Intended for healthcare professionals


A substantial tax on sugar sweetened drinks could help reduce obesity

BMJ 2013; 347 doi: (Published 31 October 2013) Cite this as: BMJ 2013;347:f5947

Re: A substantial tax on sugar sweetened drinks could help reduce obesity

We agree with Dr Block and other public health researchers that tax should be added to sugar sweetened drinks (1). But, on its own it may have little effect and may even be counterproductive.

It is well known that many major retailers in the past have used fiscal measures to successfully alter the purchasing behaviour of their customers. Health promoters have also effectively used fiscal measures (2,3). In addition, it is clearly stated in the Ottawa Charter, a seminal document of the new public health, that it is one of the complementary approaches that can be utilised (4). However, the Charter also mentions that it is coordinated action that is needed to promote health including providing information and skills through education and, creating health promoting settings. Getting people to change their behaviour must not be the sole goal – the crucial task is to improve their health.

We believe that in general, health promoters should not just be involved in tinkering around with one tool for bringing about changes in behaviour – the obesity epidemic needs a well-structured comprehensive programme. For example, in relation to fiscal measures, taxes on less healthy foods should be combined with subsidies on healthier foods such as fruit and vegetables. Moreover, in addition to fiscal measures, a diverse range of approaches are needed including: developing personal skills; creating supportive environments; and reorienting health services so that they move increasingly in a health promotion direction (4,5). Some of these measures were recently included in “Measuring Up: The Medical Profession’s Prescription for the Nations Obesity Crisis” (6).

Schools can be a very important setting for health promotion where much more can be done. Activities here can complement fiscal measures, for example providing information about the sugar content of food and drinks and introducing alternative healthier options though science and personal, social and health education (PSHE). Teachers, catering staff and school nurses are just some who potentially have important roles to play across and beyond the curriculum. Additionally, the recent Chief Medical Officer’s Annual Report (7) highlights the need to widen access to sports facilities in order for children and young people to exercise more easily. However, they will need external support if they are to fulfil their health promoting roles.

Obesity has reached epidemic proportions and should be considered one of the most serious public health challenges as its consequences include heart disease, cancers and diabetes (8-12). Curbing this epidemic will require a population-based multisectoral and multi-disciplinary approach. Fiscal measures should be included but they should be one element of a comprehensive mulitifaceted campaign. Government action is urgently needed to ensure this is prioritised and that momentum is maintained in the long term.

1) Block J. Editorial. A substantial tax on sugar sweetened drinks could help reduce obesity BMJ 2013;347:f5947

2) World Health Organization, Global strategy on diet, physical activity and health. Geneva: World Health Organization, 2004.

3) Townsend J. Price and consumption of tobacco. Br Med Bull. 1996;52(1):132-42.

4) World Health Organization. Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.

5) Watson M. Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.

6) Academy of Medical Royal Colleges. Measuring Up: The Medical Profession’s Prescription for the Nations Obesity Crisis. London: Academy of Medical Royal Colleges 2013

7) Department of Health. Annual Report of the Chief Medical Officer, 2012, Our Children Deserve Better: Prevention Pays. London: Department of Health 2013

8) Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obesity Reviews, 2004, 5(Suppl 1):4–104.

9) Foresight. Tackling Obesities: Future Choices – Project Report. Government Office for Science: London. 2007

10) World Health Organization. Global status report on noncommunicable diseases. Geneva: World Health Organization, 2010.

11) World Health Organization. Population-based approaches to Childhood Obesity Prevention. Geneva: World Health Organization, 2012.

12) NICE. Local government public health briefings - Preventing obesity and helping people to manage their weight. London: NICE, 2013

Competing interests: No competing interests

11 November 2013
Michael C. Watson
Associate Professor in Public Health
Dr John Lloyd (President Institute of Health Promotion and Education.)
University of Nottingham
Faculty of Medicine and Health Sciences, D86, Queen's Medical Centre, Nottingham. NG7 2HA