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Wolfson Institute of Population Health

Keeping everyone sweet − sugar, childhood obesity and the food industry

Bowls of sugary breakfast cereals on a white background

Professor Graham MacGregor CBE

Professor of Cardiovascular Medicine

In collaboration with

In England, 10% of reception-age children (aged 4-5) and 20% of children aged 10-11 are living with obesity. Obesity in childhood leads to health problems later in life: these children face increased risk of cardiovascular disease, type 2 diabetes, and cancer in adulthood.

With this in mind, in 2014 the Queen Mary-based research group, Action on Sugar, submitted a proposal to the UK Government to reduce childhood obesity.

The cost of obesity

Obesity causes more than 30,000 deaths and costs the NHS more than £6 billion each year.

Action on Sugar’s proposal formed the basis of the UK Government’s Childhood Obesity Plan. The plan incorporates the Soft Drinks Industry Levy and the Sugar Reduction Programme.

Highlighting excess sugar levels in products aimed at children

Over the last seven years, Action on Sugar’s research has examined a wide variety of food and drink products frequently consumed by children.

Their research revealed:

  • Fruit juices, juice drinks, and smoothies aimed at children
: 57% of these products were high in sugar, and 42% contained at least a child’s entire maximum daily intake of sugar
  • Carbonated, sugar-sweetened beverages
: 91% of beverages sold in the UK were high in sugar, and 55% had more than an adult’s recommended daily intake of free sugars per portion
  • Energy drinks
: on average, these contain 41g of sugar per serving - more than an adult’s recommended daily limit of 30g sugar per day
  • Children’s breakfast cereals
: a typical (30g) serving contained a third of the maximum daily recommendation for free sugars intake for a 4-6 year old child.

Tracking changes in average sugar content over time

The Soft Drinks Industry Levy was announced in 2016 and implemented in April 2018. Drinks manufacturers had a two-year period before this to reformulate their products. In 2018, Action on Sugar looked at sugar-sweetened beverages, to compare the sugar and energy content of soft drinks in 2018 with the same products sold in 2014.

This analysis showed that the mean sugar content of the 83 products they studied had decreased by 42% between 2014 and 2018, from 9.1 to 5.3 g/100 ml.

The mean energy content also decreased by 40%, from 38 kcal/100 ml in 2014 to 23 kcal/100 ml in 2018.

Action on Sugar has built an evidence base and strong health rationale to drive product reformulation with less sugar. There is a great deal of variation in sugar content between products that consumers would find very similar. Action on Sugar argues that this means reducing sugar content is technically feasible, while still producing a product that consumers will want to choose.

How would reducing sugar content help?

The researchers have also modelled the impact of this reformulation. A 40% reduction in free sugars added to sugar-sweetened beverages would:

  • lead to an average reduction in energy intake of 38.4 kcal per day

  • prevent 1,000,000 adults from being obese

  • prevent 274,000-309,000 cases of obesity-related type 2 diabetes over the next two decades in the UK
A close-up of a can of Red Bull energy drink

Action on Sugar's lobbying led to a ban on the sale of energy drinks to under 16s

What did Action on Sugar manage to change?

After Professor MacGregor’s paper was published in the Lancet in 2014, calling on the UK government to act on excessive sugar consumption, the Secretary of State for Health approached Action on Sugar to produce a plan to tackle childhood obesity in the UK.

The Action on Sugar proposal formed the basis of the Government’s Childhood Obesity Plan, published in 2016.

Action on Sugar aims to reduce sugar levels in food available in supermarkets. This helps to reduce sugar intake across the population, including in lower socio-economic groups. This will help to prevent obesity, type 2 diabetes and tooth decay over time.

The Childhood Obesity Plan consisted of several measures, including the following sugar reduction elements:

  • a fiscal incentive to reduce sugar levels in sugar-sweetened beverages (the Soft Drinks Industry Levy)

  • a programme to reduce sugar intake

The Soft Drinks Industry Levy

  • The Levy resulted in over 50% of manufacturers reducing the sugar content of drinks

  • Soft drinks manufacturers who did not reformulate their products pay the Levy, which is expected to raise £240 million each year

  • The Levy has led to the removal of 45,000 tonnes of sugar from the products we buy, and has reduced sugar in soft drinks by 42%.

The Sugar Reduction Programme

Action on Sugar monitors the sugar in products marketed at children. This contributes to the drive for sugar reductions and product reformulations in foods marketed towards children. The Action on Sugar team of nutrition researchers, chaired by MacGregor, has published extensively on the excessive levels of sugar in the main contributors of sugar to children’s diets, including drinks, breakfast cereals, and confectionery.

Action on Sugar contributed to the setting of Public Health England’s sugar targets per 100g of product, as well as calorie caps for specific single-servings of products.

All sectors of the food and drinks industry have been challenged to reduce overall sugar, across a range of products that contribute to children’s sugar intakes, by at least 20% by 2020, including a 5% reduction in year one.

Action on Sugar’s lobbying and information has led to:

  • commitments to reduce sugar in cereals from Kellogg’s, Waitrose and Nestle
  • a commitment from Lidl and Asda to remove cartoon characters from the packaging of children’s breakfast cereals

  • awareness of the calorie content of ‘freakshakes’, which caused several restaurant chains to remove them from their menus

  • a ban on the sale of energy drinks to those aged under 16 years

Action on Sugar’s research draws a great deal of media interest, and reaches key stakeholders and decision makers. It also raises consumer awareness; 2019 research shows that 49% of people are now aware of and concerned about sugar levels in their food. A really sweet outcome.

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