As the title of Lionel Bart's famous song from the musical Oliver has it so well, food is one of the pleasures of life as well as an essential element for life itself. Charles Dickens, as many other writers, makes great play of the role of food in society. Appropriately for this season and this issue of the BDJ, he uses food throughout A Christmas Carol as a metaphor for good against evil, health against illness and plenty against want. The two charitable gentlemen who visit Scrooge collecting for the poor are described as 'portly gentlemen, pleasant to behold' and later, baskets of chestnuts are imbued with the warm characteristic of being shaped like 'the waistcoats of jolly old gentlemen'.

Such analogies are common throughout our culture, the connection being that wealth provides food and food provides health. But the truth behind this is rather more complex than it first appears. In its apparent simplicity it has echoes of the famously trotted out formula, sugar plus bacterial plaque equals acid; acid plus tooth equals decay. Our increasing understanding of the caries process means that each of those words needs to carry a PhD's worth of explanatory text in order to qualify it and set it into the context of a population and certainly into the particular circumstances of an individual patient.

But our understanding of food, or more specifically, diet has also developed significantly in recent times. The laudatory plenty of Dickensian prose now squirms under the awkward adjectives of over-weight ('over-weight gentlemen' does not read nearly as well as 'portly' does it?) and, worse, obesity. So instead of praising excess we have come to damn it. Indeed the 'other' BDA, the British Dietetic Association, has recently issued a warning entitled The Great Christmas Stuffing! pointing out that the average person in the UK will consume around 6,000 calories (kcals) on Christmas day alone (versus the guideline daily amount of 2,000 kcals for women and 2,500 kcals for men). They issued a list of recommendations to help reduce calorie intake over the festive period.

Health-related food taxes

One-offs are just that, albeit ten-day one-offs repeated annually each December. But what of the rest of the year? The National Heart Foundation (NHF) has also recently issued a cri du coeur for what it terms 'health-related food taxes'. This followed a meeting earlier in the year on the role of food taxes in the context of addressing diet-related ill health including obesity. In its report it states that increasing rates of diet-related chronic diseases, and widening disparities in rates of these diseases between rich and poor, call for a range of policy responses to address the problems created by a food supply dominated by cheap, energy-dense and heavily marketed, processed food and drinks.1

Interestingly, the report specifically cites taxes applied to carefully defined product categories, such as sugar-sweetened soft drinks which it claims are 'straightforward to apply and are unlikely to have significant unintended effects'. In other words, a starting point for a tax on sugar. It is an issue that some sections of the profession have been advocating for years but to date has seemed to be too extreme and unlikely to be taken seriously at a political level.

But, is it a public heath measure whose time has come? Would it work? Could it work? Certainly there is a greater chance of such a development if the dental profession were to form closer alliances with agencies advocating for general health, heart disease and diabetes amongst them. As well as contributions in easing the problems caused by overweight, oral health in the form of caries prevention and arguably tooth erosion would benefit directly. But would the general consensus be that it was a step too far, the nanny state having too great a say in our choices and our private lives? Consider the gradual narrowing of tobacco use by a combination of legislation and general opprobrium, or alternatively the many questions raised by the suggestion of a minimum price per unit of alcohol. In fairness, the NHF does state that 'Duties on unhealthy foods are not likely to have substantial effects on changing consumption and supply patterns in isolation, but should be part of a comprehensive package of policy measures to shape food consumption and supply'.1 So could this at least be a step in the right direction or are our patients not yet appraised of the notion that sugar is as harmful as tobacco and alcohol?

A sugar tax would certainly make a twenty-first century Scrooge think twice before he uttered 'humbug' quite so liberally. But tax or not, in the spirit of the season I intend to leave you with a toast raised in my favourite occasional soft drink, cream soda (a guilty pleasure from childhood now ruthlessly exposed). It was said of the reformed Ebenezer that he knew 'how to keep Christmas well if any man alive possessed the knowledge'. I wish that you too keep Christmas well this year.