Ending the sale of energy drinks to children and young people: consultation

1. Introduction

1. We want to reduce the health risks associated with young people in Scotland consuming energy drinks.

2. Young people consume these drinks despite the required warning labels^[1] on packaging stating that they are not recommended for children.

3. Research suggests that preventative action may be needed to protect young people from associated health harms^[2]. Over recent years, parents, teachers, third sector organisations and young people have called for such action to be taken.

4. Since the publication of a review of related health risks by the World Health Organisation^[2], some countries have implemented restrictions on energy drink sales. The policies include:

• a mandatory age restriction of 18 in Latvia, Lithuania and Turkey^[3]
• a mandatory age restriction of 15 in Sweden where some sales are also restricted to pharmacies^[2]
• the UK Government intends to implement a mandatory age restriction of 16 in England^[4]
• the Welsh Government have committed to similar restrictions in their recently published healthy weight strategy^[5].

This consultation paper

5. We are asking for views on our proposals and thoughts on any gaps, issues or unintended consequences. We would like to hear from a range of organisations and individuals to ensure we identify the best actions, if any, to take forward.

6. Information on the Scottish Government consultation process and details on how to respond to this consultation is set out in Annex A.

7. Further information on the policy rationale behind the focus on energy drinks can be found in Annex B.

8. A glossary is in Annex C and a list of consultation questions in Annex D.

What do we mean by an 'energy drink'?

9. We intend to use the same definition of an 'energy drink' as the UK Government. In its recent consultation^[6], the UK Government defined it as any drink, other than tea or coffee, which contains over 150 milligrams of caffeine per litre. The British Soft Drinks Association^[7] and the Association of Convenience Stores^[8] also use this definition.

Recommended limits for caffeine and body weight

10. The European Food Safety Authority (EFSA) recommends for adults:

• Single doses of caffeine up to 200 milligrams - about 3 milligrams per kilogram of body weight (mg / kg bw) from all sources do not raise safety concerns for the general healthy adult population. The same amount of caffeine does not raise safety concerns when consumed less than two hours prior to intense physical exercise under normal environmental conditions. No studies are available in pregnant women or middle aged/elderly subjects undertaking intense physical exercise.
• Single doses of 100 milligrams (about 1.4mg / kg bw) of caffeine may affect sleep patterns and duration in some adults, particularly when consumed close to bedtime.
• Intakes up to 400 milligrams per day (about 5.7mg / kg bw) consumed throughout the day do not raise safety concerns for healthy adults in the general population, except for pregnant women^[9] .

11. There are concerns as to whether the health risks associated with caffeine increase when consumed by young people. This could be due to lower bodyweight or other biological factors unique to children and adolescents. Another suggestion is that younger people have not yet developed the level of tolerance to caffeine that adults have.

12. Due to the above, and the uncertainty around long-term consumption of caffeine by young people, EFSA recommended the same limit for daily consumption and for single sitting consumption (i.e. 3mg / kg bw). For non-pregnant adults the safe daily level is twice the single sitting level (i.e. about 400 milligrams for an adult weighing 70 kilograms).

Why young people?

13. Our proposals focus on young people because of the increase in risks of high caffeine consumption associated with lower bodyweight. A recent secondary analysis found consistent evidence linking energy drink consumption by young people:

• to physical symptoms including headaches, stomach aches and low appetite
• to higher sweet consumption, school exclusion and truancy, and alcohol, smoking and substance abuse^[10].

14. Caffeine consumption by young people is associated with poorer sleep^[10]. There are also significant associations between caffeine and insomnia at levels as low as 1.4 milligrams per kilogram of bodyweight^[9].

15. Energy drinks consumption has been linked to sleep-related issues^[10]. There is evidence that compared with non-consuming peers, adolescents who frequently consume energy drinks are 3.5 times more likely to report sleeping problems^[11].

16. Sleep is crucial to health and wellbeing and is particularly important for adolescents. Sustained periods of sleep deprivation can have a negative impact on both physical and mental health^[12]. Research indicates that poor sleep affects young people's attention, memory, educational attainment^[13] and perceived quality of life^[14]

17. Young people who do not meet the recommended sleep guidelines have almost a 60% increased risk of becoming overweight or obese^[15].

18. Evidence also suggests that a lack of sleep can increase the desire for sugar and caffeine in order to combat fatigue. This could start a vicious cycle of inability to sleep, drinking more energy drinks and consuming unnecessary calories^[16].

Are young people overconsuming energy drinks?

19. We define 'overconsumption' as when the recommended daily limit of caffeine intake is exceeded over the course of one 24-hour period through the consumption of energy drinks. This can be through one or multiple sittings in the period. A single can of energy drink could include more caffeine than some people's recommended daily limit^[17]. There is also the potential for one can to increase the total amount of daily caffeine dramatically, when taking into account the whole diet.

20. There could be a large number of young people overconsuming energy drinks^[18]. Recent research commissioned by the UK Government suggests that:

• up to 33% of young people (aged under 17) in the UK report frequent or heavy use with 11% consuming energy drinks on a daily basis^[19]
• some consume three or more energy drinks in one sitting^[20].