Naveed Sattar: We need to go further than sugar tax

More than two in five Scots are overweight or obese.
More than two in five Scots are overweight or obese.
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The government’s budget announcement on sugary drinks has been generally welcomed by the medical community and the wider public although there are some voices against.

In my opinion, this tax policy is a step in the right direction but several aspects need to be put into context.

Professor Naveed Sattar

Professor Naveed Sattar

Firstly, what we need to know is to what extent this tax will increase prices of sugary drinks as compared to diet-based drinks?

If this price differential is limited – and the rumour has it, it could be as little as 8 pence – then this small increase may not be enough to shift behaviour of the public but this remains to be seen.

Secondly, we must not comfort ourselves in thinking that sugar alone is the cause of obesity and that this measure will go a long way in reducing obesity in our children and future generations.

Yes, many of our kids are over consuming calories in the form of sugary drinks but the biggest culprit to obesity levels may yet be excess fat intake, and there is good evidence backing up this notion.

The tax on sugary drinks has been controversial.

The tax on sugary drinks has been controversial.

We must remember that per gram fat provides twice as many calories as does sugar and that it also makes up the bulk of calories in many ‘unhealthy’ snacks or foods – for example crisps, cakes, many biscuits, etc.

It is also clear that when individuals cut sugar intake, some increase their intake of fatty products, so that concentrating solely on reduction in sugary drinks is misplaced and we need far wider interventions.

Thirdly, rather than wait to 2018 to begin the battle against the high level of sugary drinks consumed, there is a need for a mass education programme following the useful and the country-wide debate on this issue.

Ideally, we must educate our children and adults to understand that there are multiple sugar free drinks available and that many can retrain their taste buds over time to enjoy these drinks as much as they like the sugary versions. As we all know, one can retrain palates to enjoy tea or coffee with less or no sugar and the same principle applies to sugary drinks.

Whilst some folk suggest that artificial sweeteners are to be avoided, the best medical evidence confirms their safety. Ideally, water intake is to be promoted but diet drinks are certainly better than sugar-rich versions.

Fourthly, and returning to the concern from some quarters that this taxation is ill-conceived and the government should not interfere with individual freedom to choose what they eat and drink; this is a flawed argument in my opinion.

The facts show that obesity levels have risen 4-5 fold since the 1980s so that over a quarter of the population are now obese, with the inevitable medical complications of rising obesity (more diabetes, hypertension, cancers, lung and liver disease, etc, etc) placing enormous burdens on the national health service.

It is also a fact that the vast majority of obese individuals do not wish to be obese but try as they may, they cannot return to a normal weight, or even lose weight sustainably.

Hence, we need to help individuals to not become obese in the first place and any legislation which alters behaviour towards the purchase and intake of healthier drinks or foods is to be welcomed.

In this light, the smoking ban in public places has had substantial health benefits for all generations and today few would argue against it.

Of course, we should not equate sugary drinks with smoking – the former can still be enjoyed by individuals who wish to pay more for such drinks and many active individuals who are healthy weight or weight stable find sugary drinks helpful and enjoyable in the conduct of their activities and life, whereas smoking is clearly harmful to all with no benefits whatsoever.

Finally, moving forwards, can the government legislate further to improve health?

The answer is yes but of course they face the powerful lobby of the foods and drinks industry so that further legislation is unlikely for the foreseeable future.

Nevertheless, if I were in government and could force one additional intervention now, it would be to mandate total calorie content placed in big writing on all foods possible so that individuals can much more easily recognise how many calories they will be consuming. Too many of our foods have hard to read calorie labels and many folk across all educational levels cannot fathom the calorie content of foods.

This simple intervention of total calorie labels will lead folk to make better health choices: buying more foods with less calories and avoiding more often than not those foods which have substantial calorie levels. This change in purchasing behaviour would then inevitably lead food manufacturers to improve the quality of their foods towards the better selling less fat and sugar-rich versions - leading to wider improvements in dietary intakes.

The latter change I know is a pipe dream will not be taken up anytime soon, but at least a tax on sugary drinks is a step in the right direction.

In the meantime, I will continue to lobby for more measures to help people improve their dietary behaviours without much conscious effort since obesity is undoubtedly one of the major issues of our time.

Naveed Sattar is Professor of Metabolic Medicine at the University of Glasgow