Is the healthcare sector sending the wrong message about sugar?

It’s sometimes hard to keep up to date with news about unhealthy foods these days, especially those referring to sugar.

It is often said to be time-consuming and difficult to eat healthily, but that’s not the only obstacle, for some people cost also inhibits their ability to eat healthily. In a recent study1, Which? - the largest consumer body in the UK - found that major supermarkets in United Kingdom promote junk food (53%) more than they promote healthy food (47%), particularly when we talk about confectionery products and soft drinks with high-sugar content. Only around a third of fresh fruit and vegetables were on promotional offer, this is sadly not a surprise as junk foods are more profitable, especially when targeted at those on a low income.

This study was released along with the announced sugar tax in UK on soft drinks (including some milk-based drinks) that will come into effect in 2018. This tax includes a 20% reduction of sugar levels in nine categories of products that largely contribute to children’s sugar intakes: breakfast cereals, yoghurts, biscuits, cakes, confectionery, breakfast pastries, puddings, ice cream and sweat spreads.

Other measures include:

  • Encouraging and improving physical activities programmes for schools,
  • Enabling consumers to take informed eating decisions through better labelling, technology, and data
  • Involving other public sector settings, from fitness and leisure centres to hospitals 

These measures are an effort to achieve a sustainable, long-term change that tackles childhood obesity and encourages the promotion of easy and healthy choices.

In this plan for action on childhood obesity,2 there are some particular points on making school food healthier (some updates will have to be made to the School Food Standards, to which the majority of schools are subjected). There are also plans to train health professionals on influencing behaviour change and initiating difficult conversations about health and wellbeing, so families get the best advice to ensure they focus on achieving and maintaining a healthy weight. However, further approaches need to be done across the health sector, particularly on fresh, healthy, and locally sourced food standards in hospitals.

Yet, most hospital cafes, shops, restaurants, and vending machines are stocked full of sugary drinks, crisps, chocolate, and other sugary, fatty and salty snacks. Not to mention some of the food served to patients, such as steaks, burgers, or fries - the same types of foods that may have caused the patients’ health problems in the first place. This is incredibly shocking and a shame! Hospitals have the potential to provide healthier food environments, and I am afraid we are currently missing this opportunity.

At HCWH Europe, when we talk with hospitals, they tell us the progress they are making on providing fresh, healthy, and local food to patients, staff, and visitors. Though positive, a key component in most of the cases is forgotten: vending machines. These machines are often situated in emergency or waiting rooms from which visitors and staff rely on mostly at night, as they available 24 hours a day. It is not unusual to witness your doctor drinking a sugary drink from a vending machine, one that has been associated with tooth decay, increased energy intake, weight gain, obesity, and diseases like type II diabetes or heart diseases.

Hospitals should take the lead and commit to improving our national health. Some countries (e.g. United Kingdom or Australia) are already curbing the promotion of unhealthy foods. 3 4 5 The main strategy hospitals should adopt is to start with the contracting of these services - influence which products are offered, and the portion size. Additionally, they can offer tasty, healthy, and affordable alternatives, thus vending machines can also promote good quality, healthy and sustainable eating. Such standards are rarely included in vending machines – it would have a great impact on younger and low-income demographics. This is closely related with the GPP criteria on food and catering services, which are currently under revision in the European Commission6, because of its market penetration, there are a total of 3.77 million vending machines in Europe, serving 82 million food and drink products per day.  There is a great opportunity to introduce more organic, fair-trade, and other schemes of sustainable production to vending machines, they are asking for feedback about the use of GPP criteria on vending machines

Another strategy, hospital could adopt is to educate patients and families, and those at risk of diet-related diseases through cooking or gardening workshops. This could help clarify the link between food and our health and well being, as well as saving money. Hospitals could also apply sanctions to suppliers, such as rejecting contracts, if healthy standards are not met.

Obesity is a critical global issue that can be preventable with a comprehensive, international intervention strategy. The global economic impact of obesity currently amounts to approximately $2 trillion annually, or 2.8%of global GDP, but it continues to rise.7 Therefore it must be addressed urgently and innovative policies about what and how we eat need to be changed, with the co-operation of society, academia, and industry. 

Taxes on sugar, salt, and fats on food products and drinks have been introduced in some countries (e.g. France, Finland, Hungary, among others)8 and some US states (e.g. Berkeley in California), are demonstrably effective at reducing high consumption. In this sense, Mexico provides an interesting case study9 on taxing sugary drinks, as well as Australia. In the case of Australia, it has been calculated that an additional 20% tax in the price of soft drinks and flavoured mineral waters would save 1,600 lives, prevent 4,400 heart attacks, and 1,100 strokes. Such a tax would also save the Australian national health system $609 million (AUS dollars) over 25 years. 10

Ensuring these taxes work is not simple however - we must be aware of unintended consequences: Denmark, had to abolish its saturated fat tax after only one year because consumers started buying their fatty foods outside the country, and jobs directly (and indirectly) involved in manufacturing such products. Further considerations are needed in terms of measuring the effects of a food tax: choice of food to tax (nutrient or product category), likely products substitutes or reformulation, size of the tax rate, combination with other measures such as subsidies for fruits and vegetables or fibre, and the design of the tax. Usually taxes are made for health and/or economic purposes: therefore revenues should be dedicated to promoting health, if appropriate and possible.8

Lots of us love sugar, but it is killing us (very slowly) because of its presence in most of our food and beverage products. The environment shapes our behaviour, so it is not just a matter of telling people not to consume sugar, or adopting comprehensive public health strategies, such as taxes. We really need to stop sending the wrong message about sugar, and the healthcare sector is at the forefront of such an effort. Healthcare institutions have the ability, the reach, and the moral responsibility to deliver a correct and healthy message about consuming sugary products. It is the time for all of us to act!


Have a sweet day.


- Paola Hernández, Sustainable and Healthy Food Programme Assistant


Preview image: Uwe Hermann via Flickr cc


(1) Which? reveals how supermarkets push unhealthy foods (2016).

(2) Childhood Obesity: A Plan for Action. (2016)

(3) NHS staff health and wellbeing: CQUIN guidance (2016).

(4) BBC Health (2013). Call for rules on hospital vending machines in England.

(5) Stewart, M. (2015). Fighting the fizz: last DHBs to put blanket ban on soft drinks. Stuff Health.

(6) European Commission (2016). EU GPP citeria:

(7) Dobbs, R. et al. (2014). Overcoming obesity: An initial economic analysis. McKinsey Global Institute.

(8) The European Competitiveness and Sustainable Industrial Policy Consortium (ECSIP Consortium) (2014). Food taxes and their impact on competitiveness in the agri-food sector.


(10) Batis, C. et al (2016). First-Year Evaluation of Mexico’s Tax on Nonessential Energy-Dense Foods: An Observational Study. PLoS Med 13(7): e1002057. doi:10.1371/journal.pmed.1002057.

(11) Veerman, JL et al. (2016). The Impact of a Tax on Sugar-Sweetened Beverages on Health and Health Care Costs: A Modelling Study. PLoS ONE 11(4): e0151460. doi:10.1371/journal.pone.0151460.