select search filters
briefings
roundups & rapid reactions
before the headlines
Fiona fox's blog
Prof Simon Capewell, Head of Public Health and Policy at University of Liverpool, wrote a Personal View article in the BMJ, in which he detailed why he thinks sugar sweetened drinks should carry health warnings.
Prof Tom Sanders, Head of Diabetes and Nutritional Sciences Division, School of Medicine, King’s College London, said:
“Excessive intake of sugary drinks contributes to unhealthy weight gain in children. But sugar is not like tobacco: it is not addictive and does not cause cardiovascular disease and cancer. Oral rehydration solutions, which contain sugar, have prevented millions of deaths. The risks to young people’s health presented by smoking, alcohol, drugs, unsafe sex, tattooing and body piercing are far greater – a warning label on soft drinks suggests a lack of perspective.”
Prof Naveed Sattar, Professor of Metabolic Medicine, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, said:
“This well argued, and balanced opinion piece carefully sets out the arguments for a warning on sugar sweetened drinks. It is a timely given mounting evidence for sugary drinks contributing to excess energy intake, obesity and, in turn, higher diabetes risks. Furthermore, as Prof Capewell points out, public support for an obesity warning on these drinks appears strong. In reality, sugar sweetened drinks represent the least contentious target for such a warning, and other countries are considering similar actions. Whether such obesity warnings have a meaningful effect to reduce such intake will be interesting to observe. However, given that there are plentiful low calorie drink alternatives as well as water, and that most individuals can adapt their taste buds to differing tastes over time (including diet drinks), then an obesity warning has a decent chance to help push individuals towards better quality drinking behaviour. This can only be a good thing as a time when diabetes rate continue to rise and when health budgets continue to strain. Any such actions which can meaningfully attenuate or reverse current obesity rates are to be welcomed, especially those which also have the support of the majority of the public.”
Dr Nita Forouhi, MRC Programme Leader and Public Health Physician at MRC Epidemiology Unit, University of Cambridge, said:
“Big problems need bold solutions. If the California Bill, currently being considered for health warning labels on sugary drinks, goes ahead, it will set an important precedent.
“Of the entire ‘sugar and health’ debate, the most tangible case for interventions is for sugary drinks. There is a consistent body of evidence for the adverse health effects of sugary drinks. Our own research (cited by the Capewell article) provides strong evidence from the EU-funded EPIC-InterAct Study across 8 European countries that higher intake of sugary drinks is related to the risk of developing type 2 diabetes, adding to the already strong evidence for links with obesity and tooth decay.
“As public health interventions go, on a scale of eight options in the “interventions ladder” ranging from step one of “do nothing” to step eight of “eliminate choice”, labelling products with a health warning would constitute the third step of the ladder to “enable choice”. This contrasts with proposals for taxing sugary drinks which would form step six of the ladder to “guide choice through disincentives”. Certainly if ‘knowledge is power’, providing people with the knowledge about the adverse health effects of sugary drinks through clear labels will empower them to make informed choices about products they consume.
“The practicalities of what exact wording should constitute a health warning need to be carefully considered. The proposed California example states “Drinking beverages with added sugar(s) contributes to obesity, diabetes and tooth decay.” While this is factually correct, there would be merit in placing this in context of a healthy diet and healthy lifestyle so people are reminded at the same time about making other healthy diet choices, and imply messages about not smoking, limiting alcohol, and increasing physical activity as part of healthy lifestyles. Wording like “The consumption of sugary beverages should be limited as part of a healthy diet and a healthy lifestyle” could provide one useful option to consider. The exact amount of sugar in beverages that will qualify for a health warning label will also need careful consideration to decide whether the proposed Californian level of 75g of sugar content per 12 fluid ounces (roughly 340 ml) is the most optimal for all contexts.
“As the BMJ article describes, there will be proponents and opponents of such health warnings on sugary drinks as shown by opinion polls of the public and the anticipated reaction of industry, but such action could form a complementary strategy to other interventions such as a sugary drinks tax or banning advertising to children. As the Nuffield Council on Bioethics states, policies should be based on the best available evidence, and both action and inaction require justification. We now know that the obesity and diabetes epidemics are serious problems, and that we have good research evidence about the links of sugary drinks with these health outcomes, and I believe that we are ready for action to better inform the public to make informed choices.”
Prof Kieran Clarke, BHF Principal Scientist and Professor of Physiological Biochemistry, University of Oxford, said:
“Obesity warnings on sugar-sweetened drinks may only be partially effective. If warnings should be on sugar-sweetened drinks then there is an argument for them to be on all sweetened drinks, including those sweetened artificially. Artificial sweeteners can make the brain crave glucose and increase the urge to eat sugary food, such as cakes and biscuits, which doesn’t help the obesity problem. The best way to decrease obesity and diabetes is to give up all sweeteners and (eventually) reset the brain.”
‘Sugar sweetened drinks should carry obesity warnings’ by Simon Capewell published in the BMJ on Tuesday 27 May 2014.
Declared interests
Tom Sanders does not hold not any grants or have any consultancies with companies involved in the production or marketing of sugar-sweetened drinks.
In reference to previous funding to Tom’s institution: £4.5 million was donated to King’s College London by Tate & Lyle in 2006; this funding finished in 2011. This money was given to the College and was in recognition of the discovery of sucralose by Prof Hough at the Queen Elizabeth College (QEC), which merged with King’s College London. The Tate & Lyle grant paid for the Clinical Research Centre at St Thomas’ that is run by the Guy’s & St Thomas’ Trust, it was not used to fund research on sugar. Tate & Lyle sold their sugar interests to American Sugar so the brand Tate & Lyle still exists but it is no longer linked to the Company Tate & Lyle PLC, which gave the money to King’s College London in 2006.