By David Blane:
League tables are everywhere, and no-one wants to be bottom of the class. In terms of health indicators, considerable efforts have been made across Scotland in recent years to shrug off the unfortunate title of “sick man of Europe”, but another dubious accolade is up for grabs. With some of the worst obesity figures among OECD countries – almost two-thirds of adults and a third of children were considered to be overweight in 2013  – Scotland is in danger of topping the chart as the “fat man of Europe”.
The causes of obesity are multiple and complex, but recent media attention has focussed on the role of sugar in the so-called ‘obesity epidemic’. [Health warning: fans of Scotland’s ‘other national drink’, Irn Bru (which contains about 7 heaped teaspoons of sugar per 330ml can), should stop reading now!] In brief, and unsurprisingly, there is good evidence that regular consumption of soft drinks with added sugar (known as sugar sweetened beverages or SSBs) is associated with weight gain and obesity, diabetes, heart disease and poor dental health . Furthermore, temporal trends in rising SSB intake have been associated with similar trends in obesity prevalence, although figures vary between countries and self-reported consumption of SSBs is often considerably underestimated.
The momentum behind what has become known as the ‘sugar tax’ is building. In July, the Scientific Advisory Committee on Nutrition (SACN) published its final report on Carbohydrates and Health, in which it recommended that people consume no more than 5% of their daily calorie intake from sugar – half as much as the previous recommendation of 10%.
In August, celebrity chef Jamie Oliver launched an online petition calling for a tax on sugary drinks. At the time of writing, over 150,000 people have signed (Parliament considers all petitions that get more than 100,000 signatures for a debate). In an official response, the UK Government stated that it has “no plans to introduce a tax on sugar-sweetened beverages.” Its plans for tackling childhood obesity are due to be published by the end of the year, but have already been mired in controversy. The Government’s initial decision not to publish Public Health England’s (PHE) advice on childhood obesity was described as “completely disgraceful” by Dr Sarah Wollaston, Conservative MP and chair of the Health Select Committee.
The report, “Sugar Reduction: The evidence for action”, was made public at the end of October and made eight recommendations, including the introduction of a price increase of a minimum of 10% to 20% on high-sugar products through the use of a tax or levy. It cites evidence from Norway, Finland, Hungary, France and Mexico, where the imposition of taxes on SSBs has resulted in reduced consumption.
So, the evidence behind a sugar tax looks promising, but it will only address one of the ‘three As’ of Affordability, Accessibility and Acceptability, known to be effective in reducing consumption (e.g. of cigarettes or alcohol). There is a long way to go to make SSBs less accessible and acceptable, but for advocates of a sugar tax the focus on children appears to be doing just that.
In ‘Jamie’s Sugar Rush’, the Channel 4 documentary that coincided with the launch of the petition, the most powerful and emotive scenes all featured children: a child in London going under general anaesthetic to have sugar-rotted teeth removed; a baby in Mexico drinking Coca-Cola straight from the bottle. A statement from the Faculty of Public Health puts it in stark terms: “We need to think of diet as a child protection issue, given the long-term consequences to our children’s health of obesity”.
Of course, obesity does not just affect children and the proposed sugar tax would have a significant impact on adult health too. A 2013 study in the BMJ estimated that a 20% duty on SSBs would reduce the number of obese adults by 180,000 (or 1.3% of all obese adults) . What further evidence do policy makers need? The Scottish Government, like its Westminster counterpart, has no current plans to introduce a sugar tax, but is awaiting “with interest” the outcome of three reviews on the health effects of taxes on unsaturated fat, sugar and sugar-sweetened beverages, due next year.
Scotland has a strong track record of evidence-based public health leadership, most recently in relation to action on smoking and alcohol. It can lead the way again, by being the first UK nation to introduce a tax on SSBs. These new tax powers would require Westminster approval but are unlikely to be blocked. With strong leadership from the Scottish Government, perhaps one day Scotland will be known as the “fit man of Europe”.
 Scottish Health Survey 2013
 UK Faculty of Public Health. A duty on sugar sweetened beverages. Accessed from: http://www.fph.org.uk/uploads/Position%20statement%20-%20SSBs.pdf
 Briggs ADM, Mytton OT, Kehlbacher A, Tiffin R et al. Overall and income specific effect on prevalence of overweight and obesity of 20% sugar sweetened drink tax in UK: econometric and comparative risk assessment modelling study. Accessed from: http://www.bmj.com/content/347/bmj.f6189