Two Decades of Failed Persuasion

Since 1992, the British government has released 14 strategies to combat obesity. These strategies contain a total of 689 proposed measures. Obesity rates in the country did not decrease.

Researchers from the University of Cambridge analyzed each measure. They concluded that only two had a real effect. For 30 years, the state relied on social messages, such as "Watch your health," to persuade citizens to eat better. The messages did not change behavior.

The situation changed in 2018, when a tax on sugary drinks took effect. Manufacturers quickly removed nearly half the sugar from their soft drinks.

Why the State Targeted Sugar

Around 50 years ago, a thesis spread through the scientific community that dietary fat was the main cause of health problems. Subsequent sections of this article examine how that thesis formed, how sugar entered the diet on a mass scale, and which government measures have produced results.

Sugar in Context

Sugar is not a toxin. The human body requires glucose. Sugar is often portrayed as a threat in order to generate fear, and this framing is misleading. The principle that the dose determines toxicity applies. Drinking 10 liters of plain water in one sitting can cause seizures and coma.

The problem is not sugar in itself. Sugar is now present in nearly all packaged food, often in forms that consumers do not notice.

The effects of sugar differ by source:

• Solid food: Buckwheat with chicken produces satiety.
• Liquid calories: A can of cola delivers calories without producing satiety. Liquid calories are consumed without chewing and are the most common source of excess sugar. Cola is therefore usually the first product targeted in discussions of sugar intake.

Health Consequences

• According to a 2022 WHO report, 2.5 billion people worldwide had tooth decay.
• Untreated tooth decay is the most common disease in humanity.
• The WHO recommends a daily sugar limit of 25 grams.
• A can of cola contains 35 grams of sugar.

The History of Sugar Consumption

Humans have consumed sweets throughout history. Sugar became a health problem recently because of changes in production and price:

• In medieval Europe, sugar was sold in pharmacies as a spice and medicine.
• Mass production developed on plantations in Brazil and the Caribbean. This production relied on the forced labor of millions of enslaved Africans.
• Later, sugar production expanded to sugar beets. Russia remains an active producer of beet sugar.
• The United States developed high-fructose corn syrup as its main sweetener. In the 1980s, corn subsidies and quotas, combined with tariffs on imported sugar, made sugar in the US more expensive than the global average. Corn syrup became far more profitable than other alternatives.
• Coca-Cola and Pepsi switched their American drinks to corn syrup around 1984.

The Sugar Research Foundation and Industry Influence

In 2016, an article published internal documents from the Sugar Research Foundation. The documents showed the following:

• In the 1960s, the foundation paid $6,500 for research on heart disease.
• The foundation engaged Harvard scientists to write a review for a medical journal. The review identified fat and cholesterol as the main dietary causes of heart disease. It stated that the role of sugar was exaggerated.
• A few years later, the foundation launched Project 259, a series of experiments on rats. The experiments found that sugar increased cardiovascular risks in the rats.
• The sponsors did not publish the results because they did not support the desired conclusions. The foundation stopped funding the project and kept the results unpublished. The documents became public only in 2017.

For decades, the Harvard review's conclusions went largely unchallenged. Fat became the main dietary target.

Consequences of the Fat Narrative

• Manufacturers removed fat from products and labeled them "reduced fat."
• Products without fat, such as yogurt and cookies, were less appealing to consumers.
• Manufacturers compensated for the lost fat by adding sugar.

The Tobacco Parallel

The industry's approach to sugar resembles tobacco industry practices. Tobacco companies denied the link between tobacco and cancer. When direct denial became untenable, they funded alternative viewpoints and cited them when needed.

Information about a product's harm that has been falsified for decades and has misled consumers provides grounds for government intervention. This applied to tobacco and, according to the article, to sugar.

The Economic Argument

Beyond public health, the article identifies economic costs as a second reason for state action.

Prevalence of overweight and obesity

A report titled "The Heavy Burden of Obesity," released seven years before the article, analyzed 52 countries. It found the following:

• Overweight reduces GDP by an average of 3.3%.
• More than 8% of healthcare budgets go to diseases directly linked to excess weight.
• Overweight shortens life expectancy by nearly 3 years.
• The effect is most pronounced in Mexico, where life expectancy losses exceed 4 years.

In Russia, Deputy Health Minister Vandaev estimated the country's losses from this problem at 4% of GDP.

Structural Causes of Poor Diets

The article argues that personal responsibility plays a limited role. It describes the problem as a market issue shaped by widely available temptations. The article does not absolve individuals of responsibility. It states that a household stocked mainly with sausages makes healthy eating difficult.

Two structural factors are identified:

1. Price and profit: Calories from sugar and flour are very cheap. Processed convenience foods have long shelf lives and high margins. Manufacturers can add inexpensive ingredients to these products.
2. Lack of information: Children and teenagers have little reliable information about food. Dietary habits formed in childhood can persist for life.

Low-income families do not eat worse because they lack understanding of the consequences. The article cites Galitsky, who stated that these families "buy calories at the store, not food." For a family with a budget of 20,000 rubles, calorie quality is not the priority.

Five Government Levers

Public health specialists have five levers of influence:

1. Information
2. Nudging
3. Price correction
4. Restrictive measures
5. Total prohibition

Information

Governments typically begin with information campaigns, including social advertising, flyers, and posters. The article notes that such campaigns are easy to present as intense activity without producing results. Britain ran these campaigns for 30 years. The article concludes that relying on voluntary behavior change in response to social messages does not work. The environment, however, can be changed.

Nudging

Cigarette warning images: Graphic images on cigarette packs are the clearest example of nudging. Some customers request packs with a different warning, for example, one referring to infertility instead of impotence. The article states that it has no known cases of a smoker changing behavior after viewing a photo of diseased lungs. The effect is not clearly established. The same applies to outdoor advertising billboards, whose effect on sales, including direction, is unclear. Some smokers who viewed a warning image reportedly experienced stress and then bought a full carton.

Front-of-pack labels: Latin American countries use black octagon warnings for high sugar, high fat, or high salt. The article describes these labels as clear and specific warning information. Products carrying a black warning cannot feature cartoon or children's characters. The example given is a prohibition on Smeshariki characters on high-calorie cereal.

Advertising restrictions in the UK:

• Fast food advertising is banned on public transport.
• Fast food advertising cannot appear on television in the evening.
• Such advertising is banned online.

Reports indicate a decrease of about 7% in calorie consumption per family. The article states that it is unclear whether this result stems from the advertising restrictions.

Retail placement and promotions:

• Harmful products are restricted at store checkouts and at the ends of aisles.
• In Scotland, promotions such as three-for-two and buy-one-get-one-free are no longer permitted on these products.
• Large restaurant chains are prohibited from offering free refills on sugary sodas. The article notes that students and schoolchildren were the main consumers attracted by this promotion.

Taxes

Excise taxes on sugary drinks are currently in effect in at least 116 countries. The article notes that taxes can be implemented poorly.

Denmark (2011): Denmark became the first country to introduce a tax on saturated fat, at approximately $3 per kilogram of the fat in products. The results were as follows:

• Butter, cream, cheese, and sausages became more expensive.
• The tax remained in effect for about one year before being repealed.
• Danish consumers bought butter in neighboring Germany.
• The government stated it would not introduce food taxes for a long period.
• Reports cited the possible loss of around 1,300 jobs.
• No noticeable health benefits were observed.
• Sales of margarine and oils fell by up to 20%, according to various estimates.
• Stores in German border regions recorded unprecedented growth in sales of these categories.

United Kingdom, tiered sugar tax: The UK tax applies the following rates:

Officials expected to collect £520 million in the first year. They collected £330 million because manufacturers quickly reduced sugar content. By 2024, the average sugar content of drinks had fallen by 47%. The article notes that the state did not generate the anticipated revenue but did change the composition of products on store shelves.

Mexico: Since 2014, Mexico has applied a tax of approximately 10% of the price of sugary drinks.

• In the first year, purchases fell by 6%.
• In the second year, purchases fell by a further 12%.
• Low-income families could no longer afford these products.
• The government planned to double the tax. Companies then began switching to sugar substitutes.
• Mexico now taxes sweeteners as well.

Warning Labels in Chile

According to the article, warning labels produced the strongest results among the measures examined. In the first year of the Chilean pilot project, sales of labeled products fell significantly:

The measure did not cause layoffs. Employment and wages in the food industry were unaffected. Manufacturers, seeking to avoid warning labels, began to reformulate their products.

Industry Response

The article describes several ways companies resist regulation:

• Sweetener substitution: Companies replace sugar with sweeteners. Mexico responded by extending taxes to sugar substitutes.
• Retail loopholes: Bans on chips and chocolate at checkouts and end-caps do not cover store-baked goods or products sold in bulk, which are therefore not affected by the restrictions.
• Legal challenges and policy reversals: In the United States, the "Make America Healthy Again" movement secured a ban on purchasing soda and candy with food stamps. The ban was overturned after corporations calculated that excluding sweets from the food stamp program would cost them more than $800 million. The article notes that the ban was based on the premise that these products are not essential goods.

Russia

Russia introduced an excise tax on sugary drinks in 2023. The tax is 7 rubles per liter for drinks containing more than 5 grams of sugar per 100 ml. The rate was later raised to 11 rubles per liter.

Deputy Finance Minister Alexey Sazanov stated the following:

• In 2023, 75% of non-alcoholic drinks fell under the tax.
• In the current year, the share fell to 30%.

The article notes that the more effective the tax is in changing product composition, the less revenue it generates.

Pharmacological Intervention

The article also references GLP-1 medications such as Ozempic and its analogues. Researchers tracked 150,000 families that began using these injections and compared their purchases with those of similar families that did not use the drugs.

• Among families using Ozempic, food spending dropped by up to 8% within six months.
• When people stopped the injections, their purchases returned to previous levels.
• The medication remains expensive, so the approach is not yet widely used.

Public Support for Taxation

According to The Economist, nearly 70% of Britons support further taxes on other harmful products. Support depends on the revenue being directed to promoting healthy eating rather than to general government initiatives.

Conclusion

Soda remains on shelves in English stores with nearly half the sugar content. The article states that the market adapts effectively to regulation.

For 40 years, manufacturers prioritized taste and sales. Consumer health was not a central concern until regulation made it a competitive factor. Persuading citizens to take care of their health did not succeed. Government measures did change how manufacturers approach public health.

The article concludes that when a problem is systemic, it must be addressed through the system rather than through individual behavior.