ROLE OF SUGAR SWEETENED BEVERAGES IN INCREASING NON COMMUNICABLE DISEASES IN PAKISTAN
Sugar is one of the simple forms of carbohydrates. It contains mono-saccharides, such as fructose, galactose, and glucose (found in fruits), as well as disaccharides, such as sucrose (table sugar) and lactose (found in dairy products).
A sugar-sweetened beverage (also referred to as a “soft drink”) is a drink that contains sugar or another sweetener (high fructose corn syrup, sucrose, fruit juice concentrate, or others). Drinks, such as soda, cola, tonic, fruit punch, sports, and energy drinks, are considered sugary beverages.
Over the last few years, household food consumption has increased by more than 10%, while production and prices have been steadily falling, making sugar-sweetened beverages more and more essential.
These foods and beverages, however, contain no vitamins, minerals, or fiber, because they are made with processed sugar. This is what we call ’empty calories’ and they can make people gain weight.
Diabetes, tooth decay, and obesity are all associated with excessive sugar intake. Increasing evidence suggests that the consumption of free sugars–especially in the form of sugar-sweetened beverages–increases overall energy intake and reduces intake of better nutritional foods, leading to poor eating habits, weight gain, and increased risk of non-communicable diseases.
Tooth decay is also associated with the consumption of free sugars. In the past decades, great progress has been made in the prevention and treatment of dental diseases, but despite these advancements, problems continue to arise, resulting in pain, anxiety, functional limitations and, in the case of tooth loss, social isolation.
The health hazards of sugary drinks
Sugary drinks belch out the most calories and contain hardly any other nutrients, making them the least healthy beverage. Researchers have also found that sugary beverage drinkers do not feel as full as if they had eaten the same amount of calories from solid food. They do not compensate for the high-calorie content of these beverages by eating less.
Adding sugar to sugar-sweetened soda or fruit punch adds 150 calories per can. It is safe to say you could gain 5 pounds in a year if you drank just one of these sugary drinks every day and didn’t reduce your calorie intake elsewhere.
Sugar-rich drinks can cause more than just weight gain; they can also increase your risk of developing type 2 diabetes, heart disease, and other chronic diseases. It has been found that sugary drinks increase premature death risk.
The obesity epidemic:
When someone consumes over 8 ounces of sugary beverages each day, he or she will take in more calories later on. The opposite is true for solid food since people avoid overeating by eating fewer calories at a later meal.
Because fluids don’t provide the same sense of satisfaction or fullness as solid foods, there is no compensatory effect after drinking soft drinks. You might crave other sweet, carbohydrate-rich foods if you drink sweet soft drinks.
There has been a wide range of research on the relationship between soft drinks and weight. Most of the studies show that increased consumption of soft drinks is associated with increased energy consumption.
- In a meta-analysis of 88 studies, it was found that women seemed to be more affected than men.
- In children and adults, studies have shown that cutting back on sugary drinks can cause weight loss among the overweight.
- In children, sugary drinks are associated with weight gain, according to studies. A study found that children were 60% more likely to become obese when they drank each additional 12-ounce soda daily for 1.5 years than if they didn’t consume it.
It is also associated with lower long-term weight gain to drink water instead of sugary drinks or fruit juices.
The gout:
According to a 22-year-long study of 80,000 women, women who consumed sugary drinks every day were 75% more likely to suffer from gout than those who rarely drank them. Men also had an elevated risk.
Optimal bone health:
It is possible that soda poses unique challenges to bone health:
- Soda contains a high amount of phosphate and osteoporosis can be caused by consuming more phosphate than calcium in the diet.
- As bones are being built in childhood and adolescence, calcium is very important and soft drinks do not contain calcium and other essential nutrients.
- Calcium and protein are valuable components of milk, as well as vitamin D, vitamin B6, and vitamin B12. While the consumption of soft drinks and milk are inversely related – when one increases, the other decreases.
Cardiovascular Diseases:
- According to a study that followed 40,000 men over the span of two decades, those who consumed a sugary beverage on average once a day was 20% more likely to experience a heart attack and lose their lives to one than those who rarely consumed sugary beverages.
- The sugary beverage–heart disease link has been confirmed in a similar study of women. Over a two-decade period, the Nurses’ Health Study tracked the health of nearly 90,000 women, and the study found that those who consumed more than two sugary drinks each day tended to have a greater risk of heart attacks or death from heart disease compared with those who rarely consumed sugary beverages.
- The Nurses’ Health Study showed that people who drank a lot of sugary drinks tended to weigh more than people who didn’t and ate healthily less as well. Additionally, fructose from sugar or high fructose corn syrup used to sweeten these beverages may also pose some risks.
- High glycemic load from these beverages may also increase the chances of heart disease because of adverse effects on blood glucose levels, cholesterol levels, and inflammatory responses.
Diabetes:
If you drink sugary drinks frequently that is, one to two cans a day or more, then your odds of developing type 2 diabetes are 26% greater than if you drink them rarely. Young adults and Asians are at even greater risk.
Diabetes has been strongly linked to sugary soft drinks.
More than 90,000 women were followed over eight years for the Nurses’ Health Study to examine this connection. In the study, nurses who reported drinking sugar-sweetened beverages or fruit punch once or more a day were twice as likely to develop type 2 diabetes as those who rarely had these beverages.
Morbidity:
The longer people drink sugar-sweetened beverages, the greater their risk of premature death – especially from cardiovascular disease and cancer, on the other hand, but to a lesser extent from diabetes.
- Comparatively, with infrequent drinkers, those who consumed two or more drinks daily were 31% more likely to die early from cardiovascular disease. A 10% higher risk of dying from cardiovascular disease was associated with each additional serving of sugary drinks consumed per day.
- A study found that one artificially sweetened beverage a day reduced the risk of premature death when compared with a sugary one. On the other hand, women who drank four or more artificially sweetened beverages per day had a higher mortality risk.
Reducing sugary drinks:
Sugary drinks have a negative impact on our health, so we should avoid them. The best alternative to these beverages is water, which is one of the healthiest options.
This is easier said than done, though, if you consume a lot of soda. Sparkling water is a good choice if you like the carbonation. A naturally flavored sparkling water would be a better choice if you don’t like the bland taste. Then you can add a squeeze of juice, some sliced citrus, or even some fresh herbs if that’s still too much.
Specifically, sugar reduction reduces the risk of being overweight and obese, which in turn reduces the risk of developing diabetes. Sugar reduction also significantly reduces dental caries. Reducing sugar consumption at the population level has proven to be beneficial for health.
It is the responsibility of everyone – governments, the private sector, and civil society – to promote a reduction in sugar consumption.
Pricing policies for preventing non communicable diseases:
WHO says that preventing NCDs is the most cost-effective way for countries to reduce their economic and health burdens. One NCD prevention approach governments have used or considered is to change the price of unhealthy foods and beverages or to lower the price of healthier ones.
Tobacco, alcohol, and sugar-sweetened beverages (SSBs) have all been subject to taxes in order to prevent NCDs. The basic idea is to tax these items to increase prices, lower consumption, and prevent or minimize future cases of NCDs associated with them. A total of 45 countries, cities, or regions within countries have implemented SSB taxes to date.
Meta-analyses show that consumers will reduce SSB purchases by 10% if SSB prices rise 10%.
Increasing accessibility of healthier alternatives:
Pricing healthier alternatives at a lower price or making them more affordable are also viable options. It may be possible to shift the current tax structure to create larger price differentials between health-related products and the ones that are considered to be less healthy.
In the upcoming budget, increase the tax on sugar-sweetened beverages (SSBs) including carbonated drinks so that they are unaffordable to the masses and thus reduce their consumption.
A major public health burden and an economic threat in Pakistan is diabetes mellitus. The rate of diabetes in Pakistan has been increasing at an alarming rate, with every fourth adult Pakistani suffering from type 2 diabetes according to the 2nd National Diabetes Survey of Pakistan 2016-17.
The increase in weight and obesity is a crucial factor in causing diabetes to develop early in life. In Pakistan, four out of ten adults are obese or overweight, while 37 percent suffer from hypertension, according to the National Non-Communicable Diseases Steps Survey (2014-15).
To reduce obesity and related diseases such as diabetes, the tax on SSBs was an evidence-based first step. A total of 40 countries have enacted this policy. Tax increases on SSBs have been shown to reduce their consumption, obesity and related diseases in India, South Africa, Mexico, Australia, and other countries.
Additionally, the World Health Organization (WHO) and the World Bank (WB) recommended raising taxes on sugar-sweetened beverages (SSBs) in order to reduce obesity and diabetes, however, Pakistan has lower tax rates than other countries in the region, such as India and the Maldives, and many other countries such as Saudi Arabia, Qatar, and Bahrain.
How can we reduce the consumption of sugar among the population?
Several evidence-based interventions can be implemented by government to reduce sugar intake/consumption.
- Prohibit the marketing of sugar-laden products, especially drinks.
- The use of advertising, marketing, and sponsorship for sugar-enriched food and drinks should be banned across all media platforms.
- To determine sugar-saturated foods and drinks, use nutritional profiling.
- The elimination of government subsidies for sugar and the introduction of progressive taxes on foods and drinks with added sugar are the primary recommendations.
- Improve nutrition and health training programs for individuals so that they can effectively influence population food choices.
- Educate populations about health issues and set standards across all government-sponsored institutions for food and drink.
References
Guideline: Sugars intake for adults and children. Geneva: World Health Organization; 2015
Healthy diet, Fact sheet N°394. Geneva: World Health Organization; 2015
Abdulrahman O Musaiger. Overweight and obesity in the Eastern Mediterranean Region: prevalence and possible causes. 2011. doi:10.1155/2011/407237. J Obes. 2011.407237.
WHO Global Health Observatory data repository. Geneva: World Health Organization; 2015
Global status report on noncommunicable diseases 2014. Geneva: World Health Organization; 2014
Global strategy on diet, physical activity and health. Geneva: World Health Organization; 2015
Teng AM, Jones AC, Mizdrak A, Signal L, Genç M, Wilson N. Impact of sugar-sweetened beverage taxes on purchases and dietary intake: systematic review and meta-analysis. Obes Rev 2019;20(9):1187–204. 10.1111/obr.1286831218808
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