Market evaluation of soft drinks available in the UK and Europe to understand differences in sugar and energy content and whether there is a link to the sugar tax

Brogan Munslow, Nutrition

Contents

1. Placement Year 2. Obesity Prevalence3. Associated Health Problems4. Potential Causes of Obesity5. Sugar and Dental Caries 6. How the UK government is tackling Obesity7. Evidence this approach works8. Research Project9. Data Collection10. Results

I. Average Calorie and Sugar ContentII. Sugar Content Vs. PriceIII. Source of SweetnessIV. Breakdown of SweetenersV. Sugar Content Vs. Sugar Tax

11. Supporting Study 12. Study Conclusion13. References

Placement Year

Data collected while working for Sensient regarding thecarbonated soft drink markets across the UK and Europehas been utilised in this research to create a 2-year cross-comparison study

Completed a 14-month industrial placement at

Sensient Flavors as the Innovation Intern

Collected various data on different UK and European

markets including tea and soft drinks

Developed a model system to identify how carbonated

beverages such as cola age over time

Ran multiple methods of sensory analysis such as:

triangle, tetrad, acceptability and difference from

control tests

Obesity Prevalence

Overweight and obesity affects 1.9 billion adults globally

Expected to rise to 3.3 billion = 60% globally population by 2030

In Europe 50% adults are overweight of which 16% are obese

In UK 20% children are overweight or obese by the time they enter education

Obesity accounts for over ¼ UK population, forecasted to rise to 35% by 2030

This Photo by Unknown Author is licensed under CC BY-ND

Associated Health Problems

Obesity increases the risk of developing non-communicable diseases (NCD’s) such as:

- Insulin Resistance leading to type 2 diabetes- Coronary Heart Disease

- Hypertension - Cancers e.g. colon, liver, breast, ovary and kidney- Difficulty sleeping including Obstructive Sleep Apnea

Obesity is a diagnostic factor for metabolic syndrome which also increases the risk of NCD’s Obesity affects quality of life by causing dysregulation for multiple systems including:- Immune system, Respiratory system and Digestive system

This Photo by Unknown Author is licensed under CC BY-NC-ND

Potential Causes of Obesity Sedentary Lifestyles

Desk-based jobs

Heavy reliance on driving (especially for short journeys)

More time playing videogames and watching TV

Less times spent outdoors

All lead to decreased physical activity

Dietary habits

Diets have become nutritionally poor

High consumptions of energy-dense foods high in fat, salt and sugar.

Simple carbohydrates are added to food and beverage products, increasing daily average sugar intake.

Sweeteners added to food and beverages to create low calorie “Healthy/ Diet” alternatives can stimulate passive over consumption and increase the risk of obesity and NCD’s

This Photo by Unknown Author is licensed under CC BY-SA-NC

Sugar and Dental CariesTooth Decay

Most common chronic disease in children but is entirely preventable

Prevalence increases with age

Decay in primary teeth = 31% 5 year olds and 46% 8 year olds

Decay in permanent molars = 5% 5-year olds and 25% of 15 year olds

Cause of Dental Caries:

Variety of factors: - Oral Bacteria - Acid - Saliva - Fluoride content

Main Factor is Sugar

Present in many food and beverages e.g. carbonated soft drinks

Stimulates metabolization of cariogenic bacterium. leading to acid production which lowers the mouths pH resulting in enamel demineralisation and decay

How the UK Government is tackling obesity

Soft drink industry levy “Sugar Tax”

Introduced 6th April 2018

Aims to reduce sugar content of soft drinks with:

£0.18 per litre charge on soft drinks containing 5-8 grams of sugar per 100ml£0.24 charge on drinks exceeding 8 grams per 100ml

Charges aim to:

Drive up price of high sugar beverages

Deter consumer purchases of high sugar beveragesEncourage product reformulation

£385 million is expected to be raised and will be used to Fund:

Facilities and purchase new equipment to aid physical activity in schools

Breakfast clubs in schools to promote healthier diets

Evidence this Approach WorksPublic Health Taxes have been implemented in multiple countries already including:Mexico Added sugar accounted for 12.5% energy intake. 70% of

which from sugar sweetened beverages (SSB’s). 1 peso per litre charge implemented on SSB’s in 2014Purchases of SSB’s dropped by 9.7% in two yearsWater purchases increased by 15.6%

Hungary 3.6% tax introduced in 2011 on high sugar foods and drinks

Reformulation occurred in 40% products assessed. Of this 30% completely removed taxable ingredients

France €0.0716 per litre on SSB’s and artificially sweetened beverages in 2012

Raised €300 million in 3 years

Retail prices of soft drinks increased by 7.7% in the first yearThis Photo by Unknown Author is licensed under CC BY-ND

Research ProjectAim:

Undertake a market evaluation of soft drinks available in the UK and across Europe to understand differences in sugar and energy content and whether there is a link to sugar tax

Objectives:

1. Understand the links between the sugar and energy content of carbonated soft drinks and obesity

2. Identify if there is a difference in the average sugar and energy contents of soft drinks amongst Europe and the UK.

3. Identify whether the sugar tax has influenced change to the sugar and energy content of soft drinks in the UK.

4. Has the sugar and energy content of soft drinks changed between July 2018 and January 2020 in a range of European countries.

5. Draw conclusions from sugar content, sugar tax data and links to obesity to advise future policy on effectiveness of reducing overall energy intake from soft drinks.

This Photo by Unknown Author is licensed under CC BY-SA

Identify Country Clusters.

List all online supermarkets for each cluster assigning each store a number.

Using a random number generator select two numbers (corresponding to two supermarkets from the list).

For each store identify the total number of CSD’s on the website.

From this total, using a random number generator select 10 numbers (each corresponding to a product on the website e.g. 10 = tenth CSD on the website).

Collect data for each of these products. Including: name, brand, ingredient formulation and nutritional information.

Repeat for each cluster

2018

Visit the same websites as 2018.

Using the previously collected data find the products analysed in 2018 and record any changes to the information where necessary.

Record the selling price in £, calculating the cost per 100ml.

2020

Data Collection• Countries were clustered together due

to different market sizes by: - Geographical and Cultural similarities

• Totalling 8 country clusters in total:• United Kingdom• Scandinavia (Norway, Finland,

Sweden and Denmark)• Austria and Germany• Portugal and Spain• Switzerland and France• Netherlands and Belgium • Poland• Italy

• Data collected in June 2018 and January 2020

• In total 290 carbonated soft drinks were analysed for:

• Nutritional Value including Sugar and calorie content

• Selling Price

Results: Average Calorie and Sugar Content

0 5 10 15 20 25 30 35 40 45

UK

Switzerland & France

Scandinavia

Portugal and Spain

Poland

Netherlands & Belgium

Italy

Austria & Germany

Average Calorie Content (Kcal/100ml)

Regi

on

Average Calorie Content of CSD's per region in 2018 and 2020

2018

2020

Average calorie content of CSD’s across Europe, between 2018 and 2020 categorised by geographical location.

Average sugar content of CSD’s across Europe, between 2018 and 2020 categorised by geographical location.

0 1 2 3 4 5 6 7 8 9 10

Austia & Germany

Italy

Netherlands & Belgium

Poland

Portugal & Spain

Scandinavia

Switzerland & France

UK

Average Sugar Content (g/100ml)

Regi

on

Average Sugar Content of CSD's per region in 2018 and 2020

2018 2020

The UK has the lowest average calorie and sugar content containing 11.9kcal and 2.5g per 100ml

Poland has the highest content at 37.74Kcal and 9.05g per 100ml a 262% rise

The remaining regions ranged between 20-28Kcal and 4.6-6.8g

Results: Sugar Content VS Price

Scatter graph showing the correlation between sugar content and price of

CSD's in the UK (prices are correct as of January 25th, 2020).

R² = 0.0927

0

0.1

0.2

0.3

0.4

0.5

0.6

0.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00 16.00

Cost

per

100

ml B

ever

age

(£)

Sugar Content of Beverage (100ml)

Sugar Content VS Price per 100ml European Beverages

Spearman's rho = 0.269

correlation between sugar content and price of CSD's across Europe (prices

are based on current exchange rates correct as of January 25th, 2020).

There is a positive correlation between sugar content and price with selling price rising with the amount of sugar added

Results: Source of Sweetness

10%

70%

20%

Source of Sweetness in UK beverages 2018

Sugar

Sweetener

Sugar andSweetenerCombination

58%23%

19%

Source of Sweetness in European Beverages 2018

Sugar

Sweetener

Sugar andsweetenercombination

Source of Sweetness in European Beverages 2018.Source of Sweetness in UK Beverages 2018.

The majority of UK soft drinks are artificially sweetened whereas European drinks use sugar as the main source of sweetness

Results: Breakdown of Sweeteners

28%

37%

16%

6%

13%

Breakdown of Sweeteners used in UK Beverages 2018

Aspartame

Acesulfame K

Sucralose

Saccharin

Steviol Glycosides

Breakdown of sweeteners used in UK beverages 2018.

20%

33%19%

6%

12%

1%8%

1%

Breakdown of sweeteners used in beverages across Europe 2018

Aspartame

Acesulfame K

Sucralose

Saccharin

Steviol Glycosides

Isomaltose

Sodium Cyclamate

Neohesperidin

Breakdown of sweeteners used in European beverages 2018.

The most commonly used sweeteners in the UK and Europe are Aspartame, Acesulfame K and Sucralose

Results: Sugar Content Vs Sugar Tax

R² = 0.003

0

10

20

30

40

50

60

70

0 0.1 0.2 0.3 0.4

Aver

age

Suga

r Con

tent

(g/L

)

Sugar Levy Baseline (£/L)

Average Sugar Content (2020) CSD VS. Regional Sugar Levy Costs

• UK

• Netherlands & Belgium

• Portugal & Spain

• Scandinavia

• Switzerland & France

P = 0.873Spearman's rho = -0.1

n = 5

Scatter Graph to show the correlation between a regions average sugar content and sugar levy baseline cost.

There is no correlation between sugar levy cost and average sugar content

A higher tax does not mean less sugar is added to beverages.

However, certain countries with a tax (e.g. UK) have lower sugar contents than those without (e.g. Poland).

Supporting Study

Scarborough et al. (2020)

UK soft drinks containing >5g/100ml decreased from 49% to 15% between 2015-2019

30.7% fewer products qualified for taxation 50 days after sugar tax implementation

Only 15.4% qualified by 10 months post implementation

Identified increased selling prices.

50% levy passed on consumers of high sugar CSD’s increasing selling price by £0.12

Study Conclusion

• The presence of a soft drink industry levy in the UK has been beneficial for driving product reformulations and reducing the quantity of free sugars consumed by the UK public.

• Currently it is too soon to identify and link changes in UK overweight and obesity to the sugar tax, further research needs to be completed to achieve this.

• Studies should also be completed regarding whether the changes in UK selling price have impacted consumer choice long term

ReferencesAljafari, A., Rice, C., Gallagher, J, E. and Hosey, M, T., 2015. An oral health education video game for high caries risk children: study protocol for a randomized controlled trial. Trials [online], 16 (1), 1-10

Bíró, A., 2015. Did the junk food tax make the Hungarians eat healthier? Food Policy [online], 54, 107-115.

Biro, F M. and Wien, M., 2010. Childhood obesity and adult morbidities. American Society for Nutrition [online].91 (5), 1499-1505.

Briggs, A. D. M., Mytton, O. T., Kehlbacher, A., Tiffin, R., Elhussein, A., Rayner, M., Jebb, S, A., Blakely, T. and Scarborough, P. 2017. Health impact assessment of the UK soft drinks industry levy: a comparative risk assessment modelling study. Lancet Public Health [online], 2 (1), 15-22.

Buckton, C, H., Fergie, G., Leifeld, P. and Hilton, S., 2019. A discourse network analysis of UK newspaper coverage of the “sugar tax” debate before and after the announcement of the Soft Drinks Industry Levy. BMC Public Health [online], 19 (1), 114.

Capacci, S., Allais, O., Bonnet, C. and Mazzocchi, M., 2019. The impact of the French soda tax on prices and purchases: An ex post evaluation. PLOS ONE [online], 14 (10), e0223196.

Chen, P., Cripps, A, W., West, N, P., Cox, A, J. and Zhang, P., 2019. A correlationbased network for biomarker discovery in obesity with metabolic syndrome. BMC Bioinformatics [online], 20 (6), e477.

Clarke, L. and Stevens, C., 2019. Preventing dental caries in children: why improving children's oral health is everybody's business. Paediatric and Child Health [online], 29 (12), 536-542.

Colchero, M, A., Rivera, J, A., Popkin, B, M. and Ng, S, W., 2017. Sustained consumer response: evidence from two-years after implementing the sugar sweetened beverage tax in Mexico. Health Affairs [online], 36 (3), 564-571.

Cowie, M, R., 2017. Sleep Apnea: State of the art. Trends in Cardiovascular Medicine [online]. 27, 280-289.

Daly, M., Sutin, A, R. Robinson, E., 2019. Perceived Weight Discrimination Mediates the Prospective Association Between Obesity and Physiological Dysregulation: Evidence from a Population-Based Cohort. Psychological Science [online], 30 (7), 1030-1039.

Delzenne, N, M., Neyrinck, A, M. and Cani, P, D., 2011. Modulation of the gut microbiota by nutrients with prebiotic properties: consequences for host health in the context of obesity and metabolic syndrome. Microbial Cell Factories [online], 10, 1-10.

Evans, E, H., Sainsbury, K., Marques, M, M., Santos, I., Pedersen, S., Lähteenmäki, L., Teixeira, P, J., Stubbs, R, J., Heitmann, B, L. and Sniehotta, F, F., 2019. Prevalence and predictors of weight loss maintenance: a retrospective population-based survey of European adults with overweight and obesity. Journal of Human Nutrition and Dietetics [online], 32 (6), 745-753.

Gómez-Donoso, C., Martínez-González, M, A., Gea, A., Murphy, K, J., Parletta, N. and Bes-Rastrollo, M., 2019. A food-based score and incidence of overweight/obesity: The Dietary Obesity-Prevention Score (DOS). Clinical Nutrition [online], 38 (6), 26072615.

Hong, J., Whelton, H., Douglas, G. and Kang, J. 2018. Consumption frequency of added sugars and UK children’s dental caries. Community Dentistry & Oral Epidemiology [online]. 46(5), 457-464.

Hosey, M, T., Donaldson, A, N., Huntington, C., Liossi, C., Reynolds, P, A., Alharatani, R. and Newton, J, T., 2014. Improving access to preparatory information for children undergoing general anaesthesia for tooth extraction and their families: study protocol for a Phase III randomized controlled trial. Trials [online], 15 (1), 1-22.

ReferencesJones, C, M., 2016. The UK sugar tax - a healthy start? British Dental Journal [online], 221 (2), 59-60.

Lombard, M. and Koekemoer, A., 2020. Conceptual framework for the evaluation of sugar tax systems. South African Journal of Accounting Research [online], 34 (1), 6390.

Liao, C, C., Sheu, W, H, H., Lin, S, Y., Lee, W, J. and Lee, I, T., 2020. The Relationship Between Abdominal Body Composition and Metabolic Syndrome After a Weight Reduction Program in Adult Men with Obesity. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy [online], 13, 1-8.

Marques, A., Peralta, M., Naia, A., Loureiro, N. and de Matos, M, G., 2018. Prevalence of adult overweight and obesity in 20 European countries, 2014. European Journal of Public Health [online], 28 (2), 295-300.

Mears, M., Brindley, P., Baxter, I., Maheswaran, R. and Jorgensen, A., 2020 Neighbourhood greenspace influences on childhood obesity in Sheffield, UK. Pediatric Obesity [online], March 2020, e12629.

Millard, A, D., 2012. The obesity pandemic: Implementing the evidence for children in Scottish families. Public Health [online], 126 (2), 129-134.

Paolicelli, C W., 2016. Weight Management and Obesity [online]. New York: Momentum Press.

Parlińska, A. and Rembielak, G., 2014. Comparison of approaches to reduce and prevent from children obesity within the context of UK and Poland. Acta Scientiarum Polonorum Oeconomia [online], 4, 135-146.

Pedraza, L, S., Popkin, B, M., Batis, C., Adair, L., Robinson, W, R., Guilkey, D, K. and Taillie, L, S., 2019. The caloric and sugar content of beverages purchased at different store-types changed after the sugary drinks taxation in Mexico. International Journal of Behavioral Nutrition and Physical Activity [online], 16 (1), e103

Powell, L, M. and Maciejewski, M, L. 2018. Taxes and Sugar-Sweetened Beverages. American Medical Association [online]. 319 (3), 229-230.

Roache, S, A. and Gostin, L, O. 2017. The Untapped Power of Soda Taxes: Incentivizing Consumers, Generating Revenue, and Altering Corporate Behavior. International Journal of Health Policy and Management [online]. 6(9), 489-493.

Santos, V, O, A., Browne, R, A, V., Souza, D, C., Matos, V, A, F., Macêdo, G, A, D., Farias-Junior, L, F., Farias-Júnior, J, C., Costa, E, C. and Fayh, A, P, T., 2019. Effects of High-Intensity Interval and Moderate-Intensity Continuous Exercise on Physical Activity and Sedentary Behavior Levels in Inactive Obese Males: A Crossover Trial. Journal of Sports Science and Medicine [online], 18 (3), 390-398.

Scarborough, P., Adhikari, V., Harrington, R., Elhussein, A., Briggs, A., Rayner, M., Adams, J., Cummins, S., Penney, T. and White, M., 2020. Impact of the announcement and implementation of the UK Soft Drinks Industry Levy on sugar content, price, product size and number of available soft drinks in the UK, 2015-19: A controlled interrupted time series analysis. PLOS Medicine [online], 17 (2), e1003025.

Sensient Flavors and Fragrances. 2014. Sensient Flavors: We bring products to life [online]. Milwaukee: Sensient Flavors and Fragrances. Available: https://www.sensientflavorsandfragrances.com/images/uploads/pdf/Sensient_Flavors_Capabilities_2014.pdf [Accesses: 30 May 2020].

Sheiham, A. and James, W, P, T., 2015. Diet and Dental Caries: The Pivotal Role of Free Sugars Reemphasized. Journal of Dental Research [online], 94 (10), 1341-1347.

Taylor, G, D., Pearce, K, F. and Vernazza, C, R., 2019. Management of compromised first permanent molars in children: Cross-Sectional analysis of attitudes of UK general dental practitioners and specialists in paediatric dentistry. International Journal of Paediatric Dentistry [online], 29 (3), 267-280.

Willard, C, E., Rice, A, N., Broome, M, E., Silva, S, G. and Muckler, V, C., 2019. Nasal Ventilation Mask for Prevention of Upper Airway Obstruction in Patients With Obesity or Obstructive Sleep Apnea. American Association of Nurse Anaesthetists Journal [online], 87 (5), 395-403.

Wilson, L, F., Baade, P, D., Green, A, C., Jordan, S, J., Kendall, B, J., Neale, R, E., Olsen, C, M., Youlden, D, R., Webb, P, M. and Whiteman, D, C., 2018. The impact of changing the prevalence of overweight/obesity and physical inactivity in Australia: An estimat of the proportion of potentially avoidable cancers 2013–2037. International Journal of Cancer [online], 144 (9), 2088-2098.