The leading health experts behind the Action on Sugar campaign, launched last week, believe the success in driving down salt intake in the UK following the launch of the Consensus Action on Salt and Health campaign can be replicated with sugar. Ben Cooper has his doubts.

The launch of the Action on Sugar campaign last week shows added sugar will be the new battleground between health campaigners and the food industry.

Following the model of the Consensus Action on Salt and Health (CASH) campaign, from which the new sugar campaign has sprung, the Action on Sugar coalition says its major initial focus will be to target the “huge and unnecessary amounts of sugar that are currently being added to our food and soft drinks”.

It describes the added sugar developed countries now consume in processed food as “a totally unnecessary source of calories” which “gives no feeling of fullness and is acknowledged to be a major factor in causing obesity and diabetes both in the UK and worldwide”.

In response, the UK’s Food and Drink Federation (FDF) stated “sugars consumed as part of a varied and balanced diet are not a cause of obesity, to which there is no simple or single solution”. The FDF also stated sugar content is clearly indicated on packs and that companies are making efforts to reduce sugar content in products, with “many doing so as part of the Government’s Responsibility Deal calorie reduction pledge”.

Those are the entrenched opposing views we will become very accustomed to hearing in the coming weeks, months and years.

However, the positions of two other stakeholders will have an equally critical bearing on whether we see a significant reduction in added sugar levels, namely government and the consumer.

With regard to both, the comparisons with the success of the salt reduction campaign are extremely pertinent.

Salt intake in the UK fell by 15% between 2001 and 2011 and, according to CASH, “most products in the supermarkets have been reduced by between 20% and 40%”. Action on Sugar hails the UK salt campaign as “one of the most successful nutritional policies in the UK since the Second World War”.

However, its success arguably stemmed from the active involvement from the outset of the Food Standards Agency (FSA) which set targets for the food industry to use less salt in processed products.

Action on Sugar says a “similar programme can be developed to gradually reduce the amount of added sugar”, and indeed it could. The question is whether this government will introduce sugar reduction targets along the lines of those for salt, and, judging by its actions on nutrition and health to date, it will not.

One of this administration’s most telling actions on diet and health was its early decision to remove the FSA’s remit regarding nutritional health, with those responsibilities transferred to the Department of Health (DH). The salt reduction pledge that currently sits within the government’s Public Health Responsibility Deal was inherited from the FSA process, and tellingly it has not been updated.

CASH chairman Professor Graham MacGregor said in June 2012 that salt intakes had come down “thanks to a clear set of voluntary salt targets that were developed by CASH and the Food Standards Agency, which have largely been achieved by the responsible food manufacturers”. He bemoaned then the fact that the DH had not set further targets on salt and, 18 months later, there are still no new targets, though reviewed targets are to be discussed by the DH High Level Steering Group in March.

The possibility of a sugar reduction pledge being added to the Responsibility Deal process, is unlikely. The Responsibility Deal by definition takes a consensus-based approach. It now includes the existing salt reduction pledge, a pledge on saturated fat introduced last year, and an overall calorie reduction pledge.

The food industry believes the calorie reduction pledge is sufficient as it can and will include reductions in added sugar. While campaigners have pushed for a separate sugar reduction pledge, remarks by Professor Susan Jebb, chair of the Responsibility Deal food network, when the saturated fat pledge was launched suggests the official line will remain that the calorie reduction pledge is a sufficient measure.

Jebb said last year that the Responsibility Deal now comprises “a suite of pledges that help companies cut fat, sugar and salt, which together will help consumers achieve a healthier diet and reduce the risk of cardiovascular disease”.

Underlining just what a bone of contention sugar reduction is within the dietary health debate, coordinator of the Children’s Food Campaign Malcolm Clark described Jebb’s statement as “thoroughly disingenuous” in giving the impression that there was a specific pledge on sugar reduction.

Action on Sugar states it will also “conduct a Parliamentary campaign to ensure the government and DH take action, and that, if the food industry do not comply with the sugar targets, they will enact legislation or impose a sugar tax”. Given the recent history of governments considering – and rejecting – nutrient taxes, and the limited evidence for their success in effectively addressing obesity, it is unlikely that this government, or the next, whatever its political hue, would introduce such a tax.

As for how consumers might react, Action on Sugar believes that, as with salt, consumers would adapt to a gradual reduction in added sugar. While it may be true that palates adapt in this way, two further factors need to be borne in mind, along with the possible lack of a strong push from government for manufacturers to reformulate.

While there are technical challenges in reducing salt in formulations, for example with bread and cheese, reducing sugar levels is generally seen as more of a challenge, particularly because of how sugar is used as a bulking agent.

Campaigners would certainly argue that this use of sugar as a cheap bulking agent in processed food is a significant part of the problem. As Action on Sugar points out, adding sugar to the human diet on such a scale only came about around 150 years ago as sugar became far easier to obtain and cheaper. But that speaks to the other consumer-led factor. The industrialisation of food production, including adding more sugar, has allowed food companies to produce food more cheaply.

Campaigners once again will say food companies have become used to the profits that this affords them, but by the same token consumers have become accustomed to cheap food. As with other social and environmental sustainability challenges, consumer expectations regarding the cheap supply of food have to be borne in mind.

Action On Sugar has calculated that a 20% to 30% reduction in sugar added by the food industry over three to five years is “easily achievable” and would result in a reduction in calorie intake of approximately 100kcal/day. It also states that the reduction would be greater for those people who are particularly prone to obesity. However, given the technical challenges involved, the lack of a strong push from government, the fact that foods with less added sugar may be more expensive and the direct correlation between poor dietary health and lower income, to suggest that all this is “easily achievable” is a dubious assertion to say the least.