Lagos resident Philip Akwe has been battling with diabetes for two and a half decades. He had joined a private company as a driver when he was in his early 20s, and his job entailed lots of travels across the country.

Akwe soon became addicted to energy drinks and soda, popularly called soft drinks, to keep him ‘on the go.’ The first sustained him whenever he embarked on any of the long journeys across states, while the other kept him stable in between meals.

Consumption of the sugar-sweetened beverages thus became a daily routine. By the time he got to his 40s, his drinking habit had begun to take a toll on his health.

The first symptoms were dizziness and tiredness. A visit to the hospital and the series of medical tests that followed confirmed that he had diabetes; a condition that forced him into early retirement.

“I did not know I had any condition until I began to feel weak a lot of the time and could not function well at work,” he said.

“When I was eventually told I had diabetes, it was too late. I was told I would have to live with it for the rest of my life.

“My sugar level was high and I developed high blood pressure (HBP) too. They said I would have to manage it.”

With him out of job and his source of income gone, Akwe became dependent on his nucleus family, and that compounded his ordeal.

He said: “I became a liability to my family. My wife and two children stood by me and cared for me as no income was forthcoming.

“I sold my bus and some property to be able to afford medicine and medical care, but the money was gone in no time.

“My wife used to be a petty trader. As a result of my illness, we started dipping hands into her business capital, and soon that was gone too.

“I lost a lot of weight and became a shadow of myself. Instead of using the little money we had to eat, we would be thinking about hospital bills and how to buy tester kits and insulin.

“I was building a family house but had to stop midway due to the expenses. We had to move into the half-finished building.”

When the financial challenge kept mounting, Akwe and his small family had to relocate to his village home in Delta State three years ago.

“I am still living with the illness, but it is more bearable because village life is not as expensive as the city. I also use local herbs in my treatment and there is access to natural and fresh food like vegetables and fruits,” he said.

For all the trouble, Akwe seems luckier than Edo State-born Godfrey Imaseun, 65.

Imaseun did not live to tell his own story after succumbing to a prolonged cardiovascular disease that triggered a mix of HBP, stomach disorder and diabetes.

His widow, Christy, said Imaseun lived a healthy life for much of his working life. He was neither a heavy consumer of alcohol nor a smoker.

But he loved to take sugary things, according to the widow.

She added: “He said he had a sugary mouth. It was in his early 50s that he developed HBP and within some years it became worse and his weight started dropping.

“It got to a point where he could not retain any food in his stomach. He would either throw up or visit the toilet immediately. He began to fall sick and spent the last 10 years of his life more on hospital beds than his own bed.

“He passed away in 2022.

“The night before he passed, he said he was tired and needed to go home to rest. My husband was dead tired from the illness.”

Akwe and Imaseun are two of the hundreds of patients done in by their addiction to sugar-sweetened beverages (SSBs), blamed for many non-communicable diseases (NCDs) such as obesity, diabetes, overweight, cardiovascular diseases, cancer and chronic respiratory diseases.

What are NCDs?

NCDs are enduring diseases, draining and sometimes incurable. They potentially drain sufferers and their families of funds and, often, run them into debts.

According to the World Health Organisation (WHO), NCDs accounted for an estimated 29 per cent of all deaths in Nigeria in 2018. This is approximately 617,300 deaths in one year and more than three times the number of malaria fatalities in the country, which stood at 200,000 in 2021.

Sadly, SSBs are all around us. They are the sugar and colour bottles and plastic drinks in our fridges, department stores, mega supermarkets, and in the nooks and crannies of our streets.

“Examples of SSBs are carbonated drinks, energy drinks, sports drinks, sweetened tea and coffee, fruit flavoured drinks, flavoured water among others. These beverages are known to have little or no nutritional value.”

For years, Akwe lived with the impression that energy drinks were safe for him to consume.

“I knew soft drinks had a lot of sugar and felt energy drinks were okay,” he said.

WHO has categorised energy drinks and fruit juices under SSBs, to prove they are not free of sugar. They are as injurious to health as soft drinks.

WHO says while 100% fruit juices may not contain added sugars, they have been classified with SSBs because they contain a significant amount of ‘free sugar.’

Free sugar includes monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook, or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

Experts’ opinions

Dr. Adeniyi Samuel Oginni, a public health expert, minces no word about the threat posed to consumers’ health by SSBs.

“Many studies have connected excessive sugar and SSBs consumption to NCDs as obesity, diabetes, overweight, cardiovascular diseases, cancer, and chronic respiratory diseases,” he said.

The pioneer chairman, the Forum of CEOs of State Social Health Insurance Agencies in Nigeria added: “NCDs account for 70 per cent of annual global mortality of all deaths worldwide, which is about 40 million individuals.

“Over 40 per cent of these fatalities involve adults between the ages of 30 and 69, and 80 per cent of these premature deaths take place in low-and middle-income nations.

“Of these figures, cardiovascular disease is more pronounced and fatal. It accounts for 40 per cent of all NCD-related fatalities each year, followed by cancers (22%), respiratory illnesses (10%), and diabetes (4%), respectively.”

WHO warns that Nigerians have 20 per cent chance of dying prematurely from NCDs.

Connection between SSBs and NCDs

Dr. Francis Fagbule, a periodontology and community dentistry, shares Oginni’s view on the strong connection between SSBs consumption and NCDs, saying: “We have people who think SSBs are cool and even convey status on consumers.

“It is stable in our diet. Instead of drinking water after a meal, we order a soft drink to show we are of higher status.”

According to Statista, in 2014, Nigerians consumed 6 billion litres of carbonated drinks otherwise called soft drinks, and about 5 billion litres of bottled water.

By 2020, the amount of Soda consumed had nearly doubled to 10 billion litres while water consumption increased slightly to 6.5 billion litres.

By 2022, the trend had risen to about 13 billion litres of Soda ingested and 6.4 billion litres of bottled water consumed in the same year.

There was a drop in the amount of water consumed by Nigerians and an overwhelming rise in Soda.

It is projected that by 2027, over 18 billion litres of Soda will be consumed as against less than 6 billion water taken.

Statista also pointed to the fact that medium-income Nigerians indulged more in SSBs consumption.

In 2022, 68.3 per cent of people in low and medium-income classes consumed SSBs while 31.7 per cent in the high-income bracket ingested these high risks drinks.

The result was an increased prevalence of NCD sufferers among Nigerians less than 20 years old.

Significantly, more Nigerians became hypertensive according to data obtained from Statista. It shows that in 1995, 4.3 million (8.6%) were hypertensive patients, and it rose to 27.5 million (32.5%) in 2022.

Of this number, over 70 per cent of the cases were not aware of their hypertension and only 12 per cent were on treatment. This is the cause of the upsurge in NCD deaths in recent times.

The result for type 2 diabetes is similar. There has been an astronomical increase among Nigerians.

“In 1990, two (2) per cent cases of Nigerians between the ages 20 and 79 were recorded representing 874,000 Nigerians. By 2015, the figure jumped to 4.7 million (5.7 per cent).

Juxtaposing SSBs consumption and NCD prevalence, Fagbule concluded that an increase in SSBs consumption coincides with the increase in NCD burden in Nigeria.

Dr. Oginni agrees with him: “Nigerians are consuming an increasing amount of sugary beverages and obesity is increasing at the same time.

“NCDs like diabetes, heart disease, cancer, and stroke are all recognized to be at increased risk due to obesity.”

According to WHO, those who frequently drink sugar-sweetened beverages (one to two cans a day or more) have a 26% higher risk of getting type 2 diabetes than those who do not.

Obesity as the new killer

The matter is made worse because there is no end in sight going by the growing number of children and young people at the risk of NCDs through childhood and adolescent obesity.

Sadly, it is parents that fueled the latest trend, owing to their choice of foods for their wards from infancy.

Dr. Oginni explains. “Rather than encourage our kids to take more of water, which has zero sugar, we put soft drinks and other SSBs in their lunch box. And when they begin to gain excess weight, people say it is a sign of affluence and healthy living. This is far from the truth.”

A popular 35CL bottle of soft drink in Nigeria contains 13 cubes of sugar and calories taken, which exceed the usual calorie intake. It promotes weight accumulation and obesity development.

“Higher sugar and fructose consumption in adolescents has been associated with insulin resistance and increased type 2 diabetes risk,” he added.

Such adolescent also stands the risk of HBP and a greater risk of hypertension in life.

The picture thus painted is that of a bleak future with millions of sick adults putting more burden on the already overstretched resources of the country.

It is a burden Nigeria cannot bear given the economic indexes and other health challenges cum disappearing budgets given to the health sector every year.

Today, obesity and overweight are the most common disorders connected to sugar and they are linked to other health issues including diabetes, heart disease, certain forms of cancer and stroke.

Obesity-related disorders are now among the top three deaths worldwide, according to World Bank 2020 research.

In reality, obesity and overweight are regarded as modern epidemics. These are said to be the greatest public health issues now affecting the whole globe.

Dejectedly, Nigeria is the largest consumer of SSBs in Africa and the fourth-largest consumer of SSBs in the world, according to Statista.

The 2020 survey revealed that obesity (6.5%) was among the population’s significant cardiovascular risk factors, including smoking and alcohol intake, with a generally male majority.

It means that almost 12 million people are estimated to be obese in Nigeria, with children, teenagers and women experiencing the condition at significantly greater rates. It is a burden Nigeria’s lean resources and poor economy cannot afford.

The way out

The above figures and opinions of experts have shown that education and enlightenment are not having the desired impact. The popular opinion is for government to legislate measures that can help in reducing SSBs consumption.

Austin Iraoya of Centre for the Study of the Economies of Africa (SCEA) seeks the immediate implementation of the passed SSB tax to discourage the sale and purchase of SSBs.

The SSB tax was signed into law in Nigeria as part of the 2021 Finance Act. It adds 10 naira to the cost of each litre of all non-alcoholic and SSBs.

The Task Force on Fiscal Policy for Health published a study in 2019 on how nations might reduce the prevalence of NCDs by pricing unhealthy goods, including SSBs, alcohol and tobacco.

The task committee estimated that if countries enacted tax increases big enough to boost prices of cigarettes, alcohol, and sweet beverages by 50% over the next 50 years, more than 50 million premature deaths may be avoided.

Dr. Iraoya says: “The tax will increase the retail price of SSBs and reduce their purchase and consumption thereby reducing free sugar intake in the population, particularly among low-income consumers, youth and children.

“Such legislation will also raise public awareness while giving incentives to industries to formulate sugar-free products.

“Through it, the government can also generate significant revenue, which may be earmarked for financing the health sector, improving public health and wellbeing.”

Dr. Oginni stresses: “The economic case for higher tax for SSB is that when the price of a commodity suddenly rises, the demand reduces and the need for consumption of this commodity reduces.

“Hence, the higher the tax per litre of SSBs the higher the increase in the price of the commodities and the less available it will be to persons in the lower income bracket and a disincentive to even those in the higher income bracket.

“This in turn reduces the consumption of SSBs and the risk factor of the prevalence of obesity and diabetes reduces significantly and also lowers healthcare costs.”

He said the current National Health Insurance Authority (NHIA) Law, 2022, seeks to provide health care to 83 million vulnerable Nigerians living in poverty.

The SSBs tax can form part of the revenue sources for the funding of this, which if well implemented will push Nigeria forward in her quest to achieve UHC for her citizens.

How Mexico, others are confronting the challenge

Nigeria will not be the first to use this law to fight SSBs. Some countries of the world have practised it with success.

Mexico has long been one of the world’s top users of sweetened beverages. It had the highest prevalence of adult obesity among the Organization for Economic Cooperation and Development’s members, according to a 2013 research.

The government imposed a tax on SSBs in 2014, and two years later, the poorest families were purchasing 11.7% fewer sugary drinks than the average Mexican population as a whole.

South African also imposed a 10% sugar tax in 2018 that immediately reduced the amount of sugar people consumed from sweetened beverages. According to a recent report, the amount per person per day decreased from 16.25 g before the tax to 14.26g instantly and then to 10.63g the next year.

Saudi Arabia experienced a 58 per cent reduction in consumption of taxed SSBs.

More than 50 additional countries have imposed taxes on SSBs.They include Chile, UK, Bahrain, United Arab Emirates (UAE), Kuwait, Bahrain, Qatar, Morocco, Mauritius, Seychelles, Norway, Finland Belgium, France, Panama, Ecuador, Peru, Chile, Bermuda, and the USA.

A communiqué released at the end of a regional stakeholders’ forum for Southwest zone on SSBs tax, held in Lagos recently, asked the Federal Government to, as a matter of urgency, increase taxation on SSBs towards achieving 20% of the retail price as recommended by WHO.

The stakeholders meeting was attended by prominent individuals and organisations including the Nigeria Customs Service, National Agency for Food and Drug Administration and Control (NAFDAC), media representatives, nutrition-focused and public health civil society organisations, the Nigerian Medical Association (NMA) as well as state agencies such as the Lagos State Internal Revenue Service; Ministry of Health, Oyo State; Ministry of Health, Osun State; and the Osun State Health Insurance Agency.

It enjoined government and policymakers to engage and collaborate with relevant stakeholders, including civil society organisations, media institutions, and healthcare professionals to create public awareness of the health risks associated with SSB consumption and the benefits of the SSBs tax policy, among other measures to checkmate surge in SSBs consumption.

It said: “Government should establish a monitoring and evaluation and accountability framework to track the implementation and impact of the current SSB tax policy and implement complementary regulatory instruments like Front-of-Pack Labeling, restricting availability and marketing of SSBs in school environments, among others.” (The Nation)

Update news