Sir, it is with great interest we write in response to the BDJ November 2018 editorial titled 'Sugar; tax and reformulation'. As highlighted in the article, the introduction of the sugar tax in April of 2018 has led to a considerable reduction in the consumption of high sugar containing beverages.1

Although this is a start in the changes we can make, the outcome gives us insight into only one element in the war against sugar.

There are other important ways in which the population's consumption patterns can be shaped. In recent years, due to the influence of concerned campaigners, supermarkets have actioned policies to lower the amount of unhealthy foods at checkouts.2

A recent UK study has collected data from 30,000 households and compared their consumption of sugary snacks before and after these changes were made in major UK stores.

The most noteworthy results were that around 17% less sugary snacks were brought home directly after the policies were put into place. In addition to this, 76% fewer sweet snacks including chocolate and crisps were bought and eaten immediately after checking out from the stores with checkout policies.2

These alterations have potential in subtly shaping consumer habits and diets. The future could see the replacement of sugary foods with healthier alternatives at checkouts. Furthermore, supermarket layouts can be extended to other shelves - by placing foods and snacks with high sugar content on higher shelves, it means they are out of reach and sight of young children.

With the government's endeavour to reduce obesity amongst youngsters in the next decade, they may consider a permanent ban on sugary snacks at checkouts.3

The pressures that supermarkets will face to make changes might not only affect obesity but also caries incidence in the UK. Although the sugar tax appears to be promising, this may lead to expansion of tariffs to other areas as mentioned in another BDJ editorial.4

We expect there to be some more interesting findings in the future as new transformations are brought into action and hopefully a reduction in decay rates in children.