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