Impacts of a sugar sweetened beverage tax on body mass index and obesity in Thailand: A modelling study.
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ABSTRACT: Background
The World Health Organization (WHO) recommends sugar-sweetened beverage (SSB) taxes to address obesity. Thailand has just launched the new tax rates for SSB in 2017; however, the existing tax rate is not as high as the 20% recommended by the WHO. The objective for this study was to estimate the impacts of an SSB tax on body mass index (BMI) and obesity prevalence in Thailand under three different scenarios based on existing SSB and recommended tax rates.Methods
A base model was built to estimate the impacts of an SSB tax on SSB consumption, energy intake, BMI, and obesity prevalence. Literature review was conducted to estimate pass on rate, price elasticity, energy compensation, and energy balance to weight change. Different tax rates (11%, 20% and 25%) were used in the model. The model assumed no substitution effects, model values were based on international data since there was no empirical Thai data available. Differential effects by income groups were not estimated.Findings
When applying 11%, 20%, and 25% tax rates together with 100% pass on rate and an -1.30 own-price elasticity, the SSB consumption decreased by 14%, 26%, and 32%, respectively. The 20% and 25% price increase in SSB price tended to reduce higher energy intake, weight status and BMI, when compared with an 11% increase in existing price increase of SSB. The percentage changes of obesity prevalence of 11%, 20% and 25% SSB tax rates were estimated to be 1.73%, 3.83%, and 4.91%, respectively.Conclusions
A higher SSB tax (20% and 25%) was estimated to reduce consumption and consequently decrease obesity prevalence. Since Thailand has already endorsed the excise tax structure, the new excise tax structure for SSB should be scaled up to a 20% or 25% tax rate if the SSB consumption change does not meet a favourable goal.
SUBMITTER: Phonsuk P
PROVIDER: S-EPMC8084227 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:Excessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal. METHODS AND FINDINGS:We performed a national market analysis and population-wide modelling study using market data for the years 2014-2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015-2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40-78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases-despite our efforts to mitigate them-related to the methodological differences between these sources. CONCLUSIONS:The tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels among frequent consumers of SSBs. Such taxation is an effective population-wide intervention. Reformulation alone, without the decrease in sales, would have had a far smaller effect on obesity incidence in the Portuguese population.
| S-EPMC7067376 | biostudies-literature
Project description:IntroductionSugar-sweetened beverage (SSB) taxes have been implemented worldwide to raise revenue and reduce consumption of SSBs, which is associated with health harms. Empirical evaluations have found that these taxes are successful at reducing demand for SSBs; however, SSB taxes face opposition, in part because of claims that they will lead to substantial job losses. The purpose of this study is to examine the impact of the San Francisco SSB tax, implemented on January 1st, 2018, on employment.MethodsMonthly employment counts were obtained from the Bureau of Labor Statistics from January 2013 (5-years pre-tax) through December 2019 (2-years post-tax) for the overall economy, private sector, supermarkets and other grocery stores, convenience stores, limited-service restaurants, and beverage manufacturing. A synthetic control analysis was conducted for each employment outcome. The synthetic controls (i.e., estimated counterfactuals) were generated from a pool of urban control counties using pre-tax labor market-related characteristics.ResultsThe synthetic controls had similar labor market-related characteristics and employment outcomes to those in San Francisco in the pre-tax period. Up to 2 years post-tax, differences in employment between San Francisco and the synthetic controls were small and not "statistically significant" based on placebo tests for all employment outcomes.ConclusionsUp to two years post-tax, we do not find evidence that the San Francisco SSB tax negatively impacted net employment, employment in the private sector, or employment in specific SSB-related industries.
| S-EPMC8171954 | biostudies-literature
Project description:In January 2017, Philadelphia (Pennsylvania) implemented an excise tax ($ 0.015/ounce) on sugar-sweetened and diet beverages. This study is a general population-based study to report on the longer-term impacts of the tax on within-person changes in consumption 12 months after implementation. A quasi-experimental difference-in-difference design was used to contrast Philadelphia vs. nearby comparison cities (Trenton, New Jersey; Camden, New Jersey; and Wilmington, Delaware) at baseline (December 2016-January 2017) vs. 12-month follow-up (December 2017-February 2018). A random-digit-dialing phone survey was administered to a population-based cohort. Analyses assessed changes in 30-day consumption frequency and ounces of sugar-sweetened and diet beverages (and a substitution beverage, bottled water) in the analytic sample (N = 515). After 12 months, relative to the comparison group, Philadelphians were slightly more likely to decrease their frequency of sugar-sweetened beverage consumption (39.2% vs. 33.5%), and slightly less likely to increase their frequency of sugar-sweetened beverage consumption (38.9% vs. 43.0%). The effects of the tax estimated in the adjusted difference-in-difference analysis were very small (for example, changes in monthly sugar-sweetened beverage consumption in Philadelphia relative to comparison cities was -3.03 times or -51.65 ounces) and confidence intervals were very wide. Results suggested that, one year after implementation, there was no major overall impact of the tax on general population-level consumption of sugar-sweetened or diet beverages, or bottled water. Future studies should test whether the tax's effect differs in vulnerable sub-populations.
| S-EPMC7068482 | biostudies-literature
Project description:ObjectiveTo estimate changes in taxed and untaxed beverages by volume of beverage purchased after a sugar-sweetened beverage (SSB) tax was introduced in 2014 in Mexico.DesignWe used household purchase data from January 2012 to December 2015. We first classified the sample into four groups based on pre-tax purchases of beverages: (i) higher purchases of taxed beverages and lower purchases of untaxed beverages (HTLU-unhealthier); (ii) higher purchases of both types of beverages (HTHU); (iii) lower purchases of taxed and untaxed beverages (LTLU); and (iv) lower purchases of taxed beverages and higher purchases of untaxed beverages (LTHU-healthier). Next, we estimated differences in purchases after the tax was implemented for each group compared with a counterfactual based on pre-tax trends using a fixed-effects model.SettingAreas with more than 50 000 residents in Mexico.ParticipantsHouseholds (n 6089).ResultsThe HTLU-unhealthier and HTHU groups had the largest absolute and relative reductions in taxed beverages and increased their purchases of untaxed beverages. Households with lower purchases of untaxed beverages (HTLU-unhealthier and LTLU) had the largest absolute and relative increases in untaxed beverages. We also found that among households with higher purchases of taxed beverages, the group with lowest socio-economic status had the greatest reduction in purchases of taxed beverages.ConclusionsEvidence associating the SSB tax with larger reductions among high purchasers of taxed beverages prior to the tax is relevant, as higher SSB purchasers have a greater risk of obesity, diabetes and other cardiometabolic outcomes.
| S-EPMC6581622 | biostudies-literature
Project description: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.
| S-EPMC6354371 | biostudies-literature
Project description:BackgroundSugar-sweetened beverage (SSB) consumption is highly associated with obesity, but the metabolic mechanism underlying this correlation is not understood.ObjectiveOur objective was to examine metabolomic links between SSB intake and obesity to understand metabolic mechanisms.DesignWe examined the association of plasma metabolomic profiles with SSB intake and obesity risk in 781 participants, aged 45-75 y, in the Boston Puerto Rican Health Study (BPRHS) using generalized linear models, controlling for potential confounding factors. Based on identified metabolites, we conducted pathway enrichment analysis to identify potential metabolic pathways that link SSB intake and obesity risk. Variants in genes encoding enzymes known to function in identified metabolic pathways were examined for their interactions with SSB intake on obesity.ResultsSSB intake was correlated with BMI (β = 0.607, P=0.045). Among 526 measured metabolites, 86 showed a significant correlation with SSB intake and 148 with BMI (P ≤ 0.05); 28 were correlated with both SSB intake and BMI (P ≤ 0.05). Pathway enrichment analysis identified the phosphatidylcholine and lysophospholipid pathways as linking SSB intake to obesity, after correction for multiple testing. Furthermore, 8 of 10 genes functioning in these two pathways showed strong interaction with SSB intake on BMI. Our results further identified participants who may exhibit an increased risk of obesity when consuming SSB.ConclusionsWe identified two key metabolic pathways that link SSB intake to obesity, revealing the potential of phosphatidylcholine and lysophospholipid to modulate how SSB intake can increase obesity risk. The interaction between genetic variants related to these pathways and SSB intake on obesity further supports the mechanism.
| S-EPMC7211252 | biostudies-literature
Project description: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.
| S-EPMC6104929 | biostudies-literature
Project description:We sought to describe how revenues from sugar-sweetened beverage (SSB) excise taxes in 7 U.S. cities are being allocated, who is benefiting from these investments, and whether allocations are consistent with the original intent of tax legislation. We collected information from public documents and key informants about allocations in the most recent fiscal year available (ranging from 2018 to 2021). Across the 7 U.S. cities with taxes, the average annual revenue from SSB taxes totaled $133.9 M. In the fiscal year studied, cities allocated a total of $133.2 M in SSB tax revenues. Human and community capital investments totaled $89.6 M (67% of all allocations) funding early childhood development, community infrastructure improvements, and youth and workforce development. Health-related investments totaled $36.9 M (28% of total allocations), funding access to healthy foods and beverages; support for physical activity opportunities; promotion of overall physical, mental or social health and wellbeing; health and nutrition education; chronic-disease prevention and management; and reducing SSB consumption. In the 3 cities that specified how tax revenues would be spent, allocations were consistent with promised uses of revenues. In addition, 85% of aggregated revenues ($112.9 M) were targeted to support work and programs in impacted communities (communities that experience health inequities, discrimination and exclusion). SSB tax revenues are supporting initiatives to improve community health, develop human and community capital, and advance equity. These investments may yield additional health benefits beyond those resulting from lower SSB consumption. Consistent tracking and public reporting on revenue allocations would increase transparency and accountability.
| S-EPMC8141925 | biostudies-literature
Project description:BackgroundThe influence of a high sugar diet on colorectal cancer (CRC) survival is unclear.MethodsAmong 1463 stage I-III CRC patients from the Nurses' Health Study and Health Professionals Follow-up Study, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CRC-specific and all-cause mortality in relation to intake of post-diagnosis sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), fruit juice, fructose and other sugars.ResultsOver a median 8.0 years, 781 cases died (173 CRC-specific deaths). Multivariable-adjusted HRs for post-diagnosis intake and CRC-specific mortality were 1.21 (95% CI: 0.87-1.68) per 1 serving SSBs per day (serving/day) and 1.24 (95% CI: 0.95-1.63) per 20 grams fructose per day. Significant positive associations for CRC-specific mortality were primarily observed ≤5 years from diagnosis (HR per 1 serving/day of SSBs = 1.59, 95% CI: 1.06-2.38). Significant inverse associations were observed between ASBs and CRC-specific and all-cause mortality (HR for ≥5 versus <1 serving/week = 0.44, 95% CI: 0.26-0.75 and 0.70, 95% CI: 0.55-0.89, respectively).ConclusionsHigher post-diagnosis intake of SSBs and sugars may be associated with higher CRC-specific mortality, but only up to 5 years from diagnosis, when more deaths were due to CRC. The inverse association between ASBs and CRC-specific mortality warrants further examination.
| S-EPMC8476625 | biostudies-literature
Project description:BackgroundObesity and obesity-related diseases represent a major public health concern. Recently, studies have substantiated the role of sugar-sweetened beverages (SSBs) consumption in the development of these diseases. The fine identification of populations and areas in need for public health intervention remains challenging. This study investigates the existence of spatial clustering of SSB intake frequency (SSB-IF) and body mass index (BMI), and their potential spatial overlap in a population of adults of the state of Geneva using a fine-scale geospatial approach.MethodsWe used data on self-reported SSB-IF and measured BMI from residents aged between 20 and 74 years of the state of Geneva (Switzerland) that participated in the Bus Santé cross-sectional population-based study (n?=?15,423). Getis-Ord Gi spatial indices were used to identify spatial clusters of SSB-IF and BMI in unadjusted models and models adjusted for individual covariates (education level, gender, age, nationality, and neighborhood-level median income).ResultsWe identified a significant spatial clustering of BMI and SSB-IF. 13.2% (n?=?2034) of the participants were within clusters of higher SSB-IF and 10.7% (n?=?1651) were within clusters of lower SSB-IF. We identified overlapping clusters of SSB-IF and BMI in specific areas where 11.1% (n?=?1719) of the participants resided. After adjustment, the identified clusters persisted and were only slightly attenuated indicating that additional neighborhood-level determinants influence the spatial distribution of SSB-IF and BMI.ConclusionsOur fine-scale spatial approach allowed to identify specific populations and areas presenting higher SSB-IF and highlighted the existence of an overlap between populations and areas of higher SSB-IF associated with higher BMI. These findings could guide policymakers to develop locally tailored interventions such as targeted prevention campaigns and pave the way for precision public health delivery.
| S-EPMC6856345 | biostudies-literature