Prioritisation of sugar to tackle obesity
Authors: Rhea Saksena, Lucas Scherdel
Journal: The Lancet Global Health (2015)

The global burden of obesity is well documented. In 2014, more than 1·9 billion adults were overweight (body-mass index ≥25 kg/m2), and more than 600 million of them were obese (body-mass index ≥30 kg/m2).1WHOObesity and overweight fact sheet number 311. Updated January, 2015. World Health Organization, Geneva2015http://www.who.int/mediacentre/factsheets/fs311/enGoogle Scholar Obesity is regarded as a risk factor for many chronic diseases such as cardiovascular disease, diabetes, and musculoskeletal disorders.2WHOWhat are the health consequences of being overweight? Updated March, 2013. World Health Organization, Geneva2013http://www.who.int/features/qa/49/enGoogle Scholar Populations with undernutrition now also face the paradoxical double burden of malnutrition as a result of increasing obesity prevalence.3Swinburn BA Sacks G Hall KD et al.The global obesity pandemic: shaped by global drivers and local environments.Lancet. 2011; 378: 804-814Summary Full Text Full Text PDF PubMed Scopus (2895) Google Scholar More than 50% of low-income countries have no recommendations on food and beverage consumption.4Roberto CA Swinburn B Hawkes C et al.Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking.Lancet. 2015; 385: 2400-2409Summary Full Text Full Text PDF PubMed Scopus (576) Google Scholar Together, these factors place health-care systems of developing countries at risk of being unable to respond effectively to the resulting burden of disease. On March 4, 2015, WHO released its first guideline on sugar intake for adults and children.5WHOGuideline: sugars intake for adults and children. World Health Organization, Geneva2015http://www.who.int/nutrition/publications/guidelines/sugars_intake/enGoogle Scholar We acknowledge WHO's efforts to emphasise high sugar intake as a risk factor for obesity, dental caries, and non-communicable disease.5WHOGuideline: sugars intake for adults and children. World Health Organization, Geneva2015http://www.who.int/nutrition/publications/guidelines/sugars_intake/enGoogle Scholar Although these recommendations represent progress to address the obesity epidemic, they must be followed up by further action. Evidence of positive results has been noted in countries that have introduced taxation of products high in sugar content, restrictions in marketing and advertising of these products, and voluntary self-regulation by the food industry.6Brownell KD Farley T Willett WC et al.The public health and economic benefits of taxing sugar-sweetened beverages.N Engl J Med. 2009; 361: 1599-1605Crossref PubMed Scopus (552) Google Scholar, 7Wang YC Coxson P Shen YM et al.A penny-per-ounce tax on sugar-sweetened beverages would cut health and cost burdens of diabetes.Health Aff. 2012; 31: 199-207Crossref PubMed Scopus (133) Google Scholar, 8Brownell KD Frieden TR Ounces of prevention—the public policy case for taxes on sugared beverages.N Engl J Med. 2009; 360: 1805-1808Crossref PubMed Scopus (353) Google Scholar However, there is still an unmet need for more comprehensive policy interventions by governments and industries alike. Multilevel and multiparty action is needed. Solutions could include increased government regulation of the food industry and therefore improved safeguarding of the nutritional quality of food. To achieve this goal, the food industry needs to recognise the potential health effects of products high in sugar content. Such recognition could foster improved cooperation between the food industry and governments to create more responsible and binding legislation than that presently seen. Ultimately, efforts should be shifted to focus on the political and economic systems that drive food choices, rather than to solely change consumer behaviour and individual lifestyle choices. Although the sugar intake guidelines remain insufficient at present, youth advocates are taking a lead to mobilise civil society. On March 7, 2015, the International Federation of Medical Students' Associations, which represents 1·2 million students from more than 100 member organisations, reached a consensus in support of a resolution on prioritisation of sugar to address the obesity epidemic.9International Federation of Medical Students' AssociationsIFMSA policy statement prioritising sugar in the obesity epidemic.http://www.ifmsa.org/content/download/666685/8080208/file/PS_2015MM_Prioritising_Sugar_in_the_Obesity_Epidemic.pdfGoogle Scholar Endorsed by a two-thirds majority, the policy is the first of its kind to place a call on the food industry and governments to move from voluntary, self-regulated action to more binding, state-led legislation regarding the sugar content of food. The policy specifically calls on the industry and governments to act in the best interests of health by reformulation of sugar content in foods. Cooperation is needed from all stakeholders at all levels: more ambitious legislation by governments, more industry cooperation to improve the nutritional value of foods, and greater civil-society dynamism to directly tackle the role of industry as a driver in the worldwide obesity epidemic. We declare no competing interests. RS and LS are members of Medsin-UK, the UK national membership organisation of the International Federation of Medical Students' Associations. The global obesity pandemic: shaped by global drivers and local environmentsThe simultaneous increases in obesity in almost all countries seem to be driven mainly by changes in the global food system, which is producing more processed, affordable, and effectively marketed food than ever before. This passive overconsumption of energy leading to obesity is a predictable outcome of market economies predicated on consumption-based growth. The global food system drivers interact with local environmental factors to create a wide variation in obesity prevalence between populations. Full-Text PDF Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinkingDespite isolated areas of improvement, no country to date has reversed its obesity epidemic. Governments, together with a broad range of stakeholders, need to act urgently to decrease the prevalence of obesity. In this Series paper, we review several regulatory and non-regulatory actions taken around the world to address obesity and discuss some of the reasons for the scarce and fitful progress. Additionally, we preview the papers in this Lancet Series, which each identify high-priority actions on key obesity issues and challenge some of the entrenched dichotomies that dominate the thinking about obesity and its solutions. Full-Text PDF