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

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  • Sharon S Nakhimovsky
  • Andrea B Feigl
  • Carlos Avila
  • Gael O’Sullivan
  • Elizabeth Macgregor-Skinner
  • Mark Spranca

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.

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  • Sharon S Nakhimovsky & Andrea B Feigl & Carlos Avila & Gael O’Sullivan & Elizabeth Macgregor-Skinner & Mark Spranca, 2016. "Taxes on Sugar-Sweetened Beverages to Reduce Overweight and Obesity in Middle-Income Countries: A Systematic Review," PLOS ONE, Public Library of Science, vol. 11(9), pages 1-22, September.
    • Handle: RePEc:plo:pone00:0163358
    DOI: 10.1371/journal.pone.0163358
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    3. Abay, Kibrom A. & Ibrahim, Hosam & Breisinger, Clemens, 2022. "Food policies and obesity in low- and middle-income countries," World Development, Elsevier, vol. 151(C).
    4. Cornelsen, Laura & Mazzocchi, Mario & Smith, Richard D., 2019. "Fat tax or thin subsidy? How price increases and decreases affect the energy and nutrient content of food and beverage purchases in Great Britain," Social Science & Medicine, Elsevier, vol. 230(C), pages 318-327.
    5. Tracy Comans & Nicole Moretto & Joshua Byrnes, 2017. "Public Preferences for the Use of Taxation and Labelling Policy Measures to Combat Obesity in Young Children in Australia," IJERPH, MDPI, vol. 14(3), pages 1-11, March.
    6. Violeta Chacon & Guillermo Paraje & Joaquin Barnoya & Frank J Chaloupka, 2018. "Own-price, cross-price, and expenditure elasticities on sugar-sweetened beverages in Guatemala," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-12, October.
    7. Joselin Segovia & Mercy Orellana & Juan Pablo Sarmiento & Darwin Carchi, 2020. "The effects of taxing sugar-sweetened beverages in Ecuador: An analysis across different income and consumption groups," PLOS ONE, Public Library of Science, vol. 15(10), pages 1-18, October.
    8. Gomo, Charity & Birg, Laura, 2018. "The economic and health impact of a tax on sugar sweetened beverages (SSBs) in South Africa," University of Göttingen Working Papers in Economics 356, University of Goettingen, Department of Economics.
    9. Zeqi Liu & Wei Si & Qiran Zhao & Chang Tao, 2021. "Does Subjective Dietary Knowledge Affect Sugar-Sweetened Carbonated Beverages Consumption and Child Obesity? Empirical Evidence from the Inner Mongolia Autonomous Region in China," IJERPH, MDPI, vol. 18(7), pages 1-20, April.
    10. Arbeláez, María Angélica & Cadena, Ximena & Alejandro, Becerra & Benitez, Miguel & Mejía, María José, 2022. "Elementos para el diseño de un impuesto a alimentos y bebidas altos en sodio, grasas y/o azúcares en Colombia," Informes de Investigación 21027, Fedesarrollo.
    11. Powell, Lisa M. & Jones, Kelly & Duran, Ana Clara & Tarlov, Elizabeth & Zenk, Shannon N., 2019. "The price of ultra-processed foods and beverages and adult body weight: Evidence from U.S. veterans," Economics & Human Biology, Elsevier, vol. 34(C), pages 39-48.
    12. Ahmed Mohammed Alqarni, 2020. "Saudi Smokers' Behaviors After a 100% Tax Increase," International Journal of Marketing Studies, Canadian Center of Science and Education, vol. 11(1), pages 150-150, March.
    13. Adu, Derick T. & Li, Wenying & Sawadgo, Wendiam P.M., 2023. "Estimating the unintended impact of the North American free trade agreement on U.S. public health," Social Science & Medicine, Elsevier, vol. 333(C).
    14. Fanzo, Jessica & McLaren, Rebecca & Bellows, Alexandra & Carducci, Bianca, 2023. "Challenges and opportunities for increasing the effectiveness of food reformulation and fortification to improve dietary and nutrition outcomes," Food Policy, Elsevier, vol. 119(C).

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