Katharine Jenner RNutr, Director of Action on Sugar, discusses the role of reformulation in ‘turning the tide on obesity’ in Sugar Awareness Week 2021

Whether ‘tis nobler to make small improvements to the foods people already buy and eat. Or to take arms against processed foods, and by opposing, end them?*

During Shakespeare’s time, sugar was still an expensive commodity and reserved for special occasions, not so in 2021.  This year, during Sugar Awareness Week, 8– 14 November 2021, Action on Sugar is raising awareness of the health impacts of consuming excess sugar (and calories) every day from snacking.  The aim of the week is to get people talking about the importance of reducing sugar, and to encourage food and drink companies and the government to act, so we can all have access to healthier snacks.

Reformulation of food and drink products usually takes place through gradual, unobtrusive changes to recipes, for example, to remove allergens, adjust ingredients, or to reduce harmful nutrients such as salt, saturates and sugar. This can happen in packaged foods as well as in restaurants, cafes, and takeaway foods. Reformulation can improve population diets by improving the nutritional composition of food and drinks.  However, in some food categories, and this is particularly true of processed snack foods such as confectionery and biscuits, there are products that can only become ‘healthier’ rather than ‘healthy’.

Reformulation alone will not shift population diets to those containing fewer processed products and more fresh foods overall. For this to be achieved we need comprehensive system changes including further curbs on marketing and a societal shift towards a world where wholesome food is available and affordable to all, but that will take time.  Until then, we can ensure that the foods that are currently available and affordable to all, can be improved.  As evidenced in the Obesity Health Alliance’s Healthy Weight Strategy, Turning the Tide[1], modelling studies suggest that, when people continue to buy and eat products that have been reformulated,[2] the larger the improvement in food composition, the more significant the impact on nutrients and calories purchased and consumed[3] – suggesting that people do not compensate by eating more.

The primary issue is not that reformulation wouldn’t work; it is that food companies have come up with all manner of excuses not to do it, from supply chain issues to Covid-19.  Rather than the government imposing regulation, they continue to insist that ‘they will do it voluntarily’ – however, the industry doth protest too much, methinks.*

Whilst we can point to the success of the (voluntary) salt reduction programme, which saw large reductions across entire categories (average salt consumption fell 15% from 9.1g to 8.4g a day over a 10 year period, with a corresponding fall in blood pressure[4]), to date the similarly voluntary sugar reduction programme has led to just a 3% reduction in sugar content overall. Some categories such as cereal and yoghurts have made good progress, while others, including snacking foods such as confectionery, have made minimal progress and even seen increases in sales-weighted averages.[5] There are currently no targets for commercial baby foods and snacks, many of which have added sugar or salt, or contain ingredients that are high in free sugars or salt, so it’s safe to say no progress has been made there either.

In contrast, the mandatory Soft Drinks Industry Levy (SDIL), which aimed to encourage manufacturers to reduce the sugar content of their drinks through voluntary reformulation to keep their drinks out of reach of the levy, has shown that regulatory levers can be highly effective. By February 2019, only 15% of soft drinks were liable for the levy, compared to 52% before its announcement in 2015.[6]  This equates to a fall in average sugar content in soft drinks of 29%, without harming sales.[7]

Voluntary reformulation targets have now proven themselves to be insufficient.  With no incentive for food companies to shift their business models towards those that favour healthier foods, they will not work. Reformulation targets need teeth.  Particularly in categories where voluntary approaches have not driven progress, such as in biscuits, confectionery, and baby snacks.

Governments can play a key role to incentivise food manufacturers to improve the health of their products, and Action on Sugar support the Obesity Health Alliance’s recommendations to see further gains from reformulation in their Healthy Weight Strategy by:

  1. Introducing a fiscal lever on food and drink manufacturers to incentivise further reformulation of processed food.
  2. Improving the nutritional content of infant food by strengthening the existing commercial infant and baby food and drink reformulation programme to fully align with WHO Europe recommendations for sugar and salt. Commit to the introduction of a regulatory lever (such as fines or sanctions) for manufacturers that do not reformulate their products by 2024.

Plus those recommendations that will act as further incentives to reformulation, such as restrictions on marketing and promotions, clear and honest nutrition labelling (to include free sugars), transparent reporting and evaluation.

This Sugar Awareness Week let’s champion the policies that can accelerate reformulation, and sleep, perchance to dream*, of turning the tide on obesity towards healthier weight for everyone.

*With apologies to all fans of Shakespeare, literature, and the English language.

 

 

 

[1] Turning the Tide, A 10-year Healthy Weight Strategy, Obesity Health Alliance

http://obesityhealthalliance.org.uk/wp-content/uploads/2021/09/Turning-the-Tide-A-10-year-Healthy-Weight-Strategy.pdf

[2] M. Gressier et al. 2020 ’Healthy foods and healthy diets: how government policies can steer food reformulation’ Nutrients 12(7): 1–9 https://www.mdpi.com/2072-6643/12/7/1992

[3] C. Federici et al. 2019 ‘The impact of food reformulation on nutrient intakes and health: a systematic review of modelling studies’ BMC Nutr 5: 2 https://doi.org/10.1186/s40795-018-0263-6

[4] F.J. He et al. 2013 ‘Salt reduction in the United Kingdom: a successful experiment in public health’ Journal of Human Hypertension 28(6): 345–52 https://doi.org/10.1038/jhh.2013.105 and Action on Salt 2020 ‘UK salt reduction timeline’ http://www.actiononsalt.org.uk/reformulation/uksalt-reduction-timeline/

[5] PHE 2020 Sugar Reduction: Report on Progress between 2015 and 2018 https://www.gov.uk/government/publications/sugar-reduction-progressbetween-2015-and-2018

[6] P Scarborough et al. 2020 ‘Impact of the announcement and implementation of the UK Soft Drinks Industry Levy on sugar content, price, product size and number of available soft drinks in the UK, 2015–19: a controlled interrupted time series analysis’ PLoS Medicine https://doi. org/10.1371/journal.pmed.1003025

[7] L.K. Bandy et al. 2020 ‘Reductions in sugar sales from soft drinks in the UK from 2015 to 2018’ BMC Med 18: 20 https://doi.org/10.1186/ s12916-019-1477-4