1. Sugar reduction: from evidence to policy Liliya Skotarenko, Obesity & Food Policy, Department of Health

2. Conclusions: Sugar consumption increases the risk of consuming too many calories and the risk of tooth decay, Consumption of sugar sweetened beverages is associated with increased risk of type 2 diabetes and linked to increased BMI in children. Recommendations: Intake of free sugars should be lowered to 5% of our daily energy intake; Consumption of sugar-sweetened beverages should be minimised by both children and adults. What this means in practice: When the 5% recommendation is converted to grams of sugar the amounts different age groups of children should be having each day are: 4 to 6 years – 19g per day; 7 to 10 years – 24g per day; 11 years and over – 30g per day. Link: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_a nd_Health.pdf The Scientific Advisory Committee on Nutrition Report “Carbohydrates and Health” (2015)

3. Key recommendations for action: Reduce and rebalance price promotions in across the food sector Reduce marketing of high sugar foods aimed at children Set a clear definition for high sugar foods to aid with actions 1 and 2 above via an Ofcom nutrient profile model Introduce gradual sugar reduction in everyday food and drink products, combined with reductions in portion size. Introduce a price increase of a minimum of 10-20% on high sugar products through the use of a tax or levy such as on full sugar soft drinks, based on the emerging evidence of the impact of such measures in other countries. Strengthen and promote Government Buying Standards for Food. Accredited training in diet and health for those in catering, fitness and leisure sectors and others within local authorities. Raise awareness of concerns around sugar levels in the diet to the public and professionals and provide practical steps to help people lower their own and their families sugar intake. Link: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/470179/Sugar_re duction_The_evidence_for_action.pdf https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/470179/Sugar_re duction_The_evidence_for_action.pdf “Sugar Reduction: the Evidence for Action” by Public Health England

4. Sugar intake in the UK Source: Public Health England, 2015

5. An excise duty on beverages with added sugar Policy Rationale There is a clear link between sugar consumption and excess weight/obesity. Beverages with added sugar have a high calorie content, but little nutritional value—they are not good at stopping us feeling hungry, and don’t decrease consumption of other foods. Intake of beverages with added sugar is associated with an increased risk of Type II diabetes. Teenagers in England are the biggest consumers of SSBs in Europe. SSBs provide 5.4% of total daily energy intake for children who consume them—which alone exceeds the new SACN recommendation. Countries such as Finland, Hungary, France and Mexico already introduced an tax on sugar-sweetened beverages which led to 3.3%-10% reduction in purchasing/consumption of SSBs in the short-term. The public health community and the media have called on Government to take action on obesity and protect children from overconsumption of sugar-sweetened beverages. 5 Expected outcomes An Sugar-Sweetened Beverage (SSB) tax would reduce calorie consumption from unhealthy beverages among children and teenagers and help achieve your goal of halving childhood obesity. We would be able to measure and track this on an annual basis. It would send a clear message to the public that these products are unhealthy. It would also send a clear message to industry that developing unhealthy products is not a desired direction of travel. It would bring in additional revenue. Preliminary modelling, based on a US model, and a tax of 36p per litre of a sugar-sweetened beverage, suggests an impact of the following order of magnitude: If we were to introduce the tax now, over the next 10 years, we will see: a 2.6% reduction in new cases of type 2 diabetes a 1.5% reduction in adult obesity prevalence Leading to 2800 fewer new type 2 diabetes cases per year on average 450 fewer deaths per year on average (0.1% reduction) 440 fewer hospital admissions for CHD per year on average (0.2% reduction) 150 fewer strokes per year on average (0.1% reduction) The modelling considered adults, but given the high soft drink consumption amongst teenagers, it is likely that there would be a similar if not higher impact on the obesity rate for this group An excise duty set at an appropriate level will help change consumer behaviour, as evidenced by UK experience of taxation for tobacco, alcohol and leaded petrol. For example, a 1% increase in price of cigarettes leads to approximately 1.05% drop in purchasing.

6. Option 1: tax per volume, e.g. 36p per litre (or 12p per standard can of SSB). Option 2: tax per sugar content, e.g. 5p per gram of sugar. Advantages: may encourage “downsizing” of beverages; relatively easy to implement. Advantages: may encourage reformulation of beverages to reduce sugar content. Disadvantages: will have no effect on reducing proportion of sugar in drinks via reformulation. Disadvantages: difficult to implement and possibly more difficult to administer. Sources: Ten Options for Reducing Obesity, The Behavioural Insights Team, 2014. *Direction générale de la santé, France. 2013 ; **National Institute of Public Health, Mexico, 2014; ***European Public Health Alliance, 2014; ****HMT, 2016. Options considered to reduce consumption International experience: France: excise tax of 0.07 Euro cents per litre  decrease in sales of 3.3% (2012)* ; Mexico : excise tax of 1 peso (7 US cents) per litre  decrease in sales of 10%** (1 st quarter of 2014); Finland: excise tax of 22 Euro cents per litre  decrease in sales of 4.7% (2014). Hungary: excise tax led to reformulation of high-sugar products. ****

7. Announcement: “We will be introducing a soft drinks industry levy across the UK. This is a levy on producers, and not on consumers, and is designed to encourage producers to reduce the amount of sugar in their products and to move consumers towards healthier alternatives. We have given producers and importers two years to lower the sugar in their drinks so that they won’t face the levy if they take action. “ “Tesco, Robinson’s and many others have already taken steps to reduce the overall levels of added sugar in their drinks, but the levy will create stronger incentives for action.” “In England, the revenue from the levy will be used to double the School Sports Premium, expand the school breakfast clubs to give more children a healthier start to their day, and to increase after-school activities for secondary schools, including providing more sports.” Detail: A soft drinks industry levy on UK producers and importers of added sugar soft drinks; Small producers will be excluded; Two rates with sugar content thresholds at 5g/100ml and 8g/100ml—the rates to be confirmed after consultation; No-added-sugar fruit drinks not in scope, and neither are milk drinks; Will consult over the summer on the policy detail and implementation; Comes into force from April 2018. The policy: Soft Drinks Industry Levy

8. Public opinion: Jamie Oliver Petition: 155,516 signatures and debate in Parliament; Over 60 public health organisations called for the levy; The levy became the most popular Budget announcement and polled very well –up to 65% of public supported (Sky Poll), in comparison to around 45% before the announcement (Petrescu et al., 2016); Raised awareness of impacts of sugar consumption in the media and stimulated public debate. Industry response: Britvic committed to “taking calories out of their products by 20% and ensuring 60% of new products will be lower - sugar or nutritionally enhanced drinks, and clearly displaying the calorie content per serve on the front of packs.” Lucozade launched “Lucozade Zero” (no-sugar version of Lucozade). Mars Food announced that Dolmio and Uncle Ben's sauces should only be consumed once a week due to high salt, sugar or fat content and that a number of their products will carry warning labels. Impact of the announcement so far: the signalling effect