By: Haliza Abdul Rahman 

Sugar is a form of simple carbohydrate that naturally occurs in fruits, vegetables, and milk. However, within the context of modern dietary practices, the term “sugar” commonly refers to added sugars incorporated into processed foods and beverages. Although sugar functions as a rapid source of energy, excessive sugar consumption has been identified as a major contributing factor to the rising prevalence of non-communicable diseases (NCDs) such as obesity, type 2 diabetes, cardiovascular disease, and other metabolic complications worldwide.

Recent global studies published in Nature Medicine indicate that sugar-sweetened beverages are associated with more than 2.2 million new cases of type 2 diabetes and 1.1 million cases of cardiovascular disease annually across the globe. These diseases are most pronounced in low- and middle-income countries, where healthcare systems are often ill-prepared to manage the growing burden of NCDs. Sugar-sweetened beverages have also been linked to over 330,000 deaths and 12.5 million disability-adjusted life years (DALYs) lost due to chronic complications, highlighting their substantial global health impact. This burden is particularly evident in low- and middle-income regions such as Latin America and the Caribbean, where sugar-sweetened beverages contribute to nearly 24% of all new diabetes cases and 11% of heart disease cases, while in sub-Saharan Africa, sugar accounts for over 21% of new diabetes cases. Additionally, countries such as Colombia and Mexico report high proportions of new diabetes cases attributable to sugar-sweetened beverages, reaching up to 48% and 30%, respectively. These statistics underscore the disproportionately high NCD burden among younger, urban, and more educated populations who are more exposed to sugary beverage consumption than other groups.

This phenomenon has prompted many countries to launch what is commonly referred to as the “War on Sugar,” a comprehensive approach encompassing policy interventions, fiscal measures, health education, and reforms within the food industry. In reality, this issue extends beyond individual health concerns and carries significant economic implications for healthcare systems, workforce productivity, and national development. The “War on Sugar” thus represents a long-term investment in population health and economic sustainability.

 

Sugar and the Burden of Non-Communicable Diseases

 

From a public health perspective, high intake of added sugars is closely associated with obesity, type 2 diabetes mellitus, cardiovascular disease, metabolic syndrome, and dental caries. Accordingly, the World Health Organization (WHO) recommends that added sugar intake should not exceed 10% of total daily energy intake, with an optimal target of below 5%. However, modern dietary patterns—particularly the increased consumption of sugar-sweetened beverages and ultra-processed foods—frequently exceed these recommendations.

Health statistics in Malaysia indicate that this problem has reached a critical level. At the national level, data from the National Health and Morbidity Survey (NHMS) 2023 reveal that approximately 15.6%, or nearly one in six Malaysian adults, are living with diabetes, with the consumption of sugar-sweetened beverages and high-sugar foods continuing to contribute significantly to the burden of NCDs such as obesity and diabetes. These figures demonstrate that excessive sugar consumption is not only a global threat but also an urgent public health reality in Malaysia.

Findings from the NHMS 2024 further show that 63.1% of adolescents and 47.0% of adults exceed the recommended sugar intake, with more than half of this intake derived from sugar-sweetened beverages. Obesity prevalence has reached alarming levels, with over 53.6% of adults classified as overweight or obese, while diabetes rates remain persistently high. National data also indicate a consistent rise in obesity and diabetes prevalence over the past two decades, with more than half of the adult population now categorized as overweight or obese, and approximately one-fifth living with diabetes or pre-diabetes.

Worrying trends are also evident among children and adolescents, for whom sugar-sweetened beverages constitute a major source of excess daily caloric intake. Globally, consumption of sugar-sweetened beverages has increased by nearly 23% since 1990, averaging 3.6 servings per week among young people. More than 238 million children and adolescents consume at least seven servings per week, contributing significantly to rising obesity rates and heightened risks of metabolic diseases later in life. This shift reflects a broader epidemiological transition from communicable diseases to lifestyle-related conditions.

 

Economic Implications of Excessive Sugar Consumption

 

The economic burden of excessive sugar consumption is substantial and long-term in nature. Sugar-related diseases require continuous medical treatment, clinical monitoring, pharmaceutical interventions, and the management of complications such as kidney failure, cardiovascular disease, and amputations. These direct healthcare costs place considerable strain on public health expenditure. Countries with high obesity and diabetes prevalence also face reduced workforce productivity and rising health insurance costs, resulting in significant direct and indirect economic burdens.

Beyond treatment costs, indirect economic impacts are evident through productivity losses due to work absenteeism, early retirement caused by illness, and reduced physical capacity of the workforce. International health economic studies estimate that NCDs may account for several percentage points of a country’s Gross Domestic Product (GDP), particularly in middle-income countries grappling with escalating healthcare expenditures.

In Malaysia, reports by the Ministry of Health and the WHO indicate that annual healthcare costs for major NCDs such as diabetes, cardiovascular disease, and cancer exceed RM9.65 billion, with diabetes alone accounting for nearly half of this total. This figure does not include indirect costs such as productivity losses, which are estimated to reach RM12.88 billion due to sick leave, absenteeism, and premature mortality. Furthermore, the Social Security Organisation (PERKESO) reports annual expenditures of approximately RM421 million to support sugar-related cases, including medical treatment and worker rehabilitation. These figures illustrate that sugar-related diseases not only burden the healthcare system but also exert a profound impact on the national economy.

 

Sugar-Sweetened Beverage Tax as a Policy Intervention

 

One of the most extensively studied policy approaches within the “War on Sugar” is the implementation of a sugar-sweetened beverage (SSB) tax. Mexico was among the earliest adopters of this policy, and subsequent studies demonstrate a significant reduction in the purchase of sugar-sweetened beverages, particularly among low-income households. Concurrently, increased consumption of plain water and non-sugary beverages was observed.

In response, the Malaysian government has introduced various strategies through the Sugar Reduction Strategic Plan (2024–2030) and the #WarOnSugar campaign to curb sugar intake. These initiatives include widespread nutrition education, particularly targeting younger populations; the use of the “Healthier Choice Logo” to guide consumers toward lower-sugar products; and restrictions on sugar-sweetened beverages at official government functions and in schools.

The introduction of excise duties on sugar-sweetened beverages has also driven behavioral changes among consumers and prompted product reformulation within the food and beverage industry. Many manufacturers have reduced sugar content to avoid higher tax rates, thereby lowering overall population-level sugar exposure. Evidence shows that following the tax implementation, sugar-sweetened beverage consumption among adolescents declined significantly from 36.9% to 16.4%, reflecting the effectiveness of this fiscal measure. Additionally, more than 240 food and beverage products have been reformulated to reduce sugar content. Although the long-term impact on chronic disease prevalence requires further evaluation, early evidence suggests that such fiscal policies are potentially effective and cost-efficient preventive tools, as they increase the relative cost of sugary drinks compared to non-sugary alternatives, thereby incentivizing healthier choices.

Beyond taxation, the success of the “War on Sugar” depends on a multisectoral approach. The food and beverage industry plays a crucial role through product reformulation, transparent nutritional labeling, and responsible marketing, particularly toward children. At the same time, continuous nutrition education enhances health literacy, enabling consumers to make informed dietary choices. Accordingly, the Ministry of Health Malaysia actively conducts campaigns such as “Less Sugar, Lower Price” and Malaysia Nutrition Month, emphasizing sugar reduction in daily diets. These efforts are essential in addressing obesity prevalence, which currently exceeds 53.6% among Malaysian adults, alongside persistently high sugar intake among adolescents and adults.

The environment also significantly influences dietary behavior. Policies such as restricting the sale of sugar-sweetened beverages in schools, ensuring access to non-sugary drinks, and promoting healthy foods in public institutions can structurally reduce sugar dependency rather than relying solely on individual choice. The Malaysian government has prohibited the sale of flavored drinks, cordial-based beverages, and carbonated drinks in all school premises, while encouraging schools to provide access to plain drinking water as part of school nutrition health initiatives under the Strategic Plan and the War on Sugar campaign. These measures are viewed as vital in promoting healthy eating practices among students, parents, and the school community as a whole.

Overall, the “War on Sugar” constitutes a critical public health and economic agenda. Excessive sugar consumption not only elevates the risk of chronic diseases but also imposes significant burdens on healthcare systems and national economies. Current statistics indicate that without coordinated interventions, rates of obesity, diabetes, and related diseases will continue to rise, adversely affecting population well-being and economic stability. Therefore, an integrated approach encompassing fiscal policies, education, industry reform, and environmental changes is essential to sustainably reduce this burden. The rising prevalence of sugar-related diseases poses a serious threat to public health and national economic competitiveness in the future, underscoring the importance of interventions such as banning sugar-sweetened beverages in schools to reduce children’s exposure and support healthier choices, particularly plain water, as part of a broader public health strategy to cultivate healthy eating habits from an early age.

Date of Input: 12/01/2026 | Updated: 20/01/2026 | alyarahim