There is growing and vocal consensus among health professionals that sugar has been ignored for too long

There is growing and vocal consensus among health professionals that sugar has been ignored for too long

Some campaigners believe the WHO's new guidance on sugar intake did not go far enough and are concerned the organisation will face lobbying from industry. Food manufacturers insist there is no scientific evidence to halve the recommendation from 10% of daily energy to 5%. Governments can, of course, ignore any new guidance. However, Ben Cooper argues the debate around public health and diet has changed and could make the WHO a more influential voice. 

Sugar was expected to be a recurring subject in the diet and health debate in 2014 and so it is already proving, with the World Health Organization (WHO) choosing this moment to publish a draft recommendation for sugar intake and launch a public consultation on the subject.

The WHO already recommends sugars should make up less than 10% of total daily energy intake. Its new draft guideline, however, not only proposes that sugars should be less than 10% of total energy intake, but further suggests that a reduction to below 5% (equivalent to 25g or six teaspoons of sugar per day for an adult of normal Body Mass Index) "would have additional benefits". 

Once finalised, the guideline is intended to inform the recommendations on consumption of sugars set by national governments seeking to combat problems such as obesity, diabetes and dental caries. As such, therefore, it is potentially a highly influential benchmark.

Whether directly through participation in the consultation process, set to run until 31 March, or indirectly through lobbying of national governments, notably the US, the food industry - and in particular the global sugar sector - will be seeking to ensure the WHO guidance remains at the 10% mark. Health campaigners, meanwhile, are hoping  a new 5% guideline from the WHO may represent something of a seminal moment in the battle against diet-related health problems. 

Given the confrontational stance WHO director-general Dr Margaret Chan has taken towards "big food", one might expect considerable optimism among health campaigners, and perhaps something bordering on resignation on the part of industry advocates. 

However, for all the current fire in the WHO Secretariat's rhetoric, many campaigners believe the WHO has dragged its feet on sugar intake. For example, campaign director and nutritionist at Action on Sugar Katharine Jenner says it is a "tragedy that it has taken ten years for the WHO to think about changing their recommendation on sugar".

Other campaigners voice concern the WHO has been swayed by the industry view on sugar before. The US academic and public health campaigner Marion Nestle notes in her Food Politics blog that, in spite of the existence of the WHO's 10% guideline, which dates from 2002, its 2004 Global Strategy on Diet, Physical Activity, and Health omitted any mention of the 10% sugar recommendation. That, she suggests, was as a consequence of intensive lobbying in Washington.

Industry advocates naturally play down the politicking and maintain scientific evidence supports their position.

For example, in its response to the WHO draft guideline, the Sugar Association said it was concerned the WHO draft guidelines "rely heavily on insufficient scientific evidence", citing "different conclusions" reached by the US Institute of Medicine and the European Food Safety Authority. It said it looked forward to "providing science-based comments" during the consultation period.

The International Food and Beverage Alliance (IFBA), an industry coalition formed in 2008 in response to the WHO's 2004 Global Strategy on Diet, Physical Activity and Health, made no comment on the draft guideline and told just-food it would be meeting this week to discuss whether it will contribute to the consultation and what its position would be.

In the UK, the Food and Drink Federation also urged caution over reducing the recommendation to the 5% of energy intake threshold because of weak scientific evidence supporting such a move.

Speaking to just-food, Tam Fry, spokesperson for the National Obesity Forum, conceded there is "no direct link between sugar and obesity" though it is "certainly a contributory factor". However, he stressed there was "rock solid" scientific evidence supporting a direct link between sugar intake and tooth decay. He said he would give the WHO "full marks" for suggesting a further reduction to 5% of energy intake. 

The question of whether or not the scientific evidence supports a 5% recommendation is clearly far from cut and dried. To underline this, one only has to look at the debate on sugar among senior scientists charged with advising policymakers in the UK.

The UK's Chief Medical Officer, Dame Sally Davies, went as far as to suggest in a recent interview that a sugar tax should be introduced to tackle obesity rates. However, Professor Ian MacDonald, chair of the SACN (Scientific Advisory Committee on Nutrition) panel conducting a comprehensive review of carbohydrates, including sugars, in the diet, drew criticism from health campaigners and academics when he suggested at the weekend the UK would take note of but not act on the WHO guidelines. 

Fry said he was "very concerned" by Professor MacDonald's remarks, which he described as "extremely ill-advised". The SACN review on carbohydrates is expected to report its findings in June.

While indicating the debate over sugar intake may well become increasingly acrimonious during the WHO consultation and beyond, Professor MacDonald's remarks underline that, while the eventual WHO guideline will be influential, individual governments may choose to ignore it if they believe their own evidence-based research supports a different threshold. 

Nevertheless, the WHO's final recommendation will have a major bearing on the direction of public health advice on sugar intake across many countries. Moreover, the outcome of this debate will provide the food industry with a clear indication of the prevailing view on sugar among national policymakers and their advisors, and the degree to which opinions have changed over recent years. 

As to whether the WHO will revise its guideline to a sugar intake of less than 5% of total energy, history suggests it is unwise to bet against the power and influence of big business. 

Fry is "fearful that the WHO will be persuaded by industry and politics" not to adopt a 5% recommendation. Marion Nestle, meanwhile, doubts that "the political landscape has shifted so far in the direction of reducing sugar intake that governments will ignore industry groups this time". She adds: "I think WHO needs all the help it can get with this one."

However, the circumstances around the current debate are different from ten years ago. As reflected in the WHO's own work on non-communicable diseases, the focus within the preventive public health arena on the impact of diet is far greater today than a decade ago. Furthermore, there is a growing and vocal consensus among many health professionals that sugar has been ignored for too long.

And then there is the force that is Dr Margaret Chan to consider. Campaigners may worry that the finalised guideline will be weaker than they feel is needed owing to lobbying, but industry advocates are more than aware that Dr Chan is no pushover.

Also, it is said that the director-general may now be looking to her legacy as her term in office draws to a close. Leaders pondering legacy often find new levels of resolve, hardly a department where the WHO's combative director-general appears lacking to begin with. Those seeking to influence the WHO process through political lobbying may find rather more stout opposition this time round.