Prevalence and Types of Non-Nutritive Sweeteners in the New Zealand Food Supply, 2013 and 2019.

The widely recognized association between high sugar intakes and adverse health outcomes has increased consumer demand for products lower in sugar. This may lead to increased use of other sweeteners by the food industry. The current study investigated the prevalence and types of non-nutritive sweeteners over time (2013-2019) in New Zealand's packaged food and beverages, overall and between categories. A New Zealand database of packaged foods and beverages was used to investigate the presence of Food Standards Australia New Zealand Code-approved non-nutritive sweeteners (n = 12). Products available in 2013 (n = 12,153) and 2019 (n = 14,645) were compared. Between 2013 and 2019, the prevalence of non-nutritive sweeteners in products increased from 3% to 5%. The most common non-nutritive sweeteners in both years were acesulphame-potassium, sucralose, aspartame, and stevia, which were predominantly found in special foods (breakfast beverages and nutritional supplements), non-alcoholic beverages, dairy products, and confectionery. The prevalence of non-nutritive sweeteners is increasing over time in New Zealand's packaged foods and beverages and is likely a consequence of consumer demand for lower-sugar products. Ongoing monitoring of the prevalence and type of NNS is important to detect further increases.

Simulating international tax designs on sugar-sweetened beverages in Mexico.

In response to the high prevalence of overweight and obesity, Mexico implemented a volumetric tax of one Mexican peso (MP) per liter of sugar-sweetened beverage (SSB) in 2014. In contrast to Mexico's volumetric tax design, the United Kingdom (UK) and South Africa (ZA) implemented SSB taxes based on sugar density. This kind of tax is likely to yield larger health benefits than volumetric taxes by imposing a larger tax burden on high-sugar SSB and/or encouraging reformulation. However, sugar-density taxes might yield lower tax revenues. This study aims to simulate the effect of sugar-density taxes as those in the UK and ZA on SSB purchases (in terms of volume and sugar), SSB prices, and tax revenue in Mexico and compare this effect to its counterpart under the current volumetric SSB tax. Additionally, we simulate the effect of sugar-density taxes under different scenarios of reformulation. We conducted all these simulations based on a structural model of demand and supply using household purchase data for 2012-2015 in urban Mexico. We found that the current volumetric one-MP tax led to an SSB purchase reduction of 19% for both volume and sugar and an SSB price increases by MP $1.24. We simulated similar effects under the UK and ZA sugar-density taxes when these taxes were equivalent to the volumetric one-MP tax, and there was no reformulation. When assuming reformulation, the sugar reduction under the sugar-density taxes was up to twice larger than the volumetric one-MP tax. However, we found that the volumetric one-MP tax yielded the largest tax revenue across all tax designs. From a public health perspective, sugar-density taxes are likely to be more effective in tackling the overweight and obesity prevalence in Mexico; however, tax revenue might be lower under these taxes.

A Graded Approach to Intravenous Dextrose for Neonatal Hypoglycemia Decreases Blood Glucose Variability, Time in the Neonatal Intensive Care Unit, and Cost of Stay.

OBJECTIVE: To determine associations between a graded approach to intravenous (IV) dextrose treatment for neonatal hypoglycemia and changes in blood glucose (BG), length of stay (LOS), and cost of care. STUDY DESIGN: Retrospective cohort study of 277 infants born at ≥35 weeks of gestation in an urban academic delivery hospital, comparing the change in BG after IV dextrose initiation, neonatal intensive care unit (NICU) LOS, and cost of care in epochs before and after a hospital protocol change. During epoch 1, all infants who needed IV dextrose for hypoglycemia were given a bolus and started on IV dextrose at 60 mL/kg/day. During epoch 2, infants received IV dextrose at 30 or 60 mL/kg/day based on the degree of hypoglycemia. Differences in BG outcomes, LOS, and cost of hospital care between epochs were compared using adjusted median regression. RESULTS: In epoch 2, the median (IQR) rise in BG after initiating IV dextrose (19 [10, 31] mg/dL) was significantly lower than in epoch 1 (24 [14,37] mg/dL; adjusted ß = -6.0 mg/dL, 95% CI -11.2, -0.8). Time to normoglycemia did not differ significantly between epochs. NICU days decreased from a median (IQR) of 4.5 (2.1, 11.0) to 3.0 (1.5, 6.5) (adjusted ß = -1.9, 95% CI -3.0, -0.7). Costs associated with NICU hospitalization decreased from a median (IQR) $14 030 ($5847, $30 753) to $8470 ($5650, $19 019) (adjusted ß = -$4417, 95% CI -$571, -$8263) after guideline implementation. CONCLUSIONS: A graded approach to IV dextrose was associated with decreased BG lability and length and cost of NICU stay for infants with neonatal hypoglycemia.

Cost-Utility Analysis of Prophylactic Dextrose Gel vs Standard Care for Neonatal Hypoglycemia in At-Risk Infants.

OBJECTIVE: To evaluate the long-term costs and impact on quality of life of using prophylactic dextrose gel in patients at increased risk of developing neonatal hypoglycemia. STUDY DESIGN: A cost-utility analysis was performed from the perspective of the health system, using a decision tree to model the long-term clinical outcomes of neonatal hypoglycemia, including cerebral palsy, epilepsy, vision disturbances, and learning disabilities, in patients at increased risk of neonatal hypoglycemia who received prophylactic dextrose gel vs standard care. Model parameters including likelihoods of hypoglycemia and admission to a neonatal intensive care unit, were based on the pre-Hypoglycemia Prevention with Oral Dextrose Study. Estimations of the likelihood of long-term condition(s), and their costs, were based on review of published literature. RESULTS: Patients who received prophylactic dextrose gel incurred costs to the health system of around US $14 000 over an 18-year time horizon, accruing 11.25 quality-adjusted life-years, whereas those who did not receive prophylactic treatment incurred cost of around $16 000 and experienced a utility of 11.10 quality-adjusted life-years. CONCLUSIONS: A prophylactic strategy of using dextrose gel in infants at increased risk of neonatal hypoglycemia is likely to be cost effective compared with standard care, to reduce the direct costs to the health system over an 18-year time horizon, and improve quality of life.

Corporations' use and misuse of evidence to influence health policy: a case study of sugar-sweetened beverage taxation.

BACKGROUND: Sugar sweetened beverages (SSB) are a major source of sugar in the diet. Although trends in consumption vary across regions, in many countries, particularly LMICs, their consumption continues to increase. In response, a growing number of governments have introduced a tax on SSBs. SSB manufacturers have opposed such taxes, disputing the role that SSBs play in diet-related diseases and the effectiveness of SSB taxation, and alleging major economic impacts. Given the importance of evidence to effective regulation of products harmful to human health, we scrutinised industry submissions to the South African government's consultation on a proposed SSB tax and examined their use of evidence. RESULTS: Corporate submissions were underpinned by several strategies involving the misrepresentation of evidence. First, references were used in a misleading way, providing false support for key claims. Second, raw data, which represented a pliable, alternative evidence base to peer reviewed studies, was misused to dispute both the premise of targeting sugar for special attention and the impact of SSB taxes on SSB consumption. Third, purposively selected evidence was used in conjunction with other techniques, such as selective quoting from studies and omitting important qualifying information, to promote an alternative evidential narrative to that supported by the weight of peer-reviewed research. Fourth, a range of mutually enforcing techniques that inflated the effects of SSB taxation on jobs, public revenue generation, and gross domestic product, was used to exaggerate the economic impact of the tax. This "hyperbolic accounting" included rounding up figures in original sources, double counting, and skipping steps in economic modelling. CONCLUSIONS: Our research raises fundamental questions concerning the bona fides of industry information in the context of government efforts to combat diet-related diseases. The beverage industry's claims against SSB taxation rest on a complex interplay of techniques, that appear to be grounded in evidence, but which do not observe widely accepted approaches to the use of either scientific or economic evidence. These techniques are similar, but not identical, to those used by tobacco companies and highlight the problems of introducing evidence-based policies aimed at managing the market environment for unhealthful commodities.

Sugar-sweetened beverage affordability and the prevalence of overweight and obesity in a cross section of countries.

BACKGROUND: A key component of 'obesogenic environments' is the ready availability of convenient, calorie-dense foods, in the form of hyper-palatable and relatively inexpensive ultra-processed products. Compelling evidence indicates that the regular consumption of soft drinks, specifically carbonated and non-carbonated sugar-sweetened beverages (SSBs), has a significant impact on the prevalence of overweight and obesity. However, to implement country-level effective prevention programmes we need to supplement this evidence with quantitative knowledge of the relationships between overweight/obesity and the main determinants of SSB consumption, notably SSB prices and consumers' disposable income. METHOD: Affordability considers the simultaneous effects of both price and disposable income on the buying decision. The purpose of this study was to investigate the effect of SSB affordability on the consumers' purchasing behaviour and weight-related health outcomes. Our study was divided into three parts. First, we computed SSB consumption and affordability for approximately 150 countries worldwide. Second, we estimated a demand function for SSBs to assess the impact of affordability on consumption at the country level. Third, we used a multivariate regression model and country data on the prevalence of overweight and obesity to test the role of SSB affordability in the current obesity epidemic. RESULTS: The analysis reveals that SSB affordability: 1) showed both a large variability across countries and a clear tendency to increase substantially with the level of economic development; 2) played a key role in determining cross-country differences in the amount of soft drink consumed per capita; and 3) was significantly associated with the prevalence rates of both overweight and obesity. Specifically, we show that a 10 % increase in SSB affordability was associated, on average, with approximately 0.4 more overweight/obese adults per 100 inhabitants. CONCLUSIONS: By controlling for the main possible confounding factors, our results clearly indicate that affordability is a major driver of purchasing behaviours and is significantly associated with the prevalence rates of both overweight and obesity. We thus suggest a fiscal approach to curb SSB consumption based on the effectiveness of 'soda taxes' to affect the long-term dynamic of SSB affordability.

The caries-related cost and effects of a tax on sugar-sweetened beverages.

OBJECTIVES: While taxes on sugar-sweetened beverages (SSBs) have frequently been proposed to reduce non-communicable diseases like obesity and type 2 diabetes, relatively little is known about the caries-related impacts of SSB taxation. We assessed the effect of a 20% ad valorem tax on SSBs on dental caries and related treatment costs, specifically taking into account that consumers may switch from SSBs to other (non-taxed) sugar-containing drinks. STUDY DESIGN: Cost-effectiveness analysis. METHODS: A tooth-level Markov model was developed to evaluate the cost and effects of SSB taxation. Tax-related changes in sugar consumption were calculated using available evidence on SSBs price and cross-price elasticities, thereby taking changes in drinks consumption behaviors into account. The model was used to establish lifetime disease-free tooth years, caries lesions prevented, caries-related treatment costs avoided, tax revenues, and administrative costs (reference case: the Netherlands). Deterministic and probabilistic sensitivity analyses were performed to address uncertainties. RESULTS: A 20% SSB taxation would result in an average of 2.13 (95% uncertainty interval [UI] 2.12-2.13) caries-free tooth years per person and, on population level, prevention of 1,030,163 (95% UI 1,027,903-1,032,423) caries lesions. The intervention was found to save an aggregate total of € 159.01 (95% UI 158.67-159.35) million in terms of dental care expenditures. The estimated lifetime tax revenues (€3.49billion) were larger than the administrative costs for taxation (€37.3 million). CONCLUSIONS: Our results show that SSB taxation may substantially improve oral health and reduce the caries-related economic burden. Benefits would be the greatest for younger age groups.

Modelling the impact of a tax on sweetened beverages in the Philippines: an extended cost-effectiveness analysis.

OBJECTIVE: To assess the potential impact of a new tax on sweetened beverages on premature deaths associated with noncommunicable diseases in the Philippines. METHODS: In January 2018, the Philippines began imposing a tax of 6 Philippine pesos per litre (around 13%) on sweetened beverages to curb the obesity burden. Using national data sources, we conducted an extended cost-effectiveness analysis to estimate the effect of the tax on the numbers of premature deaths averted attributed to type 2 diabetes mellitus, ischaemic heart disease and stroke, across income quintiles over the period 2018-2037. We also estimated the financial benefits of the tax from reductions in out-of-pocket payments, direct medical costs averted and government health-care cost savings. FINDINGS: The tax could avert an estimated 5913 deaths related to diabetes, 10 339 deaths from ischaemic heart disease and 7950 deaths from stroke over 20 years. The largest number of deaths averted could be among the fourth and fifth (highest) income quintiles. The tax could generate total health-care savings of 31.6 billion Philippine pesos (627 million United States dollars, US$) over 20 years, and raise 41.0 billion Philippine pesos (US$ 813 million) in revenue per annum. The poorest quintile could bear the smallest tax burden increase (14% of the additional tax; 5.6 billion Philippine pesos) and have the lowest savings in out-of-pocket payments due to relatively large health-care subsidies. Finally, we estimated that 13 890 cases of catastrophic expenditure could be averted. CONCLUSION: The new sweetened beverage tax may help to reduce obesity-related premature deaths and improve financial well-being in the Philippines.

Development of a sweetened beverage tax, Philippines.

PROBLEM: Both sugar-sweetened beverage consumption and the incidence of obesity have increased in the Philippines in recent years. APPROACH: A proposal to tax sugar-sweetened beverages was introduced in the House of Representatives and merged into a proposed comprehensive Tax Reform for Acceleration and Inclusion (TRAIN) Bill to increase the likelihood of acceptance. The health department and finance department recommended a policy that would maximize benefits to both public health and government revenue. To advance discussions, the health department expanded the health argument to include the country's poor performance in oral health. The approved TRAIN Law adopted the term sweetened beverage to emphasize that the tax covers both sugar and non-sugar sweetened beverages. The tax rate was set to 6.00 Philippine pesos (0.111 United States dollars) per litre of sweetened beverages. The sugar industry successfully lobbied for higher tax rates on beverages containing high-fructose corn syrup, resulting in a differential rate of 12.00 Philippine pesos per litre. LOCAL SETTING: Despite a 12% value-added tax on sugar-sweetened beverages, sales had been sustained by enhanced marketing and product variants being offered in small portions. RELEVANT CHANGES: One month after implementation of the tax in 1 January 2018, prices of taxable sweetened beverages had increased by 16.6 to 20.6% and sales in sari-sari (convenience) stores had declined 8.7%. LESSONS LEARNT: The tax benefited from high-level government commitment and support, keeping policy simple reduced opportunities for tax avoidance and evasion, and taking both health and non-health considerations into account were helpful in arguing for the tax.

Assessing the impact of the Barbados sugar-sweetened beverage tax on beverage sales: an observational study.

BACKGROUND: The World Health Organization has advocated for sugar-sweetened beverage (SSB) taxes as part of a broader non-communicable disease prevention strategy, and these taxes have been recently introduced in a wide range of settings. However, much is still unknown about how SSB taxes operate in various contexts and as a result of different tax designs. In 2015, the Government of Barbados implemented a 10% ad valorem (value-based) tax on SSBs. It has been hypothesized that this tax structure may inadvertently encourage consumers to switch to cheaper sugary drinks. We aimed to assess whether and to what extent there has been a change in sales of SSBs following implementation of the SSB tax. METHODS: We used electronic point of sale data from a major grocery store chain and applied an interrupted time series (ITS) design to assess grocery store SSB and non-SSB sales from January 2013 to October 2016. We controlled for the underlying time trend, seasonality, inflation, tourism and holidays. We conducted sensitivity analyses using a cross-country control (Trinidad and Tobago) and a within-country control (vinegar). We included a post-hoc stratification by price tertile to assess the extent to which consumers may switch to cheaper sugary drinks. RESULTS: We found that average weekly sales of SSBs decreased by 4.3% (95%CI 3.6 to 4.9%) compared to expected sales without a tax, primarily driven by a decrease in carbonated SSBs sales of 3.6% (95%CI 2.9 to 4.4%). Sales of non-SSBs increased by 5.2% (95%CI 4.5 to 5.9%), with bottled water sales increasing by an average of 7.5% (95%CI 6.5 to 8.3%). The sensitivity analyses were consistent with the uncontrolled results. After stratifying by price, we found evidence of substitution to cheaper SSBs. CONCLUSIONS: This study suggests that the Barbados SSB tax was associated with decreased sales of SSBs in a major grocery store chain after controlling for underlying trends. This finding was robust to sensitivity analyses. We found evidence to suggest that consumers may have changed their behaviour in response to the tax by purchasing cheaper sugary drinks, in addition to substituting to untaxed products. This has important implications for the design of future SSB taxes.

Reduction in purchases of energy-dense nutrient-poor foods in Mexico associated with the introduction of a tax in 2014.

In 2014, an 8% tax on energy-dense nutrient-poor foods was implemented in Mexico with the aim of reducing its consumption. This paper estimated changes in household purchases of taxed food. We used the latest five waves of the nationally representative Mexican Income and Expenditure Survey (2008, 2010, 2012, 2014 and 2016). The analytic sample comprises 154,777 households. We estimated changes in purchases based on a before and after comparison. Results show a reduction in purchases of taxed food of -5.4 g/week per capita, equivalent to a relative reduction of -5.3% in the 2014 and 2016 waves compared to the 2008, 2010 and 2012 rounds. The largest relative reductions were in urban areas (-6.9%), among households with children (-7.0%), households where the head had an intermediate educational level (-9.9%) and the southern region (-14.8%). We did not find a significant reduction in rural areas. While there is a large heterogeneity, the fiscal instrument has been effective in reducing taxed food purchases and has generated substantial revenue that could be used to finance policies for the prevention and treatment of obesity.

The impact of a sugar-sweetened beverages tax on oral health and costs of dental care in Australia.

Background: Despite a clear causal link between frequent consumption of sugar-sweetened beverages (SSBs) and dental disease, little is known about the implications of a tax on SSBs in the context of oral health. The aim of our study was to estimate the impacts of a SSB tax on the Australian population in the context of oral health outcomes, dental care utilisation and associated costs. Methods: We designed a cohort model that accounted for the consequences of the tax through the mechanisms of consumer response to price increase, the effect on oral health due to change in sugar intake, and the implications for dental care use. Results: Our results indicate that in the adult population an ad valorem tax of 20% would lead to a reduction in decayed, missing and filled teeth (DMFT) by 3.9 million units over 10 years, resulting in cost savings of A$666 million. Scenario analyses show that the outcomes are sensitive to the choice of the time horizon, tax rate, price elasticity of demand for SSBs, and the definition of target population. Conclusion: We found that the total and per-person consequences of SSB tax were considerable, both in terms of dental caries (tooth decay) averted and dental care avoided. These results have to be compounded with the implications of SSB tax for other aspects of health and health care, especially in the context of chronic diseases. On the other hand, the improved outcomes have to be weighted against a welfare loss associated with introducing a tax.

[Position paper on taxes to non-basic energy-dense foods and sugar-sweetened beverages]. / Posicionamiento sobre los impuestos a alimentos no básicos densamente energéticos y bebidas azucaradas.

In 2014 the Mexican government implemented taxes to reduce the consumption of sugar-sweetened beverages and nonessential energy-dense foods. In this manuscript, we analyze the scientific evidence linking the consumption of these products to chronic diseases, and summarize the studies that have evaluated the observed and expected impact of food taxes in Mexico. The implementation of taxes to unhealthy foods has reduced purchases of sugar-sweetened beverages in 7.6% and nonessential energy-dense foods in 7.4%. A reduction in consumption could decrease obesity prevalence by 2.5%; prevent 20 000 cardiovascular disease events; 189 000 diabetes cases; and 20 000 cardiovascular deaths. Additionally, this impact could save nearly 1 173 million dollars from healthcare costs. Taxes to unhealthy foods should be strengthened up and remain as an integral part of the national strategy to reduce obesity and chronic diseases in Mexico.

En 2014, el gobierno mexicano implementó una política fiscal para disminuir el consumo de bebidas azucaradas y alimentos no básicos con alta densidad energética. Este documento resume y analiza los estudios que han evaluado el impacto observado y esperado de los impuestos a alimentos y bebidas no saludables en México. La implementación de impuestos ha logrado disminuir las compras de bebidas azucaradas en 7.6% y alimentos no básicos con alta densidad energética en 7.4%. La reducción de consumo de bebidas azucaradas podría reducir la obesidad en 2.5%, prevenir 20 000 casos de enfermedad cardiovascular y 189 000 casos de diabetes al año 2022, así como prevenir 2 000 muertes. Además, se espera que estos impuestos ayuden a reducir en 1 173 millones de dólares los costos de atención a la salud. Los impuestos a alimentos no saludables deben fortalecerse y permanecer como parte integral de la estrategia nacional dirigida a reducir la obesidad y las enfermedades crónicas en México.

The impact of the tax on sweetened beverages: a systematic review.

Background: Obesity has a serious impact on public health. Sugar-sweetened beverages (SSBs) are implicated in the obesity epidemic. Regulation has been suggested as one approach to limit consumption. Objective: The aim of this study was to synthesize existing evidence related to the impact of taxes on the consumption, purchase, or sales of SSBs. Design: A systematic review was conducted by using MEDLINE through PubMed (https://www.ncbi.nlm.nih.gov/pubmed), the Cochrane Library (http://www.cochranelibrary.com/), the Web of Science (https://login.webofknowledge.com/error/Error?PathInfo=%2F&Error=IPError), and Scopus (https://www.scopus.com/search/form.uri?display=basic) in the period 2011-2017 for studies that analyzed the impact of fiscal regulatory measures on the consumption, purchase, or sales of SSBs. The quality of evidence was assessed according to the CONSORT (Consolidated Standards of Reporting Trials) and the TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) statements. Results: Of the 17 studies, 5 (29.4%) evaluated the impact of a tax on SSBs in naturalistic experiments by county or city in the United States and in Mexico. Findings indicated that purchases or sales of SSBs decreased significantly with taxation amounts of 8% (Berkeley, CA) and 10% (Mexico). One study found no effect on sales of SSBs in 2 states that enacted a 5.5% tax on sodas. Twelve (70.6%) studies were based on virtual or experimental conditions evaluating either purchasing behavior or sales (6 studies; 50.0%) or behavioral intent (6 studies; 50.0%), resulting in a decrease in either purchasing behavior or sales or intent behavior with heterogeneity according to the tax rate. Conclusions: Taxation significantly influences planned purchases and increases the probability of the purchase of healthy beverages. SSB taxes have the potential to reduce calorie and sugar intake, but further research is needed to evaluate effects on diet quality.

Own-price, cross-price, and expenditure elasticities on sugar-sweetened beverages in Guatemala.

BACKGROUND: The obesity epidemic is spreading rapidly in Guatemala, a low/middle income country still struggling with undernutrition. Sugar sweetened beverages (SSBs) consumption is strongly associated with overweight, obesity, and non-communicable diseases. In Guatemala, SSBs are readily available and consumption is high, particularly among adolescents. SSB taxes have been proposed as a cost-effective way to reduce consumption and generate revenues for public health, as has been demonstrated in several countries around the world. OBJECTIVE: To estimate the price, expenditure, quality, and cross-price elasticity of beverage demand using household survey data. METHOD: We conducted a secondary analysis on the 2014 Guatemala Living Conditions National Survey that includes national representative household data on expenditure. Own price, expenditure, quality, and cross-price elasticities of milk, soft drinks, packaged juices, and bottled water were estimated using Deaton's Almost Ideal Demand System (AIDS), controlling for goods' quality. Household characteristics and beverage expenditure are summarized for urban and rural locations using descriptive statistics. RESULTS: Positive expenditure on soft drinks was highest (50.9% of households). Positive expenditure on bottled water was next for urban households (43.8%) and lowest for rural households (10.8%). Own-price elasticities for all beverages are negative and statistically significant. Own-price elasticity of soft drinks is -1.39, suggesting that with a 10% increase in price, consumption would decrease by 13.9%. Expenditure elasticity for soft drinks (0.99) suggests that a 10% household expenditure increase would result in a 9.9% increase in demand. Milk (0.07) and soft drinks (0.07) have positive quality elasticity implying that, as household total expenditure increases, the quality of these beverages, measured by their unit values, also increases. CONCLUSION: Soft drink demand is highly sensitive to changes in prices, suggesting that SSB taxes could significantly reduce consumption, which, in turn, could contribute to curbing the overweight/obesity epidemic.

Regulatory initiatives to reduce sugar-sweetened beverages (SSBs) in Latin America.

BACKGROUND AND OBJECTIVES: Latin American (LA) countries have begun to adopt a variety of regulations targeting sugar-sweetened beverages (SSBs) for public health reasons. Our objective was to characterize the regulatory strategies designed to reduce SSB consumption over the last decade, and assess the available evidence on their enforcement and impact. METHODS: We searched legal and public health databases for public and private SSBs regulations in 14 LA countries and then conducted a systematic review of the available literature. We tracked comparative variations in the type of body issuing the regulations, their scope, and binding status. We present data following a 5-category framework we named NUTRE that classifies SSBs regulations as: (1) restrictions to SSB availability in schools (N), (2) taxes and other economic incentives to discourage consumption (U), (3) restrictions on advertising and marketing (T), (4) regulations on government procurement and subsidies (R), and (5) product labeling rules (E). RESULTS: Since 2006, 14 LA countries have adopted at least 39 public and private SSB regulatory initiatives across the NUTRE framework. Comprehensive efforts have only been approved by Chile, México and Ecuador, while the rest have comparatively few initiatives. 28 out of the 39 regulatory initiatives were passed by legislative and executive bodies; 11 initiatives represent self-regulatory undertakings by the beverage industries. An 86% (24/28) of public sector regulations are binding; 56% (22/39) contain explicit monitoring or evaluation methods; and 62% (24/39) provide for sanctions. Moreover, 23 regulations specify the body in charge of monitoring the new rules and standards. CONCLUSIONS: LA countries are targeting SSB consumption through a variety of mechanisms, particularly via restrictions to availability in schools and through taxes. Interdisciplinary evidence comparing alternative regulatory strategies is scarce, and few studies offer data on impact and implementation challenges. More evidence and further comparative assessments are needed to support future decision-making.

Posicionamiento sobre los impuestos a alimentos no básicos densamente energéticos y bebidas azucaradas / Position paper on taxes to non-basic energy-dense foods and sugar-sweetened beverages

Resumen: En 2014, el gobierno mexicano implementó una política fiscal para disminuir el consumo de bebidas azucaradas y alimentos no básicos con alta densidad energética. Este documento resume y analiza los estudios que han evaluado el impacto observado y esperado de los impuestos a alimentos y bebidas no saludables en México. La implementación de impuestos ha logrado disminuir las compras de bebidas azucaradas en 7.6% y alimentos no básicos con alta densidad energética en 7.4%. La reducción de consumo de bebidas azucaradas podría reducir la obesidad en 2.5%, prevenir 20 000 casos de enfermedad cardiovascular y 189 000 casos de diabetes al año 2022, así como prevenir 2 000 muertes. Además, se espera que estos impuestos ayuden a reducir en 1 173 millones de dólares los costos de atención a la salud. Los impuestos a alimentos no saludables deben fortalecerse y permanecer como parte integral de la estrategia nacional dirigida a reducir la obesidad y las enfermedades crónicas en México.

Abstract: In 2014 the Mexican government implemented taxes to reduce the consumption of sugar-sweetened beverages and nonessential energy-dense foods. In this manuscript, we analyze the scientific evidence linking the consumption of these products to chronic diseases, and summarize the studies that have evaluated the observed and expected impact of food taxes in Mexico. The implementation of taxes to unhealthy foods has reduced purchases of sugar-sweetened beverages in 7.6% and nonessential energy-dense foods in 7.4%. A reduction in consumption could decrease obesity prevalence by 2.5%; prevent 20 000 cardiovascular disease events; 189 000 diabetes cases; and 20 000 cardiovascular deaths. Additionally, this impact could save nearly 1 173 million dollars from healthcare costs. Taxes to unhealthy foods should be strengthened up and remain as an integral part of the national strategy to reduce obesity and chronic diseases in Mexico.

Does the Mexican sugar-sweetened beverage tax have a signaling effect? ENSANUT 2016.

OBJECTIVE: To evaluate the potential signaling effect of the Mexican tax on sugar-sweetened beverages (SSBs) by analyzing the association between awareness of and opinions about its effectiveness with current consumption of taxed SSBs and with a self-reported change in consumption of SSBs since the implementation of the tax. We also examined the association between psychosocial and environmental determinants of SSB consumption with current consumption of taxed SSBs and with a reported change in consumption of SSBs. METHODS: Cross-sectional analyses of survey and food-frequency questionnaire data from the Mexican National Health and Nutrition Survey 2016. Participants were Mexican adults (20-59 years, N = 6,650). Logistic regression was used to evaluate the probability of a person reporting a decrease in SSB consumption, given their awareness of the tax, opinion about its effectiveness, psychosocial (SSB health-related beliefs, self-efficacy, and liking of SSBs) and environmental (availability of potable water) determinants. Multiple linear regression analysis was utilized to examine the association between the aforementioned factors and current consumption of taxed SSBs. RESULTS: Compared with adults not aware, adults who were aware of the SSB tax were more likely (OR = 1.30) to report a decrease in SSB consumption (p = .012). In urban areas, adults aware of the tax drank a significantly lower amount of taxed SSBs (-15.7%; p = .023) than those not aware. Self-efficacy and liking of SSBs were significantly associated with a reported decrease in consumption and with current consumption (p < .001), while health beliefs and availability of potable water were not significantly associated with either reported change in SSB consumption or current consumption of taxed SSBs. CONCLUSIONS: Implementation of an SSB tax accompanied by highly visible campaigns may further influence the impact of taxes on SSBs consumption. Future public health and nutrition education campaigns designed to increase knowledge and enhance motivation should be complemented by programs to assist individuals develop self-efficacy and self-regulation skills.

Taxation of sugar sweetened beverages and unhealthy foods: a qualitative study of key opinion leaders' views.

BACKGROUND: Fiscal policies to fight obesity such as taxation of unhealthy foods or sugar-sweetened beverages (SSBs) have gained considerable attention in recent years. Many studies modelling the impact of various magnitudes of taxes on SSB purchasing and their potential effects on various health outcomes have been published; however, legislation and implementation of such taxes have encountered many obstacles in the countries that have implemented them to date. We investigated the perceptions and views of key opinion leaders, policy makers and various other Israeli stakeholders on taxation of SSBs and unhealthy snacks. We also evaluated the challenges and barriers that may be expected for initiating such a policy. METHODS: A qualitative study based on 39 in-depth interviews with Israeli stakeholders in the fields of health, nutrition, economics, public advocacy and policymaking. RESULTS: All stakeholders viewed obesity as a combined societal and personal issue that should be under government responsibility. Only stakeholders from economic sectors thought that taxation of SSBs and unhealthy snacks would reduce their consumption, while the prevailing notion among non-economists was that such a tax would not be acceptable because the higher price would not decrease consumption. Concerns were raised that the tax would mostly affect individuals from low socioeconomic backgrounds. Some of the stakeholders indicated that they would support such a tax only if its revenue would be directed to specific causes such as health-promoting plans. Potential barriers to taxation include: opposition of various sectors, technical and bureaucratic obstacles impeding tax implementation, difficulties in defining which products to tax, and opposition of the treasury to earmark tax revenue for health education. CONCLUSIONS: Taxation should be a part of a multipronged strategy rather than a sole measure for fighting obesity. Dedicating tax revenues to specific predefined causes should be considered, particularly towards health promotion activities, obesity treatment and prevention, education, and subsidies of healthy food.