Jamie Oliver in his latest documentary, Jamie's Sugar Rush. Credit: Photograph: ©Channel 4

Shaun Howe RDH

– Storm in a teacup

It's in the news, wherever you look sugar is in the news. The problem is that it is not news is it? Collectively, the profession of dentistry has known for some significant time that frequent sugar consumption is a factor in caries and our medic colleagues have known that too much sugar will cause weight gain. We were fed a lie in the 1970s that too much fat (regardless of the source) was bad for us and in the 80s and 90s people sought low fat products because of this. Remove fat from processed food and then you have to replace the taste and that is invariably done with sugar.

Why do we need Jamie Oliver and his recent television programme ‘Sugar Rush’ to highlight a message that we all knew and have been passing on to patients for some time? I am angry that it has taken a TV chef to bring this to the nation's attention; the Scientific Advisory Committee on Nutrition made some startling revelations in its recently published ‘SACN Carbohydrates and Health Report’ and it appears it took a group of experts to state:

  • High levels of sugar consumption are associated with a greater risk of tooth decay

  • The higher the proportion of sugar in the diet, the greater the risk of high energy intake

  • Drinking high-sugar beverages results in weight gain and increases in BMI in teenagers and children

  • Consuming too many high-sugar beverages increases the risk of developing type 2 diabetes.

Really? It took a group of high end academics to come up with the first conclusion; Miller first described the relationship between sugar and caries in the 1890s and whilst this model has evolved and we now know there are numerous factors the basic message was the same over 100 years ago. Despite being angry at it requiring Jamie Oliver to highlight this issue, I admire his tenacity and enthusiasm for anything he becomes involved in yet the cynic in me wonders whether it is a storm in a teacup and that in 6 months' time we will have forgotten about the hype. There are many powerful multi-national companies that will continue to produce sugar laden food and the masses will continue to buy it.

Sugar is not a poison nor is it bad for us in small amounts yet it is being made out to be so. We need sugars to function but perhaps the storm on social media may prove to be a force for good. It is always interesting to watch the profession's reaction on various forums following an event like Sugar Rush and it has at least galvanised the profession and got patients talking. Like I said earlier, I am cynical and now I am sitting eagerly awaiting Jamie's new book which will undoubtedly be titled along the lines of ‘Jamie's Low Sugar tasty meals’ which will use expensive ingredients and may well be beyond the reach of those that really do need to stop buying the four pack of chocolate bars for one because they are cheaper than four apples. Pukka.

Dominique Tillen

– Harnessing the power of communities to reduce tooth decay in children

Following numerous TV programme covering the appalling scenarios for young children's dental health I welcome Jamie's sugary drinks tax initiative which is taking positive action to prevent tooth decay.

Similar to his reaction during the television programme, I could not fail to be moved by the sight of little Mario having his milk teeth removed, but what saddened me more, was when the surgeon said that there were another five cases like Mario in the same operating theatre that day.

Statistics from Royal College of Surgeons (Jan 2015) report ‘The State of Children's Oral Health in England’ show that the peak age of having a tooth removed for decay is five years old. Tooth decay doesn't happen overnight, it is the result of poor oral hygiene and frequent exposure of teeth to sugars during the first five years of life. Indeed the report states that 30% of children under five have tooth decay.

While dental health professionals have been provided with an evidenced based ‘dental tool kit’ and there have been calls for young children to visit the dentist at an earlier age, a wider based community initiative is lacking. I suggest that greater focus is needed where oral care of babies, toddlers and young children takes place, in the community and in the home.

A community approach could include:

  • Positive attitude change toward primary teeth - a ‘Milk teeth do matter’ campaign

  • Promotion of ‘Early Years Toothcare’ routine, specifically for under-fives which takes into account care of toothless gums, teething and the first set of teeth

  • Introduction of oral hygiene practices at an earlier age in order to establish good habits e.g. teaching young children how to floss

  • In line with Jamie, action to reduce snacks targeted at this young age group and snacking between meals

  • Serious consideration of Xylitol as cheap and wide reaching public health measure. Our only disappointment in the current Sugar Tax debate, is that the natural and the ‘good sugar guy’ – Xylitol, whose tooth-friendly properties have been well-documented and used by our Scandinavian neighbours for many years has not been mentioned. Hailed as the ‘biggest advance against cavities since fluoride’ by the BDHF, few people in the UK are aware of the potential benefits of Xylitol.

Change is initiated from the community. The early 2000s saw a revolution in food available for babies and young children led by entrepreneurial parents Paul Lindley (Ella's Kitchen) and Susie Willis (Plum Baby) both dissatisfied with what was available and concerned about obesity. Both have helped raise awareness and improve the quality of foods available.

Likewise Brush-Baby was founded because I was dissatisfied with what was on offer for my young child's oral care and horrified at the appalling statistics. We have all seen the horror programmes on TV, now we need a positive community based initiative and wide reaching messages to prevent tooth decay in our children. Well done Jamie!

Claire Stevens, BDS

– An opportunity to engage and change

The broadcast of Jamie's Sugar Rush was always going to be an interesting one. With the Naked Chef turned public health campaigner declaring war on sugar, the spotlight was only going to shine brighter.

As Sugar Rush opened we jumped straight into graphic scenes of 6-year-old Mario having teeth ‘yanked’ out (Jamie's words, not mine). You certainly couldn't get a more hard-hitting opening and despite similar scenes having been shown in ‘The Dentists’ and ‘Junk Food Kids’, Jamie will have reached a new audience with Sugar Rush and I am sure they were equally appalled.

There were also thought provoking scenes with Consultant Dietician, Lucy Jones, demonstrating the sugar content in a ‘healthy’ breakfast and pre-prepared sauces. Even Jamie who one would assume was fairly savvy on these matters seemed surprised. I do wonder if the general public might have been left feeling confused, perhaps overwhelmed, because it quickly became clear just how easy it would be to exceed the daily recommended levels of sugar intake.

If I were to critique the programme, I felt it could have been a little more balanced. A tax on sugary drinks alone is not the answer to improving oral health, but there was no mention of key preventive messages recommended by paediatric dentists, nor mention of fluoride nor discussion of the fact that it is not just what we eat but also when and how often we eat that will determine caries risk.

Credit: © IngaIvanova/iStock/Thinkstock

Sadly, there was no mention of incentivising healthy choices. Instead Jamie charged on to introduce a tax on sugary drinks in his own restaurants. The food and drinks industry are fighting back hard, their backs perhaps raised as a result of the failure to acknowledge the work already ongoing in product reformation. A discussion of the challenges in changing the nation's palate or curbing the consumer demand for sugar-laden products was nowhere to be seen.

The Jamie Oliver effect is certainly not to be underestimated. At 5pm, prior to the first broadcast, Jamie's petition to introduce a Sugar Tax had around 2000 signatories, by 1pm the following day, the half-way mark of 50,000 supporters was exceeded and now the count stands over the 100,000 needed for the matter to be discussed by parliament. But do the British public really know what they have signed up to? The response was not all positive. After the school dinners campaign, some will see his involvement as intrusive, and his suggestions have been described as ‘nanny state’.

Credit: © SoberP/iStock/Thinkstock

That said, I do welcome Jamie Oliver's involvement and the broadcast of Sugar Rush. I am delighted that the very real impact on oral health was highlighted. My only hope is that Jamie uses his influence wisely, by consulting widely with those working in the field and engaging with industry and government. He has the passion to drive this agenda. I only hope he is appropriately advised to ensure he can bring everyone with him.

Dr Judith Husband

– It could provide the spark, but social change takes time

Sugar, we all love it and we all know the terrible impact it can have on oral health when misused, especially for children.

Some of us are jaded after decades of extracting teeth, witnessing the ever increasing power of big business and the normalisation in our society of very high sugar concentrations in food and drink. The use of advertising and purposeful misuse of the media, together with confusing labelling leads to what can often feel like a battle that can't be won.

Sugar tax is once again a hot topic, for some an ideological issue and perceived infringement of free choice. This is a strong argument, very popular with the sugar industry and food manufacturers.

Free choice requires a level of knowledge, understanding and the ability to opt for an alternative. With ‘hidden’ sugar in our food, nutritional information is represented in a variety of forms often requiring a magnifying glass and doctorate to decipher, or available only online for some restaurant purchases. It takes dedication and significant effort to be fully informed.

The choices we are currently making are also far from free in economic terms. We know the real financial cost of treating dental decay in our own practices, and other health teams know the associated costs of type-2 diabetes and obesity. The majority of which is funded by the public through taxation and provided by an increasingly overstretched and underfunded NHS.

We are already paying for the profits of food manufacturers and poor choices by individuals.

Social change takes time. Its movement is not linear but can be halted or dramatically sped up by using legislation. Some of us remember a time when children climbed around merrily in the back seat of cars, waving or pulling faces through the rear window. My favourite spot was to hang between the front seats peering forward - a perfect position to go hurtling through the windscreen in a crash.

Legislation changed, seat belts initially had to be worn, then child seats were introduced. It's now illegal to have a child unrestrained in a car and more importantly socially unacceptable. Lives have been saved and serious life-changing injuries avoided. This is where legislation is powerful; it hastens behavioural change, remodelling what is considered normal within our society and that is key to the sugar debate.

The income generated from a few pennies on a sugar laden drink are not inconsiderable, and would be a useful addition to the woeful funding for public health and prevention strategies in our communities. The real benefit would be the recognition that sugar is a substance to be used, and enjoyed, sparingly.

A sugar tax could provide the spark, coupled to improved education, prevention programmes and additional legislative change in the future. We have to kick start the dramatic shift in attitudes and behaviour needed to prevent the current tidal wave of sugar related disease and disability that we face today.

Alexis Poole, (ANutr)

– A small step to tackling a big issue

Obesity levels in the United Kingdom have reached epidemic proportions and, therefore, I believe this documentary is just what the doctor ordered.

Sugar has come under a lot of scrutiny of late and for good reason. This year the Scientific Advisory Committee on Nutrition (SACN) released new recommendations for sugar following a review of the current evidence base. Free-sugar intakes are now recommended to be below 5% of total energy intakes.1 This equates to less than 7 teaspoons (30g) of sugar per day for individuals above 11 years. ‘Free-sugars’ are classified as sugars added to food or naturally present in honey, syrup and unsweetened fruit juices, however this excludes lactose in milk and milk products and sugars in fruit and vegetables. The evidence that prompted this lower sugar intake requirement found that free-sugar consumption contributes to higher energy intakes, weight gain in children, tooth decay and type-2 diabetes (T2D).1

Jamie's documentary emphasised the urgency for dietary change to support the new recommendations. We live in an obesogenic environment, surrounded by high sugar, fat and salt foods, making weight gain exceptionally easy. Self-regulation and responsibility within the food industry have not been effective at reducing obesity levels and this is exactly why governmental regulation is required. I passionately support the introduction of a sugar tax. The action proposed against sugar is not to eliminate it completely from the diet. Sugars are carbohydrates, an essential macronutrient, and a vital component of foods such as fruit, vegetables and dairy products, contributing to a balanced diet. The issue is that sugars are being consumed at levels well over what is physiologically required.

One culprit that received attention in Thursday's documentary was the consumption of sugar-sweetened beverages (SBB). Intake of SBBs, which has increased in parallel with the rising prevalence of obesity, is significantly associated with a higher incidence of T2D.2 What was once considered an adult onset disease is now present in children and adolescents, contributing to the enormous economic strain on the NHS. This is not to say sugar or SBB are the sole contributors, for the aetiology of obesity and T2D is complex, however, there is certainly evidence for an association and opportunity for intervention.

Credit: © kwanchaichaiudom/iStock/Thinkstock

So will this tax make a difference? Surely 20p per litre is not enough to prevent purchase and consumption of sugar sweetened beverages? With promising results in Mexico, I have every reason to remain optimistic. Moreover, I personally feel as though the greatest benefit accrued from such a tax will be the money that is generated, and its potential impact. According to Mr. Oliver the tax could raise £1 billion yearly, which he would like to fund nutrition education in schools and obesity prevention strategies for the NHS. School based education programmes, aimed at reducing SSB consumption, have already proven effective.3 Funding aimed at supporting these programmes could ensure they are implemented in the near future.

This is a small step towards tackling an enormous health issue, nevertheless, it has raised its public profile and begun to generate the need for governmental action. Great work Jamie!