Sugar Reduction: The evidence for action PHE s response to the SACN recommendations on sugar

Transcription

1 Sugar Reduction: The evidence for action PHE s response to the SACN recommendations on sugar Dr Alison Tedstone, National Lead for Diet & Obesity and Chief Nutritionist December 2015

2 Key findings: Scientific Advisory Committee on Nutrition s Carbohydrate and Health report (July 2015) Sugar consumption increases the risk of consuming too many calories Sugar consumption is associated with increased risk of tooth decay Sugar sweetened beverages associated with increased risk of type 2 diabetes and linked to higher BMI in children Recommendations: A definition for free sugars should be adopted in the UK* The Dietary Reference Value for free sugars should not exceed 5% of total dietary energy for age groups from 2 years upwards Consumption of sugar-sweetened beverages, by children and adults, should be minimised -carbohydrates-and-health-report *Sugars added to food and those naturally present in honey, syrups and fruit juice 2

3 Meta-analysis of RCTs looking at higher versus lower sugar consumption on energy intake Between treatments Trial Weighted change in sugars name difference in means (95% CI) intake (% energy) Drummond & Kirk, (-0.82, 1.90) 2.5 Drummond et al., (-1.46, 1.04) 2.9 Reid et al., (-0.63, 1.69) 9.5 Saris et al., (0.40, 1.80) 10.7 Aeberli et al., (-0.33, 2.47) 11 Reid et al., (0.05, 2.14) 12.9 Byrnes et al., (-0.32, 2.08) 13.3 Poppitt et al., (-0.49, 3.43) 13.6 Njike et al., (-0.13, 1.90) 18.3 Raben et al., (0.53, 3.58) 19 Reid et al., (0.68, 1.95) 20.1 Overall (I-squared = 0.0%, p = 0.638) 1.01 (0.70, 1.32) Favours higher sugar diet Favours lower sugar diet Difference in energy intake between groups (MJ/day) 3

4 4 Sugar intakes compared to the new SACN recommendation

5 Children aged 4 to 18 years Main contributors to sugar intakes in the UK Adults aged 19 to 64 years *other includes savoury sauces, baked beans, soups, powdered beverages and other minor sources 5

6 Cost savings of achieving the reduction to 5% of energy from sugar Assuming the SACN recommendations to reduce sugar intakes to 5% of energy intake are achieved within 10 years, the cost saving to the NHS is estimated to be about 500M per annum by year 10 (due to reductions in the costs associated with dental caries and consequences of obesity). 6

7 Sugar Reduction: The evidence for action (October 2015) PHE has carried out an extensive programme of work over the past 12 months in order to provide a package of evidence to inform the government s thinking on sugar in the diet Considers the need for action and draws conclusions about what drives our consumption. Advises on actions that could be implemented in these areas: Influencers: marketing and advertising, price promotions and fiscal measures Food supply: sugar content of food and drinks Knowledge, education, training & local action 7

8 Impact of promotions on purchasing Kantar Worldpanel purchasing data from last two years (from a continuously reporting panel of 30,000 British shoppers) was used to assess impact of promotions of high sugar foods on purchasing. Promotions in Britain are highest in Europe, account for 40% of food and drink take home expenditure. Promotions lead to expansion of all food and drinks categories, not just switching from one brand to another Promotions encourage people to buy and spend more overall - 22% more purchased as a result of promotions High sugar items are promoted more frequently and at a greater discount than non-high sugar items, but this does not seem to lead consumers to buy more than other categories Around 6% of the volume of sugar within high sugar products is additional as a consequence of promotions, and could, in theory, be prevented if promotions in higher sugar markets did not occur 8

9 Impact of marketing and advertising Review of current literature and interviews with key informants on the impact of marketing targeted at high sugar food and non-alcoholic drinks. Much of the evidence focuses on children. Primary research shows children are exposed to a high volume of marketing and advertising which, in all its forms, consistently influences food preference, choice and purchasing. This includes: advertising (TV, print) advergames price discounting end of aisle displays cartoon/spokes characters branding product size Evidence is relatively consistent, but of moderate quality. More research is required for sponsorship, digital and online marketing (except advergaming) 9

10 Work relevant to the food supply Lessons learnt from salt Suggests a similar structured and universal programme of reformulation would significantly reduce sugar intakes, particularly if accompanied by reductions in portion size. Reformulation modelling Suggests that a 50% reduction in the average sugar content of key food groups would reduce mean sugar intake to about 9% of energy for adults (from 12%) and about 10% for teenagers and children (from around 15% for both groups) Public sector food provision PHE catering guidance to help people meet government buying standards for food and catering services (GBSF) and those who wish to go further. Example menus suggest that the SACN sugar and fibre recommendations are achievable. Literature review of sweetness Suggests there is limited evidence as to whether approaches to sugar reduction should be focused on removing sugar with or without replacement with an artificial or intense sweetener Fat/sugar see saw Suggests that reducing the sugar content of foods would not necessarily result in an increased fat content. 10

11 Sugar reduction: areas for action 1) Reduce and rebalance the number and type of price promotions in all retail outlets 2) Significantly reduce opportunities to market and advertise high sugar food and drink 3) The setting of a clear definition for high sugar foods (to aid with 1 & 2 above) 4) Introduction of a broad, structured and transparently monitored programme of gradual sugar reduction in everyday food and drink 5) Introduction of a price increase of a minimum of 10-20% on high sugar products through the use of a tax or levy such as on full sugar soft drinks 6) Adopt, implement and monitor the government buying standards for food and catering services across the public sector 7) Ensure that accredited training in diet and health is routinely delivered to all of those who have opportunities to influence food choices 8) Continue to raise awareness of concerns around sugar levels in the diet to the public as well as health professionals, employers, the food industry etc. 11

12 It is unlikely that a single action alone would be effective in reducing sugar intakes The evidence suggests that a broad, structured approach, involving restrictions on price promotions and marketing, product reformulation, portion size reduction and price increases on unhealthy products, implemented in parallel, is likely to have a more universal effect. Positive changes to the food environment (e.g. public sector food procurement, provision and sales of healthier foods) as well as information and education are also needed to help support people in making healthier dietary choices. 12