Driving policy change around carbohydrates and health

Sugar

Research at the University of Leeds, on carbohydrates and carbo-metabolic health, by Dr Charlotte Evans and the Nutritional Epidemiology Group provided key evidence to the Scientific Advisory Committee on Nutrition (SACN). This led to UK Government policy changes including: new national guidelines for free sugars and fibre intakes (2013); ‘Sugary Drinks Industry Levy’ (2016) and reformulation by the international food industry. As a result, the use of sugar has fallen by 28% in sugar-sweetened beverages and by 2.9% across all foods and drinks in the UK (2019).

Sugary diets have critical, costly health implications. In the UK alone, Type 2 Diabetes Mellitus and obesity, risk factors for cardiovascular disease, cost the NHS £14.9billion annually. In 2010, the Department of Health commissioned the group to undertake a two-year review of evidence from 42,583 scientific papers in the largest systematic review and meta-analysis of published research in this area, linking carbohydrates to cardio-metabolic health outcomes. These included cardiovascular disease, coronary heart disease, blood pressure, type 2 diabetes mellitus, lipidaemia and cholesterolaemia, obesity and inflammation.

Leeds research composed 60% of the evidence in the Carbohydrates and Health report, published by SACN in 2015.

In separate research conducted by Dr Evans, a systematic review of interventions to reduce Sugary Sweetened Beverages showed that educational interventions can significantly reduce consumption of sugary sweetened drinks in children and adolescents, but crucially not in adults. This change needed a wider environmental approach, such as a sugar levy and commitment from industry to reformulate beverages, to tackle high sugar consumption across the whole population.  This wider approach was more likely to address diet and health inequalities, such as high intakes of sugars in children and adolescents in more deprived households, more successfully than through education alone.

Leeds research highlighted the need for urgent policy action on sugars and fibre. Within three months of publication of the final report, UK government dietary guidelines were changed for free sugars, from 11% down to 5% of food energy and for fibre intake a recommended increase from 24g to 30g per day.

Public Health England (PHE) published a report based on the evidence, “Sugar Reduction: the evidence for Action”. This recommended a range of actions to reduce free sugars consumption including a Soft Drinks Industry Levy, which came into force in 2018, and the ‘Childhood Obesity Plan’ that incorporated actions to reduce sugar intake.

The industry levy gave the soft drinks industry two years to reduce the levels of free sugars present in sugary sweetened beverages. Data shows that between 2015 and 2018 there was a 35% increase in sales of lower sugar products exempt from the levy and a 40% reduction in sales of levied categories (equivalent to a reduction of 450,000 litres). A PHE report in 2019 found the levy had achieved a 3% reduction in foods and drinks overall and a 29% reduction in sugar levels of drinks. The Royal Society for Public Health, in 2019, voted the levy as the 2nd greatest public health achievement of the 21st century.

The SACN report has had international reach and is accredited in policy documents relating to sugars in Australia and New Zealand and has also been endorsed by the Australian Dental Association and the Australian Public Health Association.