Sugar sugar

Today, the tax on sugar-sweetened drinks (SSDs) comes into effect in Ireland. This will mean a 2 litre bottle of Coca Cola, for example, will cost 60 cent more. On balance, I welcome this move. It is clear that we consume too much sugar, and that this is particularly injurious to the health of children. On its own, this measure will not eliminate any threat to the health of the population, but – with rare exceptions such as vaccination programs – this is not how public health campaigns work. Instead, public health is improved by subjecting a given threat to a death of a thousand cuts. The decline in smoking prevalence, for example, cannot be attributed solely to the workplace smoking ban, or to the provision of supports for smoking cessation, or to the increased tax on cigarettes, or to packaging and advertising laws. But taken together, measures like these have a significant impact. The tax on SSDs could function in the same way: Alone, it won’t dramatically reduce the amount of excess sugar consumption, but in conjunction with other interventions, it just might have a positive effect. If I had any doubts about the effectiveness of these taxes, they are put to rest by the fact that the industry opposes them. Their opposition suggests to me that they believe it can reduce consumption, and they, with their billion dollar market research budgets, should know.

So SSD taxes might play a part in reducing excess sugar consumption. Good. I’m all in favour of that. But. But. The point of the SSD tax is not to reduce consumption of sugar; it is, we are told, to reduce childhood obesity. This is where I find myself getting uncomfortable. I believe this is harmful to both slim and fat people. First, when public health messaging constantly links SSD taxes with obesity, it sends the message that SSDs and other high-sugar ‘foods’ like sweets and cakes are only bad for you if they make you fat. It is the case that, if you are genetically predisposed to weight gain, environmental and behavioural factors will cause you to gain weight. But it doesn’t follow that SSDs and other sugary junk are perfectly safe to consume as long as they don’t cause you to gain weight, and it is disingenuous to push this message on parents and the public in general.

In fact, there are lots of good reasons not to let children consume too much sugar, even if they never become overweight. For one thing, the link between sugar and tooth decay is well established. But I think there are deeper worries that deserve consideration here too. I admit this is somewhat intuitive, and requires both more evidence and more argument than I can give here, but my sense is that it is just not healthy to encourage children to develop a taste for extremely sweet junk foods many of which are, in my opinion, deliberately engineered to be ‘more-ish’. I think there is a danger that letting kids consume these things on a regular basis inhibits their ability to appreciate real, healthy food, and disrupts the natural relationship between their bodies, food and drinks. If you are constantly consuming high-calorie ‘foods’ that don’t give you a feeling of satiety, mightn’t this affect your ability to regulate your behaviour in response to hunger and satiety cues? This is potentially most dangerous to families in poverty, who may lack the resources to make a habit of eating fresh, home-cooked food. (Imagine trying to avoid giving your kids SSDs and sugary, processed foods while living in emergency accommodation.) As has been pointed out time and again, unless it is accompanied by measures to improve health education and access to good food, an SSD tax is basically just another regressive tax, impacting hardest on those who can least afford it. In short, the idea that SSDs – and rubbishy ‘treats’ in general – are fine as long as you don’t get fat seems potentially harmful to me.

But if this messaging is potentially harmful to slim people (and slim children in particular), it is even more harmful to fat people, including overweight and fat children. This is because it reinforces the stigmatising conflation of unhealthy eating with fatness. Yet again, our public health institutions are pushing the notion that, if you are fat, you must be over-consuming, and if you are not fat, your consumption must be fine. Yet again, we are being encouraged (subtly, implicitly) to consider weight as the be-all, end-all of health, and to consider fatness as the greatest threat to our collective health. Yet again, fat people – including children – are being constructed as the living embodiment of all that is wrong with western society. But, it is not clear that fatness is always so dangerous, and it is not clear that weight loss is the best or only solution to the problems that are associated with overweight and obesity. In fact, many of those who maintain clinically-significant weight loss certainly would not look slim or healthy to the average person on the street, who has learned what ‘healthy’ looks like from our public health messaging. In short, as fat acceptance advocates are weary from saying, you can’t tell how healthy somebody is just by looking at them. Yet governments and others, whether by accident or design, keep pushing the idea that body size and shape are clear and direct manifestations of over-eating, under-exercising and other unhealthy behaviours. This contributes to the shame and stigma experienced by fat people. Shame and stigma are harmful in themselves, and they are not good motivators for positive behavioural change of any sort.

This kind of problematic anti-obesity messaging is presumably justified on the grounds that it leads to an overall improvement in the health of the population and that this is good for individuals. I think of this as ‘trickle-down’ ethics, and to me it is just as worrisome as its economic counterpart. Just as, in Reaganomic-type economies, the money stops trickling down well before it reaches those who need it most, so the benefits of anti-obesity policies do not make it to fat people. Rather, I suggest, public health anti-obesity messaging is extremely harmful to actual fat people. In short, while this tax may be a good thing for our collective health, the way it has been announced and justified seems to be yet another case of an ‘anti-obesity’ policy that looks, walks and quacks like an ‘anti-obese-people’ policy.