Sweet lies, bitter truth... would a tax on sugar work?
A tax on fizzy drinks was mooted this week to tackle Ireland's alarming child obesity crisis. But would it make a difference ... and don't indulgent parents have a big part to play too?
It's a statement that's as sobering as it gets. "If only a small fraction of what we know about the effects of sugar were to be revealed in relation to any other material used as a food additive, that material would promptly be banned."
The words date from a 1972 book, Pure, White and Deadly, written by British nutrition professor John Yudkin. It attracted a lot of attention at the time, but the thesis that too much sugar had devastating consequences for health was trashed by the food industry and some prominent nutritionists.
Fast forward more than 40 years, and while Yudkin has been largely forgotten, his views have become mainstream: sugar is now public health enemy number one thanks to the campaigning work of everyone from child obesity expert Robert Lustig to celebrity chef Jamie Oliver.
And it's a hot topic in Ireland too. The Government - with the support of all parties - is keen to introduce a sugar tax, where it's proposed that 10c would be added to the price of every can and bottle of sugary drinks. But the manufacturers have come out fighting, with lobby group the Irish Beverage Council arguing within the past week that such a tax would not solve the country's obesity crisis and would be bad news for the economy. And, there is a crisis, make no doubt about it. Ireland is on course to be Europe's fattest country by 2030 if current trends continue and, right now, one in every four children is classed as either overweight or obese. The health implications of obesity include diabetes, cancer, heart attacks and strokes.
For consultant endocrinologist and leading obesity doctor Donal O'Shea, dramatic steps have to be taken now to address the bulging waistlines of the country's children. "A sugar tax would be a step in the right direction," he says, "but it needs to be part of a wider strategy to encourage healthy eating and greater physical activity."
Dr O'Shea says it is remarkable just how quickly Ireland has gone from a comparatively healthy population - among the thinnest in Europe in the 1950s - to a society that's ballooning, in every sense of the word today.
"The Celtic Tiger has to take a lot of the blame. We Irish love to enjoy ourselves and live it up, and that certainly happened when the good times were rolling. Unfortunately, all that consumption played havoc with our diets and the knock-on effects of that can be seen in our children today."
While the rate of overweight people has gone up dramatically, the increase in chronic obesity has gone off the scale. "Back in the 70s and 80s, the only exposure Ireland had to it were people coming off the plane from America. Now, we're seeing it all the time."
Introducing a sugar tax, he believes, would lay down a marker that something tangible is being done to combat a ticking time bomb.
It's a stance shared by the Irish Heart Foundation and its nutritionist Janis Morrissey. She believes a large part of the child obesity problem stems from their love of sugary drinks. The average Irish person consumes 82 litres of cola and other sugar-laden beverages per annum, and the demographic where these products enjoy greatest success is among teenage boys. "Liquid sugar is a huge problem," she says. "People simply don't realise how much sugar they're putting into their bodies."
According to Coca-Cola's website, each standard can of Coke contains 35g of refined sugar, the equivalent of seven teaspoons. That amounts to an adult's daily recommended 'free sugar' intake, according to the most recent guidelines from the World Health Organisation. For young children, one serving of Coke is more than their recommended sugar allowance of five teaspoons per day.
"And none of that counts the chocolate bars, biscuits and other snack foods that have become so commonplace," Morrissey says, "or the processed foods where you wouldn't expect to find sugar, but it's there in the ingredients. It all can add up to frightening amounts, and when you factor in high fat and high salt foods, plus the reduction in physical activity, its something of a perfect storm where obesity levels can grow and grow."
In 1981, half of all Irish children walked to school. Today, only 25pc do. A sedentary lifestyle, aided by televisions in bedrooms and smart-phones, has pushed their weight up and, so too has the normalisation of snacking and the 'supersizing' of food stuffs. Today's typical doughnut, one study found, is three times larger than in 1990.
"Portion sizes are a big problem," she says, "and well-meaning parents often don't realise that they're overfeeding their children. Sometimes, they don't realise that their children are carrying excess weight."
It's a sentiment echoed by weight loss specialist Dr Eva Orsmond, who believes many parents don't want to admit to themselves that their children are overweight or obese. "Often, they can't see that they themselves have a problem and even if they do, they don't recognise it in their children.
"Sometimes, I'd have an adult coming to see me for a consultation and their child would be in the waiting room and I'd see that they're quite overweight."
Orsmond, originally from Finland but living in Ireland for 16 years, runs a series of weight-loss clinics that bear her name and is well known to viewers of RTÉ's Operation Transformation, thanks to her straight-talking approach to losing weight. She also fronted an arresting documentary, Sugar Crash, which aired earlier this year.
The programme was especially compelling when highlighting the amount of sugar we unwittingly consume in everyday products that few would think of as high in sugar.
But while she is convinced the white stuff plays a significant role in making us fatter, she is opposed to a tax. "It's just lip service from the Government," she says. "Adding 10c will not deter a parent from buying a sugary drink for their children."
She says much more stringent steps are needed to tackle the problem, among them a culture where every school child, at least once a year, is weighed and has his/her 'circumference' measured. Such a policy, she says, is used effectively in Finnish schools and provides parents and health professionals with knowledge they need to intervene when weight is starting to get out of control.
Furthermore, she argues that "no sweets or high-sugar products be allowed near checkout counters in any schools or medical facilities" and she says it is adamant that each child be compelled to study home economics to Junior Cert even where a "modern food pyramid" with "fruit and vegetables for the base" is taught on the curriculum. "It's all about changing a mindset, just like the smoking ban did when it came to cigarettes".
Orsmond says there is nothing extreme about her proposals, and reckons they would help transform the waistlines of our children. "But the politicians don't want to hear it," she says. "None of them have asked to speak to me, and I'm seeing obese patients every single day so I know at first hand just how serious the problem is."
And the problem is likely to get worse if overweight children are allowed become obese adults. According to an exhaustive study of 200 countries by the medical journal, The Lancet, Ireland has the fourth highest rate of severe obesity in the EU and the second highest rate of morbid obesity in the union. The former is characterised by those with a body mass index of 35 to 40 and the latter is over 40. (Healthy people should have a BMI of under 25.)
But such findings have not discouraged the soft drinks manufacturers to come out fighting. The blame should not be placed on their doorsteps and they argue that food-based 'sin' taxes are regressive and have a disproportionate effect on low-income households.
According to the Irish Beverage Council report which has been submitted to the Government, the soft drinks industry has "taken thousands of tonnes of sugar and billions of calories out of the national diet" in recent years by changing recipes and offering a wider choice. "A sugar tax may be populist, but it is simply not supported by evidence," adds its director Kevin McPartlan.
But such an assertion is rejected by the Irish Heart Foundation's Janis Morrissey, who says when France introduced a 7c tax to soft drinks, consumption fell by 3pc. There's also been positive news from Mexico - a country with a chronic child obesity problem - after a tax was imposed on sugary drinks there.
"We can't put our heads in the sand and hope that its going to fix itself," Dr Donal O'Shea says. "We owe it to our children to make sure we take every step possible to turn the problem around and a sugar tax is a step in the right direction."
NO SUGAR COATING: THE FACTS
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Irish children are classed as overweight or obese
Ireland is on track to have the EU's second highest obesity mortality rate by this year, when it's projected that 38pc of men and 37pc of women will be obese
Overweight and obesity is now the most common childhood disorder in Europe
of Irish adults are categorised as obese (having a BMI of 30+)
Women in France and Belgium have seen no average BMI increase in the past 40 years
The number of obese people worldwide rose from 104 million in 1975 to this figure in 2014.