UK soft drinks industry levy linked to improved dental health in kids, study suggests

Two years after the UK soft drinks sugar tax came into force, incident rates of child hospital admissions for tooth extraction due to dental caries fell by 12.1%. Researchers found these reductions for children living in most areas, regardless of socioeconomic status.

The study mainly found lower hospital admissions in children up to four (-28.6%) and children aged 5-9 (-5.5%). According to the researchers, children aged 5-9 will most likely be admitted for tooth extractions under general anesthesia. Incidence rates were unchanged in older age groups — between ten and 18 years old.

“This is one of the first studies of sugar-sweetened beverage taxes on health outcomes. It contributes to a growing body of literature that sugar-sweetened beverage taxes can impact outcomes such as body weight and dental health,” senior author Jean Adams, professor at the University of Cambridge, UK, tells Food Ingredients First.

“This study contributes to the minimal literature on the health impacts of soft drinks taxes and only a handful of previous studies on how they impact dental health. We hope it will help others understand the potential impacts of soft drinks taxes and inform future decisions about implementing or extending these taxes.”

The soft drinks industry levy, introduced in 2018, encourages producers to reformulate their beverages as drinks with a higher sugar content are subject to a higher levy.

Real-world hospital data  
The study, published in BMJ Nutrition, Prevention & Health, uses hospital data for tooth extractions due to decay in children up to 18 years old in England from January 2014 — four years before the levy was introduced — until February 2020, 22 months after its implementation.

The researchers estimate that hospital admissions reduced by 5,638 cases per year with the levy.The researchers analyzed overall trends and broke these down by age groups and neighborhood deprivation, as they noted that tooth extraction due to dental caries is associated with socioeconomic deprivation.

Hospital admissions reduced by 6.5 per 100,000 kids aged 0-4 and by 3.3 per 100,000 kids aged 5-9. According to the researchers, this comes down to an estimated 5,638 averted cases per year.

The study’s authors explain that dental extraction due to caries is the leading reason for children having an elective admission to the hospital in England, adding that nearly 90% of extractions in young children are due to decay.

Sugar-sweetened beverages are a primary source of dietary added sugars for children, accounting for 30% of added sugars consumed by kids aged one to three and over 50% by late adolescence. The researchers add that the relationship between these drinks and dental caries is well-established.

Influencing factors 
The researchers note that a national intervention program and compulsory nutritional labeling may have influenced consumer buying habits.

“The soft drink industry levy was announced after much discussion in the UK media about sugar and its health impacts. The levy also got quite a lot of media coverage,” explains Adams.

For example, the UK’s sugar reduction program, operating from 2015 to 2020, alongside the industry levy, may have raised public awareness of sugar consumption. From December 2016 onwards, nutritional labeling on pre-packaged foods such as “with sugar(s)” may have raised consumer awareness.

“All of these things could have made people more aware of sugar and sugar-sweetened beverages and led to them changing their behavior in ways that were not directly linked to any changes in price or sugar content of drinks associated with the tax,” asserts Adams.

Sugar-sweetened beverages are a primary source of dietary added sugars for children.“However, one could think of all of these things as part of the levy — it wasn’t just a change in taxation, but part of a wider national conversation about sugar and sugar-sweetened beverages.”

Through a secondary analysis, the researchers suggest that the most significant benefits to oral health occurred between the announcement of the levy and its implementation when most reformulation occurred.

Part of more extensive research  
As the study is observational, it cannot establish causality. The authors also note that without a comparable control group, it limits their ability to attribute the observed changes to the industry levy fully.

Adams explains that designing a randomized controlled trial at a national level is challenging, which is why the current research used observational analyses, suggesting potential pathways of causation and triangulating findings to support the conclusions.

“This study is part of a much larger project on the soft drink industry levy exploring the association between the levy and reformulation of soft drinks, purchasing of soft drinks, consumption of sugar and obesity and dental outcomes. We’ve also examined how the industry responded in the media, parliamentary discussion of the levy, and economic impacts on industry.”

“Our final piece of work will attempt to bring together all of the peer-reviewed literature on the levy, to update our theory of what it might have achieved and how, and draw conclusions from the body of work as a whole,” she details.

Dental health 
Sumantra Ray, executive director of the NNEdPro Global Centre for Nutrition and Health, welcomes the research as it “attempts to draw the links between policy-level changes and the impact on early life oral or dental health outcomes which, if untoward, would produce a significant onward burden on dental services through the life course.”

The soft drinks industry levy encourages soft drink manufacturers to lower the sugar content in their beverages.“The economic effects of this are more pronounced given current challenges in the provision of far-reaching dental health coverage both in countries with nationalized health care systems as well as others.”

He adds that the study provides the basis for the design of further policy-sensitive research investigating these relationships in a manner that links cause and effect.

Industry levy impact
UK soft drink companies have been making strides in reducing the sugar content of their beverages after the government introduced the sugar tax. One year after the levy’s implementation, sugar intake from soft drinks dropped 10%.

While research estimates that the tax may have prevented 5,000 cases of obesity in young girls of 10 to 11 years old, campaigners argue that the levy is not solely responsible for decreasing child obesity levels.

Moreover, Action on Sugar has called for effective strategies, such as the UK soft drinks industry levy, to reduce the consumption of soft drinks, as teenagers’ overconsumption of such beverages has been directly linked to obesity in different countries.

In this week’s Sugar Awareness Week, Action on Sugar also shared a new survey, revealing that over a third of sweet food and drink products sold in major UK coffee shops contain over 30 g of free sugars — an adult’s daily sugar limit — in one serving.

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