Sweet Surrender – by Chris Askew
This is a blog about sugar and the causes of diabetes. But let’s start with some facts. Most cases of Type 2 diabetes are linked to lifestyle and in particular to weight gain. But not all cases, and that’s important to remember. As also is the fact that Type 1 and Type 2 diabetes are quite distinct conditions with entirely different causes at their root. Type 1 diabetes is an autoimmune condition and not caused by being overweight. And nothing to do with eating too much sugar.
Obesity problem starts in childhood
So what is the problem with sugar and why all the talk of sugar now? It has scarcely been out of the headlines in 2016 and there is no sign that it is likely to lose its foody A List status any time soon, as commentators on both sides of the table line up to give the evidence for and against a sugar tax ahead of the Government publishing its Childhood Obesity Strategy.
And here the strands of sugar and Type 2 diabetes come together. Earlier this month Diabetes UK released new figures putting the total number of cases of diabetes in the UK above four million for the first time. This staggering figure, up 65 per cent in the last ten years, breaks down as 3.5 million people diagnosed with diabetes (of whom roughly 90 per cent have Type 2) and a further half a million people living with undiagnosed Type 2 diabetes. Most, but not all, of this rise in diabetes cases overall results from the sharp rise in lifestyle-related Type 2 diabetes. And behind these figures, Public Health England estimates that a further 5 million of us are at risk of a Type 2 diabetes diagnosis in England alone, due to our weight; no great surprise, given that two thirds of us are either overweight (BMI of 25-29) or obese (BMI above 30). And our children fare no better; a recent OECD report of 34 developed nations put the UK second to bottom on childhood obesity, between the United States and Greece, with our number of obese children at twice the level of France and Germany. That is a truly alarming stat, behind which excess levels of sugar in our diet play a major role.
Piling on the pounds
If the inexorable spread in our national waistline does not reverse radically in the decades ahead, then we can expect a continued rise in new cases of Type 2 diabetes, along with other conditions like cancer (where one third of cancers are now thought to be preventable by changing our lifestyle), cardiovascular disease, osteoarthritis, hypertension, stroke, non-alcoholic fatty liver disease…the list goes on, as do the dire predictions for the impact of managing this burden of ‘preventable disease’, both on us ourselves and on the hard pressed resources of the NHS. As things stand now, we spend £5.1 billion tackling the direct effects of obesity and this figure is set to soar.
Deniers of these predictions point to a levelling off in the rise of obesity in recent years (which fails to acknowledge the long term trend) or see this not as a problem of calories in, but of calories out and cite the need for us to exercise more. It is true that we do need to exercise more, but where 91 per cent of children, one third of men and one half of women are failing to meet the minimum recommended levels of exercise as it is and where it takes an hour’s jogging to burn off the calories in a ‘full strength’ can of fizzy drink, we cannot rely upon Olympic-scale change here alone to tackle the obesity crisis.
Help and education
Surely this is a simple matter of apportioning blame and waiting for the inevitable behaviour change to follow? Definitely not; beyond the irony of the third blaming the two thirds, there is little of proven value, or indeed of humanity, in seeing ‘blaming and shaming’ as a viable strategy. Certainly we each of us have the central role to play to stay healthy and well, but we need help and education (and welcome to the newcomer here, the SugarSmart app), as a nation, to ‘own the problem’ in the first place, to make the better decisions in buying and eating more healthily and in moving more. And in this, as in other areas of public health and safety, we are right to look to government and industry for help.
And so we are back to sugar, and specifically to a tax on drinks and foods that have very high sugar content. For the record, at Diabetes UK, we do see value in a ‘sugar tax’ (with provision for where sugary drinks are used to treat hypoglycaemia) but only as part of a range of measures which include, for example, tackling portion size, clearer labelling, limiting promotions on unhealthy foods and changes to food formulation. Many retailers and manufacturers are already making moves in this direction, and some talk of the need for government regulation to ensure change happens universally and without competitive disadvantage.
So we now look to a Government which is at a point in the election cycle where it can most afford to be bold with its Childhood Obesity Strategy, to show real appetite to tackle the biggest threat to the nation’s health, by setting out the right type and scale of requirements on and initiatives with industry, local government, our regulators and others. To fail to do so will mean a key opportunity missed to create change towards a healthier nation, will deny industry a fair and equitable framework for a change in practice, will ignore the advice of expert bodies and will mean we continue to play a high stakes game of ‘wait and see’ with our children’s health and with our health services. Let’s hope for a bold strategy, not a too-sweet surrender.