Just a few centuries ago, sugar was an unimaginable luxury to all but the rich and powerful. As late as 1700, the per-capita consumption of the typical Briton was less than 10lb, although your average tenant farmer probably enjoyed far less than that. The rise of modern industrialisation – to say nothing of a globalised economy that cheapened imports – would change everything.

By the turn of the 20th century, most Victorians were guzzling around 60lb of sugar each year. And by the time of the 21st, that figure had doubled, with biscuits and muffins now making up a stomachchurning proportion of the British diet.

Obviously, the UK is far from alone here. Across the developed world, a bonanza of processed food has transformed national cuisines; with consequences that span from bad to terrible. That’s true when considering the effect on the individual body, of course, with diabetes and heart disease being only two illnesses that could blight those addicted to sugar. But more than that, an excess of sugar can often have broader societal consequences.

To return to the UK, for instance, recent government research estimates that treating obesity, of which sugar is doubtless a contributing factor, directly costs the NHS some £6bn each year. Not even the most laissez faire minister could hope to close their eyes to a tax bill that large. It’s unsurprising, then, that politicians of all stripes have spent years battling the exploding scourge of sugar, promoting everything from healthy eating campaigns to advertising limits in the media.

That’s shadowed by more direct interventions, with bureaucrats prodding manufacturers to cut the amount of sugar they funnel into foods. But without specific, mandatory limits on the white stuff, can change ever be permanent? And with the UK being only one of the countries serene with using sugar everywhere from tea to breakfast cereals, is a deeper cultural shift needed, too?

Something’s rotten

Though he’s thousands of miles away and talking over a web camera, it’s clear that Professor Graham MacGregor is not a happy man. A professor of cardiovascular medicine at Queen Mary University of London and chairman of the Action on Sugar charity, MacGregor is complaining about the lack of official action against sugar consumption – and he doesn’t mince his words. “We have a useless government, which you’ve probably read about,” is how he vividly puts it. “It has failed miserably in doing anything.”

Fundamentally, MacGregor’s frustration can be understood from a policy perspective. In 2018, a so-called ‘sugar tax’ was introduced in the UK, obliging retailers to slap an extra £0.18 charge on litre-sized drinks containing 5 to 8g of sugar per 100ml. The even more sugary drinks faced an even steeper levy.

For MacGregor’s part, he saw the law as “successful” – a point apparently bolstered by the statistics. As research by the University of Oxford notes, the 2018 rules resulted in drink manufacturers tweaking their ingredients and cutting the amount of sugar in their products to avoid higher costs. In turn, this had a positive impact on consumption with the average household cutting their sugar intake of 30g per week according to research from NDPH.

Yet as MacGregor’s irritation implies, little has been achieved since then. While the government introduced voluntary 20% targets to cut sugar in food, lack of enforcement has seen progress stagnate; a recent drop in sales measured at just 3.5%.

All the while, says Jane DeVille-Almond, sugar is having an insidious effect on millions up and down the country. That’s clear, argues the president of the British Obesity Society, from a shockingly young age. “Most children who are obese at five end up being obese adults,” she explains. “And if the parents have made them obese in the first place, the likelihood is that they’re obese too. Right from early childhood, sugar is bad for you.”

Combined with the abiding power of sugar through adulthood – studies have found that conditioning can make it very hard for people to dump the substance from their diets – it’s hard to disagree. In a place like the UK, the worst impact of this has been the rise in type 2 diabetes; although, notes MacGregor, that’s hardly surprising when 60% of the population is overweight.

Then there are the wider consequences of sugar. For example, consider the US, where scientists uncovered that too much sucrose can lead to depression. It’s a similar story in Germany, where sugar consumption can apparently be correlated with anxiety.

“We have a useless government, which you’ve probably read about. It has failed miserably in doing anything.”
Professor Graham MacGregor

Chewing the fat

Certainly, it’d be wrong to say that the powers-thatbe – even MacGregor’s “useless government” in Whitehall – are unmoved by these dangers. Over recent decades, health ministries across Europe and North America have attempted to cut sugar consumption in food in a range of ways. In the UK, Public Health England launched the ‘Sugar Smart’ campaign in 2016, offering educational packs about the dangers of sugar to parents. That’s shadowed by a parallel focus on marketing. Though its implementation has been pushed back to 2025, the government has committed to banning adverts for sugary drinks both on TV and online.

“I started nursing 49 years ago, and there was no such thing as type two diabetes – it was called elderly onset diabetes.”
Jane DeVille-Almond

Yet considering the success of compulsory targets when it comes to sugary drinks, is a more robust approach needed? MacGregor, for his part, has no doubt. There’s “no reason” why you shouldn’t regulate sugar in foods, he says. “We have trigger targets in the UK to reduce it – but they’re not doing it.”

The total annual estimated cost of obesity in the UK.
Frontier Economics

It’s a reasonable point, though, and even the industry itself has on occasion advocated for clearer guidelines. A typical example comes from Gavin Partington, director general of the British Soft Drinks Association, who noted in 2018 that it’s “no surprise” that the stricter rules for fizzy drinks meant progress was faster there.

The average reduction of household sugar consumption in a week after the ‘sugar tax’ levy.

But if stricter rules are probably part of the solution, DeVille-Almond warns that they must be accompanied by a general re-evaluation of how the British relate to food. To explain what she means, she recalls her own early career as a nurse in the 1970s. In those times, her hospital canteen served little more than “meat and veg”, with barely a chip in sight. Though most modern punters would probably dismiss that as drab, DeVille-Almond stresses that this approach does have advantages over her local hospital these days, stocked as it is with a Greggs bakery. “I started nursing 49 years ago,” she says, “and there was no such thing as type 2 diabetes – it was called elderly onset diabetes.”

Sugar crash Of course, changing the food options available to vulnerable patients is one way of cutting their sugar intake. But what about when they leave the care of the state and are left to their own devices at home?

For DeVille-Almond, success here requires an even more fundamental culinary revolution, particularly when it comes to people further down the socioeconomic ladder. This is another point supported by the numbers. English adults living in the poorest neighbourhoods are twice as likely to be obese when compared with their richer compatriots, according to a report in Plos Medicine. This is far from a law of nature: though she also grew up poor, DeVille- Almond notes that her family always ate decent meals, while the experiences of countries like Italy and Greece imply that high-sugar habits can be expunged with time and culture.

Clearly, prodding a nation of cake lovers towards a Mediterranean-style diet won’t be achieved overnight. DeVille-Almond is unsure of the alternatives, especially as a lack of funding in the NHS may ultimately mean that overweight people are obliged to pay for their own care. It goes without saying that integrating a degree of personal financial responsibility into health is anathema to many, not least DeVille-Almond herself, especially in a country weaned on the Bevanite dream of universal aid. But given the strain the NHS is under already, she suggests that we’ll finally reach that point regardless, even as she concedes that her view represents a worst-case “Armageddon” scenario.

 MacGregor also approaches the problem from a financial perspective. With politicians worried about being tarred with the dreaded ‘nanny state’ brush, he’s sceptical that a fizzy drinks-style levy on sugary food can make much headway in the UK – as long as it’s promoted moralistically. As an alternative, MacGregor argues that policymakers should focus on wallets rather than blood-sugar levels, noting that slashing the tax burden could ultimately be an appealing pitch for tougher sugar laws.

As MacGregor says, the total cost of obesity is estimated to be upwards of £53bn a year. “That’s a substantial portion of the national health budget.” Maybe so. But for as long as Britons find it more pleasant to eat doughnuts than they do fresh fish, and they see their health as a challenge to be fixed by the state, it’s hard to see sugar consumption go anywhere but up.