Written for Health-e News
Written By: Thabo Molelekwa
Liquid sugar is easily absorbed, and most of the sugar from sweetened beverages has no nutritional value beyond the sugar content.
The fact that sugary drinks are a major cause of obesity and diabetes came into focus at the recent Cardio Vascular Disease Imbizo in Sandton, Johannesburg.
Speaking at the Imbizo Lynn Moeng Mahlangu, the cluster manager of Health Promotion and Nutrition at the National Department of Health, said that the consumption of sugar-sweetened beverages or SSBs has strongly been linked with type 2 diabetes.
“In 2013 the Department of Health developed a strategy to tackle non-communicable diseases, and one of the keys was to reduce sugar intake by 10%,” she said.
Moeng Mahlangu said that South Africa is in the top three countries in Africa when it comes to people living with obesity.
She said one of the reasons for this is the high cost of healthy food.
“People choose healthy products because they are cheaper,” said Moeng Mahlangu.
“This is one of the debates we are having, involving other departments like agriculture,” she said.
“Our children are consuming 40-to-60 grams of sugar a day. This means their intake is between 100 and 200% more than they should,” she said.
Obesity in children
She said this was a dangerous situation as obese children generally tended to remain obese throughout life, and much of this was due to the consumption of sugary drinks.
According to Professor Karen Sliwa, director of the Hatter Institute for Cardiovascular Research in Africa and president-elect of the World Heart Federation, there is overwhelming data to confirm that a very high sugar intake has a negative impact on health.
“It is bad in many ways. It makes us obese, especially when we don’t move enough,” she said.
“You can develop diabetes, high blood pressure, you can develop heart disease or have a stroke,” said Sliwa, adding that these factors can lead to long periods of ill health or early death.
According to Sliwa, implementing a tax on sugar tax is one way of trying to combat this disease, as making SSBs more expensive would drive down consumption.
“By decreasing the amount of sugar in beverages we can address some of those issues,” she said, adding that a sugar tax alone was not enough to address the problem properly.
“Although the sugar beverage tax will hopefully show the same results experienced in other countries where it saw a decrease in obesity, the core issues around poverty still needed to be looked at,”said Sliwa.
She said it was important for government to take the lead and make South Africa one of the first countries in Africa to implement the tax.
Sliwa said that educating the people on healthy living was important.
“Some people don’t know that if you are short of breath it can mean that your heart is failing. People don’t know that there is no cure for diabetes and that you always have to take your medication,” she said.
Professor Liesl Zuhlke, President of the South African Heart Association said the health of children needed to be made a priority.
“If you are fat at 13 years, its possible that you will stay fat until you are old,” she said, explaining why children needed to be taught to make good choices for themselves.
“It ain’t over until the fat lady sings “-
the South African sugar tax finale
Authors: SANCDA Vicki and David Pinkney-Atkinson
Written for NCDA and published on the SANCDA website
After 18 months of public wrangling the Health Promotions Levy (HPL), also known as the “sugar tax”, is inching closer to a finale. With stakeholder consultation drawing to a close, a final step is an Act that includes a tax on sugary drinks. The decision must be made by legislative structures to implement or withdraw the tax. It is a final critical drama. For now.
The outcome cannot be taken for granted within the current South African political climate. In other words, it is a “don’t count your chickens until they hatch” scenario. A cliffhanger to the last. The South African NCDs Alliance (SANCDA), its partners and allies, have participated in the public roller coaster ride. It supports the tax as a positive step towards health in a whole package of interventions. Note, it is one of many planned but unfinanced interventions needed to promote health and kerb non-communicable diseases (NCDs). Sugar is the new tobacco.
If you are like us, the nuances of what it takes to pass a tax law are mysterious and not within our everyday grasp of life. So, get to know music overture to the final act of how this happens. In South Africa, this is how a law is tabled and passed.
Using the “sugar” and “tax” together is an oxymoron. Simply confusing with one seen as good and the other as bad. Like the “teenage brain”. So, from childhood we learn the following:
- Tax is bad = “Nothing is certain but taxation and death.”
- Sugar is good = “Sugar and spice and all things nice.”
So, sugar is good? Fact check: too much sugar, especially in a cheap and easy to access form like “soft drinks” or “sodas” is linked to obesity, diabetes, cancer, tooth decay and heart disease. The illnesses resulting from sugary drinks are estimated to have cost the South African economy R23 billion in 9 years to treat and fight obesity only. A local study shows R10 billion will be saved over the next 20 years if we count type 2 diabetes alone.
Tax is bad. So, predictably questions in our country are likely one of the following versions:
- Why should I care, I don’t drink Coke and I am not fat?
- This is another clever money grabbing way for the government to hit my shrinking wallet.
- Don’t waste my money on a frivolous tax that will be wasted like so much of our money is already lost through wasteful expenditure and other nefarious means.
Let’s start by educating our people that this is an important issue that is bigger than simply saying “no” to sugary drinks. South Africans simply don’t know enough about the risks and dangers of too much sugar and its relationship to obesity and NCDs. This tax has just highlighted how much further must be done. It’s not simply about sugary drinks, these are the visible part of the problem
The cost of obesity and diabetes to South Africans is called the “burden of disease” and is often expresses as the number of people who get sick and die of certain diseases. It costs all of South Africa because our fragile health system must cope with most of the people and each of us have to pay for it in some way. It may be your mother or brother or child. Who cares for you when you have lost your leg to diabetes and can’t walk? Someone in your family needs to stop everything and care for you. This means that they and often you lose their income in caring for you.
Fact checks
- South Africa is the fattest nation in sub-Saharan Africa
- Diabetes the number 2 killer of people in South Africa after TB
- Cutting sugar levels will cut obesity and crippling illnesses.
Our collective lack of awareness as a nation and education is why the SANCDA calls for part of the money collected to be used for the prevention of obesity and related non-communicable diseases (NCDs). NCDs in the health budget is neglected and underfunded, even though these illnesses are the leading cause of death in South Africa.
“Government is committed to increasing investment towards health promotion targeting non- communicable diseases alongside the implementation of the sugary drinks tax, such as diabetes screening and nutrition education.”
Minister Pravin Gordhan, Budget speech 22 February2017
The SANCDA celebrates the proposed allocation of additional resources for health and NCDs prevention. We lament that organisations like CANSA, Diabetes South Africa and the Heart and Stroke Foundation with active programmes are not considered for funding. Let’s not forget over 10 cancers are linked to, and many children lose teeth because of sugar excess.
The HPL is a better, if not as catchy, name that puts the focus where it belongs on health promotion and primary prevention of obesity and NCDs. The sugary drinks tax timeline in the box below shows where we have come from and where we are going in the “final” act for now.
As expected the food and beverage industry does not want this tax and has aggressively campaigned against it. The ultimate weapon, in a country with all-time high unemployment rates and in a technical recession, is to claim that massive job losses will result. Job loss claims range from 72,000 jobs to 5,000. The initial estimate from Treasury was less than 11% of those claimed.
The ball is firmly in the court of the food and beverage industry according to Treasury’s response published this week and presented to the Finance Standing Committee. If the beverage industry reformulates to meet the new requirements of 4g/100ml the job losses are estimated to be significantly less at 2,392 jobs across the sector.
The HPL isn’t only a tax digging into your pocket and costing you more. We, the South Africans, are acting now to change the health of our children’s future. We did it for HIV/AIDS now we need to do it for all of us once again. Take a lesson from the past. When taxes and levies were first placed on cigarettes it was met with the same view, but as money, educated people and the health risks became more abundant. You’d be hard pressed to find a single person upset about the cost of smoking and the measures taken to dissuade people from it. The HPL is here to stop an even greater cost to us in the next 10 years.
The introduction of the draft taxation bill in February is watered-down version with the taxation reduced by almost half. The graphic shows the details.
In our democratic society, the bill must be passed with the taxation of sugary drinks at any level to change the health of the nation.
As the discussion is set continue as we reach the final act. The SANCDA, together with its global and local partners, will keep monitoring the progress and keep you informed. These insights make what is being worked towards an evidence based path to follow having been tailored to fit the uniquely South African way forward. Together they are all working towards this goal finally becoming a reality.
We are committed to sharing experiences and lessons learnt in this crucial final act as we wait for the “fat lady to sing”.
|
SOUTH AFRICA’S SUGARY DRINKS TAXATION TIMELINE |
| 1993 -2002 |
Taxation of “soft drinks and mineral water” by volume not related to sugar content. Repealed following lobby by the food & beverage industry. |
| 2013 |
National Department of Health NCDs policy published including SSB tax is part of the effective measures to combat obesity and non-communicable diseases (NCDs). |
| 2014 |
Food labelling and marketing to children regulation published (R429) and remains to be finalised. |
| 2015 |
Publication of SA National Health Promotion policy & SA obesity control and prevention policy |
| 2016 |
| February |
SSB tax announced in budget speech for implementation in 2017 |
| July |
Treasury releases SSB tax policy paper recommending a 20% tax. |
| August |
· Closing date for comments
· SANCDA submits comment. |
| November |
Treasury stakeholder workshop on the SSB
SANCDA makes a presentation |
| 2017 |
| January 31 & February 14 |
Standing Committee on Finance – legislative activities to allow for implementation of tax
SANCDA make a submission |
| February |
· Budget speech announcing a reduced SSB tax in a draft tax bill
· Tax rate reduce to half and amount of sugar to be taxed reduced.
· Now called a “Health Promotion Levy” (HPL)
· Unspecified part of money collected to be allocated for obesity prevention and diabetes care |
| May 28 & June 6 |
Standing Committee on Finance – more public hearings on HPL in the draft bill.
SANCDA makes presentation |
| 4 June |
National Economic Development and Labour Council (NEDLAC) meetings on SSB tax |
| 22 June |
Standing Committee on Finance meetings and publication of draft summary of findings |
| August |
Standing Committee on Finance decision referred to Council of the Provinces |
| 2020 |
ê obesity by 10% national target to be achieved |
By Serena Gordon
HealthDay Reporter
Young people with type 2 diabetes are much more likely to show signs of complications from the blood sugar disease than those who have type 1 diabetes, a new study shows.
While the researchers found that about three in four teens and young adults with type 2 diabetes had at least one complication, only one in three with type 1 diabetes did.
Why?
“The one big difference in the kids with type 1 and type 2 was obesity. When we controlled the data for obesity, there was no longer an excess of complications for type 2 diabetes,” explained lead author Dr. Dana Dabelea. She’s a professor of epidemiology and pediatrics at the Colorado School of Public Health, in Aurora.
The one bright spot in the findings was that the complications were mostly in the “early or subclinical” stages, Dabelea added.
That means there’s still time to reverse the damage, she explained.
Both types of diabetes have been on the rise, according to the researchers. The obesity epidemic has played a significant role in the increase in type 2 diabetes in both adults and children.
People with type 2 diabetes first develop insulin resistance. Insulin is a hormone that helps the body use sugars from food as fuel. When the body is insulin-resistant, it doesn’t use insulin efficiently. Because insulin isn’t helping sugar into cells to be used as energy, sugar stays in the bloodstream, causing blood sugar levels to rise.
In response, the pancreas — the organ that makes insulin — produces more and more insulin to try to bring blood sugar levels down. Eventually, the pancreas can’t keep up with the demand, and type 2 diabetes develops.
There are a number of medicines available for adults with type 2 diabetes, Dabelea said, but treatment is more limited in young people with type 2 diabetes. They can make lifestyle changes and take insulin and the drug metformin, which makes the body more sensitive to insulin.
Type 1 diabetes is an autoimmune disease. Weight doesn’t play a role in causing type 1 diabetes. Instead, the body’s immune system mistakenly attacks the insulin-producing cells in the pancreas. So many cells are destroyed that the pancreas makes little to no insulin.
To survive, people with type 1 diabetes must take multiple daily insulin injections or receive insulin through a tiny catheter placed underneath the skin that attaches to an insulin pump. But, unlike people with type 2 diabetes, their bodies can efficiently use insulin.
The study included more than 1,700 young people with type 1 diabetes and nearly 300 with type 2 diabetes. They were treated in five different locations in the United States between 2002 and 2015.
The average age of the those with type 1 diabetes was 18, and three-quarters were white. For those with type 2 diabetes, the average age was about 22, and only about one-quarter were white, according to the report.
Both groups had diabetes for about eight years. Their blood sugar levels were similar, the study showed.
The researchers found that almost 20 percent of the type 2 group had early signs of possible kidney disease, as did 6 percent of those with type 1 diabetes.
Dr. William Cefalu, chief science, medical and mission officer for the American Diabetes Association (ADA), pointed out that a number of factors can affect test results for early kidney disease, and this study only looked at one test.
The study also found that 9 percent of those with type 2 diabetes had early signs of eye disease, as did nearly 6 percent of the type 1 group.
Arterial stiffness was seen in 47 percent of those with type 2 diabetes and less than 12 percent with type 1 diabetes. Twenty-two percent of those with type 2 diabetes and 10 percent of those with type 1 diabetes had high blood pressure.
Dabelea said those two complications were the most concerning, because they may not be as reversible with good disease management as the other complications.
Factors other than obesity may play a role in the differences between the two groups of patients, the researchers noted. For example, type 2 may be a more aggressive disease in children. It’s also possible that the limited treatment options for type 2 diabetes affected the rate of complications.
Dabelea also noted that kids with type 2 diabetes were a more diverse population. They may have come from economically disadvantaged families with less access to health care.
Cefalu said he wasn’t “really surprised by the study’s findings, but the statistics are startling, given that these are youth and adolescents.”
He said parents and physicians should see this study as “a call to action to have a heightened awareness that complications are present at a high rate.”
Blood sugar management can help stave off these complications. Losing weight is helpful for kids with type 2 diabetes, and regular physical activity can make a big difference. Make sure your child’s blood pressure is being measured, and that their kidney health is tested, Cefalu added.
Also, get your child’s eyes checked by an ophthalmologist, Cefalu suggested. For kids with type 2 diabetes, annual eye exams should begin right after diagnosis. For those with type 1 diabetes, eye exams are recommended starting five years after diagnosis, according to the ADA.
Cefalu also noted that parents and providers need to keep in mind that there are treatments available for diabetes complications.
The findings were published Feb. 28 in the Journal of the American Medical Association.
Copyright © 2017 HealthDay. All rights reserved.
SOURCES: Dana Dabelea, M.D., Ph.D., professor, epidemiology and pediatrics, Colorado School of Public Health, Aurora; William Cefalu, M.D., chief science, medical and mission officer, American Diabetes Association; Feb. 28, 2017, Journal of the American Medical Association
