GPs can only do so much - we need legislation against sugar
About 40 to 50% of all consultations in GP practices are as a direct consequence of diet-related illness like a new diagnosis of Type 2 diabetes or its complications - heart disease, stroke, certain type of cancers and kidney failure. In England, almost two-thirds of adults and a third of children are either overweight or obese; without effective action this could rise to nine in 10 adults and two-thirds of children by 2050. There is also no doubt that it is a major cause of dental caries and dental disease. Nigel Hunt, dean of the Royal College of Surgeons’ dental faculty, rightly warns that ‘50,000 children a year are being admitted to hospital to have teeth removed under general anesthetic’.
The direct and indirect costs to the UK of type 2 diabetes is close to £20. billion and projected to approach £40bn by 2030. If we do nothing, this will cripple the NHS. It is simplistic and unhelpful to suggest that obesity is caused purely by moral failure of individuals. It is in fact an unintended consequence of modern culture, misleading dietary advice that has incorrectly demonised fat, and powerful advertising.
I therefore have to support the BMA’s call for a 20p tax on fizzy and fruit drinks in a bid to combat Britain’s ever growing obesity crisis.
One of the real culprits is the amount of sugar we consume in fizzy drinks and processed food. The food industry is currently adding growing amounts of sugar to our food. Consumers are largely unaware of this, as the sugar is mostly hidden.
Not just the well-known cola brands (9 teaspoonfuls of sugar in one 330ml can), but also flavoured water (27.5g per 500ml), vitamin water (15g per 500ml) and sports drinks (20g per 500ml) contain huge amounts of the white stuff.
Confectionery is already known to contain high amounts of sugar, but foods like yogurt (15g per 125g pot), canned soup (20g per 400g can), ketchup (4g per 15ml serving), ready meals (7g per 400g serving) and even bread (1g in 1 slice) are among the everyday foods that also contain large amounts of hidden sugar.
Time to legislate
The food industry spends billions in junk food and sugary drink advertising, targeting the most vulnerable members of society, including children. Unlike fat and protein, refined sugars offer no nutritional value and, contrary to what the food industry want you to believe, the body does not require any carbohydrate from added sugar for energy. Thus it is a source of completely unnecessary calories.
To make greater inroads into public health, more action is needed at central government level.
Sugar fulfills four criteria that justify its regulation like alcohol and tobacco. It is toxic, unavoidable has potential for abuse and has a negative impact on society. A tax on sugary drinks by about 20%: we know that would prevent around 180,000 people from becoming obese within one year.1
We know from experiences in other countries that taxation on unhealthy food and drinks can improve health outcomes, and the strongest evidence of effectiveness is for a tax on sugar-sweetened beverages. We mustn’t forget that it took 50 years from when the first scientific studies between smoking and lung cancer were made before any effective legislation was introduced through regulation. Why? Because Big Tobacco very successfully adopted a corporate strategy of denial. By planting doubt, confusing the public, bribing political allies and even buying the loyalty of rogue scientists.
Such steps may be seen as radical, and in some cases may be unpopular but legislation against smoking was once seen in the same way.
We are facing major problems, and they need major solutions. Without such preventative measures, the NHS bill for treatment of acute illnesses will keep on soaring and our society will be the poorer for it - both in financial and health terms.
Dr Kailash Chand is a reitred GP and deputy chair of the BMA.
1 Overall and income specific effect on prevalence of overweight and obesity of 20% sugar sweetened drink tax in UK: econometric and comparative risk assessment modelling study. www.bmj.com/cgi/doi/10.1136/bmj.f6189