Fat taxation in India: A critical appraisal of need, public health impact, and challenges in nationwide implementation

Trends and determinants of obesity among ever-married women aged 15-49 in India: insights from National Family Health Surveys (NFHS 1998-2021)

BACKGROUND

Obesity has emerged as a significant public health concern in India, particularly among ever-married women of reproductive age (EMWRA). This study analyses trends in obesity among EMWRA across India and its states from 1998 to 2021 and explores the factors contributing to obesity in this group.

METHODS

Data from four National Family Health Survey (NFHS) rounds, spanning 1998-99 to 2019-21, were pooled to create a dataset of 1,117,433 participants. We analysed obesity trends in India and its states and assessed β- and σ-convergence in obesity rates during this period. Additionally, we examined changes in socioeconomic differentials in obesity over this period. Binary logistic regression was used to explore the association of obesity with socioeconomic, demographic, and temporal factors.

RESULTS

Over the study period, obesity among ever-married women of reproductive age (EMWRA) in India has shown a startling increase, tripling from 5.1% (95% CI: 4.7-5.5) in 1998-99 to 15.7% (15.4-15.9) in 2019-21. While obesity rates have surged across all states, the degree of increase varies significantly (ranging from 22.9% points in Tamil Nadu to 2.6 in Meghalaya). Presently, two prominent regions in the country exhibit high obesity rates: the southern region, including Tamil Nadu (29%), Kerala (25%), Goa (25%), and Andhra Pradesh (23%), and the northwestern region, encompassing Delhi (33%), Punjab (31%), and Haryana (24%). Moreover, the disparity in obesity rates across states has widened over time, with states initially showing higher rates experiencing a faster growth rate compared to those with lower initial rates, as highlighted by the β- and σ-convergence analyses. There was substantial variation in obesity rates across education, wealth, place of residence, and social group categories. The risk of obesity is higher among older, educated, wealthy, non-Hindu EMWRAs and TV watchers, but lower among those living in rural areas, the southern region, smaller households, and belonging to SC, ST, and OBC social groups.

CONCLUSION

The surge in obesity among Indian ever married women of reproductive age calls for immediate public health measures. Customized strategies, acknowledging regional differences, are vital to tackle diverse obesity rates across states. Prioritizing vulnerable groups, including the poor, uneducated, and urban populations, is critical for ensuring fair health outcomes.

BMI/Obesity and consumers' price sensitivity: Implications for food tax policies

We examine the relationship between BMI and food purchase behavior using a unique dataset that links individual-level food purchases to health data. We find that individuals with higher BMI are significantly more sensitive to price changes in vice categories but do not show similar sensitivity in comparable nonvice categories. We rely on past literature that defines and identifies vice categories as those that are tempting and purchased impulsively. We explore the effectiveness of a 10% price increase on vice food categories, a hypothetical policy similar in spirit to a fat tax or sugar tax. We predict that such a tax would substantially reduce consumption of these foods, and would be particularly effective in reducing consumption by individuals with higher BMI.

Trends estimation of obesity prevalence among South Asian young population: a systematic review and meta-analysis

The premise for effective prevention and treatment of obesity is the availability of accurate prevalence figures. However, the prevalence of pediatric obesity and overweight in South Asian countries has seldom been analyzed. This article provides a comprehensive review and meta-analysis of studies on overweight and obesity to provide a more precise prevalence estimate. The study protocol was registered on PROSPERO (CRD42022320625). PubMed and Embase databases were comprehensively searched from inception till September 2023. The random-effects model was utilized to derive the pooled prevalence of obesity and overweight. Subgroup meta-analysis was used to assess variations in prevalence estimates across subgroups. A meta-regression analysis was also performed to assess the trend of overweight and obesity over the years. 152 studies were included with 489,525 participants. The pooled prevalence was 12.4 (95% CI 11.1-13.6) for overweight, 6.6% (95% CI 5.6-7.8) for obesity, and 19.3% (95% CI 17.1-21.7) for obesity and overweight. In subgroup analysis, Bangladesh reported a higher prevalence for both obesity (8.9%; 95% CI 4.9-13.9) and overweight (13.6%; 95% CI 9.2-18.8). Meta-regression analysis found a significant association between obesity prevalence and the publication year (β = 0.004; p = 0.03; R2 = 2.74%). The results of this study indicate a relatively higher prevalence of childhood obesity in South Asia, emphasizing the necessity for large-scale awareness efforts and context-specific preventative methods.

Problems and Solutions of Taxation to Control Unhealthy Goods: A Qualitative Study

Background: Taxes on unhealthy goods, in addition to reducing the consumption of these goods, preventing related diseases, and promoting public health, can provide significant financial resources for the health sector. Objectives: The purpose of this study was to investigate the problems and solutions of taxation to control the consumption of unhealthy goods to improve public health. Methods: This qualitative study was conducted in 2021. Semi-structured interviews with open-ended questions were held to collect information. Sampling was performed by purposive and snowball methods with 31 managers and key experts. The data were analyzed using the content analysis method. MAXQDA software (version 12) was used for classification and coding. Results: This study labeled 2 main themes and 10 subthemes. The main themes included problems of controlling unhealthy goods and solutions to controlling unhealthy goods. Poor decision-making, planning, and execution, production-related problems, smuggling and poor supervision, increased consumption of harmful goods, conflicts of interest, and advertisements of unhealthy goods are the most important of these problems. Imposing taxes, duties, and price hikes, providing alternatives, paying attention to all determinants of supply and demand, and taxation on advertising are also solutions to control unhealthy products. Conclusions: The health level of individuals should be improved by imposing taxes on unhealthy goods, determining accurate tax rates, and simultaneously using measures, such as providing alternatives to unhealthy goods and controlling advertisements. Paying serious attention to the list of harmful goods, coordination and cooperation of related organizations in formulating and implementing tax policies, and providing suitable alternatives to harmful products are the practical suggestions of this study.

The role of taxation measures in the management of harmful products, services, and practices in Iran: a qualitative study

BACKGROUND AND AIM

Levying a tax on harmful products, services, and practices can affect consumer choices, effectively preventing diseases and reducing health care costs. The goal of this study was to investigate the role of taxation as a powerful financial tool in the management of harmful products, services, and practices to maintain and improve public health and preserve the financial sustainability of the health care system.

MATERIALS AND METHODS

This qualitative study was conducted in 2020-2021. In order to collect information for this study, semi-structured interviews were conducted. Using purposive and snowball sampling methods, 38 managers, policymakers, economists, and key experts were interviewed. Data were analyzed using the content analysis method. The transcribed interviews were further imported into MAXQDA for classification, and relevant codes were extracted.

FINDINGS

In this study, 6 main themes and 19 subthemes were labeled. The main themes included 1) objectives, effects, and requirements of the taxation of harmful products, services, and practices, 2) definition, instances, elasticity, and grading of harmful products, services, and practices, 3) Problems in controlling harmful products, services, and practices, 4) controlling harmful products, services, and practices, 5) traffic violations and accidents, and social harms, and 6) tax revenue use and the share of health care. The effects of taxing harmful products include reduced access to these products, reduced demand for harmful products, and the promotion of public health.

CONCLUSION

Harmful products, services, and practices have major health and financial implications for individuals, families, and society. To improve public health, the demand for these products and services can be controlled through taxation measures to push consumers toward less harmful alternatives.

The Escalating Health Threats from Ultra-processed and High Fat, Salt, and Sugar Foods: Urgent Need for Tailoring Policy

With its colonial past, and a glaring problem of poverty and hunger, India oft fails to acknowledge a new, rapidly growing problem of overnutrition. With the economic boost and entry of various foreign players from the food industry, Indian citizens have been increasingly exposed to ultra-processed, high in sugar, salt and fat foods (HFSS foods). The last decade or so has seen an exponential rise in the consumption of such foods, leading to increasing prevalence of overweight- and obesity-related illnesses like diabetes, hypertension, etc. In this scenario, examining the efficacy of policy-related measures in reducing consumption of these harmful foods and preventing the associated health issues is paramount. Across the globe, several countries have explored options from taxation on HFSS foods to restricting marketing to children, as well as different practices for front of the pack labeling. In the context of India and its increasing burden of preventable, diet-related illnesses, the urgent need of instituting these preventive policies at national scale cannot be neglected.

Dietary practices among children with early childhood caries and the associated factors: A qualitative study

BACKGROUND

Parents play a vital role in their children's dietary habits. A comprehensive understanding of the perspectives of parents of children with early childhood caries (ECC) is required for prevention program planning.

AIM

To describe the parental perspective of the dietary habits of children with ECC.

DESIGN

In this descriptive qualitative study, the participants were parents of children with ECC receiving routine dental care. Data were collected through focus groups using an interview guide. Data were analyzed manually using the content analysis method.

RESULTS

Five focus groups involving 27 participants were conducted. Two main categories emerged: cariogenic food literacy and factors that affect food choices. Most of the participants knew that sugary foods are responsible for tooth decay. Parents felt that children's snacking habits were influenced by multiple factors, such as family environment, peers, commercials on television or the Internet, and affordability of food.

CONCLUSIONS

Parents are not able to translate their knowledge into action to modify their children's diet as they may lack self-efficacy and feel pressured by their children, the media and the environment in which they live. Motivational interviewing of parents and governmental and school policies to reduce sugary food consumption may be required.

An Update on the Epidemiology of Type 2 Diabetes: A Global Perspective

Type 2 diabetes (T2D) is a public health burden associated with immense health care and societal costs, early death, and morbidity. Largely because of epidemiologic changes, including nutrition transitions, urbanization, and sedentary lifestyles, T2D is increasing in every region of the world, particularly in low-income and middle-income countries. This article highlights global trends in T2D and discusses the role of genes, early-life exposures, and lifestyle risk factors in the cause of T2D, with an emphasis on populations in current hotspots of the epidemic. It also considers potential impacts of the coronavirus disease 2019 pandemic and T2D prevention policies and action.

Early Childhood Junk Food Consumption, Severe Dental Caries, and Undernutrition: A Mixed-Methods Study from Mumbai, India

In India, globalization has caused a nutrition transition from home-cooked foods to processed sugary snacks and drinks, contributing to increased early childhood caries (ECC). This mixed-methods study describes risk factors for ECC and associations with undernutrition in low-income communities in Mumbai. Interviews with mothers of 959 children, ages six-months through six-years, addressed maternal-child nutrition and oral health, and children received dental exams and anthropometric assessments. Focus groups with community health workers and mothers explored experiences and perceptions of oral health, nutrition, and ECC. Descriptive and logistic regression analyses of quantitative data, and content analysis of qualitative data were performed. Eighty percent of children lived 5 min from a junk-food store, over 50% consumed junk-food and sugary tea daily, 50% experienced ECC, 19% had severe deep tooth decay, 27% experienced mouth pain, and 56% experienced chronic and/or acute malnutrition. In children ages 3–6, each additional tooth with deep decay was associated with increased odds of undernutrition (Odds Ratio [OR] 1.10, Confidence Interval [CI] 1.02–1.21). Focus groups identified the junk-food environment, busy family life, and limited dental care as contributors to ECC. Policy interventions include limits on junk-food marketing and incorporating oral health services and counseling on junk-food/sugary drinks into maternal–child health programs.