I welcome this considered and authoritative review on carbohydrates which updates the UK dietary recommendations, particularly for fibre and free sugars. It reinforces the prior data that sugar adds calories to the diet but shows too that there are detrimental effects of sugar on health, independent of body weight. This is particularly the case for sugar-sweetened beverages.
Amidst the current media focus on sugar, it’s important not to overlook the recommendations in the report on fibre. Increasing fibre intake would have clear public health benefits, helping to control body weight and reducing the risk of chronic disease.
Dietary recommendations are set on a nutrient basis, but consumers need to put this information in the context of the foods they eat and their overall eating pattern. There is no suggestion that sugary foods should be replaced in the diet by fatty foods. Water should be the drink of choice and we need to eat less confectionery and fewer biscuits and cakes. This will cut calories, fat and sugar and bring holistic health benefits.
Practitioners in primary care have a privileged and trusted position from which they can engage and communicate with millions of people across the country. We need to ensure that everyone is trained to make brief opportunistic interventions to encourage dietary change and that patients at higher risk are supported to change their diet. We also need more research, embedded in routine primary care, to understand which interventions are most effective in helping people to change their diet.
As Chair of the Responsibility Deal Food Network I am conscious that this report sets some new priorities for action. We need to consider whether voluntary initiatives, beyond the existing pledge to increase fruit and vegetable intake, can help to increase fibre in the diet, perhaps by encouraging consumers to switch from refined grains to high fibre or wholegrain alternatives. We also need to accelerate action to cut sugar further. We have seen a range of actions by some of the leaders in the various business sectors to cut sugar; including reformulation to cut sugar content, innovation with no/low sugar alternatives and portion control, with a specific focus on sugary drinks. The changes we are seeing in as part of the Responsibility Deal Food Network in England are faster than anywhere else in the world, but there is no room for complacency and progress needs to be accelerated and actions taken across the whole industry.
But the Responsibility Deal Food Network can only do so much and as a public health researcher I know that the scale of the challenge means we need to consider a much broader range of policies to support and enable consumers to make these fundamental changes in their eating habits. I am encouraged to hear that PHE plan to review the range of options available and the evidence of their effectiveness. This report should be a stimulus for renewed focus in research, policy and healthcare on the importance and urgency of the need to change the nation’s diet.
Professor of Diet and Population Health
Nuffield Department of Primary Care Health Sciences, University of Oxford;
and Independent Chair, Public Health Responsibility Deal Food Network.