EVIDENCE-BASED HEALTH BENEFITS OF

REDUCED SUGAR CONSUMPTION:

OBESITY AND WHOLE-HEALTH

Dr Rachel Pryke

GP and Clinical Lead for Nutrition, Royal College of

General Practitioners

MY BACKGROUND

GP and trainer in Redditch, Worcestershire

RCGP Clinical Lead for Nutrition for Health

Author Weight Matters for Children and

Weight Matters for Young People, Radcliffe

Publishing

Member Academy of Medical Royal Colleges

Obesity Steering Group and RCP Obesity

working party

Author of many obesity e-Learning sessions

AIMS OF SESSION

• Recognise the hidden burden of obesity

and lack of recognition of its impact

• SACN report - clear call for action based

on strengthened evidence

• Look at correlations between increased

sugar and health problems, particularly

dental caries, obesity and hence type 2

diabetes.

• Supporting consumers in the tsunami of

choice

•Opportunities for food industry

engagement to support individuals

SUGAR - DOUBLE-EDGED DELIGHT

• Food has evolved into a common emotional

currency and cure for misery - Nutrition now

a peripheral factor

• Sensation of hunger is now blurred with

boredom, loneliness, anger, sadness, and a

general desire for gratification

• Employment/economic drivers mean no

political desire to demonize consumption

• Instead - voluntary agreement, the

Responsibility Deal, for commercial partners

to sign up to health-related changes

‘NORMALISATION’ OF OBESITY

NORMALISATION OF CHILD OBESITY

• NCMP evaluation demonstrates that 3/4 parents of

overweight and obese children do not recognise their child

to be overweight

•Where acknowledged, 41% parents do not perceive

overweight to be a health risk

• Cultural factors as well as deprivation contribute to high

levels of obesity among black and South Asian children

BMI DISTRIBUTION: YEAR 6 CHILDREN NATIONAL CHILD MEASUREMENT PROGRAMME 2012/13

7

Patterns and trends in child obesity

BMI z score

Girls

Boys

1990 baseline

2nd centile

85th centile

91st centile

95th centile

98th centile

SACN REPORT - 2014

• Highlighted complex and incomplete

evidence base

• Low fat diets support weight loss

• Increased free sugar correlates with

increased calorie intake

• People do not compensate for

calories in drinks. Soft drinks provide

almost a third of sugars in children

aged 11-18

SUGAR AND OBESITY

•Complex factors influence weight - including

deprivation and 'cultural norms'

•Strong correlation with changes in average

consumption and in population weight trends.

•Adipose tissue is inflammatory - strongly linked

to metabolic syndrome, obstructive sleep

apnoea, cancer, PCOS and fertility problems

•Sugary drinks are displacing milk consumption

with detrimental effect on intake of other

nutrients found in milk

SUGAR AND FAT ARE BOTH IMPLICATED IN OBESITY

DIABETES AFFECTS 4.5% UK POPULATION

• Commonest complications

• heart disease and stroke,

• retinopathy (blindness),

• nephropathy (kidney failure),

• neuropathy (nerve damage),

• shortened life expectancy

• Impacts on

• health service costs

• loss of employment

• sick pay/benefits

• carers and families

• Can we allow this to become 'normalized'?

TEETH

• Dental caries - almost a third of 5 year olds have tooth decay -

despite widespread fluoridation of water supplies

• Demonstrates widening health inequalities and geographical as

well as socio-economic inequality. 21% 5 year olds have tooth

decay in South East England compared to 35% in North West

• Evidence is clear that increased sugar consumption is detrimental to

oral health

• Dentition impacts on malnutrition risk in later life

Effect of frequency of sugar rinses on lesion depth when

fluoride toothpaste or a nonfluoride toothpaste is used.

Touger-Decker R , and van Loveren C Am J Clin Nutr

2003;78:881S-892S

DIETARY FIBRE

•Reduced intake of dietary fibre, despite

food industry development of

'wholegrain' products

•Dietary fibre, particularly wholegrain

intake is beneficial to cardiovascular

disease, fasting lipids, blood pressure,

diabetes, constipation and colorectal

cancer

•Colo-rectal cancer is third commonest

cancer in UK, most of which is sporadic

not familial, with environmental factors

being important

CONSUMER/PATIENT CONCERNS

How can families

establish a liking for the

ordinary?

Nanny state-ism

and nudge

theory – over or

under-employed?

BEHAVIOURAL NORMS - NOW CHAOTIC

• What is UK staple diet? nobody now

knows!

• Food hierarchy has been lost

• Default choices are unhealthy

• Healthy things perceived costly and

complex

• Making the healthy choice the easy choice

• Fear and demonisation of hunger rather

than recognition of its prime signaling

function

GUILT FROM EATING

• Can be profound

• Can food industry help to reduce guilt and

promote appropriate consumption and hence

enjoyment of foods?

• Hunger lessened by structured and consistent

approach to meals and snacks

• Marketing of 'good plain sense‘ is not sexy

“Cereal is my binge food! If I start

with something else I always end up

eating bowl after bowl of cereal in

a binge.. so hard to stop! I can't wait

until I do not binge anymore.”

INFLUENCING 'DEFAULT' CHOICES

• Dieting requires effort which is typically

transient – more important are default

choices made without much thought

• Altering expectations - not missed if not

expected

• Make healthier products more acceptable

- raise acceptance of artificial sweeteners

• Campaign to reduce reliance on

'sweetness' – only takes around 2 weeks to

adjust to unsweetened tea and coffee

LEARNING TO LIKE …

• Repeated calm exposure

• Eating together

• Seeing others enjoying it

• Forbidden foods are preferred

• Forced foods are hated

• Positive food associations

• Minimising negative food

associations

MANAGING EXPECTATIONS…

• Stronger focus on treats being occasional

• ‘Save it ‘til Sunday’

• Avoid using food as reward. Sell

alternatives - stickers, small toys and

certificates in the confectionary isle?

• Food structures – teach restraint, help

children to recognise hunger as a useful

signal not sign of terror

• Coping with hunger – distraction, routine,

expectation

CAN THE ANSWERS TO OBESITY AND SUGAR REDUCTION WORK FOR THE FOOD INDUSTRY?

• Product ranges to embrace health needs

• Improved ‘behavioural’ education on

packaging and marketing campaigns

• Targeting specific groups and conditions- e.g.

people at risk of malnutrition

•Move away from the illogical concept of

‘children’s food’

• Harm reduction – e.g. timing of snacks, sugar

free gum after confectionary

• Smaller and more varied portion sizing - the

option to buy 3 sausages?

RESOURCES

• RCGP Nutrition webpages - search on ‘RCGP Nutrition’

http://www.rcgp.org.uk/clinical-and-research/clinical-

resources/nutrition.aspx

• RCGP Obesity and malnutrition e-learning modules

http://elearning.rcgp.org.uk/course/info.php?id=147&popup

=0

• Tackling obesity through the Healthy Child Programme

http://www.noo.org.uk/Mary_Rudolf

Introduction to Obesity and malnutrition study day, March 17th 2015 at

RCN,- suitable for all primary care staff