20/04/16 – The tax on sugary drinks (and what else we might expect from the National Obesity Strategy)

Speakers: Tim Rycroft, Food and Drink Federation; Prof. Philip James, London School of Hygiene and Tropical Medicine; Prof. Simon Capewell, University of Liverpool

20th April 2016 – meeting notes

All-Party Parliamentary Group on a Fit and Healthy Childhood

The tax on sugary drinks (and what else we might expect from the National Obesity Strategy)

Baroness Benjamin welcomed the group and introduced the speakers.

Tim Rycroft, Director of Corporate Affairs, Food and Drink Federation

Childhood obesity is a real and serious public policy challenge. The work that this group had done has been very serious and important in looking at that challenge.

We represent all aspects of the food and drink industry across the country, from big multi-nationals to small companies. The industry is diverse and entrepreneurial, we should be proud of the diversity in our industry and its achievements. I think that it is important to put that on record, and to also take on our responsibilities.

We hope that, once published, the childhood obesity framework will be a holistic framework. It is disappointing that we have had to wait for so long for it.  We need the power of government to catalyse the changes that are needed.

Focusing on the role of one nutrient in the diet has the potential to create issues. It is disappointing that the sugar levy does focus on this one nutrient. In its work, the Health Select Committee has stated that sugar is not the only cause of obesity.

SACN, also a good report, reminds us that the role of fibre is forgotten, there is a worry that consumers might focus on this one area, sugar.

We feel that it is a shame that the government has focused on an area that has already done so much to make improvements.

Prof. Philip James, Hon. Professor of Nutrition, London School of Hygiene and Tropical Medicine

This new epidemic began in about 1980, globally the developing world is about 10 years behind, it has now become such a serious problem it is now recognised as a major public health problem.

The proportion of people who are obese in England is worse in poorer sections of society. There is an even gradient from the poorest to the richest children. Fat children, from fat families are often genetically sensitive. The children of fat people need to take more care about their eating than average. Before getting to school a quarter of the poorest children are already overweight.  This is a massive problem that needs to be dealt with in a coherent way.

We know from data from Denmark that even if you are just plump at age seven (it gets worse if you remain plump at the age of 13) that predicts that those children will die from heart disease.

Dental health problems come about because of sugar and very refined carbohydrates. The evidence is that there is no difference made by physical activity. This is such a problem emergency admission to hospitals with dental abscesses (needing anaesthesia for treatment) is now a big problem.

We need to get kids to run around. Research has shown that the real physical activity (particularly for girls) does not start until the age of 9. For girls, it is downhill from there. Children spend a lot of money on soft drinks and confectionary on route to and from school, about £130 million a year. Interventions involving the schools, educating the adults, all these things are not working that well. It is about the food that children eat.

When consuming, it looks like the calories in drink form don’t trigger the brain response of fullness; the responses that tell you have taken in calories. Soft drink calories get round the brain’s regulatory system. This is something we previously missed on World Health Organisation studies. Carbohydrates are a bit better, proteins are best. Kids have the normal biological shut down when they eat too much, but not when they take the calories from soft drinks.

We have a fundamental problem; it needs to be dealt with before children get to school. We have to understand that we need to intervene sooner. Studies have shown that if girls are overweight or obese when pregnant, there is a greater chance of fat babies and a greater chance of them becoming fat kids. The fear is that Britain is facing a generational biological cycle of worse and worse obesity. We cannot wait another 20 years.

Prof. Simon Capewell, Vice President for Policy, UK Faculty of Public Health, Prof. of Clinical Epidemiology, Univ. of Liverpool

Obesity is a major challenge, particularly in deprived neighbourhoods. Sugar is the principle cause, a major threat to public health, and is the new tobacco. Some parts of the industry are fighting back, using the denial-ism tactics that was favoured by the tobacco industry in previous years.

The science is clear, SACN/PHE call for a reduction (by two thirds) in sugar consumption to 6 (for an adult) and 3 (for a child) teaspoons a day. That sugar is mostly hidden in junk food and sugary drinks. We have a comprehensive obesity strategy (supported by the Health Select Committee) being developed as we speak in the Department of Health and Cabinet Office. We know that it should contain the 12 recommendations from the Health Select Committee:

Reformulation

  • Restrictions on advertising to children
  • 20% tax on full sugar soft drinks
  • Portion sizes and caps
  • Price promotions
  • Placement of food and drink within retail environment
  • Labelling
  • Nutrition standards in all schools
  • Support local authorities and wider public sector
  • Early interventions
  • Calorie reduction (not just sugar)
  • Physical Activity

Reformulation should be mandated and an even playing field created. There is no marketing on billboards to encourage children to smoke so why are they being encouraged to drink sugary drinks? Other recommendations are also evidence based; we need regulation and taxation, the voluntary approaches, like the Responsibility Deal, do not work and blaming individuals, advising people to eat less and move more does not work either.

What does work is a sugary drinks tax; it has worked in Latvia, Hungary, Sweden and Mexico. In Mexico within a year sugary drink consumption had gone down by 10%. It is effective and particularly so in the most disadvantaged households. So that is a solution, it has government and major public support (surveys have shown that more than 70% of adults in the UK supported a sugary drinks tax). It is not sufficient but it is a symbolic first test, we know that some companies are already reformulating products. The main message this is carrying is that sugar is a problem. The government must be encouraged to produce a good framework to continue this work. Some companies are already moving with the tide, Tesco, Robinsons, AG Barr are already reformulating, whilst some companies are fighting back with anti sugar tax myths.

The main message is that sugar is a problem, a danger to children’s health. The government must create a comprehensive solution. Denial tactics wont’ work and we must commend the clever companies that are already working on reformulation.

Gavin Partington, British Soft Drinks Association made a contributions from the floor

Not indulging in denial-ism, the industry has been reformulating products.

The evidence of what has been done is that the drinks sector is the only one that has been removing sugar from products. In 2015 we set a target to reach across the market. There are voluntary agreements coming to not advertise to children under 16.

We need to look at the entire diet, physical exercise and the built environment of children. Look at the evidence in relation to the sugar tax; in France there was an initial reduction in sales, those are now back to normal, the same in Mexico.

Yes, let’s look at the full diet.

Questions and comments

Does the evidence from France and Mexico show a reduction in sugar consumption correlated in BMI reductions?

In France the tax added 7 cents per litre to drinks; we do not have comprehensive data analysis on body weight change.

Baroness Benjamin: Do we have any information on China? Has any nation solved this problem so far?

Prof. Philip James: There is a Chinese childhood obesity group (of 14 organisations). In the last 10 years soft drink consumption has gone up and they continue to experience obesity escalation in China. China is losing 2%-4% of its GDP from the impact of heart disease and diabetes and so on. That is going to escalate and become a major economic challenge. There is not a country in the world that will be able to withstand the impact of childhood obesity. In the Middle East a fifth of adults are obese (with 40% of women obese), we are seeing there what will happen unless we take control. No nation has solved this problem. The Finns did well in bringing down heart disease rates by cutting down saturated fats, but they thought that sugar should not be a focus, so sugar intake rates went up and obesity and diabetes rates have gone up. Their interventions, in adults, has shown some improvements. People are looking to the UK to be clear-cut in our approach.

The Asian community in Britain are much more sensitive to diabetes, they need to take a much more careful approach.

Are obesity rates in Cuba different?

Prof. Philip James: Cuba is the only country that had a drop in obesity, which is associated with the end of perestroika, semi-starvation and the collapse of the provision of foods.

What are the food and drink industry doing to lead the agenda, are companies taking more proactive routes to address the problems?

One of the frustrations for the industry is that we have been reformulating for about 15 years, starting with salt (which people consider to have been a success). The attention has now moved on to sugar. The industry may not have led, but has been a follower. Sugar reduction (and low sugar soft drinks across the market) is the result of industry listening to the consumer. It is disappointing that we have had poor engagement with the government over the child obesity strategy. We have tried to talk to government about what the industry can do to push this agenda forward, again had a very poor response. The industry is trying to do the right thing but having difficulty getting the government to work with us.

Prof. Philip James: I have talked to many of the major international companies who say that the reductions and reformulations are voluntary (not all competitors carry through their changes), they ask for governments to set standards and benchmarks in public health, with two to three years to adapt to changes.

Prof. Simon Capewell: the success of salt reduction in the UK was quasi voluntary, having been mandated by successive Ministers of Health, it was overseen by the Food Standards Agency, industry did negotiate and make reductions. Since the targets have been relaxed in the last five years the reductions have been minimal. We probably have 6,000 avoidable deaths simply because the targets have been reduced. It was less voluntary than done under the threat that regulation would be just around the corner.

Baroness Benjamin: What would the cost be to the industry if this tax was brought in? Would it be wiser to have a sugar tax across the board in all foods?

Tim Rycroft: At this stage it is impossible to say, it depends on the level of reformulation. The industry has already started a process of reformulation of soft drinks. It is very hard to see how the levy will produce the types of sums talked about in the budget.

Prof. Philip James: In France in the first year (their very modest tax) it brought in 185 million Euros.

I have always been of the view that sugar should be a commodity tax, but you remember that I said soft drinks are a funny feature in appetite control. So a restriction on the fluid intake area is particularly beneficial. Under the new regime in 2017 the European regulations in relation to the sugar prices will be defunct. It is well realised that the commodity price of sugar will decrease, therefore there will be an enormous inducement to the commodity traders to sell to the food producers.

Prof. Simon Capewell: The tax might raise a billion pounds a year. The treasury thinks that obesity is costing the UK Economy around £27 billion. I think that is a fair trade off.

What would companies be replacing sugars with in soft drinks? Artificial sweeteners may not be suitable for a fit and healthy childhood either.

Tim Rycroft: Public Health England has recognised that the use of artificial sweeteners are providing a route for a reduction in sugar and calorie intake. The soft drinks category has the scope to use sweeteners as a way to reduce sugar in drinks, you can take 30% of the sugar out of a drink and replace some of it with sweeteners, this is an easier way to get consumers to decrease their sugar intake than just moving from soft drinks to water.

Prof. Simon Capewell: If we still keep the sweeteners we still retain the sweet tooth. We need to bring down the sweetness in our diets.

Prof. Philip James: There is a lot of interest in sweeteners, with expert groups set up. There is evidence that the sweet tooth adapts physiologically; you drop the sugar intake and you get used to it. As for the effect of sugar on the brain; there is a dependency process that does develop (in the brain) which gets worse the more obese you get.

Are there any innovative solutions as to what to do with the money from the tax, will giving the money to school sports just give more resources to children who are already sporty? Can we have a debate on how the money might be better spent, perhaps educating families around healthy choices and empowering communities?

Baroness Benjamin: I have asked those questions in the House of Lords on a regular basis (as you will see in Hansard) I am putting pressure on Lord Prior to find out where the money will be spent. We need better ways of letting the public know what the government are doing.

It is worth noting that there is a diet project with cooperation between restaurants and the Children’s Health Fund which has just finished its first round of funding community projects.

Do you have a view on the Chancellor’s decision to exempt some drinks on the basis of their health benefits?

Prof. Philip James: There is no reason why sugar in milky drinks will not have a damaging effect (unless they are high fat content) fruit juices are now classified by SACN and WHO as containing free sugars, it is not appropriate to pour fruit juice into children. We really need to take down the free sugar intake, especially from drinks.

We have heard conflicting definitions on intake of sugar in the UK, what are your thoughts on the panel?

Prof. Simon Capewell: The science is very clear, our sugar energy intake at the moment is 14% or 15% a day, particularly in children. The advice on intake from WHO is less than 3% and from SACN is less than 5%. On average adults take about 20 teaspoons a day, we need to get that down to 6 teaspoons in all forms, junk food and soft drinks. We still have a long way to go, congratulations to the companies who are already ahead and reformulating.

What did you think of the school food nutrient standards that were abolished, also, what do you think about France?

Prof. Philip James: France banned all vending machines from schools, ruled that no soft drinks should be available in schools and that water should be provided. In theory the Finns have had that policy for two or three decades. It is really quite remarkable. You are not allowed to bring any food to school, it’s a public health wellbeing and nurturing policy

In France and Mexico – what has the effect been on dental caries?

Prof. Philip James: There is no evidence on that just yet. To expect dental caries to drop you will have to get consumption to drop.

Baroness Benjamin closed the meeting at this point.