Taxes on Sugar-Sweetened Beverages to Reduce Overweight and Obesity in Middle-Income Countries: A Systematic Review

The price of ultra-processed foods and beverages and adult body weight: Evidence from U.S. veterans

The consumption of ultra-processed foods in the U.S. and globally has increased and is associated with lower diet quality, higher energy intake, higher body weight, and poorer health outcomes. This study drew on individual-level data on measured height and weight from U.S. Department of Veterans Affairs medical records for adults aged 20 to 64 from 2009 through 2014 linked to food and beverage price data from the Council for Community and Economic Research to examine the association between the price of ultra-processed foods and beverages and adult body mass index (BMI). We estimated geographic fixed effects models to control for unobserved heterogeneity of prices. We estimated separate models for men and women and we assessed differences in price sensitivity across subpopulations by socioeconomic status (SES). The results showed that a one-dollar increase in the price of ultra-processed foods and beverages was associated with 0.08 lower BMI units for men (p ≤ 0.05) (price elasticity of BMI of -0.01) and 0.14 lower BMI units for women (p ≤ 0.10) (price elasticity of BMI of -0.02). Higher prices of ultra-processed foods and beverages were associated with lower BMI among low-SES men (price elasticity of BMI of -0.02) and low-SES women (price elasticity of BMI of -0.07) but no statistically significant associations were found for middle- or high-SES men or women. Robustness checks based on the estimation of an individual-level fixed effects model found a consistent but smaller association between the price of ultra-processed foods and beverages and BMI among women (price elasticity of BMI of -0.01) with a relatively larger association for low-SES women (price elasticity of BMI of -0.04) but revealed no association for men highlighting the importance of accounting for individual-level unobserved heterogeneity.

Price and sales volume of sugar-sweetened beverages, diet drinks, sweets and chocolates: analysis of Danish retail scanner data

OBJECTIVES

The objective of the present study was to investigate the relationship between price and sales volume of non-alcoholic sugar-sweetened beverages (SSBs), diet drinks, sweets and chocolates, including own and cross price elasticity to further quantify the potential impact of price.

METHODS

The study was based on retail scanner data for grocery sales from retail outlet chains in Denmark during the year 2008-2015. A fixed-effects model was used to estimate the association between price and sales volume, using own price and cross price elasticity.

RESULTS

Sales volume of all sugary products except for chocolates were significantly negatively associated with price. Own price elasticity varied from -0.3 to -0.4 for drinks and sweets indicating that a 10% increase in price would cause a reduction in sales by 3 or 4%. A 10% increase in price of carbonated SSBs would increase sales of diet drinks by 7%. Cross price elasticities for other products were not significant.

CONCLUSIONS

The results of the present study demonstrated significant negative associations between changes in price and changes in the sale of SSBs, diet drinks and sweets.

Efficacy of population-wide diabetes and obesity prevention programs: An overview of systematic reviews on proximal, intermediate, and distal outcomes and a meta-analysis of impact on BMI

We conducted an overview of systematic reviews and a meta-analysis of the impact on body mass index (BMI) of primary studies of population-wide obesity and diabetes prevention programs, in order to evaluate their efficacy. We searched eight databases for reviews of population-level programs reporting effect on diet, physical activity, BMI, or prevalence of obesity/overweight or type 2 diabetes mellitus (T2DM). Meta-analysis of primary studies within reviews reporting effect on BMI. Interventions were categorized using ANGELO framework and quality assessment using AMSTAR. Fifty-three systematic reviews were included. Primary studies were largely natural experiments or cross-sectional studies of national data. Increased price of sugar-sweetened beverages (SSBs) and fast food, decreased price of fruit and vegetables, food labelling, and grocery store interventions were associated with positive effects on diet. Park and playground renovations and point-of-choice prompts to increase stair use were associated with positive effects on physical activity. Increased price of SSBs, menu labelling, grocery store interventions, and multicomponent interventions were associated with small reductions in BMI. There was insufficient evidence of impact of any interventions on the prevalence of overweight, obesity, or T2DM. We have identified a promising suite of population-wide actions to improve diet, increase physical activity, and reduce BMI. Impact on subsequent incidence of T2DM remains speculative.

Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health

BACKGROUND

Frequent consumption of excess amounts of sugar-sweetened beverages (SSB) is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. Environmental interventions, i.e. interventions that alter the physical or social environment in which individuals make beverage choices, have been advocated as a means to reduce the consumption of SSB.

OBJECTIVES

To assess the effects of environmental interventions (excluding taxation) on the consumption of sugar-sweetened beverages and sugar-sweetened milk, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes.

SEARCH METHODS

We searched 11 general, specialist and regional databases from inception to 24 January 2018. We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors.

SELECTION CRITERIA

We included studies on interventions implemented at an environmental level, reporting effects on direct or indirect measures of SSB intake, diet-related anthropometric measures and health outcomes, or any reported adverse outcome. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) and interrupted-time-series (ITS) studies, implemented in real-world settings with a combined length of intervention and follow-up of at least 12 weeks and at least 20 individuals in each of the intervention and control groups. We excluded studies in which participants were administered SSB as part of clinical trials, and multicomponent interventions which did not report SSB-specific outcome data. We excluded studies on the taxation of SSB, as these are the subject of a separate Cochrane Review.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. We classified interventions according to the NOURISHING framework, and synthesised results narratively and conducted meta-analyses for two outcomes relating to two intervention types. We assessed our confidence in the certainty of effect estimates with the GRADE framework as very low, low, moderate or high, and presented 'Summary of findings' tables.

MAIN RESULTS

We identified 14,488 unique records, and assessed 1030 in full text for eligibility. We found 58 studies meeting our inclusion criteria, including 22 RCTs, 3 NRCTs, 14 CBA studies, and 19 ITS studies, with a total of 1,180,096 participants. The median length of follow-up was 10 months. The studies included children, teenagers and adults, and were implemented in a variety of settings, including schools, retailing and food service establishments. We judged most studies to be at high or unclear risk of bias in at least one domain, and most studies used non-randomised designs. The studies examine a broad range of interventions, and we present results for these separately.Labelling interventions (8 studies): We found moderate-certainty evidence that traffic-light labelling is associated with decreasing sales of SSBs, and low-certainty evidence that nutritional rating score labelling is associated with decreasing sales of SSBs. For menu-board calorie labelling reported effects on SSB sales varied.Nutrition standards in public institutions (16 studies): We found low-certainty evidence that reduced availability of SSBs in schools is associated with decreased SSB consumption. We found very low-certainty evidence that improved availability of drinking water in schools and school fruit programmes are associated with decreased SSB consumption. Reported associations between improved availability of drinking water in schools and student body weight varied.Economic tools (7 studies): We found moderate-certainty evidence that price increases on SSBs are associated with decreasing SSB sales. For price discounts on low-calorie beverages reported effects on SSB sales varied.Whole food supply interventions (3 studies): Reported associations between voluntary industry initiatives to improve the whole food supply and SSB sales varied.Retail and food service interventions (7 studies): We found low-certainty evidence that healthier default beverages in children's menus in chain restaurants are associated with decreasing SSB sales, and moderate-certainty evidence that in-store promotion of healthier beverages in supermarkets is associated with decreasing SSB sales. We found very low-certainty evidence that urban planning restrictions on new fast-food restaurants and restrictions on the number of stores selling SSBs in remote communities are associated with decreasing SSB sales. Reported associations between promotion of healthier beverages in vending machines and SSB intake or sales varied.Intersectoral approaches (8 studies): We found moderate-certainty evidence that government food benefit programmes with restrictions on purchasing SSBs are associated with decreased SSB intake. For unrestricted food benefit programmes reported effects varied. We found moderate-certainty evidence that multicomponent community campaigns focused on SSBs are associated with decreasing SSB sales. Reported associations between trade and investment liberalisation and SSB sales varied.Home-based interventions (7 studies): We found moderate-certainty evidence that improved availability of low-calorie beverages in the home environment is associated with decreased SSB intake, and high-certainty evidence that it is associated with decreased body weight among adolescents with overweight or obesity and a high baseline consumption of SSBs.Adverse outcomes reported by studies, which may occur in some circumstances, included negative effects on revenue, compensatory SSB consumption outside school when the availability of SSBs in schools is reduced, reduced milk intake, stakeholder discontent, and increased total energy content of grocery purchases with price discounts on low-calorie beverages, among others. The certainty of evidence on adverse outcomes was low to very low for most outcomes.We analysed interventions targeting sugar-sweetened milk separately, and found low- to moderate-certainty evidence that emoticon labelling and small prizes for the selection of healthier beverages in elementary school cafeterias are associated with decreased consumption of sugar-sweetened milk. We found low-certainty evidence that improved placement of plain milk in school cafeterias is not associated with decreasing sugar-sweetened milk consumption.

AUTHORS' CONCLUSIONS

The evidence included in this review indicates that effective, scalable interventions addressing SSB consumption at a population level exist. Implementation should be accompanied by high-quality evaluations using appropriate study designs, with a particular focus on the long-term effects of approaches suitable for large-scale implementation.

Assessment of Diet Quality in Chilean Urban Population through the Alternate Healthy Eating Index 2010: A Cross-Sectional Study

Most worldwide causes of disease and death are strongly associated with dietary factors and the application of eating indexes has proved to be a useful tool to determine diet quality in populations. The aim of this study was to evaluate the diet quality in Chile through the application of the Alternate Healthy Eating Index 2010 (AHEI-2010). A representative sample (n = 879) of Chilean urban population aged 15–65 years old from the Latin American Study of Nutrition and Health (Estudio Latinoamericano de Nutrición y Salud; ELANS) was used. Dietary intake data were obtained through two 24-hour food recalls and one beverage frequency questionnaire, which were used to calculate AHEI-2010 and its association with sociodemographic and anthropometric variables. In this Chilean sample, the AHEI-2010 score was 43.7 ± 7.8 points (mean ± SD). Trans fats and sodium intake were the highest scoring AHEI-2010 components whereas sugar-sweetened beverages and whole grains had the lowest score. Women, older subjects, and individuals in medium-high socioeconomic levels had significantly higher mean AHEI-2010 scores. No association was found between AHEI-2010 and body mass index (BMI), or nutritional status. Conclusions: Diet quality in the Chilean urban population aged 15–65 years old is far from optimal. Thus, there is room for significant improvement of diet quality in Chile through design and implementation of public health policies, particularly in high-risk groups for chronic diseases.

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.

Smoking and obesity in Chile's Third National Health Survey: light and shade

The Chilean Ministry of Health recently disclosed the first results of the 2016-2017 National Health Survey (Encuesta Nacional de Salud, ENS). The survey was cross-sectional and used a multistage stratified random sampling strategy resulting in a final sample of 6 233 persons ≥ 15 years old, with national, regional, and urban/rural representativeness. The survey results show consistent reductions in tobacco consumption compared to previous national health surveys (ENS 2003 and ENS 2009-2010), most likely due to stringent tobacco control policies enacted in the last 10 years. However, the results also show that there were alarming increases in obesity in the last 15 years. Stronger regulatory policies may be needed to curb the obesity epidemic that besets Chile, along the lines of what was done with tobacco use. The lesson learned seems to be that pushing for stronger policy measures leads to good results, as seems to be the case for tobacco use, while weak measures may not be sufficient for the scale of the health epidemics Chile is now facing, such as excess weight.

When Diabetes Confronts HIV: Biological Sub-citizenship at a Public Hospital in Nairobi, Kenya

This article investigates how international donor policies cultivate a form of biological sub-citizenship for those with diabetes in Kenya. We interviewed 100 patients at a public hospital clinic in Nairobi, half with a diabetes diagnosis. We focus on three vignettes that illustrate how our study participants differentially perceived and experienced living with and seeking treatment and care for diabetes compared to other conditions, with a special focus on HIV. We argue that biological sub-citizenship, where those with HIV have consistent and comprehensive free medical care and those with diabetes must pay out-of-pocket for testing and treatment, impedes diabetes testing and treatment. Once diagnosed, many are then systematically excluded from the health care system due to their own inability to pay. We argue that the systematic exclusion from international donor money creates a form of biological sub-citizenship based on neoliberal economic policies that undermine other public health protections, such as universal primary health care.

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.

Gaps in the Evidence on Population Interventions to Reduce Consumption of Sugars: A Review of Reviews

There is currently considerable attention directed to identifying promising interventions to reduce consumption of sugars among populations around the world. A review of systematic reviews was conducted to identify gaps in the evidence on such interventions. Medline, EMBASE CINAHL, and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews published in English from January 2005 to May 2017 and considering research on interventions to reduce sugar intake. Twelve systematic reviews that considered price changes, interventions to alter the food available within specific environments, and health promotion and education programs were examined. Each of the identified reviews focused on sugar-sweetened beverages (SSBs). The existing literature provides some promising indications in terms of the potential of interventions to reduce SSB consumption among populations. However, a common thread is the limited scope of available evidence, combined with the heterogeneity of methods and measures used in existing studies, which limits conclusions that can be reached regarding the effectiveness of interventions. Reviewed studies typically had limited follow-up periods, making it difficult to assess the sustainability of effects. Further, there is a lack of studies that address the complex context within which interventions are implemented and evaluated, and little is known about the cost-effectiveness of interventions. Identified gaps speak to the need for a more holistic approach to sources of sugars beyond SSBs, consensus on measures and methods, attention to the implementation of interventions in relation to context, and careful monitoring to identify intended and unintended consequences.

[Affordability of beer and soft drinks in 15 Latin American countriesAcessibilidade a cervejas e refrigerantes em 15 países da América Latina]

OBJECTIVE

The objective of this study was to look at trends in the affordability of beer and soft drinks in 15 Latin American countries.

METHODS

The data correspond to government statistics pertaining to price indices for beer and soft drinks, the consumer price index, and the nominal wage index based on monthly frequency. The methods involved the performance of an econometric analysis, using time series, to measure the expected rate of increase in the absolute affordability indicator (using nominal prices) or the relative affordability indicator (using general prices) for soft drinks and beers.

RESULTS

In nine of the 15 countries analyzed, the affordability of soft drinks or beer (whether absolute or relative) has shown a statistically significant increase. In the case of soft drinks, absolute affordability increased in five countries (Chile, Colombia, Costa Rica, Ecuador, and Uruguay) and decreased in Mexico. In the case of beer, it increased in Colombia and Ecuador, remained unchanged in Argentina, Brazil, Chile, Costa Rica, and Uruguay, and dropped in Mexico.

CONCLUSIONS

Although most countries levy taxes on beer and soft drinks, the effect of such taxes on price has not been enough to reduce the affordability of these products in all countries in the sample. Taxes should be modified to make these beverages less affordable and have an impact on their consumption.

Fluid intake of Latin American adults: results of four 2016 Liq.In7 national cross-sectional surveys

Purpose

To report total fluid intake (TFI) and the intake of different fluid types in adults (≥ 18 years old) from Mexico, Argentina, Brazil and Uruguay. To compare intakes between countries and with recommended adequate intake (AI) of water from fluids.

Methods

Cross-sectional data were collected using a validated liquid intake 7-day record (Liq.In⁷) in populations from Argentina (n = 1089), Brazil (n = 477), Mexico (n = 1677) and Uruguay (n = 554). Population characteristics, including age, gender, body mass index and socioeconomic level were recorded. Mean TFI was compared with the AI of water from fluids set by the USA Institute of Medicine.

Results

The lowest TFI was recorded in Mexican women (1748 mL/day) and the highest in Argentinean men (2318 mL/day). Median daily TFI was significantly different between countries; Uruguay and Argentina had higher values than Mexico and Brazil. In the former, plain water contributed to only 25% of TFI, the remainder being predominantly from hot beverages. Approximately, a third of adults did not drink enough fluid to meet the recommended AI. High SSB consumption was reported, which was significantly different between countries (p < 0.05), the highest being in Mexico (median 25–75th percentiles): 531 (300–895 mL/day.

Conclusions

This survey highlights the need to increase water consumption and reduce SSB intake in this region to avoid potential associated health risks. These findings may be useful information in monitoring public health policy strategies.

Electronic supplementary material

The online version of this article (10.1007/s00394-018-1724-z) contains supplementary material, which is available to authorized users.

Equity impacts of price policies to promote healthy behaviours

Governments can use fiscal policies to regulate the prices and consumption of potentially unhealthy products. However, policies aimed at reducing consumption by increasing prices, for example by taxation, might impose an unfair financial burden on low-income households. We used data from household expenditure surveys to estimate patterns of expenditure on potentially unhealthy products by socioeconomic status, with a primary focus on low-income and middle-income countries. Price policies affect the consumption and expenditure of a larger number of high-income households than low-income households, and any resulting price increases tend to be financed disproportionately by high-income households. As a share of all household consumption, however, price increases are often a larger financial burden for low-income households than for high-income households, most consistently in the case of tobacco, depending on how much consumption decreases in response to increased prices. Large health benefits often accrue to individual low-income consumers because of their strong response to price changes. The potentially larger financial burden on low-income households created by taxation could be mitigated by a pro-poor use of the generated tax revenues.

Fast food in the diet: Implications and solutions for families

Fast food is omnipresent in the United States (U.S.) and contributes to poor dietary quality and poor health among youth and adults alike. Children need adults to teach them good eating habits to attain and maintain good health by introducing them to healthful foods and being good role models. The fast food industry, through vast funds and advertising, contribute to challenges parents face to provide healthful foods for their families and thwart our best efforts to meet health goals. Research shows fast food consumption is influenced by lack of cooking confidence, time pressures, and perceptions of ease and convenience. We need practical strategies to help parents and children make healthier food choices. As a product of conference proceedings, this paper provides a non-exhaustive narrative summary of the fast food marketplace and marketing, the contributions of fast food to diet and health, struggles with healthful eating among families, and possible solutions of how we can help children and parents empower themselves to have healthier lives.

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition

Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action.

Obesity, Metabolism, and Aging: A Multiscalar Approach

Obesity contributes to the aging process through the alteration of metabolic pathways evidenced biochemically in the relationship between caloric restriction and longevity. Humans have entered into an era of metabolism and aging entirely unprecedented in their evolution, with a diet that, for many, contains a majority of calories as sugar and yields an expected lifespan of over 80years in industrialized nations. Deeply embedded in the complex issue of obesity are questions of behavior, causality versus correlation, and appropriate models. For example, are primates a better reference than mice for studying metabolic connections between obesity and aging? We consider those issues from the standpoint of life-history theory, especially implications of the interplay of refined sugar and socioeconomic disparities for the future of human health.

The Untapped Power of Soda Taxes: Incentivizing Consumers, Generating Revenue, and Altering Corporate Behavior

Globally, soda taxes are gaining momentum as powerful interventions to discourage sugar consumption and thereby reduce the growing burden of obesity and non-communicable diseases (NCDs). Evidence from early adopters including Mexico and Berkeley, California, confirms that soda taxes can disincentivize consumption through price increases and raise revenue to support government programs. The United Kingdom's new graduated levy on sweetened beverages is yielding yet another powerful impact: soda manufacturers are reformulating their beverages to significantly reduce the sugar content. Product reformulation - whether incentivized or mandatory - helps reduce overconsumption of sugars at the societal level, moving away from the long-standing notion of individual responsibility in favor of collective strategies to promote health. But as a matter of health equity, soda product reformulation should occur globally, especially in low- and middleincome countries (LMICs), which are increasingly targeted as emerging markets for soda and junk food and are disproportionately impacted by NCDs. As global momentum for sugar reduction increases, governments and public health advocates should harness the power of soda taxes to tackle the economic, social, and informational drivers of soda consumption, driving improvements in food environments and the public's health.

Taxing Sugary Beverages Reduces Their Purchase, Especially Among Poor Households

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study. Colchera MA, Popkin BM, Rivera JA, Ng SW. Br Med J 2016;352:h6704.

SOURCE OF FUNDING

Bloomberg Philanthropies, Robert Wood Johnson Foundation, Instituto Nacional de Salud Pública and Carolina Population Center.

TYPE OF STUDY/DESIGN

Observational study.

Public Preferences for the Use of Taxation and Labelling Policy Measures to Combat Obesity in Young Children in Australia

Objective: Childhood obesity is a serious concern for developed and developing countries. This study aimed to assess the level of support in Australia for regulation and to assess whether systematic differences occur between individuals who support increased regulation and individuals who oppose it. Methods: An online survey (n = 563) was used to assess parental/caregiver preferences for taxation policy options and nutrition labelling designed to address the incidence of childhood obesity. Participants were parents or caregivers of young children (3 to 7 years) who were actively enrolled in an existing birth cohort study in South-East Queensland, Australia. Results: The majority of the parents (over 80%) strongly agreed or agreed with labelling food and drink with traffic light or teaspoon labelling. Support for taxation was more variable with around one third strongly supporting and a further 40% of participants equivocal about using taxation; however, a quarter strongly rejected this policy. Cluster analysis did not detect any socio-demographic differences between those who strongly supported taxation and those who did not. Conclusions: Better food labelling would be welcomed by parents to enhance food choices for their children. Taxation for health reasons would not be opposed by most parents. Implications for Public Health: Governments should consider taxation of unhealthy drinks and improved labelling to encourage healthy food purchasing.