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Sugar tax is here

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Sugar tax in South Africa came into effect on 1st April 2018. Abby Courtenay recaps what sugar tax is, the aims and how it will affect you.

Firstly, what is sugar tax?

We all know (or should know) what tax is. It is a compulsory payment you make to the South Africa Revenue Service (SARS) on a regular basis to fund the South African government and their initiatives.

Sugar tax is similar but rather than being compulsory it is a method to dissuade consumers on a household level (this means you) from purchasing and subsequently consuming less healthy sugary choices by making them more expensive.

Whilst we are currently unsure of how South African’s will react to these increases, studies from around the world have shown that only when a hefty sugar tax (up to 20%)1 is implemented does this truly have an impact on consumer spending.

In some countries, when foods become more expensive, consumers tend to look for less expensive substitutes. In this case, beverages that are light/zero or sugar-free (usually artificially sweetened) may be a cheaper (but similar) substitute that consumers might lean towards.

This tax might also drive manufacturers to find innovative ways to reduce the amount of sugar in their products to prevent the tax from affecting their sales.

In a modelling study in South Africa it has been predicted that a sugar tax increase of 20% may reduce obesity rates by 3,8% in males and 2,4% in females.2

What are the sugar tax charges?

Currently, sugar tax is to be implemented only to sugar sweetened beverages (SSBs), syrups and other concentrates, not food nor 100% fruit juice or milk. Sugar tax will be charged at the following rates:3,4

  • There is a threshold of 4g sugar/ 100mL of beverage below which sugar is not taxed.
  • SSBs in excess of 4g sugar/ 100mL beverage will be taxed at 2,1 cents per gram above this rate (this is approximately 11% for the most popular soft drink).
  • Syrups and concentrates in excess of 4g sugar/ 100mL beverage will be taxed at 1,05 cents per gram above this rate.

What will happen with this extra money?5

The revenue generated from sugar tax should ideally be used to fund further investigations and interventions, to help reduce obesity in our country. Obesity is rapidly growing out of proportion, much the same as many South African’s waist lines.

Why is it important to reduce your intake of free and added sugars?

Firstly, let’s define what free and added sugars are:

Free sugars are energy-providing sugars, such as monosaccharides (e.g. glucose, fructose, galactose) and disaccharides (e.g. lactose, maltose and sucrose – called table sugar), that are added to foods and drinks during processing by food manufacturing companies, cooks or consumers, as well as sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates – so free sugars include added sugars.

Free sugars do not include intrinsic sugars, which are sugars incorporated within the structure of intact fresh fruits and vegetables, and sugars naturally present in milk.5

There is a large body of evidence that links a high intake of free and added sugars (especially in the form of SSBs) to an increased overall energy intake and subsequently weight gain (and an increased risk of becoming overweight or obese).6,7

Obesity in South Africa

We know that this is a huge (pun intended) problem for South Africans; with up to 65,1% of women and 31,2% of men being overweight or obese and alarmingly, 22,9% of children aged 2-14 years are already overweight/obese.8 Obesity substantially increases your risk for diseases, such as diabetes, heart disease, cancer and respiratory diseases.

In addition to this bleak picture, a high intake of free sugars also increases your risk for dental caries a.k.a rotten teeth.6,7 Treating and managing these diseases places a huge financial burden, not only on the patient and their family but the South African healthcare system as a whole.

The World Health Organization (WHO) recommends that no more than 10% of your total energy intake should come from free/added sugars, and they recommend a further reduction to 5% for additional health benefits. In household measurements, this equates to < 6 – 12 tsp added sugar per day (and to put this into context, 1 x 330mL tin of popular soft drink can contain up to 9 tsp added sugar).

We must always remember that many sugar sweetened products are high in energy and do not contain a significant amount of beneficial nutrients (vitamins and minerals). Thus, when you consume them, you’re displacing more nutritious food options thus decreasing the overall quality of the diet and placing the risk of micronutrient deficiencies.8

So, will sugar tax alone help decrease the burden of disease in our country?

It is important to note that whilst price is a major determining factor for many, it is not the only one. Factors, such as taste and cultural norms, also shape purchasing decisions. Interestingly, only 1 in 7 women consider health aspects when purchasing food.8 Just as taxing tobacco does not reduce or stop people from smoking, taxing SSBs will not reduce or stop all purchasing and consumption of SSBs and reduce obesity on its own. So, on its own it is not enough, however, it is potentially a step in the right direction as part of an overall strategy to tackle a complex problem.5

References:

  1. Powell, LM., Chriqui JF, Khan T, Wada R, Chaloupka FJ. Assessing the potential effectiveness of food and beverage taxes and subsidies for 
improving public health: a systematic review of prices, demand and body weight outcomes. Obesity Reviews, 2013; 14:110-128
  2. Manyema M, Veerman LJ, Chola L, Tugendhaft A, Sartorius B, Labadarios D, et al. (2014) The Potential Impact of a 20% Tax on Sugar- Sweetened Beverages on Obesity in South African Adults: A Mathematical Model. PLoS ONE 9(8): e105287. doi:10.1371/journal.pone.0105287
  3. Economics Tax Analysis Chief Directorate. Taxation of Sugar Sweetened Beverages: Policy Paper. 8 July 2016. 
http://www.treasury.gov.za/public%20comments/Sugar%20sweetened%20beverages/POLICY%20PAPER%20AND%20PROPOSALS%20O 
N%20THE%20TAXATION%20OF%20SUGAR%20SWEETENED%20BEVERAGES-8%20JULY%202016.pdf
  4. Republic of South Africa, Minister of Finance. Draft: Rates and Monetary Amounts and Amendment of Revenue Law Bill. 22 February 2017. 
http://www.treasury.gov.za/public%20comments/Draft%20Rates%20and%20Monetary%20Amounts%20and%20Amendment%20of%20Reve 
nue%20Laws%20%20Bill%20-22%20February%202017.pdf
  5. Association of Dietetics in South Africa (ADSA). Position Statement on the Proposed Taxation of Sugar-Sweetened Beverages in South Africa. April 2017. http://www.adsa.org.za/Portals/14/Documents/2017/March/ADSA%20Position%20Statement%20on%20Sugar%20Tax_Updated%20post%20budget%20speech_2%20Mar%202017.pdf
  6. World Health Organization. Guideline: Sugars intake for adults and children. Geneva: World Health Organization; 2015 
(http://www.who.int/nutrition/publications/guidelines/sugars_intake/en/)
  7. Scientific Advisory Committee on Nutrition. Carbohydrates and Health. 2015, London, TSO 
(https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf)
  8. Shisana O, Labadarios D, Rehle T, Simbayi L, Zuma K, Dhansay A, Reddy P, Parker W, Hoosain E, Naidoo P, Hongoro C, Mchiza Z, Steyn 
NP, Dwane N, Makoae M, Maluleke T, Ramlagan S, Zungu N, Evans MG, Jacobs L, Faber M, & the SANHANES-1 Team (2014) South African National Health and Nutrition Examination Survey (SANHANES-1): 2014 Edition. Cape Town: HSRC Press. (http://www.hsrc.ac.za/uploads/pageNews/72/SANHANES-launch%20edition%20(online%20version).pdf)

MEET OUR EXPERT

Abby Courtenay RD (SA) is an associate dietitian at Nutritional Solutions Grayston and Melrose. She graduated with a Bachelor of Dietetics at University of Pretoria and also holds a Masters’ degree in Nutrition from the University of Stellenbosch. Abby has a special interest in: women’s health, infant feeding and oncology.

Love lives here… Our Story

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Marriage can be tough at the best of times, but then throw in a chronic disease like diabetes and the road can only get bumpier. We hear the amazing story of Alan and Shirley Goosen and how love, support, patience and understanding in a relationship will always win the day.

Alan (84) and Shirley (81) live in Gerdview, Germiston, JHB. They have two children, seven grandchildren and four great grandchildren, and will be celebrating their 62nd wedding anniversary in June. Alan has been living with Type 2 diabetes for 18 years.

Our Story4 DFAut17Alan was diagnosed with Type 2 diabetes at the age of 66. He went to his local GP as he had a painful growth on the back of his leg that was making it hard to sit and lie down. The doctor reluctantly cut it out. Through routine tests, it was discovered that Alan had diabetes. His sugar level was sky-high – sitting on 27mmol/L.

Even though Alan was put on numerous medications, he thought the doctor was “talking nonsense”. It was only in early 2000, when he lost part of his sight due to diabetic retinopathy, that he finally accepted and acknowledged his disease. Shirley too admitted that she never thought of his condition as serious until he went partially blind. “At that time, I never knew much about diabetes,” Shirley said.

With Alan losing part of his sight, change was imminent. Shirley had to be the designated driver and do all the tasks that Alan couldn’t. “I just naturally took over,” Shirley said. However, it was Alan who grappled with the adjustment. “When I realised I was now…let’s say disabled, I knew I would be a load on Shirley so I told her to leave me and go because I didn’t want her to carry that load,” Alan said. Shirley was upset by Alan’s response but refused to leave him. Shirley’s reaction, made Alan feel loved and supported. “It made me feel pretty good that she wouldn’t leave me,” Alan said.

Shirley got advice from a sister at the clinic (the medication was too expensive so they asked their doctor to refer them to a clinic), on the types of foods that a Type 2 diabetes patient should avoid (fatty foods, fizzy drinks, sugar) and should eat more of (salads). Shirley added that she then followed the same diet, and that it wasn’t difficult for them to change their way of eating, however, one of Alan’s pet hates is lettuce.

Not being able to see took a toll on Alan; to not be able to drive was a massive blow – with him becoming dependent on Shirley if he wanted to go to the shops. He also had to give up his much-loved hobby gardening as he couldn’t see what he was planting. But in the true Alan-Goosen-fashion, he found a new hobby – woodwork, much to Shirley’s horror. He had collected woodwork machines throughout his younger days so set up a workshop. In the beginning, it was a “painful experience” as when Alan tried to do woodturning, many a times he would land up cutting his face. “I wanted to hit him,” Shirley retorted. Alan responded, “I still have all my fingers!” Soon, Alan learned how to do woodwork through the sensitive touch of his fingers and not with his eyes. If things got too difficult, he would ask Shirley to come assist him. He added that he has done some of his best woodwork during that period. Shirley also underwent emotional suffering. “If we went shopping and he couldn’t feel me or sense me, he would get into a panic…it would just break my heart seeing him like that,” Shirley said.

Nevertheless, the semi-retired couple carried on with their life, doing mission work while living in Breyton, Mpumalanga and gradually adjusted to the changes, persevering through the normal ups and downs that occur in marriage. In 2006, they relocated back to Johannesburg as Alan’s hearing was deteriorating, and they thought it would be best to be closer to their children. However, 18 months after moving back, Alan’s explained that “the Lord restored my hearing.”

Now, every morning after breakfast they go for a walk (Alan uses a walker) – just to the end of their road, weather permitting. “It is not far, but at least we’re trying,” they said. Shirley makes sure Alan takes the correct tablets every day at the right time, arranging them in a weekly pill box and gives them to him to take. She drives them everywhere, cooks all their meals and sometimes must assist him in getting up and walking as he also suffers from diabetic neuropathy (nerve damage caused by high blood sugar resulting in numbness of feet and legs). Alan vulnerably admits, “If it wasn’t for Shirley, I wouldn’t manage. I rely totally on her.”

However, in the same breath, Alan finds Shirley’s constant need to help him do everything exasperating. “My hope is to help myself, whereas she demands to do it for me,” Alan explained, joking “she likes to show who is the boss.” In Shirley’s defence, she does it out of love and concern. “My worry is that he is going to fall so I am inclined to do things for him,” Shirley explained.

Alan has a knack for twisting Shirley’s arm, which she said annoys her. “He’ll say he feels like chocolate when he knows he isn’t allowed it and then I feel bad as he doesn’t enjoy the diabetic chocolates, so I land up giving him some…just a piece, I make sure he doesn’t go overboard!” Shirley said. When they do go out to functions, such as their senior church meetings, Shirley will dish-up food for him, making sure he eats correctly, and in moderation. She always carries hard sweets in her handbag in case Alan has a low.

Alan is still pushing-on and has taken up painting as his new hobby. He also has a tablet that he uses a magnifying glass to see and use. “Call it stubbornness but I will never give up,” he said.

At times, Shirley feels like she is not doing what she should for her husband and is letting him down. “I flare-up and say the wrong thing and upset him, and I don’t like that,” she acknowledged.

Despite all the negative effects diabetes had on Alan and Shirley’s relationship, there is a significant positive. “It made me realise how much I trust my wife and how much I need her not only from a practical point, but also emotionally,” Alan said.

Alan and Shirley’s daily meals

Breakfast (8am): Oats with a banana and yoghurt.

Morning tea (10am): Cup of tea (with Suganon) with a piece of cheese and polony and sometimes a fruit.

Lunch (12:30 noon): Homemade soup with a slice of bread (if it is cold) or a sandwich.

Afternoon tea (3pm): A cup full of popcorn or a biscuit.

Dinner (6pm): Fat-free mince/chicken/fish with rice and always vegetables with a cup of coffee.

After dinner: A fruit (whatever is available).

thumb_IMG_6873_1024Diabetic Retinopathy develops over long periods with high levels of blood glucose which cause damage to blood vessels in the retina, causing them to clog or leak. In turn, these vessels are unable to deliver an adequate supply of nutrients to light-sensitive cells in the retina, resulting in partial or complete vision loss1.

References:

  1. https://www.visionweb.com/content/consumers/dev_consumerarticles.jsp?RID=16

MEET OUR EDITOR - Laurelle Williams

Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on editor@diabetesfocus.co.za