by James Walvin
The report was, however, merely the latest episode in a long process of social and political concern about obesity. There had been a rising crescendo of public alarm throughout the early years of the twenty-first century – government reports, medical enquiries and a veritable blizzard of articles and programmes in the media, most notably, perhaps, by celebrity chefs such as Jamie Oliver. All had served to push the question of obesity to the centre of public and political attention. It was no longer something that could be overlooked.
At one level, the problem was indisputable, because it was so visible. The evidence of obesity in society is plain for everyone to see, every day, in public life. It was, however, medical professionals who found themselves struggling to cope with the consequences of obesity. Yet the root causes of the problem were much less obvious – and debatable – although there was no doubt about the impact on the NHS. The 2015 report asserted: ‘Obesity and its consequences alone cost the NHS £5.1 billion per year . . .’ and claimed it had no doubts about the prime cause of the problem – the high concentrations of sugar in the nation’s food and drink.4
The short-term explanation lay in the profound changes that had transformed our relationship with food and drink in the years after the Second World War. For a start, in real terms, food became cheaper than ever. But food itself was also different – much of it became processed and industrialised, with sugar used extensively in that process. It was also marketed and sold in a very different manner, overwhelmingly in supermarkets. At first glance this might seem a marginal issue in any discussion about obesity, but these new forms of shopping played a central role in the complex transformation of people’s food and drink. Supermarkets were a vital agent in infiltrating unprecedented volumes of sugar into people’s diet.
These years also heralded a new age of mass consumption, and people were constantly urged, by advertising, promotions and slick propaganda, to buy and consume more of everything – including food.5 In common with material life at large, we simply consumed more and more. Just as we had been lured into filling our lives with an abundance of material objects we once managed to live without, so had we been wooed into eating more food than we needed. And much of that food was of little nutritional value and had been sweetened en route to the supermarket shelves. The end result is that sugar is being consumed, largely unknowingly, on a scale that would have made an eighteenth-century sugar planter rub his hands with delight.
The 2015 study by Public Health England paid particular attention to children. The evidence confirmed that children were consuming on average three times the medically recommended levels of sugar, and adults twice the levels.6 The main sources of that sugar were as might be expected – soft drinks, household sugar, confectionery, fruit juice, biscuits and similar treats, and breakfast cereals. For adults, alcohol was a major source of sugar.
There were some variations between different age groups. Among teenagers, for example, soft drinks provided the largest source of sugar, while younger children absorb sugar via biscuits, cakes, breakfast cereals, confectionery and fruit juices. Again, and not surprisingly, perhaps, sugar intake was greatest among low-income groups, and consequently the related problems of obesity – among all ages – were worst in communities and areas blighted by widespread deprivation.
Stated crudely, the poor, the unemployed – indeed, whole communities abandoned by the collapse of local industries in the face of globalisation – once again fared worst. Yet it is hardly original to restate that the poor – on both sides of the Atlantic – suffer most from the personal and physical problems created by a bad diet of cheap, sweet, processed foods and drinks.
Here, then, was an English perspective on the much broader problem which linked a nation’s food to a wider study of how people were persuaded to buy the food and drink they consume. Lurking over the entire question is the power of modern advertising, and the way food and drink are marketed by costly and manipulative campaigns. The changing dietary habits of, say, the past forty years are closely related to the way food and drink products are promoted. Advertising is no longer the world of colourful public hoardings, or simple catchy TV adverts and jingles. The very channels of advertising have themselves undergone a revolution to keep pace with the emergence of the Internet and social media, notably in the form of ‘pop-up’ ads on smartphones, tablets and computers. Recent restrictions on advertising aimed at children on TV and in supermarkets are easily circumvented by relocating adverts to social media. The more children use smartphones or tablets, the more adverts they are likely to see for sweet food and drink. And the industry for online advertising is growing all the time: in 2013, £6.3 billion was spent on advertising on the Internet in the UK.
A great deal of the advertising of food and drink is aimed specifically at children. They are bombarded with cartoon characters from favourite shows, colourful images and stories, and child-friendly packaging, and many adverts are designed both to entertain the young and win them over to a particular product. Away from the screen, elaborate displays of sweets, chocolates, cakes and drinks are strategically located in supermarkets to catch a child’s attention in the hope of an impulsive purchase by a parent or by children themselves. It is these products which usually contain unhealthy levels of sugar. Recent research confirms that such advertising, both in the new media and on TV, is successful in persuading children to crave, then to buy, sugary items – children will consistently opt for sweet products.7
We also know that children’s choices can be swayed by a product promoted by a popular star, typically a famous sportsman or woman, and this became a well-used commercial tactic. So, too, is the ploy of proclaiming price cuts, or offering ‘two-for-one’ special offers. Sales are dramatically affected by such offers. We also know that goods with a high sugar content are the very items more likely to be placed on offer, because, again, market research has confirmed that people are tempted to buy goods of high-sugar content in this way. Equally, the exact location of a product in a supermarket is important; which spot in the aisle or on the shelf is most likely to attract a child’s attention. The end result is that an estimated 7–8 per cent of all the sugar entering the home is bought in this fashion – by eyecatching price reductions or special offers.8 These marketing techniques have been tried and tested, in one form or another, for half a century and no serious student or researcher in the field is in any doubt that they are highly successful in selling sweet products.
While sugar is the main dietary culprit behind modern obesity, it has been able to reach its current levels of consumption via the skills and power of marketing agencies.9 The achievements of advertisers are, in their turn, closely linked to the recent history of changing shopping habits, none more dramatic than the rise of the modern supermarket and the emergence of other food outlets on the high street, in the workplace and school. There is, then, a complex, interconnected web of factors which determine how and what people buy to eat and drink – but the focus returns, time and again, to sugar.
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Our diet has changed with astonishing speed, but it now embraces a range and choice of foods available which is more profuse, varied and more international than our grandparents could possibly have imagined. We now find ourselves surrounded by countless opportunities to buy food: supermarkets, revitalised corner shops, restaurants, fast-food outlets, takeaways, cafés and coffee shops. Food and drink outlets in the UK now account for a large and growing proportion of all the meals consumed – 18 per cent of meals came from this sector in 2015, and 75 per cent of the population claimed that they ate out or bought takeaway food in 2014.10 The food sold at such outlets are the very foods in which sugar levels are at their highest and, here again, sugar makes its presence felt, often in unlikely places. The massive expansion of coffee culture’, for example, has also encouraged extra sugar consumption via its proliferation of new forms of hot beverages, alongside all the varieties of sugary confectionery that are offered with the hot drinks. Customers came to exp
ect not simply a coffee but a variety of sweet delights at their local coffee shop. Even the coffee changed – heavily sweetened, flavoured syrups can now be added to a hot coffee, and often contain as much sugar as the more obvious cans of fizzy drinks.11
This proliferation of eating and drinking places, and the availability of pre-cooked or takeaway meals, form part of a broad cultural invitation to eat more and more food. We also eat more because food is cheaper than ever. Today in the UK, around 15 per cent of most people’s weekly expenditure goes on food; half a century ago, it was 33 per cent. In addition, the portion sizes we consume – especially in takeaway and prepared foods – have grown. The end result is that the average Briton consumes between 200 and 300 more calories each day than the body requires.12 And the finger once again points at sugar. But what is to be done?
All the evidence, by 2015, confirmed that any attack on sugar and obesity needed to move well beyond mere exhortation or providing educational and health messages about diet. That had been tried many times, but the nation – the world – was still growing fatter. The target audience seemed deaf to such pleas. Poor people especially – the very people with limited access to healthy food – persistently showed themselves unmoved by sermons about healthy, sugar-free diets.
The key targets in the attack on sugary diets are easily identified: the manufacturers who introduce high levels of sugar into their products, the advertising industry which supports them, and the powerful supermarket chains which tantalise customers – especially the young – with their irresistible displays and targeted price cuts. By 2015, there was broad agreement about the urgent need to reduce the volumes of sugar added to food and drink. It was equally important to curtail the aggressive marketing of sweet items at children. There was an encouraging example to follow: the British campaign to persuade food manufacturers to reduce salt levels in food. Salt in bread, for example, had been reduced by more than 40 per cent since the 1980s, without any appreciable customer backlash.13 This raised, though, an unresolved and fundamental question about the different biological and physiological reactions to sugar and salt. Humans seem to have an innate love for sweetness, but not for salt. In simple terms, we don’t crave salt in the same way as sugar, and we don’t miss salt in the way we love and would miss sugar.
By the time Sugar Reduction was published in 2015, what had emerged from this welter of evidence and argument – not only in Britain, but globally – was a need to make decisive moves against sugar. One apparently simple and very tempting proposal was the idea of a ‘sugar tax’.
Naturally enough, the prospects of a tax on sugary items raised howls of outrage from the sugar lobby, from drinks and food manufacturers and from the retail outlets which sell those products. However strong the evidence about the links between obesity and sugar, the food industry was unwilling to see its trade limited by taxation. Two main factors, however, lent support to the idea of a sugar tax when it was first raised in Britain. First, it had already been pioneered in a number of other countries, all of them alarmed about their own problems of obesity and sugar consumption. Secondly, the early evidence suggested that such taxes seemed to work. Various forms of sugar taxes had been introduced in Norway, Finland, Hungary, France and Mexico, and in some US cities. And they seemed to be having the desired effect. Sales of sweetened soft drinks, for instance, had fallen more or less in line with the percentage of sugar taxation; the 10 per cent Mexican tax has seen a fall of 6–9 per cent in soft-drink sales, a fall most striking among the poor, who were the most at risk from spiralling ill health.14
The British Conservative Government was, by instinct, resistant to interference in industry and uneasy about new forms of taxation, but the 2015 report forced its hand. Following a number of delays, and various leaks, the report, which had been commissioned by the Government in the first place, finally appeared in 2015. The British media then took up the case with a vengeance.
Newspapers of all political persuasions launched an attack on sugar. The Times – traditionally a Conservative advocate – thundered its own vocal support for a sugar tax, and chided ministers for holding back both the evidence and the necessary political action. In a leading article in October 2015, The Times neatly summarised the argument for such a tax. It offered its own résumé of the evidence, lending publicity to the problem of highly sweetened food and drink, the rise of obesity – more especially among children – and the financial stress on the NHS.
The Times also pointed to a precedent. Between 1994 and 2003, a number of medical and governmental studies had urged a reduction in the volumes of salt added to processed foods. A public-awareness campaign against salt – which is still ongoing – had gone hand in hand with discussions with food manufacturers to scale back salt in foodstuffs. The Times argued that ‘there is no reason why sugar cannot undergo a similar trajectory’. While accepting that individuals needed to make their own informed decisions about what they buy and drink, The Times realised that the time had long gone when personal choice might slow the rise of obesity. The time was ripe for the Government to ‘give serious consideration to a sugar tax’.15
Following the report’s publication in October 2015, a number of journalistic heavy-hitters joined in the attack on sugar. They, of course, were unrestrained by the protocols of the leader writers on The Times. Some took a much more severe line, arguing that a sugar tax alone was inadequate; it needed to be bolstered by a ban on fast-food outlets in railway stations, airports and other public places. In answer to critics who found such ideas unnecessarily draconian and intrusive, they made the obvious – and telling – point that critics had raised very similar objections over the past thirty years when the attack on smoking in public places had gathered momentum.16 Jamie Oliver, the celebrity chef with an enormous TV following and a thriving commercial empire of restaurants and books, also caught the public eye by linking tobacco and sugar, calling sugar ‘the next tobacco’.17 Given his celebrity status, Oliver’s ideas and pronouncements received major coverage.
In fact, medical authorities had already been making much the same point – that we should think of the threat from sugar much as we once thought of tobacco.18 Epidemiologists, medical experts of various specialisms and medical sociologists, all and more had for some time been pointing to the similarities. What was once said about tobacco was now being alleged of sugar. This ever-increasing group of critics, on both sides of the Atlantic, were growing in numbers and stridency, and formed a broad if unorganised coalition of famous media faces, medical experts, social scientists and politicians. Each, from their own corner, accused the food-and-drink industry of ignoring the widespread damage caused by sugar. Sugar’s opponents saw the food industry cynically enhancing profits with little or no regard for the physical and social impact sugar was having – especially among the young.19
Linking sugar and tobacco, and comparing the behaviour of the sugar lobby to the rearguard tactics of the tobacco lobby, proved to be the most telling of blows. By the early twenty-first century, no one could be in any doubt of the ravages caused by tobacco, and to place tobacco alongside sugar was perhaps the most damaging blow to sugar’s credibility. It was now up to the sugar lobby to prove that the tobacco-sugar link was inaccurate or plain wrong.
Some voluntary agreements had already been brokered by the British Government with companies to reduce the sugar contents of their food and drinks. But such deals inevitably involved only willing partners, and were still a long way from addressing the core problem. Demands for a sugar tax would not go away.
The first practical step towards such a tax was taken by the NHS itself, with a proposed tax on sugar and sweet food and drinks throughout all NHS infrastructure – in hospital catering locations, shops and staff facilities.20 By the New Year of 2016, the British Cabinet, despite its earlier hard stance, had been won over to the idea of a sugar tax as a viable initiative in the fight against obesity. It was agreed to introduce a tax on sugary drinks in 2018. It had been a hard sell, b
ut ministers were apparently persuaded by the evidence from countries which had already levied taxes on sugary confectionery and drinks. As documented earlier, in Mexico, the tax on soft drinks had seen a marked fall in sugary drink consumption, and this despite Mexicans having become infamous as a people who loved soft, sugary drinks.21 Norway’s tax had encouraged people to eat sweets and chocolates less frequently and, in Finland, soft-drink sales had fallen after a sugar tax. In Hungary, there had been a sharp decline in heavily sweetened products, with companies manufacturing items containing less sugar to avoid the tax.22
Through all this, the soft-drink industry, in particular, had not remained idle. Faced with this growing alarm about sugar, and by the upsurge of concern among politicians and consumers, they responded. The buzzwords were ‘reformulation, smaller packaging sizes, and a growing emphasis on low- or no-calorie options.
So it was, in the summer of 2016, that millions of TV viewers found themselves bombarded by adverts proclaiming Coca-Cola to be ‘Zero Sugar’. Sugar was about to be taxed and had, now, been virtually ‘banned’ as an ingredient from one of the products that it had done so much to help become pre-eminent the world over.23 Sugar had taken on a pariah status. This was little short of a major transformation in the way sugar was used and perceived, and how it was now seen by the food industry and by consumers. What had, for centuries, been promoted as an ingredient that delivers simple pleasure – a commodity that made food and drink tastier and made us feel happy – was now being denounced for its capacity to do untold harm.
Conclusion