A national campaign for sugar reduction in the UK · Major Underlying Factors Causing Death -...
Transcript of A national campaign for sugar reduction in the UK · Major Underlying Factors Causing Death -...
Graham MacGregor Professor of Cardiovascular Medicine
Chairman of Action on Sugar
Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry,
Queen Mary University of London, UK
A national campaign for sugar reduction in the UK
Major Underlying Factors Causing Death - Worldwide
GBD 2013 Risk Factors Collaborators. Lancet 2015;385:117 Number of Deaths in thousands
0 2,000 4,000 6,000 8,000 10,000 12,000
Sexual abuse and violenceLow bone mineral density
Occupational risksOther environmental risks
Unsafe water, sanitation, and handwashingUnsafe sex
Child and maternal malnutritionLow GFR
Low physical activityHigh total cholesterolAlcohol and drug use
High fasting plasma glucoseHigh BMI
Air pollutionTobacco smokeHigh systolic BP
Dietary risks
0 2,000 4,000 6,000 8,000 10,000 12,000
Sexual abuse and violenceLow bone mineral density
Occupational risksOther environmental risks
Unsafe water, sanitation, and handwashingUnsafe sex
Child and maternal malnutritionLow GFR
Low physical activityHigh total cholesterolAlcohol and drug use
High fasting plasma glucoseHigh BMI
Air pollutionTobacco smokeHigh systolic BP
Dietary risks
Unhealthy diet High systolic BP
High BMI High plasma glucose
High cholesterol
Processed foods and soft drinks
Fat (saturated) Sugar
Calorie
Dental caries
Cholesterol Blood Pressure Obesity Type 2 Diabetes Cancer
Salt
Heart disease Stroke
Why are we getting so fat?
11 bananas or 18 oranges or half a marathon
A Big Mac, large chips and coca cola
Food/soft drink industry
Calorie-dense Cheap
Profitable
Transient satiation/fullness
Calorie intake ↑
Obesity/type 2 diabetes ↑
“Brilliant” marketing Any time
Everywhere
Eat more
Por$onsizeincreaseover$me
Relentless pressure on consumers
Unhealthy foods/soft drinks are available
• Any time
• Everywhere
• Brilliant marketing + advertising (particularly to children)
• Very cheap
Who is responsible?
• Public
• Government
• Food industry
Food industry must reduce salt, fat & sugar content of foods
What can we do? • Tax - High salt, sugar, fat foods
• Subsidise healthy food, e.g. fruit & veg
• Ban unhealthy food advertising
• Restrict availability
• Reduce portion size
• Reformulation
What is practical?
• Big food – very powerful
• Biggest industry & employer
• Strong ties to & influence on government
• Some similarities to tobacco (50 yrs)
Sugar- Impact on health
• The only cause of dental decay (caries)
• Major source of hidden calories
• Leads to obesity & diabetes
Stephan Guyenet http://wholehealthsource.blogspot.co.uk/2012/02/by-2606-us-diet-will-be-100-percent.html
Sugar, Obesity & Diabetes Sugar consumption
(lb/person/yr)
Johnson et al Am J Clin Nutr 2007
Obesity rate for 60-year-old men
Diabetes per 100,000
population
Oneinthreeadultsareobese
Onein30adultsareobese
Oneinnineadultsarediabe$c
Onein50,000
adultsarediabe$c
Relative risk of type 2 diabetes
Soft drink consumption & type 2 diabetes (Cohort study in young and middle-aged women)
Sugar sweetened soft drink consumption
>1 per day
1-4 per month
2-6 per week
<1 per month
Schulze et al. JAMA 2004;292:927
Added Sugar Similar to Salt
• Pure, white
• Makes inedible food palatable
• Only recently part of human diet
• Sensitivity of taste receptor depends on intake
• Hidden
Hidden Sugar (tsp)
x11
x9
x7
x6
x4
x6
x5
x4
Fantastic for Public Health
Very little cost
Food industry slowly reduce - No rejection by public
No need to change diet
Hidden Salt in food e.g. processed, fast, takeaway, restaurant food
↓ BP
CASH Strategy for Reducing Salt in UK
Table/Cooking (15%)
Natural (5%)
Food industry (80%)
0.9 g
0.5 g
4.6 g
40% reduction
No reduction
40% reduction
Salt intake Reduction needed
Total 9.5 g
1.4 g
0.5 g
7.6 g
Target 6.0 g
∴ The food industry needs to slowly reduce salt content of all foods by 40% over the next 5 years by setting target for each food category
Source g/day Target intake
g/day
www.actiononsalt.org.uk
Incremental reformulation (UK)
• Progressive salt reduction targets have been set, i.e. 2005, 2008, 2013 for over 80 categories of food
• Gradual reduction, 10-20% a year. No rejection by public, i.e. progressive gradual reformulation
• Continuous media publicity to ensure industry collaborate or regulate targets
https://responsibilitydeal.dh.gov.uk/wp-content/uploads/2012/01/Salt-Targets-for-Responsibility-Deal.pdf
A level playing field - all companies work to the same target
Incremental salt targets (UK) re-set every 2-3 years
Main
Product Category
2010 Targets
(g salt or mg sodium per
100g)
2012 Targets
(g salt or mg sodium per
100g)
2017 Targets
(g salt or mg sodium per
100g)
Bread
1.1g salt or 440mg sodium
(average)
1.0g salt or 400mg sodium
(average)
0.9g salt or 360mg sodium
(average)
1.13g salt or 450mg sodium
(maximum)
Salt Intake, BP and CVD Mortality in England 2003 - 2011
***
***
***
***
7
8
9
10
*
50
100
150
200
250
126
128
130
132
70
72
74
76
Deaths per
100,000 per year
Blood pressure (mmHg)
Salt intake (g/d)
(from 24h UNa)
IHD
Stroke
2003 2006 2008 2011 He et al. BMJ Open 2014; 4:e004549
* P<0.05 *** P<0.001
≈18,000 (9,000 fatal) stroke/heart
attacks prevented/yr
http://guidance.nice.org.uk/PH25
Fantastic for Public Health
Very little cost
Food industry slowly reduce salt, sugar & fat - No rejection by public
No need to change diet
Reformulation of unhealthy food e.g. processed, fast, takeaway, restaurant food
↓ BP, obesity & cholesterol
• Liquid drinks & foods: easy to reduce
• Solid foods: ↓portion size or add polyols or insoluble fibre)
• Incremental targets, i.e. 10% reduction per year (e.g. 50% reduction within 5 yrs)
• Artificial sweeteners?: Need to ↓sweetness
This will → ↓calorie intake by >100 Kcal/person/d
Incremental sugar targets like salt
• Fat: the major calorie contributor
• Easier than sugar (fat 2.5 x calorie/g)
• Sat fat →↑ LDL cholesterol ∴ focus sat fat, e.g. palm oil
• Incremental targets, i.e. 4% /yr (20% over 5 yrs)
This will → ↓calorie intake by >100 Kcal/person/d
Incremental fat targets like salt
Obesity plan by AoS for UK 2015
1. Incremental reduction
3. 20% sugar levy (+reformulation) ─ soft drinks
Sugar (free) 50% ↓ in 5 yrs
Fat (Sat) 20% ↓
2. Only healthy foods promoted/advertised
↓100 Kcal/person/d
↓100 Kcal/person/d
↓ 50-100 Kcal/person/d
4. All public sector food must meet strict guidelines
5. Uniform colour-coded labelling
UK Obesity Plan 2017 Announced by Theresa May
• Tax on sugar-sweetened drinks (opportunity to reformulate)
• 20% voluntary sugar reformulation by 2020 (PHE) (Targets now set)
• Will also set targets for reformulation to reduce calorie (fat reduction)
• No further restrictions on marketing or promotion
Sugar levy 2018 Above 8 g/100 ml (8% sugar) tax 24p /L
5 to 8 g/100 ml (5-8% sugar) tax 18p /L
Less than 5 g/100 ml (<5% sugar) No tax payable
Tesco already reduced its own label drinks below 5 g/100 ml.
Suntory (Lucozade, Ribena) pledged to reduce below 5 g/100 ml.
(Not applied to either pure fruit juice or milk drinks)
Incremental reformulation
Industry must have • Level playing field • Gradual reduction with incremental targets • Technical knowledge & support • Transparent reporting & analysis
Quicker
Media pressure
Politically easy
Smaller reductions
Voluntary
Initially slower
No media pressure
Politically difficult
Bigger reduction
∴ Industry needs mandated or regulated targets for level playing field
Regulation/legislation
UK industry feedback to AoS
Supermarkets & branded companies (Nestle) want mandatory targets e.g. • CEO Sainsbury’s: “We need compulsory and measured targets for the reduction of sugar & fat . Nothing less will work.…..”
• British Retail Consortium Mandated targets
• Nestle Regulated targets
Summary
Sugar ↓ >100 Kcal
Fat ↓ >100 Kcal
Other ↓ 50-100 Kcal (↓marketing, tax, etc)
Total >250 Kcal
Reduction in calorie intake per person per day
This will prevent obesity & type 2 diabetes