SUGAR. DAVID HAMMOND PhD. Applied Public Health Chair

Transcription

1 SUGAR DAVID HAMMOND PhD Applied Public Health Chair

2 DISCLOSURE CONSULTANT / PAID SPEAKER / ADVISORY COMMITTEES Regulatory agencies e.g., Canada, Australia, UK, EC, etc. Non-governmental associations e.g., CCS, HSF International public health authorities e.g., WHO PUBLIC HEALTH LITIGATION San Francisco vs. American Beverage Association Warnings on SSB ads UK, Department of Health Point of sale legal challenge & Plain packaging Commonwealth of Australia Plain packaging Government of Canada Health care cost recovery litigation Uruguay Health warnings / Single Presentation Rule Irish Department of Health Plain packaging Class actions Craft v. Philip Morris USA Milner v. Philip Morris USA Donovan et al. v. Philip Morris USA 2

3 SUGAR Humans like sugar. A lot.

4 SUGAR History

5 SUGAR History

6 Global sugar consumption has risen from 5kg to 23 kg/person in past century

7 Canadian adults consume 26 teaspoons of sugar each day. Source: Langois K, Garriguet D. Sugar consumption among Canadians of all ages. Statistics Canada, 2014.

8 Canadian children consume 33 teaspoons of sugar each day. Source: Langois K, Garriguet D. Sugar consumption among Canadians of all ages. Statistics Canada, 2014.

9 SUGAR Free-sugar intake 10% of total energy intake RECOMMENDED 5% of total energy intake SUGGESTED World Health Organization. Guideline: Sugars Intake for Adults and Children. Geneva;

10 SUGAR Health effects Direct health effects from excess energy intake are mediated through BMI and Type 2 diabetes.

11 SUGAR Health effects CANCER Esophageal cancer Colon and rectum cancer Liver cancer Gallbladder and biliary tract cancer Pancreatic cancer Breast cancer (before menopause; after menopause) Uterine cancer Ovarian cancer Kidney cancer Thyroid cancer Leukemia HEART & STROKE Ischemic heart disease Ischemic stroke Hemorrhagic stroke Hypertensive heart disease OTHER Type 2 diabetes mellitus Chronic kidney disease Osteoarthritis Dental diseases

12 SUGAR Health effects Do sugars have a unique effect on obesity beyond energy intake? Are sugars a direct cause of other diseases?

13 Do all sugars have the same health effects? NATURAL SUGAR SUBSTITUTES FOR KIDS We ve all heard about the dangerous health effects caused by refined white sugar and high fructose corn syrup (HFCS).. let s think of ways we can give our kids the occasional sweet treat without feeding them toxic refined white sugar or HFCS. GREENMOM.COM

14 No evidence that natural or raw sugars are more healthy. SUCROSE (table sugar) 50% fructose, 50% glucose HIGH FRUCTOSE CORN SYRUP 55% fructose, 45% glucose

15 "A rose by any other name would smell as sweet SIMPLE CARBOHYDRATE 4 calories per gram of sugar SUGAR IS SUGAR. White sugar, brown sugar, raw sugar, honey, maple syrup, agave and corn syrup...

16 SUGAR Total, added and free sugars TOTAL SUGAR Includes natural sugars in fruits and milk ( lactose ). ADDED SUGAR Sugars added during the processing of foods, including syrups and honey, and sugars from concentrated fruit or vegetable juices. FREE SUGAR Same as added sugars, including sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates World Health Organization. Guideline: Sugars Intake for Adults and Children. Geneva;

17 SSB Sugary drink? 500 ml 201 kcal 13 tsp 500 ml 244 kcal 12 tsp 60 kcal 3 tsp

18 SUGAR Understanding sugar amounts 1 gram of sugar = 4 calories 4 grams = 1 teaspoon = 1 cube

19 Interventions to reduce sugar intake

20 Need for primary prevention Source:

21 Changes in sugar consumption driven by changes in food environment

22 POPULATION LEVEL Changing product environments

23 FOOD ENVIRONMENT Product innovation

24 SOURCE OF PROBLEM Changing environments 66% off all packaged foods contain added sugar 63% Dairy drinks 3g vs 11g sugar 78% Sports/Energy drink/flavoured water 4g vs 27g sugar 80% Juice 16g vs 24g sugar

25 FOOD ENVIRONMENT Product innovation

26 Portion sizes. 177 ml 71 kcal 4.5 tsp sugar 500 ml 201 kcal 13 tsp sugar

27 FOOD ENVIRONMENT Product innovation

28 FOOD ENVIRONMENT Product innovation

29 Sugary drinks

30 SUGAR Why focus on drinks? Rapid delivery of high levels of sugar. Low nutrient density. Liquids bypass physiological mechanisms that regulate appetite. SOURCE: LANGOIS K, GARRIGUET D. SUGAR CONSUMPTION AMONG CANADIANS OF ALL AGES. STATISTICS CANADA,

31 Liquid sugar is a major source of energy intake.

32 Sugar Sweetened Beverage Consumption 20% Proportion of calories from drinks among kids. 60% Increase in SSB consumption among kids % Increase soft drinks consumption since Sources: Langois K, Garriguet D. Statistics Canada (2014); Bray GA1, Popkin BM. Pediatr Obes (2013); Lasater G, Piernas C, Popkin BM. Nutr J. (2011).

33 Fruit juice and fruit drinks are the largest source of sugar among Canadian children. SOURCE: LANGOIS K, GARRIGUET D. SUGAR CONSUMPTION AMONG CANADIANS OF ALL AGES. STATISTICS CANADA,

34 SUGAR INTERVENTIONS Industry opposition SSB interventions not needed: SSBs have already declined. sugar-sweetened-and-artificially-sweetened-beverages/

35 SOURCE: JONES AC, VEERMAN JL. HAMMOND D. THE HEALTH AND ECONOMIC IMPACT OF A TAX ON SUGARY DRINKS IN CANADA. MARCH 2017.

36 SUGARY DRINK CONSUMPTION SOURCE: JONES AC, VEERMAN JL. HAMMOND D. THE HEALTH AND ECONOMIC IMPACT OF A TAX ON SUGARY DRINKS IN CANADA. MARCH 2017.

37 SUGARY DRINK CONSUMPTION SOURCE: JONES AC, VEERMAN JL. HAMMOND D. THE HEALTH AND ECONOMIC IMPACT OF A TAX ON SUGARY DRINKS IN CANADA. MARCH 2017.

38 SUGARY DRINK CONSUMPTION Sugary drink consumptions remains near historic highs.

39 Soft drink production in US 12 Oz CANS / PERSONS SOURCE: USDA Economic Research Service ; Beverage Digest , as cited in:

40 Tobacco consumption in Canada PER CAPITA Source: Cunningham R. Smoke & Mirrors; 1996.

41 578 ml Youth 9-18/ per day Estimated sugary drink intake 2015 NON-DIET POP FRUIT JUICES & DRINKS FLAVOURED MILK FLAVOURED WATERS ENERGY DRINKS SPORTS DRINKS SWEETENED TEA AND COFFEES DRINKABLE YOGHURT SOURCE: JONES AC, VEERMAN JL. HAMMOND D. THE HEALTH AND ECONOMIC IMPACT OF A TAX ON SUGARY DRINKS IN CANADA. MARCH 2017.

42 SUGARY DRINKS Health & economic impact Total health care costs (CAD) SUGARY DRINKS $50.6 billion SUGAR SWEETENED BEVERAGES $33.7 billion

43 Population interventions

44 Public education & communication

45 PUBLIC EDUCATION SOURCE:

46 NUTRITION FACT TABLE Proposed changes Improvements in how sugars are labelled in ingredient list % Daily Value for total sugar No separate amounts of added sugars 46

47 SUGARY DRINKS Front-of-pack labels

48 SUGARY DRINKS Front-of-pack labels

49 NFT new information What additional information would you like to see on food products? N=2,001 63% High Symbols 60% Genetically modified 61% Country of origin 47% Organic 46% Allergy 8% Other Source: Hammond et al., Nutrition Facts Table: Consumer perceptions among young adults; 2014.

50 SUGARY DRINKS Front of packs labels

51 SUGARY DRINKS Public education campaigns

52 MARKETING RESTRICTIONS

53 ADVERTISING REGULATIONS Marketing to kids One fifth of TV ads seen by kids are food related. 90% of ads are for unhealthy foods and beverage. Children under the age of 5 cannot distinguish ads from content. SOURCES: JOHN, 1999 POTVIN KENT M, DUBOIS L, WANLESS A. INTERNATIONAL JOURNAL OF PEDIATRIC OBESITY, 2011; 6: E433 E441. POTVIN KENT M, DUBOIS L, WANLESS A. OBESITY (2011) DOI: /OBY POTVIN KENT, DUBOIS & WANLESS, 2012)

54 MARKETING TO KIDS Traditional Advertising

55 MARKETING TO KIDS Online & social media

56 MARKETING TO KIDS Food packaging

57 MARKETING TO KIDS Food packaging

58 MARKETING TO KIDS Food packaging

59 Self-regulation and voluntary measures ineffective at reducing marketing of unhealthy food to kids. SOURCES: HARRIS, WEINBERG, SCHWARTZ, ROSS, OSTROFF, & BROWNELL, 2015; POTVIN KENT & WANLESS, 2014; HEBDEN, KING, GRUNSEIT, KELLY, & CHAPMAN, 2011; POWELL, SZCZYPKA,& CHALOUPKA, 2010

60 MANDATE LETTER TO HEALTH MINISTER Promote public health by.introducing new restrictions on the commercial marketing of unhealthy food and beverages to children, similar to those now in place in Quebec

61 SSB TAXATION

62 Price is among the most effective policy levers for modifying consumer behaviour.

63 Excise tax 20%

64 MARKETING CHALENGES Do SSB taxes work? Yes. Powell L.M., Chriqui J.F., Khan T., Wada R., Chaloupka F.J. Obesity Reviews. 2013;14:

65 POLICY INNOVATION

66 MEXICO SSB TAX ~10% tax on SSBs ~10% reduction in SSB sales

67 SSB TAX CHALLENGES Industry opposition SSB taxes don t work. sugar-sweetened-and-artificially-sweetened-beverages/

68 SSB TAX Precedents

69 Canadian sugary drink tax?

70 SSB TAX CHALLENGES Population level impact 20% EXCISE TAX ON SUGARY DRINKS Prevent 700,000+ cases of overweight and obesity 215,000 Type 2 diabetes cases 60,000 Ischemic heart disease cases 20,000 cancer cases $11 billion in direct healthcare cost savings $43 billion in annual revenue ADAPTED FROM LONG ET AL. AM J PREV MED 2015;49(1):

71 SSB TAX CHALLENGES Industry opposition Taxes won t solve obesity. sugar-sweetened-and-artificially-sweetened-beverages/

72 INTERPRETING POLICY IMPACT As health economist John Cawley concludes in a recent paper for the Journal of Health Economics, there is no dominant cause of obesity and no magic bullet that will reduce it.

73 EVIDENCE

74 Policy measures work in a complementary, incremental manner.

75 POLICY IMPLEMENTTATION Industry opposition & conflict of interest Health Canada NGOs Industry

76 Conflict of interest

77 Conflict of interest

78 Summary Sugar consumption makes an important contribution to excess energy intake, including sugar intake from beverages. Population-level interventions and policies will be required to reduce intake. Modest, incremental changes have substantial impact on health and economic burden from sugar intake.

79 Thank you. David Hammond PhD CIHR PHAC APPLIED PUBLIC HEALTH CHAIR SCHOOL OF PUBLIC HEALTH & HEALTH SYSTEMS UNIVERSITY OF WATERLOO WEB TWITTER