Mumbai Declaration on Sugary Drinks and Healthy Food

24 June 2022

The Mumbai Declaration on Sugary Drinks and Healthy Food was drafted during a key stakeholder roundtable and workshop hosted jointly by the Indian Dental Association (IDA) and FDI World Dental Federation (FDI).

This Declaration is endorsed by key health organizations and the related actions seek to reduce harm caused by sugary drink consumption.

Considering that:

• Sugary drinks, also known as sugar-sweetened beverages, are a significant source of sugars consumed by children and young people in India. These include any beverage that has added sugar such as carbonated or fizzy drinks, energy drinks, sports drinks, fruit drinks and juices, sweetened milk drinks, powdered drinks, cordial and flavoured waters.
• The consumption of sugary drinks is strongly associated with dental caries, weight gain and obesity. Obesity is a leading risk factor for type 2 diabetes, cardiovascular disease and some cancers. A third of all Indian adults are either overweight or obese3 and 19% of children are either overweight or obese in India
• Dental caries is a significant health problem. Good oral health is not only a vital component of general health but also a basic human right. Children with ongoing or untreated dental caries are in significant pain and this affects their ability to learn. It is not uncommon for children as young as 18 months old to have their teeth restored or removed due to decay or infection. The most common treatment for dental caries amongst children in India is dental extractions due to decay, abscesses, infection or gum disease.
• The shocking rate of dental caries and tooth extractions among young Indians needs immediate attention. Currently, there is insufficient focus on reducing the dietary cause of dental caries. Free sugars are the main dietary factor responsible for dental caries. The dental caries process initiated by demineralization of enamel and dentine is caused by the presence of high levels of sugar that are metabolized by the cariogenic bacteria in the mouth.
• Consumption of sugary drinks significantly increases the risk of dental caries due to their high sugar content. The sugar in these drinks also increases their energy content without any useful nutrients. Consumption of one can of soft drink per day can result in significant weight gain. A 600 ml bottle of soft drink contains approximately 16 teaspoons of sugar and a regular 375 ml can of soft drink contains about 10 teaspoons of sugar. Sugary drinks are cheap, readily available and accessible, and are one of the most widely advertised products.
• Research suggests that a ban on advertising targeted at children is effective in lowering consumption7. The World Health Organization (WHO) strongly recommends that the intake of free sugars should be reduced to less than 10 per cent of total energy intake approximately 12 teaspoons per day per child or adult. Further reduction to less than 5 per cent of total energy intake (approximately 6 teaspoons per day per adult), is recommended to help prevent dental caries in particular9. Beverages like buttermilk, lassi, coconut water, and lemon water should be consumed instead of bottled soft drinks and fruit juices which are high in sugar.
• The Indian Academy of Paediatrics Guidelines for Parents on nutrition for children between 5-12 years recommend that children replace high-sugar drinks such as fizzy and sports drinks with plain water. The Guidelines also recommend a ban on the sales and advertisements of junk foods in school canteens and 50 meters around school canteens.
• Sugary drinks are unique in that they have no nutritional value, they contribute empty calories and replace healthier beverage options. They are also extremely acidic. IDA recommends that adults and children switch sugary drinks to water. To reduce the intake of sugary drinks, a range of actions by government, the beverage industry, schools, non-government organisations and others is urgently needed.

The Mumbai Declaration on Sugary Drinks calls for seven key areas of action:

1. Introduction of evidence-based nationwide social marketing campaigns such as “Switch to Water” and “Shift to fibrous diet” to improve dietary practices
2. Observation of a national “No Sugar Day” to be held on the 1st September annually
3. Encouragement of “only healthy food and water” policies for all hospitals and health care facilities
4. Ban or limit schools from selling sugary drinks and junk food through school canteens
5. Working with educational institutes to introduce ‘more water’ policies for schools’ children.
6. Creating an environment to adopt WHO Guidelines on Sugar
7. Stringent compliance norms and better-informed consumers of sugary drinks Through the implemention of bans or limits on the marketing of unhealthy foods and sugary drinks to children.

The Mumbai Declaration on Sugary Drinks is supported by the organizations:

• Food Safety and Standards Authority of India (FSSAI)
• Tata Memorial Centre
• Central Council for Research in Ayurvedic Sciences (CCRAS)
• Public Health Foundation of India (PHFI)
• Indian Society of Pedodontics and Preventive Dentistry (ISPPD)
• Indian Academy of Paediatrics
• Indian Dietetic Association
• Vital Strategies
• Queen Mary University
• United Diabetes Forum

Supported by:

References

1. Mathur MR, Nagrath D, Malhotra J, Mishra V. Determinants of Sugar-Sweetened Beverage Consumption among Indian Adults: Findings from the National Family Health Survey-4. Indian J Community Med [Internet]. 2020 Mar [cited 2022 June 22];45(1):60-65. Available from: https://pubmed.ncbi.nlm.nih.gov/32029986/
2. Hayden C, Bowler J, Chambers S, Freeman R, Humphris G, Richards D et al. Obesity and dental caries in children: a systematic review and meta-analysis. Community Dent Oral Epidemiol [Internet]. 2013 Aug [cited 2022 June 22];41(4):289-308. Available from: https://pubmed.ncbi.nlm.nih.gov/23157709/
3. Rai R, Kumar C, Singh L, Singh P, Acharya S, Singh S. Rising burden of overweight and obesity among Indian adults: empirical insights for public health preparedness. Journal of Biosocial Science [Internet]. 2021 Sep [cited 2022 June 22];53(5): 709-723. Available from: https://pubmed.ncbi.nlm.nih.gov/32962795/
4. Ranjani H, Mehreen TS, Pradeepa R, Anjana R, Garg R et al. Epidemiology of childhood overweight & obesity in India: A systematic review. Indian J Med Res [Internet]. 2016 Feb [cited 2022 June 22];143(2):160-174. Available from: https://pubmed.ncbi.nlm.nih.gov/27121514/
5. World Health Organization. The Liverpool Declaration. Promoting oral health in the 21st Century. A Call for Action. Geneva: WHO. Rev. bioét. (I mpr.) [Internet]. 2017 Oct [cited 2022 June 22];25(2): 224-233. Available from: https://www.scielo.br/j/bioet/a/9x5GKCH3xMj5TBrHTpMv7yR/?format=pdf&lang=en
6. FDI policy statement on dietary free sugars and dental caries. Adopted by the FDI General Assembly: 24 September 2015, Bangkok, Thailand. Int Dent J [Internet]. 2016 Feb [cited 2022 June 22];66(1):9-10. Available from: https://pubmed.ncbi.nlm.nih.gov/26803942/
7. Malik VS, Hu FB. The role of sugar-sweetened beverages in the global epidemics of obesity and chronic diseases. Nat Rev Endocrinol [Internet]. 2022 Jan [cited 2022 June 22];18(1): 205–218. Available from: https://www.nature.com/articles/s41574-021-00627-6
8. Taillie LS, Busey E, Stoltze F, Dillman Carpentier F. Governmental policies to reduce unhealthy food marketing to children. Nutrition Reviews [Internet]. 2019 Nov [cited 2022 June 22];77(11): 787-816. Available from: https://academic.oup.com/nutritionreviews/article/77/11/787/5536919?login=true
9. World Health Organisation. Guideline: Sugars intake for adults and children. Geneva: WHO. 2015 Mar [cited 2022 June 22]. Available from: https://www.who.int/publications/i/item/9789241549028
10. Minister of Health and Family Welfare, Government of India. Module for Multi-Purpose Workers (MPW) – Female/Male on Prevention, Screening and Control of Common Non-communicable Diseases [Internet]. Available from: https://main.mohfw.gov.in/sites/default/files/Module%20for%20MultiPurpose%20Workers%20-%20Prevention%2C%20Screening%20and%20Control%20of%20Common%20NCDS_2.pdf
11. IAP Action Plan 2021. Guidelines for Parents. Indian Academy of Pediatrics [Internet]. 2021 Jan [cited 2022 June 22]. Available from: https://iapindia.org/pdf/IAP-action-plan-for-2021-updated.pdf
12. Christian, D.; Maharjan, M.; Kotov, A.; Cotter, T.; Mullin, S.; Nurse, V.; McGaw, B.; Chen, D.; Puri, P.; Wang, S.; Negi, N.S.; Murukutla, N. How the “Are We Drinking Ourselves Sick?” Communication Campaign Built Support for Policy Action on Sugary Drinks in Jamaica. Nutrients 2022, 14, 2866. Available from: https://doi.org/10.3390/nu14142866
13. Murukutla N, Cotter T, Wang S, Cullinan K, Gaston F, Kotov A, Maharjan M, Mullin S,. Results of a Mass Media Campaign in South Africa to Promote a Sugary Drinks Tax. Nutrients [Internet]. 2020, 12(6) [cited 2022 July 22]. Available from: https://www.mdpi.com/2072-6643/12/6/1878/htm

Supporting quotes

Dr L Swasticharan, Directorate General of Health Services, India said, “We remain committed to address the Common Risk Factors for Non-communicable diseases”.

Indian Dental Association’s President Dr Puneet Girdhar said, "The Declaration signifies the desire of the IDA to inform the public about the negative health impacts of sugary drinks, and to advocate for a comprehensive approach to reduce sugary drink consumption.”

Dr Ashok Dhoble, Secretary General IDA along with Dr Rajiv Chugh President Elect, Dr Sanjay Joshi JointSecretary IDA, Dr Deepak Muchhala Treasurer IDA, said “Sugary drinks are a public health crisis. By working collaboratively and acting with urgency, we can help prevent not only tooth decay, but also obesity, type 2 diabetes, cardiovascular disease and some forms of cancers.”

Ms Pritee Chaudhary, Regional Director of western region for FSSAI said, “It is time we start motivating people to drink water and advise them to replace it with sugary beverages”.

Dr Govind Reddy, Asst. Director (Ayu) In charge, CCRAS, Ministry of Ayush said, “There is a need for an integrative approach to target the common risk factors to tackle the non-communicable diseases.”

Dr Sharad Kapoor, workshop chairman IDA said, “Sugary drink advertisements directly affect the choices of children and attracts them to consume it”.

Ms Rachael England, workshop contributor remarked, “A strong advocacy focus on sugar can enable better general health including oral health”.

Dr. Ashwin Jawdekar, suggested, “An observation of National No Sugar Day to create future awareness on health risks of sugar consumption”.