#SugarTax

I had a great opportunity last week to weigh in on the Sugar Tax announcement made by our controversial South African Finance Minister Pravin Gordhan in the Annual Budget Speech for 2016.

For the full interview with Aubrey Masango on 702 Radio please click here.

So how does sugar, and more specifically the type of sugar added to Sugar Sweetened Beverages (SSBs) effect your body. SSBs are generally defined by their added sweeteners in the form of high-fructose corn syrup (HFCS) and or sucrose. These beverages range in product from fruit-juice concentrates, soft drinks, energy drinks, lemonades, sweetened iced teas, vitamin water drinks and many others (1). An interesting side note to this debate is the high sugar content of some of our favourit sauces like mayonnaise, tomato, HP, Mrs Balls Chutney and Sweet chilli sauces (5).

These sugars are metabolised by the liver into fat. Increased levels of sugar leads to more fat storage and higher glycemic load which has been connected to increased risk of obesity and type 2 diabetes (2). Apart from these clearly negative associations SSBs provide little to no other nutritional benefits and have in fact also been linked to increased risks of dental caries and fractures (4).

A recent study of South African Households SANHANES (South African National Health and Nutrition Examination Survey) found that almost 1 in 5 participants (more than 25000 people took part in this survey, across socio-economic backgrounds) had impaired glucose homeostasis with a prevalence of this along with diabetes above 10% in 5 out of our 9 provinces (3). The highest %’s being Asian/Indian Females from Urban Formal Areas in the Free State (a close second to KwaZulu Natal at 26%) (3).

Finance Minister (still in position as of today 3.2.16) Pravin Gordhan announced an estimated 20% tax to be implemented from April 2017 in his public Finance Speech. A couple of things are relevant to this discussion:

1. Will this really effect consumers and reduce them purchasing these SSB’s?

2. Is there evidence to show this type of tax has any positive results on public health?

3. Will this expand deeper into the sugar industry and effect more products?

4. How much money will the government make off of this and where will this money go?

I am no economist but I do hope that even this small increase in the price of SSB’s will have an effect on ALL peoples buying choices. Perhaps the most dramatically affected would be those in lower income brackets. The evidence that taxing SSB’s is effective in reducing consumption and or obesity is still not extremely conclusive but countries like Mexico have started implementing such taxes and quote recent stats of a 10% decrease in SSB consumption with a 10% tax implementation (16). Interesting and thought provoking when you compare their SSB intake which is estimated to be 164L per person per year (17). There have been predictions by researchers that the 20% tax will reduce energy intake by about 36kJ per day, obesity by 3.8% in men and 2.4% in women and the number of obese adults would decrease by over 220 000 (18). Will this tax bleed into other foods?

From a nutritional point of view I would hope that more can be done to impact the pockets fast food industry and that the foods on the shelf where held accountable for their labelling and ingredients. But convenience food is a huge industry with many benefactors so it is not likely this call for change would be heeded without a drastic shift in priorities globally. Already the beverage industry has taken a stab at the idea this tax would curb increases in obesity (19). The government stands to earn an estimated R7 billion a year from the 20% SSB tax, so for now thier benefit wins out (19). This revenue is earmarked for re-investment into public health but no real strategy has been released, which does leave much to be desired of their intentions.

The most important point to be made here I believe is no matter what the governments true ambitions are through implementing this tax on SSB’s let the overall consequence be that we begin to raise awareness on the pressing issues at hand:

- 13.5% of our children and adolescents are overweight/obese.

- Sugar and Sugar Sweetened Beverage consumption is too high, reducing consumption has positive health benefits and could reduce obesity and type 2 diabetes (4,1,2,16).

- Type 2 diabetes and NCD (Non-Communicable diseases) are on the increase.

- The average South African’s unhealthy food behaviours are influenced by social and physical environmental factors including: energy rich foods involved in socialising, easily available and low cost fast food outlets, the overuse of technology most noteworthily the TV, pressure on household spending and the use of cars for transport which has shown to be linked with decreased physical activity levels (6;7;8;9;10;11;12;13;14) to name a few.

- Younger generations (15-24yrs) have been shown to be more likely to have meals prepared outside of the home (3).

The picture painted World Wide is that there are HUGE health issues developing because of higher sugar and fat rich diets and sedentary lifestyles (15). The encouraging and (it must be said) vital information is that we can do SO MUCH to prevent disease through taking responsibility of what we put into our bodies. Increased amounts of sugar has such a steeply adverse effect on our bodies, our only rational response to this information is to reduce our consumption of it drastically.

References:

1. Andrew A. Bremer, MD, PhD; Robert H. Lustig, MD (2012) “Effects of Sugar-Sweetened Beverages on Children”. Pediatric Annals; 41 (1): 26 - 30

2. Willett W, Manson J, Liu S. (2002) “Glycemic index, glycemic load, and risk of type 2 diabetes.” American Journal of Clinical Nutrition; 76 : 274S - 280S.

3. Shisana O, Labadarios D, Rehle T, Simbayi L, Zuma K, Dhansay A, Reddy P, Parker W, Hoosain E, Naidoo P, Hongoro C, Mchiza Z, Steyn NP, Dwane N, Makoae M, Maluleke T, Ramlagan S, Zungu N, Evans MG, Jacobs L, Faber M, & the SANHANES-1 Team (2014) South African National Health and Nutrition Examination Survey (SANHANES-1): 2014 Edition. Cape Town: HSRC Press.

4. Apovian CM. (2004) “Sugar-sweetened soft drinks, obesity, and type 2 diabetes.” Journal of the American Medical Association ;292 :978–9.

5. “How much sugar is in Sa’s most popular sauces vs. a can of coke.” Available online at: http://www.viralbru.com/sa-sauces-vs-coke-sugar/

6. Schneider M, Norman R, Steyn N & Bradshaw D (2007) “The South African Comparative Risk Assessment Group: Estimating the burden of diseases attributable to low fruit and vegetable intake in South Africa in 2000.” South African Medical Journal 97(8): 717–723

7. Steyn NP, Burger S, Monyeki KD, Alberts M & Nthangeni G (2001) “Seasonal variation in the dietary intake of the adult population of the Dikgale.” South African Journal of Clinical Nutrition 14(4): 140–145

8. Reddy SP, Panday S, Swart D, Jinabhai CC, Amosun SL, James S, Monyeki KD, Stevens G, Morejele N, Kambaran NS, Omardien RG & Van den Borne HW (2003) “Umthenthe Uhlaba Usamila: The South African Youth Risk Behaviour Survey 2002.” Cape Town: South African Medical Research Council, Available at : http://www.mrc.ac.za/healthpromotion/reports.htm

9. McVeigh JA, Norris SA & De Wet T (2004) “The relationship between socio-economic status and physical activity patterns in South African children.” Acta Paediatr 93: 982–988

10. Hughes GD, Puoane T & Bradley H (2006) “Ability to manage diabetes: Community health workers’ knowledge, attitudes and beliefs.” Journal of Endocrinology, Metabolism and Diabetes of South Africa 11(1): 10–14

11. Bradley HA & Puoane T (2007) “Prevention of hypertension and diabetes in an urban setting in South Africa: Participatory action research with community health workers.” Ethnicity & Disease 17(1): 49–54

12. Reddy SP, Panday S, Swart D, Jinabhai CC, Amosun SL, James S, Monyeki KD, Stevens G, Morejele N, Kambaran NS, Omardien RG & Van den Borne HW (2003) “Umthenthe Uhlaba Usamila: The South African Youth Risk Behaviour Survey 2002.” Cape Town: South African Medical Research Council, Available at: http://www.mrc.ac.za/healthpromotion/reports.htm

13. Prista A, Maia AJ, Saranga S, Nhantumbo L, Marques AT & Beunen G (2005) “Somatic growth of a school-aged population from Mozambique: trend and biosocial meaning.” Human Biology, 77: 457–470

14. Bradley HA & Puoane T (2007) “Prevention of hypertension and diabetes in an urban setting in South Africa: Participatory action research with community health workers.” Ethnicity & Disease,17(1): 49–54

15. Uauy R, Kumanyika S, Seidell J, Swinburn B, Mann J, Steyn N, Parsons N (2003) “WHO/FAO release independant Expert Report on diet and chronic disease” Available online at: http://www.who.int/mediacentre/news/releases/2003/pr20/en/

16. Barquera S, Campos I and Rivera J. A. (2013) “Mexico attempts to tackle obesity: the process results, push backs and future challenges.” Obesity Reviews, 14 (2), 69 - 78.

17. Valadez B. Desplaza México a EU en consumos de refrescos de cola, (2012) [WWW document].

Available at: http://www.milenio.com/cdb/docnoticias2011/4d61be05ee00877e942fca43bc3ac46e Milenio: Mexico.

18. Manyema, M, Lennert J. Veerman, Chola L, Tugendhaft A, Sartorius B, Labadarios D, and Hofman K. J. (2014); 9(8): e105287. “The Potential Impact of a 20% Tax on Sugar-Sweetened Beverages on Obesity in South African Adults: A Mathematical Model” Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4138175/

19. Donnelly L (2016) “Tax on soft drinks could benefit obese SA” - Published online 5 Feb 2016, Available online at:

http://mg.co.za/article/2016-02-04-tax-on-soft-drinks-could-benefit-obese-sa

#sugartax #sugar #nutrition #food #nitrition #nutritionist #sasugartax #sapolitics