Noncommunicable diseases | Information resources | Reducing sugar consumption to prevent and control noncommunicable diseases in the Eastern Mediterranean Region

Reducing sugar consumption to prevent and control noncommunicable diseases in the Eastern Mediterranean Region

Print PDF

Q: What is sugar?

Sugar is one of the simple forms of carbohydrates which contains mono-saccharides, such as fructose (found in fruits) and galactose (found in milk products), and disaccharides (carbohydrates with two sugars), such as sucrose (table sugar) and lactose (from dairy) (1).

Simple carbohydrates are also in candy, soda and syrups. However, these foods and beverages are made with processed and refined sugars and do not have vitamins, minerals or fiber. They are called "empty calories" and can lead to weight gain.

Free sugars include mono-saccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

Q: Is sugar consumption unhealthy?

Excessive sugar consumption is a key factor in promoting overweight and obesity, tooth decay and diabetes (2). There is increasing concern that intake of free sugars – particularly in the form of sugar-sweetened beverages – increases overall energy intake and may reduce the intake of foods containing more nutritionally adequate calories, leading to an unhealthy diet, weight gain and increased risk of noncommunicable diseases. Another concern is the association between intake of free sugars and tooth decay. Dental diseases are the most prevalent noncommunicable diseases globally and, although great improvements in prevention and treatment of dental diseases have occurred in the past decades, problems still persist, causing pain, anxiety, functional limitation, including poor school attendance and performance in children, and social impediment through tooth loss (1). 

Q: Which foods are high in sugar?

Sugar is available in one form or another in the majority of foods and sugar-sweetened beverages. High levels of sugar are present in sugar-sweetened beverages, sugary snacks and sweets.

Q: What is the WHO-recommended sugar intake?

The intake of free sugars should be reduced throughout the life-course. WHO recommends less than 10% of total energy intake from free sugars, which is for a person of healthy body weight consuming approximately 2000 calories per day, but ideally less than 5% of total energy intake for additional health benefits. Considering the high prevalence of obesity and diabetes in the Region, WHO recommends that children and women should consume less than 5% (roughly 25 grams per person a day) of free sugars in their diet (3).

Q: What is the current average sugar intake in the Region?

Data indicate that the contribution of sugar to the total average daily food energy supply is relatively high in most countries of the Region, especially in high- and middle-income countries ranging from 9% to 15%. Even in low-income countries, it can be as high as 12% (4). Children, especially school children and young adults, usually have exceptionally high intakes. Sugar intakes are also increasing as national incomes rise. Sugar consumption in almost half the countries of the Region exceeds 70 g per person a day, with consumption in some countries even exceeding 85 g per person a day (5). The Region has the fastest growth in sugar consumption globally and this dietary transition has markedly reduced the quality of the diet of the population (5).

Q: What is the impact of the current average sugar intake in the Region?

Diets high in sugar are linked to obesity and overweight, both which increase the likelihood and prospect of diabetes. There is a strong link between obesity and mortality. In the Region, both males and females suffer from being overweight and obese. It is estimated that over 50% of women are overweight. Roughly half of overweight women are obese (6). In the case of children and adolescents the picture is even more alarming. The overindulgence in high calorie food and indoor leisure activities, such as watching television, surfing the net and playing computer games, all contribute to childhood obesity. Regionally, overweight and obesity in children under-five years of age has increased from 5.8% to 8.1% between 1990 and 2012, which is above the global average of 6.7%. Overweight and obesity in adolescents (13–15 years) are highly prevalent (7).

Q: What are the benefits of reducing sugar intake on the individual and the population?

Reducing sugar intake lowers specifically the risk of developing overweight and obesity, and in turn in developing diabetes. It also has a significant effect on lowering dental caries. The evidence for the health benefits of population-wide reduction in sugar intake is strong.

Q: Who is responsible for reducing sugar intake/consumption?

Everyone has a role in promoting a reduction in sugar consumption – governments, the private sector and civil society. 

Q: How can governments reduce population sugar intake/consumption?

To reduce population sugar intake/consumption, government can implement the following evidence-based interventions.

  • Reformulate sugar-rich foods and drinks to lower sugar intakes.
  • Set standards for all food and drink served by government-sponsored institutions. 
  • Restrict promotion of sugar-enriched products, especially drinks. 
  • Impose restrictions on marketing, advertising and sponsorship of all sugar-enriched foods and drinks across all media platforms.
  • Use nutritional profiling to establish clear definitions of foods and drinks high in sugar.
  • Eliminate sugar subsidies provided by national governments and introduce progressive taxes initially on sugary drinks and then on all foods and drinks with added sugar.
  • Improve accredited training on diet and health for individuals with opportunities to influence population food choices. 
  • Provide routine health education to populations.

Q: What is the role of WHO in supporting countries to promote a reduction in sugar consumption? 

One of the strategic interventions under the area of prevention and reduction of risk factors in the Regional framework for action is to ensure healthy nutrition in early life. In addition, WHO is working within the Global strategy on diet, physical activity and health and closely with governments to meet nine global targets to reduce noncommunicable diseases and give us all a better chance at a longer, healthier life by 2025. The seventh global target aims to halt the rise in diabetes and obesity (8,9). Furthermore, technical guidance was developed to support countries in their efforts to reduce sugar consumption (10). 

References

1. Guideline: Sugars intake for adults and children. Geneva: World Health Organization; 2015

2. Summary report on the technical consultation on reducing sugar intake in the Eastern Mediterranean Region. Cairo: WHO Regional Office for Eastern Mediterranean; 2015 

3. Healthy diet, Fact sheet N°394. Geneva: World Health Organization; 2015 

4. Abdulrahman O Musaiger. Overweight and obesity in the Eastern Mediterranean Region: prevalence and possible causes. 2011. doi:10.1155/2011/407237. J Obes. 2011.407237.

5. Sugar supply (kcal/capita/d) in Northen Africa and Western Asia between 1970 and 2010. In FAO/Statistics Division. Italy; Food and Agriculture Organization of the United Nations; 2013

6. WHO Global Health Observatory data repository. Geneva: World Health Organization; 2015

7. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization; 2014 

8. Regional framework for action. In WHO/Noncommunicable diseases [website]. Cairo: WHO Regional Office for Eastern Mediterranean; 2015 

9. Global strategy on diet, physical activity and health. Geneva: World Health Organization; 2015

10. The Work of WHO in the Eastern Mediterranean Region Annual Report of the Regional Director 2014. Cairo: WHO Regional Office for Eastern Mediterranean; 2015