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

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Title: Projected impact of the Portuguese sugar-sweetened beverages tax on obesity incidence across different age groups: a modelling study
Authors: Goiana-da-Silva, F
Severo, M
Cruz-E-Silva, D
Gregório, MJ
Allen, L
Muc, M
Morais Nunes, A
Torres, D
Miraldo, M
Ashrafian, H
Rito, A
Wickramasinghe, K
Breda, J
Darzi, A
Araújo, F
Lopes, C
Item Type: Journal Article
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 the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40–78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases—despite our efforts to mitigate them—related to the methodological differences between these sources. Conclusions The tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels among frequent consumers of SSBs. Such taxation is an effective population-wide intervention. Reformulation alone, without the decrease in sales, would have had a far smaller effect on obesity incidence in the Portuguese population.
Issue Date: 12-Mar-2020
Date of Acceptance: 24-Jan-2020
URI: http://hdl.handle.net/10044/1/77317
DOI: 10.1371/journal.pmed.1003036
ISSN: 1549-1277
Publisher: Public Library of Science (PLoS)
Start Page: 1
End Page: 17
Journal / Book Title: PLoS Medicine
Volume: 17
Issue: 3
Copyright Statement: © 2020 Goiana da Silva et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Sponsor/Funder: National Institute of Health Research
National Institute for Health Research
Funder's Grant Number: NF SI 061710038
Keywords: 11 Medical and Health Sciences
General & Internal Medicine
Publication Status: Published
Online Publication Date: 2020-03-12
Appears in Collections:Imperial College Business School
Department of Surgery and Cancer
Department of Surgery and Cancer
Institute of Global Health Innovation