To fight obesity and other related life-threatening diseases, the World Health Organization (WHO) in October 2016, advocated for countries to impose tax on sugary drinks. It also presented new findings on the health benefits of such a tax, which would curb the obesity menace that has nearly trebled since 1975.
It would also tackle the ripple effect of obesity-related Non Communicable Diseases (NCDs) like heart disease, osteoarthritis, stroke, gout, high blood pressure, tooth decay, caries, diabetes, cancer, gallbladder disease, and gallstones.
Dr. Douglas Bettcher, director of the WHO’s Department for the Prevention of Non-Communicable Diseases, said in a statement then that if governments tax products like sugary drinks, they can reduce suffering and save lives. “They can also cut healthcare costs,” he said.
There are two types of taxes: one for drinks with a total sugar content of more than 5g per 100ml. A second higher one is on drinks with 8g per 100ml or more. A 355ml (12 fl oz) can of Coca Cola contains 39g of sugar.
The sugar tax also forces companies to reduce sugar in their products to get into the lower tax category.
Although this proposition has been fraught with controversy, with the attempt to increase the tax by up to 50 per cent in some countries causing stand-offs between beverage companies and health ministries, it has in recent times gained grounds with countries beginning its implementation.
South Africa and Britain are the newest to join the trend, after others like Mexico, France, and Belgium.
Since France implemented the tax in 2012, soft drinks consumption has reduced, and water sale increased. Also in Mexico, renowned for its love of Coca Cola, an analysis of sugary drinks purchases showed a 5.5% drop in 2014 after the tax was introduced followed by a 9.7% decline in 2015, averaging 7.6% over the two-year period.
South Africans are among the top 10 consumers of soft drinks, and the market more than doubled from 1998-2012, with 15 to 24-year-olds being high consumers. Experts say sugary drinks have no nutritional value, but the average 500ml fizzy drink contains around 10 spoons of sugar.
Research reveals that a 20% tax on sugary drinks will reduce obesity by 3.8% in men and 2.4% in women, resulting in 220,000 fewer obese adults.
In Nigeria, Abuja housewife, Sylvia Obahor, has no worry over the price hike of fizzy drinks. She is determined her children would not be obese, and has completely taken them off such drinks.
This is the reason she makes homemade alternatives. Zobo (also known as Bissap, is made from the specie of hibiscus flower known as the Roselle), or kunu (a drink mostly made from milled millet, sorghum, or maize). At weekends there are treats which could include any of, or all of pastries, pizzas, and ice cream.
The mother of three said, “I don’t like them drinking soft drinks because of the sugar and other artificial ingredients.”
Weekly, she makes at least 15 litres of either drink, “Very concentrated, so that they are rich and the children can benefit from the nutrients.”
Making a drink like zobo as concentrated as hers, is rather unappealing to the palate of her children ages eight to four, who complain: “Mummy makes zobo like she wants to dye cloth.” After they eventually abandoned it, she was forced to increase the sugar she uses. For every 15 litres, she now uses 600 to 700 grams of sugar.
Yet, Obahor is concerned her second child, at age five, is visibly tilting scales in obesity’s direction. This is as a National Bureau of Statistics Survey on Nigeria reveals that Bayelsa State has the highest under-five child overweight prevalence rate of 2.9%, while Nasarawa and Taraba states each have 2.4%.
According to the WHO, 41 million children under the age of five were overweight or obese in 2016, and over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.
Obahor worries her child may be adding to the WHO obesity statistics. But is she adopting the right measures to nip it in the bud?
In this regard, a clinical dietician at the Garki Hospital, Abuja, Oluwayemisi Abidakun RD, said Obahor could do more by introducing a fruit or vegetable blend that takes care of adding sugar to the drinks, and more importantly, help her children cultivate a water-drinking habit early on. “Children love food presentation, so making it attractive would also be beneficial.”
The expert also said tackling childhood obesity requires action from all. “Government, industry, schools, and the public sector, all have a part to play in supporting healthier choices for children. Reducing obesity will save lives and decrease inequalities,” she said.
Abidakun added: “The goal is to reduce their rate of weight gain, while allowing normal growth and development.” She also warned that children should not be placed on a weight-reduction diet without the consultation of a healthcare provider.
While the advocacy is geared towards reducing the consumption of sugary drinks, through the tax, there should also be focus on other foods fuelling obesity and related NCDS impeding proper early childhood development.
In this light, Tatjana Milenkovic, a professor of Internal Medicine at the Medical Faculty in Skopje, Macedonia, in an email response said, “There is a lot of sugar in fast food also, especially in large burgers and French fries, we should therefore limit the portion size to cut the sugar. In 12 French fries sticks there is one carbohydrate serving and around 120-140 kcal. Not just sugary drinks, but also junk food, fried food. Chips are full of carbs, saturated fat, trans fats, high caloric value, and should be taken in limited portions.”
Milenkovic, who was a panellist at the recently-concluded World Health Assembly, at a side event on nutrition education to tackle obesity and prevent diabetes among children, also said the food industry should be forced to exclude trans fats from food, to limit portion size, and to mark clear the content of fat and calories in different foods.
The expert added that awareness should increase among the general population, on what is healthy food. “And finally – although this could be very difficult – to forbid advertising unhealthy food.”
Bitter truth about sweet food and drink
According to the WHO’s guidelines on sugar intake for adults and children, free sugars contribute to the overall energy density of diets, and may promote a positive energy balance. Sustaining energy balance is critical to maintaining healthy body weight and ensuring optimal nutrient intake. There is increasing concern that intake of free sugars – particularly in the form of sugar-sweetened beverages – increases overall energy intake and may reduce the intake of foods containing more nutritionally adequate calories, leading to an unhealthy diet, weight gain and increased risk of NCDs.
Another concern the guideline raised is the association between intake of free sugars and dental caries. Dental diseases are the most prevalent NCDs globally, and although great improvements in prevention and treatment of dental diseases have occurred in past decades, problems still persist, causing pain, anxiety, functional limitation (including poor school attendance and performance in children) and social handicap through tooth loss.
The treatment of dental diseases is expensive, consuming 5-10% of healthcare budgets in industrialized countries, and will exceed the entire financial resources available for the healthcare of children in most lower income countries.
