Policy context relating to sugars in Australia and New Zealand

Dental caries and overweight and obesity in Australia and New Zealand

As the added sugars have been associated with unhealthy weight gain and dental caries, this section examines the prevalence of these conditions in Australia and New Zealand. Causes of both these conditions are complex and do not relate solely to added sugar consumption.
Overweight and obesity in Australia

High body mass index³² accounted for 6.8% of the total disease burden in Australia in 2015³³ and was the second leading risk factor contributing to total disease burden after smoking (7.2%)³⁴. For Australians aged 18 years and over, the prevalence of overweight and obesity increased in Australia from 56.3% in 1995 to 63.4% (11.2 million people) in 2014-15³⁵. For children aged 5-17 years, the proportion who were overweight or obese increased from 20.9% in 1995 to 25.7% in 2011-12 and then remained stable to 2014-15 (27.4%)³⁶.

The prevalence of overweight and obesity in the Aboriginal and Torres Strait Islander population (aged 15 years and over) in 2012/13 was 66%, with 29% being overweight and 37% being obese. Aboriginal and Torres Strait Islander adults (aged 15 years and over) were reported to be 1.2 times more likely to be overweight, and 1.6 times more likely to be obese compared to the non-Indigenous population³⁷.
Overweight and obesity in New Zealand

In New Zealand, high body mass index accounted for 7.6% of the total burden of disease in 2015, and was the third leading risk factor contributing to total disease burden after blood pressure (8.1%) and smoking (7.9%). In New Zealand the total disease burden attributed to high body mass index has remained static since 2010 (7.6%) and increased slightly since 2005 (7.4%)³⁸. However, obesity rates for adults are increasing, with more than three in ten adults (32%) obese in 2015/2016, up from 27% in 2006/07. However, obesity rates in children have been stable since 2011/12, with one in nine children aged 2-14 years (11%) classified as obese³⁹.

Obesity rates are strongly linked to socioeconomic deprivation⁴⁰, with the obesity rate for children living in the most deprived neighbourhoods being five times that of those living in the least deprived neighbourhoods. For adults the equivalent rate ratio is 1.7 times, after adjusting for age, sex and ethnic differences. However, this inequality was more pronounced for extreme obesity rates (BMI ≥ 40), with adults living in the most deprived neighbourhoods 4.1 times more likely to be extremely obese than adults living in the least deprived neighbourhood. Māori adults have higher obesity rates (47%) than non-Māori, with Māori children in particular having comparatively high rates of obesity (14.7%). Pacific adults and children have the highest rates of obesity. About two-thirds of Pacific adults (67%) and almost one-third of Pacific children (29.8%) are obese.

Dental caries in Australia

In Australia, during the 30 year period 1989-2007, 46% of children under the age of 6 had already experienced caries. Dental decay is also estimated to affect up to five million people in Australia each year⁴¹.
Dental caries in New Zealand

In New Zealand, despite improvements in oral health over time, dental caries remain the most prevalent chronic (and irreversible) disease. The 2009 Our Oral Health survey⁴² found large improvements in oral health had occurred for children since the 1980s, with the proportion of 12–13-year-olds who were caries-free almost doubling between 1988 (28.5%) and 2009 (51.6%). The oral health of most preschool children (aged 2–4 years) was also relatively good, with four in five (79.7%) 2–4-year-olds were caries-free in their primary teeth.

Policy initiatives in relation to sugars in Australia and New Zealand

Government, public and media attention towards added and total sugar has noticeably increased in recent years. With assistance from FRSC members, the Australian Government Department of Health has completed a non-exhaustive review of the initiatives that are currently in place in Australia and New Zealand focussing on sugars.
Government activities relating to sugars

Attachment A provides a summary of the current activities relating to added and total sugar that are being implemented in Australia and New Zealand at the national and jurisdictional level. In response to the Australian Government’s consultation on this work, FRSC members provided information on a range of healthy eating policies, campaigns, and initiatives that are in place. However as the focus of this paper is specifically sugar, some of these have not been included in the attachment as they are very broad.
Many of the initiatives relating to sugar have a key focus on reducing the consumption of sugar-sweetened beverages. The evidence cited in this paper supports the focus on sugar-sweetened beverages as these beverages are particularly detrimental to health. Examples of initiatives in this area include posters depicting the number of teaspoons of sugar in sugar-sweetened beverages, swap ideas including swapping sugar-sweetened beverages for water, and health promotion messages through social marketing. Other initiatives include restricting high sugar foods being sold in venues such as school canteens and health care settings.
Non-Government activities

Attachment B provides a summary of selected examples of the campaigns and activities focusing on sugar which are being conducted outside of Government. This list does not represent a thorough audit of all activities undertaken outside Government as total activities are not coordinated by any one organisation. The activities listed mostly focus on raising consumer awareness of the added sugar content of foods and drinks and/or advocating for changes to food labels to allow consumers to more easily identify foods high in added sugars.
The activities identified in this attachment contain some mixed messages about which types of sugar to reduce in the diet, which may be confusing to the general public.


Industry initiatives

Food and beverage manufacturers are looking for ways to reduce the sugar content of products in response to perceived consumer demand. However, from a food technology perspective this is challenging due to the many functions sugar provides in processing, including bulk, density, and viscosity of food products. For example, replacing high sugar containing products with lower energy sweeteners requires the addition bulking agents which don’t necessarily reduce the energy content (which is the intention of reducing sugar content)⁴³.

Attachment B includes some examples of food industry action relating to sugar and other nutrients of concern. The Australian Food and Grocery Council provides information on its website about sugar, such as types of sugar and function of sugars in food, but at the time of writing this paper, the website did not provide detail on any industry action to reduce sugar in foods⁴⁴. However, the AFGC is a member of a Healthy Food Partnership (see Attachment A) which, amongst other things, will consider food reformulation to reduce the content of various unhealthy ingredients, including sugar.
Some public health advocates have called for mandatory limits to be established for the added sugar (as well as salt and trans-fat) content of foods and drinks to drive reformulation⁴⁵. The Australian Government Department of Health is not aware of any examples mandatory limits on added sugar being established elsewhere.