The development of a method for the global health community to assess the proportion of food and beverage companies' sales that are derived from unhealthy foods.

CONTEXT: Corporate engagement with food and beverage companies who produce food associated with health harms is a divisive topic in the global nutrition community, with high-profile cases of conflict of interest increasingly coming under scrutiny. There is a need for an agreed method to support health organizations in deciding whether and how to engage with large food and beverage manufacturers. AIM: The aim of this study was to develop a method to quantify the proportion of sales from food and beverage companies that are derived from unhealthy foods to support organizations in determining which companies might be considered high-risk for engagement. METHODS: The 2015 WHO Euro nutrient profile model was applied to 35,550 products from 1294 brands manufactured by the top 20 global food and beverage companies from seven countries (Australia, Brazil, China, India, South Africa, UK and USA). For the purpose of this study, products that met the WHO Euro criteria were classified as "healthier" and those that failed were classified as "unhealthy". Products were grouped by brand and weighted by the brand's value sales for 2020. The primary outcome was the proportion of each company's sales that were classified as unhealthy and healthier by company and category. RESULTS: Overall, 89% of the top 20 companies' brand sales were classified as unhealthy. For every USD$10 spent on the top 20 companies' brands, only $1.10 was spent on products considered healthier. All companies saw the majority of their sales come from unhealthy foods, including soft drinks, confectionery and snacks. None of Red Bull or Ferrero's sales were classified as healthier and less than 5% of total sales were healthier for Mondelez, Mars, and PepsiCo. Some companies had higher proportions of sales deriving from healthier products, including Grupo Bimbo (48%), Danone (34%) and Conagra (32%), although the majority of their sales were still derived from unhealthy foods. DISCUSSION: The results presented in this study highlight the reliance the leading food and beverage companies have on sales of unhealthy products that are contributing to diet-related disease globally. The method and steps we have laid out here could be used by organizations in the global health community to identify companies that have conflicts of interest when it comes to engaging with governments, international organizations and public health bodies on issues of policy and regulation.

Changes in household food and drink purchases following restrictions on the advertisement of high fat, salt, and sugar products across the Transport for London network: A controlled interrupted time series analysis.

BACKGROUND: Restricting the advertisement of products with high fat, salt, and sugar (HFSS) content has been recommended as a policy tool to improve diet and tackle obesity, but the impact on HFSS purchasing is unknown. This study aimed to evaluate the impact of HFSS advertising restrictions, implemented across the London (UK) transport network in February 2019, on HFSS purchases. METHODS AND FINDINGS: Over 5 million take-home food and drink purchases were recorded by 1,970 households (London [intervention], n = 977; North of England [control], n = 993) randomly selected from the Kantar Fast Moving Consumer Goods panel. The intervention and control samples were similar in household characteristics but had small differences in main food shopper sex, socioeconomic position, and body mass index. Using a controlled interrupted time series design, we estimated average weekly household purchases of energy and nutrients from HFSS products in the post-intervention period (44 weeks) compared to a counterfactual constructed from the control and pre-intervention (36 weeks) series. Energy purchased from HFSS products was 6.7% (1,001.0 kcal, 95% CI 456.0 to 1,546.0) lower among intervention households compared to the counterfactual. Relative reductions in purchases of fat (57.9 g, 95% CI 22.1 to 93.7), saturated fat (26.4 g, 95% CI 12.4 to 40.4), and sugar (80.7 g, 95% CI 41.4 to 120.1) from HFSS products were also observed. Energy from chocolate and confectionery purchases was 19.4% (317.9 kcal, 95% CI 200.0 to 435.8) lower among intervention households than for the counterfactual, with corresponding relative reductions in fat (13.1 g, 95% CI 7.5 to 18.8), saturated fat (8.7 g, 95% CI 5.7 to 11.7), sugar (41.4 g, 95% CI 27.4 to 55.4), and salt (0.2 g, 95% CI 0.1 to 0.2) purchased from chocolate and confectionery. Relative reductions are in the context of secular increases in HFSS purchases in both the intervention and control areas, so the policy was associated with attenuated growth of HFSS purchases rather than absolute reduction in HFSS purchases. Study limitations include the lack of out-of-home purchases in our analyses and not being able to assess the sustainability of observed changes beyond 44 weeks. CONCLUSIONS: This study finds an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy, sugar, and fat purchased from HFSS products. These findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products.

Price Trends of Healthy and Less Healthy Foods and Beverages in Mexico from 2011-2018.

BACKGROUND: Cost is one of the main drivers of food selection; thus it is important to monitor food prices. Evidence from low- and middle-income countries such as Mexico is limited. OBJECTIVE: The aim of this study was to evaluate the prices and price trends of healthy and less healthy food/beverage groups in Mexico from 2011 to 2018. DESIGN: This study used a time series of the prices of foods and beverages classified by 1) healthiness, 2) processing level, and 3) pairs of healthy/less healthy substitutes. SETTING: Food and beverage prices used to estimate the Consumer Price Index were obtained. Prices were collected weekly from 46 cities (>20,000 habitants) distributed across the country. MAIN OUTCOME MEASURES: Price trend (% change/year) from 2011 to 2018 for all food/beverage groups and price/100 g in 2018 for pairs of healthy/less healthy substitutes were obtained. STATISTICAL ANALYSES: Linear regression models were used for each food/beverage group, with the logarithm of deflated price as the dependent variable and time (years) as the independent variable. RESULTS: On average, prices for less healthy foods and beverages increased more than prices of healthy foods and beverages (foods: 1.72% vs 0.70% change/year; beverages: 1.61% vs -0.19% change/year). The price change was similar for unprocessed/minimally processed foods and ultraprocessed foods (1.95% vs 1.85% change/year); however, within each processing category, the price of less healthy foods increased more. By pairs of substitutes (within food/beverage groups), the healthier option for bread, sodas, and poultry was more expensive (price/100 g) in 2018, whereas for red meat, cheese, mayonnaise, and milk, the healthier option was cheaper. CONCLUSIONS: Overall, the food prices of less healthy foods and beverages increased more than the food prices of healthy foods and beverages. However, by processing level there was no difference, and for pairs of healthy/less healthy substitutes results were mixed. Continued monitoring of food prices is warranted, and future research is needed to understand how these price changes affect dietary quality.

Changes in food pricing and availability on the Navajo Nation following a 2% tax on unhealthy foods: The Healthy Diné Nation Act of 2014.

INTRODUCTION: In 2014, the Navajo Nation Healthy Diné Nation Act (HDNA) was passed, combining a 2% tax on foods of 'minimal-to-no-nutritional value' and waiver of 5% sales tax on healthy foods, the first-ever such tax in the U.S. and globally among a sovereign tribal nation. The aim of this study was to measure changes in pricing and food availability in stores on the Navajo Nation following the implementation of the HDNA. METHODS: Store observations were conducted in 2013 and 2019 using the Nutrition Environment Measurement Survey-Stores (NEMS-S) adapted for the Navajo Nation. Observations included store location, type, whether healthy foods or HDNA were promoted, and availability and pricing of fresh fruits and vegetables, canned items, beverages, water, snacks and traditional foods. Differences between 2013 and 2019 and by store type and location were tested. RESULTS: The matched sample included 71 stores (51 in the Navajo Nation and 20 in border towns). In 2019, fresh produce was available in the majority of Navajo stores, with 71% selling at least 3 types of fruit and 65% selling at least 3 types of vegetables. Compared with border town convenience stores, Navajo convenience stores had greater availability of fresh vegetables and comparable availability of fresh fruit in 2019. The average cost per item of fresh fruit decreased by 13% in Navajo stores (from $0.88 to $0.76) and increased in border stores (from $0.63 to $0.73), resulting in comparable prices in Navajo and border stores in 2019. While more Navajo stores offered mutton, blue corn and wild plants in 2019 compared to 2013, these changes were not statistically significant. DISCUSSION: The findings suggest modest improvements in the Navajo store environment and high availability of fruits and vegetables. Navajo stores play an important role in the local food system and provide access to local, healthy foods for individuals living in this rural, tribal community.

Production, Consumption, and Potential Public Health Impact of Low- and No-Alcohol Products: Results of a Scoping Review.

Switching from higher strength to low- and no-alcohol products could result in consumers buying and drinking fewer grams of ethanol. We undertook a scoping review with systematic searches of English language publications between 1 January 2010 and 17 January 2021 using PubMed and Web of Science, covering production, consumption, and policy drivers related to low- and no-alcohol products. Seventy publications were included in our review. We found no publications comparing a life cycle assessment of health and environmental impacts between alcohol-free and regular-strength products. Three publications of low- and no-alcohol beers found only limited penetration of sales compared with higher strength beers. Two publications from only one jurisdiction (Great Britain) suggested that sales of no- and low-alcohol beers replaced rather than added to sales of higher strength beers. Eight publications indicated that taste, prior experiences, brand, health and wellbeing issues, price differentials, and overall decreases in the social stigma associated with drinking alcohol-free beverages were drivers of the purchase and consumption of low- and no-alcohol beers and wines. Three papers indicated confusion amongst consumers with respect to the labelling of low- and no-alcohol products. One paper indicated that the introduction of a minimum unit price in both Scotland and Wales favoured shifts in purchases from higher- to lower-strength beers. The evidence base for the potential beneficial health impact of low- and no-alcohol products is very limited and needs considerable expansion. At present, the evidence base could be considered inadequate to inform policy.

Socioeconomic Disparities in Foods/Beverages and Nutrients Consumed by U.S. Adolescents When Snacking: National Health and Nutrition Examination Survey 2005-2018.

Snacking contributes a significant portion of adolescents' daily energy intake and is associated with poor overall diet and increased body mass index. Adolescents from low socioeconomic status (SES) households have poorer snacking behaviors than their higher-SES counterparts. However, it is unclear if the types of food/beverages and nutrients consumed during snacking differ by SES among adolescents. Therefore, this study examines SES disparities in the aforementioned snacking characteristics by analyzing the data of 7132 adolescents (12-19 years) from the National Health and Nutrition Examination Survey 2005-2018. Results reveal that adolescents from low-income households (poverty-to-income ratio (PIR) ≤ 1.3) have lower odds of consuming the food/beverage categories "Milk and Dairy" (aOR: 0.74; 95% CI: 0.58-0.95; p = 0.007) and "Fruits" (aOR: 0.62, 95% CI: 0.50-0.78; p = 0.001) as snacks and higher odds of consuming "Beverages" (aOR: 1.45; 95% CI: 1.19-1.76; p = 0.001) compared to those from high-income households (PIR > 3.5). Additionally, adolescents from low- and middle-income (PIR > 1.3-3.5) households consume more added sugar (7.98 and 7.78 g vs. 6.66 g; p = 0.012, p = 0.026) and less fiber (0.78 and 0.77 g vs. 0.84 g; p = 0.044, p = 0.019) from snacks compared to their high-income counterparts. Future research is necessary to understand factors that influence snacking among adolescents, and interventions are needed, especially for adolescents from low-SES communities.

Distribution and patterns of use of food additives in foods and beverages available in Brazilian supermarkets.

The growing consumption of ultra-processed foods and beverages has drawn attention to the use of different food additives in these products. The use of these additives for different purposes in food products is permitted under specific legislation. The objective of the present study was to assess the distribution and patterns of occurrence of the different categories of food additives present in packaged foods and beverages sold in Brazil. A descriptive cross-sectional study was conducted based on data from lists of ingredients used in foods and beverages sold in supermarkets in Brazil, collected by photographing product labels. The number, technological purpose and proportion of food additives in 9856 items (25 groups) were assessed. Exploratory factor analysis was employed to derive the patterns of food additive categories. Linear regression models were used to assess the association between the patterns and food items analyzed. Only 20.6% of the products analyzed contained no food additives, while 24.8% contained ≥6 additives. The use of food additives was high, particularly cosmetic additives, predominantly flavoring agents, colorings and stabilizers. Five patterns of food additive categories were identified and associated with ultra-processed foods and beverages. The results revealed that food additives are highly prevalent in several types of food items sold in the Brazilian market. Also, the same additive category was common to several different food groups, as were specific food additive combinations. This exposure is potentially harmful to human health, given the known deleterious effects associated with the consumption of these substances.

Favorable Commercial and Health Behavior Impacts of a Healthy Vending Policy at an Australian University.

BACKGROUND: The World Health Organization recognizes universities as an important health-promotion setting, including in healthy food provision. Previous research shows that healthy food retail interventions also need to consider commercial sustainability, including financial outcomes, and should take a holistic approach to consumer experience. OBJECTIVE: Our aim was to determine the health behavior and commercial outcomes of a multicomponent traffic light-based healthy vending policy implemented as one part of a holistic university food policy. The hypothesis was that purchases of less healthy "red" beverages would decrease compared with predicted sales, that purchases of healthier "green" and "amber" alternatives would increase, and that there would be no change in revenue. DESIGN: A quasi-experimental design evaluated a real-world food policy using monthly aggregated sales data to compare pre-intervention (January 2016 to March 2018) and post-intervention period sales (December 2018 to December 2019). PARTICIPANTS/SETTING: Electronic sales data were collected from 51 beverage vending machines across 4 university campuses in Victoria, Australia. INTERVENTION: A multicomponent policy was implemented between April and November 2018. Beverages were classified using a voluntary state government traffic light framework. Policy included display ≤20% red beverages and ≥50% green beverages; machine traffic light labeling; health-promoting machine branding; review of machine placement; and recycled bottle packaging. MAIN OUTCOME MEASURES: Changes in red, amber, and green volume sales, and revenue compared with predicated sales. STATISTICAL ANALYSES PERFORMED: Interrupted time series analysis of sales data compared post-policy sales with predicted sales. RESULTS: In the 13th month post-policy implementation, there was a 93.2% (95% CI +35.9% to +150.5%) increase in total beverage volume sold and an 88.6% (95% CI +39.2% to +138.1%) increase in revenue. There was no change in red beverage volume sold, but increases in green (+120.8%; 95% CI +59.0% to +182.6%) and amber (+223.2%; 95% CI +122.4% to +323.9%) volume sold. CONCLUSIONS: Sustained behavior change and commercial outcomes suggest that holistic vending interventions can effectively promote healthier beverage sales.

Shifting toward a healthier dietary pattern through nudging and pricing strategies: A secondary analysis of a randomized virtual supermarket experiment.

BACKGROUND: Nudging and salient pricing are promising strategies to promote healthy food purchases, but it is possible their effects differ across food groups. OBJECTIVE: To investigate in which food groups nudging and/or pricing strategies most effectively changed product purchases and resulted in within-food groups substitutions or spillover effects. METHODS: In total, 318 participants successfully completed a web-based virtual supermarket experiment in the Netherlands. We conducted a secondary analysis of a mixed randomized experiment consisting of 5 conditions (within subject) and 3 arms (between subject) to investigate the single and combined effects of nudging (e.g., making healthy products salient), taxes (25% price increase), and/or subsidies (25% price decrease) across food groups (fruit and vegetables, grains, dairy, protein products, fats, beverages, snacks, and other foods). Generalized linear mixed models were used to estimate the incidence rate ratios and 95% CIs for changes in the number of products purchased. RESULTS: Compared with the control condition, the combination of subsidies on healthy products and taxes on unhealthy products in the nudging and price salience condition was overall the most effective, as the number of healthy purchases from fruit and vegetables increased by 9% [incidence rate ratio (IRR) = 1.09; 95% CI: 1.02, 1.18], grains by 16% (IRR = 1.16; 95% CI: 1.05, 1.28), and dairy by 58% (IRR = 1.58; 95% CI: 1.31, 1.89), whereas the protein and beverage purchases did not significantly change. Regarding unhealthy purchases, grains decreased by 39% (IRR = 0.72; 95% CI: 0.63, 0.82) and dairy by 30% (IRR = 0.77; 95% CI: 0.68, 0.87), whereas beverage and snack purchases did not significantly change. The groups of grains and dairy showed within-food group substitution patterns toward healthier products. Beneficial spillover effects to minimally targeted food groups were seen for unhealthy proteins (IRR = 0.81; 95% CI: 0.73, 0.91). CONCLUSIONS: Nudging and salient pricing strategies have a differential effect on purchases of a variety of food groups. The largest effects were found for dairy and grains, which may therefore be the most promising food groups to target in order to achieve healthier purchases. The randomized trial on which the current secondary analyses were based is registered in the Dutch trial registry (NTR7293; www.trialregister.nl).

¿Cuál es el efecto de los impuestos a bebidas azucaradas sobre su consumo en la población general? / What is the effect of beverage taxes sugars on its consumption in the general population?

INTRODUCCIÓN: La malnutrición por exceso, junto con las enfermedades crónicas no transmisibles, se han convertido en un importante problema de salud pública mundial, con un 39% de la población adulta con sobrepeso, y un 13% obesidad (1). Una dieta insuficiente, alta en calorías, grasas y azúcares, está estrechamente relacionada con enfermedades crónicas no transmisibles (cáncer, diabetes, hipertensión, enfermedades cardiovasculares, entre otras)(2,3). Así mismo, se ha descrito que una dieta saludable podría prevenir una de cada cinco muertes a nivel mundial, independiente del sexo, edad o nivel socioeconómico(2). Chile presenta una de las prevalencias más altas de sobrepeso y obesidad en adultos globalmente con un 75%, según los datos de la última Encuesta Nacional de Salud (ENS) (4). Un 82% de la carga de enfermedad en Chile está dada por las enfermedades crónicas no transmisibles, como diabetes, cáncer, hipertensión y enfermedades cardiovasculares (5). Como ejemplo, la diabetes en Chile causó 3.426 muertes en el año 2014 y su prevalencia en personas mayores de 15 años alcanza al 10%, mientras que la prevalencia de hipertensión llega al 28% y al 27% las enfermedades cardiovasculares (5). El gasto público total relacionado con obesidad en Chile es de un 3%, lo que equivale al 0,5% del Producto Interno Bruto (PIB) chileno, equivalente a 455 mil millones de pesos anuales (6,7). RESUMEN DE LOS HALLAZGOS: A partir de la metodología descrita anteriormente, se identificaron inicialmente 466 revisiones sistemáticas. De estas, se excluyeron 450 por disenso o duplicados y se incluyeron finalmente 16 revisiones sistemáticas (RS) (17­32) publicadas entre 2010 y 2020. A los estudios primarios evaluados por estas RS se le aplicaron los mismos criterios de inclusión y exclusión presentados en el recuadro de metodología. Del total de estudios incluidos por las RS, 51 estudios primarios reportados en 54 referencias (33­86) evaluaron los efectos de los impuestos en el consumo de bebidas azucaradas. Una vez evaluado el diseño y la metodología de los estudios primarios identificados, 29 estudios fueron excluidos del análisis dado que no cumplían con los criterios EPOC para estimar el efecto de la intervención (87). Cuatro estudios eran transversales (43,48,53,56), 19 estudios eran de modelamiento (33­35,37­42,44­46,49,51,52,55,57,59,60,84,85) y 6 estudios no contaban con los suficientes puntos de datos (data points) o no identificaban claramente la fecha de la intervención como para poder incorporarlos en el análisis (36,50,54,58,61,82). Los estudios transversales se excluyeron dado que es difícil atribuir causalidad a los resultados provenientes de ellos (87) y en el caso de los estudios de modelación, se consideró que frente a la disponibilidad de evidencia directa, la inclusión de este tipo de estudios -que "predice" la evidencia- no aplicaría (88). Con estos criterios, se consideraron finalmente 22 estudios primarios (47,62­81,83,86), de los cuales 3 son ensayos controlados aleatorizados (ECAs)(68,70,72) y 19 corresponden a estudios observacionales (principalmente series de tiempo interrumpido y antes-después controlados)(47,62­67,69,71,73­81,83,86). El diseño original de dos de los estudios evaluados corresponde a un ensayo aleatorizado (83,86), sin embargo, los estudios evaluaron más de una intervención y su aleatorización no fue de acuerdo a la exposición o no a impuestos, por lo que para este informe se les ha considerado como estudios observacionales. Los hallazgos aquí presentados se han separado de acuerdo a tipo de outcome, diseño de estudio, y país, estado o ciudad donde se aplicó el impuesto. Cada hallazgo contiene además una tabla resumen con los resultados, mostrando la certeza en la evidencia de cada uno de los desenlaces encontrados. CONSIDERACIONES DE IMPLEMENTACIÓN: Para el análisis de las consideraciones de implementación, durante la selección de títulos, resúmenes y texto completo de esta síntesis, se realizó una selección de revisiones sistemáticas que pudieran entregar antecedentes para el análisis de la aplicabilidad de la evidencia al contexto local, consideraciones económicas, equidad y de monitoreo y evaluación. Además, se realizaron búsquedas complementarias de antecedentes nacionales. Consideraciones de Aplicabilidad: La evidencia analizada se basa en 3 ensayos controlados aleatorizados realizados en los Países Bajos y Estados Unidos y de 16 estudios observacionales (diseño de series de tiempo interrumpido o antes-después controlado) provenientes de 6 países donde efectivamente se aplicó un impuesto sobre las bebidas azucaradas (Chile, España, Francia, México, Reino Unido y Estados Unidos). En algunos casos el impuesto se aplicó a un estado o comunidad autónoma, mientras que en otros, se aplicó en todo el país. Esta síntesis de evidencia consideró como desenlace prioritario el consumo de bebidas azucaradas, lo que fue evaluado a través de la ingesta o de manera indirecta a través de las compras y ventas de este tipo de bebidas. No fue priorizado el impacto del impuesto sobre el estado de salud de las personas, entendido como sobrepeso, obesidad o enfermedades cardiovasculares, dado que el desarrollo de éstos es multifactorial y el efecto percibido de los impuestos podría estar sujeto a otros factores que aportan confusión, a juicio del solicitante. La unidad de análisis de los estudios seleccionados fueron adolescentes, personas adultas, hogares o población general, y ventas o compras en supermercados o tiendas. Consideraciones Económicas: Se ha descrito que los impuestos en alimentos y bebidas altos en nutrientes críticos podrían mostrar elasticidad-precio negativa en su consumo, lo que significa que la compra y consumo de estos disminuye en función al aumento de su precio (20,21). Al respecto, los estudios chilenos (67,69) no detectaron cambios importantes en el precio de las bebidas azucaradas tras la aplicación del impuesto. Una de las explicaciones de esto es que los fabricantes reaccionaron estratégicamente para absorber total o parcialmente la carga tributaria adicional, evitando que se transfiriera el impuesto al precio final de las bebidas azucaradas o que compensaron el aumento del precio con aquellas bebidas en las que se redujo dicho impuesto. Consideraciones de Equidad: Se debe tener en cuenta si la propuesta de gravamen tendrá un impacto en restricciones de libertad de selección de productos o si aumentará inequidades, afectando de forma desproporcionadas a algunos grupos. Se ha descrito que los impuestos a alimentos y bebidas podrían tener un efecto diferenciado por nivel socioeconómico (NSE), ya que frente a un aumento en el precio, es más probable que las personas de menores ingresos disminuyan el consumo de bienes no esenciales (17). Sin embargo, en el caso de Chile se reportó el efecto contrario. Nakamura et al., 2018 reportó que la magnitud de la reducción de bebidas compradas con impuestos altos fue mayor para el grupo de NSE alto que para el grupo de NSE medio y estadísticamente insignificante para el grupo de NSE bajo (69). Del mismo modo, Caro et al., 2018 encontró que los hogares con un NSE alto tuvieron una mayor disminución en el volumen de compras de bebidas altas en azúcar (−6,4%) que los hogares con un NSE bajo (−1,6%), en relación con sus respectivos contrafactuales (67). Consideraciones de Monitoreo y Evaluación: Chile ya tiene experiencia con la implementación innovadora de impuestos a bebidas azucaradas (67,69), por lo que es crucial identificar cuáles han sido y siguen siendo los facilitadores, barreras y contratiempos que se identificaron en este proceso. Así mismo, y como lo plantea Caro et al (67) junto con Nakamura et al. (69), se recomienda efectuar evaluaciones a corto, mediano y largo plazo, desde el comienzo de la ejecución de los impuestos, idealmente, incluyendo un grupo control para las comparaciones. Para poder evaluar de mejor forma los efectos de los impuestos de bebidas azucaradas, es importante diseñar un plan de monitoreo integral de la implementación de los impuestos, en todas sus etapas. La evaluación de los impuestos debe contemplar datos diagnósticos o línea base del consumo de los líquidos que serán gravados y mediciones de seguimiento post implementación (10,101).

Pass-through of the Oakland, California, sugar-sweetened beverage tax in food stores two years post-implementation: A difference-in-differences study.

INTRODUCTION: Taxes on sugar-sweetened beverages (SSBs) have gained support as a policy response to adverse health effects associated with SSB consumption. On July 1, 2017, Oakland, California, implemented a one-cent/ounce tax on SSBs with ≥25 calories/12 fluid ounces. This study estimated the long-term impact of the tax on taxed and untaxed beverage prices. METHODS: Data on 5,830 taxed and 5,146 untaxed beverage prices were obtained from 99 stores in Oakland and 111 stores in Sacramento (comparison site), California, in late May-June 2017 and June 2019. Linear regression difference-in-differences models were computed with store and product fixed effects, with robust standard errors clustered on store, weighted based on volume sold by beverage sweetener status, type, and size. RESULTS: Taxed beverage prices increased by 0.73 cents/ounce (95% CI = 0.47,1.00) on average in supermarkets and grocery stores in Oakland relative to Sacramento and 0.74 cents/ounce (95% CI = 0.39,1.09) in pharmacies, but did not change in convenience stores (-0.09 cents/ounce, 95% CI = -0.56,0.39). Untaxed beverage prices overall increased by 0.40 cents/ounce (95% CI = 0.05,0.75) in pharmacies but did not change in other store types. Prices of taxed individual-size soda specifically increased in all store types, by 0.91-2.39 cents/ounce (p<0.05), as did prices of untaxed individual-size soda in convenience stores (0.79 cents/ounce, 95% CI = 0.01,1.56) and pharmacies (1.66 cents/ounce, 95% CI = 0.09,3.23). CONCLUSIONS: Two years following SSB tax implementation, there was partial tax pass-through with differences by store type and by beverage type and size within store type.

Industry strategies in the parliamentary process of adopting a sugar-sweetened beverage tax in South Africa: a systematic mapping.

BACKGROUND: In 2016, the South African government became the first in the African region to announce the introduction of an SSB tax based on sugar content as a public health measure to reduce obesity. This tax was introduced against the backdrop of South Africa having a large sugar production and SSB manufacturing industry, as well as very high unemployment rates. The introduction of fiscal measures, such as a SSB tax, has been met with well-coordinated and funded opposition in other countries. METHODS: The aim of this study is to describe and analyse the arguments and strategies utilised by industry during policymaking processes to oppose regulatory actions in LMIC. This study analyses arguments and strategies used by the beverage and related industries during the public consultation phase of the process to adopt the South African SSB tax. RESULTS: Industry opposition to the SSB tax was comprehensive and employed several tactics. First, industry underscored its economic importance and the potential job losses and other economic harms that may arise from the tax. This argument was well-received by policymakers, and similar to industry tactics employed in other middle income countries like Mexico. Second, industry discussed self-regulation and voluntary measures as a form of policy substitution, which mirrors industry responses in the US, the Caribbean and Latin America. Third, industry misused or disputed evidence to undermine the perceived efficacy of the tax. Finally, considerations for small business and their ability to compete with multi-national corporations were a unique feature of industry response. CONCLUSIONS: Industry opposition followed both general trends, and also introduced nuanced and context-specific arguments. The industry response experienced in South Africa can be instructive for other countries contemplating the introduction of similar measures.

The Healthiness of Food and Beverages on Price Promotion at Promotional Displays: A Cross-Sectional Audit of Australian Supermarkets.

Supermarket environments can strongly influence purchasing decisions. Price promotions are recognised as a particularly persuasive tactic, but the healthiness of price promotions in prominent in-store locations is understudied. This study compared the prevalence and magnitude of price promotions on healthy and unhealthy food and beverages (foods) displayed at prominent in-store locations within Australian supermarkets, including analyses by supermarket group and area-level socio-economic position. A cross-sectional in-store audit of price promotions on foods at key display areas was undertaken in 104 randomly selected stores from major Australian supermarket groups (Woolworths, Coles, Aldi and independents) in Victoria, Australia. Of the display space dedicated to foods with price promotions, three of the four supermarket groups had a greater proportion of display space devoted to unhealthy (compared to healthy) foods at each promotional location measured (end of aisles: 66%; island bins: 53%; checkouts: 88%). Aldi offered very few price promotions. Few measures varied by area-level socio-economic position. This study demonstrated that price promotions at prominent in-store locations in Australian supermarkets favoured unhealthy foods. Marketing of this nature is likely to encourage the purchase of unhealthy foods, highlighting the need for retailers and policy-makers to consider addressing in-store pricing and placement strategies to encourage healthier food environments.

Beverage milk consumption patterns in the United States: Who is substituting from dairy to plant-based beverages?

This research used a survey of 995 US households to explore how dairy milk and plant-based beverage substitutes were consumed. Long-term trends of declining beverage milk consumption have been exacerbated in recent years by increasing consumption of plant-based beverages. Although beverage milk consumption has been declining, total dairy consumption in the United States continues to increase, driven by growth in sales of cheese, butter, and yogurt. Using k-means cluster analysis, 3 consumption clusters for US households were identified. The largest cluster, consisting of 61.6% of households, consumed dairy milk with some regularity and consumed little or no plant-based beverages. A second cluster, flexitarian households, consisting of 15.6% of respondent households, frequently consumed both dairy milk and plant-based beverages. The third cluster, plant-based consumers, consisting of 22.8% of households, consumed almost exclusively plant-based beverages. Examining differences in demographics between clusters, flexitarian households were larger, more likely to include young children, more likely to include a vegetarian or vegan, and more liberal than traditional dairy-consuming households. Plant-based households had many similarities to flexitarian households. The flexitarian and plant-based clusters were willing to substitute plant-based beverages for dairy milk for almost all consumption uses.

Patterns of beverage purchases amongst British households: A latent class analysis.

BACKGROUND: Beverages, especially sugar-sweetened beverages (SSBs), have been increasingly subject to policies aimed at reducing their consumption as part of measures to tackle obesity. However, precision targeting of policies is difficult as information on what types of consumers they might affect, and to what degree, is missing. We fill this gap by creating a typology of beverage consumers in Great Britain (GB) based on observed beverage purchasing behaviour to determine what distinct types of beverage consumers exist, and what their socio-demographic (household) characteristics, dietary behaviours, and weight status are. METHODS AND FINDINGS: We used cross-sectional latent class analysis to characterise patterns of beverage purchases. We used data from the 2016 GB Kantar Fast-Moving Consumer Goods (FMCG) panel, a large representative household purchase panel of food and beverages brought home, and restricted our analyses to consumers who purchase beverages regularly (i.e., >52 l per household member annually) (n = 8,675). Six categories of beverages were used to classify households into latent classes: SSBs; diet beverages; fruit juices and milk-based beverages; beer and cider; wine; and bottled water. Multinomial logistic regression and linear regression were used to relate class membership to household characteristics, self-reported weight status, and other dietary behaviours, derived from GB Kantar FMCG. Seven latent classes were identified, characterised primarily by higher purchases of 1 or 2 categories of beverages: 'SSB' (18% of the sample; median SSB volume = 49.4 l/household member/year; median diet beverage volume = 38.0 l), 'Diet' (16%; median diet beverage volume = 94.4 l), 'Fruit & Milk' (6%; median fruit juice/milk-based beverage volume = 30.0 l), 'Beer & Cider' (7%; median beer and cider volume = 36.3 l; median diet beverage volume = 55.6 l), 'Wine' (18%; median wine volume = 25.5 l; median diet beverage volume = 34.3 l), 'Water' (4%; median water volume = 46.9 l), and 'Diverse' (30%; diversity of purchases, including median SSB volume = 22.4 l). Income was positively associated with being classified in the Diverse class, whereas low social grade was more likely for households in the classes SSB, Diet, and Beer & Cider. Obesity (BMI > 30 kg/m2) was more prevalent in the class Diet (41.2%, 95% CI 37.7%-44.7%) despite households obtaining little energy from beverages in that class (17.9 kcal/household member/day, 95% CI 16.2-19.7). Overweight/obesity (BMI > 25 kg/m2) was above average in the class SSB (66.8%, 95% CI 63.7%-69.9%). When looking at all groceries, households from the class SSB had higher total energy purchases (1,943.6 kcal/household member/day, 95% CI 1,901.7-1,985.6), a smaller proportion of energy from fruits and vegetables (6.0%, 95% CI 5.8%-6.3%), and a greater proportion of energy from less healthy food and beverages (54.6%, 95% CI 54.0%-55.1%) than other classes. A greater proportion of energy from sweet snacks was observed for households in the classes SSB (18.5%, 95% CI 18.1%-19.0%) and Diet (18.8%, 95% CI 18.3%-19.3%). The main limitation of our analyses, in common with other studies, is that our data do not include information on food and beverage purchases that are consumed outside the home. CONCLUSIONS: Amongst households that regularly purchase beverages, those that mainly purchased high volumes of SSBs or diet beverages were at greater risk of obesity and tended to purchase less healthy foods, including a high proportion of energy from sweet snacks. These households might additionally benefit from policies targeting unhealthy foods, such as sweet snacks, as a way of reducing excess energy intake.

Inventory of marketing techniques used in child-appealing food and beverage research: a rapid review.

OBJECTIVES: Restrictions on child-appealing food and beverage marketing have been prioritized globally. However, the concept of "child-appealing marketing" has not been consistently defined, leading to variability in policies and research. The objective of this review was therefore to generate an inventory of the marketing techniques that have been used in research to identify child-appealing marketing. METHODS: Based on WHO guidelines, this review identified primary research that analyzed child-appealing marketing techniques, using the OVID Medline database and hand searches in Google Scholar and PubMed. All marketing techniques were extracted, counted, and synthesized into an inventory, organized thematically and by popularity. RESULTS: From 133 publications, 1421 marketing techniques were extracted (mean 10.7/publication; range: 1-66). The final inventory included 117 techniques; the "use of characters, children, and actors" was the most popular theme. CONCLUSIONS: The inventory and categorization generated by this research can be used for informing future research and for alerting policy-makers globally to the breadth of child-appealing food and beverage marketing techniques, helping move toward a consistent and comprehensive definition of child-appealing marketing in regulations aimed at restricting this type of marketing.

Higher Sugar-Sweetened Beverage Retail Prices After Excise Taxes in Oakland and San Francisco.

Objectives. To examine how much sugar-sweetened beverage (SSB) excise taxes increased SSB retail prices in Oakland and San Francisco, California.Methods. We collected pretax (April-May 2017) and posttax (April-May 2018) retail prices of SSBs and non-SSBs from 155 stores in Oakland, San Francisco, and comparison cities. We analyzed data using difference-in-differences high-dimensional fixed-effects regressions, weighted by regional beverage sales.Results. Across all beverage sizes, the weighted average price of SSBs increased by 0.92 cents per ounce (95% confidence interval [CI] = 0.28, 1.56) in Oakland and 1.00 cents per ounce (95% CI = 0.35, 1.65) in San Francisco, compared with prices in untaxed cities. The tax did not significantly alter prices of water, 100% juice, or milk of any size examined. Diet soda only, among non-SSBs, exhibited a higher price increase for some sizes in taxed cities.Conclusions. Within 4 to 10 months of implementation, Oakland's and San Francisco's SSB excise taxes significantly increased SSB retail prices by approximately the amount of the taxes, a key mechanism for reducing consumption.

Reducing consumption of unhealthy foods and beverages through banning price promotions: what is the evidence and will it work?

OBJECTIVE: Increasing prevalence of overweight and obese people in England has led policymakers to consider regulating the use of price promotions on foods high in fat, sugar and salt content. In January 2019, the government opened a consultation programme for a policy proposal that significantly restricts the use of price promotions that can induce consumers to buy higher volumes of unhealthy foods and beverages. These proposed policies are the first of their kind in public health and are believed to reduce excess purchasing and, therefore, overconsumption of unhealthy products. This study summarises evidence relating price promotions to the purchasing of food and drink for home consumption and places it in the context of the proposed policy. DESIGN: Non-systematic review of quantitative analyses of price promotions in food and drink published in peer-reviewed journals and sighted by PubMed, ScienceDirect & EBSCOhost between 1980 and January 2018. RESULTS: While the impact of price promotions on sales has been of interest to marketing academics for a long time with modelling studies showing that its use has increased food and drink sales by 12-43 %, it is only now being picked up in the public health sphere. However, existing evidence does not consider the effects of removing or restricting the use of price promotions across the food sector. In this commentary, we discuss existing evidence, how it deals with the complexity of shoppers' behaviour in reacting to price promotions on foods and, importantly, what can be learned from it in this policy context. CONCLUSIONS: The current evidence base supports the notion that price promotions increase purchasing of unhealthy food, and while the proposed restriction policy is yet to be evaluated for consumption and health effects, there is arguably sufficient evidence to proceed. This evidence is not restricted to volume-based promotions. Close monitoring and proper evaluation should follow to provide empirical evidence of its intended and unintended effects.

[Asessment of television food marketing for children according to Ministry of Health nutrition profile guidelines]. / Ulusal yayin yapan bazi uluslararasi çocuk televizyon kanallarinda çocuklara yönelik gida ve içecek reklamlarinin Saglik Bakanligi besin profili rehberine göre degerlendirilmesi.

Obesity is a growing problem in infants, children, and adolescents in our country and all over the world. Obese children usually remain obese in their adulthood and they are risk of chronic diseases. In our country, » (24.5%) of 2nd grade students in primary school, approximately 1/3 (30.1%) of middle school students and 1/5 (20.6%) of high school students are obese/overweight. This study was conducted to evaluate TV advertising of these products according to the Healthy Nutrition and Active Life Program of the Turkish Ministry of Health, which is based on World Health Organization recommendations. It was observed that there were numerous inappropriate increased number and time food and beverage advertisements broadcast during programming directed at children. Monitoring and evaluation of mechanisms should be founded according to the 27.03.2018 regulation about Broadcast Service Procedures and Principles initiated by Radio and Television Supreme Council (RTÜK). It is important to encourage healthy habits and take measures to prevent chronic diseases such as obesity in childhood.