EVIDENCE-BASED HEALTH BENEFITS OF REDUCED SUGAR CONSUMPTION:

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1 EVIDENCE-BASED HEALTH BENEFITS OF REDUCED SUGAR CONSUMPTION: OBESITY AND WHOLE-HEALTH Dr Rachel Pryke GP and Clinical Lead for Nutrition, Royal College of General Practitioners

2 MY BACKGROUND GP and trainer in Redditch, Worcestershire RCGP Clinical Lead for Nutrition for Health Author Weight Matters for Children and Weight Matters for Young People, Radcliffe Publishing Member Academy of Medical Royal Colleges Obesity Steering Group and RCP Obesity working party Author of many obesity e-learning sessions

3 AIMS OF SESSION Recognise the hidden burden of obesity and lack of recognition of its impact SACN report - clear call for action based on strengthened evidence Look at correlations between increased sugar and health problems, particularly dental caries, obesity and hence type 2 diabetes. Supporting consumers in the tsunami of choice Opportunities for food industry engagement to support individuals

4 SUGAR - DOUBLE-EDGED DELIGHT Food has evolved into a common emotional currency and cure for misery - Nutrition now a peripheral factor Sensation of hunger is now blurred with boredom, loneliness, anger, sadness, and a general desire for gratification Employment/economic drivers mean no political desire to demonize consumption Instead - voluntary agreement, the Responsibility Deal, for commercial partners to sign up to health-related changes

5 NORMALISATION OF OBESITY

6 NORMALISATION OF CHILD OBESITY NCMP evaluation demonstrates that 3/4 parents of overweight and obese children do not recognise their child to be overweight Where acknowledged, 41% parents do not perceive overweight to be a health risk Cultural factors as well as deprivation contribute to high levels of obesity among black and South Asian children

7 BMI DISTRIBUTION: YEAR 6 CHILDREN NATIONAL CHILD MEASUREMENT PROGRAMME 2012/13 Girls Boys 1990 baseline 85th centile 91st centile 95th centile 98th centile 2nd centile BMI z score 7 Patterns and trends in child obesity

8 SACN REPORT Highlighted complex and incomplete evidence base Low fat diets support weight loss Increased free sugar correlates with increased calorie intake People do not compensate for calories in drinks. Soft drinks provide almost a third of sugars in children aged 11-18

9 SUGAR AND OBESITY Complex factors influence weight - including deprivation and 'cultural norms' Strong correlation with changes in average consumption and in population weight trends. Adipose tissue is inflammatory - strongly linked to metabolic syndrome, obstructive sleep apnoea, cancer, PCOS and fertility problems Sugary drinks are displacing milk consumption with detrimental effect on intake of other nutrients found in milk

10 SUGAR AND FAT ARE BOTH IMPLICATED IN OBESITY

11 DIABETES AFFECTS 4.5% UK POPULATION Commonest complications heart disease and stroke, retinopathy (blindness), nephropathy (kidney failure), neuropathy (nerve damage), shortened life expectancy Impacts on health service costs loss of employment sick pay/benefits carers and families Can we allow this to become 'normalized'?

12 TEETH Dental caries - almost a third of 5 year olds have tooth decay - despite widespread fluoridation of water supplies Demonstrates widening health inequalities and geographical as well as socio-economic inequality. 21% 5 year olds have tooth decay in South East England compared to 35% in North West Evidence is clear that increased sugar consumption is detrimental to oral health Dentition impacts on malnutrition risk in later life

13 Effect of frequency of sugar rinses on lesion depth when fluoride toothpaste or a nonfluoride toothpaste is used. Touger-Decker R, and van Loveren C Am J Clin Nutr 2003;78:881S-892S

14 DIETARY FIBRE Reduced intake of dietary fibre, despite food industry development of 'wholegrain' products Dietary fibre, particularly wholegrain intake is beneficial to cardiovascular disease, fasting lipids, blood pressure, diabetes, constipation and colorectal cancer Colo-rectal cancer is third commonest cancer in UK, most of which is sporadic not familial, with environmental factors being important

15 CONSUMER/PATIENT CONCERNS How can families establish a liking for the ordinary? Nanny state-ism and nudge theory over or under-employed?

16 BEHAVIOURAL NORMS - NOW CHAOTIC What is UK staple diet? nobody now knows! Food hierarchy has been lost Default choices are unhealthy Healthy things perceived costly and complex Making the healthy choice the easy choice Fear and demonisation of hunger rather than recognition of its prime signaling function

17 GUILT FROM EATING Can be profound Can food industry help to reduce guilt and promote appropriate consumption and hence enjoyment of foods? Hunger lessened by structured and consistent approach to meals and snacks Marketing of 'good plain sense is not sexy Cereal is my binge food! If I start with something else I always end up eating bowl after bowl of cereal in a binge.. so hard to stop! I can't wait until I do not binge anymore.

18 INFLUENCING 'DEFAULT' CHOICES Dieting requires effort which is typically transient more important are default choices made without much thought Altering expectations - not missed if not expected Make healthier products more acceptable - raise acceptance of artificial sweeteners Campaign to reduce reliance on 'sweetness' only takes around 2 weeks to adjust to unsweetened tea and coffee

19 LEARNING TO LIKE Repeated calm exposure Eating together Seeing others enjoying it Forbidden foods are preferred Forced foods are hated Positive food associations Minimising negative food associations

20 MANAGING EXPECTATIONS Stronger focus on treats being occasional Save it til Sunday Avoid using food as reward. Sell alternatives - stickers, small toys and certificates in the confectionary isle? Food structures teach restraint, help children to recognise hunger as a useful signal not sign of terror Coping with hunger distraction, routine, expectation

21 CAN THE ANSWERS TO OBESITY AND SUGAR REDUCTION WORK FOR THE FOOD INDUSTRY? Product ranges to embrace health needs Improved behavioural education on packaging and marketing campaigns Targeting specific groups and conditions- e.g. people at risk of malnutrition Move away from the illogical concept of children s food Harm reduction e.g. timing of snacks, sugar free gum after confectionary Smaller and more varied portion sizing - the option to buy 3 sausages?

22 RESOURCES RCGP Nutrition webpages - search on RCGP Nutrition RCGP Obesity and malnutrition e-learning modules =0 Tackling obesity through the Healthy Child Programme Introduction to Obesity and malnutrition study day, March 17 th 2015 at RCN,- suitable for all primary care staff