Obesity rates would be reduced across the UK population and the NHS would save money under Public Health England’s sugar-reduction programme – but only if both industry and consumers play ball, new research from Oxford University has found.
PHE has proposed that the sugar content of certain products be slashed by 20% by 2020 through reformulation, reducing product size and moving sales promotions from high-sugar products to lower-sugar alternatives.
Oxford’s study examined how the strategy could cut obesity and its related diseases, along with healthcare costs in England.
Estimates found the programme could mean 5.5% fewer obese 4-10-year-olds and 2.2% fewer obese 11-18-year-olds, while also affecting the adult population, as they consume many of the same foods as children.
In fact, obesity in 19-80-year-olds could drop by 5.5%, according to Oxford University, not to mention wider impacts on chronic diseases such as type-2 diabetes, with 155,000 fewer cases over 10 years – more than the influence of the soft drinks levy, which was estimated to reduce incidences in 20,000 people.
Around 6,000 cases of cirrhosis and colorectal cancer could also be prevented
The results, which were published in the British Medical Journal, also showed the NHS would save £286m over the next 10 years with the strategy.
Which sugar strategy works best?
- Reformulation could account for a 40% calorie reduction in 4 to 10-year-olds (9.8 kcal/day), 34% in 11 to 18-year-olds (8.6 kcal/day) and 37% in 19 to 80-year-olds (7 kcal/day).
- For portion reduction, figures were 43% (10.6 kcal/day), 51% (12.9 kcal/day) and 46% (8.6 kcal/day) for the respective groups.
- In terms of sales weighting, the projected results were 17% (4.2 kcal/day), 16% (4.0 kcal/day), and 17% (3.2 kcal/day) for the respective groups.
Is legislation needed?
However, the researchers warned that the success of the strategy hinged on manufacturers’ behaviour.
“Early evidence indicates that industry has not met the ambitious target of achieving a quarter of the total reduction in the first year of the programme,” it noted. “Industry might also adjust portion sizes to contribute to their targets, for example, by rebranding products to a ‘sharing’ size. The reformulation approach might also fail if industry replaces sugar calories with other calories or if reformulated products are commercially unsuccessful.”
Ben Amies-Cull, who led the research group at Oxford, acknowledged that manufacturers need to develop a commercially successfully product when reformulating, but there were risks sugar could be replaced with saturated fats or salt, which have their own negative health outcomes.
As long as companies are still trying, there is hope the PHE initiative could be successful overall, he added – though Amies-Cull also flagged the possibility that the government could introduce legislation to ensure compliance in what is at present a voluntary scheme.
“Industry may be looking to avoid hard legislation, and they are going to need to meet these obligations strictly in the sugar reduction to avoid that,” he told Food Spark’s sister site Food Navigator. “Public pressure is falling down against sugar and I think the government could have a lot of public support to legislate if this approach isn’t successful.”
Consumer response was also difficult to predict, wrote the authors of the study, as people could simply eat more if the portion size is reduced or replace sugar calories with other calories if they weren’t happy with a reformulation.
Amies-Cull revealed there was also uncertainty over the way humans absorb sugar. “It is thought when you take calories out of a product in the form of sugar, bodies may not detect that change in calorie intake,” he said. “But we don’t know that for sure.
“So if you eat a piece of cake that contains 100 calories, but 20% of those calories come from sugar, your body may only detect the 80% that weren’t sugar. That is not completely confirmed in the research and there is a lot of debate about it. But it is something we need to bear in mind when monitoring the impacts of the strategy.”
But Amies-Culll was adamant that the study’s findings showed that the food system has a hugely important role to play in determining the population’s wellbeing, which can’t otherwise be addressed from the traditional approaches of the health system.
Estimates suggest that achieving the programme’s sugar-reduction targets will result in the average energy consumption falling in:
4 to 10-year-olds – 23.5 kcal/day for girls and 25.7 kcal/day for boys. The proportion of this age group classified as overweight would also drop from 26% to 22.5% for girls and from 18.9% to 16.6% for boys.
11 to 18-year-olds – 22.4 kcal/day for girls and 28.2 kcal/day for boys. The proportion of overweight girls would fall from 19.2% to 18.6%; the proportion of overweight boys would remain unchanged at 13.6%.
19 to 80-year-olds – 17 kcal/day for women and 20.7 kcal/day for men, equivalent to 5% for both. This would result in an average weight loss of 1.7kg for women in the overweight range, while men would lose around 1.5kg.