Hugh Pym: Is sugar the missing ingredient in election manifestos?

The party manifestos on health and the NHS have included plenty of food for thought, including promises to cut waiting lists, modernise hospitals and increase GP and dentist visits.

But prevention plans were missing from politicians’ menus, as were proposals on how to help us stay healthy.

With a worsening obesity and diabetes crisis and a growing number of children requiring immediate treatment for rotting teeth, some experts say keeping people out of the hospital is just as important as caring for them when they get sick. A recent report by the Health Foundation think tank said that “the nation’s health is in decline, putting an increasing strain on public services and limiting future prosperity. Much of this ill health could be prevented.”

Reducing sugar consumption would be an essential part of any effort to improve society’s health, but the word “sugar” appears only twice in total in the manifestos of the five main parties in England. This is surprising, given that policies to reduce sugar consumption and regulate unhealthy foods have been the subject of very public debate for almost a decade.

In 2015, chef Jamie Oliver launched his own campaign for a sugar tax after a television documentary showed a six-year-old boy having his rotten teeth pulled under general anaesthetic.

In 2018, the government did indeed introduce a tax on high-sugar soft drinks. Manufacturers, in an effort to avoid paying the tax, reduce the sugar content of their products to below the tax threshold. The Institute for Government reported that between 2015 and 2019, the total level of sugar sold in soft drinks fell by more than 35%.

Then the focus turned to sugary foods. Public Health England (which has since been abolished) began publishing league tables of the sugar content of foods such as biscuits, cakes and cereals. Officials and some ministers made veiled threats about a tax.

In the final weeks of his term in office in 2016, then-Prime Minister David Cameron came close to revealing plans to ban “buy one get one free” offers on unhealthy products in supermarkets and to restrict TV adverts for junk food and other high-sugar products.

But like unwanted leftovers on a plate, these plans were rejected by his successors at 10 Downing Street. Theresa May and Boris Johnson were unimpressed with the menu of anti-obesity policies and skeptical of state intervention in public health. The government, it was argued, should not interfere in people’s decisions about what to eat and drink.

The pandemic has complicated these debates, as ministers and officials have focused solely on fighting Covid-19. And as rising food price inflation has hit households, politicians have argued that adding a tax on sugary foods would not be fair.

What is the result? In England, restrictions have been introduced on where unhealthy products can be promoted in supermarkets. However, other rules, discussed on and off for a decade, have been deferred until October 2025. The ban on advertising these products on broadcast stations before 9 p.m. and at any time online will not come into effect before that date. The ban will also cover “buy one, get one free” promotions.

The delay was announced in June 2023 by Prime Minister Rishi Sunak, who explained his thinking: “At a time when household budgets are under continued pressure from global food price increases, it is not fair for the Government to limit the options available to consumers in their weekly shop.”

In England, the proportion of adults classified as overweight or obese increased from 61.2% in 2015-16 to 63.8% in 2021-2022, according to government data.

Opponents of a sugar tax on drinks may point to these numbers to argue that it has not had enough of an impact. Supporters say the numbers would be worse if the levy had not been imposed. A study published last year in PLOS Medicine found that this was “associated with reduced rates of obesity in girls over the age of six, with the greatest differences occurring for girls living in the most deprived areas.”

Internationally, the statistics are bleak. A February report in The Lancet found that more than a billion people worldwide are obese, based on data from 2022. The UK, where 27% of men reported being obese, fared worse than Germany (23%), Spain (19%), Italy (18%) and France (10%).

The financial pressures are obvious. The cost of treating diabetes is rising rapidly. Research from the University of York found that diabetes cost the UK almost £14bn in 2021-22 – more than £10bn of that to the NHS. Demand for diabetes weight loss drugs such as Wegovy is expected to soar. Doctors say the risk of type 2 diabetes can be lowered by a healthy diet and exercise.

The statistics are clear, but what is the reality for patients? Professor Kamila Hawthorne is president of the Royal College of GPs. Several years ago she moved to a practice in a deprived part of south Wales, where she sees many overweight and obese patients. They are more likely to suffer from back and knee pain, so they need time off work, she says. They are also at increased risk of developing diabetes, cancer and high blood pressure. GPs can encourage people to adopt a healthier diet, says Professor Hawthorne, but there is only so much they can do.

Many of her patients, who work multiple jobs while raising children, “just don’t have time, so they order takeout,” she says. “They know what the problem is and have tried to lose weight, but they often feel helpless.”

Dr Jack Jacobs, a GP who practices near Ashford in Kent, says the number of people with diabetes and pre-diabetes has risen by about 50% in five years, mainly among young adults. He says local GP practices employ health coaches to promote activities such as Couch to 5k, but “there seems to be a lack of effort to educate about diet and lifestyle – it’s amazing that some teenagers and young adults simply don’t understand what exercise is.”

The British Medical Journal reports that one in six integrated care boards, responsible for managing health services in their region, have stopped accepting patients for specialist weight management services. The number of patients was allegedly out of control and demand far exceeded capacity. An academic expert told the BMJ that where services do exist, there are often too many of them and there is a risk of budget cuts.

Some other experts say that only an intergovernmental approach will be sufficient to solve the problems. Professor Jonathan Pearson-Stuttard, head of health analytics at consultancy LCP, says this must be a priority for all Whitehall departments: “The links between poor health and poor economic performance are becoming increasingly clear. Preventing the onset of disease is key to managing complex health care demands, as well as supporting health-driven well-being.”

So why didn’t political leaders do more? Some were clearly concerned about accusations of a “nanny state” if restrictions were imposed. Business leaders also tend to oppose new food taxes.

The Food and Drink Federation says these taxes will not result in “reformulation”. There is talk in the industry about creating new recipes with fewer unhealthy ingredients and trying not to lose customers.

In a statement, a spokesperson said: “The food and drink industry knows it has an important role to play in tackling obesity and poor diets, and we would welcome the opportunity to work with government and others to find solutions that better support balanced diets and healthier lifestyles. The industry continues to invest in the innovation needed to reformulate much-loved products to make them healthier, by removing fat, salt and sugar and adding extra fruit, vegetables and fibre, giving consumers a wider choice of healthier foods and drinks.”

The governments of Scotland, Wales and Northern Ireland have developed their own strategies to tackle obesity. All four UK countries tended to defend existing policies and point to bold ambitions to intervene. But as the debate about the sustainability of the NHS intensifies, a broader discussion about health will be needed – and that did not feature in this campaign.

The problem is that developing consistent policies across departments will take time and won’t make for catchy manifesto headlines.

But as Amanda Pritchard, chief executive of NHS England, said in a recent speech: “Will we tackle the problems at source or accept that the NHS will become an expensive safety net?”

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