Public Health England is Working with the Industry to Reduce Sugar in Food and Beverages

Public Health England oversees on behalf of the government a sugar reduction and reformulation program, which was presented at the 2019 IANPHI Annual Meeting and recognized as one of the successes of 2019 by IANPHI members.

According to Public Health England (PHE), the United Kingdom’s population, particularly children, consume too much sugar. The main health problem associated with excess sugar intake is weight gain which, over time, can lead to increased numbers of those living with obesity. High sugar intakes are also associated with tooth decay. 

The high prevalence of obesity in England among adults and children has health, social and economic impacts including significant costs to individuals, families and the National Health Service (NHS), England’s publicly-funded healthcare system. Living with overweight and obesity can lead to bullying and stigmatization in children and in adulthood can lead to an increased risk of type-two diabetes, some cancers and heart disease. 

In 2019, 68% of men and 60% of women in England were overweight or obese. The prevalence of obesity among adults rose from 15% to 28% between 1993 and 2019 (NHS Digital (2020) Health Survey for England 2019 Overweight and Obesity in Adults and Children). Younger generations are becoming obese at earlier ages and staying obese into adulthood. More than one in five children starting school are living with overweight and obesity and this rises to one in three by the time they are 10-11 years old (PHE (2020) National Child Measurement Programme).

In 2016, the UK’s government asked PHE to initially design and oversee a voluntary sugar reduction program focused on the foods that contribute the most to intakes of children. The program has since been extended, and the UK became the first country to introduce a structured and closely monitored reformulation process to reduce levels of salt, sugar and calories consumed. High salt intakes are associated with an increased risk of hypertension. 

PHE’s health economic analysis demonstrated that if the UK achieved its goal to reduce free sugars intake to less than 5% of total caloric intake in ten years, the NHS would save £500 million annually, 4,100 premature deaths would be prevented, and approximately 200,000 cases of tooth decay could be averted. The government’s national ambition is to halve childhood obesity and significantly reduce the gap in obesity between children from the most- and least-deprived areas of the country by 2030. The program is contributing to the UK’s achievements of Sustainable Development Goals 2 and 3 and the nine WHO global voluntary targets for health. 

Pioneering Approaches to Driving Product Improvement with Industry

PHE has been working with all sectors of the food industry – manufacturers, retailers and the eating out of home sector e.g., quick service dining, restaurants, cafes, takeaways and meal delivery services – to reduce the amount of sugar consumed from the categories that contribute the most to children’s intakes by 20% by 2020 from the 2015 baseline. The foods covered by the program include sweets, chocolate, cakes, biscuits, ice cream, breakfast cereal and yogurts. The sugar reduction program was extended in 2018 to include juices and milk-based drinks that are excluded from the UK’s Soft Drinks Industry Levy (SDIL), a tax on soft drinks, commonly referred to as the ‘Sugar Tax’ and created in 2016. 

To provide flexibility to the industry, three mechanisms for action were included: reducing levels of total sugar per 100g of products, reducing individual portion sizes, and shifting consumers’ purchasing towards lower or no added sugar products. 

Category specific guidelines to help industry achieve the 20% sugar reduction ambition were devised following engagement with the food industry and civil society organizations. This engagement has been key to help ensure industry buy in and delivery of its objectives, and has had a specific focus on eating out of home businesses. Commercially available data were used to set baselines, guidelines and targets devised for sugar, salt and calories, and to analyze progress across categories and by top selling products and businesses. 

Overall Reductions Achieved

Industry progress was documented in annual progress reports published in 2018, 2019 and in October 2020. This latest report included the first year of data for juice and milk-based drinks, as well as the food categories covered by the program and drinks covered by the SDIL. The report showed continued mixed progress across the food categories and different sectors covered, but that overall progress was being achieved too slowly. 

Overall, there was a 3% reduction in average sugar content for retailers and manufacturer branded foods between 2015 and 2019 with larger reductions seen in some categories (around 13% in breakfast cereals and yogurts and fromage frais), and by some businesses. The larger reductions achieved in some categories, however, is negated by increased sales of higher sugar products. The eating out of home sector achieved hardly any change in the average sugar content of products since 2017 but has made reductions in the calories in relevant products. 

Some good progress has been achieved in reducing sugar in juice and milk-based drinks. Most milk-based drinks from retailers and manufacturers have achieved the 10% interim reduction ambition between 2017 and 2019; and there has also been progress towards the ambitions set for juices. Progress across the eating out of home sector has been mixed. 

The SDIL has produced further substantial change, benefiting all socio-economic groups, at the same time as sales continue to increase. Between 2015 and 2019, there was a 43.7% reduction in the average sugar content for retailers and manufacturer branded drinks subject to the SDIL.

A final progress report for the food categories included in the sugar reduction program will be published in 2021, together with data on drinks subject to the soft drinks industry levy and a second year of data on juices and milk-based drinks. 

“Through the lifetime of the program we have seen progress in reducing sugar in everyday food and drink products – breakfast cereals, yogurts, milk-based drinks – which shows that success is possible through reformulation,” said Alison Tedstone, PHE’s deputy director responsible for the reformulation program and chief nutritionist. “These changes will make it easier for everyone to make healthier choices.” 

“The sugar reduction program is also notable for its transparency and structured monitoring, and the significant time that is spent interacting with stakeholders across all sectors of industry as well as civil society,” she added. “However, faster and more robust action is needed to help us consume less sugar, which will help us become healthier and lower the economic burden of obesity and preventable pressure on the UK health service.” 

Photo by Sharon McCutcheon

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