Government urges food industry to cut 20% of sugar and reduce portion sizes
BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5348 (Published 03 October 2016) Cite this as: BMJ 2016;355:i5348
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The article outlines the Government’s plea to the food industry to cut 20% of sugar and reduce portions in England. (1) The voluntary measures proposed, although backed by the threat to name and shame those failing to comply, have been criticised by several organisations from the industry representatives, professional and charity organisations among others (2,3) on the grounds that compulsory and measured targets for the reduction of sugar (and other nutrients such as saturated fat) are needed across the whole of the food and drinks industry.
These criticisms could be extended to the approach proposed from the World Health Organisation (WHO) for ending childhood obesity (4). The proposed plan by WHO, while including recommendations for limiting sales of sweetened beverages and other proposals to limit children’s exposure to these obesogenic products, recommends that Member States “develop guidelines, recommendations or policy measures that appropriately engage relevant sectors – including the private sector, where applicable – to implement actions, aimed at reducing childhood obesity …..” [ref. 4 , p.10]. Engaging the food industry on a voluntary basis has been tried in the UK (5) and the USA (6) without success either because the companies fail to adhere to the agreement or many companies marketing unhealthy foods are not party to the voluntary agreement; only enforceable legislation and regulation can force the food industry to comply. Proposals which depend on voluntary cooperation of multinational food companies fail to take account of their role in the generation of an obesogenic environment. Thus, the proposals should approach how and to what extent these companies would be involved in the interventions to reduce obesity when these companies have an overriding interest in profiting from childhood obesity.
An indicator of the promotion of obesity by multinational food companies is childhood TV exposure to advertisements on unhealthy foods. This exposure was evaluated In the USA (7) and other countries (8). Although a clear link was not established between the increased incidence of childhood obesity and increased exposure to these TV ads, this hypothesis is plausible. It is highly likely there is an association and possible interaction between this exposure and individual, family and social factors such as social class and educational level of the family. Moreover, these unhealthy foods are massively promoted by the "heroes" of TV series (represented by people or cartoons). The success of the food industry in promoting these foods is confirmed by a study integrating qualitative and quantitative methods which showed that children do not choose food because it is healthy (9), but for its taste, presentation and promotion. The latter indicates the need to improve and increase control and legislation at local and International levels to ensure compliance with the measures to effectively avoid exposure to obesogenic advertisements.
Obesity, driven by the obesogenic environment to which the food industry is a major contributor, is recognised by the UK Government and the WHO as a threat to health in childhood and across the life course: however, experience in the UK and the USA indicates that, unless they promote and enact legislation rather than relying on voluntary agreements with the food industry, consumption of obesogenic products especially by children will not be significantly reduced.
Nick Spencer
Luis Rajmil
References
1) Iacobucci G. Government urges food industry to cut 20% of sugar and reduce portion sizes. BMJ 2016;355:i5348 doi: I
2) O’Dowd A. Clinicians underwhelmed by “watered down” childhood obesity strategy. BMJ 2016;354:i4576 doi: 10.1136/bmj.i4576
3) Iacobucci G. Supermarkets criticise obesity strategy’s lack of mandatory restrictions on sugar. BMJ 2016;354:i4597 doi: 10.1136/bmj.i4597
4) World Health Organization. Ending Childhood Obesity. Geneva: WHO; 2016.
5) Guardian Newspaper London 18.08.16: “Childhood obesity: UK's 'inexcusable' strategy is wasted opportunity, say experts”. Available at: https://www.theguardian.com/society/2016/aug/18/childhood-obesity-strate....
6) Kunkel DL, Castonguay JS, Filer CR. Evaluating Industry Self-Regulation of Food Marketing to Children. Am J Prev Med. 2015;49(2):181-7. doi: 10.1016/j.amepre.2015.01.027.
7) Powell LM, Schermbeck RM, Chaloupka FJ. Nutritional content of food and beverage products in television advertisements seen on children's programming. Child Obes 2013;9:524-31. doi: 10.1089/chi.2013.0072.
8) Royo-Bordonada MA, Bosqued-Estefanía MJ, Damián J, López-Jurado L, Moya-Geromini MA. Nutrition and health claims in products directed at children via television in Spain in 2012. Gac Sanit 2016;30:221-226.
9) Thomas J, Harden A, Oakley A, Oliver S, Sutcliffe K, Rees R, Brunton G, Kavanagh J. Integrating qualitative research with trials in systematic reviews. BMJ 2004;328:1010-2.
Competing interests: No competing interests
Re: Government urges food industry to cut 20% of sugar and reduce portion sizes
Contrary to the suggestions in the BMJ response to ‘Government urges food industry to cut 20% of sugar and reduce portion sizes’, there is evidence demonstrating that the gradual, voluntary approach to reformulation can be successful. In 2003, the Scientific Advisory Committee on Nutrition (SACN) published its report on ‘Salt and health’ (1). This concluded that a reduction in average salt intakes to 6g per day, with lower levels set for children, would lower population blood pressure levels and reduce the risk of cardiovascular disease. The UK Food Standards Agency (FSA) and Department of Health (DH) committed to a programme encouraging reformulation of foods to reduce salt content, supported by a campaign to raise awareness and offer guidance to the public. To date, four sets of targets have been published (2006, 2009, 2011 and 2014) covering around 80 individual product categories. As a result of the salt reduction programme sodium intakes significantly reduced between 2001 and 2011 (2). A reduction in blood pressure, and the incidence of stroke and coronary heart disease, has been attributed by some to the success of the salt reduction programme (3). The salt reduction programme was voluntary, but open, accountable and highly managed.
PHE are confident that industry will rise to the challenge of reducing sugar levels in their products in a similar way to salt. Some companies have already done a lot of work in reducing the levels of sugar in their products. All sectors of the food industry will be expected to engage with the sugar reduction programme including retailers, manufacturers and the out of home sector (e.g. restaurants, takeaways and cafés). PHE will remain independent, be driven by the evidence and ensure scrutiny by consulting with non-government organisations and others.
To ensure that the achievement matches expectations, PHE will publish interim reports on progress every 6 months. Within these reports, we will include details of companies who are engaging with PHE and the programme as a whole. Data published will be detailed and consistent allowing progress by sector, top selling products and companies to be easily and comparably checked. Progress will be assessed at 18 and 36 months post launch. This programme is a high priority for PHE who will put maximum effort into enabling its success. If there has not been sufficient progress by 2020 government will take a view about whether levers are required e.g. further legislation.
1. Scientific Advisory Committee on Nutrition. (2003) Salt and Health. Online. Available from: https://www.gov.uk/government/publications/sacn-salt-and-health-report
2. Department of Health (2012). Report on dietary sodium intakes 2012. Online. Available from: https://www.gov.uk/government/news/report-on-dietary-sodium-intakes
3. He FJ, Pombo-Rodrigues S, Macgregor GA. (2014) Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality. BMJ Open; 4 e004549.doi:10.1136/bmjopen-2013-004549.
Competing interests: No competing interests