Obesity and diet-related illness are rising across the UK, and with the increased risk that these pose in the context of Covid, it is not surprising that the new National Food Strategy in England has focused much of its attention on breaking the ‘junk food cycle’. Its bold recommendation for a tax on wholesale sugar and salt certainly raised eyebrows, and made for some interesting headlines. FFCC Food and Health Programme Lead Dr Courtney Scott asks: will it work, and will it be enough?

Taxes and levies of this kind have a long history of effectiveness in public health, most famously in helping to reduce smoking rates (1). There is also precedent in the UK with the Sugary Drink Industry Levy. It is an approach that is supported by the British public, especially when they are shown messaging about the affordability of healthy food in the UK, as our recent research found. The Strategy is bold and brave for taking this approach, and the potential health benefits of the tax could reach further as some of the revenue raised will go towards making fruit and vegetables more affordable for those on a low income.

The key to the tax’s success will rest on if or how the tax is incorporated into the government’s White Paper that will follow publication of the strategy. Taxes and levies are powerful policy tools, and that power needs to be harnessed in the best possible way to avoid unintended consequences.

No matter how much a company reformulates, a biscuit will never turn into an apple.

Taxes on unhealthy food and drinks can be designed to encourage reformulation (that is, the redesigning of products) to decrease the unhealthy nutrients within products, or to try to sway us away from eating the taxed foods and drinks. From what the Strategy says, it seems the aim of its proposed tax is to reformulate. This could pose challenges for achieving significant dietary change, because no matter how much a company reformulates, a biscuit will never turn into an apple.

It is also not yet known whether there will be any restrictions on what substitutes companies can use when they take out the sugar or salt from their products, and how these substitutes might affect our health and the planet. When companies took trans fats out of their products (for good reason), they often substituted with palm oil, which is damaging rainforests and biodiversity around the world (2). The Sugary Drink Industry Levy prompted mass reformulation of sugary drinks, and introduced high levels of artificial sweeteners into our diets, without reducing consumption of the drinks overall (3). There is little population level evidence of the impact this level of sweeteners will have on our health, which is especially worrying given that the National Diet and Nutrition Survey shows that two-thirds of children as young as 18 months are drinking an average of one can of artificially sweetened drinks every day (4).

As a first step, we support the sugar and salt levy, and government should act on this – keeping in mind the caveats above. They will, however, need to move quickly beyond this. One of the biggest dietary challenges we face is a food system that is ever pushing us towards more processed and packaged foods – and those foods are hard to turn down for a whole host of reasons, including their affordability, incredible taste that keeps us coming back for more, and the fact that they are so very convenient. However, dietary recommendations consistently tell us the opposite: to eat more whole foods like fruit, veg, nuts and pulses.

Half of the UK’s diet comes from ultra-processed foods.

So what else could be done? One idea is to tax ultra-processed foods rather than specific nutrients like salt or sugar. Half of the UK’s diet comes from ultra-processed foods, and evidence shows that these products are damaging our health and increasing risk of obesity (5,6). A large study from France found that a 10% increase of ultra-processed foods in the diet, increased the risk of cancer by 10% (7).

‘Ultra-processed’ sounds daunting and unknown, but apart from a few surprising foods that you wouldn’t expect, like most supermarket breads, it’s fairly easy to spot an ultra-processed food. There is a huge difference between the ingredient list of a food with lots of industrial ingredients – which we would never use at home – and a food which we could (in theory) make at home, and the ways in which these ingredients interact in our bodies. Research is on-going into how these products increase our risk for ill health and obesity, but emerging evidence suggests it could be because they prompt overeating, due to their highly attractive taste and because they can be eaten easily and quickly, or because the processing, additives or ingredients change the way our guts and bodies handle that food (7,8,9).

To really change diets, we know we need to eat less, and less ultra-processed foods.

Nutrient-focused approaches, like reformulation, are easier for the food industry to support as it allows companies to demonstrate they are ‘part of the solution’ to the challenges we face, whilst continuing to selling their usual products. And as ultra-processed foods are usually produced or sold by large or multinational companies, they hold a lot of sway in the system. To really change diets, however, we know we need to eat less, and less ultra-processed foods, which will pose a challenge to the business models of many companies.

This gets right to the heart of why it is so important for government to take the lead and responsibility for completely rebalancing the types of foods made and sold in our food system: it really is the only way to get out of the ultra-processed pickle. Food can be healthy and affordable if government and companies take bold and urgent action to realign the food system, so it works better for everyone. Taxing ultra-processed foods, and using the money raised to help people afford healthy food, would be a radical and practical way to move in that direction.

References can be found below.

This short paper is part of Healthy food is everyone's business - a series exploring and developing the ideas in the National Food Strategy, and discussing what needs to happen now.

The National Food Strategy is a rigorously researched, eloquently written and passionate call to action. As the dust settles, it’s time for serious conversation about how we work together to take the eminently achievable recommendations in the Strategy into the promised White Paper. They are the first steps on the route to a different future for food, farming and land use, improving the public’s health, reducing inequalities and acting on the nature and climate crises.

This is a critical moment. It’s both deadly serious - we have just 9 growing seasons left until 2030 - and hopeful, as we see a growing consensus forming around a route to a better future. When we published Our Future in the Land in 2019, which shares the same analysis and many recommendations as Henry’s Strategy, that consensus was not so clear.

It’s time to let governments know we want them to be bold, radical and practical, to create the conditions for business and citizens to work together to get this done.

References

1. Wright, A., Smith, K. E., & Hellowell, M. (2017) Policy lessons from health taxes: a systematic review of empirical studies BMC Public Health, 17(1), 583

2. Russell, M. (2020) Palm oil: Economic and environmental impacts

3. Pell, D., Mytton, O., Penney, T. L., Briggs, A., Cummins, S., Penn-Jones, C., Rayner, M., Rutter, H., Scarborough, P., Sharp, S. J., Smith, R. D., White, M., & Adams, J. (2021) Changes in soft drinks purchased by British households associated with the UK soft drinks industry levy: controlled interrupted time series analysis BMJ, 372

4. First Steps Nutrition Trust. (2019). Sweet enough already? Artificial sweeteners in the diets of young children in the UK

5. Lane, M. M., Davis, J. A., Beattie, S., Gómez-Donoso, C., Loughman, A., O’Neil, A., Jacka, F., Berk, M., Page, R., Marx, W., & Rocks, T. (2021) Ultraprocessed food and chronic noncommunicable diseases: A systematic review and meta-analysis of 43 observational studies Obesity Reviews : An Official Journal of the International Association for the Study of Obesity, 22(3), e13146

6. Monteiro, C. A., Moubarac, J.-C., Levy, R. B., Canella, D. S., Louzada, M. L. da C., & Cannon, G. (2018) Household availability of ultra-processed foods and obesity in nineteen European countries Public Health Nutrition, 21(1), 18–26

7. Fiolet, T., Srour, B., Sellem, L., Kesse-Guyot, E., Allès, B., Méjean, C., Deschasaux, M., Fassier, P., Latino-Martel, P., Beslay, M., Hercberg, S., Lavalette, C., Monteiro, C. A., Julia, C., & Touvier, M. (2018) Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort BMJ (Clinical Research Ed.), 360

8. Hall, K. D., Ayuketah, A., Brychta, R., Cai, H., Cassimatis, T., Chen, K. Y., Chung, S. T., Costa, E., Courville, A., Darcey, V., Fletcher, L. A., Forde, C. G., Gharib, A. M., Guo, J., Howard, R., Joseph, P. V., McGehee, S., Ouwerkerk, R., Raisinger, K., … Zhou, M. (2019) Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake Cell Metabolism, 30(1), 67-77.e3

9. Juul, F., Vaidean, G., & Parekh, N. (2021) Ultra-processed Foods and Cardiovascular Diseases: Potential Mechanisms of Action Advances in Nutrition