional quality of the diet,” she says.

Getting the UK population to reduce its sugar intake may be easier said than done, however. As things stand, many people – particularly children and teenagers – are not even meeting the current guidelines of no more than 10 per cent. There is much that needs to be done. “In order to help us achieve this target, many of our foods – and especially drinks - will need to be reformulated,” says Gaynor Bussell.

PHE released a paper on the same day the SACN draft report appeared. ‘Sugar Reduction: Responding to the Challenge’, called on consumers, retailers, charities, businesses and nongovernmental organisations to work together to reduce the nation’s sugar intake.

The Food and Drink Federation says that its members have committed to reducing calories in their products under the Department of Health’s Responsibility Deal – and in some cases this has included a reduction in sugar as part of the wider calorie reduction plan.

Action on Sugar, a group of specialists concerned with sugar and its effects on health has calculated that a 30-40 per cent reduction in free sugars by the food industry is easily achievable over the next three to five years. “Done slowly, people will not notice the difference in taste,” says Kawther Hashem, a nutritionist for Action on Sugar.

Many of our foods – and especially drinks – will need to be reformulated

Huge challenge

 

If the 5 per cent target was met, what impact would this have on obesity levels in the UK? “Evidence suggests that health risks start to notably increase when energy intake from sugars exceeds 10 per cent,” says Professor Jebb. However achieving the 5 per cent goal represents a “huge challenge”, she adds.

“The impact on obesity will depend on whether the calories consumed as sugar are replaced in the diet by other sources of calories. Any decrease will contribute to reducing obesity, but reducing sugar alone is unlikely to be the whole solution. We need to look at broader dietary habits and reduce intake of other energy dense foods to maximise progress in tackling obesity.”

And obesity is something that has to be tackled, says Tam Fry, chair of the Child Growth Foundation and spokesperson for the National Obesity Forum. “The Government quotes figures to suggest that obesity levels in children are going down. However in some areas of the country obesity levels are escalating. There aren’t so many obese children in the UK as there were three or four years ago, but those who are obese are getting fatter.

“If the 5 per cent target is met, it would remove trillions of calories from the food that we eat in the UK and that is what has tobe done if we are to address the issue of obesity.”