(MENAFN- The Conversation) South Africa is facing a sharp rise in obesity-related diseases like type 2 diabetes . Between 2010 and 2019, the prevalence of diabetes nearly tripled from 4.5% to 12.7% . This increase is linked to lifestyle risk factors including drinking sugary beverages , eating unhealthy foods , and not getting enough physical activity .

To help tackle the problem, the government has introduced several public health measures targeting key risk factors, including unhealthy eating .

One of the most prominent measures was the introduction of a tax on sugar-sweetened beverages in 2018 . The tax targets added sugars, encouraging manufacturers to reformulate products like soft drinks and energy drinks to reduce their sugar content. But beverages containing naturally occurring sugars, such as 100% fruit juices, are exempt.

Often, 100% fruit juices are seen as healthier alternatives to sugar-sweetened or artificially sweetened drinks. But growing research shows this may not be true. A 2023 meta-analysis of 72 published studies involving over 3 million people found that drinking fruit juice does not lower the risk of type 2 diabetes or high blood pressure. It was instead linked to a higher risk of dying from cardiovascular diseases.

The recommendation from that meta-analysis and other studies is that fruit juices should not be considered a healthier alternative to sugar-sweetened beverages. This could be because, although fruit juices contain more vitamins and minerals than soft drinks, they are also high in natural sugars and lack the fibre found in whole fruits , which helps control blood sugar and keeps you feeling full.

In a further move to curb sugar intake in beverages the government has proposed new food labelling regulations. These would require front-of-package warning labels for products high in added sugar, saturated fat, sodium, or artificial sweeteners . The regulations are still under review. But they align with international best practices adopted by countries like Chile , Mexico and Brazil .

If implemented effectively, they could help South African consumers make more informed dietary choices.

But, once again, fruit juices are getting a free ride. This is even though they have the highest energy (calories) and sugar content (8.4%) across a range of soft and energy drinks, according to our recent study .

As researchers in public health nutrition, we are concerned that the regulations had some important gaps. The proposed regulations introduce a simple package warning label system for prepacked foods that contain added sugar, saturated fat, or sodium and exceed specific nutrient thresholds. It also requires warning labels for products containing artificial sweeteners, reflecting growing concerns about their long-term health effects.

But the regulations exclude certain sugar-containing beverages from front-of-pack warning label requirements, particularly those with naturally occurring sugars. Many juices, such as 100% fruit juices, are exempt despite their high sugar content and significant contribution to overall sugar and energy intake. This raises concerns about the consistency of the policy and whether it adequately addresses the health risks associated with excessive sugar consumption across all types of beverages.

To test the scale of the problem, we analysed over 600 non-alcoholic beverages sold in major South African supermarkets. The study found that 21.4% of beverages would require a warning for high sugar, 49.8% for artificial sweeteners, and 58.7% for at least one of these criteria.

The study found that 21.4% of beverages would require a warning for high sugar, 49.8% for artificial sweeteners, and 58.7% for at least one of these criteria. Author supplied

Juices were least likely to qualify for warning labels. Only 30% of juices met the criteria , versus 94.1% of soft drinks and 96.9% of energy drinks. Excluding 100% fruit juices from South Africa's proposed warning label regulations could have serious public health consequences.

We recommend that the health department revise the criteria for warning labels to include beverages that are high in naturally occurring sugars.

Fruit juices

Fruit juices are often seen as a healthier choice because of their natural origin. In South Africa, regular consumption of 100% fruit juice is common, with many consumers perceiving it as beneficial despite its high sugar content.

This is a problem for a number of reasons.

Because of their high sugar content, fruit juices can cause sharp spikes in blood glucose. For more than 2.3 million South Africans living with diabetes regular consumption may interfere with blood glucose control. But this is not only a concern for people with diabetes. Research shows that even among non-diabetics, frequent intake of fruit juice increases weight gain, and the risk of developing type 2 diabetes over time.

Labelling policies that ignore naturally occurring sugars risks misleading consumers. In particular, it misleads those trying to make healthier choices into over-consuming these products. International examples, such as Chile's approach to food labelling, show that including total sugar content in warning criteria can reduce purchases of high-sugar items and improve public awareness.

Exempting juices also creates an uneven playing field. While soft drink and energy drink manufacturers are pushed to reformulate products to avoid taxes and warning labels, juice producers face no such pressure, despite offering products with comparable health risks.

We also demonstrated that nearly half of the beverages analysed contained artificial sweeteners, which are increasingly used to lower sugar content and bypass the sugar tax. Emerging research suggests these additives may negatively affect gut health and contribute to nutrition-related diseases . Taken together, these factors highlight the need for comprehensive regulation that reflects the full spectrum of health risks posed by sugary beverages.

Next steps

South Africa's efforts to regulate sugary beverages are commendable and reflect a growing commitment to tackling lifestyle-related diseases. But excluding fruit juices from key policies risks undermining these efforts.

By aligning regulations with scientific evidence and international best practices, the country can take a more comprehensive approach to sugar reduction. This approach will protect all consumers, especially the most vulnerable.

To ensure that South Africa's food labelling regulations achieve their intended public health outcomes, we recommend the following steps.

• Include naturally occurring sugars: Revise the criteria for warning labels to account for total sugar content, not just added sugars. This would ensure that high-sugar juices are appropriately labelled, and consumers are fully informed.

• Extend the sugar tax: Consider applying the sugar tax to fruit juices with high sugar content. This would encourage manufacturers to explore lower-sugar formulations.

• Public education campaigns: Launch targeted education initiatives to raise awareness about the health risks associated with all types of sugar, including those found in fruit juices.

• Ongoing monitoring: Establish systems to monitor the impact of both labelling and taxation policies on consumer behaviour and health outcomes, allowing for evidence-based adjustments over time.

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