DAVID HAMMOND PhD - Home - Stop Marketing to Kids...

SUGAR DAVID HAMMOND PhD

Applied Public Health Chair

2

DISCLOSURE

CONSULTANT / PAID SPEAKER / ADVISORY COMMITTEES

• Regulatory agencies e.g., Canada, Australia, UK, EC, etc.

• Non-governmental associations e.g., CCS, HSF

• International public health authorities e.g., WHO

PUBLIC HEALTH LITIGATION • San Francisco vs. American Beverage Association Warnings on SSB ads

• UK, Department of Health Point of sale legal challenge & Plain packaging

• Commonwealth of Australia Plain packaging

• Government of Canada Health care cost recovery litigation

• Uruguay Health warnings / “Single Presentation Rule”

• Irish Department of Health Plain packaging

• Class actions • Craft v. Philip Morris USA

• Milner v. Philip Morris USA

• Donovan et al. v. Philip Morris USA

SUGAR

Humans like sugar. A lot.

SUGAR

History

Global sugar consumption has risen from 5kg to 23 kg/person in past century. 1900-2013

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Canadian adults consume 26 teaspoons of sugar each day.

Source: Langois K, Garriguet D. Sugar consumption among Canadians of all ages. Statistics Canada, 2014.

Canadian children consume 33 teaspoons of sugar each day.

Source: Langois K, Garriguet D. Sugar consumption among Canadians of all ages. Statistics Canada, 2014.

SUGAR

Free-sugar intake

10% of total energy intake RECOMMENDED

5% of total energy intake SUGGESTED

World Health Organization. Guideline: Sugars Intake for Adults and Children. Geneva; 2015. http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf?ua=1.

SUGAR

Health effects

Direct health effects from excess energy intake are mediated through BMI and Type 2 diabetes.

HEART & STROKE

Ischemic heart disease Ischemic stroke Hemorrhagic stroke Hypertensive heart disease

CANCER Esophageal cancer Colon and rectum cancer Liver cancer Gallbladder and biliary tract cancer Pancreatic cancer Breast cancer (before menopause; after menopause) Uterine cancer Ovarian cancer Kidney cancer Thyroid cancer Leukemia

OTHER Type 2 diabetes mellitus Chronic kidney disease Osteoarthritis Dental diseases

SUGAR

Health effects

SUGAR

Health effects

Do sugars have a unique effect on obesity beyond energy intake?

Are sugars a direct cause of other diseases?

https://green-mom.com/natural-sugar-substitute-for-kids/#.WNvjk1XyuUk

Do all sugars have the same health effects?

NATURAL SUGAR SUBSTITUTES FOR KIDS

We’ve all heard about the dangerous health effects caused by refined white sugar and high fructose corn syrup (HFCS)…. …. let’s think of ways we can give our kids the occasional sweet treat without feeding them toxic refined white sugar or HFCS.

GREENMOM.COM

No evidence that ‘natural’ or ‘raw’ sugars are more healthy.

SUCROSE (table sugar)

50% fructose, 50% glucose HIGH FRUCTOSE CORN SYRUP 55% fructose, 45% glucose

"A rose by any other name would smell as sweet…’

SIMPLE CARBOHYDRATE

4 calories per gram of sugar

SUGAR IS SUGAR.

White sugar, brown sugar, raw sugar, honey, maple syrup, agave and corn syrup...

TOTAL SUGAR

Includes natural sugars in fruits and milk (‘lactose’).

World Health Organization. Guideline: Sugars Intake for Adults and Children. Geneva; 2015. http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf?ua=1.

SUGAR

Total, ‘added’ and ‘free’ sugars

‘ADDED’ SUGAR

Sugars added during the processing of foods, including syrups and honey, and sugars from concentrated fruit or vegetable juices.

‘FREE’ SUGAR

Same as added sugars, including sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates

500 ml

201 kcal

13 tsp

500 ml

244 kcal

12 tsp

60 kcal

3 tsp

SSB

Sugary drink?

SUGAR

Understanding sugar amounts

1 gram of sugar = 4 calories 4 grams = 1 teaspoon = 1 cube

Interventions to reduce sugar intake

Source: http://www.cbc.ca/news/health/obesity-research-confirms-long-term-weight-loss-almost-impossible-1.2663585

Need for primary prevention

Changes in sugar consumption driven by changes in food environment

POPULATION LEVEL

Changing product environments

FOOD ENVIRONMENT

Product innovation

SOURCE OF PROBLEM

Changing environments

66% off all packaged foods contain added sugar

63% Dairy drinks 3g vs 11g sugar

78% Sports/Energy drink/Flavoured water 4g vs 27g sugar

80% Juice 16g vs 24g sugar

FOOD ENVIRONMENT

Product ‘innovation’

177 ml

71 kcal

4.5 tsp sugar

500 ml

201 kcal

13 tsp sugar

Portion sizes.

FOOD ENVIRONMENT

Product innovation

Sugary drinks

Rapid delivery of high levels of sugar.

Low nutrient density.

Liquids ‘bypass’ physiological mechanisms that regulate appetite.

SOURCE: LANGOIS K, GARRIGUET D. SUGAR CONSUMPTION AMONG CANADIANS OF ALL AGES. STATISTICS CANADA, 2014. HTTP://WWW.STATCAN.GC.CA/PUB/82-003-X/2011003/ARTICLE/11540-ENG.HTM

SUGAR

Why focus on drinks?

“Liquid” sugar is a major source of energy intake.

500% Increase soft drinks consumption since 1950.

Sources: Langois K, Garriguet D. Statistics Canada (2014); Bray GA1, Popkin BM. Pediatr Obes (2013); Lasater G, Piernas C, Popkin BM. Nutr J. (2011).

60% Increase in SSB consumption among kids. 1989-2008

20% Proportion of calories from drinks among kids.

Sugar Sweetened Beverage Consumption

Fruit juice and fruit drinks are the largest source of sugar among Canadian children.

SOURCE: LANGOIS K, GARRIGUET D. SUGAR CONSUMPTION AMONG CANADIANS OF ALL AGES. STATISTICS CANADA, 2014. HTTP://WWW.STATCAN.GC.CA/PUB/82-003-X/2011003/ARTICLE/11540-ENG.HTM

SUGAR INTERVENTIONS

Industry opposition

http://www.canadianbeverage.ca/news-media/press-releases/canadian-beverage-association-statement-in-response-to-calls-for-taxation-on-sugar-sweetened-and-artificially-sweetened-beverages/

SSB interventions not needed:

SSBs have already declined.”

SOURCE: JONES AC, VEERMAN JL. HAMMOND D. THE HEALTH AND ECONOMIC IMPACT OF A TAX ON SUGARY DRINKS IN CANADA. MARCH 2017.


SUGARY DRINK CONSUMPTION

SUGARY DRINK CONSUMPTION

Sugary drink consumptions remains near historic highs.

SOURCE: USDA Economic Research Service 1947-87; Beverage Digest 1997-204, as cited in: https://cspinet.org/sites/default/files/attachment/liquid_candy_final_w_new_supplement.pdf.

Soft drink production in US 12 Oz CANS / PERSONS

Tobacco consumption in Canada PER CAPITA 1921-1995

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578 ml Youth 9 -18/ per day Estimated sugary drink intake 2015

NON-DIET POP

FRUIT JUICES & DRINKS

FLAVOURED MILK

FLAVOURED WATERS

ENERGY DRINKS

SPORTS DRINKS

SWEETENED TEA AND COFFEES

DRINKABLE YOGHURT


Total health care costs 2015-2041 (CAD)

SUGAR SWEETENED

BEVERAGES

SUGARY DRINKS

$33.7 billion

$50.6 billion

SUGARY DRINKS

Health & economic impact

Population interventions

Public education & communication

SOURCE: HTTP://WWW.CBC.CA/NEWS/POLITICS/FOOD-REGULATION-MARKETING-CHILDREN-JANE-PHILPOTT-1.3818267

PUBLIC EDUCATION

NUTRITION FACT TABLE

Proposed changes

46

Source: http://www.hc-sc.gc.ca/fn-an/alt_formats/pdf/label-etiquet/nutrition-facts-valeur-nutritive-fs-fr-eng.pdf

• Improvements in how sugars are labelled in ingredient list

•% Daily Value for total sugar

•No separate amounts of added sugars

SUGARY DRINKS

Front-of-pack labels

NFT new information

What additional information would you like to see on food products? N=2,001

8% “Other”

46% Allergy

47% Organic

61% Country of

origin

60% Genetically

modified

63% “High”

Symbols

Source: Hammond et al., Nutrition Facts Table: Consumer perceptions among young adults; 2014.

SUGARY DRINKS

Front of packs labels

SUGARY DRINKS

Public education campaigns

MARKETING RESTRICTIONS

SOURCES:

JOHN , 1999

POTVIN KENT M, DUBOIS L, WANLESS A. INTERNATIONAL JOURNAL OF PEDIATRIC OBESITY, 2011; 6: E433–E441.

POTVIN KENT M, DUBOIS L, WANLESS A. OBESITY (2011) DOI:10.1038/OBY.2011.161.

POTVIN KENT, DUBOIS & WANLESS, 2012)

•One fifth of TV ads seen by kids are food related.

• 90% of ads are for unhealthy foods and beverage.

•Children under the age of 5 cannot distinguish ads from content.

ADVERTISING REGULATIONS

Marketing to kids

MARKETING TO KIDS

Traditional Advertising

MARKETING TO KIDS

Online & social media

MARKETING TO KIDS

Food packaging

Self-regulation and voluntary

measures ineffective at reducing

marketing of unhealthy food to kids.

SOURCES: HARRIS, WEINBERG, SCHWARTZ, ROSS, OSTROFF, & BROWNELL, 2015; POTVIN KENT & WANLESS, 2014; HEBDEN, KING, GRUNSEIT, KELLY, & CHAPMAN, 2011; POWELL, SZCZYPKA,& CHALOUPKA, 2010

http://news.gc.ca/web/article-en.do?nid=1037069

Promote public health by….introducing new

restrictions on the commercial marketing of unhealthy

food and beverages to children, similar to those now

in place in Quebec…

MANDATE LETTER TO HEALTH MINISTER

SSB TAXATION

Price is among the most effective policy levers for modifying consumer behaviour.

Excise tax 20%

Yes.

MARKETING CHALENGES

Do SSB taxes work?

Powell L.M., Chriqui J.F., Khan T., Wada R., Chaloupka F.J. Obesity Reviews. 2013;14:110–128.

POLICY INNOVATION

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~10% tax on SSBs

~10% reduction in SSB sales

MEXICO SSB TAX

SSB TAX CHALLENGES

Industry opposition


“SSB taxes don’t work.”

http://money.cnn.com/2016/03/16/news/sugar-levy-uk-budget/

SSB TAX

Precedents

http://www.cbc.ca/news/politics/soda-tax-canada-1.3712411

Canadian sugary drink tax?

SSB TAX CHALLENGES

Population level impact

• Prevent 700,000+ cases of overweight and obesity

• 215,000 Type 2 diabetes cases

• 60,000 Ischemic heart disease cases

• 20,000 cancer cases

• $11 billion in direct healthcare cost savings

• $43 billion in annual revenue

ADAPTED FROM LONG ET AL. AM J PREV MED 2015;49(1):112-123.

20% EXCISE TAX ON SUGARY DRINKS 2015-2040

SSB TAX CHALLENGES

Industry opposition


“Taxes won’t solve obesity.”

http://www.theglobeandmail.com/report-on-business/rob-commentary/what-canada-can-learn-from-mexicos-sugar-tax-its-no-panacea-for-obesity/article28233833/

“As health economist John Cawley concludes in a

recent paper for the Journal of Health Economics,

there is no dominant cause of obesity and no magic

bullet that will reduce it.”

INTERPRETING POLICY IMPACT

https://publichealthmatters.blog.gov.uk/wp-content/uploads/sites/33/2015/11/obesity-map-full-hi-res-page-001.jpg

EVIDENCE

Policy measures work in a complementary, incremental manner.

POLICY IMPLEMENTTATION

Industry opposition & conflict of interest

Health Canada

Industry

NGOs

Conflict of interest

HTTP://WWW.EATRIGHTPRO.ORG/RESOURCES/ABOUT-US/ADVERTISING-AND-SPONSORSHIP/MEET-OUR-SPONSORS

Conflict of interest

Summary

• Sugar consumption makes an important contribution to excess energy intake, including sugar intake from beverages.

• Population-level interventions and policies will be required to reduce intake.

• Modest, incremental changes have substantial impact on health and economic burden from sugar intake.

Thank you.

David Hammond PhD

CIHR PHAC APPLIED PUBLIC HEALTH CHAIR

SCHOOL OF PUBLIC HEALTH & HEALTH SYSTEMS

UNIVERSITY OF WATERLOO

WEB [email protected]

EMAIL WWW.DAVIDHAMMOND.CA

TWITTER @DAVIDHAMMONDPHD

DAVID HAMMOND PhD - Home - Stop Marketing to Kids...

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