Durban - Consumers can’t step into a supermarket without encountering thousands of food products that contain hidden, added sugar that provides energy-dense but empty calories.
Sauces, mayonnaise, breakfast cereals, crisps, biscuits, yoghurt, cold drinks, snacks, bread and many other processed foods contain sugar in some form - maltrose, dextrose, fructose, high fructose corn syrup, and the list goes on.
If you have seen That Sugar Film, which highlights the copious amount of hidden sugar in so-called “healthy foods” - Australian director Damon Gameua documented the effects of a high sugar diet as he experimented, consuming only foods perceived as “healthy” options - and the US film Fed Up, which pins that country’s obesity and overweight epidemic on the nation’s high sugar diet, you will have some idea of what has transpired in the food industry over the past 40 years.
Both films highlight how new nutritional guidelines in the US advised consumers to reduce fat intake in 1977, leaving the food industry with the problem of less palatable low-fat food, one it solved by adding sugar.
But experts interviewed in the documentaries say this led to a new problem - a global epidemic of overweight and obesity and a spike in non-communicable diseases, including heart disease, stroke and type 2 diabetes.
According to the World Health Organisation (WHO), around 2.8 million adults die annually around the world as a result of overweight and obesity.
And it’s a problem many governments now fear will cripple public health care systems - one the food industry has vehemently denied is attributable to sugar alone, but which health experts claim we will one day view with the same wisdom of hindsight as we now do the cancer-causing harm of smoking tobacco.
South Africa faces a similar obesity and overweight epidemic to the US and Australia, and is ranked the most obese nation in Sub-Saharan Africa, with two in three women, almost one in three men and almost one in four children overweight or obese, according to the Heart and Stroke Foundation.
But following the lead of countries like Denmark, Norway, Finland and Mexico, which have implemented a sugar tax to address the global epidemic, the government has announced a sin tax on sugar sweetened beverages (SSBs) that kicks in on April 1, 2017, and which could later be expanded to other sugary foods.
The government hopes the tax, which experts suggest should be set at around 20%, will make it more expensive for consumers to splurge on sugary soft drinks.
The move has drawn criticism from the food and beverage industry, which says the tax will affect jobs and result in cheaper illegal imports.
It's received mixed approval and criticism from consumer groups, which have raised concerns about the impact on the poor, and a stamp of approval from health experts.
Last month the National Treasury released its 30-page Policy Paper and Proposals on the Taxation of Sugar-Sweetened Beverages, which highlights the global epidemic and expert views on a 20% sugar tax.
The public has until August 22 to comment.
According to research by Priceless SA (Priority Cost Effective Lessons for System Strengthening South Africa), at the Wits University School of Public Health and the SA Medical Research Council, adult diabetes will escalate health-care costs by between $1.1 billion (R15 billion) and $2 billion by 2030.
It has calculated that over 20 years, a 20% sugar tax could avert 21 000 diabetes-related deaths and save more than R10 billion in health-care costs in our already overburdened health system.
Registered dietitian and Association of Dietetics of SA (Adsa) spokeswoman Jessica Byrne said research published by the WHO showed the tax had to result in a 10-20% price increase to have a positive impact on purchasing, consumption, obesity and population health.
“The proposal is that a tax rate of 2.29 cents per gram of sugar be implemented based on the current product-labelling framework. This roughly equates to a 20% tax incidence for the most popular soft drink.
“A 330ml can of a commonly consumed sugar-sweetened beverage (SSB), with about 35g of added sugar, would in future cost R10.15, compared to the current price of about R7.99,” she said.
“The proposed tax seems to be a sufficient increase to allow those households who struggle more insight on how to spend their money more wisely.
“This could encourage consumers to reconsider purchase and switch to cheaper, lower sugar-content beverages, such as artificially-sweetened options, rather than spending the little money they have on fizzy drinks of little nutritional benefit,” she said.
However, she added that just as taxing cigarettes does not stop all people smoking, taxing SSBs will not necessarily reduce affluent consumers’ consumption.
She said evidence indicated that a high-sugar diet increased the risk of developing dental problems, obesity and type 2 diabetes, and probably cardiovascular disease.
“Studies have shown that in SA, the average person consumes 17 teaspoons (70g) of sugar and similar sweeteners a day - three times higher than recommended.
Children typically consume about 40-60g a day, possibly rising to 100g a day in adolescents. This represents roughly 5-10% of dietary energy, but could be as much as 20% in many individuals, she added.
Adsa supports WHO recommendations that added sugar consumption should be limited to four to six teaspoons, or 5% of daily energy intake, and the The South African Food-Based Dietary Guidelines states that “sugar and foods and drinks high in sugar should be consumed sparingly”.
Byrne said studies in the UK and Ireland had shown the potential of a SSB tax to reduce obesity by 1.3% (20% tax) and 1.3% (10% tax) respectively.
“In Mexico a tax on SSBs has been shown to decrease the purchase of SSBs - a 17% decrease in the purchase of SSBs was seen in the poorest households.
“Each country is unique so it's difficult to predict if a sugar tax here would have the same impact,” she said.
She added that a modelling study by Manyema, Veerman and others published in the journal PLoS One had predicted the effects of a 20% tax on SSBs on the prevalence of obesity, and estimated a 3.8% reduction in obesity in men and a 2.4% drop in women.
“However, changing dietary habits and purchasing behaviour is more complicated than just hiking price.
Education around why high intakes of sugar are detrimental to health is still important, she said.
“Consumers need to be aware of other hidden sources of sugar in store-bought foods, and try to limit these foods where possible.
“Adsa encourages consumers to empower themselves and to learn to read labels,” she said.
Imraahn Mukkadam, a consumer activist with the Consumer Action Network and National Co-ordinating Committee member of the South African Food Sovereignty Campaign, said the tax was necessary to curtail the nation’s addiction to a sugar-intense diet.
“Sweetened beverages is a major contributor to child obesity and most definitely aggravates the prevalence of diabetes, which is causing havoc with our nation’s health status,” he said.
“We believe legislation restricting marketing and requiring health warnings on labelling and packaging should accompany the the levy, so that consumers could be conscientised to make informed decisions when purchasing sugar-intense beverages,” he said.
However, Mukkadam said the organisation was concerned about how sugar tax would disproportionately impact food inflation.
“The intention is to alter people’s diets by making unhealthy food more expensive, but the healthier alternative is already unaffordable for most of our population.
“The sugar intense diet is not consumed because consumers are deliberately choosing it - in many instances it is because the alternative healthy option is just too expensive,” he said.
But SA National Consumer Union spokesman Clif Johnston said the proposed sugar tax was “simply another tax to be imposed on hard pressed consumers”.
“It has little to do with consumption, and in years to come the levy will be increased, as in the case of the fuel levy and taxes on tobacco and alcohol, in order to balance the national budget,” he said.
“Unless the money collected is ring-fenced to be used exclusively for public information, research and education on obesity and the responsible use of sugar, it is unlikely to have any lasting impact on sugar consumption,” he said.
Johnston said poorer communities might change their habits, but many would adapt to higher prices.
“If they crave sugar, they will pay more for it, even to the extent of consuming less of other, possibly healthier, things,” he said.