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Taxing sugar

BMJ 2016; 352 doi: (Published 06 January 2016) Cite this as: BMJ 2016;352:h6904

Re: Taxing sugar

We are pleased that Sassi highlights the staggering growth of obesity rates in different countries and describes some of the considerable costs to society.(1) We are in agreement that a sugar tax will not be a “magic bullet” and should only be seen as one element of a long term multifaceted campaign.(2) Urgent action and a shift in momentum are needed in other areas.(3-6)

There is a pressing need for high quality health education to improve attitudes and knowledge about the health risks of a poor diet and what healthy dietary behaviour is. This should include better standardised nutritional information on all food and drink products.(7) There is also a need for action in different settings. Public health should work with catering staff, school nurses and teachers in schools using a whole-school approach to promote healthy eating and exercise. There are opportunities to promote enjoyable exercise in PE and sport but there are also other physical leisure activities available in school and in the community. Any activity which enables children and young people to be warm and breathless for significant periods of time which they enjoy and helps them overcome the barriers to participation brought about by disability, gender, religion and culture, should be valued.(8) Action is also needed in hospitals – it’s time to ban junk food on hospital premises and high quality appropriate food should be served to patients and staff.(9)

Fiscal measures to subsidise the sale of fruit and vegetables; work with manufacturers to alter portion sizes of some items and the salt content of certain foods; and, regulations to prohibit the marketing of unhealthy food products to young people should be implemented.(4,6)

In order to facilitate action in different settings such as schools, hospitals and workplaces a high impact long term media campaign is needed to encourage both professionals and the public to act and to keep this important public health issue in the spotlight. Doctors, nurses and other professional groups could be a tremendous resource but they must be given adequate time, and enough support by public health staff, if they are to fulfil their potential in this area.

Although many individuals and organisations have heralded the introduction of the sugar tax as a great victory, we do not think that this on its own will counter the obesity epidemic and it may even be counterproductive. We strongly feel that a national long term healthy eating strategy is needed now. It should not just focus on physical health: mental health and social norms should be included. In addition, it should not just target individuals but seek to change our obesogenic environments into health promoting ones.

1) Sassi F. Taxing sugar. An old idea with a new place in the fight against obesity? BMJ 2016;352:h6904.

2) Watson M and Lloyd J, 2015. Taxing sugar should be just one element of a multifaceted campaign BMJ 2015;351:h4388.

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

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

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

6) BMA Food for thought: promoting healthy diets among children and young people. London: BMA 2015.

7) Watson M 2013 Consistent food labelling system is rolled out across UK. BMJ Rapid Response 23rd June 2013.

8) Lloyd J, 2015. Compassion through development of physical and mental health and well-being. In, Towards the Compassionate School. Ed. Maurice Irfan Coles. London: Trentham Books/IOE Press. 2015.

9) Watson M and Lloyd J, 2013 It’s time to ban junk food on hospital premises. BMJ Rapid Response 1st July 2013.

Competing interests: No competing interests

21 March 2016
Michael Craig Watson
Associate Professor of Public Health.
Dr John Lloyd (Vice President Institute of Health Promotion and Education, Institute of Health Promotion and Education,
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA