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expert reaction to modelling study looking at the sugary drinks levy and potential health impacts

A study published in The Lancet Public Health looks at the sugary drinks levy and its potential health impacts.


Dr Ian Johnson, Nutrition researcher and Emeritus Fellow, Institute of Food Research, said:

“This interesting study provides valuable evidence for the potential health benefits of taxation designed to influence the consumption of sugar-sweetened beverages. The results are broadly consistent with those of similar modelling of sugary drink taxes in the USA, and they are timely, given the impending introduction of legislation here in Britain.”


Prof. Tom Sanders, Professor emeritus of Nutrition and Dietetics, King’s College London, said:

“This research makes an estimate of the impact of the government’s proposed tax on soft drinks and concludes that it would reduce energy intake by 5 kcal/head/day which is equivalent to a third of a teaspoon (1.3 g) of sugar or the amount provided by 4 sultanas. This is a very small reduction in energy intake – equivalent to the amount of energy expended by one minute of brisk walking. The authors then go on to predict the health outcomes that might result from this reduction in sugar intake. I find some of these predictions hard to swallow. In terms of risk of type 2 diabetes and dental caries, these estimates are made by reported intakes from observational studies and not from trials. Evidence from trials is important because dietary patterns reported in observational studies are often associated with other differences in lifestyle – so this is a major weakness. A further limitation is that the estimate for the impact on caries does not use data gathered in children, which the authors acknowledge. This is important because it is children who are at most risk of dental caries particularly when their teeth are erupting.

“The case against sugar is strongest for dental caries and although the total intake of sugar is correlated with risk of caries, it is well known that frequency of consumption is what promotes the growth of the oral bacteria that cause dental decay (especially sugary solutions in trainer cups/dummies). Reduced sugar drinks would still contribute to dental caries. It is generally held that 80% of the caries occurs in 20% of the population and is concentrated in low-income groups as well as recent migrants. This higher incidence is also associated with lower prevalence of tooth brushing and lack of awareness regarding the harmful effects of sweets and sugary drinks on dental health. Fluoride and good oral hygiene undoubtedly play a major role in reducing dental caries. While reductions in sugar from soft drinks may help reduce caries, the problematic foods for promoting caries are sweets and biscuits, which have a longer residence time in the mouth making them available for fermentation by oral bacteria into acid that erodes the enamel.

“The onset in of type 2 diabetes is usually in middle-age or older people and I find it odd that this study predicts the greatest impact of the sugar tax on type 2 diabetes in men and women over the age of 65 in whom the intake of sugar sweetened beverages (pop and cordial) is very low with a median intake of zero. Accumulation of body fat around the middle, increasing age and lack of physical activity are the driving factors causing type 2 diabetes. While weight loss does reduce risk of diabetes, the predicted effect of the sugar tax on the prevalence of adults is miniscule with reductions ranging from 0.1-0.3% in adults. However, the tax would be more likely to have a greater effect of obesity in children who are the major consumers of sugar sweetened beverages so, in the long-term, may reduce their risk of developing type 2 diabetes as adults.”


Dr Laura Cornelsen, Assistant Professor in Health Economics at the London School of Hygiene & Tropical Medicine:

“This is an important study, the first comprehensive model of the probable health impacts of the Government proposed soft drink industry levy while considering how the industry could respond. It is crucial to highlight the likely positive impacts of reformulating drinks to contain less sugar, as the emphasis on encouraging producers to do this is unique to the levy proposed in the UK.

“In reality, as the authors discuss, it is likely that we will see a combination of these responses. These, alongside raising awareness of the harmful effects of excessive sugar consumption, could produce a much larger health impact from the levy.”


Prof. Neena Modi, President of the Royal College of Paediatrics and Child Health (RCPCH), said:

“This research into the likely effectiveness of a sugar Levy is very encouraging. The authors are to be commended for conducting an objective analysis. Their conclusions provide a powerful steer to industry to reduce the sugar content of soft drinks, and also increase the price of high and mid-sugar drinks, and persuade consumers to switch to low sugar drinks.

“The strengths of this study, for which the authors are to be congratulated, are in providing an objective, precisely defined framework upon which to test the impact of a key Government policy, as well as the contribution of the constituent actions of industry.

The weaknesses, for which they are not responsible, lie in the paucity of high quality UK datasets from which to derive modelling parameters.

“Children stand to benefit the most, so this study is a clarion call to industry to fulfil their moral obligations to promote child wellbeing. We also reiterate the importance of evaluating the true impact of the sugar tax, once it is introduced, so that the UK can provide much needed evidence to other countries that are considering emulating this potentially powerful public health intervention.”


* ‘Health impact assessment of the UK soft drinks industry levy: a comparative risk assessment modelling study’ by Adam D M Briggs et al. will be published in The Lancet Public Health at 23:30 UK time on Thursday 15 December 2016, which is also when the embargo will lift. 


Declared interests

Dr Ian Johnson: “Ian Johnson was an external member of the SACN Carbohydrates Working Group in the UK.”

Prof Tom Sanders: “Prof Tom Sanders is a Scientific Governor of the charity British Nutrition Foundation, member of the scientific advisory committee of the Natural Hydration Council (which promotes the drinking of water), and honorary Nutritional Director of the charity HEART UK.

He is now emeritus but when he was doing research at King’s College London, the following applied:

Tom does not hold 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 the artificial sweetener 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.

Tom also used to work for Ajinomoto on aspartame about 8 years ago.

Tom was a member of the FAO/WHO Joint Expert Committee that recommended that trans fatty acids be removed from the human food chain.

Tom has previously acted as a member of the Global Dairy Platform Scientific Advisory Panel and Tom is a member of the Programme Advisory Committee of the Malaysian Palm Oil Board.

In the past Tom has acted as a consultant to Archer Daniel Midland Company and received honoraria for meetings sponsored by Unilever PLC.

Tom’s research on fats was funded by Public Health England/Food Standards Agency.”

Dr Laura Cornelsen: “No conflicts of interests to declare.”

No others received.

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