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ALL PARTY PARLIAMENTARY
FOOD & HEALTH FORUM
SACN Carbohydrate & Health Report
5.30-7pm, Tuesday 27 October 2015
Committee Room 18, House of Commons
Minutes
Introduction
Lord Rea welcomed members and guests to the meeting. He reminded members that the Scientific
Advisory Committee on Nutrition (SACN) published its long awaited final report on carbohydrate
and health (supporting documents, PHE summary) on 17 July. The Government has been
considering SACN’s report since then. Public Health England (PHE) had also been working on a
review of the factors that influence how much sugar we consume and its report (supporting
evidence) was published, unexpectedly, last week following representations from the Commons
Select Health Committee and sustained media pressure on the Government to release it.
Professor Ian Macdonald, Chair, SACN Carbohydrate & Health Working Group
Professor Ian Macdonald began by explaining that the Scientific Advisory Committee on Nutrition
(SACN) is a committee of independent experts that advises the UK Government on the scientific
aspects of nutrition and health. It advises the Government on nutrition science not on nutrition
policies.
SACN’s carbohydrate working group’s terms of reference were to review the evidence on dietary
carbohydrate (not just sugars) and colorectal health, including colorectal cancer, bowel function,
and constipation. It was also asked to review the evidence on cardio-metabolic health (CVD, type
2 diabetes and obesity); and oral health. In addition it was asked to review the terminology,
classification and definitions of types of carbohydrates in the diet; and to review current dietary
reference values (DRVs), which are used for a variety of purposes, including catering, wider public
health and in a clinical context.
The SACN working group decided at the outset that it would only look at the highest quality
research studies. So, the evidence base used by SACN only included prospective cohorts and
randomised controlled trials (RCTs); it did not include ecological or cross-sectional studies. In
terms of study duration, the RCTs had to last at least 6 weeks, unless they were for outcomes on
body weight in which case their duration had to be at least a year. A previous WHO report had
included a much wider evidence base, but SACN took the view that such RCTS should last at least
a year and so show a sustained effect on body weight in order for SACN to be comfortable they
had a good basis for conclusions. SACN also stipulated that for cohort studies to be included in
the evidence base they had to last at least 3 years, although SACN placed no limit on study
duration for colorectal health. The research also had to be focussed on healthy subjects - that is
those without overt chronic disease. Several thousand studies were considered against these
criteria and narrowed down to 600 publications that were included in the SACN assessment.
For its recommendations on dietary fibre, SACN recommended a move to the AOAC based
definition, which includes resistant starch and oligosaccharides, rather than the Englyst definition of
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Food & Health Forum
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fibre. SACN also insisted there needed to be evidence of physiological benefit to the person in
order for a substance to be considered as fibre. This was a message for the food industry as much
as for public health benefit.
SACN’s main conclusions on fibre were that there is strong evidence that increased intakes of total
dietary fibre, and particularly cereal fibre and wholegrain, as they are classified in the SACN report,
are associated with a lower risk of cardio-metabolic disease and colo-rectal cancer.
SACN also recommended that the definition of dietary fibre should be broadened.
For adults the dietary reference value (DRV) for the average population intake of dietary fibre
should be 30g/day and for children the average population intake ranges from 15g/day to 30g/day
depending on their age (see slide 5). This is an increase in the previous DRVs, which date back to
1991. There is not much evidence of health benefit beyond 30g/day, which is why SACN set its
recommendation at that level.
SACN recommends that dietary fibre intake should be obtained from a variety of food sources.
SACN concluded that fibre is of clear benefit for colorectal health and cardiometabolic health. The
risk of cardiovascular disease (CVD) falls with increasing levels of total fibre intake and there is
evidence of similar benefit for other disease outcomes (see slide 6).
SACN found no consistent effect of total carbohydrate on risk markers for cardiovascular disease
or type-2 diabetes.
When SACN looked at the evidence on total carbohydrate and weight management, it found that
higher carbohydrate, lower fat diets are certainly more effective than lower carbohydrate, higher fat
at reducing BMI and weight when overall energy intake is restricted. But SACN found no
association between total carbohydrate intake and energy intake. SACN’s recommendation on
total carbohydrate was that the dietary reference value (DRV) for total carbohydrate should be
maintained at a population average of approximately 50% dietary energy, as it has been for the
last 24 years.
Looking at the evidence base for conclusion on sugars, SACN found that the prospective cohort
studies indicate that: higher consumption of sugar and sugar-containing foods and drinks is
associated with a greater risk of dental caries (10 studies); and greater consumption of sugarsweetened beverages (SSBs) is associated with increased risk of type-2 diabetes. This is not a
trivial risk: the evidence shows around a 20% increase in risk for each 330ml/day increase in SSB
consumed (5 studies). SACN could not uncover any scientific explanation for this evidence, but the
observation is a matter for concern.
The evidence from RCTs indicates that in adults, increasing or decreasing the percentage of total
dietary energy as sugars when consuming an ad libitum (at one’s pleasure/unrestricted) diet leads
to a corresponding increase or decrease in energy intake (11 studies). In children and adolescents,
consumption of (SSBs), as compared with non-calorically sweetened drinks, results in greater
weight gain and increases in body mass index (3 studies).
Ian Macdonald showed a slide that illustrates the meta-analysis of studies looking at sugar
consumption and energy intake (see slide 10), which shows the majority of studies demonstrate a
positive benefit (lower energy intake) associated with a lower intake of sugars.
SACN defined “free sugars” as sugars added to food, and naturally present in honey, syrup and
fruit juice. It recommended that the dietary recommendation for free sugars should be set at a
population average of around 5% dietary energy for age groups from 2 years upwards. It also
recommended that consumption of sugars-sweetened beverages by children and adults should be
minimised because of their relevance to energy intake, weight gain for children, dental caries, and
the risk for adults of type-2 diabetes.
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Dr Alison Tedstone, National Lead for Diet & Obesity, Public Health England (PHE)
Dr Alison Tedstone began by confirming that governments across the UK have accepted SACN’s
recommendations on carbohydrate and health and it is being integrated into all the public health
advice given by these governments, for example through Change4Life. Alison emphasised that in
the PHE report and throughout her remarks to FHF members ‘sugar’ is used as a short hand term
for all sugars added to food and those released from foods during process, including those in fruit
juices.
As Ian said, SACN recommends that the average population intake of sugar should not exceed 5%
of total dietary energy for age groups from 2 years upwards; and consumption of sugar-sweetened
beverages (SSBs), by children and adults, should be minimised. As Ian’s slides showed there is a
lot of evidence on SSBs.
Looking at what SACN’s advice means, we can see that it is the equivalent of children having
between 3 and 7 teaspoons a day of sugar depending on their age (see slide 2), assuming a
teaspoon represents 4-6g of sugar. The size and weight of sugar cubes varies, but if the
recommendations were translated into sugar cubes, assuming a 4g (Silver Spoon) sugar cube has
been used it would be 5-7 sugar cubes a day.
Looking at UK sugar intakes compared to the new SACN recommendation, we can see that all age
groups and both sexes consume in excess of SACN recommended levels (see slide 3). There has
been no reduction in sugar intake over recent years.
If we look at the main contributors to sugar intakes in the UK, we can see that for children (aged 4
to 18 years) and for adults (aged 19-64) they are broadly the same. Sugars come from a range of
foods, but SSBs are a significant contributor (about a third for adults and children). Other
significant sources of sugars are biscuits, buns, cakes and pastries; sugar and chocolate
confectionary, fruit juices; and dairy deserts including yoghurts. Alcoholic drinks are another
significant source of sugars for adults (see slide 5).
Assuming the SACN recommendations to reduce sugar intakes to 5% of energy intake are
achieved within 10 years, the cost saving to the NHS is estimated to be about £500 million per
annum (pa) by year 10 to the NHS alone, due to reductions in the costs associated with dental
caries and, more significantly the costs of the consequences of obesity, especially type-2 diabetes.
SACN’s report is a major source of evidence informing the development of the Government’s
thinking on sugar as is the new PHE work. These are both influencing childhood obesity strategy
for England being developed by the Department of Health.
PHE has undertaken a numbers of reviews to inform the new report. These included reviews on
the impact of advertising and marketing and the impact of fiscal measures, an analysis on the
effect of price promotions and an assessment of the approaches to reducing the sugar content of
the food supply. PHE also considered the areas of knowledge, training and local action and have
taken forward updates of the 5-A-Day scheme and the eatwell plate following SACN’s advice.
PHE undertook a mixed methods evidence review of the impact of marketing high sugar foods and
drinks on preferences, purchasing and consumption. It is clear from this that children are more
exposed to more advertising now than they ever have been before. The “take home” message of
all this research is that advertising works! For this review PHE shortlisted 544 papers, including 45
primary research studies, during its review of the current literature on the impact of marketing
targeted at high sugar food and non-alcoholic drinks. It also undertook interviews with key
informants. Most of this evidence focuses on children. Primary research shows marketing is
effective in influencing purchasing or consumption of high sugar food including through: advertising
(television & print), advergames, price discounting, end of aisle displays, cartoon/spokes
characters, branding and product size. There is a lot of talk about new media, but television
advertising is a major source of the advertising seen by children, as is print media including adverts
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on things like billboards and buses. The evidence is relatively consistent, but of moderate quality.
At the moment there are no tight controls over non-licenced carton characters, such as the Coco
Pops monkeys, or over sports personalities promoting products.
The evidence shows that “place in store” is effective: one study showed that end of aisle positions
lead to a 50% increase in sales of sugar sweetened drinks.
PHE’s evidence portion size does affect the amount of calories consumed and the effect of portion
size has just been confirmed by a Cochrane Review.
PHE also found one study that looked at the impact of sponsorship, which showed that it did have
a positive effect on sales, but more research is required for sponsorship, as well as digital and
online marketing, except for advergaming. There is a small amount of evidence on texting, which
again shows it is effective in influencing food choices.
Kantar Worldpanel purchasing data from the last 2 years (from a continuously reporting panel of
30,000 British shoppers) was used to assess the impact of price promotions of high sugar foods on
purchasing in UK retailers. Promotions in Britain are the highest in Europe and account for 40% of
the food and drink we buy; in Germany and France, the next highest, food promotions account for
20% of food and drink bought. Different social groups may respond in slightly different ways, but
we do all respond and in roughly the same way. This work did show that promotions lead to
expansion of all food and drinks categories, consumers are not just switching from one brand to
another. Promotions encourage people to buy and spend more overall, by more than 22%, and
this effect is consistent.
The research also showed that foods high in added sugar are promoted more frequently and at a
greater discount than non-high sugar items, b. Naturally high in sugar products, such as fruit and
vegetables are promoted less with the exception of fruit juices that are which are deeply promoted.
The Kantar research showed that if the promotion of high sugar food and drinks was no longer
permitted, it would lead to a 6% reduction in sugar purchases.
PHE also undertook a mixed methods review of fiscal measures. This looked at the evidence from
countries which have introduced taxes on unhealthy food and produce some evaluation of impact..
The review covered current literature (from 2010 onwards) and interviews with key informants on
the impact of fiscal measures targeted at high sugar food and non-alcoholic drinks. Early sales
data from 5 countries (Norway, Finland, Hungary, France and Mexico) show a reduction in sales of
soft drinks/SSBs following implementation of the tax. A 10% tax on SSBs in Mexico resulted in an
average reduction in purchases of 6% in 2014. The evidence shows that in the short term there is
some reduction in purchasing around the time a tax on high sugar foods and SSBs is introduced,
but we can not be certain whether this is because of a “halo” effect the introduction of the tax or an
independent effect of the price increase. The evidence is relatively consistent, suggesting taxes on
high sugar foods and drinks reduce purchases, at least in the short term, but the evidence is of
moderate quality. The effect appears to be proportional to the size of the tax implemented.
Modelling suggests taxes need to be set at a relatively high level (around 10% to 20%) to have an
effect on purchases.
There is no evidence of the long term effects of sugar taxes on the nutritional quality of the diet or
health, or the impact on different population groups.
The lessons learnt from salt - where there is still more to do - suggests a similar, voluntary, broad,
structured programme, with targets, rigorous monitoring and evaluation, and proactive approach
should reduce sugar intake.
The evidence suggests that a cap on portion sizes could be a way of reducing sugar and calorie
intake.
PHE looked at whether reducing sugar or reducing sweetness would be the best way forward for
food reformulation and found that it is hard to be sure which way forward would be best. A
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literature review of ‘sweetness’ suggests there is limited evidence as to whether approaches to
sugar reduction should be focused on removing sugar with or without replacement with an artificial
or intense sweetener. The evidence we have suggests that if you want to reduce sugar
consumption quickly, sweeteners would be necessary at least in part to secure progress. If one
takes the view that more gradual progress is acceptable, then gradually reducing the sugar content
in mainstream food products – as the food industry has gradually reduced the salt content in our
food – will secure positive change with very little public awareness of the change in their food. The
reformulation modelling suggests that a 50% reduction in the average sugar content of key food
groups would reduce mean sugar intake to about 9% of energy for adults (from 12%) and about
10% for teenagers and children (from around 15% for both groups).
The fat/sugar see-saw analysis suggests that reducing the sugar content of foods would not
necessarily result in an increased fat content.
PHE has produced catering guidance to help people meet Government buying standards for food
and catering services (GBSF), and those who wish to go further, so it is clear that the SACN sugar
and fibre recommendations are achievable.
Last summer (2014), when PHE published its first report on the sugar challenge, it tested various
messages on consumers and found, slightly to its surprise, that very direct and clear messages
were welcome. Hence the development of the key Change4Life messages “that sugary drinks
have no place in a child's daily diet”; and we should swap to water, lower fat milks, sugar free, diet
and no added sugar drinks instead of SSBs. PHE will continue to look at Change4Life messaging
to increase consumer awareness and support efforts to ensure that our diets are more aligned with
SACN’s recommendations
Overall the evidence collated and assessed by PHE suggests that the following levers could be
successful in reducing the amount of sugar consumed in the UK:

Reducing and rebalancing the number and type of price promotions in all retail outlets including
supermarkets and convenience stores and the “out of home” sector, including restaurants,
cafes and takeaways.

Significantly reducing opportunities to market and advertise high sugar food and drink products
to children and adults across all media including digital platforms and through sponsorship.

The setting of a clear definition for high sugar foods to support other steps being taken.
Currently the only regulatory framework for doing this is via the Ofcom nutrient profiling model,
which would benefit from being reviewed and strengthened.

Introducing a broad, structured and transparently monitored programme of gradual sugar
reduction in everyday food and drink products, combined with reductions in portion size.

Introducing a price increase of a minimum of 10-20% on high sugar products through the use
of a tax or levy such as on full sugar soft drinks, based on the emerging evidence of the impact
of such measures in other countries.

Adopting, implementing and monitoring the Government buying standards for food and catering
services (GBSF) across the public sector, including national and local government and the
NHS to the ensure provision and sale of healthier food and drinks in hospitals, leisure centres
etc.

Ensuring that accredited training in diet and health is routinely delivered to all of those who
have opportunities to influence food choices in the catering, fitness and leisure sectors and
others within Local Authorities.

Continuing to raise awareness of concerns around sugar levels in the diet to the public as well
as health professionals, employers, the food industry and other stakeholders; encouraging
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action to reduce intakes and providing practical steps to help people lower their own and their
families’ sugar intake.
Alison emphasised that it is unlikely that a single action alone would be effective in reducing sugar
intakes. The evidence suggests that a broad, structured approach, involving restrictions on price
promotions and marketing, product reformulation, portion size reduction and price increase on
unhealthy products, implemented in parallel, is likely to have a more universal effect.
Positive changes to the food environment – for example through public sector food procurement
and the provision and sales of healthier foods - as well as information and education are also
needed to help support people in making healthier choices.
Questions
Professor Jack Winkler of Food and Behaviour Research asked the speakers to comment on
sugar consumption in the UK. He expressed support for SACN’s key recommendations, but
concern about under-reporting of sugar consumption, noted by SACN, and SACN’s reluctance to
express a “reasoned judgement” on the evidence, such as it is, of the amount of sugar we actually
eat. Ian Macdonald said we need to distinguish between total calories and the percentage of
dietary energy consumed as sugar. He suggested it does not matter if the amount of sugar
actually consumed is under-reported, so long as its proportion in the average diet is accurate,
because SACN’s recommendations concern the proportion of sugars within the diet. If underreporting across food groups varied it could be problematic, depending on what population groups
you were looking at, but SACN has not seen convincing evidence on this, so it thinks it is
appropriate to assume that it is likely to be consumption of foods high in sugar, salt and fats that
are under-reported. As technical analysis of food residues in urine improves we will have better
data on this in the future. Alison Tedstone added that there are differences in under-reporting by
age: it is much lower in children and lower again in very young children. She also noted that this
problem is not confined to nutrition; smoking is also under-reported and the amount of exercise
taken is over-reported. We need to be careful not to make sweeping statements for which there is
limited evidence.
Lord Rooker said he would support a sugar tax, but does not think this will happen and asked, if
there is the political will to implement PHE’s other recommendations, how beneficial they are likely
to be without a sugar tax. Alison Tedstone said that in terms of effectiveness in reducing sugar
consumption, PHE had ranked food reformulation and tackling advertising and food promotions,
above a tax on sugar. The sales data evidence from Mexico shows a 6% reduction in SSB
purchases associated with their tax and PHE’s view is that there is evidence to support a SSB tax
in the UK, but the other measures could be very helpful even without such a tax. Ian Macdonald
said that food reformulation is the critical issue because people will not stop wanting to eat cakes
and biscuits. He referred to some recent media reporting of the industry links of scientists also
advising the UK Government and said that in his view both the food industry and the Government
are entitled to receive the best advice. The food industry has been reformulating food for a long
time, but sugar is not just in our food to make it sweet; it confers other properties that the food
industry needs so it is a challenge to reduce the sugar content of our food. Responsible parts of
the food industry are grappling with this challenge and they should be encouraged. Ian added that
he believes technological advances will enable the food industry to reduce the sugar content in our
food. Alison Tedstone agreed with Ian Macdonald and said this is one reason why PHE thinks
portion size is important. She welcomed the steps that some parts of the food industry have taken
to reduce portion size and calorie content, which shows that it can be done, and said PHE would
like to see more food companies taking this approach.
Lord Rea asked if there is any recent evidence on progress in reducing the salt content of our food
and Alison Tedstone said that robust data on this would be published next year.
Patricia Mucavele of the Children’s Food Trust said that the school food regulation had had a
major impact on the amount of sugar consumed in schools and suggested we should have a rights
based approach to this issue and, for example, extend the scope of the regulations to places
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where children take physical exercise, such as leisure centres, and restaurants where they eat.
Alison Tedstone agreed that the “out of home” sector is very important as we now consume 20%
of our calories out of home. One of the lessons of the salt reduction campaign was that the out of
home sector was slow to respond to it and it still has not done as much as food producers and
retailers to reduce the salt content of its food.
Lindsay Bagley of the Institute of Food Science and Technology noted the success of the salt
reduction initiative, but said that a lot of the “low hanging” fruit had been taken (where salt was
present for taste rather than for technical reasons) and further progress would be more difficult.
She said it would be much easier for the food industry to reduce sugar content if they are allowed
to use sweeteners more extensively and asked if there might be regulatory changes to enable the
food industry to do this. Alison Tedstone accepted that there are some challenges associated
with reducing the sugar content of our food but said that some drinks companies have reduced
sugar content by 4% without sugar replacement so we know that this can be done. Lindsay
Bagley suggested it would be difficult to go further than that without using sweeteners, but if the
food industry were allowed to use sweeteners more widely then it could achieve much bigger
reductions in sugar content. Alison Tedstone emphasised that PHE does not expect huge
changes in food reformulation to be achieved immediately: they are suggesting a programme of
work that would result in reformulation over a number of years. PHE recognises that this may be
challenging to achieve, but in some areas it should be possible to make good progress. Alison
questioned the necessity of soft drinks containing 9 tea spoons of sugar or yoghurts having a 25%
sugar content. Ian Macdonald agreed and said that SSBs are a real concern. He said the official
portion size for adults is 250ml, but most products are sold in supermarkets in much larger
volumes. He called for more common sense in the catering industry as well as among food
producers to help consumers understand what a sensible portion looks like. He emphasised that
we also need to be careful about proportions. He said Alison was referring to a 4% reduction in the
sugar content of soft drinks which typically have a sugar content in the range of 10-11% (ie
grammes of sugar per 100ml of drink) and he suggested that most people would not notice any
difference in taste associated with a change of that magnitude. Ian said that the best progress had
been made on salt as food manufacturers gradually reduced the salt content of their products. He
agreed reducing sugar content is challenging and said technological innovation would be required
to achieve it. Alison Tedstone pointed out that there is still some “low hanging fruit” in terms of
salt content and cited the comparative salt content of pizzas sold in supermarkets and from
takeaways, which showed there is room for further progress there.
Lord Rea asked about the sugar content of fruit juice and the use of artificial sweeteners. Alison
Tedstone said the sugar content of fruit juices is similar to that of cola drinks and PHE supports
the European Food Safety Authority’s (EFSA’s) conclusions on the safety of artificial sweeteners.
PHE would like all children to drink just water or low fat milk, but that is not realistic so PHE
advised parents to switch children to low sugar drinks. Ian Macdonald said that the current adult
portion size for fruit juice is 150ml, less for children, but this is much less than you are offered in
restaurants and by the food industry. We need more information for consumers about sensible
portion sizes and after children (and adults) drink fruit juice it would be good for their teeth if they
drank water. Alison Tedstone said that the Kantar data shows that fruit juices are heavily
promoted and it would be good if this stopped.
Lord Rea asked how applicable the voluntary work on salt reduction is to sugar consumption given
that people like sweet tasting foods. Alison Tedstone said that most of the sugar we eat is
already in our food, not added by us to it, so there is a lot of scope for sugar content reduction.
Sarah Toule of the World Cancer Research Fund said that there is low public awareness of
portion size and most of the public are unlikely to be aware of SACN’s recommendations. Given
that it may take a long time to implement the changes recommended by PHE, she asked if any
work is being done to update traffic light labelling to reflect SACN’s recommendations. Alison
Tedstone said that nutrition labelling is an EU competence, but the SACN report is being
discussed with the EU by officials. The UK is rightly proud of its traffic light food labelling which
has been very important, not just because it informs the public but also because it has encouraged
food reformulation.
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Donna Neary of the Agriculture and Horticulture Development Board asked if the sugar content of
milk was included in SACN’s report and whether all 5 SACN recommendations had been accepted
by the UK Governments. Alison Tedstone said that sugars naturally present in milk were not
included, but added sugars – for example, in a milk shake – were included. She confirmed that all
5 recommendations have been accepted by all the UK Governments, but noted that SACN had not
made any recommendations on fibre in relation to obesity. Donna Neary asked if PHE would be
discussing the inclusion of fibre in nutritional labelling with the EU because it is not a mandatory
requirement at the moment. She also asked if the UK Government would do more to promote the
importance of fibre in the diet. Alison Tedstone said she is not involved in discussions with the EU
on nutrition labelling but she thought this issue would be raised by UK officials, although sugars are
a higher priority for them at the moment. She said Change4Life messaging will include information
on fibre and other public health tools are being reviewed at the moment to include fibre, though
PHE is not planning a specific fibre campaign. She added that the evidence does not support the
suggestion that eating more fibre helps with weight management. Ian Macdonald said his
research group had looked at the evidence on 4 major commercial diets and the evidence was the
same for all of them – successful weight management depends upon adherence to the diet. The
evidence SACN reviewed did not suggest that a high fibre diet led to a reduction in obesity, but it
did have positive impacts on various serious chronic diseases, especially for colorectal diseases.
Ian noted that about 12.5% of the UK population meets the 30g/day recommended level, so we
know that that is feasible. Alison Tedstone said that some people do eat the recommended levels
of sugar and the new menus devised by PHE show that it is possible to do this on a realistic diet.
Dr Jenny Lisle of the Royal Colleges of Physicians Faculty of Public Health suggested that current
levels of childhood obesity in the UK suggest that implementing measures to achieve SACN’s
recommendations should be an urgent priority and expressed concern that this does not seem very
likely given the views expressed by the Government to date. Alison Tedstone said that SACN’s
recommendations are made to the Government and we are all waiting with interest to see what will
be in the Government’s childhood obesity strategy, which is expected to be published in the New
Year. She added that obesity in the UK has been increasing over many years and reducing levels
of obesity is also likely to take many years; the speed of any change will depend upon the political
will to implement the measures that can help. Ian Macdonald noted that type-2 diabetes used to
be associated with people whose pancreas had effectively become exhausted and was not
working properly, but it is now associated with being over-weight and it is occurring in people at a
younger and younger age. It is not the role of SACN to tell the Government what to do, but if he
was in charge he would seek to develop a sensitive approach to help overweight and obese
children eat healthily and take exercise, whilst ensuring that children who are not overweight also
receive this guidance. We need to be careful to avoid stigmatising certain groups of children.
Ian Macdonald also noted that the Treasury faces an awkward problem. Over the long term
public health measures that prevent ill health occurring are very cost effective, but in the short-term
the Government still needs to meet the cost of treating people with chronic diseases, so it cannot
easily meet the cost of health prevention work by transferring resources from treatment to
prevention. We need to prevent overweight children from becoming over-weight adults, but in the
short-term additional spending is needed for health prevention work to achieve long term savings.
Alison Tedstone agreed and said that PHE is aware that many local government public health
services are at risk of budgetary cuts.
Dr Alison Boyd of Sugar Nutrition UK asked for an update on the eatwell plate. Alison Tedstone
said that she expects it to be updated in the New Year. She added that although it is an important
tool used by health professionals, the information it provides is not going to solve the nation’s
obesity problem.
Nicole Madden of Cambridge Catering expressed concern that while they teach how much sugar
is in a baked potato on diabetes programmes, the general public does not understand how much
sugar is in their food. Ian Macdonald expressed concern about what is said about the sugar
content of potatoes. While the starch in a hot baked potato can be rapidly broken down to glucose,
absorbed and raise blood sugar levels, if you ate the same potato when it was cold, the starch
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would be digested more slowly and blood sugar levels would rise more gradually, as with salad
potatoes. The important point is that potatoes contain starch not sugar. Carbohydrates in bread
and vegetables are broken down to produce free sugars but it is wrong to describe those foods as
containing glucose. SACN did look at the contribution to the diet of starch in food, as well as
sugars, and on the whole did not see the same effect on health outcomes as they did for sugars.
SACN had, for example, looked at rice studies which suggested an increased risk to health with
high intakes but these are not relevant for the UK population because we do not eat nearly as
much rice as is commonly eaten in some other countries. SACN had also restricted its evidence
base to studies of healthy people, so it did not consider the impact of diet on people with diabetes.
Alison Tedstone said that in broad terms people with diabetes were advised to follow the same
advice on a healthy diet as other people.
Nicole Madden asked when Alison expected school meals to reflect the SACN advice that free
sugars should not make up more than 5% of the diet. Alison Tedstone said that school food
already excludes SSBs, but as they do include puddings they do not currently meet the 5% target.
Earl Baldwin of Bewdley asked if the sugars naturally present in fruit are less bad for you than
sugars added to drinks. Alison Tedstone said that the evidence SACN looked at suggests that
the natural, intrinsic sugars in intact fruit are not a problem. Ian Macdonald said that fruit
contributes important nutrients and SACN does want them to be part of our diet. Ideally more of
our fibre would come from proportionately more vegetables than fruit because they contain less
sugar and contribute a range of valuable nutrients, but there is no evidence to demonise fruit
consumption.
Conclusion
Lord Rea thanked both speakers for their excellent presentations. He said it had been very
interesting to hear about the SACN report and the new PHE report, and the substantial evidence
for action collated by it, and it is now up to the politicians to act on it. He suggested the problems
of obesity and type-2 diabetes in the UK mean that action is quite urgent and we can now all see
that the sugar tax is not the only way forward, even if it is desirable.
CLC, October 2015
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