Australia

‘Frustrated’ health sector turns to tobacco-like labelling to issue sugar warning

Despite years of warnings about Australia's obesity rates, public health advocates are frustrated by the lack of action and researchers are having to get creative to draw attention to the problem.

Key points:

  • Public health advocates turn to graphic labelling
  • 'Frustrated' sector wants Health Star Rating to be mandatory
  • New study found label featuring decayed teeth to be a deterrent
  • Health experts back introduction of labels as part of wider strategy

The latest idea comes from researchers at Deakin University who have presented research at the European Congress on Obesity in Vienna finding graphic labelling, similar to that seen on cigarette cartons, is likely to reduce the consumption of sugar-sweetened drinks.

The release of the research coincided with a similar study conducted at the University of Melbourne that assessed the effect of graphic labels on consumers evaluating snack foods items.

Health experts across Australia backed the Deakin findings and called for the labels to be introduced on the sweetened beverages — the product that often sits at the centre of the sugar debate.

These drinks are widely talked about by public health advocates because, as Simon Tatz from the Australian Medical Association says, they "have absolutely no food value".

The proposed graphic labels would see the products treated like tobacco, and in some parts of the world, alcohol, where consumers would face warnings about the health impacts of excessive sugar consumption every time they reached for one.

In the Deakin study, graphic warning labels with an image of decayed teeth had the greatest impact, according to lead researcher Professor Anna Peeters.

"Participants were 36 per cent less likely to purchase sugary drinks that included a graphic warning compared to a drink with no label," she said.

Researchers interviewed 1,000 people aged 18 to 35 years old across Australia about which drink they would choose from a selection labelled in one of five different ways.

"Our findings highlight the potential of front-of-pack health labels, particularly graphic images and health star ratings, to change consumer behaviour, reduce purchases of sugar sweetened drinks, and help people make healthier choices," Professor Peeters said.

This option was the most effective in reducing the selection of a sugar-sweetened drink:

Look familiar?

Gums and teeth with damage.

Research 'shows frustration' of public health sector

Graphic or not, front-of-pack labelling is known to influence consumer purchasing behaviour.

Australia already has a front-of-pack labelling system — the Health Star Rating — and examples of it were included in the Deakin study.

The study found the Health Star Rating labels were significant and that "labels that also identify healthier alternatives may influence consumers to substitute sugar-sweetened beverages with healthier drinks".

There is frustration among public health advocates that manufacturers can opt out of labelling their products this way.

Obesity Policy Coalition executive manager Jane Martin helped to develop the Health Star Rating system and told Four Corners the food and beverage industry fought to make sure the labelling was not mandatory.

"This research shows the importance and potential to influence people's consumption that front-of-pack labels have," she said.

A screen capture of promotional material from the Health Star Rating System says "the more stars, the healthier".

Ms Martin said the coalition would support the introduction of graphic health warnings on labels as part of a wider strategy.

Terry Slevin from the Public Health Association of Australia said making the existing Health Star Rating system mandatory was a good place to start.

"While I support this research, I guess it's being done in part because it's showing the frustration of people from the public health world that there's been enormous effort to create this Health Star Rating system and it's being blocked, it's being obfuscated, it's being slowed.

"It's being, in part, derailed by industry to ensure that it remains voluntary rather than mandatory.

"If we take this seriously, it should be on every product we pick up that has a package.

"If it's on the healthy cereal, it should be on the packet of chips."

The Health Star Rating system is currently under review, with findings expected to be released from mid-2019.

But when it comes to products that affect public health, labelling is only one way to make change and Australia's history with tobacco shows that.

Is sugar really as bad as tobacco?

Plain packaging

Health experts say, no, but that's not the point.

Mr Slevin said "smoking is harmful from the first cigarette to the last" and those in the sector are careful not to directly compare sugar to tobacco.

"But, by the same token there is an enormous amount of unnecessary sugar in a variety of foods we consume and those are, without doubt, adding to the growing burden of obesity," he said.

"So it's perfectly legitimate that the public health community conduct research and advocate policies that help reduce the consumption of those sugars.

"That's why this research happens and that's why it should be considered seriously in the halls of power of this country."

Professor Timothy Gill from the University of Sydney said front-of-pack labels had been successful in promoting behaviour changes in smokers.

Again, he was careful to say that this did not mean sugar and tobacco were directly comparable, but that people's behaviour towards the products could potentially be changed in a similar way.

"By taking lessons from tobacco and alcohol control, it doesn't imply that sugar-sweetened beverages are equivalent," he said.

"But it means previous public health actions provide us with a good understanding of purchase and consumption behaviours that can be applied to all discretionary products including sugar-sweetened drinks."

Australia has some of the strictest tobacco packaging requirements in the world, legislating how much of the carton must be covered with warnings, including large graphic images. The legislation, passed in 2011, even notes cartons "must be the colour known as Pantone 448C".

In the Government's review of the new legislation, completed in 2016, it was concluded that the plain packaging and graphic health warning measure had "begun to achieve its public health warning of reducing smoking and exposure to tobacco in Australia and it is expected to continue to do so".

According to the most recent National Health Survey (2014-15), 14.5 per cent of Australian adults were daily smokers.

The same survey found 63.4 per cent of Australian adults were overweight or obese and a PricewaterhouseCoopers report from the same year put the "cost of obesity" at $8.6 billion a year.

PWC forecast that "if no further action is taken to slow the rate of obesity", the additional cost to society over the 10 years to 2025 would be $87 billion.

Two of the interventions the report recommended were a tax on unhealthy foods and labelling reform.

"One of the biggest and growing threats to public health in Australia is [being] overweight and obesity and anyone who says otherwise isn't paying attention to the data before our eyes," Mr Slevin said.

"No-one thinks one policy is the solution — it never was with tobacco.

"When it comes to anything that seeks to prevent health harm, we need to answer the question: By how much? And how much will that save us?"

Putting a number on how much graphic warning labels on sugar-sweetened drinks would save the health system would be a speculative exercise, but there is modelling that suggests a 20 per cent tax on the products would reduce annual health expenditure by $29 million.

Several public health groups including the AMA and the Obesity Policy Coalition have called for a sugar tax, but both sides of politics have refused to consider the measure.

Graphic labelling would be 'punitive' measure

Just as it does not support a potential tax, the Australian Beverages Council says it does not support the use of graphic warnings on sugar-sweetened drinks.

Chief executive Geoff Parker said the council supported increased education on how to read and interpret current labelling on drinks.

"The beverages industry has already taken action to reduce sugar in beverages, in the absence of any punitive labelling measures," he said.

"Many of our members have reformulated a range of products to reduce sugar content while introducing smaller pack sizes and promoting responsible consumption."

A 2017 report from consultancy Brand Finance assessed the impact of plain packaging on food and beverage companies.

It assessed eight major brands including Pepsi and Coca Cola and found if plain packaging were to be legislated across alcohol, confectionery, savoury snack and sugary drink products globally, the potential loss of value would be $186.7 billion.

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