Taxing sugary drinks is not the cure-all for obesity, but it is a start
Falling in line with countries including Mexico, France and Norway, the UK Government has announced plans to impose a tax on beverages with high sugar content, set to take effect in 2018. Many media outlets have debated the efficacy of a sugar tax, and whether the UK would benefit from such an intervention. However, there has been little analysis of the report that the government has used to justify its plans. As part of the ongoing research into global sugar taxes, the Polygeia Sugar Tax team has been looking at the UK’s policy, and how it compares to other countries. So, why does the UK need a sugar tax?
In October 2015, Public Health England (PHE) published ‘Sugar Reduction’, a comprehensive report outlining the evidence that the UK government should take action against rising obesity rates by, among several other strategies, implementing a tax on sugary drinks.  Here is a quick summary:
The first section draws heavily from the Scientific Advisory Committee on Nutrition’s (SACN) report ‘Carbohydrates and health’ to justify that current average consumption rates of sugar are too high, and that this increases the risk of obesity. Following this, the focus is turned to how the population’s purchases of sugar-sweetened beverages are influenced by marketing, advertising, and the detrimental effects of retail price promotions. The report cites evidence from imposed taxes in Norway, Finland, Mexico, France and Hungary that conclude taxing such beverages tends to reduce purchasing of sugar-sweetened drinks.
Aside from tax, the ‘Sugar Reduction’ report also outlines how lowering the sugar content of food may be an effective way of reducing sugar intake within a population. Other interventions proposed included regulating and lowering portion sizes, promoting fitness and regulating advertising. Throughout the report, there is significant reference to the effects of all of these factors on children, suggesting that interventions proposed may be aimed at young people in order to reduce the incidence of childhood obesity. Finally, the report concludes by providing eight points of action, one of which mentions levying a tax on sugar-sweetened beverages. It is clear that PHE promote a multi-faceted approach to tackling childhood obesity, with a tax being a component of this. On the basis of PHE’s recommendations, the government have planned to impose a graded tax on sugary drinks. Perhaps we will need more time to see how the other seven recommendations affect the government’s ‘Childhood Obesity Strategy’.
Outside of the UK government, responses to ‘Sugar Reduction’ were mostly positive. Statements from professional bodies such as the Royal College of Physicians and The British Society of Dental Hygiene and Therapy support the report and especially its evidence-based approach.[2,3] Sugar Reduction also caught the attention of international non-governmental organisations, with both the World Cancer Research Fund International and, unsurprisingly, ‘Action on Sugar’ welcoming the report.
Health-related charities did also criticise the report. Reynolds et al, part of the Children’s Food Campaign, published a response to Public Health England’s report in the BMJ.  They argued against giving the eight propositions’ efficacy equal weighting, claiming that not prioritising actions would lead to governmental inaction. Also highlighted, is the lack of putting numbers to the policies, including cost-effectiveness. In a response by one of the key Authors, Dr Tedstone acknowledges this gap, and cites a current lack of cohesive evidence present in primary research. An overall estimate of £500 million per year was quoted to be saved by the NHS if nutritional targets are met: presumably if government policy cost falls below this level, there will be an overall gain in pure economic terms. A recent paper published in April makes claim to possibly being the first summary of “cost-effectiveness studies of obesity-related policy/environmental interventions”.  While research into the efficacy of interventions is gaining pace, the economic analysis is not; however, the results are promising and most interventions show an economic benefit.
A published response to the BMJ critique from the PHE authors argues that remaining distant from a specific action on sugar is necessary for the document to concisely inform Parliament ahead of presenting their ‘Childhood Obesity Strategy’. To combat obesity the need for a broad perspective is unanimously agreed upon. The breadth of ‘Sugar Reduction’ was both applauded and found lacking; arguments on one hand that focusing solely on SACN’s changes in advice on sugar over other similar warnings such as a lack of dietary fibre, is too narrow and ineffective. On the other hand, there is a wish to see specific policies, such as sugar sweetened beverage tax, receive the prioritisation necessary to be implemented at all.
Colin Berry and Ankeet Tanna are co-editors of Polygeia’s Cambridge Sugar Tax Team. Colin is a third year medical student at Magdalene College, and Ankeet is a second year medical student at Christ’s College.
Public Health England’s report “Sugar Reduction: Evidence for action” (2015) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/470179/Sugar_reduction_The_evidence_for_action.pdf
Ignoring Public Health England report on sugar reduction would be reckless. (2015). BDJ Team, 2(10), 15157. http://doi.org/10.1038/bdjteam.2015.157
RCP statement on Public Health England’s new evidence review: “Sugar Reduction: The evidence for action” | RCP London. (n.d.). Retrieved May 15, 2016, from https://www.rcplondon.ac.uk/news/rcp-statement-public-health-england-s-new-evidence-review-sugar-reduction-evidence-action
Rayner, M., Scarborough, P., & Briggs, A. (2015). Public Health England’s report on sugar reduction. BMJ (Clinical Research Ed.), 351(nov19_11), h6095. http://doi.org/10.1136/bmj.h6095
McKinnon, R. A., Siddiqi, S. M., Chaloupka, F. J., Mancino, L., & Prasad, K. (2016). Obesity-Related Policy/Environmental Interventions: A Systematic Review of Economic Analyses. American Journal of Preventive Medicine, 50(4), 543–9. http://doi.org/10.1016/j.amepre.2015.10.021