NHS Choices

Anti-smoking drug may also help combat sugar cravings

NHS Choices - Behind the Headlines - Mon, 11/04/2016 - 14:30

"Anti-smoking drugs could stub out your sugar cravings," the Daily Mail reports.

A study in rats suggests that varenicline (Champix), used to relieve nicotine cravings, could also help reduce the desire to consume sugary foods and drinks.

Varenicline targets what are known as the "reward pathways" of the brain. These are areas that respond to certain stimuli, which can range from illegal drugs, sex or gambling to sugary foods.

They react by releasing more of the "feel-good" neurotransmitter dopamine, which can stimulate feelings of pleasure.

The smoking cessation drug varenicline blocks receptors in the pathway, preventing nicotine from stimulating the same reward and response cycle. The researchers wanted to see if it would work the way same with sugar.

Rats were given sugar solution for 4 or 12 weeks, and when they were given varenicline after this time it reduced their sugar consumption for 30 minutes. The research provides evidence that sugar consumption involves the same reward pathway as other potentially addictive substances, such as nicotine – at least in rats.

The drug would need to undergo testing to see if it was similarly effective for excessive sugar consumption in humans, if the benefits outweighed the risks of the drug, and also whether it offered any advantage over other standard approaches to treating obesity.

Overall, this is interesting research, but varenicline is currently only licensed for smoking cessation in humans. Whether it may or may not have a future role in sugar addiction is unknown.

 

Where did the story come from?

The study was carried out by researchers from the Queensland University of Technology, Brisbane, and SRI International in California. Funding was provided by the Australian Research Council, National Health & Medical Research Council, and the National Institute of Health.

The study was published in the peer-reviewed scientific journal PLOS One. This is an open-access journal, so the study is freely available to read online.

The Mail's coverage is highly premature, with claims that: "Discovery could prove a significant breakthrough in the war on obesity". Despite calling this "groundbreaking research", the fact the study involved rats was only mentioned once, halfway down the article, and even then, the Mail incorrectly reported that the researchers used mice.

 

What kind of research was this?

This was an animal study investigating the reward pathways in the brain that are involved when we eat sugar.

The researchers say previous studies where rats have been fed an excessive amount of sugary drinks have been shown to elevate levels of dopamine in an area of the brain called the nucleus accumbens. This is part of the mesolimbic pathway, often referred to as the reward pathway. Pleasurable activity such as eating food or taking particular drugs causes the release of the chemical dopamine in this pathway, which causes further desire for stimulus.

It is this pathway that is known to be involved in substance use and addiction. The rat studies have shown that when the excessive sugar is subsequently withdrawn, this causes a similar effect to that seen among people who are dependent on substances such as nicotine, alcohol or heroin.

This research aimed to see whether there could be a therapeutic target for reducing sugar consumption. Varenicline (brand name Champix) is a tablet licensed for smoking cessation. It works by binding to specific nicotinic acetylcholine receptors (α4β2). Normally, when nicotine activates these receptors, it reinforces the release of dopamine and associated behaviour.

Champix blocks these receptors, preventing the reinforcement and reward experienced with smoking. The study's aim was to see whether these drugs may also be effective in reducing sugar consumption.  

 

What did the research involve?

The study involved five-week old rats housed under standard conditions and given unlimited access to food and water. On about three days a week, they were also presented with another drinking bottle that contained 5% sugar solution. The researchers then started giving varenicline after short-term sugar exposure in one group of rats – four weeks on the sugar drinks – and after long-term sugar exposure in another group – 12 weeks. Varenicline was given by injection and the researchers tested different doses.

They also carried out different control scenarios. In one, another group of rats were given continuous exposure to sugar solution to look at voluntary consumption when it was available all the time, rather than intermittently. Instead of sugar, another group of rats were given saccharin solution three times a week, as per the standard protocol. This was to look at the effects of varenicline on consumption of a non-calorific sweetener.

The researchers also tested the effects of another drug called mecamylamine (not licensed in the UK) which binds to the receptors in a similar way.

The rats' weight, and volume of fluid consumed, were measured throughout. The brains of some rats were also examined after death.    

 

What were the basic results?

The researchers found that varenicline significantly reduced sugar consumption after both the short- and long-term intermittent sugar exposures. However, varenicline was only effective at the higher dose (2mg/kg) in the short-term group. In the long-term group, it was effective at both lower and higher doses (1 and 2mg/kg). The drug effect lasted for up to 30 minutes, but was no longer effective when the rats were assessed two and 24 hours after injection. 

Interestingly, varenicline also reduced consumption of saccharin solution. However, it was not effective in the rats with continuous access to sugar solution. Mecamylamine was similarly effective to varenicline at both 1 and 2mg/kg doses, and unlike varenicline was effective up to two hours after injection.

Examination of the rat brains also confirmed what the researchers had expected – that sugar consumption had been associated with increased binding at the nicotinic acetylcholine receptors in the nucleus accumbens, in a similar way to nicotine.

 

How did the researchers interpret the results?

The researchers conclude: "our results suggest that [nicotinic acetylcholine receptors] drugs such as varenicline may represent a novel treatment strategy for reducing sugar consumption." 
 

Conclusion

This animal research provides evidence that, as expected, the chemical reward pathways within brain – involving a region called the nucleus accumbens – are involved when excessive amounts of sugar are consumed on a regular basis. This is similar to that involved with substance addiction, such as nicotine. The researchers subsequently found evidence that the smoking cessation drug varenicline can reduce sugar consumption when injected into rats.

However, it is difficult to draw many further implications from the research at this stage. For one thing, we don't really know what type of dietary intake in humans this intermittent exposure to sugar solution in rats would be equivalent to. Also, the only evidence we have is that giving varenicline reduced sugar consumption in the immediate term for only 30 minutes after administration. After this, sugar consumption returned to previous levels. The drug would need to keep being given to be effective.

It seems highly unlikely that people would be given a varenicline tablet every day to stop them eating sugar. Such an approach on a population basis would be unfeasible and unsafe. Even for smoking cessation, the drug is normally only given for a maximum of 24 weeks.

The only theoretical implication it is possible to see at this stage, is that obese people who find it hard to stop eating sugar-laden foods and snacks could possibly be given varenicline in the short term to try and help them "quit".

However, this is only a speculation. The drug would first need to undergo testing in people to see if it was effective for excessive sugar consumption, if the benefits outweighed the risks of the drug, and whether it offered any advantage over other standard approaches to overweight and obesity, such as dietary control, physical activity and behavioural support.

There is also the issue of side effects. People who take varenicline often report feelings of irritability and anxiety, but it is hard to assess whether this is caused by the drug or is a result of nicotine withdrawal. It is unclear whether people taking varenicline because they had a "sweet tooth" would also experience similar side effects.

Overall, this is interesting research, but varenicline is still only licensed for smoking cessation in humans. Whether it may or may not have a future role in sugar addiction is unknown. What is known is that a healthy, balanced diet is currently the best way to reduce excessive sugar consumption and associated health risks of diabetes, overweight and obesity.   

Read more advice about how to reduce the amount of sugar you eat throughout the day.

Links To The Headlines

Anti-smoking drugs could stub out your sugar cravings: Common treatment that targets brain's 'reward pathways' may be used on people who are addicted to sugar. Daily Mail, April 11 2016

Links To Science

Shariff M, Quik M, Holgate J, et al. Neuronal Nicotinic Acetylcholine Receptor Modulators Reduce Sugar Intake. PLOS One. Published online March 30 2016

Categories: NHS Choices

Pregnancy diabetes screening should be 'performed earlier'

NHS Choices - Behind the Headlines - Fri, 08/04/2016 - 11:28

"Tests for diabetes in pregnancy – which affects the developing baby – are taking place too late," BBC News reports.

Screening often takes place during the 28th week, but a new study suggests that diabetes-related changes to the baby can occur before that time.

Diabetes that develops during pregnancy – known as gestational diabetes – is one of the most common complications of pregnancy, affecting around one in five women. It has been linked to various complications, such as the baby being large for its gestational age, which can cause problems during labour. Gestational diabetes can also increase the risk of stillbirth and miscarriages.

Due to the widespread nature of the condition, guidelines for England recommend that pregnant women are screened for it between the 24th and 28th week of their pregnancy.

Read about screening for gestational diabetes.

The study found that some babies of women with diabetes during pregnancy had already started to grow abnormally large for their age by the time the women were diagnosed at 28 weeks or later.

The authors expressed concern, as screening often takes place around the 28th week period, not the 24th.

The lead author of the study suggested that the lower estimate of current guidelines would be better to aim for.

The study didn't show whether any changes could be picked up at 24 weeks, so we don't know whether changes in the guidelines would improve outcomes. Other studies may be able to hone in on the optimum target age. 

Where did the story come from?

The study was carried out by researchers from The University of Cambridge and was funded by the National Institute for Health Research and the Stillbirth and Neonatal Death Charity.

Two of the authors disclosed potential conflicts of interest. One author has a patent submitted with the pharmaceutical company GlaxoSmithKline for the prevention of preterm birth. Another received support from GE Healthcare (another pharma company) in the form of the diagnostic ultrasound systems used for the study.

The study was published in the peer-reviewed medical journal Diabetes Care.

Both BBC News and ITV News reported the study accurately. The BBC usefully quoted Professor Gordon Smith, one of the researchers, who put the findings in context of current recommendations. He said: "The recommendations are that screening should take place at some point between 24 and 28 weeks, but in practice a lot screen at 28 weeks. Our findings indicate that it should be brought forward to 24 weeks and that would still be consistent with existing guidelines."

 

What kind of research was this?

This was a prospective cohort study looking at whether babies started growing larger before their mothers were diagnosed with diabetes in pregnancy – known as gestational diabetes.

Gestational diabetes is when there is too much glucose (sugar) in the blood of women during pregnancy (gestation). It affects about 18 in every 100 women giving birth in England and Wales. 

Gestational diabetes usually develops in the third trimester (after 28 weeks) and usually disappears after the baby is born. Most women with gestational diabetes have normal pregnancies and healthy babies. 

However, women who develop gestational diabetes are more likely to develop type 2 diabetes later in life. It also affects the unborn baby.

For example, the baby can grow larger than normal, causing problems during delivery, like raising the chance of caesarean section, premature birth, miscarriage or still birth. The baby itself is also more likely to be overweight or have diabetes later in life. 

 

What did the research involve?

The researchers tracked 4,069 first-time mothers-to-be and monitored their baby's growth rates in the womb.

Women were categorised into those with gestational diabetes diagnosed on or after 28 weeks (171, 4.2%) and a much larger group without gestational diabetes at all (3,898, 95.8%).

The main growth measure was the baby's waist circumference, estimated by ultrasound scans of the mum's womb at 20 and 28 weeks of pregnancy. They also measured head circumference and used a composite measure (head circumference to waist circumference ratio) as a second method of identifying babies with abnormal growth.   
 
The analysis adjusted for any slight inaccuracies in the duration of pregnancy, as it is not always easy to know your exact conception date, or estimate it looking back.

Baby growth at 20 and 28 weeks was divided into 10 groups, each representing 10% increments of growth. For example, a baby in the top 10%, sometimes called the 90th percentile, will be larger than 9 out of 10 other babies at this point in time. The researchers used these top 10% cut offs to identify babies that were larger than normal.

 

What were the basic results?

Of the 4,069 women, 171 (4.2%) had a diagnosis of gestational diabetes at or beyond 28 weeks.

At the 20-week scan, there were no differences in baby growth between those diagnosed with gestational diabetes and those without. However, the risk of having a large baby (head circumference and head-to-waist ratio) was higher in obese mothers.

At week 28, there were more pronounced differences.

Mothers diagnosed with gestational diabetes at 28 weeks or later were about twice as likely to have a large baby than those without, using head circumference as the main measure (relative risk [RR] 2.05, 95% confidence interval [CI] 1.37 to 3.07). The added risk using head-to-waist circumference ratio was about the same.

Obese mothers had a similar doubling in risk of larger babies.

Women who were obese and diagnosed with gestational diabetes at 28 weeks or later were around five times more likely to have a larger baby measured by head circumference (RR 4.52 5%; CI 2.98 to 6.85) and three times higher using head-to-waist circumference ratio (RR 2.80 9%; CI 1.64 to 4.78).

 

How did the researchers interpret the results?

The researchers concluded: "Diagnosis of GDM [gestational diabetes] is preceded by excessive growth of the fetal AC [abdominal circumference] between 20 and 28 wk gestational age, and its effects on fetal growth are additive with the effects of maternal obesity."

 

Conclusion

This cohort study suggests that babies of women diagnosed with gestational diabetes at 28 weeks or later may have already started to grow abnormally large for their age. Not every baby was affected, but the risk of a larger baby was higher in women who developed diabetes, and the changes had happened before they were diagnosed.

This increases the argument that screening for diabetes in pregnancy should be moved earlier than 28 weeks, although no differences were seen at 20 weeks, so this looked too early to be of any practical use.

Current recommended practice in England and Wales suggest women with gestational diabetes would usually be picked up at 24-28 weeks.  Although women with risk factors like obesity may be picked up much sooner. Those with a range of risk factors who book their first antenatal appointment in the first (up to week 12) or second trimester (up to week 27) are offered blood glucose self monitoring or a two-hour 75g oral glucose tolerance test to detect it. Women without these risk factors may be less likely to be detected until the 24-28 week window.

Prof Gordon Smith, one of the researchers, told BBC News: "The recommendations are that screening should take place at some point between 24 and 28 weeks, but in practice a lot screen at 28 weeks. Our findings indicate that it should be brought forward to 24 weeks and that would still be consistent with existing guidelines."

It is worth noting that the two groups of women were noticeably different at the start of the study. Women who went on to develop gestational diabetes were younger, shorter, more likely to be obese, gained less weight during pregnancy, and were more likely to have an induced labour or caesarean delivery.

This partly reinforces the approach of current guidelines, which aim to look at a range of risk factors in newly pregnant women to help identify mothers more likely to develop diabetes in pregnancy later on. Risk factors for gestational diabetes include:

  • BMI above 30kg/m2 – the obese category
  • previous large baby weighing 4.5kg or more
  • previous gestational diabetes
  • family history of diabetes (first-degree relative with diabetes)
  • minority ethnic family origin with a high prevalence of diabetes

While many of these risk factors are unavoidable, you can take steps to lower your BMI before trying for a baby.

Read more advice on lowering your weight while planning for a baby.  

Links To The Headlines

Pregnancy diabetes tests 'too late', warn scientists. BBC News, March 8 2016

Diabetes during pregnancy can put mothers at risk from 'abnormally large' babies, study shows. ITV News, March 8 2016

Links To Science

Sovio U, Murphy HR, Smith GCS. Accelerated Fetal Growth Prior to Diagnosis of Gestational Diabetes Mellitus: A Prospective Cohort Study of Nulliparous Women. Diabetes Care. Published online April 7 2016

Categories: NHS Choices

Fruit may be good for you, but don’t ditch the statins

NHS Choices - Behind the Headlines - Thu, 07/04/2016 - 17:30

"Daily fresh fruit lowers heart death risk as much as statins," The Daily Telegraph reports.

A study of over a half a million Chinese people found that a diet rich in fresh fruit was linked to a reduced risk of cardiovascular diseases.

But don't ditch the statins in favour of an "apple a day", if they have been recommended for you.

The study looked at people without cardiovascular disease, and did not compare fruit to statins.

Statins are prescribed for people with cardiovascular disease, or a raised chance of getting it, and fruit is not a suitable alternative to medication. The study was also carried out in a country with different lifestyles to the UK. Finally, the study did not prove that fruit caused the lower death rate in people who ate it regularly.

The effect of fresh fruit that the study found was much bigger than the effects found in previous research in Western countries. People who ate fruit every day were likely to be richer and better educated, which itself could have affected their chances of dying of cardiovascular disease (although the researchers did try to account for this). 

The study adds to evidence that people who eat fruit daily tend to be healthier, but it does not mean that fruit can be used instead of medication for people with cardiovascular disease.

Fresh fruit should be seen as an addition to statin treatment, not an alternative.

Where did the story come from?

The study was carried out by researchers from the University of Oxford, Peking University, the Chinese Academy of Medical Sciences, the Chinese National Center for Food Safety Risk Assessment, and three regional Chinese centres for disease control.

It was funded by the Wellcome Trust, the Kadoorie Charitable Foundation and the Chinese National Natural Science Foundation. The study was published in the peer-reviewed New England Journal of Medicine.

The Telegraph's reporting unhelpfully mixed information about the effect of statins in with the report of the Chinese study. It is unclear why the newspaper did this, as the Chinese study did not look at statins at all.

Although the report admitted that the researchers "do not recommend swapping statins for fruit", it may give some people the impression that statins and fruit are equally effective.

The Mail Online's reporting was clearer, as its headline mentioned that the study was in China, and results may be specific to that country.

The Daily Express' reporting was also accurate and contained an interesting quote from one of the lead researchers, who said: "We still don't know exactly what it is about fruit that appears to reduce heart attack and stroke risk."

 

What kind of research was this?

This was a large prospective cohort study, which recruited half a million volunteers in China to measure diet, health and deaths from disease. Researchers wanted to see whether the link between fruit consumption and cardiovascular disease seen in previous Western studies also applied in China. Cohort studies are good at picking out patterns of associations, but they can't prove that one thing (in this case, fruit consumption) is a cause of another (death from cardiovascular disease).

 

What did the research involve?

Researchers questioned around half a million Chinese adults about their health and diet, and took measurements including their body mass index (BMI) and blood pressure. They followed them up for seven years. After adjusting their figures to take account of confounding factors, they looked to see whether people who regularly ate fruit were less likely to have died from cardiovascular disease, or had a heart attack or stroke.

The study recruited 512,891 adults aged 35 to 74, living in different locations across China from 2004 to 2008. People underwent a battery of tests and questions; researchers recorded information about their weight, height, blood pressure, glucose level, whether they smoked or drank alcohol, their income and education level, and their diet. They filled in a food questionnaire asking how frequently they consumed food from 12 major groups, including fresh fruit and vegetables.

The researchers followed up on 451,665 people who didn't have cardiovascular disease at the start of the study, and who weren't taking any medicine to lower blood pressure. They checked whether they were still alive, and whether they'd been treated for a major coronary event such as a heart attack, and whether they'd had either an ischaemic or haemorrhagic stroke. An ischaemic stroke is when a blood clot blocks a blood vessel in the brain. A haemorrhagic stroke is when a blood vessel ruptures, causing bleeding in the brain. The latter type of stroke is more common in China than in Western countries.

Researchers ran a number of analyses on the data to try to account for factors that are known to affect the risk of heart attack and stroke (confounders) such as age, sex and smoking. They calculated the chances of having any of the major outcomes for people who ate fruit never or rarely, compared to people who ate it at least daily. They used that to estimate how many deaths might be attributed to people not eating fruit, assuming that fruit was the cause of the lower risk of death.

 

What were the basic results?

Only 18% of people in the study ate fresh fruit daily. Compared to people who rarely or never ate fresh fruit, daily fruit eaters were 40% less likely to have died of cardiovascular disease (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.54 to 0.67). They were also 34% less likely to have had a heart attack (HR 0.66, 95% CI 0.58 to 0.75), 25% less likely to have had an ischaemic stroke (HR 0.75, 95% CI 0.72 to 0.79) and 36% less likely to have had a haemorrhagic stroke (HR 0.64, 95% CI 0.56 to 0.74). 

The study also showed that people who ate fresh fruit daily had lower blood pressure and blood glucose levels at the beginning of the study, although interestingly these did not explain the differences in deaths, heart attacks and strokes. Fruit eaters were also likely to be younger, female, from urban areas, better educated, with a higher income and less likely to smoke or drink alcohol.

Assuming that fruit is the reason for the lower risk of cardiovascular death among daily fruit eaters, the researchers say, 16% of deaths from cardiovascular disease could be avoided – a whopping 560,000 deaths a year in China – if everyone ate fresh fruit daily.

 

How did the researchers interpret the results?

The researchers said: "it is difficult to establish causality reliably in observational studies of dietary factors that have such moderate relative risks and potential for confounding." In other words, they can't be sure the "moderate" differences in risk they found were down to fruit alone, and not to other factors. They say that, in particular, "residual confounding by socioeconomic status is still possible," despite their attempts to adjust figures to take account of this.

However, they say, given the healthy properties of fruit, it is plausible that it could be the cause of the lower death and disease rates seen among Chinese people who eat fruit daily.

They suggest that the weaker association between fruit consumption and cardiovascular death seen in previous studies, which have mainly been carried out in Western countries, can be explained partly because daily fruit eating is rare in China. They say this could mean that only a little fruit is needed, whereas previous studies have looked at the effect of each additional piece of fruit, in a population where daily fruit consumption is common.

 

Conclusion

The study adds to evidence that fresh fruit is likely to be good for our cardiovascular health, although we can't be sure from this study that it definitely prevents deaths, heart attacks or strokes. Observational studies cannot prove that one factor causes another, even when they are as big as this study, because other unmeasured factors could be responsible for the results. In this case, a major potential confounder that the researchers failed to take into account was whether the participants were taking any medication – they only excluded people taking blood pressure tablets.

The link with statins, made by the Telegraph, is unhelpful, confusing and unnecessary. While statins have been shown to reduce the risk of heart attacks and strokes by about the same figure – approximately one third, depending on the study – the statin studies were randomised controlled trials, which can show a causal relationship. In addition, they were carried out in Western populations with cardiovascular disease, or at risk of cardiovascular disease. These studies had little in common with this mass observational study of diet in healthy Chinese people.

However, we do know that fruit is likely to be a healthy part of a balanced diet. It's important to note that people in the study were asked about whether they ate fruit, not whether they drank fruit juice. Fruit juice often contains a lot of sugar, and misses out on the fibre found in fresh fruit. Whole fruit is likely to be healthier.

It’s also worth noting that the researchers couldn’t check for an effect of eating fresh vegetables daily, because almost everyone in China eats vegetables every day. The UK dietary recommendations are to eat five portions of fruit and vegetables a day. This research backs the idea that eating fruit regularly as part of a balanced diet is good for your heart and circulation health.

If you have been prescribed statins, then you should not stop taking them without first consulting your doctor. Adding a daily portion of fresh fruit to your diet could help to increase their effectiveness, but should not be regarded as a suitable alternative to statin treatment.

Links To The Headlines

Daily fresh fruit lowers heart death risk as much as statins. The Daily Telegraph, April 6 2016

An apple a day really CAN keep the doctor away: 100g portion of fresh fruit 'slashes risk of heart attack or stroke by a third'. Mail Online, April 6 2016

Could eating one banana a day cut your risk of dying from a heart attack by a THIRD? Daily Express, April 6 2016

Links To Science

Du H, Li L, Bennett D, et al. Fresh Fruit Consumption and Major Cardiovascular Disease in China. The New England Journal of Medicine. Published online April 7 2016

Categories: NHS Choices

'Exercise labels' should be added to food packets, expert argues

NHS Choices - Behind the Headlines - Thu, 07/04/2016 - 11:28

"Food and drinks should carry labels showing how long it would take to walk or run off the calories, a leading health expert suggests," the Daily Mail reports.

In an opinion piece in the British Medical Journal, Shirley Cramer, chief executive of the Royal Society for Public Health, argues that the current "traffic light" food labelling system is not promoting positive changes in public health.

Cramer makes the case that "activity equivalent" labelling could change people's behaviour. 

Traffic light labelling

The widely used "traffic light" food labelling system is based on concepts most of us learn very early on in our childhood: green means "good", amber means "OK", and red means "bad".

Traffic light information is provided on an item's fat content, saturated fat content, sugar content, and carbohydrate content. In short, the more green on the label, the healthier the choice.

However, a 2015 poll carried out by Populus found 41% of UK adults found current front-of-pack information confusing.

As Cramer points out, "Such information needs to be as simple as possible so that the public can easily decide what to buy and consume in the average six seconds people spend looking at food before buying." 

Activity equivalent labelling

The idea behind activity equivalent labelling is that a series of easily recognisable icons would be used to represent types of physical activities, such as brisk walking (walking fast enough to get you slightly out of breath), running, cycling, and swimming.

The icons would be combined with a number representing the number of minutes you would need to spend doing that activity to burn off the calories in the food or drink item.

Examples helpfully provided by the Daily Mail include:

  • an apple (93 calories) – this would take 21 minutes of brisk walking or 13 minutes of running to burn off
  • a can of Coca-Cola (139 calories) – this would take 32 minutes of brisk walking or 20 minutes of running to burn off
  • a 48g Snickers bar (245 calories) – this would take 56 minutes of brisk walking or 35 minutes of running to burn off
  • a 50g bowl of cornflakes served with semi-skimmed milk (263 calories) – this would take an hour of brisk walking to burn off 

Cramer makes an intriguing case that such a scheme would offer the public a carrot rather than a stick: "The public is used to being told to avoid particular drinks and to cut down on specific foods. By contrast, activity labelling encourages people to start something, rather than calling for them to stop." 

Could the scheme be introduced?

Currently, legislation regarding the mandatory labelling of food and drink is decided at the European level.

Even if there was a political will and the food and drink industry was on board, it would probably take several years for such a scheme to come into place. And that is a very big if.

There is the possibility that some forward-thinking manufacturers might adopt the scheme on a voluntary basis. If the scheme proves popular with the public, it could also boost their sales and so be a possible win-win.

Our Understanding calories page has a calorie checker widget that allows you to check the calories of more than 100,000 different products.   

Links To The Headlines

Almost an hour for a Snickers, but only 20 minutes for an apple: Labels should tell you how much exercise will burn off your food to help tackle obesity crisis, says expert. Daily Mail, April 7 2016

Activity icons 'could help healthy living’. BBC News, April 7 2016

Run 'n junk: Unhealthy snacks need exercise labels to tackle obesity. The Sun, April 7 2016

How much exercise will you need to burn off your lunch? ITV News, April 6 2016

Links To Science

Cramer S. Food should be labelled with the exercise needed to expend its calories. BMJ. Published online April 6 2016

Categories: NHS Choices

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