Reducing sugar, preventing obesity – turning evidence into action

Many thanks to Sam Byfield, Senior Policy Advisor (LiveLighter), Heart Foundation of Australia (Western Australia) and Associate, Nossal Institute for Global Health, for this article on the recently released guideline on sugar consumption from WHO. 

Sam writes:

Last week the World Health Organization released its guideline on sugar consumption, recommending that adults and children reduce their daily intake of added sugars to less than 10% of their total energy intake and noting that a further reduction to below 5% (6 teaspoons of sugar for an average adult) would have further health benefits. These guidelines particularly target those sugars that are ‘hidden’ in processed foods – that consumers are often unknowingly exposed to, and which are a substantial and rapidly growing driver of chronic disease in Australia and globally.

As the guideline notes, a single can of sugar-sweetened drink can contain as much as 10 teaspoons of sugars – almost double the recommended level. One tablespoon of barbeque sauce has been shown to contain almost three teaspoons of sugar, while a 200 gram tub of low-fat yoghurt contains about four teaspoons of extra sugar – partly because when reducing fat content the food industry replaces it with sugar, thereby maximising ‘palatability’.

The guideline reflects the best and most up to date evidence concerning the role of sugar as a cause of overweight, obesity and ill-health. It is an important element of international efforts to address chronic disease, including the WHO’s Global Action Plan for NCDs which aims to halt the rise in obesity and diabetes and reduce the burden of premature mortality caused by NCDs by 25% by 2025.

Globally, about two-thirds of all people are killed by non communicable diseases, of which sugar is a major driver. In Australia, 63% of the population is now overweight, and our obesity prevalence is growing faster than anywhere else in the world. More than two thirds of Australian men, 55% of women, and one quarter of children aged 12 to 17 years, are overweight or obese. Diet – particularly sugar intake – is a key risk factor in a range of diseases and health conditions, including cardiovascular disease (at 45,000 deaths in 2012 Australia’s biggest killer), Type 2 diabetes (nearly 850,000 Australians in 2011-12) and some cancers.

Obesity and chronic disease leads to disability and loss of independence – think for instance of the rehabilitation and care required by someone who has had a stroke or heart attack, or has lost a limb or their sight because of diabetes. We know that obesity and overweight lead to significantly higher healthcare expenditure, keeps people out of work during their most productive years, and sometimes requires a family member (often a child) to stay home to provide care. At a macro level, the global economic impact of obesity amounts to roughly $2 trillion annually, or 2.8% of global GDP –almost on par with the global impact of smoking, or armed violence, war, and terrorism grouped together.

On top of the death, disability, loss of independence, financial hardship and economic burden associated with overweight and obesity, there’s another powerful and often overlooked argument for addressing it – that health is a fundamental human right. The right to health is enshrined in Article 12 of the International Covenant on Economic, Social and Cultural Rights, which notes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The UN’s Committee on Economic, Social and Cultural Rights has asserted that the Covenant not only obliges Parties (including Australia) to provide adequate healthcare, but also to address the determinants of health including nutrition and health education, both of which are clearly important when it comes to reducing sugar intake and preventing obesity and disease.

The UN Convention on the Rights of the Child is another useful reference point. It outlines the rights of children to develop to the fullest and the right to protection from harmful influences which, it can be argued, includes exposure to harmful amounts of sugar and a lifetime of overweight, ill-health and lost opportunity.

The good news is that we know what to do about sugar intake. The bad news is that, all too often as a nation, we’re not doing it. What’s needed is a range of interventions to change both the ‘food environment’ and individual behaviour. This requires appropriate funding, and it needs to be expressed in a national strategy for the prevention of obesity. Without a strategy it’s impossible to know what’s needed, what’s happening, and where the gaps are.

We know that population-level interventions work – like significantly reducing the exposure of children to the promotion and marketing of junk food in all its forms ; taxing unhealthy products; reducing the amount of sugar in fast food or supermarket products; or by better-informing consumers about what they are actually eating through package labelling. The national Health Star Ratings, and kilojoule labelling being trialled by some states and councils, are good examples – perhaps down the track we will see the introduction of plain packaging or graphic warnings for sugary food and beverages like we’ve seen with tobacco.

We also know that programs in specific settings have a big role to play – like providing healthy food in schools or healthcare facilities. What’s needed is more funding for prevention – as a percentage of total health expenditure, Australia’s expenditure on prevention in 2011 was only 1.7% (placing us in the bottom third of OECD countries), compared to Canada at 7% and NZ at 5.9%.

Sustained and realistic funding for public education campaigns have a big role to play as well. In this area, Western Australia has led the way through the LiveLighter campaign, which commenced in 2012 and raising awareness about the dangers of unhealthy foods (including sugary drinks, processed food and junk food), and the benefits of choosing healthier options. This campaign has recently been adopted in ACT and Victoria.

Obesity is the next frontier of public health in Australia – and sugar is a key battlefront. The WHO’s sugar guideline represents an important opportunity for Australia to start transforming evidence into action.