Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling study

Abstract

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

Consumption of ultra-processed foods and non-communicable disease-related nutrient profile in Portuguese adults and elderly (2015–2016): the UPPER project

“…The SSB tax has a banded structure and is applied to any drink with added sugar or artificial sweeteners, except those considered with nutritional value (milk-based drinks, fruit-or vegetable-based juices, cereal-or nut-based drinks and drinks for special dietary needs or nutritional supplements) (61) . This tax has been associated with decrease in SSB sales, beverage reformulation to avoid the highest tax rate and consequently reduction in the energy intake from SSB (58,62) . A modelling study has projected the impact of this SSB tax on obesity incidence according to scenarios in which sales volume plus reformulation or reformulation alone were considered.…”

Sugar-sweetened beverage taxes: Lessons to date and the future of taxation

“…In the United Kingdom, the multitiered Sugar Drinks Industry Levy based on sugar content has prompted remarkable reformulations and shifts in purchases with new low-calorie beverages emerging [ 15 ]. In Portugal, earlier findings suggest both sugar reduction in beverage formulations and reduced sales [ 16 ], and the latest paper by Goiana-da-Silva and colleagues simulates its implication for lowering new cases of obesity in children, adolescents, and adults [ 17 ]. Likewise, reformulations are an important driver of change in response to Chile’s integrated food labeling, marketing, and school food regulations [ 18 ].…”

“…Nonetheless, a meta-analysis shows that the average consumer will lower his/her SSB purchases by 10% if SSB prices rise 10% (price elasticity of demand of −1) [ 24 ]. Health implications (e.g., weight change, flattening of diabetes prevalence rates, or reductions in obesity incidence) take years to emerge at the population level, so researchers have used the available results to estimate longer-term health and economic implications, such as in the recent analysis by Goiana-da-Silva and colleagues [ 17 ].…”

Awareness and perceptions regarding taxation and health warnings related to sugar-sweetened beverages and the factors associated with these among visitors of a general out-patient clinic in Bhopal, India

“…[ 37 ] Modelling studies regarding taxes on SSBs have been shown to predict the decrease incidence of obesity among the population. [ 38 ] The younger age groups including adolescents, especially overweight adolescents have been found to have higher SSB intakes. [ 39 ] Primary care physicians, especially those providing care in NCD clinics can thus make obese patients aware of the taxes, particularly younger groups, highlighting dual loss of health and finances.…”