A website for a children's cereal, viewed on 18 September 2011, stated "Sugar & health", "Sugar gets a lot of bad press, and we are frequently being told to 'watch out for sugar'. But why is this? Is it detrimental to health? Let's see what the experts say. An independent dietitian [sic] has gathered the evidence so you can see the facts for yourself. THE FACTS FROM THE EXPERTS A panel of world health experts recently reviewed all the scientific evidence and concluded that a high sugar intake is not related to obesity, or the development of diseases such as heart disease, diabetes, high blood pressure or cancer. Nor was it connected to behavioural problems, such as hyperactivity, in children (1)(2). As well as this, the panel did emphasise the beneficial role that carbohydrates like sugars play in health". (1) and (2) referred to sources at the bottom of the page.
The complainant challenged whether the claim that World Health Organisation (WHO) experts had concluded high sugar intake was not related to obesity, heart disease, diabetes, high blood pressure, cancer or behavioural problems in children, in the context of a website promoting a children's cereal brand, was misleading as he believed the referenced evidence did not support this claim.
Kellogg Marketing and Sales Company (UK) Ltd (Kellogg's) said they used credible scientific evidence and reviews when preparing their website, in particular the Food and Agriculture Organisation (FAO) /WHO 1998 report on Carbohydrates in Human Nutrition (the FAO/WHO 1998 report). They said they appreciated that quoting the evidence in isolation might lead consumers to believe there were no public health recommendations or dietary guidelines for sugar intake. They said they had used front of pack Guideline Daily Amounts for almost eight years, and that this information was also contained on their website. They said they would never intend to give customers the wrong impression about sugar, and that they had removed the section headed "Sugar & health" from their website.
The ASA acknowledged Kellogg's had based their claim on credible scientific evidence and reviews.
In relation to obesity, we noted a literature review, Is Sugar Consumption Detrimental to Health? A Review of the Evidence 1995-2006 (the literature review), stated that even when sugar intake was "pushed to extremes there were few apparent disadvantages for body weight and metabolic syndrome". However, the article also said there were adverse associations for dental health and cancer, but that these could be the result of other factors. The article stated there did not appear to be a positive relationship between sugar consumption and obesity, and that there may be a negative one, and this was supported by a paper, Central aspects of sugars in human nutrition, Obesity Reviews (the Obesity Reviews article). However, it also stated that some studies had shown a relationship between the consumption of sugar-sweetened beverages and obesity, particularly when "considerable amounts" were consumed. We noted the Obesity Reviews article also referred to the possibility of a link between sugar-sweetened beverages and obesity, and that it specifically referred to a study that suggested children with a high consumption of these were more likely to be overweight and gain weight. We noted that a 2003 WHO Expert panel also concluded there was "probable" evidence that high intakes of free sugars in beverages probably increase the risk of weight gain. We considered the claim there was no link between a high sugar intake and obesity was misleading, as it overstated the certainty of the conclusions, and did not refer to the potential link between sugar-sweetened beverages and obesity.
In relation to heart disease we noted the FAO/WHO 1998 report stated there was no evidence of a link between sugar and the development of coronary heart disease. In relation to diabetes, we noted the Obesity Reviews article said that studies had not demonstrated an obvious relationship between the intake of total simple carbohydrates and the development of diabetes. We also noted that they referred to a potential dietary affect if sucrose was a very high proportion of calorific intake, and that in general further studies were required. We noted the FAO/WHO 1998 report also stated there was no evidence of a direct link between sugar intake and the development of diabetes. However, we concluded the claim a high sugar intake was not related to diabetes was misleading as it overstated the certainty of the conclusions.
In relation to cancer, we noted that the literature review stated "consistent evidence implicating sugar in cancer development is lacking" but that "an association between dietary sugar and colorectal cancer cannot be ruled out". We also noted a 2007 World Cancer Research Fund expert report stated "The evidence is hard to interpret. There is limited evidence suggesting that sugar is a cause of colorectal cancer", and that this was consistent with the FAO/WHO 2007 Update on Carbohydrates in Human Nutrition. We also noted the FAO/WHO 1998 report stated there was no known link between sugar and a number of cancers, but that there was some evidence of increased risk of ovarian cancer in women with a certain medical condition. We concluded the claim that a high sugar diet was not related to cancer was misleading as it overstated the certainty of the conclusions.
In relation to behavioural problems in children we noted the FAO/WHO 1998 report stated an extensive literature review had concluded there was no evidence to support the claim that refined sugar intake had a significant influence on the behaviour or cognitive performance of children. We also noted the report said it was not appropriate to recommend restricting children's sugar intake for the purposes of controlling their behaviour.
We considered the wording of the claims implied there was absolute certainty about the claims being made, as no qualifying words were used. We noted the evidence did, in general, support the claims that experts did not believe sugar was related to obesity, heart disease, diabetes, high blood pressure, cancer or behavioural problems in children. However, we also noted that most information about the relationship between dietary carbohydrates, sugars and health came from observational epidemiological studies that were not able to prove causality.
We also noted that Kellogg's referred in particular to a high sugar intake, rather than just sugar intake in general, and that the website went on to state "as well as this, the panel did emphasise the beneficial role that carbohydrates like sugars play in health". We considered that, in the context of a webpage about sugar, this claim implied the FAO/WHO 1998 report said sugar was of benefit to health. However, we noted the report emphasised that dietary carbohydrates should come from a variety of sources and did not state that sugar in particular was beneficial to health.
We also noted that in 2003 the World Health Organisation and FAO had proposed a population nutrient intake goal for free sugars of less than 10% of total energy. We also noted that the Department of Health and Food Standards Agency both advised only eating small amounts of sugary foods. We noted the website prominently featured the Coco Pops logo and brand character, and considered that consumers would be likely to relate the information contained on the webpage to the Coco Pops products, as well as to sugar in general.
We considered it was particularly important for health and nutritional information to be accurate when related to children's food products. We acknowledged Kellogg's had based their claims on credible scientific evidence and reviews, and welcomed their assurance that they would remove the claims. However, we considered that Kellogg's had overstated the certainty of the experts' conclusions, and in relation to some health conditions had failed to state important caveats, particularly in relation to obesity. We therefore concluded that the claim was misleading.
The website breached CAP Code (Edition 12) rules 3.1 3.1 Marketing communications must not materially mislead or be likely to do so. (Misleading advertising) and 3.7 3.7 Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove claims that consumers are likely to regard as objective and that are capable of objective substantiation. The ASA may regard claims as misleading in the absence of adequate substantiation. (Substantiation).
We told Kellogg's to revise the claims.