Sugar levy leaves bitter taste

A new government child obesity strategy, centred around a levy for high-sugar drinks, has been criticised for not doing enough to tackle the issue. We spoke to three psychologists about what had been missed, what better approaches there could be and what impact the existing strategy could have.

The UK-wide sugar tax will come into effect in April 2018, and drinks with more than 5g of sugar per 100ml will face a levy, while a higher tax will be placed on drinks with more than 8g per 100ml. Manufacturers have until that date to reduce the sugar content of their products, and money raised from the eventual levy will be put towards breakfast and sports clubs for children.

The strategy also recommends children get an hour of physical activity per day, half in school and half at home. Many have said the strategy lacks power and gently 'suggests' or 'promotes' where changes should be more stringent in the face of a population where up to a third of children are overweight or obese.

Chair in Biological Psychology and Health Behaviour at the University of Liverpool, Jason Halford, said he was particularly concerned about the strategy's focus on sugar. He explained: 'Both sugar and fat in the diet contribute to energy density, which in turn drives obesity in a twofold way. These types of food have weaker impact on appetite regulation and are also very palatable… both things drive increased consumption.'

Other than the tax, Professor Halford added, the strategy relies large on many voluntary aspects, an approach that is largely seen to have failed in the previous responsibility deal. This approach, introduced by the Department of Health in early 2011, asked food manufacturers to pledge to cut salt, fat and sugar content from foods: many believe it has done little to change eating habits.

Halford added: 'The new strategy said nothing about the promotion of high fat and sugar foods to children, which surprised me after the work of the Department of Health and Public Health England on the effects of marketing. This wasn't referred to at all. My impression is that it's been culled.'

Despite the health benefits of exercise, which the government encourages in its plans, Halford said a more efficient way to combat weight was first to focus on over-eating. He added: 'I'm not denying the many health and psychological benefits of exercise in any way, but getting people to eat less food has a greater impact on weight. You have to do a lot of exercise to work off one unhealthy snack. It's an easier intervention to focus on energy in than energy out.'

Lou Atkinson, a health psychology researcher from Coventry University, who shared many of the concerns that the strategy didn't go far enough, suggested our battle against obesity should start from an even earlier point – in utero. Atkinson also pointed to the strategy's lack of two key pieces of evidence put forward by Public Health England, which encouraged the government to tackle both advertising of junk foods to children and price promotions of unhealthy foods in supermarkets.

Atkinson told us she was positive about the sugar levy but nervous that the government's approach did not go far enough: 'If you look at tobacco, alcohol and the carrier bag tax, there's good evidence that financial interventions affect people's behaviour in terms of choices they make and benefits to their health. Although the sugar tax is mostly untested, small trials on a city level show reasonably good results, but it's unproven at a national level. There's a good chance it will work, but unfortunately price promotions and the voluntary nature of the changes the government are pushing for, in terms of reducing sugar content, or reformulating recipes, might wipe out any benefit we get from the levy,' she said. Atkinson pointed to a lack of help for parents in the new strategy, and said many have a lack of self-efficacy and confidence in restricting their children's diets and resisting the urge to give in to tantrums and pester power where unhealthy foods are concerned.

Much of Atkinson's work focuses on pregnancy and a child's early years, and she suggested that earlier interventions could also have been included by the government. Evidence has shown that babies born to mothers who had a high BMI at the start of pregnancy, or those who gain too much weight during pregnancy, are more likely to have a high birthweight and become overweight or obese later in life. Awareness-raising of this, and support for women to make healthy choices during pregnancy, could be valuable in giving children the best start in life. Atkinson added: 'Even in women who begin pregnancy with a healthy lifestyle, that lifestyle can get worse during pregnancy due to a number of perfectly understandable reasons, such as feeling nauseous, tired, and a relaxation of the social pressure to have a desirable body shape. Making healthy choices during pregnancy can be even more difficult than doing it outside of pregnancy, and yet it's so clearly linked to the trajectory of the offspring weight and health as they go through later life. The strategy has missed a trick there in providing support to mothers during this time.'

Professor in Health Psychology Jane Ogden (University of Surrey) said she was surprised the government hadn't fully acknowledged obesity as being a societal and environmental problem as much as an individual issue. News of the sugar tax (tinyurl.com/hlajdk7), she said, had given people the impression that the government would do more from a societal point of view. She added: 'I thought they'd start tackling the food industry, advertising and marketing, and take a higher-level approach. There'd been murmurings about that before the policy came out, but it looks like at the last minute they changed their minds and decided to push the responsibility back down to the individual.'

The government, however, Ogden added, is in a tricky position: 'It's a political position between being a nanny state, being involved and interventionist and being more libertarian, or traditionally right-wing,' she said. Although on the surface obesity may seem like a simple thing to tackle, it goes much deeper than individual choice, Ogden said: 'It's all about messaging; eating behaviour and exercise are individual behaviours and individuals do have to make choices and take control of their own behaviour. But you have to acknowledge that the environment you live in can make it very difficult to make those choices.'

Ogden pointed to a recent debates about obesity being a problem of both genetics and society, rather than the individual. 'It's a really complicated issue, because what you tell people can sometimes be very different to how you have to treat them. You need to send the message that obesity is a problem for the individual to encourage them to make healthy choices, whilst at the same time you also have to behave as if it's a social problem and tackle obesity at an environmental level,' she added.

According to Ogden, 'the environment needs to be changed in order for it to be easier to make healthier choices. For activity, this could be about providing cycle paths, better street lighting, or about public transport, schools increasing the numbers of hours of activity every day, or letting children do classes outside, just to be more physical. One of the bits of evidence I always find compelling is the dangers of being sedentary, and there's a need to make people aware of that. There also needs to be a focus on creating an environment where it's easier to be more active. It doesn't have to be about expensive gyms or swimming pools, just encouraging people to walk more or cycle more by making the environment better. And for eating behaviour it has to take the form of tackling portion sizes, food prices and marketing.' 

You can read the government's strategy in full at tinyurl.com/h4pawkv