Slash recommended sugar intakes, WHO tells governments

The war on sugar entered a new phase today after the World Health Organisation (WHO) advised governments to slash the recommended sugar intake in people’s diets to 5% of total energy intake. Even more controversially, the body called for governments to unleash new sugar taxes to back up the recommendations, despite admitting that it does not have strong evidence to support the new guideline.

In a long awaited recommendation, the WHO claimed that reducing sugar intake could help weight loss and singled out the impact of high sugar soft drinks, which it said was contributing to childhood obesity.

It is the latest and perhaps most globally significant move yet against sugar, especially soft drinks, yet the decision has sparked a huge debate among nutritionists over whether the WHO has overstepped the mark. The WHO has advised governments to propose a recommended daily limit of 10% energy intake from free sugars, claiming that the evidence of the impact on obesity shows a “strong” evidence base for such a limit.

However, as in draft guidelines published last year, it goes further by suggesting a “conditional recommendation” to reduce the intake of free sugars to below 5% of total energy intake. The FDF today claimed that the advice was based on “poor quality” evidence, and a string of nutritionists warned it posed serious questions.

To add spice to the debate , the WHO’s move comes after Department of Health experts at the Scientific Advisory Committee on Nutrition (SACN) issued draft guidance last summer calling for a 5% limit in the UK. SACN is expected to provide a final report in the late spring, but its draft recommendations claimed its move was based on strong scientific evidence linking products high in sugar with obesity and heart related illness.

The WHO, in stark contrast, admits that it found very little evidence to back up the 5% figure and the evidence that it did had dated back to the Second World War. Yet today it called on governments to use dietary guidelines, nutrition labelling and regulation of marketing of food and non-alcoholic beverages that are high in sugars, as well as launch “fiscal policies targeting foods that are high in free sugars.”“

The DH is already exploring the possible effectiveness of a sugar tax, despite the fact that it has been ruled out by both the current government and Labour as too “nanny state”. “Individuals can implement these recommendations by changes in their food choices,” adds the WHO guidance.

Regarding the lack of evidence to support its lower threshold, the WHO describes it as a public health trade off.

“Given the nature of existing studies, the recommendation of reducing intake of free sugars to below 5% of total energy is presented as “conditional” in the WHO system for issuing evidence-based guidance,” says the report. “Few epidemiological studies have been undertaken in populations with a low sugars intake. Only three national population-wide studies allow a comparison of dental caries with sugars intakes of less than 5% of total energy intake versus sugars intakes of more than 5% of total energy intake, but less than 10% of total energy intake.

“These population-based ecological studies were conducted during a period when sugar’s availability dropped dramatically from 15 kg per person per year before the Second World War to a low of 0.2 kg per person per year in 1946. “This “natural experiment”, which demonstrated a reduction in dental caries, provides the basis for the recommendation that reducing the intake of free sugars below 5% of total energy intake would provide additional health benefits in the form of reduced dental caries.

“The treatment of dental diseases absorbs from 5% to 10% of health budgets in wealthy countries. Dental caries goes largely untreated in lower income countries, where the cost would exceed all financial resources available for the health care of children. “

WHO said it issued “conditional recommendations” even when the quality of evidence “may not be strong on the issues related to public health importance”

“A conditional recommendation is one where the desirable effects of adhering to the recommendation probably outweigh the undesirable effects but these trade-offs could not be clarified; therefore, stakeholder dialogue and consultations are needed before the recommendation is implemented as policy,” it added.

Barbara Gallani, director of regulation, science and health at the FDF, said she feared the recommendations would be followed by more “hysterical” headlines over sugar.

“The WHO’s final guidance supports current UK policy that individuals’ intake of free sugars should not exceed 10% of total energy,” she says. “Where a conditional recommendation of a reduction to 5% of total energy is made, WHO is clear that this is based on very low quality evidence of sugars contribution to dental caries, not obesity nor associated disease.

“The hysterical food and nutrition messages we are increasingly seeing peddled by a range of stakeholders often focus on individual nutrients and are rarely backed by robust or up-to-date science. These messages unfortunately are misleading, unhelpful and at the expense of the simple message of promoting a balanced diet within the context of a healthy lifestyle.”

Nutritionists told The Grocer the UK would have its work cut out to meet a 5% limit even if SACN followed the WHO’s and its own draft report, by making a 5% figure the target for the UK. “We’re not yet meeting 10% recommendation, and it’s been around for a while so we need to focus now on getting people to work towards it,” said registered nutrionist Jenny Rosborough. “The amount of confusion around added vs natural sugars (eg honey and fructose) amongst the general public is likely to make it harder for us to meet the recommendations.

“The majority of evidence linking sugar to obesity is in sugary drinks. So perhaps a specific guideline on maximum sugar from drinks would be helpful, to increase awareness. ”This new recommendation will be important for policy makers to develop a strategy for reducing sugars consumption which will also help to battle rising obesity rates and improve dental health,” said registered nutrionist Zoe Griffiths.

With weeks, if not months, before the SACN report becomes final, and a general Election to come in between, the controversy over sugar looks set to run and run.