Change4Life Sugar Smart

Q&A

January 2016

Contents

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1. About sugar

2. Sugar guidelines and consumption

3. Nutrition labels

4. The Sugar Smart campaign

5. Sugar Smart app

6. Sugar Smart partners

1. About sugar

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1.1 What is sugar?

Sugar is a sweet crystalline substance obtained from various plants, especially sugar

cane and sugar beet, consisting essentially of sucrose, and used, as a sweetener in

food and drink.1 Sugar is a carbohydrate along with starch.2

Definitions of sugar vary. There are two main types of sugar, those that are

contained within the cellular structure of foods and drinks and naturally present in

dairy products, and those that are ‘free’ or ‘added sugars’.3

1.2 What are the different types of sugar?

There are surprisingly large amounts of sugar lurking in everyday foods and drinks.

Added by manufacturers (such as fructose, sucrose, glucose and high fructose

corn syrup)

Added at home (on cereal, hot drinks and whilst cooking)

Honey, syrups, fruit juice concentrates and nectars

In fruit juices (they do count towards your 5-a-day but limit the amount to

150ml per day)

1.3 What is the worst type of sugar for our health?

Sugars occur naturally in foods such as fruit and milk, but it’s the sugars that are

added to things by manufacturers (breakfast cereals, chilled desserts, yoghurts,

sweets, cakes, biscuits, chocolate, and some fizzy drinks) as well as sugar added at

home (on cereal, hot drinks and whilst cooking) that we should cut down on.3

1.4 What are the dfferences between...:

added sugar and natural sugar?

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Naturally occurring sugar is the sugar found in whole, unprocessed foods, such as

milk, fruit, vegetables and some grains. The most common natural sugars are

fructose, which is found in fruit, and lactose, which is found in milk products.4

Added sugar is the sugar added to processed food and drinks when they are

being made, as well as sugar you may add to your food at home.3

Food manufacturers may add both natural sugars (such as fructose) and

processed sugars (such as high-fructose corn syrup) to processed food and

drinks.

intrinsic and extrinsic sugars?

Intrinsic sugars are those that present naturally within the cellular structure of

food, these sugars are mainly found in fruits and vegetables. Extrinsic sugars are

those that are added to food.5

hidden and added sugars?

Hidden sugar is the sugar found naturally in most foods. On the other hand,

‘added sugar’ is the sugar added to many foods to make them taste nicer.5

1.5 What types of sugar is Public Health England / Change4Life trying to get people

to cut down on?

It’s the sugars that are added to things such as breakfast cereals, chilled desserts,

yoghurts, sweets, cakes, biscuits, chocolate, and some fizzy drinks and juice drinks

that we should cut down on.

1.6 Are you suggesting that people should cut fruit out of their diet?

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No. Fruit does contain sugar as part of its structure but it’s a healthier choice

because it also contains fibre, vitamins and minerals. Fruit also contributes to your 5

A DAY. 6

1.7 What is the guidance from Public Health England about drinking fruit juice?

Current Government guidance outlines one glass (150ml) of unsweetened 100% fruit

juice counts toward your 5 A DAY. However, these drinks do contain sugar (and

therefore calories) so the advice is to have no more than this a day. It is also

recommended that fruit juice be consumed with meals to protect against dental

cavities.7

1.8 What is the issue with fizzy drinks?

In every age group, fizzy drinks are a key contributor of sugar in the diet and there is

a significant amount of scientific evidence to prove that there is no place for them,

especially amongst children. Soft drinks, including fizzy drinks, are the largest single

source of sugar for teenagers. For younger children soft drinks, confectionery and

fruit juice are the major sources of sugar. In adults table sugar and preserves and

soft drinks are the main sources. 8

Families also need to be conscious that some flavoured waters contain large

quantities of added sugar even though they may appear to be a healthier alternative.

1.9 Are you demonising fizzy drinks?

No, a wealth of robust and scientific data has been published which has shown that

there is no place in our diets for fizzy drinks. Soft drinks, including fizzy drinks, are

the largest single source of sugar for teenagers. For younger children soft drinks,

confectionery and fruit juice are the major sources of sugar. In adults table sugar and

preserves and soft drinks are the main sources.8

1.10 Are diet drinks ok to drink?

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Clearly the ‘ideal’ would be to swap from sugary drinks to water but research shows

there are no obesity/dietary related health risks to drinking diet versions of

carbonated drinks. In fact, there are significant health benefits to switching from a

sugary drink to a diet or sugar free version.

1.11 Aspartame has been documented in the media as causing cancer, surely PHE should not be promoting drinks with sweetners as an alternative.

In December 2014 the European Food Safety Authority (EFSA) completed a full risk

assessment on aspartame, taking into account all available scientific research and

concluded it is safe at current levels of exposure.

Ideally families could cut down on sugar by swapping to healthier alternatives, for

example by swapping sugary drinks for milk (ideally semi-skimmed, 1% fat or

skimmed) or water, but our research has shown that many people find it hard to

make long term changes if they have to cut out their favourite foods or drinks, in

which case swapping to reduced and sugar free versions can help them to do this,

whilst still having significant benefits over eating sugar.

1.12 What are the health implications of consuming too much sugar?

According to recently published data from the National Child Measurement

Programme (NCMP), almost one in ten children aged 4-5 years is obese, rising to one

in five children aged 10-11 years. Even more are overweight.

Evidence shows that eating too much sugar results in extra calories which causes fat

to build up inside the body, which can lead to weight gain and obesity. Children who

are overweight or obese are more likely to develop illnesses such as type 2 diabetes,

go onto experience weight and health problems in adolescence, and are more likely

to become overweight or obese adults.

If an individual is overweight or obese they are more prone to a range of serious

health problems. These include cardiovascular disease; type 2 diabetes; endometrial,

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breast and colon cancer; as well as psychological and social problems such as stress,

low self-esteem, depression, stigma, prejudice and bullying.

1.13 How confident is Public Health England about the evidence behind sugar

causing tooth decay?

There is clear evidence to support the connection between sugar and tooth decay

and recent estimates suggest poor dental health costs the NHS alone £3.4 billion a

year.12 In 2012, almost one-third of five year olds in England had tooth decay with

stark inequalities across the country.1 A systematic review commissioned by the

World Health Organisation found that when less than 10% of total energy (calorie)

intake is made up of free sugar there are much lower levels of cavities. Dental decay

progresses with age and the effects from sugars on teeth are lifelong.13

1.14 How confident is Public Health England about the evidence behind sugar

causing obesity and deadly/chronic diseases?

Data from the National Diet and Nutrition Survey clearly demonstrates that we are

all eating too much salt, saturated fat and sugars. In addition, the Scientific Advisory

Committee on Nutrition (SACN) which updated it’s guidance in July 2015 highlighted

that eating too much sugar results in extra calories, which causes fat to build up, and

could lead to heart disease, cancer or type 2 diabetes. NHS costs attributable to

being overweight and obese are projected to reach £9.7 billion by 2050, with wider

costs to society estimated to reach £49.9 billion per year.15

Helping people choose, cook and eat a diet lower in salt, saturated fat and sugars

(and higher in fruit and veg, fibre and oily fish) will lead to longer, healthier lives.

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2. Sugar guidelines and consumption

2.1 What is the recommended daily allowance for sugar for adults and children?

No more than 5% of people’s (from 2 years old and above) daily energy intake

should come from free sugars. This is a new recommendation announced by the

Scientific Advisory Committee on Nutrition (SACN) in July 2015.14

2.2 Why can we only eat 5% free sugars of our daily energy intake?

The Government’s advice on sugar intake is based on robust evidence compiled by

an independent expert body - the Scientific Advisory Committee on Nutrition (SACN).

The evidence considered by SACN shows that reducing free sugars intake to below

5% of total energy intake reduces the risk of eating too many calories.14

SACN have proposed a recommendation of around 5% of total energy intake from

total sugars on the bases that it could help reduce obesity, and tooth decay. They

have also taken into account evidence on type 2 diabetes. A diet where sugars intake

is 5% of daily energy intake approximately equates to 30g or 7 cubes of sugar per day

on average.14

2.3 When do we expect to achieve the 5% sugar intake figure? Is it realistic?

The new recommendations on sugar pose a significant challenge but are achievable

in the long-term. The scientific evidence shows that we all have to reduce our sugar

consumption in order to protect our health. This is why a broad range of measures is

needed in response - there is no single solution. We need to change our

environment to help the nation make healthier choices.

Current estimates of UK sugar intakes from the National Diet and Nutrition Survey

programme (NDNS), show that average intakes are three times higher than the 5%

maximum recommended level in school-aged children and teenagers (15% of energy

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intake) and around twice the maximum recommended level in adults (12% of energy

intake).

2.4 Currently how much sugar does the average person consume in the UK?

The average person in Britain consumes 700g of sugar a week – equivalent to 175

sugar cubes of sugar!

2.5 Does this differ between age groups?

The below shows a breakdown of daily total sugar intake14

Children aged 1 and a half to 3 consume on average 36.1g of sugar (11.9%)

Children aged 4-10 consume on average 60.8g of sugar (23.8%)

Teenagers aged 11 – 18 consume on average 74.2g of sugar (15.4%)

Adults aged 19 - 64 consume on average 58.8g of sugar (12.1%)

Adults aged 65+ consume on average 51.6g of sugar (11.5%)

2.6 Which foods and drinks consumed by 4-10 year olds in England contain the

most sugar?

Children’s sugar consumption, as a percentage of energy intake, is up to 55% greater

than the current SACN recommendation. The highest contributor to added sugar in

the diet 4 to 10 year olds is:

• 30% drinks (including 17% from soft drinks). This is not low calorie drinks

• 29% cereals (mainly from biscuits, cakes and breakfast cereals)

• 22% sugar, preserves and confectionery

• 12% milk and milk products

2.7 Why are people in England eating and drinking too much sugar?

There does not seem to be one definitive reason for people in England eating too

much sugar. However, could include, but are not limited to:

A lack of awareness around the level of sugars of food

Confusion over the levels of sugar in food

People ignoring health messages

A lack of access to healthy foods

Preference for the taste of high sugar foods

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A perception that healthy foods are more expensive than unhealthy foods

The Change4Life Sugar Smart campiagn aims to raise awareness of what is

considered an acceptable level of sugar consumption and illustrate how

consumption builds up throughout the day, so people can make informed decisions

about whether their own diet is healthy.

The launch of the Sugar Smart app will allow families to find out exactly how much

sugar is in the food and drink they eat in a quick and easy way. The Change4Life

website will provide additional support and offer lower sugar alternatives and

recipes.

3. Nutrition labels

3.1 How do people know if they are buying foods with too much sugar?

Nutrition labels often tell you how much sugar a food contains. You can compare

labels and choose foods that are lower in sugar. Some food labels use red, amber

and green colour coding which makes it easier to choose food that is lower in sugar.

A food is classified as high in sugar if it contains more than 22.5g of total sugars per

100g or more than 27g per portion of product. It is low in sugar if it contains 5g of

total sugars or less per 100g. A drink is high in sugar if it contains more than 11.25g

of total sugars per 100g or more than 13.5g of total sugars per portion of product. It

is low in sugar if it contains 2.5g of total sugars or less per 100g. An example of a

nutrition label can be found below:

A food containing lots of fruit or milk will be a healthier choice than one that

contains lots of added sugars, even if the two products contain the same total

amount of sugars. You can tell if the food contains lots of added sugars by checking

the ingredients list. Sometimes you will see a figure for "Carbohydrates", and not for

"Carbohydrates (of which sugars)".

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The "Carbohydrates" figure will also include starchy carbohydrates, so you can't use

it to work out the sugar content. In this case, check the ingredients list to see if the

food is high in ‘added sugars’.

3.2 What is classified as a sugar on nutrition labels?

The sugars figure in the nutrition label is the total amount of sugars in the food. It

includes sugars from fruit and milk, as well as the sugars that have been added.

4. The Sugar Smart campaign

4.1 What is the Sugar Smart Campaign

The Change4Life Sugar Smart campaign aims to raise awareness of the high levels of

sugar consumed and the associated health harms. It will do this by encouraging

families to download the Sugar Smart app and find out exactly how much sugar is in

everyday food and drink so that they can make the changes needed to protect their

kids.

We will also have a series of Sugar Smart episodes, which will feature a well-known

mum learning about the sugar content in their family’s food and how to monitor and

curb the amount of sugar that their children consume from a leading nutritionist.

4.2 Why are you only focusing on sugar?

Last year’s Smart Swaps campaign was our most successful healthy eating campaign

yet in terms of behaviour change, registrations and partnership contributions. Public

Health England wants to build on this to make the 2016 campaign bigger and better.

Data from the National Diet and Nutrition Survey clearly demonstrates that we are

all eating too much sugar and therefore the January 2016 activity has an even tighter

campaign, focusing on raising awareness of content of everyday foods through a

specially designed app. Fat and salt reduction will continue to be secondary

messages.

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4.3 Sugar has received increased amounts of attention from the media and political

environment, has this influenced your decision to focus on sugar once again?

No. People eat more sugar than they should and the nation’s health would benefit if

average sugar intakes were reduced. Eating too much sugar results in extra calories,

which causes fat to build up that could lead to heart disease, cancer or type 2

diabetes. Public Health England is committed to help improve the diet of the nation

and in January 2016 is launching the Change4Life Sugar Smart campaign to help

people reduce their sugar intake. Wider Change4Life activities will also continue to

encourage a much wider range of healthier swaps with fat and salt reduction

continuing to be important, additional messages.

4.4 What is the aim of the campaign?

In January 2016 Public Health England will launch the Change4Life Sugar Smart

campaign. We will see the introduction of a Sugar Smart app, which will allow

families to see how much sugar is in everyday foods by simply scanning a bar code.

The campaign will encourage and support families in reducing the amount of sugar

they consume.

4.5 Who will the campaign target?

The Change4Life Sugar Smart campaign targets everyone in England, particularly

families with children aged 5-11 from a C2DE background.

4.6 Why have you decided to launch this campaign now?

The New Year is a time when people are more willing to consider making positive

changes. This therefore provides an opportunity to tap into this mindset and

encourage as many families as possible to make healthier choices about what they

eat and drink.

4.7 How do you plan to help families reduce their sugar intake?

The Change4Life Sugar Smart campaign will raise awareness of the high levels of

sugar consumed and the health harms of sugar. It will do this by encouraging families

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to download the Sugar Smart app and find out exactly how much sugar is in everyday

food and drink so that they can make the changes needed to protect their kids.

4.8 How long will the campaign run?

The Change4Life ‘Sugar Smart’ campaign launches on 14 January 2016 with media

throughout January and early February. App availability and support on the

Change4Life website will run throughout the year.

5. Sugar Smart app

5.1 What is the Change4Life Sugar Smart app?

The Sugar Smart app enables users to scan the barcode of over 75,000 food or drink

products and see a visualisation of the number of 4 gram sugar cubes it contains.

They can then share a ‘sugar reveal’ using the share-sheet on their device to

encourage others to go to the Change4Life website.

5.2 Why have you developed the app?

We know from our user research that people are often shocked at how much sugar

is in seemingly healthy products. We have good evidence that visualising sugar in

this way drives behaviour change.

5.3 Why sugar cubes?

The clear visualisation of sugar content is popular with Change4Life’s audience.

Sugar cubes are a tangible unit that can be ‘stacked up’ to show sugar content and

are a uniform measurement that doesn’t invite potential confusion associated with

teaspoons where volume could be variable, e.g. level or heaped teaspoon. In the

previous Sugar Swaps campaign TV advertisement, the visualisation of sugar cubes in

a can/bottle was received as ‘very high impact’ bringing ‘sugar content to life’. It is

important that we are consistent with our advertising.

5.4 What about fruit and veg? Does the app show total or added sugar?

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The app shows total sugar, in line with front of pack labeling, so it does include fruit

and vegetable items. We have added Sugar Smart badging across 4 main product

categories such as plain dairy milks and whole fruit and veg to make it clear that you

don’t need to worry about the sugar in these products as it isn’t added sugar – see

below:

Plain milks: This product contains naturally occurring sugars. You don’t need

to worry about the sugar in plain milks, as this isn’t added sugar.

Plain natural yoghurts: This product contains naturally occurring sugars. You

don’t need to worry about sugar in plain yoghurts, as this isn’t added sugar.

Whole fruit & veg: This product contains naturally occurring sugars. You

don’t need to worry about sugar in whole fruit/vegetables, as this isn’t added

sugar.

Tinned fruit & veg: This product may contain naturally occurring sugars in the

fruit or veg, added sugars and/or juice. Check the label and choose those with

less sugar.

5.5 What is the data source behind the app?

The app works by tapping into two data sources which we have combined: (1) a

dataset from Action on Sugar of over 100,000 food and drink products (this is the

same dataset behind the Health X winning FoodSwitch app) and (2) a supplementary

data feed from MySupermarket, providing data on an additional 20,000 products, as

well as updates every month on new products entering the market.

Both datasets take the barcode information and sugar information from the

nutritional label on the food or drink product, and simply divides that by 4 grams to

show the number of 4 gram sugar cubes in the pack/per 100g/per manufacturer’s

portion size, depending on what data we hold. This is publically available information

– we are simply showing that in a more visual way that is easier for people to

understand.

5.6 How many products does the app cover?

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The app covers over 75,000 food and drink products and we are adding more

products every month.

5.7 What does the result screen show after I’ve scanned something?

The ‘sugar reveal’ screens show the amount of total sugar in the pack, in 100g/ml

and in the manufacturer’s portion size, wherever we hold the data for all three

measures. As the app shows the amount of total sugar, when you scan one of our

Sugar Smart badged products (plain dairy milks, plain natural yoghurt, whole fruit

and veg and tinned fruit and veg) a corresponding message will appear on screen to

explain that you don’t need to worry about the sugar in that item as it isn’t added

sugar. Where we don’t have the product at all, the app will return a message saying

‘Sorry, we don’t have that product yet. Try scanning something else.’

5.8 How has the amount of sugar in the pack been calculated?

Examples of we have calculated the amount of sugar in a pack follow below – this

approach is policy approved:

Action on Sugar data: Taking Kellogg’s Frosties (750g pack) as an example:

We calculated the amount of sugar per g from the sugar per 100g value:

37.0g / 100 = 0.37g

Then we multiplied this by the pack weight: 750g x 0.37 = 277.5g

Finally, we divided this value by 4 to calculate the number of sugar cubes in

the pack: 277.5g / 4 = 69.4 sugar cubes

MySupermarket data: Tesco Bunched Carrots (500g) has a sugar value of 7.4g per

100 gram, so for 500 grams it's 37grams: 7.4/100 *500 (quantity of product)

5.9 When will the Sugar Smart app launch?

The iOS and Android apps will be submitted to the stores for approval on 7

December 2015. Exact live dates are subject to the stores’ own timings, but the apps

will be live before the campaign launches on 5 January 2016.

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5.10 How are we describing the app on the stores?

Sometimes it's hard to know how much sugar is in food and drink. The Change4Life

Sugar Smart app is designed to show quickly and easily how much sugar is in the

things we’re eating and drinking. You just have to scan the barcode and see how

much sugar it contains*. Let's get Sugar Smart and start scanning now! For more

information search Change4Life.

*The number of sugar cubes featured is based on total sugar in grams per

portion/100g/pack divided by 4 grams (the weight of one 4 gram sugar cube).

6. Sugar Smart partners

6.1 How will Local Authorities be supporting the campaign?

The Change4Life Sugar Smart campaign has been designed to be flexible to suit local

needs. We have named contacts across all 152 upper tier local authorities and many

other boroughs, district and parish level, are engaged with Change4Life. We update

them regularly via our newsletters and encourage them to order a range of

Change4Life resources that they can use to engage their local populations.

6.2 How are you working with schools to deliver this campaign?

From our campaign evaluation and numerous conversations with school

representatives and teachers, we know many of them would like to engage with the

campaign on a more in-depth level. They want guidance and information that fits

with the curriculum and helps to facilitate the educational process in making children

and their families eat better and keep active.

Change4Life will be providing teachers with resources and ideas for including healthy

eating messages across the curriculum. Adverts in key trade publications and social

media activity will be used to promote the resources available to teachers.

6.3 How is Change4Life working with charities?

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Change4Life is working with a range of charities which promote healthier eating to

families. They will be promoting the campaign messages through their channels as

well as distributing the campaign consumer leaflet.

6.4 How will advertising feature within this campaign?

The Change4Life ‘Sugar Smart’ campaign launches on 4 January 2016 with media

throughout January and early February. Following the success of last year’s ‘Sugar

Swaps’ campaign, Change4Life continue to expand their dietary offering with the

launch of the ‘Sugar Smart’ app.

This year the campaign aims to motivate and enable families to change their dietary

habits through the new ‘Sugar Smart’ app which allows users to scan the products

they eat and drink and reveal the amount of sugar each contains.

The advertising campaign will feature a range of video content distributed across

broadcast TV and Video on demand (VoD) to publicise the new recommended daily

intake of sugar and the new app. There will also be messages to remind and

encourage users to download and use the app across Out of Home (OOH) media,

digital and social channels.

Throughout January, TV adverts featuring the Aardman animated Change4Life

characters will depict scenarios which every mum will be familiar with; keeping their

kids sugar intake under control. The ‘Little Monkeys’ 30 second spot shows how

excess sugar from a chocolate bar can turn into fat inside the body and reveals the

high levels of sugar in everyday products, using sugar cubes to demonstrate the

amounts.

Finally, there are a number of products in the advert for which we reveal the sugar

content. These products are based on the product categories which are the top

contributors to children’s sugar intake, as defined by the National Diet and Nutrition

survey (NDNS). Using Kantar Worldpanel Data we have matched calculations of the

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average sugar content per 100g to the illustrations. Using this average from a range

of products means that it may not equate to any individual product.

We then calculated sugar content per portion (see below) in grams and divided this

figure by 4 grams (based on the weight of one Silver Spoon sugar cube). This figure

was rounded down to the nearest whole sugar cube.

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[Accessed December 2015]

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complex-carbs.html [Accessed December 2015]

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http://www.karimdavid.com/the-difference-between-natural-sugar-added-sugar/ [Accessed

December 2015]

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sugars/ [Accessed December 2015]

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December 2015]

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11. Public health England Economics of Obesity. Available at http://www.noo.org.uk/NOO_about_obesity/economics

[Accessed December 2015]

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