NACCHO Aboriginal Diabetes Health #NDW2017 : Targeting sugary drinks in remote Indigenous communities

Part of our healthy food strategy is looking at reducing sugary drinks because consumption of sugary drinks across the whole population, but particularly in remote communities, is very high and high intake of sugary drinks has been linked to obesity, diabetes, heart disease, poor oral health and kidney disease.”

Outback Stores health and nutrition manager, Jen Savenake ( Interview Health Times )

Amata SA was an alcohol-free community, but some years earlier its population of just under 400 people had been consuming 40,000 litres of soft drink annually.

The thing that I say in community meetings all the time is that, the reason we’re doing this is so that the young children now do not end up going down the same track of diabetes, kidney failure, dialysis machines and early death, which is the track that many, many people out here are on now,”

Mai Wiru, meaning good health, and managed by long-time community consultant John Tregenza.

The Sugar Trip on Australian Story  View HERE

All previous NACCHO Diabetes 120 + articles over 5 years

Noting all graphics added by NACCHO

A nutrition strategy to reduce the portion size and availability of soft drink has reduced the consumption of sugary drinks in a remote Indigenous community.

Outback Stores, which provides retail services to more than 30 remote stores on behalf of Indigenous communities across the Northern Territory, Western Australia and South Australia, found its strategy decreased the sale of soft drinks by 10 per cent in six months.

Outback Stores health and nutrition manager, Jen Savenake, an Advanced Accredited Practising Dietitian, says the store joined forces with one local community to trial the implementation of extra measures on top of its usual healthy food strategy.

Ms Savenake says the usual policy features measures such as stocking at least half of its fridges with water and diet drinks, with the remainder comprising sugary drinks.

“Our standard policy around sugary drinks includes things like – we always have the water fridges at the front of the store, where you have to go searching for the sugary drink at the back of the store,” she says.

“We have a special deal on water so that we get Mt Franklin water at $1 and the sugary drinks are 25 per cent more expensive than the diet drinks, and the diet drinks are more expensive than the water.

“We don’t promote sugary drinks ever, so we’ll do promotions on water and diet drinks but never promoting the sugary drinks, so you never see them on the end of the aisle and on discount.”

Download these Info graphics as PDF poster

Soft-drink-in-Aboriginal-communities-report_summaryFINAL

Despite the existing measures, Ms Savenake says sugary drinks remain a “really big problem”.

“Part of our healthy food strategy is looking at reducing sugary drinks because consumption of sugary drinks across the whole population, but particularly in remote communities, is very high and high intake of sugary drinks has been linked to obesity, diabetes, heart disease, poor oral health and kidney disease.”

As part of the trial, the store stopped selling sugary drinks on school days between 8.30am and 2pm, and also reduced the soft drink portion size.

“We never stock bottles more than 1.25 litres so we haven’t got any 2 or 2.5 litre bottles but what we looked at was reducing the size of the bottle,” she says.

“So now we stock the biggest selling line in our 1 litre bottle rather than 1.25 (litre) so you get a 25 per cent reduction immediately for all of those.

“We also changed from stocking a 375ml can to a 250ml can and from a 600ml bottle to a 390ml bottle.”

Ms Savenake, who presented the preliminary results of the trial at the recent Dietitians Association of Australia’s (DAA) 34th National Conference, says the remote Indigenous community is now experiencing “some big changes” in the amount of sugary drinks being consumed.

Burunga NT in store promotion

“We still actually need some more time to see what the total results are going to be, but we’re getting at least a 10 per cent reduction in sugary drinks over the comparable period.”

Early indications also show an increase in sales of water, dietary drinks, fruit juices and milk drinks.

While different strategies may be needed in different communities, particularly communities with easy access to other stores, Ms Savenake says dietitians working at the food supply level can have an impact on consumption but they also need to work with all their stakeholders to ensure there is community support for these strategies.

“To do this project in the community, we had the support of the whole community…this is not Outback Stores imposing these conditions on the community, this is the community saying – what can we do to improve the health of our people,” she says.

“So we worked with them to develop that and that’s probably one of the most important things that we got out of it, that yes – we can implement the strategies at the food supply level but we need to make sure that people are on board.

“There is actually a case study where one community banned sugary drinks and what happened was they just set up a huge black market, so people would bring boot loads of the stuff and sell it for $10 a can out of the back of the car, and so it didn’t achieve the desired outcomes because people were just spending a whole lot of money on sugary drinks on their alternative supply route.”

Ms Savenake says Outback Stores will continue to examine the strategies in the community and may expand some of the measures, including smaller portion sizes, to more stores in a bid to assist communities to improve their health.

“I’ve been doing this for 20 years but there’s almost like a tipping point where suddenly there’s a broader community awareness that we all need to get involved in doing something to improve our health and working towards healthier food,” she said.

“We’re still providing choice – you can still get it. It might be just a little bit harder to get, the shop is not open all the time so it’s still your choice around what you want to consume but we’re just providing a few incentives to mean that it’s a little bit more expensive, it’s a little bit less available, but if you really want it, it’s still there.”

NACCHO Aboriginal Health @DiabetesAus #NDW2017 #ItsAboutTime for National #Diabetes Week

 

 “It is National Diabetes Week from 9-15 July and Diabetes Australia’s “It’s About Time” campaign aims to raise awareness about the importance of early detection and early treatment for all types of diabetes.

Too many Australians are being diagnosed with diabetes too late. The is true for both type 1 diabetes and type 2 diabetes. The delay in diagnosis is putting many people at risk of major life threatening health problems.

It’s About Time  we detected all types of diabetes earlier and save lives.

 Aboriginal and Torres Strait Islander people are almost four times more likely than non-Indigenous Australians to have diabetes or pre-diabetes.

Improving the lives of people affected by all types of diabetes and those at risk among Aboriginal and Torres Strait Islander communities is a priority for Diabetes Australia.”

See full Aboriginal and Torres Strait Islander diabetes info below Part 1

Read over 120 NACCHO published articles about Diabetes  in past 5 years

 ” New research has found that only 5% of Australians aged over 40 have had a type 2 diabetes risk check in the past two years.

Also, more than half of people surveyed were unable name any diabetes related complication despite type 2 diabetes being a leading cause of vision loss, kidney damage, heart attacks, stroke and limb amputation.

The release of the research comes at the start of National Diabetes Week as Diabetes Australia launches a new campaign, It’s About Time, to raise awareness of the seriousness of the type 2 diabetes, and urge 500,000 Australians who could have undiagnosed type 2 diabetes to get checked  ”

IT’S ABOUT TIME WE DETECTED  SILENT UNDIAGNOSED TYPE 2 DIABETES see Part 2 below

Part 1 Aboriginal and Torres Strait Islander diabetes info

Watch the short video below for a quick guide to the benefits of the National Diabetes Services Scheme (NDSS) ”

You can reduce the risk of developing type 2 diabetes by eating a more healthy diet and being physically active which will help maintain a healthy weight to keep your sugar (glucose) levels normal and your body strong.

If you have any worries about diabetes, check the symptoms below and find out more from your Aboriginal Health Worker, Health Clinic/Community Centre, Aboriginal Medical Service or doctor.

The following information is from the ‘Keep Culture Life & Family Strong; Know Early About Diabetes’ flipcharts for Indigenous Australians.

It is of a general nature only and should not be substituted for medical advice or used to alter medical therapy. It does not replace consultations with qualified healthcare professionals to meet your individual medical needs.

The ‘Keep Culture Life & Family Strong; Know Early About Diabetes’ resource was originally developed by Healthy Living NT with funding provided by the Department of Health and Ageing through Diabetes Australia. The reprinting and distribution of the most recent addition has been made possible with funding by the National Diabetes Services Scheme (NDSS) – an initiative of the Australian Government administered by Diabetes Australia.

How do you feel? (Symptoms)

If you have any of the following symptoms you should talk to your doctor, health worker or nurse.

  • Feeling tired or weak
  • Go to the toilet a lot
  • Feeling thirsty
  • Leg cramps
  • Feeling itchy
  • Sores and boils that won’t heal
  • Blurry vision
  • Pins and needles
  • Feeling grumpy or angry.

Through a simple test, a doctor can find out if they’re the result of diabetes.

What is it? (About diabetes)

Sugar (glucose) gives your body energy. The sugar (glucose) moves from your blood into your muscles with something called insulin. With diabetes your insulin isn’t working properly, so the sugar (glucose) doesn’t get into your muscles and body easily and there is too much sugar (glucose) in your blood.

Everyone has a little bit of sugar (glucose) in their blood. The optimum sugar (glucose) level is between 4 to 6 mmol/L (after fasting).

Sugar (glucose) is fuel that comes from some of the food you eat and drink. It gives your body energy to do all sorts of things:

  • Walk
  • Think
  • Play sports
  • Hunt
  • Work
  • Rake
  • Gardening
  • Resting.

To help the sugar (glucose) move into your muscles and body cells your body needs something called insulin. Insulin is made in the pancreas – a body part which is near your stomach.

Insulin helps keep your sugar (glucose) levels normal.

With diabetes, the insulin isn’t helping the sugar (glucose) move from your body into your muscles and body cells. So it stays and builds in your body, making your blood sugar (glucose) level high.

Type 2 Diabetes

There are different types of diabetes. A lot of Aboriginal and Torres Strait Islanders have type 2 diabetes. Type 2 is when your body stops the insulin working properly.

Fat bellies, not being active enough, eating a big mob of fatty food can stop the insulin working properly in your body.

Being active, eating healthy and being a healthy weight can help your insulin work better to keep your sugar (glucose) normal. Sometimes people might need to take tablets and insulin everyday to keep their sugar (glucose) levels normal.

Gestational Diabetes

Another type of diabetes is gestational diabetes. This happens when you are pregnant, but not all women get it. It goes away after pregnancy but you and your baby can get type 2 diabetes later in life.

Pre Diabetes

There is also Pre Diabetes or Impaired Glucose Tolerance (IGT). This happens when your sugar (glucose) level is high, but not high enough to be called diabetes. It doesn’t mean you have diabetes now, but it does mean you might get it later. Being active and eating healthy you can slow down the start of type 2 diabetes.

Type 1 Diabetes

Some Aboriginal and Torres Strait Islanders have type 1 diabetes. This usually happens in kids and teenagers. Type 1 diabetes is when your body kills the insulin making part in the pancreas and no insulin is made in your body. To give the body the insulin it needs, insulin injections are needed every day for the rest of their life.

What do I do? (Management of diabetes)

When there is too much sugar (glucose) in your blood it damages your heart, kidneys, feet, eyes and nerves.

You can keep your sugar (glucose) levels normal by:

Eating healthy

  • Have plenty of bush tucker and have shop foods and home cooked meals that are low in fat, sugar and salt.
  • Have something from each of the core food groups every day. They give you energy, fight sickness and help care for your body to keep it strong.
  • Drink plenty of water.

Avoiding and eat less fat, sugar and salt

  • Eat less fat as it makes you put on weight and gives you problems with your heart.
  • Pick meat with no fat or only small bits of fat on it. Cut the fat off the meat and take the skin off chicken.
  • Drain the juices (fat) after cooking meat and scoop out the fat from the top of stews.
  • Avoid cooking with or having fats like butter, oil, margarine or dripping.
  • It is better to boil, steam, stew, grill, microwave or stir-fry food.

Being a healthy weight (not too fat and not too skinny)

  • Do this by eating less, eating healthy and being more active.

Keeping active

  • It helps you lose weight and keep it off and it keeps you healthy.
  • It helps your insulin to work properly.
  • Walk, job, play sport, hunt, garden, work around the place.
  • Be active for 30 minutes or more every day OR do 10 minutes 3 times a day.

Taking your medicine

  • Take your medicine at the times the doctor tells you.
  • Take them with or after eating in the morning, afternoon and supper time every day.
  • Refill your medicine box in the morning (get some more medicine before it gets low and so you don’t run out).
  • Take your medicine with you when you go to see family, walkabout or away from home.
  • Put your medicines somewhere cool, dry and safe so they won’t go bad.
  • Keep your medicines out of reach of kids.

Remember to:

  • Have your check-ups with your doctor, health worker or nurse. Have regular check-ups for your eyes, feet, kidneys, blood pressure, skin and teeth. If you notice anything different about your body talk to your doctor, health worker or nurse.
  • Check your sugar (glucose) levels at the times your doctor, health worker or nurse tells you.
  • See your doctor, health worker or nurse straight away if you feel sick.
  • Check your feet and skin for sores and/or cracks every day.

Why take medicine for? (Medications for diabetes)

Indigenous  

Diabetes medicine helps to keep your body strong and well and it helps to keep your sugar (glucose) levels normal.

When eating healthy, being active and being a healthy weight isn’t working at keeping your sugar (glucose) levels normal, you might need to take tablets and/or insulin.

The doctor might put you on tablets called Metformin to help your insulin work better and to lower the amount of sugar (glucose) in your blood.

After a while the pancreas gets tired from working too hard and can’t make enough insulin, so your doctor might put you on tablets called Sulphonylurea. This medicine helps your body make more insulin.

Or, after awhile, the doctor might need to add another lot of tablets called Glitazone or Acarbose.

Remember to have your medicine with or after eating, in the morning, afternoon or supper time. Take them at the time the doctor tells you to.

All tablets work differently and some can have side effects.

If the following problems don’t go away or if you are still worried about them, then talk to your doctor.

  • Feel sick like you want to vomit (nausea)
  • A sore belly
  • Diarrhoea
  • Sugar (glucose) levels going too low
  • Have fluid build-up (retention)

When your sugar (glucose) levels get too high and stays high the doctor might put you on tablets and give you insulin.

  • Having insulin doesn’t mean you have type 1 diabetes.
  • Insulin isn’t like tablets so it shouldn’t be swallowed.
  • You inject the insulin under your skin in different places on your belly.

Talk to your doctor, health worker or nurse about insulin and what is right for you.

Having too much insulin or taking too many Sulphonylurea tablets can make your sugar (glucose) levels go too low (under 3) and make you hypo (hypoglycaemia).

You can also go hypo (hypoglycaemia) if you are:

  • Not eating, not eating enough or eating too late
  • Being extra active
  • Drinking grog (alcohol).

You might not feel anything when you have a hypo (hypoglycaemia), but sometimes you might feel:

  • Shaky
  • Hungry
  • Get headaches
  • Weak
  • Confused
  • Angry
  • Talk like you’re drunk when you’re not
  • Sweaty.

When you have these feelings or think you are having a hypo (hypoglycaemia), get your sugar (glucose) level up fast by drinking or eating something sweet.

Keep your sugar (glucose) level normal and stop having another hypo (hypoglycaemia) by eating a sandwich or meal after you have something sweet.

Remember, after taking your tablets or insulin:

  • Keep them somewhere cool, dry and safe (maybe in the fridge at home or at the clinic) so that they won’t go bad
  • Keep them out of reach of children
  • Get rid of your syringes/needles and finger pricking needles by putting them in a “sharps container” or “hard plastic” empty container with a lid (see if the clinic has one).

Remember when you go see family, walkabout or are away for home take your tablets and/or insulin with you.

Why me? (Risk factors)

Nobody knows how or why some people get diabetes but there are some things we know that can add to your chances of getting it. You have more chance of getting it when you are Aboriginal or Torres Strait Islander, but not all Aboriginal or Torres Strait Islande people have diabetes.

Aboriginal or Torres Strait Islander people live different to how they used to live. Changes that add to your chances of getting diabetes are:

  • Not as active
  • More overweight
  • Eating fatty salty, sugary foods.

People living the old way were:

  • Active
  • Leaner and fit
  • Eating healthy food (bush tucker).

Other chances of getting diabetes include:

  • It is in your family tree or when someone in your family has diabetes
  • You had diabetes when pregnant
  • You get older
  • You eat too much and you eat too many fatty and sugary foods
  • You are overweight
  • You are not active enough
  • You have pancreatitis (a sickness of the pancreas).

There are things you can’t change or stop you from getting diabetes:

  • It’s in your family
  • You are Aboriginal or Torres Strait Islander
  • You are pregnant with diabetes
  • You are getting older.

The things you can do to slow down the start of diabetes:

  • Eat healthy and be a healthy weight
  • Be active
  • Don’t drink too much grog.

Nobody knows why or how people get diabetes. After a while it can damage your heart, kidneys, eyes, feet and nerves making you really sick.

Talk to your doctor, clinic, nurse or health worker about having a test to find out if you have diabetes.

You can’t always feel it or see it happening, so you might not know you have it.

Part 2 :IT’S ABOUT TIME WE DETECTED  SILENT UNDIAGNOSED TYPE 2 DIABETES

New research has found that only 5% of Australians aged over 40 have had a type 2 diabetes risk check in the past two years.

Also, more than half of people surveyed were unable name any diabetes related complication despite type 2 diabetes being a leading cause of vision loss, kidney damage, heart attacks, stroke and limb amputation.

The release of the research comes at the start of National Diabetes Week as Diabetes Australia launches a new campaign, It’s About Time, to raise awareness of the seriousness of the type 2 diabetes, and urge 500,000 Australians who could have undiagnosed type 2 diabetes to get checked.

Diabetes Australia CEO Professor Greg Johnson said there was great concern about the length of time many people have silent, undiagnosed type 2 diabetes without it being diagnosed.

“It’s about time we detected silent undiagnosed type 2 diabetes. Many people have type 2 diabetes for up to seven years before being diagnosed and during that time up to half begin to develop a diabetes-related complication,” Professor Johnson said.

“The tragedy is that much of the damage to the body that causes diabetes-related complications like vision loss, kidney damage, heart attack, stroke and limb amputation is preventable.

“AUSDRISK is a free, online risk assessment you can take to determine your risk of type 2 diabetes. Despite over 60% of Australians having risk factors for type 2 diabetes, the research shows only 5% of Australians over the age of 40 have done the type 2 diabetes risk assessment in past two years” he said.

The survey found:

  •  Only 21% of Australians over the age of 40 had heard of the Australian Type 2 Diabetes Risk (AUSDRISK) Assessment;
  •  Only 5% of Australians over the age of 40 had completed the AUSDRISK assessment in the past two years; and
  •  More than 51% of people over the age of 18 were unable to name any serious diabetes-related complication despite type 2 diabetes being a leading cause of vision loss and blindness, limb amputation, kidney damage, heart attacks and stroke.

Diabetes NSW & ACT CEO Sturt Eastwood urged people take the free type 2 diabetes risk assessment today.

“Type 2 diabetes is the single biggest challenge confronting Australia’s health system and it’s time we did a better job of detecting type 2 diabetes earlier,” Mr Eastwood said.

“The earlier a diagnosis of type 2 diabetes occurs, the sooner a management plan can be put in place delivering better outcomes for the individual and the community.

“The AUSDRISK check only takes about five minutes. If you take the check and get a high score, see your doctor so they can determine if you have type 2 diabetes.

“If you are diagnosed there is a lot of support and advice, and many effective treatments available to help you manage type 2 diabetes and reduce the risk of developing diabetes-related complications.”

Professor Lesley Campbell from St. Vincent’s Hospital said front line health professionals were spending more and more time treating patients who present with type 2 diabetes complications. Diabetes was often still undiagnosed until admission for heart attack, stroke or lung or heart transplantation.

“Unfortunately we are seeing people with type 2 diabetes diagnosed too late and the impact of late diagnosis and lack of treatment is filling our hospital beds,” Professor Campbell said.

“Diabetes is ranked in the top ten causes of death in Australia and is the leading cause of preventable blindness, limb amputation and end stage kidney disease.

“Much of this can be avoided with early diagnosis and optimal treatment.”

For Sydney woman Belinda Nakauta, having her toe amputated because of type 2 diabetes was a major wake up call.

“I went to the doctor about a urinary tract infection and he suggested I get checked for type 2 diabetes. I was shocked when it came back positive and the scary thing is I have no idea about how long I was living with type 2 diabetes before I was assessed,” Ms Nakauta said.

“Having a toe amputated a couple of years ago was a wakeup call. Having a part of your body cut off, no matter how small, is a scary experience. With the help of a dietitian and regular gym visits, I’ve lost more than 20 kilograms and dramatically cut back on the medication I need to manage my type 2 diabetes.

“I wish I had done something five or ten years ago. I don’t want to be that person in the ICU on dialysis. I don’t want to have foot complications or lose my eye sight. I don’t want to be that person.

“It was about time I started taking my diabetes seriously and I hope my story helps convince all Australians that it is about time we do something about diabetes.”

NACCHO Aboriginal Health and Chronic Disease #prevention

 

prevention

 ” The Australian Chronic Disease Prevention Alliance recommends that the Australian Government introduce a health levy on sugar-sweetened beverages, as part of a comprehensive approach to decreasing overweight and obesity, and with revenue supporting public education campaigns and initiatives to prevent chronic disease and address childhood obesity.

A health levy on sugar-sweetened beverages should not be viewed as the single solution to the obesity epidemic in Australia.

Rather, it should be one component of a comprehensive approach, including restrictions on children’s exposure to marketing of these products, restrictions on their sale in schools, other children’s settings and public institutions, and effective public education campaigns[42].

Health levy on sugar-sweetened beverages

ACDPA Position Statement

Key messages

  •  The Australian Chronic Disease Prevention Alliance (ACDPA) recommends that the Australian Government introduce a health levy on sugar-sweetened beverages (sugary drinks)i, as part of a comprehensive approach to decreasing overweight and obesity.
  •  Sugar-sweetened beverage consumption is associated with increased energy intake and in turn, weight gain and obesity. Obesity is an established risk factor for type 2 diabetes, heart disease, stroke, kidney disease and certain cancers.
  •  Beverages are the largest source of free sugars in the Australian diet. One in two Australians usually exceed the World Health Organization recommendation to limit free sugars to 10% of daily intake (equivalent to 12 teaspoons of sugar).
  •  Young Australians are the highest consumers of sugar-sweetened beverages, along with Aboriginal and Torres Strait Islander people and socially disadvantaged groups.
  •  Young people, low-income consumers and those most at risk of obesity are most responsive to food and beverage price changes, and are likely to gain the largest health benefit from a levy on sugary drinks due to reduced consumption.
  •  A health levy on sugar-sweetened beverages in Australia is estimated to reduce consumption and potentially prevent thousands of cases of type 2 diabetes, heart disease and stroke over 25 years. The levy could generate revenue of $400-$500 million each year, which could support public education campaigns and initiatives to prevent chronic disease and address childhood obesity.
  •  A health levy on sugar-sweetened beverages should not be viewed as the single solution to the obesity epidemic in Australia. Rather, it should be one component of a comprehensive approach, including restrictions on children’s exposure to marketing of these products, restrictions on their sale in schools, other children’s settings and public institutions, and effective public education campaigns.

i ‘Sugar-sweetened beverages’ and sugary drinks are used interchangeably in this paper. This refers to all non-alcoholic water based beverages with added sugar, including sugar-sweetened soft drinks and flavoured mineral waters, fortified waters, energy and electrolyte drinks, fruit and vegetable drinks, and cordials. This term does not include milk-based products, 100% fruit juice or non-sugar sweetened beverages (i.e. artificial, non-nutritive or intensely sweetened). 2

About ACDPA

The Australian Chronic Disease Prevention Alliance (ACDPA) brings together five leading non-government health organisations with a commitment to reducing the growing incidence of chronic disease in Australia attributable to overweight and obesity, poor nutrition and physical inactivity. ACDPA members are: Cancer Council Australia; Diabetes Australia; Kidney Health Australia; National Heart Foundation of Australia; and the Stroke Foundation.

This position statement is one of a suite of ACDPA statements, which provide evidence-based information and recommendations to address modifiable risk factors for chronic disease. ACDPA position statements are designed to inform policy and are intended for government, non-government organisations, health professionals and the community.

www.acdpa.org.au

Chronic disease

Chronic diseases are the leading cause of illness, disability, and death in Australia, accounting for around 90% of all deaths in 2011[1]. One in two Australians (i.e. more than 11 million) had a chronic disease in 2014-15 and almost one quarter of the population had at least two conditions[2].

However, much chronic disease is actually preventable. Around one third of total disease burden could be prevented by reducing modifiable risk factors, including overweight and obesity, physical inactivity and poor diet[2].

Overweight and obesity

Overweight and obesity is the second greatest contributor to disease burden and increases risk of type 2 diabetes, heart disease, stroke, kidney disease and some cancers[2].

The rates of overweight and obesity are continuing to increase. Almost two-thirds of Australians are overweight or obese and one in four Australian children are already overweight or obese[2]. Children who are overweight are also more likely to grow up to become overweight or obese adults, with an increased risk of chronic disease and premature mortality[3].

The cost of obesity in Australia was estimated to be $8.6 billion in 2011-12, comprising $3.8 billion in direct costs and $4.8 billion in indirect costs[4]. If no further action is taken to slow obesity rates in Australia, the cost of obesity over the next 10 years to 2025 is estimated to total $87.7 billion[4].

Free sugars and weight gain

There is increasing evidence that high intake of free sugarsii is associated with weight gain due to excess energy intake and dental caries[5]. The World Health Organization (WHO) strongly recommends reducing free sugar intake to less than 10% of total energy intake (equivalent to around 12 teaspoons of sugar), or to 5% for the greatest health benefits[5].

ii ‘Free sugars’ refer to sugars added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

In 2011-12, more than half of Australians usually exceeded the recommendation to limit free sugar intake to 10%[6]. There was wide variation in the amounts of free sugars consumed, with older children and teenagers most likely to exceed the recommendation and adults aged 51-70 least likely to exceed the recommendation[6]. On average, Australians consumed around 60 grams of free sugars each day (around 14 teaspoons)[6]. Children and young people were the highest consumers, with adolescent males and females consuming the equivalent of 22 and 17 teaspoons of sugar each day respectively [6].

Beverages contribute more than half of free sugar intake in the Australian diet[6]. In 2011-12, soft drinks, sports and energy drinks accounted for 19% of free sugar intake, fruit juices and fruit drinks contributed 13%, and cordial accounted for 4.9%[6]. 3

Sugar-sweetened beverage consumption

In particular, sugar-sweetened beverages are mostly energy-dense but nutrient-poor. Sugary drinks appear to increase total energy intake due to reduced satiety, as people do not compensate for the additional energy consumed by reducing their intake of other foods or drinks[3, 7]. Sugar-sweetened beverages may also negatively affect taste preferences, especially amongst children, as less sweet foods may become less palatable[8].

Sugar-sweetened beverages are consumed by large numbers of Australian adults and children[9], and Australia ranks 15th in the world for sales of caloric beverages per person per day[10].

One third of Australians consumed sugar-sweetened beverages on the day before the Australian Health Survey interview in 2011-12[9]. Of those consuming sweetened beverages, the equivalent of a can of soft drink was consumed (375 mL)[9]. Children and adolescents were more likely to have consumed sugary drinks than adults (47% compared with 31%), and consumption peaked at 55% amongst adolescents[9]. Males were more likely than females to have consumed sugary drinks (39% compared with 29%)[9].

Australians living in areas with the highest levels of socioeconomic disadvantage were more likely to have consumed sugary drinks than those in areas of least disadvantage (38% compared with 31%)[9]. Half of Aboriginal and Torres Strait Islander people consumed sugary drinks compared to 34% of non-Indigenous people[9]. Amongst those consuming sweetened beverages, a greater amount was consumed by Aboriginal and Torres Strait Islanders than for non-Indigenous people (455 mL compared with 375 mL)[9]. 4

The health impacts of sugar-sweetened beverage consumption

WHO and the World Cancer Research Fund (WCRF) recommend restricting or avoiding intake of sugar-sweetened beverages, based on evidence that high intake of sugar-sweetened beverages may increase risk of weight gain and obesity[7, 11]. As outlined earlier, obesity is an established risk factor for a range of chronic diseases[2].

The Australian Dietary Guidelines recommend limiting intake of foods and drinks containing added sugars, particularly sugar-sweetened beverages, based on evidence of a probable association between sugary drink consumption and increased risk of weight gain in adults and children, and a suggestive association between soft drink consumption and an increased risk of reduced bone strength, and dental caries in children[3].

Type 2 diabetes

Sugar-sweetened drinks may increase the risk of developing type 2 diabetes[3]. Evidence indicates a significant relationship between the amount and frequency of sugar-sweetened beverages consumed and increased risk of type 2 diabetes[12, 13]. The risk of type 2 diabetes is estimated to be 26% greater amongst the highest consumers (1 to 2 servings/day) compared to lowest consumers (<1 serving/month)[13].

Cardiovascular disease and stroke

The consumption of added sugar by adolescents, especially sugar-sweetened soft drinks, has been associated with multiple factors that can increase risk of cardiovascular disease regardless of body size, and increased insulin resistance among overweight or obese adolescents[14].

A high sugar diet has been linked to increased risk of heart disease mortality[15, 16]. Consuming high levels of added sugar is associated with risk factors for heart disease such as weight gain and raised blood pressure[17]. Excessive dietary glucose and fructose have been shown to increase the production and accumulation of fatty cells in the liver and bloodstream, which is linked to cardiovascular disease, and kidney and liver disease[18]. Non-alcoholic fatty liver disease is one of the major causes of chronic liver disease and is associated with the development of type 2 diabetes and coronary heart disease[18].

There is also emerging evidence that sugar-sweetened beverage consumption may be independently associated with increased risk of stoke[19].

Chronic kidney disease

There is evidence of an independent association between sugar-sweetened soft drink consumption and the development of chronic kidney disease and kidney stone formation[20]. The risk of developing chronic kidney disease is 58% greater amongst people who regularly consume at least one sugar-sweetened soft drink per day, compared with non-consumers[21].

Cancer

While sugar-sweetened beverages may contribute to cancer risk through their effect on overweight and obesity, there is no evidence to suggest that these drinks are an independent risk factor for cancer[7]. 5

A health levy on sugar-sweetened beverages

WHO recommends that governments consider taxes and subsidies to discourage consumption of less healthy foods and promote healthier options[22]. WHO concludes that there is “reasonable and increasing evidence that appropriately designed taxes on sugar-sweetened beverages would result in proportional reductions in consumption, especially if aimed at raising the retail price by 20% or more”[23].

Price influences consumption of sugar-sweetened beverages[24, 25]. Young people, low-income consumers and those most at risk of obesity are most responsive to food and beverage price changes, and are likely to gain the largest health benefit from a levy on sugary drinks due to reduced consumption[23]. While a health levy would result in lower income households paying a greater proportion of their income in additional tax, the financial burden across all households is small, with minimal differences between higher- and lower-income households (less than $5 USD per year)[26].

A 2016 study modelled the impact of a 20% ad valorem excise tax on sugar-sweetened beverages in Australia over 25 years[27]. The levy could reduce sugary drink consumption by 12.6% and reduce obesity by 2.7% in men and 1.2% in women[27]. Over 25 years, there could be 16,000 fewer cases of type 2 diabetes, 4,400 fewer cases of ischaemic heart disease and 1,100 fewer strokes[27]. In total, 1,600 deaths could potentially be prevented[27].

The 20% levy was modelled to generate more than $400 million in revenue each year, even with a decline in consumption, and save $609 million in overall health care expenditure over 25 years[27]. The implementation cost was estimated to be $27.6 million[27].

A separate Australian report is supportive of an excise tax on the sugar content of sugar-sweetened beverages, to reduce consumption and encourage manufacturers to reformulate to reduce the sugar content in beverages[28]. An excise tax at a rate of 40 cents per 100 grams was modelled to reduce consumption by 15% and generate around $500 million annually in revenue[28]. While a sugary drinks levy is not the single solution to obesity, the introduction of a levy could promote healthier eating, reduce obesity and raise revenue to combat costs that obesity imposes on the broader community.

There is public support for a levy on sugar-sweetened beverages. Sixty nine percent of Australian grocery buyers supported a levy if the revenue was used to reduce the cost of healthy foods[29]. A separate survey of 1,200 people found that 85% supported levy revenue being used to fund programs reducing childhood obesity, and 84% supported funding for initiatives encouraging children’s sport[30].

An Australian levy on sugar-sweetened beverages is supported by many public health groups and professional organisations.

 

NACCHO Diabetes Day News: Australia delivers new national diabetes strategy 201

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Australia delivers new national diabetes strategy 2016-2020

“A growing number of people with diabetes also had other chronic diseases – known as co-morbidities – and therefore a key theme of the strategy was to provide a seamless partnership between people with diabetes and their health and community care providers”

Health Minister Sussan Ley

The Turnbull Government has released a new national strategy to tackle diabetes, which is emerging as a major chronic illness for patients – and threat to the health of the economy – in Australia.

DOWNLOAD THE STRATEGY HERE

To coincide with World diabetes Day, Health Minister Sussan Ley said the Australian National Diabetes Strategy was a blueprint for improving the prevention, care and management of diabetes to the end of the decade.

“It is likely that more than one million Australians, that is five per cent of adults, are living with diabetes,” Ms Ley said.

“In Australia Type 2 diabetes accounts for approximately 85 per cent of people with diabetes, with approximately 12 per cent with diabetes diagnosed with Type 1 diabetes. Around 12-14 per cent of pregnant women will develop Gestational Diabetes Mellitus which usually disappears following the birth of the baby, but puts women at risk of subsequently developing diabetes.

“Diabetes related complications including heart attack, stroke, amputation, blindness, kidney failure, depression and nerve disease but in many cases the disease is preventable.

“For this reason the emphasis of the strategy is on prevention, early diagnosis, intervention, management and treatment, centred on the role of primary care.”

Ms Ley said that the theme of this year’s World Diabetes Day was on healthy eating as a key factor in preventing the onset of Type 2 diabetes and an important part of the effective management of all Types of diabetes to avoid complications.

“This is an area that we have been concentrating on for the past two years with our Health Star Rating system on processed foods now well accepted by the food industry and consumers.

“Rural Health Minister Fiona Nash will also chair an historic first meeting of the new Healthy Food Partnership on Friday – a working group of health, retail and farm organisations which will agree on strategies to reformulate food, increase the eating of fresh fruit and vegetables and increase consumer awareness about portion sizes.”

Minister Ley said a growing number of people with diabetes also had other chronic diseases – known as co-morbidities – and therefore a key theme of the strategy was to provide a seamless partnership between people with diabetes and their health and community care providers.

“This will be enhanced by the work being undertaken by the Government’s Primary Healthcare Advisory Group and broader National Strategic Framework for Chronic Conditions,” Ms Ley said.

“Under this strategy people will be better informed about diabetes so they can make better decisions. In addition, research and evidence will strengthen prevention and care and, hopefully, move us that much closer to a cure for diabetes.”

The Australian government provides support to people with diabetes through Medicare and a range of programs and this new Strategy will not replace or override existing processes. This Strategy aims to better coordinate health resources across the sector to where they are needed most.

 

 

NACCHO Aboriginal health news alert :War on sugar: Food industry likened to big tobacco in debate

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The food and beverage sector is hitting back against new campaigns aimed at reducing sugar consumption, prompting critics to compare the industry’s position to that of tobacco companies decades ago.

ABC Report

In Australia, three major health organisations want a sugar tax on all sweetened beverages – not just soft drinks, but also products like flavoured milk and sports drinks – to limit consumption.

Meanwhile, in Britain a campaign called Action on Sugar has just been launched, hoping to reverse that country’s obesity epidemic by targeting the “huge and unnecessary amounts of sugar that are currently being added to our food and soft drinks”.

The campaign’s expert advisors include heavyweights from the scientific and medical community.

And last month leaked draft guidelines from the World Health Organisation (WHO) suggested the organisation is considering halving the recommended daily intake of sugar from ten teaspoons to five.

Its latest “global strategy on diet” also says an unhealthy diet is a major risk factor for chronic disease and recommends reducing sugar intake to help prevent conditions like type 2 diabetes and dental problems.

Australia’s Food and Grocery Council, however, says there is nothing wrong with sugar.

The council’s deputy chief executive, Geoffrey Annison, says scientific evidence, including data from WHO, shows that sugar is not related to obesity.

“There’s no demonstration that sugar of itself is particularly obesogenic or related to any health outcomes,” he said.

Professor Greg Johnson from Diabetes Australia says the Food and Grocery Council argument is eerily familiar.

“These are the sorts of responses that we saw out of the tobacco industry decades ago, when we first started hearing from the College of Surgeons in the United States and leading clinicians and researchers around the problems of tobacco and ill health,” he said.

“So it’s not a surprise to hear this. But all we can say is: look at the evidence that’s coming out and being talked about by many independent, reputable experts and organisations around the world.”

Diabetes Australia calls for sugar tax on sweetened drinks

Professor Johnson says the UK’s Action on Sugar campaign has the right idea.

Diabetes Australia is calling for a sugar tax on sweetened drinks, as just one of a series of measures to combat Australia’s rising obesity rates and the rise in diabetes.

“Australia’s in the top 10 countries for the per capita consumption of these products,” he said.

“From 2007 we know that one in two, nearly 50 per cent of all Australian children consume sugar-sweetened beverages every day. Every day.

“There is no dietary need to have sugar-sweetened beverages. And the other part of it is: they’re particularly associated with weight gain.”

The Food and Grocery Council says the industry is already responding by putting out low-calorie products.

Dr Annison claims not only is there no direct correlation between sugar consumption and obesity but Australia’s sugar consumption is dropping.

“There’s absoutely no doubt that we’re consuming less sugar than before,” he said.

“For example, in 1938 they were consuming about 55 kilograms per person, and it went down to 42 kg per person by 2011.”