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08/02/2019 – Country Focus / Saudi Arabia / Diabetes

The Kingdom’s candy crush


Over the past few decades, the number of diabetes sufferers in Saudi Arabia has skyrocketed, to account for nearly one-quarter of the population today. Manufacturers must play their part in helping to curb this growing and lethal problem if they hope to succeed for the long-term in the GCC’s largest food & beverage market.


Back in the 18th century, doctors prescribed sugar pills for virtually everything – heart problems, headache, consumption, labour pains, insanity, old age and blindness. Today, practitioners view the sweet stuff as creating far more problems than it solves. Globally, rapidly rising incomes per head have led to increasingly sedentary lifestyles and a shift to Western-style diets laden with sugar – and this, in turn, has led to a dramatic rise in incidences of diabetes. The disease – a metabolic disorder characterised by high blood sugar levels over a prolonged period – today affects roughly 8.5 per cent of the world’s population.


While genetics plays a part, it is those profound shifts in culture, lifestyle, and dietary habits accompanying economic development that have primarily underpinned the rise in Type II Diabetes Mellitus (T2DM), which accounts for around 90 per cent of all cases today. And in few countries across the world is the problem more pronounced than in Saudi Arabia. With just a handful of tiny island states in the Pacific, Micronesia and Indian Ocean ahead of it in the rankings, the Kingdom sits near the top of the list as one of the world’s most diabetic countries, according to the International Diabetes Federation (IDF), with an 18.5-per-cent prevalence rate in the adult population and 24 per cent of the total population estimated to be affected by the disease. 


The price of inaction


One of the fastest growing health problems in the world today, Type II Diabetes can lead to serious health implications including heart and kidney disease, strokes, leg amputations, blindness and mental disorders such as depression. In 2017, there were 14,665 diabetes-related deaths in Saudi Arabia alone. 


Aside from this devastating human cost, the disease poses a substantial economic burden to the Kingdom. “Economically, diabetes costs no less than 35 per cent of the annual budget of the Ministry of Health [in Saudi Arabia]; and this is just the cost of management, not including the complications,” advises Kamil M. Salamah, Secretary-General of the Saudi Diabetes and Endocrine Association (SDEA). 


Across the wider GCC region, the cost of diabetes is set to explode in the years ahead, should inaction on the issue prevail. Expenditure on primary healthcare in the Arabian Gulf could skyrocket from US$12.8bn in 2015 to US$21.8bn in 2040, according to the IDF – although some consider even that to be an underestimation. Indeed, such a forecast omits the indirect costs associated with diabetes – such as absenteeism, loss of productivity from disease-related complications, unemployment due to disability and early mortality by disease. 


Nonetheless, it is clear that as the region’s most populous country by a considerable margin, and as the GCC’s most diabetic nation, Saudi Arabia will be lumbered with the lion’s share of those projected cost impacts. “The health burden due to diabetes in Saudi Arabia is predicted to rise to very high levels unless a wide-ranging epidemic control programme begins, with a great emphasis on advocating a healthy diet, including exercise and active lifestyles, and weight control,” warned Dr Fathi Yousef Al-Giurani, a consultant in internal medicine at the UAE’s Medeor 24x7. Despite the potentially devastating effects of Type II Diabetes, the fact that symptoms can be reversed to normal if caught early enough by adopting a healthy lifestyle, and not least adopting a low-sugar, low-calorie diet, offers an opportunity for countries like Saudi Arabia to turn things around.


Saudi’s Health Food Strategy


To achieve progress in driving down sugar consumption – and, in turn, reduce fresh diagnoses of diabetes – WHO has said that: “Governments should work with food and non-alcoholic beverage companies in areas such as reformulation, labelling, and regulating marketing”. 


Launched in September last year, the Saudi Food & Drug Authority (SFDA)’s Health Food strategy aims to do just that – and could be a key tool to help curb the country’s considerable diabetes challenge. The new Strategy is aligned with the Kingdom’s Vision 2030, which aims to reduce sugar, salt, saturated and trans-fats in products, and to entice the country’s food manufacturers and importers to support that goal.


Many global food and beverage firms – including Nestlé Middle East, Mars Saudi Arabia, Mondelez Arabia, Ferrero, Kellogg’s Arabia, PepsiCo International, Coca-Cola, Unilever, and Freeze Land – have already voluntarily signed up to support the strategy. All firms are members of the International Food & Beverage Alliance (IFBA), which boasted a combined annual revenue in excess of US$410 billion in 2016. The Alliance has revealed plans to reformulate existing products alongside launching new healthier innovations.   


Reformulation required


Some IFBA members have already taken the lead in reformulating their products. In July last year, Kellogg’s launched a new Coco Pops cereal for the GCC market featuring 40-per-cent less sugar. Alongside earlier reduction measures, this meant the sugar content in Coco Pops was effectively halved from 2017-2018. In this first quarter of 2019, the company has said it will also launch a healthier version of its Coco Pops biscuits, with sugar, salt and saturated fats slashed by seven per cent, 26 per cent and 40 per cent respectively. 


Nestlé meanwhile stressed that it had been working on producing healthier products over the years. “Thanks to a breakthrough nutrition reformulation that allowed up to 30 per cent sugar reduction, all our children and teenage breakfast cereals contain less than nine grams of sugar per 30-gram serving,” said Karine Antoniades, Public Affairs and Creating Shared Value Manager for Nestlé Middle East. 


Beyond those two high-profile examples, reformulation is undoubtedly a preoccupation for the product development teams at every major F&B manufacturer operating in the KSA market right now. 


At a governmental level too, decisive steps are already being taken to encourage personal responsibility for healthcare to stem the rising Type II Diabetes epidemic. Such measures include mandating the implementation of front-of-pack food labelling (designed to act as a nudge to consumers to make healthier dietary choices) and also launching a wide range of fitness initiatives across the Kingdom. Furthermore, in June 2017 Saudi Arabia became the first GCC country to impose a ‘sin tax’ covering a 100-per-cent levy on energy drinks and a 50-per-cent tax on carbonated soft drinks. The region’s second-largest consumer market – the UAE – shortly thereafter followed suit with a similar taxation blueprint.


To date, 28 countries worldwide have implemented a sugar tax of some sort, the main target often being sugar-sweetened beverages. While there is little data to confidently claim that levies of this kind will significantly reduce Type II Diabetes, it seems clear that many more nations are set to follow these early adopter’s lead by establishing their own sin taxes in the months and years ahead, as they strive to curb the rise of this largely preventable disease.


Certainly, for those F&B companies that can navigate the market’s new health requirements and regulations while still delivering on taste, the rewards could prove huge. For example, the soft drinks market in the GCC – worth US$8.4 billion – is amongst the biggest in the world, with fizzy drinks by far the largest category (accounting for around 40 per cent of the total). In the KSA, this amounts to 88 litres per capita. In 2015, Saudi citizens received a whopping 35 per cent of their sugar from soft drinks – nearly double the global average, while WHO recommends that no more than five per cent of calories should come from added sugar (across all food categories). 


Within the context of new regulations and shifting perceptions across Saudi Arabia, the GCC region and indeed the wider world, capturing even a small share of the inevitably huge new market for low-sugar, low-calorie innovations could present an enduringly sweet proposition for manufacturers – strengthening both their CSR credentials and their bottom lines.

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