Article of the Week - February 4th 2016

This is a new segment I want to start for my blog where I discuss an article that we should pay special attention to because it will either (1) influence the way people practice their craft in schools or health care or (2) shift the way you vote based on a candidates knowledge of a particular aspect of their platform. For example, if someone says they are advocates for population health approaches to preventing diabetes but are not familiar with the latest evidence, they may not be the best person to vote for. Knowledge is power. The more knowledge you have for your practice or, more importantly, the knowledge you have when you participate in the democratic process, the more likely it is that our society will grow and evolve into something better than the one we have now.

POPULATION HEALTH INTERVENTIONS: When is comes to population-based initiatives to prevent obesity there are many that governments taut as effective or cost-effective. Rarely do they refer to the science that backs up their claim. For example, in my province of Manitoba we have a policy mandating physical education for grade 11 and 12 students Ontario and Alberta have mandatory daily physical activity (DPA) policies and the Canadian government has policies that reduce the cost of organized sport through a fitness tax credit. Population health interventions are meant to nudge the entire population away from less healthy behaviours/risk and towards a more healthy profile. A new study has tested the theory that a population shift in sugar intake may be an effective approach to preventing obesity and type 2 diabetes.

THE STUDY: A recent publication in the prestigious journal The Lancet that describes a statistical modelling exercise which examined the theory that if we reduced the intake of sugar through drinks by 40% over a 5 year period it would shift the population towards a more healthy profile. The reduction of 40% may be ambitious, but a recent study in Mexico revealed that increasing tax on soda reduced consumption/purchase rates by 12% over one year (see an idiotic globe and mail review of the study here for an alternative interpretation).

THE METHODS: The study took data from two sources: (1) a nationally representative survey of diet profiles of people in the UK and (2) beverage consumption rates from the British Soft Drinks Association. They created a theoretical model that described a collaboration with the industry to lower sugar content within beverages, monitor intake through surveys, praise the industry and the model for achieving targets and increasing regulation if they didn't. The assumption was that (1) a predicted change in weight is associated with actual change in weight (which has been established) and (2) the change in weight would translate into a reduced risk for type 2 diabetes (established here).

WHAT THEY FOUND: Between 2005 and 2013 rates of overweight in the UK increased from 60.5 to 62.1% and average consumption was 272 g per person per day. ~85% of children (n=1900) and 65%  adults (n=~2200) consumed sugar-sweetened drinks daily. Rates of consumption were highest in the poorest households across all age groups. The proposed strategy predicted that daily consumption would reduce daily energy intake by 38kcals. This small reduction would translate into a small 0.4 kg/m2 decline in the average BMI in the population and "This reduction would in turn prevent about 274 000–309 000 incident cases of type 2 diabetes over the subsequent two decades (ie, roughly 15 000 per year)". Importantly, these benefits would be the greatest among the lowest income segment of the population, potentially contributing to a reduction in inequities in obesity and type 2 diabetes that characterized western countries.

WHY IS THIS THE PAPER OF THE WEEK? Working closely with industry and creating policies that result in small nudges or shifts in behaviours could prevent up to 1 million cases of overweight and obesity and protect hundreds of thousands of people from type 2 diabetes. The data provide a model for countries to try an test/validate and hope that small changes can lead to massive shifts in health.

LIMITATION: As this is merely a statistical model it does not prove that this would happen in a real life setting. A gradual reduction of sugar content in drinks may be realistic, but would consumers accept a 40% drop in the sweetness of drinks or progressively move towards less sweet options as was seen in the study in Mexico? Finally the data may be asking a lot of industry who seem reluctant to engage in population health efforts led by government. I suggest we would need some industry champions to be bold and act as role models as Bill/Melinda and Warren have for the poor and less fortunate.