Would a sugar tax help GPs manage obesity?
Dr Jacqueline Marshall says that sugar is toxic and GPs need support, whereas Dr Paul Charlson argues that a sugar tax is regressive and will not help the profession
I don’t need to tell you how difficult it is for GPs to manage diabetes and obesity. In the UK, 64% of adults are classed as overweight and this is largely down to eating excessive sugar – it forms up to 15% of our children’s calorie intake.
Sugar rots teeth, makes children hyper and increases obesity. But most importantly, it causes type 2 diabetes, leading to heart attacks, blindness and amputations, as well as increasing GPs’ workload and accounting for more than 10% of the NHS budget.
The recently published investigation into a tax on high-sugar foods by Public Health England predicted that reducing sugar consumption to 5% of energy intake could save the NHS £15bn and 80,000 lives in a generation. Children eat three times the recommended amount of sugar, with adults close behind. Five other countries have introduced a tax with tangible results – a 10% tax on sugary drinks in Mexico has reduced sales by 6%.
So why are we still trying to decide if we should have a sugar tax here? We as doctors are guided by facts, science and a wish to do good. Indeed, a recent Pulse survey found seven out of 10 GPs support a sugar tax. However, politicians are driven by what will be popular and what will generate income for the Treasury. They are good at knowing the price of everything and the cost of nothing. Even though a sugar tax would raise money, I suspect they are concerned about losing more money from multinational companies – and possibly losing votes.
Our Government also does not wish to be paternalistic. So instead the Prime Minister supports measures such as a reduction in advertising at peak times, which will do little to dent the problem. The argument that a tax is instant, while education and guiding companies towards healthier products is a slow process, falls on deaf ears. Obviously we should support a curb on advertising and two-for-one deals, and pressure companies to make healthier products. But this is not enough.
Those who argue that sugar is not poisonous and should not be taxed like tobacco need to look at its long-term effects. Yes ‘a spoonful of sugar’ might help the medicine go down, but at 15% of our children’s intake, it is taking away resources and lives. A sugar tax would go some way to stopping this excessive consumption, improving the health of our nation and reducing the cost to us all.
Dr Jacqueline Marshall is a GP in Brent, north-west London, diabetes lead for her practice and a fellow of Royal College of Physicians
The sugar tax aims to change people’s eating habits and ultimately reduce obesity. But sugar consumption alone is not the major villain; total calorie intake and lack of exercise are the key factors. A sugar tax will not help these.
A sugar tax is initially attractive but, as with all taxes, would be a blunt instrument and have unintended effects. If people are encouraged to avoid sugar in some foods, they will either find other sources or eat something that may be even more unhealthy, and those with addictive personality might even switch to a more harmful addiction than sugar. They are unlikely to take a less appetising healthy option. The causes of obesity are complex and tackling one is unlikely to help overall reduction in calorie intake.
The Institute of Economic Affairs agrees that this kind of tax is an inefficient way to change behaviour and is particularly unhelpful to poorer people, who spend a higher proportion of their income on food. It argues that sugar consumption in the UK has dropped by 20% since the 1970s but obesity rates have increased.
Denmark experimented with a fat tax, which was deeply unpopular and had little effect on eating habits as it was easy to circumvent. It may have cost an estimated 1,300 jobs because of higher administrative costs in the food industry, and it was dropped – along with proposals for a sugar tax. It is difficult to quantify what effects a sugar tax would have on UK jobs if consumption of sugar-based products decreased. It would certainly have an effect on sugar beet farmers in the struggling UK rural economy and on producers in developing countries who are also struggling to survive.
A more global strategy aimed at reducing obesity is the Government’s preferred option, and mine. Sugar tax is regressive and another example of the nanny state that would mean the Government further imposing constraints on our lives and on choice.
The PHE report that supports the sugar tax also recommends reductions in: advertising of sugary products aimed at children; special offers on junk food in supermarkets; and ‘bottomless’ cups of fizzy drinks. These measures are less controversial and more widely supported as they do not limit freedom of choice, but can be considered health education.
Dr Paul Charlson is a GP in Brough, East Yorkshire and strategic medical director of One Medical Group