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Rearranging the deck chairs on the Titanic

In the book I mention the report by Public Health England (September 2019) ‘Sugar

reduction: Report on progress between 2015 and 2018’. My conclusion was that while trying to reduce sugar by taxation and other means is a valiant effort, it has unfortunately had no significant impact at societal level. Why, because a lot of the reduction is achieved by changing sugar for sweetener (see separate blog or the book why this is not a solution) or a reduction in one category (as celebrated as it may be) may simply shift consumption to other categories.

I personally remember the first time I had sushi. It was a truly eye opening experience. I was not comfortable eating raw fish but the blend of flavors, the slight tanginess of the rice and the kick of the wasabi together with the fresh taste of the fish all came together to create something magical (and still a bit scary). There was very little sweetness to the taste, a little maybe from the rice vinegar that is added to the rice during preparation. Today, I have a hard time eating sushi in a restaurant, as it is dowsed in sugar. Nobody measures this anywhere, nor how much ketchup my kids put on their fries, or, or, or,...

My point is that success in one food category does not mean much no matter how much it is celebrated. As with the benefits of fiber that I measure in terms of all cause mortality rather than reduction of a particular disease, so with sugar reduction effort, all that matters is if the overall sugar consumption has gone down by a meaningful amount and not if manufacturer xyz has reduced the sugar in their chocolate bar by 90%.

Now a new report has been released, so lets look at the latest facts (hint: same conclusion as in the book):

  • The stated goal was to reduce sugar by 20% by 2020, especially in categories that contribute most to the sugar intakes of children (based on a baseline of 2015)

  • Across the basket of food categories there is an overall reduction of 3% for in-home and 0.3% reduction for out-of-home consumption over 3 years. So the goal even for the selected categories, retailers and manufacturers has been missed by a long shot and with each year the reduction shows a decline (see chart below).(i)

  • In terms of calories consumed there has been an increase for in-home by 0.9% and decrease for out-of-home of 9.7%

  • In the meantime the overall sugar consumption in the UK has increased by 2.6%. Now to make a fair comparison we would have to consider the population growth in the UK, particularly the adult population growth from net migration and deaths vs. new births (who do not consume large amounts of food or sugar). The UK population grew over that period (2015-2019) by 2.89% of which 1.54% was due to net migration (of course this also includes infants, but I'm ignoring that for this analysis). So in my view, sugar consumption has gone up (or at least not gone down).

Another source is the National Diet and Nutrition Survey results from 2008 to 2017. They have looked at different age groups and trends in nutrient consumption levels. They show a slight yearly reduction of "free" sugars (i.e., added) of 0.13% in adults and a 0.27-0.39% reduction for children. This is roughly the same as saying that the average person has reduced their sugar intake by a few grains (1/50th of a teaspoon) every year. While I'm happy that there is a reduction, it should be patently obvious that at this rate this strategy will take around 30-50 years to reach acceptable sugar intake levels.

The report also shows the fiber consumption trends and the news is not encouraging. Overall it has been stagnant, and worryingly fiber consumption of children, especially for 4-10-year-olds, falling. The little silver lining is that men (19-64) have slightly increased their fiber intake by around 0.1g per day per year. To put this into context that is about half a corn kernel (i.e., half a single pop corn worth of fiber), so not much of a silver lining, but any fiber helps.

You were warned, all that the above does is to describe how we and our policy makers are rearranging the deck chairs on the titanic of obesity. We need a new way of thinking about this.

(i) Note: The numbers for the previous period that I reported in the book are 2.9% (in-home) and 4.9 % (out-of-home) respectively, so not much progress or even regression over the year, but this may be due to the dataset having changed

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