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What is the HPB Healthier Choice? Singapore Soft Drinks and the War on Diabetes.

Updated: Apr 16

Singapore Healthier Choice Nutri-Grade

There is little doubt that soft drinks – sugar sweetened beverages – are bad for health. Some marketers working for the manufacturers might argue that they are fine in ‘the context of a balanced diet’, that they ‘support an active lifestyle’. Hard to argue with such carefully phrased words, whether one product is healthy or not can depend on context. For some, a sugary beverage can support, say, their athletic performance. However, for most, the reality of sugary beverage consumption and its relation to obesity, diabetes and population health indicates otherwise.

 

In Singapore, the Ministry of Health is well aware of the trends in eating practices and health, announcing (27 September 2023):


"The prevalence of obesity has also continued its steady increase, from 8.6% in 2013 to 10.5% in 2019-2020 and 11.6% in 2021-2022."


"Sugar intake has improved.The total sugar intake has reduced from 60g in 2018 prior to the announcement of the Nutri-Grade labelling and advertisement prohibition measures, to 56g in 2022. 67% of residents are within the recommended maximum sugar allowance of no more than 10% of daily total energy intake (10 teaspoons of sugar) in 2022, compared to 61% in 2019. Sugar sweetened beverages remain the single biggest source of dietary sugar, contributing 52% of sugar intake."


As part of the war on diabetes, they are rolling out new Nutri-Grade pack labelling regulations for beverages. The system provides an on-package colour-coded graded label (from a ‘Green A’ to ‘Red D’) to help consumers make a healthy choice. Confusingly. There is also an older, existing Healthy Choice label system that allows the consumer to pick the appropriately labelled product and to make a healthier choice in their purchasing decision. In the Health Promotion Board’s own words:


Healthy Choice


“Making healthier choices while grocery shopping may be rather challenging at times. To solve this, we have introduced the Healthier Choice Symbol. The Healthier Choice Symbol on packaged food products indicates that they are healthier options, and are an easy way for consumers to tell which food products are better for their diet than others! This empowers the individual to make informed food choices.”


Nutri-Grade


“The Singapore Government decided to introduce mandatory nutrition labels and advertising prohibitions for Nutri-Grade beverages, after carefully considering the feedback received from public, industry and expert stakeholders, and reviewing existing overseas and local evidence. Together, these measures aim to help consumers identify beverages that are higher in sugar and saturated fat and to reduce the influence of advertising on consumer preferences, thus encouraging more informed, healthier choices and spurring industry reformulation.”


These are the gentle nudges that the government uses to engineer health in the Singapore Blue Zone version 2.0 as described by Dan Buetnerr. We will come back later to what the locally conducted research has shown about the effectiveness of these labels.

 
Milo Coca Cola healthier choice
These beverages are a 'healthier choice' than what?

When talking nutrition and making a healthy choice it is always necessary to ask the question “A healthy choice compared to what?” So, it is surprising to see soft-drinks aka sugar sweetened beverages or other labelled as being a Healthier Choice. What are they being compared to?


Let’s see what sugary facts are, when we compare a selection of bottled drinks that populate the supermarket shelf. What is ‘healthy’? All measurements have been taken from the nutritional panel of the products themselves during our supermarket visit. Those labelled as a Healthier Choice in bold; those bearing a Nutri-Grade label also mentioned.


Total Sugars per 100ml beverage:


  1. Pokka Sparklin’ Fuji Apple Drink 10.5g (Nutrigrade D)

  2. Nestle Milo 6.9g (note, there is some variance between different bottles & cans)

  3. Pocari Sweat 5.8g (Nutrigrade C)

  4. 100 Plus 4.9g

  5. Kickapoo Joy Juice 4.9g

  6. F&N Cherryade 4.9g

  7. 7 Up 4.7g

  8. Pokka Green Tea 4.6g

  9. Grape Fanta 4.6g

  10. Coca-Cola Original Taste (Less Sugar) 4.6g

  11. Nestle Milo Dairy Free Soy-Almond 3.7g

  12. Yeo’s 100% Natural Coconut Water 3.5g

The sugar content of beverages is labelled both by quantity (100ml) and by Serving. Serving sizes are typically 250ml, however, a small plastic bottle of Milo is 500ml, 2 servings, 33g of sugar!

 

Much beloved beverage Milo, a "household must have" since the 1950s according to Nestle's website makes an interesting study. Often marketed as having 'no added sugar as the nutrition information clearly states:


Malt Extract (contains Barley), Skimmed Milk (Cow’s Milk), Cocoa, Palm Oil, Minerals, Resistant Dextrin, Flavourings, Vitamins


The words in bold as per their own label. There is no added sugar in the ingredients. So where is the sugar? The main ingredient, Malt Extract, IS sugar. Perhaps the added minerals and vitamins make it a healthier choice than... something else?

 

With Nutri-Grade currently rolling out and the Healthier Choice well established, where does this leave the consumer? A February 2023 study by Singapore’s DukeNUS Medical School (citation at bottom of page) found that Nutri-Grade packing will help the consumer to make informed choices and reduce caloric intake, that nudges work. In a 2021 study the DukeNUS team also concluded that “Positive labels, like the Healthier Choice Symbol, are likely to increase purchases of labelled products. However, these changes may not lead to improvements in diet quality or calorie intake.


But I wonder, when it comes to soft or high sugar drinks, why label them as a healthier choice at all?


Stay Healthy,


Alastair

 
Singapore diabetes

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Related Studies

Cordova R, Viallon V, Fontvieille E, Peruchet-Noray L, Jansana A, Wagner KH, Kyrø C, Tjønneland A, Katzke V, Bajracharya R, Schulze MB, Masala G, Sieri S, Panico S, Ricceri F, Tumino R, Boer JMA, Verschuren WMM, van der Schouw YT, Jakszyn P, Redondo-Sánchez D, Amiano P, Huerta JM, Guevara M, Borné Y, Sonestedt E, Tsilidis KK, Millett C, Heath AK, Aglago EK, Aune D, Gunter MJ, Ferrari P, Huybrechts I, Freisling H. Consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study. Lancet Reg Health Eur. 2023 Nov 14;35:100771. doi: 10.1016/j.lanepe.2023.100771. PMID: 38115963; PMCID: PMC10730313.



Finkelstein EA, Doble B, Ang FJL, Wong WHM, van Dam RM. A randomized controlled trial testing the effects of a positive front-of-pack label with or without a physical activity equivalent label on food purchases. Appetite. 2021 Mar 1;158:104997. doi: 10.1016/j.appet.2020.104997. Epub 2020 Oct 13. PMID: 33065191.


Meng Y, Li S, Khan J, Dai Z, Li C, Hu X, Shen Q, Xue Y. Sugar- and Artificially Sweetened Beverages Consumption Linked to Type 2 Diabetes, Cardiovascular Diseases, and All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Nutrients. 2021 Jul 30;13(8):2636. doi: 10.3390/nu13082636. PMID: 34444794; PMCID: PMC8402166.


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