The UK supply of sugar is three times what we should be eating for our health. No wonder obesity strategies continue to fail, writes Nick Hughes.

There can be few better examples of modern day policy failure than that of obesity. Every UK government since 1992 has identified obesity as a major problem, according to a new report from the Institute for Government (IfG) think-tank, and every government has comprehensively failed to find a solution. In 1970 one in 10 British adults was living with obesity; now it is almost one in three.

The reasons why successive governments have failed to reverse the tide of diet-related ill health are interrogated at length in the report. They can be summarised as a lack of political will and funding; poor coordination of policy across government departments; a public more concerned with the healthcare system than with preventing ill health; a preference for voluntary over mandatory industry action to tackle obesity; and a focus on policies that emphasise individual responsibility over changing the food environment.

A few weeks prior to publication of the IfG report, a separate report from the charities Feedback and Action on Sugar made the case for how UK supermarkets are driving higher sugar sales. As well as creating food environments that encourage excessive consumption, they found that nine out of 10 leading UK supermarkets lack any policies to measure total sugar sales across all their products and no supermarkets are willing to publicly support mandatory reduction targets.

The charities set the results of their own research in the context of the final results of the government’s sugar reduction programme which showed a meagre 3.5% fall in the average sugar content of retailer products covered by the programme against a 20% target and a 7% increase in the total amount of sugar sold across all products between 2015 and 2020. Businesses in the out of home sector recorded just a 0.2% reduction in the average sugar content in products sold between 2017 and 2020 despite pockets of positive progress in categories such as cakes and by individual brands like Costa and Greggs.

Although the two reports were unrelated the case of sugar neatly illustrates many of the general failings the IfG diagnosed in obesity policy. Despite the known links between consumption of sugar in food and drinks and illnesses such as liver disease, type 2 diabetes, hypertension and tooth decay, UK sugar supply remains three times the recommended maximum intake – that is to say the volume of sugar on the market hugely outweighs the amount we should collectively be eating.

Why has this happened? What can be done about it? And what are the lessons for wider obesity policy?

Sugar supply

In 2019, a Food Research Collaboration briefing paper set out a policy agenda for reducing sugar supply and consumption. Authored by Ben Richardson, associate professor in international political economy at the University of Warwick, and Jack Winkler, emeritus professor of nutrition policy at London Metropolitan University, the paper argued that two important policies had recently been introduced to reduce average sugar consumption: the soft drinks industry levy (SDIL) and the aforementioned sugar reduction programme. The latter, as we now know, ended in relative failure however the former has, as the IfD report noted, been “highly effective” in reducing the total sugar sold in soft drinks by retailers and manufacturers by 35.4% between 2015 and 2019, from 135,500 tonnes to 87,600 tonnes.

Richardson and Winkler however argued that these kind of demand-side policies, while potentially impactful, would not be sufficient to reduce average sugar consumption in line with recommended levels and that supply-side levers would also need to be pulled. Brexit, the pair argued, presented UK policy makers with the opportunity to break free from an EU model that had led to systematic over-production of sugar and low prices, which in turn had undermined efforts to encourage food manufacturers to use less of it in their products. (Richardson and Winkler estimated that in 2017/18 of the 2.42 million tonnes of sugar sold in the UK around 87% was made into manufactured food and drink products, the majority of which were sold by retailers. The remainder went to businesses in the out of home sector and to retailers as bagged sugar to be sold direct to consumers.)

They settled on five potential post-Brexit policy options to support the sugar reduction agenda. These were to impose limits on the supply of sugar to the UK market; to set a minimum price for refined sugar and/or sugar beet; to introduce an excise tax on sugar or a levy on manufacturers using sugar in particular foods; to reform farm subsidies to shift production away from sugar beet and toward the provision of foods that are currently under-consumed in diets; and to establish new compositional regulations setting maximum sugar content in certain foods plus mandatory labelling requirements.

Four years on from their paper none of these supply-side policies has been enacted. Although some new demand-side measures such as tighter controls on advertising and promotions of foods high in fat, salt and sugar (HFSS) have been adopted in the intervening period many are now subject to delay amid concerns over the cost implications for businesses and consumers.

Policy paradox

More fundamentally, government policies concerning sugar continue to operate at cross-purposes. Policies to reduce consumption such as the sugar reduction programme rub up against those designed to liberalise trade that in turn risk increasing the supply of sugar (and making it cheaper). The Feedback and Action on Sugar report noted how, since Brexit, new quotas permit an additional 340,000 tonnes of tariff-free sugar cane imports into the UK including via the recently signed free trade agreement with Australia.

This example perfectly illustrates the lack of joined up policy making cited by the IfG as a key reason for the consistent failure of obesity strategies (another example is alcohol policy where health policies attempt to moderate consumption and reduce harm while the Treasury often uses a duty freeze or cut as a popular budget measure). In its report, the IfG noted that despite being the lead department on obesity, the Department of health and social care (DHSC) controls few of the policy levers that could address it (such as taxation). Defra, it said, tends to see its role on food as being a ‘sponsor’ of the UK food industry, which puts it into conflict with policies that might seek to reduce sales of unhealthy and ultra-processed foods. The Treasury, meanwhile, “has generally been sceptical of the evidence around many preventative measures, including obesity interventions”.

Policy design has also been hindered by the poor relationship between DHSC and food and drink companies, according to the IfG. Although it acknowledged how many companies want to work collaboratively with government businesses often find themselves shut out from the policy design process. Interviewees claimed DHSC was often not able to answer key questions about how policies that had been announced should be implemented and how uncertainty over time frames of policies could be disruptive (drinks producers subject to UK deposit return schemes will surely be able to sympathise).

Business shift

There have been isolated policy success stories, according to the authors of the IfG report. The implementation of the soft drinks levy, which gave companies two years to reformulate their products before the levy came into effect, showed how “clear and consistent communication of a firm window before implementation can work well, even for a policy that requires industry to make significant changes”.

Moreover, while food industry lobbying against regulations designed to tackle obesity clearly persists, there is growing recognition among businesses that some degree of market intervention is necessary. Citing national food strategy author Henry Dimbleby, the IfG said many in the food industry now privately admit that for driving systemic changes voluntary schemes will never work, and the only way forward will be to adopt mandatory regulations that ensure there is a level playing field (as Tesco has called for on food waste).

What might this mean in practice where sugar is concerned? Potentially an expansion of the SDIL to the use of sugar in particular foods as proposed by Richardson and Winkler? Perhaps too a new round of sugar reduction targets that are mandatory rather than voluntary, but are also mindful of industry concerns over the technical limitations to reformulation in some products and categories?

For their part, Action on Sugar and Feedback want supermarkets to commit to publicly disclosing and reducing overall sugar sales by 50% by 2025 and by two thirds by 2030, and for the government to drive this by implementing mandatory targets.

Perhaps most importantly of all, there needs to be proper coordination of policy across government in areas such as sugar so that perverse outcomes whereby production is incentivised and consumption disincentivised are avoided. To this end, the IfG is calling for the creation of a long-term strategy for obesity driven by a new food and health policy unit, jointly owned by Defra and DHSC.

There is no sign the current prime minister is minded to change course on obesity. As the IfG pointed out, the government is still nominally committed to a target of halving childhood obesity by 2030 but has offered little indication of how it intends to meet the target. Sugar could be one lens through which ministers commit to some serious thinking about how decades of failure to tackle obesity can finally be reversed. 

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