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

View Article: PubMed Central - PubMed

ABSTRACT

Background: The consumption of sugar-sweetened beverages (SSBs), which can lead to weight gain, is rising in middle-income countries (MICs). Taxing SSBs may help address this challenge. Systematic reviews focused on high-income countries indicate that taxing SSBs may reduce SSB consumption. Responsiveness to price changes may differ in MICs, where governments are considering the tax. To help inform their policy decisions, this review compiles evidence from MICs, assessing post-tax price increases (objective 1), changes in demand for SSBs and other products, overall and by socio-economic groups (objective 2), and effects on overweight and obesity prevalence (objective 3).

Methods and findings: We conducted a systematic review on the effectiveness of SSB taxation in MICs (1990–2016) and identified nine studies from Brazil, Ecuador, India, Mexico, Peru, and South Africa. Estimates for own-price elasticity ranged from -0.6 to -1.2, and decreases in SSB consumption ranged from 5 to 39 kilojoules per person per day given a 10% increase in SSB prices. The review found that milk is a likely substitute, and foods prepared away from home, snacks, and candy are likely complements to SSBs. A quasi-experimental study and two modeling studies also found a negative relationship between SSB prices and obesity outcomes after accounting for substitution effects. Estimates are consistent despite variation in baseline obesity prevalence and per person per day consumption of SSBs across countries studied.

Conclusions: The review indicates that taxing SSBs will increase the prices of SSBs, especially sugary soda, in markets with few producers. Taxing SSBs will also reduce net energy intake by enough to prevent further growth in obesity prevalence, but not to reduce population weight permanently. Additional research using better survey data and stronger study designs is needed to ascertain the long-term effectiveness of an SSB tax on obesity prevalence in MICs.

No MeSH data available.


Documentation of Study Search and Selection.
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pone.0163358.g002: Documentation of Study Search and Selection.

Mentions: Database searches for relevant studies published between March 2013 and March 2016 initially identified 1,151 records (Fig 2). Another study was included from a reference list. Seventy-eight duplicates were removed and, based on a review of titles and abstracts, 1,059 records were excluded because they did not align with this review or data were not from MICs. The full text of the remaining 15 records, along with the three studies focused on MICs from the previous systematic review (period 1990–2013), was then reviewed. Three of these 18 studies were excluded because they were not from MICs, six were excluded because scopes did not align, and one was excluded because the study type did not match the inclusion criteria. Additionally, one study was excluded because its statistical methods were weak. Specifically, this study did not estimate the relationship between price and consumption of soda directly. Rather, it estimated average changes in the prices and consumption of soda relative to other goods over an eight year period (1992–2000). This study also did not report statistical significance, nor did it define the SSB product studied in detail [43].


Taxes on Sugar-Sweetened Beverages to Reduce Overweight and Obesity in Middle-Income Countries: A Systematic Review
Documentation of Study Search and Selection.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036809&req=5

pone.0163358.g002: Documentation of Study Search and Selection.
Mentions: Database searches for relevant studies published between March 2013 and March 2016 initially identified 1,151 records (Fig 2). Another study was included from a reference list. Seventy-eight duplicates were removed and, based on a review of titles and abstracts, 1,059 records were excluded because they did not align with this review or data were not from MICs. The full text of the remaining 15 records, along with the three studies focused on MICs from the previous systematic review (period 1990–2013), was then reviewed. Three of these 18 studies were excluded because they were not from MICs, six were excluded because scopes did not align, and one was excluded because the study type did not match the inclusion criteria. Additionally, one study was excluded because its statistical methods were weak. Specifically, this study did not estimate the relationship between price and consumption of soda directly. Rather, it estimated average changes in the prices and consumption of soda relative to other goods over an eight year period (1992–2000). This study also did not report statistical significance, nor did it define the SSB product studied in detail [43].

View Article: PubMed Central - PubMed

ABSTRACT

Background: The consumption of sugar-sweetened beverages (SSBs), which can lead to weight gain, is rising in middle-income countries (MICs). Taxing SSBs may help address this challenge. Systematic reviews focused on high-income countries indicate that taxing SSBs may reduce SSB consumption. Responsiveness to price changes may differ in MICs, where governments are considering the tax. To help inform their policy decisions, this review compiles evidence from MICs, assessing post-tax price increases (objective 1), changes in demand for SSBs and other products, overall and by socio-economic groups (objective 2), and effects on overweight and obesity prevalence (objective 3).

Methods and findings: We conducted a systematic review on the effectiveness of SSB taxation in MICs (1990–2016) and identified nine studies from Brazil, Ecuador, India, Mexico, Peru, and South Africa. Estimates for own-price elasticity ranged from -0.6 to -1.2, and decreases in SSB consumption ranged from 5 to 39 kilojoules per person per day given a 10% increase in SSB prices. The review found that milk is a likely substitute, and foods prepared away from home, snacks, and candy are likely complements to SSBs. A quasi-experimental study and two modeling studies also found a negative relationship between SSB prices and obesity outcomes after accounting for substitution effects. Estimates are consistent despite variation in baseline obesity prevalence and per person per day consumption of SSBs across countries studied.

Conclusions: The review indicates that taxing SSBs will increase the prices of SSBs, especially sugary soda, in markets with few producers. Taxing SSBs will also reduce net energy intake by enough to prevent further growth in obesity prevalence, but not to reduce population weight permanently. Additional research using better survey data and stronger study designs is needed to ascertain the long-term effectiveness of an SSB tax on obesity prevalence in MICs.

No MeSH data available.