Patricia Thompson | You are diluting nutrition health, Minister Tufton

Dear Mr Minister of Health Christopher Tufton:

Further to your article on page A8 in The Sunday Gleaner of March 17, your points have been well taken. In fact, nutritionists have been saying all along that both sides of the controversy are missing the real point, which is, “The problem facing us is that nutrition is the only holistic solution.” Nutrition education of the public and, more specifically, a comprehensive school nutrition programme, should be given the priority needed in any sugar or health strategy.

Indeed, tough decisions must be taken in health promotion/public health and you are sidestepping the real decision. Why do we keep ignoring nutrition in the budget for the Ministry of Health and, instead, favour high-profile, one-sided messages in the media?

Indeed, Jamaican students may, in fact, drink carbonated drinks, one or more times per day, and the same cohort of 13-15-year-olds are indeed getting more obese, but you are making an association between the two and not direct causation. Your strategies to reduce consumption of sugar in the expectation to reduce obesity may actually be flawed.

The standard of five-six grams of sugar per 100ml assumes that children will be consuming only one bottle of the reformulated beverages. It is likely that the same cohort do not actually consume water at all – they have never been conditioned to drink water by their parents since infancy.

These students require at least 2,000ml of fluid daily, a small proportion of which may come from fresh foods like fruits, vegetables and provisions. So even if the student drank only 1,500ml of the diluted sugar beverage, this translates into 75g–90g of sugar daily or 300–360 calories from sugar, or, put another way, 14 per cent to 16 per cent of 2,200 total daily calories (the average recommended population energy intake). However, the average World Health Organization (WHO) recommended sugar calories is no more than five to 10 per cent.

On the other hand, the child consuming 22g per 100ml of a normal sugar beverage is consuming 55g per 240-250ml of the quarter-litre box or less, designed for students. This is 220 calories or 10 per cent of the 2,200 calories (within the WHO guidelines).

DON’T FORGET THE NUTRITIONISTS

As you have noted, the more active child could better utilise the sugar. This child should, however, hydrate with only water to the tune of 1,500ml or more daily, depending on nutritional needs.

Hence, the need for a holistic approach, since all other sources of ‘calories in versus calories out’ must then be calculated by the nutritionist to ensure a balanced diet which meets nutritional needs. The holistic approach requires a comprehensive strategy, since other factors also play a role. These will be discussed at the Jamaica Island Nutrition Network (JINN) upcoming conference on nutrition and parenting, including obesity prevention, as you have already been informed.

“Excellence in public health is not an act, but a habit”. Therefore, no single, lopsided strategy will, be effective. Moreover, without nutritional health, there will be no public health for Jamaicans.

There is only one effective, known strategy, as was applied in the 1970s onwards for protein-energy-malnutrition in children. Nutritionists were appropriately trained to enter the field to take charge of the various causative factors.

Since then, the budget for nutrition personnel has been cut and there is much resistance to employ an adequate number of professionals to go into the schools.

The JINN has the answer to your challenges. So when you invite the private-sector stakeholders to the table to discuss this, don’t forget the nutritionists in the private sector to guide you to achieve the best possible health outcomes, which require nutritional health first.

Patricia Thompson is executive director of Jamaican Island Nutrition Network. Email feedback to columns@gleanerjm.com.